以口外裝置間接評估髁在使用樞軸咬合板的移動方向

The Direction of Condyle Displacement with a Pivot Splint Indirectly Evaluated by Extraoral Devices

張志麟(Chih-Ling Chang) ； 周孫隆(Sun-Long Chou)

《中華牙醫學雜誌（中文版）》 1卷2期 (2005/06) Pp. 113-122

https://doi.org/10.7106/CJD.200506.0113

摘要

早在一百多年以前Goodwillie提出利用樞軸咬合板成功地治療顳顎關節障礙的患者。根據我們的臨床經驗發現，樞軸咬合板比穩定形咬合板更能快速有效減少關節疼痛及治療關節盤紊亂，當患者戴著閉口時，下顎會處於較前下方的位置，使髁遠離關節盤後組織減少關節內的壓力。如果緊咬時力量通過樞軸點的前方，則在第二大臼齒附近為支點，產生槓桿的作用使髁向下被拉離關節窩。但這種治療方式其作用機轉仍有爭議，至今還缺乏科學的證據。許多研究認為，因為樞軸點位於閉口肌合力的前方，反而造成關節負荷，除非在下巴給予向上的力量才能使髁外偏離開關節面。本研究的目的要闡明戴著樞軸咬合板時，髁於後縮接觸位置至緊咬時其位移的方向及路徑。24位自願者參與本研究，具有完整的自然齒列並且沒有顳顎關節障礙的症狀，每位受測者接受上顎樞軸咬合板的製作，使用鍛製金屬線(0.036 in; 17 mm)固定於下顎前牙區，以記錄髁移動的路徑。當受測者用力緊咬時，可觀察到鍛製金屬線向上移動，代表閉口肌合力通過樞軸點前方所形成的槓桿效應，使髁向下被拉離關節窩。

關鍵字

樞軸咬合板 ； 髁外偏 ； 顳顎關節障礙

並列摘要

The pivot splint was developed by Goodwillie for the treatment of temporomandibular disorders (TMDs) more than 100 years ago. According to our clinical experience, such a treatment is more efficient and effective in reducing pain and disk derangement than is the traditional stabilization splint. As a patient closes his/her mouth, it is logical that the mandible is positioned more downward and forward to avoid the pivot. If this occurs, the condyle is positioned off of the retrodiscal tissues, and the interarticular pressure is lessened. If the clenching forces are located anterior to the pivot, this creates a fulcrum around the second molar, pivoting the condyle downward away from the fossa. However, no scientific evidence has been offered and the mechanisms of this therapy are still controversial. Many studies have suggested that such an appliance loads the joint because the pivot is anterior to the force of the elevator muscles; it does not distract the joint only if an extraoral upward force is applied to the chin. The purpose of this study was to clarify the direction and path of condyle displacement from the retruded contact position to the clenched position with a pivot splint. Participants consisted of 24 volunteers with natural dentition and with no TMD symptoms. Maxillary pivot splints were fabricated, and the path of the condyle was depicted with wrought wire (0.036 in; 17 mm) attached to a resin plate and cemented to the mandibular anterior teeth. The direction of the wire was upward as the volunteer clenched, so the condyle was distracted away from the fossa, and the net biting force was located anterior to the pivot.

並列關鍵字

pivot splint ； distract ； temporomandibular disorders