Journal of Oral Medicine and Pain

  • 제36권3호
  • /
  • Pages.187-197
  • /
  • 2011
  • /
  • 2288-9272(pISSN)
  • /
  • 2383-8493(eISSN)
대한안면통증구강내과학회 (Korean Academy of Orofacial Pain and Oral Medicine)
권호 표지
DOI QR코드

DOI QR Code

컴퓨터 교학분석기인 T-Scan II를 이용한 측방운동시 구치부 이개시간에 관한 연구

Study of Disclusion Time during Mandibular Eccentric Movement in Myofascial Pain Syndrome Patients by T-Scan II, Computerized Occlusal Analysis System

  • 신준한 (연세대학교 치과대학 구강내과학교실) ;
  • 권정승 (연세대학교 치과대학 구강내과학교실) ;
  • 김성택 (연세대학교 치과대학 구강내과학교실) ;
  • 박형욱 (연세대학교 치과대학 구강내과학교실) ;
  • 최종훈 (연세대학교 치과대학 구강내과학교실)
  • Shin, Jun-Han (Department of Oral Diagnosis and Oral medicine, College of Dentistry, Yonsei University) ;
  • Kwon, Jeong-Seung (Department of Oral Diagnosis and Oral medicine, College of Dentistry, Yonsei University) ;
  • Kim, Seong-Taek (Department of Oral Diagnosis and Oral medicine, College of Dentistry, Yonsei University) ;
  • Park, Hyung-Uk (Department of Oral Diagnosis and Oral medicine, College of Dentistry, Yonsei University) ;
  • Choi, Jong-Hoon (Department of Oral Diagnosis and Oral medicine, College of Dentistry, Yonsei University)
  • 투고 : 2011.05.12
  • 심사 : 2011.07.23
  • 발행 : 2011.09.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

측두하악관절장애는 저작근, 측두하악관절, 주변 구조물 또는 모두를 포함하는 다수의 임상문제를 포함하는 용어이다. 근막동통은 측두하악관절장애 중 저작근 장애의 한 종류로, 근막 발통점에 의해 발생하는 감각, 운동, 자율신경 증상이다. 측두하악관절장애와 근막동통의 원인에 대한 논쟁이 지속되어왔다. 특히 교합 원인은 오랫동안 논쟁의 핵심이었으며, 많은 노력에도 불구하고 교합원인에 대한 연구는 상반된 결과를 보였다. 이런 논쟁은 대부분이 측두하악관절장애 본연의 복잡성에서 기인하지만, 부적절하고 부적당한 연구설계, 선정기준, 연구방법 또한 중요한 역할을 한다. 최근에 교합분석시 시간과 상대적 힘이 측정가능한 컴퓨터 교합분석 기기인 T-Scan II가 소개되었다. 일부 저자들은 T-Scan II를 이용하여 이개시간 개념 및 연장된 구치부 이개시간과 근막통증의 연관성에 대하여 제안하였다. 그러나 T-Scan II를 이용한 기존의 연구들은 근막통증에 대한 정확한 진단 기준을 제시하지 못하였으며, 대조군과의 비교 부재 및 다른 많은 문제점을 가지고 있었기 때문에 신뢰할 만하지 못하다. 이번 연구의 목적은 컴퓨터 교합분석 기기인 T-Scan II을 이용하여 30명의 실험군을 선택하고 이를 38명의 대조군과 비교함으로써, 근막통증과 구치부 이개시간과의 연관성을 평가하는 것이다. 통계적으로 분석된 결과는 다음과 같다: 1. 반복 측정한 이개시간의 Cronbach ${\alpha}$ 계수는 0.92 였다. 2. 반복 측정한 이개시간 평가시 양측에서 실험군과 대조군 사이 유의성 있는 차이를 보이지 않았다. 3. 이개시간 평가시 좌측 우측 사이에 유의성 있는 차이를 보이지 않았다. 이상의 결과로부터 근막통증과 이개시간 사이에는 관련성이 없는 것으로 판단된다. 따라서 근막통증을 치료하기 위하여 이개시간을 줄이는 비가역적인 치료는 적절치 않다. 향후의 연구에 있어서, 여러 교합요소와 헬키모 지수 등을 이용하여 증상의 정량화를 고려한 보다 통제된 대규모 환자 집단에 대한 연구가 필요할 것으로 사료된다.

