Dao T T, Lavigne G J
Faculty of Dentistry, University of Toronto, Ontario, Canada.
Crit Rev Oral Biol Med. 1998;9(3):345-61. doi: 10.1177/10454411980090030701.
Despite the extensive use of oral splints in the treatment of temporomandibular disorders (TMD) and bruxism, their mechanisms of action remain controversial Various hypotheses have been proposed to explain their apparent efficacy (i.e., true therapeutic value), including the repositioning of condyle and/or the articular disc, reduction in the electromyographic activity of the masticatory muscles, modification of the patient's "harmful" oral behavior, and changes in the patient's occlusion. Following a comprehensive review of the literature, it is concluded that any of these theories is either poor or inconsistent, while the issue of true efficacy for oral splints remains unsettled. However, the results of a controlled clinical trial lend support to the effectiveness (i.e., the patient's appreciation of the positive changes which are perceived to have occurred during the trial) of the stabilizing splint in the control of myofascial pain. In light of the data supporting their effectiveness but not their efficacy, oral splints should be used as an adjunct for pain management rather than a definitive treatment. For sleep bruxism, it is prudent to limit their use as a habit management aid and to prevent/limit dental damage potentially induced by the disorder. Future research should study the natural history and etiologies of TMD and bruxism, so that specific treatments for these disorders can be developed.
尽管口腔矫治器在颞下颌关节紊乱病（TMD）和磨牙症的治疗中被广泛应用，但其作用机制仍存在争议。人们提出了各种假说来解释其明显的疗效（即真正的治疗价值），包括髁突和/或关节盘的重新定位、咀嚼肌肌电活动的降低、患者“有害”口腔行为的改变以及患者咬合的变化。在对文献进行全面综述后得出的结论是，这些理论中的任何一种都不完善或不一致，而口腔矫治器的真正疗效问题仍未解决。然而，一项对照临床试验的结果支持了稳定型矫治器在控制肌筋膜疼痛方面的有效性（即患者对试验期间所发生的积极变化的认可）。鉴于支持其有效性而非疗效的数据，口腔矫治器应作为疼痛管理的辅助手段而非确定性治疗方法使用。对于睡眠磨牙症，谨慎的做法是限制将其用作习惯管理辅助工具，并预防/限制该病症可能导致的牙齿损伤。未来的研究应探究TMD和磨牙症的自然病史及病因，以便开发针对这些病症的具体治疗方法。
