颞下颌关节急性不可复性盘前移位复位后改良前牙咬合板联合再定位咬合板维持的疗效初步评估

doi:10.7518/hxkq.2025.2024317

摘要/Abstract

摘要：

目的利用磁共振成像（MRI）观察改良前牙咬合板（MAS）联合再定位咬合板（ARS）维持协调盘-髁关系的疗效。方法收集2024年1—6月就诊于南昌大学附属口腔医院，手法复位成功的10例颞下颌关节急性不可复性盘前移位（ADDwoR）患者的临床及影像学资料。每位患者在复位后使用MAS和ARS治疗，分别在治疗前，治疗2周、1月、3月后记录患者的最大主动开口度（MMO）和疼痛视觉类比评分（VAS）。通过MRI分析治疗前、治疗3个月后盘-髁关系、盘-髁角度、关节积液及双线征的变化。结果经3个月治疗，患者临床症状明显改善，MMO由治疗前的28.90 mm增加到46.85 mm，VAS值由治疗前的4.68降至0.61。MRI显示，6例盘-髁关系正常，2例为可复性盘前移位，2例为ADDwoR，盘-髁角度由治疗前的58.84°降低至25.99°。结论急性ADDwoR在手法复位成功后，MAS联合ARS能有效维持正常的盘-髁关系。

关键词: 颞下颌关节紊乱病, 手法复位, 再定位咬合板, 不可复性盘前移位

Abstract:

Objective Magnetic resonance imaging (MRI) was used to study the efficacy of modified anterior splint (MAS) combined with anterior repositioning splint (ARS) in maintaining the normal disk-condyle relationship. Methods We obtained clinical and imaging data of 10 patients with acute anterior disk displacement without reduction (ADDwoR) of the temporomandibular joint undergoing successful mandibular manipulation in the Affiliated Stomatological Hospital, Nanchang University from January to June 2024. The MAS and ARS were used for subsequent treatment. Maximum active mouth opening (MMO) and visual analogue score (VAS) were recorded before treatment and 2 weeks, 1 month, and 3 months after treatment. The changes in the disk-condyle relationship, disk-condyle angle, joint effusion, and double contour sign before and after treatment were analyzed through MRI. Results Three months after treatment, the MMO increased from 28.90 mm to 46.85 mm, VAS decreased from 4.68 to 0.61, and the disk-condyle angle decreased from 58.84° to 25.99°. MRI analysis found that 6 patients showed normal disk-condyle relationship, 2 patients exhibited displacement with reduction, and 2 patients exhibited ADDwoR. The disk-condyle angle was 58.84° before treatment and 25.99° after treatment. Conclusion The MAS combined with ARS could further stabilize the coordinated disk-condyle relationship and reduce the recurrence rate.

Key words: temporomandibular joint disorders, mandibular manipulation, anterior repositioning splint, anterior disk displacement without reduction

中图分类号:

R782.6

黄超, 吴兴胜, 湛圳, 张林, 石连水. 颞下颌关节急性不可复性盘前移位复位后改良前牙咬合板联合再定位咬合板维持的疗效初步评估[J]. 华西口腔医学杂志, 2025, 43(2): 262-268.

Huang Chao, Wu Xingsheng, Zhan Zhen, Zhang Lin, Shi Lianshui. Preliminary evaluation of modified anterior splint combined with anterior repositioning splint after successful mandibular manipulation in treatment of acute anterior disc displacement without reduction of temporomandibular joint[J]. West China Journal of Stomatology, 2025, 43(2): 262-268.

