软硬颌垫结合综合康复治疗颞下颌关节盘不可复性 前移位复位固定术后咬合的临床研究.

Objective To observe the effect of comprehensive rehabilitation combined with soft and hard occlusion therapy for disc anchor surgery of anterior disc displacement with reduction. Methods A total of 60 patients with anterior disc displacement with reduction who underwent unilateral disc anchor surgery from January 2017 to April 2021 were treated in The Affiliated Hospital of Yunnan University. The position of the postoperative condyle was maintained by assisted occlusion therapy. The subjects were randomly divided into two groups: the experimental group was the soft occlusion therapy group ( n = 30 cases), and the control group was the hard occlusion therapy group (n = 30 cases). Comprehensive physical therapy and open-mouth training were performed 3 months after the operation, followed up 1, 3 and 6 months after the operation, and MRI was performed immediately, 3 and 6 months after the operation. Fricton index and MRI evaluation criteria were used to evaluate the reduction effect of joint disc, improvement degree of mouth opening, the comfort of patients wearing occlusion and visual analog scales. To study the efficacy of two occlusion therapy. Results Postoperative malocclusion occurred in all patients. The use of occlusion therapy for 3-6 months may decrease the proportion of malocclusion. The postoperative Friction index in both groups was significantly decreased compared with that before surgery. 1 month after surgery, CMI of the soft occlusion therapy group (0.149±0.054) was significantly lower than that of the hard occlusion therapy group (0.221±0.052) . Immediate postoperative MRI evaluation showed that the effective rate of soft and hard occlusion was 100% (30/30). MRI evaluation results at 3 and 6 months after surgery were the same, and the effective rate of soft and hard occlusion treatment was 97% (29/30). One month after surgery, the mouth opening degree in the soft occlusion therapy group was ( 2.73±0.27) mm better than that in the hard occlusion therapy group (2.07±0.39) mm, with statistical significance (P < 0.05). One month after surgery, the VAS of the soft occlusion therapy group ( 2.18±0.54) was significantly lower than that of the hard occlusion therapy group (3.03±0.29), with statistical significance (P < 0.05). The wear comfort survey of patients in the two groups one month after surgery showed that the comfort rate of 86.7% in the soft occlusion therapy group was significantly higher than that in the hard occlusion therapy group ( 73.3%), and the difference was statistically significant. Conclusions Soft occlusion and hard occlusion have similar effects, but the treatment effect of soft occlusion is significantly better than hard occlusion 1 month after surgery, and the patient’s comfort level is also significantly better than hard occlusion. Combined with the advantages and disadvantages of soft occlusion and hard occlusion, soft occlusion can be used immediately to 1 month after the operation, and hard occlusion can be used for treatment after 1-3 months after the patient's mouth opening significantly improves, or fixed orthodontics can be used for treatment according to specific malocclusion. [ABSTRACT FROM AUTHOR]