Kraniomandibul?re Dysfunktionen bei der Therapie mit intraoralen Protrusionsschienen

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• 作者：M. Thier ; U. Bu?meier ; Dr. J. Langenhan ; S. Kopp
• 关键词：Schlafapnoe ; Compliance ; Kiefer ; Mandibul?re Protrusion ; Schienen (Sch?fLa? ; Bu?La?) ; Sleep apnea ; Compliance ; Jaw ; Mandibular advancement ; Splints (Sch?fLa? ; Bu?La?)
• 刊名：Stomatologie
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：112
• 期：3
• 页码：86-91
• 全文大小：692 KB
• 作者单位：M. Thier (1)
  U. Bu?meier (2)
  Dr. J. Langenhan (3)
  S. Kopp (4)
  
  1. Praxis Dr.D.Thier, R?dermark, Deutschland
  2. Greven, Deutschland
  3. IZS -Idsteiner Zentrum für Zahn?rztliche Schlafmedizin, Bahnhofstr. 35, 65510, Idstein, Deutschland
  4. Zentrum der Zahn-, Mund- und Kieferheilkunde ?Carolinum- Poliklinik für Kieferorthop?die, Goethe-Universit?t Frankfurt am Main, Frankfurt am Main, Deutschland
  
• 刊物主题：Dentistry;
• 出版者：Springer Vienna
• ISSN：1613-7698

文摘

Background A relevant target in obstructive sleep apnea (OSA) is opening of the posterior tongue space for a free passage of air during sleep. This can be achieved by using intraoral advancement splints, whereby an atypical load on the masticatory organ inevitably occurs. Fundamentally relevant is whether and which joint lesions were present before splint therapy and what quantitative dimensions the inserted advancement has in a three dimensional spatial view. Material and methods A completely unselected cohort of 130 OSA patients who were treated with intraoral advancement splints was investigated. In this study the prevalence of hypomobile joints in various types of dentition, clinically detectable craniomandibular dysfunction (CMD) before splint therapy and if relevant any improvements, the prevalence of permanent occlusal disorders due to therapy-linked decompression of previously damaged temporomandibular joints and the prevalence of dentogenic side effects due to therapy with intraoral advancement splints were analyzed. Results Normal and end-to-end bite dentitions seemed to be more at risk in intraoral advancement splint therapy, whereas deep bite and overbite dentitions could be clearly more positively assessed with respect to splint effects and compliance. In nearly 50?% of cases CMD symptoms existed before splint therapy, especially in the bilaminar zone and in two thirds an improvement in these symptoms can be expected. In 10-20?% of cases temporary mild grade CMD symptoms occurred in muscular and capsule regions with hypomobile joints. In 1-2?% of cases a manifest lateral disclusion occurred under splint therapy as a result of regenerative processes in the bilaminar zone. Dental or dentoalveolar side effects or damage/deterioration of endangered structures did not occur in any case. Conclusion Motility disorders of the craniomandibular system have primarily a decisive influence on the selection of the optimal splint and secondarily on the structure of the splint construct. Furthermore, there are very close therapeutic relationships between CMD and intraoral advancement splints. Advancement splints with an integrated removable partial denture from “Modem AGZSH-(working group on dental sleep medicine Hessen) have substantial advantages with respect to avoidance of dental and dentoalveolar side effects.