中国实用口腔科杂志

中国实用口腔科杂志 ›› 2011, Vol. 4 ›› Issue (04): 212-216.

• 专题笔谈 • 上一篇    下一篇

咬合板治疗口颌系统疾病

  

  1. 兰州大学口腔医学院口腔医学研究所，兰州 730000
  • 收稿日期:2011-03-12 出版日期:2011-04-15 发布日期:2011-05-10
  • 作者简介:康宏，教授、博士研究生导师。1988年毕业于西安医科大学口腔医学系，1997、2000年分别获得华西医科大学口腔解剖生理学硕士和口腔修复学博士学位，2006—2007年在美国莱斯大学生物工程系肌骨骼生物工程实验室任访问教授。曾任兰州医学院口腔医学系主任、兰州大学口腔医学院院长。兼任国际牙医师学院院士，国际牙科研究协会（IADR）会员，中华口腔医学会颞下颌关节病学与牙合学专业委员会委员，卫生部口腔本科专业规划教材《牙合学》、研究生规划教材《口腔生物力学》及4种专业期刊的编委和审稿人。为甘肃省卫生系统领军人才。主要从事牙合学与口腔修复学的基础与临床研究工作。2002年入选中组部、中科院“西部之光”人选，2003、2005年入选甘肃省医疗卫生中青年学术技术带头人和甘肃省“555”创新人才工程第一、二层次人选。主持完成各级科研项目6项，获省部级科技奖励2项，出版专著4部，发表SCI、EI、Medline、CSCD收录论文30余篇。

  • Received:2011-03-12 Online:2011-04-15 Published:2011-05-10

摘要：

提要：咬合板治疗口颌系统的功能紊乱已有100余年历史，并且至今仍在广泛使用。虽然各种假说一直用来解释其作用，但科学证据不多。普遍认为，咬合板具有保护牙齿不被磨耗的作用，但咬合板在颞下颌关节紊乱病（TMD）处理中的功效始终很难确定。尽管许多研究认为咬合板减少了夜磨牙发生的频率，但并不表明这会消除磨牙症。戴用咬合板会使咀嚼肌和关节疼痛减少，但也可能是安慰剂效应和症状随时间而自然回归的结果。最新的系统回顾和Meta分析显示，合理调改硬质稳定咬合板对治疗TMD疼痛有效，有证据表明其他类型的咬合板包括软质稳定咬合板、再定位咬合板、松弛咬合板也有一些减少TMD疼痛的功效，但其潜在的副效应也存在，建议在密切监测下使用。本文对目前临床上使用的咬合板的种类及其作用机制进行了评述，重点对咬合板特别是稳定咬合板的作用、治疗价值、应用和注意事项等进行了介绍。强调合理选用和调改咬合板是治疗口颌系统功能紊乱能否成功的关键因素。

关键词: 咬合板, 口颌系统, 循证医学, 颞下颌关节紊乱病

Abstract:

Summary：Occlusal splint has been used in the treatment of dysfunction of stomatological system for more than 100 years of history and is still widely used， although various hypotheses have been used to explain its role， but there’s not much scientific evidence. It is generally considered that splint plays a role in protecting teeth against occlusal wear. However， how to determine the splint efficacy in the treatment of the TMD is always very difficult. Many studies suggest that splint reduces the frequency of occurrence of bruxism，but this does not indicate it will eliminate bruxism. Splint will reduce masticatory muscle and TMJ pain， but the placebo effect and the natural regression results over time could exist potentially. The latest systematic review and meta-analysis showed hard stabilization appliances， when adjusted properly， have good evidence of modest efficacy in the treatment of TMD pain compared to non-occluding appliances and no treatment. Other types of appliances， including soft stabilization appliances， anterior positioning appliances， and anterior bite appliances， have some RCT evidence of efficacy in reducing TMD pain. However， the potential for adverse events with these appliances is higher and suggests the need for close monitoring. This article reviewed types of occlusal splint currently used in clinical conditions and its functional mechanism， focusing in particular on the stabilization splint， its therapeutic value， application and precautions. It should be emphasized that the rational use and adjustment of appliances are key factors to treating successfully dysfunction of stomatological system.

Key words: occlusal splint；stomatognathic system；evidence-based medicine；temporomandibular joint disorders