Effects of centric mandibular splint therapy on orofacial pain and cerebral activation patterns
Effects of centric mandibular splint therapy on orofacial pain and cerebral activation patterns
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DOI：
10.1007/s00784-019-03064-y
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发表时间：
2020-06-01
影响因子：
3.4
通讯作者：
Lotze, Martin
中科院分区：
文献类型：
--
作者：
Ernst, Marius;Schenkenberger, A. Elisa;Lotze, Martin
目的 探讨 3 个月的下颌夹板治疗对疼痛、运动运动学和大脑表征的影响。材料和方法 使用功能性磁共振成像 (fMRI) 对 13 名患有颞下颌关节病 (TMD) 和中度疼痛强度的患者进行了术前 (PRE)、术前 (PRE)、术后 (2 周后，POST1) 和术后 12 周 (POST2) 的研究，以显示天然牙齿和单独安装的下颌夹板的咬合运动。此外，还测量了下颌运动的运动学研究、肌肉肌电图和使用疼痛日记的疼痛评级（VAS 等级 0-100）。结果 尽管患者的疼痛等级降低了约 60%，但治疗过程中的运动学和肌电图特征并未显着改变。在治疗过程中，我们观察到闭塞期间初级体感皮层 (S1) 和次级体感皮层 (S2) 以及岛叶皮层的 fMRI 激活强度降低。左半球前岛叶和小脑功能磁共振成像激活的减少与随着时间的推移疼痛的减少有关。结论 在本初步研究的限制范围内，疼痛处理的辨别区（初级和次级体感皮层）和情感区（前岛叶）的减少表明，疼痛预期的改变对于 TMD 后下颌夹板治疗的治疗效果至关重要。
Objectives To investigate the effects on pain, movement kinematics, and cerebral representation by a 3-month mandibular splint therapy. Material and methods Thirteen patients with temporo-mandibular joint disease (TMD) and moderate pain intensity were investigated before (PRE), within (after 2 weeks, POST1) and after a period of 12 weeks (POST2) using functional magnetic resonance imaging (fMRI) of representation of occlusal movements on natural teeth and on an individually fitted mandibular splint. In addition, kinematic investigations of jaw movements, muscle electromyography and pain ratings using a pain diary (VAS-scale 0-100) were measured. Results Although the patient's pain ratings decreased about 60%, kinematic and electromyographic characteristics over therapy were not significantly altered. Over therapy, we observed a decrease of fMRI activation magnitude in the primary somatosensory cortex (S1) and secondary somatosensory cortex (S2) and insular cortex during occlusion. Left hemispheric anterior insula and the cerebellar fMRI activation decrease were associated with decrease in pain over time. Conclusions Within the limitations of this pilot study, a reduction in both discriminative (primary and secondary somatosensory cortex) and affective (anterior insula) areas for pain processing suggest that altered pain anticipation is critical for the therapeutic effects of mandibular splint therapy after TMD.