ВНЧС расстройства Манфредини PDF

• -
@dentistinfo первый стоматологический телеграм канал

Daniele Manfredini
Current Concept s on
Tem porom andibular Disorders
QUIN TESSEN CE PUBLISHING

London, Berlin, Chicago, Tokyo, Barcelona, Istanbul, Milan, Moscow,
New Delhi, Paris, Beijing, Prague, Sao Paulo, Seoul and Warsaw

-
:
, ,
,
:
, , ,
, -
, - , , ,
2013

British Library Cataloguing in Publication Data
Current concepts on temporomandibular disorders.

1. Temporomandibular joint—Diseases-Diagnosis.
2. Temporomandibular joint—Diseases-Treatment.
3. Temporomandibular joint-Pathophysiology.
I. Manfredini, Daniele.
617.6'43-dc22
ISBN-13: 9781850971993
Copyright © 2010 by Quintessence Publishing Co. Ltd.
. . .
(2, 6-22, 24-33), (23),
(3-5), (1)
, , ,
, -
,
© « », 2013
, 119048, , . , . 62, . 1, 1
./ : 8(499)245-52-79
E-mail: info@dental-azbuka.ru. http:/ / www.dental-azbuka.ru
.
.
ISBN 978-5-9-91443-026-6

:
- ,
( ) , , ( ).
, ,
, ,
, . .

,
, ,
, .

,
.
,
, . , -
.
. ,
, , , ,
« -
», .
, 45
, - ,
. , , .

, ,
,

, .
, « -
- .
( ) »
. ,
, .
@dentistinfo первый стоматологический телеграм канал V

, ,
, ,

I.
1. -
............................................................................................... 3
-
2.
- ..................................................................... 25
3. - ................. 41
II.
4. ................................................................. 61
5. - ........... 81
6. - ............................................... 111
7. - ......................................... 135
8.
- ..................................................................... 153
@dentistinfo первый стоматологический телеграм канал VII

III.
9. - ............... 171
10. .................................................................................. 179
11. ..................................................................... 191
12. - ......................................... 207
13. - ...................................................... 225

,
14. ............................................................................................................. 239
15. - .......................... 249
16. - .......................... 267
17.
- ...................................................... 279
18. ................................................................................ 287
19.
- ................................................................... 299
VIII @dentistinfo первый стоматологический телеграм канал

IV.
20. - ........................ 309
21. -
......................................................................................... 321
22. - ................................ 329

-
23. - ............................ 343

- -
24 .
- ................................................................... 365
25. ........................................................................................................ 391

, , ,
26. - ........................................... 401
27.
- ....................................................................... 411
28.
- ...................................................... 425
29.
- ................................................................... 439
30. ................................................................................................... 457
31. ................................... 471
32. ..................................................................... 481
33. - :
, .............................................................................. 497
, )<
@dentistinfo первый стоматологический телеграм канал IX

(Kazuyoshi Baba), DOS,
PhD ,
,
VU ( )
( )
(Robert J. Gatchel), PhD,
- (Am brosio
Bermejo- Fenoll), MD, DDS, PhD ,
,
, ( )
-
( ) (Greg Goddard), DDS
(Jan A. De Boever), DDS, DMD, - ( )

PhD
(Charles S. Greene), DDS
( )

(Marco . Bucci), MD
- -
( , ( )
)
(George Dimitroulis),
(Ephraim Winocur), DMD MDSc, FDSRCS (Eng), FFDRCS (Irel),
FRACDS (OMS)

. -
( ) .
( )
(Corine . Visscher), , PhD
,
,
@dentistinfo первый стоматологический телеграм канал XI

(Sanjivan (Daniele Manfredini),
Kandasamy), BDSc, BScDent, DocClin-Dent, DDS
MOrthoRCS
-
( )
( , )
(Giovanni Mauro), MD,
(Glenn . Clark), DDS, M S DDS, PhD

( - , ) ( )
(Antoon De Laat), DDS, (Ambra Michelotti), MD,

PhD DDS, PhD
-
-
( ) II ( )
(Rachel . . Leeson), BDS, (Franco Mongini), MD

M Sc, PhD, FDS, RCS, FHEA
,
- ( )
.
( , (Greg . Murray), BDS, MDS,
) PhD, FRACDS

(Frank Lobbezoo) DDS, ( )
PhD
(Machiel Naeije), PhD
,
,
VU
( ) ,
VU ( )
(Guido . Macaluso), MD,
DDS, MDS (Luca Guarda Nardini),
MD, DDS

( ) -
( )
(Edoardo Manfredi),
DDS (Peter Nicolakis), MD

( ) ( )
XII @dentistinfo первый стоматологический телеграм канал

(Dorrit W. Nitzan), DMD - (Celia
Marisa Rizzatti-Barbosa), DDS, MS, PhD
-

( , ) ( )
( )
(Yasuhiro ), DDS, PhD
(Donald J. Rinchuse), DMD,
MS, MDS, PhD
( )
(Daniel Paesani), DDS ( )

( - (Alejandro Roisentul),
, ) DDS

(Christopher . Peck), BDS, -
MScDent, PhD ( ,
)
( )
(Kirsi Sipila), DDS, PhD
(Redento Peretta), MD, -
DDS, PhD
- ( )
( )
(Tuija Suvinen), DDS, PhD
(Arne Petersson), DDS,
Odontdr

- ( )
( ) (Jens . ), DDS, Dr Med Dent

Habit
(Edward F. Wright), DDS, M S ,
-

-
( ) ( )
- (Mauro Farella), DDS, PhD

(Margarete Cristiane Ribeiro-Dasilva), DDS,
MS, PhD -

( ) II
( )
@dentistinfo первый стоматологический телеграм канал XIII

(Giuseppe Ferronato), (Marc Schmitter), DMD
MD, DDS
,
- ( )
( )
(Rudiger Emshoff),
- (Veronika Fialka- Dr Med, Dr (H)
Moser), MD
-
( ) ( )
(Hans J. Schindler), DDS,

Dr Med Dent Habil

( )
XIV @dentistinfo первый стоматологический телеграм канал

1
-
-
,
.56
.
1
- ( ),
-
.2

,
,

. .7 « »

- ,
, , .8
.3
( 1-1 ):9 ,

: « ; ,
;
, , , ,
».4 .
,
,
, ( ),
, .

.
. -
@dentistinfo первый стоматологический телеграм канал 3

-
1-1. 1-2. -

( ) (
)
( ),
1 .
-
«
».
:
- :
( ) / ,
J
;
- (
) ;
,
- ;
, - (
, -
. );
- .
. : ,
.

.
-
( . 1-1)
,
.
,
(
.- , .), 20 8
.10-13 .
1-2.7'1'1-17
15-25°
.

.
, ,
,
.
,
4 @dentistinfo первый стоматологический телеграм канал

-
. 1-1. . ( ). . ( ), .
:
-
, .20
. , ,
( )
.21
. ( . 1-2 1-3)
,

.
- ,
(
) . .
:
( .
).
- , .
- -
.
, , .
.
.
,
(
- ).18 .
,
:
.19 (lig. discotemporalis. - , .),
(lig. discomandibularis. - ,
, .).

-
. 1-2. . . .
- . . ,
(
.- , .) .
.
, ,
.
(Testut),23
, . -
2 .23
, .

. ,
1954 . (Leonard A. Rees) .24

,
.22 12 .
, :
,
, - .26

.26
.
(
). 1- (85 %
).27
( ) ,23
, 2-
- .29
, - .30
,
,31 -
. .
. .8 -

-
. 1-3. .
.
.
( )
,
,
,
, .
;
,
.32
.22
,22
.33
,

( . 1-2 1-3) .
,
. ,
. .
,
, .
,
(Glaser), .
. ,
:
, .
. , ,
,
,
: .
.
.3435
.
, ,

-
’ 1
- -
/
-

. 1-4. . - . .
( . 1-4) . -
, . .
,
• - (
. ).

-
.
• -
.
,
,
, ,
- .10 .
, ,
,
.
.
.
• ,
• - - ,
.
.

-
• - ), - -
,
. .1142

(lingula).
• ( . 1-4 1-5)
.
1897 1995 . , -
42 ,
, .10'17
.36 , ,
- ,
, , ,
.
.37

,
, , .
.38 ,
- , ,
.
,
.39
,
.40'41
,
-
. .843
8- .
,

.
- 8-
, .
, ,
-
, . 12-
.1042 ,
:
,
.
.
,
( ,

-
. 1-5.
- /

-
.50
. .
16-
.47 . . 1-6
,

,51 . 1-7
.
: - ,
, ,
, .48
.52
: ,
.
, . ,

( . 1-6 ).49 ,53
, ,
- -

-
. 1-6. . ( ), ( ) ( )
. .
. 1-7.
,54 .55 .

, 50± 6 , -
- 7,5± 1,5 , -
9,6± 1,8 .58
.56 ,59
50
, 16 ,
10 ,
.57 34°.
, ,
, ,

-
. 1-8. .
( ). .
( ), . . (
,
( )- )( . 1-10-1-12).
( . 1-8).26

( )

.
( . 1-9) - (
- ),
, ( -
, ) -
, . (
,— ) ( . 1-11, 1-13 1-14).
.
.60 .
, .
.
, -
: ;
(
), .
(
) ( . 1-5,1-12,1-15 1-16).

( . 1-9)
-
—
----
-
-
. 1-9. . . .
............
/
/
^
— -
. 1-10. . 1-11. -
,

-
\
\ /
. 1-12. . 1-13. ,
>

!
ijm \ -
^ \
/

- I ' -
. 1-14. . . 1-15. -
( )

( . 1-9)
. 1-1 1-2
.

. ,

,
(
). . 1-16.

.
.
,
, .66
.60
,
.
, :
, .61 .
-
, -
.62 .66 ,

.67
,

. ,
( ) .
.63
- , - ,
- , .
, , :
.22
, - .64
, ,

.68
.
,
,

• 1-1. ,
\ ______________________ _________________________ __________

:
. : . .
: , , - :
-
, -
.
,
- ( )

:
: : - . ,
,
. . - .
: . , . :
( :
) , - .
:
,

, .
. :
-

: :
. : - .

. - .
. . : .
: ,
: - .
,


1-2. ,
:
: - : -
. .
, - : . .
: -
, , -
,
. ,
: ,
,
,
- - - - -
, :
-
. . ,
, ,
-
, -
.

, (XII -
- .
- )
(
. 1-9)
-
: ,

,
:
• .13
. 1-17.
12 (
.- , .)
•
.2265
,
,
.
( . 1-2
1-3).
•

,
( . 1-2 1-3), , , :
.69
•

,50
.
, .
, ( . 1-6 ).
•
. . ,
(
) . . 1-17
( ) .71
( . 1-6 ).51 ,
,
( ), ,
. .
•
, . ,
( . 1-8).26’70 , .
, . . , ,

. , - .

:
. 1-18. -
: 1- ;2- ;3-
;4- - ;5- - ;6-
- ;7- - ;8-
- ;9- - ; 10 - -
; 11 - - . - -
( - ); - - ( -
); - - ; D-
( - ). -

, , ,
.
. ,
, -
, , :
,
. 1-17. , - -
, . ,
.
, .
. Bermegio-Fenoll .
, - ( ),
,
,
- ( . 1-3, . 1-18-1-20).
.
. ,
- ( 1-3)
, - , ,7273 ,74
( ) .75

-
. 1-19. - . 1-20.
. .
. -
,
1-3.
,76
.
, , ,
, -
( 1-1). ( ).
, ,
.
, -
, . .
,
.77 , ,

.43 ( . 1-3).
,
, . .
.
.
,
.
. ,

(
).78-80

1-3. : , ,
- -
( )
( - ) ( - )
( - ( -
) )
( )
-
, . . .

. (F. Sanchez
del Campo) . (A. Puchades).

- - - (Elena
Tari-Amoros),
. , -
(Juan Dengra-Martinez)
, - (M anuel Perez-Gomez)
, ,
(Joe Perkins) (
. Partington)
.

-
joint dysfunction and asymptomatic volunteers.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod
1. Dorland. Diccionario enciclopedico ilustrado de me- 1995;80:242- 249.
dicina, ed 30. Madrid: Elsevier Espana S.A., 2005. 21. Kaugars G, Mercuri L, Laskin DM . Pneumatization
2. Mongini F. The Stomatognathic System. Chicago, of the articular eminence of the temporal bone:
IL: Quintessence Publishing, 1984. prevalence, development, and surgical treatment.
3. The Academy of Prosthodontics. The Glossary of Pros- J Am Dent Assoc 1986;113:55- 57.
thodontic Terms, ed 6. Chicago, IL: Mosby, 1994. 22. Rees LA. The structure and function of the man
4. The American Academy of Orofacial Pain, de Leeuw dibular joint. Br Dent J 1954;96:125- 133.
R (eds). Orofacial Pain: Guidelines for Assessment, 23. Testut L. Tratado de anatomia humana. Tomo I. Bar
Diagnosis, and M anagement, ed 4. Chicago, IL: celona: Salvat Editores, 1904.
Quintessence Publishing, 2008. 24. Kino K, Ohmura Y, Amagasa T. Reconsideration
5. Hylander WL. Functional anatomy and biomechan of the bilaminar zone in the retrodiskal area of the
ics of the masticatory apparatus. In: Laskin DL, temporomandibular joint. Oral Surg Oral Med Oral
Green CS, Hylander W L (eds). Temporomandibular Pathol 1993;75:410^ J21.
Disorders: An Evidence-based Approach to Diagno 25. DuBrul LL. Sicher and DuBrul's Oral Anatomy, ed 8.
sis and Treatment. Chicago, IL: Quintessence Pub Tokyo: Ishiyaky Euroamerica, 1988.
lishing, 2006:3- 34. 26. Jagger RG. The surface structure of the temporo
6. Okeson JP. M anagement of Temporomandibular mandibular joint disk: a scanning electron micro
Disorders and Occlusion. St. Louis, M O: Mosby- scopic study. J Oral Rehab 1980;7:225- 234.
Elsevier, 2008. 27. Johns DE, Athanasiou KA. Design characteristics for
7. Perez Casas A, Bengoechea M E. Anatomia funcio- temporomandibular joint disc tissue engineering:
nal del aparato locomotor. M adrid: Paz M ontalvo, learning from tendon and articular cartilage. Proc
1978. Inst Mech Eng 2007;221 (5):509- 526.
8. M cDevitt WE. Functional Anatomy of the M astica 28. Tanaka E, van Eijden T. Biomechanical behavior of
tory System. London: Butterworth, 1989. the temporomandibular joint disc. Crit Rev Oral Biol
9. Rodnan GP, Schumacher HR (eds). Primer on Rheu Med 2003 ;14(2):138- 150.
matic Diseases, ed 8. Atlanta, GA: The Arthritis 29. Detamore M S, Athanasiou KA. Structure and func
Foundation, 1983. tion of the temporomandibular joint disc: implica
10. Testut L. Tratado de anatomia, Vol I, ed 7. Barce tions for tissue engineering. J Oral M axillofac Surg
lona: Salvat Editores, 1925. 2003;61 (4):494- 506.
11. Rouviere H. Anatomia humana, Vol I, Cabeza 30. Kurita K, Westesson PL, Sternby NH, Eriksson L,
cuello, ed 7. Madrid: Bailly-Bailliere, 1964. Carlsson LE, Lundh H et al. Histologic features of
12. Bouchet A, Cuilleret J. Anatomia descriptiva, topo- the temporomandibular joint disk and posterior disk
grafica funcional. Cara, cabeza organos de los attachment: comparison of symptom-free persons
sentidos. Buenos Aires: Medica Panamericana, 1979. with normally positioned disks and patients with
13. M cKay GS, Yemm R. Estructura funcion de la ar- internal derangement. Oral Surg Oral Med Oral
ticulacion temporomandibular. Arch Odontoestom- Pathol 1989;67:635- 643.
atol 1993;9(1):36—15. 31. Sabu C, Carvalho de Moraes LO, de Cuadros Uze-
14. Zarb GA, Carlsson GE (eds). Temporomandibu da-Gonzalez S, Marques SR, Vretos C, Aguillera AH
lar Joint: Function and Dysfunction. Copenhagen: et al. Ultrastructural evidence of vascularization of
Munksgaard, 1979. the central zone of the temporomandibular joint
15. Basmajian JV. Grant's method of Anatomy, ed 10. disc in human fetuses. Eur J Anat 2006;10:45- 48.
Baltimore, M D: Williams and Wilkins, 1980. 32. Gonzalez-Sequeros O, Guijarro de Pablos JE, Ber-
16. Orts Llorca F. Anatomia humana, Vol I, ed 5. Barce mejo-Fenoll A, Gonzalez-Gonzalez J. Caracteristi-
lona: Cientifico-M edica, 1981. cas morfologicas de las superficies del menisco del
17. Lanton DP, Eggleton TM . Functional Anatomy of complejo articular temporomandibular humano
the Temporomandibular Joint Complex. Santiago, (CATM ): Estudio a microscopla electronica de bar-
Chile: Alfabeta, 1992. rido. Arch Esp Morfol 1996;1:151- 158.
18. Haskell B, Day M , Tetz J. Computer-aided model 33. Gallo LM . Modeling of temporomandibular joint
ing in the assessment of the biomechanical deter function using M RI and jaw-tracking technologies -
minants of diverse skeletal patterns. Am J Orthod mechanics. Cells Tissues Organs 2005;180:54- 68.
1986;89:363- 382. 34. Nitzan DW. The process of lubrication impairment
19. Pereira FJ, Lundh H, Westesson P-L, Carlsson LE. and its involvement in temporomandibular joint disc
Clinical findings related to morphologic changes in displacement: a theoretical concept. J Oral M axil
TM J autopsy specimens. Oral Surg Oral Med Oral lofac Surg 2001;59,1:36- 45.
Pathol 1994;78:288- 295. 35. M eng QG, Long X. A hypothetical biological syn
20. Galante G, Paesani D, Tallents RH, Hatala M A, ovial fluid for treatment of temporomandibular joint
Katzberg RW, M urphy W. Angle of the articular disease. Med Hypotheses 2008;70:835- 837.
eminence in patients with temporomandibular

36. Sato , Strom D, Carlsson GE. Controversies on 54. Barie J. Mecanisme de I'oclusion dentaire. Actual
anatomy and function of the ligaments associated Odontostomatol 1986;156:747- 759.
with the temporomandibular joint: a literature sur 55. Alvarez-Arenal A, Villa-Vigil M A, Saban-Gutierrez
vey. J Orofacial Pain 1995;9:308- 316. L, Ibasseta-Dias G, Casado-Lompart JR, Aguado-
37. Deodato F, Trusendi R, Giorgetti R, Scalese M U. Blazquez M . Situacion del eje vertical de rotation del
Predisposition for temporomandibular joint disor condilo de trabajo en los movimientos de lateralidad
ders: loose ligaments. Cranio 2006;24(3):179- 183. mandibular. Av Odontostomatol 1992;8:595- 598.
38. Koolstra JH. Dynamics of the human masticatory 56. Naeije M , Huddleston Slater JJ, Lobbezoo F. Varia
system. Crit Rev Oral Biol Med 2002;13:366- 376. tion in movement traces of the kinematic center
39. Carvalho de Moraes LO, Sabii C, de Cuadros of the temporomandibular joint. J Orofac Pain
Uzeda-Gonzalez S, Marques SR, Vretos C, Iteze- 1999;13:121- 127.
rote AM , et al. Macroscopy and light microscopy 57. Gallo LM , Gossi DB, Colombo V, Palla S. Relation
of the discomallear ligament passing through the ship between kinematic center and TM J anatomy
petrotympanic fissure in human fetuses. Eur J Anat and function. J Dent Res 2008;87:726- 730.
2007;11:47- 51. 58. Schiffman EL, Fricton JR, Haley DP, Shapiro BL. The
40. Rowicki T, Zakrzewska J. A study of the discomal- prevalence and treatment needs of subjects with
leolar ligament in the adult human. Folia Morphol temporomandibular disorders. J Am Dent Assoc
(Warsz) 2006;65:121- 125. 1990;120:295- 303.
41. Sencimen M , Yalgin B, Dogan N, Varol A, Okgu 59. Jirman R, Fricova M , Horak Z, Krystufek J, Konvick-
KM , Ozan H et al. Anatomical and functional as ova S, M azanek J. Analyses of the temporoman
pects of ligaments between the malleus and the dibular disc. Prague Med Rep 2007;108:368- 379.
temporomandibular joint. Int J Oral M axillofac Surg 60. Wood WW. A review of masticatory muscle func
2008;37:943- 947. tion. J Prosthet Dent 1987;57(2):222- 232.
42. Ide Y, Nakazawa K. Anatomical Atlas of the Tem 61. Gaudy JF, Zouaoui A, Bravetti P, Charrier JL, Guettaf
poromandibular Joint. Osaka, Japan: Quintessence, A. Functional organization of the human masseter
1991. muscle. Surg Radiol Anat 2000;22:181- 190.
43. Gonzalez-Gonzalez JM , Bermejo-Fenoll A, Gonzalez- 62. Gaudy JF, Zouaoui A, Bravetti P, Charrier JL, Laison
Sequeros O. Morfogenesis de la articulacion tem F. Functional anatomy of the human temporal mus
poromandibular: relacion entre el origen en un cle. Surg Radiol Anat 2001 ;23:389- 398.
doble blastema el concepto de doble articulacion. 63. El Haddioui A, Bravetti P, Gaudy JF. Anatomical
Rev Eur Odontoestomatol 1992;4,5:277- 280. study of the arrangement and attachments of the
44. Keith DA. Development of the human temporo human medial pterygoid muscle. Surg Radiol Anat
mandibular joint. Br J Oral Surg 1982;20:217- 224. 2007;29:115- 124.
45. Cascone P, Scopelliti D, Capuano A, Borrachini A, 64. M cNamara JA. The independent functions of the
Contarelli L. Anatomia miscroscopica della artico- two heads of the lateral pterygoid muscle. Am J
lazione temporomandibolare. Min Stom 1987;36: Anat 1973;138:197- 206.
857- 866. 65. Usui A, Akita K, Yamaguchi K. An anatomic study of
46. Checa Sagra M , Marti Pena M , Rodriguez Mateos the divisions of the lateral pterygoid muscle based
V. Artropatias temporomaxilares. An Otorrinolarin- on the findings of the origins and insertions. Surg
gol IberoAm 1987;XIV:47- 49. Radiol Anat 2008;30:327- 333.
47. Molina W, Pino S, Sosa G. Distribution of muco- 66. M urray GM , Phanachet I, Uchida S, Whittle R. The
polyshaccarides and glycoproteins in the articular human lateral pterygoid muscle: a review of some
discs of temporomandibular joints in human fetus experimental aspects and possible clinical relevance.
es. J Orofac Pain 2005;19:325- 330. Aust Dent J 2004;49:2- 8.
48. Posselt U. Range of movement of the mandible. 67. Bhutada M K, Phanachet I, Whittle T, Peck CC,
J Am Dent Assoc 1958;56:10- 13. M urray GM . Regional properties of the superior
49. McMillan AS, M cMillan DR, Darwell BW. Centers head of human lateral pterygoid muscle. Eur J Oral
of rotation during jaw movements. Acta Odontol Sci 2008;116:518- 524.
Scand 1989;47:323- 328. 68. Meyenberg K, Kubik S, Palla S. Relationships of the
50. Bennett NG. A contribution to the study of the muscles of mastication to the articular disc of the
movements of the mandible. Proc Roy Soc Med temporomandibular joint. Schweiz Mschr Zahmed
1908;1:79- 98. 1986;96:815- 834.
51. Posselt U. M ovement areas of the mandible. 69. Merida-Velasco JR, Rodriguez JF, de la Cuadra C,
J Prosth Dent 1957;7:375- 385. Peces M D, Merida JA, Sanchez I. The posterior seg
52. Koolstra JH, Naeije M , van Eijden TM . The three- ment of the temporomandibular joint capsule and
dimensional active envelope of jaw border movement its anatomic relationship. J Oral M axillofac Surg
and its determinants. J Dent Res 2001 ;80(19):1908- 2007;65:30- 33.
1912. 70. Bourton BM. Anatomy and biomechanics of the
53. Forrest R. Finge-axes: intercondylar versus intrafos- TM J. In: Kraus SL (ed). Temporomandibular Joint
sal. J Am Dent Assoc 1961;63:71- 76. Disorders. New York: Churchill Livingstone, 1988.

-
71. Posselt U. Fisiologia de la oclusion rehabilitation, 76. Bermejo-Fenoll A, Gonzalez-Sequeros O, Gonzalez-

ed 2. Barcelona: Editorial JIM S, 1973. Gonzalez JM . The pig: an animal model for ex
72. Bermejo-Fenoll A, Puchades-Orts A, Sanchez-del- perimentation of the temporomandibular ar
Campo F, Panchon-Ruiz A, Flerrera-Lara M . Mor- ticular complex. Oral Surg Oral Med Oral Pathol
phologische Untersuchungen an der menschlichen 1993;75:18- 23.
articulatio temporo-mandibularis. Verh Anat Ges 77. Gonzalez-Gonzalez JM , Bermejo-Fenoll A, Gonzalez-
1986;80:S761. Sequeros O, Panchon-Ruiz A. Anatomia funcion
73. Bermejo-Fenoll A, Puchades-Orts A, Sanchez- del menisco dentro del concepto de complejo ar
del-Campo F, Panchon-Ruiz A, Herrera-Lara M. ticular temporomandibular. Revision bibliografica.
Morphology of the meniscotemporal part of the Av Odontoestomatol 1998;14:391- 402.
temporomandibular joint and its biomechanical im 78. Bermejo-Fenoll A. Articulaciones temporomandi-
plications. Acta Anat 1987;129:220- 226. bulares: conceptos morfologicos funcionales de
74. Bermejo-Fenoll A, Gonzalez-Sequeros O, Gonzalez- aplicacion clinica. In: Bagan JV, Ceballos A, Bermejo
Gonzalez JM . Histological study of the temporo A, Aguirre JM , Penarrocha M (eds). Medicina Oral.
mandibular joint capsule: theory of the articular Barcelona: Masson SA, 1995.
complex. Acta Anat 1992;145:24- 28. 79. Bermejo-Fenoll A. Parte II: Desordenes temporo-
75. Bermejo-Fenoll A, Panchon A, Gonzalez J, Gonzalez mandibulares. In: Bermejo-Fenoll A (ed). Medicina
O. A study of the movements of the human tem Bucal II. Madrid: Editorial Sintesis, 1998.
poromandibular joint complex in the cadaver. 80. Bermejo-Fenoll A. Desordenes Temporomandibu-
J Cranio Mandib Pract 2002;20(3):181- 191. lares: Tomos 1 ,2 3. M adrid: Editorial Science Tools
SL, 2008.

2
« -
» ( )
,
-
( ) ( )
,1
- 10 .
- 4
:
, - : ( )
, , ; ;
.2'3 ,
,5
. ,
, , ,
.
. -
.

. ,

,
, . ,
. .6
,
1-75 % ,
- 5-33 %.7 ,
( )
,

-
20 40 ,
. (10-15 %
, ),
.
,

- ,19
.

, .
Casanova-Rosado .,9
( . 2-1). 46,1 %
( 17 )
( .
,
) ,
( , ,
,
). . ,
6-30 % 15 %
, ,
5-33 % - , 4-16 % - Rantala .,14
,
.101618 -
. , .
, , 4-6 %

, (10,9 %).
. , (52,9
, 37,9 %, ).
, Schmitter
: .12
- 8-20 %, /
- 4-15 %, - 4-10 %,
- ( 83 ).
3- 17,5 %, - ,
4- 9 %. ,
, ,
(38 % 7 %)
, (21 % 0 %),
,
. ,
( / ) ,
. ,
Rantala .,14 (16 %
0 % 22,7 % 10,3 %, -

2-1.
(%)
( )
Ru t kiew icz, 2006s 6335 (M = 2869; = 3466; 15 8 4 14 9

30- 80)
Casan o va- Ro sa- 506 (46% ; 15,6 0 0 10,9 5,9
d o , 20069 14- 25) ( / )
M cM illan , 2006'° 1222 ( = 505; = 717; 6,9 3,2- 6,1 5
> 18)
Jo h an sso n , 12,468 ( = 46%; 12,1 11,1
2006"
50 60 )
Sch m it t er, 200512 58 ( = 11; 38; 7 21; 0 0; 10,3;
= 47; 68- 96); ( / ) 16 22,7
44 ( = 14;
= 30; 18- 45)
Gesch-, 200413 4289 ( = 2109; = 2180; 20 7,2 2- 6,9 3,5- 17,5 9,1
20- 79)
Ran t ala, 200314 241 (48% ; 10- 13,7 7- 15 2,1- 3,7 12,9 14,9 0,4
48 + 7) ( / )
N assif , 200315 523 17- 24,7 4,2 9,9 3- 13,7 13 27,7
( 18- 25)
Po w , 2001'6 1526 ( = 769; = 757; 6- 29,9 33 4- 8,2
> 18 )
O t u yem i, 200017 308 ( = 207; = 101; 8,1 2,6 3,2 4,5
17- 32) (
)
Go u let , 199518 897 ( = 400; = 497; 9- 30 7- 30 4- 16
> 18)
- , - , - , / - -
KJ
-
).
, , .
.
,

, ,
20-40 . ,
.23 1934 .,
(Costen)
. ,24
, ,
, ,
,
, .
,
,
.20 , ,26
, , ,
,
. ,
. 27 % ,
,26 10 %
, .27 ,
,
, . , ,

,
.
1950- . Lupton Schwartz,
28
.
,

, ,
, .22-29
/ 30
.22
- ,3132
, .2’ ,

, (

, , ).33

. ,
, ( . Manfredini
Lobbezoo34).

, ,
. , ,
,

,
, - .
( . 8).
,
.
.
, ,
.
-

.
,
-
.35 -

,
.36'37 .

, ,
,

.39 1 6 .
,
, ,
( . Suvinen et al.,22
. Okeson2).
.40
-
( , Academ y of Orofacial
, Pain)42
( / ).30
.
.41 ,
, . .

,
. , -

-
2-1. -
(De Leeu w 42) .
,
, , ,
. ,

,
•
.
•

• ,
• .
•
,
.
•
• .
-
•
• .
• ,
• .
.
,
.
-
(. .
) .

,
. ,

. ,
, ,
, ,
, . ,
.
,
, ,

, ,
.
, . .

, ,
,
.
. .
.
,
.
. ,
.
.

,
.

. .
,
. .
.
.
,
.
. ,
. ,
.
, ,
.
,
, .
.
, .
,
,
. .
,
. ,
,- .
,
,
.
. .

-
,
,
, - /
.
, ( I) ( II)
.
, I
,
. .
. : ( 1);
( 2); ,
. ,
( 3).

, , , ,
. ,
, . . .
.
. ( 1)
,
. ,
.
,
20 ( 10
- , ).
.
,
40 . ,
.
.
.
(
2)
, , .
, . :
;
, ;
.
.

.
.
. ,

(
),

/
2-2.
. -
(Dwo rkin LeResche30)
35 «
I
». 35
1

a.
.
b.
,
, 3,
2
( )
a.
.
b.

( II),
c.
,
3
.
a.
b.
.
c.
/
II
•
( ,
•
,
•
, ,

, ),
•

•
•
.
0:
I:
/ ,
II:
.
,

III:
,
. ,
IV:

,
.
,

, ,

-
. ,
,
-

. , . . 2-2
,
, / .

. 3, 11 21.
, ,

, , ( 2,6 : 1
. 7,3 : 1),
/ .
, /

( 1) 31 %
. 48 76 %
, .49
,
,
. / 2% ,
, 30 %
. , / .

. ,
,
/ ( .
, ,
),
,
. , .
,
, (4,3 : 1),44

, , , ,

,
. , 1 (3,3 : 1).48
,
.
,

, -
.50 ,
,
, ,
. .19

2-2. , /
/ (%)

Ilia
( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( )
Winocur, 298 (M=65; 47 18 36,2 ( ) 12,8 ( ) 8,1 ( ) 14,1 ( ) 6,4 ( ) 2,9 ( )
200943 =233)
14; 38 ( ); 25; 75 11 ( ) 5( ) 2( )
86
Manfredini, 377 (M=101; 36,6 1,9 32,1 31,6 2,9 1,9 1,8 2,9 17,5 17,2 12,7 10,8 11,6 12,4
200644 =276)
25,7; 0,9; 33,6; 23,7; 0,9; ; 0,9; 1,8; 14,8; 9,9; 13,8; 5,0; 7,9; 7,9;
40,2 2,1 31,5 33,6 3,6 2,8 2,1 3,2 18,4 18,4 12,3 12,6 13 14,1
Reiter, 200645 115 (65
,
: = 1:2.4; 50 32 28 2 0 40 6 4
50
,
: = 1:7.3)
Plesh, 2005® 61 47,5 32,8 32,7 ( ) 0( ) 0( ) 41 ( ) 6,5 ( ) 0( )
Manfredini, 285 ( =63; 50,2 38,6; 22,8 ; 19,3 50,2; 27,4 ; 30,2
200417 = 222)
Yap, 200348 191 ( = 53; 13 18 12,5 9,9 2,6 4,1 0,5 1 11,5 10,9 0,5 0 1,0 1,5
= 138) ( ( ( ( ( ( ( ( ( ( ( (
) ) ) ) ) ) ) ) ) ) ) )
16,9; 11,6; 9,4; 11,3; 3,7; 1,8; ; ; 5,6; 3,7; ; ; ; ;
9,4 21,7 13,7 9,4 2,1 5 0,7 1,4 13,7 13,7 0,7 1,4 2,1
List, 199649 82 50 26 28 34 0-4 16 23 0-6
210 US 46 30 18 24 43 38
32 ; 39 25 ; 31
- ; - .
( II III) , .
/
U)
U1
-
, ,
,
, 2 (10-35 % .
).
,
(
) .
(0-12 %).
,

2 (15,8 %).14 , ,
-
, .

, ,
.
,
3,
(
50 %). ,
43
,48
.
. , ,
,
. ,
.52 ,
,4447 .
,

,
.
/ . ,
,
,
. ,
, .
. ,
, .
-
.
.
,
,
. .

, , .
( , ,
,
,
,
) ( )
( ) ,
. .

, ,
.
.63 ,

.54 ,
, . - .
,
-
. , ,
,
.
/
.65

, .
, ,
.56 , .

. , ,
, , -
. .

, , ,

.57 , .
.58 ,
, ,
.

,
, ,


-
15. Nassif NJ, Al-Salleeh F, Al-Admawi M . The preva

lence and treatment needs of symptoms and signs
1. McNeill . M anagement of temporomandibular of temporomandibular disorders among young
disorders: concepts and controversies. J Prosthet adult males. J Oral Rehabil 2003;30:944- 950.
Dent 1997;77:510- 522. 16. Pow EH, Leung KCM , McMillan A. Prevalence of
2. Okeson JP. Th e classification o f orofacial pains. Oral symptoms associated with temporomandibular
Maxillofac Surg Clin North Am 2008;20:133- 144. disorders in Hong Kong Chinese. J Orofac Pain
3. McNeill C. History and evolution of TM D concepts. 2001;15:228- 234.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 17. Otuyemi OD, Owotade FJ, Ugboko VI, Ndukwe
1997;83:51- 60. , Olusile OA. Prevalence of signs and symptoms
4. LeResche L. Epidemiology of temporomandibular of temporomandibular disorders in young Nigerian
disorders: implications for the investigation of etio- adults. J Orthod 2000;27:61- 65.
logic factors. Crit Rev Oral Biol Med 1997;8:291- 18. Goulet JP, Lavigne GJ, Lund JP. Jaw pain prevalence
305. among French-speaking Canadians in Quebec and
5. Laskin DM. Etiology of the pain-dysfunction syn related symptoms of temporomandibular disorders.
drome. J Am Dent Assoc 1969;79:147- 153. J Dent Res 1995;74:1738- 1744.
6. Dworkin SF, Huggins KH, LeResche L, Von Korff M , 19. Fillingim RB. Sex, gender, and pain: women and men
Howard J, Truelove E et al. Epidemiology of signs really are different. Curr Rev Pain 2000;4:24- 30.
and symptoms in temporomandibular disorders: 20. Al-Jundi M A, John MT, Setz JM , Szentperry A, Kuss
clinical signs in cases and con t rols. J Am D en t Asso c O. M eta-analysis of treatment need for temporo
1990;120:273- 281. mandibular disorders in adult nonpatients. J Orofac
7. Fricton JR, Schiffmann EL. Epidemiology of tem Pain 2008;22:97- 107.
poromandibular disorders, in: Fricton JR, Dubner R 21. Gr een e C. The etiology o f t em porom an dibu lar dis
(eds). Orofacial Pain and Temporomandibular Dis orders: implications for treatment. J Orofac Pain
orders. New York: Raven Press, 1995:1- 14. 2001;15:93- 105.
8. Rutkiewicz T, Kononen M , Suominen-Taipale L, 22. Suvinen Tl, Reade PC, Kemppainen P, Kononen M,
Nordblad A, Alanen P. Occurrence of clinical signs Dworkin SF. Review of aetiological concepts of tem
of temporomandibular disorders in adult Finns. poromandibular pain disorders: a biopsychosocial
J Orofac Pain 2006;20:208- 217. model for integration of physical disorder factors
9. Casanova-Rosado JF, Medina-Solis CE, Vallejos- with psychological and psychosocial illness impact
Sanchez AA, Casanova-Rosado A), Hernandez- factors. Eur J Pain 2005;9:613- 633.
Prado B, Avila-Burgos L. Prevalence and associated 23. Lobbezoo F, Drangsholt M , Peck C, Sato H, Kopp
factors for temporomandibular disorders in a group S, Svensson P. Topical review: new insights into
of M exican adolescents and youth adults. Clin Oral the pathology and diagnosis of disorders of the
Investig 2006;10:42- 49. temporomandibular joint. J Orofac Pain 2004;18:
10. M cM illan A, Wong M C, Zheng J, Kam CL. Preva 181-191.
lence of orofacial pain and treatment seeking in 24. Cost en JB. A syn d rom e o f ear and sinus symptoms
Hong Kong Chinese. J Orofac Pain 2006;20:218- dependent upon disturbed function of the tem
225. poromandibular joint. Ann Otol Rhinol Laryngol
11. Johansson A, Unell L, Carlsson GE, Soderfeldt B, 1934;43:1- 15.
Hailing A. Risk factors associated with symptoms 25. Alanen P. Occlusion and temporomandibular dis
of temporomandibular disorders in a population orders (TM D): still unsolved question? J Dent Res
of 50- and 60-year-old subjects. J Oral Rehabil 2002;81:518- 519.
2006;33:473- 481. 26. Pullinger AG, Seligman DA. Quantification and vali
12. Schmitter M , Rammelsberg P, Hassel A. The preva dation of predictive values of occlusal variables in
lence of signs and symptoms of temporomandib temporomandibular disorders using a multifactorial
ular disorders in very old subjects. J Oral Rehabil analysis. J Prosthet Dent 2000;83:66- 75.
2005;32:467- 473. 27. Landi N, Manfredini D, Tognini F, Romagnoli M ,
13. Gesch D, Bernhardt O, Kocher T, John U, Hensel Bosco M . Quantification of the relative risk of
E, Alte D. Association of malocclusion and func multiple occlusal variables for muscle disorders
tional occlusion with signs of temporomandibu of the stomatognathic system. J Prosthet Dent
lar disorders in adults: results of the population- 2004;92:190- 195.
based study of health in Pomerania. Angle Orthod 28. Molin C. From bite to mind: TM D - a personal
2004;74:512- 520. and literature review. Int J Prosthodnt 1999;12:
14. Rantala M AI, Ahlberg J, Suvinen Tl, Savolainen A, 279- 288.
Kononen M . Symptoms, signs, and clinical diagno 29. Manfredini D, Landi N, Bandettini Di Poggio A,
ses according to the Research Diagnostic Criteria Dell'Osso L, Bosco M . A critical review on the im
for Temporomandibular Disorders among Finnish portance of psychological factors in temporoman
multiprofessional media personnel. J Orofac Pain dibular disorders. M inerva Stomatol 2003;52:321-
2003;17:311- 316. 330.

30. Dworkin S, LeResche L. Research diagnostic criteria Jewish and Arab populations according to RDC/
for temporomandibular disorders: review, criteria, TM D evaluation. J Orofac Pain 2006;20:36- 12.
examinations and specifications, critique. J Crani- 46. Plesh O, Sinisi SE, Crawford PB, Gansky SA. Diag
omandib Disord Fac Oral Pain 1992;6:301- 355. noses based on the research diagnostic criteria for
31. Steenks M H, de Wijer A. Validity of the research temporomandibular disorders in a biracial population
diagnostic criteria for temporomandibular disorders of young women. J Orofac Pain 2005;19:65- 76.
axis I in clinical and research settings. J Orofac Pain 47. Manfredini D, Segu M , Bertacci A, Binotti G, Bosco
2009;23:9- 16. M . Diagnosis of temporomandibular disorders ac
32. Ohrbach R, Svensson P (Orgs). Validation studies of cording to RDC/ TM D axis I findings: a multicenter
the RDC/ TM D: progress toward version 2. Sympo Italian study. M inerva Stomatol 2004;53:429- 438.
sium, International Association for Dental Research, 48. Yap AU, Dworkin SF, Chua EK, List T, Tan KB, Tan
Toronto, 2008. FILL Prevalence of temporomandibular disorder
33. Fishbain DA, Cutler R, Romosoff HL, Romosoff RS. subtypes, psychologic distress, and psychoso
Chronic pain-associated depression: antecedent or cial dysfunction in Asian patients. J Orofac Pain
consequence of chronic pain? A review. Clin J Pain 2003;17:21- 28.
1997;13:116- 137. 49. List T, Dworkin SF. Comparing TM D diagnoses and
34. Manfredini D, Lobbezoo F. Role of psychosocial clinical findings at Swedish and US TM D centers
factors in the etiology of bruxism. J Orofac Pain using research diagnostic criteria for temporoman
2009;23:153- 166. dibular disorders. J Orofac Pain 1996;10:240- 253.
35. Dao TT, LeResche L. Gender differences in pain. 50. Gran JT. The epidemiology of chronic generalized
J Orofac Pain 2000;14:169- 184. musculoskeletal pain. Gr Best Pract Res Clin Rheu
36. Abubaker AO, Hebda PC, Gunsolley JN. Effects of matol 2003;17:547- 561.
sex hormones on protein and collagen content of 51. Westesson P-L, Eriksson L, Kurita K. Reliability of a
the temporomandibular joint disc of the rat. J Oral negative clinical temporomandibular joint examina
M axillofac Surg 1996;54:721- 727. tion: prevalence of disk displacement in asymptom
37. Landi N, Lombardi I, Manfredini D, Casarosa E, atic temporomandibular joints. Oral Surg Oral Med
Biondi K, Gabbanini M et al. Sexual hormone serum Oral Pathol 1989;68:551- 554.
levels and temporomandibular disorders. A prelimi 52. Greene C. Concepts of TM D etiology: effects on
nary study. Gynecol Endocrinol 2005;20:99- 103. diagnosis and treatment. In: Laskin DM , Greene
38. LeResche L. The global year against pain in women. CS, Plylander W L (eds). TM Ds: An Evidence-based
J Orofac Pain 2008;22:95- 96. Approach to Diagnosis and Treatment. Chicago, IL:
39. LeResche L, Mancl L, Drangsholt MT, Fluang G, Quintessence Publishing, 2006:219- 228.
Von Korff M . Predictors of onset of facial pain and 53. De Leeuw R, Boering G, Stegenga B. Clinical signs
temporomandibular disorders in early adolescence. of TM J osteoarthrosis and internal derangement 30
Pain 2007;129:269- 278. years after non-surgical treatment. J Orofac Pain
40. Stohler CS. Taking stock: from chasing occlusal con 1994;8:18- 24.
tacts to vulnerability alleles. Orthod Craniofac Res 54. Kononen M , Waltimo A, Nystrom M . Does clicking
2004;7:157- 161. in adolescence lead to painful temporomandibular
41. Ren K, Dubner R. Central nervous system plasticity joint locking? Lancet 1996;347:1080- 1081.
and persistent pain. J Orofac Pain 1999;13:155-163. 55. De Laat A. TM D as a source of orofacial pain. Acta
42. De Leeuw R. (ed) / The American Academy of Oro Neurol Belg 2001;101:26- 31.
facial Pain. Orofacial Pain: Guidelines for Assess 56. Milam SB. TM J osteoarthritis. In: Laskin DM , Greene
ment, Diagnosis, and M anagement. Chicago, IL: CS, Hylander WL (eds). TM Ds: An Evidence-based
Quintessence Publishing, 2008. Approach to Diagnosis and Treatment. Chicago, IL:
43. Winocur E, Steinkeller-Dekel M , Reiter S, Eli I. A Quintessence Publishing, 2006:105- 123.
retrospective analysis of temporomandibular find 57. Rammelsberg P, LeResche L, Dworkin SF et al. Long
ings among Israeli-born patients based on the RDC/ itudinal outcome of temporomandibular disorders:
TM D. J Oral Rehabil 2009;36:11- 17. a 5-year epidemiologic study of muscle disorders
44. Manfredini D, Chiappe G, Bosco M . Research Di defined by research diagnostic criteria for temporo
agnostic Criteria for Temporomandibular Disorders mandibular disorders. J Orofac Pain 2003;17:9- 20.
(RDC/ TM D) axis I diagnosis in an Italian patient 58. Magnusson T, Egermark I, Carlsson GE. A longitu
population. J Oral Rehabil 2006;33:551- 558. dinal epidemiologic study of signs and symptoms of
45. Reiter S, Eli I, Gavish A, Winocur E. Ethnic differ temporomandibular disorders from 15 to 35 years
ences in temporomandibular disorders between of age. J Orofac Pain 2000;14:251- 260.

-
( )
,
, , .

,
.
.
(IASP), «
(
, ) .

».1
.

.
.
, ,
. ,
1960- « .
» -
3-6 ,
, ,
.5
.23 ,
( )
.
- .6
-
( ).4-5 ,
, ,

-

,
.6-8
« -
»
. ,
,
,
- -
-
. ( . 3-1).
-
,
( ,
)78 , ( )
.
, ,
. : ( )
;
;
.
( )
(
, , .
). ,
, ,
,
( )
, .
. ,

. ,
.
( -
).
-
-
. ( . . 3-1). ,
,
,

-
,

( )
.

(£ ^ ^ ^ ^ ^)
( £) ( ^ ^ ) tJounaabHog)
( ) (^ ) -
. 3-1. ( ) ( )
( )
-
. ( . 3-2).
( - ,
, )
. .
.
( / ) -
( , ,
I) ( 3-1 ).9 .610

,
-
, -
. .4'67
, / /
(
. www.rdc- tm dinternational.org)

.9 .
3 : ,
.
.
, /
.

,7

-
3-1. - .
,
,
:

• ( )
.6'7
•

( I / ):
,
I:

II:
III: ,
.
,

( ),

,
( ).
, ,
,
(
) 7'8” ( . 21).
,
,
,
.

« »
,

.
,

( . 3-3).
,

-
,
( )
. 3-2.
( Su vin en et al.7)
. 3-3.

-
.
,

. .

,
, /
.
( )
.712 .13

, .
,
.
. ,
,
, ( . 3-4):
• ( , .
); ,
• - ( ),
( , ,
.7
); ,
• , . .
. ,

: .
• - (
); ,
• ,
; ,
• .8
;
•
.
,
(
) .
,

.8’12'14'15

-
, ,

. 3-4. (Su vin en et al.7).
: ( ) ; (
, ); ( , );
; ( ) ;

-
3-2. ,
(
)
:
•
•
•
• , , , , /
• , ,
•
• ( , )
:
•
•
•
• -
• -
•
• ( , ,
, , .)
•
:
•
• ( )
•
7
• ,
:
• ,
•
•
•
•
:
•
•
• ,
(
, - .
.).
, ( . / ).
. 3-2 -

.
.16 ,
.

, ,
. ,
( - , -
, ,

. ),
.
. •
, ,
,
(
,
. ,

.), ,
.

, ,
. .
• ,
.

( . 3-2). ,
•

, . , ,
,
.

(
), , .
, , ,
, , ,
, , ,
.8
, ,
.
• , ,
, ,
. -

-
. 3-5. . ,
,
. .10'17

.1819
,
, -
( . 3-5),
( ,
, ) ,
, .14 - ( . 3-6).
/
, ( I)
( , , , ( II) .
).
, . .

. 3-6. - :
•
( ) .19 (SCL90R) .
.
.
/

/ (International RDC/ TMD
. Consortium).

.
, /
.7-914 .
( I) ,
« ,
» .
( II)
( .
,
)
( , . .
). 4 (
. ),
( ).
:
•
;

-
. 3-7. ,
: ;
: ( ) ; ,
;
;
: ; ; ,
, , , (
) ,
.8 ;
• ,
.
. ,
.1920

. , ,
, ,
, 3
( . 3-7):
• ;
• , .7'2122

. 3-8.
a. : . - 63/ 100;
-4 ; - 27/ 100 ( ).
II: , . -
: , , , , ,
. : - 3/ 6;
- 2/6
b. : , .
- 73/ 100; - 31+ = 3/3 ; -
70+ / 100 = 3/3 . IV: ,
. : , ,
, , , ,
. 3-8
.

,

.
.
,
,

,

,
. , ,
,
,
/ . .
,

-
,
.23 ,
.
. ,

.
( 3-3).
. ,

,
. ,

, .
,
, , ,
,
,
. ,
, .

. ,
.
.
.
.
, ,
, . .,

. .726

.
.
,
,

,
.
. ,
70-80 %.242S ,


3-3. ( ,
,
).
•

•
•
.
-
•
,
•
.
•

•
,
.

« » ,
,
.725
.
,
, , ,
, , ,
, .
, , .
.
, -
. , ,

.7'81012

. ,

.
,

.22
.
,
, ,
,23
.7
.

.17 , .

,
,

-
- 3-4.
( 3-4).

•
.
• -

.816
•

•
,
•
.24-25 ,
•

. ,
,

. .
,
. ,
.

,
(Heli Forssell),
. (Yrsa Le Bell) -
(Annikki Vaisto)
.
. -
(Pentti Kemppainen)
(Academy of Finland)
. .

.

.

,

. ,

14. Laskin DM , Greene CS, Hylander W L. Temporo
mandibular Disorders. An Evidence-based Approach
1. Merskey . Classification of chronic pain: descrip to Diagnosis and Treatment. Chicago, IL: Quintes
tions of chronic pain syndromes and definitions of sence Publishing, 2006.
pain terms. Pain 1986;(Suppl 3):1- 8. 15. Forssell H, Ohrbach R. Temporomandibular disor
2. M elzack R, Wall PD. Pain mechanisms: a new theo ders. In: Zakrzewska JM (ed). Orofacial Pain. New
ry. Science 1965;150:971- 979. York: Oxford University Press, 2009.
3. M elzack R, Casey KL. Sensory, motivational, and 16. Von Korff M , Miglioretti DL. A prognostic approach
central control determinants of pain: a new concep to defining chronic pain. Pain 2005;117:304- 313.
tual model. In: Kenshalo DR (ed). The Skin Senses. 17. Melzack R. Pain: an overview. In: Proceedings of
Springfield, IL: Thomas, 1968:423^ 143. the 2nd International Copenhagen Pain Sympo
4. De Leeuw (ed). Orofacial Pain: Guidelines for As sium: Aspects of Chronic Pain, 1999;43:880- 884.
sessment, Diagnosis, and M anagement. Hanover 18. M cM ahon SB, Koltzenburg M . Wall and Melzack's
Park, IL: Quintessence Publishing, 2008. Textbook of Pain, ed 5. London: Elsevier, 2006.
5. Okeson JP (ed). M anagement of Temporoman 19. Turk DC, M elzack R (eds). Handbook of Pain As
dibular Disorders and Occlusion, ed 5. Edinburgh: sessment, ed 2. New York: Guilford Press, 2001.
Mosby, 2003. 20. Rudy , Turk DC, Zaki HS, Curtin HD. An empiri
6. Turp JC, Sommer C, Hugger A (eds). The Puzzle of cal taxometric alternative to traditional classification
Orofacial Pain: Integrating Research into Clinical of temporomandibular disorders. Pain 1989;70:
M anagement. Pain Headache. Basel: Karger, 2007. 158-164.
7. Suvinen T, Reade PC, Kemppainen P, Kononen 21. Suvinen Tl, Hanes KR, Gerschman JA, Reade PC.
M , Dworkin SF. Review of aetiological concepts Psychophysical subtypes of temporomandibular
of temporomandibular pain disorders: towards an disorders. J Orofac Pain 1997;11:200- 205.
integrated conceptual model of physical disorders 22. Suvinen Tl, Kononen M , Reade PC, Kemppainen
and psychological and psychosocial illness impact P. Temporomandibular disorder subtypes according
factors. Eur J Pain 2005;9:613- 633. to self-reported physical and psychosocial variables
8. Dworkin SF. Psychological and psychosocial as in female patients: a re-evaluation. J Oral Rehabil
sessment. In: Laskin DM , Greene CS, Hylander WL 2005;32:166- 173.
(eds). Temporomandibular Disorders: An Evidence- 23. Von Korff M , Dunn KM . Chronic pain reconsidered.
based Approach to Diagnosis and Treatment. Chi Pain 2008;13:267- 276.
cago, IL: Quintessence Publishing, 2006:203- 217. 24. Greene CS. Focus paper: the etiology of temporo
9. Dworkin SF, LeResche L. Research diagnostic criteria mandibular disorders: implications for treatment.
for temporomandibular disorders: criteria, examina J Orofac Pain 2001;15:93- 105.
tions and specifications, critique. J Craniomand Dis 25. Greene CS. Concepts of TM D etiology: effects on
Fac Oral Pain 1992;77:301- 355. Available updates diagnosis and treatment. In: Laskin DM , Greene CS,
at: www.rdc-tmdinternational.org. Hylander WL (eds). Temporomandibular Disorders:
10. Diatchenko L, Nackley AG, Slade GD, Fillingim RB, An Evidence-based Approach to Diagnosis and
M aixner W. Idiopathic pain disorders: pathways to Treatment. Chicago, IL: Quintessence Publishing,
vulnerability. Pain 2006;123:226- 230. 2006.
11. Dworkin SF, Von Korff M , LeResche L. Epidemio 26. Massoth DL, Dworkin SF, Whuitney CW, Harrison
logic studies of chronic pain: a dynamic-ecologic RG, Wilson L, Turner J. Patient explanatory models
perspective. Ann Behav Med 1992;14:3- 11. for temporomandibular disorders. In: Gebhard GF
12. Turner JA, Dworkin SF. Screening for psychosocial et al. (eds). Proceeding of the 7th World Congress
factors in patients with chronic orofacial pain. J Am of Pain. Seattle: IASP Press, 1994:187- 200.
Dent Assoc 2004;135:1119- 1125.
13. Suvinen T, Kemppainen P. Assessment of asymp
tomatic and muscle related TM D parameters: criti
cal review of clinical electromyographic studies.
J Oral Rehabil 2007;34:631- 644.

II

4
, . .

, -
. .
,
.
,

.

. ,
- . ,
, , , ,
,
, ,
. .6

.
, ,
,
. ,
. ,
( .6
), ( ,
), , , 17

. 4-1.

( , ,
),
,
-
. M ense Hoheisel ,
(N GF)
IV ,
( ),
.1'
, .

.
-
,
( ,
, )
N GF
IV .
,

. TN F -
; TRPV - ; PG -
; N M D A - N- - - ;
-
, , . -
, . ,
.
, .

,
.

.1 ,

, , .
,
,
( , *), ,
( ,
* Catastrophizing ( .) -
).
.{ , .)

4-1. , , ,
- + . .
(ASIC) pH. +
.
pH
-
94
. .
TRPV1 + pH. +
(
)
2 3

N M DA-
TrkA ( -
) (N GF)
1/ 2
4- ( ),
. - ( 2 ) . .
( IV) ( . 4-1).
(~1 / ) ,1
, . -
-
( III), , ,
(2,5-35 / ), .
, .
,
,
. III ,
IV ,
( ).
( ) ,
.8
.
- (ASIC,
TRPV1, / - -D- TRPV1) ( 2 3)
(NMDA) , ,
- - - -5- - ( . 4-1).

( ) .
(
).
-
( ).
( , (sprouting).9 ,
, ),
( . . 4-1, . 4-1).
,
( . . 4-1)
.
-
( . . 4-1).
,10
. , ,
.
,
, .
-
, - .10
.

- « » -
. , ,

( , ,
),
( )
. (trigeminal
brainstem sensory nuclear com plex, VBSNC)
. ( . 4-2).8
,
(
( 4-1). ),
(
4-1. - )
(
).
• -
,

,
• - - ,
, , , -

. 4-2.

-
( ), ( )
( ).

.
,
,
,
- -
3- -5- -4-

( )
. ,5'11 -

, , .
. . ,
, . .12
( . . 4-2).
30

.
.
,
.
( ) ,
, .
-

. 4-3.

.
, ,
, , ,
. ,

,

.
-
- (
). 2 3
(
)
, .
-
,
.

(G)
(SP),
N M DA-
( ).
( ) - ,
, .
.
( ), ,
.
.
.5
(NM DA- )

.
( . 4-3).
.
(CGRP),
NMDA- .

- , -1- ,


.
( ) ,
.
, ,

. ,
« » . ,
(wind-up).
NMDA-
, ,
. , .
-
, ,
. (
,
. . 4-3 ,
),
b ( ,
. ,
, )
,

, . .

b .

, , .
( )

. -
( ) ,
. . ,
-
« »
.

.
,
.
. ,
. ,

,
.13 ,

.
( ,
-
).

(
, )
.

- , - ( ) -
, ( ).19'20 ( )
. ,
.
. ,
- ( )
( ).3'19-20
,

.
- -
.

( , - .
)
. (
,5 4~17 [-] . 4-4).
,

. .
, (5- ,
5- ), ( ),
, -
( , ( ).
, - (
- a, -1, , ,
)
(BDNF) . .), ( ,
)
( . . 4-3).
, .

.1718 ,
,
( ). ,
.11'17'18 , -

. 4-4.
.
-
( [+]
[- ]). - ;
PAG - ;
CSN V -
; RVLM -
;
DRN - ;
N ST - ; PBN - -
; PN - ;
-
, (
, , )
.
.
,
( [+]
. . 4-4).
-
( ).
( , , .20
,
. .)
.3'21 .
, ,
.
. -
.
.

.21
,
( )
. ,
-

. ,24
, -
.22
.
.

, ( )
,
,
. , . 4-3
. ( )

. ( )
( ).
,22
« » .
.23

,
I . ( )

, ,
.
-1- - NMDA- . « »

. , ( ,
, , . .)
, .

.
. , ,
.
, ( ) .
,

. .
, ,
.
,
(
)
. ,
. (
) .
,
.

(
)
- (
, ).26

( , ,
)325 . ,
,
( .27 -
).

.25 ,
,
SLC6A4,
.26
.
.
- - .25

,
.25 ( ,
).

-
, .
.25 .2829
,
( ,
, )
,
,
.30-34
,
.30"32'34"36

, Lund .35 1991 .
,
.

.
.3536
( . 4-4).
- ,

- , , -
. , ,
(. .
)

. ( . 4-5).
(
. , ,
. .)
.
.
(
) . - (
- , , ,
« » ), -
, , , (
.3637 , , -
) - (
)
. , .

, . ,
- -
.2834-39
, ,
. ,
, -
,
.48
,40-42 -
- - ,
.143'44 .
,
.49 ,
,45 38
,4647 ,
.60-62
. -

.

.

( ).28'29 ( )
, .


. 4-5.
( ).

,

, -
-
49
,
( ) .53 (
,
) ( )
, ( ,
.3854 , ,
. ),
,
, , ( ,
).55 ,
. ( , ,
, ) (
, )
. .56

,
,
. .57

,
,

, .
,

.58 .
: ,
,59 - ,
,

.60
.
20- ,
, ,
, ,

7. - ,
, ,66
, -
. (100 )
.
,
,
.6162 .6667
,
,
. .68 ,
,

.24 ,69
27 %
. .70'71
.

.24
/
( ,
,
, ) .72 /
,
,

, (
.6364 ).
73,
,
- , /
. -

.81 ,
.74
-
,
.3176
, ( ), .81 ,

.
.

.

.
,
.
(
, , ,
,
).
, .
.76 ,
, .82

. 24-48

, 3-7 .
.
( ,
19 )
.83
.77
,
( ) .34
, ,
.78-79 ,
.
ASIC- TRPV1-
. ,
.
,
. -
, . ,
( - ),
.80
,
.


.84 .85

.
,
( . 14)
-
, . 75 %
.37 .86

, ,
( , . .). ,
, ,
, (
. ).86 ,
. 87,
.86
.
- (International
Headache Society),
. .
,
, ( ).88
. ,
, 78 %
.37 .88 ,

, .89
. ( )
90
.
( ) .33 -
,
,
,
.91
. (
,
.86 , ,
, , )
.82 50 .
-
( ,
), , , .91
. ,
,

.
2 ,
1. Mense S. The pathogenesis of muscle pain. Curr
. Pain Headache Rep 2003;7:419- 425.
. 2. Marchand F, Perretti M , M cMahon SB. Role of the
, immune system in chronic pain. Nat Rev Neurosci
2005;6:521- 532.

3. Svensson P, Jadidi F, Arima T, Baad-Hansen L, Sessle
.92 BJ. Relationships between craniofacial pain and
bruxism. J Orofac Pain 2008;35:524- 547.
4. Dubner R, Ren K. Brainstem mechanisms of
persistent pain following injury. J Orofac Pain
(
2004;18:299- 305.
-- 5. Sessle BJ. Central mechanisms of craniofacial mus
, , ), culoskeletal pain: a review. In: Graven-Nielsen T,
( ), Arendt-Nielsen L, Mense S (eds). Fundamentals
of Musculoskeletal Pain, ed 1. Seattle: IASP Press,
,
2008:87- 103.
( ), 6. Walder RY, Sluka KA. Bilateral, long-lasting hyper-
( ).93 algesis due to repeated excitation of muscle no
, ciceptors: a role for ASIC3. In: Graven-Nielsen T,
Arendt-Nielsen L, Mense S (eds). Fundamentals
. of Musculoskeletal Pain, ed 1. Seattle: IASP Press,
2008:75- 85.
7. Lewis T. Pain. New York: M acM illan, 1942.
8. Cairns BE. Physiological properties of thin-fiber
muscle afferents: excitation and modulatory effects.
In: Graven-Nielsen T, Arendt-Nielsen L, Mense S
(eds). Fundamentals of Musculoskeletal Pain, ed 1.
, Seattle: IASP Press, 2008:19- 32.
9. Reinert A, Kaske A, Mense S. Inflammation-induced
,
increase in the density of neuropeptide-immuno-
- . reactive nerve endings in rat skeletal muscle. Exp
Brain Res 1998;121:174- 180.
10. Cairns BE. The influence of gender and sex steroids
on craniofacial nociception. Headache 2007;319-
324.
11. Mense S, Hoheisel U. Mechanisms of central ner
. vous hyperexcitability due to activatioin of muscle
nociceptors. In: Graven-Nielsen T, Arendt-Nielsen
L, Mense S (eds). Fundamentals of Musculoskeletal

Pain, ed 1. Seattle: IASP Press, 2008:61- 73.
. , 12. Hu JW, Sessle BJ, Raboisson P, Dallel R, Woda A.
, Stimulation of craniofacial muscle afferents induces
prolonged facilitatory effects in trigeminal nocicep
tive brain-stem neurones. Pain 1992;48:53- 60.
, 13. Henderson LA, Bandler R, Gandevia SC, Macefield
VG. Distinct forebrain activity patterns during deep
versus superficial pain. Pain 2006;120:286- 296.
.
14. M cM ahon SB, Cafferty WBJ, Marchand F. Immune
and glial cell factors as pain mediators and modula
. tors. Exp Neurol 2005;192:444- 462.
15. De Leo JA, Tawfik VL, LaCroix-Fralish M L. The tet-
rapartite synapse: path to CNS sensitization and
chronic pain. Pain 2006;122:17- 21.
16. Bains JS, Oliet SHR. Glia: they make your memories
. stick! Trends Neurosci 2007;30:417- 424.
17. Sessle BJ. Glia: Non-neural players in orofacial pain.
J Orofac Pain 2007;21:169- 170.

18. Guo , Wang , Watanabe , Shimizu , Zou S, 34. Stohler CS. Craniofacial pain and motor function:
LaGraize SC et al. Glial-cytokine-neuronal interac pathogenesis, clinical correlates, and implications.
tions underlying the mechanisms of persistent pain. Crit Rev Oral Biol Med 1999;10:504- 518.
J Neurosci 2007;27:6006- 6018. 35. Lund JP, Donga R, Widmer CG, Stohler CS. The pain-
19. M aixner W. Pain modulatory systems. In: Sessle BJ, adaptation model: a discussion of the relationship
Lavigne G, Lund JP et al. (eds). Orofacial Pain: From between chronic musculoskeletal pain and motor
Basic Science to Clinical M anagement, ed 2. Chi activity. Can J Physiol Pharmacol 1991;69:683-694.
cago, IL: Quintessence Publishing, 2008:61- 68. 36. Lund JP. Pain and movement. In: Lund JP, Lavigne
20. Millan M J. Descending control of pain. Prog Neuro- G, Dubner R et al. (eds). Orofacial Pain: From Basic
biol 2002:66:355^ 74. Science to Clinical M anagement. Chicago, IL: Quin
21. Yarnitsky D, Crispel Y, Eisenberg E, Granovsky Y, tessence, 2001:151- 163.
Ben-Nun A, Sprecher E et al. Prediction of chronic 37. Svensson P, Graven-Nielsen T. Craniofacial muscle
post-operative pain: pre-operative DNIC testing pain: review of mechanisms and clinical manifesta
identifies patients at risk. Pain 2008;138:22- 28. tions. J Orofac Pain 2001;15:117- 145.
22. Passatore M , Roatta S. Modulation operated 38. van J, Selen LPJ, Cholewicki J. Trunk muscle ac
by the sympathetic nervous system on jaw re tivation in low-back pain patients: an analysis of the
flexes and masticatory movement. Arch Oral Biol literature. J Electromyogr Kinesiol 2003;13:333- 351.
2007;52:343- 346. 39. Graven-Nielsen T, Svensson P, Arendt-Nielsen L.
23. LeResche L, Drangsholt MT. Epidemiology of orofa Interaction between muscle pain and motor control.
cial pain: prevalence, incidence, and risk factors. In: In: Johansson H, Windhorst U, Djupsjobacka M et
Sessle BJ, Lavigne G, Lund JP et al. (eds). Orofacial al. (eds). Chronic Work-related Myalgia: Neuro
Pain: From Basic Science to Clinical M anagement, muscular Mechanisms behind Work-related Chron
ed 2. Chicago: Quintessence Publishing, 2008:13- ic Muscle Pain Syndromes. Umea: Gavle University
18. Press, 2003:141- 154.
24. Glaros AG, Burton E. Parafunctional clenching, pain, 40. Svensson P, Arendt-Nielsen L, Houe L. Muscle pain
and effort in temporomandibular disorders. J Behav modulates mastication: an experimental study in
Med 2004;27:91- 100. humans. J Orofac Pain 1998;12:7- 16.
25. Diatchenko L, Nackley AG, Tchivileva IE, Shabalina 41. Stohler CS, Ashton-Miller JA, Carlson DS. The ef
SA, M aixner W. Genetic architecture of human pain fects of pain from the mandibular joint and muscles
perception. Trends Genet 2007;23:605- 613. on masticatory behaviour in man. Arch Oral Biol
26. Schmidt-Wilcke T, Leinisch E, Ganbbauer S, Dra- 1988;33:175- 182.
ganski B, Bogdahn U, Altmeppen J et al. Affective 42. Sae-Lee D, Whittle T, Peck CC, Forte ARC, Klineberg
components and intensity of pain correlate with IJ, M urray GM . Experimental jaw muscle pain has a
structural differences in gray matter in chronic back differential effect on different jaw movement tasks.
pain patients. Pain 2006;125:89- 97. J Orofac Pain 2008;22:15- 29.
27. Sessle BJ. Awareness of pain awareness. J Orofac 43. Svensson P, Arendt-Nielsen L, Houe L. Sensory-
Pain 2005;19:5. motor interactions of human experimental unilat
28. M urray GM , Peck CC. Orofacial pain and jaw muscle eral jaw muscle pain: a quantitative analysis. Pain
activity: a new model. J Orofac Pain 2007;21:263- 1995;64:241- 249.
278. 44. Sae-Lee D, Whittle T, Forte ARC, Peck CC, Byth K,
29. Peck CC, M urray GM , Gerzina TM . How does pain Sessle BJ et al. Effects of experimental pain on jaw
affect jaw muscle activity? The integrated pain ad muscle activity during goal-directed jaw movements
aptation model. Aust Dent J 2008;53:201- 207. in humans. Exp Brain Res 2008;189:451- 462.
30. Travell JG, Rinzler S, Herman M . Pain and disability 45. Graven-Nielsen T, Svensson P, Arendt-Nielsen L. Ef
of the shoulder and arm: treatment by intramus fects of experimental muscle pain on muscle activity
cular infiltration with procaine hydrochloride. J Am and co-ordination during static and dynamic mo
Med Womens Assoc 1942;120:417- 422. tor function. Electroencephalogr Clin Neurophysiol
31. Travell JG, Simons DG. Myofascial Pain and Dys 1997;105:156- 164.
function: The Trigger Point M anual. Baltimore, M D: 46. Birch L, Christensen H, Arendt-Nielsen L, Graven-
Williams and Wilkins, 1983. Nielsen T, Sogaard K. The influence of experimental
32. Johansson H, Sojka P. Pathophysiological mecha muscle pain on motor unit activity during low-level
nisms involved in genesis and spread of muscular contraction. Eur J Appl Physiol 2000;83:200- 206.
tension in occupational muscle pain and in chronic 47. Ervilha UF, Arendt-Nielsen L, Duarte M , Graven-
musculoskeletal pain syndromes: a hyopthesis. Med Nielsen T. The effect of muscle pain on elbow
Hypotheses 1991;35:196- 203. flexion and coactivation tasks. Exp Brain Res
33. Mense S, Simons DG, Russell IJ. Muscle Pain: Under 2004;156:174- 182.
standing its Nature, Diagnosis, and Treatment. Phila
delphia, PA: Lippincott, Williams & Wilkins, 2001.

