背景:颞下颌关节紊乱病(TMD)包括颌骨疼痛和功能障碍,肌肉,和相邻的结构。本研究旨在探索定量(髁突位置,形态学)和定性(骨矿物质密度(BMD))治疗后,使用锥形束计算机断层扫描(CBCT)诊断为有/没有下颌外侧不对称(MA)的成年患者的稳定夹板(S.S.)治疗后的治疗结果。
方法:在这项回顾性临床研究中,纳入60例接受S.S.治疗的成人TMD患者,分为TMD组(TMDG)和TMD合并MA组(TMD+MAG)。根据TMD(DC/TMD)AXISI诊断标准进行诊断。从中矢面到Menton点测量MA。CBCT用于扫描治疗前(T0)和治疗后(T1)的颞下颌关节以进行三维分析。使用Wilcoxon符号等级和Kruskal-Wallis检验进行组内和组间统计比较。
结果:对于定量比较,T0和T1在TMD+MAG的关节间隙中存在统计学上的显著差异(前,上级,后部,在偏侧和上级的冠状外侧,对侧冠状内侧关节间隙)。形态学上,偏侧的髁宽度较窄,髁突高度降低,和更陡峭的隆起角度。相比之下,对侧往往有较大的髁突长度。对于定性测量,BMD在大多数髁斜坡的T0和T1之间也显示出统计学意义(AS,SS,PS,和LS在TMD+MAG的偏离侧以及AS和MS在对侧)。此外,只有AS和PS在TMDG中显示出显著性。
结论:多个关节间隙加宽(AJS和CMS)和变窄(SJS,PJS,和CLS)可以表征TMD+MA中的偏离侧。像髁宽度较窄的因素,髁突高度降低,倾斜侧的较陡的隆起角会使TMD+MA恶化。con-disc位置的正确对齐对于最佳功能和载荷分布至关重要,可能影响骨矿物质密度(BMD)。MA在干扰骨密度中起着重要作用。S.S.治疗在TMD+MAG(偏离侧与对侧相比)中显示出比TMDG更明显的结果。
BACKGROUND: Temporomandibular disorders (TMDs) encompass pain and dysfunction in the jaw, muscles, and adjacent structures. This
study aimed to explore the quantitative (condylar position, morphology) and qualitative (bone mineral density (BMD)) therapeutic outcomes following a stabilization splint (S.S.) therapy in adult patients diagnosed with TMD (Arthralgia) with/without lateral mandibular asymmetry (MA) using cone beam computed tomography (CBCT).
METHODS: In this retrospective clinical
study, 60 adult TMD patients who received S.S. therapy were enrolled and allocated into the TMD group (TMDG) and TMD with MA group (TMD + MAG). The diagnosis was made according to the Diagnostic Criteria for TMD (DC/TMD) AXIS I. MA was measured from the mid-sagittal plane to the Menton point. CBCT was used to scan the temporomandibular joints pre- (T0) and post- (T1)-treatment for three-dimensional analysis. Intra- and intergroup statistical comparisons were performed using the Wilcoxon signed ranks and the Kruskal‒Wallis test.
RESULTS: For quantitative comparisons, there was a statistically significant difference between T0 and T1 in the joint spaces of TMD + MAG (anterior, superior, posterior, and coronal lateral on the deviated side as well as in the superior, coronal medial joint space of the contralateral side). Morphologically, the deviated side had a narrower condylar width, reduced condylar height, and a steeper eminence angle. In contrast, the contralateral side tended to have a greater condylar length. For qualitative measurements, BMD also showed statistical significance between T0 and T1 in the majority of the condyle slopes (AS, SS, PS, and LS on the deviated side and in AS and MS on the contralateral side) of TMD + MAG. Additionally, only the AS and PS showed significance in TMDG.
CONCLUSIONS: Multiple joint space widening (AJS and CMS) and narrowing (SJS, PJS, and CLS) could characterize the deviated side in TMD + MA. Factors like narrower condylar width, reduced condylar height, and steeper eminence angle on the deviated side can worsen TMD + MA. Proper alignment of the condyle-disc position is essential for optimal function and load distribution, potentially affecting bone mineral density (BMD). MA plays a prominent role in disturbing bone densities. S.S. therapy shows more evident outcomes in TMD + MAG (on the deviated side compared to the contralateral side) than the TMDG.