hrvatski

Značaj okluzije kod pacijenta s temporomandibularenim poremećajem

U razvoju koncepcija etiopatogeneze, dijagnostike i terapije muskuloskeletalnih bolesti stomatognatskog sustava okluzija je oduvijek imala istaknutu i kontroverznu ulogu. Evaluirani su rezultati kliničke dijagnostike populacije od 557 konsekutivnih pacijenata s orofacijalnim bolovima temeljem multidisciplinarne dijagnostike. Od sudjelovanja u studiji odustalo je 15, 6% pacijenata. U ovom istraživanju pokazala se je nedvojbena povezanost broja izgubljenih zubi s porastom dobi (p<0, 001). U pacijenta s osteoartritisom veći je udio pacijenta (34, 5%) kojima se ne može zbog gubitka zubi odrediti status okluzije, nego u podskupine pacijenata (8, 4%) s pomakom diska temporomandibularnog zgloba (TMZ). Kod pomaka diska 51, 7%, a kod osteoartritisa 41, 6% pacijenata ima klasu I po Angleu (p<0, 00001). Ako se promatraju samo pojedine anomalije za te dvije podskupine TMZ pacijenata (po Angleu klasa II/1, klasa II/2, klasa III, križni i otvoreni zagriz) razlika je bila nesignifikantna (p=0, 5846). Inicijalna okluzijska terapija može biti provedena kod svih pacijenata s temporomandibularnim poremećajima (TMP), bez obzira da li imaju intaktne zube i fiziološke okluzijske odnose, odnosno ako im je potrebna ortodontska ili protetska terapija. U liječenju pacijenata s TMP postoji nedoumica da li postoji indikacija za definitivnom terapijom, ako se bolni TMP može izliječiti oblicima reverzibilne terapije, odnosno inicijalnom terapijom. Pojam okluzije i okluzijskog liječenja temelj je protetskog liječenja, a povezanost okluzije s fiziološkim TMZ-om je nedovojbena. Okluzija osigurava ortopedsku stabilnost čeljusnih zglobova, a okluzijska stabilnost osiguravaju međusobni antagonistički dodiri u položaju maksimalne interkuspidacije. Klasificirano malokluzijsko stanje pokazalo se nedovoljno specifičnim u povezivanju s patofiziologijom TMP- a. Occlusion has always had a prominent and controversial role in developing the concept of etiopathogenesis, diagnosis and therapy of musculoskeletal diseases of the stomatognathic system. Clinical diagnostic results of the population of 557 consecutive patients with orofacial pain were evaluated based on multidisciplinary diagnostics. 15.6% of patients gave up of the participation in the study. In this study, there was a definite correlation between the number of lost teeth and age (p <0.001). There was a higher proportion of patients with osteoarthritis (34.5%) who could not determine the occlusion status due to the loss of teeth than in the subgroup of patients (8.4%) with the displacement of temporomandibular joint (TMJ). 51.7% of patients with disc displacement and 41.6% of patients with osteoarthritis had Class I by Angle (p <0.00001). If only certain abnormalities were observed for these two subgroups of TMJ patients (Class II / 1, Class II / 2, Class III, Cross and Open Bite), the difference was insignificant (p = 0.5846). Initial occlusion therapy can be performed in all patients with temporomandibular disorders (TMD) regardless of whether they have intact teeth and physiological occlusal relationships, or if they require orthodontic or prosthetic therapy. In the treatment of TMD patients there is a doubt as to whether there is an indication for definitive therapy, that is, if the painful TMD can be cured by reversible therapy or initial therapy. The term occlusion and occlusal therapy is the basis of prosthetic treatment, and the association of occlusion with physiological TMJ is doubtless. Occlusion provides orthopedic stability of the temporomandibular joints, and occlusal stability provides mutual antagonistic contact in the position of maximal intercuspidation. Classified maloclussion condition has been shown to be insufficiently specific in association with the pathophysiology of TMD.