48. Turner JA, Brister H, Huggins KH, Mancl LA, Aaron 63. Chen C-Y, Palla S, Erni S, Sieber M , Gallo LM . Non
LA, Truelove E. Catastrophizing is associated with functional tooth contact in healthy controls and
clinical examination findings, activity interference, patients with myogenous facial pain. J Orofac Pain
and health care use among patients with temporo 2007;21:185- 193.
mandibular disorders. J Orofac Pain 2005;19:291- 64. Peck CC, Kaldenberg M , De Vries S et al. Non-func
300. tional masseter activity in jaw muscle pain subjects
49. Craig AD Jr. A new view of pain as a homeostatic [abstract], J Dent Res 2007;86 (Spec Is A):2479.
emotion. Trends Neurosci 2003;26:303- 307. 65. Carlsson GE, Egermark I, Magnusson T. Predictors
50. Mogil JS. The genetic mediation of individual dif of signs and symptoms of temporomandibular dis
ferences in sensitivity to pain and its inhibition. Proc orders: a 20-year follow-up study from childhood to
Natl Acad Sci USA 1999;96:7744- 7751. adulthood. Acta Odontol Scand 2002;60:180- 185.
51. Sessle BJ. Acute and chronic craniofacial pain: brain 66. Kirveskari P, Alanen P, Jamsa T. Association between
stem mechanisms of nociceptive transmission and craniomandibular disorders and occlusal interfer
neuroplasticity, and their clinical correlates. Crit Rev ences. J Prosthet Dent 1989;62:66- 69.
Oral Biol Med 2000;11:57- 91. 67. Kirveskari P, Le Bell Y, Salonen M , Forsell H, Grans
52. Casey KL. Forebrain mechanisms of nociception L. Effect of elimination of occlusal interferences on
and pain: analysis through imaging. Proc Natl Acad signs and symptoms of craniomandibular disorders
Sci USA 1999;96:7668- 7674. in young adults. J Oral Rehabil 1989;16:21- 26.
53. De Troyer A, Kirkwood PA, Wilson . Respira 68. Stohler CS. Management of dental occlusion. In:
tory action of the intercostal muscles. Physiol Rev Laskin DM , Greene CS, Hylander W L (eds). Tem
2005;85:717- 756. poromandibular Disorders: An Evidence-based Ap
54. Johansson H, Arendt-Nielsen L, Bergenheim M , proach to Diagnosis and Treament. Chicago, IL:
Blair S, van Dieen J, Djupsjobacka M . Epilogue: An Quintessence Publishing, 2006:403- 411.
integrated model for chronic work-related myalgia 69. Zhang X, Ashton-M iller JA, Stohler CS. Three-
“ Brussels M odel". In: Johansson H, Windhorst U, dimensional unilateral method for the bilateral
Djupsjobacka M et al. (eds). Chronic Work-relat measurement of condylar movements. J Biomech
ed M yalgia: Neuromuscular Mechanisms behind 1995;28:1007- 1011.
Work-related Chronic Muscle Pain Syndromes. 70. De Boever JA, Carlsson GE, Klineberg IJ. Need for
Umea: Gavle University Press, 2003:291- 300. occlusal therapy and prosthodontic treatment in the
55. Diatchenko L. Idiopathic pain disorders - pathways management of temporomandibular disorders, part
of vulnerability. Pain 2006;123:226- 230. II: tooth loss and prosthodontic treatment. J Oral
56. Huang GJ, LeResche L, Critchlow CW, Martin M D, Rehabil 2000;27:647- 659.
Drangsholt MT. Risk factors for diagnostic sub 71. Greene CS. The etiology of temporomandibular
groups of painful temporomandibular disorders disorders: implications for treatment. J Orofac Pain
(TM D). J Dent Res 2002;81:284- 288. 2001;15:93- 105.
57. M acFarlane TV. Predictors of outcome for orofacial 72. Dworkin SF, LeResche L. Research diagnostic criteria
pain in the general population: a four-year follow for temporomandibular disorders: review, criteria,
up study. J Dent Res 2004;83:712- 717. examinations and specifications, critique. J Crani-
58. Velly AM , Gornitsky M , Philippe P. Contributing omandib Disord 1992;6:301- 326.
factors to chronic myofascial pain: a case-control 73. Fricton JR. M anagement of masticatory myofascial
study. Pain 2003;104:491- 499. pain. Semin Orthod 1995;1:229- 243.
59. Dohrenwend BP, Raphael KG, Marbach JJ, Gallagher 74. Schmitter M , Ohlmann B, John MT, Hirsch C, Ram-
RM. Why is depression comorbid with chronic myo melsberg P. Research diagnostic criteria for tem
fascial face pain? A family study test of alternative poromandibular disorders: a calibration and reliabil
hypotheses. Pain 1999;83:183- 192. ity study. Cranio 2005;23:212- 218.
60. Slade GD, Diatchenko L, Bhalang K, Sigurdsson A, 75. Hong CZ, Simons DG. Pathophysiologic and elec-
Fillingim RB, Belfer I et al. Influence of psychologi trophysiologic mechanisms of myofascial trigger
cal factors on risk of temporomandibular disorders. points. Arch Phys Med Rehabil 1998;79:863- 872.
J Dent Res 2007;86:1120- 1125. 76. Borg-Stein J. Focused review: myofascial pain. Arch
61. Nicholson RA, Townsend DR, Gramling SE. Influ Phys Med Rehabil 2002 ;83.
ence of a scheduled-waiting task on EM G reactiv 77. Tough EA. Variability of criteria used to diagnose
ity and oral habits among facial pain patients and myofascial trigger point pain syndrome-evidence
no-pain controls. Appl Psychophysiol Biofeedback from a review of the literature. Clin J Pain 2007;23:
2000;25:203- 219. 278- 286.
62. Hori N, Yuyama N, Tamura K. Biting suppresses 78. MacDonald JW, Hannam AG. Relationship between
stress-induced expression of corticotropin-releasing occlusal contacts and jaw-closing muscle activ
factor (CRF) in the rat hypothalamus. J Dent Res ity during tooth clenching: part II. J Prosthet Dent
2004;83:124- 128. 1984;52:862- 867.

79. Hannam AG, M cM illan AS. Internal organization 87. Wolfe F. Fibromyalgia. In: Sessle BJ, Bryant PS,
in the human jaw muscles. Crit Rev Oral Biol Med Dionne RA (eds). Temporomandibular Disorders
1994;5:55- 89. and Related Pain Conditions. Seattle: IASP Press,
80. Palla S. Trigger points as a cause of orofacial pain. 1995:31- 46.
J Musculoskel Pain 2005;12:29- 36. 88. Headache Classification Cubcommittee of the Inter
81. Gandevia SC. Spinal and supraspinal factors in hu national Headache Society. The International Clas
man muscle fatigue. Physiol Rev 2001;81:1725- sification of Headache Disorders, ed 2. Cephalalgia
1789. 2004;24:1- 160.
82. Gonzalez YM , Mohl ND. Masticatory muscle pain 89. Bendtsen L. Central sensitization in tension-type
and dysfunction. In: Laskin DM , Greene CS, Hy headache: possible pathophysiological mechanisms.
lander W L (eds). Temporomandibular Disorders: Cephalalgia 2000;20:486- 508.
An Evidence-based Approach to Diagnosis and 90. Tato F, Hoffman U. Giant cell arteritis: a systemic
Treament. Chicago, IL: Quintessence Publishing, vascular disease. Vase Med 2008;13:127- 140.
2006:255- 269. 91. Cantini F, Niccoli L, Nannini C, Bertoni M , Salvarani
83. Armstrong RB. Mechanisms of exercise-induced de C. Diagnosis and treatment of giant cell arteritis.
layed onset muscular soreness: a brief review. Med Drugs Aging 2008;25:281- 297.
Sci Sports Exerc 1984;16:529- 538. 92. Kreiner M , Okeson JP. Toothache of cardiac origin.
84. Graven-Nielsen T, Arendt-Nielsen L. Human models J Orofac Pain 1999;13:201- 207.
and clinical manifestations of musculoskeletal pain 93. Bliddal H, Curatolo M . Clinical Manifestations of
and pain-potor interactions. In: Graven-Nielsen T, muscle and joint pain. In: Graven-Nielsen T, Arendt-
Arendt-Nielsen L, Mense S (eds). Temporoman Nielsen L, Mense S (eds). Fundamentals of M uscu
dibular Disorders: An Evidence-based Approach loskeletal Pain. Seattle: IASP Press, 2008:327- 345.
to Diagnosis and Treatment. Seattle: IASP Press, 94. Mense S, Hoheisel U. Morphology and functional
2008:255- 269. types of muscle nociceptors. In: Graven-Nielsen T,
85. Mense S. Neurobiological basis for the use of botu- Arendt-Nielsen L, Mense S (eds). Fundamentals of
linum toxin in pain therapy. J Neurol 2004;251. Musculoskeletal Pain. Seattle: IASP Press, 2008:
86. Plesh O, Gansky SA. Fibromyalgia. In: Laskin DM , 3- 17.
Greene CS, Hylander W L (eds). Temporomandibu
lar Disorders: An Evidence-based Approach to Di
agnosis and Treatment. Chicago, IL: Quintessence
Publishing, 2006:335- 345.

5
,
- - ( )
( )
- 78 %
( ), .7
( ) ,
.1

« - .
»,2
. Tasaki .

(Bell) « - ,
»3. MPT-
. ,
.8

- .4
,
( )
( ,
) ( .
, . .).
18 %
, 70 % ,
( ) , .
,
,
,
.56 6 % (

-
. 5-1. .
( ).
,
.
.
.
. 5-1 .
( )
( ), .
. 5-1 .
.
( ).
.
,
11 ),9 34 % ( ,
16-19 )10 31-34 % -
.1112
, .
,
-
,13 30
2 5
.14 ( . 5-1).
, ,

,
,
.
.
,
- . .
.

.
.15-17 ,
75 %

. , 6-12 - ,

, ,
.
: ,
, ,
-

, .
, ,
.
. ,
, , Borrelia
burgdorferi ( ) Chlamydia
trachomatis (
( ) ).
,

, Henry .19 -
,
.1

. , 39 %
Ch. trachomatis.
. ( )
( )
Ch. trachomatis
.
( . ,

) , - ,
,
,
, .

.18 Ch. trachom atis 6,6 %

-
50 %
(10-45 %).28
.
.29
Ch. trachomatis
, ,
.20 ,
, .
Ch. trachom atis
.

Henry . .
Mycoplasm a genitalium, , ,
Ch. trachomatis,
.21 (HLA),
(
, )
Neisseria gonorrhoeae22 . genitalium ,23 ,
HLA
.
HLA ,
.
, ,
. genitalium (86 %), Staphy ,
lococcus aureus (51,2 %), Mycoplasm a .30
fermentans/ orale (37,2 %), Actinobacillus ,
actinom ycetem com itans (25,6 %) St repto
coccus m itis (7 %).24 , ,
7 CREG. ,

. ,
, S. aureus
(60,6 %) HLA.
,
(20 %).
, Ch.
trachomatis -
(TNF-a)
6 (IL-6) 67 47 % ,
. .
Ch. trachomatis
Ch. trachomatis 16 8 %, .
, ,
, , Ch.
(36 5 %, trachomatis
),25-27
- .31

,
, .
,
( . 5-3). ,
,
.

.
32
,33' 35 .37
-
. (Isberg)
11'12 (Westesson), -
, 60 %
,

,36 , ,
.
, .38
57 % Hall .,
.36 ,
.39

,
. ,
.40
1982 . (Welden Bell)
,
.3
, .41
,
( . 5-2).
(Atkinson) (Bates) .
,

.42'43 Sato .44
,
-

-
. 5-2. . .
( )3. .
. (
)3
. 5-3. . .
, ( ),
. ,
( ),
(
)37. . .
, ( ),
. ,
( ),
, ,
(
)37, .
.
(
)37

.
-
,
, ,
. Panmekiate .46 - , -
,
( = 54) .

20 :
,
.

. , ,
, ,
,
,
. ,
Ren .,
. ,
, ,
.46
, ,
. .
,

,

.
Kurita
.47 MPT-
,50-52
,

.48 - ,
151 ( 2:1 4:1 ).63'54
Kurita 49
,
(
. 5:1 9:1, ).711

4-6 , .5354
.

,
. .

-
3
.55 Abubaker
.
, ,
,5657 .65 ,
.56 80
(Cecil) (Archer)59
, ,
.
- ,
,
. , .
- :
.
20 ,
,
. , .

,
. ( ) 17 - .
.6^ Yasuoka .
.61
.66
,
(
.62 in vivo ),
-
.63 ,

.

.

.
. Okuda .
, .
.64
- .

,
,
.
.

. .57

.
,
,
,
5:1 9:1,7.11
.
2
, ,9-11
( .72-73
)

. .74

.67 .7576

,
.68 1993 . Abubaker .
.77
.69 ,
( .
Nekora-Azak78) ,
.

, ,
.
.
14
.70
28 .71

,
.
,
. , ,
, , .
, 1948 . -
- . , (Cecil Wakeley)79
.

( ,
. .)
, ( ).

-
,83 , Gerhard
.,
, ,
(18,4 %)
( . 5-4).
( ,
) .84
-
( . 5-5 5-6). :
9,1 %
,
(1- ). 2-
( . 5-7 3-
5-8). 30,8 85,7 % ,
, . . ,
,
. ,

, , , .
.85
.
, ,
MPT-

. 86 ( . 5-9).
MPT-
(50 %) , ,
.80 (
)

,81 .
, ,87
. ,
.
36,3 %
, 26 % 39 %
, .
, ( ,
1,5:1 1,8:1, ).82
: .88
MPT-
,
, . Sullivan . ,
( ) 77 %
,89

. 5-4.
. 5-5. .
, 24 . . .
. 5-6. .
.
.
.

-
. 5-7. .
, 4 .

. .
(
)
. 5-8. . 11 . . .
( )

. 5-9. .
. . .
( )
,
. .
, ( )
.8490 « »
1945 . (Davis)
.
, .93
.91 ,
( .

) 95 %92.
.94
. ,
,
, ,95-97
,
. .98
22 25
.95 -


-
56 % ."
,
87 % .100
.

,
, -
. .
M cKay Christensen ,
.101 ,
. ,
Bergman . - « »
60 , 3-14
.
.102
53 (Costen),
.
.105106 1934 . -
,
.107
(53 45 %, ).

,
. , -
.
, 5
.
. - .
,
2 ,
,
.103 ,
Braun ., , 75
,
,
« » .
.104

. , ,
,
.

.
,
, , ,
.108
,
, .

,109" 0
( ,
).111'112
. ,

. Schuyler113 (1935 .)
M cCollum114 (1938 .) .43 ,
« [ ]
» ,
, . ,
. « »
, .
. Ricketts, ,
II « » «
» -
.115 Granger ,
, .119
Pullinger Seligman
.115 Ramfjord ,
,
, ,
.117 , . .
, .120 ,
,
,
. .
,
,
« » .118
, , ,
-
. , .
,
,
.
.
,
.
.

-
( , ,
,
. Pullinger Seligman )
11 , ,
,
(
)
.120 ,
« » . ,
, ,
.
,
.

. ,
, ,
.
, (National Institute
of Health),
.1'122
, , ,
-
.123
.
,
,

( )
( ) 2 1967 .
24
5 . , -
,
, 124 ( . 5-10).
. «
» ( ).
« »
. , ,

, . ,
, ,
Pullinger Seligm an120
.121 .
, , ,
,
, ,

. .

,
.133

(
, - ).
125 (
« » ),
- , ,134
,

. ,

. , .
,

,
.126 M PT- .

81 % .127

( . 5-16).
. ,

( . 5-11-5-13). ,
( . 5-14 .136
5-15), ,
( 3%
128)
21-30 .129 71 % .135
1950 . Ricketts - 68 %

.
,
.130
Wassm und ,
.131

(70 % .
), Nevakari 1984 . Solberg
«elapsio praearticularis»,132 ( ).136 Bates .

Katzberg .

.137
.

-
. 5-10a-5-10f.

. 5-11. . (46 ).
. .
end . . ,
( , )

-
. 5-12. .
(51 ).
.
.
.
( )

, 9 % .144
13 39
,140 , ,
,
.141 .
Kavuncu .

.146
.142
. 895 -

.146
( , ,
) , ,

III
.143 39 % I
.

. 5-13. .
(55 ).
. .
.
( )
.
,
, d u e.


-
. 5-14. . . .
.
.
, -
, . (Farrar) d.

. .
. ,
.147 37 %
- .
. .

, 13 39
(30 %)
. , , ,

. 5-15. . 73 3
. ( ).
. . .
( ) ( - (Lu is Giam b art o lo m ei), ,
)
. 5-16.

-

.148 - 3 4 .
Agerberg .
- -

, .
,
,
,
.149 .
.160
Greenwood, .

,

.151
,
.
.152 Winocur .

.43157
15-16 .153 Conti . ,
,
.154 . ,
,
2002 , -
,

, .
.166

.
-
(Beight o n), .
•
.14
( ).156

,
, . . , .
. •
, .

• ing orthodontic patients with temporomandibular
joint disorders. Am J Orthod Dentofacial Orthop
1992;101:54- 59.
10. Ribeiro RF, Tallents RH, Katzberg RW, M urphy WC,
. Moss M E, Magalhaes AC et al. The prevalence of
• disc displacement in symptomatic and asymptom
atic volunteers aged 6 to 25 years. J Orofac Pain
1997;11:37- 47.
, 11. Katzberg RW, Westesson P-L, Tallents RH, Drake
CM . Orthodontics and temporomandibular joint
internal derangement. Am J Orthod Dentofacial
Orthop 1996;109:515- 520.
12. Kircos LT, Ortendhal DA, M ark AS, Arakawa M.
. M agnetic resonance imaging of the TM J disk in
• - asymptomatic volunteers. J Oral Maxillofac Surg
1987;45:852- 854.
.
13. De Bont LGM , Dijkgraaf LC, Stegenga B. Epide
, miology and natural progression of articular tem
, poromandibular disorders. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 1997;83:72- 76.
14. Paesani D, Salas E, M artinez A, Isberg A. Prevalence
.
of temporomandibular joint disk displacement in in
fants and young children. Oral Surg Oral Med Oral
15. Lundh T, Westesson P-L, Erikkson L, Brooks S. Tem
poromandibular joint disk displacement without
reduction: treatment with flat occlusal splint ver
sus no treatment. Oral Surg Oral Med Oral Pathol
1. Okeson JP (ed). Orofacial Pain: Guidelines for As 1992;73:655- 658.
sessment, Diagnosis, and M anagement. The Ameri 16. Kurita K, Westesson P-L, Yuasa H, Toyama M,
can Academy of Orofacial Pain. Chicago, IL: Quin Machilda J, Ogi N. Natural course of untreated symp
tessence, 1996. tomatic temporomandibular joint disc displacement
2. McNeill C, Danzig W M , Farrar WB, Gelb H, Ler- without reduction. J Dent Res 1998;77:361-365.
man M D, M offett BC et al. Position paper of the 17. Sato S, Goto S, Kawamura H, Motegi K. The natu
American Academy of Craniomandibular Disorders. ral course of nonreducing disc displacement of the
Craniomandibular (TM J) disorders - the state of the TM J: relationship of clinical findings at initial visit
art. J Prosthet Dent 1980;44:434- 437. to outcome after 12 months without treatment.
3. Bell WE. Clinical M anagement of Temporoman J Orofac Pain 1997;11:315- 320.
dibular Disorders. Chicago, IL: Year Book Medical 18. Primer of the Rheumatic Diseases, ed 12. Georgia:
Publishers, 1982. Arthritis Foundation, 2001:239- 258.
4. Okeson JP. Bell's Orofacial Pains, ed 5. Chicago, IL: 19. Henry CH, Hudson AP, Gerard HC, Franco PF, Wol
Quintessence, 1995:123- 133. ford LM . Identification of chlamydia trachomatis in
5. Carlsson GE, DeBoever JA. Epidemiology. In: Zarb the human temporomandibular joint. J Oral M axil
GA, Carlsson GE, Sesle BJ, M ohl ND (eds). Temporo lofac Surg 1999;57:683- 688.
mandibular Joint and Masticatory M uscle Disorders, 20. Schumacher HR, Arayssi T, Crane M , Lee J, Gerard
ed 2. Copenhagen: Munksgaard, 1994:171- 187. H, Hudson AP et al. Chlamydia trachomatis nucleic
6. Dworkin SF. Approach to the problem. J Crani- acids can be found in the synovium of some asymp
omandib Disord 1992;6:302- 306. tomatic subjects. Arthritis Rheum 1999;42:1281-
7. Paesani D, Westensson P-L, Hatala M , Tallents RH, 1284.
Kurita K. Prevalence of temporomandibular joint 21. Henry CH, Hughes CV, Gerard HC, Hudson AP,
internal derangement in patients with cranioman Wolford LM . Reactive arthritis: preliminary micro-
dibular disorders. Am J Orthod Dentofacial Orthop biologic analysis of the human temporomandibular
1992;101:41- 47. joint. J Oral M axillofac Surg 2000;58:1137- 1142.
8. Tasaki M M , Westesson PL, Isberg AM , Ren YF, Tal 22. Chue PWY. Gonococcal arthritis of the temporo
lents RH. Classification and prevalence of temporo mandibular joint. Oral Surg Oral Med Oral Pathol
mandibular joint disk displacement in patients and Oral Radiol Endod 1975;39:572- 577.
symptoms-free volunteers. Am J Orthod Dentofa 23. Taylor-Robinson D, Gilroy CB, Horowitz S, Horow
cial Orthop 1996;109:249- 262. itz J. Mycoplasma genitalium in the joints of two
9. Hans M G, Liberman J, Goldberg J, Rozencweig G, patients with arthritis. Eur J Clin Microbiol Infect Dis
Bellon E. A comparison of clinical examination his 1994;13:1066- 1069.
tory and magnetic resonance imaging for identify

-
24. Kim SJ, Park YH, Hong SP, Cho BO, Park JW, Kim 37. Atkinson WB, Bates RE. The effects of the angle
SG. The presence of bacteria in the synovial fluid of the articular eminence on anterior disk displace
of the temporomandibular joint and clinical sig ment. J Prosthet Dent 1983;49:554- 555.
nificance: preliminary study. J Oral Maxillofac Surg 38. Isberg A, Westesson P-L. Steepness of articular
2003;61:1156- 1161. eminence and movement of the condyle and disk
25. Henry CH, Pitta M C, Wolford LM , Keene NH. Fre in asymptomatic temporomandibular joints. Oral
quency of chlamydial antibodies in patients with Surg Oral Med Oral Pathol Oral Radiol Endod
internal derangement of the temporomandibular 1998;86:152- 157.
joint. Oral Surg Oral Med Oral Pathol Oral Radiol 39. Hall M B, Gibbs CC, Sclar AG. Association be
Endod 2001 ;91:287- 292. tween the prominence of the articular eminence
26. M eijer CJ, Calame JJ, de Windt EJ, Risse EK, Bleker and displaced TM J disks. J Craniomandibular Pract
OP, Kenemans P et al. Prevalence of chlamydia tra 1985;3:237- 239.
chomatis infection in a population of asymptomatic 40. Alsawaf M , Garlapo DA, Gale EN, Carter M J. The
women in a screening program for cervical cancer. relationship between condylar guidance and tem
Eur J Clin Microbiol Infect Dis 1989;8:127- 130. poromandibular joint clicking. J Prosthet Dent
27. Schachter J. Chlamydial infections. N Engl J Med 1989;61:349- 354.
1978:298:428- 435. 41. Kertens HCJ, Tuizing DB, Golding RP, Van der Kwast
28. Ostergaard L, Traulsen J, Birkelund S, Christiansen WAM . Inclination of the temporomandibular joint
G. Evaluation of urogenital chlamydia trachomatis eminence and anterior disc displacement. Int J Oral
infections by cell culture and the polymerase chain M axillofac Surg 1989;18:229- 232.
reaction using a closed system. Eur J Clin Microbiol 42. Roberts CA, Tallents RH, Katzberg RW, Sanchez-
Infect Dis 1991:10:1057- 1061. Woodworth RE, M anzione JV, Espeland M A et al.
29. Paegle Dl, Holmlund AB, Ostlund M R, Grillner L. Clinical and arthrographic evaluation of temporo
The occurrence of antibodies against chlamydia mandibular joint sounds. Oral Surg Oral Med Oral
species in patients with monoarthritis and chronic Pathol Oral Radiol Endod 1986;62:373- 376.
closed lock of the temporomandibular joint. J Oral 43. Paesani D, Westesson P-L, Hatala MP, Tallents RH,
M axillofac Surg 2004;62:435- 439. Brooks SL. Accuracy of clinical diagnosis for TM J in
30. Henry CH, Nikaein A, Wolford LM . Analysis of hu ternal derangement and arthrosis. Oral Surg Oral
man leukocyte antigens in patients with internal de Med Oral Pathol 1992;73:360- 363.
rangement of the temporomandibular joint. J Oral 44. Sato S, Kawamura H, Motegi K, Takahashi K. M or
M axillofac Surg 2002;60:778- 783. phology of the mandibular fossa and the articular
31. Henry CH, Whittum-Hudson JA, Tull CT, Wolford eminence in temporomandibular joints with ante
LM . Reactive arthritis and internal derangement of rior disk displacement. Int J Oral M axillofac Surg
the temporomandibular joint. Oral Surg Oral Med 1996;25:236- 238.
Oral Pathol Oral Radiol Endod 2007;104:e22- e26. 45. Panmekiate S, Petersson A, Akerman S. Angulation
32. Fuseler JW, Conner EM , Davis JM , Wolf RE, and prominence of the posterior slope of the emi
Grisham M B. Cytokine and nitric oxide production nence of the temporomandibular joint in relation to
in the acute phase of bacterial cell wall-induced ar disc position. Dentomaxillofac Radiol 1991;19:205-
thritis. Inflammation 1997;21:113- 131. 208.
33. Quinn JH, Bazan NG. Identification of prostaglan 46. Ren YF, Isberg A, Westesson P-L. Steepness of the
din E2 and leukotriene B4 in the synovial fluid of articular eminence in the temporomandibular joint.
painful, dysfunctional temporomandibular joints. J Oral Surg Oral Med Oral Pathol Oral Radiol Endod
Oral M axillofac Surg 1990;48:968- 971. 1995;80:258- 266.
34. Shafer DM , Assael L, White LB, Rossomando EF. Tu 47. Kurita H, Ohtsuka A, Kobayashi H, Kurashina K.
mor necrosis factor-alpha as a biochemical marker Flattening of the articular eminence correlates
of pain and outcome in temporomandibular joints with progressive internal derangement of the
with internal derangements. J Oral M axillofac Surg temporomandibular joint. Dentomaxillofac Radiol
1994;52:786- 791. 2000;29:277- 279.
35. Fu , M a X, Zhang Z, Chen W. Tumor necrosis factor 48. Galante C, Paesani D, Tallents RH, Hatala M A,
in synovial fluid of patients with temporomandibu Katzberg RW, M urphy W. Angle of the articular
lar disorders. J Oral M axillofac Surg 1995;53:424- eminence in patients with temporomandibular
426. joint dysfunction and asymptomatic volunteers.
36. Isberg A, Stenstrom B, Isacsson C. Frequency of Oral Surg Oral Med Oral Pathol Oral Radiol Endod
bilateral temporomandibular joint disk displace 1995;80:242- 249.
ment in patients with unilateral symptoms: a 5-year 49. Kurita H, Ohtsuka A, Kobayashi H, Kurashina K.
follow-up of the asymptomatic joint. A clinical and Is the morphology of the articular eminence of
arthrotomographic study. Dentomaxillofac Radiol the temporomandibular joint a predisposing fac
1991;20:73- 76. tor for disc displacement? Dentomaxillofac Radiol
2000;29:159- 162.

50. Agerberg G, Carlsson GE. Functional disorders of 65. Abubaker AO, Hebda PC, Gunsolley JN. Effects of
masticatory system, I. distribution of symptoms sex hormones on protein and collagen content of
according to age and sex as judged from inves the temporomandibular joint disc of the rat. J Oral
tigation by questionnaire. Acta Odontol Scand M axillofac Surg 1996;54:721- 727.
1972;30:597- 613. 66. Yasuoka T, Nakashima M , Okuda T, Tatematsu N.
51. Helkimo M . Studies on function and dysfunction of Effect of estrogen replacement on temporomandib
the masticatory system, IV: age and sex distribution ular joint remodeling in ovariectomized rats. J Oral
of symptoms of dysfunction of the masticatory sys M axillofac Surg 2000;58:189- 196.
tem in Lapps in the north of Finland. Acta Odontol 67. Ng M C, Harper RP, Le CT, Wong BS. Effects of estro
Scand 1974;32:255- 267. gen on the condylar cartilage of the rat mandible in
52. Helkimo M . Epidemiological surveys of symptoms organ culture. J Oral M axillofac Surg 1999;57:818-
of dysfunction of the masticatory system. Oral Sci 823.
Rev 1976;7:54- 69. 68. Tsai CL, Liu TK, Chen TJ. Estrogen and osteoarthri
53. Isacsson G, Unde C, Isberg A. Subjective symptoms tis: a study of synovial estradiol and estradiol recep
in patients with temporomandibular disk displace tors binding in human osteoarthritic knee. Biochem
ment versus patients with myogenic cranioman Biophys Res Commun 1992;183:1287- 1291.
dibular disorders. J Prosthet Dent 1989;61:70- 77. 69. Abubaker AO, Raslan WF, Sotereanos GC. Estrogen
54. Ishigaki S, Bessette RW, M aruyama T. The distri and progesterone receptors in temporomandibular
bution of internal derangement in patients with joint discs of symptomatic and asymptomatic per
temporomandibular joint dysfunction: prevalence, sons: a preliminary study. J Oral M axillofac Surg
diagnosis and treatments. J Craniomand Pract 1993;51:1096- 1100.
1992;10:289- 296. 70. Campbell JH, Courey M S, Bourne P, Odziemiec C.
55. Isberg A, Hagglund M , Paesani D. The effect of age Estrogen receptor analysis of human temporoman
and gender on the symptomatic temporomandibu dibular disc. J Oral M axillofac Surg 1993;51:1101—
lar joint disk displacement. Oral Surg Oral Med Oral 1105.
Pathol Oral Radiol Endod 1998;85:252- 257. 71. Henry CH, Tull GT, Whittum-Hudson JA, Wolford
56. Ganshorn M L, Gartner F. Studies in possible corre LM . Analysis of estrogen binding sites of the pos
lation between diseases of the temporomandibular terior ligament of the humam TM J. Oral Surg Oral
joint and female sex hormones. Zahnarztl Welt Zah- Med Oral Pathol Oral Radiol Endod 2008; 105:698-
narztl Rundsch 1975;84:726- 728. 701.
57. Bush FM , Harkins SW, Harrington W G, Price DD. 72. Solberg W K, Hansson TL, Nordstrom B. The tem
Analysis of gender effects on pain perception and poromandibular joint in young adults at autopsy:
symptoms presentation in temporomandibular pain. a morphologic classification and evaluation. J Oral
Pain 1993;53:73- 80. Rehabil 1985;12:303- 321.
58. Tsai CL, Liu TK. Osteoarthritis in women: its rela 73. ObergT, Carlsson , Fajers CM . The temporoman
tionship to estrogen and current trends. Life Sci dibular joint: a morphologic classification and evalu
1992;50:1737- 1744. ation. Acta Odontol Scand 1971;29:349- 384.
59. Cecil RL, Archer BH. Arthritis of the menopause. 74. Widmalm SE, Westesson P-L, Kim IK, Pereira FJ Jr,
J Am Med Assoc 1925;84:75- 79. Lundh H, Tasaki M M . Temporomandibular joint
60. Aufdemorte , Van Sickels JE, Dolwick MF, Sheri pathosis related to sex, age, and dentition in au
dan PJ, Holt GR, Aragon SB et al. Estrogen receptors topsy material. Oral Surg Oral Med Oral Pathol
in the temporomandibular joint of the baboon (pa- 1994;78:416- 425.
pio cynocephalus): an autoradiographic study. Oral 75. Mogil JS, Sternberg WF, Kest , Marek P, Liebe-
Surg Oral Med Oral Pathol 1986;61:307- 314. skind JC. Sex differences in the antagonism of swim
61. Milam SB, Aufdemorte , Sheridan PJ, Triplett RG, stress-induced analgesia: effects of gonadectomy
Van Sickels JE, Holt GR. Sexual dimorphism in the and estrogen replacement. Pain 1993;53:17- 25.
distribution of estrogen receptors in the temporo 76. Sternberg WF, Mogil JS, Kest B, Page GG, Leong
mandibular joint complex of the baboon. Oral Surg Y, Yam V et al. Neonatal testosterone exposure in
Oral Med Oral Pathol 1987;64:527- 532. fluences neurochemistry of nonopioid swim stress-
62. Young PC, Stack MT. Estrogen and glucocorticoid induced analgesia in adult mice. Pain 1995;63:321-
receptors in adult canine articular cartilage. Arthritis 326.
Rheum 1982;25:568- 573. 77. Dao TTT, Knight K, Ton-That V. Modulation of
63. Dayani N, Corvol MT, Robel P, Eychenne B, Mon- myofascial pain by the reproductive hormones: a
charmont B, Tsagris L et al. Estrogen receptors in preliminary report. J Prosthet Dent 1998;79:663-
cultured rabbit articular chondrocytes: influence of 670.
age. J Steroid Biochem 1988;31:351- 356. 78. Nekora-Azak A. Temporomandibular disorders in
64. Okuda T, Yasuoka T, Nakashima M , Oka M . The relation to female reproductive hormones: a litera
effect of ovariectomy on the temporomandibu ture review. J Prosthet Dent 2004;91:491- 493.
lar joints of growing rats. J Oral M axillofac Surg 79. Wakeley C. The mandibular joint. Ann R Coll Surg
1996;54:1201- 1210. Engl 1948;2:111- 120.

-
80. Goddard G. Articular disk displacement of TM J due 98. Howard RP, Benedict JV, Raddin JH, Smith HL. As
to trauma. J Craniomandib Pract 1993;11:221—223. sessing neck extension-flexion as a basis for tem
81. Garcia R Jr. Air bag implicated in temporomandibu poromandibular joint dysfunction. J Oral M axillofac
lar joint injury. Cranio 1994;12:125- 127. Surg 1991;49:1210- 1213.
82. Holan G. Traumatic injuries to the chin: a survey 99. Pressman BD, Shellock FG, Schemes J, Schames M.
in a paediatric dental practice. Int J Paediatr Dent M R imaging of temporomandibular joint abnormal
1998;8:143- 148. ities associated with cervical hyperextension/ hyper-
83. Anderson Q. Trauma and internal derangements. flexion (whiplash) injuries. J Magn Reson Imaging
Temporomandibular Joint - Pain and Dysfunction, 1992;2:569- 574.
fifth annual meeting. Philadelphia, PA, 12- 14 No 100. Garcia R Jr, Arrington JA.Th e relationship between
vember 1987. cervical whiplash and temporomandibular joint in
84. Gerhard S, Ennemoser T, Rudisch A, Emshoff R. juries: an M RI study. Cranio 1996;14:233- 239.
Condylar injury: magnetic resonance imaging find 101. M cKay DC, Christensen LV. Whiplash injuries of
ings of temporomandibular joint soft-tissue chang the temporomandibular joint in motor vehicle
es. Int J Oral M axillofac Surg 2007;36:214- 218. accidents: speculations and facts. J Oral Rehabil
85. Goss AN, Bosanquet AG. The arthroscopic appear 1998;25:731- 746.
ance of acute mandibular trauma. J Oral M axillofac 102. Bergman H, Andersson F, Isberg A. Incidence of
Surg 1990;48:780- 783. temporomandibular joint changes after whiplash
86. Jones JK, Van Sickels JE. A preliminary report of arth trauma. AJR Am J Roentgenol 1998:171:1237-
roscopic findings following acute condylar trauma. J 1243.
Oral M axillofac Surg 1991;49:55- 60. 103. Sale H, Isberg A. Delayed temporomandibular joint
87. Harris SA, Rood JP, Testa HJ. Post-traumatic changes pain and dysfunction induced by whiplash trauma.
of the temporo-mandibular joint by bone scintigra J Am Dent Assoc 2007;138:1084- 1091.
phy. Int J Oral Maxillofac Surg 1988;17:173- 176. 104. Braun BL, DiGiovanna A, Schiffman E, BonnemaJ,
88. Katzberg RW, Tallents RH, Hayakawa K, M iller TL, Fricton J. A cross-sectional study of temporoman
Goske M J, Wood BP. Internal derangements of the dibular joint dysfunction in post-cervical trauma
temporomandibular joint: findings in the pediatric patients. J Craniomandib Disord 1992;6:24- 31.
age group. Radiology 1985;154:125- 127. 105. Wright WH. Deafness as influenced by malposition
89. Sullivan SM, Banghart PR, Anderson Q. Magnetic of the teeth. Natl Dent Assoc J 1920;7:979- 992.
resonance imaging assessment of acute soft tis 106. Decker JC. Traumatic deafness as a result of retru-
sue injuries to the temporomandibular joint. J Oral sion of condyles of mandible. Ann Otol Rhinol Lar-
M axillofac Surg 1995;53:763- 766. yngol 1925;34:519- 517.
90. Takaku S, Yoshida M , Sano T, Toyoda T. Magnetic 107. Costen JB. A syndrome of ear and sinus symptoms
resonance images in patients with acute traumatic dependent upon disturbed function of the tem
injury of the temporomandibular joint: a preliminary poromandibular joint. Ann Otol Rhinol Laryngol
report. J Craniomaxillofac Surg 1966;24:173- 177. 1934;43:1- 15.
91. Goss AN, Bosanquet AG, Tideman H. The accuracy 108. Greene CS, Mohl ND, McNeill C, Clark GT, True-
of temporomandibular joint arthroscopy. J Cranio love EL. Temporomandibular disorders and science:
maxillofac Surg 1987;15:99- 102. a response to the critics. Am J Orthod Dentofacial
92. Tasaki M M , Westesson P-L. Temporomandibular Orthop 1999;116:430- 431.
joint: diagnostic accuracy with sagittal and coronal 109. Rubinoff M S, Gross A, M cCall WD. Conventional
M R imaging. Radiology 1993;186:723- 729. and nonoccluding splint therapy compared for pa
93. Davis AG. Injuries of the cervical spine. J Am Med tients with myofascial pain dysfunction syndrome.
Assoc 1945;127:149- 156. Gen Dent 1987;35:502- 506.
94. Burgess JA, Dworkin SF. Litigation and post-trau 110. Dao TTT, Lavigne GJ, Charbonneau A, Feine JS,
matic TM D: how patients report treatment out Lund JP. The efficacy of oral splints in the treat
come. J Am Dent Assoc 1993; 124:105- 110. ment of myofascial pain of the jaw muscles: a con
95. Weinberg S, Lapointe H. Cervical extension-flexion trolled clinical trial. Pain 1994;56:85- 94.
injury (whiplash) and internal derangement of the 111. Goodman P, Greene CS, Laskin DM . Response of
temporomandibular joint. J Oral M axillofac Surg patients with myofascial pain-dysfunction syn
1987;45:653- 656. drome to mock equilibration. J Am Dent Assoc
96. M annheimer J, Attanasio R, Cinotti WR, Pertes R. 1976;92:755- 758.
Cervical strain and mandibular whiplash: effects 112. Tsolka P, Dip DS, Morris RW, Preiskel HW. Oc
upon the craniomandibular apparatus. Clin Prev clusal adjustment therapy for craniomandibular
Dent 1989;11:29- 32. disorders: a clinical assessment by double-blind
97. Dunn JJ, M annheimer JS. The cervical spine. In: method. J Prosthet Dent 1992;68:957- 964.
Pertes RA, Gross SG (eds). Clinical M anagement of 113. Schuyler CH. Fundamental principles in the correc
Temporomandibular Disorders and Orofacial Pain. tion of occlusal disharmony, natural and artificial.
Chicago, IL: Quintessence, 1995:13. J Am Dent Assoc 1935;22:1193- 1202.

114. M cCollum . Considering the mouth as a func 132. Nevakari K. "Elapsio praearticularis" of the tem
tioning unit as the basis of a dental diagnosis. poromandibular joint: a pantomographic study of
J South Calif Dent Assoc 1938;5:268- 276. the so-called physiological subluxation. Acta Od
115. Ricketts RM. Abnormal function of the temporo ontol Scand 1960;18:123- 170.
mandibular joint. Am J Orthod 1955;41:435- 441. 133. Katzberg RW, Keith DA, Guralnick W C, Ten Eick
116. Granger ER. Occlusion in TM J pain. J Am Dent As WR. Correlation of condylar mobility and arthro-
soc 1958;56:659- 664. tomography in patients with internal derange
117. Ramfjord SP. Dysfunctional TM J and muscle pain. ments of the temporomandibular joint. Oral Surg
J Prosthet Dent 1961;11:353- 374. Oral Med Oral Pathol 1982;54:622- 627.
118. Takahashi I. Surgical-orthodontic treatment of 134. Dijkstra PU, de Bont LGM , Stegenga B, Boering G.
a patient with temporomandibular disorder sta Angle of mouth opening measurement: reliability
bilized with a gnathologic splint. Am J Orthod of a technique for temporomandibular joint mobil
Dentofacial Orthop 2008;133:909- 919. ity assessment. J Oral Rehabil 1995;22:263- 268.
119. Iszkula S, Kandasamy S, Rinchuse DJ. Temporo 135. Johansson AS, Isberg A. The anterosuperior in
mandibular disorder and gnathologic splints. Let sertion of the temporomandibular joint capsule
ters to the editor. Am J Orthod Dentofacial Orthop and condylar mobility in joints with and without
2008;134:599- 600. internal derangements: a double-contrast arthro-
120. Pullinger AG, Seligman DA. Quantification and tomographyc investigation. J Oral M axillofac Surg
validation of predictive values of occlusal variables 1991;49:1142- 1148.
in temporomandibular disorders using a multifac 136. Solberg W K, Clark GT, Pullinger AG. The trou
torial analysis. J Prosthet Dent 2000;83:66- 75. bled temporomandibular joint: new challenges in
121. Ismail Al, Bader JD. Evidence-based dentistry in teaching, research, and clinical management. J Ca
clinical practice. J Am Dent Assoc 2004;135:78- 83. lif Dent Assoc 1984;12:36- 42.
122. National Institutes of Health. Technology assess 137. Bates RE, Stewart CM , Atkinson WB. The rela
ment conference statement: management of tem tionship between internal derangements of the
poromandibular disorders: April 29- M ay 1, 1996. temporomandibular joint and systemic joint laxity.
Washington, DC: US Government Printing Office. J Am Dent Assoc 1984;109:446- 447.
123. Glaros AG, Glass EG, McLaughlin L. Knowledge 138. Harinstein D, Buckingham RB, Braun T, Oral K,
and beliefs of dentist regarding temporomandib Baumann DH, Killian PJ et al. Systemic joint lax
ular disorders and chronic pain. J Orofacial Pain ity (the hypermobile joint syndrome) is associated
1994;8:216- 222. with temporomandibular joint dysfunction. Arthri
124. Kirk JA, Ansell BM, Bywaters EGL. The hypermo tis Rheum 1988;31:1259- 1264.
bility syndrome: musculoskeletal complaints asso 139. Adair SM , Hecht CH. Association of generalized
ciated with generalized joint hypermobility. Ann joint hypermobility with history, signs, and symp
Rheum Dis 1967;26:419- 425. toms of temporomandibular joint dysfunction in
125. Jessee EF, Owen DS, Sagar KB. The benign hy- children. Pediatr Dent 1993;15:323- 326.
permobile joint syndrome. Arthritis Rheum 140. Khan FA, Pedlar J. Generalized joint hypermobility
1980;23:1053- 1056. as a factor in clicking of the temporomandibular
126. De Coster PJ, Van den Berghe LI, M artens LC. joint. Int J Oral Maxillofac Surg 1996;25:101-104.
Generalized joint hypermobility and temporo 141. Buckingham RB, Braun T, Harinstein D, Oral K,
mandibular disorders: inherited connective tissue Baumann D, Bartynski W et al. Temporoman
disease as a model with maximum expression. dibular joint dysfunction syndrome: a close asso
J Orofac Pain 2005;19:47- 57. ciation with systemic joint laxity (the hypermobile
127. Bauss O, Sadat-Khonsari R, Fenske C, Engelke W, joint syndrome). Oral Surg Oral Med Oral Pathol
Schwestka-Polly R. Temporomandibular joint dys 1991;72:514- 519.
function in M arfan syndrome. Oral Surg Oral Med 142. Kavuncu V, Sahin S, Kamanli A, Karan A, Alksoy C.
Oral Pathol Oral Radiol Endod 2004;97:592- 598. The role of systemic hypermobility and condylar hy
128. Merrill RG. M andibular dislocation and hyper permobility in temporomandibular joint dysfunction
mobility. Oral M axillofac Surg Clin North Am syndrome. Rheumatol Int 2006;26:257- 260.
1989;1:399- 413. 143. Hirsch C, John MT, Stang A. Association between
129. Luz JG, Oliveira NG. Incidence of temporoman generalized joint hypermobility and signs and di
dibular joint disorders in patients seen at a hospital agnoses of temporomandibular disorders. Eur J
emergency room. J Oral Rehabil 1994;21:349-351. Oral Sci 2008;116:525- 530.
130. Ricketts RM. Variations of temporomandibular 144. Elfving L, Helkimo M , Magnusson T. Prevalence
joint as revealed by cephalometric laminagraphy. of different temporomandibular joint sounds, with
Am J Orthod 1950;36:877- 898. emphasis on disc-displacement, in patients with
131. Wassmund M . Surgery of the temporomandibular temporomandibular disorders and controls. Swed
joint. Suom Hammaslaak Toim 1952;48:95- 111. Dent J 2002;26:9- 19.

-
145. Plunkett GA, West VC. Systemic joint lax 152. Chun DS, Koskinen-Moffett L. Distress, jaw habits,
ity and mandibular range of movement. Cranio and connective tissue laxity as predisposing factors
1988;6:320- 326. to TM J sounds in adolescents. J Craniomandib Dis
146. Westiing L. Temporomandibular joint dysfunc ord 1990;4:165- 176.
tion and systemic joint laxity. Swed Dent J Suppl 153. Winocur E, Gavish A, Halachmi M , Bloom A, Gazit
1992;81:1- 79. E. Generalized joint laxity and its relation with oral
147. Perrini F, Tallents RH, Katzberg RW, Ribeiro RF, habits and temporomandibular disorders in ado
Kyrkanides S, Moss M E. Generalized joint laxity lescent girls. J Oral Rehabil 2000;27:614- 622.
and temporomandibular disorders. J Orofac Pain 154. Conti PCR, Miranda JES, Araujo CRP. Relation
1997;11:215- 221. ship between systemic joint laxity, TM J hyper
148. Dijkstra PU, de Bont LGM , Stegenga B, Boering G. translation, and intra-articular disorders. Cranio
Temporomandibular joint osteoarthrosis and gener 2000;18:192- 197.
alized joint hypermobility. Cranio 1992;10:221-227. 155. Dijkstra PU, Kropmans TJB, Stegenga B. The as
149. Agerberg G. M aximal mandibular movements in sociation between generalized joint hypermobility
teenagers. Acta Morphol Neerl Scand 1974;12: and temporomandibular joint disorders: a system
79- 102. atic review. J Dent Res 2002;81:158- 163.
150. McCarroll RS, Hesse JR, Naeije M , Yoon CK. 156. Beighton P, Solomon L, Soskolne CL. Articular
M andibular border positions and their relation mobility in an African population. Ann Rheum Dis
ships with peripheral joint mobility. J Oral Rehabil 1973;32:413- 418.
1987;14:125- 131. 157. Roberts CA, Katzberg RW, Tallents RH, Espeland
151. Greenwood LF. Is temporomandibular joint dys M A, Handelman SL. Correlation of clinical param
function associated with generalized joint hyper eters to the arthrographic depiction of temporo
mobility? J Prosthet Dent 1987;58:701- 703. mandibular joint internal derangements. Oral Surg
Oral Med Oral Pathol 1988;66:32- 36.

6
-
- . , , ,
.
« -
» ( )
-
( ), -
, ,
.
.
,
.
,
,
.
.

. , ,
, .

, .
, ,
. . ,
,
,
, .
.
, ,
,

-
( , ,
.1 . .),
.
,
,
( ). .

,
, ,
,
. ,
,
,
, .
.
.
( ) ,

.
. ,
.

, ,
( -
). .

, .6
.
,
( . 6-1).
,

.2 ,
, .
,
, ,
, ,
.
.3
, , ,
,
. ,
, ,
( . 6-2).7
.4'5
.
,

.Г 1 / W
I
. 6-1.
( ) ( )
><-
. 6-2.
. , 0,14-0,36 %

,89 ,
. , Tanaka .
.,5
-
, .
.
,

. .

.5
,
.5 44 %
, , 45 % -
11 % - -
. ( ). ,
D- .8
D-N- , ,
.10 .89

-
. 6-3. . . :
( ), - ( )
2 ( 2). .
2

( . 6-3).
. , Marchetti .12
,
,
.8 . ,
,
.
. 2
Chang .11 ,
,13
,14
,
. , .

, ,
.11 .
2 ( 2)
,
.
, ,
. 2 30 %
,
.9 1-3 %.1S ,

, «
», .
,
. Nitzan .10 , ,
.
2,

. 6-4. ( ), ( ),
( )

( . 6-4).16
( )
,
, ( . 6-5).
.

. ,
-
,
, ,
, . .
,
.1718 ,
, .
1980 .
. ,
,
.19
.
.
( ) ,
. ,
,
( ) .
,
. ,

-
. 6-5. ( )
( )
,
, . .21
,
8-200 . .(
63,9 ± 52,25 . .) ( . 6-6),20
, , ,22
, .
. ,

, .

.
-
( , ) ( . . 6-6).
, .
,
, , ( ,
.21 , ,
,
, )
.23
( , ,
) . .
, ,
, ,
. , ,

— — ------- -----------
: \
\ \
:
- /
-
^
. . -------------------—
. 6-6.
:
-
— —
. 6-7. ( )
.
, , -
.
,

,
.19-24'25 .
,
,
,
,
. .
,
. ( . 6-7).
,
,

( . . 6-2).26-27
,

-
, ,
, Arnett .28 .38 ,
«
». ,
.
, , • .
, ,
,
. .36
,

.19-28
• . ,
,19 .
.29
,

.3031 ,
2,5 86 .
.37
2000 • .
300 ,
. , ,
• .
, .

, .3233
, 50 %-
.38

. , 2q, 9q, 11 q
16 .

: VDR,
.33 AGC1, IGF-1, ER-oc, TGF-(5, CRTM (
), CRTL (
, ),
2- , 9- 11- . ,
.34
,
, .38 ,
,
( ).
, .
, • . ,
-

.
. , ,

,
. .41
, • .
,34 , ,

. , .
,
.
,
( ,
. )
, .42
.
,
, .34
,

( )
(
).39 , .43

,
40 ,
, -3,
, , , (Amir G, BJOM S, ,
2009) ( . 6-8 6-8 ).
, ,
( - -
. .), ,
,
.
• . .
,
. ,

.
, ,
. ,
,
. , .
,
,
, .44

-
. 6-8. ,
. (2- ). .
. . (
- , )
,

, .
, ,
. , .
,
. ,
, , , .17
,
,
.
,
.45 .

( ,
),

.
,

, .
,
. .
, ,
,
,


.
( . 6-9).49
,
. 6-9.
, ,
.50 , .
• .
, . . -
.

,
( ) . , , -
.
, , •
.
,
51 -
.52 , ,
.
, ,
.
( , ,
, ) .
,
. ,
,
,
, , ,
,51
.

.53 , .54
,
( ,
)
. ,
.
2, • .
( . . 6- ). ,

, .

, . , 1 (IL-1),
2 6 (IL-6) -

-
? .
,
2,
,
.4066
• .
( ,
, )
,
.

.
. 6-10.

. ,
,
, -

.56
,
, ( . 6-10).
, .
. 6-11. 1.
, ,

?
,
2.

(TNF-P), , ,

.34 , ?
. Wilkes67 ,

, .
,
. , -

•»
. 6-12.
,
,
.
,
. , .
, ,
.
, .
.58

, .1
.62'63
59 ( . 6-11)
(Nitzan, ).
, ,
.60 ( . 6-12). -

.61 ,
. ,

.
, .
, , ,
,
.
( - .1564
),
, ,
.
.
,

-
(Ludin ., , ,
, 2009). ( )
, . .
,

, (Amir G, BJOM FS, .
, 2009). ,
, ( ) .

, , . ,

. .
,
,
,
,46
. .
3-7 % , ,
16-59 %, .
33-86 %, 11 % ,
,
.19'47 ,
. ,
« - »,
.
.
. ,
- ( )

( / ).48 .
.
,
: .
,
. ( )

,
.66
.65
,
, , ,

:
. 6-13.
.
,
.
. .
, .
( )
,
. ,
- ( ),
,
, . ,
, ,

.67
.
,
.69
. Undt .68 ,

.69
. ,
, . ,
. -

-
. 6-14.
,
. ,
. .
, . ,
, . ( )
, , .
,

.
. • -
.
.
• . / .
,
, ,
,
,
. , ,
, ,
,
, , .
, , ,
,
. , ,
(
), . .
( ), ( . 6-14). ,

-

,
, , ,
. , ,

, ,
.
. , ,
,
. ,
.
. , ,
,
,
( . ).
.
. ,
,
,
-
.

, .

. ,
.
( ,
,
) - ,
.
. ,
,
.
.19
,
.
, ,
.
.
,
,
. .
( )
,
. .70

-
. 6-15. -
. a-f .
. .
.
. .
, .
, d.
,
.
. f. ,
. g-j. .
.
, h.
, .
, j.
,
,
.
, ,
,
. . -

-

, ,
.
.

( ).
,
81,2 % ,
.20 .
5% , .71

,
, .
.
,
, ,
,
.
, .

.

-
. 6-16.
. .
. .
. .
, ,
d. . .
- .
f.
.
. . h.

-
• . ,

.

( ) ,
,
, .
, -
,
. ,
, -

. ( ),
.7273
.

,
68,4 % ,
. 73
• . ( . 6-15).
, - ,
,
,
. . ,

, , ( .
6-16). , 31,6
. %
-

-
, .
. , ,
, ,
, .
(Nitzan,
, 1994) .
. • ,
,
,
.
• .
.
•
, ,
1. Loughner , M iller J, Broumand V, Cooper . The
development of strains, forces and nociceptor ac
.
tivity in retrodiscal tissues of the temporomandibu
• lar joint of male and female goats. Exp Brain Res
1997;113:311- 326.
( ) 2. Laskin DM . Etiology and pathogenesis of internal
derangement of the temporomandibular joint: cur
. , rent controversies in surgery for internal derange
ments of the temporomandibular joint. Oral M axil
, lofac Surg Clin North Am 1994;6:217.
. 3. Dijkgraaf LC, de Bont LG, Boering G, Liem RS.
Structure of the normal synovial membrane of the
• temporomandibular joint: a review of the literature.
J Oral M axillofac Surg 1996;54:332- 338.
4. de Bont LG, Liem RS, Boering G. Ultrastructure of
the articular cartilage of the mandibular condyle:
aging and degeneration. Oral Surg Oral Med Oral
. Pathol 1985;60:631- 641.
• 5. Tanaka E, Detamore M S, Tanimoto K, Kawai N.
Lubrication of the temporomandibular joint. Ann
Biomed Eng 2008;36:14- 29.
6. Charles C, Boyer CC, Williams TW, Stevens FH.
. Blood supply of the temporomandibular joint.
. J Dent Res 1964;43:224- 228.
7. Levick JR. The influence of hydrostatic pressure
on trans-synovial fluid movement and on capsular
expansion in the rabbit knee. J Physiol 1979;289:
69- 82.
. 8. Schwarz IM, Hills BA. Surface-active phospholipid
• as the lubricating component of lubricin. Br J Rheu
matol 1998;37:21- 26.
. 9. Hills BA, Monds M K. Enzymatic identification of the
70 % load-bearing boundary lubricant in the joint. Br J
Rheumatol 1998;37:137- 142.
. 10. Nitzan DW, Nitzan U, Dan P, Yedgar S. The role of
hyaluronic add in protecting surface-active phos
• pholipids from lysis by exogenous phospholipase
A(2). Rheumatology (Oxford) 2001;40:336- 340.

11. Chang DP, Abu-Lail Nl, Guilak F, Jay GD, Zauscher 27. Levick JR. An investigation into the validity of sub-
S, Conformational mechanics, adsorption, and nor atmospheric pressure recordings from synovial flu
mal force interactions of lubricin and hyaluronic acid id and their dependence on joint angle. J Physiol
on model surfaces. Langmuir 2008;24:1183- 1193. 1979;289:55- 67.
12. Marchetti C, Bernasconi G, Reguzzoni M , Farina 28. Arnett GW, Milam SB, Gottesman L. Progressive
A. The articular disc surface in different functional mandibular retrusion - idiopathic condylar re
conditions of the human temporomandibular joint. sorption. Part I. Am J Orthod Dentofacial Orthop
J Oral Pathol Med 1997;26:278- 282. 1996;110:8- 15.
13. Rahamim E, Better H, Dagan A, Nitzan DW. Elec 29. Holmes M W, Bayliss MT, M uir H. Hyaluronic acid
tron microscope and biochemical observations of in human articular cartilage. Age-related changes in
the surface active phospholipids on the articular content and size. Biochem J 1988;250:435^ t 41.
surfaces and in the synovial fluid of the temporo 30. Takano Y, M oriwake Y, Tohno Y, Minami T, Tohno S,
mandibular joint: a preliminary investigation. J Oral Utsumi M et al. Age-related changes of elements in
M axillofac Surg 2001 ;59:1326- 1332. the human articular disk of the temporomandibular
14. Zea-Aragon Z, Terada N, Ohtsuki K, Ohnishi M , joint. Biol Trace Elem Res 1999;67:269- 276.
Ohno S. Immunohistochemical localization of phos 31. Tanaka E, Sasaki A, Tahmina K, Yamaguchi K, Mori
phatidylcholine in rat mandibular condylar surface Y, Tanne K. Mechanical properties of human ar
and lower joint cavity by cryotechniques. Histol His- ticular disk and its influence on TM J loading stud
topathol 2005;20:531- 536. ied with the finite element method. J Oral Rehabil
15. Imhof H, Sulzbacher I, Grampp S, Czerny C, 2001 ;28:273- 279.
Youssefzadeh S, Kainberger F. Subchondral bone 32. AgerbergG, Inkapool I. Craniomandibular disorders
and cartilage disease: a rediscovered functional in an urban Swedish population. J Craniomandib
unit. Invest Radiol 2000;35:581- 588. Disord 1990;4:154- 164.
16. Tanaka E, van Eijden T. Biomechanical behavior of 33. LeResche L, Saunders K, Von Korff M R, Barlow
the temporomandibular joint disc. Crit Rev Oral Biol W, Dworkin SF. Use of exogenous hormones and
Med 2003;14:138- 150. risk of temporomandibular disorder pain. Pain
17. Krasnokutsky S, Attur M , Palmer G, Samuels J, 1997;69:153- 160.
Abramson SB. Current concepts in the patho 34. Milam SB. Pathogenesis of degenerative tem
genesis of osteoarthritis. Osteoarthritis Cartilage poromandibular joint arthritides. Odontology
2008;16(Suppl 3):S1—3. 2005;93:7- 15.
18. Abramson SB, Attur M , Yazici Y. Prospects for dis 35. Kapila S, Xie Y. Targeted induction of collage-
ease modification in osteoarthritis. Nat Clin Pract nase and stromelysin by relaxin in unprimed and
Rheumatol 2006;2:304- 312. beta-estradiol-primed diarthrodial joint fibrocarti
19. Tanaka E, Detamore M S, Mercuri LG. Degenerative laginous cells but not in synoviocytes. Lab Invest
disorders of the temporomandibular joint: etiol 1998;78:925- 938.
ogy, diagnosis, and treatment. J Dent Res 2008;87: 36. Jiang LS, Zhang ZM , Jiang SD, Chen WH, Dai LY.
296- 307. Differential bone metabolism between postmeno
20. Nitzan DW. Intraarticular pressure in the function pausal women with osteoarthritis and osteoporosis.
ing human temporomandibular joint and its altera J Bone M iner Res 2008;23:475- 483.
tion by uniform elevation of the occlusal plane. 37. Dequeker J, Mokassa L, Aerssens J, Boonen S. Bone
J Oral M axillofac Surg 1994;52:671- 679, discus density and local growth factors fn generalized os
sion 679- 680. teoarthritis. Microsc Res Tech 1997;37:358- 371.
21. Hylander WL. The human mandible: lever or link? 38. Spector TD, M acGregor AJ. Risk factors for os
Am J Phys Anthropol 1975;43:227- 242. teoarthritis: genetics. Osteoarthritis Cartilage
22. Tanaka E, Kawai N, Tanaka M , Todoh M , van Eijden 2004;12(Suppl A):S39- 44.
T, Hanaoka et al. The frictional coefficient of the 39. Nitzan DW, Goldfarb A, Gati I, Kohen R. Changes in
temporomandibular joint and its dependency on the reducing power of synovial fluid from temporo
the magnitude and duration of joint loading. J Dent mandibular joints with "anchored disc phenom
Res 2004;83:404- 407. enon” . J Oral M axillofac Surg 2002;60:735- 740.
23. Gallo LM , Chiaravalloti G, Iwasaki LR, Nickel JC, Palla 40. Mori , Beilin LJ. Omega-3 fatty acids and inflam
S. Mechanical work during stress-field translation in mation. Curr Atheroscler Rep 2004;6:461- 467.
the human TM J. J Dent Res 2006;85:1006- 1010. 41. Gabay O, Hall DJ, Berenbaum F, Henrotin Y, San
24. Yun PY, Kim YK. The role of facial trauma as a pos chez C. Osteoarthritis and obesity: experimental
sible etiologic factor in temporomandibular joint dis models. Joint Bone Spine 2008;75:675- 679.
order. J Oral Maxillofac Surg 2005;63:1576- 1583. 42. Berenbaum F, Sellam J. Obesity and osteoarthri
25. Bucholtz M R. TM J and whiplash. J Am Dent Assoc tis: what are the links? Joint Bone Spine 2008;75:
2007;138:1422, author reply 1422. 667- 668.
26. Alexander Q . Idiopathic osteoarthritis: time to change 43. Conaghan PG, Vanharanta H, Dieppe PA. Is pro
paradigms? Skeletal Radiol 2004;33:321-324. gressive osteoarthritis an atheromatous vascular
disease? Ann Rheum Dis 2005;64:1539- 1541.

