ガイドの位置が下顎運動に及ぼす影響 : 顎関節脱臼症例の治療からの観察  [in Japanese] Influence of changing the location of anterior guidance on mandibular movement : Clinical case of condylar dislocation  [in Japanese]

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Author(s)

    • 澤田 宏二 SAWADA Koji
    • 新潟大学歯学部歯科補綴学第一講座 Department of Removable prothodontics, School of Dentistry, Niigata University
    • 荒井 良明 ARAI Yoshiaki
    • 新潟大学歯学部歯科補綴学第一講座 Department of Removable prothodontics, School of Dentistry, Niigata University
    • 河野 正司 KOHNO Shoji
    • 新潟大学歯学部歯科補綴学第一講座 Department of Removable prothodontics, School of Dentistry, Niigata University
    • 大竹 博之 OHTAKE Hiroyuki
    • 新潟大学歯学部歯科補綴学第一講座 Department of Removable prothodontics, School of Dentistry, Niigata University
    • 池田 圭介 IKEDA Keisuke
    • 新潟大学歯学部歯科補綴学第一講座 Department of Removable prothodontics, School of Dentistry, Niigata University
    • 平野 秀利 HIRANO Hidetoshi
    • 新潟大学歯学部歯科補綴学第一講座 Department of Removable prothodontics, School of Dentistry, Niigata University

Abstract

顎関節脱臼の治療には, 口腔外科領域での観血的処理が行われることが多く, 咬合治療が行われることはまれである.しかし, 顎関節脱臼症例に対して, 咬合治療を行うことにより治癒をみた報告はこれまでもある.今回, 我々も顎関節脱臼症例に対して, ガイドの位置を変化させる咬合治療により顎関節脱臼の治癒をみた.症例は起床時の右側顎関節習慣性脱臼を有する18歳男性1名である.平成6年頃より, 起床時に右側顎関節脱臼が生じたが, 自力で整復が可能であったので放置した.しかし, 脱臼の発生頻度が高くなり, 平成7年2月には毎朝右側顎関節脱臼が生じるようになり, 当科に来院した.患者は側方滑走運動時に第2大臼歯のみが歯牙接触していた.スタビリゼーションスプリントを上顎歯列に装着したところ, 翌日から起床時の右側顎関節脱臼は消失した.その後, 作業側ガイドと非作業側ガイドのどちらが脱臼の消失に寄与しているのかを追求し, さらに6自由度顎運動測定装置(東京歯材社製TRIMET)により, 3種類の滑走接触における顎運動の解析を行った.その結果, ガイドを歯列の前方歯に修正することによって, 下顎の滑走運動のみならず, 歯牙接触のない下顎運動経路, さらには顆頭の運動量にも変化を認め, 右側顎関節脱臼は消失した.今回の症例より, 顎関節脱臼症例にアンテリアル・ガイダンスの修正が有効な治療法となりうることが示唆された.

Temporomandibular(TMJ)surgery is a common option in the treatment of chronic condylar dislocation, but some authors have reported disappearance of its symptomatology after occlusal therapy. A case in which condylar dislocation(CD)disappeared by changing the location of anterior guidance is presented. The patient was an 18 year-old male with an Angle class III malocclusion who had been suffering-one year-from condylar dislocation of the right TMJ upon waking up. Initially, he did not seek medical assistance for he was able to reduce it by himself. Clinical inspection showed that the mandibular right second molar was guiding mandibular eccentric movements. A stabilization splint was successfully used as therapy; within 24 hours most of the symptomatology had disappeared. Thereafter , we made removable metal appliances shich fixed anterior guidance either on the canine tooth of the afflicted side or on the healthy side, and requested the patient to wear them alternately in order to determine whether changing the location of anterior guidance would contribute to the cure of CD. Moreover, we recorded jaw and condyle movements with a 6-degree-of-freedom measuring device during lateral excursions with and without wearing of the splints. By shifting anteriorly the location of tooth guidance, the range of mandibular border movements increased ; and the condylar range of motion decreased during parafunctional grinding tasks. The condyle's rotation and movement became smoother and smaller within the confines of the glenoid fossa. CD of the right TMJ disappeared by shifting anteriorly the tooth guidance. We conclude that correction of anterior guidance is a non-invasive alternative therapy in some cases of condylar dislocation.

Journal

  • The Journal of Japanese Society of Stomatognathic Function

    The Journal of Japanese Society of Stomatognathic Function 3(1), 59-66, 1996-06-30

    Japanese Society of Stomatognathic Function

References:  4

Cited by:  6

Codes

  • NII Article ID (NAID)
    110001091905
  • NII NACSIS-CAT ID (NCID)
    AN1047134X
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13409085
  • Data Source
    CJP  CJPref  NII-ELS 
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