| BackgroundTemporomandibular joint disorders(TMD)had a high clinical incidence,which was common in women aged 20-40.Disc displacement was a common type of TMD,including anterior displacement,external displacement,internal displacement,posterior displacement,and rotational displacement,of which the anterior displacement was the most common.In the early stage,Patients had anterior disc displacement with reduction and the main symptom was joint snapping during opening and closing mouth.If intervention wasn’t given at this time,some patients may appear joint locking symptoms,which will further develop into anterior disc displacement without reduction,and even cause organic damage,such as disc perforation,and osteoarthropathy.Clinically,the treatment of anterior disc displacement had always advocated sequential treatment,that is,conservative treatment was carried out first,and then surgical treatment was performed when the effect of conservative treatment was invalid.Finally,orthodontic treatment was performed to adjust the occlusion to stabilize the joint structure.The most common conservative treatment method was anterior repositioning splint(ARS).Its anatomical shape can guide the mandible to a comfortable position of the joint,which can coordinate the relationship between the mandible,skull and maxilla while improving the joint function.So as to improve joint function and facial shape at the same time.Therefore,analyzing the MRI image results accurately for patients with anterior disc displacement after the ARS treatment,combined with clinical examination and CBCT analysis,had important guiding significance for the treatment of anterior disc displacement through ARS in clinic.Objective1.To evaluate the clinical treatment effect of ARS on anterior disc displacement;2.To study the changes of articular disc shape,disc-condyle relationship,condyle movement state,and joint effusion in patients with anterior disc displacement after the ARS treatment,so as to comprehensively evaluate the clinical diagnosis and treatment value of the ARS.MethodsIn this study,38 patients with anterior disc displacement who were treated in the Orthodontics Department of the First Affiliated Hospital of Zhengzhou University from October 2018 to October 2020 were selected.Among them,10 were males and 28 were females,with an average age of 19-27(23.55±3.47)years old.First,performing routine orthodontic clinical examination and taking lateral cranial radiographs,CBCT and MRI,then selecting ARS therapy after comprehensive analysis,and which wear for 3 to 6 months.Collecting the following data before and after treatment:1.Perform clinical examination and record the patient’s joint symptoms;2.Take MRI and measure related 8 joint indexes;3.Take CBCT to measure the joint space and calculate the position of the condyle.The SPSS 21.0 statistical software was used to perform a paired t-test on the MRI and CBCT measured values,while other enumeration data were expressed as rates(%)to evaluate the effect of the ARS on the anterior disc displacement comprehensively.Resultsl.Clinical efficacy96.88%of the snapping symptoms alleviated or disappeared,85.19%of the pain relieved or eliminated,84.00%of the opening degree increased or returned to normal,and 89.28%of the opening deflection degree decreased or returned to normal.2.The results of MRI items were as follow(1)Changes of MRI observation items① In the anterior disc displacement with reduction,some abnormal disc morphology returned to normal,and the biconcave type accounted for 65.63%.In the anterior disc displacement without reduction,some folded type changed to the elongated type,and the elongated type accounted for 43.75%.②The movement restriction state of the anterior disc displacement without reduction became normal gradually,and the normal movement state accounted for 93.75%.③ The amount of effusion was significantly reduced and no-effusion accounted for the highest proportion,where 93.75%for anterior disc displacement with reduction and 53.13%for anterior disc displacement without reduction.④In the sagittal direction,most of the anterior disc displacement with reduction was completely reset,accounting for 84.38%,while the anterior disc displacement without reduction had a higher proportion of partial reset(37.50%)and unreset(46.88%);in the coronal direction,full reset(72.73%)and partial reset(27.27%)accounted for a relatively high number of positions in the anterior disc displacement with reduction,while partial reset(57.14%)and unreset(28.57%)accounted for a relatively high percentage of anterior disc displacement without reduction.(2)Changes of MRI measurement itemsThe disc-condyle distance and angle of the anterior disc displacement with reduction were decreased by(3.00±1.60)mm and(21.41±8.00)° respectively,and these items in the anterior disc displacement without reduction were decreased by(3.83±2.62)mm and(24.68± 10.76)° respectively.The above differences were statistically significant(P<0.05).3.The results of CBCT items were as follow(1)On the reversible side,the anterior space was decreased by(0.87±0.58)mm,the upper and posterior space were increased by(1.42±10.79)mm and(1.83±0.29)mm,respectively.On the irreversible side,the anterior space was decreased by(0.67±0.26)mm,the upper space and posterior space were increased by(1.44±0.52)mm and(1.64±0.28)mm respectively.These differences were statistically significant(P<0.05).(2)Before treatment,on the reversible side,93.75%of the condyle was in the posterior position and 6.25%in the median position;on the irreversible side,the condyle was 87.50%in the posterior and 12.50%in the median position.After the ARS treatment,90.63%were in the anterior position of the bilateral condyles and 9.38%were in the middle.Conclusions1.ARS can alleviate the degree of disc advancement significantly,restore the shape of discs that were still flexible,improve the condylar movement and reduce the amount of joint effusion,which were reduce the occurrence of inflammatory reactions,and avoid the continued progress of TMD.2.ARS can completely reset part of discs to eliminate symptoms,while it can also improve the internal environment of the joint and reduce inflammatory stimulation,so as to achieve the effect of alleviating clinical symptoms and exercising joint function normally. |
PDF Full Text Request