-
44. Burner TW, Rosenthal . Diabetes and rheumatic 60. de Bont LG, Boering G, Liem RS, Eulderink F,
diseases. Curr Opin Rheumatol 2009;21:50- 54. Westesson P-L. Osteoarthritis and internal de
45. Polzer K, Diarra D, Zwerina J, Schett G. Inflamma rangement of the temporomandibular joint: a light
tion and destruction of the joints: the Wnt pathway. microscopic study. J Oral M axillofac Surg 1986;44:
Joint Bone Spine 2008;75:105- 107. 634- 643.
46. Carlsson GE. Epidemiology and treatment need 61. de Bont LG, Stegenga B. Pathology of temporo
for temporomandibular disorders. J Orofac Pain mandibular joint internal derangement and osteoar
1999;13:232- 237. throsis. Int J Oral Maxillofac Surg 1993;22:71- 74.
47. Mejersjo C, Hollender L. TM J pain and dysfunction: 62. Zarb GA, Carlsson GE. Temporomandibular dis
relation between clinical and radiographic find orders: osteoarthritis. J Orofac Pain 1999;13:
ings in the short and long term. Scand J Dent Res 295- 306.
1984;92:241- 248. 63. M ow VC, Ateshian GA. Lubrication and wear of
48. LeResche L. Epidemiology of temporomandibu diarthrodial joints. In: M ow VC, Hayes WC (eds).
lar disorders: implications for the investigation of Basic Orthopaedic Biomechanics. Philadelphia, PA:
etiologic factors. Crit Rev Oral Biol Med 1997;8: Lippincott-Raven, 1997:275- 315.
291- 305. 64. Lajeunesse D, Reboul P. Subchondral bone in os
49. Forster H, Fisher J. The influence of continuous teoarthritis: a biologic link with articular cartilage
sliding and subsequent surface wear on the fric leading to abnormal remodeling. Curr Opin Rheu
tion of articular cartilage. Proc Inst Mech Eng H matol 2003;15:628- 633.
1999;213:329- 345. 65. Stegenga B. Osteoarthritis of the temporomandib
50. Pufe T, Kurz B, Petersen W, Varoga D, Mentlein ular joint organ and its relationship to disc displace
R, Kulow S et al. The influence of biomechanical ment. J Orofac Pain 2001;15:193- 205.
parameters on the expression of VEGF and en-
dostatin in the bone and joint system. Ann Anat 66. Lobbezoo F, Drangsholt M , Peck C, Sato H, Kopp
2005;187:461- 472. S, Svensson P. Topical review: new insights into
51. Fukuoka Y, Hagihara M , Nagatsu T, Kaneda T. The the pathology and diagnosis of disorders of the
relationship between collagen metabolism and tem temporomandibular joint. J Orofac Pain 2004;18:
poromandibular joint osteoarthrosis in mice. J Oral 181-191.
M axillofac Surg 1993;51:288- 291. 67. Gynther GW, Tronje G, Holmlund AB. Radiographic
52. Kawai Y, Kubota E, Okabe E. Reactive oxygen spe changes in the temporomandibular joint in patients
cies participation in experimentally induced arthritis with generalized osteoarthritis and rheumatoid ar
of the temporomandibular joint in rats. J Dent Res thritis. Oral Surg Oral Med Oral Pathol Oral Radiol
2000;79:1489- 1495. Endod 1996;81:613- 618.
53. Zardeneta G, Milam SB, Lee T, Schmitz JP. Detec 68. Undt G, Wild K, Reuther G, Ewers R. MRI-based
tion and preliminary characterization of matrix met stereolithographic models of the temporomandib
alloproteinase activity in temporomandibular joint ular joint: technical innovation. J Craniomaxillofac
lavage fluid. Int J Oral M axillofac Surg 1998;27: Surg 2000;28:258- 263.
397- 403. 69. Nakaoka K, Hamada Y, Holmlund AB, Saito T, Arai
54. Levine JD, Khasar SG, Green PG. Neurogenic G, Horiuchi T et al. The changes of joint effusion on
inflammation and arthritis. Ann N Y Acad Sci MRI and arthroscopic findings after visually guided
2006;1069:155- 167. TM J irrigation correlated to the clinical outcome.
55. Milam SB. Pathophysiology and epidemiol Oral Surg Oral Med Oral Pathol Oral Radiol Endod
ogy of TM J. J Musculoskelet Neuronal Interact 2009;108:99- 104.
2003;3:382- 390, discussion 406- 387. 70. Nitzan DW. Arthrocentesis-incentives for using this
56. Martel-Pelletier J, Lajeunesse D, Fahmi H, Tardif G, minimally invasive approach for temporomandib
Pelletier JP. New thoughts on the pathophysiology ular disorders. Oral M axillofac Surg Clin North Am
of osteoarthritis: one more step toward new thera 2006;18:311- 328.
peutic targets. Curr Rheumatol Rep 2006;8:30- 36. 71. Dimitroulis G. The role of surgery in the manage
57. Wilkes C. Internal derangement of the TM J. Arch ment of disorders of the temporomandibular joint:
Otolaryngol Head Neck Surg 1989;115:469. a critical review of the literature. Part 2. Int J Oral
58. Nitzan DW. The process of lubrication impairment M axillofac Surg 2005;34:231- 237.
and its involvement in temporomandibular joint disc 72. Kendell BD, Frost DE. Arthrocentesis atlas. Oral
displacement: a theoretical concept. J Oral M axil M axillofac Surg Clin North Am 1996;4:1- 14.
lofac Surg 2001 ;59:36- 45. 73. Nitzan DW, Price A. The use of arthrocentesis for
59. Scapino RP. Histopathology associated with malpo the treatment of osteoarthritic temporomandibular
sition of the human temporomandibular joint disc. joints. J Oral M axillofac Surg 2001;59:1154- 1159,
Oral Surg Oral Med Oral Pathol 1983;55:382- 397. discussion 1160.

7
-

(American Academy of Sleep , .
M edicine),

, ,
( ) .813-16
.1
-
(American Academy of Orofacial Pain)
.12
,
, , -

.2 -
( ).
-
,
.
.
-
( ).

, -

.3-4 ,

.5"12 ,
, .

. ,

-
6 20 %
, , -
, ,
3-5 % .1617 ,
18
,
50 , .19 ,
, .29 ,
(
. )

. ,
,
,1320 - ,
, .

, ,
, .
.5-8
, , ,
.11'12'21-23
,
,
,2425 ,
, 9 2008 .
.26
, , PubMed.
:
(2073
.69 ), -
, - ,
, .
,
.
. , • ,

, ,
.27 ( ).
• ,
,
. ,
( )
( ).
- • ,
.28

-
. « »
•
. , ,

,

.

, .
. ,

.
-
«
» « -
»
613 , 81 -
( . 7-1).
34 ( ), .
.
« » .
« - » ,
659 ,
.
, .
.
« » -
« » .
57 , « » «
» - 164 , ,30
.
Medline (Hill) ( . 7-2).31
Plus .
, 37
( ),
. .
• .
,
7-1. M ed line (9 2008 .)
- 613 81
- 659 20
57 12
164 23

-
, • : ,
. .
-
,
,
. .
• .
.
. ( ) ,
•
. . ,
.
.
• .

( ) .
(
).
7-2. -
(1965)31
(Manfredini
Lobbezoo, 2009)

-

:
,
- ,

: -
: )
. . Baba
- .33
103

.

, .
Van Seim s .32'35

- . . ,

, .
,
( . 7-3).32-35 .
Rossetti .34 ,

,
( ) ( . 7-4).
( ). ,
,
. , 36'37 ,3839
,
( , ,40
, .
7-3. : ,
( ) ( ) ( )
(

)
Van Seim s, 4 ; 140
20 0835 (20- 30 %
)
Ro sset t i, 14 ; 1
2008 ;
14
Bab a, 20 0533 103 ; 6

Van Seim s, 1 ; 91 (25 % -

200432 )

-
7-4. : , ( )
(
)
Storm , 200741 22 ; -
46
Osterberg, 913 ( )
200737 70
Sato, 200642 229 ( -
-
)
Johansso n, 17138
200636 50-60
Van der 529
M eulen, 200643
Casanova- 506
Rosado, 200640
Kobs, 200544 185
; 114
M undt, 200538 2963

Glaros, 200545 96

;
Gesch, 200539 4310
Carlsson, 135
200446 15 (
20 )
M anfredini, 212 ;
200347 77 ,
Velly, 200348 83
; 100 ,
Choi, 200249 27978
Celic, 200250 230
Chung, 200051 26
(
)
M olina, 199952 276


: -
.53
29 , ( / ).57 M anfredini .47

,
(58 44,1 %,
34-44 % 55-76 %, . ).
Ciancaglini .54 ,
(6-30 %) / ,
. ,

, (71,4 53,3 % 60,9 %,
). ,
.
,
, .
.
, Molina .,52'55
80 %
, .
(57 %),
(133 ).56 ( . 7-5).
133 ,

, .
37 % .56 ,

, .
Manfredini .47
7-5. : ,
Jan al, 200758 51
,
Sch ierz, 200759 646

,
Hirsch, 2004“ 1011
Perg am alian, 84
200361 ,
John, 200262 154 ;

120

-

. -
.3
,
,
.29 ,
, 18 45 . ,
,
. , .63
, ,
, ,64 65-66
,
.
70 %.

, ,
,

,
(
). , ( . Svensson Graven-Nielsen,67
, Svensson et al.4),
,
, ,
. ( ) .
,

.
,

, .
,

. , , ,
.
,
,

, ,
, .6869
, . . ,

. ,70

: -
, ,
. .
,
.71
, ,
, ,
, -
7-6. : ( )

To risu, 20 0673 23
30- ,
;
Glaro s, 20 0470 14 5 20-

( - , . .
- );
Sven sso n , 11 60-

2001 -
;
Glaro s, 20 0076 20
-
(
- );
Arim a, 199976 12 9 5-
;
3 ,
Plesh , 199877 14 2
;
24
Glaro s, 199872 5 17- (10
); (1- 8 ;
); 10-15 )
- -
Sven sso n , 10 15-

199678
5 ;
3
Ch rist ensen, 9 30-
197179 ;
2

-
7-7. :

Perez del
Palo m ar, 200880
Tanaka, 200881
,

Pileicikiene,
200782

Tanaka, 200783

Hiro se, 20 0684

,
Perez del
Palo m ar, 200685 ( ,
( ) ,
)

Ch o i, 200586

Tanaka, 200187 No

- - ; - ; - -
; / -
( . 7-6) Glaros .
,
( . 7-7).

: -
20 8 . ,90 ,
,
.46'7072 ,
25 %
.7679
/ . ,
,
,
.91-93
,
. , -
,
« »
, .
.
. -
.
(Svensson Graven- Nielsen,67 Svensson

et al.4). , Svensson .84'85'94-96
Arendt-Nielsen,78 15-
,8084 -
5 25 % .85
,
. , .
,

, .
. Hirose .84

, .

.
.
, ,

,88 .97 ,

, ,
, ,
, .89 . ,
-

-
.98" ,
.68
Perez del Palomar .80 .

,
-
.
, . .

,
Lobbezoo Lavigne3

. .
,
.
. Perez M olina .52
del Palomar .88
.

,
. ,
,
, ,
.
. ,

. , . ,
,

, . ,
. ,
.35'43'58'61
. ,
, .
,

. , .
. , -
,
,

, ,
.78'91 ,
-

.
( , , ,
, )
:
, .102103
,
,
-

(. . .

),
.
,
, .

. ,
,

( , , -
)
( ,
). , .
,
.67 ,

, . ,

,78'79100 , / ,

.101
, .
.
,
, .

,
.
. , ,


-
,
. .
,

, -
. ,
. ,
.
,
- ,
. ,

, , .
,
,
.
.
( ),
,
.
.

, ,

. , . , ,

, ,

. , , -

,
, . ,

. , ,
. ,
, .

.
,
.

, .
,

related to periodic arousal during sleep. J Dent Res
1998;77:565- 573.
14. Kato T, Thie NM, Montplaisir JY, Lavigne GJ. Brux
ism and orofacial movements during sleep. Dent
, Clin North Am 2001;45:657- 684.
15. Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael
K. Bruxism physiology and pathology: an overview
. , for clinicians. J Oral Rehabil 2008;35:476- 494.
16. Glaros A. Incidence of diurnal and nocturnal brux
ism. J Prosthet Dent 1981;45:545- 549.
17. Lavigne GJ, Montplaisir J. Restless leg syndrome
and sleep bruxism: prevalence and association
among Canadians. Sleep 1994;17:739- 743.
. 18. Widmalm SE, Christensen RL, Gunn SM. Oral para-
functions as temporomandibular disorder risk factors
in children. J Craniomandib Pract 1995;13:242-246.
19. Lavigne GJ, Montplaisir J. Bruxism: epidemiology,
diagnosis, pathophysiology, and pharmacology.
Adv Pain Res Ther 1995;23:387- 404.
20. Kato T, Montplaisir JY, Guitard F, Sessle BJ, Lund JP,
1. American Academy of Sleep M edicine. International Lavigne GJ. Evidence that experimentally induced
Classification of Sleep Disorders, ed 2. Westchester, sleep bruxism is a consequence of transient arousal.
IL: American Academy of Sleep Medicine, 2005. J Dent Res 2003;82:284- 288.
2. De Leeuw R (ed). American Academy of Orofacial 21. Manfredini D, Landi N, Romagnoli M , Bosco M.
Pain. Orofacial Pain: Guidelines for Assessment, Di Psychic and occlusal factors in bruxers. Aust Dent J
agnosis, and M anagement, ed 4. Chicago, IL: Quin 2004;49:84- 89.
tessence Publishing, 2008. 22. Manfredini D, Ciapparelli A, Dell'Osso L, Bosco M.
3. Lobbezoo F, Lavigne GJ. Do bruxism and temporo Mood disorders in subjects with bruxing behavior.
mandibular disorders have a cause-and-effect rela J Dent 2005;33:485- 490.
tionship? J Orofac Pain 1997;11:15- 23. 23. Manfredini D, Landi N, Fantoni F, SegtJ M , Bosco
4. Svensson P, Jadidi F, Arima T, Baad-Flansen L, Sessle M . Anxiety symptoms in clinically diagnosed brux
BJ. Relationships between craniofacial pain and ers. J Oral Rehabil 2005;32: 584- 588.
bruxism. J Oral Rehabil 2008;35:524- 547. 24. Kato T, Thie N, Huynh N, M iyawaki S, Lavigne GJ.
5. Bader G, Lavigne GJ. Sleep bruxism: overview of Topical review: sleep bruxism and the role of pe
an oro-mandibular sleep movement disorder. Sleep ripheral sensory influences. J Orofac Pain 2003;17:
Med Rev 2000;4:27- 43. 191- 213.
6. Lobbezoo F, Naeije M . Bruxism is mainly regu 25. Michelotti A, Farella M , Gallo LM , Veltri A, Palla
lated centrally, not peripherally. J Oral Rehabil S, M artina R. Effect of occlusal interference on
2001;28:1085- 1091. habitual activity of human masseter. J Dent Res
7. De Laat A, Macaluso GM . Sleep bruxism is a motor 2005;84:644- 648.
disorder. M ov Disord 2002;17(Suppl 2):S67- S69. 26. Manfredini D, Landi N, Tognini F, Montagnani G,
8. Lavigne GJ, Kato T, Kolta A, Sessle BJ. Neurobiologi- Bosco M . Occlusal features are not a reliable pre
cal mechanisms involved in sleep bruxism. Crit Rev dictor of bruxism. M inerva Stomatol 2004;53:231-
Oral Biol Med 2003;14:30- 46. 239.
9. Manfredini D, Landi N, Romagnoli M , Cantini E, 27. Lavigne GJ, Manzini C. Bruxism. In: Kryger M H,
Bosco M . Etiopathogenesis of parafunctional activi Roth T, Dement W C (eds). Principles and Practice
ties of the stomatognathic system. M inerva Stoma- of Sleep Medicine. Philadelphia, PA: WB Saunders
tol 2003;52:339- 349. Co., 2000:773- 785.
10. Lobbezoo F, van der Zaag J, Naeije M . Bruxism: its 28. Marbach JJ, Raphael KG, Janal M N, Hirschkorn-
multiple causes and its effects on dental implants: an Roth R. Reliability of clinician judgement of brux
updated review. J Oral Rehabil 2006;33:293- 300. ism. J Oral Rehabil 2003;30:113- 118.
11. Manfredini D. Emotional factors in the etiology of 29. Lavigne GJ, Rompre PH, Montplaisir JY. Sleep brux
bruxism. In: Paesani D. (ed) Bruxism: Theory and ism: validity of clinical research diagnostic criteria in
Practice. Berlin: Quintessence Publishing, 2010, a controlled polysomnographic study. J Dent Res
87-97. 1996;75:546- 552.
12. Manfredini D, Lobbezoo F. Role of psychosocial 30. Susser M . Judgement and causal inference: cri
factors in the etiology of bruxism. J Orofac Pain teria in epidemiologic studies. Am J Epidemiol
2009;23:153- 166. 1977;105:1- 5.
13. Macaluso GM , Guerra P, Di Giovanni G, Boselli M, 31. Hill BA. The environment and disease: association or
Parrino L, Terzano M G. Sleep bruxism is a disorder causation? Proc Royal Soc Med 1965;58:295- 300.

-
32. Van Seims , Lobbezoo F, Wicks DJ, Hamburger 44. Kobs G, Bernhardt O, Kocher T, M eyer G. Oral
HL, Naeije M . Craniomandibular pain, oral para- parafunctions and positive clinical findings. Stoma-
functions, and psychological stress in a longitudinal tologija 2005;7:81- 83.
case study. J Oral Rehabil 2004;31:738- 745. 45. Glaros AG, Williams K, Lausten L. Predicting facial
33. Baba K, Haketa T, Sasaki Y, Ohyama T, Clark GT. pain: role of parafunctions, emotions and stress.
Association between masseter muscle activity lev J Am Dent Assoc 2005;136:451- 458.
els recorded during sleep and signs and symptoms 46. Carlsson GE, Magnusson T, Egermark I. Prediction
of temporomandibular disorders in healthy young of demand for treatment of temporomandibular
adults. J Orofac Pain 2005;19:226- 231. disorders based on a 20-year follow-up study. J Oral
34. Rossetti LM , Rossetti PH, Conti PC, de Araujo CRP. Rehabil 2004;31:511- 517.
Association between sleep bruxism and temporo 47. Manfredini D, Cantini E, Romagnoli M , Bosco
mandibular disorders: a polysomnographic pilot M . Prevalence of bruxism in patients with differ
study. Cranio 2008;26:16- 24. ent research diagnostic criteria for temporoman
35. Van Seims M K, Lobbezoo F, Visscher CM , Naeije M. dibular disorders (RDC/ TM D) diagnoses. Cranio
Myofascial temporomandibular disorder pain, para- 2003;21:279- 285.
functions and psychological stress. J Oral Rehabil 48. Velly AM , Gornitsky M , Philippe P. Contributing
2008;35:45- 52. factors to chronic myofascial pain: a case-control
36. Johansson A, Unell L, Carlsson GE, Soderfeldt B, study. Pain 2003;104:491- 499.
Hailing A. Risk factors associated with symptoms 49. Choi YS, Choung PH, Moon HS, Kim SG. Temporo
of temporomandibular disorders in a population mandibular disorders in 19-year-old Korean men.
of 50- and 60-year-old subjects. J Oral Rehabil J Oral M axillofac Surg 2002;60:797- 803.
2006;33:473- 481. 50. Celic R, Jerolimov V, Panduric J. A study of the influ
37. Osterberg T, Carlsson GE. Relationship between ence of occlusal factors and parafunctional habits
symptoms of temporomandibular disorders and on the prevalence of signs and symptoms of TM D.
dental status, general health and psychomatic fac Int J Prosthodont 2002;15:43- 48.
tors in two cohorts of 70-year-old subjects. Gero- 51. Chung SC, Kim YK, Kim HS. Prevalence and pat
dontology 2007;24:129- 135. terns of nocturnal bruxofacets on stabilization
38. M und t T, M ack F, Schwahn C, Bernhardt O, Kocher splints in temporomandibular disorder patients.
T, John U et al. Gender differences in association Cranio 2000;18:92- 97.
between occlusal support and signs of temporo 52. Molina OF, Dos Santos J Jr, Nelson SJ, Nowlin T.
mandibular disorders: results of the population- A clinical study of specific signs and symptoms of
based Study of Health in Pomerania (SHIP). Int J CM D in bruxers classified by the degree of severity.
Prosthodont 2005;18:232- 239. Cranio 1999;17:268- 279.
39. Gesch D, Bernhardt O, M ack F, John U, Kocher T, 53. Kampe T, Tagdae T, Bader G, Edman G, Karlsson S.
Alte D. Association of malocclusion and functional Reported symptoms and clinical findings in a group
occlusion with subjective symptoms of TM D in of subjects with longstanding bruxing behaviour.
adults: results of the Study of Health in Pomerania J Oral Rehabil 1997;24:581- 587.
(SHIP). Angle Orthod 2005;75:183- 190. 54. Ciancaglini R, Gherlone E, Radaelli G. The relation
40. Casanova-Rosado JF, Medina-Solas CE, Vallejos- ship of bruxism with craniofacial pain and symp
Sanchez AA, Casanova-Rosado AJ, Hernandez- toms from the masticatory system in the adult
Prado B, Avila-Burgos L. Prevalence and associated population. J Oral Rehabil 2001 ;28:842- 848.
factors for temporomandibular disorders in a group 55. Molina OF, Dos Santos J Jr, Nelson SJ, Nowlin T.
of Mexican adolescents and youth adults. Clin Oral Profile of TM D and bruxer compared to TM D and
Investig 2006;10:42- 49. nonbruxer patients regarding chief complaint, pre
41. Storm C, Wanman A. A two-year follow-up study vious consultations, modes of therapy, and chronic-
of temporomandibular disorders in a female Sami ity. Cranio 2000;18:205- 219.
population: validation of cases and controls as 56. Molina OF, Dos Santos J Jr, Nelson SJ, Grossman
predicted by questionnaire. Acta Odontol Scand E. Prevalence of modalities of headaches and brux
2007;65:341- 347. ism among patients with craniomandibular disorder.
42. Sato F, Kino K, Sugisaki M , Haketa T, Amemori Y, Cranio 1997;15:314- 325.
Ishikawa T et al. Teeth contacting habit as a con 57. Dworkin S, LeResche L. Research diagnostic criteria
tributing factor to chronic pain in patients with for temporomandibular disorders: review, criteria
temporomandibular disorders. J Med Dent Sci examinations and specifications, critique. J Crani
2006;53:103- 109. omandib Disord Fac Oral Pain 1992;6:301- 355.
43. Van der Meulen M J, Lobbezoo F, Aartman IH, 58. Janal M N, Raphael KG, Klausner J, Teaford M . The
Naeije M . Self-reported oral parafunctions and pain role of tooth-grinding in the maintenance of myo
intensity in temporomandibular disorder patients. fascial face pain: a test of alternate models. Pain
J Orofac Pain 2006;20:31- 35. Med 2007;8:486- 496.

59. Schierz , Joh n MT, Sch ro ed er E, Lo b b ezo o F. Asso 75. Glaros AG, Forbes M , Shanker J, Glass EG. Effect
ciation between anterior tooth wear and temporo of parafunctional clenching on temporomandibular
mandibular disorder pain in a German population. disorder pain and proprioceptive awareness. Cranio
J Prosthet Dent 2007;97:305- 309. 2000;18:198- 204.
60. Hirsch C, John MT, Lobbezoo F, Setz JM , Schaller 76. Arima T, Svensson P, Arendt-Nielsen L. Experi
HG. Incisal tooth wear and self-reported TM D mental grinding in healthy subjects: a model for
pain in children and adolescents. Int J Prosthodont post-exercise jaw muscle soreness. J Orofac Pain
2004;17:205- 210. 1999;13:104- 114.
61. Pergamalian A, Rudy , Zaki HS, Greco CM . The 77. Plesh O, Curtis DA, Hall L), M iller A. Gender dif
association between wear facets, bruxism, and se ferences in jaw pain induced by clenching. J Oral
verity of facial pain in patients with temporoman Rehabil 1998;25:258- 263.
dibular disorders. J Prosthet Dent 2003;90:194- 200. 78. Svensson P, Arendt-Nielsen L. Effects of 5 days of
62. John MT, Frank H, Lobbezoo F, Drangsholt M , repeated submaximal clenching on masticatory
Dette KE. No association between incisal tooth muscle pain and tenderness: an experimental study.
wear and temporomandibular disorders. J Prosthet J Orofac Pain 1996;10:330- 338.
Dent 2002;87:197- 203. 79. Christensen LV. Facial pain and internal pressure of
63. Kieser JA, Groeneveld HT. Relationship between masseter muscle in experimental bruxism in man.
juvenile bruxing and craniomandibular dysfunction. Arch Oral Biol 1971;16:1021- 1031.
J Oral Rehabil 1998;25:662- 665. 80. Perez del Palomar A, Santana-Penin U, Mora-
64. Lavigne GJ, Goulet JP, Zucconi M , Morisson F, Lob Bermudez M J, Doblare M . Clenching TMJs-loads
bezoo F. Sleep disorders and the dental patient: an increases in partial edentates: a 3D finite element
overview. Oral Surg Oral Med Oral Pathol Oral study. Ann Biomed Eng 2008;36:1014- 1023.
Radiol Endod 1999;88:257- 272. 81. Tanaka E, Hirose M , Koolstra JH, van Eijden TM ,
65. Rugh JD, Harlan J. Nocturnal bruxism and temporo Iwabuchi Y, Fujita R et al. Modeling of the effect of
mandibular disorders. Adv Neurol 1988;49:329-341. friction in the temporomandibular joint on displace
66. Magnusson T, Egermark I, Carlsson GE. Treatment ment of its disc during prolonged clenching. J Oral
received, treatment demand, and treatment need M axillofac Surg 2008;66:462- 468.
for temporomandibular disorders in 35-year-old 82. Pileicikiene G, Surna A, Barauskas R, Surna R,
subjects. Cranio 2002;20:11- 17. Basevicius A. Finite element analysis of stresses in
67. Svensson P, Graven-Nielsen T. Craniofacial muscle the maxillary and mandibular dental arches and
pain:review of mechanisms and clinical manifesta TM J articular discs during clenching into maximum
tions. J Orofac Pain 2001;15:117- 145. intercuspation, anterior and unilateral posterior oc
68. Nitzan DW. The process of lubrication impairment clusion. Stomatologija 2007;9:121- 128.
and its involvement in temporomandibular joint disc 83. Tanaka E, Hirose M , Inubushi T, Koolstra JH, van
displacement: a theoretical concept. J Oral M axil Eijden TM , Suekawa Y et al. Effect of hyperactivity
lofac Surg 2001;59:36- 45. of the lateral pterygoid muscle on the temporoman
69. Haskin CL, Milam SB, Cameron IL. Pathogen dibular joint disk. J Biomech Eng 2007;129:890-
esis of degenerative joint disease in the human 897.
temporomandibular joint. Crit Rev Oral Biol Med 84. Hirose M , Tanaka E, Tanaka M , Fujita R, Kuroda Y,
1995;6:248- 277. Yamano E et al. Three-dimensional finite-element
70. Glaros AG, Burton E. Parafunctional clenching, pain, model of the human temporomandibular joint
and effort in temporomandibular disorders. J Behav disc during prolonged clenching. Eur J Oral Sci
Med 2004;27:91- 100. 2006; 114:441- 448.
71. Lund JP. Pain and the control of muscles. Adv Pain 85. Perez del Palomar A, Doblare M . Finite element
Res Ther 1995;21:103- 115. analysis of the temporomandibular joint dur
72. Glaros AG, Tabacchi KN, Glass EG. Effect of para ing lateral excursions of the mandible. J Biomech
functional clenching on temporomandibular disor 2006;39:2153- 2163.
der pain. J Orofac Pain 1998;12:145- 152. 86. Choi AH, Ben-Nissan B, Conway RC. Three-dimen
73. Torisu T, Wang K, Svensson P, De Laat A, Fujii H, sional modelling and finite element analysis of the
Arendt-Nielsen L. Effects of muscle fatigue induced human mandible during clenching. Aust Dent J
by low-level clenching on experimental muscle pain 2005;50:42- 48.
and resting jaw muscle activity:gender differences. 87. Tanaka E, Tanaka M , Watanabe M , Del Pozo R,
Exp Brain Res 2006;174:566- 574. Tanne K. Influences of occlusal and skeletal dis-
74. Svensson P, Burgaard A, Schlosser S. Fatigue and cepancies on biomechanical environment in the
pain in human jaw muscles during a sustained, TM J during maximum clenching: an analytic ap
low-intensity clenching task. Arch Oral Biol proach with the finite element method. J Oral Re
2001;46:773- 777. habil 2001 ;28:888- 894.
88. Newham DJ, Edwards RHT, Mills KR. Skeletal muscle
pain. In: Wall PD, Melzack R (eds). Textbook of Pain.
Edinburgh: Churchill Livingstone, 1994:423-440.

-
89. Proske U. Muscle tenderness from exercise: mecha 97. M , Aarnts MP, Koolstra JH, Feilzer AJ, Van
nisms? J Physiol 2005;564:259- 268. Eijden TM GJ. Dynamic properties of the human
90. Lund JP, Stohler CS. Effects of pain on muscular ac temporomandibular joint disc. J Dent Res 2001 ;80:
tivity in temporomandibular disorders and related 876- 880.
conditions. In: Stohler CS, Carlson DS (eds). Bio 98. Pullinger AG, Seligman DA. Quantification and vali
logical and Psychological Aspects of Orofacial Pain. dation of predictive values of occlusal variables in
Craniofacial Growth Series 29. Center for Human temporomandibular disorders using a multifactorial
Growth and Development. Ann Arbor, M l: Univer analysis. J Prosthet Dent 2000;83:66- 75.
sity of M ichigan, 1994:75- 91. 99. Landi N, Manfredini D, Tognini F, Romagnoli M ,
91. Lavigne GJ, Rompre PH, Montplaisir JY, Lobbezoo Bosco M . Quantification of the relative risk of
F. M otor activity in sleep bruxism with concomitant multiple occlusal variables for muscle disorders
jaw muscle pain: a retrospective pilot study. Eur J of the stomatognathic system. J Prosthet Dent
Oral Sci 1997;105:92- 95. 2004;92:190- 195.
92. Arim aT, Arendt-Nielsen L, Svensson P. Effect of jaw 100. Clark GT, Adler RC, Lee JJ. Jaw pain and tender
muscle pain and soreness evoked by capsaicin be ness levels during and after repeated sustained
fore sleep on orofacial motor activity during sleep. maximum voluntary protrusion. Pain 1991 ;45:
J Orofac Pain 2001;15:245- 256. 17-22.
93. Lobbezoo F, van Seims M KA, Naeije M . Masticatory 101. Dao TTT, Lund JP, Lavigne GJ. Comparison of pain
muscle pain and disordered jaw motor behavior: lit and quality of life in bruxers and patients with
erature review over the past decade. Arch Oral Biol myofascial pain of the masticatory muscles. J Oro
2006;51:713- 720. fac Pain 1994;8:350- 356.
94. Korioth T, Romilly D, Hannam A. Three-dimensional 102. Imamura K, Ozawa H, Hiraide T, Takahashi N,
finite element analysis of the dentate human man Shibasaki Y, Fukuhara T. Continuously applied
dible. Am J Phys Anthropol 1992;88:69- 96. compressive pressure induces bone resorption by
95. M , Koolstra JH, Van Ruijven LJ, Van Eijden a mechanism involving prostaglandin E synthesis.
TM GJ. Three-dimensional finite element analysis J Cell Physiol 1990;144:222- 228.
of the human temporomandibular joint disc. J Bio 103. Quinn TM , Grodzinsky AJ, Buschmann M D, Kim
mech 2000;33:307- 316. YJ, Hunziker EB. Mechanical compression alters
96. Donzelli PS, Gallo LM , Spilker PL, Palla S. Biphasic proteoglycan deposition and matrix deformation
finite element simulation of the TM J disc from in around individual cells in cartilage explants. J Cell
vivo kinematic and geometric measurements. J Bio Sci 1998;111:573- 583.
mech 2004;37:1787- 1791.

8
- ( ).

. .
,

.
.

.
-
( )
XIX
,

,

. :
, ,
,
,1 .
,

,
, ,
. .

,
,

- .

-
1934 , .8
(Costen) ,
,

-
, , .9
.2
(
, 3 21 ).
( . 8-1). ,
, 75
. ,

( )
( ) , .
,
. ,
.
.
(Schwartz)3 (Laskin)4 ,
. ,
, ,

, .
.
(Gold)5
, (
)
. (
,
, ) .

- , .
. « »
, , ,
, .
, « -
»
, . . ,
( . Rollm ann
Gillesp ie,6 Suvinen et al.7). -
15 4 @dentistinfo первый стоматологический телеграм канал

8-1.
1934
( )
1955
1969 :
1975
1987
1992 -
,
.

.
.

, ,
( . 14-19). . , ,

.
,
- , ( ) ,
,
,
,

. .11

,
,
,
, , ,1213
.
,
,
,
- ( )

.910 ,
, .14-17 ,
,

-
,

.
. 6.
, ,
,
.18-21 , .
,

, ,
. ,
.
,
( , -
)
.22
.28
.23

, . ,
,
.24 .

,

,
. ,
,
, .
.

:
. ( )
, ( ).
90 % (
),
.25 ,

.26 .
,
, .
.27
( )

( ),
.
,
,
.
.
,
.
.

.
.
, ,
,
. ,
, ,
. .

,
, , ,
, .
-
. ( . 8-2).

,
,
, , .
.
.
. .29
,
.
.
.
.
,
,
: 1) -

-
8-2. -
.32
;
2)
. .3334 ,
, ,
,
.35 ,
,
,

,
, ( . 8-2 8-2 ).
( . 8-1 -8-1 ).
, ,
.
,
, ,
. .
, ,

.
.30'31 ,

,
II .3637
,
. ,
, .

6

. 8-1 -8-1 .

(
, DICOM )
. 8-2 8-2 .
.

-
8-3.
(Ahn et al., 200438)

(Pullinger Seligm an,
200036)
>6 II ;
.
, -
.

.
,

. ,
. 8-3. .39
( , )
( , )
II

,
,
,
, . .
II 4041 ( . 8-4).
, .

-
38 ( . 8-3). ,
, ,
,
, , ,
.42
( . 8-3). ,

.
,

.43-44
,

. 8-4.
.
Ferrario .,4546 ( )

( . 8-5).
.
.
,

, .

, , . ,
,
.
.

.
( ) ,

.
,
. . ,
-

-
. 8-5. , . - ;M- ;
LPT - ; DF - ; SF -
, ,
.
,
. -
,

,
- , .
. .
,
,

- .
.
,15
,

,
. ,
« »( .
7).
. , ,
, ,

.
( )
( )

« ».
,

,
( )
, , , ( )
. .
,

. ( = F/ S).

, ,
.
.
.
.
.
.
,
.
,
( . 8-4).
8-4.
6
( ) ( )
0
( ) (
)

-
( )
( ) .
« » ,
, - ,
, .
.
,
, ,

.4748 ,
, , .

,
,49 . ,
, ,
, ,
-
.
• ( . 8-5).52
?
• ,
,
? .
• ,
? .53

,
. ,
,
.
( . 13).
,
,
. (Torque
Index),

.5051
,
, .54
,


8-5. :

R2
( 95 %)
(Ilia) / 16,4% 94,0% 63,0% 13,2%
( ) /
0,049 4,62 (1,0- 21,22)

>4
0,010 2,83 (1,28- 6,24)
>5
0,007 2,77 (1,31- 5,88)
0,030 2,67(1,1- 6,48)

0,012 0,37 (0,17- 0,80)
0,020 0,27 (0,09- 0,81)

0,032 0,23 (0,06- 0,88)

>4

,
.
,
, ,
,
, .
.
, ,
. ,
,
.
.18 , , ,

,

. ,

-
.55
6,
,

. .

,
6 -
. ,
.

.
-
( ,
),56
.
,
II
, . ,
( . ,
Lobbezoo Lavigne,57 Svensson et al.68).
« » ( ).

( ) ,
.
,
« » .

,

.59
1. Kuhn T. The Structure of Scientific Revolution. Chi
cago, IL: University of Chicago, 1962.
2. Costen JB. A syndrome of ear and sinus symptoms
« » dependent upon disturbed function of the tem
« » poromandibular joint. Ann Odontol 1934;43:1- 15.
, 3. Schwartz L. Pain associated with the temporoman
dibular joint. J Am Dent Assoc 1955;51:394- 397.
, « » « - 4. Laskin DM . Etiology of the pain-dysfunction syn
» drome. J Am Dent Assoc 1969;79:147- 153.
.60'61 5. Cold SI. A psychophysiologic concept of temporo
mandibular joint dysfunction. N Y State Dent J
1975;41:214- 217.
6. Rollmann GB, Gillespie JM . The role of psychosocial
factors in temporomandibular disorders. Curr Rev
Pain 2000;4:71- 81.

7. Suvinen , Reade PC, Kemppainen P, Kononen M, 22. Haskin CL, Milam SB, Cameron IL. Pathogen
Dworkin SF. Review of aetiological concepts of tem esis of degenerative joint disease in the human
poromandibular pain disorders: a biopsychosocial temporomandibular joint. Crit Rev Oral Biol Med
model for integration of physical disorder factors 1995;6:248- 277.
with psychological and psychosocial illness impact 23. Pereira FJ Jr, Lundh H, Westesson P-L. Morphologic
factors. Eur J Pain 2005;9:613- 633. changes in the temporomandibular joint in differ
8. Rugh JD. Psychological components of pain. Dent ent age groups: an autopsy investigation. Oral Surg
Clin North Am 1987;31:579- 594. Oral Med Oral Pathol 1994;78:278- 289.
9. Dworkin S, LeResche L. Research diagnostic criteria 24. Lobbezoo F, Drangsholt M , Peck C, Sato H, Kopp
for temporomandibular disorders: review, criteria S, Svensson P. Topical review: new insights into the
examinations and specifications, critique. J Crani pathology and diagnosis of disorders of the tem
omandib Disord 1992;6:301- 355. poromandibular joint. J Orofac Pain 2004;18:181-
10. The American Academy of Orofacial Pain. De 191.
Leeuw R (ed). Orofacial Pain: Guidelines for Assess 25. De Bont LGM , Dijkgraaf LC, Stegenga B. Epide
ment, Diagnosis, and M anagement. Chicago, IL: miology and natural progression of articular tem
Quintessence Publishing, 2008. poromandibular disorders. Oral Surg Oral Med Oral
11. Liedberg J, Westesson P-L. Sideways position of the Pathol Oral Radiol Endod 1997;83:72- 76.
temporomandibular joint disk: coronal cryosection- 26. Stohler CS. Phenomenology, epidemiology, and
ing of fresh autopsy specimens. Oral Surg Oral Med natural progression of the muscular temporoman
Oral Pathol 1988;66:644- 649. dibular disorders. Oral Surg Oral Med Oral Pathol
12. Mejersjo C, Hollender L. TM J pain and dysfunction: Oral Radiol Endod 1997;83:77- 81.
relation between clinical and radiographic find 27. Nitzan DW, Etsion I. Adhesive force: the underly
ings in the short and long term. Scand J Dent Res ing cause of the disc anchorage to the fossa and/
1984;92:241- 248. or eminence in the temporomandibular joint: a new
13. Flygare L, Rohlin M , Akerman S. Macroscopic and concept. Int J Oral Maxillofac Surg 2002;31:94- 99.
microscopic findings of areas with radiologic ero 28. De Laat A. Temporomandibular disorders as a source
sions in human temporomandibular joints. Acta of orofacial pain. Acta Neurol Belg 2001 ;101:26- 31.
Odontol Scand 1992;50:91- 100. 29. Gallo LM . M odellingof the temporomandibular joint
14. Emshoff R, Puffer P, Rudisch A, Gassner R. Tem function using M RI and jaw-tracking technologies -
poromandibular joint pain: relationship to internal mechanics. Cells Tissues Organs 2005;180:54- 68.
derangement type, osteoarthrosis, and synovial 30. Gidarakou IK, Tallents RH, Kyrkanides S, Stein S,
fluid mediator level of tumor necrosis factor-a. Moss M . Comparison of skeletal and dental mor
Oral Surg Oral Med Oral Pathol Oral Radiol Endod phology in asymptomatic volunteers and symp
2000;90:442- 449. tomatic patients with bilateral degenerative joint
15. Stegenga B. Osteoarthritis of the temporomandibu disease. Angle Orthod 2003;73:71- 78.
lar joint organ and its relationship to disc displace 31. Nakamura T, Okamoto K, M aruyama T. Facial
ment. J Orofac Pain 2001;15:193- 205. asymmetry in patients with cervicobrachial pain and
16. Manfredini D, Tognini F, Zampa V, Bosco M . Predic headache. J Oral Rehabil 2001;28:1009- 1014.
tive value of clinical findings for temporomandibu 32. Hwang SJ, Haers PE, Zimmermann A, Oechslin C,
lar joint effusion. Oral Surg Oral Med Oral Pathol Seifert B, Sailer HF. Surgical risk factors for condy
Oral Radiol Endod 2003;96:521- 526. lar resorption after orthognathic surgery. Oral Surg Oral
17. Manfredini D, Basso D, Arboretti R, Guarda-Nardini Med Oral Pathol Oral Radiol Endod 2000;89:542-552.
L. Association between magnetic resonance signs 33. Fujimura K, Segami N, Sato J, Kanayama K, Nishimura
of temporomandibular joint effusion and disk dis M , Demura N. Advantages of intraoral verticosag-
placement. Oral Surg Oral Med Oral Pathol Oral ittal ramus osteotomy in skeletofacial deformity
Radiol Endod 2009;107:266- 271. patients with temporomandibular joint disorders.
18. Dao TT, Lavigne GJ. Oral splints: the crutches for J Oral M axillofac Surg 2004;62:1246- 1252.
temporomandibular disorders and bruxism? Crit 34. Nishimura M , Segami N, Sato J, Honjou M, Fujimura
Rev Oral Biol Med 1998;9:345- 361. K. Transitional joint effusion in the mandibular
19. Nitzan DW, Price A. The use of arthrocentesis for prognathic surgery patient: intraoral vertical ramus
the treatment of osteoarthritic temporomandibular osteotomy versus sagittal split ramus osteotomy.
joints. J Oral M axillofac Surg 2001 ;59:1154-1159. J Oral M axillofac Surg 2004;62:545- 548.
20. Guarda-Nardini L, Stifano M , Brombin C, Salmaso 35. Mercuri LG. Osteoarthritis, osteoarthrosis, and id
L, Manfredini D. A one-year case series of arthro iopathic condylar resorption. Oral M axillofac Surg
centesis with hyaluronic acid injections for temporo Clin North Am 2008;20:169- 183.
mandibular joint osteoarthritis. Oral Surg Oral Med 36. Pullinger AG, Seligman DA. Quantification and vali
Oral Pathol Oral Radiol Endod 2007;103:e14- e22. dation of predictive values of occlusal variables in
21. Hersch EV, Balasubramaniam R, Pinto A. Pharmacolog temporomandibular disorders using a multifactorial
ic management of temporomandibular disorders. Oral analysis. J Prosthet Dent 2000;83:66- 75.
Maxillofac Surg Clin North Am 2008;20:197-210.

-
37. Landi N, M anfredini D, Tognini F, Romagnoli M , Bos 49. Nitzan DW, Benoliel R, Pleir G, Dolwick F. Pain and
co M . Quantification of the relative risk of multiple dysfunction of the temporomandibular joint. In:
occlusal variables for muscle disorders of the stom- Sharav E, Benoliel R (eds). Orofacial Pain and Head
atognathic system. J Prosthet Dent 2004;92:190- ache. Philadelphia, PA: Mosby-Elsevier, 2008:149-
195. 192.
38. Ahn SJ, Kim TW, Nahm DS. Cephalometric keys to 50. Baba K, Haketa T, Sasaki Y, Ohyama T, Clark GT.
internal derangement of temporomandibular joint Association between masseter muscle activity lev
in women with Class II malocclusions. Am J Orthod els recorded during sleep and signs and symptoms
Dentofacial Orthop 2004;126:486- 494, discussion of temporomandibular disorders in healthy young
494- 495. adults. J Orofac Pain 2005;19:226- 231.
39. Egermark-Eriksson I. M andibular dysfunction in chil 51. Van Seims M K, Lobbezoo F, Visscher CM , Naeije M.
dren and in individuals with dual bite. Swed Dent J Myofascial temporomandibular disorder pain, para
Suppl 1982;10:1- 45. functions and psychological stress. J Oral Rehabil
40. Dibbets JM . Morphological associations between 2008;35:45- 52.
the angle classes. Eur J Orthod 1996;18:111- 118. 52. Manfredini D, Peretta R, Guarda-Nardini L, Ferronato
41. Dibbets JM , van der Weele LT. Signs and symp G. Role of clinically diagnosed bruxism and occlu
toms of temporomandibular disorders (TM D) and sion in TM J pain: a logistic regression model. J Cran
craniofacial form. Am J Ortho Dentofacial Orthop iomandibular Pract 2010 (in press).
1996;110:73- 78. 53. Ferrario VF, Tartaglia GM , Galletta A, Grassi GP,
42. Okeson JP. M anagement of Temporomandibu Sforza C. The influence of occlusion on jaw and
lar Disorders and Occlusion, ed 6. St Louis, M O: neck muscle activity: a surface EM G study in healthy
Elsevier-Mosby, 2008. young adults. J Oral Rehabil 2006;33:341- 348.
43. Thilander B, Rubio G, Pena L, de M ayorga C. Preva 54. Ferrario VF, Sforza C, Colombo A, Ciusa V. An elec
lence of temporomandibular dysfunction and its tromyographic investigation of masticatory muscles
association with malocclusion in children and ado symmetry in normo-occlusion subjects. J Oral Reha
lescents: an epidemiologic study related to speci bil 2000;27:33- 40.
fied stages of dental development. Angle Orthod 55. Nitzan DW. The process of lubrification impairment
2002;72:146- 154. and its involvement in temporomandibular joint disc
44. Pahkala R, Qvarnstrom M . Can temporomandibu displacement: a theoretical concept. J Oral M axil
lar dysfunction signs be predicted by early mor lofac Surg 2001;59:36- 45.
phological or functional variables? Eur J Orthod 56. Manfredini D, Lobbezoo F. Role of psychosocial
2004;26:367- 373. factors in the etiology of bruxism. J Orofac Pain
45. Ferrario VF, Sforza C, Miani A Jr, Colombo A. Sim 2009;23:153- 166.
plified cephalometric lines for the estimation of 57. Lobbezoo F, Lavigne GJ. Do bruxism and temporo
muscular lines of action. Int J Adult Orthodont mandibular disorders have a cause-and-effect rela
Orthognath Surg 1999;14:47- 54. tionship? J Orofac Pain 1997;11:15- 23.
46. Ferrario VF, Sforza C, Sartori M , Ciusa V. The 58. Svensson P, Jadidi F, Arima T, Baad-Hansen L, Ses
mechanical advantage of the masseter muscle in sle BJ. Relationships between craniofacial pain and
subjects with different vertical and sagittal facial bruxism. J Oral Rehabil 2008;35:524- 547.
morphology. Clin Orthod Res 1999;2:162- 170. 59. Clark GT. Classification, causation and treatment of
47. Torzilli PA, Deng XH, Ramcharan M . Effect of com masticatory myogenous pain and dysfunction. Oral
pressive strain on cell viability in statically loaded M axillofac Surg Clin North Am 2008;20:145- 157.
articular cartilage. Biomechan Model Mechanobiol 60. Turp JC. Myoarthropathy of the temporomandibu
2006;5:123- 132. lar joint and masticatory muscles. Pain therapy man
48. Peeters EA, Oomens CW, Bouten CV, Bader DL, agement and relaxation instead of aggressive sur
Baaijens FP. M echanical and failure properties of gery. M M W Fortschr Med 2003;145:33- 35.
single attached cells under compression. J Biomech 61. De Laat A. Arthrogenous and myogenous pain.
2005;38:1685- 1693. Different pathologies, different therapies? Zurich:
EACD Annual Meeting, 2008.

III

9

, ,
, . . ,
. . 9-1
- ,
. ,
.
, ,
-
, ( )
.1 .

( . 9-1). .

:

. 9-1.

-
9-1. . ,
( )
( )
(%) .
100 %,
(%) ,
.
100 %,
(
) ( )
:
,23
PubM ed,
26 2008 ., .
7000 , ,
. .
, , ,
, : 1)
, ( ) ; 2)
( .
)
( ), ,
0,5 % ( . 9-2). . ,

9-2. ,
(
)
-
(26 2008 .) ( ).4
.
7761
818 .5
/ 278 ,
18
12

.6 ,

,
. ,
,
, .14

,
-
(American Academy of Orofacial ,
Pain),7
(European
Academ y of Craniomandibular Disorders),8 (
, -
,9-12 )
, , -
( ),1516
,13

- . .17

,
/ ( )

.18
.
, ,
, ,1920
. , .2122 ,

,
. , .23 ,

,
,
.
.

,
,
,
,
.24
. ,

-
( ) ,
,
,
.25 ,30
,

. .
,

,
.26

,
,
. ,
12. .31
, ,

, , , ( . 11).
,
. ,
,
,
-
.27 .3233 ,
, .34

,
, ,
, .35
,
.28
( )
,
,
( . 3 21 ).36
.1429 ,
,
,
, / ( II),
.
( . 13).

9-3.
,%

, ( )
, % ( )
%
0,18- 1,00 8-39-40-45 0,68- 0,864144^ 6
0,79- 0,9015'1 0,67- 0,7943 0,57- 0,9643 0,26- 0,7118-4°
0,65- 0,8915-17'42 0,55- 0,7917 0,70- 0,8817 0,00—0,9218
0,7820 0,8420 0,7420 0,22- 0,7918'39 0,73- 0,8441'4446
0,51- 0,8418
0,40- 0,8718
- .
: Wenneberg 1983;45 Fricton Schiffman 1986;al Paesani .,
1992;42 Goulet ., 1998;44Yatani ., 19 8;17Yatani ., 1998;43 Orsini ., 1999;15 Manfredini
., 2003;20John ., 2005;18 Leher ., 2005;39 Schmitter ., 2005;46 List ., 2006;40 Manfredini
Guarda-Nardini, 2008.16
10.

,
,
, , .
.
,
.37

,
-

, -
,
( . 9-3).38 .47
,

, ( ) ,
.3940 ,
, , -

-
9-1. , .

,
,
.48

-
, . ,
,
.
( 9-1). ,
14-19.
, , ,

,
,

.

. , ,
. 9-2.
,
:

,
:

. 9-2.

10. National Institute of Health Technology Assess
ment Conference Statement. M anagement of
.
temporomandibular disorders. J Am Dent Assoc
1996;127:1595- 1603.
11. Phillips DJ, Gelb M , Brown CR, Kinderknecht KE,
, Neff PA, Kirk WS et al. American Association of
Temporomandibular Joint Surgeons. Guide to eval
. uation of permanent impairment of the temporo
, mandibular joint. Cranio 1997;15:170- 176.
, 12. Manfredini D, Guarda-Nardini L. Temporoman
( dibular joint injury assessment: traumatic and iat
rogenic lesions. Guidelines of the Italian society of
legal medicine and dentistry. Arch Legal Med Dent
) 2008;1:1- 20.
13. Dworkin S, LeResche L. Research diagnostic criteria
for temporomandibular disorders: review, criteria
( ),
examinations and specifications, critique. J Crani
omandib Disord 1992;6:301- 355.
. 14. Baba K, Tsukiyama Y, Clark GT. Reliability, validity
, and utility of various occlusal measurement methods
and techniques. J Prosthet Dent 2000;83:83- 89.
.
15. Orsini M G, Kuboki T, Terada S, M atsuka Y, Yatani
H, Yamashita A. Clinical predictability of temporo
mandibular joint disc displacement. J Dent Res
1999;78:650- 660.
16. Manfredini D, Guarda-Nardini L. Agreement be
tween research diagnostic criteria for temporo
mandibular disorders and magnetic resonance di
1. Goulet JP, Palla S. The path to diagnosis. In: Sessle agnoses of temporomandibular disc displacement
BJ, Lavigne GJ, Lund JP, Dubner R (eds). Orofa in a patient population. Int J Oral M axillofac Surg
cial Pain: From Basic Science to Clinical M anage 2008;37:612- 616.
ment, ed 2. Chicago, IL: Quintessence Publishing, 17. Yatani H, Suzuki K, Kuboki T, M atsuka Y, M aekawa
2008:135- 143. K, Yamashita A. The validity of clinical examination
2. McNeill C. History and evolution of TM D concepts. for diagnosing anterior disk displacement without
Oral Surg Oral Med Oral Pathol Oral Radiol Endod reduction. Oral Surg Oral Med Oral Pathol Oral Ra
1997;83:51- 60. diol Endod 1998;85:654- 660.
3. Goldstein BH. Temporomandibular disorders: a re 18. John MT, Dworkin SF, Mancl LA. Reliability of clini
view of current understanding. Oral Surg Oral Med cal temporomandibular disorder diagnoses. Pain
Oral Pathol Oral Radiol Endod 1999;88:379- 385. 2005;118:61- 69.
4. De Leeuw R. Internal derangements of the tem 19. Emshoff R, Puffer P, Rudisch A, Gassner R. Tem
poromandibular joint. Oral M axillofac Surg Clin poromandibular joint pain: relationship to internal
North Am 2008;20:159- 168. derangement type, osteoarthrosis, and synovial
5. De Bont LGM , Dijkgraaf LC, Stegenga B. Epidem fluid mediator level of tumor necrosis factor-a.
iology and natural progression of articular temporo Oral Surg Oral Med Oral Pathol Oral Radiol Endod
mandibular disorders. Oral Surg Oral Med Oral 2000;90:442- 449.
Pathol Oral Radiol Endod 1997;83:72- 76. 20. Manfredini D, Tognini F, Zampa V, Bosco M . Predic
6. Manfredini D, Bucci M B, Guarda-Nardini L. The di tive value of clinical findings for temporomandibu
agnostic process for temporomandibular disorders. lar joint effusion. Oral Surg Oral Med Oral Pathol
Stomatologija 2007;9:35- 39. Oral Radiol Endod 2003;96:521- 526.
7. The American Academy of Orofacial Pain. De 21. Stegenga B. Osteoarthritis of the temporomandibu
Leeuw R (ed). Orofacial Pain: Guidelines for Assess lar joint organ and its relationship to disc displace
ment, Diagnosis, and M anagement. Chicago, IL: ment. J Orofac Pain 2001;15:193- 205.
Quintessence Publishing, 2008. 22. Manfredini D, Basso D, Arboretti R, Guarda-Nardini
8. De Boever JA, Nilner M , Orthlieb JD, Steenks M H. L. Association between magnetic resonance signs
Recommendations by the EACD for examina of temporomandibular joint effusion and disk dis
tion, diagnosis, and management of patients with placement. Oral Surg Oral Med Oral Pathol Oral
temporomandibular disorders and orofacial pain Radiol Endod 2009;107:266- 271.
by the general dental practitioner. J Orofac Pain 23. Stegenga B, De Bont LGM , Boering G, van Willigen
2008;22:268- 278. JD. Tissue responses to degenerative changes in the
9. Davies S. EACD GDP guidelines. Dent Update temporomandibular joint: a review. J Oral M axillo
2008;35:210- 211. fac Surg 1991;49:1079- 1088.

-
24. Tasaki , Westesson P-L. Temporomandibular 38. Schmitter M , Kress B, Leckel M , Henschel V, Ohl-
joint: diagnostic accuracy with sagittal and coronal mann B, Rammelsberg P. Validity of temporoman
M R imaging. Radiology 1993;186:723- 729. dibular disorder examination procedures for as
25. Westesson P-L. Reliability and validity of imaging sessment of temporomandibular joint status. Am J
diagnosis of temporomandibular joint disorders. Orthod Dentofac Orthop 2008;133:796- 803.
Adv Dent Res 1993;7:137- 151. 39. Leher A, Graf K, PhoDuc JM , Rammelsberg P. Is
26. Manfredini D, Guarda-Nardini L. Ultrasonography there a difference in the reliable measurement of
of the temporomandibular joint: a literature review. temporomandibular disorder signs between experi
Int J Oral M axillofac Surg 2009;38:1229- 1236. enced and inexperienced examiners? J Orofac Pain
27. Farella M , Michelotti A, Steenks M H, Romeo R. The 2005;18:58- 64.
diagnostic value of pressure algometry in myofascial 40. List T, John MT, Dworkin SF, Svensson P. Recalibra
pain of jaw muscles. J Oral Rehabil 2000;27:9- 14. tion improves inter-examiner reliability of TM D ex
28. Gonzalez YM , Greene CS, Mohl ND. Technologi amination. Acta Odontol Scand 2006;64:146- 152.
cal devices in the diagnosis of temporomandibu 41. Fricton JR, Schiffman EL. Reliability of a cranioman
lar disorders. Oral M axillofac Surg Clin North Am dibular index. J Dent Res 1986;65:1359- 1364.
2008;20:211- 220. 42. Paesani D, Westesson P-L, Hatala MP, Tallents RH,
29. Mohl ND. Reliability and validity of diagnostic mo Brooks SL. Accuracy of clinical diagnosis for TM J in
dalities for temporomandibular disorders. Adv Dent ternal derangement and arthrosis. Oral Surg Oral
Res 1993;7:113- 119. Med Oral Pathol 1992;73:360- 363.
30. Schiffmann E, Fricton JR, Harley D, Shapiro BL. The 43. Yatani H, Suzuki K, Kuboki T, M atsuka Y, M aekawa
prevalence and treatment needs of subjects with K, Yamashita A. The validity of clinical examination
temporomandibular disorders. J Am Dent Assoc for diagnosing anterior disk displacement with re
1990;120:295- 304. duction. Oral Surg Oral Med Oral Pathol Oral Ra
31. Dworkin SF. Perspectives on the interaction of bio diol Endod 1998;85:647- 653.
logical, psychological and social factors in TM D. 44. Goulet JP, Clark GT, Flack VF, Liu C. The reproduc
J Am Dent Assoc 1994;125:856- 863. ibility of muscle and joint tenderness detection
32. Dworkin SF, Von Korff M , LeResche L. Multiple pains methods and maximum mandibular movement
and psychiatric disturbance: an epidemiologic inves measurement for the temporomandibular system.
tigation. Arch Gen Psychiatry 1990;47:239-244. J Orofac Pain 1998;12:17- 26.
33. Gatchel RJ, Garofalo J, Ellis E, Holt C. Major psycho 45. Kopp S, Wenneberg B. Intra- and interobserver vari
logical disorders in acute and chronic TM D: an initial a b ly in the assessment of signs of disorder in the
examination. J Am Dent Assoc 1996;127:1365-1374. stomatognathic system. Swed Dent J 1983;7:239-
34. Rudy , Turk DC, Kubinski JA, Zaki HS. Differential 246.
treatment response of TM D patients as a function of 46. Schmitter M , ohlmann B, John M T, Hirsch C,
psychological characteristics. Pain 1995;61:103-112. Rammelsberg P. Research diagnostic criteria for
35. Epker JT, Gatchel RJ, Ellis E. An accurate model for temporomandibular disorders: a calibration and
predicting TM D chronicity: practical applications in reliability study. J Craniomandib Pract 2005;23:
clinical settings. J Am Dent Assoc 1999;130:1470- 212- 218.
1475. 47. Okeson JP. Bell's Orofacial Pain, ed 5. Chicago, IL:
36. Gatchel RJ, Stowell AW, Wildenstein L, Riggs R, Ellis Quintessence Publishing, 2005.
E. Efficacy of an early intervention for patients with 48. Klasser GD, Greene CS. The changing field of t em
acute TMD-related pain: a one-year outcome study. poromandibular disorders: what dentists need to
J Am Dent Assoc 2006;137:339- 347. know. J Can Dent Assoc 2009;75:49- 53.
37. Moses AJ. Book review: TM Ds: an evidence-based
approach to diagnosis and treatment. J Cranioman
dib Pract 2007;25:5- 7.

Глава 10
М арк Шмиттер
. ,

. ,
, .
-
( ).

,1 15 %
, .
. ,
,
, , .

-
.
,
. ,
.
« -
» ( )
-
( )
, .
,2 .
( )
. ( )
, -

. 10-1.

.
( )
( ),
( )
,
( . 10-1). .
,

,

,
(. . ).6-8
.

.
.3

( , ( . 10-1 ),
. .).

, ( . 10-1 ).
, ,
.4
, ,

.

.5 ,
« » « ».
( , ) ,
,
, -
. ,
.
. ,
, :
, -

. 10-2.
. . , ,
. ,

( )
. . 10-2
.
,
,
, .
,
.
. ,
,
.
40
. ,

.

.
,
, ,
, ,
,
. 10-3.
. ( . 10-4
).
. , ,
,
. , ,
.12
,
,
,13-15
, .
, . ,
,
.14
,
.
, ,5
13.

( . 10-5),

.4'16 ,
, ( . 10-6)
,1718
.
9 .
10
,

.11
,
. ,
,
. ( . 10-7
10-8).
,

. 10-3. ,
. 10-4 -10-4 .
. 10-5. . 10-6.

. 10-7. . 10-8. . 10-9.
( . 10-9)
. ,
, .
,
,
.20
.
.
.3
,

.

, .24
,
( ) . ,

. .
,
,21"23
, ,
. , ,
( . 10-10).
« » «
» .
,
.

. 10-10 10-10 .
.
:
( ) ;
:
.

( ) .

( ).

,2126
,
. 20
26 .

.
.30'31
, ,
,
,27'28 ,
, .32'33
.
,
.
,
, ,
( )
,
.29 . ,
,
. Bell,34
,

. 10-11.
. 10-12.

,
( ,
).
,
,
,
.35 , . .
( . 10-11 10-12).
,3940

,
, .

, .36 ,
24. .4142
,
,
.

(
) ,37'38
, (
. )
,
-

. ,

.43 ,

11.
,

.

,

. 1992 .
.

-
(Helkimo) ( / ).3
,
1970- .44 /
.
/
/ 46-48

, .16'22-40'49'50
/

. , ,

.
.
.46 / ,
. I
, II -
.
( ,

.
)
,
-
. / .

,
.

,
I / .
• III: , ,

-
.
.
, ,
, . ,
.
-
. , .
-
, ,
,
.
.
.
• I: ,
III,
,

. ,
40
. .
/
20 .
(

).
• II:
- :

, -
, .
. , ,
-
: .
.
35 .
.
- ,
: .

, / .
,

.22'4050 , 14. Goulet J, Clark G, Flack V. Reproducibility of exam
iner performance for muscle and joint palpation in
/
the temporomandibular system following training
and calibration. Community Dent Oral Epidemiol
. 1993;21:72- 77.
15. Schmitter M , Zahran M , Due JM , Henschel V, Ram
melsberg P. Conservative therapy in patients with
.51 anterior disc displacement without reduction using
2 common splints: a randomized clinical trial. J Oral
19. M axillofac Surg 2005;63:1295- 1303.
16. List T, John MT, Dworkin SF, Svensson P. Recalibra
tion improves inter-examiner reliability of TM D ex
amination. Acta Odontol Scand 2006;64:146- 152.
17. Bernhardt O, Schiffman EL, Look JO. Reliability and
validity of a new fingertip-shaped pressure algo-
meter for assessing pressure pain thresholds in the
temporomandibular joint and masticatory muscles.
1. Al-Jundi M A, John MT, Setz JM , Szentpetery A,
J Orofac Pain 2007;21:29- 38.
Kuss O. Meta-analysis of treatment need for tem
18. List T, Helkimo M , Falk G. Reliability and validity of
poromandibular disorders in adult nonpatients.
a pressure threshold meter in recording tenderness
J Orofac Pain 2008;22:97- 107.
in the masseter muscle and the anterior temporalis
2. Okeson J. Orofacial Pain. Chicago, IL: Quintessence
m u scle. Cran io 1989;7:223- 229.
Publishing, 1996.
19. Ohlmann B, Rammelsberg P, Henschel V, Kress B,
3. Dworkin SF, LeResche L. Research diagnostic criteria
Gabbert O, Schmitter M . Prediction of TM J arthral
for temporomandibular disorders. J Craniomandib
gia according to clinical diagnosis and MRI findings.
Disord 1992;6:301- 355.
Int J Prosthodont 2006;19:333- 338.
4. Dworkin S, LeResche L, DeRouen T. Reliability of
20. Simons D, Travell J, Simons L. Myofascial Pain and
clinical measurement in temporomandibular disor
Dysfunction: The Trigger Point M anual. Volume
ders. Clin J Pain 1988;4:88- 99.
1: Upper Half of Body. Baltimore, M D: Williams &
5. Leher A, Graf K, PhoDuc JM , Rammelsberg P. Is
Wilkins, 1999.
there a difference in the reliable measurement of
21. John MT, Zwijnenburg AJ. Interobserver variability
temporomandibular disorder signs between experi
in assessment of signs of TM D. Int J Prosthodont
enced and inexperienced examiners? J Orofac Pain
2001;14:265- 270.
2005;19:58- 64.
22. Schmitter M , Ohlmann B, John M , Hirsch C, Ram
6. Fleiss J. The design and analysis of clinical experi
melsberg P. Research diagnostic criteria for tem
ments. New York: Wiley, 1986.
poromandibular disorders: a calibration and reliabil
7. Shrout P, Fleiss JL. Intraclass correlations: uses in as
sessing rater reliability. Psychol Bull 1979;86:420- ity study. Cranio 2005;23:212- 218.
23. Carlsson G, Egermark-Eriksson I, Magnusson T.
428.
Intra- and inter-observer variation in functional ex
8. Landis J. The measurement of observer agreement
amination of the masticatory system. Swed Dent J
for categorial data. Biometrics 1977;33:159- 174.
1980;4:187- 194.
9. Rauhala K, Oikarinen KS, Jarvelin M R, Raustia AM .
24. Ohrbach R, Granger C, List T, Dworkin S. Pre
Facial pain and temporomandibular disorders: an
liminary development and validation of the Jaw
epidemiological study of the Northern Finland 1966
Functional Limitation Scale. Community Dent Oral
birth cohort. Cranio 2000;18:40- 46.
Epidemiol 2008;36:228- 236.
10. Akhter R, Hassan NM , Ohkubo R, Tsukazaki T, Aida
25. DeWijer A, Lobbezoo-Scholte AM , Steenks M H,
J, M orita M . The relationship between jaw injury,
Bosman F. Reliability of clinical findings in temporo
third molar removal, and orthodontic treatment
mandibular disorders. J Orofac Pain 1995; 9:181-
and TM D symptoms in university students in Japan.
191.
J Orofac Pain 2008;22:50- 56.
26. Dworkin SF, LeResche L, DeRouen T, Von Korff M .
11. Persson LG, Kiliaridis S. Dental injuries, temporo
Assessing clinical signs of temporomandibular disor
mandibular disorders, and caries in wrestlers. Scand
ders: reliability of clinical examiners. J Prosthet Dent
J Dent Res 1994;102:367- 371.
1990;63:574- 579.
12. Turp J, Minagi S. Palpation of the lateral pterygoid
27. Widmalm S, Williams WJ, Zheng C. Time fre
region in TM D - where is the evidence? J Dent
quency distributions of TM J sounds. J Oral Rehabil
2001;29:475- 483.
1991;18:403- 412.
13. Duinkerke A, Luteiijn F, Bouman TK, deJong HP.
28. Ogutcen-Toller M . Sound analysis of temporoman
Reproducibility of a palpation test for the stoma-
dibular joint internal derangements with phonograph
tognathic system. Community Dent Oral Epidemiol
ic recordings. J Prosthet Dent 2003;89:311-318.
1986;14:80- 85.

29. J, VachW, Strub JR. Die klinische Bedeutung 40. Schmitter M , Kress B, Leckel M , Henschel V, Ohl
von Kiefergelenkgerauschen. Schweiz Monatsschr mann B, Rammelsberg P. Validity of temporoman
Zahnmed 1997;107:191- 195. dibular disorder examination procedures for as
30. Gesch D, Bernhardt O, Kirbschus A. Association of sessment of temporomandibular joint status. Am J
malocclusion and functional occlusion with tem Orthod Dentofacial Orthop 2008;133:796- 803.
poromandibular disorders (TM D) in adults: a sys 41. Perinetti G. Temporomandibular disorders do not
tematic review of population-based studies. Quin correlate with detectable alterations in body pos
tessence Int 2004;35:211- 221. ture. J Contemp Dent Pract 2007;8:60- 67.
31. Landi N, Manfredini D, Tognini F, Romagnoli M , 42. Armijo Olivo S, Magee DJ, Parfitt M , M ajor P, Thie
Bosco M . Quantification of the relative risk of NM . The association between the cervical spine,
multiple occlusal variables for muscle disorders the stomatognathic system, and craniofacial pain: a
of the stomatognathic system. J Prosthet Dent critical review. J Orofac Pain 2006;20:271- 287.
2004;92:190- 195. 43. List T, Wahlund K, Larsson B. Psychosocial function
32. Pullinger AG, Seligman DA. Quantification and vali ing and dental factors in adolescents with temporo
dation of predictive values of occlusal variables in mandibular disorders: a case-control study. J Orofac
temporomandibular disorders using a multifactorial Pain 2001;15:218- 227.
analysis. J Prosthet Dent 2000;83:66- 75. 44. Helkimo M . Studies on function and dysfunction
33. Schmitter M , Balke Z, Hassel A, Ohlmann B, Ram of the masticatory system. II. Index for anamnes
melsberg P. The prevalence of myofascial pain and tic and clinical dysfunction and occlusal state. Swed
its association with occlusal factors in a threshold Dent J 1974;67:101- 121.
country non-patient population. Clin Oral Investig 45. Nielsen L, Terp S. Screening for functional disorders
2007;11:277- 281 of the masticatory system among teenagers. Com
34. Bell W. Classification of TM disorders. In: Laskin D, munity Dent Oral Epidemiol 1990;18:281- 287.
Greenfield W, Gale E (eds). The President's Confer 46. John MT, Hirsch C, ReiberT, Dworkin SF. Translating
ence on the Examination, Diagnosis, and M anage the research diagnostic criteria for temporomandib
ment of Temporomandibular Disorders. Chicago, IL: ular disorders into German: evaluation of content
American Dental Association, 1983:24- 29. and process. J Orofac Pain 2006;20:43- 52.
35. Alanen P. Occlusion and temporomandibular dis 47. Lobbezoo F, van Seims M K, John MT, Huggins K,
orders (TM D): still unsolved question? J Dent Res Ohrbach R, Visscher CM et al. Use of the research
2002;81:518- 519. diagnostic criteria for temporomandibular disorders
36. Stohler C. M anagement of dental occlusion. In: for multinational research: translation efforts and
Laskin D, Greene C, Hylander W (eds). TM Ds: reliability assessments in The Netherlands. J Orofac
an Evidence-based Approach to Diagnosis and Pain 2005;19:301- 308.
Treatment. Chicago, IL: Quintessence Publishing, 48. de Lucena LB, Kosminsky M , da Costa LJ, de Goes
2006:403- 411. PS. Validation of the Portuguese version of the
37. Barbosa Tde S, M iyakoda LS, Pocztaruk Rde L, RDC/ TM D Axis II questionnaire. Braz Oral Res
Rocha CP, Gaviao M B. Temporomandibular disor 2006;20:312- 317.
ders and bruxism in childhood and adolescence: re 49. Dworkin SF, Sherman J, Mancl L, Ohrbach R,
view of the literature. Int J Pediatr Otorhinolaryngol LeResche L, Truelove E. Reliability, validity, and
2008;72:299- 314. clinical utility of the research diagnostic criteria for
38. Baba K, Haketa T, Sasaki Y, Ohyama T, Clark GT. temporomandibular disorders axis II scales: depres
Association between masseter muscle activity lev sion, non-specific physical symptoms, and graded
els recorded during sleep and signs and symptoms chronic pain. J Orofac Pain 2002;16:207- 220.
of temporomandibular disorders in healthy young 50. John MT, Dworkin SF, Mancl LA. Reliability of clini
adults. J Orofac Pain 2005;19:226- 231. cal temporomandibular disorder diagnoses. Pain
39. Lobbezoo-Scholte A, deWijer A, Steenks M , Bos 2005;118:61- 69.
nian F. Interexaminer reliability of six orthopaedic 51. Steenks M H, de Wijer A. Validity of the research
tests in diagnostic subgroups of craniomandibular diagnostic criteria for temporomandibular disorders
disorders. J Oral Rehabil 1994;21:273- 285. Axis I in clinical and research settings. J Orofac Pain
2009;23:9- 16, discussion 7- 27.

