Articular disc-assisted repositioning occlusal plate for treating temporomandibular joint disorder of anterior articular disc displacement type and manufacturing method thereof

Abstract

The present invention discloses a disc-assisted repositioning bite plate for treating temporomandibular joint disorder of anterior disc displacement type and a manufacturing method thereof, and relates to the field of oral medical devices. The patient's oral and maxillary system data information is imported into the mimics software to complete the three-dimensional reconstruction of the upper and lower jaws and the occlusal relationship; the three-dimensional data is imported into the proplan software to adjust the mandibular position so that the condyle is displaced downwardly and counterclockwise in the fossa; a bracket is printed to record the new upper and lower jaw occlusal relationship after the mandibular adjustment; and a disc-assisted repositioning bite plate is manufactured. The present invention utilizes the principle of space giving way to increase the vertical distance in the joint space to make room for the repositioning of the disc, and the disc is pulled backwards by displacing the condyle backwards and downwards in conjunction with counterclockwise rotation, which is conducive to pulling the disc to reposition, relaxes the posterior joint area that has been in a tense state for a long time, stretches the lateral pterygoid muscle and the anteriorly displaced disc, and stretches the wrinkled disc.

Description

Technical Field

[0001] The invention relates to the technical field of oral medical instruments, in particular to a disc-assisted repositioning occlusal plate for treating temporomandibular joint disorder of anterior disc displacement type and a manufacturing method thereof. Background Art

[0002] At present, the commonly used bite splints in clinical practice are widely used as a conservative treatment for temporomandibular joint disorders. According to their shape and purpose of use, they can be roughly divided into: ① Stable bite splints (flat ① Pads), full-arch coverage bite splints that do not intentionally change the horizontal jaw relationship. The jaw relationship is determined on the habitual opening and closing path, and the mandible is not guided forward, backward or laterally, but the vertical distance of the bite can be changed; ② Mandibular adjustment bite splint (mandibular repositioning bite splint), which guides the mandible to move forward, backward or laterally to try to change the original jaw relationship to achieve a unique therapeutic effect. ③ Specially designed partial bite splints include anterior teeth bite splints (loose bite splints), posterior teeth pivot bite splints, posterior teeth hydrodynamic bite splints, etc. The most commonly used in clinical practice are full-arch stable bite splints and repositioning bite splints. Stable / stabilization splint (SS) is a hard bite splint that covers the entire occlusal surface of a single jaw. pad, The surface is flat, and the cusps of the opposing teeth are The pad is in point contact. Therefore, it can also be called a flat bite plate. However, the stable bite plate is a full-dentition bite plate, and the patient feels a foreign body when wearing it. The anterior repositional splint (ARS) is formed by adding self-curing plastic to the maxillary full-dentition stable bite pad. The concave and convex interlocking shape of the surface, after hardening, grind off the high parts of the occlusal surface and the edge, and fully adjust the make The depth of the concave and convex marks left by the mandibular cusps on the face should not exceed 1mm, so that the mandible is fixed in the protruding position. The degree of mandibular protrusion is determined by letting the patient's mandible protrude to the position where the snapping sound just disappears. Long-term wearing of the repositioning bite plate, improper adjustment and grinding or long follow-up time, is prone to posterior tooth opening However, if the bite plate is removed too early, joint symptoms may reappear and the curative effect is difficult to maintain. The front teeth bite plate is also called a loose bite plate. It does not touch the back teeth during wearing. After long-term wearing, the teeth under the bite plate will be pushed down, and the other teeth will be too long, resulting in tooth opening after the bite plate is removed. It is only suitable for initial or short-term treatment. Some patients need surgical reduction after conservative treatment is ineffective, including arthroscopic disc reduction and fixation and open disc reduction and anchoring. In temporomandibular joint surgery, arthroscopic surgery requires high operating skills of doctors and expensive equipment, which is not suitable for grassroots hospitals. Although fine instruments and minimally invasive equipment are constantly changing, these incisions are long or difficult to operate, and the trauma is large, resulting in a high incidence of postoperative scars, and may damage the facial nerve, cause facial paralysis and increase patients' anxiety about surgical scars. Compared with the above treatments, the efficacy of combined treatment with multiple conservative methods based on manual reduction is that it does not require surgical dissection of the disc tissue, can preserve the patient's own disc and joint structure to the greatest extent, and at the same time promote limited mouth opening, improve pain symptoms, and increase mouth opening. In addition, the auxiliary reduction bite plate can also reset the disc and maintain its normal position, which is a more effective conservative treatment method. Summary of the invention

