Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Effect of conservative therapy and Mandibular condylar bone change on Adolescents with osteoarthritis of TMJ

청소년 측두하악관절 골관절염의 보존적 치료효과 및 관절면의 변화 비교

  • Jeon, Hye-Mi (Department of Oral Medicine, School of Dentistry, Pusan National University) ;
  • Kim, Kyung-Hee (Department of Oral Medicine, Pasan Paik Hospital, Inje University) ;
  • Ok, Soo-Min (Department of Oral Medicine, School of Dentistry, Pusan National University) ;
  • Heo, Jun-Young (Department of Oral Medicine, School of Dentistry, Pusan National University) ;
  • Jeong, Sung-Hee (Department of Oral Medicine, School of Dentistry, Pusan National University) ;
  • Ko, Myung-Yun (Department of Oral Medicine, School of Dentistry, Pusan National University) ;
  • Ahn, Young-Woo (Department of Oral Medicine, School of Dentistry, Pusan National University)
  • 전혜미 (부산대학교 치의학전문대학원 구강내과학교실) ;
  • 김경희 (인제대학교 부산백병원 구강내과학교실) ;
  • 옥수민 (부산대학교 치의학전문대학원 구강내과학교실) ;
  • 허준영 (부산대학교 치의학전문대학원 구강내과학교실) ;
  • 정성희 (부산대학교 치의학전문대학원 구강내과학교실) ;
  • 고명연 (부산대학교 치의학전문대학원 구강내과학교실) ;
  • 안용우 (부산대학교 치의학전문대학원 구강내과학교실)
  • Received : 2013.11.12
  • Accepted : 2013.12.05
  • Published : 2013.12.30
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Abstract

This study is designed to evaluate the treatment outcome of occlusal stabilizing splint and to assess follow-up study of condylar bony changes using cone beam computed tomography(CBCT) in adolescents patients (12-19 years) with TMJ osteoarthritis(OA). 167 eroded condyles in 149 subjects were chosen among the patients who presented to the Department of Oral Medicine of Pasan National University Hospital, diagnosed as TMJ osteoarthritis by clinical exam, x-ray and CBCT from 2009 to 2012. They were treated conservatively with physical therapy, medication, behavioral therapy and occlusal stabilizing splint therapy. After average 9 months, CBCT was retaken and subjective symptoms and clinical findings were investigated. Condyle bony changes were classified by unchanged, less severe and more severe. The obtained results were as follow: 1. Pain, Noise, LOM(Limitation of motion) and MCO(Maximum comfortable opening) measurement of TMJ OA patients were markedly improved after conservative treatment. 2. In the occlusal stabilizing splint therapy group, Pain and LOM were statistically significant improved than non-occlusal stabilizing splint therapy group. 3. In the acute occlusal stabilizing splint therapy group, Pain and LOM were remarkably improved. 4. In comparison of CBCT1 and CBCT2 images, the transition of bone changes to lesser severe was most commonly in joint with erosive change. 5. In the non-occlusal stabilizing splint therapy group, the transition of condylar bone changes from erosion to more severe was many than occlusal stabilizing splint therapy group.

2009년부터 2012년까지 부산대학교치과병원 구강내과에 측두하악장애를 주소로 내원한 만 12세-19세(평균나이 : $15.75{\pm}2.17$세)의 청소년환자 중 임상검사, 방사선검사 및 전산화 단층촬영 (Cone Beam Computed Tomography, CBCT)을 통하여 측두하악관절 골관절염으로 진단되고 하나이상의 과두나 하악와의 관절하골에서 erosive change를 보이는 149명 167개의 관절을 대상으로 하였다. 치료 후 평균 9개월($9.03{\pm}4.64$ 개월) 이후 CBCT를 재촬영하고, 임상검사를 재실시하였다. 구강내과 전문의와 치과 방사선과 전문의가 영상 진단을 하였고, 임상 검사 결과와 CBCT의 영상 결과를 추적 연구 비교하여 다음과 같은 결과를 얻었다. 1. 약물치료, 물리치료, 행동조절치료, 교합안정장치치료를 병행한 환자군은 교합안정장치치료를 병행하지 않은 환자군에 비해 치료 후 통증, 개구제한 증상에서 유의한 증상 개선을 나타냈다. 2. 교합안정장치치료를 병행한 급성환자군은 교합안정장치치료를 병행하지 않은 급성환자군보다 치료 후 통증, 관절잡음, 개구제한이 더 많이 개선되었고, 그 중 통증과 개구제한은 유의한 증상 개선을 보였다. 3. 치료 후 침식을 보이는 하악과두의 골변화 양상은 치료방법에 상관없이 개선되는 방향(improved)으로 진행되었으나, 교합안정장치치료를 병행한 환자군에 비해서 교합압정장치치료를 병행하지 않은 환자군에서는 하악과두의 침식성 골 변화가 더 악화(worsen)되어 나타나는 경우가 많았으며, 반대쪽 하악과두에 새로운 침식이 나타난 경우도 더 많이 관찰되었다.

Keywords

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