Examination and diagnosis of bruxism and occlusal trauma in periodontitis patients

本研究旨在了解牙周炎患者磨牙症的实际情况、咬合创伤和牙周组织破坏。研究结果如下：1.应用K-6诊断系统对中重度牙周炎患者下颌运动和肌肉活动进行监测，结果显示：牙周炎患者表现为：（1）闭合时接触速度减慢;（2）咬紧时肌电活动降低;（3）咬紧时肌电活动降低。3)肌电活动随牙周炎的进展和咬合部位的减少而降低.一种监测睡眠中下颌运动的装置被制造出来。记录并分析下颌运动、咬肌活动、咬合接触、咬合音。磨牙症分为三种类型：A型（磨牙）、B型（紧咬）和C型（A和B除外）。有磨牙症意识者以A型多见，无磨牙症意识者以B型多见。这些差异似乎有助于他们对磨牙症的认识。对睡眠磨牙监测自记录装置进行改进，增加了一次性电极和发光二极管监测器，使测量更加准确.对牙周组织破坏合并咬合创伤和炎症进行了研究。选用2只猕猴，将磨牙区分为4组。14周和28周后进行临床和病理学观察。结果表明，当隔纤维中有炎性细胞浸润时，破坏迅速向根尖部扩散，伴有咬合创伤.为检查过早接触导致磨牙症，T扫描系统用于牙周炎患者。结果表明，由于磨牙症患者咬合不稳、牙齿松动、咬合力减弱等因素的影响，该系统对牙周炎患者的诊断不够准确，有待于进一步研究磨牙症的客观诊断和治疗方法。

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.