中国实用口腔科杂志

中国实用口腔科杂志

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牙列咬合特征与颞下颌关节紊乱综合征关系研究

李    博，胡晟奭，常    新   

  1. 大连医科大学附属第二医院口腔科，辽宁  大连116023
  • 出版日期:2016-07-15 发布日期:2016-07-25

  • Online:2016-07-15 Published:2016-07-25

摘要：

目的    研究牙列咬合特征对颞下颌关节紊乱综合征（TMDs）的影响。方法    选择2013年11月至2014年11月于大连医科大学附属第二医院口腔科就诊患者及自愿参加本研究的学生共126例作为研究对象，按照有无TMDs症状分为阴性（28例）和阳性（98例）两组。根据颞下颌关节紊乱病双轴诊断（RDC-TMD）轴1诊断标准进行颞下颌关节（TMJ）检查，取牙列模型，对两组模型前牙覆牙合、前牙覆盖、后牙覆牙合覆盖和Spee曲线等4种主要的咬合特征进行测量，结果运用SPSS13.0软件进行分析。结果    正畸治疗史对于TMDs的发生并无显著影响（P > 0.05）；而前牙覆牙合、覆盖对TMDs发生均有一定影响（均P < 0.05），后牙反牙合、锁牙合对TMDs症状无明显影响（P > 0.05）。无论左侧还是右侧，TMJ出现杂音者的同侧Spee曲线曲度均较TMJ无杂音者的同侧Spee曲线曲度明显减小，差异均有统计学意义（均P < 0.05）；TMJ肌肉群扪诊疼痛与否对Spee曲线曲度的影响均无统计学意义（均P > 0.05）。结论    前牙覆牙合、覆盖异常可能是TMDs发生的危险因素之一；TMJ出现杂音与Spee曲线的曲度有显著相关性，当Spee曲线较平直时，TMJ杂音的发生率相对较高。

关键词: 颞下颌关节紊乱综合征, Spee曲线, 覆牙合, 覆盖, 牙合

Abstract:

Objective    To identify differences in occlusal features between subjects with signs and symptoms of temporomandibular disorders and asymptomatic subjects. Methods    126 subjects who consented to participate in this research were examined for signs and symptoms of TMDs according to the guidelines of RDC-TMD. In addition，occlusal measurements were performed for all subjects on plaster models. The 126 patients were divided into the TMDs group and the no-TMDs group. Four occlusal features were recorded for each patient：overbite，overjet，posterior crossbite and the curve of Spee. All statistical analyses were performed with SPSS 13.0. Results    Significant associations were revealed between the curve of Spee and TMJ sounds. There were statistically significant differences between the TMDs group and the no-TMDs group in the overjet and overbite of inciors. No differences were found between subjects with and without a history of orthodontic treatment. The curve of Spee is not associated with pain of muscular origin or the posterior crossbite. Conclusion     The abnormal overjet and overbite could be occlusal risk factors for TMDs. Subjects with TMJ sounds tend to have a faltter curve of Spee compared to subjects without TMJ sounds.

Key words: temporomandibular disorders, curve of spee, overjet, overbite, occlusion