中国实用口腔科杂志

中国实用口腔科杂志 ›› 2023, Vol. 16 ›› Issue (2): 156-161.DOI: 10.19538/j.kq.2023.02.007

• 论著 • 上一篇    下一篇

颞下颌关节紊乱病单侧颞下颌关节疼痛患者与夜磨牙患者的咬合关系比较研究

王翠翠1，2，张振萍2，宋李幸1，刘    璐1，刘继光2，王美青1，2   

  1. 1. 军事口腔医学国家重点实验室，国家口腔疾病临床医学研究中心，陕西省口腔疾病国际联合研究中心，空军军医大学第三附属医院口腔解剖生理学教研室及颞下颌关节病科，陕西  西安  710000；2. 佳木斯大学附属口腔医院口腔医学实验中心，黑龙江  佳木斯  154007
  • 出版日期:2023-03-30 发布日期:2023-04-19
  • 基金资助:
    国家自然科学基金（81530033）

  • Online:2023-03-30 Published:2023-04-19

摘要： 比较研究颞下颌关节紊乱病（temporomandibular disorders，TMD）单侧颞下颌关节疼痛患者与夜磨牙患者的咬合关系特点，为临床鉴别诊断及治疗方案的设计提供参考依据。方法    选取2015—2017年于空军军医大学第三附属医院颞下颌关节病科就诊的169例TMD单侧颞下颌关节疼痛患者（TMD组）和189例夜磨牙患者（夜磨牙组）的临床资料进行回顾性分析。对2组患者治疗前牙颌石膏模型进行测量分析，比较其错牙合畸形分类、上下牙列中线位置、前牙覆牙合和覆盖情况、个别牙错牙合、个别牙错位、缺牙（第三磨牙除外）、第三磨牙萌出及口腔修复情况。结果    ①2组患者错牙合畸形分类、上下牙列中线位置、前牙覆牙合覆盖情况比较，差异均无统计学意义（均P > 0.05）。②TMD组患者反牙合发生率（28.4%）明显高于夜磨牙组（17.5%），差异有统计学意义（χ2 = 6.102，P = 0.014）；而2组患者锁牙合、对刃及开牙合发生率比较，差异均无统计学意义（均P > 0.05）。③TMD组上颌侧切牙伴其他牙位唇倾的占比（22.6%）明显高于夜磨牙组（4.9%），上颌中切牙伴其他牙位扭转的占比（53.3%）低于夜磨牙组（74.5%），而上颌尖牙伴其他牙位扭转的占比（37.8%）明显高于夜磨牙组（5.5%），差异均有统计学意义（均P < 0.05）；而2组其他牙位错位情况比较，差异均无统计学意义（均P > 0.05）。④TMD组缺牙发生率（23.7%）高于夜磨牙组（15.3%），差异有统计学意义（χ2 = 3.974，P = 0.046）；在各组缺牙患者中，TMD组多颗牙缺失患者占比（47.5%）大于夜磨牙组（24.1%），夜磨牙组单颗牙缺失患者占比（75.9%）大于TMD组（52.5%），其分布差异有统计学意义（χ2 = 3.907，P = 0.048）。⑤TMD组患者双侧下颌第三磨牙的萌出率均高于夜磨牙组，差异均有统计学意义（均P < 0.05）；而2组上颌第三磨牙萌出率比较，差异无统计学意义（P > 0.05）。⑥在各组固定义齿修复患者中，TMD组多颗修复患者占比（89.5%）大于夜磨牙组（占33.3%），夜磨牙组单颗修复患者占比（66.7%）大于TMD组（10.5%），其分布差异有统计学意义（P < 0.001）。结论    TMD单侧颞下颌关节疼痛患者与夜磨牙患者的咬合特点在个别牙反牙合、个别牙错位、缺牙（第三磨牙除外）、下颌第三磨牙萌出及口腔修复情况方面存在一定差异，可为临床鉴别诊断提供参考依据。

关键词: 颞下颌关节紊乱病, 咬合, 错牙合, 颞下颌关节, 口颌面痛, 夜磨牙

Abstract: Objective    To compare the occlusal relationship between patients with unilateral temporomandibular joint（TMJ）arthralgia of temporomandibular disorders（TMD）and patients with sleep bruxism，and to provide reference for clinical differential diagnosis and treatment. Methods    The clinical data of 169 patients with unilateral temporomandibular joint arthralgia of TMD（TMD group）and 189 patients with sleep bruxism（sleep bruxism group）who visited the Department of Temporomandibular Joint Disease，the Third Affiliated Hospital of Air Force Military Medical University from 2015 to 2017 were selected for retrospective analysis. The plaster models of jaw were measured and analyzed in the two groups before treatment. The malocclusion classification，midline position of upper and lower dentition，anterior overbite and overjet，individual malocclusion，individual malposition，missing tooth（except third molar），third molar eruption and oral restoration were compared between the two groups. Results    ①There was no significant difference in malocclusion classification，midline position of upper and lower dentition or anterior overbite and overjet between the two groups（all P > 0.05）. ②The incidence of crossbite in TMD group（28.4%）was significantly higher than that in sleep bruxism group（17.5%）（χ2 = 6.102，P = 0.014），but there was no significant difference in the incidence of lock bite，edge-to-edge bite or open bite between the two groups（all P > 0.05）. ③The proportion of maxillary lateral incisors with labial inclination in other tooth positions in the TMD group（22.6%）was significantly higher than that in the sleep bruxism group（4.9%），and the proportion of maxillary central incisors with torsion in other tooth positions（53.3%）was lower than that in the sleep bruxism group（74.5%），while the proportion of maxillary canines with torsion in other tooth positions（37.8%）was significantly higher than that in the sleep bruxism group（5.5%），and the differences were statistically significant（all P < 0.05）；however，there were no significant differences in malposition of other tooth position between the 2 groups（all P > 0.05）. ④The incidence of missing teeth in the TMD group（23.7%）was higher than that in the sleep bruxism group（15.3%），and the difference was statistically significant（χ2 = 3.974，P = 0.046）；among the patients who had missing teeth in each group，the proportion of patients with multiple missing tooth in the TMD group（47.5%）was greater than that in the sleep bruxism group（24.1%），and the proportion of patients with single missing teeth in the sleep bruxism group（75.9%）was greater than that in the TMD group（52.5%），and its distribution was statistically different（χ2 = 3.907，P = 0.048）. ⑤The eruption rates of mandibular third molars on both sides in the TMD group were higher than those in the sleep bruxism group，and the differences were statistically significant（all P < 0.05）；however，there was no significant difference in the eruption rates of maxillary third molars between the 2 groups（P > 0.05）. ⑥Among the patients with fixed restorations in each group，the proportion of patients with fixed restoration of multiple teeth was greater in the TMD group（89.5%）than in the sleep bruxism group（33.3%），and the proportion of patients with fixed restoration of single teeth was greater in the sleep bruxism group（66.7%）than in the TMD（10.5%）group，and their distribution was statistically different（P < 0.001）. Conclusion    There are some differences in occlusal characteristics between patients with unilateral temporomandibular joint arthralgia and those with sleep bruxism，including individual crossbite，individual malposition，missing teeth（except third molars），mandibular third molar eruption and oral restoration，which can provide reference for clinical differential diagnosis.

Key words: temporomandibular disorders, occlusion, malocclusion, temporomandibular joint, oral facial pain, sleep bruxism