背景:颞下颌关节紊乱病(TMD)是一组具有多因素起源的异质性疾病。稳定夹板(SS)已证明在TMD中具有可接受的治疗效果。骨骼的可能变化,牙科,和软组织水平需要进行评估,以评估该治疗程序的获益/风险比。因此,这项研究旨在三维评估骨骼,SS治疗后TMD患者的齿槽和软组织变化。
方法:这项回顾性研究包括74例患有肌筋膜和/或关节内疾病的成年患者(男25例,女49例),平均年龄为22.88±4.8岁,接受SS治疗的人。使用Invivo6.0.3软件分析治疗前和治疗后的锥形束计算机断层扫描。主要结果是垂直骨骼和牙槽骨的变化,而次要结果是前后骨骼,齿槽和软组织改变。采用配对t检验和Wilcoxon秩和检验进行统计分析。
结果:对于主要结果;骨骼,下颌平面倾斜度显著增加(差值:0.82°±1.37),降低面部高度比(差异:0.45%±1.07)和牙槽水平,功能的倾斜度(FOP-SN,FOP-FH)和平分(BOP-SN,BOP-FH)咬合平面也显示出显着增加(差异:0.38±1.43°,0.49±1.62°,0.44±1.29°和0.41±1.17°,分别)和过咬减少(差异:-0.54±0.83)。对于次要结果;下颌位置(SNB)显着降低(差异:1.60±1.36°),过度喷射增加(差异:0.93±1.04,p<0.001),并且嘴唇明显减少(差异:0.33±1.01mmp<0.01),也被观察到了。
结论:SS治疗导致显著的垂直骨骼和牙槽改变,主要表现为面部高度比,下颌和咬合平面的变化,在较小程度上,重要的前后骨骼,齿状肺泡,下颌位置的软组织改变,增加了过度喷射和更有吸引力的下唇。在开始SS治疗之前,应在患者选择期间考虑这些变化。
BACKGROUND: Temporomandibular disorder (TMD) is a grouping of heterogeneous disorders with multifactorial origins. Stabilization splints (SS) have demonstrated an acceptable treatment effect in TMD. The possible changes at the skeletal, dental, and soft tissue levels need to be addressed to evaluate the benefit/risk ratio of this therapeutic procedure. Accordingly, this study aimed to three‑dimensionally evaluate skeletal, dentoalveolar and soft tissue changes after SS treatment for patients with TMD.
METHODS: This retrospective study included 74 adult patients with myofascial and/or intra-articular disorders (25 males and 49 females), with an average age of 22.88 ± 4.8 years, who underwent SS treatment. Pre- and post-treatment Cone beam computed tomography were analysed using Invivo 6.0.3 software. The primary outcome was the vertical skeletal and dentoalveolar changes, while the secondary outcomes were the anteroposterior skeletal, dentoalveolar and soft tissue changes. Paired t-test and Wilcoxon rank sum test were used for statistical analyses.
RESULTS: For the primary outcome; skeletally, there was a significant increase in mandibular plane inclination (difference: 0.82°±1.37), decrease facial height ratio (difference: 0.45%±1.07) and at the dentoalveolar level, the inclination of the functional (FOP-SN, FOP-FH) and bisecting (BOP-SN, BOP-FH) occlusal planes exhibited a significant increase too (difference: 0.38 ± 1.43°, 0.49 ± 1.62°, 0.44 ± 1.29° and 0.41 ± 1.17°, respectively) and also a decrease in the overbite (difference: -0.54 ± 0.83). For the secondary outcomes; there was a significant decrease in mandibular position (SNB) (difference: 1.60 ± 1.36°) and increase in the overjet (difference: 0.93 ± 1.04, p < 0.001) and a significant lower lip retrusion (difference: 0.33 ± 1.01 mm p < 0.01), was observed too.
CONCLUSIONS: SS therapy resulted in significant vertical skeletal and dentoalveolar changes that were manifested mainly by facial height ratio, mandibular and occlusal plane changes, and to a lesser extent, significant anteroposterior skeletal, dentoalveolar, and soft tissue changes in the form of mandibular position, increased overjet and a more retrusive lower lip. These changes should be considered during patients\' selection prior to initiating SS therapy.