图/表 5

图 1

图 2

表 1

表 2

图 3

参考文献 33

1	Manfredini D, Guarda-Nardini L, Winocur E, et al. Research diagnostic criteria for temporomandibular disorders: a systematic review of axisⅠepidemiologic fin-dings[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2011, 112(4): 453-462.
2	Yura S. Natural course of acute closed lock of the tempo-romandibular joint[J]. Br J Oral Maxillofac Surg, 2012, 50(7): 646-649.
3	Takatsuka S, Yoshida K, Ueki K, et al. Disc and condyle translation in patients with temporomandibular disorder[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2005, 99(5): 614-621.
4	Fan PD, Han SLR, Cheng QY, et al. Exploring the effect of disc displacement on the risk and severity of condylar erosion in adult temporomandibular disorder patients: a CBCT and MRI study[J]. J Oral Rehabil, 2024, 51(7): 1166-1174.
5	Murakami KI, Iizuka T, Matsuki M, et al. Recapturing the persistent anteriorly displaced disk by mandibular manipulation after pumping and hydraulic pressure to the upper joint cavity of the temporomandibular joint[J]. Cranio, 1987, 5(1): 17-24.
6	Lei J, Yap AU, Li Y, et al. Clinical protocol for mana-ging acute disc displacement without reduction: a magnetic resonance imaging evaluation[J]. Int J Oral Maxillofac Surg, 2020, 49(3): 361-368.
7	Kurita H, Kurashina K, Ohtsuka A. Efficacy of a mandibular manipulation technique in reducing the permanently displaced temporomandibular joint disc[J]. J Oral Maxillofac Surg, 1999, 57(7): 784-788.
8	Segami N, Murakami K, Iizuka T. Arthrographic evaluation of disk position following mandibular manipulation technique for internal derangement with closed lock of the temporomandibular joint[J]. J Craniomandib Disord, 1990, 4(2): 99-108.
9	姜鑫, 范帅, 蔡斌, 等. 手法复位配合运动与牙合垫治疗急性颞下颌关节盘不可复性前移位的近期疗效评价[J]. 上海口腔医学, 2016, 25(5): 570-573.
	Jiang X, Fan S, Cai B, et al. Mandibular manipulation technique followed by exercise therapy and occlusal splint for treatment of acute anterior TMJ disk displacement without reduction[J]. Shanghai J Stomatol, 2016, 25(5): 570-573.
10	陈慧敏, 傅开元, 李优伟, 等. 再定位牙合垫戴入前后颞下颌关节盘和髁突的位置改变[J]. 华西口腔医学杂志, 2009, 27(4): 408-412.
	Chen HM, Fu KY, Li YW, et al. Positional changes of temporomandibular joint disk and condyle with insertion of anterior repositioning splint[J]. West China J Stomatol, 2009, 27(4): 408-412.
11	Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the international RDC/TMD consortium network and orofacial pain special interest group[J]. J Oral Facial Pain Headache, 2014, 28(1): 6-27.
12	傅开元, 胡敏, 余强, 等. 颞下颌关节常规MRI检查规范及关节盘移位诊断标准的专家共识[J]. 中华口腔医学杂志, 2020, 55(9): 608-612.
	Fu KY, Hu M, Yu Q, et al. Experts consensus on MRI examination specification and diagnostic criteria of temporomandibular joint disc displacement[J]. Chin J Stomatol, 2020, 55(9): 608-612.
13	Igarashi C, Kobayashi K, Ito H, et al. Clinical and magnetic resonance imaging findings in patients with and without improvement after mandibular manipulation and conservative physical therapy for temporomandibular joint disorders[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2023, 135(2): 294-302.
14	孙浩, 吴璇, 石涛, 等. 数字化再定位咬合板治疗颞下颌关节盘可复性前移位临床效果研究[J]. 中国实用口腔科杂志, 2024, 17(2): 180-185.
	Sun H, Wu X, Shi T, et al. Clinical evaluation of digital repositioning splint in the treatment of temporomandibular anterior disc displacement with reduction[J]. Chin J Pract Stomatol, 2024, 17(2): 180-185.
15	Drace JE, Enzmann DR. Defining the normal temporomandibular joint: closed-, partially open-, and open-mouth MR imaging of asymptomatic subjects[J]. Radiology, 1990, 177(1): 67-71.
16	Yano K, Nishikawa K, Sano T, et al. Relationship between appearance of a double contour on the mandibular condyle and the change in articular disc position after splint therapy[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108(4): e30-e34.
