再定位颌垫和口腔健康教育治疗 颞下颌关节可复性盘前移位的 临床疗效及形态学评价

Efficacy and Morphological Evaluation of Repositioning Jaw Pads and Oral Health Education in the Treatment of Reversible Anterior Displacement of the Temporomandibular Joint

摘要: 目的：1) 研究再定位颌垫和口腔健康教育对治疗颞下颌关节可复性盘前移位的临床疗效；2) 从MRI角度研究再定位颌垫和口腔健康教育治疗前后颞下颌关节的内部组织结构变化。方法：收集43例符合纳入标准的于2024年3月~2025年10月在亳州市人民医院口腔科就诊的颞下颌关节可复性盘前移位患者，分为再定位颌垫治疗组(23例29侧)和口腔健康教育治疗组(20例24侧，使用皖南医科大学原创的颞下颌关节虚拟仿真课程软件)，治疗3月后复诊，治疗前、后均进行颞下颌关节专科检查及MRI拍摄，分别比较治疗前后视觉模拟疼痛评分(VAS)、开口度、MRI影像学关节盘的形态、关节盘的长度、髁突的形态、髁突的高度、闭口位盘髁前移的角度等来研究再定位颌垫和口腔健康教育的临床疗效。结果：治疗前，两组研究对象的年龄、视觉模拟疼痛评分(VAS)、开口度、MRI影像学关节盘的长度、髁突的高度、闭口位盘髁前移的角度等的比较，差异无统计学意义(p > 0.05)，治疗结束后，再定位颌垫组与口腔健康教育组均能改善关节区疼痛(p < 0.05)，再定位颌垫可以改善患者开口度(p < 0.05)、髁突高度(p < 0.05)、关节盘前移角度(p < 0.05)、关节盘形态以及髁突形态，但对于关节盘长度的改变无统计学意义(p > 0.05)，口腔健康教育对于患者开口度(p > 0.05)、关节盘长度(p > 0.05)、髁突高度(p > 0.05)、关节盘形态以及髁突形态的变化上无统计学意义。结论：1) 口腔健康教育可改善颞下颌关节盘移位患者的临床症状但对于关节内部结构的改善效果不佳；2) 再定位颌垫可改善患者的临床症状而且效果优于口腔健康教育，对于关节内部结构的改善具有重要意义，并可使大部分患者前移关节盘的位置恢复正常(治愈率79.3%)，而且对吸收髁突的骨质重建也具有重要意义。

Abstract: Objective: 1) To study the clinical efficacy of repositioning jaw pads versus oral health education in treating temporomandibular joint (TMJ) disc repositioning. 2) To study the changes in the internal tissue structure of the temporomandibular joint before and after repositioning jaw pad treatment and oral health education from the perspective of MRI. Methods: A total of 43 patients with TMJ disc repositioning who met inclusion criteria were enrolled between March 2024 and October 2025 at the Department of Stomatology, Bozhou People’s Hospital. Patients were divided into two groups: repositioning jaw pad therapy group (23 cases, 29 sides) and oral health education group (20 cases, 24 sides). Follow-up examinations were conducted three months post-treatment, with both groups undergoing specialized TMJ evaluations and MRI imaging. Clinical outcomes were assessed through visual analog scale (VAS) pain scores, mouth opening range, MRI imaging of articular disc morphology, disc length, condylar morphology, condylar height, and angle of disc condylar anterior displacement in closed-mouth position. Results: Before treatment, there were no statistically significant differences (p > 0.05) in age, visual analog pain score (VAS), mouth opening range, MRI-assessed disc length, condylar height, or condylar anterior displacement angle between the two groups. After treatment, both the repositioning jaw pad group and oral health education group showed significant improvements in joint pain (p < 0.05). The repositioning jaw pad effectively improved mouth opening range (p < 0.05), condylar height (p < 0.05), disc anterior displacement angle (p < 0.05), disc morphology, and condylar morphology, though it showed no significant effect on disc length (p > 0.05). Oral health education showed no significant effects on mouth opening range (p > 0.05), disc length (p > 0.05), condylar height (p > 0.05), disc morphology, or condylar morphology. Conclusion: 1) Oral health education can alleviate clinical symptoms in temporomandibular disc displacement patients but shows limited improvement in intra-articular structures. 2) The repositioning jaw pad significantly improves clinical symptoms with better efficacy than oral health education, demonstrating substantial value in restoring intra-articular structures. It normalizes disc position in most patients (cure rate: 79.3%) and enables bone reconstruction of resorbed condyles, making it clinically significant.