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目的:分析解除第三磨牙咬合干扰后,Fricton颞下颌关节紊乱指数(craniomandibular index,CMI)、疼痛视觉模拟评分(VAS)和下颌运动功能检查评价的变化,探讨第三磨牙的位置与颞下颌关节紊乱病(TMD)的临床相关性。方法:随机选择符合纳入标准的TMD病例120例,采取调及拔除第三磨牙等方法去除第三磨牙干扰。在治疗前、治疗1个月、3个月后分别测量患者的CMI、VAS、无痛最大开口度、下颌前伸距离、左侧偏动距离、右侧偏动距离。结果:120例患者中,由于第三磨牙伸长引起的咬合干扰占72.5%,由于第三磨牙颊舌向异位萌出引起的锁占20%,反占7.5%。治疗后,患者TMD症状明显减轻,治疗3个月时,症状明显改善,病情趋于稳定,各项指标基本接近正常。患者的无痛最大开口度、下颌前伸距离(PE)下颌侧方运动距离(LLE/RLE)均显著增加,并随作用时间的延长,逐渐增大,差异有显著性。结论:①第三磨牙干扰是TMD的重要致病因素;②去除第三磨牙干扰有利于改善TMD的临床症状,增大下颌运动范围,解除开口受限。
OBJECTIVE: To analyze the change of Fricton’s CMI, VAS and mandibular motor function assessment after disengaging the third molars, and to explore the relationship between the position of the third molars and the temporomandibular joint Disorders (TMD) clinical relevance. Methods: A total of 120 cases of TMD were selected randomly. The third molars were removed by tweaking and removal of the third molars. CMI, VAS, maximal painless opening, mandibular extension, left deviation and right deviation were measured before treatment, 1 month after treatment and 3 months after treatment. Results: Among the 120 patients, occlusal interference caused by the third molars elongation accounted for 72.5%. As the third molars caused ectopic eruption, the occlusion accounted for 20% and the anti-gall bladder accounted for 7.5%. After treatment, patients with TMD symptoms significantly reduced, 3 months of treatment, the symptoms were significantly improved, the disease tends to be stable, the basic indicators of the normal close to normal. The maximal painless opening and the mandibular flexion distance (LLE / RLE) of the patients both increased significantly, and gradually increased with the prolongation of time. The difference was significant. Conclusion: The third molars interference is an important risk factor for TMD. The removal of the third molars is conducive to improving the clinical symptoms of TMD, increasing the scope of mandibular movement, lifting the opening is limited.