[0003] The purpose of the present invention is to provide an articular disc auxiliary reduction occlusal plate for treating temporomandibular joint disorder of anterior articular disc displacement type and a manufacturing method thereof, which utilizes the principle of space giving way to increase the vertical distance in the joint space to make room for the reduction of the articular disc, and pulls the articular disc backward by shifting the condyle backward and downward in conjunction with counterclockwise rotation, which is conducive to pulling the articular disc for reduction, relaxes the posterior joint area that has been in a tense state for a long time, stretches the lateral pterygoid muscle and the anteriorly displaced articular disc, and stretches the wrinkled articular disc.

[0004] To achieve the above object, the present invention provides a method for manufacturing a disc-assisted reduction occlusal plate for treating temporomandibular joint disorder of anterior disc displacement type, comprising the following steps:

[0005] 1) The patient's maxillofacial CT and full-mouth dental scan or model scan data are imported into the mimics software to complete the three-dimensional reconstruction of the upper and lower jaws and occlusal relationship;

[0006] 2) Import the 3D data reconstructed by mimics into the Proplan software and adjust the position of the mandible through three actions:

[0007] ① Lower the mandible, causing the condyle to descend in the joint capsule, increasing the bone space in the joint capsule, and providing space for the articular disc to reposition backwards;

[0008] ② and / or move the mandible backward, so that the condyle moves backward in the joint capsule, exerting a pulling force on the articular disc;

[0009] ③ With the condyle as the rotation center, rotate the mandible counterclockwise to make the bilateral condyles rotate counterclockwise downward in the articular fossa, deepen the force pulling the articular disc backward, and increase the space in the joint;

[0010] 3) Print a bracket using 3D printing technology to record the occlusal relationship of the upper and lower jaws after the mandible moves, that is, to record the occlusal relationship of the upper and lower jaws when the condyle is in the corresponding position;

[0011] 4) Use transparent hard film on the plaster dental model by vacuum pressing technology to make upper and lower jaw dentition pads covering the entire crown;

[0012] 5) The mandibular dentition jaw pads are fixed on the maxillary dentition jaw pad using oral self-curing plastic and the bracket that records the occlusal relationship of the upper and lower jaws printed in step 3).

[0013] Furthermore, the specific operation of step 2) is:

[0014] ① Using the Proplan software, first move the mandible downward by about 2-4 mm to open the joint cavity, increase the vertical distance in the joint cavity, and eliminate or reduce the bone resistance formed by the fossa and condyle in the joint cavity when the articular disc is repositioned backward;

[0015] ② On this basis, the condyle is used as the axis to rotate counterclockwise by 1-3 degrees, so that the highest point of the condyle in the fossa is further rotated and moved backward and downward, giving the articular disc a backward pulling force to guide the articular disc that has been displaced anteriorly to move backward, or by stretching the articular disc backward, stretching the articular disc that has been wrinkled in front of the condyle or shortened due to long-term compression;

[0016] ③ On this basis, the mandible is moved back 1-2 mm according to the position of the condyle in the articular fossa, so that the condyle further stretches the articular disc backward, stretching the articular disc that has already shrunk in front of the condyle or shortened due to long-term compression.

[0017] Furthermore, after mid-rotation ②, no occlusal interference of the anterior teeth will occur.

[0018] The present invention also provides a joint disc auxiliary reduction occlusal plate manufactured by the manufacturing method.

[0019] Furthermore, it includes a maxillary dentition jaw pad and a mandibular dentition jaw pad arranged below the maxillary dentition jaw pad, the maxillary dentition jaw pad and the mandibular dentition jaw pad are connected by an adhesive, the maxillary dentition jaw pad is provided with a groove adapted to the maxillary dentition inside, and the mandibular dentition jaw pad is provided with a groove adapted to the mandibular dentition inside.

[0020] Furthermore, the thickness of the maxillary dentition jaw pad and the mandibular dentition jaw pad is 1.0-2.0 mm, the maxillary dentition jaw pad covers the maxillary dentition crowns, and the mandibular dentition jaw pad covers the mandibular dentition crowns.

[0021] Furthermore, the adhesive includes oral self-curing plastic or light-curing resin.