11
« » ,
( , ,
, , , ,
) ,
( , , ,
, , ,
) , -
.1 ( )( . 11-1).
,
-
( ).2 1950- . ,
.
(Schwartz), (Lupton)
, ,

.3

,
.
, ,
.
( )
.7
Rollmann Gillespie,4 M anfredini
.,5 Suvinen .6
,
.
, 20 ,
20 20
( ) .

11-1.
So cial Read just m ent Rating Scale (SRRS); Life Even t s Assessm en t ;
Sexu al/ Ph ysical Ab use Hist o ry Quest io nnaire
Ham ilton Rating Scale fo r Dep ressio n (HRSD); Beck Dep ressio n Invent o ry
(BDI); Zung 's Self- rat ing Dep ressio n Scale
Sp ielb erg er St at e- Trait An xiet y Invent o ry (STAI); Ham ilton Rating Scale
fo r An xiet y (HRSA)
Visual Analo g Scale (VAS); M cGill Pain Quest io nnaire (M PQ); M ult id im en
sio nal Pain Invent o ry (M PI)
M inneso t a M ult ip hasic Perso n alit y Invent o ry (M M PI); Sym p t o m Checklist
90-R (SCL- 90- R)
St ruct ured Clinical In t erview fo r DSM (SCID)
,
,
( ) ,
.8
, ,
, -
.8 .12'13
,
Jo nes .,
. ,
,
.
( ) . -
, .14-16
,

.9 ,
,
.17
.18
,
-

.1011 .1920 ,
-
- .21
,
,
.
.22-24

.
,
, ,

, .

, ( . 11-2),
.
(Hamilton Rating Scale for
- , Anxiety, HRSA)

( , - (Spielberger State-Trait Anxiety
. .), Inventory, STAI- S, STAI-T). ,

. .26

11-2. 25
Taylor, 1953 50/20 -

(M AS)
Hamilton, 1959 14 0-56
(HRSA)
STAI ( ) Spielberger et al., 20 20-80
1970
STAI ( ) Spielberger et al., 20 20-80
1970
(SAS) Zung, 1971 20 35-65
Zung, 1971 20 20-80

(ASI)
- Schalling et al., 10 10-50
(SARS) 1973
, Leher & 36 0-288
, Woolfolk, 1982
(SCBAI)
Sheehan, 1983 35 + 11 0-140
(SPRAS)
Sheehan, 1983 35 0-140
(SCRAS)
Covi & Lipman, 3 3-15
(CARS) 1984
Thyer, 1992 25 0-100
(CAS)

11-3. ( )25

(BDI) Beck et al., 1961 21 0-63

(0-3)
Zung, 1965 20 20-80
(SDS) (1-4)
Rockliff, 1969 12 + 6 0-36
(SRQ-D) (0-3)
Aitken, 1969 1 0-100
(VAS) (0-100)
Carroll et al., 52 0-52
(CRS) 1981 (0-1)
Pancheri & 25 25-100
Carilli, 1982 (1-4)
Cassano & 31 31-124
(SAD) Castrogiovanni, (1-4)
1982
(PS) Fawcett et al., 36 0-144
1983 (0-4)
Zimmermann 22 0-88
ODD) et al., 1983 (0-4)
Plutchik & van 34 0-68
- ( ) Praag, 1987 (0-2)
Hudson, 1992 25 0-100
(GCS) (1-7)
Legeron et al., 8 0-24
(ACQ) 1993 (0-3)
Svanborg & 19 0-57
CPRS (CPRS-S-A) Asberg, 1994 (0-3)
11-4. 25

Hamilton, 1960 21 0-67

(HDRS) (0-2/
- / ^
Wechsler et al., 27 28-131
(DRS) 1963 (1-3/ 1-6)
Zung, 1972 20 20-80
(DSI) (1-4)
M ontgomery & 10 0-60
- Asberg, 1979 (0-6)
(M ADRS)
Widlocher, 1980 14 0-56
(ERD) (0-4)
Faravelli et al., 15 0-150
(SVDE) 1982 (0-10)
Kellner, 1986 8 8-72
(BDRS) (1-9)

,26-28
.36
,
.

,

( . 11-3 11-4). (
, ),
.40
.29-31 ,
,
,
.32-34
« » ,
,
.35 .41

,
, -
- .42
.36-37 ,

,
.3839 SCL-90-R (Symptom Checklist,
SCL-90-R).
SCL-90-R
,
,
.43
,
,34 - -
II

, , ( / ).44'45
.2833 , SCL-90-R
90 , 83

, : (somatization, SOM );
. -
- (obsessiveness- com pulsiveness, - );
(interpersonal
sensitivity, -S); (depression,
, DEP); (anxiety, AN X); (hostility,
, , HOS); (phobic anxiety, PHOB);
, (paranoid

11-5. SCL- 90- R
-90-R (SCL-90-R)
12
- 10
13
, 10
, 6
7
6
10
ideation, PAR); (psychoticism , I / ,

PSY). , , ,
,

( . 11-5). , .
,
:
(Global Severity Index, GSI); ,
(Positive .6
Symptom Total, PST);
(Positive Symptom (M innesota
Distress Index, PSDI).43 M ultiphasic Personality Inventory, MMPI)
SCL-90-R
(M ultidimensional Pain Inventory, )
,
56-69 % .4849
.34'42'46'47 ,
,
,
, , , .
. « » « »

.

,
.49

: II /
,
110 , .

: (52 %);
(12 %); (11 %); , ,
(24 %).50
67-68
.69
:
(46 %); 21.
(22 %);
(32 %)} ,
/ .
,2-48 /
10.
,51
, 1 ,
.
.52
: II /
Turk, Rudy

,

.
, .70-71
. ,72
,
.2
( , 1992 .
), , ( )
,
,
( . 11-6). , .44

- :
. (Graded Chronic Pain Scale, GCPS),
, SCL-90-R,

, (Jaw Disability Checklist).

11-6. , ,
19 8

M anfredini, 96 SCL-90-R 58; MP + TM JP 85; + TM JP

200934 59; TM JP37 69; TM JP 59 ,
,
,
Winocur, 298 / II 45 61
200953
Reissm ann, 225 / 44,7; + 62; MP + TM JP
200833 II TM JP 47,4; TM JP 66,7; TM JP 49
52,8
Lee, 2008 87 / II 42 59,7
M ongini, 532 DSM -IV 22,3; TM JP
200755 15,7

Nifosi, 200747 79 SCL-90-R; HDRS * * ,
Celic, 200656 154 SCL-90-R 19,5*** 27,3**’
Reiter, 200657 115 / II 88 96

Plesh, 200558 60 / II 65 85
M anfredini, 114 M OODS-SR 55; + TM JP
200432 54,5; TM JP 33,3;
NP 8
Rantala, 211 / II * *
200459
M anfredini, 131 M OODS-SR I: 51,6; II: 7,8;
200428 III: 22,2
,
Yap, 200460 196 / II 44,9 51,8
M anfredini, 117 M OODS-SR CD11:20,9;

20 0331 CDI 2: 44,8
Yap, 200361 191 / II 39,8 47,6
Yap, 200242 117 / II I: 45,1; II: 22,8; III: I: 64,5; II: 40;
60; I + II: 42,8; I + III: 40; I + 11:71,4;
III: 56,2; I + III: 75; ,
II + III: 40; II + III: 60;
I + II + III: 12,5 I + II + III: 40
Sip ila, 200130 5696 ( SCL-25DS 23 BH4R
)
M cFarlane, 113 IBQ 60 77
200162
M adland, 80 23,6
200063
M ichelotti, 50
199849 ( )
List, 199664 82 261 / II 50** 60**
Korszun, 51 DSM -IV 58

199665
M cCreary, 112 M PQ;

199166 .

./ 5 , II / SCL-90-R,
( + ).
* , .
’’ .
*"* .
- ', SCL-90-R - 90-R (Sym ptom Checklist-90-R); DSM -IV - ,
;
4- . (Diagnostic and St atistic M anual of M ental Disorders ed 4); MPI - (M ultidim ensional Pain Inventory); M MPI - -
(M innesota M ultiphasic Personality Inventory); HDRS - (Hamilton Depression Rating
II
Scale); M OODS-SR - (Mood Sp ectrum - Self Report); M PQ - - (M cGill Pain Questionnaire);
SCL- 25DS - (Sym ptom Checklist Depression Subscale); IBQ - (Illness Behaviour
19 9
Quest ionnaire); - ; TM JP - ; CDI (1 ,2 )- (Clinical Dysfunction Index); 1, 2, 3 -
/
I / .
11-7. (GCPS)

0 10
(0 - , 10 -
0 1 2 3 4 5 6 7 8 9 10
)?

-
6 0 10 0 1 2 3 4 5 6 7 8 9 10
(0 - , 10 -
)?
6 0 0 1 2 3 4 5 6 7 8 9 10
10 (0 - , 10 -
)?
6
(
)
?

6

0 10 (0 - ,
10 -
)? 0 1 2 3 4 5 6 7 8 9 10

6
0 10 (0 - ,
10 - )? 0 1 2 3 4 5 6 7 8 9 10

(
) 6
0 10 (0 - -
, 10 - )? 0 1 2 3 4 5 6 7 8 9 10
11-8. (GCPS)
( )
: : 0- 29: 0
30- 49: 1
+ X 10
50- 69: 2
70 +: 3
0- 6 : 0
7- 14 : 1
15- 30 : 2
31 + :3

: II ИДК/ВНЧР
11-9. GCPS
0 6
I, <50 3
II, >50 3
III, 3- 4 ,
IV, 5- 6 ,
90-R

90-R (SCL-90-R)
/ . Derogatis .43

/

GCPS Von Korff .7374 ,
.
II 31 ,

, (b, , h, , k, I, m, n, v, y, cc,
. GCPS dd, ) ,
, 10-
, - ( *, , d*, j* , *,
*, f, a, w, ).
( . 11-7). , «
» .
. ,
, (f, g, q, z, aa, bb, ff) ( . 11-10;

: Dworkin LeResche44).
,
. .
GCPS ,

, ( . 11-11).
( . 11-8 11-9). II / , SCL-90-R
.
,
-

11-10.

( ) 0 1 2 3 4
( ) 0 1 2 3 4
( ) 0 1 2 3 4
(d) 0 1 2 3 4
( ) 0 1 2 3 4
(f) 0 1 2 3 4
(g) 0 1 2 3 4
(h) 0 1 2 3 4
() , 0 1 2 3 4
(j) 0 1 2 3 4
(k) 0 1 2 3 4
(I) 0 1 2 3 4
(m) 0 1 2 3 4
(n) , 0 1 2 3 4
(o) 0 1 2 3 4
(P) 0 1 2 3 4
(q) 0 1 2 3 4
(r) 0 1 2 3 4
(S) 0 1 2 3 4
(t) 0 1 2 3 4
<u) 0 1 2 3 4
(v) 0 1 2 3 4
(w) 0 1 2 3 4
(x) 0 1 2 3 4
( ) 0 1 2 3 4
(z) 0 1 2 3 4
(aa) 0 1 2 3 4
(bb) 0 1 2 3 4
(cc) 0 1 2 3 4
-
(dd) 0 1 2 3 4
(ff) 0 1 2 3 4
11-11. SCL- 90- R:
< 0,535 0,535 < 1,105 1,105+

< 0,500 0,500 < 1,000 1,000+
( )
< 0,428 0,428 < 0,857 0,857+
( )

11-12. ,

.
? 12 ( . 11-12).
0 1
0 1 ,
0 1
0 1
0 1
. Ohrbach
/ 0 1
.75

0 1

0 1
(M andibular
0 1
Functional Impairment Questionnaire, MFIQ),
0 1
,
0 1

0 1
( ,
,
,
,42 ,34 ,46 64 ),
,33
. , (Jaw Functional Limitation Scale,
JFLS), ,
SCL-90-R
,
.45
, .

,
,

. ,
,
. ,
,
,
,
,
II / . .
II /
, ,
/ , ,


13. Korszun A, Papadopoulos E, Demitrack M , Engle-
berg C, Crofford L. The relationship between tem
.
poromandibular disorders and stress-associated
syndromes. Oral Surg Oral Med Oral Pathol Oral
, , Radiol Endod 1998;86:416- 420.
14. M cM illan AS, Blasberg B. Pain-pressure threshold
in painful jaw muscles following trigger point injec
tion. J Orofac Pain 1994;8:384- 390.
/ . 15. Hedenberg-Magnusson B, Ernberg M , Kopp P.
Symptoms and signs of temporomandibular disor
ders in patients with fibromyalgia and local myalgia
of the temporomandibular system: a comparative
study. Acta Odontol Scand 1997;55:344- 349.
16. M aixner W, Fillingim R, Kincaid S, Sigurdsson A,
Harris M B. Relationship between pain sensitivity
1. Martikainen , Bartley , Lahelma . Psychosocial and resting arterial blood pressure in patients with
determinants in social epidemiology. Int J Epidemiol painful temporomandibular disorders. Psychosom
2002;31:1091- 1093. Med 1997;59:503- 511.
2. Turk DC. Psychosocial and behavioral assessment 17. M aixner W, Fillingim R, Sigurdsson A, Kincaid S,
of patients with temporomandibular disorders: Silva S. Sensitivity of patients with painful tem
diagnostic and treatment implications. Oral Surg poromandibular disorders to experimentally evoked
Oral Med Oral Pathol Oral Radiol Oral Endod pain: evidence for altered temporal summation of
1997;83:65- 71. pain. Pain 1998;76:71- 81.
3. Molin C. From bite to mind: TM D - a personal and 18. Lautenbacher S, Rollman GB. Possible deficien
literature review. Int J Prosthodont 1999;12:279-288. cies of pain modulation in fibromyalgia. Clin J Pain
4. Rollman GB, Gillespie JM . The role of psychosocial 1997;13:189- 196.
factors in temporomandibular disorders. Curr Rev 19. Kuttila M , Niemi PM , Kuttila S, Alanen P, Le Bell
Pain 2000;4:71- 81. Y. TM D treatment need in relation to age, gen
5. Manfredini D, Landi N, Bandettini di Poggio A, der, stress, and diagnostic subgroup. J Orofac Pain
Dell'Osso L, Bosco M . A critical review on the impor 1998;12:67- 74.
tance of psychological factors in temporomandibular 20. Riley III J, Gilbert G. Orofacial pain symptoms: an
disorders. Minerva Stomatol 2003;52:321- 330. interaction between age and sex. Pain 2001 ;90:
6. Suvinen Tl, Reade PC, Kemppainen P, Kononen M, 245- 256.
Dworkin SF. Review of aetiological concepts of tem 21. Fillingim R, Edwards R, Powell T. The relationship of
poromandibular pain disorders: a biopsychosocial sex and clinical pain to experimental pain responses.
model for integration of physical disorder factors Pain 1999;83:419- 425.
with psychological and psychosocial illness impact 22. LeResche L, Saunders K, Van Korff M , Barlow W,
factors. Eur J Pain 2005;9:613- 633. Dworkin SF. Use of exogenous hormones and
7. Speculand B, Hughes AO, Goss AN. Role of recent risk of temporomandibular disorder pain. Pain
stressful life events experience in the onset of TM J 1997;69:153- 160.
dysfunction pain. Community Dent Oral Epidemiol 23. Dao TT, Kight K, Ton-That V. Modulation of myo
1984;12:197- 202. fascial pain by the reproductive hormones: a pre
8. Flor H, Birbaumer N, Schugens M M , Lutzenberger liminary report. J Prosthet Dent 1998;79:663- 670.
W. Symptom-specific psychophysiological re 24. Landi N, Lombardi (, Manfredini D, Casarosa E,
sponses in chronic pain patients. Psychophysiology Biondi K, Gabbanini M et al. Sexual hormone serum
1992;29:452^ t60. levels and temporomandibular disorders: a prelimi
9. Jones DA, Rollman GB, Brooke RL. The cortisol re nary study. Gynecol Endocrinol 2005;20:99- 103.
sponse to psychological stress in temporomandibu 25. Manfredini D, Bosco M , Segu M , Romagnoli M.
lar dysfunction. Pain 1997;72:171- 182. Test psicodiagnostici per pazienti affetti da DTM
10. Lund JP, Donga R, Widmer CG, Stohler CS. The pain (Italian). Dental Cadmos 2001;12:43- 55.
adaptation model: a discussion of the relationship 26. Kinney RK, Gatchel RJ, Ellis E. M ajor psychologi
between chronic musculoskeletal pain and motor ac cal disorders in chronic TM D patients: implica
tivity. Can J Physiol Pharmacol 1991;69:683-694. tions for successful management. J Am Dent Assoc
11. Murray GM , Peck CC. Orofacial pain and jaw muscle 1992;123:49- 54.
activity: a new model. J Orofac Pain 2007;21:263-278. 27. Gatchel RJ, Garofalo J, Ellis E, Holt C. M ajor psy
12. Demitrack M , Crofford L. Evidence for and patho chological disorders in acute and chronic TM D: an
physiologic implications of hypothalamic-pitu- initial examination. J Am Dent Assoc 1996;127:
itary-adrenal axis dysregulation in fibromyalgia 1365-1374.
and chronic fatigue syndrome. Ann N Y Acad Sci
1998;840:684- 697.

28. Manfredini D, Bandettini di Poggio A, Cantini E, 44. Dworkin SF, LeResche L. Research diagnostic criteria
Dell’Osso L, Bosco M . Mood and anxiety psychopa for temporomandibular disorders: review, criteria,
thology and temporomandibular disorder: a spec examinations and specifications, critique. J Crani
trum approach. J Oral Rehabil 2004;31:933- 940. omandib Disord 1992;6:301- 355.
29. Gallagher RM , Marbach JJ, Raphael KG, Dohren- 45. Dworkin SF, Sherman J, Mancl L, Ohrbach R, LeRe
wend BP, Cloitre M . Is major depression comorbid sche L, Truelove E. Reliability, validity, and clinical
with temporomandibular pain and dysfunction syn utility of the research diagnostic criteria for tem
drome? A pilot study. Clin J Pain 1991;7:219- 225. poromandibular disorders axis II scales: depression,
30. Sipila K, VejolaJ,Jokelainen J, Jarvelin M R, Oikarinen non-specific physical symptoms, and graded chron
K, Raustia A et al. Association between symptoms ic pain. J Orofac Pain 2002;16:207- 220.
of temporomandibular disorders and depression: an 46. Yap AUJ, Chua EK, Tan KBC. Depressive symptoms
epidemiological study of the Northern Finland 1966 in Asian TM D patients and their association with
birth cohort. Cranio 2001;19:183- 187. non-specific physical symptoms reporting. J Oral
31. Manfredini D, Bandettini di Poggio A, Romagnoli Pathol Med 2004;33:305- 310.
M , Dell'Osso L, Bosco M . A spectrum approach 47. Nifosi F, Violato E, Sifari L, Novello, Guarda-Nardini
for the assessment of manic-depressive symptoms L, Manfredini D et al. Clinical psychiatric assessment
accompanying temporomandibular disorders. M in and psychopathological measure of patients with
erva Stomatol 2003;52:231- 240. myofascial and temporomandibular joint pain. Int J
32. Manfredini D, Bandettini di Poggio A, Romagnoli Psychiatr Res 2007;37:283- 300.
M , Dell'Osso L, Bosco M . Mood spectrum in pa 48. Turk DC, Rudy . A dual-diagnostic approach assess
tients with different painful temporomandibular es TM D patients. J Mass Dent Soc 1995;44:16-19.
disorders. Cranio 2004;22:234- 240. 49. Michelotti A, M artina R, Ru sso R, Romeo R. Person
33. Reissmann D, John MT, Wassell RW, Hinz A. Psy ality characteristics of temporomandibular disorder
chosocial profiles of diagnostic subgroups of tem patients using M M PI. Cranio 1998;16:119- 125.
poromandibular disorder patients. Eur J Oral Sci 50. Parker M W, Flolmes EK, Terezhalmy GT. Personality
2008;116:237- 244. characteristics of patients with temporomandibular
34. Manfredini D, Marini M , Pavan C, Pavan L, Guar disorders: diagnostic and therapeutic implications.
da-Nardini L. Psychosocial profiles of painful tem J Orofac Pain 1993;7:337- 344.
poromandibular disorders. J Oral Rehabil 2009;36: 51. Dworkin SF. The case for incorporating biobehav-
193-198. ioral treatment into TM D management. J Am Dent
35. Von Korff M , LeResche L, Dworkin SF. First onset Assoc 1996;127:1607- 1610.
of common pain symptoms: a prospective study of 52. Suvinen Tl, Flanes KR, Gerschman JA, Reade PC.
depression as a risk factor. Pain 1993;55:251- 258. Psychophysical subtypes of temporomandibular
36. Fishbain DA, Cutler R, Romosoff FIL, Romosoff RS. disorders. J Orofac Pain 1997;11:200- 205.
Chronic pain-associated depression: antecedent or 53. Winocur E, Steinkeller-Dekel M , Reiter S, Eli I. A
consequence of chronic pain? A review. Clin J Pain retrospective analysis of temporomandibular find
1997;13:116- 137. ings among Israeli-born patients based on the RDC/
37. Verma S, Gallagher RM . Evaluating and treating TM D. J Oral Rehabil 2009;36:11- 17.
co-morbid pain and depression. Int Rev Psychiatry 54. Lee LT, Yeung RW, Wong M C, M cMillan AS. Di
2000;12:103- 114. agnostic subtypes, psychological distress and psy
38. Korszun A, Ship J. Diagnosing depression in patients chosocial dysfunction in southern Chinese people
with chronic facial pain. J Am Dent Assoc 1997; with temporomandibular disorders. J Oral Rehabil
128:1680- 1686. 2008;35:184- 190.
39. Dohrenwend B, Raphael K, Marbach JJ, Gallagher 55. Mongini F, Ciccone G, Ceccarelli M , Baldi I, Fer-
RM. Why is depression comorbid with chronic myo rero L. Muscle tenderness in different types of
fascial face pain? A family study test of alternative facial pain and its relation to anxiety and depres
hypotheses. Pain 1999;183- 192. sion: a cross-sectional study on 649 patients. Pain
40. American Psychiatric Association Committee on 2007;131:106- 111.
Nomenclature and Statistics. Diagnostic and Statis 56. Celic R, Panduric J, Dulcic N. Psychologic status in
tical Manual of Mental Disorders, ed 4. 1994. patients with temporomandibular disorders. Int J
41. Dworkin SF, Von Korff M , LeResche L. Multiple pains Prosthodont 2006;19:28- 29.
and psychiatric disturbance: an epidemiologic inves 57. Reiter S, Eli I, Gavish A, Winocur E. Ethnic differ
tigation. Arch Gen Psychiatry 1990;47:239-244. ences in temporomandibular disorders between
42. Yap AUJ, Tan KBC, Chua EK, Tan HH. Depression Jewish and Arab populations according to RDC/
and somatization in patients with temporomandib TM D evaluation. J Orofac Pain 2006;20:36- 42.
ular disorders. J Prosthet Dent 2002;88:479- 484. 58. Plesh O, Sinisi SE, Crawford PB, Gansky SA. Diag
43. Derogatis LR, Lipman RS, Covi L. SCL-90: an out noses based on the research diagnostic criteria for
patient psychiatric rating scale. Preliminary report. temporomandibular disorders in a biracial popu
Psychopharmacol Bull 1973;9:13- 28. lation of young women. J Orofac Pain 2005;19:
65- 76.

59. Rantala M A, Ahlberg J, Suvinen , Savolainen A, 67. Epker J, Gatchel RJ. Coping profile differences in
Kononen M . Chronic myofascial pain, disk dis the biopsychosocial functioning of patients with
placement with reduction and psychosocial fac temporomandibular disorder. Psychosom Med
tors in Finnish non-patients. Acta Odontol Scand 2000;62:69- 75.
2004;62:293- 297. 68. Turner JA, Brister H, Huggins K, Mancl L, Aaron LA,
60. Yap AU, Chua EK, Tan KB, Chan YH. Relationship Truelove EL. Catastrophizing is associated with clini
between depression/ somatization and self-reports cal examination findings, activity interference, and
of pain and disability. J Orofac Pain 2004;18: health care use among patients with temporoman
220- 225. dibular disorders. J Orofac Pain 2005;19:291- 300.
61. Yap AU, Dworkin SF, Chua EK, List T, Tan KB, Tan 69. Turner JA, Mancl L, Aaron LA. Short- and long
HH. Prevalence of temporomandibular disorder term efficacy of brief cognitive-behavioral therapy
subtypes, psychologic distress, and psychoso for patients with chronic temporomandibular dis
cial dysfunction in Asian patients. J Orofac Pain order pain: a randomized, controlled trial. Pain
2003;17:21- 28. 2006;121:181- 194.
62. M acfarlane TV, Gray RJM , Kincey J, Worthington 70. Turk DC, Rudy . Toward a comprehensive as
HV. Factors associated with the temporomandibu sessment of chronic pain patients: a multiaxial ap
lar disorder, pain dysfunction syndrome (PDS): proach. Behav Res Ther 1987;25:237- 249.
M anchester case-control study. Oral Dis 2001 ;7: 71. Turk DC, Rudy . Robustness of an empirically
321- 330. derived taxonomy of pain patients. Pain 1990;43:
63. Madland G, Feinmann C, Newman S. Factors asso 27- 36.
ciated with anxiety and depression in facial arthro- 72. Kerns RJ, Turk DC, Rudy . The West Have-Yale
myalgia. Pain 2000;84:225- 232. Multidimensional Pain Inventory (WHYM PI). Pain
64. List T, Dworkin SF. Comparing TM D diagnoses and 1985;23:245- 256.
clinical findings at Swedish and US TM D centers 73. Von Korff M , Dworkin SF, LeResche L. Graded
using research diagnostic criteria for temporoman chronic pain status: an epidemiologic evaluation.
dibular disorders. J Orofac Pain 1996;10:240- 253. Pain 1990;40:279- 291.
65. Korszun A, Hinderstein B, Wong M . Comorbidity 74. Von Korff M , Ormel J, Keefe FJ, Dworkin SF. Grad
of depression with chronic facial pain and temporo ing the severity of chronic pain. Pain 1992;50:
mandibular disorders. Oral Surg Oral Med Oral 133- 149.
Pathol Oral Radiol Endod 1996;82:496- 500. 75. Ohrbach R, Granger C, List T, Dworkin SF. Prelimi
66. M cCreary CP, Clark GT, Merril RL, Flack V, Oakely nary development and validation of the Jaw Func
M E. Psychological distress and diagnostic sub tional Limitation Scale. Community Dent Oral Epi
groups of temporomandibular disorder patients. demiol 2008;36:228- 236.
Pain 1991;44:29- 34.

12
-
, ,
-
( ). 1992 . .

( / ), .5
Fryback Thornbury5

.
1. .
, - .
( ), 2. . ,
, ,
,
,

.1 , Wiese ,
.2 (receiver operating
characteristic, ROC) ( . 12-1).
( 3. .
/ ) ,
. Koh .3 . .
.
4. .
-
( )
. .
Limchaichana .,4 5.
, , .

/ .
. 6. .
.

-
12-1. 12-2.

( , ) . .
-
. :
• ( ),
. - ( )
• :
,
. • - ( )
• :
,
. :
• : •
,
. •
• :
, •
.
• : , - :
:
. : •
/
( -
). •
• : , :
. •
:
/(
+ •
).
• :
: •

. •
: .
/(
+
).
,
•
:
,
.
: .
/(
+
).
,
• ,
0 1( 0 100 %), .
1
,
0,5 . .
2 0 8 @dentistinfo первый стоматологический телеграм канал

,
( 12-2).
1.
. - ,

. ,
2. , ,
.

. .67 Dahlstrom
3. . . Lind vall,8
4.
. ,
:
, , ,

. .
5. ,
,
, .910
M agnusson Karlsson,11
.
.
,

: . Epstein .12
,
, ,
( ),
- ,
( ). - . ,

.
,
. , .12

( ). (International Commission on Radiological

Protection, ICRP),

.13

,

-
. 12-1. .
, b .
.
,
,
. 12-2.
24
( . 12-1).
,

,
( . 12-2). .
, -

. . Cholitgul
Omnell Petersson,14 .22

, .

.
.
67-90 %, - 73-93 %.

.1516 , .
,
, .
, , Flygare .,23

.17
0,58 0,53,
, - 0,89 0,95,
. ,

.18 .23 ,
,

. .
. 12-3
12-4, . Wiese
.,24 ,

.
.
,
.
.2 ,24

. , ,

, . ,
.
, .
,

,
.1920 Eckerdal21 , -

-
. 12-3. . 12-4.
, .
, .

,
( . 12-5) .
( . 12-6). , Westesson
.,27

, 0,75 1,00, ,

,
. 1,0 0,78, . ,
, .27
Hussain .
,28

,
.
,

( . 12-7 12-8).
.
,
.25 Hintze
.26
,
. ,

. 12-5. . 6,5 .
. 2 . .
. 3
,
. 12-6. .
. . .
.

. 12-7.

.
.
1 : - ;
- ;
-

-
. 12-8.
.
.

. : .
1 :
- ;
- ; -
. 12-9.
.
( )
. .3031
,

( . 12-10).
( . 12-9).
,
Westesson .32

,
1970- - 1980- . ,
( . 12-11).

. 12-10. .
.
. .
. 12-11. -

,34
-
.33
,

. 1996 . Liedberg .34 .

,

.
Lim chaichana .35
,
- -

-

.
,
,
. Tasaki .37
,
8
, ,
.
. 12-12. (
)
. .
.
( 12 ),
( )

( . 12-12).
1,5 .

, ( . 12-13).

. Tasaki .37
, ,
1- , ,
2- ,
,

( ) .
. Wang .36
.38
, Orsini .39
.
. ,
Lim chaichana .35 (
12 11 ),
. . ,
, ,
,

.
. . 12-14

. 12-13. ( ) : -
- . :
-

.36
Takano .,40 7

,
. ,

.41
Westesson .27
. 12-14.
.
.
0,86, - 0,63,
( 12 ),
,
- 0,67
0,83, .
,
.
. Schm itter .42
Lim chaichana .,35
(
) ,

. . ,
-

-
. 12-15. 65

.
,
. .

. .
.

. . (
)
.
. , d. ,
2- . , . ( )
.
, 2- , f.
44. . ( )
. ,
, . ,
.35
, ,
.40
( . 12-16)
, ( . 12-15),43'44
, Larheim .,44 ,
,
,
0,54

. 12-16. : ) ; )
2- ,
, ; ) 2-
( ),
0,79, .44 ,
.47 , White
. .,48
, , .

,
.
,
. ,
, 12-2.
•
. ,
.
• .3 ,
.
•
. ,
.
,
.
.
,

. Rudisch .49
.

,45'46

-
. 12-17. . 12-18. 56 ,
. 2 . .
( . .
- , (
. - (Jean- Paul Go ulet ),
- , , )
,
)
( )
. , ,

, .
.

0,73, - 0,75,
,53
- 0,89 ,
0,50, .
,
. M elis .54
.,50

51,5 100 %. ,

.

(73 %), ( )

.61
, .
79 % ( 0,85,
0,67).52 . 12-17 -
, -99 ,
. , , -

.
- ,
. ,
.
,
( . 12-18). .
.
, , , ,
, ,
,
.
,
, ,
,66
.
.66
.
, Epstein .,57
,
. 1. Dworkin SF, LeResche L. Research diagnostic criteria
for temporomandibular d isor d er s: review, criteria,
,
. 2. Wiese M , Svensson P, Bakke M , List T, Hintze H,
Petersson A et al. Association between temporo
mandibular joint symptoms, signs, and clinical
diagnosis using the RDC/ TM D and radiographic
findings in temporomandibular joint tomograms. J
Orofac Pain 2008;22:239- 251.
3. Koh KJ, List T, Petersson A, Rohlin M . Relationship
between clinical and magnetic resonance imaging
diagnoses and findings in degenerative and inflam
matory temporomandibular joint diseases. A sys
tematic review. J Orofac Pain 2009;23:122- 139.
4. Limchaichana N, Nilsson H, Ekberg EC, Nilner M ,
, .
Petersson A. Clinical diagnoses and MRI find
, ings in patients with TM D pain. J Oral Rehabil
2007;34:237- 245.
5. Fryback DG, Thornbury JR. The efficacy of diagnos
tic imaging. Med Decis M aking 1991;11:88- 94.
. ,
6. M awani F, Lam EW, C, M cKee I, Raboud DW,
M ajor PW. Condylar shape analysis using panoram
ic radiography units and conventional tomography.
. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
2005;99:341- 348.
7. Schmitter M , Gabbert O, Ohlmann B, Plassel A,
, Wolff D, Rammelsberg P et al. Assessment of the
reliability and validity of panoramic imaging for as
. sessment of mandibular condyle morphology using
both M RI and clinical examination as the gold stan
dard. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 2006;102:220- 224.

-
8. Dahlstrom L, Lindvall AM . Assessment of temporo 23. Flygare L, Rohlin M, Akerman S. Microscopy and to
mandibular joint disease by panoramic radiography: mography of erosive changes in the temporomandib
reliability and validity in relation to tomography. ular joint. Acta Odontol Scand 1995;53:297-303.
Dentomaxillofac Radiol 1996;25:197- 201. 24. Wiese M , Wenzel A, Hintze H, Petersson A, Knuts-
9. Brooks SL, Westesson P-L, Eriksson L, Hansson LG, son , Bakke M et al. Osseous changes and condyle
Barsotti JB. Prevalence of osseous changes in the position in TM J tomograms: impact of RDC/ TM D
temporomandibular joint of asymptomatic persons clinical diagnoses on agreement between expected
without internal derangements. Oral Surg Oral Med and actual findings. Oral Surg Oral Med Oral Pathol
Oral Pathol 1992;73:118- 122. Oral Radiol Endod 2008;106:52- 63.
10. Crow HC, Parks E, Campbell JH, Stucki DS, Daggy 25. Loubele M , Bogaerts R, Van Dijck E, Pauwels R,
J. The utility of panoramic radiography in temporo Vanheusden S, Suetens P et al. Comparison be
mandibular joint assessment. Dentomaxillofac Ra tween effective radiation dose of CBCT and M SCT
diol 2005;34:91- 95. scanners for dentomaxillofacial applications. Eur J
11. Magnusson T, Karlsson C. Clinical impact of ra Radiol 2008;71:461- 468.
diological examinations of patients with suspect 26. Hintze H, Wiese M , Wenzel A. Cone beam CT and
ed temporomandibular disorders. Swed Dent J conventional tomography for the detection of mor
2002;26:67- 74. phological temporomandibular joint changes. Den
12. Epstein JB, Caldwell J, Black G. The utility of pan tomaxillofac Radiol 2007;36:192- 197.
oramic imaging of the temporomandibular joint in 27. Westesson P-L, Katzberg RW, Tallents RH, Sanchez-
patients with temporomandibular disorders. Oral Woodworth RE, Svensson A. CT and M R of the
Surg Oral Med Oral Pathol Oral Radiol Endod temporomandibular joint: comparison with autopsy
2001;92:236- 239. specimens. Am J Roentgenol 1987;148:1165-1171.
13. International Commission on Radiological Protection. 28. Hussain AM , Packota G, M ajor PW, Flores-Mir C.
At: http:/ / www.icrp.org (accessed 25 March 2009). Role of different imaging modalities in assessment
14. Omnell -A, Petersson A. Radiography of the of temporomandibular joint erosions and osteo
temporomandibular joint utilizing oblique lat phytes: a systematic review. Dentomaxillofac Radiol
eral transcranial projections. Odontol Revy 2008;37:63- 71.
1976;27:77- 92. 29. Wilkes CH. Arthrography of the temporomandibu
15. Pullinger AG, Hollender L, Solberg WK, Petersson lar joint in patients with the TM J pain-dysfunction
A. A tomographic study of mandibular condyle syndrome. Minn Med 1978;61:645- 652.
position in an asymptomatic population. J Prosthet 30. Farrar WB. Characteristics of the condylar path in
Dent 1985;53:706- 713. internal derangements of the TM J. J Prosteth Dent
16. Blaschke DD, Blaschke TJ. Normal TM J bony 1978;39:319- 323.
relationships in centric occlusion. J Dent Res 31. M cCarthy Jr W L, Farrar WB. Surgery for internal
1981;60:98- 104. derangements of the temporomandibular joint.
17. Kurita H, Ohtsuka A, Kobayashi H, Kurashina K. A J Prosteth Dent 1979;42:191- 196.
study of the relationship between the position of 32. Westesson P-L, Omnell -A, Rohlin M . Double
the condylar head and displacement of the tem contrast tomography of the temporomandibular
poromandibular joint disk. Dentomaxillofac Radiol joint: a new technique based on autopsy specimen
2001;30:162- 165. examination. Acta Radiol Diagn 1980;21:777- 784.
18. McNeill C (ed). Craniomandibular Disorders: Guide 33. Westesson P-L, Rohlin M . Diagnostic accuracy of
lines for Evaluation, Diagnosis, and Management. double-contrast arthrotomography of the temporo
Chicago, IL: Quintessence Publishing, 1990. mandibular joint: correlation with postmortem mor
19. Rosenberg HM , Grazyk RJ. Temporomandibular ar phology. Am J Roentgenol 1984;143:655- 660.
ticulation tomography: a corrected anteroposterior 34. Liedberg J, Panmekiate S, Petersson A, Rohlin M.
and lateral cephalometric technique. Oral Surg Oral Evidence-based evaluation of three imaging meth
Med Oral Pathol 1986;62:198- 204. ods for the temporomandibular disc. Dentomaxil
20. Heffez L, Jordan S, Rosenberg H, Miescke K. Ac lofac Radiol 1996;25:234- 241.
curacy of temporomandibular joint space measure 35. Limchaichana N, Petersson A, Rohlin M . The effica
ments using corrected hypocycloidal tomography. cy of magnetic resonance imaging in the diagnosis
J Oral M axillofac Surg 1987;45:137- 142. of degenerative and inflammatory temporomandib
21. Eckerdal O. Tomography of the temporomandibular ular joint disorders: a systematic literature review.
joint: correlation between tomographic image and Oral Surg Oral Med Oral Pathol Oral Radiol Endod
histologic sections in a three-dimensional system. 2006;102:521- 536.
Acta Radiol 1973;329:1- 107.
22. Cholitgul W, Petersson A, Rohlin M , Tanimoto K,
Akerman S. Diagnostic outcome and observer
performance in sagittal tomography of the tem
poromandibular joint. Dentomaxillofac Radiol
1990;19:1- 6.

36. Wang EY, Mulholland TP, Pramanik BK, Nusbaum 46. Wiese M , Wenzel A, Hintze H, Petersson A, Knuts-
AO, Babb J, Pavone AG et al. Dynamic sagittal son , Bakke M et al. Influence of cross-sectional
half-Fourier acquired single-shot turbo spin-echo TM J tomography on management of patients with
M R imaging of the temporomandibular joint: initial temporomandibular disorders. Oral Surg Oral Med
experience and comparison with sagittal oblique Oral Pathol Oral Radiol Endod 2010 (submitted).
proton-attenuation images. Am J Neuroradiol 47. Nilner M , Petersson A. Clinical and radiological
2007;28:1126- 1132. findings related to treatment outcome in patients
37. Tasaki M M , Westesson P-L, Isberg AM , Ren Y-F, with temporomandibular disorders. Dentomaxillo
Tallents RH. Classification and prevalence of tem fac Radiol 1995;24:128- 131.
poromandibular joint disk displacement in patients 48. White SC, Pullinger AG. Impact of TM J radiographs
and symptom-free volunteers. Am J Orthod Dento on clinical decision making. Oral Surg Oral Med
facial Orthop 1996;109:249- 262. Oral Pathol Oral Radiol Endod 1995;79:375- 381.
38. Nebbe B, Brooks SL, Hatcher D, Hollender LG, 49. Rudisch A, Emshoff R, M aurer H, Kovacs P,
Prasad NGN, M ajor PW. Magnetic resonance imag Bodner G. Pathologic-sonographic correlation in
ing of the temporomandibular joint: interobserver temporomandibular joint pathology. Eur Radiol
agreement in subjective classification of disk status. 2006;16:1750- 1756.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 50. Melis M , Seed S, Ceneviz C. Use of ultrasonog
2000;90:102- 107. raphy for the diagnosis of temporomandibular joint
39. Orsini M G, Kuboki T, Terada S, M atsuka Y, Yatani disorders: a review. Am J Dent 2007;20:73- 78.
H, Yamashita A. Clinical predictability of temporo 51. Tognini F, Manfredini D, Melchiorre D, Bosco M.
mandibular joint disc displacement. J Dent Res Comparison of ultrasonography and magnetic
1999;78:650- 660. resonance imaging in the evaluation of temporo
40. Takano Y, Honda K, Kashima M , Yotsui Y, Igarashi mandibular joint disc displacement. J Oral Rehabil
C, Petersson A. Magnetic resonance imaging of the 2005;32:248- 253.
temporomandibular joint: a study of inter- and in 52. Manfredini D, Tognini F, Melchiorre D, Bazzichi L,
traobserver agreement. Oral Radiol 2004;20:62- 67. Bosco M . Ultrasonography of the temporomandib
41. Orsini M G, Terada S, Kuboki T, M atsuka Y, Yamash ular joint: comparison of findings in patients with
ita A. The influence of observer calibration in tem rheumatic diseases and temporomandibular disor
poromandibular joint magnetic resonance imaging ders. A preliminary report. Oral Surg Oral Med Oral
diagnosis. Oral Surg Oral Med Oral Pathol Oral Pathol Oral Radiol Endod 2005;100:481- 485.
Radiol Endod 1997;84:82- 87. 53. Emshoff R, Jank S, Rudisch A, Walch C, Bodner G.
42. Schmitter M , Kress B, Hahnel S, Rammelsberg P. Error patterns and observer variation in the high-
The effect of quality of temporomandibular joint resolution ultrasonography imaging evaluation of
M R images on interrater agreement. Dentomaxil the disk position of the temporomandibular joint.
lofac Radiol 2004;33:253- 258. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
43. Larheim , Westesson P-L, Sano T. M R grading 2002;93:369- 375.
of temporomandibular joint fluid: association with 54. Manfredini D, Guarda-Nardini L. Ultrasonography of
disk displacement categories, condyle marrow ab the temporomandibular joint: a literature overview.
normalities and pain. Int J Oral M axillofac Surg Int J Oral Maxillofac Surg 2009;38:1229-1236.
2001;30:104- 112. 55. Pogrel M A. Quantitative assessment of isotope ac
44. Larheim , Westesson P-L, Hicks DG, Eriksson L, tivity in the temporomandibular joint regions as a
Brown DA. Osteonecrosis of the temporomandibu means of assessing unilateral condylar hypertrophy.
lar joint: Correlation of magnetic resonance imag Oral Surg Oral Med Oral Pathol 1985;60:15- 17.
ing and histology. J Oral M axillofac Surg 1999;57: 56. Saridin CP, Raijmakers PGHM , Tuinzing DB, Beck
888- 898. ing AG. Comparison of planar bone scintigraphy
45. Callender Kl, Brooks SL. Usefulness of tomography and single photon emission computed tomography
in the evaluation of patients with temporoman in patients suspected of having unilateral condylar
dibular disorders: a retrospective study. Oral Surg hyperactivity. Oral Surg Oral Med Oral Pathol Oral
Oral Med Oral Pathol Oral Radiol Endod 1996;81: Radiol Endod 2008;106:426- 432.
710- 719. 57. Epstein JB, Rea A, Chahal O. The use of bone scin
tigraphy in temporomandibular joint disorders. Oral
Dis 2002;8:47- 53.

13
-
,
- .
( ) -
( ) ,
,
, ,
.

,
, .

,
,
( ),
,
,
.

. ,
.
,
. ,
. ,
, -
,
.1 .
, ,
, -

13-1. ( )
226
( ), ,
-

Goulet, 1990s ( = 19) ( = 16); , : 0,61-0,71
Reeves, 19864 ( : 0,71-0,89,

, = 15; , = 12), : 0,69-0,86
Visscher, 20046 ( = 148), , : 0,22

,
Gom es, 20087 ( = 40) ( = 40), , : : 0,68-0,80, :

, 0,5- 0,69; : : 0,73- 0,84,
: 0,53-0.65, : 0,75,
: 0,90
Sand, 199713 ( = 30) ( = 10), : 0,72, : 0,66
19 33 ,
13
Bernhardt, ( = 15) ( = 15); : :

200714 15 : 0,74-0,77, : 0,74-0,81,
, , : 0,8, : 0,73. :
: 0,85- 0,96, : 0,82-0,96,
: 0,93, : 0,87
Goulet, 199812 ( = 36) ( = 36), :
, : 0,73/ 0,81,
, : 0,61/ 0,87,
, : 0,85/ 0,85,
: 0,41/ 0,53,
: 0,67/ 0,64
Ohrbach, 198910 ( = 10), : 0,81-0,91
4-5 ,
( = 10), : 0,55-0,93
,

.
,2
,
. ,
«
=;
,
,
.
,
- - ,
,
.
*
S
,
0 S
—^ 0 .3
^ S
о. 5g i f
S m
"^ X t l m CO
5 =
0 CD^ S5 Ef
I 0
_Q I- I-
1= I
.
X
'
о 21
. C
D
. -- 0
- * =- g ,
II" i -s X II 5 8 ° ”
CL
•5 1 3 £® S T .
О СО 5 0-
* j? 2 I s
Q Q >• £ X > 1— CO
1 00 £ 0

« о о2 е5 0 I I
g 2
c
“ ><
CD
X
; —
0
.
- S 5 - )
^ |Г .8 1 5
m ^ О s II §
g S
I ,03 CD Ш -О 0 - 0 0 CD -S X ,
СО Г J I- VO S * m 0 S
* S S 0 t -О 2
-
^ J
_ —
-О LO X - ^ — 0 —) s0
) _
5.
>. m
*
.
£ 3 X 3 см X
•W -
0
J ^
0
; II
0 2 2 MS
,
СО I I- '
- I .S 2
•& J s Q- 0 .^ 0
S 1 | | ,
III
s - X
5
^s S ° X
0 (D , ,
2 Q. ; I . 8 LQ
, . . ,
-
I о
0 S
s s
(D 0
S
Q) 0
S о
0 s
s s

-Г о
5 О S = % S s :
§ 5 5 --g f 5 6
f 1 - - . . . •§• * a£ -& Q. .
о о. •
m X * m *
0
^ 2 *: *
s
[= ^ 2
O 0
^ 2 ^ * =
о. .
о I-
-
°-
-
°-
°
5-
О о
со
00
)
,
. -

-
( )
( )
. ( . 13-2).4'10' 4_20

. ,
.410
:
( ) .

.

. ,
.
0,67 0,87
, . 0,77 0,87
, , .19

. ,
- .
, .
,
,
. ,
( . 13-1 ( 7
.5
,
.
,4'8-14

.

.10
,

. (American Dental Association)
,
.21 ,
.12
(
) .

Таблица 13-2. ( )
(n)

Reeves, 19864 (n = 9) ;( ) , ANOVA ( < 0,05), ( ) < ( )

( ) ( )
Ohrbach, 198910 ( = 13) : - ( < 0,05), ( ) < ( )
( ) ;( )
( = 10) - ( < 0,05), ( ) < ( )
( = 10) ( ;
) ( ) ,( ) (
)
Reid, 1994" ( = 29) 4 ANOVA ( < 0,05); ( ) < ( )
( = 11) :( ) ,
( )
Kosek, 1996 ( = 10) 4 ( / ANOVA ( < 0,001),
( = 10) ): ( ) , ( )<( ) ,
( ) ( ) ANOVA ( < 0,01); ( ) < ( )
:( ) , ,
( )
Hendenberg- ( = 23) U- - ( < 0,05),
Magnusson, ( = 23) : ( )<( )(
199715 ( = 20) ( ) ,( ) ), ( ) < ( ) < ( ) (
,() )
Kim, 1995,s - ( = 31) 26 (13 2) MANOVA ( < 0,01),
( = 32) :( ) - ,( ) ( ) < ( ) (3 )
Jensen, 199817 - , , U- - ( < 0,05),

( = 18), , -
( = 10) - ,( ) ,( ) , ( ) < ( ) (3 ),
- . - ,
( = 14), - , , d: (3
( = 14) () , (d) , )
( = 30)
Jensen, 199318 ( = 70) :( ) ANOVA ( < 0,05),
T- ,( ) -
( = 144) ( ,() - ,
- ) (d):
( = 14)
( = 31)
Farella, 200019 ( = 40) : - ( < 0,05), ( ) < ( ),
( = 40) ( ( ) ,( ) (
) ) : 0,67 :
0,85,
: 0,77 :
0,87
22 9
Bernhardt, 200714 ( = 15) 8 , - ( < 0,05); ( ) < ( )

( = 15) :( ) ,
( )
-
, ,
, , .33

.22 ,
, .33
,

.23'24
.33
, ,
. ,

.
,
, ( )

-
. .3435
,
. ,
14 %.25
, (
) ,
24 , -
.36
18 %. ( )
-
31-38 %.25 ,
37
Klasser Okeson,38 Lund
. , .,39 Widmer .,2 Suvinen
, Kem ppainen,40
. 13-3. , , ,
26-33 , ,
, ,
.27'29-30'32-33 , ,
, .
,
,
. ,
, , ,
, ,
,
. ,
.
,
, , (17 %
, 47 % ).41

Таблица 13-3. ( )
(n)

M ajewski, 198426 ( ) (% ), ( .): ( ) = 2,4,

( = 4,0, ( )
( = 11), ( ) ( = 11) = 11,4,
) = 7,2
ANOVA ( s 0,05): ( ),
(
)
Dahlstrom, 198527 ( ) ( = 20), ( ) ( : ( ) = 0,14, ( ) = 0,09
( = 20) ( / ( < 0,05); ( ) > ( )
)
)
Sherm an, 198528 (a) ( = 9), (mV) : ( ) = 14,2, ( ) = 13,8, ( ) = 5,9, (d) = 4,5
(b ) ( - ( < 0,01)
( = 7), ( ) ( )
( = 16), (d) ) : ( ), ( ) > ( ), (d)
( = 14)
Rugh, 198729 ( ) ( = 23), ( ) (mV) ( / ): ( ) = 5,1/ 4,8,
( = 23) ( ) = 2,1/ 2,3
ANOVA ( < 0,05), ( ) > ( )
Gervais, 198930 ( ) ( = 61), ( ) (mV) : ( ) = 4,7- 6,1, ( ) = 1,9-2,3,
( = 31), ( ) ( ) = 1,8-2,5
( = 24) M ANOVA ( < 0,05), ( ) > ( ) ( ) (
)( ) ( )(
)
Glaros, 198931 ( ) (mV) : ( ) = 2,9- 4,7, ( ) = 1,4-2,7
( = 20), ( ) ( = 20) ( , ,
)
Schroeder, 199132 ( ) ( = 30), ( ) (s/ min) : ( ) = 8,4, ( ) = 1,3 ( .)
( = 25) ( - ( < 0,05), ( ) > ( )
)
Bodere, 200533 ( ) (mV) : ( ) = 55, ( ) = 25
( = 33), ( ) ( = 32), , ANOVA (Ps 0,05) ( ) < (b)
231
( ) . :( ) = 42,
( = 9), = 42 ( )( ,
.)
-
,

: .
15-40 %.31
, ,
,

75 % , . Dworkin
.,42
.
, ( 0,62
0,61, ). ,
.
,
( 0,30
, 0,44, ).
Dworkin .43
.

. ,

,21 50 %
. ,
,
. ,
. , Goulet Clark,6
(

)
90 %. ,
, ,
,
. .

,
,
.44"61 ,

.

,52
( )
. ,52

,
. , ,

. ,
,
,
. ,
.

.
, .

25-50 % .5354
.

.
0,49

.56 , ,
.45
,
.
.
-
.
.56
,
.
, ,
.
( ),
,
.
,5758 ,
.
.
, .
. -

-
.

.
,
. Goulet .,12
Dworkin .,42
( )
(0,78-0,93 0,90-0,98,
),
( ). ,
,
.

.
, , ,
.
, .50'59-63 ,
, ,
, ,
,
.
(
, ), ,
.
, -
. ,
,

, . ,

. ,
,

. .

, ,
. (M ylar). ,
,
.
,
.
, ,

,

. .
: ,
,
, ,
, .

.
1980- . , .
( , ;
( ; Dental Prescale, Fuji Film)
Dental Sound Checker, Yoshida Dental Trade
Distr. Co. Ltd.).
, Watt,64 , .
,
.
, .69
. Kifune Araki .70
.65

.
. ,

,
. .
1987 . M aness .66 ,

T- ( ; -Scan system , - ,
Sentek .). T- , ,

, .
,
. , ,
,

. 1991 . Neff67 ,
, . ,
T-

, ,
,
,
, .
, ,
. Mizui
.68 ,
T-
60 ,

-
( 20-30 ) 6. Visscher CM , Lobbezoo F, Naeije M . Comparison of

algometry and palpation in the recognition of tem
poromandibular disorder pain complaints. J Orofac
. , Pain 2004;18:214- 219.
7. Gomes M B, Guimaraes JP, Guimaraes FC, Neves
AC. Palpation and pressure pain threshold: reliabil
ity and validity in patients with temporomandibular
disorders. J Craniomandibular Pract 2008;3:202-
210 .
8. Jensen K, Andersen H 0 , Olesen J, Lindblom U.
. Pressure-pain threshold in human temporal re
gion. Evaluation of a new pressure algometer. Pain
1986;25:313- 323.
9. Ohrbach R, Gale EN. Pressure pain thresholds in
normal muscles: reliability, measurement effects,
and topographic differences. Pain 1989;37:257-
263.
10. Ohrbach R, Gale EN. Pressure pain thresholds, clini
cal assessment, and differential diagnosis: reliability
, and validity in patients with myogenic pain. Pain
1989;39:157- 169.

11. Reid Kl, Gracely RH, Dubner RA. The influence
of time, facial side, and location on pain-pressure
. , thresholds in chronic myogenous TM disorder.
J Orofac Pain 1994;8:258- 265.
. 12. Goulet JP, Clark GT, Flack VF, Liu C. The reproduc
ibility of muscle and joint tenderness detection
, methods and maximum mandibular movement
, measurement for the TM system. J Orofac Pain
1998;12:17- 26.
, 13. Sand T, Zwart JA, Helde G, Bovim G. The repro
ducibility of cephalic pain pressure thresholds in
. , control subjects and headache patients. Cephalalgia
, 1997;17:748- 755.
14. Bernhardt O, Schiffman EL, Look JO. Reliability and
validity of a new fingertip-shaped pressure algom
. eter for assessing pressure pain thresholds in the
. temporomandibular joint and masticatory muscles.
J Orofac Pain 2007;21:29- 38.
15. Hedenberg-Magnusson B, Ernberg M , Kopp S.
Symptoms and signs of TM disorders in patients
with fibromyalgia and local myalgia of the TM
system: a comparative study. Acta Odontol Scand
1997;55:344- 349.
16. Kim HS, Chung SC, Kim YK, Lee SW. Pain-pressure
1. Baba , Tsukiyama Y, Yamazaki , Clark GT.
threshold in the head and neck region of episodic
review of temporomandibular disorder diagnostic
tension-type headache patients. J Orofac Pain
techniques. J Prosthet Dent 2001;86:184- 194.
1995;9:357- 364.
2. Widmer CG, Lund JP, Feine JS. Evaluation of diag
17. Jensen R, Bendtsen L, Olesen J. Muscular factors
nostic tests for TM D. J Calif Dent Assoc 1990; 18:53-
are of importance in tension-type headache. Head
60.
ache 1998;38:10- 17.
3. Lund JP, Lavigne G, Feine JS, Goulet JP, ChaytorDV,
18. Jensen R, Rasmussen BK, Pedersen B, Olesen J. M us
Sessle BJ et al. The use of electronic devices in the
cle tenderness and pressure pain thresholds in head
diagnosis and treatment of temporomandibular dis
ache: a population study. Pain 1993;52:193-199.
orders. J Can Dent Assoc 1989;55:749- 750.
19. Farella M , Michelotti A, Steenks M H, Romeo R,
4. Reeves JL, Jaeger B, Graff-Radford SB. Reliability of
Cimino R, Bosman F. The diagnostic value of pres
the pressure algometer as a measure of myofacial
sure algometry in myofacial pain of the jaw muscles.
trigger point sensitivity. Pain 1986;24:313- 321.
J Oral Rehabil 2000;27:9- 14.
5. Goulet JP, Clark GT. Clinical TM J examination meth
ods. J Calif Dent Assoc 1990;18:25- 33.

20. Kosek , Ekholm J, Hansson P. Sensory dysfunction 36. Jensen R, Fuglasan-Frederiksen A, Olesen J. Quan
in fibromyalgia patients with im plication s fo r patho titative su r fa ce EMG of pericranial m u scles in head
genic mechanisms. Pain 1996;68:375- 383. ache: a population study. Electroencephalogr Clin
21. ADA council on scientific affairs. Report on ac Neurophysiol 1994;93:335- 344.
ceptance of TM D devices. J Am Dent Assoc 37. Hatch JP, Moore PJ, Cyr-Provost M , Boutros NN,
1996;127:1615- 1616. Seleshi E, Borcherding S. The use of electromyo
22. Jankelson RR. Scientific rationale for surface elec graphy and muscle palpation in the diagnosis of
tromyography to measure postural tonicity in tension-type headache with and without pericranial
dental patients. J Craniomandibular Pract 1990;8: muscle involvement. Pain 1992;49:175- 178.
207- 209. 38. Klasser GD, Okeson JP. The clinical usefulness of
23. Hardage JL, Gildersleeve JR, Rugh JD. Clinical work surface electromyography in the diagnosis and
posture for the dentist: an electromyographic study. treatment of temporomandibular disorders. J Am
J Am Dent Assoc 1983;107:937- 939. Dent Assoc 2006;137:763- 771.
24. Mohl ND, Zarb GA, Carlsson GE, Rugh JD. A Text 39. Lund JP, Donga R, Widmer CG, Stohler CS. The
book of Occlusion. Chicago, IL: Quintessence Pub pain-adaptation model: a discussion of the rela
lishing, 1988:336. tionship between chronic musculoskeletal pain and
25. Jensen R, Fuglsang-Frederiksen A, Olesen J. Quan motor activity. Can J Physiol Pharmacol 1991;69:
titative surface EM G of pericranial muscles: repro 683- 694.
ducibility and variability. Electroencephalogr Clin 40. Suvinen Tl, Kemppainen P. Review of clinical
Neurophysiol 1993;89:1- 9. EM G studies related to muscle and occlusal fac
26. Majewski RF, Gale EN. Electromyographic activity of tors in healthy and TM D subjects. J Oral Rehabil
anterior temporal area pain patients and non-pain 2007;34:631- 644.
subjects. J Dent Res 1984;63:1228- 1231. 41. Jensen R, Rasmussen BK. M uscular disorders in ten
27. Dahlstrom L, Carlsson SG, Gale EN, Jansson TG. sion-type headache. Cephalalgia 1996;16:97- 103.
Stress-induced muscular activity in mandibular dys 42. Dworkin SF, LeResche L, DeRouen T, Von Korff M.
function: effects of biofeedback training. J Behav Assessing clinical signs of TM disorders: reliabil
Med 1985;8:191- 200. ity of clinical examiners. J Prosthet Dent 1990;63:
28. Sherman RA. Relationships between jaw pain 574- 579.
and jaw muscle contraction level: underlying fac 43. Dworkin SF, LeResche L, De Rouen T. Reliability of
tors and treatment effectiveness. J Prosthet Dent clinical measurement in TM Disorders. Clin J Pain
1985;54:114- 118 1988;4:89- 99.
29. Rugh JD, Montgomery GT. Physiological reactions 44. Gay T, Bertolami CN, Donoff RB, Keith DA, Kelly
of patients with TM disorders vs symptom-free JP. The acoustical characteristics of the normal
controls on a physical stress task. J Craniomandib and abnormal TM joint. J Oral M axillofac Surg
Disord 1987;1:243- 250. 1987;45:397- 407.
30. Gervais RO, Fitzsimmons GW, Thomas NR. 45. Gay T, Bertolami N. The spectral properties of TM
Masseter and temporalis electromyographic activity joint sounds. J Dent Res 1987;66:1189- 1194.
in asymptomatic, subdinical, and TM joint dysfunc 46. Davidson SL. Doppler auscultation: an aid in TM
tion patients. J Craniomandibular Pract 1989; 7: joint diagnosis. J Craniomandib Disord 1988;2:
52- 57. 128-132.
31. Glaros AG, M cGlynn FD, Kapel L. Sensitivity, speci 47. Ishigaki S, Bessette RW, M aruyama T. A clinical
ficity, and the predictive value of facial electromyo study of TM joint (TM J) vibrations in TM J dysfunc
graphic data in diagnosing myofacial pain-dysfunc tion patients. J Craniomandibular Pract 1993;11:
tion. J Craniomandibular Pract 1989;7:189- 193. 7- 13
32. Schroeder FI, Siegmund H, Santibanez-H G, Kluge 48. Ishigaki S, Bessette RW, M aruyama T. Vibration of
A. Causes and signs of TM joint pain and dysfunc the TM joints with normal radiographic imagings:
tion: an electromyographical investigation. J Oral comparison between asymptomatic volunteers and
Rehabil 1991;18:301- 310. symptomatic patients. J Craniomandibular Pract
33. Bodere C, Tea SH , Giroux-Metges M A, Woda A. Ac 1993;11:88- 94.
tivity of masticatory muscles in subjects with differ 49. Ishigaki S, Bessette RW, M aruyama T. Vibration
ent orofacial pain conditions. Pain 2005;116:33- 41. analysis of the TM joints with meniscal displace
34. M iller DJ. Comparison of electromyographic ac ment with and without reduction. J Cranioman
tivity in the lumbar paraspinal muscles of subjects dibular Pract 1993;11:192- 201.
with and without chronic low back pain. Phys Ther 50. Toolson GA, Sadowsky C. An evaluation of the rela
1985;65:1347- 1354. tionship between TM joint sounds and mandibular
35. Arena JG, Sherman RA, Bruno GM , Young TR. Elec movements. J Craniomandib Disord 1991;5:187-196.
tromyographic recording of low back pain subjects 51. Brown DT, II LK, Hafez AA, Cox CF. "True nor
and non-pain controls in six different positions: ef mal" TM D control subjects: a rare clinical finding.
fect of pain levels. Pain 1991;45:23- 28. J Craniomandibular Pract 1998;16:84- 89.
@dentistinfo первый стоматологический телеграм канал 2 37

-
52. Wabeke , Spruijt RJ, van der Weyden KJ, Naeije 62. Arakawa Y, Yamaguchi H. Chewing movements in
M . Evaluation of a technique for recording TM joint near ideal occlusion with and without TM symp
sounds. J Prosthet Dent 1992;68:676- 682. toms. J Craniomandibular Pract 1997;15:208- 220.
53. Gross A, Gale EN. A prevalence study of the clinical 63. Stohler CS, Ashton-M iller JA, Carlson DS. The ef
signs associated with mandibular dysfunction. J Am fects of pain from the mandibular joint and muscles
Dent Assoc 1983;107:932- 936. on masticatory motor behaviour in man. Arch Oral
54. Dworkin SF, Huggins KH, LeResche L, von Korff M , Biol 1988;33:175- 182.
Howard J, Truelove E et al. Epidemiology of signs 64. Watt DM . Recording the sounds of tooth contact: a
and symptoms in TM disorders: clinical signs in cases diagnostic technique for evaluation of occlusal dis
and controls. J Am Dent Assoc 1990;120:273- 281. turbance. Int DentJ 1969;19:221- 238.
55. Puri P, Kambylafkas P, Kyrkanides S, Katzberg R, 65. Kifune R, Honma S, . The development of
Tallents RH. Comparison of doppler sonography a new occlusal sound checker. Nippon Shishubyo
to magnetic resonance imaging and clinical ex Gakkai Kaishi 1985;27:482- 491.
amination for disc displacement. Angle Orthod 66. Maness W L, Benjamin M , Podoloff R, Bobick A.
2006;76:824- 829. Computerized occlusal analysis: a new technology.
56. Gale E, Gross A. An evaluation of TM joint sounds. Quintessence Int 1987;18:287- 292.
J Am Dent Assoc 1985;111:62- 63. 67. Moini M R, Neff PA. Reproducibility of occlusal con
57. Kernohan WG, Beverland DE, M cCoy GF, Hamilton tacts utilizing a computerized instrument. Quintes
A, Watson P, Mollan R. Vibration arthrometry: a sence Int 1991;22:357- 360.
preview. Acta Orthop Scand 1990;61:70- 79. 68. Mizui M , Nabeshima F, Tosa J, Tanaka M , Kawa-
58. Jiang CC, Liu YJ, Yip KM , Fu SE, Su JL. Vibration zoe T. Quantitative analysis of occlusal balance in
arthrometry of the knee with torn meniscus: a intercuspal position using the -Scan system. Int J
preliminary report. J Formos Med Assoc 1994; 93: Prosthodont 1994;7:62- 71.
622- 625. 69. Hattori Y, Okugawa H, Watanabe M . Occlusal force
59. Nielsen IL, Marcel T, Chun D, M iller AJ. Patterns measurement using dental prescale. J Jpn Prost
of mandibular movements in subjects with crani hodont Soc 1994;38:835- 841.
omandibular disorders. J Prosthet Dent 1990;63: 70. Araki A, Ito H, Mukaida Y, Sotoyama M . Clinical
202- 217. application of new occlusal evaluation system (Den
60. Clark GT, Lynn P. Horizontal plane jaw movements tal Prescale OCCLUZER). Shikaitenbou (Japanese)
in controls and clinic patients with TM dysfunction. 1994;84:7- 19.
J Prosthet Dent 1986;55:730- 735.
61. Ozaki Y, Shigematsu T, Takahashi S. Analysis of the
chewing movement in TM disorders. Bull Tokyo
Dent Coll 1990;31:91- 103.