Temporomandibular disorders(TMD) is a collective term which is embracing a number of clinical problems that involve the masticatory musculature, the TMJ and associated structures, or both. Myofascial pain, which is a kind of masticatory muscle disorder of TMD, is the sensory, motor, and autonomic symptoms caused by myofascial trigger points. There has been some controversies regarding etiologies of TMD and MFP. Especially the issue of occlusal conditions has been a critical issue for long time. Despite much efforts, the results of studies regarding occlusal conditions were contradictory. These controversies might be mostly due to various factors resulting from the complex nature of TMD, however, inaccurate and inappropriate study design, selection criteria, methodologies also play significant roles. Recently, a computerized occlusal analysis system, T-Scan II which made it possible to reveal quantifiable time data and relative force data for analyzing occlusion, was introduced. Some authorities suggested that the concept of disclusion time and prolonged disclusion time of posterior tooth and MFP are related using T-Scan II. But the previous studies which used T-SCAN II are not reliable for they did not provide accurate diagnostic criteria of MFP. Morever they did not compare with controls, and had many other problems. The purpose of this study was to evaluate the relationship between MFP and prolonged disclusion time of posterior tooth, which is one of the occlusal factors of TMD, by selecting 30 subjects as the study group through strict criteria and comparing them with 38 controls using T-SCAN II, computerized occlusal analysis system. The results, statistically analyzed, are summarized as follows: 1. Cronbach ${\alpha}$ coefficient of repeated measurements of disclusion time was 0.92. 2. There were no statistically significant differences at repeated measured disclusion time of both side between control and study group. 3. There was no statistically significant diffefence in the disclusion time between right and left side. From the results above, we can suggest that there was no relationship between MFP and disclusion time, so irreversible treatments leading to the reduction of disclusion time for treating MFP would not be appropriate. However more controlled, large scaled study, which consider various occlusal factors, and quantification of symptoms using Helkimo index would be necessary in the future.