[0022] The advantages and positive effects of the articular disc auxiliary reduction occlusal plate for treating articular disc anterior displacement type temporomandibular joint disorder and the manufacturing method thereof of the present invention are:

[0023] By utilizing the principle of space giving way, the vertical distance within the joint space is increased to make room for the reduction of the articular disc. By shifting the condyle posteriorly and inferiorly and coordinating with counterclockwise rotation, the articular disc is pulled posteriorly, which is conducive to the reduction of the articular disc, relaxes the posterior area of ​​the joint that has been in a state of tension for a long time, stretches the lateral pterygoid muscle and the anteriorly displaced articular disc, and stretches the wrinkled articular disc.

[0024] The technical solution of the present invention is further described in detail below through the accompanying drawings and embodiments. BRIEF DESCRIPTION OF THE DRAWINGS

[0025] Figure 1 It is a front view of the articular disc assisted reduction occlusal plate in an embodiment of the present invention;

[0026] Figure 2 It is a side view of the articular disc assisted reduction occlusal plate in an embodiment of the present invention;

[0027] Figure 3 Schematic diagram of the occlusal relationship before and after the occlusal plate is repositioned with the aid of the articular disc in an embodiment of the present invention, wherein A is the original occlusal relationship, and B is the occlusal relationship after the occlusal plate is repositioned with the aid of the articular disc;

[0028] Figure 4 Schematic diagram of the anterior and posterior condylar positions using an articular disc to assist in repositioning an occlusal plate in an embodiment of the present invention, wherein A is the original position of the condyle, and B is the position of the condyle after the articular disc is used to assist in repositioning the occlusal plate.

[0029] Reference numerals

[0030] 1. Maxillary dentition jaw pad; 2. Mandibular dentition jaw pad; 3. Groove; 4. Adhesive. DETAILED DESCRIPTION

[0031] The technical solution of the present invention is further described below through the accompanying drawings and embodiments.

[0032] Unless otherwise defined, the technical terms or scientific terms used in the present invention should be understood by people with ordinary skills in the field to which the present invention belongs. The words "first", "second" and similar words used in the present invention do not indicate any order, quantity or importance, but are only used to distinguish different components. "Include" or "comprise" and similar words mean that the elements or objects appearing before the word include the elements or objects listed after the word and their equivalents, without excluding other elements or objects. "Connect" or "connected" and similar words are not limited to physical or mechanical connections, but may include electrical connections, whether direct or indirect. "Up", "down", "left", "right" and the like are only used to indicate relative positional relationships. When the absolute position of the described object changes, the relative positional relationship may also change accordingly.

[0033] Embodiment 1 Structure of the articular disc-assisted reduction occlusal plate

[0034] like Figure 1 and Figure 2 As shown, the articular disc assisted repositioning occlusal plate comprises a maxillary dentition jaw pad 1 and a mandibular dentition jaw pad 2 arranged below the maxillary dentition jaw pad 1, the maxillary dentition jaw pad 1 and the mandibular dentition jaw pad 2 are connected by an adhesive 4, the maxillary dentition jaw pad 1 is provided with a groove 3 adapted to the maxillary dentition inside, and the mandibular dentition jaw pad 2 is provided with a groove 3 adapted to the mandibular dentition inside. The thickness of the maxillary dentition jaw pad 1 and the mandibular dentition jaw pad 2 is 1.0-2.0 mm, and the maxillary dentition jaw pad 1 and the mandibular dentition jaw pad 2 both cover the entire crown of the upper and lower dentitions, respectively. The adhesive 4 comprises oral self-curing plastic and light-curing resin.

[0035] Embodiment 2 Method for making articular disc assisted reduction occlusal plate

[0036] 1) The patient's maxillofacial CT and full-mouth dental scan or model scan data are imported into the mimics software to complete the three-dimensional reconstruction of the upper and lower jaws and occlusal relationship.

[0037] 2) Import the 3D data reconstructed by mimics into the proplan software.

[0038] ① Using this software, first move the mandible downward by 2-4 mm to open the joint cavity, increase the vertical distance in the joint cavity, and eliminate or reduce the bone resistance formed by the fossa and condyle in the joint cavity when the articular disc is repositioned posteriorly.

[0039] ② On this basis, rotate counterclockwise 1-3 degrees with the condyle as the axis, so that the highest point of the condyle in the articular fossa moves further posteriorly and inferiorly, guiding the anteriorly displaced articular disc to move posteriorly, or stretching the articular disc backwards to stretch the articular disc that has wrinkled in front of the condyle or shortened due to long-term compression. The specific degree of rotation is based on whether there will be occlusal interference with the anterior teeth.

