目的:本范围综述旨在阐明牙科修复术中咬合垂直尺寸(VDO)的概念,解决流行的神话,以及关于其临床管理和对口颌系统的影响的争议。
方法:本文通过广泛的文献回顾和国际调查,批判性地研究了关于VDO改变及其对颞下颌关节紊乱病(TMD)的影响的普遍信念。该调查包括862名普通牙医和修复医生,并探讨了他们改变VDO的方法及其对临床意义的看法。文献综述对VDO改性技术的现有研究进行了全面分析,口颌系统的适应性,以及VDO变化与TMD的关系。
结果:调查揭示了牙医对VDO的看法,表明,尽管许多从业者出于对患者适应性的担忧而测试了一种新的VDO,绝大多数患者观察到,无论使用何种技术,患者通常都能很好地适应新的VDO.该调查强调了关于VDO变更需要逐步过程和试验阶段的不同信念,以及改进的VDO的稳定性。文献综述表明,由于肌肉适应性,VDO变化的稳定性和适应性,并且表明VDO变化与TMD之间没有直接的因果关系或治愈性联系。传统的确定全口义齿中VDO的方法可能不适用于磨损的牙列。强调需要量身定制的方法。
结论:本文建议,根据支持口颌系统适应性的证据,可以重新考虑需要延长VDO改变试验阶段的传统观念。此外,它强调区分适合全口义齿的方法和处理牙列磨损病例的方法的重要性。据称,VDO改变和TMD之间的联系也缺乏科学证据,强调基于当前证据和临床判断的个性化患者护理的必要性。
OBJECTIVE: This scoping review aims to clarify the concept of vertical dimension of occlusion (VDO) in prosthetic dentistry, addressing prevalent myths, and controversies regarding its clinical management and impact on the stomatognathic system.
METHODS: This paper critically examines common beliefs about VDO alteration and its effects on temporomandibular disorders (TMD) through an extensive literature review and an international survey. The survey included 862 general dentists and prosthodontists and explored their approaches to altering VDO and their perceptions of the clinical implications. The literature review provided a thorough analysis of existing research on VDO modification techniques, the adaptability of the stomatognathic system, and the relationship between VDO changes and TMD.
RESULTS: The survey revealed insights into dentists\' perspectives on VDO, showing that while many practitioners test a new VDO due to concerns about patient adaptation, a significant majority observed that patients typically adjust well to a new VDO regardless of the technique used. The survey highlighted differing beliefs about the need for a gradual process and trial phase for VDO alteration, as well as the stability of modified VDO. Literature review suggests the stability and adaptability of VDO changes due to muscle adaptability and indicates no direct causal or curative link between VDO changes and TMD. Traditional methods for determining VDO in complete dentures may not be suitable for worn dentition, underscoring the need for tailored approaches.
CONCLUSIONS: This paper suggests that the traditional belief in the need for a prolonged trial phase for VDO alterations may be reconsidered in light of evidence supporting the adaptability of the stomatognathic system. Moreover, it emphasizes the importance of distinguishing between methods suitable for complete dentures and those for managing cases of worn dentition. The purported link between VDO alterations and TMD is also found to lack scientific evidence, highlighting the need for individualized patient care based on current evidence and clinical judgment.