14
.
-
( )
. 10 %
- .
, « » .5
,
.
, .36-9 ,
,
, .6
( / ).1
I ,

, .2 ,
, II
, , .10
,
,”
.
. ,
.1213
. ,
, 10-20 %
.2-4 ,
20-40 .2 ,68 .3'9'1415

, 31- ,
, ,
8,3 % .15 .11-29
,
.
35-

,
, ,
, .14
,
. « »

.30
,

, 3 .
, 4
. 11
, 18 ,
( . 14-1).30
.16 , ,
.

.16-19 ,
,
.
.20 , , , ,
( ) ,
.
,
.21 , ,
, ,
,
,
.22-27 , .31

- ,
- .28 , ,
,
. , .32
,

. 14-1.
.30 « »
3
11 18
.
:
1) (
):
5- 7
2) (
): -
3) ( ):
4} (
):
5) ( ):
6) ( ): 2
7) ( ):
8) (
):
9) :
,
, ,
,
. ,
,
.33 ,
,3940
,
, .
.34-38
,
,
0,5-5 % ,
. , ,
.
. ,
, (9 : 1), ,
.
, . ,
65 %
, .39
45-60 .3039 ,


, .46

. , ,
.1162
- - ,
,

. .
,
.41 ,
, ,
.42
.

.
,
( . 14-1 ).43-50 ,
, 53-94 % .49 ,
39 60
.43-45'47-49 /
, 41 % .43
, ,
29 % - , 71 % - 18 % ,
, .47'48 75 %
, (
).
(
).46
( ,
, . .),
.9 , .
30
, - 30 ,
, , 87 %
.46
, 10 %
.47
. ,
,
, .
, Salvetti .48
, ,
, , ,
,61 93 %

14-1. , ( ) - ( )
( )

Plesh, 199643 99 44.4 ± 13,2 60 / » »* 18 %

, / 39 / ,
50.5 ± 9,9 (75 %)
Hedenberg- 46 48 23
M agnusson, (3 , / 23 .
199744 43 )
,
Hedenberg- 191 : 52,5 191 94 %

M agnusson, (11 , ( 26 77 )
199945 180 ) : 53,4 12 .
( 25 86 )
Rhodus, 200346 67 47,6 ± 2,3 67

( )
, ,
,
M anfredini, 60 (9 , 50 , 30 / 87 %
200447 51 ) 41 / 30 , 10 %
Sipila, 20059 104 34 52

(20 , ,
84 ) / 52
( )
Balasubrama- 51 52,2 ± 7,8 32 / 53 % 11 %
niam, 200749 (6 , / 19
45 ) . 71 %
,
,
Leblebici, 200750 52 35,15 ± 10,19 31 , 80 %
( ) / 21 , 52%
,
Salvett i, 200748 93 (5 , 50,1 ± 9,8 93 / 80 %
243
88 )
• 1
•• @dentistinfo
30 первый стоматологический телеграм канал
/ .
, ,
, ,
, .
181 , . ,
, 74
(80 %) .
- (
/ ). ,
,
.
,
.
,
( )
, ,
, ,
, ,
.44
- . Raphael M arbach53
,

63
, .7 , .
,
( ) , ,
.43 .
Hedenberg-M agnusson .45
191 .
6
, 94 % ( ,
). ,
. ,

, .
. ,
, ,
.11'47'48
, , ,
. .
,

, , ,
, .
,
.

,
.32
.
.
, .
.

.
,
- ,
, , . .54 ,

- , , ,
.6
,
, .

. ,
Adiels .55
.
,
. , .

. ,

,
for temporomandibular disorders: review, criteria,
,
examinations and specifications, critique. J Crani-
. omand Disord 1992;6:301- 355.
, 2. LeResche L. Epidemiology of temporomandibular dis
orders: implications for the investigation of etiologic
factors. Crit Rev Oral Biol Med 1997;8:291-305.
3. Rauhala K, Oikarinen KS, Jarvelin M R, Raustia AM .
. Facial pain and temporomandibular disorders: an epi
demiological study of the Northern Finland 1966 birth
cohort. J Craniomandibular Pract 2000;18:40-46.
4. Ahlberg K, Ahlberg J, Kononen M , Alakuijala A,
Partinen M , Savolainen A. Perceived orofacial pain
. , and its associations with reported bruxism and
insomnia symptoms in media personnel with or
without irregular shift work. Acta Odontol Scand
2005;63:213- 217.
, 5. Friction JR. The relationship of temporomandibu
. lar disorders and fibromyalgia: implications for di
agnosis and treatment. Curr Pain Fleadache Rep

2004:8:355- 363.
6. Hagberg , Hagberg , S. Musculoskeletal 21. Ernberg M , Hedenberg-Magnusson B, Alstergren
symptoms and psychosocial factors among patients P, Lundeberg T, Kopp S. Pain, allodynia, and serum
with craniomandibular disorders. Acta Odontol serotonin level in orofacial pain of muscular origin.
Scand 1994;52:170- 177. J Orofac Pain 1999;13:56- 62.
7. Dao TT, Reynolds WJ, Tenenbaum HC. Comorbidity 22. Kuttila M , Kuttila S, Niemi PM , Alanen P, LeBell Y.
between myofascial pain of the masticatory muscles Fluctuation of treatment need in relation to age,
and fibromyalgia. J Orofac Pain 1997;11:232- 241. gender, stress, and diagnostic subgroups. Acta Od
8. Turp JC, Kowalski CJ, O'Leary N, Stohler CS. Pain ontol Scand 1997;55:350- 355.
maps from facial pain patients indicate a broad pain 23. Uhac I, Kovac Z, Valentic-Peruzovic M , Juretic M ,
geopraphy. J Dent Res 1998;77:1465- 1472. LiJ, Grzic R. The influence of war stress on the
9. Sipiia K, Zitting P, Siira P, Niinimaa A, Raustia AM . prevalence of signs and symptoms of temporoman
Generalized pain in community subjects with fa dibular disorders. J Oral Rehabil 2003;30:211- 217.
cial pain- a case-control study. J Orofac Pain 24. De Leeuw R, Bertoli E, Schmidt JE, Carlson CR.
2005;19:127- 132. Prevalence of post-traumatic stress disorder symp
10. John MT, Miglioretti DL, LeResche L, Von Korff M, toms in orofacial pain patients. Oral Surg Oral Med
Critchlow CW. Widespread pain as a risk factor for Oral Pathol Oral Radiol Endod 2005;99:558- 568.
dysfunctional temporomandibular disorder pain. 25. De Leeuw R, Bertoli E, Schmidt JE, Carlson CR.
Pain 2003;102:257- 263. Prevalence of traumatic stressors in patients with
11. Korszun A, Papadopoulos E, Demitrack M , Engle- temporomandibular disorders. J Oral M axillofac
berg C, Crofford L. The relationship between tem Surg 2005;63:42- 50
poromandibular disorders and stress-associated 26. Glaros AG, Williams K, Lausten L. The role of para
syndromes. Oral Surg Oral Med Oral Pathol Oral functions, emotions and stress in predicting facial
Radiol Endod 1998;86:416- 420. pain. J Am Dent Assoc 2005;136:451- 458.
12. Raphael KG, Marbach JJ, Klausner J. M yofas 27. Sipiia K, Ylostalo P, Ek E, Raustia AM . Association
cial face pain: clinical characteristics of those with of stress level with facial pain: the role of coping.
regional vs. widespread pain. J Am Dent Assoc J Craniomandibular Pract 2008;26:216- 221.
2000;131:161- 171. 28. Lariviere WR, Melzack R. The role of corticotro
13. Velly AM , Philippe P, Gornitsky M . Heterogeneity pin-releasing factor in pain and analgesia. Pain
of temporomandibular disorders: cluster and case- 2000;84:1- 12.
control analyses. J Oral Rehabil 2002; 29:969- 979. 29. Korszun A. Facial pain, depression and stress-
14. Wanman A. The relationship between muscle ten connections and directions. J Oral Pathol Med
derness and craniomandibular disorders: a study of 2002;31:615- 619.
35-year-olds from the general population. J Orofac 30. Wolfe F, Smythe HA, Yunus M B, Bennett RM , Bom
Pain 1995;9:235- 243. bardier C, Goldenberg DL et al. The American Col
15. Sipiia K, Ylostalo PV, Joukamaa M , Knuuttila M L. lege of Rheumatology criteria for the classification
Comorbidity between facial pain, generalized pain of fibromyalgia. Report of the M ulticenter Criteria
and depressiveness in young adults. J Orofac Pain Committee. Arthritis Rheum 1990;33:160- 172.
2006;20:24- 30. 31. Wallace DJ. The fibromyalgia syndrome. Ann Med
16. M aixner W, Fillingim R, Booker D, Sigurdsson A.
1997;29:9- 21.
Sensitivity of patients with painful temporomandib
32. Aaron LA, Buchwald D. A review of the evidence
ular disorders to experimentally evoked pain. Pain
for overlap among unexplained clinical conditions.
1995;63:341- 351.
Ann Intern Med 2001;134:868- 881.
17. Kashima K, Rahman Ol, Sakoda S, Shiba R. In
33. Arnold LM , Hudson Jl, Keck PE, Auchenbach MB,
creased pain sensitivity of the upper extremities
Javaras KN, Hess EV. Comorbidity of fibromy
of TM D patients with myalgia to experimentally-
algia and psychiatric disorders. J Clin Psychiatry
evoked noxious stimulation: possibility of worsened
2006;67:1219- 1225.
endogenous opioid systems. J Craniomandibular
34. Walker EA, Keegan D, Gardner G, Sullivan M , Bern
Pract 1999;17:241- 246.
stein D, Katon WJ. Psychosocial factors in fibromy
18. Farella M , Michelotti A, Steenks M H, Romeo R,
algia compared with rheumatoid arthritis: II. Sexual,
Cimino R, Bosman F. The diagnostic value of pres
physical, and emotional abuse and neglect. Psycho-
sure algometry in myosfascial pain of the jaw mus
som Med 1997;59:572- 577.
cles. J Oral Rehabil 2000;27:9- 14.
35. Wigers SH. Fibromyalgia outcome: the predic
19. Mohn C, Vassend O, Knardahl S. Experimental pain
tive values of symptom duration, physical activity,
sensitivity in women with temporomandibular dis
disability pension, and critical life events - a 4.5
orders and pain-free controls: the relationship to
year prospective study. J Psychosom Res 1996;41:
orofacial muscular contraction and cardiovascular
235- 243.
responses. Clin J Pain 2008;24:343- 352.
36. M cFarlane GJ, Thomas E, Papageorgiou AC, Schol
20. Sarlani E, Greenspan JD. Why look in the brain for
ium J, Croft PR, Silman AJ. The natural history of
answers to temporomandibular disorder pain? Cells
chronic pain in the community: a better prognosis
Tissues Organs 2005;180:69- 75.

than in the clinic? J Rheumatol 1996; 23:1617-1620. 47. Manfredini D, Tognini F, Montagnani G, Bazzichi L,
37. Hunt IM, Silman AJ, Benjamin S, McBeth J, McFar- Bombardieri S, Bosco M . Comparison of masticatory
lane GJ. The prevalence and associated features of dysfunction in temporomandibular disorders and fi
chronic widespread pain in the community using bromyalgia. M inerva Stomatol 2004; 53:641- 650.
the "M anchester'' definition of chronic widespread 48. Salvetti C, Manfredini D, Bazzichi L, Bosco M . Clini
pain. Rheumatology (Oxford) 1999;38:275- 279. cal features of the stomatognathic involvement in
38. Sherman JJ, Turk DC, Okifuji A. Prevalence and im fibromyalgia syndrome: a comparison with tem
pact of posttraumatic stress disorder-like symptoms poromandibular disorders patients. J Cranioman
on patients with fibromyalgia syndrome. Clin J Pain dibular Pract 2007;25:127- 133.
2000:16:127- 134. 49. Balasubramaniam R, de Leeuw R, Zhu H, Nicker
39. Neumann L, Buskila D. Epidemiology of fibromyal son RB, Okeson JP, Carlson CR. Prevalence of tem
gia. Curr Pain Headache Rep 2003;7:362- 368. poromandibular disorders in fibromyalgia and failed
40. Buskila D, Neumann L. Fibromyalgia syndrome back syndrome patients: a blinded prospective
(FM ) in and nonarticular tenderness in relatives of comparison study. Oral Surg Oral Med Oral Pathol
patients with FM . J Rheumatol 1997;24:941- 944. Oral Radiol Endod 2007;104:204- 216.
41. Bazzichi L, Giannaccini C, Betti L, Mascia G, Fab- 50. Leblebici B, Pektas ZO, Ortancil O, Human EC, Bagis
brini L, Italiani P et al. Alteration of serotonin trans S, Akman MN. Coexistence of fibromyalgia, tem
porter density and activity in fibromyalgia. Arthritis poromandibular disorder, and masticatory myofascial
Res Ther 2006;8:R99. pain syndromes. Rheumatol Int 2007;27:541- 544.
42. Ablin JN, Cohen H, Buskila D. Mechanisms of dis 51. Pennacchio EA, Borg-Stein J, Keith DA. The in
ease: genetics of fibromyalgia. Nat Clin Pract Rheu cidence of pain in the muscles of mastication
matol 2006;2:671- 678. in patients with fibromyalgia. J Mass Dent Soc
43. Plesh O, Wolfe F, Lane N. The relationship between 1998;47:8- 12.
fibromyalgia and temporomandibular disorders: 52. Aaron LA, Burke M M , Buchwald D. Overlapping
prevalence and symptom severity. J Rheumatol conditions among patients with chronic fatigue
1996;23:1948- 1952. syndrome, fibromyalgia, and temporomandibular
44. Hedenberg-Magnusson B, Ernberg M , Kopp S. disorder. Arch Intern Med 2000;160:221- 227.
Symptoms and signs of temporomandibular disor 53. Raphael , Marbach JJ. Widespread pain and the
ders in patients with fibromyalgia and local myalgia effectiveness of oral splints in myofascial face pain.
of the temporomandibular system: a comparative J Am Dent Assoc 2001;132:305- 316.
study. Acta Odontol Scand 1997;55:344- 349. 54. Goldenberg DL, Burckhardt C, Crofford L. M anage
45. Hedenberg-Magnusson B, Ernberg M , Kopp S. ment of fibromyalgia syndrome. J Am Med Assoc
Presence of orofacial pain and temporomandibular 2004;292:2388- 2395.
disorder in fibromyalgia: a study by questionnaire. 55. Adiels AM , Helkimo M , Magnusson T. Tactile stimu
Swed Dent J 1999;23:185- 192. lation as a complementary treatment of temporo
46. Rhodus NL, Friction J, Carlson P, Messner R. Oral mandibular disorders in patients with fibromyalgia
symptoms associated with fibromyalgia syndrome. syndrome: a pilot study. Swed Dent J 2005;29:
J Rheumatol 2003;30:1841- 1845. 17-25.

15
15-1.

• - / -
,
•

•
.
•
« - »
•
,
•

.

, 15-2. -
,
, ,
•
,
(IHS, International Headache
( 15-1).
Society, 1988)1
•
.
( / ;
-
Research Diagnostic Criteria for
15-2.
Temporomandibular Disorders, 1992)2

•
,
(IASP, International
,
Association for the Study of Pain, 1994)3
,
•
.
(American Academ y of
Orofacial Pain, AAOP, 2008)4
-
•
, ,
(International
, ,
Classification of Headache Disorders,
,
ICHD, 2- ., 2004)6
, , -

-
15-3.
-
15-4,
.
• ,
•
• ,
• ( ), ,
• ,
• - . ,
•
• - ,

.
.
,
- .
,
.4'67
, ,
. ,

.
, ,
- .
,
. .
:
, .
,
, ,
, , , -
- ,
. , .3

, -
( )
. ,
. ,
,
: ,
.
,
, ,
, , , .89
- , ,
( 15-3).

-
15-4. ,
-
:
: • : ( ,
• , , , )
• ( ,
• , )
•
• : (
: ,
• ( , );
, , , ( ,
) )
• ( • : ,
, , , , - (
, ) )
•
• ( :
) • ( ,
• , , , )
• • ( ,
• , , ,
,
• , ,
• , )
•
• ( - :
, , • -
) ( )
( , ,
: )
• , • ( )
• ( , :
, , • (
, , , )
, • (
)
• ( -
) )
• •
( ) - .10
(
)( 15-5).9 : ,
, .”


-
15-5.
(W o o lf9)
• - , .
,
,
• - .

, ,
• -
.
,
• -
.

-

,
-
.
,

,
.
.
, 10-15 % , 80 %
, 12 % .
6 .12

.
, 10 %
25 %
. .5
,
( 15-6).
60 ,
.5
.13
( ).
,
-
.20
- ,

.
(Jam es

-
15-6.
( ) :
: (
, . )
:
, • : , ,
.
: • :
• : ( ),
• : , ,
• : ,
• : ,
• :
:
• : • :
• : , • :
, ,
,
: ( ) • :
• : , , ,
• : , (
, ):
• :
• : ,
• :
• : • :
• : ,
( , , ,
) ,
• : ,
,
,
,
, • : -
• : , (
, ), ,
, , ,
, • : ,
• : , , -
, , ,
, , • : ,
, ,

. ( )
• : , , . • :
• : , ,

-
15-6. ( )
• : , -
( ,

), , • :
, ,
,
• : , , , • :
, , , .
,
• :
, ,
, , , •
, , , .
, ,
, ,
, ,
,
, .
, ,
• : , ,
, • -
- ,
, , • -
( ), , ,
,
,
( )14 13
• : • -
• : ,
15
• - ,
« » ,
. 16'17
. • 18
• - -
, • -
,
• : , ( , (
), ),
, - .19
,
,
• :
, • ( ,
, , )

-
Ram say Hunt), 15-7.

. • :

, • : ,
• :
. • : (
, , ),
, , ,
. ,
. • : ,
, ,
( )
. • :
. ,
-
,

, ,
- ,
, , . .
,
32 .21-23 .
10-14 .
,
-
,
,
.
.2'’-26
( ,
, ,
( 15-7), , , -
, , ), ,
, (
, , ),
. -
(

, ).
, , , - -
, (
, )
, ,
.

-
.
. 16.

.27-29

.
4-72 ,
( ) , - -
- ,
.5
( 15-8). 5-60
( )
,

,
, ,
,
. .3132
40 % 15 %
,
.30 ( 3:1),
,1 100 .33
( )
. .

14 : ,
, ,
, .
,
.6
-
.
, 80 %
.3435
15-8. , 15
- .
•
3% .36
•
( ),
• -
,
•

•

-
. ,
.5 ,
,
,
, ,37 , ,
.
0,05 %
.3839
( 6:1)
20 ,
,
1-2
15-180 .5'30
, ,
« ». .5

. , ,
, , , ,
, , , ,
,
( - .5
).
, ,
6-12 1-2 . .40
1 ,
, 1 .530 , , ,
( .
) ,
,
(2-30 ) ,
. , .
.5 .
,
,

5-240 .
3 200 .
,
, .
, ,
,
.5 ,
. ,
,
. . ,

,

-
. ,
.
2% ,
5 , ,
.41 , ,
.41 ( ),
( , ,
) (
. ).
-
,
( ,
)
30 ,42 ,

, ,

.42 , .
-
,
,43

.
, .

, .
.
.44
45

.5 .

.

. ,

,
. .
,
, ,
, , . ,
,
. 40

-
.4647
.

.
, ,
. , ,
.6'50
, ,
( ,
), - (Tolosa-Hunt) (
,
III, IV VI
.47 )
. ,

,
.
, , I( I) -
, , II
( ) .
, , .
, . .
,
.48'49 ,
.5
. ,
. I
1
,
, , ,

. . II
,
(ICHD-II).5 ,
,
.51
,
, ,
,
. ,
@dentistinfo первый стоматологический телеграм канал 2 5 9

-
. ,
.47

,

.
(
)
,
.62
.54
(
) -
,

.

.
, .62
,
.53
- (ICHD-II).5'56
.18 ( )

,
( 15-9).
,
5
, .
, ,

. .
(anest hesia dolorosa)

-
-


- .2
.
30 .
15-9.
• :
( • :
):
• : • : , ,
• :
• : , , , 57
• :
( , ,
,
• :
)
• : • :
( , ,
• : ), ,
• : , ,
• :
• : ,
,
( , ):
• , 56 • :
• : ,
,
• : , • :
, ( • :
, - • :
) • :
• :
( ) • : ,
56
• :
( , ( , , ,
, )
): • :
• : ( , ),
, ,
• :
,
• : , , ,
, ,
• :

-
15-10. 15-11. /
• : I
1
• : a.
, , , , b.
• :
2
• : a.
b.
• :
c.
• :
, 3
, a.
b.
• : c.
( , ,
), II

• : ,
,
• :
, ,

Woda .67
( ),

( . . 15-1).
15-10. « »
,
/ , ,
I , ,
II -
( 15-11 ).66 , .

, , , ,
.

.

, .
,
. ( . 15-2). ,

,

. 15-1.

(Woda et al.57)

,
.9
,
,

.
.
. 15-2.
. ,

.58-61 .65-67
-
,
,
.62-64
- .

-
8. Woolf CJ, Bennett GJ, Doherty M , Dubner R, Kidd

B, Koltzenburg M et al. Towards a mechanism based
classification of pain. Pain 1998;77:227- 229.
- 9. Woolf CJ. Pain: moving from symptom control to
ward mechanism-specific pharmacologic manage
, ment. Ann Intern Med 2004;140:441- 451.
10. Hansson P. Difficulties in stratifying neuropathic
. , pain by mechanisms. Eur J Pain 2003;7:353- 357.
, 11. Finnerup NB, Otto M , M cQuay HJ, Jensen TS,
Sindrup SH. Algorithm for neuropathic pain treat
, ment: an evidence based proposal. Pain 2005;118:
289- 305.
- 12. Lipton JA, Ship JA, Larach-Robinson D. Estimated
prevalence and distribution of reported orofa
, cial pain in the United States. J Am Dent Assoc
1993;124:115- 121.
,
13. Cohen S, Hargreaves K. Pathways of the Pulp, ed 9.
, , Edinburgh: Mosby-Elsevier, 2006.
, . 14. Graff-Radford SB. Headache problems that
- can present as toothache. Dent Clin North Am
1991;55:155- 170.
, - (
15. Alonso A, Nixdorf D. Case series of four different
, ), ( headache types presenting as tooth pain. J Endod
, ) 2006;32:1110- 1113.
. 16. Drangsholt M , Truelove EL, Yamuguchi G. The case
of a 52 year old woman with chronic tooth pain
, unresolved by multiple traditional dental proce
, dures: an evidence-based review of the diagnosis of
, trigem inal n eu ropat h ic pain . J Evid Based Dent Pract
. 2005;5:1- 10.
17. Forssell H, Svensson P. Atypical facial pain and
burning mouth syndrome. Chapter 39, Handb Clin
Neurol 2006;81:597- 608.
18. Capobianco DJ. Facial pain as a symptom of non-

metastatic lung cancer. Headache 1995;35;581-585.
19. List T, Leijon G, Svensson P. Somatosensory abnor
1. International Headache Society. Classification and malities in atypical odontalgia: a case-control study.
diagnostic crit eria fo r headache disorders, cra Pain 2008;139:333- 341.
nial neuralgias and facial pain. Cephalalgia 1988;8 20. Harpaz R, Ortega-Sanchez IR, Seward JF. Preven
(Suppl 7):1 - 96. tion of herpes zoster: recommendations of the Advi
2. Drangsholt M , LeResche L. Temporom andibular sory Committee on Immunization Practices (ACIP).
disorder pain. In: Crom bie IK, Cro ft PR, Linton SJ, M M WR Recomm Rep 2008;57(RR- 5):1- 30.
LeResche L, Vo nKo rff M (ed s). Epidemiology of 21. Andreason JO, Andreason FM , Bakland LK, Flores
Pain. Seattle: IASP Press, 1999:203- 233. MT. Traumatic Dental Injuries: A M anual, ed 2. O x
3. M erskey H, Bogduk N (ed s). Classification of Chro n ford: Munksgaard Blackwell, 2003.
ic Pain: Descriptions of Chronic Pain Syndrom es and 22. Banks P, Brown A. Fractures of the Facial Skeleton.
Definitions of Pain Term s, ed 2. Seattle, W A: IASP London: Wright, 2001.
Press, 1994:1- 222.
23. Miloro M , Ghali GE, Larsen PE. Peterson’s Principles
4. The Am erican Acad em y o f Orofacial Pain. De of Oral and Maxillofacial Surgery, ed 2. Hamilton,
Leeuw R (ed). Orofacial Pain Guidelines fo r Assess ON: BC Decker, 2004.
m ent, Diagnosis and M anag em ent , ed 4. Chicago, 24. Pindborg JJ. Atlas of Disease of the Oral M ucosa, ed
IL: Quintessence Publishing, 2008. 5. Copenhagen: Munksgaard, 1992.
5. The International Classification of Headache Dis 25. Laskaris G, Scully C. Periodontal Manifestations of
orders, ed 2. (ICH D- II) Cephalalgia 2004;24(Sup p l Local and Systemic Diseases. Colour Atlas and Text.
1):9- 160.
Berlin: Springer-Verlag, 2003.
6. Sharav Y, Benoliel R. Orofacial Pain and Headache. 26. Scully C. Oral and Maxillofacial Medicine: The Ba
Edinburgh: Elsevier, 2008.
sis of Diagnosis and Treatment. Edinburgh: Elsevier,
7. Haug RH, Balasubram aniam R, Klasser G (eds).
2008.
Orofacial pain and dysfunction. Oral M axillo fac
Surg Clin North Am 2008;20(2).

27. M arx RE, Sawatari Y, Fortin M , Broumand V. Bis- 43. Feinmann C. Idiopathic orofacial pain: a multidisci
phosphonate induced exposed bone (osteonecrosis) plinary problem: the contribution of psychiatry and
of the jaws: risk factors, recognition, prevention and medicine to diagnosis and management. Pain - an
treatment. J Oral M axillofac Surg 2005;63:1567- updated review. Seattle, WA: IASP Press, 1996:
1575. 397- 402.
28. Pancholi M , Edwards A, Langton S, Bisphosphonate 44. Zakrzewska JM . Trigeminal neuralgia. In: Zakrzews-
induced osteochemonecrosis of the jaw mimicking kaJM , Harrison SD (eds). Assessment and M anage
tumour. Br Dent J 2007;203:87- 89. ment of Orofacial Pain: Pain Research and Clinical
29. Barker K, Rogers S. Bisphosphonate-associated os M anagement, vol 14. Amsterdam: Elsevier Science,
teonecrosis of the jaws: a guide for the general den 2002:267- 369.
tal practitioner. Dent Update 2006;33:270- 275. 45. Drangsholt M , Truelove EL. Trigeminal neuralgia
30. (BASH). Guidelines for all healthcare profession mistaken as temporomandibular disorder. J Evid
als in the diagnosis and management of migraine, Based Dent Pract 2001 ;1:41- 50.
tension-type, cluster and medication-overuse head 46. Nurmikko TJ, Eldridge PR. Trigeminal neuralgia-
ache, 2008. At: http:Wwww.bash.org.uk (accessed pathophysiology, diagnosis and current treatment.
2 June 2009). Br J Anaesth 2001 ;87:117-132.
31. Boes CJ, Matharu M S, Goadsby PJ. M anagement 47. Zakrzewska JM . Classification issues related to neu
of difficult migraine. Adv Clin Neurosci Rehabil ropathic trigeminal pain. J Orofac Pain 2004;18:
2 001 ; 1 :6- 8 . 325- 331.
32. Ducros A, Tournier-Lasserve E, Bousser M -G. 48. Laha RK, Janetta PJ. Glossopharyngeal neuralgia.
The genetics of migraine. Lancet Neurol 2002;1: J Neurosurg 1977;47:316- 320.
285- 293. 49. M inagor A, Scheremata WA. Glossopharyngeal
33. Steiner IJ, Scher Al, Stewart WF, Kolodner K, Liber neuralgia and M S. Neurology 2000;54:1368- 1370.
man J, Lipton RB. The prevalence and disability 50. Bruyn GW. Superior laryngeal neuralgia. Cephalal
burden of adult migraine in England and their rela gia 1983;3:235- 240.
tionships to age, gender and ethnicity. Cephalalgia 51. Stanos SP Jr, Harden RN, Wagner-Raphael L, Saltz
2003;23:519- 527. SL. A prospective clinical model for investigating
34. Rasmussen BJ, Jensen R, Schroll M , Olesen J. Epi the development of CRPS. In: Harden RN, Baron R,
demiology of headache in a general population: a Janing W (eds). Complex Regional Pain Syndrome.
prevelance study. J Clin Epidemiol 1991;44:1147- Seattle, WA: IASP Press, 2001:151- 164.
1157. 52. Merrill RL. Differential diagnosis of orofacial pain.
35. Stovner LJ, Hagen K, Jensen R, KatasaravaZ, Lipton In: Laskin DM , Greene CS, Hylander W L (eds).
R, Scher Al et al. The global burden of headache: Temporomandibular Disorders: An Evidence-based
a documentation of headache prevalence and dis Approach to Diagnosis and Treatment. Chicago, IL:
ability worldwide. Cephalalgia 2007;27:193- 210. Quintessence Publishing, 2008:299- 318.
36. Schwartz BS, Stewart WF, Simon D, Lipton RB. 53. Cook RJ, Sharif I, Escudier M . Meningioma as a
Epidemiology of tension-type headache. J Am Med cause of chronic orofacial pain: case reports. Br J
Assoc 1998;279:381- 383. Oral M axillofac Surg 2008;46;487- 489.
37. De Benedicts C. SUNCT syndrome associated with 54. Bowsher D, Leijon G, Thuomas KA. Central post
cavernous angioma of the brain stem. Cephalalgia stroke pain: correlation of M RI with clinical pain
1996;16:503- 506. characteristics and sensory abnormalities. Neurol
38. Goadsby PJ, Mathuru M S, Boes CJ. SUNCT syn ogy 1998;51:1352- 1358.
drome or trigeminal neuralgia with lacrimation. Ce 55. Harrison SD. Atypical facial pain and atypical od
phalalgia 2001;21:82- 83. ontalgia. In: Zakrewska JM , Harrison SD (eds). As
39. Benoliel R, Sharav Y. Trigeminal neuralgia with sessment and M anagement of Orofacial Pain: Pain
lacrimation or SUNCT syndrome? Cephalalgia Research and Clinical M anagement, vol 14. Am
1998;18:85- 90. sterdam: Elsevier, 2002:251- 262.
40. Benoliel R, Birman N, Eliav E, Sharav Y. The Inter 56. Dworkin SF, LeResche L. Reasearch diagnostic cri
national Classification of Headache Disorders: accu teria for temporomandibular disorders: review,
rate diagnosis of orofacial pain? Cephalalgia 2008; criteria, examinations and specifications, critique.
28:752- 762. J Craniomandib Disord 1992;6:301- 355.
41. Diener HC, Limmroth V, Medication-overuse 57. Woda A, Tubert-Jeannin S, Bouhassira D, Attal N,
headache: a worldwide problem. Lancet Neurol Fleiter B, Goulet JP et al. Towards a new taxonomy
2004;3:475- 483. of idiopathic orofacial pain. Pain 2005;116:396-
42. Diagnostic and Satistical Manual of Mental Disor 406. (Reproduced with permission of the Interna
ders: DSM-IV, ed 4. New York: American Psychiatric tional Association for the Study of Pain® (IASP®).
Association, 1994. This figure may not be reproduced for any other
purpose without permission.)
58. Lavigne G, Sessle B, Choiniere M , Soja PJ. Sleep and
Pain. Seattle, WA: IASP Press, 2007.

-
59. Brousseau , Manzini TN, Lavigne GJ. Understand 64. John MT, Miglioretti DL, LeResche L, Von Korff M,
ing and managing the interaction between sleep Critchlow CW. Widespread pain as a risk factor for
and pain: an update for the dentist. J Can Dent As dysfunctional temporomandibular disorder pain.
soc 2003;69:437- 442. Pain 2003;102:257- 263.
60. Vazquez-Delgado E, Schmidt J, Carlson C, De 65. Dohrenwend B, Raphael K, Marbach J, Gallacher R.
Leeuw R, Okeson JP. Psychological and sleep qual Why is depression co-morbid with chronic myofa
ity differences between chronic daily headache and cial pain? A family study test of alternative hypoth
temporomandibular disorder patients. Cephalalgia eses. Pain 1999;83:183- 192.
2004;24:446- 454. 66. Auerbach SM , Laskin DM , Frantsve M A, Tamara O.
61. Naughton F, Ashworth P, Skevington M . Does sleep Depression, pain, exp o su r e t o stressful life events
quality predict pain-related disability in chronic pain and long-term outcomes in temporomandibular
patients? The mediating roles of depression and disorder patients. J Oral M axillofac Surg 2001 ;59:
pain severity. Pain 2007;127:243- 252. 628- 633.
62. LeResche L, Dworkin SF, Von Korff M . Epidemiol 67. Yap AU, Tan KB, Ch u a EK, Tan H H . Depression and
ogy of temporomandibular disorders: an analysis of somatization in patients with temporomandibular
multiple pain complaints. Pain 1987, Suppl 4. disorders. J Prosthet Dent 2002;88:479- 484.
63. Dworkin SF, Von Korff M , LeResche L. Multiple
pains and psychiatric disturbance: an epidemio
logic investigation. Arch Gen Psychiatry 1990;47:
239- 244.

16
-
-
( ),
- « »
. .
, - -
. ( )

, . ,
- .1 .
: ,
• ,23
; ,
• .
- ;
• ,
, ,
. ,
, , : .14-7
• ( )
;
•
; .8-13
• ( )
;
• ( ) ,614-17
.
,
,
.1819
.
,

-
. , :
,
,
.1819 ( ),
,
- .
:
• , : ( )
- , .
;
• 15
.
;
• 15
. . ,
( )
.
,
,
.
-
.
.
,
.2'3'20"22
Stovner .,2 ,
46 % . - ,
11 % .
, 42 % - -
3 % -
.2 .
(International
Headache Society (IHS)23 ( ,
( ) ), ,
,
.
. .

, ,
. ,
. ,
.
, .
4-72 . .

,
.
.
,
.
, .
4-
, ,
(Diagnostic
and Statistical M anual of Mental Disorders .
Fourth Edition, DSM -IV).24 ,

, - ,
,
, .
.

, ,
,
. .
,
,
, ,
.14'26-29 -
, .
.
( .
, ,
). ,

. ,

,
( ) .23
. ,
-
. , 3031
( )
. ,3233
. ,
.32-34

, , ,

-
® 1.2 . 16-1.
0
1 1.0
I
§ -8 ,
ч

§ 0.6
.
(
95 %).
0 30 60 90 120 150 180 210 240

( )

.
192 192 192 192 183 180 178 177 169
192 192 192 192 186 180 182 181 178 (

M ong ini et al.44)
, . . ( ) , 70,2 %
, . 18,2 %
11,5 % -
, .44
.36
. , 40 %
36
.37 Anttila . , ( . 16-1),
, , ,
,
, .
. , ,

.38 .
.45^17
.
,3940 , ( )
.41^13

, .
Mongini .44 ,
.
44
30 %
.
384 ,
. -

. 16-2. -
. ,

.
, ,
,
, (
M ongini et al.48)
, , ,
.6
.
,
. , ,47'4950
, .51-53
(44,9 %).
,
.48
.

.
,
, .
.
,
, , ,
,
.28 , ,
.
, , ,
. ,
. , .48

,
.28
,

.12 -

-
. 16-3. . 16-4. ,
, . 16-3.
, ,
. , ,
.
, 3
.4654 ( . 16-3).
,
.
.
« ,
.44
, ».
28 %
. .
. 16-2.
,
-
( . 16-4).
.
1 I DSM-IV (
,
)
.
. 56 «
,
. ,
,
,
. , ».
-

2005
. 16-5. , . 16-3. . 16-6. ,

. 16-3.
. 16-7. . 16-8. ,
. 16-7.
( M ongini et al.1) (
M ong ini et al.1)
. 16-9. , . 16-7.
2 ( M ong ini et al.1)

-
: 400
1 , a 20
, 15 2
. , ,
.144 .
(
. 7 ),

( . 16-5).
. ,
( . 16-6). ,
, ,
.
2 a
10 2 (
27 1 ).
, 15
, ,
. 15 .
2
, .
, ,
( . 16-9).
( ,
7-8 ), .

. .
,
. 3

( . 16-8) 30
.
( . 16-10).

, .
,
,
. « ,

, , ».
, ,
,
.
32 ( . 16-11).
, .
,
, 43

. 16-10. . 16-11. , . 16-12.
. 16-10. , . 16-10.

(
). ,
32
( . 16-12).

,
. ,
,

4 . 10
.
- .
. 28 , ,
, ,
, , - , ,
10 ,
. .
,
. .

, ( . 16-13),
.
.
,
, 33 ( . 16-14).
,
. ,
, .

,
, .
. ,
,
. 1,5 -

-
. 16-13. . 16-14. , . 16-15. ,

. 16-13. . 16-13.
,
( M ong ini et al.’ )
. ( M ong ini et al.’ )

( M ong ini et al.1)
, ,
,
.
( ,
.
,
, -
, ,
)
.
.
- - .
,
, ( ) ,
, .

. .
6
,
( . 16-15). ,

, .
,
. ,
,
« »
. ,
,
.
.

. 13. Zwart JA, Dyb G, Hagen K, Odegard KJ, Dahl AA,
Bovim G et al. Depression and anxiety disorders
associated with headache frequency. The Nord-
Trondelag Health Study. Eur J Neurol 2003;10:
147- 152.
- 14. Feinmann C. The M outh, the Face and the Mind.
Oxford: Oxford University Press, 1999.
. 15. Korszun A, Hinderstein B, Wong M . Comorbidity
of depression with chronic facial pain and temporo
mandibular disorders. Oral Surg Oral Med Oral
16. Korszun A. Facial pain, depression and stress:
connections and directions. J Oral Pathol Med
2002;31:615- 619.
1. Mongini F. Headache and Facial Pain. New York: 17. Vimpari SS, Knuuttila M L, Sakki TK, Kivela SL. De
Thieme, 1999. Italian Edition: Le Cefalee e il Dolore pressive symptoms associated with symptoms of
Faciale. Torino: Utet, 1998. the temporomandibular joint pain and dysfunction
2. Stovner U, Hagen K, Jensen R, Katsarava Z, Lipton syndrome. Psychosom Med 1995;57:439- 444.
RB, Scher Al et al. The global burden of headache: 18. Sipiia K, Ylostalo PV, Joukamaa M , Knuuttila M L.
a documentation of headache prevalence and dis Comorbidity between facial pain, widespread pain,
ability worldwide. Cephalalgia 2007;27:193- 210. and depressive symptoms in young adults. J Orofac
3. Wiendels NJ, Knuistingh Neven A, Rosendaal Pain 2006;20:24- 30.
FR, Spinhoven P, Zitman FG, Assendelft WJ et al. 19. Stohler CS. Clinical perspectives on masticatory and
Chronic frequent headache in the general popula related muscle disorders. In: Sessle BJ, Bryant PS, Di
tion: prevalence and associated factors. Cephalalgia onne RA (eds). Temporomandibular Disorders and Re
2006;26:1434- 1442. lated Pain Conditions: Progress in Pain Research and
4. Dworkin SF, LeResche L. Research diagnostic criteria Management. Seattle, WA: IASP Press, 1995:3-30.
for temporomandibular disorders: review, criteria, 20. Ghaffari M , Alipour A, Farshad AA, Yensen I,
examinations and specifications, critique. J Crani Vingard E. Incidence and recurrence of disabling
omandib Disord 1992;6:301- 355. low back pain and neck-shoulder pain. Spine
5. Mongini F, Italiano M . TM J disorders and myogenic 2006;31:2500- 2506.
facial pain: a discriminative analysis using the McGill 21. Riddle DL, Schappert SM . Volume and character
Pain Questionnaire. Pain 2001;91:323- 330. istics of inpatient and ambulatory medical care for
6. Mongini F, Ciccone G, Ceccarelli M , Baldi I, Fer- neck pain in the United States: data from three na
rero L. Muscle tenderness in different types of tional surveys. Spine 2007;32:132- 140.
facial pain and its relation to anxiety and depres 22. Stovner LJ, Zwart JA, Hagen K, Terwindt GM , Pas-
sion: a cross sectional study on 649 patients. Pain cual J. Epidemiology of headache in Europe. Eur J
2007;131:106- 111. Neurol 2006;13:333- 345.
7. Okeson JP (ed). Orofacial Pain - Guidelines for As 23. International Headache Society. The International
sessment, Diagnosis, and M anagement. Chicago, Classification of Headache Disorders. Cephalalgia
IL: Quintessence, 1996. 2004;24(Suppl 1):1- 160
8. Breslau N, Lipton RB, Stewart WF, Schultz LR, 24. American Psychiatric Association. Diagnostic and
Welch KM . Comorbidity of migraine and depres Statistical Manual of Mental Disorders (DSM -IV),
sion: investigating potential etiology and prognosis. ed 4. Washington, DC: 1994.
Neurology 2003;60:1308- 1312. 25. Baile WF, M yers D. Psychological and behavioral
9. Bensenor IM, Tofoli LF, Andrade L. Headache com dynamics in chronic atypical facial pain. Anesth
plaints associated with psychiatric comorbidity in Prog 1986;33:252- 257.
a population-based sample. Braz J Med Biol Res 26. Eversole LR, Stone CE, Matherson DW, Kaplan H.
2003;36:1425- 1432. Psychometric profiles and facial pain. Oral Surg
10. Cao M , Zhang S, Wang K, Wang Y, Wang W. Per Med Oral Pathol 1985;60:269- 274.
sonality traits in migraine and tension-type head 27. Mongini F, Ferla E, Maccagnani . M M PI profiles in
aches: a five-factor model study. Psychopathology patients with headache or craniofacial pain: a com
2002;35:254- 258. parative study. Cephalalgia 1992;12:91- 98.
11. Merikangas KR, Stevens DE, Angst J. Psychopathol 28. Mongini F, Ciccone G, Deregibus A, Ferrero L,
ogy and headache syndromes in the community. Mongini T. Muscle tenderness in different headache
Headache 1994;34:S17- 22. types and its relation to anxiety and depression.
12. Mongini F, Keller R, Deregibus A, RaviolaF, Mongini Pain 2004;112:59- 64.
T, Sancarlo M . Personality traits, depression and mi 29. Taye T, Fineberg N, Sherman JA, Rao H, Creak D.
graine in women: a longitudinal study. Cephalalgia Chronic pain disorder manifesting as dental pain:
2003;23:186- 192. case report. Dent Update 2006;33:54- 56.

-
30. Jensen R, Rasmussen , Pedersen , Olesen J. 44. Mongini F, Ciccone G, Rota E, Ferrero L, Ugolini A,
Muscle tenderness and pressure pain thresholds in Evangelista A et al. Effectiveness of an educational
headache: a population study. Pain 1993;52:193-199. and physical programme in reducing headache,
31. Lipchik GL, Holroyd KA, Talbot F, Greer M . Peric neck and shoulder pain: a workplace controlled
ranial muscle tenderness and exteroceptive sup trial. Cephalalgia 2008;28:541- 552.
pression of temporalis muscle activity: a blind 45. Allen JD, Rivera-Morales W C, Zwemer JD. The oc
study of chronic tension-type headache. Headache curence of temporomandibular disorder symptoms
1997;37:368- 376. in healthy young adults with and without evidence
32. Jensen R. Mechanisms of spontaneous tension-type of bruxism. Cranio 1990;8:312- 318.
headaches: an analysis of tenderness, pain thresh 46. Parker M W. A dynamic model of etiology in
olds and EM G. Pain 1996;64:251- 256. temporomandibular disorders. J Am Dent Assoc
33. Jensen R, Rasmussen BK. Muscular disorders in ten 1990;120:283- 290.
sion-type headache. Cephalalgia 1996;16:97- 103. 47. Winocur E, Littner D, Adams I, Gavish A. Oral hab
34. Jensen R, Bendtsen L, Olesen J. M uscular factors its and their association with signs and symptoms of
are of importance in tension-type headache. Head temporomandibular disorders in adolescents: a gen
ache 1998;38:10- 17. der comparison. Oral Surg Oral Med Oral Pathol
35. Jensen K, Tuxen C, Olesen J. Pericranial muscle tender Oral Radiol Endod 2006;102:482^ J87.
ness and pressure-pain threshold in the temporal region 48. Mongini F. Temporomandibular disorders and
during common migraine. Pain 1988;35:65-70. tension-type headache. Curr Pain Headache Rep
36. Vernon H, Steiman I, Hagino C. Cervicogenic dys 2007;11:465- 470.
function in muscle contraction headache and mi 49. Johansson A, Unell L, Carlsson GE, Soderfeldt B,
graine: a descriptive study. J Manipulative Physiol Hailing A. Gender difference in symptoms related
Ther 1992;15:418- 429. to temporomandibular disorders in a population
37. Kidd RF, Nelson R. Musculoskeletal dysfunction of of 50-year-old subjects. J Orofac Pain 2003;17:
the neck in migraine and tension headache. Head 29- 35.
ache 1993;33:566- 569. 50. Rutkiewicz T, Kononen M , Suominen-Taipale L,
38. Anttila P, M etsahonkala L, Mikkelsson M , Aromaa Nordblad A, Alanen P. Occurrence of clinical signs
M , Kautiainen H, Salminen J et al. Muscle tender of temporomandibular disorders in adult Finns.
ness in pericranial and neck-shoulder region in chil J Orofac Pain 2006;20:208- 217.
dren with headache: a controlled study. Cephalalgia 51. Hiltunen K, Peltola JS, Vehkalahti M M , Narhi T, Ain-
2002;22:340- 344. amo A. A 5-year follow-up of signs and symptoms
39. M ense S. Neurophysiology of muscle in relation of TM D and radiographic findings in the elderly. Int
to pain. In: Vaeroy H, M erskey H (eds). Progress J Prosthodont 2003;16:631- 634.
in Fibromyalgia and Myofascial Pain. Amsterdam: 52. Magnusson T, Egermarki I, Carlsson GE. A prospec
Elsevier, 1993:23- 39. tive investigation over two decades on signs and
40. Vanderas AP. Synergistic effect of malocclusion and symptoms of temporomandibular disorders and as
oral parafunctions on craniomandibular dysfunction sociated variables: a final summary. Acta Odontol
in children with and without unpleasant life events. Scand 2005;63:99- 109.
J Oral Rehabil 1996;23:61- 65. 53. Mongini F, Ciccone G, Ibertis F, Negro C. Personal
41. Biondi DM . Physical treatments for headache: a ity characteristics and accompanying symptoms in
structured review. Headache 2005;45:738- 734. temporomandibular joint dysfunction, headache,
42. Grimmer K, Nyland L, Milanese S. Repeated mea and facial pain. J Orofac Pain 2000;14:52- 58.
sures of recent headache, neck and upper back pain 54. Alamoudi N. Correlation between oral parafunction
in Australian adolescents. Cephalalgia 2006;26: and temporomandibular disorders and emotional
843- 851. status among saudi children. J Clin Pediatr Dent
43. Sjaastad O, Wang H, Bakketeig LS. Neck pain and 2001;26:71- 80.
associated head pain: persistent neck complaint
with subsequent, transient, posterior headache.
Acta Neurol Scand 2006;114:392- 399.

17
,

.21
-
( )
, ,
- ( ). ,
(
: , - ).22 ,
, ( ),
( ), .22
.
,
, , 48-88 % ( . 17_2).2-18-23-24

. ,
, ,
,
.6-7 .910'25

90 % ( . 17-3).21723
, ,
, , ,
, ,5-7 ,
.8-10 , ,
,
46-95 % ( . 17-1 ).2 11-19 - .91025

92-100 %
, .520 .218

-
17-1.

,%( ) ,
% In) ,
,%( ) %( )
,%
Bernst ein et al.” - 28 - - 75 (21) 25 (7)
Bu sh ’2 33 35 31 (11) 54(19) 86 (30) 14(5)
Gelb et al.13 34 38 37(14) 45(17) 82 (31) 18(7)
Gelb et al.14 43 26 65(17) 31 (8) 96 (25) 4 (1 )
Kelly et al.15 - 46 43 (20) 37 (17) 80 (37) 20 (9)
Kerst ein 16 23 23 - - . 83(19) 17(4)
Kull Leary17 55 117 - - 76 (135) 24 (42)
Rub inst ein et al.4 25 57 - - 46 (26) 54 (31)
Sim m o n s Gib b s18 66 - 64(41) 31 (20) 95(61) 5 (3 )
Tullb erg Ernb erg 1 - 73 - - 73 (53) 27(20)
W rig ht Bifano 19 38 93 56(52) 30 (28) 86 (80) 14(13)
W rig ht 2 35 132 55 (72) 28 (37) 83 (110) 17 (23)
17-2.

, ,
%( ) %( ) , ,
, %( ) %( )
%
Co o p er Kleinb erg 23 51 162 88(142) - - -
Keersm aekers et al.24 42 167 48 (- ) - - -

Sim m o n s Gib b s18 - - 71 (55) 23 (18) 95 (73) 5 (4 )
W rig ht 2 33 125 70 (87) 24 (30) 94(119) 6(8)
17-3.

,
%( ) ,%( ) ,
,% , %( )
%( )
Co o p er Kleinb erg 23 37 117 82 (96) - - -
Ku ll17 45 144 - - 90 (129) 10 (15)
W rig ht 2 20 75 63 (47) 28 (21) 91 (66) 9(7)

.36

,
, .
. 20 Levine37
(Costen), ,
- ,
( ), ,
,26 , .

.
.38 ,
.27 ,
,
,
.
,
.39
- ,
, .28
,

.
, , ,

, .
.2 ~31

.32-
34 , 68 %
-
- , , ,
, 8%
.33 ,
.40'41
, .
.35

, ,
, .10
, ,
( )36 , ,

-
( )
: 10 ).
• ;
•
; ,
• - .
;
• ,
, , ,
.42 . .
« »,
,
.
.10
.
, ,
, ( ,
. ,
,
( ). ).46
, 6 %
( -
- .43 ).46

,
.44 , ,
7% , ,
( ) .3'47-61
, 91
.45
( )
: (20 %
),
: (35 % )
• (30 % ).52
( ) ;
• 123
. ( )
.53

,
, .
- 46 41 %
/ ( , 500 , .53
2 10 )
( , 60 4-6 -

,
.

,

,
,
.
, .

,
.
,
,
( . 17-1 ). . 17-1.
. :
, -
, .
,
: ,
, - - . ,
,
( . 17-1
).54
2.
( , ),
.
3. (
)-
4. .
5. -
.
6.
.
7.
.10 .
. 8.
19 .
9.
. .
10. .
. 11.
1. (
18 1 ,
67 ). , .

-

,
, ,
.
1, 3, 4, 6, 7, 10 11 ,
.56-58
( = 0,0001). ,
.55

, .
2
( 18-78 ) ( )
.
, ( ) ,
.
,
,
( )
. .
1. .
2.
,

. 1. Tullberg , Ernberg . Long-term effect on tinni
tus by treatment of temporomandibular disorders: a
3. ,
two-year follow-up by questionnaire. Acta Odontol
Scand 2006;64:89- 96.
. 2. Wright EF. Otologic symptom improvement through
TM D therapy. Quintessence Int 2007;38:E564- 71.
3. Bjorne A, Agerberg C. Symptom relief after treat
, , ment of temporomandibular and cervical spine dis
, orders in patients with Meniere's disease: a three-
, year follow-up. Cranio 2003;21:50- 60.
( ) 4. Rubinstein B, Carlsson GE. Effects of stomatog
nathic treatment on tinnitus: a retrospective study.
Cranio 1987;5:254- 259.
. 5. Tuz HH, Onder EM , Kisnisci RS. Prevalence of
otologic complaints in patients with temporoman
dibular disorder. Am J Orthod Dentofacial Orthop
2003;123:620- 623.
, 6. Parker WS, Chole RA. Tinnitus, vertigo, and tem
, poromandibular disorders. Am J Orthod Dentofacial
, Orthop 1995;107:153- 158.
7. Chole RA, Parker WS. Tinnitus and vertigo in pa
,
tients with temporomandibular disorder. Arch Oto
. , laryngol Head Neck Surg 1992;118:817- 821.
8. Shulman A (ed). Tinnitus: Diagnosis/ Treatment.
. New York: M artha Entenmann Research Center
Inc., 2004.
,
9. American Academy of Orofacial Pain. De Leeuw R
(ed). Orofacial Pain: Guidelines for Assessment, Di
, agnosis, and M anagement, ed 4. Chicago, IL: Quin
.56 tessence Publishing, 2008.

10. Wright EF. M anual of Temporomandibular Disor 27. Stoikes NF, Dutton JM . The effect of endoscopic
ders, ed 2. Ames, IA: Wiley-Blackwell Publishing, sinus surgery on symptoms of eustachian tube dys
2010 . function. Am J Rhinol 2005;19:199- 202.
11. Bernstein JM , Mohl ND, Spiller H. Temporoman 28. Chan SW, Reade PC. Tinnitus and temporoman
dibular joint dysfunction masquerading as disease dibular pain-dysfunction disorder. Clin Otolaryngol
of the ear, nose, and throat. Trans Am Acad Oph 1994;19:370- 380.
thalmol Otolaryngol 1969;73:1208- 1217. 29. Rubinstein B. Tinnitus and craniomandibular disor
12. Bush FM . Tinnitus and otalgia in temporomandibu ders - is there a link? Swed Dent J Suppl 1993;95:
lar disorders. J Prosthet Dent 1987;58:495- 498. 1 ^ )6 .
13. Gelb H, Tarte J. A two-year clinical dental evalu 30. Ramirez LM , Ballesteros LE, Sandoval GP. Otological
ation of 200 cases of chronic headache: the cran symptoms among patients with temporomandibu
iocervical-mandibular syndrome. J Am Dent Assoc lar joint disorders. Rev Med Chil 2007; 135:1582-
1975;91:1230- 1236. 1590.
14. Gelb H, Calderone JP, Gross SM , Kantor M E. The 31. Penkner K, Kole W, Kainz J, Schied G, Lorenzoni
role of the dentist and the otolaryngologist in M . The function of tensor veli palatini muscles in
evaluation of temporomandibular joint symptoms. patients with aural symptoms and temporoman
J Prosthet Dent 1967;18:497- 503. dibular disorder. An EM G study. J Oral Rehabil
15. Kelly HT, Goodfellow DJ. Vertigo attributable to 2000;27:344- 348.
dental and temporomandibular joint causes. J Pros 32. Anagnostopoulou S, Venieratos D, Antonopoulou
thet Dent 1964;14:159- 173. M . Temporomandibular joint and correlated fis
16. Kerstein RB. Treatment of myofascial pain dys sures: anatomical and clinical consideration. Cranio
function syndrome with occlusal therapy to re 2008;26:88- 95.
duce lengthy disclusion time: a recall study. Cranio 33. Alkofide EA, Clark E, El-Bermani W, Kronman JH,
1995;13:105- 115. M ehta N. The incidence and nature of fibrous conti
17. Kull RS, Leary NR. A new survey instrument: a sam nuity between the sphenomandibular ligament and
ple of atypical TM D practice. Cranio 1999;17:164- the anterior malleolar ligament of the middle ear.
175. J Orofac Pain 1997;11:7- 14.
18. Simmons PIC 3rd, Gibbs SJ. Anterior repositioning 34. Komori E, Sugisaki M, Tanabe H, Katoh S. Disco-
appliance therapy for TM J disorders: specific symp malleolar ligament in the adult human. Cranio
toms relieved and relationship to disk status on 1986;4:299- 305.
M RI. Cranio 2005;23:89- 99. 35. Myers U. Possible inflammatory pathways relating
19. Wright EF, Bifano SL. Tinnitus improvement through temporomandibular joint dysfunction to otic symp
TM D therapy. J Am Dent Assoc 1997;128:1424- toms. Cranio 1988;6:64- 70.
1432. 36. Lockwood AH, Salvi RJ, Coad M L, Towaley M L,
20. Gelb PI, Gelb M L, Wagner M L. The relationship Wack DS, M urphy BW. The functional neuroanato
of tinnitus to craniocervical mandibular disorders. my of tinnitus: evidence for limbic system links and
Cranio 1997;15:136- 143. neural plasticity. Neurology 1998;50:114- 120.
21. Kuttila SJ, Kuttila M H, Niemi PM , Le Bell YB, Al 37. Levine RA. Somatic (craniocervical) tinnitus and the
anen PJ, Suonpaa JT. Secondary otalgia in an adult dorsal cochlear nucleus hypothesis. Am J Otolaryn
population. Arch Otolaryngol Head Neck Surg gol 1999;20:351- 362.
2001;127:401- 405. 38. Shore S, Zhou J, Koehler S. Neural mechanisms
22. Kuttila M , Le Bell Y, Savolainen-Niemi E, Kuttila S, underlying somatic tinnitus. Prog Brain Res
Alanen P. Efficiency of occlusal appliance therapy in 2007;166:107- 123.
secondary otalgia and temporomandibular disor 39. De Ridder D, De M ulder G, M enovsky T, Sunaert S,
ders. Acta Odontol Scand 2002;60:248- 254. Kovacs S. Electrical stimulation of auditory and so
23. Cooper BC, Kleinberg I. Establishment of a temporo matosensory cortices for treatment of tinnitus and
mandibular physiological state with neuromuscular pain. Prog Brain Res 2007;166:377- 388.
orthosis treatment affects reduction of TM D symp 40. Charlett SD, Coatesworth AP. Referred otalgia: a
toms in 313 patients. Cranio 2008;26:104- 117. structured approach to diagnosis and treatment. Int
24. Keersmaekers K, De Boever JA, Van Den Berghe L. J Clin Pract 2007;61:1015- 1021.
Otalgia in patients with temporomandibular joint 41. Herraiz C, Toledano A, Diges I. Trans-electrical
disorders. J Prosthet Dent 1996;75:72- 76. nerve stimulation (TENS) for somatic tinnitus. Prog
25. Goebel JA (ed). Practical M anagement of the Dizzy Brain Res 2007; 166:389- 394.
Patient. Philadelphia, PA: Wolters Kluwer Health/ 42. Raphael KG, Marbach JJ. Widespread pain and the
Lippincott Williams & Wilkins, 2008. effectiveness of oral splints in myofascial face pain.
26. Costen JB. A syndrome of ear and sinus symptoms J Am Dent Assoc 2001;132:305- 316.
dependent upon disturbed function of the tem 43. Kreiner M , Okeson JP, Michelis V, Lujambio M , Is
poromandibular joint. Ann Otol Rhinol Laryngol berg A. Craniofacial pain as the sole symptom of
1934;43:1- 15. cardiac ischemia: a prospective multicenter study.
J Am Dent Assoc 2007;138:74- 79.

-
44. Merrill RL. Differential diagnosis of orofacial pain. 52. Kuttila S, Kuttila M , Le Bell Y, Alanen P, Suonpaa J.
In: Laskin DM , Greene CS, Hylander WL (eds). Characteristics of subjects with secondary otalgia.
Temporomandibular Disorders: An Evidenced-based J Orofac Pain 2004;18:226- 234.
Approach to Diagnosis and Treatment. Chicago, IL: 53. Jaber JJ, Leonetti JP, Lawrason AE, Feustel PJ. Cer
Quintessence Publishing, 2006:299- 317. vical spine causes for referred otalgia. Otolaryngol
45. Jeon YD, Lee Jl, Cho BO, Rotaru H, Kim JC, Kim SC. Head Neck Surg 2008;138:479- 485.
Statistical correlation between pharyngitis and tem 54. Wright EF. Referred craniofacial pain patterns in
poromandibular joint disease. Oral Surg Oral Med patients with temporomandibular disorders. J Am
Oral Pathol Oral Radiol Endod 2005;99:677- 681. Dent Assoc 2000; 131:1307- 1315.
46. ReiterS, Gavish A, Emodi-Perlman A, Eli I. Nasopha 55. Wright EF, Syms CA III, Bifano SL. Tinnitus, diz
ryngeal carcinoma mimicking a temporomandibular ziness, and non-otologic otalgia improvement
disorder: a case report. J Orofac Pain 2006;20:74- 81. through temporomandibular disorder therapy. Mil
47. Abel M D, Levine RA. Muscle contractions and audi Med 2000;165:733- 736.
tory perception in tinnitus patients and nonclinical 56. Cox KW. Temporomandibular disorder and new
subjects. Cranio 2004;22:181- 191. aural symptoms. Arch Otolaryngol Head Neck Surg
48. Levine RA, Nam EC, Oron Y, M elcher JR. Evidence 2008;134:389- 393.
for a tinnitus subgroup responsive to somatosen 57. Seedorf H, Jude HD. Otalgia as a result of certain
sory based treatment modalities. Prog Brain Res temporomandibular joint disorders. Laryngorhinoo-
2007;166:195- 207. tologie 2006;85:327- 332.
49. Kraus S. Temporomandibular disorders, head and 58. Silveira AM , Feltrin PP, Zanetti RV, Mautoni M C.
orofacial pain: cervical spine considerations. Dent Prevalence of patients harboring temporoman
Clin North Am 2007;51:161- 193. dibular disorders in an otorhinolaryngology depart
50. Krabak BJ, Borg-Stein JP, Oas J, Dumais D. Re ment. Rev Bras Otorhinolaringol (Engl ed) 2007;73:
duced dizziness and pain with treatment of cervical 528- 532.
myofascial pain. Arch Phys Med Rehabil 1996;77:
939- 940.
51. Lam DK, Lawrence HP, Tenenbaum HC. Aural
symptoms in temporomandibular disorder patients
attending a craniofacial pain unit. J Orofac Pain
2001;15:146- 157.

Глава 18
Амбра Микелотти и Мауро Фарелла

:
,
, .1-3
, , ,

,
.
( )
.
. ,
, , ,
. (
)
.4
. ,
,

. ,
.5
,

, ,
. ,
,
. ,
.6

-

. 18-1. . I: . . II:
, . III:
.
,
- ( )

,
.
5, 6 7 .7
1 (Angle)10

."
I:
, -
.89 ,
-
, ( . 18-1 ).
II:
.
( . 18-1 ).
III:
( . 18-1 ).
.
,

.6'12-14

,

,

.61213 , ,
-
II .

. ,
I III .
,
(. .
), .

.1516
Gadotti .17
. - ,
( ) ,

,
.
- ( . Michelotti et al.,21
II , Korbmacher et al.,6 Arm ijo Olivo et al.19
Hanke et al.22). - ,
. -
, Nobili .18
- .
50 , 23
. ,
.
,
. , ,
II
, ,
III
. .

,
- -
( ). , 1 .
,

, .24
, ,25
.19
.20
.

(
. -
, .)
.
,
, ,
.12131626 , ,
, .31

.2728
,

.
, - -
.15 ( . 18-2).
, (7-23 %
,28 )

29 - .32
80 %
.
,
6 : .33
, ,
, ,
, , , ,
. ,
.
. .34

, .
, ,
. . ,
,
. , .
,

. Sato .35
.30 -

. 18-2 18-2 . ,
). , ,
.
: , ,
. ( )
,
2 . ( )
.
1 . ,

.
,

.
1-2 ,

( . 18-3).
. ,
,
- ( )

.37
.15 , -
. ,
.15
Huggare .30 , ,
- ( .38
) M ichelotti .39
,
( )
. Ben-Bassat .36
96 ( ),
,
705 , .
( .

. 18-3. , . 18-4.
.
( - , .
; St efano Co lam aio )
.
( )
(
.
)
,
1291
1159 , ,
1.
. ,
,
.
130 , , ,
( . 18-4). ,
,
. ,
,
( = 1,6). ,
. 10 .
,
. 120 ,
(10,3 %) . -
,
142 (12,2 %) 1159 .
. ,

, .,1
.

. . Gangloff .2
,
,
, .
, ,
, ( )
,
. , .
, ,
II 1- ,

. , .40

, .41
26 (14 12 )
.21 ,
, .
, 52 «
, , » ,
.
.
. -
( . 18-5 18-5 ).

,

.

,

, ( )
.
.
.12
. , ,
, ( , )
,
.

. 18-5. . 1- 5- .
. .
, - , - .
,
. . .
. )
, (
( ), . . 20-
) 30 . ,
.
, ,
,
,
, .
.

, « »
(
)

. , ,
,
.
.
: ,
. , .
,

, (. . .
-

. 18-6. . .
.
( )
.
41 -
. :
, , 10
( ,
. ), 10-
, ( ) ,
,
( ).
. ( . 18-6 )
.
. 5
15° .
, ,
.
,42
, , ( . 18-6 ).
,
,
.
, ,
.
. Farella .43 ,
,
: , .
,

, 10
. 10 (
, ).
,
,
,

. ,
.
, ,
:
,
. . Perinetti45
. ,
-
,
. .

. ,
,
. ,
, Perinetti46
,
, (
,
)
. .
-
,
,
, ,

. , . ,
, -
. ,
,
.
.

,
-
. , Ferrario
.44 ,
. ,
10 ,
II

,
-
. Hill,47 (
, ),
,
: .
(
), (
), (
),
( 1. Bracco , Deregibus A, Piscetta R. Effects of differ
ent jaw relations on postural stability in human sub

jects. Neurosci Lett 2004;356:228- 230.
), 2. Gangloff P Louis JP, Perrin PP. Dental occlusion
( modifies gaze and posture stabilization in human
), subjects. Neurosci Lett 2000;293:203- 206.
3. Milani RS, De Periere DD, Lapeyre L, Pourreyron L.
( Relationship between dental occlusion and posture.
). Cranio 2000;18:127- 134.
4. Wada M , Sunaga N, Nagai M . Anxiety affects the
,22 postural sway of the antero-posterior axis in college
students. Neurosci Lett 2001;364:157- 159.
, , , 5. Cuez G. The posture. In: Kandel ER, Schwartz JH,
Jessel TM (eds). Principles of Neural Science. Am
, sterdam: Elsevier, 1991:612- 623.
6. Korbmacher H, Eggers-Stroeder G, Koch L, Kahl-

Nieke B. Correlations between anomalies of the
, dentition and pathologies of the locomotor sys
, . tem: a literature review. J Orofac Orthop 2004;65:
190-203.
7. Pinganaud G, Bourcier F, Buisseret-Delmas C, Buis-
,
seret P. Primary trigeminal afferents to the vestibu
lar nuclei in the rat: existence of a collateral pro
, jection to the vestibulo-cerebellum. Neurosci Lett
, 1999;264:133- 136.
8. Buisseret-Delmas C, Compoint C, Delfini C, Buis-
, seret P. Organization of reciprocal connections be
tween trigeminal and vestibular nuclei in the rat.
. J Comp Neurol 1999;409:153- 168.
, 9. M arfut CF, Rajchert DM . Trigeminal primary affer
ent projection to "non trigeminal" areas of the rat
central nervous system. J Comp Neurol 1991 ;303:
489- 511.
, 10. Angle EH. Treatment of Malocclusion of the Teeth
and Fractures of the M axillae: Angle's System, ed 6.

Philadelphia, PA: SS White Dental, 1990.
11. Proffit WR. Contemporary Orthodontics, ed 4. Phil
( ) adelphia, PA: Mosby-Elsevier, 2007.
12. Festa F, Tecco S, Dolci M , Ciufolo F, Di Meo S, Filippi
M R et al. Relationship between cervical lordosis and
facial morphology in Caucasian women with a skel
. , etal Class II malocclusion; a cross-sectional study.
Cranio 2003;21:121- 129.
13. Huggare J. Postural disorders and dentofacial mor
phology. Acta Odontol Scand 1998;56:383- 386.
,
.