[0040] ③ On this basis, the condyle is moved back 1-2mm in the articular fossa for each patient, so that the condyle can further stretch the articular disc backward, stretching the articular disc that has already wrinkled in front of the condyle or shortened due to long-term compression.

[0041] Through the above three actions, the mandible causes the condyle to move downward and posteriorly in the articular fossa.

[0042] 3) The above data is used to print a bracket through 3D printing technology to record the occlusal relationship between the upper and lower jaws.

[0043] 4) Use a transparent hard film to make upper and lower jaw pads covering the entire crown on the plaster dental model using vacuum pressing technology.

[0044] 5) Fix the upper and lower dentition jaw pads together with oral self-curing plastic through the bracket that records the occlusal relationship of the upper and lower jaws printed in step 3), so that after wearing in the mouth, the position of the mandible is at the designed position of the mandibular condyle.

[0045] A transparent hard film with a thickness of 1.0-2.0 mm was used on the plaster dental model using vacuum pressing technology to produce only the mandibular and maxillary dentition pads covering the entire crown.

[0046] Example 3 Method of using the articular disc assisted reduction bite plate

[0047] The articular disc assisted repositioning bite plate is worn directly in the mouth and matches the upper and lower jaw dentition. The articular disc assisted repositioning bite plate is worn 3-4 times a day, each time for about 10 minutes. After wearing, the bite plate is repositioned by itself for 5-10 minutes. Hot compresses can be applied before treatment and during wearing. The mandibular dentition jaw pad can be worn all the time except for eating until it is healed.

[0048] The steps of manual resetting are:

[0049] ① In front of the tragus, opposite the hairline on the outside of the temples, use the index finger to find the gap between the articular fossa and the condylar head as the mouth opens and closes. Instruct the patient to keep the mouth open about 1-2 cm between the upper and lower teeth to slightly open the joint gap and make appropriate space for the movement of the articular disc.

[0050] ② First push the surface skin upward, then forward, and then downward, and finally push the skin and the inner articular disc slightly backward and downward. At this time, the articular disc that can be relocated anteriorly will be restored to the correct position, or there will be a great improvement. At this time, ask the patient to open his mouth slowly. Most patients with reducible articular disc anterior displacement will not have a clicking sound. Then ask the patient to close his mouth slowly. Repeat this for about 10 minutes.

[0051] Finally, according to the results of MRI or specialist examination, for cases diagnosed as irreducible anterior disc displacement, sodium hyaluronate injection can be added to the joint cavity to open the adhesion between the disc and the surrounding soft tissue. Inject once a month and then proceed with the above steps.

[0052] Figure 3 This is a schematic diagram of the anterior-posterior occlusal relationship using an articular disc to assist in the reduction of the bite plate; Figure 4 This is a schematic diagram of the anterior and posterior condylar positions when using an articular disc to assist in the reduction of an occlusal splint. Figure 3 and Figure 4 It can be seen that after wearing it, the vertical distance in the joint space is increased, making room for the reduction of the articular disc. By shifting the condyle backward and downward, combined with counterclockwise rotation, the articular disc is passively pulled backward, which is conducive to the reduction of the articular disc by pulling it backward. In addition, it can relax the posterior joint area and the double plate area of ​​the articular disc that have been in a tense state for a long time, stretch the lateral pterygoid muscle and the anteriorly displaced articular disc, and even stretch the wrinkled articular disc.

[0053] Forty patients diagnosed with TMJ disc anterior displacement were selected, 29 of whom were reducible and 11 were irreversible. According to CT data, the condylar posterior displacement bite plate was designed and produced using mimics and proplan software, and the patients were taught to wear it by themselves. Patients with irreversible disc displacement were injected with sodium hyaluronate into the joint cavity before wearing it to maximize the opening of possible adhesions in the cavity. At 1, 3, and 6 months, the changes in joint clicking and pain were compared, and CT examination was performed at the 6th month to compare the changes in the anterior and posterior joint space.

[0054] At 1, 3, and 6 months after treatment, the joint clicking and pain levels of all patients were improved to varying degrees (p < 0.05). At the same time, according to the magnetic resonance imaging 6 months later, the articular discs of all patients were reduced to varying degrees (p < 0.05).

