De Boever J A, De Boever A M
Universiteit Gent-UZ De Pintelaan.
Rev Belge Med Dent (1984). 1997;52(1):258-73.
Over the last years, aetiological concepts have changed drastically. The role of occlusal factors in the aetiology has been overestimated in the past. The role of occlusal therapy should be aimed at restoring function. In the initial phase of treatment an occlusal splint, counseling, physiotherapy and occasionally NSAID's, leads to relieve pain and reduction of dysfunction in most patients. A repositioning splint in cases of anterior disc dislocation is not longer recommended. Selective grinding can be done in "occlusally sensitive" patients with pain or dysfunction of muscular origin. The adjustment should have a limited character, and is not indicated as preventive measure. Occlusal prosthetic reconstruction is in most patients not indicated for reasons linked to TMD because the aetiologic relationships between TMD and loss of molars has not been established. In cases of rheumatoid arthritis, osteo-arthrosis and spondylitis ankylosans, occlusal changes can occur due to the degeneration of the joint components. After the initial phase of treatment replacing the lost molars by prostheses in these particular patients, results in unloading of the joints and in decreasing recurrence of symptoms.
在过去几年中，病因学概念发生了巨大变化。过去，咬合因素在病因学中的作用被高估了。咬合治疗的作用应旨在恢复功能。在治疗的初始阶段，使用咬合板、咨询、物理治疗，偶尔使用非甾体抗炎药，可使大多数患者缓解疼痛并减少功能障碍。对于前盘移位病例，不再推荐使用复位夹板。对于有肌肉源性疼痛或功能障碍的“咬合敏感”患者，可以进行选择性调磨。调整应具有局限性，不作为预防措施。由于颞下颌关节紊乱病（TMD）与磨牙缺失之间的病因关系尚未确立，大多数患者不建议进行咬合修复重建。在类风湿性关节炎、骨关节炎和强直性脊柱炎病例中，由于关节部件的退变，可能会发生咬合变化。在这些特殊患者的治疗初始阶段后，用假体替换缺失的磨牙，可减轻关节负荷并减少症状复发。
