肌位板对颌间关系调整作用的研究
作者：焦国良 王永海
单位：
关键词：颅颌功能紊乱；咬合板；肌接触位；牙尖交错位
肌位板对颌间关系调整作用的研究肌位
板对颌间关系调整作用的研究
摘要 目的:研究肌位板对下颌位置的调整作用。方法:对102例颅颌功能紊乱(CMD)患者均戴用肌位板,戴板后1周、2周、1月各复查1次,以后每月复查1次,共戴板3～6月。记录戴板后是否出现咬合不稳,若有咬合印迹变化者则磨去原有咬合印迹重垫,直至不再变化,待症状消失后去除板,轻咬至肌接触位,记录与颌位是否协调。结果:戴板期间66例患者的咬合印迹始终不变,36例患者出现咬合不稳,经重垫后,咬合板的关系稳定不变。待症状消失后去板。102例患者中,12例表现为肌牙位不一致,其中前牙早接触2例,先天性垂直距离不足1例,牙尖交错位(ICP)偏位9例。结论:肌位板对下颌位置的调整作用是调正肌位,在肌位正常情况下,判断肌牙位是否一致,从而检出ICP异常。
, 百拇医药
Effects of Muscular Position Splint on Maxillomandibular Realignment
Jiao Guoliang, Wang Yonghai
Department of Dental Sciences, Bethune International Peace Hospital
Abstract Objective: To study the effects of muscular position splint on maxillomandibular realignment. Methods: The changes of occlusal impression on splint in 102 craniomandibular disorder (CMD) patients were recorded after wearing the splint 1 week , 2 weeks, 1 month, two to three or six months. If there appeared instability of occlusal impression when biting, the original impression was cleared and new soft resin was placed on its surface in order to get a new impression. The splint was always adjusted to fit well. When the signs and symptoms of CMD disappeared, the splint was worn off. Finally, whether the muscular contact position harmonized with the intercuspal position (ICP) or not was recorded. Results: There appeared two different conditions:①The original occlusal impression remained unchanged in 66 patients; ②Being unfitted in 36 patients, occlusal analysis revealed that 12/102 patients had abnormal occlusion including premature anterior teeth contact (2 cases), natural defective vertical dimension (1 case) and deflected ICP (9 cases). These abnormal occlusion could not be determined before treatment. Conclusion: The muscular position splint can correct the abnormal muscular position. On the premise that the muscular position is normal, the muscular position splint can be used to judge whether the ICP is normal.
, 百拇医药
Key words:craniomandibular disorder splint muscular contact position intercuspal position
多数学者认为对颅颌功能紊乱(cranioman-dibular disorders, CMD)患者进行咬合治疗前首先要获得神经肌肉协调的颌间关系,这种关系的获得有不同的方法且存在争议。肌位板是依据学原理完成咬合重建的新型板。强调在口内以姿势位为起点,轻咬至与对颌牙广泛接触时确定下颌治疗位。笔者采用肌位板治疗102例CMD患者,调整颌间关系,研究肌位板对下颌位置的调整作用。
, 百拇医药
1 材料和方法
1.1 研究对象
选择1995年10月～1997年2月第四军医大学附属口腔医院颞颌关节门诊患者102例为研究对象。其中男39例,女63例,平均年龄32岁(13～73岁)。
纳入标准:TMJ弹响、TMJ和(或)咀嚼肌疼痛、张口受限或偏斜,具有3种症状之一即可。排除标准:特异性炎症、近期外伤、肿瘤、风湿或类风湿等全身性疾病。
1.2 研究方法
1.2.1 临床检查 ①TMJ弹响:张闭口弹响的时程、音质。②TMJ和(或)咀嚼肌疼痛:TMJ后极、外极、乙状切迹区、嚼肌、颞肌运动痛及触压痛。③张口运动:切牙间张口度及是否偏斜。④颌间关系:前后向关系依Angle's分类,左右关系依中线偏斜与否而确定(前牙排列整齐者),上下关系以垂直距离是否过低而确定。
, 百拇医药
1.2.2 肌位板的制作与戴用在口腔模型上制作肌位板的基底板,然后调拌自凝塑料加于基底板上,戴入口内,嘱患者坐直、两眼平视、稳定于下颌姿势位,由姿势位轻咬至与对颌牙广泛接触。塑料固化后,磨去与对颌支持牙尖接触以外的塑料,以消除锁结。夜间戴用板,症状消失则隔日戴并逐渐不戴。戴板后1周、2周、1月复查1次,以后每月复查1次。初戴板后可出现两种情况:①咬合印迹不变,肌位正常;②咬合印迹发生变化,出现板与对颌牙咬合接触不稳,则磨去原有的咬合印迹重垫,直至咬合印迹不再变化。症状好转或消失后去板,如肌位与牙位一致,表明牙尖交错位(intercuspal position, ICP)正常,如肌位与牙位不一致,肌位时牙尖交错(intercuspal occlusion, ICO)不密合,表明ICP异常。
, 百拇医药
2 结 果
2.1 戴用肌位板后CMD症状和体征的变化
102例CMD患者夜间戴用肌位板3～6月后,CMD症状和体征的变化见图1。
图1 102例患者戴肌位板3～6月后,CMD症状和体征的变化
, 百拇医药
图1表明,戴板后TMJ和(或)面部疼痛明显缓解(P<0.05),张口受限明显改善(P<0.05),而TMJ弹响无明显变化(P>0.05),表明肌位板对消除弹响的意义有限。
2.2 戴用肌位板对下颌位置的调整
102例CMD患者在戴板过程中,66例未出现咬合印迹变化,36例患者则出现板与对颌牙咬合接触不稳定,下颌需滑动后才能产生稳定的接触关系。此时调整Transfer interrupted!, http://www.100md.com
