A Comparative Study On The Effect Between Occlusal Adjustment And Three Conservative Treatments Of TMD Pain

TMD(temporomandibular disorders) is a common in orofacial disease and has a high incidence. Patients with temporomandibular disorders may have a cluster of joint and muscle disorders characterized primarily by pain, joint sounds, and irregular or deviating jaw function.Pain is one of the first chief complaints of TMD patients, but pain is a complex subjective syntom,it's decision and evaluation is mainly through patients'expression and description.The etiologic theories proposed for temporomandibular disorders(TMDs) was always disputed. The dignosis of TMD is mainly by the clinical symptom and signs,the means of the rapy emphasise on conservative treatment. Occlusion factor theory is important to TMD etiology mechanism,but study on pathology occlusion in literature is limited to protrusion, lateral and retrusion interference, even take this kind of "occlusion interference" as "malocclusion".So this kind of report about the relationship between TMD and this occlusion has always dispited and this concept of "malocclusion"has become a chief embarrassment to determine the relationship between TMD and occlusion.This study firstly introduce an occlusal adjustment the ory that oriented to develop a stable, concordant occlusal contact relationship in ICP.On the onehand,to removal those nodus, uneven abrasion area and high cusp steep cliff because of abrasion on occlusal surface, and those unstable occlusion lead by over fillings and improper denture.On the other hand fairly adjust those malocclusion such as individul crossbite and lockbite so as to release the local malocclusal contact conditiont.This study included 33 subjects(have 3 month as the boundary,acute group:25cases,chronic group:33cases),perform occlusal adjustment,the operation was divided into 2-3 times.Take lasertreatment(acute group 20 cases,chronic group 14 cases) ,myomonitor treatment(acute group 17cases,chronic group 19cases) and stabilization splint(acute group 28 cases,chronic group 33 cases) as control group. Arandmised and double blind method is applied in this study on the four treatment of TMD.The treatment time is 1 month. This study assessed the effect using certain parameters such asVisual Analog Scale (VAS) value, EMG activities of bilateral anterior temporolis (TA) and masseter muscle (MM) and occlusal contact points (with Dental Presale? Occluzer) in subjects with temporomandibular disorder symptoms during biting in intercuspal position were recorded before and after treatment.The purpose of the study is to make a subjective clinical evaluation of occlusal adjustment to TMD pain and pilot investigation on the tretamtnt mechanism and its indication.1, Occlusal adjustment: Fifty-eight patients were divided into two groups, those without any of following three types of occlusion, impinging occlusion, occlusion that with cusp-to-cusp contact relationship distal-medially, or the occlusion with 3 or more in-continuous pairs of cross-bite posterior teeth, were assigned to Group A (35 cases) . The othe rs were assigned to Group B (23 cases). Results :1) In Group A ,the VAS values decreased remarkably (p<0.01) both immediately after occlusal ajustment andone month later, while in Group B the decrease of VAS value could only be detected after 1 month of occlusal adjustment (p<0.05). (2) In Group A the symmetry of bilateral activity of TA and MM was improved significantly after 1 month of occlusal adjustment (p<0.05) but in Group B no similar results were found (p>0.05). (3) In Group A the occlusal contact number was increased and more symmetrically distributed after 1 month of occlusal adjustment (p<0.05) but the sefeatures were not found in Group B (p>0.05).(4) The treatment effect was not influenced by the degree of TMJ pathological features on radiographs, disease period or age. Conclusions: Occlusal adjustment was very effective on TMD pain but the effect depended on the occlusion type.2, Laser and myomonitor treatment both belong to physiotherapy.the y both can relieve TMD pain. But for the chronic pain myomonitor was found more effective than laser treatment (p<0.01) .The symmetry of bilateral EMG activity was improved significantly of TA and MM in both laser treatment acute sub-group and myomonitor treatment acute sub-group, and also of MM in myomonitor treatment sub-chronic group.The occlusal contacts number was found increased only in myomonitor treatment acute sub-group after treatment (p<0.05).No improvement was found of occlusal contact symmetry for each of the four sub-groups after treatment(p>0.05). The TMD pain associated with masticatory muscle dysfunction closely.3, Stabilization splint treatment: sixty-one patients were divided into two groups, acute pain group and chronic pain group. In both group , the VAS values decreased remarkably (p<0.01) after treatment one month later. In acute group the symmetry of bilateral activity of TA and MM was improved significantly after 1 month of splint treatment(p<0.05) but in chronic group nosimilar results were found (p>0.05). In both group the occlusal contact number was not increased and the symmetry not improved after 1 month of splint treatment(p>0.05). Conclusions: Occlusal splint was very effective on TMD pain ,its treatment mechanism is related to the quick improvement of masticatory muscles.So,to those patients who are suitable to occlusal adjustment,occlusal adjustment can improve the symmetry of EMG of bilateral masticatory muscles, increase occlusal contact points,decrease the asymmetry index of occlusal contact. But this change is gradual and is different to pain instant reaction. This change showed off until 1 month later,this could interpreted as that masticatory system adjusted itself to adapt occlusion function. While other three treatment can only improve pain syndrom and is limited to increase masticatory muscle function and little effect to occlusal contact. Occlusion is the main factor which affect the function of MM and TA, long existing malocclusion making the function of TA and MM coordination becomes stimulating factors of TMD pain. The result of the study showed that extensive and stabile occlusal contact,the close relationship between the EMG activity of TA and MM and pain syndrom,while the occlusal contact is the important initiating factor,unstable occlusion and disconcordant occlusal contact affect the contration activity of MM and make the TA compensatory adjustment.Occlusal contact become stable and extend and concordant,the harmony activity between TA and MM is obtained, thus to treat pain from etiology mechanism.Conclusions:1, It shows significant instant and persistent effect to TMD pain after occlusal adjustment,but the treatment effect is related to the type of...