키워드

참고문헌

  1. Okeson JP. Orofacial pain. Guidelines for Assessment, Diagnosis, and Management. 3rd ed., Chicago, 1996, Quintessence Pub Co Inc., pp. 127-141.
  2. Okeson JP. Bell's Orofacial Pains. 5th ed., Chicago, 1995, Quintessence Pub Co Inc., pp. 123-133.
  3. Griffiths RH. Report of the President's Conference on Examination, Diagnosis, and Management of Temporomandibular Disorders. J Am Dent Assoc 1983;106:75-77. https://doi.org/10.14219/jada.archive.1983.0020
  4. Simon DG, Travell JG, Simon LS. Travell & Simons' Myofascial Pain and Dysfunction. The Trigger Point Manual Vol 1. Upper Half of Body. 2nd ed., Baltimore, 1999, Williams and Williams Pub., pp 1-8.
  5. Brooke RI, Stenn PG. Post-injury myofascial pain dysfunction syndrome: its etiology and prognosis. Oral Surg Oral Med Oral Pathol 1978;45(6):846-850. https://doi.org/10.1016/S0030-4220(78)80003-6
  6. Brown CR. TMJ injuries from direct trauma. Pract Periodontics Anesthet Dent 1997;9: 581-582.
  7. Nilner M. Relationship between oral parafunctions and functional disturbances in the stomatognathic system in 15 to 18 years olds. Acta Odontol Scand 1983;41: 197-201. https://doi.org/10.3109/00016358309162324
  8. De Boever JA, Keersmaekers K. Trauma in patients with temporomandibular disorders: frequenct and treatment outcome. J Oral Rehabil 1996;23(2):91-96. https://doi.org/10.1111/j.1365-2842.1996.tb01215.x
  9. Lipowski ZJ. Somatization: The concept and its clinical application. Am J Psychiatry 1988;145(11): 1358-1368. https://doi.org/10.1176/ajp.145.11.1358
  10. Akeel R, Nilner M, Nilner K. Masticatory efficiency in individuals with natural dentitions. Swed Dent 1993;17:191-198.
  11. Egermark-Eriksson I, Ingervall B, Carlsson GE. The dependence of mandibular dysfunction in children on functional and morphologic malocclusion. Am J Orthod 1983;83:187-194. https://doi.org/10.1016/0002-9416(83)90082-9
  12. Castro L. Importance of the occlusal status in the research diagnostic criteria of craniomanibular disorders. J Orofac Pain 1995;9:98.
  13. Pullinger AG, Seligman DA, Gornbein JA. A multiple logistic regression analysis of the risk and relative odds of temporomandibular disorders as a function of common occlusal features. J Dent Res 1993;72: 968-979. https://doi.org/10.1177/00220345930720061301
  14. Seligman DA, Pullinger AG. The role of functional occlusal relationships in temporomandibular disorders: A review. J Craniomandib Disord Facial Oral Pain. 1991;5: 265-279.
  15. McNamara JA, Seligman DA, Okeson JP. Occlusion, orthodontic treatment, and temporomandibular disorders: A review. J Ororacial Pain. 1995;9:73-90.
  16. Moyers RE. An electromyogram analysis of certain muscles involved in temporomandibular movement. Am J Orthod 1950;36:481. https://doi.org/10.1016/0002-9416(50)90063-7
  17. Majewski RF, Gale EN. Electromyographic activity of anterior temporal area pain patients and non-pain subjects. J Dent Res 1989;63:1228-1231.
  18. Maness WL. Laboratory comparison of three occlusal registration methods for identification of induced interceptive contacts. J Prosthet Dent 1991;65: 483-487. https://doi.org/10.1016/0022-3913(91)90284-4
  19. Ahmet Saraḉoğlu, Birgül Özoinar. In vivo and in vitro evaluation of occlusal indicator sensitivity. J Prothet Dent 2002;88(5):522-526. https://doi.org/10.1067/mpr.2002.129064
  20. Millstein PL. An evaluation of occlusal contact marking indicators: a descriptive, qualitative method. Quintessence Int 1983;14(8):813-836.
  21. Kerstein RB. Current applications of computerized occlusal analysis in dental medicine. General Dentistry 2001;Sep-Oct:521-530.
  22. Hirano S, Okuma K, Hayakawa I. In vitro study on accuracy and repeatability of the T-Scan II system. Kokubyo Gakkai Zasshi 2002; 69(3):194-210. https://doi.org/10.5357/koubyou.69.194
  23. Ash MM, Ramfjord SP. Occlusion. 4th ed., Philadelphia, 1995, Saunders.
  24. Dowson PE. Evaluation, diagnosis and treatment of occlusal problems. 2nd ed., St. Louis, 1998, Mosby., pp 434-456.
  25. Kerstein RB, Wright NR. Electromyographic and computer analyses of patients suffering from chronic myofascial pain-dysfunction syndrome: before and after treatment with immediate complete anterior guidance developement. J Prosthet Dent 1991;66: 667-686.