[0055] Therefore, the present invention adopts the above-mentioned articular disc auxiliary reduction occlusal plate and its manufacturing method for treating temporomandibular joint disorder with anterior displacement of the articular disc, utilizes the principle of space giving way, increases the vertical distance in the joint space, makes room for the reduction of the articular disc, and pulls the articular disc backward by shifting the condyle backward and downward and cooperating with counterclockwise rotation, which is conducive to pulling the articular disc for reduction, relaxes the posterior area of ​​the joint that has been in a tense state for a long time, stretches the lateral pterygoid muscle and the anteriorly displaced articular disc, and stretches the wrinkled articular disc.

[0056] Finally, it should be noted that the above embodiments are only used to illustrate the technical solution of the present invention rather than to limit it. Although the present invention has been described in detail with reference to the preferred embodiments, those skilled in the art should understand that they can still modify or replace the technical solution of the present invention with equivalents, and these modifications or equivalent replacements cannot cause the modified technical solution to deviate from the spirit and scope of the technical solution of the present invention.

Claims

1. A method for manufacturing a disc-assisted reduction occlusal plate for treating temporomandibular joint disorder of anterior disc displacement type, characterized in that: The following steps are involved: 1) The patient's maxillofacial CT and full-mouth dental scan or model scan data are imported into the mimics software to complete the three-dimensional reconstruction of the upper and lower jaws and occlusal relationship; 2) Import the 3D data reconstructed by mimics into the Proplan software and adjust the position of the mandible through three actions: ① Lower the mandible, causing the condyle to descend in the joint capsule, increasing the bone space in the joint capsule, and providing space for the articular disc to reposition backwards; ② and / or move the mandible backward, causing the condyle to move backward in the joint capsule, exerting a pulling force on the articular disc; ③ With the condyle as the rotation center, rotate the mandible counterclockwise to make the bilateral condyles rotate counterclockwise downward in the articular fossa, deepen the force pulling the articular disc backward, and increase the space in the joint; 3) Print a bracket through 3D printing technology to record the occlusal relationship of the upper and lower teeth after the mandible moves, that is, to record the occlusal relationship of the upper and lower teeth when the condyle is in the corresponding position; 4) Use transparent hard film on the plaster dental model by vacuum pressing technology to make upper and lower jaw dentition pads covering the entire crown; 5) Fix the mandibular dentition jaw pads to the maxillary dentition jaw pads using oral self-curing plastic and the bracket that records the occlusal relationship of the upper and lower jaws printed in step 3); The specific operation of step 2) is as follows: ① Using the Proplan software, first move the mandible downward by 2-4 mm to open the joint cavity, increase the vertical distance in the joint cavity, and eliminate or reduce the bone resistance formed by the fossa and condyle in the joint cavity when the articular disc is repositioned backward; ② On this basis, the condyle is used as the axis to rotate counterclockwise by 1-3 degrees, so that the highest point of the condyle in the articular fossa is further rotated and moved backward and downward, giving the articular disc a backward pulling force to guide the articular disc that has been displaced anteriorly to move backward, or by stretching the articular disc backward, stretching the articular disc that has been wrinkled in front of the condyle or shortened due to long-term compression; after the rotation, there will be no occlusal interference with the anterior teeth; ③ On this basis, the mandible is moved back 1-2 mm according to the position of the condyle in the articular fossa, so that the condyle further stretches the articular disc backward, stretching the articular disc that has already shrunk in front of the condyle or shortened due to long-term compression.

2. An articular disc assisted reduction occlusal plate manufactured by the manufacturing method according to claim 1.

3. The articular disc assisted reduction occlusal plate according to claim 2, characterized in that: It includes a maxillary dentition jaw pad and a mandibular dentition jaw pad arranged below the maxillary dentition jaw pad, the maxillary dentition jaw pad and the mandibular dentition jaw pad are connected by an adhesive, the maxillary dentition jaw pad is provided with a groove adapted to the maxillary dentition inside, and the mandibular dentition jaw pad is provided with a groove adapted to the mandibular dentition inside.

4. The articular disc assisted reduction occlusal plate according to claim 3, characterized in that: The thickness of the maxillary dentition jaw pad and the mandibular dentition jaw pad is 1.0-2.0mm. The maxillary dentition jaw pad covers the maxillary dentition crowns, and the mandibular dentition jaw pad covers the mandibular dentition crowns.

5. The articular disc assisted reduction occlusal plate according to claim 3, characterized in that: Adhesives include oral self-curing plastics or light-curing resins.

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