Clinical Study On The Treatment Of Temporomandibular Joint Disorders Due To Abnormal Occlusal By Functional Exercise Of The Oral And Maxillofacial System

Objective:By using CBCT combined with Teeester Tooth Bite Force Analyzer to examine occlusal contact,this study explores the clinical treatment effect and key points of functional exercise of the oral and maxillofacial system for temporomandibular joint disorders(TMD)caused by abnormal occlusal factors,in order to provide reference and basis for the clinical diagnosis and treatment of TMD.Methods:1.Study object:From August 2021 to August 2022,50 patients with TMD who were admitted to the temporomandibular joint disease clinic of the Stomatology Department of the Affiliated Hospital of Qingdao University were selected and found to have abnormal occlusal factors through clinical examination,CBCT imaging examination,and Teetester Tooth Bite Force Analyzer.Other pathogenic factors such as joint trauma history,rheumatoid arthritis,and primary myopathy were excluded,including 24 males and 26 females,with an average age of 26.36±5.51 years.2.therapeutic method:All the patients were explained the disease and guided the treatment methods of functional exercise of the oral and maxillofacial system.The exercise therapy for functional exercise of the oral and maxillofacial system is as follows:Have the patient sit or stand upright with their chest raised and their eyes facing straight ahead.Perform a swallowing motion first,and then homeopathically achieve intercuspal position.At this position,make both posterior teeth bite tightly with the maximum bite force of the same size for about 10 seconds.Then relax the occlusion of the upper and lower teeth to place the lower jaw in the mandibular postural position and relax the muscles on both sides for10 seconds.Finally,perform 10 mouth opening and closing exercises.The mouth opening movement requires starting from the mandibular postural position,with the jaw moving vertically downward without lateral deviation,until the maximum mouth opening position.The mouth opening degree is about 35-40 mm,and the entire process is natural,slow,and uniform.The closed mouth movement raises the lower jaw to the intercuspal position with the same requirements.The above process is one oral and maxillary system function exercise.Four times a day,four oral and maxillary system function exercises each time.3.Observation indicators:The symptoms and signs of patients before and after treatment were recorded using the outpatient medical records of temporomandibular joint disease recommended by the temporomandibular joint disease group of the Chinese Stomatological Association,and the craniomandibular index(CMI)was calculated quantitatively according to the corresponding examination items.Use CBCT to visually observe the patient’s occlusal contact before and after treatment.Use the Teetester Tooth Bite Force Analyzer to check and record the occlusal contact characteristics of the patient before and after treatment,including the total occlution force,the total contact area,the position of the center of force,the asymmetry index of occlusal force,the percentage of left and right occlusal force,and the occlusal contact time.4.Statistical analysis:All observation indicators recorded at the initial diagnosis of the patient were classified into T1 group.The observation indicators recorded during the follow-up visit 3months after the functional exercise of the oral and maxillofacial system were classified into group T2.SPSS27 software was used to statistically analyze the data of T1 and T2groups.Paired T-tests were used for quantitative data and chi-square tests for qualitative data.The difference was considered statistically significant with a bilateral P<0.05.Result:The CMI at initial diagnosis and 3 months after treatment were 0.14±0.04 and 0.04±0.02,respectively.Compared with the initial diagnosis,the CMI decreased 3 months after treatment,with a statistically significant difference(P<0.05).At the initial diagnosis,the total occlution force was 51.16±20.18 kg,the total occlusal contact area was 214.46±66.04 mm~2,the asymmetry index of occlusal force was 19.76±10.27,the percentage of left occlusal force was 45.48±10.25%,and the percentage of right occlusal force was 54.52±10.25%.The number of the center of force located inside and outside the gray circle was 12 and 38,and the vertical distance from the center of force to the centerline was 5.18±2.49 mm,The occlusal contact time of forward extension occlusal motion is 0.75±0.19 seconds,the occlusal contact time of left side occlusal motion is 0.52±0.13 seconds,and the occlusal contact time of right side occlusal motion is 0.61±0.14 seconds.After 3 months of treatment,the total occlution force was 57.26±18.93 kg,the total occlusal contact area was 236.06±61.43 mm~2,the asymmetry index of occlusal force was 8.6±4.45,the percentage of left occlusal force was 48.14±4.51%,and the percentage of right occlusal force was 51.86±4.51%.The number of the center of force located inside and outside the gray circle was 30 and 20,and the vertical distance from the center of force to the centerline was 3.87±2.29 mm,The occlusal contact time of forward extension occlusal motion is 0.54±0.11 seconds,the occlusal contact time of left side occlusal motion is 0.39±0.11 seconds,and the occlusal contact time of right side occlusal motion is 0.42±0.12 seconds.Compared with the occlusal contact characteristics at the initial diagnosis,the total occlusal force and total occlusal contact area increased,the asymmetry index of occlusal force decreased,the position of the center of force tended to be within the gray circle range,the percentage of occlusal force on the left and right sides tended to be balanced,and the occlusal contact time decreased after 3 months of treatment,with statistically significant differences(P<0.05).Conclusion:1.CBCT combined with Teetester Tooth Bite Force Analyzer can be used as a new method for evaluating occlusal contact.2.Functional exercise of the oral and maxillofacial system can effectively change the abnormal occlusal contact of TMD patients,restore balance and stability of occlusal contact,and alleviate the symptoms and signs of patients with TMD caused by abnormal occlusion.