  26. Williamson EH, Lundquist DO: Anterior Guidance. Its Effect on Electromyographic Activity of the Temporal and Masseter Muscle. J Prosthet Dent 1983;49:816-823. https://doi.org/10.1016/0022-3913(83)90356-6
  27. Kerstein RB, Chapman R, Klein M. A comparison of ICAGD to Mock ICAGD for symptom reduction in chronic myofascial pain dysfunction patients. Craniomandib Pract 1997;15(1):21-37.
  28. Kerstein RB. Disclusion time-reduction therapy with immediate complete anterior guidance development to treat chronic myofascial pain-dysfunction sydrome. Quintessence Int 1992;23(11):735-747.
  29. Kenji O, Shigezo H, Iwao H. A clinical application of the T-Scan II system-usefulness for evaluating occlusal contacts of complete denture wearers. Kokubyo Gakakai Zasshi 2002;69(4):277-284. https://doi.org/10.5357/koubyou.69.277
  30. Harkins S. Treatment of myofascial pain dysfunction sydrome with occlusal equilibration. J Prosthet Dent 1991;65(1):153-154.
  31. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examination and specifications, critique. J Craniomandib Disord 1992;6(4):301-355.
  32. Kerstein RB. Combining Technologies: A Computerized occlusal Annalysis System Synchronized with a Computerized Electromyography System. Cranio 2004;22(2):96-109. https://doi.org/10.1179/crn.2004.013
  33. Makofsky HW, Sexton TR, Diamond DZ, Sexton MT. The effect of head posture on muscle contact position using the T-Scan system of occlusal analysis. Cranio 1991;9(4):316-321. https://doi.org/10.1080/08869634.1991.11678378
  34. Kim KS. Contributing factors of TMD. J Koream Dent Ass 1991;29(5):354-358.
  35. Costen JB. Syndrome of ear and sinus symptoms dependent upon disturbed dunctions of TMJ. Ann Otol Rhinol & Laryngol 1934;43:1-15. https://doi.org/10.1177/000348943404300101
  36. Seaver EP Jr. Temporomandibular joint malocclusion and the inner ear. Ann Otol Rhinol Laryngol 1937;46: 140-149. https://doi.org/10.1177/000348943704600111
  37. Riise CM, Schikholeslam A. Influences of experimental interfering occlusal contacts on postural activity of the anterior temporalis and masseter muscles in young adults. J Oral Rehabil 1982;9:419-425. https://doi.org/10.1111/j.1365-2842.1982.tb01031.x
  38. Ingervall B, Carlsson GE. Masticatory muscle activity before and after elimination of balancing side occlusal interference. J Oral Rehabil 1982; 9(3):183-192. https://doi.org/10.1111/j.1365-2842.1982.tb01008.x
  39. Roth RH. Temporomandibular pain-dysfunction and occlusal relationships. Angle Orthod 1973;43(2): 136-153.
  40. Williamson EH, Simmons MD. Mandibular asymmetry and its relation to pain dysfunction. Am J Ortho 1979;76:612-617. https://doi.org/10.1016/0002-9416(79)90207-0
  41. Cacchiotti DA, Plesh O, Bianchi P, McNeill C. Sings and symptoms in samples with and without temporomandibular disorders. J Craniomandib Disord 1991;5:167-172.
  42. Keeling SD, McGorray S, Wheeler TT, King GJ. Risk factors associated with temporomandibular joint sounds in children 6 to 12 years of age. Am J Orthod Dentofacial Orthop 1994;105:279-287. https://doi.org/10.1016/S0889-5406(94)70122-9
  43. Kirveskari P, Alanen P. Scientific evidence of occlusion and craniomandibular disorders. J Orofac Pain 1993;7(3):235-240.
  44. Maness WL, Benzamin M, Podoloff R, Robbick A, Golden RF. Computerized occlusal analysis: A new technology. Quintessence International 1987;4:287.
  45. Maness WL, Podoloff R. Distribution of occlusal contacts in maximum intercuspation. J Prosthet Dent 1989;62(2):234-242. https://doi.org/10.1016/0022-3913(89)90320-X
  46. Reza Moini M, Neff PA. Reproducibility of occlusal contacts utilizing a computerized instrument. Quintessence International 1991;22(5):357-360.
  47. Kerstein RB. Disclusion time measurement studies: A comparison of disclusion time between chronic myofascial pain dysfunction patients and nonpatients: A population analysis. J Prosthet Dent 1994;72: 473-480. https://doi.org/10.1016/0022-3913(94)90117-1
  48. Kerstein RB. Treatment of myofascial pain dysfunction sydrome with occlusal therapy to reduce lengthy disclusion time - A recall evaluation. J Craniomandib Pract 1995;13(2):105-115.
  49. Osterberg T, Carlsson GE, Wedel A, Johansson U. A cross-sectional and longitudinal stu요 of craniomandibular dysfunction in an elderly population. J Craniomandib Disord 1992;6(4):237-245.