14. Solow , Sonnesen L. Head posture and malocclu 32. Alarcon JA, Martin C, Palma JC. Effect of unilateral
sions. Eur J Orthod 1998;20:685- 693. posterior crossbite on the electromyographic activ
15. D'Attilio M , Filippi M R, Femminella B, Festa F, Tecco ity of human masticatory muscles. Am J Orthod
S. The influence of an experimentally-induced mal Dentofacial Orthop 2000;118:328- 334.
occlusion on vertebral alignment in rats: a controlled 33. Pinto AS, Buschang PH, Throckmorton GS, Chen
pilot study. Cranio 2005;23:119- 129. P. Morphological and positional asymmetries of
16. Lippold C, Danesh G, Schilgen M , Drerup B, Hack- young children with functional unilateral poste
enberg L. Relationship between thoracic, lordotic, rior crossbite. Am J Orthod Dentofacial Orthop
and pelvic inclination and craniofacial morphology 2001;20:513- 520.
in adults. Angle Orthod 2006;76:779- 785. 34. Kilic N, Kiki A, Oktay H. Condylar asymmetry in
17. Gadotti IC, Berzin F, Biasotto-Gonzalez D. Pre unilateral posterior crossbite patients. Am J Orthod
liminary rapport on head posture and muscle ac Dentofacial Orthop 2008;133:382- 387.
tivity in subjects with Class I and II. J Oral Rehabil 35. Sato C, Muramoto T, Soma K. Functional lateral de
2005;32:794- 799. viation of the mandible and its positional recovery
18. Nobili A, Adversi R. Relationship between posture on the rat condylar cartilage during the growth pe
and occlusion: a clinical and experimental investiga riod. Angle Orthod 2006;76:591- 597.
tion. Cranio 1996;14:274- 285. 36. Ben-Bassat Y, Yitschaky M , Kaplan L, Brin I. Occlus
19. Armijo Olivo S, Bravo J, Magee DJ, Thie NM R, M a al patterns in patients with idiopathic scoliosis. Am J
jor PW, Flores-Mir C. The association between head Orthod Dentofacial Orthop 2006;130:629- 633.
and cervical posture and temporomandibular disor 37. Valentino B, Melito F. Functional relationship be
ders: a systematic review. J Orofac Pain 2006;20:9-23. tween the muscles of mastication and the muscles
20. M akofsky H. The effect o f head posture on m u scle of the leg: an electromyographic study. Surg Radiol
contact position: the sliding cranium theory. Cranio Anat 1991;13:33- 37.
1989;7:286- 292. 38. Chinappi AS, Getzoff H. The dental-chiropractic
21. Michelotti A, Manzo P, Farella M , M artina R. Occlu- co-treatment of structural disorders of the jaw and
sione e postura: quali le evidenze di correlazione? temporomandibular joint dysfunction. J M anipula
M inerva Stomatol 1999;48:525- 534. tive Physiol Ther 1995;18:476- 481.
22. Hanke BA, Motschall E, Turp JC. Association between 39. Michelotti A, Farella M , Buonocore G, Pellegrino
orthopedic and dental findings: what level of evidence G, Piergentili C, M artina R. Is unilateral posterior
is available? J Orofac Orthop 2007;68:91-107. crossbite associated with leg length inequality? Eur
23. Solow B, Sandham A. Craniocervical posture: a fac J Orthod 2007;29:622- 626.
tor in the development and function of the dento 40. Gangloff P, Perrin PP. Unilateral trigeminal anes
facial structures. Eur J Orthod 2002;24:447- 456. thesia modifies postural control in human subjects.
24. Phillips C, Snow M D, Turvey , Proffit WR. The Neurosci Lett 2002;330:179- 182.
effect of orthognathic surgery on head posture. Eur 41. Michelotti A, Buonocore G, Farella M , Pellegrino G,
J Orthod 1991;13:397- 403. Piergentili C, Altobelli S et al. Postural stability and
25. Armijo Olivo S, M agee DJ, Parfitt M , M ajor P, Thie unilateral posterior crossbite: is there a relationship?
NM R. The association between the cervical spine, Neurosci Lett 2006;392:140- 144.
the stomatognathic system, and craniofacial pain: a 42. Hestboek L, Leboeuf-Yde C. Are chiropractic tests
critical review. J Orofac Pain 2006;20:271- 287. for the lumbo-pelvic spine reliable and valid? A
26. Lippold C, Danesh G, Hoppe G, Drerup B, Hacken- systematic critical literature review. J Manipulative
berg L. Sagittal spinal posture in relation to craniofa Physiol Ther 2000;23:258- 275.
cial morphology. Angle Orthod 2006;76:625- 631. 43. Farella M , Michelotti A, Pellegrino G, Giani U, M ar
27. Gole DR. A clinical observation: a relationship of tina R. Interexaminer reliability and validity for diag
occlusal contacts to distal musculature. Cranio nosis of temporomandibular disorders of visual leg
1993;11:55- 61. measurements used in dental kinesiology. J Orofac
28. Valentino B, Melito F, Aldi B, Valentino T. Correla Pain 2005;19:285- 290.
tion between interdental occlusal plane and plantar 44. Ferrario VF, Sforza C, Serrao G. The influence of
arches. An EMG study. Bulletin du Groupement In crossbite on the coordinated electromyographic ac
ternational pour la Recherche Scientifique en Stom- tivity of human masticatory muscles during masti
atologie et Odontologie 2002;44:10- 13. cation. J Oral Rehabil 1999;26:575- 581.
29. Lippold C, Danesh G, Hoppe G, Drerup B, Hacken- 45. Perinetti G. Temporomandibular disorders do not
berg L. Trunk inclination, pelvic tilt and pelvic ro correlate with detectable alterations in body pos
tation in relation to the craniofacial morphology in ture J Contemp Dent Pract 2007;8:60- 67.
adults. J Orofac Orthod 2007;77:29- 35. 46. Perinetti G. Dental occlusion and body posture:
30. Huggare J, Pirttiniemi P, Serlo W. Head posture and no detectable correlation. Gait Posture 2006;24:
dentofacial morphology in subjects treated for sco 165-168.
liosis. Proc Finn Dent Soc 1991;87:151- 158. 47. Hill AB. The environment and disease: association or
31. Burwell RG. Aetiology of idiopathic scoliosis: cur causation? Proc Royal Soc Med 1965;58:295- 300.
rent concepts. Pediatr Rehabil 2004;6:137- 170.

Глава 19
Рудигер Эмсхофф
( / I)
- ,
( )
, , , , ,
( /
. II).

,
1 2
, . /

,
.
.
( / )
,
, .
.
.

.

,
/ / :
.
( / )
/
.
.2 , I

-
, ,
( ) ,
II 78
•
,
. •
/ / :
. •
/
:
9
,
.
2:
.
•
, .
• :
I
1: 10
•
•
•
3
• , ,

46 " 12 ( . 19-1)
• •
, ,
, ,
10
•

3: , ,
•
• -
6 13
•
14

/ :
. 19-1. - . ( )
: - . ( }
( ; ), b - , ( ) ( )
• / :

,
16
•
/ : / -
• ,
: . /
,

II .2
/
• ( ) .
:
(Helkimo Clinical Dysfunction
• Index) -
, ( , Craniomandibular Index).17-19
:

•
. ,
.16
/ .
-
( , Temporomandibular Index)20

-
19-1.
(Pehling et al.20)
« » , «1» -
I.
(0) (1)
(> 40 )
(> 40 ) (0) (1) (0) (1)
(> 40 ) (0) (1) (0) (1)
(> 7 ) (0) (1) (0) (1)
: (> 7 ) (0) (1) (0) (1)
- (> 7 ) (0) (1) (0) (1)
-
( )
(0)
(1)
(1)
( . .) (1)
II.
(0) (1) (0) (1)

(0) (1) (0) (1)
(0) (1) (0) (1)
(0) (1) (0) (1)

(0) (1) (0) (1)
:
(0) (1) (0) (1)
(0) (1) (0) (1)
/20 (0) (1) (0) (1)
(0) (1) (0) (1)
III.
(0) (1) (0) (1)
(0) (1) (0) (1)
( )
:
(0) (1) (0) (1)
/8 = (0) (0)
(1) (1)
(0) (1) (0) (1)
(0) (1) (0) (1)
(0) (1) (0) (1)
(0) (1) (0) (1)

(0) (1) (0) (1)
IV. -
+ + / 3=

- :
( . 19-1). , .

. , .21
,
.
,
. ,
- .
: ,
.22
-
-
19-2. 23

( = 27) ( = 24) ( = 29) ( = 28/ 22)**
53,5 ± 49,5 54,5 ± 47,6 55,0 ± 53,0 48 ,6 ± 74,2
1 31 ,4 ± 7 5 ,0 36 ,4 ± 57,7 27,2 ± 59,8 38 ,4 ± 86,9
* 22,1 ± 72,8 18,1 ± 5 8 ,6 27,8 ± 59,84 10,1 ± 7 3 ,5
1,56 ± 1,98 1,74 ± 2 ,0 5 1,77 ± 2,01 1,61 ± 2 ,8 8
1 1,11 ± 1,74 1,19 ± 1 ,6 5 1,13 ± 1 ,7 5 1,36 ± 3,01

* 0,46 ± 2,59 0,55 ± 2,42 0,63 ± 2,294 0,25 ± 2,03
0,29 ± 0,76 0,35 ± 0,58 0 ,34 ± 0,67 0,40 ± 0,82
1 0,17 ± 0 ,7 7 0,17 ± 0 .4 0 0,15 ± 0 ,4 9 0 ,34 ± 0,74
* 0,12 ± 0 .9 0 0,18 ± 0 ,7 1 4 0,19 ± 0 ,6 3 * * * 0,03 ± 0,76
+
* 1
** /
*** . 1 ,
, ,
. .
-
-

-
.12
,
. ,

.24

.

( . 19-2).26
. 19-2.
( )
.25
,
( ), (
) ( ), ,
2
( .
).

.
, .

( Em sh o f f Ru d isch 26)
,
.25'27
.
,
,
( . 19-2).23

.
:
.
,

,
, , ,

13. Visscher CM , Lobbezzo F, Naeije M . A reliabil
ity st udy o f dynam ic and st at ic pain tests in t em
. porom andibular disorder patients. J Oro fac Pain
2007;21:39- 45.
14. A rm ijo Olivo S, M ag ee DJ, Parfitt M , M ajo r P, Thie
N M . The association between the cervical spine,
the stom atognat hic system , and craniofacial pain: a
critical review. J Oro fac Pain 2006;20:271- 287.
15. Wiese M , Svensson P, Bakke M , List T, Hintze H, Pe
1. Truelove EL, Som m ers , LeResche L, Dworkin SF, tersson A et al. Association between tem p orom an
Von Ko rff M . Clinical diagnostic crit eria fo r TM D: dibular jo int sym ptom s, signs, and clinical diagnosis
new classification permits multiple diagnosis. J Am using the RDC/ TM D and radiographic findings in
Dent Assoc 1992;123:47- 54. tem porom andibular jo int tom ogram s. J Oro fac
2. Dworkin SF, LeResche L. Research diagnostic criteria Pain ;2008;22:239- 251.
fo r tem porom andibular disorders: review, criteria, 16. Ohrb ach R, Larrson P, List T. The jaw functional
exam inations and specifications, critique. J Crani limitation scale: developm ent , reliability, and valid
omandib Disord 1992;6:301- 355. ity of 8- item and 20- item versions. J Oro fac Pain
3. Nilsson IM , List T, Drangsholt M . The reliability and 20 08;22:219- 230.
valid it y of seif-reported tem porom andibular dis 18. Hatch JP, Rugh JD, Sakai S, Prihoda TJ. Reliabil
order pain in adolescents. J Oro fac Pain 2006;20: ity of the craniom andibular index. J Oro fac Pain
138- 144. 2002;16:284- 295.
4. Dos Santos Silva R, Conti PCR, Lauris JRP, Da Silva 19. Helkim o M . Studies on function and dysfunction o f
ROF, Pegoraro LF. Pressure pain threshold in the de the m asticatory system : index fo r anam nest ic and
tection o f m asticatory m yofascial pain: an algome- clinical dysfunction and occlusal state. Swed Dent J
ter-based study. J Oro fac Pain 20 05;19:318- 324. 1974;67:101- 121.
5. Farella M , M ichelotti A , Steenks M H, Romeo R, 20. Pehling J, Schiffm an E, Look J, Shaefer J, Lenton P,
Cim ino R, Bosman F. The diagnostic value of pres Fricton J. Int erexam iner reliability and clinical valid i
sure algom etry in m yofascial pain o f the jaw m us t y o f the tem porom andibular index: a new outcome
cles. J Oral Rehabil 20 00;27:9- 14. measure fo r tem porom andibular disorders. J Oro fac
6. Chaves TC, Nagamine HM , De Sousa LM , De O l Pain 2002;16:296- 304.
iveira AS, Grossi DB. Intra- and int errat er agreem ent 21. Flor H, Herm ann C. Biopsychosocial models o f pain.
of pressure pain threshold fo r m asticatory structures In: Dworkin RH, Breitbart W S (ed s). Psychosocial
in children reporting orofacial pain related to t em Aspects o f Pain: A Handbook fo r Health Care Pro
porom andibular disorders and sym ptom - free chil viders. Progress in Pain Research and M anagem ent .
dren. J Oro fac Pain 2007;21:133- 142 Seattle: IASP Press, 2004:47- 75.
7. Ariji Y, Sakum a S, Izumi M , Sasaki J, Kurita K, Oqi 22. Turk DC. The potential of t reatm ent m atching for
N et al. Ult rasonographic feat ures of the masseter subgroups o f patients wit h chronic pain. Clin J Pain
muscle in fem ale patients wit h tem p orom and ibu 20 05 ;2 1:44- 5 5.
lar disorder associated wit h m yofascial pain. Oral 23. Gardea M A, Gat chel RJ, M ishra KD. Long-term ef
Surg Oral M ed Oral Pathol Oral Radiol Endod ficacy o f biobehavioral t reatm ent o f tem p orom an
2004;98:337- 341. dibular disorders. J Behav M ed 2001 ;24:341- 359.
8. Boom HP, van Spronsen PH, van Ginkel FC, van 24. Fricton JR, Schiffman EL. The craniom andibular in
Schijndel RA, Castelijns JA, Tuinzing DB. A com pari d ex: validity. J Prosthet Dent 1987;58:222- 228.
son o f human jaw muscle cross-sectional area and 24. Stohler CS, Zarb GA. On the m anagem ent of t em
volum e in long- and short - face subjects, using M RI. porom andibular disorders: a plea fo r a low- t ech,
Arch Oral Biol 2 0 0 8 ;5 3:273 - 28 1. high- prudence t herapeutic approach. J Oro fac Pain
9. Turp JC, M inagi S. Palpation of the lateral pt ery 1999;13:255- 261.
goid region in TM D - where is the evidence? J Dent 25. M cGinn TG, Guyat t GH, W yer PC, Nayler CD , Shell
2001;29:475- 483. IG, Richardson W S. User's guide to the medical lit
10. Tym o fiyeva O , Proff P, Richter EJ, Jakob P, Fang- erature: XXII. How to use an article about clinical
hand J, Gedrange T et al. Correlation of M RT im decision rules. J Am M ed Assoc 2000;284:79- 84.
aging wit h real-time axiog raphy o f TM J clicks. Ann 26. Em shoff R, Rudisch A. Likelihood ratio m ethodol
An at 2007;189:356- 361. ogy to identify predictors o f t reatm ent outcom e
11. Em shoff R, Jank S, Bertram S, Rudisch A, Bodner G. in tem porom andibular jo int arthralgia patients.
Disk displacem ent o f the tem porom andibular joint : Oral Surg Oral M ed Oral Pathol Oral Radiol Endod
sonography vs. M R imaging. AJR Am J Roentgenol 2008;106:525- 533.
2002;178:1557- 1562. 27. Laupacis A, Sekar N, Shell IG. Clinical predic
12. Ohlm ann B, Ram melsberg P, Henschel V, Kress B, tion rules: a review and suggested modifications
Gab b ert O , Schm itter M . Prediction o f TM J arthral o f methodological standards. J Am M ed Assoc
gia according to clinical diagnosis and M RI findings. 1997;277:488- 494.

IV

20
-
- 16 % ,
( ) .3 ,
-
. ( ,
, - ,
( ), , ,
) ,
16-59 % - -
, .4
( ) ,
33-86 %.’ ,
,
,
, . ,
, ,
.
, , .
,
, ,
.
,
,
,
17 , .2
,

, ,
, , ,

. .5
, ,
,

-
, 20-1.

•
. ,
:

• :
.
, •
,
:
, ,
•
, , -
.
:

-
( . 5), .
( .
24). ,
, ( . 20-1).
, . 20-1

( ) ,
( 20-1). ,
, .
, , . . -
20-1.

( )
,

(
)

ВНЧР
,
-
( . 27).
, .
.
- ,
,
,
, .17'1921

,
. ,
, -
.
,
.6
, . ,
,
, -, -,
, .
( ), ,
.
75-90 %
.7
.
20-2. PubM ed
(24 2009 . : TM D
t reat m ent . : 6954).
,
1933

. PubMed 1080
, /
( . 20-2). 722
,
615
,
179
, 165
151
95
( . 20-3). , 86
. 53
, 51
, 31

-
20-3. ,

St ap elm an n , N TI- tss 9 , N TI- tss

20088 .

.

,
Guard a- 30
N ard ini, 20089 , ,
,
.

Ab raham sso n, - 3
200710
,
.
Al- Belasy, 19
2007” ( .
)
,
,
,
, 200712 11 ,
V S.
, -
,
.

, 200713 7 ,
, ,

,
M edlicot t , , 30
200614
, .
,
,
,
, .
.

ВНЧР
20-3.
M cN eely, 12 ,
200615
. ,
Al- Ani, 200516 12 ,
(
) ,

.
Ko h, 2004" 17
,
, 200418 13
,
(
) .
,
,
.
Fo rssell, 16
200419
.

List , 20 0320 7
.

Fo rssell, 18
199921 (

12 ,
).

(
,

)
NTI-tss - Nociceptive Trigeminal Inhibition Clenching

Suppression System; - .

-
, . ,

. .
- ,
, ,
,

, - (
. ,
, , )
.12 ( ).
,
,
. .
.
.

, .
.1 '18'19'21 ,
,
,
,22 , - ,
. ,23

.
,
.
, ,
,
.

, ,
,
, ( . 4).24
, -
,
,
. .2526
, ,
, .
,

, , .27

. 20-1. -
.
( )

.
alN S - ; Orb F -
- ; -
(
Bened et t i,29
Luana , M D, PhD, )
, .30
, ,
,
,
,
( . 25). .
,
, - :
31
( . 20-1 ).28-29
.32
, , , ,
,
,
. , . 24
, ,

, ,
, , ( . 8),
( . 6).
,
.
,
, , ,
, .
,
-, -
. , , , ,
,
.
,
- ,
. ,
.

-
, 37
,

, .38
.

.

,
. . ,
,
,
.33
, ( ),

. .

,
.
- ,

,
, ,
.
- , .39
,
2008 ., ,
,34 ,

- .
Clark35 ( . 20-4). ,
: / 40
,

.
. - ,

, ,

. ( . 20-2 20-2 ).
, ,
. ,
,
. , ,
( -
,36 ),
( -

. 20-2. - .
, ,
, ( M ichele Vano , DDS, PhD, )
)
(
. )
,

.

.
.
( ,
,
, ), ,

.41 , / . , -
20-4. ,
( )
1 31 2008 . (199 ; 166 , 33 ; 43,2 )
,%
( ) 53,3
( ) 51,3
( ) 15,7
( ) 18,7
( ) 29,6
( ) 36,7
( / )- 49,7
- 29,8
- 19,8

-
( ) 20-2.
,

• :
.
91 %
,
•
• :
( . 21 ).42 ,

• :
,

,
• :

.
,
• :
,
,

.
, 80 % .44

,
.46'46
( 20-2). ,

, . . ,
,

( , )
( .
)
, ,
.
,
.
,
. ,
43
« »
, .
.

4. Kuttila M, Niemi PM, Kuttila S, Alanen P, Le Bell Y.
TM D treatment need in relation to age, gender,
(
stress, and diagnostic subgroup. J Orofac Pain
), 1998;12:67- 74.
5. Turp JC, Greene CS, Strub JR. Dental occlusion: a
critical reflection on past, present and future con
cepts. J Oral Rehabil 2008;35:446- 453.
.
6. Stohler CS. Temporomandibular joint disorders -
the view widens while therapies are constrained.
. J Orofac Pain 2007;21:261.
7. Okeson JP. M anagement of Temporomandibular
Disorders and Occlusion, ed 6. St. Louis, M O: El-
sevier-Mosby, 2008.
8. Stapelmann H, Turp JC. The NTI-tss device for the
therapy of bruxism, temporomandibular disorders
and headache - where do we stand? A qualita
tive systematic review of the literature. BMC Oral
Health 2008;8:22.
16 % , 9. Guarda-Nardini L, Manfredini D, Ferronato G. Tem
poromandibular joint total replacement prosthesis:
current knowledge and considerations for the fu
ture. Int J Oral M axillofac Surg 2008;37:103- 110.
10. Abrahamsson C, Ekberg E, Henrikson T, Bondemark L.
. Alterations of temporomandibular disorders before
and after orthoganthic surgery: a systematic review.
Angle Orthod 2007;77:729- 734.
, 11. AI-BelasyFA, DolwickMF. Arthrocentesisforthetreat
. ment of temporomandibular joint closet lock: a review
article. Int J Oral Maxillofac Surg 2007;36:773-782.
12. Turp JC, Jokstad A, Motschall E, Schindler HJ,
,
Windecker-Getaz I, Ettlin DA. Is there a superiority
of multimodal as opposed to simple therapy in pa
, tients with temporomandibular disorders? A quali
. tative systematic review of the literature. Clin Oral
Implants Res 2007;18(Suppl 3):138- 150.
, 13. Turp JC, Motschall E, Schindler HJ, Heydecke G.
In patients with temporomandibular disorders,
, do particular interventions influence oral health-
related quality of life? A qualitative systematic
review of the literature. Clin Oral Implants Res
. 2007;18(Suppl 3):127- 137.
14. Medlicott M S, Harris SR. A systematic review of
. the effectiveness of exercise, manual therapy, elec
trotherapy, relaxation training, and biofeedback in
the management of temporomandibular disorders.
Phys Ther 2006;86:955- 973.
15. M cNeely M L, Armijo-Olivo S, Magee DJ. A system
atic review of the effectiveness of physical therapy
interventions for temporomandibular disorders.
Phys Ther 2006;86:710- 725.
1. Drangsholt , LeResche L. Temporomandibular
16. Al-Ani Z, Gray RJ, Davies SJ, Sloan P, Glenny AM .
disorder pain. In: Crombie M K, Croft PR, Linton
Stabilization splint therapy for the treatment of
SJ, LeResche L, Von Korff M (eds). Epidemiology of
temporomandibular myofascial pain: a systematic
Pain. Seattle, WA: IASP Press, 1999:203- 233.
review. J Dent Educ 2005;69:1242- 1250.
2. Al-Jundi M A, John MT, Setz JM , Szentperry A, Kuss
17. Koh H, Robinson PG. Occlusal adjustment for treat
O. Meta-analysis of treatment need for temporo
ing and preventing temporomandibular joint disor
mandibular disorders in adult nonpatients. J Orofac
ders. J Oral Rehabil 2004;31:287- 292.
Pain 2008;22:97- 107.
18. Turp JC, Komine F, Hugger A. Efficacy of stabiliza
3. Carlsson GE. Epidemiology and treatment need
tion splints for the management of patients with
for temporomandibular disorders. J Orofac Pain
masticatory muscle pain: a qualitative systematic
1999;13:232- 237.
review. Clin Oral Investig 2004;8:179- 195.

-
19. Forssell , Kalso . Application of principles of 33. Manfredini D, Lobbezoo F. Role of psychosocial
evidence-based medicine to occlusal treatment for factors in the etiology of bruxism. J Orofac Pain
temporomandibular disorders: are there lessons to 2009;23:153- 166.
be learned? J Orofac Pain 2004;18:9- 22. 34. Stegenga B, de Bont LGM , Boering C. Osteoarthro
20. List T, Axelsson S, Leijon G. Pharmacologic inter sis as the cause of craniomandibular pain and dys
ventions in the treatment of temporomandibular function: a unifying concept. J Oral M axillofac Surg
disorders, atypical facial pain, and burning mouth 1989;47:249- 256.
syndrome: a qualitative systematic review. J Orofac 35. Clark GT. Classification, causation and treatment of
Pain 2003;17:301- 310. masticatory myogenous pain and dysfunction. Oral
21. Forssell H, Kalso E, Kostela P, Vehmanen R, Pukka A, M axillofac Surg Clin North Am 2008;20:145- 157.
Alanen P. Occlusal treatments in temporomandibu 36. Farella M . The clinch about clenching. Zurich: EACD
lar disorders: a qualitative systematic review of ran Annual M eeting, 2008.
domized controlled trials. Pain 1999;83:549- 560. 37. Svensson P, Burgaard A, Schlosser S. Fatigue and
22. Klasser GD, Greene CS. Oral appliances in the pain in human jaw muscles during a sustained,
management of temporomandibular disorders. low-intensity clenching task. Arch Oral Biol
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;46:773- 777.
2009;107:212- 223. 38. Nitzan DW, Benoliel R, Heir G, Dolwick F. Pain and
23. Travell JG, Rinzler S, Herman M . Pain and disability dysfunction of the temporomandibular joint. In:
of the shoulder and arm: treatment by intramus Sharav E, Benoliel R (eds). Orofacial Pain and Head
cular infiltration with procaine hydrochloride. J Am ache. Philadelphia, PA: Mosby-Elsevier, 2008:149-
Dent Assoc 1942;120:417- 422. 192.
24. M urray GM , Peck CC. Orofacial pain and jaw mus 39. Steenks M H, de Wijer A. Validity of the research
cle activity: a new model. J Orofac Pain 2007;21: diagnostic criteria for temporomandibular disorders
263- 278. axis I in clinical and research settings. J Orofac Pain
25. De Bont LGM , Dijkgraaf LC, Stegenga B. Epide 2009;23:9- 16.
miology and natural progression of articular tem 40. Ohrbach R, Svensson P (Orgs). Validation studies of
poromandibular disorders. Oral Surg Oral Med Oral the RDC/ TM D: progress toward version 2. Toronto:
Pathol Oral Radiol Endod 1997;83:72- 76. Symposium of International Association for Dental
26. Stohler CS. Phenomenology, epidemiology, and Research, 2008.
natural progression of the muscular temporoman 41. Dibbets JM , van der Weele LT. Signs and symp
dibular disorders. Oral Surg Oral Med Oral Pathol toms of temporomandibular disorders (TM D) and
Oral Radiol Endod 1997;83:77- 81. craniofacial form. Am J Ortho Dentofacial Orthop
27. Raphael K, Marbach JJ. Evidence-based care 1996;110:73- 78.
of muscoloskeletal facial pain: implications for 42. Epker JT, Gatchel RJ, Ellis E. An accurate model for
the clinical science of dentistry. J Am Dent Assoc predicting TM D chronicity: practical applications in
1997;128:73- 79. clinical settings. J Am Dent Assoc 1999;130:1470-
28. Benedetti F, Mayberg HS, Wager TD, Stohler CS, 1475.
Zubieta JK. Neurobiological mechanisms of the pla 43. Moses AJ. TM Ds: An evidence-based approach to
cebo effect. J Neurosci 2005;25:10390- 10402. diagnosis and treatment. J Craniomandibular Pract
29. L, Benedetti F. Placebo and painkillers: is 2007;25:5- 7 (book review).
mind as real as matter? Nat Rev 2005;6:545- 552. 44. Greene CS. The role of biotechnology in TM D di
30. Clark GT, Minakuchi H. Oral appliances. In: Laskin agnosis. In: Laskin DM , Greene CS, Hylander WL
DM , Greene CS, Hylander WL (eds). TM Ds: An Evi (eds). TM Ds: An Evidence-based Approach to Di
dence-based Approach to Diagnosis and Treatment. agnosis and treatment. Chicago, IL: Quintessence
Chicago, IL: Quintessence Publishing, 2006:377- Publishing, 2006:193- 202.
390. 45. Manfredini D, M ontagna F, Bucci M B. Temporo
31. Farella M , Palumbo A, Milani S, Avecone S, Gallo mandibular disorders assessment in the medi
LM , Michelotti A. Synergist coactivation and substi cal legal setting. Tagete Arch Legal Med Dent
tution pattern of the human masseter and tempora 2007;12:1- 20.
lis muscles during sustained static contractions. Clin 46. Manfredini D, Bucci M B, M ontagna F, Guarda-Nar
Neurophysiol 2009;120:190- 197. dini L. Electromyography of jaw muscles is not use
32. Ettlin DA, Mang H, Colombo V, Palla S, Gallo LM . ful in the medical legal setting. Tagete Arch Legal
Stereometric assessment of TM J space variation by Med Dent 2008;13:1- 17.
occlusal splints. J Dent Res 2008;87:877- 881.

21

.12 , ,
-
, 75 % ,

( ) -
( ), 5-10 % ( )
.3 .6
-
, 12-20 .
.7
- Von Korff .,8 ,
( ) 10 % ,
6% , 20
.4 , , .
6-12 5,3 , ,
,
2
.
, .
, , ,
, 28 % ,
, .
.6
,
, , ,
4 , . ,
,
. Stohler Zarb9

-
,
. ,
( )
. , ,
,
(
) .14
, ,
,
, « -
» .

, ,
( )
. . ,

,
,

,
- . .15 ,
Fricton Schiffm an,10
,
, ,
40 %
- ,
. .

, - (the
. National Institute of Dental and Craniofacial
, Research)

, , ( / ).16

,
,
, .1 Dworkin12 .
-
,
. George Engel13

,

. ,
, .1

,
« »
« ». ,

, . Waddell Loeser19
Engel13 -
, .
, ,
.1718 ,
,
,
. , .
,
,
.
,
- .
.
.
,

( ),
( )
,
.
,
,

.
, .11
,
, ( )
.117 ( ) ,
Loeser19 ,
.
. , ,
, ,
.21
, ,
, ,
, .22
(
-
. .). , -
Waddell20 , ( )

-
( ). ,
,
. . .
•
.29-31 , Dworkin
.32
•
, ,
• . .
. ,
• , 6 , ,
.
Turk .33
•
.34-38
• .49
.
• (200 )
, :
( ),
,
,
,
,
( ,
) ,
.24 ,

,25-27 ( );

. ;
. 12
I( / ). ,
,
,
.
Dworkin .35
,
Dahlstrom
Carlsson28. , ,
. 4
,

, ,
,
, .
.
Turner .40
- (12 )
.
M ishra .23
( , ,
)
. ,

,
,
.
. Gardea .26 ,
(
. 6 ). Epker .41

,
.
(
/ ),
.
( / ).
. ,
91 % ,
1
.
.
1 ,

. ,
. .
21-1.
0,872 ( )
( )
BDI 0,44 ( )
0,40 ( , )
( ,
, )

( , , , -
, )

-
,
.26 . 21-1
( = 56)
( =45) ,
.
,
,
,
. 21-1.
.

.43 - ; -
. , ; -
(2- 6 )
. ,

,
.27 . ,

( )
,
. . ,
96 %
,
.
422,91
131,84 ,
. , ( . 21-1).

,
. ,

.
, ,
,
.
.

.26'27
Robinson ., 2-6 M orley .23 ,

.42'43

,

1. Gatchel RJ. Clinical Essentials of Pain Management.
Washington, DC: American Psychological Associa
tion, 2005.
.44 2. Gremillion HA. The prevalence and etiology of tem
poromandibular disorders and orofacial pain. Tex
Dent J 2000;117:30- 39.
Truelove .,39 Dworkin 3. The American Academy of Orofacial Pain. De
.,35 Turner .40 Leeuw R. (ed). Orofacial Pain: Guidelines for As
sessment, Diagnosis, and Management. Chicago,
IL: Quintessence Publishing, 2008.
4. Drangsholt M , LeResche L. Temporomandibular dis
order pain. In: Task Force on Epidemiology of the
International Association for the Study of Pain (IASP)
(ed). Epidemiology of Pain. Seattle, WA: Internation
al Association for the Study of Pain, 1999:203-233.
5. Von Korff M , Ormel J, Keefe FJ, Dworkin SF. Grading
the severity of chronic pain. Pain 1992;50:133-149.
6. Chiles JA, Lambert M J, Hatch AL. The impact of
psychological interventions on medical cost offset:
.
a meta-analytic review. Clinical Psychology: Science
and Practice 1999;6:204- 220.
7. Brotman S. Managed health care and orofacial pain.
Stohler Orofac Pain Relat Disord 1997;41:297- 307.
8. Von Korff M , Lin EH, Fenton JJ, Saunders K. Fre
Zarb9
quency and priority of pain patients' health care
, use. Clin J Pain 2007;23:400- 408.
. 9. Stohler CS, Zarb GA. On the management of tem
poromandibular disorders: a plea for a low-tech,
high-prudence therapeutic approach. J Orofac Pain
, 1999;13:255- 261.
, 10. Fricton JR, Schiffman EL. Epidemiology of temporo
mandibular disorders. In: Fricton JR, Dubner R (eds).
Orofacial Pain and Temporomandibular Disorders.
New York: Raven Press, 1995.
. 11. Gatchel RJ. Treatment of patients with temporo
mandibular disorders. In: Turk DC, Gatchel RJ (eds).
Psychological Approaches to Pain M anagement: A
Practitioner's Handbook, ed 2. New York: Guilford,
2002 .
12. Dworkin SF. Behavioral characteristics of chronic
temporomandibular disorders: diagnosis and as
sessment. In: Sessle BJ, Bryant PS, Dionne RA (eds).
Temporomandibular Disorders and Related Pain
R01 DE010713 2R01 DE010713 Conditions. Seattle, WA: IASP Press, 1995.
13. Engel GL. The need for a new medical model: a
- challenge for biomedicine. Science 1977;196:129-
(the National Institute of Dental and Craniofacial 136.
14. Gatchel RJ, Baum A. An Introduction to Health Psy
Research) 1K05 MH71892 chology. Reading, M A: Addison-Wesley, 1983.
(the 15. Rugh JD. Psychological factors in the etiology of
National Institute of Mental Health). masticatory pain and dysfunction. In: Laskin D,
Greenfield W, Gale E, Rugh J, Neff P, Ailing C et
al. (eds). The President's Conference on the Exami
nation, Diagnosis, and M anagement of Temporo
mandibular Disorders. Chicago, IL: American Dental
Association, 1983:85- 94.
for temporomandibular disorders. J Craniomandib
Disord 1992;6:301- 355.

-
17. Turk DC, Monarch ES. Biopsychosocial perspec 32. Dworkin SF, Turner JA, Wilson L, Massoth D, Whit
tive on chronic pain. In: Turk DC, Gatchel RJ (eds). ney C, Huggins KH et al. Brief group cognitive-be
Psychological Approaches to Pain M anagement: A havioral intervention for temporomandibular disor
Practitioner's Handbook, ed 2. New York: Guilford, ders. Pain 1994;59:175- 187.
2002 . 33. Turk D, Zaki H, Rudy T. Effects of intraoral appliance
18. Gatchel RJ. Comorbidity of chronic mental and and biofeedback/ stress management alone and
physical health disorders: the biopsychosocial per in combination in treating pain and depression in
spective. Am Psychol 2004;59:792- 805. TM D patients. J Prosthet Dent 1993;70:158- 164.
19. Loeser JD. Concepts of pain. In: Stanton-Hicks J, 34. Dworkin SF, Huggins KH, Wilson L, Mancl L, Turner
Boaz R (eds). Chronic Low Back Pain. New York: J, Massoth D et al. A randomized clinical trial using
Raven Press, 1982. research criteria for temporomandibular disorders-
20. Waddell G. A new clinical method for the treatment Axis II to target clinic cases for a tailored self-care
of low back pain. Spine 1987;12:632- 644. treatment program. J Orofac Pain 2002;16:48- 63.
21. Moss RA, Garrett JC. Temporomandibular joint 35. Dworkin SF, Turner JA, Mancl L, Wilson L, Massoth
dysfunction syndrome and myofascial pain dys D, Huggins KH et al. A randomized clinical trial of
function syndrome: a critical review. J Oral Rehabil a tailored comprehensive care treatment program
1984;11:3- 28. for temporomandibular disorders. J Orofac Pain
22. Crider AB, Glaros AG. A meta-analysis of EMG bio 2002;16:259- 276.
feedback treatment of temporomandibular disor 36. Greco CM , Rudy , Turk DC, Herlich A, Zaki HH.
ders. J Orofac Pain 1999;13:29- 37. Traumatic onset of temporomandibular disorders:
23. M orley S, Eccleston C, Williams A. Systematic re positive effects of a standardized conservative treat
view and meta-analysis of randomized controlled ment program. Clin J Pain 1997;13:337- 347.
trials of cognitive behavior therapy and behavior 37. Rudy , Turk DC, Kubinski JA, Zaki HS. Differen
therapy for chronic pain in adults, excluding head tial treatment response of TM D patients as a func
ache. Pain 1999;80:1- 13. tion of psychological characteristics. Pain 1995;61:
24. M ishra KD, Gatchel RJ, Gardea M A. The relative ef 103-112.
ficacy of three cognitive-behavioral treatment ap 38. Turk DC, Rudy , Kubinski JA, Zaki HS, Greco CM .
proaches to temporomandibular disorders. J Behav Dysfunctional patients with temporomandibular
Med 2000;23:293- 309. disorders: evaluating the efficacy of a tailored treat
25. Gardea M A, Gatchel RJ, M ishra KD. Long-term ef ment protocol. J Consult Clin Psychol 1996;64:
ficacy of biobehavioral treatment of temporoman 139-146.
dibular disorders. J Behav Med 2001;24:341- 359. 39. Truelove E, Huggins KH, Mancl L, Dworkin SF. The
26. Gatchel RJ, Stowell AW, Wildenstein L, Riggs R, Ellis efficacy of traditional, low cost, and nonsplint thera
E. Efficacy of an early intervention for patients with pies for temporomandibular disorder: a randomized
acute TMD-related pain: a one-year outcome study. controlled trial. J Am Med Assoc 2006;137:1099-
J Am Dent Assoc 2006;137:339- 347. 1107.
27. Stowell AW, Gatchel RJ, Wildenstein L. Cost analy 40. Turner JA, Mancl L, Aaron LA. Short- and long
sis of temporomandibular disorders: biopsychosocial term efficacy of brief cognitive-behavioral therapy
intervention versus treatment as usual. J Am Dent for patients with chronic temporomandibular dis
Assoc 2007;138:202- 208. order pain: a randomized, controlled trial. Pain
28. Dahlstrom L, Carlsson SG. Treatment of mandibu 2006;121:181- 194.
lar dysfunction: the clinical usefulness of biofeed 41. Epker JT, Gatchel RJ, Ellis E. An accurate model for
back in relation to splint therapy. J Oral Rehabil predicting TM D chronicity: practical applications in
1984;11:277- 284. clinical settings. J Am Dent Assoc 1999;130:1470-
29. Dworkin SF, Massoth DL. Temporomandibular dis 1475.
orders and chronic pain: disease or illness? J Pros 42. Gatchel RJ, Oordt M S. Clinical Health Psychol
thet Dent 1994;72:29- 38. ogy and Primary Care: Practical Advice and Clinical
30. Fernandez E, Turk DC. The utility of cognitive cop Guidance for Successful Collaboration. Washington,
ing strategies for altering pain perception: a meta DC: American Psychological Association, 2003.
analysis. Pain 1989;38:123- 135. 43. Morley S, Vlaeyen JWS. Epilogue to the special top
31. Flor H, Birbaumer N. Comparison of the efficacy of ics series. Clin J Pain 2005;21:69- 72.
electromyographic biofeedback, cognitive-behav 44. Edinger JD, Wohlgemuth W K, Radtke RA, Marsh
ioral therapy, and conservative medical interven GR, Quillian RE. Cognitive behavioral therapy
tions in the treatment of chronic musculoskeletal for treatment of chronic primary insomnia: a
pain. J Consult Clin Psychol 1993;61:653- 658. randomized controlled trial. J Am Med Assoc
2001;285:1856- 1864.
B28 @dentistinfo первый стоматологический телеграм канал

Глава 22
-
Петер Николакис и Вероника Фиалка-Мозер
- ,
( )
-
. .
( ) . .

,
,
, ,
,
. .

. ,
.
- ( )
( )
, ,
.
. ,
,
.
.
, 1- 2
.1-3
. ,
, . ,


-

. ,
. Andrade .16

,4 ,
, ,
.56
, . Visscher .17
250
.7'8
,
,

. .
,9
( .17
)10
.11
.
,
,18-21
.12 ,
.22 ,

.
, ,23
.12 8'24 -
( )
- -
. , .25
-
,2627
2829
. , .3031 ,

,
- .13 ,

.14 .32
Munhoz .15
, ,
,
2 ,
(20,7 10,5 %, ),

. Wright .
,
( 30 ).33 .

,
, .
, ,

. ,
.
41,9 38,2 % , .
. Wright .33
8,1 9,3 %
. , .
, ,
. Nicolakis .35
.33
Komiyama .34 ,

- .
,
.
,
.
6 16 20
.
, 13
,
.35 Gavish .36

( )
( ) .

, ,
, , . ,
(Pain Relief Scale)
, .36
Katsoulis .37 27
,
. ,
.
-
, . 93 %
, , ,
, , , 33 %

-
,
2 .43
.37 Mulet .38 Yoda .44

( ,
) 6 6 -
(Rocabado),
4 , . .
61,9 % (13 21 )
0 % (0 21 )
.38 , ,
.

, 23,1 % .44

.39
.42'4345

.
, ,
. Kirk .45
.,40 86 % 2 ,
2

,
. ,
10 .43
,
7% , ,
,
, .
. Jagger,46
, ,
,
.40 M essenger .41
8 .
.

.47
,
25 %.41 2 .48
Cleland .49 Yoda .44 ,
Nicolakis .,42 ,
,
13,3 %
13,3 %.42 , .

,
,

.50 , .
, Taube,59
(0,08 / 2 0,5 / 2)
, , , a Gray

(0,25 / 2, 3 ,
. Nicolakis .,51 2:1).60
6
90 % ,
(
. , 10 )
, 76 % , ( 60 , 100 / , 20 )
, ,
.60
3 .52
,
( ) (250 , 600 , 6 15 ,
7 )
.53-56 , ,
.61
,

.
.
904
(904 ,
4 / 2, 3 )60 (904 ,
27 , 9 )62 ,
830
Linde,57 (830 ,
( ) (90 , 10 , 40 ).63 ,
30 , -
)
. .64
6%
,
50 % .
(0,3 , 100 , ,
10 )
, , 69 %
( ).58


-
35 %
, .
.65
,
.65
,66
. .
• -
( )

, ,
.
• ,
- .
. ,

,
( ).
10-30 .
,
, ,
, .
( . 22-1).
,
- ,

( )
.

,
. ( ).
1.
. ( . 22-2).
2.
.
3.
.
,

.

. 22- 1. . 22- 2. - . 22-3.
.
,
.
, , .
-
. (
, )
.
( ) ( . 22-5).

, .
( )
(
, )
. , .

( . 22-3).
.

( . 22-6).

, .
-
(
, )
. , .
( . 22-4).
.

-
. 22-4. . 22- 5. . 22-6.
. 22-7. .
. .

( . 22-7 22-7 ). .
.
.
( . 22-9 ) ( . 22-9 )
,
- ,
, .
( . 22-9 ).

.
( . 22-8).
- -
,
.

. 22-8. . 22-9 -22-9 . - - ,
( ), ( ) ( )
, ,
.
( . 22-10).

.

1
. 3
.
. 20 ,

( ) ,
.
,
.

(
( ) ).
.
, .
,
,

, . .
10 ,
.

-
. 22-10. - . 22-11 -22-11 .
. 22-12a-22-12d. . 22-13.
- -

- -
,

,
. .
.
-

. -
-
10 ,
, .
,
, .
. ( . 22-13).

.
10 ,
( . 22-11 ).
.
1. Bogduk N. The clinical anatom y o f the cervical dor
sal rami. Spine 1982;7:319- 330.
2. Hu JW , Dostrovsky JO , Sessle BJ. Functional proper
- ties of neurons in cat trigeminal subnucleus caudalis
( . 22-11 ). (m edullary dorsal horn). I. Responses to oral-facial
noxious and nonnoxious stimuli and projections
to t halam us and subnucleus oralis. J Neurophysiol
1981;45:173- 192.
( . 22-11 ). 3. Sessle BJ, Hu JW , Dubner R, Lucier- CE. Functional
properties of neurons in cat trigeminal subnucleus
caudalis (m edullary dorsal horn). II. M odulation of
responses to noxious and nonnoxious stimuli by pe
riaqueductal gray, nucleus raphe m agnus, cerebral
co rt ex, and afferent influences, and effect of nalo x
one. J Neurophysiol 1981;45:193- 207.
4. Darian- Sm it h I. The trigem inal system . In: Iggo A
(ed ). Handbook of Sensory Physiology, ed 2. Som a
, tosensory System . Berlin: Springer, 1973:271- 314.
. 5. Fricton J, Kroening R, Haley D. M yofascial pain
, syndrom e: a review of clinical characteristics o f 168
cases. J Oral Surg 1982;60:615- 623.
( )
6. Rocabado M , Johnston BE, Blakney M G. Physical
10-15 . therapy and dentistry: an o verview. J Cranio m an
3 dibular Pract 1983;1:47- 49.
30 ( . 22-12 —22-12 ). 7. Carossa S, Catapano S, Previgliano V, Preti G. The
incidence of craniom andibular disorders in patients

wit h cervical dysfunctions. A clinico- statistical as
sessm ent. M inerva Stomatol 1993;42:229- 233.
- - 8. Braun BL. Postural differences between asym pt om
( . 22-12d). atic men and wom en and craniofacial pain patients.
Arch Phys M ed Rehabil 1991;72:653- 656.

-
9. Lund , Nishiyam a , M oller . Postural act iv 26. Boyd CH , Slagle WF, Boyd CM , Bryant RW, Wiygul
ity in the muscles of mastication wit h the subject JP. The effect of head position on electrom yography
upright, inclined, and supine. Scand J Dent Res evaluations o f representative m andibular position
1970;78:417- 424. ing muscle groups. Cranio 1987;5:50- 54.
10. Preiskel HW. Some observations on the postural posi 27. Forsberg CM , Hellsing E, Linder-Aronson S, Sheik-
tion of the mandible. J Prosthet Dent 1965;15:625. holeslam A . EM G activit y in neck and masticatory
11. Brat zlavsky M , Eecken V. Postural reflexes in cranial muscles in relation to extension and flexion o f the
muscles in man. Act a Neurol Belg 1977;77:5- 11. head. Eur J Ort hod 1985;7:177- 184.
12. M ako fsky HW. The effect o f head posture on 28. Goldstein DF, Kraus SL, William s W B, Glasheen-
muscle contact position: the sliding cranium theory. W ray M . Influence of cervical posture on m andibu
J Craniom andibular Pract 1989;7:286- 292. lar m ovem ent. J Prosthet Dent 1984;52:421^ J26.
13. Sonnesen L, Bakke M , Solow B. Temporomandibular 29. Visscher CM , Huddleston Slater JJ, Lobbezoo F,
disorders in relation to craniofacial dimensions, head Naeije M . Kinematics of the hum an mandible fo r d if
posture and bite force in children selected fo r orth ferent head postures. J Oral Rehabil 20 00 ;2 7:299 -
odontic treatment. Eur J Orthod 2001 ;23:179- 192. 305.
14. loi H, M atsum oto R, Nishioka AA, Goto TK, Nakata S, 30. Ayub E, Glasheen- W ray M , Kraus S. Head posture:
Nakasima A et al. Relationship of TM J osteoarthritis/ a case study o f the effects on the rest position of
osteoarthrosis to head posture and dentofacial mor the mandible. J Ort hop Sports Phys Th er 1984;5:
phology. Orthod Craniofac Res 2008;11:8- 16. 179- 183.
15. M unho z W C, M arques AP, Siq ueiraJT. Radiograph 31. M ohl N D. Head posture and its role in occlusion.
ic evaluation o f cervical spine o f subjects wit h t em N Y State Dent J 1976;42:17- 23.
porom andibular jo int internal disorder. Braz Oral 32. Olivo SA, Bravo J, M agee DJ, Thie N M , M ajor PW,
Res 2004;18:283- 289. Flores- M ir C. The association between head and
16. Andrade AV, Gom es PF, Teixeira- Salm ela LF. Cer cervical posture and tem porom andibular disorders:
vical spine alignm ent and hyoid bone positioning a system atic review. J Oro fac Pain 20 06;20:9- 23.
wit h tem porom andibular disorders. J Oral Rehabil 33. Wrig ht EF, Domenech M A, Fischer JR Jr. Usefulness of
2007;34:767- 772. posture training for patients with temporomandibular
17. Visscher CM , De Boer W, Lobbezoo F, Habets LL, disorders. J Am Dent Assoc 2000;131:202- 210.
Naeije M . Is there a relationship between head 34. Kom iyam a O , Kaw ara M , Arai M , Asano T,
posture and craniom andibular pain? J Oral Rehabil Kobayashi K. Posture correction as part of b ehav
2002;29:1030- 1036. ioural therapy in treatm ent of myofascial pain with
18. Clark GT, Green EM , Bornan M R, Flack VF. Cranio limited opening. J Oral Rehabil 1999;26:428- 435.
cervical dysfunction levels in a patient sample from 35. Nicolakis P, Erdogmus B, Kop f A, Nicolakis M ,
a tem porom andibular jo int clinic. J Am Dent Assoc Piehslinger E, Fialka- M oser V. Effectiveness o f ex
1987;115:251- 256. ercise therapy in patients wit h myofascial pain
19. Alanen P, Kirveskari P. Occupational cervicobrachial dysfunction syndrom e. J Oral Rehabil 2002;29:
disorder and tem porom andibular jo int dysfunction. 362- 368.
J Craniom andibular Pract 1985;3:69- 72. 36. Gavish A , W ino cur E, Astandzelo v- Nachm ias T,
20. Heloe B, Heiberg AN , Krogstad BS. A m ultipro Gazit E. Effect of controlled m asticatory exercise on
fessional study o f patients wit h myofascial pain- pain and muscle perform ance in m yofascial pain pa
dysfunction syndrom e, I. Act a Odont ol Scand tients: a pilot study. Cranio 2006;24:184- 190.
1980;38:109- 117. 37. Katsoulis J, Richter M . Efficacy o f specific physio
21. Nicolakis P, Nicolakis M , Piehslinger E, Ebenbichler t herapy fo r tem porom andibular jo int dysfunction
G, Vachud a M , Kirtley C et al. Relationship between of m uscular origin. Rev Stomatol Chir M axillofac
craniom andibular disorders and poor posture. Cran 2008;109:9- 14.
io 2000;18:106- 112. 38. M ulet M , Decker KL, Look JO , Lenton PA,
22. Darlow LA, Pesco J, Greenberg M S. The relation Schiffm an EL. A randomized clinical trial assessing
ship o f posture to myofascial pain dysfunction syn the efficacy o f adding 6 x 6 exercises to self-care
drom e. J Am Dent Assoc 1987;114:73- 75. fo r the t reatm ent o f m asticatory myofascial pain. J
23. Huggare JA, Raustia AM . Head posture and cervi- Oro fac Pain 2007;21:318- 328.
covertebral and craniofacial m orphology in patients 39. Grace EG, Sarlani E, Reid B. The use o f an oral ex
wit h craniom andibular dysfunction. J Cranio m an ercise device in the t reatm ent of m uscular TM D .
dibular Pract 1992;10:174- 179. Cranio 2002;20:204- 208.
24. Olm os SR, Kritz- Silverstein D, Halligan W , Silver- 40. Kirk W S Jr, Calabrese DK. Clinical evaluation of
stein ST. The effect of condyle fossa relationships physical therapy in the m anagem ent of internal d e
on head posture. Cranio 20 05 ;23:48- 52. rangem ent o f the tem porom andibular joint . J Oral
25. M iralles R, M end oza C, Santander H, Zunig a C, M axillo fac Surg 19 8 9 ;4 7 :113- 119.
M o ya H. Influence o f stabilization occlusal splints 41. M essenger K, Barghi N, Burg arC, Rey R. Effect o f ex
on sternocleidomastoid and masseter electrom yo ercise and rest on amplitude of TM J click [abstract]. J
graphic activity. Cranio 1992;10:297- 304. Dent Res 1982;61:IADR abstract no. 1549.

42. Nicolakis , Erdogmus , Kop f A, Djaber-Ansari , 54. M edlicott M S, Plarris SR. A system atic review of the
Piehslinger , Fialka- M oser V. Exercise therapy fo r effectiveness o f exercise, manual therapy, electro
craniom andibular disorders. Arch Phys M ed Rehabil therapy, relaxation t raining, and biofeedback in the
2000;81:1137- 1142. m anag em ent of tem porom andibular disorder. Phys
43. Nicolakis P, Erdogmus B, Kop f A, Schm id- Schwap Th er 2006;86:955- 973.
M , Ebenbichler G, Fialka- M oser V. Effectiveness 55. M ichelotti A, de W ijer A , Steenks M , Farella M .
of exercise therapy in t reatm ent o f t em p orom an Hom e- exercise regimes fo r the m anagem ent of
dibular disorders: long term results. Physikalische non- specific tem porom andibular disorders. J Oral
M edizin Rehabilitationsm edizin Kurortm edizin Rehabil 2005;32:779- 785.
2001;11:51- 55. 56. Orlando B, M anfredini D, Bosco M . Efficacy of
44. Yoda T, Sakam oto I, Imai FI, Flonma Y, Shinjo Y, physical therapy in the treatm ent of masticatory
Takano A et al. A randomized controlled trial of m yofascial pain: a literature review. M inerva Stoma-
therapeutic exercise fo r clicking due to disk anterior tol 2006;55:355- 366.
displacem ent wit h reduction in the t em p orom an 57. Linde C, Isacsson G, Jonsson BG. Outcom e of
dibular joint . Cranio 2003;21:10- 16. 6- w eek t reatm ent wit h t ranscutaneous electric nerve
45. Carm eli E, Sheklow SL, Bloomenfeld I. Com parative stimulation compared wit h splint on sym ptom atic
st udy o f repositioning splint therapy and passive tem porom andibular jo int disk displacem ent wit ho ut
manual range o f motion techniques fo r ant erior dis reduction. Act a Odont ol Scand 1995;53:92- 98.
placed tem porom andibular discs wit h unstable ex 58. Bertolucci LE, Grey T. Clinical com parative study
cursive reduction. Physiotherapy 2001;87:26- 36. of m icrocurrent electrical stimulation to mid-laser
46. Jag ger RC. M and ibular manipulation o f anterior and placebo t reatm ent in degenerative joint disease
disc displacem ent wit ho ut reduction. J Oral Rehabil o f the tem porom andibular jo int . Cranio 1995;13:
1991;18:497- 500. 116- 120.
47. Nicolakis P, Erdogmus B, Kop f A, Ebenbichler G, 59. Taube S, Ylip aavalniem i P, Kononen M , Sunden B.
Kollm itzer J, Piehslinger E et al. Effect iveness of Th e effect of pulsed ultrasound on myofacial pain.
exercise therapy in patients wit h internal derange A placebo controlled study. Proc Finn Dent Soc
m ent of the tem porom andibular joint . J Oral Reha 1988;84:241- 246.
bil 2001;28:1158- 1164. 60. Gray RJ, Quayle AA, Hall CA , Schofield M A. Phys
48. Nicolakis P, Erdogmus B, Kop f A, Schm id- Schwap iotherapy in the t reatm ent o f tem porom andibular
M , Ebenbichler G, Fialka- M oser V. Effect iveness of jo int disorders: a com parative study of fo ur t reat
exercise t herapy in treatm ent o f ant erior disc dis ment methods. Br D e n t J 1994;176:257- 261.
placem ent wit ho ut reduction: long term results. 61. Al- Badawi EA, M eht a N, Forgione AG, Lobo SL,
Stomatologie 2001;6:141- 143. Zawaw i KH. Efficacy o f pulsed radio frequency en
49. Cleland J, Palmer J. Effect iveness of manual physical ergy therapy in tem porom andibular jo int pain and
therapy, therapeutic exercise, and patient education dysfunction. Cranio 2004;22:10- 20.
on bilateral disc displacem ent wit ho ut reduction of 62. Bertolucci LE, Grey T. Clinical analysis of mid-laser
the tem porom andibular jo int : a single-case design. versus placebo treatm ent of arthralgic TM J d e
J Ort ho p Sports Phys Ther 2004;34:535- 548. generative joint s (904 nm, 27W , 9 m in). Cranio
50. Sato S, Kaw am ura FI. Evaluation of mouth opening 1995;13:26- 29.
exercise after pumping o f the tem porom andibular 63. Conti PC. Lo w level laser therapy in the treatm ent
jo int in patients wit h nonreducing disc displace o f tem porom andibular disorders (TM D ): a double
m ent. J Oral M axillo fac Surg 2008;66:436- 440. blind pilot study. Cranio 1997;15:144- 149.
51. Nicolakis P, Burak EC, Kollm itzer J, Kop f A, 64. Kulekcioglu S, Sivrioglu K, Ozcan O , Parlak M .
Piehslinger E, Wiesing er GF et al. An investigation Effect iveness o f low- level laser t herapy in t em
o f the effectiveness o f exercise and manual therapy porom andibular disorder. Scand J Rheumatol
in treating sym ptom s o f TM J osteoarthritis. Cranio 2003;32:114- 118.
20 01 ;1 9:26- 3 2. 65. Crid er AB, Glaros AG. A m eta- analysis o f EM G bio
52. Nicolakis P, Erdogmus CB, Kollm itzer J, Kerschan- feed back treatm ent of tem porom andibular disor
Schindl K, Sengstbratl M , Nuhr M et al. Long-term ders. J Oro fac Pain 1999;13:29- 37.
outcom e after treatm ent o f tem porom andibular 66. Crid er A, Glaros AG, Gevirt z RN. Efficacy o f bio-
jo int osteoarthritis wit h exercise and manual ther feedback- based treatm ents fo r tem p orom an
apy. Cranio 20 02 ;2 0:23- 2 7. dibular disorders. Appl Psychophysiol Biofeedback
53. M cN eely M L, Arm ijo Olivo S, M agee DJ. A system 20 05 ;3 0:333 - 34 5.
atic review o f the effectiveness of physical therapy
interventions fo r tem porom andibular disorders.
Phys Ther 2006;86:710- 725.

23
-
-
-
- ,
( )

, .
,
, ,
.
. ,
. ,
, , ,
.1 .
,
.
( ), ,
, , , -
, .23
.
, , ,
, . .
.
.
,

5 ( -
3 10)
3
.

,

. . -

-
.
,
,
, , - ,
( ) . ., .
.4-6 (
, ),
,
. ,
1( )
, ( ),
, ,
- , .6 ,
.
, . 4
, (LTB4)
,
, ,
.
.
,
, ,
( ) -
,
( ) . 23-1.
,
. - :
, •
. ,
;
• ,

. ;
• ,

2, .
2;
• ,
.
, ;
• ,
- ( ) -
. .


.
( ). ,
,
, .
. ,
,
,
, ,
. ,

.15 ,
.
4 .

, .
,

. , , . .

. .
,
.16

.
, ,
, -
( 23-1). .
,
, ,
,
, -
. ,9

,
.18

.1011
, ,

,
, ,7'8 13 .14
,9
.10-14
,
,7 , 20 ,
. 23-1.

-
23-1.

-
Ekberg, 1998 - .
( (50 2-3 ,
)8 )
32 ,
.
Di Rienzo - 36
Businco, 2004 2
( .
(18 )
)’9 (50 2
) 14 .
(18 )
- 16 / (
-
, 10 4
14 )
M ejersjo, 2008 - 27 2 (
( 36-76 ) «
)7 ». ,

(50 3 3 ,
)
1
Obeid,1992 - - 42
(
.
- 3 .
)16 - (12
)- .
(15 )
17 /
. (15 )
34 / .
( <0, 01)
( < 0,05).
Swift , 1998 - - ,
( ,
-
)20 . -
( ) 50
42 iPGE2
. - .
- 3
, iPGE2
-

23-1.
, 2004 ( - -
-
)’5 68 ,
.
-
, .
. -
100 2 3
500 2 ,
6 6 .

,
.
, ,

-
M iyamoto, 2007 - - 10 ( )
( 15 /
-
)2’ - -
. -

. 2-6 . ,
( )
, -
(
II) - 15 / .
8

, 1981 15
( (
), 18 ,
)22 .
1 3 . .
,
,
-

. ,

,

-
,


-
23-1.
Appelgren, 1996 22
( (29 )
« »
)23 ,
,
NPY-LI
. 2-3
.

. ,
NPY-LI
Y- 2-3 ,
(NPY-LI)
( , .
4-6 ) ,

NPY-LI
Plesh, 2000
( - a
(10-30 ) 6 1 6 1
)10 .

6 1
,

1
6-
Rizzatti- 12 -
Barbosa, 2003 - a
( 2 , 1 (75 %)
2 (28 %)
)11 14 : 1 - 25 3
2- ( < 0,1). A
.

7
( ), 14-
7-
Harkins, 1991 - -
( - -
,
)2"
,

.
, ,
.
,


23-1.
Nemcovsky, -
1992 ( - -

: .
)25 ,
61 .
.
,
( ),

. 61 19 .
, 30
12 -
,
(
,
)
Singer, 1997 -
(
-
)13 ,
.

. ,
39
(35 ,4 )
,
,
3 .

.
: , ,
, -
DeNucci, 1998 -
( - - 20 , - ,
4 .
)14 , ,
-
,
, .
3
Herman, 2002 - 41 ,
( - - « -
, / ».
)26 -

,
.

3 : (0,5 .
), (10
),

-
23-1.
Rizzatti- -
Barbosa, 2003
( (S),
(28,5 % -
)27 ( ) 47,6 % - )
( ) - -
( )
, 2008
( -
- ,
)12
( ,
- ,
- ) ( =30) ,
, ,
( .
, =38).

/
Ayesh, 2007 - ,
( - -

)28
, -
28
( 27,4± 6,2 )
. ,
(2,5 / ) -
( =14) . ,
(
) -
( =14) ,
, 2008 45
( - ,
( < 0,05),
)29 ,
: G1 -
(
); G2 - 0,25 %
; G3 - 0,25 %
.
12-

23-1.
Castrillon, 2008 - ,
( - N- -
- 14 D- (NM DA)
)30
(10 ,
4 ). .
0,2
( NaCi
150 / )
. ,

Ayesh, 2008 -
( -
-
)31 .
N-Memn-D- (NMDA)
18
,
N-M emn-D-
(NM DA) -
Kim os, 2007

( 12-
- . 50
)32 :

28 ,
25 - .
,
, 2004 11
( 5- 3- - -
- -
)32 (5- )

5- 3
5- .
M anfredini, 145
2004 ( - « - 42 78 (53,8 %)
»
)9 , 18 78
/ . (23,1 %)
78
- , ,
( )- 4 /
(1 2 2
- ) , 18 78 (23,1 %)
2
,


-
23-1.
Ishim aru, 2003 - - 26

(
, ( < 0,01).
)34
(400 ) 2 .
,

. .
-3
(200 )
( < 0,05),
Nguyen, 2001 ,
( ( ) 1500
- 1200 12
)35 , ,
( ) ,
. 45 , ,

.
,

4
.
Winocur, 2000 -
( -
30 .
)36
.

.
0,025 % ,
-
4 4
Lobo, 2004
( - -

)37 -TM J 2
2 .
. 52 (5 ,
47 ) - TM J -
- 2
2 .
-
TM J, -

23-1.
, 1991
( , (4 )
,
)” ( .
, 41
)
,

,
List, 2001
( ( 0,1

)38 ) 53 ,
/ -

,
( 1 . -
)

. ,
,

1
M pystad, 2008 40
( , :2 ,

)39 ( , . -
36
6
.

Furst, 2001 - 32
(
, (
)40 ( - - ).
) . ( )
4 . 1(
) ,
, 2-
, 3- 24-
, 4-

-
23-1.
Kunjur, 2003
( 10- ,
- 298 ,
)41 405 < 0,001, 269
(90 %)
.
.

, 1 6
1 ,

El- Hakim, 2005 - 27

( -
)42
10 -
10 . ,
3 . 1 1 .
( )-
, 2-

1,2 / , 3-
- 1,2 /
( 10 )
Schiffm an, 1996 - 27 , -
(

)43 ( ) 3 : ,
( ,
), -
( )
-
/ - -
, : -1, -2, -3.

-1 -2. ,
-1.
-1
.

, . -2

.44'45 , -2
,
,
. , ,
1990- . -2,

80 .

,
23-2.
. ,
- -2,
, , , -
, . - 50 8
15 12
-2. 40 12
-2.46 100 12
15 24
, 200 24
. 400 24
.

4-5 .
,

.

, .
,
. ,
, -
( , , ).47
,
,
.
,
.
2 . (
, ) -
,
. .
,
. 23-2.
.

. ,
36 ,
, ,
,

48 . . ,
, -2
, ,
. ,

-
. 8
, 12 .
-
, .
,
. 1950- .,
, ,
,
, , ,
. ,
( ) .

, ,
.
2
,
2
,
. , ,
.
, ,
-2. , ,
-

- .
,
,
. ,
, .48
,
, -
23-3.
,
,
20 90
4 5 60
4 5 200
5 4 300
25- 30 0,75 300
25- 30 0,6 300

,
, 500-800 / 12 /
4-6 .
.49
-
,
, , .
,
. ,
-6- .
, ,
, ,
- ,

.
. 23-3.
, ,

,
.

, , -
, ( - ),
(
), .
,
. ,
.
. ,
, .
,
,
,
2,
.
, ,
- ,
. - .
,
.
, 23-4. ,

,
. ,
100 , , A 10-75
, , , 10-50
, . 10-75
. 10-75

-

, - ,

.
- , .
,

,
. .

- -
. .

,
-
, .
-
, , ,
.
. ,
. .
,
. - ,a , -
5-10 , , ( . 23-4).
- , ,
,
3-7 .50
.
, ,
, , .
.
,
( , , ),
, , , .
.
16 .
23-5. ,
,
2- 5
0,5-1
. 0,5-1
15- 50

,
, , -
, ,
(
) .
, , .
,
, . , ,
.
.
.
.

, , -
, . ( ),
1 2% ,
-
, (GABA), .
. GABA
.
, 45-60 ,
. 20-50 , . .
.

- , - ,
A- . ,
.
, -450,
, .
,
. ,
,
,
23-6. ,

. ,
, 350 3
750 3
10 3
. * 2- 5 3
* ,
{ ,
.).

-
-
, , .
, . -
- , ,
, ,
. .18
-
,
5-10 .
48 . , ,
- 2 , - 0,2-0,5 / . , ,
.
- ,
. ,
,
,
. .
: ,
. ,
, .
,
- ,

. .
, .
, .
. -

, .
( ), , , ,
,
. ,
,
,
- , .
, ,
. ,
, , ,
, ,
, .
, , -

.

,
, ,

.
,5152
,
. .

.

.

. - ,
5-30 . -
2- - .
,
,
.
.
. ,
3 2-4 8-
. .

. 23-6. .
,
,
( . 23-1).
.
.

, , 1. Turner J, Deyo R, Loesser J, Von Korff M,
Fordyce WE. The importance of placebo effects
, ,
in pain treatment and research. J Am Med Assoc
, , 1994;271:1609- 1614.
. 2. Gregg JM , Rugh JD. Pharmacological therapy. In;
Mohl ND, Zarb GA, Carlsson GE, Rugh JD (eds). A
Textbook on Occlusion. Chicago, IL: Quintessence,
- , 1988:351- 353.
3. Hersch EV, Balasubramaniam R, Pinto A. Pharma
. cologic management of temporomandibular disor
, ders. Oral M axillofac Surg Clin North Am 2008;20:
197-210.
4. Dray A. Inflammatory mediators of pain. Br J An-
, aesth 1995;75:1725- 1731.