单位：
关键词：颅颌功能紊乱；咬合板；肌接触位；牙尖交错位
肌位板对颌间关系调整作用的研究肌位
板对颌间关系调整作用的研究摘要 目的:研究肌位
板对下颌位置的调整作用。方法:对102例颅颌功能紊乱(CMD)患者均戴用肌位板,戴板后1周、2周、1月各复查1次,以后每月复查1次,共戴板3～6月。记录戴板后是否出现咬合不稳,若有咬合印迹变化者则磨去原有咬合印迹重垫,直至不再变化,待症状消失后去除板,轻咬至肌接触位,记录与颌位是否协调。结果:戴板期间66例患者的咬合印迹始终不变,36例患者出现咬合不稳,经重垫后,咬合板的关系稳定不变。待症状消失后去板。102例患者中,12例表现为肌牙位不一致,其中前牙早接触2例,先天性垂直距离不足1例,牙尖交错位(ICP)偏位9例。结论:肌位板对下颌位置的调整作用是调正肌位,在肌位正常情况下,判断肌牙位是否一致,从而检出ICP异常。, 百拇医药
Effects of Muscular Position Splint on Maxillomandibular Realignment
Jiao Guoliang, Wang Yonghai
Department of Dental Sciences, Bethune International Peace Hospital
Abstract Objective: To study the effects of muscular position splint on maxillomandibular realignment. Methods: The changes of occlusal impression on splint in 102 craniomandibular disorder (CMD) patients were recorded after wearing the splint 1 week , 2 weeks, 1 month, two to three or six months. If there appeared instability of occlusal impression when biting, the original impression was cleared and new soft resin was placed on its surface in order to get a new impression. The splint was always adjusted to fit well. When the signs and symptoms of CMD disappeared, the splint was worn off. Finally, whether the muscular contact position harmonized with the intercuspal position (ICP) or not was recorded. Results: There appeared two different conditions:①The original occlusal impression remained unchanged in 66 patients; ②Being unfitted in 36 patients, occlusal analysis revealed that 12/102 patients had abnormal occlusion including premature anterior teeth contact (2 cases), natural defective vertical dimension (1 case) and deflected ICP (9 cases). These abnormal occlusion could not be determined before treatment. Conclusion: The muscular position splint can correct the abnormal muscular position. On the premise that the muscular position is normal, the muscular position splint can be used to judge whether the ICP is normal.
, 百拇医药
Key words:craniomandibular disorder splint muscular contact position intercuspal position
多数学者认为对颅颌功能紊乱(cranioman-dibular disorders, CMD)患者进行咬合治疗前首先要获得神经肌肉协调的颌间关系,这种关系的获得有不同的方法且存在争议。肌位
板是依据学原理完成咬合重建的新型板。强调在口内以姿势位为起点,轻咬至与对颌牙广泛接触时确定下颌治疗位。笔者采用肌位板治疗102例CMD患者,调整颌间关系,研究肌位板对下颌位置的调整作用。, 百拇医药
1 材料和方法
1.1 研究对象
选择1995年10月～1997年2月第四军医大学附属口腔医院颞颌关节门诊患者102例为研究对象。其中男39例,女63例,平均年龄32岁(13～73岁)。
纳入标准:TMJ弹响、TMJ和(或)咀嚼肌疼痛、张口受限或偏斜,具有3种症状之一即可。排除标准:特异性炎症、近期外伤、肿瘤、风湿或类风湿等全身性疾病。
1.2 研究方法
1.2.1 临床检查 ①TMJ弹响:张闭口弹响的时程、音质。②TMJ和(或)咀嚼肌疼痛:TMJ后极、外极、乙状切迹区、嚼肌、颞肌运动痛及触压痛。③张口运动:切牙间张口度及是否偏斜。④颌间关系:前后向关系依Angle's分类,左右关系依中线偏斜与否而确定(前牙排列整齐者),上下关系以垂直距离是否过低而确定。
, 百拇医药
1.2.2 肌位
板的制作与戴用在口腔模型上制作肌位板的基底板,然后调拌自凝塑料加于基底板上,戴入口内,嘱患者坐直、两眼平视、稳定于下颌姿势位,由姿势位轻咬至与对颌牙广泛接触。塑料固化后,磨去与对颌支持牙尖接触以外的塑料,以消除锁结。夜间戴用板,症状消失则隔日戴并逐渐不戴。戴板后1周、2周、1月复查1次,以后每月复查1次。初戴板后可出现两种情况:①咬合印迹不变,肌位正常;②咬合印迹发生变化,出现板与对颌牙咬合接触不稳,则磨去原有的咬合印迹重垫,直至咬合印迹不再变化。症状好转或消失后去板,如肌位与牙位一致,表明牙尖交错位(intercuspal position, ICP)正常,如肌位与牙位不一致,肌位时牙尖交错(intercuspal occlusion, ICO)不密合,表明ICP异常。, 百拇医药
2 结 果
2.1 戴用肌位板后CMD症状和体征的变化
102例CMD患者夜间戴用肌位
板3～6月后,CMD症状和体征的变化见图1。图1 102例患者戴肌位
板3～6月后,CMD症状和体征的变化, 百拇医药
图1表明,戴板后TMJ和(或)面部疼痛明显缓解(P<0.05),张口受限明显改善(P<0.05),而TMJ弹响无明显变化(P>0.05),表明肌位
板对消除弹响的意义有限。2.2 戴用肌位板对下颌位置的调整
102例CMD患者在戴板过程中,66例未出现咬合印迹变化,36例患者则出现
板与对颌牙咬合接触不稳定,下颌需滑动后才能产生稳定的接触关系。此时调整Transfer interrupted!, http://www.100md.com