Temporomandibuläre Störungen im Vergleich zu Okklusion und kieferorthopädischer Therapie - eine kontrollierte, prospektive und longitudinale Studie

Zusammenfassung

Symptome und Anzeichen für Kiefergelenkerkrankungen (TMD) treten bei Kindern und Jugendlichen relativ häufig auf. Diese Symptome und Anzeichen für TMD können während des zweiten Lebensjahrzehnts auftreten und in ihrer Häufigkeit und Schwere zunehmen. In diesem Zeitraum unterziehen sich etwa 20-30% der Kinder und Jugendlichen in den meisten westeuropäischen Ländern einer kieferorthopädischen Behandlung.

In Hinblick auf das häufige Auftreten von Symptomen und Anzeichen für TMD bei Kindern und Jugendlichen ist es wahrscheinlich, dass kieferorthopädisch behandelte Patienten vor, während oder nach der Therapie Anzeichen und Symptome für temporomandibuläre Störungen zeigen. Das Auftreten von Anzeichen und Symptomen für TMD während einer kieferorthopädischen Therapie muss daher im Zusammenhang mit normalen longitudinalen Veränderungen bei gleichaltrigen Individuen mit ähnlichen, aber unbehandelten Anomalien, sowie bei Individuen vorzugsweise ohne Fehlstellungen betrachtet werden. Dieser Hintergrund war der Anlass zur Durchführung der vorliegenden Untersuchung.

Das Ziel der Studie lag in der prospektiven und longitudinalen Untersuchung sowohl von Symptomen und Anzeichen für temporomandibuläre Störungen (TMD), als auch okklusaler Veränderungen bei Mädchen mit kieferorthopädisch behandelten Klasse-II-Anomalien im Vergleich zu Individuen mit unbehandelten Klasse-II-Fehlstellungen bzw. mit normaler Okklusion.

65 Klasse-II-Patientinnen wurden mit Multibandapparaturen kieferorthopädisch behandelt (Orthodontiegruppe), 58 blieben unbehandelt (Klasse-II-Gruppe) und 60 Mädchen hatten eine normale Okklusion (Normalgruppe).

In allen drei Gruppen zeigten sich bei den Angaben zu Symptomen und Anzeichen für TMD individuelle Schwankungen im Verlauf der zwei- bzw. dreijährigen Studie. In der Orthodontiegruppe lag die Häufigkeit von muskulären Anzeichen für temporomandibuläre Störungen posttherapeutisch signifikant niedriger. Die Klasse-II- und die Normalgruppe zeigten demgegenüber im Verlauf der zwei Jahre nur geringfügige Veränderungen. Kiefergelenkknacken nahm zwar bei allen drei Gruppen im Verlauf der zwei Jahre zu, war allerdings in der Normalgruppe weniger weit verbreitet. In der Normalgruppe traten auch die Symptome und Anzeichen für TMD generell weniger häufig auf, als in der Orthodontie- bzw. in der Klasse-II-Gruppe. Zwar nahm in der Orthodontiegruppe die Zahl der funktionellen okklusalen Interferenzen im Verlauf der zwei Jahre ab, sie blieb aber in den anderen beiden Gruppen unverändert.

Zusammenfassend lässt sich feststellen, dass eine kieferorthopädische Therapie, ob mit oder ohne Extraktion von Zähnen, weder das Risiko für die Ausprägung von Anzeichen für TMD erhöht, noch bereits bestehende Symptome verschlechtert. Bei Individuen mit Klasse-II-Anomalien und muskulären Anzeichen für TMD schien sich die Situation über den Beobachtungszeitraum von zwei Jahren hinweg sogar eher zu verbessern. Die Normalgruppe zeigte eine geringere Häufigkeit von Symptomen und Anzeichen für TMD als die Orthodontie- bzw. die unbehandelte Klasse-II-Gruppe. Die beobachteten großen Schwankungen von Symptomen und Anzeichen für TMD im Verlauf der Zeit führen uns dazu, eine eher konservative Behandlungsstrategie zu empfehlen, wenn es um die Therapie des stomatognathen Systems bei Kindern und Jugendlichen geht.

Abstract

Symptoms and signs of temporomandibular disorders (TMD) are relatively common in children and adolescents. These symptoms and signs of TMD can appear, increase in frequency and severity during the second decade of life. During this period, about 20-30 % of the population of children and adolescents in most western European countries receive orthodontic treatment.

In view of the high prevalence of symptoms and signs of TMD in children and adolescents, it is likely that patients receiving orthodontic treatment might experience TMD before, during or after their orthodontic treatment. The occurrence of signs and symptoms of TMD during orthodontic treatment must therefore be seen in the light of normal longitudinal changes in subjects of the same age with similar but untreated malocclusions and preferably also in subjects without malocclusion. The above mentioned background was the reason for performing this study.

The aim of this study was to prospectively and longitudinally study symptoms and signs of temporomandibular disorders (TMD) and occlusal changes in girls with Class II malocclusion receiving orthodontic treatment in comparison with untreated Class II malocclusions and with normal occlusion subjects.

Sixty-five Class II subjects received orthodontic fixed straight-wire appliance treatment (Orthodontic group), 58 subjects were orthodontically untreated (Class II group) and 60 subjects had a normal occlusion (Normal group).

Individual fluctuations of reported symptoms and signs of TMD were found in all three groups over the two-three year period of the study. In the Orthodontic group, the prevalence of muscular signs of TMD was significantly less common post-treatment. The Class II group and the Normal group showed minor changes during the two-year period. Temporomandibular joint clicking increased in all three groups over the two years but was less common in the Normal group. The Normal group also had a lower overall prevalence of symptoms and signs of TMD than the Orthodontic and the Class II group. Functional occlusal interferences decreased in the Orthodontic group but remained the same in the other two groups over the two years.

In conclusion, orthodontic treatment either with or without extractions did not increase the risk for or worsen pre-treatment signs of TMD. On the contrary, subjects with Class II malocclusions and signs of TMD of muscular origin seemed to benefit functionally from orthodontic treatment in a two-year perspective. The Normal group had a lower prevalence of symptoms and signs of TMD than the Orthodontic and the untreated Class II groups. The large fluctuation of symptoms and signs of TMD over time leads us to suggest a conservative treatment approach when stomatognathic treatment in children and adolescents is considered.

Schlüsselwörter

Temporomandibuläre Störungen - Okklusion

Key words

Temporomandibular disorders - occlusion

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