17	Choi BH, Yoo JH, Lee WY. Comparison of magnetic re-sonance imaging before and after nonsurgical treatment of closed lock[J]. Oral Surg Oral Med Oral Pathol, 1994, 78(3): 301-305.
18	Kai S, Kai H, Tabata O, et al. Long-term outcomes of nonsurgical treatment in nonreducing anteriorly displa-ced disk of the temporomandibular joint[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1998, 85(3): 258-267.
19	Zhuo Z, Cai X, Xie Q. Is anterior disc displacement without reduction associated with temporomandibular joint condylar height in juvenile patients younger than 20 years[J]. J Oral Maxillofac Surg, 2015, 73(5): 843-849.
20	Di Paolo C, Qorri E, Falisi G, et al. RA.DI.CA. splint therapy in the management of temporomandibular joint displacement without reduction[J]. J Pers Med, 2023, 13(7): 1095.
21	Sembronio S, Albiero AM, Toro C, et al. Is there a role for arthrocentesis in recapturing the displaced disc in patients with closed lock of the temporomandibular joint[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008, 105(3): 274-281.
22	宋志强, 张颖, 张清彬. 手法复位联合Twin-Block咬合板治疗急性颞下颌关节盘不可复性前移位的临床效果评价[J]. 中华口腔医学研究杂志(电子版), 2022, 16(3): 144-149.
	Song ZQ, Zhang Y, Zhang QB. Clinical evaluation of manual reduction combined with Twin-Block splint in the treatment of acute anterior temporomandibular joint disk displacement without reduction[J]. Chin J Stomatol Res (Electron Ed), 2022, 16(3): 144-149.
23	Liparoti S, Franco P, Pantani R, et al. Polycaprolactone/polyethylene-glycol capsules made by injection molding: a drug release modeling[J]. Mater Sci Eng C Mater Biol Appl, 2021, 123: 112036.
24	Arif ZU, Khalid MY, Noroozi R, et al. Recent advances in 3D-printed polylactide and polycaprolactone-based biomaterials for tissue engineering applications[J]. Int J Biol Macromol, 2022, 218: 930-968.
25	Li H, Shen D, Chen ZH, et al. Step-back anterior repo-sitioning splint retraction for temporomandibular joint disc displacement with reduction in adult patients[J]. J Oral Rehabil, 2023, 50(10): 965-971.
26	Rabie AB, Xiong H, Hägg U. Forward mandibular po-sitioning enhances condylar adaptation in adult rats[J]. Eur J Orthod, 2004, 26(4): 353-358.
27	Hayashi H, Fujita T, Shirakura M, et al. Role of articular disc in condylar regeneration of the mandible[J]. Exp Anim, 2014, 63(4): 395-401.
28	De Barros Melo MN, Dos Santos Melo JN, Sarmento VA, et al. Influence of arthrocentesis irrigation volume at temporomandibular disorder treatment[J]. Indian J Dent Res, 2017, 28(6): 655-660.
29	Albagieh H, Alomran I, Binakresh A, et al. Occlusal splints-types and effectiveness in temporomandibular di-sorder management[J]. Saudi Dent J, 2023, 35(1): 70-79.
30	Zhu JY, Gong YJ, Zheng FJ, et al. Relationships between functional temporomandibular joint space and di-sc morphology, position, and condylar osseous condition in patients with temporomandibular disorder[J]. Clin O-ral Investig, 2024, 28(3): 193.
31	Hu YK, Yang C, Xie QY. Changes in disc status in the reducing and nonreducing anterior disc displacement of temporomandibular joint: a longitudinal retrospective study[J]. Sci Rep, 2016, 6: 34253.
32	张颖, 卢锦芬, 张清彬. 改良后牙咬合板治疗颞下颌关节盘不可复性前移位的效果评价[J]. 上海口腔医学, 2021, 30(2): 210-213.
	Zhang Y, Lu JF, Zhang QB. Clinical study of modified posterior dental splint in the treatment of anterior disk displacement without reduction of the temporomandibular joint[J]. Shanghai J Stomatol, 2021, 30(2): 210-213.
33	Lei J, Yap AU, Liu MQ, et al. Condylar repair and regeneration in adolescents/young adults with early-stage degenerative temporomandibular joint disease: a randomi-sed controlled study[J]. J Oral Rehabil, 2019, 46(8): 704-714.