-
5. Ong CKS, Seymour RA. Pathogenesis of postopera 20. Swift JQ, Roszkowski MT, Alton T, Hargreaves KM.
tive oral surgical pain. Anesth Prog 2003;50:5- 17. Effect of intra-articular versus systemic antiinflam
6. Bathon JM , Chilton FH, Hubbard W C, Towns M C, matory drugs in a rabbit model of temporoman
Solan NJ, Proud D. Mechanisms of prostanoid syn dibular joint inflammation. J Oral M axillofac Surg
thesis in human synovial cells: cyt ok in e- p ep t id e 1998;56:1288- 1295.
synergism. Inflammation 1996;20:537- 554. 21. Miyamoto H, Onuma H, Shigematsu H, Suzuki S,
7. Mejersjo C, Wenneberg B. Diclofenac sodium Sakashita H. The effect of etodolac on experimen
and occlusal splint therapy in TM J osteoarthri tal temporomandibular joint osteoarthritis in dogs.
tis: a randomized controlled trial. J Oral Rehabil J Craniomaxillofac Surg 2007;35:358- 363.
2008;35:729- 738. 22. Kopp S, Wenneberg B. Effects of occlusal treatment
8. Ekberg EC, Kopp S, Akerman S. Diclofenac sodium and intra-articular injections on temporomandibu
as an alternative treatment of temporomandibular lar joint pain and dysfunction. Acta Odontol Scand
joint pain. Acta Odontol Scand 1996;54:154- 159. 1981;39:87- 96.
9. Manfredini D, Romagnoli M , Cantini E, Bosco M. 23. Alstergren P, Appelgren A, Appelgren B, Kopp S,
Efficacy of tizanidine hydrochloride in the treatment Lundeberg T, Theodorsson E. The effect on joint flu
of myofascial face pain. M inerva Med 2004;95: id concentration of neuropeptide Y by intra-articu
165-171. lar injection of glucocorticoid in temporomandibular
10. Plesh O, Curtis D, Levine J, M cCall WD Jr. Ami joint arthritis. Acta Odontol Scand 1996;54:1- 7.
triptyline treatment of chronic pain in patients 24. Harkins S, Linford J, Cohen J, KramerT, Cueva L. Ad
with temporomandibular disorders. J Oral Rehabil ministration of clonazepam in the treatment of TM D
2000;27:834- 841. and associated myofascial pain: a double-blind pilot
11. Rizzatti-Barbosa CM , Nogueira MT, de Andrade ED, study. J Craniomandib Disord 1991;5:179- 186.
Ambrosano GM , de Albergaria-Barbosa JR. Clinical 25. Nemcovsky CE, Gazit E, Serfati V, Gross M . A com
evaluation of amitriptyline for the control of chronic parative study of three therapeutic modalities in a
pain caused by temporomandibular joint disorders. temporomandibular disorder (TM D) population.
Cranio 2003;21:221- 225. Cranio 1992;10:148- 155.
12. Ivkovic N, Miadenovic I, Petkoci S, Stojic D. TM D 26. Herman CR, Schiffman EL, Look JO, Rindal DB. The
chronic pain and masseter silent period in psychiat effectiveness of adding pharmacologic treatment
ric patients on antidepressive therapy. J Oral Rehabil with clonazepam or cyclobenzaprine to patient
2008;35:424- 432. education and self-care for the treatment of jaw
13. Singer E, Dionne R. A controlled evaluation of ibu- pain upon awakening: a randomized clinical trial.
profen and diazepam for chronic orofacial muscle J Orofac Pain 2002;16:64- 70.
pain. J Orofac Pain 1997;11:139- 146. 27. Rizzatti-Barbosa CM , Martinelli DA, Ambrosano GM ,
14. DeNucci DJ, Sobiski C, Dionne RA. Triazolam im de Albergaria-Barbosa JR. Therapeutic response of ben
proves sleep but fails to alter pain in TM D patients. zodiazepine, orphenadrine citrate and occlusal splint as
J Orofac Pain 1998;12:116- 123. sociation in TM D pain. Cranio 2003;21:116-120.
15. LE, Dionne RA. Treatment of painful temporo 28. Ayesh EE, Ernberg M , Svensson P. Effects of lo
mandibular joints with a cyclooxygenase-2 inhibi cal anesthetics on somatosensory function in
tor: a randomized placebo-controlled comparison the temporomandibular joint area. Exp Brain Res
of celecoxib to naproxen. Pain 2004;111:13- 21. 2007;180:715- 725.
16. Obeid G, Zhang X, Wang X. Effect of ibuprofen on 29. Venancio RA, Alencar FG, Zamperini C. Differ
the healing and remodeling of bone and articular ent substances and dry-needling injections in pa
cartilage in the rabbit temporomandibular joint. tients with myofascial pain and headaches. Cranio
J Oral M axillofac Surg 1992;50:843- 849. 2008;26:96- 103
17. Kopp S, Akerman S, Nilner M . Short-term effect of 30. Castrillon EE, Cairns BE, Ernberg M , Wang K,
intra-articular sodium hyaluronate, glucocorticoid, Sessle BJ, Arendt-Nielsen L et al. Effect of peripheral
and saline injections on rheumatoid arthritis of the NM DA receptor blockade with ketamine on chronic
temporomandibular joint. J Craniomandib Disord myofascial pain in temporomandibular disorder pa
1991;5:231- 238. tients: a randomized, double-blinded, placebo-con-
18. Manfredini D, Landi N, Tognini F, Orlando B, Bosco trolled trial. J Orofac Pain 2008;22:122- 130.
M . Muscle relaxants in the treatment of myofas 31. Ayesh EE, Jensen TS, Svensson P. Effects of intra-
cial face pain: a literature review. M inerva Stomatol articular ketamine on pain and somatosensory func
2004;53:305- 313. tion in temporomandibular joint arthralgia patients.
19. Di Rienzo Businco L, Di Rienzo Businco A, D'Emilia Pain 2008;137:286- 294.
M , Lauriello M , Coen Tirelli G. Topical versus sys 32. Kimos P, Biggs C, Mah J, Heo G, Rashiq S, Thie NM
temic diclofenac in the treatment of temporo-man- et al. Analgesic action of gabapentin on chronic
dibular joint dysfunction symptoms. Acta Otorhino- pain in the masticatory muscles: a randomized con
laryngol Ital 2004;24:279- 283. trolled trial. Pain 2007;127:151- 160.

33. Voog U, Alstergren , Leibur , Kallikorm R, Kopp 42. El-Hakim IE, Abdel-Hamid IS, Bader A. Temporo
S. Influence of serotonin on the analgesic effect of mandibular joint (TM J) response to intra-articular
granisetron on temporomandibular joint arthritis. dexamethasone injection following mechanical
Mediators Inflamm 2004;13:373- 376. arthropathy: a histological study in rats. Int J Oral
34. Ishimaru Jl, Ogi N, M izu i T, M i y a m o t o K, Shibata M axillofac Surg 2005;34:305- 310.
T, Kurita K. Effects of a single arthrocentesis and a 43. Schiffman EL, Braun BL, Lindgren BR. Temporoman
COX- 2 inhibitor on disorders of temporomandibu dibular joint iontophoresis: a double-blind random
lar joints: a preliminary clinical study. Br J Oral M ax ized clinical trial. J Orofac Pain 1996;10:157- 162.
illofac Surg 2003:41:323- 328. 44. Crofford LJ, Wilder RL, Ristimaki AP, Sano H, Rem-
35. Nguyen P, Mohamed SE, Gardiner D, Salinas T. A mers EF, Epps HR et al. Cyclooxygenase-1 and -2
randomized double-blind clinical trial of the effect expression in rheumatoid synovial tissue. J Clin In
of chondroitin sulfate and glucosamine hydrochlo vest 1994;93:1095- 1101.
ride on temporomandibular joint disorders: a pilot 45. Anderson GD, Hauser SD, M cGarity KL, Bremer
study. Cranio 2001;19:130- 139. M E, Isakson PC, Gregory SA. Selective inhibition of
36. Winocur E, Gavish A, Halachmi M , Eli I, Gazit E. cyclooxygenase (COX- 2) reverses inflammation and
Topical application of capsaicin for the treatment of expression of COX-2 and interleukin 6 in rat adju
localized pain in the temporomandibular joitn area. vant arthritis. J Clin Invest 1996;97:2672- 2679.
J Orofac Pain 2000;14:31- 36. 46. Vane JR, Botting RM. Overview - mechanisms of
37. Lobo SL, M ehta N, Forgione AG, Melis M , Al- action of antiinflammatory drugs. In: Vane J, Bot
Badawi E, Ceneviz C et al. Use of Theraflex-TM J ting JH, Botting RM (eds). Improved Non-steroid
topical cream for the treatment of temporoman Antiinflammatory Drugs: COX- 2 Enzyme Inhibitors.
dibular joint and muscle pain. Cranio 2 0 0 4 ,2 2 : London: Kluwer Academic Publishers, 1996:1- 27.
137-144. 47. Nussmeier NA, Whelton AA, Brown MT, Langford
38. List T, Tegelberg A, Haraldson T, Isacsson G. Intra- RM, Hoeff A, Parlow JL et al. Complications of the
articular morphine as analgesic in temporoman COX-2 inhibitors pareconxib and valdecoxib after
dibular joint arthralgia/ osteoarthritis. Pain 2001 ;94: cardiac surgery. N Engl J Med 2005,352:1081-
275- 282. 1091.
39. Moystad A, M ork-Knutsen BB, Bjarnland T. Injec 48. Wennenberg B, Kopp S, Grondahl HG. Long term
tion of sodium hyaluronate compared to a corticos effect of intra-articular injection of glucocorticos-
teroid in the treatment of patients with temporo teroid into TM J: A clinical and radiographic 8 years
mandibular joint osteoarthritis: a CT evaluation. follow up. J Craniomandib Disord 1991;5:11- 18.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 49. Paoloni JA, Orchard JW. The use of therapeutic
2008;105:e53- 60. medications for soft-tissue injuries in sports medi
40. Furst IM , Kryshtalskyi B, Weinberg S. The use of cine. Med J Aust 2005;183:384- 388.
intra-articular opioids and bupivacaine for analge 50. Sharav Y, Singer E, Schmidt E, Dionne RA, Dubner
sia following temporomandibular joint arthroscopy: R. The analgesic effect of amitriptyline on chronic
a prospective, randomized trial. J Oral M axillofac facial pain. Pain 1987;31:199- 209.
Surg 2001;59:979- 983. 51. Freund B, Schwartz M , Symington J. A new treat
41. Kunjur J, Anand R, Brennan PA, (lankovan V. An ment for temporomandibular disorders using botu-
audit of 405 temporomandibular joint arthrocente linum toxin. Oral Health 1998;88:32- 37.
sis with intra-articular morphine infusion. Br J Oral 52. Guarda-Nardini L, Manfredini D, Salamone M ,
M axillofac Surg 2003;41:29- 31. Salmaso L, Tonello S, Ferronato G. Efficacy of
botulinum toxin in treating myofascial pain in
bruxers: a controlled placebo pilot study. Cranio
2008;26:126- 135.

Глава 24
Иене Турп и Ганс Шиндлер

« , ?
- , , ?»
1
.9
,
,
-
( ) . ,
- ( ).
, . ,
.2-6
( / )7
« » « ,

». ,
, ,
« » « ».7 .10
.
,
( )
-
- - ,
. ( 24-1).
, , , ,
,8
,
,
,
.
-

-
24-1.
.
Palla"
, , ,
( )
.
,
,
,

( 3-6 ).
.
,

-
,
,

.
.
.

, , -
, . .16
,
,
. « ,
( .1617 ,
) ,
. ,
< ...> ,
.18
, ,
,

».12 ( )
.
:19
• ( 24-2);
•
, ;
« » « », • ;
. « • ;
» . • .
,
( ,
. , ,
, ) ,
,
.'3™ .

, 24-2.

«
, .
»
« »,
.20
« »
150
« »

,
,
Klasser Greene20 ,

. (

, .
Schwartz,21 Perry,22 M cNeill23 Greene24.)
,
, 1924-1959 .
. 20 ,32-49 ,
, ,
,
,
. ,
(Jam es Bray Costen).
-
- ,
,
,
( ) .
,
1850- . ,
,
, , .
,
.
.25-30

.
,
,
.31 ,
, . .
.
,
.

-
24-3.

• « »
70
«
,
» «
.
».
• ,
,
,
.

. 100
.

,
(Wilhelm
Wallisch) ,
.70 ( ,

:
« ?»
.
2005 .,
«
»
.- , .) « »:

,
, « ».59-65
,
.50-03 ,
: « »
(Harry Sicher) ( ) « » ( ).66-68
.64
1959 .69
(Zim m erm an).55 ( . 24-3): «
-
(Laszlo Schwartz)
2500 , ,
.
.21
1950- . .
,
, ,
,
« » .

.5667 ».

« »:
,
1 .
,
,
( ) :71
« , .
, « , ,

».69 .

.
2
,
,
.
. ,
,
,
.69 . ,

.71 .
-
,
( 1959 .) ».69
(Shore) : «
,

.
, .
, , 1. ,

. .
».71 2.
:73
(Ramfjord),72 a)
32 ;
, b)
, . .
, ( ),
(
) ;
. c) , . .
,
( .- , .) .

-
24-4. «
»
, .73
« ,
» « ,
» . , , ( )

, ( 24-4).
« » ,

, ,71 . .

.74 , ( . 24-5).79
,

,
.75 .

« »,
,
. ,
,
70
( )

- .
« »( . 24-1).
,
,
( ) ,
24-1. (8- .) « »
,
, *
,
*
*** ( )
**
***
( ):
* « » .
** - ,76 «
», « ».
* ** « » . ,
,77'78
.

« »:
24-5.
,
,
. Klineberg80 .
:
,
.
,

:
•
; .80
• ,

; .
• , , «
» «
»
. «
».71 ,

. ( ,
, - ).16

«
».

, , ,86
.3182 87 .

, «
.83'84 Ren » « »
.85 34 , .88 Ross89 : «
, ,

( , ».
, ) - (9 10)

. 41 % (
).90-92 Agerberg Sandstrom77 ,
. 88 % 89 %
,

-
. Stohler,97
, .
.77
,
,

.77
Agerberg Sandstrom :
« ,
,
9 10 ,
( ,
, ) .9899
Michelotti .98
.

».77 . ,
(
) , -
.
.
, - ,
,
, ,93 ,
.73 .100
, ,
Michelotti .98
,94
.95 , 0,25 ,
(
) ( )
, . 8 .
, .
- 8 .
,
,
,
.
. (Welden
Bell)96 « (!)
»,
,
, 2 .

« »:
, ,

.
(
,
. ,
).
,
.
,

8 ( )
.
.
, Le Bell ."
.
, •
.98
(
Le Bell ),
.99 .
• (!)
. ,
( ). ,

, (
, , , -
)
. .

( ),

,
22 , 10
. ,
, , ,

0,3 , .101
. 25 ,
,
, (
). 2
( ,
. , ),
.102 ,

-
.103104 (1995),

.115 ,
, ,
« » ,
. , - (
( , , )
)
,

.
( ,
), ,
.105 . Stohler,116
,
,106107
.95 .
, •
,
,
. . ,
,
.
• ( ,
, , )
,
.108 ,
, 2006 . .

, , .
16 % 9% ,
.109
-
110 .

,

. ,
111"114 .
, -

:
. 24-1. - . 24-2. . 24-3. ...

... ,
(the European Academy of

Craniomandibular Disorders) ( . 24-3).
,
,
.15 ( , 3-6 ) ,

.
.97117'118 ,
-

, , .117

.
, ,119
117118'120
( 6 ). 121-124
, , .
- ,

.97 ,

, .76

,

:
. ,

( . 24-1 24-2).

,
. -

-
•
3-4 . .
• ,
,
.125"131 .
,

, -
, ,
, . . .19
. ,

,
,
, .138-141
,132
,
,133 .134-136 .142

( . 24-4).129'130'143144
,
,
. ,146 ,
• ( ,
).
•
(
). ,
• ( .146"148
).
• (
). ,
.
( )
( ).
,137
, ,
.
.

:
.149-152
,
,

.
,
50
: «

»100.
,
. 24-4.
(M E)
( 4 ) . , ME
.
, , . .
M E,
,153
. ,
, .
. ,
,

,
.24 6-8
, .
,
.136
.
3 ,
,

, .
,
( ) 1
.135
,
7 .156
. ,
, .
138154 ( )
165 ,
, , , ,
,

-
. ( ,
). ,
.157 , ,
,
, « »
, ,
.158 , « ».70
, ,
,
,
( ) .
,
,
, -
,
.159 ,
, .162

, ,
.160 ,
,
, . 80 % .163-164
,
, ( ) .165-168
,
- ,
,161
.
- ,15
.106-107 1960- .
, ,
(Ramfjord Ash),
.
.128 , ,
,
,
, . .
.145
( ). 1978 . Geering Lang
( , )
144 ,
.169
( .145
) •
.

:
. 24-5.
:
.
-
.
( 1 )
,
, .
- ( )
. 24-6.
. 24-7.
. 24-8.
• ( . 24-5-24-7).
( ). , ,
• (
).
• ( ( . 24-8).
) . •
• (
145) :170
1
145
.

-
•

,172
(1 )

, .
-
. ,
,
.
. ,

, 1-2 ,
.
.154
.20
1-2 . -
6 -

. ,
( (< 1 )
, (
) 6-8 )
.15
. , (
24 ) ,
, : (6-8 ),
• 171 ( (Hawley), (Sved)
- (Shore),
.
, );
•
171 ( ,
);
• (Best Bite),173
.154 (anterior midline point stop
device, AM PS),174 (Swedish
, device)175
, (Nociceptive
Trigeminal Inhibition Tension Suppression
, System , NTI-tss).
.109 ,176 NTI-tss
( . 24-9)
.
,
.20164 , -

:
4* »>*
іМ й
. 24-9. N TI- t ss . 24-10.
,
,
,
,
.
, ,

. .
NTI-tss
( ) .177
, ,
, -
.176
.178 ,

, ,
( . 24-10). 3-4 ,106 -
•
• *
. 24-11. - . 24-12.
...

-
. 24-13. ... . 24-14. -

-
. 24-15. . 24-16.
, ,

.
( . 24-14 24-15).

( . 24-16).177
.

( . 24-11).
( . 24-12).

( . 24-13).
, :
8 .
, .

,

.179-181 ,
,
.
.100
100 : «
,
, ,

.116
, ,
». 182

43 ,
,
.
.
-
. , ,
.
.72

.
20
,
.
, ,
,
, .188

, .182 .
,
,
.
, ,
,183184 ,
,185 . ,
,
,186 - ,

( )
. .
,
187

-
11. Palla S. A need to redefine chronic pain? J Orofac

Pain 2006;20:265- 266.
.
12. Evans RW. Concepts of disease, the physician,
, and chronic pain in the workplace. Pain Forum
, 1997;6:239- 242.
13. Metcalfe DHH. Measurement of outcomes in gen
eral practice. In: Hopkins A, Costain D (eds). M ea
suring the Outcomes of Medical Care. London: The
Royal College of Physicians, 1990:93- 104.
14. Stohler CS. M anagement of persistent orofacial
pain. In: Lund JP, Lavigne GJ, Dubner R, Sessle
BJ (eds). Orofacial Pain: From Basic Science to
Clinical Management. Chicago, IL: Quintessence,
. 2001:193- 209.
15. De Boever JA, Nilner M , Orthlieb JD, Steenks M H.
Recommendations by the EACD for examina
tion, diagnosis, and management of patients with
temporomandibular disorders and orofacial pain
by the general dental practitioner. J Orofac Pain
2008;22:268- 278.
1. Carlin G. Brain Droppings. New York: Hyperion, 16. Suvinen Tl, Reade PC, Kemppainen P, Kononen M,
1997:200. Dworkin SF. Review of aetiological concepts of tem
2. Vollaro S, Michelotti A, Cimino R, Farella M , M ar poromandibular pain disorders: towards a biopsy
tina R. Epidemiologic study of patients with tem chosocial model for integration of physical disorder
poromandibular disorders. Report of data and clini factors with psychological and psychosocial illness
cal findings. M inerva Stomatol 2001;50:9- 14. impact factors. Eur J Pain 2005;9:613- 633.
3. Rantala M A, Ahlberg J, Suvinen Tl, Nissinen M, 17. Turp JC, Jokstad A, Motschall E, Schindler HJ,
Lindholm H, Savolainen A et al. Temporomandibu Windecker-Getaz I, Ettlin DA. Is there a superiority
lar joint related painless symptoms, orofacial pain, of multimodal as opposed to simple therapy in pa
neck pain, headache, and psychosocial factors tients with temporomandibular disorders? A quali
among non-patients. Acta Odontol Scand 2003;61: tative systematic review of the literature. Clin Oral
217- 222. Implants Res 2007;18(Suppl 3):138- 150.
4. Yap AU, Dworkin SF, Chua EK, List T, Tan KB, Tan 18. Stohler CS. The end of an era: orofacial pain enters
HH. Prevalence of temporomandibular disorder the genomic age. In: Turp JC, Sommer C, Hugger
subtypes, psychologic distress, and psychoso A (eds). The Puzzle of Orofacial Pain: Integrating
cial dysfunction in Asian patients. J Orofac Pain Research into Clinical M anagement. Basel: Karger,
2003;17:21- 28. 2007:236- 247.
5. Plesh O, Sinisi SE, Crawford PB, Gansky SA. Diag 19. Stohler CS. Management of persistent orofacial
noses based on the Research Diagnostic Criteria for pain. In: Sessle BJ, Lavigne GJ, Lund JP, Dubner R
Temporomandibular Disorders in a biracial popu (eds). Orofacial Pain: From Basic Science to Clini
lation of young women. J Orofac Pain 2005;19: cal M anagement, ed 2. Chicago, IL: Quintessence,
65- 75. 2008:153- 160.
6. Lee LTK, Yeung RWK, Wong M CM , M cM illan AS. 20. Klasser GD, Greene CS. Oral appliances in the
Diagnostic sub-types, psychological distress and management of temporomandibular disorders.
psychosocial dysfunction in southern Chinese peo Oral Surg Oral Med Oral Pathol Oral Radiol Endod
ple with temporomandibular disorders. J Oral Reha 2009;107:212- 223.
bil 2008;35:184- 190. 21. Schwartz L. Development of concepts and methods
7. Dworkin SF, LeResche L. Research diagnostic criteria of treatment. In: Schwartz L (ed). Disorders of the
for temporomandibular disorders: review, criteria, Temporomandibular Joint. Philadelphia, PA: Saun
ders, 1959:3- 27.
22. Perry HT. Temporomandibular joint dysfunction:
from Costen to the present. Ann Acad Med Singa
8. Storey AT. The fallibility of clinical judgment. J Cran-
pore 1995;24:163- 167.
iomand Disord 1992;6:155- 156.
23. McNeill C. History and evolution of TM D concepts.
9. Loeser JD, Treede RD. The Kyoto protocol of IASP
Oral Surg Oral Med Oral Pathol Oral Radiol Endod
basic pain terminology. Pain 2008;137:473- 477.
1997;83:51- 60.
10. Rossman LE, Hasselgren G, Wolcott JF. Diagnosis
24. Greene CS. Concepts of TM D etiology: effects on
and management of orofacial dental pain emergen
diagnosis and treatment. In: Laskin DM , Greene
cies. In: Cohen S, Hargreaves KM (eds). Pathways
CS, Hylander WL (eds). TM Ds: An Evidence-based
of the Pulp, ed 9. St. Louis, M O: Mosby, 2006:
Approach to Diagnosis and Treatment. Chicago, IL:
40- 58.
Quintessence, 2006:219- 228.

25. Crane JW. Hearing restored by artificial teeth. N Y 45. Costen JB. Classification and t reatm ent o f t em poro
Dent Rec 1854;8:188- 189. m andibular jo int problems. J M ich State M ed Soc
26. Prentiss HJ. A preliminary report upon the temporo 1956;55:673- 677.
mandibular articulation in the human type. Dental 46. Costen JB. Recognition o f m andibular joint sym p
Cadmos 1918;60:505- 514. tom s and treatm ent of t heir sources. Ann Dent
27. Summa R. The importance of the inter-articular 1956;15:90- 96.
fibro-cartilage of the temporo-mandibular articula 47. Costen JB. Differential diagnosis of m andibular joint
tion. Dental Cadmos 1918;60:512- 514. neuralgia. Clin M ed 1957;4:1095- 1099.
28. Wright WH. Deafness as influenced by malposition 48. Costen JB. Outline of the m andibular joint syn
of the jaws. Nati Dent Assoc J 1920;7:979- 990. drome. Laryngoscope 1959;69:408^ H 4.
29. Monson GS. Impaired function as a result of closed 49. Costen JB. Diagnosis and treatm ent o f m andibu
bite. Natl Dent Assoc J 1921;8:833- 839. lar jo int reactions. J M ed Assoc State Ala 1959;29:
30. Harris HL. Anatomy of temporomandibular articu 45^ J8.
lation and adjacent structures. J Am Dent Assoc 50. Connors M C. Tissue reactions in the tem p orom an
1932;19:584- 589. dibular articulation following loss of teeth. Dent
31. Stohler CS. Interocclusal appliances: do they offer a Cadm os 1925;67:124- 135.
biologic advantage? In: McNeill C (ed). Science and 51. Batson OV. Closed bite and related clinical prob
Practice of Occlusion. Chicago, IL: Quintessence, lems. J Am Dent Assoc 1938;25:1191- 1196.
1997:381- 393. 52. Junem ann HR. Consequences o f shortening
32. Costen JB. A syndrome of ear and sinus symptoms the int erm axillary distance. J Am Dent Assoc
dependent upon disturbed function of the tem 1941;28:1427- 1436.
poromandibular joint. Ann Otol Rhinol Laryngol 53. Schier M BA. A new technique fo r radiography of
1934;43:1- 15. the tem porom andibular articulat ion. Dent Items In
33. Costen JB. A group of symptoms frequently in terest 1943;65:324- 336,419- 428.
volved in general diagnosis, typical of sinus and ear 54. Sicher H. Temporomandibular articulation in mandib
disease and of mandibular joint pathology. Mo Med ular overclosure. J Am M ed Assoc 1948;36:131- 139.
1935;32:182- 190. 55. Zim m erm an AA. An evaluation o f Costen's syn
34. Costen JB. Neuralgias and ear symptoms involved drome from an anatom ic point of view. In: Sarnat
in general diagnosis due to mandibular joint pathol BG (ed ). The Tem porom andibular Joint. Springfield,
ogy. J Kans Med Soc 1935;36:315- 321. IL: Tho m as, 1951:82- 110.
35. Costen JB. Glossodynia: reflex irritation from the 56. M ichael LA. Jaw s revisited: Costen's syndrom e. Ann
mandibular joint as the principal etiologic factor. Ot o l Rhinol Laryngol 1997;106:820- 822.
Arch Otolaryngol 1935;22:554- 564. 57. Seedorf H, Leuwer R, Fenske C, Jude HD. Das " Co s
36. Costen JB. Neuralgias and ear symptoms associated ten Synd ro m " - welche Befunde lassen aus HN O-
with disturbed function of the temporomandibular arzt licher Sicht die Zusam m enarbeit mit einem
joint. J Am Med Assoc 1936;107:252- 255. Zahnarzt sinnvoll erscheinen? Laryngorhinootologie
37. Costen JB. Some features of the mandibular articu 20 02;81:268- 275.
lation as it pertains to medical diagnosis, especially 58. Wallisch W. Referate und Kritiken. M echanik
in otolaryngology. J Am Dent Assoc Dent Cosmos des Unt erkiefers und der zahnarzt lichen Proth-
1937;24:1507- 1511. ese. Von Dr. m ed. Ernst Eltner. Ost err Z Stomatol
38. Costen JB. Correlation of x-ray findings in the man 1911;9:372- 374.
dibular joint with clinical signs, especially trismus. 59. Friel S. Occlusion: observation on its developm ent
J Am Dent Assoc 1939;26:405- 407. from infancy to old age. Int J Ort hod 1927;13:
39. Costen JB. The mechanism of trismus and its oc 323- 342.
currence in mandibular joint dysfunction. Ann Otol 60. Hellm ann M . Factors influencing occlusion. Angle
Rhinol Laryngol 1939;48:499- 514. Ort ho d o nt 1942;12:3- 27.
40. Costen JB. Reflex effects produced by abnormal 61. Beyron H. Characterist ics o f functionally optimal
movement of the lower jaw. Arch Otolaryngol occlusion and principles o f occlusal rehabilitation.
1942;36:548- 555. J Am Dent Assoc 1954;48:648- 656.
41. Costen JB. Diagnosis of mandibular joint neuralgia 62. St uart CE. Good occlusion fo r natural teeth. J Pros
and its place in general head pain. Ann Otol Rhinol t het Dent 1964;14:716- 724.
Laryngol 1944;53:655- 659. 63. Ramfjord SP, Ash M M . Occlusio n. Philadelphia, PA:
42. Costen JB. The transmission of pain impulses via the Saunders, 1966.
chorda tympani nerve. Ann Otol Rhinol Laryngol 64. Huffm an RW, Regenos JW , Taylor RR. Principles of
1951;60:591- 609. Occlusion. Laboratory and Clinical Teaching M an u
43. Costen JB. The present status of the mandibular al. Ohio State University. Departm ent of Op erative
joint syndrome in otolaryngology. Trans Am Acad Dentistry. Colum b us, O H: H & R Press, 1969.
Ophthalmol Otolaryngol 1951;55:809- 823. 65. And rews LF. The six keys to normal occlusion. Am J
44. Costen JB. Masseter muscle tremor: an important Ort hod 1972;62:296- 309.
factor in mandibular joint dysfunction. Laryngo
scope 1955;65:1129- 1135.

-
66. Keshvad A, Winstanley RB. An appraisal of the lit 84. Pullinger AG, Hollender L, Solberg W K, Petersson
erature on centric relation. Part II. J Oral Rehabil A. A tomographic study of mandibular condyle
2000;27:1013- 1023. postition in an asymptomatic population. J Prosthet
67. Keshvad A, Winstanley RB. An appraisal of the Dent 1985;53:706- 713.
literature on centric relation. Part I. J Oral Rehabil 85. Ren YF, Isberg A, Westesson P-L. Condyle posi
2000;27:823- 833. tion in the temporomandibular joint: comparison
68. Keshvad A, Winstanley RB. An appraisal of the lit between asymptomatic volunteers with normal
erature on centric relation. Part III. J Oral Rehabil disk position and patients with disk displacement.
2001;28:55- 63. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
69. Kerr DA, Ash M M , Millard HD. Oral Diagnosis. St. 1995;80:101- 107.
Louis, M O: Mosby, 1959:261- 262. 86. Turp JC, Alt KW, Vach W, Harbich K. Mandibular
70. The Academy of Prosthodontics. The Glossary of condyles and rami are asymmetric structures. Cran
Prosthodontic Terms, ed 8 (GPT-8). J Prosthet Dent io 1998;16:51- 56.
2005;94:10- 92. 87. JasineviciusTR, Pyle M A, Lalumandier JA, Nelson S,
71. Shore NA. Occlusal Equilibration and Temporoman Kohrs KJ, Turp JC et al. Asymmetry of the articular
dibular Joint Dysfunction. Philadelphia, PA: Lippin- eminence in dentate and partially edentulous popu
cott, 1959:218, 307. lations. Cranio 2006;24:85- 94.
72. Ramfjord SP. Dysfunctional temporomandibular joint 88. Woda A, Vigneron P, Kay D. Nonfunctional and
and muscle pain. J Prosthet Dent 1961;11:353-374. functional occlusal contacts: a review of the litera
73. McNeill C. Fundamental treatment goals. In: McNeill ture. J Prosthet Dent 1979;42:335- 341.
C (ed). Science and Practice of Occlusion. Chicago, 89. Ross B. Satisfactory occlusal relations for the indi
IL: Quintessence, 1997:306-322. vidual with a craniofacial anomaly. Int J Prosthodont
74. Ash M M Jr. Philosophy of occlusion: past and pres 2003;16(Suppl):74- 75, discussion 89- 90.
ent. Dent Clin North Am 1995;39:233- 255. 90. Posselt U. Physiology of Occlusion and Rehabilita
75. Ash M M , Nelson SJ. Wheeler's Dental Anatomy, tion. Philadelphia, PA: FA Davis, 1968.
Physiology, and Occlusion, ed 8. Philadelphia, PA: 91. Reynolds JM . Occlusal wear facets. J Prosthet Dent
Saunders, 2003. 1970;24:367- 372.
76. Okeson JP (ed.) Orofacial Pain: Guidelines for As 92. Rieder CE. The prevalence and magnitude of man
sessment, Diagnosis, and M anagement, ed 4. Chi dibular displacement in a survey population. J Pros
cago, IL: Quintessence, 2008:171. thet Dent 1978;39:324- 329.
77. AgerbergG, Sandstrom R. Frequency of occlusal in 93. Klineberg I, Stohler CS. Study group report and dis
terferences: a clinical study in teenagers and young cussion. Int J Prosthodont 2003;16(Suppl):89- 90.
adults. J Prosthet Dent 1988;59:212- 217. 94. Lobbezoo F, van Seims M K, Naeije M . Masticatory
78. Minagi S, Watanabe H, Sato T, Tsuru H. The rela muscle pain and disordered jaw motor behaviour:
tionship between balancing-side occlusal contact literature review over the past decade. Arch Oral
patterns and temporomandibular joint sounds in Biol 2006;51:713- 720.
humans: proposition of the concept of balancing- 95. Obrez A, Turp JC. The effect of musculoskeletal fa
side protection. J Craniomandib Disord 1990;4: cial pain on registration of maxillomandibular rela
251- 256. tionships and treatment planning: a synthesis of the
79. Solnit A, Curnutte DC. Occlusal Correction: Princi literature. J Prosthet Dent 1998;79:439^ W5.
ples and Practice. Chicago, IL: Quintessence, 1988. 96. Bell WE. Classification of TM disorders. In: Laskin
80. Au A, Klineberg I. The role of occlusal adjustment. D, Greenfield W, Gale E, Rugh J, Neff P, Ailing C et
In: Klineberg I, Jagger R (eds). Occlusion and Clini al. (eds). The President’s Conference on the Exami
cal Practice: An Evidence-based Approach. Edin nation, Diagnosis, and Management of Temporo
burgh: Wright, 2004:133- 138. mandibular Disorders. Chicago, IL: American Dental
81. Gesch D, Bernhardt O, Kirbschus A. Association of Association, 1983:24- 29.
malocclusion and functional occlusion with tem 97. Stohler CS. M anagement of dental occlusion.
poromandibular disorders (TM D) in adults: a sys In: Laskin DM , Greene CS, Hylander WL (eds).
tematic review of population-based studies. Quin TM Ds: An Evidence-based Approach to Diagnosis
tessence Int 2004;35:211- 221. and Treatment. Chicago, IL: Quintessence, 2006:
82. Gesch D, Bernhardt O, Alte D, Kocher T, John U, 403- 411.
Hensel E. Malocclusions and clinical signs or sub 98. Michelotti A, Farella M , Gallo LM , Veltri A, Palla
jective symptoms of temporomandibular disorders S, M artina R. Effect of occlusal interference on
(TM D) in adults: results of the population-based habitual activity of human masseter. J Dent Res
Study of Health in Pomerania (SHIP). J Orofac 2005;84:644- 648.
Orthop 2004;65:88- 103. 99. Le Bell Y, Jamsa T, Korri S, Niemi PM , Alanen P. Ef
83. Blaschke DD, Blaschke TJ. Normal TM J bony fect of artificial occlusal interferences depends on
relationships in centric occlusion. J Dent Res previous experience of temporomandibular disor
1981;60:98- 104. ders. Acta Odontol Scand 2002;60:219- 222.

100. Ramfjord SP. Bruxism: a clinical and electromyo 114. Tsukiyama Y, Baba K, Clark GT. An evidence-based
graphic study. J Am Dent Assoc 1961;62:21^ f4. assessment of occlusal adjustment as a treatment
101. Carlsson GE, Haraldson T, Mohl ND. The denti for temporomandibular disorders. J Prosthet Dent
tion. In: Mohl N, Zarb GA, Carlsson GE, Rugh JD 2001;86:57- 66.
(eds). A Textbook of Occlusion. Chicago, IL: Quin 115. National Institutes of Health. National institutes of
tessence, 1988:57- 69. health technology assessment conference state
102. WaltherW. Determinants of a healthy aging denti ment: management of temporomandibular disor
tion: maximum number of bilateral centric stops ders. J Am Dent Assoc 1996;127:1595- 1603.
and optimum vertical dimension of occlusion. Int 116. Stohler CS. Clinical decision-making in occlusion:
J Prosthodont 2003;16(Suppl):77- 79, discussion a paradigm shift. In: McNeill C (ed). Science and
89- 90. Practice of Occlusion. Chicago, IL: Quintessence,
103. Jasinevicius TR, Yellowitz JA, Vaughan GG, Brooks 1997:294- 305.
ES, Baughan LW, Cline N et al. Centric relation 117. Plesh O, Stohler CS. Prosthetic rehabilitation in
definitions taught in 7 dental schools: results temporomandibular disorder and orofacial pain
of faculty and student surveys. J Prosthodont patients: clinical problem solving. Dent Clin North
2000;9:87- 94. Am 1992;36:581- 589.
104. Baker PS, Parker M H, Ivanhoe JR, Gardner FM. 118. Turp JC, Strub JR. Prosthetic rehabilitation in pa
M axillomandibular relationship philosophies for tients with temporomandibular disorders. J Pros
prosthodontic treatment: a survey of dental edu thet Dent 1996;76:418- 423.
cators. J Prosthet Dent 2005;93:86- 90. 119. Schmitter M , Wacker K, Pritsch M , Klose C, Fag-
105. Celenza FV. The theory and clinical management gion C, Kress et al. Preliminary longitudinal report
of centric positions: II. Centric relation and centric on symptom outcomes in symptomatic and asymp
relation occlusion. Int J Periodontics Restorative tomatic females with imaging evidence of TM J ar
Dent 1984;4:62- 86. thritic changes. IntJ Prosthod 2010;23(in press).
106. Lund JP, Donga R, Widmer CG, Stohler CS. The 120. De Boever JA, Carlsson GE, Klineberg IJ. Need for
pain-adaptation model: a discussion of the rela occlusal therapy and prosthodontic treatment in
tionship between chronic musculoskeletal pain the management of temporomandibular disorders.
and motor activity. Can J Physiol Pharmacol Part II: Tooth loss and prosthodontic treatment.
1991;69:683- 694. J Oral Rehabil 2000;27:647- 659.
107. M urray GM , Peck CC. Orofacial pain and jaw 121. Collett T, Stohler CS. The orthodontic/ TM D pa
muscle activity: a new model. J Orofac Pain tient: review of the literature and an introduction
2007;21:263- 278, discussion 279- 288. to structured clinical decision making. Aust Orthod
108. Kirveskari P, Jamsa T, Alanen P. Occlusal adjust J 1994;13:188- 193.
ment and the incidence of demand for temporo 122. M cNamara JA Jr, Turp JC. Orthodontic treatment
mandibular disorder treatment. J Prosthet Dent and temporomandibular disorders: is there a rela
1998;79:433^ 38. tionship? Part 1: Clinical studies. J Orofac Orthop
109. Ommerborn M A, Kollmann C, Handschel J, Dep- 1997;58:74- 89.
prich RA, Lang H, Raab H-M . A survey on German 123. Mohlin B, Kurol J. To what extent do deviations
dentists regarding the management of cranioman from an ideal occlusion constitute a health risk?
dibular disorders. Clin Oral Investig 14 M ay 2009; Swed Dent J 2003;27:1- 10.
(Epub ahead of print). 124. Luther F. TM D and occlusion part I. Damned if
110. Koh H, Robinson PG. Occlusal adjustment for we do? Occlusion: the interface of dentistry and
treating and preventing temporomandibular joint orthodontics. Br Dent J 2007;202:E2, discussion
disorders (Cochrane Review). Cochrane Database 38- 39.
Syst Rev 2003;lssue 1:CD003812. 125. Blanksma NG, van Eijden TM . Electromyo
111. Zarb GA, Carlsson GE, Rugh JD. Clinical manage graphic heterogeneity in the human tempora
ment. In: Zarb GA, Carlsson GE, Sessle BE, Mohl lis and masseter muscles during static biting,
ND (eds). Temporomandibular Joint and M astica open/ close excursions, and chewing. J Dent Res
tory Muscle Disorders. Copenhagen: M unksgaard- 1995;74:1318- 1327.
Mosby, 1994:529- 548. 126. Blanksma NG, van Eijden TM , van Ruijven LJ,
112. Clark GT, Tsukiyama Y, Baba K, Simmons M . The Weijs WA. Electromyographic heterogeneity in the
validity and utility of disease detection methods human temporalis and masseter muscles during
and of occlusal therapy for temporomandibular dynamic tasks guided by visual feedback. J Dent
disorders. Oral Surg Oral Med Oral Pathol Oral Res 1997;76:542- 551.
Radiol Endod 1997;83:101- 106. 127. M urray GM , Phanachet I, Klineberg IJ. Electro
113. Forssell FI, Kalso E, Koskela P, Vehmanen R, myographic evidence for functional heterogeneity
Puukka P, Alanen P. Occlusal treatments in tem in the inferior head of the human lateral pterygoid
poromandibular disorders: a qualitative system muscle: a preliminary multi-unit study. Clin Neuro
atic review of randomized controlled trials. Pain physiol 1999;110:944- 950.
1999;83:549- 560.

-
128. Turp JC, Schindler HJ, Pritsch , Rong Q. An- 144. Turp JC, Schindler HJ. Zum Zusammenhang zwis-
tero-posterior activity changes in the superficial chen Okklusion und Myoarthropathien: Einfiihrung
masseter muscle after exposure to experimental eines integrierenden neurobiologischen Modells.
pain. Eur J Oral Sci 2002;110:83- 91. Schweiz Monatsschr Zahnmed 2003;113:964- 977.
129. Schindler HJ, Turp JC, Blaser R, Lenz J. Differen 145. Ramfjord SP, Ash M M . Reflections on the Michigan
tial activity patterns in the masseter muscle under occlusal splint. J Oral Rehabil 1994;21:491- 500.
simulated clenching and grinding forces. J Oral 146. Rivera-Morales WC, Mohl ND. Relationship of oc
Rehabil 2005;32:552- 563. clusal vertical dimension to the health of the masti
130. Schindler HJ, Rues S, Turp JC, Lenz J. Heteroge catory system. J Prosthet Dent 1991;65:547- 553.
neous activation of the medial pterygoid mus 147. Palla S. The vertical dimension: a prosthodontist's
cle during simulated clenching. Arch Oral Biol perspective. In: M cNamara JA Jr (ed). The Enigma
2006;51:498- 504. of the Vertical Dimension. Ann Arbor, M l: Cen
131. Farella M , Palumbo A, Milani S, Avecone S, Gallo ter for Human Growth and Development, 2000:
LM , Michelotti A. Synergist coactivation and sub 75- 101.
stitution pattern of the human masseter and tem 148. Woda A, Piochon P, Palla S. Regulation of man
poralis muscles during sustained static contrac dibular postures: mechanisms and clinical implica
tions. Clin Neurophysiol 2009;120:190- 197. tions. Crit Rev Oral Biol Med 2001;12:166- 178.
132. Svensson P, Sessle B. Orofacial pain. In: Miles TS, 149. Hagg GM . Static work and myalgia: a new ex
Nauntofte B, Svensson P (eds). Clinical Oral Physi planation model. In: Andersson PA, Hobart DJ,
ology. Chicago, IL: Quintessence, 2004:93- 139. Danoff JV (eds). Electromyographical Kinesiology.
133. Schindler HJ, Rong Q, Spiefb WEL. Der Einfluss Amsterdam: Elsevier, 1991:141- 144.
von Aufbissschienen auf das Rekrutierungsmus- 150. Zennaro D, Laubli T, Krebs D, Krueger H, Klipstein
ter des Musculus temporalis. Dtsch Zahnarztl Z A. Trapezius muscle motor unit activity in symp
2000;55:575- 581. tomatic participants during finger tapping using
134. Chu SA, Suvinen Tl, Clement JG, Reade PC. The properly and improperly adjusted desks. Hum Fac
effect of interocclusal appliances on temporoman tors 2004;46:252- 266.
dibular joints as assessed by 3D reconstruction of 151. Staal JB, de Bie RA, Hendriks EJM . Aetiology
M RI scans. Aust Dent J 2001 ;46:18- 23. and management of work-related upper ex
135. Ettlin DA, M ang H, Colombo V, Palla S, Gallo LM . tremity disorders. Best Pract Res Clin Rheumatol
Stereometric assessment of TM J space variation by 2007;21:123- 133.
occlusal splints. J Dent Res 2008;87:877- 881. 152. Visser B, van JH. Pathophysiology of upper
136. Demling A, Fauska K, Ismail F, Stiesch M . A com extremity muscle disorders. J Electromyogr Kine-
parison of change in condylar position in asymp siol 2006;16:1- 16.
tomatic volunteers utilizing a stabilization and a 153. Chen CY, Palla S, Erni S, Sieber M , Gallo LM . Non
pivot appliance. Cranio 2009;27:54- 61. functional tooth contact in healthy controls and
137. van der Glas HW, Buchner R, van Grootel RJ. patients with myogenous facial pain. J Orofac Pain
Vergelijking tussen behandelingsvormen bij myo- 2007;21:185- 193.
gene temporomandibulaire dysfunctie. Ned Tijd- 154. Clark GT, Minakuchi H. Oral appliances. In: Laskin
schr Tandheelkd 2000;107:505- 512. DM , Greene CS, Hylander W L (eds). TM Ds: An
138. Kreiner M , Betancor E, Clark GT. Occlusal stabili Evidence-based Approach to Diagnosis and Treat
zation appliances: evidence of their efficacy. J Am ment. Chicago, IL: Quintessence, 2006:377- 390.
Dent Assoc 2001;132:770- 777. 155. Clark GT. Occlusal Therapy: Occlusal Appliances.
139. Al-Ani M Z, Davies SJ, Gray RJM , Sloan P, Glenny In: Laskin D, Greenfield W, Gale E, Rugh J, Neff
AM . Stabilisation splint therapy for temporoman P, Ailing C et al. (eds). The President's Conference
dibular pain dysfunction syndrome. Cochrane Da on the Examination, Diagnosis and Management
tabase Syst Rev 2004;lssue 1:CD002778. of Temporomandibular Disorders. Chicago, IL:
140. Forssell H, Kalso E. Application of principles of American Dental Association, 1983:137- 146.
evidence-based medicine to occlusal treatment for 156. Svensson P, Romaniello A, Wang K, Arendt-Niels
temporomandibular disorders: are there lessons to en L, Sessle BJ. One hour of tongue-task training
be learned? J Orofac Pain 2004;18:9- 22. is associated with plasticity in corticomotor control
141. Turp JC, Komine F, Hugger A. Efficacy of stabiliza of the human tongue musculature. Exp Brain Res
tion splints for the management of patients with 2006;173:165- 173.
masticatory muscle pain: a qualitative systematic 157. Duchateau J, Semmler JG, Enoka RM . Training ad
review. Clin Oral Invest 2004;8:179- 194. aptations in the behavior of human motor units.
142. Raphael KG, Marbach JJ. Widespread pain and the J Appl Physiol 2006;101:1766- 1775.
effectiveness of oral splints in myofascial face pain. 158. Lotze M , Braun C, Birbaumer N, Anders S, Cohen
J Am Dent Assoc 2001;132:305- 316. LG. M otor learning elicited by voluntary drive.
143. Van Eijden TM GV, Blanksma NG, Brugman P. Brain 2003;126:866- 872.
Amplitude and timing of EM G activity in the hu 159. Buccino G, Solodkin A, Small SL. Functions of the
man masseter muscle during selected motor tasks. mirror neuron system: implications for neuroreha
J Dent Res 1993;72:599- 606. bilitation. Cogn Behav Neurol 2006;19:55- 63.

160. lacoboni , M azziotta JC. M irror neuron system: 175. Nilner M , Ekberg E, Doepel M , Andersson J, Selo-
basic findings and clinical applications. Ann Neurol vuo K, Le Bell Y. Short-term effectiveness of a
2007;62:213- 218. prefabricated occlusal appliance in patients with
161. Dao I I I, Lavigne GJ, Charbonneau A, Feine JS, myofascial pain. J Orofac Pain 2008;22:209- 218.
Lund JP. The efficacy of oral splints in the treat 176. Stapelmann H, Turp JC. The NTI-tss device for the
ment of myofascial pain of the jaw muscles: a con therapy of bruxism, temporomandibular disorders,
trolled clinical trial. Pain 1994;56:85- 94. and headache: where do we stand? A qualita
162. Thieme K, Turk DC, Flor H. Comorbid depression tive systematic review of the literature. BM C Oral
and anxiety in fibromyalgia syndrome: relationship Health 2008,8:22.
to somatic and psychosocial variables. Psychosom 177. Schindler HJ. Die therapeutische Positionierung
Med 2004;66:837- 844. des Unterkiefers mit ballistischen SchlieBbewegun-
163. Von Korff M , Ormel J, Keefe FJ, Dworkin SF. Grad gen - eine Pilotstudie. Dtsch Zahnarztl Z 2002;57:
ing the severity of chronic pain. Pain 1992;50: 368- 372.
133-149. 178. Jankelson B. Neuromuscular aspects of occlusion.
164. Paak S, Flugger A, Bollmann F, Stiittgen U. Effects of occlusal position on the physiology and
Schmerzbezogene psychosoziale Aspekte bei Pa- dysfunction of the mandibular musculature. Dent
tienten der Myoarthropathie-Sprechstunde. Dtsch Clin North Am 1979;23:157- 168.
Zahnarztl Z 2001;56:317- 321. 179. Velly AM , Gornitsky M , Philippe P. Contributing
165. Greene CS, Laskin DM . Long-term evaluation of factors to chronic myofascial pain: a case-control
treatment for myofascial pain-dysfunction syn study. Pain 2003 ;104:491^ 99.
drome: a comparative analysis. J Am Dent Assoc 180. Glaros AG, Burton E. Parafunctional clenching,
1983;107:235- 238. pain, and effort in temporomandibular disorders.
166. McNeill C. M anagement of temporomandibular J Behav Med 2004;27:91- 100.
disorders: concepts and controversies. J Prosthet 181. Magnusson T, Egermarki I, Carlsson GE. A pro
Dent 1997;77:510- 522. spective investigation over two decades on signs
167. Dworkin SF, Fluggins KH, Wilson L, Mancl L, Turner and symptoms of temporomandibular disorders
J, Massoth D et al. A randomized clinical trial using and associated variables: a final summary. Acta
research diagnostic criteria for temporomandibular Odontol Scand 2005;63:99- 109.
disorders-axis II to target clinic cases for a tailored 182. Macedo CR, Silva AB, Machado M A, Saconato H,
self-care TM D treatment program. J Orofac Pain Prado GF. Occlusal splints for treating sleep brux
2002;16:48- 63. ism (tooth grinding). Cochrane Database Syst Rev
168. Truelove E, Huggins KH, Mancl L, Dworkin SF. 2007;CD005514.
The efficacy of traditional, low-cost, and non 183. Dube C, Rompre PH, Manzini C, Guitard F, de
splint therapies for temporomandibular disorder: Grandmont P, Lavigne GJ. Quantitative poly
a randomized controlled trial. J Am Dent Assoc graphic controlled study on efficacy and safety
2006;137:1099- 1107. of oral splint devices in tooth-grinding subjects.
169. Geering AH, Lang NP. Die Michigan-Schiene, ein J Dent Res 2004;83:398^ 03.
diagnostisches und therapeutisches Hilfsmittel bei 184. Ommerborn M A, Schneider C, Giraki M , Schafer
Funktionsstorungen im Kausystem. I. Herstellung R, Handschel J, Franz M et al. Effects of an oc
im Artikulator und Eingliederung am Patienten. clusal splint compared with cognitive-behavioral
Schweiz Monatsschr Zahnmed 1978;88:32- 38. treatment on sleep bruxism activity. Eur J Oral Sci
170. Schuyler CH. Freedom in centric. Dent Clin North 2007;115:7- 14.
Am 1969;13:681- 686. 185. Landry M L, Rompre PH, Manzini C, Guitard F,
171. List T, Helkimo M . Adverse events of acupuncture de Grandmont P, Lavigne GJ. Reduction of sleep
and occlusal splint therapy in the treatment of bruxism using a mandibular advancement device:
craniomandibular disorders. Cranio 1992;10:318- an experimental controlled study. Int J Prosthodont
324, discussion 324- 326. 2006;19:549- 556.
172. Perry HT. Occlusal therapy: repositioning. In: 186. Baad-Hansen L, Jadidi F, Castrillon E, Thomsen
Laskin D, Greenfield W, Gale E, Rugh J, Neff P, PB, Svensson P. Effect of a nociceptive trigeminal
Ailing C et al. (eds). The President's Conference on inhibitory splint on electromyographic activity in
the Examination, Diagnosis, and Management of jaw closing muscles during sleep. J Oral Rehabil
Temporomandibular Disorders. Chicago, IL: Amer 2007;34:105- 111.
ican Dental Association, 1983:155- 160. 187. Ommerborn M A, Giraki M , Schneider C, Schaefer
173. Goldstein L, Gilbert LM . Use of the BEST-BITE an R, Gotter A, Franz M et al. A new analyzing meth
terior discluder for the treatment of migraine head od for quantification of abrasion on the Bruxcore
ache: a case study. Funct Orthod 2004;21:34- 37. device for sleep bruxism diagnosis. J Orofac Pain
174. Al Quran FAM , Kamal M S. Anterior midline point 2005;19:232- 238.
stop device (AM PS) in the treatment of myoge 188. Turp JC, Greene CS, Strub JR. Dental occlusion: a
nous TM Ds: comparison with the stabilization critical reflection on past, present and future con
splint and control group. Oral Surg Oral Med Oral cepts. J Oral Rehabil 2008;35:446- 453.

25
, ,
,

, ,
.
, , ,
. , ,
.8
, ,
,
. , ,9
.10
,
,
,
.11
. ,
,
.12
,
« » ,
, ,

, .
, ,

, 13 .14
.1-7 ,

,

. .23 -
, :
, , ,
,

. (visual analog
scale, VAS) 2-3 ( 10-
). (
, /
, )
, .15 0,56, . .
, 56 %
.16 ,

-
.
.
,

.

,
-
.
- ,
, ,
, -
,
.1617 .24-28
- ,
.18 ,
- , -
,
. ,
.1920
« ,
» , ,
.
,21
1722

.

,
:
. ,

-
.
,

, :
.29-33

. -
,

( ) .
. , ,
,
, - -
, .
.21'32 •
,

. .
, ,

( ) , , ,
, , , ,
, . ,
.22'32 , , ,
- . .
« », .36
« », •

.
, (
, ).37
, , « »
.1-7
, ,
,
(« .
»),
.34 ,
,35 ,
, , , ,
,

- /
.38 , )
( ,
)
.
-
: .
M oerman,39 - ,

, . .
,
.
.41'42 ,
.39 ,
( ) .18

( ).
.
,
,
,
.43
. : ,
,

, .18 ,
- .
, 44 ,

,
. , ( , )
, -
.
, , ,

.40 ,
.

- -
.
, , /
(
/

( ).45 (
),
(
)

(RVM ),
,
(PAG).
.
- - PAG
, RVM.

. , ,
(alNS) ,
.
( ; single-photon-emission computed ,
tomography, SPECT)
-
( ). - (DLPFC), ,
( ; positron PAG
em ission tomography, PET) - .18-46-47

. .
,

( -
) -
. .
, - ,

,
(
. , ).48

, (
). -

.
( ,
( , ,
) )
, .
,
: , ,
( ) - .

.
(
) .
,
.

. .
, ,
.

.
,
,
, 40 .
, ( )
. Schwartz .49
1958 ,
.
1960-1970- .
,
( , )
Laskin, Greene .,

.
- ( 50
51 ),
- ,
,
« ,52
».
, , ,53
,54
« ».
, .55
. ,
, ,
, ,
« »
, « »
, .

,

,
,
. .67
,

,56-68 ,
.67
.
(. . )

. ,
.68 ,
. , , ,

.6970 ,
,
,
.59-60
,71-73
,
. ,

,74 - ,

.
, ,

,
« » .
. ,
, ,75-79 Ekberg .

.61-66 Beecher,66 -
, , ,
(
.78-83
), Dao
, Lavigne84
. , ,
.
, « »
, ( « ») « ».
. , ,

- 4. de la Fuente-Fernandez R, Stoessl AJ. The pla
cebo effect in Parkinson's disease. Trends Neurosci
. 2002;25:302- 306.
5. de la Fuente-Fernandez R, Schulzer M , Stoessl AJ.
, Placebo mechanisms and reward circuitry: clues from
, Parkinson's disease. Biol Psychiatry 2004;56:67- 71.
6. Kaasinen V, Naagren K, Aalto S, Rinne JO Expecta
tion of caffeine induces dopaminergic responses in
humans. Eur J Neurosci 2004;19:2352- 2356.
. 7. Fricchione G, Stefano GB. Placebo neural systems:
nitric oxide, morphine and the dopamine brain
reward and motivation circuitries. Med Sci M onit
2005;11:54- 65.
. , 8. Kradin R. The placebo response complex. J Anal
Psychol 2004;49:617- 34.
9. de Craen AJ, Tijssen JG, de Gans J, Kleijnen J. Pla
( cebo effect in the acute treatment of migraine: sub
cutaneous placebos are better than oral placebos.
) J Neurol 2000;247:183- 188.
10. Wall PD. Pain and the placebo response. In: Ex
perimental and Theoretical Studies of Conscious
ness. Wiley, NY: Ciba Foundation Symposium 174,
. 1993:187- 216.
11. Kaptchuk TJ, Goldman P, Stone DA, Stason WB. Do
medical devices have enhanced placebo effects?
J Clin Epidemiol 2000;53:786- 792.
12. Benedetti F, Arduino C, Amanzio M . Somatotopic
activation of opioid systems by target-directed ex
pectations of analgesia. J Neurosci 1999;19:3639-
3648.
,
13. Price DD, Milling LS, Kirsch I, Duff A, Montgomery
, GH, Nicholls SS. An analysis of factors that contrib
. ute to the magnitude of placebo analgesia in an ex
perimental paradigm. Pain 1999;83:147- 156.
14. Flaten M A, Simonsen T, Olsen H. Drug-related in
formation generates placebo and nocebo responses
( ) that modify the drug response. Psychosom Med
( 1999;61:250- 255.
). 15. Whalley B, Hyland M E, Kirsch I. Consistency of
the placebo effect. J Psychosom Res 2008;64:
537- 541.
- , 16. Benedetti F, Amanzio M . The neurobiology of pla
cebo analgesia: from endogenous opioids to chole-
cystokinin. Prog Neurobiol 1997;52:109- 125.

17. Benedetti F. Cholecystokinin type-A and type-B re
. ceptors and their modulation of opioid analgesia.
News Physiol Sci 1997;12:263- 268.
18. Benedetti F. Placebo analgesia. Neurol Sci 2006;27
(Suppl 2):100- 102.
19. Levine JD, Gordon NC, Fields HL. The mechanism
of placebo analgesia. Lancet 1978;2:654- 657.
20. Levine JD, Gordon NC. Influence of the method of
1. Schultz W. Predictive reward signal of dopamine drug administration on analgesic response. Nature
neurons. J Neurophysiol 1998;80:1- 27. 1984;312:755- 756.
2. Bardo MT. Neuropharmacological mechanisms of 21. Gracely RH, Dubner R, Wolskee PJ, DeeterWR. Pla
drug reward: beyond dopamine in the nucleus ac- cebo and naloxone can alter postsurgical pain by
cumbens. Crit Rev Neurobiol 1998;12:37- 67. separate mechanisms. Nature 1983;306:264- 265.
3. de la Fuente-Fernandez R, Ruth TJ, Sossi V, Schulzer 22. Amanzio M , Benedetti F. Neuropharmacological
M , Caine DB, Stoessl AJ. Expectation and dopamine dissection of placebo analgesia: expectation-acti
release: mechanism of the placebo effect in Parkin vated opioid systems versus conditioning-activated
son's disease. Science 2001 ;293:1164-1166. specific subsystems. J Neurosci 1999;19:484- 494.

23. Benedetti F, Amanzio M , Baldi S, Casadio C, Cavallo 40. Walach H, Jonas WB. Placebo research: the evidence
A, Mancuso M et al. The specific effects of prior base for harnessing self-healing capacities. J Altern
opioid exposure on placebo analgesia and placebo Complement Med 2004;10(Suppl 1):S103- 112.
respiratory depression. Pain 1998;75:313- 319. 41. Okeson JP. Defining the problem. In: Bell's Orofacial
24. Benedetti F. Mechanisms of placebo and placebo- Pains, ed 6. Chicago, IL: Quintessence, 2005:3- 12.
related effects across diseases and treatments. Annu 42. Dworkin SF. Psychological and psychosocial as
Rev Pharmacol Toxicol 2008;48:33- 60. sessment. In: Laskin DM , Greene CS, Hylander WL
25. Enck P, Benedetti F, Schedlowski M . New insights (eds). TM Ds: An Evidence-based Approach to Di
into the placebo and nocebo responses. Neuron agnosis and Treatment. Chicago, IL: Quintessence,
2008;59:195- 206. 2006:203- 217.
26. Goebel M U, Trebst AE, Steiner J, Xie YF, Exton 43. Mauro G, Tagliaferro C, Montini M , Zanolla L. Dif
M S, Frede S et al. Behavioral conditioning of im fusion model of pain language and quality of life in
munosuppression is possible in humans. FASEB J orofacial pain patients. J Orofac Pain 2001 ;15:36-46.
2002;16:1869- 1873. 44. Dworkin SF, LeResche L. Research diagnostic criteria
27. Pacheco-Lopez G, Engler H, Niemi M B, Schedlowski for temporomandibular disorders: review, criteria,
M . Expectations and associations that heal: immu examinations and specifications, critique. J Crani
nomodulatory placebo effects and its neurobiology. omandib Disord 1992;6:301- 355.
Brain Behav Immun 2006;20:430- 446. 45. Petrovic P, Kalso E, Petersson KM , Ingvar M . Place
28. Olshansky B. Placebo and nocebo in cardiovascular bo and opioid analgesia: imaging a shared neuronal
health: implications for health care, research, and network. Science 2002;295:1737- 1740.
the doctor-patient relationship. J Am Coll Cardiol 46. Wager TD, Rilling JK, Smith EE, Sokolik A, Casey
2007;49:415- 421. KL, Davidson RJ et al. Placebo-induced changes in
29. Grevert P, Albert LH, Goldstein A. Partial an FM RI in the anticipation and experience of pain.
tagonism of placebo analgesia by naloxone. Pain Science 2004;303:1162- 1167.
1983;16:129- 143. 47. Bingel U, Lorenz J, Schoell E, Weiller C, Buchel C.
30. Benedetti F, Amanzio M , Maggi G. Potentia Mechanisms of placebo analgesia: rACC recruit
tion of placebo analgesia by proglumide. Lancet ment of a subcortical antinociceptive network. Pain
1995:346:1231. 2006;120:8- 15.
31. Benedetti F. The opposite effects of the opiate 48. Zubieta JK, Bueller JA, Jackson LR, Scott DJ, Xu Y,
antagonist naloxone and the cholecystokinin an Koeppe RA et al. Placebo effects mediated by en
tagonist proglumide on placebo analgesia. Pain dogenous opioid activity on mu-opioid receptors.
1996;64:535- 543. J Neurosci 2005;25:7754- 7762.
32. ter Riet G, de Craen AJ, de Boer A, Kessels AG. Is 49. Schwartz L. Conclusions of the temporomandibu
placebo analgesia mediated by endogenous opi lar joint clinic at Columbia. J Periodontol 1958;29:
oids? A systematic review. Pain 1998;76:273- 275. 210- 212.
33. Benedetti F, Mayberg HS, Wager TD, Stohler CS, 50. Greene CS. Meprobamate therapy for the myofascial
Zubieta JK. Neurobiological mechanisms of the pla pain-dysfunction (M PD) syndrome: a double-blind
cebo effect. J Neurosci 2005;25:10390- 10402. evaluation. J Am Dent Assoc 1971;85:587-590.
34. Scott DS, Stohler CS, Egnatuk CM , Wang H, Koeppe 51. Laskin DM , Greene CS. Influence of the doctor-
RA, Zubieta JK. Individual differences in reward re patient relationship on placebo therapy for patients
sponding explain placebo-induced expectations with myofascial pain-dysfunction (M PD) syndrome.
and effects. Neuron 2007;55:325- 336. J Am Dent Assoc 1972;85:892- 894.
35. Scott DJ, Stohler CS, Egnatuk CM , Wang H, Koeppe 52. Greene CS, Laskin DM . Splint therapy for the myo
RA, Zubieta JK. Placebo and nocebo effects are fascial pain-dysfunction (M PD) syndrome: a com
defined by opposite opioid and dopaminergic re parative study. J Am Dent Assoc 1972;84:624-628.
sponses. Arch Gen Psychiatry 2008;65:220- 231. 53. Olson RE, Greene CS, Solar S. Comparison of two re
36. Wickramasekera I. A conditioned response model laxation training methods for the treatment of M PD
of the placebo effect predictions from the model. syndrome. AADR Abstract no. 998, 1980:518.
Biofeedback Self Regul 1980;5:5- 18. 54. Eisen RC, Kaufman A, Greene CS. Evaluation of
37. Polio A, Amanzio M , Arslanian A, Casadio C, physical therapy M PD syndrome patients. IADR
Maggi G, Benedetti F. Response expectancies in Abstract no. 1561, 1984:344.
placebo analgesia and their clinical relevance. Pain 55. Goodman P, Greene CS, Laskin DM . Response of
2001;93:77- 84. patients with myofascial pain-dysfunction syn
38. Benedetti F, Polio A, Lopiano L, Lanotte M, Vighetti S, drome to mock equilibration. J Am Dent Assoc
Rainero I. Conscious expectation and unconscious con 1976;92:755- 758.
ditioning in analgesic, motor, and hormonal placebo/ 56. Block LS. Diagnosis and treatment of disturbances
nocebo responses. J Neurosci 2003;23:4315-4323. of the temporomandibular joint, especially in re
39. Moerman DE, Jonas WB. Deconstructing the pla lation to vertical dimension. J Am Dent Assoc
cebo effect and finding the meaning response. Ann 1947;34:253- 260.
Intern Med 2002;136:471- 476.

