颞下颌关节功能障碍患者的硬件治疗方法分析

A. A. Dolgalev, D. Y. Khristoforando, Ya. N. Garus, V. N. Ivensky, A. N. Brazhnikova, O. Y. Khorev, E. A. Bulycheva, P. N. Geletin, Z. V. Kerefova, Yu. V. Chepurko, O. A. Uspenskaya
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摘要

目的对颞下颌关节功能障碍(DTMJ)患者使用各种类型的闭塞性护齿的硬件治疗方法的疗效进行比较分析。材料和方法。自 2013 年至 2023 年,对 99 名具有不同颞下颌关节功能障碍显露和确诊体征组合的患者(88 名女性和 11 名男性,年龄为 41.2 ± 10.7 岁)进行了检查。根据个人临床症状、主诉、病因和发病机制,对对比组和两个主要组的所有患者(99 名患者)进行了 DTMJ 的个体综合治疗。治疗的目的是消除疼痛、缓解咀嚼肌痉挛、改善张口程度、矫正下颌位置、消除咬合干扰和恢复面部下三分之一的高度。在进行硬件治疗时,根据患者的下颌模型制作了 3 种类型的闭塞性护齿。这些模型来自颌骨的硅胶印模。结果99 名患者的颞下颌关节核磁共振图像显示,关节盘腹侧脱位发生率最高(88 名患者)。与关节盘侧向脱位同时发生的情况较少(4% 的病例)。很少发生关节盘远端脱位,占病例总数的 1.9%(2 名患者)。对不同类型的闭锁性护齿器使用效果的研究表明,有必要确定闭锁性护齿器的类型,以便对颞下颌关节元素进行减压,使下颌位置居中,并通过正畸消除导致闭锁性干扰的颌面部异常和畸形。结论对用于诊断和治疗 DTMJ 患者的咬合器械的分析表明,最有效的器械是那些成功结合了夹板元素的器械,其用途较窄。
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Analysis of hardware methods of treatment of patients with temporomandibular joint dysfunction
Objective. To conduct a comparative analysis of effectiveness of treatment of patients with dysfunction of temporomandibular joint (DTMJ) using hardware methods of treatment with occlusive mouthguards of various types. Materials and methods. 99 patients (88 females and 11 males aged 41,2 ± 10,7) with different combinations of revealed and confirmed signs of DTMJ were examined from 2013 to 2023. According to the personal clinical picture, complaints revealed, aetiology and pathogenesis of the disease all the patients of the comparison group and 2 main groups (99 patients) were administered individual complex treatment for DTMJ. The treatment was aimed at the elimination of pain, relief of masticatory muscles spasm, improvement of the extent of opening of mouth, correction of the lower jaw position, occlusive interference elimination and restoration of height of the lower third of the face. While carrying out the hardware treatment, occlusive mouthguards of 3 types were made based on the jaw model of the patients. The models were got from the silicone imprints of the jaw. Results. MR images of temporomandibular joints of the 99 patients showed that ventral dislocation of articular disk occurred most frequently (in 88 patients). Less frequently (4 % of cases) it was combined with dislocation of the disk laterally. Rarely distal dislocation of the articular disk occurred – 1,9 % of cases (2 patients). Study of the results of the appliance of different types of occlusive mouthguards demonstrates the necessity to work out the types of occlusive devices allowing decompression of temporomandibular joint elements, centering lower jaw position and orthodontic elimination of dentofacial abnormalities and deformities which lead to occlusive interference. Conclusions. Analysis of occlusive devices used in the diagnosis and treatment of patients with DTMJ shows that the most effective devices are those that successfully combine elements of splints with a narrower purpose.
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