Examination and diagnosis of bruxism and occlusal trauma in periodontitis patients

这项研究是为了阐明牙周炎患者磨牙症、咬合创伤和牙周破坏的实际情况。研究结果如下：1.应用K-6诊断系统监测中重度牙周炎患者的下颌运动和肌肉活动，发现牙周炎患者表现为：1)闭口接触速度减慢；2)咬合牢固时肌电活动减慢；3)随着牙周炎的进展和咬合部位的减少，肌电活动降低。研制了一种用于监测睡眠时下颌运动的装置。记录并分析下颌运动、咬肌活动、咬合接触、咬合声音。磨牙症分为A型(磨牙型)、B型(咬合型)和C型(A、B型除外)。有意识磨牙症的受试者多为A型，无意识的受试者多为B型。这些差异似乎有助于他们对磨牙症的认识。采用处置电极和发光二极管监护仪对自行记录的睡眠磨牙症监测装置进行了改进，提高了测量的准确性。对牙周破坏合并咬合创伤和炎症进行研究。实验选用恒河猴2只，磨牙区分为4组。术后14周和28周分别进行临床和病理观察。结果表明，当炎性细胞在跨隔纤维内渗入时，破坏迅速蔓延至咬合创伤的根尖部位。为了检查导致磨牙症的过早接触者，对牙周炎患者使用了T-SCAN系统。观察表明，由于患者咬合不稳定、牙齿活动和咬合力减弱，该系统对牙周炎患者的检查不够准确。我们计划对磨牙症的客观诊断和治疗方式进行进一步的研究。

This study was undertaken to clarify the actual conditions of the bruxism in periodontitis patients, occlusal traumatism, and periodontal destructions. Following findings were obtained.1. Monitoring mandibular movement and muscle activities of moderate to severe periodontitis patients with K-6 diagnostic system revealed that periodontitis patients showed : 1) slower contact velocity in mouth closure ; 2) lower electromyogram activity in firm biting ; . 3) decreased electromyogram activities as periodontitis progressed and occluding site decreased.2. A device for monitoring jaw movement during sleep was made. Jaw movement, masseter activity, occluding contacts, occluding sound were recorded and analyzed. Bruxism was classified into three types : A type (grinding), B type (clenching), and C type (except A and B). Subjects with consciousness of bruxism had more A type, and subjects without consciousness had more B type. These difference seemed to contribute to the awareness of their bruxism.3. The self recording device for monitoring bruxism during sleep was improved by disposal electrode and illuminated diode monitor, and they made the measurement more accurate.4. Periodontal destruction combined with occlusal traumatism and inflammation was studied. Two macaca monkies were used and molar area were divided into four groups. After 14 and 28 weeks, clinical and pathological observations were performed. The result showed when inflammatory cells were infiltrated in trans-septal fibers, the destruction spread rapidly into apical site with occlusal traumatism.5. For examining premature contacts which cause bruxism, T-scan system was used for periodontitis patients. The observations revealed that this system is not accurate enough for periodontitis poitients examinations because of patients instability of occlusion, teeth mobility and weekened occlusal force.We are planning to have further research for the objective diagnosis and treatment modalities for bruxism.