颞下颌关节紊乱病与正畸治疗的研究进展

Research Progress on Temporomandibular Disorders and Orthodontic Treatment

摘要: 颞下颌关节紊乱病是累及咀嚼肌、颞下颌关节及相关结构的常见疾病。其典型症状包括关节区疼痛、弹响、张口受限及咀嚼功能障碍，严重影响患者生活质量和健康。长期以来，正畸治疗与颞下颌关节紊乱病的关系存在巨大争议：早期理论认为“理想咬合”可预防颞下颌关节紊乱病，而现代循证医学证实二者无明确因果关系。然而，这并不意味着颞下颌关节评估在正畸诊疗中可被忽视。相反，因正畸操作可能改变咬合状态、关节负荷及神经肌肉协调性，颞下颌关节紊乱病的筛查、动态监测及风险管理已成为保障治疗安全的核心环节。本文系统阐述颞下颌关节紊乱病评估在正畸全程管理中的必要性，旨在为临床提供标准化路径，规避医疗风险。

Abstract: Temporomandibular joint disorder is a common disease involving masticatory muscles, tempo- romandibular joints and related structures. Its typical symptoms include joint pain, snapping, limited mouth opening and masticatory dysfunction, which seriously affect the quality of life and health of patients. For a long time, there has been a huge controversy about the relationship between orthodontic treatment and temporomandibular joint disorders: early theories believed that “ideal occlusion” could prevent temporomandibular joint disorders, while modern evidence-based medicine confirmed that there was no clear causal relationship between the two. However, this does not mean that temporomandibular joint assessment can be ignored in orthodontic diagnosis and treatment. On the contrary, because orthodontic operation may change the occlusal state, joint load and neuromuscular coordination, the screening, dynamic monitoring and risk management of temporomandibular joint disorders have become the core links to ensure the safety of treatment. This paper systematically expounds the necessity of the evaluation of temporomandibular disorders in the whole process management of Orthodontics, aiming to provide a standardized path for clinical practice and avoid medical risks.