okluzija ; temporomandibularni poremećaj ; magnetska rezonancija

nije evidentirano

engleski

Significance of Occlusion in Patients with Temporomandibular Disorders

U razvoju koncepcija etiopatogeneze, dijagnostike i terapije muskuloskeletalnih bolesti stomatognatskog sustava okluzija je oduvijek imala istaknutu i kontroverznu ulogu. Evaluirani su rezultati kliničke dijagnostike populacije od 557 konsekutivnih pacijenata s orofacijalnim bolovima temeljem multidisciplinarne dijagnostike. Od sudjelovanja u studiji odustalo je 15, 6% pacijenata. U ovom istraživanju pokazala se je nedvojbena povezanost broja izgubljenih zubi s porastom dobi (p<0, 001). U pacijenta s osteoartritisom veći je udio pacijenta (34, 5%) kojima se ne može zbog gubitka zubi odrediti status okluzije, nego u podskupine pacijenata (8, 4%) s pomakom diska temporomandibularnog zgloba (TMZ). Kod pomaka diska 51, 7%, a kod osteoartritisa 41, 6% pacijenata ima klasu I po Angleu (p<0, 00001). Ako se promatraju samo pojedine anomalije za te dvije podskupine TMZ pacijenata (po Angleu klasa II/1, klasa II/2, klasa III, križni i otvoreni zagriz) razlika je bila nesignifikantna (p=0, 5846). Inicijalna okluzijska terapija može biti provedena kod svih pacijenata s temporomandibularnim poremećajima (TMP), bez obzira da li imaju intaktne zube i fiziološke okluzijske odnose, odnosno ako im je potrebna ortodontska ili protetska terapija. U liječenju pacijenata s TMP postoji nedoumica da li postoji indikacija za definitivnom terapijom, ako se bolni TMP može izliječiti oblicima reverzibilne terapije, odnosno inicijalnom terapijom. Pojam okluzije i okluzijskog liječenja temelj je protetskog liječenja, a povezanost okluzije s fiziološkim TMZ-om je nedovojbena. Okluzija osigurava ortopedsku stabilnost čeljusnih zglobova, a okluzijska stabilnost osiguravaju međusobni antagonistički dodiri u položaju maksimalne interkuspidacije. Klasificirano malokluzijsko stanje pokazalo se nedovoljno specifičnim u povezivanju s patofiziologijom TMP- a. Occlusion has always had a prominent and controversial role in developing the concept of etiopathogenesis, diagnosis and therapy of musculoskeletal diseases of the stomatognathic system. Clinical diagnostic results of the population of 557 consecutive patients with orofacial pain were evaluated based on multidisciplinary diagnostics. 15.6% of patients gave up of the participation in the study. In this study, there was a definite correlation between the number of lost teeth and age (p <0.001). There was a higher proportion of patients with osteoarthritis (34.5%) who could not determine the occlusion status due to the loss of teeth than in the subgroup of patients (8.4%) with the displacement of temporomandibular joint (TMJ). 51.7% of patients with disc displacement and 41.6% of patients with osteoarthritis had Class I by Angle (p <0.00001). If only certain abnormalities were observed for these two subgroups of TMJ patients (Class II / 1, Class II / 2, Class III, Cross and Open Bite), the difference was insignificant (p = 0.5846). Initial occlusion therapy can be performed in all patients with temporomandibular disorders (TMD) regardless of whether they have intact teeth and physiological occlusal relationships, or if they require orthodontic or prosthetic therapy. In the treatment of TMD patients there is a doubt as to whether there is an indication for definitive therapy, that is, if the painful TMD can be cured by reversible therapy or initial therapy. The term occlusion and occlusal therapy is the basis of prosthetic treatment, and the association of occlusion with physiological TMJ is doubtless. Occlusion provides orthopedic stability of the temporomandibular joints, and occlusal stability provides mutual antagonistic contact in the position of maximal intercuspidation. Classified maloclussion condition has been shown to be insufficiently specific in association with the pathophysiology of TMD.

occlusion ; temporomandibular disorders ; magnetic resonance imaging

nije evidentirano