序号	MMO/mm				VAS
序号	治疗前	治疗后2周	治疗后1月	治疗后3月	治疗前	治疗后2周	治疗后1月	治疗后3月
1	24	47	47.5	48	4	0.8	0.3	0
2	23	44	46	49	6.5	2	0.9	0.2
3	35	51.5	51.7	52	5	1.8	0.8	0
4	28	41.8	41	38.5	2	1.5	0.7	1.6
5	25.3	46	45.5	48	3.8	1.8	1.2	0.3
6	36.3	46.5	46.3	45	3.8	1.3	0.6	0
7	30.4	47.7	45	54	6.8	1.4	0	0
8	26	46	46.5	44	3.9	0.4	0	0
9	34.5	41	40.5	41	5.4	4.4	4.2	3
10	26.5	49.5	51	49	5.6	0.4	0.8	1

序号	盘-髁角度/°		关节积液		双线征	盘-髁关系
序号	治疗前	治疗后3月	治疗前	治疗后3月	双线征	盘-髁关系
1	60.64	13.78	是	否	否	正常
2	63.31	13.82	是	否	否	正常
3	51.40	2.78	是	否	是	正常
4	67.78	76.55	是	否	否	不可复
5	47.85	64.77	是	是	否	不可复
6	51.36	24.65	否	否	是	可复
7	92.35	32.40	是	否	是	可复
8	64.49	3.74	是	否	是	正常
9	44.85	14.87	是	否	是	正常
10	44.32	12.55	是	否	是	正常

[1]	于海洋, 颜哲彬, 解晨阳, 吴秦. 正中关系的临床决策[J]. 华西口腔医学杂志, 2024, 42(5): 558-565.
[2]	龚衍吉, 刘洋, 尹德强. 数字孪生辅助调整颌位流程的临床新技术和应用效果研究[J]. 华西口腔医学杂志, 2024, 42(2): 268-276.
[3]	闫森, 乔永明, 段亮伟. 37例颞下颌关节盘不可复性前移位患者自然转归的临床及磁共振成像特征分析[J]. 华西口腔医学杂志, 2024, 42(1): 82-88.
[4]	章巧, 黄东宗, 翟孝庭, 李鸿波, 胡敏, 刘洪臣, 姜华. 伴颞下颌关节紊乱病症状的偏侧咀嚼者咬合分析[J]. 华西口腔医学杂志, 2022, 40(4): 457-467.
[5]	尹圆圆, 李飞, 何姝姝, 陈嵩. 颞下颌关节紊乱病患者静态与动态脑功能异常的磁共振研究[J]. 华西口腔医学杂志, 2021, 39(6): 682-689.
[6]	滕海东, 舒敬恒, 孙庭晖, 潘识宇, 刘展. 可复性关节盘前移位对颞下颌关节三维形态学参数的影响[J]. 华西口腔医学杂志, 2021, 39(2): 203-208.
[7]	康冬梅廖学娟王悦冯娜. 不同门诊护理宣教方法对门诊颞下颌关节紊乱病患者依从性及治疗满意度的影响[J]. 华西口腔医学杂志, 2013, 31(1): 42-44.
[8]	王美青. 口腔修复中的咬合接触问题[J]. 华西口腔医学杂志, 2012, 30(6): 557-561.
[9]	潘光华1 李春洁2 李双君2 赵洪伟2 陈海燕3. 椅旁循证在颞下颌关节骨关节炎治疗中的应用研究[J]. 华西口腔医学杂志, 2012, 30(6): 624-627.
[10]	杨介平1 刘伟1 钟跃2 赵洪伟3. 高分辨率超声对颞下颌关节不可复性盘前移位的诊断价值研究[J]. 华西口腔医学杂志, 2012, 30(6): 632-634.
[11]	梁秋娟古力巴哈·买买提力刘海霞韩亮. 认知行为疗法治疗颞下颌关节紊乱病随机对照试验的质量评价[J]. 华西口腔医学杂志, 2011, 29(05): 509-513.
[12]	韩扬傅开元陈慧敏李婧. 糖皮质激素对关节腔灌洗治疗关节盘不可复性前移位疗效的影响[J]. 华西口腔医学杂志, 2010, 28(06): 629-632.
[13]	周振王美青李楠贺建军. 颞下颌关节紊乱病患者疼痛的临床描述分析[J]. 华西口腔医学杂志, 2008, 26(04): 402-405.
[14]	李江宁简野瑞诚相马邦道. 伴有颞下颌关节紊乱病的女性开患者的咬合力分析研究[J]. 华西口腔医学杂志, 2007, 25(06): 536-539.
[15]	许跃,张志光,郑有华. 突发性严重绞锁颞下颌关节的压力测量和分析[J]. 华西口腔医学杂志, 2005, 23(01): 41-42.