Abstract
Rationale: Occlusal appliance is one of methods for temporomandibular joint anterior disc displacement with reduction (ADDWR). However, most studies have focused on the symptom reliefs rather than the disc-condyle positional relationship. Aim: To evaluate the success rate and the prognosis of occlusal appliances in repositioning of the disc in temporomandibular joint ADDWR. Materials and methods: One hundred and forty four (144) patients (210 joints) diagnosed with temporomandibular joint ADDWR based on magnetic resonance imaging (MRI) were consecutively included in our study. For all joints it was confirmed by MRI that the disc could be recaptured in a mandible anterior position. Occlusal appliances, including anterior repositioning appliance, twinblock or Herbst, were worn to keep the mandible in this position. MRI scanning was carried out before, 6 months later, at the end of treatment and at the follow-up visit. Logistic regression was used to analyze the risk factors for success. Cox regression model was applied to estimate the prospective risk of failure. Results: Among the occlusal appliances used, there were 100 anterior repositioning appliances, 23 twin-blocks, and 21 Herbst, with mean treatment duration of 9.5 ± 2.6 months. One hundred and seventy seven (177) joints (84.3%) were successfully repositioned at the end of splint treatment, according to MRI. Logistic regression showed that the appliance types were significantly associated with the success rate. At 2 years of regular follow-up, in almost 53% of the cases the disc-condyle relationship was normal. Gender, age, treatment duration and orthodontics were identified in the final Cox regression model with hazard ratios of 1.375, 1.141, 0.396 and 0.364 respectively. Conclusion: Occlusal appliance is one of the useful methods to recapture the disc in patients with temporomandibular joint ADDWR. However, the patient selection should be rigorous.
Highlights
Пациентам с диагнозом переднего вывиха диска ВНЧС с репозицией выполнялась магнитно-резонансной томографии (МРТ) с протрузией нижней челюсти до положения зубных рядов «край в край» с восковой фиксацией
Conflicts of Interest The authors declare that they have no conflict of interest
Summary
В исследование были последовательно набраны пациенты, которые обращались для проведения окклюзионной сплинт-терапии в клинику ВНЧС при отделении челюстно-лицевой хирургии и хирургической стоматологии Шанхайского 9-го народного госпиталя с августа 2009 по июнь 2016 г. Пациентам с диагнозом переднего вывиха диска ВНЧС с репозицией выполнялась МРТ с протрузией нижней челюсти до положения зубных рядов «край в край» с восковой фиксацией Если на МРТ было получено подтверждение, что диск при этом занимает нормальное положение, то в этом же положении нижней челюсти снимали слепок для изготовления функциональных шин, включая переднюю репозиционирующую систему с полным охватом нижней челюсти, твин-блок или аппарат Гербста Всем включенным в исследование больным МРТ проводили до лечения, через 6 месяцев ношения шины, в конце сплинт-терапии и на визите для динамического наблюдения. Независимые переменные включали возраст, пол, длительность лечения, тип сплинт-системы, ортодонтическое лечение (проводилось или нет) и период динамического наблюдения. Ковариаты включали в модель при p < 0,05, если тест на отношение
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