57. Thompson JR. Concepts regarding function of 73. M edlicott M S, Harris SR. A systematic review of the
the stomatognathic system. J Am Dent Assoc effectiveness of exercise, manual therapy, electro
1954;48:626- 637. therapy, relaxation training, and biofeedback in the
58. Shore NA. Occlusal Equilibration and Temporoman management of temporomandibular disorder. Phys
dibular Joint Dysfunction. Philadelphia, PA: JB Lip- Ther 2006;86:955- 973.
pincott, 1959. 74. Dao TT, Lavigne GJ, Charbonneau A, Feine JS, Lund
59. Moulton RE. Emotional factors in non-organic tem JP. The efficacy of oral splints in the treatment of
poromandibular joint pain. Dent Clin North Am myofascial pain of the jaw muscles: a controlled
1966:609- 620. clinical trial. Pain 1994;56:85- 94.
60. Lupton DE. Psychological aspects of temporo 75. Turp JC, Komine F, Hugger A. Efficacy of stabiliza
mandibular joint dysfunction. J Am Dent Assoc tion splints for the management of patients with
1969;79:131- 136. masticatory muscle pain: a qualitative systematic
61. Greene CS, Laskin DM . Long-term evaluation of review. Clin Oral Investig 2004;8:179- 195.
treatment for myofascial pain-dysfunction syn 76. Al-Ani M Z, Davies SJ, Gray RJ, Sloan P, Glenny AM .
drome: a comparative analysis. J Am Dent Assoc Stabilisation splint therapy for temporomandibular
1983;107:235- 238. pain dysfunction syndrome. Cochrane Database
62. Mejersjo C, Carlsson GE. Analysis of factors influ Syst Rev 2004;(1):CD002778.
encing the long-term effects of treatment of TMJ 77. Al-Ani Z, Gray RJ, Davies SJ, Sloan P, Glenny AM .
pain-dysfunction. J Oral Rehabil 1984;11:289- 297. Stabilization splint therapy for the treatment of
63. Okeson JP, Hayes DK. Long-term results of treatment temporomandibular myofascial pain: a systematic
for temporomandibular disorders: an evaluation by review. J Dent Educ 2005;69:1242- 1250.
patients. J Am Dent Assoc 1986;112:473-478. 78. Ekberg EC, Sabet M E, Petersson A, Nilner M . Oc
64. Greene CS, Laskin DM . Long-term status of clicking clusal appliance therapy in a short-term perspec
in patients with myofascial pain and dysfunction. tive in patients with temporomandibular disorders
J Am Dent Assoc 1988;117:461- 465. correlated to condyle position. Int J Prosthodont
65. de Leeuw R, Boering G, Stegenga B, de Bont LG. 1998;11:263- 268.
Symptoms of temporomandibular joint osteoar 79. Ekberg E, Vallon D, Nilner M . Treatment outcome of
throsis and internal derangement 30 years after headache after occlusal appliance therapy in a ran
non-surgical treatment. Cranio 1995;13:81- 88. domised controlled trial among patients with tem
66. Beecher HK. The powerful placebo. J Am Med As poromandibular disorders of mainly arthrogenous
soc 1955;159:1602- 1606. origin. Swed Dent J 2002;26:115- 124.
67. Greene CS, Laskin DM . Temporomandibular disor 80. Ekberg E, Nilner M . A 6- and 12-month follow-up
ders: moving from a dentally based to a medically of appliance therapy in TM D patients: a follow-up
based model. J Dent Res 2000;79:1736- 1739. of a controlled trial. Int J Prosthodont 2002;15:
68. De Laat A, Stappaerts K, Papy S. Counseling and 564- 570.
physical therapy as treatment for myofascial pain 81. Ekberg E, Vallon D, Nilner M . The efficacy of appli
of the masticatory system. J Orofac Pain 2003;17: ance therapy in patients with temporomandibular
42- 49. disorders of mainly myogenous origin: a random
69. DeBar LL, Vuckovic N, Schneider J, Ritenbaugh C. ized, controlled, short-term trial. J Orofac Pain
Use of complementary and alternative medicine 2003;17:133- 139.
for temporomandibular disorders. J Orofac Pain 82. Ekberg E, Nilner M . Treatment outcome of appli
2003;17:224- 236. ance therapy in temporomandibular disorder pa
70. Raphael KG, Klausner JJ, Nayak S, Marbach JJ. tients with myofascial pain after 6 and 12 months.
Complementary and alternative therapy use by Acta Odontol Scand 2004;62:343- 349.
patients with myofascial temporomandibular disor 83. Ekberg EC, Nilner M . Treatment outcome of short-
ders. J Orofac Pain 2003;17:36- 41. and long-term appliance therapy in patients with
71. Kreiner M , Betancor E, Clark GT. Occlusal stabili TM D of myogenous origin and tension-type head
zation appliances: evidence of their efficacy. J Am ache. J Oral Rehabil 2006;33:713- 721.
Dent Assoc 2001;132:770- 777. 84. Dao TT, Lavigne GJ. Oral splints: the crutches for
72. Turp JC. Myoarthropathy of the temporomandib temporomandibular disorders and bruxism? Crit
ular joint and masticatory muscles: pain therapy Rev Oral Biol Med 1998;9:345- 361.
management and relaxation instead of aggressive
surgery. M M W Fortschr Med 2003;145:33- 35.

26
-

,
,
.
. ,
1990- .1 ,
.
, 1975 .
Onishi.2
1980- 1990- . ,
-

. .4 «
, » Dorrit Nitzan.1
,
,
. ,
,
.

3(
.1
). ,
:
•
, -
;
- •
. ( -
);
• ;

-
. 26-1. . 26-2.
,
• ;
• , ,
; .
• ,
( , ,
, ). , (Holmlund).
,
, -
, .
. ,
,
,
. ( . 26-2).

, 10-12
, ,6-6 2-3 ,
7 .8-12

-
.
. ,
,

2
1 , . .
.
,
, . 26-1. ,

1
. 26-3. . 26-4. . 26-5. 19-

, .
. , ,
. 19-
.13
, ,
( ( . 26-5).
).

, ( . 26-6).
,
2 ( . 26-3). ,
(2 ) .
19-
, ( . 26-4). ( . 26-7) .

( . 26-8).
,
,
, . ( . 26-9)

- , 500
. ( .
)
300
( ) 14 ( . 26-1 26-1 ).
. ,

-
. 26-6. - . 26-7.
. 26-8. . 26-9.
-
. 26-10 26- . ,

,
.16
.17 ,

,
. , - ,
,
, , - ,
. 26-11.
( 26-1).
.
,
,
,
( . 26-11). -

-
, ( / )( 26-2).
.915
,

5 . ,
,
, ( ) -

.12
26-2.
(
), /
26-1.

. +
.
•
• .
• +
Ilia. +
• . +
• . +
- ; -
; -

-
( ).

( . 5) ( ) .
,
,

. .

.
.23-26
.1819

. ,

.

. , .10-12'27

( .
6).
,
,
.

.28'29
( ,
, ), -
,
2.

.
. ,
, ,
.
( ) ,

.1820-22 .
,
.30

. ,
« »

, ,7
5 :8-12
, , - •
, , , ,
.3132 ,
.
• ,

.5 .

.
•

,
.
,
.
.833 .
,

, .
.
,
.
.34
,
,

.

, .

,
,
, .
@dentistinfo первый стоматологический телеграм канал 4 0 7

-
,
, ,

. ,

,
. -

.
.

.39
,
.

. ,

-
. ,
.35'36

-
10-12 .
,
.89
,
-

.8 ,
-
5 .12
.
,
.3738 , -
, ,

.
.12

,
.
- ,
.
,

15. Alkan A, Kilic E. A new approach to arthrocentesis
of the temporomandibular joint. Int J Oral M axil
1. Nitzan DW, Dolwick MF, M artinez GA. Temporo lofac Surg 2009,-38:85-86.
mandibular joint arthrocentesis: a simplified treat 16. Guarda-Nardini L, Manfredini D, Ferronato G. Ar
ment for severe, limited mouth opening. J Oral throcentesis of the temporomandibular joint: a
M axillofac Surg 1991 ;49:1163-1167. proposal for a single-needle technique. Oral Surg
2. Onishi M . Arthroscopy of temporomandibular joint. Oral Med Oral Pathol Oral Radiol Endod 2008; 106:
Kokubyo Gakkai Zasshi 1975;42:207- 213. 483—486.
3. Goudot P, Jaquinet AR, Hugonnet S, Haefliger W, 17. Manfredini D, Guarda-Nardini L, Ferronato G. Sin
Richter M . Improvement of pain and function after gle-needle temporomandibular joint arthrocentesis
arthroscopy and arthrocentesis of the temporoman with hyaluronic acid injections. Preliminary data
dibular joint: a comparative study. J Craniomaxillo- after a five-injections protocol. M inerva Stomatol
fac Surg 2000;28:39- 43. 2009;58:471- 478.
4. Emshoff R, Rudisch A. Temporomandibular joint 18. Nitzan DW. 'Friction and adhesive forces': pos
internal derangement and osteoarthrosis: are effu sible underlying causes for temporomandibular
sion and bone marrow edema prognostic indicators joint internal derangement. Cells Tissues Organs
for arthrocentesis and hydraulic distention? J Oral 2003;174:6- 16.
M axillofac Surg 2007;65:66- 73. 19. Sembronio S, Albiero AM , Toro C, Robiony M , Politi
5. Kunjur J, Anand R, Brennan PA, llankovan V. An M . Is there a role for arthrocentesis in recapturing
audit of 405 temporomandibular joint arthrocente the displaced disc in patients with closed lock of the
sis with intra-articular morphine infusion. Br J Oral temporomandibular joint? Oral Surg Oral Med Oral
M axillofac Surg 2003;41:29- 31. Pathol Oral Radiol Endod 2008;105:274- 280.
6. Brennan PA, llankovan V. Arthrocentesis for tem 20. Nitzan DW, M ahler Y, Simkin A. Intra-articular pres
poromandibular joint pain dysfunction syndrome. sure measurements in patients with suddenly de
J Oral M axillofac Surg 2006;64:949- 951. veloping, severely limited mouth opening. J Oral
7. Kopp S, Carlsson G, Haraldson T, Wenneberg B. M axillofac Surg 1992;50:1038- 1042.
The short-term effect of intra-articular injection of 21. M urakami K, Hosaka H, M oriya Y, Segami N, lizu-
sodium h yalu ron at e an d corticosteroid on temporo ka T. Short-term treatment outcome study for the
mandibular joint pain and dysfunction. J Oral M ax management of temporomandibular joint closed
illofac Surg 1985;43:429- 435. lock: a comparison of arthrocentesis to nonsurgical
8. Alpaslan GH, Alpaslan C. Efficacy of temporomandib therapy and arthroscopic lysis and lavage. Oral Surg
ular joint arthrocentesis with and without injection of Oral Med Oral Pathol Oral Radiol Endod 1995;80:
sodium hyaluronate in treatment of internal derange 253- 257.
ments. J Oral Maxillofac Surg 2001;59:613-618. 22. Al-Belasy FA, Dolwick MF. Arthrocentesis for the
9. Sato S, Oguri S, Yamaguchi K, Kawamura H, treatment of temporomandibular joint closed
Motegi K. Pumping injection of hyaluronic acid for lock: a review article. Int J Oral M axillofac Surg
patients with nonreducing disc displacement of 2007;36:773- 782.
the temporomandibular joint: two year follow-up. 23. Dimitroulis G, Dolwick MF, M artinez A. Temporo
J Craniomaxillofac Surg 2001 ;29:89- 93. mandibular joint arthrocentesis and lavage for the
10. Guarda-Nardini L, Tito R, Staffieri A, Beltrame A. treatment of closed lock: a follow-up study. Br J
Treatment of patients with arthrosis of the tem Oral M axillofac Surg 1995;33:23- 26.
poromandibular joint by infiltration of sodium hy 24. Hosaka H, Murakami K, Goto K, lizukaT. Outcome
aluronate: a preliminary study. Eur Arch Otorhino- of arthrocentesis for temporomandibular joint with
laryngol 2002;259:279- 284. closed lock at 3 years follow-up. Oral Surg Oral Med
11. Guarda-Nardini L, Masiero S, Marioni G. Conserva Oral Pathol Oral Radiol Endod 1996;82:501- 504.
tive treatment of temporomandibular joint osteoar 25. Nitzan DW, Samson B, Better H. Long-term out
throsis: intra-articular injection of hyaluronic acid. come of arthrocentesis for sudden-onset, persis
J Oral Rehabil 2005;32:729- 734. tent, severe closed lock of the temporomandibular
12. Guarda-Nardini L, Stifano M , Brombin C, Salmaso joint. J Oral Maxillofac Surg 1997;55:151- 157.
L, Manfredini D. A one-year case series of arthro 26. Alpaslan C, Dolwick MF, Heft M W. Five-year
centesis with hyaluronic acid injections for temporo retrospective evaluation of temporomandibu
mandibular joint osteoarthritis. Oral Surg Oral Med lar joint arthrocentesis. Int J Oral M axillofac Surg
Oral Pathol Oral Radiol Endod 2007;103:14- 22. 2003;32:263- 267.
13. Laskin DM . Needle placement for arthrocentesis. 27. Nitzan DW, Price A. The use of arthrocentesis for
J Oral M axillofac Surg 1998;56:907. the treatment of osteoarthritic temporomandibular
14. Kaneyama K, Segami N, Nishimura M , Sato J, joints. J Oral M axillofac Surg 2001;59:1154- 1159.
Fujimura K, Yoshimura FI. The ideal lavage volume
for removing bradykinin, interleukin-6, and protein
from the temporomandibular joint by arthrocent
esis. J Oral M axillofac Surg 2004;62:657- 661.

-
28. Gynther G, Holmlund A. Efficacy of arthroscopic 34. Guarda-Nardini L, Manfredini D, Ferronato G. To
lysis and lavage in patients with temporomandibu tal temporomandibular joint replacement: a clinical
lar joint symptoms associated with generalized os case with a proposal for post-surgical rehabilitation.
teoarthritis or rheumatoid arthritis. J Oral M axillofac J Craniomaxillofac Surg 2008;36:403- 409.
Surg 1998;56:147- 151. 35. Nitzan DW, Nitzan U, Dan P, Yedgar S. The role of
29. Trieger N, Hoffman CH, Rodriguez E. The effect of hyaluronic acid in protecting surface-active phos
arthrocentesis of the temporomandibular joint in pholipids from lysis by exogenous phospholipase
patients with rheumatoid arthritis. J Oral M axillofac A2. Reumatology 2001 ;40:336- 340.
Surg 1999;57:537- 540. 36. Nitzan DW, Kreiner B, Zeltser B. TM J lubrification
30. Yun PY, Kim YK. The role of facial trauma as a possi system: its effect on the joint function, dysfunction,
ble etiologic factor in temporomandibular joint dis and treatment approach. Compend Contin Educ
order. J Oral M axillofac Surg 2005;63:1576- 1583. Dent 2004;25:437- 444.
31. Alpaslan C, Bilgihan A, Alpaslan GH, Guner B, 37. Altman R, M oskowitz R. Intra-articular hyaluronic
Ozgiir Yis M , D. Effect of arthrocentesis and acid (hyalgan) in the treatment of patients with
sodium hyaluronate injection on nitrite, nitrate, and osteoarthritis of the knee: a randomized clinical
thiobarbituric acid-reactive substance levels in the trial. J Rheumatol 1998;25:2203- 2212.
synovial fluid. Oral Surg Oral Med Oral Pathol Oral 38. Kolarz G, Kotz R, Hochmayer I. Long-term benefits
Radiol Endod 2000;89:686- 690. and repeated treatment cycles of intraarticular hy
32. Kaneyama K, Segami N, Sato J, Fujimura K, Nagao aluronic acid (hyalgan) in patients with osteoarthritis
T, Yoshimura H. Prognostic factors in arthrocente of the knee. Semin Arthritis Rheum 2003;32:310-
sis of the temporomandibular joint: comparison of 319.
bradykinin, leukotriene B4, prostaglandin E2, and 39. Carroll , Smith K, Jakubowski J. Extradural hae-
substance P level in synovial fluid between success matoma following temporomandibular joint arthro
ful and unsuccessful cases. J Oral M axillofac Surg centesis and lavage. Br J Neurosurg 2000;14:152-
2007;65:242- 247. 154.
33. Yoda T, Imai H, Shinjyo Y, Sakamoto I, Abe M , Eno-
moto S. Effect of arthrocentesis on TM J disturbance
of mouth closure with loud clicking: a preliminary
study. Cranio 2002;20:18- 22.

27
-
( ) , .
- ,
( )
. ,
.
,
,
. .
,

. ,

.1
,
« »
,
. ,
.3
XX ,

.2 , 1970- .
-
, ,

. , .45
,
, ,67 ,

-
. 27-1. . . . .
.
-
.49 ( ),

1975 .,10 .16
( . 27-1). ,

, .
,
,

." 12 16 ( . 27-2).

1980- .
,
.13 .
,
,
. 1990- .
,

-
.
.14 , ,
.


. 27-2. - . . ,
. .
.
.
.
, 10 % -
.16
,
-
. . ,
, , , ,
,
- ,
. .
, -

,
, .
- ,
-
,
.
, .
- - ,
.917
,
,
. , ,
,
( . 27-3).9,16

-
. 27-3. . 27-4.
. 2
.
, -
.
.
18
.
.

, . ,
,
.
- .18
.16
,
, ,
. .
, , ,
.1819
.15

,

.17
,

27-1.
:
• ( );
• ( ,
);
• ( );
• ( ,
).
:
• ;
• ;
• .
:
•
. 27- 5. ;
•
,
.
:
6 - ;
-
. ;
-
;
-
.
:
•

( 27-1). 1994 . ;
•
Dolwick Dim itroulis9
;
•
.
,

,
;
•
( . 27-4), -
( . 27-5).

,
,20 .
, ,917
,
,
,
, .2
,
.
,

-
. 27- 6. . 27- 7. . 27- 8.

,

.17
, .9
,
.

,
. ,
,
, .17
, ,
, ,
. , -
, ,
. .
-

,
,
,
, .1819

. 27-9. . 27-10. . 27-11. 2

( 5-0) ,

24 ,
( . 27-10).
.
( . 27-11) ,
, -
( . 27-6). .

,
( . 27-7 27-8), ,
.21 .16
- , ,21 ,

,
.
.
,
.
, . ,
,
( 5-0) ( . 27-9), , ,
.
.

-
. 27-12.

.929

,
.30
.916
( . 27-12)
, ,31-33 . .
.22 ( . 27-13).
,
,
.22-26 , 20-
,34-38 ,
- ,

, .2226 ,
.39^ 1
10 27
-
,
, , .
- (Teflon-proplast)
.12'1428 (Silastic),
,
.13-42
,
,

,

. 27-13.

. 27-14. . -
.
. -
-
2
.19'43
.47 Dimitroulis48
,
,44

.45 .19

-
,46
, ,
.19 .49
,
,
,

-
. 27-15.
.
( ; Lorenz)

.
,

( ; Biom et )
.
,
. .4360 -

,
-
,
, .

. -
,
,
( . 27-15). ,
.
.51 ,
.
,
,
.
.
,
, - .
( . 27-14),


27-2. , ,
,
:
, .43
• :
- ;
8-10 ,
- ;
.
•
,
;
, 40-50 ,
• ;
•
-
.
.
:
,
•
,
;

• :
,
- ;
- , ;
• .
. ,
:
• ;
• ;
-
• :
, ,
- ;
,- ,
- .

• ( ):
,
- ;
- ;
.
- .
:
•
;
•
;
• -
.
, ,
.52 ,
,
( 27-2).54

,
, Guarda-
Nardini .53 , . ,
,
.

-
-
, .
.

,
,
1. Al-Belasy FA, Dolwick MF. Arthrocentesis for the
. treatment of temporomandibular joint closed
lock. A review article. Int J Oral M axillofac Surg
, 2007;36:773- 782.
2. Dimitroulis G. Temporomandibular disorders: a clin

ical update. Brit Med J 1998;317:190- 194.
, 3. Merrill RG. Historical perspectives and comparisons
. of temporomandibular joint surgery for internal de
rangements and arthropathy. J Craniomandibular
Pract 1986;4:74- 85.
4. Dolwick MF, Katzberg RW, Helms CA. Internal de
rangement of the temporomandibular joint: fact or
, fiction? J Prosthet Dent 1983;49:415- 418.
. 5. Farrar WB. Diagnosis and treatment of anterior
dislocation of articular disc. N Y J Dent 1971 ;41:
348- 351.
, 6. Dolwick MF, Nitzan DW. TM J disk surgery: 8-year
, follow-up evaluation. Fortschr Kiefer Gesichtschir
. 1990;35:162- 167.
7. Dolwick MF, Nitzan DW. The role of disc reposi
tioning su rgery fo r internal derangements o f the
temporomandibular joint. Oral M axillofac Surg Clin
North Am 1994;6:271- 275.
8. M cCarty W L, Farrar WB. Surgery for internal de
rangement of the temporomandibular joint. 1 Pros
thet Dent 1979;42:191- 196.
9. Dolwick MF, Dimitroulis G. Is there a role for tem
poromandibular joint surgery? Brit J Oral M axillofac
Surg 1994;32:307- 313.
10. Onishi M . Arthroscopy of the temporomandibular
, joint [Japanese]. J Jpn Stomat 1975;42:207- 212.
11. Dimitroulis G. A review of 56 cases of chronic closed
lock treated with temporomandibular joint arthros
copy. J Oral M axillofac Surg 2002;60:519- 524.
. ,
12. Holmlund AB, Gynther GW, Axelsson S. Efficacy of
, arthroscopic lysis and lavage in patients with chron
ic locking of the temporomandibular joint. Int J Oral
, M axillofac Surg 1994;23:262- 265.
13. Kaplan PA, HK, Williams SM . Erosive arthritis of
the temporomandibular joint caused by Teflon-Pro-
. plast implants: plain film features. Am J Roentgenol
1988;151:337- 340.
, 14. Nitzan DW, Samson B, Better H. Long-term out
come of arthrocentesis for sudden-onset, persis
, tent, severe closed lock of the temporomandibular
. , joint. J Oral M axillofac Surg 1997;55:151- 157.
15. Larheim . Role of magnetic resonance imaging
in the clinical diagnosis of the temporomandibular
joint. Cells Tissues Organs 2005;180:6- 21.
. 16. Dolwick MF, Sanders B. TMJ Internal Derangement and
- Arthrosis - Surgical Atlas. St. Louis, M O: Mosby, 1985.

17. Dimitroulis G. The role of surgery in the manage 35. Hansson LG, Eriksson L, Westesson P-L. Magnetic
ment of disorders of the temporomandibular joint: resonance evaluation after temporomandibular
a critical review of the literature: Part 1. Int J Oral joint diskectomy. Oral Surg Oral Med Oral Pathol
M axillofac Surg 2005;34:107- 113. 1992;74:801- 810.
18. Reston JT, Turkelson CM . Meta-analysis of surgical 36. Silver CM L. Long-term results of menisectomy of
treatments for temporomandibular articular disor the temporomandibular joint. J Craniomandibular
ders. J Oral M axillofac Surg 2003;61:3- 10. Pract 1984;3:46- 49.
19. Dimitroulis G. The role of surgery in the manage 37. Takaku S, Toyoda T. Long-term evaluation of dis
ment of disorders of the temporomandibular joint: cectomy of the temporomandibular joint. J Oral
a critical review of the literature: Part 2. Int J Oral M axillofac Surg 1994;52:722- 726.
M axillofac Surg 2005;34:231- 273. 38. Tolvanen M , Oikarinen VJ, Wolf J. A 30 year follow
20. Dimitroulis G. Condylar injuries in growing patients. up study of temporomandibular joint meniscecto
Aust Dent J 1997;42:367- 371. mies: a report of 5 patients. Br J Oral M axillofac
21. Al Kayat A, Bramley P. A modified pre-auricular ap Surg 1988;26:311- 313.
proach to the temporomandibular joint and malar 39. Agerberg G, Lundberg M . Changes in the temporo
arch. Br J Oral Surg 1979;17:91- 103. mandibular joint after surgical treatment. A radio
22. Dolwick MF. Disc preservation surgery for the treatment logical follow-up study. Oral Surg Oral Med Oral
of internal derangements of the temporomandibular Pathol 1971;32:865- 875.
joints. J Oral Maxillofac Surg 2001 ;59:1047-1050. 40. Eriksson L, Westesson P-L. Temporomandibular
23. Conway WF, Hayes CW, Campbell RL, Laskin DM , joint discectomy. Oral Surg Oral Med Oral Pathol
Swanson KS. Temporomandibular joint after me- 1992;74:259- 272.
niscoplasty: appearance at M R imaging. Radiology 41. Hinton RJ. Alteration in rat condylar cartilage follow
1991;180:749- 753. ing discectomy. J Dent Res 1992;71:1292- 1295.
24. Kaplan PA, Reiskin A, H. Temporomandibular 42. Westesson P-L, Eriksson L, Lindstrom C. Destructive
joint arthrography following surgical treatment of lesions of the mandibular condyle following diskec
internal derangement. Radiology 1987;163:217. tomy with temporary silicone implant. J Oral M axil
25. Montgomery MT, Gordon SM , Van Sickels JE, lofac Surg 1989;47:1290- 1293.
Harms ST. Changes in signs and symptoms follow 43. Macintosh RB. The use of autogenous tissues for
ing temporomandibular joint disc repositioning sur temporomandibular joint reconstruction. J Oral
gery. J Oral M axillofac Surg 1992;50:320- 328. M axillofac Surg 2000;58:63- 69.
26. Bosanquet AG, Ishimaru J, Goss AN. Effect of fas 44. Dimitroulis G, Lee DK, Dolwick MF. Autogenous ear
cia repair of the temporomandibular disk of sheep. cartilage grafts for treatment of advanced temporo
Oral Surg Oral Med Oral Pathol 1991;72:520- 523. mandibular joint disease. Ann R Australas Coll Dent
27. Nitzan DW, Dolwick MF, Martinez GA. Temporo Surg 2004;17:87- 92.
mandibular joint arthrocentesis: a simplified treat 45. Dimitroulis G, Slavin J. Histological evaluation of full
ment for severe, limited mouth opening. J Oral thickness skin as an interpositional graft in the rab
M axillofac Surg 1991 ;49:1163-1167. bit craniomandibular joint. J Oral M axillofac Surg
28. Dolwick MF, Dimitroulis G. A re-evaluation of the 2006;64:1075- 1080.
importance of disc position in temporomandibular 46. Feinberg SE. Use of composite temporalis muscle
disorders. Aust Dent J 1996;41:184- 187. flaps for disc replacement. Oral M axillofac Clin
29. Revington PJD. The Dautrey procedure - a North Am 1994;6:335- 337.
case for reassessment. Br J Oral M axillofac Surg 47. Dimitroulis G. The use of dermis grafts after discec
1986;24:217- 220. tomy for internal derangement of the temporoman
30. Henny FA, Baldridge OL. Condylectomy for the dibular joint. J Oral M axillofac Surg 2005;63:173-
persistently painful temporomandibular joint. J Oral 178.
Surg 1957;15:24- 31. 48. Dimitroulis G. The interpositional dermis-fat graft in
31. Holmlund AB, GyntherGW, Axelsson S. Diskectomy the management of temporomandibular joint anky
in treatment of internal derangement of the tem losis. Int J Oral M axillofac Surg 2004;33:755- 760.
poromandibular joint. Follow-up at 1,3 and 5 years. 49. Allen KD, Athanasiou KA. Tissue engineering of
Oral Surg Oral Med Oral Pathol 1993;76:266- 271. the TM J disc: a review. Tissue Eng 2006;12:1183-
32. M cKenna SJ. Discectomy for the treatment of inter 1196.
nal derangements of the temporomandibular joint. 50. Politis C, Fossion E, Bossuyt M . The use of costo
J Oral M axillofac Surg 2001 ;59:1051- 1056. chondral grafts in arthroplasty of the temporoman
33. Nyberg J, Adell R, Svensson B. Temporomandibular dibular joint. J Craniomaxillofac Surg 1987;15:345-
joint diskectomy for treatment of unilateral internal 354.
derangements - a 5 year follow-up evaluation. Int J 51. Baltalti E, Keller EE. Surgical management of ad
Oral M axillofac Surg 2004;33:8- 12. vanced osteoarthritis of the temporomandibular
34. Eriksson L, Westesson P-L. Long-term evaluation joint with metal fossa-eminence hemijoint replace
of menisectomy of the temporomandibular joint. ment: 10 year prospective study. J Oral M axillofac
J Oral M axillofac Surg 1985;43:263- 269. Surg 2008;66:1847- 1855.

-
52. Mercuri LG. The use of alloplastic prostheses for 54. Vallerand WP, Dolwick MF. Complications of tem
temporomandibular joint reconstruction. J Oral poromandibular joint surgery. Oral M axillofac Surg
M axillofac Surg 2000;58:70- 75. Clin North Am 1990;2:481- 488.
53. Guarda-Nardini L, Manfredini D, Ferronato G. Tem
poromandibular joint total replacement prosthesis:
current knowledge and considerations for the fu
ture. Int J Oral M axillofac Surg 2008;37:103- 110.

Глава 28
Ян Де Бовер и Антоон Де Паат

.23
-
( ) -
(Costen) 1934 .1 . , ,
,
,
- .
( ).
, .
,

,
. . ,«
» ,
,
, -
, ,
.4-6
. ,
,

, ,

. 1970- . .7
, ,
,
20 ,

-
. ,

, .” ,
, 5% ,
. ,
,
:
•
( .16
) ?

,
?
• . ,
? ,
•
.17'18
? ,
• , , ,
, ,
, ,
? .19
• ,
.20
? ,
,

.18

,
( ) ?
(
).2122

? ,
, .

.2324 ,
,8-12 ,
, ,
- ,
.13'14 8-18 % ,
Witter .,15 , ,

. Bergendahl M agnusson27
6-9-

-
, , ,
, .30-32
78 % ,
,
(Di = 0 1). Hammad .28 .
20 ,
,

. .

,
.
. , •
.
,
:
•
, . ,
. .
• ,
.33
.
,
?
, .
• , ,
,

.
.34
.29 ,
• ,
,

.35
,
.13 , .

.
. ,
, ,
( ,
. ,
), , 25 % ,

-
, ,

,
.
.
,
, ,
.36
.
. •
XX
(
,
)
. . ,
43 %
.
« •
» . ,
, ,

.37
.
, , ,
, , ,
.
,

.40
.38'39

: ,
•
.
,
-
. .
• ,

(
)
,
.
• ,
, .
-

-
, (
( ) , ) .
.41 ( ,
• ,
. .),
.
. ,

.43

. .
, ,
,
,
, ,
( [ ] > 10).41 .
• .
,
,
, , .44
.
•
.45 Luder,46

.

. ,
.
.47
.
.
,
,
.42
.

,
?

, ,
( ),
( ) ,
.
,

-

. , ,
,
(
, , ).

.4849
, .
:
•
,
. ,

,
.
- ?

,
. .
•
,
, ,
.
,
.
• .60
,
,
,

,
.
.
,
.
• ,
,
.51
,
,
.
• .
,

. .62-64

-
.55 .
, •
,
,
, .
• .
.53'5657
,
,
.61
, •
( )
.
,
, , ,
, .62-63

.58
, .
- ,

.

, ,
, ?
.5960
, ,
, ,
, .
- - ,
( . 7).
, ,
- , , .
,
.56 -
. ,
:
• , , ,
,
, ,
, .64

.65
.
,

-

. ( .
)
,
,

,

.66 45 , 20-
( . 28-1-28-4)
.
,
• 45 ,
,
, •
.67 •
,
•
.
, • :
-
.
, - :
28
,
. Raustia .68

.
•
- .
.
,
, ,
. • , ,
•
.
4
. , , • ;

. 28-1 -28-1 .
. 28-2.
. 28- 28- .
. 28-4. 17
• : 37 , 5

• ,
•
• :
,
• : ,
• : ,
. ,
• : 3- 4
;

-
. 28-5 28-5 .
. 28-6. . 28-7 28-7 . .

18
, ,

• +7 . 1
, • +18 . - ,
• +10 .
; 45
, -
.
;

-
4
, - ,
. ,

,
, 5
. 3 .

.
18- • (
)
( •

) ,
,
.
. •

, •
. • :

( . 28-5-28-8)
• ,
• 40 , , , ,
,
(Dentatus)
• (. .
• )
• •
2
• :
- •
, (1 )
- •
- •
48 , (
)

-
20 7. De Boever JA, Nilner M , Orthlieb JD, Steenks M H.

Recommendations by the EACD for examina
•
tion, diagnosis, and management of patients with
; temporomandibular disorders and orofacial pain
4 by the dental general practitioner. J Orofac Pain
2008;17:268- 278.
8. Ciancaglini R, Gherlone EF, Radaelli G. Unilateral
temporomandibular disorder and asymmetry of oc
• clusal contacts. J Prosthet Dent 2003;89:180- 185.
• 9. Budtz-Jorgensen E, Luan W M , Holm-Pedersen P.
M andibular dysfunction related to dental, occlusal
and prosthetic conditions in a selected elderly popu
• lation. Gerodontics 1985;1:28- 32.
10. Ciancaglini R, Gherlone ER Radaelli G. Association
between loss of occlusal support and symptoms of
functional disturbances of the masticatory system.
J Oral Rehabil 1999;26:248- 253.
11. Sarita PT, Kreulen CM , Witter D, Creugers NH.

Signs and symptoms associated with TM D in adults
with shortened dental arches. Int J Prosthodont

2003;16:265- 270.
. 12. Seedorf H, Seetzen F, Scholz A, Sadat-Khonsari M R,
Kirsch I, Jude H D. Impact of posterior occlusal
support on the condylar position. J Oral Rehabil
2004;31:759- 763.
. , 13. De Kanter R, Truin GJ, Burgersdijk RCW, Van 't Hop
M A, Battistuzzi PG, Kalsbeek H et al. Prevalence in
, the Dutch adult population and a meta-analysis of
signs and symptoms of temporomandibular disor
ders. J Dent Res 1993;72:1509- 1518.
. 14. De Boever JA, Adriaens PA. Occlusal relation
ship in patients with pain-dysfunction symptoms
in the temporomandibular joints J. Oral Rehabil
1984;10:1- 8.
15. Witter DJ, Kreulen CM , M ulder J, Creugers NH.
Signs and symptoms related to temporomandibular
disorders: follow-up of subjects with shortened and
1. Costen JB. A syndrome of ear and sinus symptoms complete dental arches. J Dent 2007;35:521- 527.
dependent upon disturbed function of the tem 16. Wilding RJ, Owen CP. The prevalence of tem
poromandibular joint. Ann Otol Rhinol Laryngol poromandibular joint dysfunction in edentulous
1934;43:1- 15. non-denture wearing individuals. J Oral Rehabil
2. Gerber A. Kiefergelenk und Zahnokklusion. Dtsch 1987;14:175- 182.
Zahnarztl Z 1971;26:119- 141. 17. Osterberg, T, Carlsson GE. Relationship between
3. Weinberg LA. The role of condylar position in symptoms of temporomandibular disorders and
TMJ-dysfunction-pain syndrome. J Prosthet Dent dental status, general health, psychosomatic factors
1979;41:636- 643. in two cohorts of 70-year-old subjects. Gerodontol-
4. Boering G. Temporomandibular joint osteoarthrosis: ogy 2007 24:129- 135.
an analysis of 40 cases - a clinical and radiographic 18. Hiltunen K, Vehkalahti M , Ainamo A. Occlusal im
investigation. Doctoral thesis. Groningen: Gronin balance and temporomandibular disorders in the
gen University, 1966. elderly. Acta Odontol Scand 1997;55:137- 141.
5. De Leeuw R, Boering G, Stegenga B, De Bont LG. 19. Schmitter M , Rammelsberg P, Hassel A. The preva
Clinical signs of TM J osteoarthrosis and internal lence of signs and symptoms of temporomandib
derangement 30 years after nonsurgical treatment. ular disorders in very old subjects. J Oral Rehabil
J Orofac Pain 1994;8:18- 24. 2005;32:467- 473.
6. Murakami K, Kaneshita S, Kanoh C, Yamamura I. 20. Hiltunen K, Peltola JS, Vehkalahti M , Narhi T, Aina
Ten-year outcome of nonsurgical treatment for the mo A. A 5-year follow-up of signs and symptoms of
internal derangement of the temporomandibular TM D and radiographic findings in the elderly. Int J
joint with closed lock. Oral Surg Oral Med Oral Prosthodont 2003;16:631- 634.

21. Wolfart S, Heydecke G, Luthardt RG, Marre B. Ef 36. Mongini F, Ibertis F, Manfredi A. Long-term results
fects of prosthetic treatment for shortened dental in patients with disk displacement without reduction
arches on oral health-related quality of life, self- treated conservatively. Cranio 1996;14:301- 305.
reports of pain and jaw disability: results from the 37. M oloney F, Howard JA. Internal derangements of
pilot-phase of a randomized multicentre trial. J Oral the temporomandibular joints. Part III: anterior re
Rehabil 2005;32:815- 822. positioning therapy. Aust Dent J 1986;30:39- 44.
22. Baba K, Igarashi Y, Nishiyama A, John MT, Akagawa 38. Ohnuki T, Fukuda M , Nagai H, Takahashi T, Sassano
Y. Patterns of missing occlusal units and oral health- T, Myamoto Y. Evaluation of the position, mobility
related quality of life in SDA patients. J Oral Rehabil and morphology of the disc before and after four dif
2008;35:621- 628. ferent treatments for temporomandibular disorders. J
23. Hobo S. Occlusion in temporomandibular disorders: Dentomaxillofac Radiology 2006;35:103-109.
treatment after occlusal splint therapy. Int Dent J 39. Schmitter M , Zabran M , PhuDuc JM , Henschel V,
1996;46:146- 155. Rammelsberg P. Conservative therapy in patients
24. Fuji T. Occlusal conditions just after the relief of with anterior disc displacement without reduction
temporomandibular joint and masticatory muscle using 2 common splints: a randomized clinical trial.
pain. J Oral Rehabil 2002;29:323- 329. J Oral Maxillofacial Surg 2005;63:1295- 1303.
25. Wedel A. Heterogeneity of patients with crani 40. Steenks M H, The GL, Aaftink HM . Jaw position
omandibular disorders: a longitudinal study. Swed in stabilization splint treatment for musculoskel
Dent J Suppl 1988;55:1- 51. etal disorders [in Dutch]. Nederl Tijdschr Tandheelk
26. Peltona M K, Raustia AM , Salonen M AM . The effect 2005;112:279- 282.
of stomatognathic treatment: a clinical follow-up 41. Pullinger AG, Seligman DA. Quantification and vali
study. J Craniomandibular Pract 1997;24:419. dation of predictive values of occlusal variables in
27. Bergendhal T, Magnusson T. Changes in signs and temporomandibular disorders using a multifactorial
symptoms of temporomandibular disorders follow analysis. J Prosthet Dent 2000;83:66- 75.
ing treatment with implant supported fixed pros- 42. De Boever JA, Carlsson GE. Temporomandibular
theses: a prospective -year follow-up. Int J Prost disorders and the need for prosthetic treatment.
hodont 2000;13:302. In: Owall B, Kayser AF, Carlsson GE (eds). Prost-
28. Hammad IA, Nassif NJ, Salameh ZA. Full-mouth hodontics: Principles and M anagement Strategies.
rehabilitation following treatment of temporoman London: Mosby-Wolfe, 1996:97- 110.
dibular disorders and teeth-related signs and symp 43. Seligman DA, Pullinger AG. Association of occlusal
toms. Cranio 2005;23:289- 296. variables among TM D patient diagnostic groups.
29. Plesh O, Stohler CS. Prosthetic rehabilitation in J Craniomandib Disord 1989;3:227- 236.
temporomandibular disorder and orofacial pain pa 44. Kapila S. Biology of TM J degeneration: the role of
tients: clinical problem solving. Dent Clin North Am matrix-degrading enzymes. In: McNeill C. Science
1992;36:581- 589. and Practice of Occlusion. Chicago, IL: Quintes
30. Pahkala RH, Laine-Alava MT. Do early signs of sence, 1997:235- 258.
oral dysfunctions and occlusal variables predict de 45. Broussard JS. Derangement, osteoarthrosis and
velopment of TM D in adolescence. J Oral Rehabil rheumatoid arthritis of the temporomandibular
2002;29:737- 743. joint: implications, diagnosis, and management.
31. Gesch D, Bernhardt O, Kocher T, Hohn U, Hensel E, Dent Clin North Am 2005;49:327- 348.
Alte D. Association of malocclusion and functional oc 46. Luder HU. Factors affecting degeneration in human
clusion with signs of temporomandibular disorders in temporomandibular joints as assessed histologically.
adults: results of a population-based study of health in Eur J Oral Sci 2002;110:106- 113.
Pomeriana. Angle Orthod 2004;74:512-520. 47. De Pablo P, Dietrich T, McAlidon . Association
32. Magnusson T, Egermark I, Carlsson GE. A prospec between periodontal disease and tooth loss with
tive investigation over two decades on signs and rheumatoid arthritis in US population. J Rheumatol
symptoms of temporomandibular disorders and as 2008;35:70- 76.
sociated variables: a final summary. Acta Odontol 48. De Boever JA, Carlsson GE, Klineberg IJ. Need for
Scand 2005;63:99- 109. occlusal therapy and prosthodontic treatment in the
33. Hagag G, Yoshida K, M iura H. Occlusion, prost management of temporomandibular disorders. Part
hodontic treatment and temporomandibular disor II: Tooth loss and prosthodontic treatment. J Oral
ders: a review. J Med Dent Sci 47:61- 66. Rehabil 2000;27:647- 659.
34. Stohler CS. Disk-interference disorders. In: Zarb GA, 49. Ardic F, Gokharman D, Atsu S, Guner S, Yilmaz M ,
Carlsson GE, Sessle BJ, Mohl ND (eds). Temporo Yorganicioglu R. The comprehensive evaluation of
mandibular Joint and Masticatory Muscle Disorders. temporomandibular disorders seen in rheumatoid
Copenhagen: Munksgaard, 1994:271. arthritis. Aust Dent J 2006;5:23- 28.
35. Kononen M , Waltimo A, Nystrom M . Does clicking 50. Johansson A, Johansson AK, Omar R, Carlsson GE.
in adolescence lead to painful temporomandibular Rehabilitation of the worn dentition. J Oral Rehabil
joint locking? Lancet 1996;347:1080- 1081. 2008;35:548- 566.

-
51. Ainamo A. The continuous eruption of the teeth in 61. Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael
adult man and its influence on the width of the ana K. Bruxism physiology and pathology: an overview
tomical attached gingiva. Doctoral thesis. Helsinki: for clinicians. J Oral Rehabil 2008;35:476- 494.
University of Helsinki, 1977. 62. Carlsson GE, Egermark I, Magnusson T. Predic
52. Ramfjord SP, Blankenship JR. Increased verti tors of signs and symptoms of temporomandibular
cal dimension in adult monkeys. J Prosthet Dent disorders: A 20-year follow-up study from child
1981;45:78- 83. hood to adulthood. Acta Odontol Scand 2002;60:
53. De Boever JA, Adriaens PA, Seynhave T. Raising the 180-185.
vertical dimension of occlusion with fixed bridges 63. Seligman DA, Pullinger AG. Dental attrition models
[abstract], J Dent Res 1989;68:902. predicting temporomandibular joint disease or mas
54. Gross M , Ormianer Z. A preliminary study on the ticatory muscle pain versus asymptomatic controls.
effect of occlusal vertical dimension increase on J Oral Rehabil 2006;33:789- 799.
mandibular rest position. Int J Prosthodont 1994;3: 64. Dervis E. Changes in temporomandibular disorders
216- 221. after treatment with new complete dentures. J Oral
55. Hellsing G. Functional adaptation to changes in ver Rehabil 2004;31:320- 326.
tical dimension. J Prosthet Dent 1984;52:867- 870. 65. Lambardakis L, Kazakis HC. Changes in the man
56. Dahl B, 0ilo G. Wear of teeth and restorative ma dibular rest position after removal of remain
terials. In: Owall B, Kayser AF, Carlsson GE (eds). ing teeth and the insertion of complete dentures.
Prosthodontics: Principles and M anagement Strate J Prosthet Dent 1992;68:74- 77.
gies. London: M osby-Wolfe, 1996:187- 200. 66. Palla S. Occlusal considerations in complete dentures.
57. Rivera-Morales W C, Mohl ND. Relationship of oc In: McNeill C (ed). Science and Practice of Occlusion.
clusal vertical dimension to the health of the masti Chicago, IL: Q u in t essen ce, 1997:457-467.
catory system. J Prosthet Dent 1991 ;65:547- 553. 67. Amorim VC, Lagana DC, De Paula E, Zanetti A.
58. Mizrahi B. The Dahl principle: creating space and Analysis of the condyle/ fossa relationship before
improving the biomechanical prognosis of anterior and after prosthetic rehabilitation with maxillary
crowns. Quintessence Int 2006;37:245- 251. complete dentures and mandibular removable par
59. Svensson P, Jadidi F, Arim aT, Baad-Hansen L, Sessle tial dentures. J Prosthet Dent 2003;89:508- 514.
BJ. Relationships between craniofacial pain and 68. Raustia AM , Peltola M , Salonen M AM . Influence
bruxism. J Oral Rehabil 2008;35:524- 547. of complete denture renewal on craniomandibular
60. Chen CY, Palla S, Erni S, Sieber M , Gallo LM . Non disorders: a 1-year follow-up study. J Oral Rehabil
functional tooth contact in healthy controls and 1997;24:30.
patients with myogenous facial pain. J Orofac Pain
2007;21:185- 193.

29
-
( ) , .
. ,

.
. ,

, .
,

.
:
.

1987 . 1930- .
(Brimm v. M alloy).1
,
, 16- , .23
. Brodie,2'3
Perry,45 M oyers,6 Thom pson7"9 Ricketts.10
« - »
.
. 1970- .

, (Ronald . Roth),1112

- ( ), ,
,
. ,

-
. ,
( ) .

.11' 15
.35-42
,

(Angle)16'17 (And rews),18 ,

. ,
.
,

( ). .43
,
,
,
( ) .
. , ,
.
,
, ,
.
.11'12 ,
,
( )
.18-26 , ,
,
,
,
.22 .
, -
,

.22
, -

, .26-35 ,
,

.23 , .44^16 Clark
, Evans,47
. ,
.


100 . ,
, .
-
.
.44
,
,

. ,
.60 ,

,
.
, ,
.3551 ,
-
( ) ,
.14'15'48 ,52

,44 , , ,
, ,
. , ,
- , . ,
. ,
M cNamara ,49 ,
,
, .44
.
,
.
, .

-
, .44
,
,
,
.44 ,

100
.

-

50 . - .
, ,
- -
( . ,
).53 ,
« .
» . ,
Johnston , ,
.
, ,
, - ,
.64 : « ,
, ,
.27"30'58
. ,
,
».54
( )
. ,
4 , , -
, -
.43 : « 30
- .
,
».55 , -
, .
,
,
- , .
, , , ,
.53 ,
,
.4356 ,
,

, ,
, , , .60
, 29-1.

.23'24'53'57~53
, ,
-
, . , ,

29-1. 29-2.
• • ( )
, ,
• ?
• « »
?
• , - •
( )
?
• •
?
•
• , ?
•
?
• •
?
• •
, , ,
?
•
• ? ,
?
•
,

•
.

,
( 29-2).2256 ,
•
( 29-3).22
•

,
.22
•
, ?
•
,
, .5360 ,
, ?
• ?

-
29- 3. ,
.
-
1.
,
,
2.
,
.
3.
,
(
4.
) ,

5.
, ,
,
6. ,
. ,
,

,
(
.61-63 ,
), ,

,
.

7. ,
.23'2633'36'49

.
,
, : -
,
, , , .
. , ,
.6566 I
- , II .
,
,
,
. .
.
,
,
- .
-
- (
)
( ,
).
, ( II),
. , ,
.66
.61-64


, .67 ,
,
, .
. ,
,
(
, ), .
.

( )
. .68-70
Watt,69 ,
, , ,
, ,
, ,
.67 ,
,
,
.
, , ,
-
.
. , ,

,
- -
.
.68'7071 ,
,7273
( , .
) , ,
,
, (
, , ).
,
, ,
.
.
20-30
.
,74
,3132 , ,
. .

-
,
,

. , , 30 %
-
( ) .57'7779'80
, ,
.
12, ,
. .
, ,
,
.75 (

).

.76 ,
.81-83 ,

,
,
.53 ,
, ,

.8486
.74-77 ,
,

,
.78
, .86 ,

- , . .
( ),
,
. .84 , ,
,

, -
.84'86

- . .

.87-88 .94^98 ,

. ,
, .77'79'86

.
,
« » , .
. , ,

87.
,
,
,
- , ,
.9091 -
( )
.

,
, ,
,
.9293 ,
, .99-101

, ,
. ,
, , -
, , ,
, ,
.86-86
.101
, ,

.6488'94 ,
II
, ,
,
. , .

-
.102
.105'106
,
. ,
.
,
,
. Greene Laskin,
,
.
.70
. ,
-

-
- ,
, , « ».22'56'64,107'108
,
,
,
.102
. ,

. , .2256'64
,
(
, ,
,
)
-
(

)
.103 ,

, -
, .19'25'109-112 ,
.104
.
,
,
. .

-

.
,
.
,
(
, )
( ,
).
,
.
,
,
,
, , ,
, .
, - .
.
,
.63
,
.
,
,
( . 29-1 29-1 ).
( -
) .
.
, ,

, ,

( ,
. -115 , . .).

, -
.63
( ,
),
.
.
,

.116'117 ,

-
. 29-1 29-1 . , -
. 29-2 29-2 . .
. ,
,

(
)( . 29-2 29-2 ).
.
, ,
,

, .
.63 ,
, -
.
, ,
,
, ( )
,

. ,

Выводы

. ( )
, .120
20-30 ,
.
, .121-125
.3132
, ,
( )
« -
»
.
. ,

, .

( 29-4). ,

. .
,
,
, ,22'56'62'67'109118 .
,
( ; transcutaneous nerve .
stimulation, TEN S),
, ,
. .
,
( ; Dr. ,
Michael Powers, SonicTechnology),

.119 , .

, , , ,
, .
,
.
,
( ) ( )

-
29-4.
• : ( , );
- , , ;
, , ; ;
. ;
- .
, . •
( ( ):
.
.) .
• :
,
.
( , .
,

, .
).
,
- « ». II.
• : , • :
( 20 (
3-4 ); )
. ,
.
. : , , ,
• ( ): ,
, ,
,
, . .
, , ,
.
,
; .
, .
1. Pollack, . Cases of note: Michigan jury awards

$850,000 in ortho case: a tempest in a teapot. Am
(Charles S. Greene) J Orthod Dentofacial Orthop 1988;94:358- 360.
- (Lysle . Jo h n 2. Brodie AG. Differential diagnosis of joint conditions
in orthodontia. Angle Orthod 1934;4:160- 176.
ston Jr.) ,
3. Brodie AG. The temporo-mandibular joint. III. Dent
J 1939;8:2- 12.
, 4. Perry HT Jr. Principles of occlusion applied to modem
. orthodontics. Dent Clin North Am 1969;13:581-590.

5. Perry . Temporomandibular joint and occlusion. 25. Rinchuse DJ, M cMinn J. Summary of evidence-
Angle Orthod 1976;46:284- 293. based systematic reviews of temporomandibu
6. Moyers RE. An electromyographic analysis of cer lar disorders. Am J Orthod Dentofacial Orthop
tain muscles in temporomandibular movement. Am 2006;130:715- 720.
J Orthod 1950;36:481- 515. 26. Reynders RM. Orthodontics and temporomandibu
7. Thompson JR The rest position of the mandible and lar disorders: a review of the literature (1966-1988).
its significance to dental science. J Am Dent Assoc Am J Orthod Dentofacial Orthop 1990;97:463^ t67.
1946;33:151- 180. 27. Gianelly AA, Hughes HM , Wohlgemuth P, Gildea C.
8. Thompson JR. Concepts regarding function of Condylar position and extraction treatment. Am J
the stomatognathic system. J Am Dent Assoc Orthod Dentofacial Orthop 1988;93:201- 205.
1954;48:626- 637. 28. Gianelly AA. Condylar position and Class II deep
9. Thompson JR. Anatomical and physiological consid bite, no overjet malocclusion. Am J Orthod Dento
erations for positions of the mandible. Dent J Aust facial Orthop 1989;96:428- 432.
1951;23:161- 166. 29. Gianelly AA, Cozzanic M , Boffa J. Condylar posi
10. Ricketts RM . Laminography in the diagnosis of tem tion and maxillary first premolar extraction. Am J
poromandibular joint disorders. J Am Dent Assoc Orthod Dentofacial Orthop 1991;99:473- 476.
1953;46:620- 648. 30. Gianelly AA, Anderson CK, Boffa J. Longitudinal
11. Roth RH. Temporomandibular pain-dysfunction and evaluation of condylar position in extraction and
occlusal relationships. Angle Orthod 1973;43:136- nonextraction treatment. Am J Orthod Dentofacial
153. Orthop 1991;100:416- 420.
12. Roth RH. The maintenance system and occlusal dy 31. De Kanter RJ, Truin GJ, Burgersdijk RC, Van 't Hop
namics. Dent Clin North Am 1976;20:761- 788. M A, Battistuzzi PG, Kalsbeek H et al. Prevalence in
13. Roth RH. Functional occlusion for the orthodontist. the Dutch adult population and a meta-analysis of
J Clin Orthod 1981;15:32- 51. signs and symptoms of temporomandibular disor
14. Roth RH. Treatment mechanics for the straight-wire der. J Dent Res 1993;72:1509- 1518.
appliance. In: Craber TM , Swain BK (eds). Ortho 32. Mohlin BO, Derweduwen K, Pilley R, Kingdon A,
dontics: Current Principles and Techniques. St. Lou Shaw W C, Kenealy P. Malocclusion and temporo
is: Mosby, 1985:665- 716. mandibular disorder: a comparison of adolescents
15. Roth RH. Functional occlusion for the orthodontist, with moderate to severe dysfunction with those
Part III. J Clin Orthod 1981;15:174- 179, 182-198. without signs and symptoms of temporomandibular
16. Angle EH. Classification of malocclusion. Dent Cos disorders and their further development to 30 years
mos 1899;41:246- 264. of age. Angle Orthod 2004;74:319- 327.
33. Kim M R, Grab erTM , Viana M A. Orthodontics and
17. Angle EH. Malocclusion of Teeth, ed 7. Philadel temporomandibular disorders: a meta-analysis. Am
phia, PA: SS White Dental M fg Co., 1907. J Orthod Dentofacial Orthop 2002;121:438- 446.
18. Andrews LF. The six keys to normal occlusion. Am J 34. Luther F. Orthodontics and the temporomandibu
Orthod 1972;62:296- 309. lar joint: Where are we now? Part I. Orthodontics
19. Gesch D, Bernhardt O, Kirbshus A. Association of and temporomandibular disorders. Angle Orthod
malocclusion and functional occlusion with tem 1998;68:295- 304.
poromandibular disorders (TM D) in adults: a sys 35. Luther F. Orthodontics and the temporomandibu
tematic review of population-based studies. Quin lar joint: Where are we now? Part 2. Functional
tessence Int 2004;35:211-221. occlusion, malocclusion, and TM D. Angle Orthod
20. Mohl ND. Temporomandibular disorders: role of 1998;68:305- 318.
occlusion, TM J imaging, and electronic devices - a 36. Gokalp H, Arat M , Erden I. The changes in temporo
diagnostic update. J Am Coll Dent 1991;58:4- 10. mandibular joint disc position and configuration in
21. Seligman DA, Pullinger AG. The role of intercuspal oc early orthognathic treatment: a magnetic resonance
clusal relationships in temporomandibular disorders: a imaging evaluation. E J Orthod 2000; 22: 217- 224.
review. J Craniomandib Disord 1991;5:96-106. 37. Deguchi T, Uematsu S, Kawahara Y, M imura H.
22. McNeill C, Mohl ND, Rugh JD, Tanaka TT. Tem Clinical evaluation of temporomandibular joint
poromandibular disorders: diagnosis, manage disorders (TM D) in patients treated with chin-cup.
ment, education, and research. J Am Dent Assoc Angle Orthod 1998;68:91- 94.
1990;120:253- 260. 38. Dibbets JM H, van der Weele LT. Extraction, orth
23. Gianelly AA. Orthodontics, condylar position, odontic treatment, and craniomandibular dysfunc
and TM J status. Am J Orthod Dentofacial Orthop tion. Am J Orthod Dentofacial Orthop 1991 ;99:
1989;95:521- 523. 210- 219.
24. LeResche L, Truelove EL, Dworkin SF. Temporoman 39. Dibbets JM H, van der Weele LT. Orthodontic treat
dibular disorders: a survery of dentists’ knowledge ment in relation to symptoms attributed to dysfunc
and beliefs. J Am Dent Assoc 1993;124:90- 105. tion of the temporomandibular joint - a 10 year
report of the University of Groningen study. Am J
Orthod Dentofacial Orthop 1987;91:193- 199.

-
40. Carlton KL, Nanda RS. Prospective study of posttreat 56. Griffiths RH. Report of the president’s conference
ment changes in the temporomandibular joint. Am J on the examination, diagnosis, and management
Orthod Dentofacial Orthop 2002;122:486- 490. of temporomandibular disorders. J Am Dent Assoc
41. Luppanapornlap S, Johnston LE Jr. The effects 1983;106:75- 77.
of premolar extraction: A long-term comparison 57. Kircos LT, Ortendahl DA, Arakawa M . Magnetic reso
of outcomes in "clear-cut" nonextraction and nance imaging of the TM J disc in asymptomatic vol
extraction class II patients. The Angle Orthod unteers. J Oral Maxillofac Surg 1987;45:852-853.
1993;63:257- 272. 58. Bean LR, Thomas CA. Significance of condylar posi
42. Beattie JR, Paquette DE, Johnston LE Jr. The func tions in patients with temporomandibular disorders.
tional impact of extraction and nonextraction J Am Dent Assoc 1987;114:76- 77.
treatments: a long-term comparison in patients 59. Rinchuse DJ, Rinchuse DJ. The impact of the Ameri
with "borderline", equally susceptible Class II can Dental Association's guidelines for the man
malocclusions. Am J Orthod Dentofacial Orthop agement of temporomandibular disorders on orth
1994;105:444- 449. odontic practice. Am J Orthod Dentofacial Orthop
43. National Institutes of Health Technology Assess 1983;83:518- 522.
ment Conference Statement. Management of 60. Rinchuse DJ, Kandasamy S. Articulators in ortho
temporomandibular disorders. J Am Dent Assoc dontics: an evidence-based perspective. Am J Or
1996;127:1595- 1606. thod Dentofacial Orthop 2006;129:299- 308.
44. Rinchuse DJ, Kandasamy S, Sciote J. A contem 61. Klasser GD, Greene CS. Predoctoral teaching of
porary and evidence-based view of canine pro temporomandibular disorders: survery of U.S.
tected occlusion. Am J Orthod Dentofacial Orthop and Canadian dental schools. J Am Dent Assoc
2007;132:90- 102. 2007;138:231- 237.
45. Rinchuse DJ, Sassouni V. An evaluation of eccentric 62. Turp JC, Greene CS, Strub JR. Dental occlusion: a
occlusal contacts in orthodontically treated subjects. critical reflection on past, present and future con
Am J Orthod Dentofacial Orthop 1982;82:251- cepts. J Oral Rehabil 2008;35:446- 453.
256. 63. Greene CS. Orthodontists and TM D. Orthodontic
46. Tipton RT, Rinchuse DJ. The relationship between Products 2007;14:12.
static occlusion and functional occlusion in a dental 64. Klasser GD, Greene CS. Role of oral appliances in the
school population. Angle Orthod 1991;61:57- 66. management of sleep bruxism and temporomandib
47. Clark JR, Evans RD. Functional occlusion - I . A re ular disorders. Alpha Omegan 2007;100:111- 119.
view. J Orthod 2001 ;28:76- 81. 65. Dworkin SF, LeResche L. Research diagnostic criteria
48. Cordary FE. Centric relation treatment and articu for temporomandibular disorders: review, criteria,
lator mountings in orthodontics. Angle Orthod examinations and specifications, critique. J Crani
1996;66:153- 158. omandib Disord 1992;6:301- 355.
49. M cNamara JA, Seligman DA, Okeson JA. Occlu 66. Okeson JP. The classification of orofacial pain. Oral
sion, orthodontic treatment, temporomandibular Maxillofacial Surg Clin North Am 2008;20:135- 144.
disorders: a review. J Orofac Pain 1995;9:73- 90. 67. Greene CS. The etiology of temporomandibular
50. Woda A, Vigneron P, Kay D. Non-functional and disorders: implications for treatment. J Orofac Pain
functional occlusal contacts: a review of the litera 2001;15:93- 105.
ture. J Prosthet Dent 1979;42:335- 341. 68. Gross A, Gale EN. A prevalence study of the clinical
51. Lopez-Gavito G, Wallen TR, Little RM , Joonedeph signs associated with mandibular dysfunction. J Am
DR. Anterior open-bite malocclusion: a longitudinal Dent Assoc 1983;107:932- 936.
ten-year postretention evaluation of orthodontically 69. Watt DM . Temporomandibular joint sounds. J Dent
treated patients. Am J Orthod Dentofacial Orthop 1980;8:119- 127.
1985;87:175- 186. 70. Greene CS, Laskin DM. Long-term status of TM D
52. van't Spijker A, Kreulen CM , Creugers NHJ. At clicking in patients with myofascial pain and dys
trition, occlusion, (dys)function, and interven function. J Am Dent Assoc 1988;117:461- 465.
tion: a systematic review. Clin Oral Implants Res 71. Greene CS, Laskin DM . Long-term evaluation of
2007;18:117- 126. treatment for myofascial pain-dysfunction analysis.
53. Rinchuse DJ, Kandasamy S. Centric relation: a his J Am Dent Assoc 1983;107:235- 238.
torical and contemporary orthodontic perspective. 72. Vincent SD, Lilly GE. Incidence and characterization
J Am Dent Assoc 2006;137:494- 501. of temporomandibular joint sounds in adults. J Am
54. Johnston LE Jr. Fear and loathing in orthodontics: Dent Assoc 1988;116:203- 206.
notes on the death of theory. In: Carlson DS, Fer 73. Walker RV, Kalamchi SA. Surgical technique for
rara AM (eds). Craniofacial growth theory and orth the management of internal derangement of the
odontic treatment. Ann Arbor, Michigan: Center for temporomandibular joint. J Oral M axillofac Surg
Human Growth and Development, University of 1987;45:200- 205.
M ichigan, 1990:75- 91.
55. Keim RG. Centric Shangri-la. J Clin Orthod 2003;
37:349- 350.

74. Rinchuse DJ, Abraham J, Medwid L, M ortimer R. 90. Rasmussen OC. Description of population and
TM J sounds: Are they a common finding or are they progress of symptoms in a longitudinal study of
indicative of pathosis/ dysfunction? Am J Orthod temporomandibular arthropathy. Scand J Dent Res
Dentofacial Orthop 1990;98:512- 515. 1981;89:196- 203.
75. Emshoff R, Brandlmaier I, Gerhard S, Stobl H, Ber 91. Rasmussen OC. Temporomandibular arthropathy:
tram S, Rudisch A. M agnetic resonance imaging clinical, radiographic, and therapeutic aspects, with
predictors of temporomandibular joint pain. J Am emphasis on diagnosis. Int J Oral Surg 1983;12:
Dent Assoc 2003;134:705- 714. 365- 397.
76. Ludlow JB, Davies-Ludlow LE, White SC. Patient risk 92. Scapino RP. Histopathology associated with malpo
related to common dental radiograph examinations - sition of the human temporomandibular joint disc.
the impact of 2007 international commission on ra Oral Surg Oral Med Oral Pathol 1983;55:382- 397.
diological protection recommendations regarding dose 93. Blaustein Dl, Scapino RP. Remodeling of the tem
calculation. J Am Dent Assoc 2008;139:1237-1243. poromandibular joint disk and posterior attach
77. Gonzalez YM , Greene CS, Mohl ND. Technologi ment in disk displacement specimens in relation
cal devices in the diagnosis of temporomandibu to glycosaminoglycan content. Plast Reconstr Surg
lar disorders. Oral M axillofac Surg Clin North Am 1986;78:756- 764.
2008;20:211- 220. 94. Kurita K, Westesson P-L, Yuasa H, Toyama M,
78. Isaacson KG, Thom AR, Horner K, Whaites E. Orth Machida J, Ogi N. Natural course of untreated symp
odontic radiographs: guidelines for the use of radio tomatic temporomandibular joint disc displacement
graphs in clinical orthodontics, ed 3. London: British without reduction. J Dent Res 1998;77:361- 365.
Orthodontic Society, 2008. 95. Sato S, Nasu F, Motegi K. Natural course of nonre
79. Stegenga B. Osteoarthritis of the temporomandibu ducing disc displacement of the temporomandibu
lar joint organ and its relationship to disc displace lar joint: changes in chewing movement and mas
ment. J Orofac Pain 2001;15:193- 205. ticatory efficiency. J Oral M axillofac Surg 2002;60:
80. Emshoff R, Brandllmaier I, Bertram S, Rudisch A. 867- 872.
Comparing methods for diagnosing temporoman 96. Sato S, Takahashi K, Kawamura H, Motegi K. The
dibular joint disk displacement without reduction. natural course of nonreducing disk displacement
J Am Dent Assoc 2002;133:442- 451. of the temporomandibular joint: changes in con
81. Flores-Mir C, Nebbe B, Heo G, M ajor PW. Longitu dylar mobility and radiographic alterations at one-
dinal study of temporomandibular joint disc status year follow up. Int J Oral M axillofac Surg 1998;27:
and craniofacial growth. Am J Orthod Dentofacial 173- 177.
Orthop 2006;130:324- 330. 97. De Leeuw R, Boering G, Stegenga B, De Bont LG.
82. Nebbe B, M ajor PW, Prasad NG. Female adolescent Clinical signs of TM J osteoarthrosis and internal
facial pattern associated with TMJ disk displace derangement 30 years after nonsurgical treatment.
ment and reduction in disk length. Part I. Am J Or J Orofac Pain 1994;8:18- 24.
thod Dentofacial Orthop 1999;116:167- 176. 98. De Leeuw R. Internal derangements of the tem
83. Nebbe B, M ajor PW, Prasad NG. Male adolescent poromandibular joints. Oral Maxillofacial Surg Clin
facial pattern associated with TM J disk displace North Am 2008;20:159- 168.
ment and reduction in disk length. Part II. Am J Or 99. Arnett GW, Milam SB, Gottesman L. Progressive
thod Dentofacial Orthop 1999;116:301- 307. mandibular retrusion: idiopathic condylar resorp
84. Hall HD. Intra-articular disc displacement. Part I: Its tion. Part II. Am J Orthod Dentofacial Orthop
significant role in temporomandibular joint pathol 1996;110:117- 127.
ogy. J Oral M axillofac Surg 1995;53:1073- 1079. 100. Arnett GW, Milam SB, Gottesman L. Progressive
85. Hall HD, Nickerson JW. Is it time to pay more atten mandibular retrusion: idiopathic condylar resorp
tion to disc position? J Orofac Pain 1994;8:90. tion. Part I. Am J Orthod Dentofacial Orthop
86. Ikeda K. Doctors' Scientific Lectures: Disc displace 1996;110:8- 15.
ment and orthodontics. 107th session, American 101. Mercuri LG. Osteoarthritis, osteoarthrosis, and
Association of Orthodontists, Seattle, WA, 2007. idiopathic condylar resorption. Oral Maxillofacial
87. Larheim , Westesson P-L, Sano T. Temporo Surg Clin North Am 2008;20:169- 183.
mandibular joint disk displacement: comparison in 102. Wolford LM , Cardenas L. Idiopathic condylar
asymptomatic volunteers and patients. Radiology resorption: diagnosis, treatment protocol, and
2001;218:428- 432. outcomes. Am J Orthod Dentofacial Orthop
88. Dolwick LF. Intra-articular disc displacement. Part 1999;116:667- 677.
I: Its questionable role in temporomandibular joint 103. Obwegeser HL, M akek M S. Hemimandibular hy
pathology. J Oral M axillofac Surg 1995;53:1069- perplasia- hemimandibular elongation. J M axillo
1072. fac Surg 1986;14:183- 208.
89. Carlsson GE. Temporomandibular joint disorders.
In: Klineberg I, Jagger R (eds). Occlusion and Clini
cal Practice: An Evidence-based Approach. London:
Wright, 2004:68.

-
104. Matteson SR, Proffit WR, Terry , Staab EV, 115. Seligman DA, Pullinger AG. The role of functional
Burkes EJ, Hill C. Bone scanning with 99m tech occlusal relationships in temporomandibular dis
netium phosphate to assess condylar hyperpla orders: a review. J Craniomandib Disord 1991 ;5:
sia. Oral Surg Oral Med Oral Pathol 1985; 60: 265- 279.
356- 367. 116. Rilo B, da Silva JL, M ora M J, Cadarso-Swarez C,
105. Lippold C, Kruse-Losler B, Danesh G, Joos U, Santana U. Midline shift and lateral guidance an
M eyer U. Treatment of hemimandibular hyperpla gle in adults with unilateral posterior crossbite. Am
sia: the biological basis of condylectomy. Br J Oral J Orthod Dentofacial Orthop 2008;133:804- 808.
Maxillofac Surg 2007;45:353- 360. 117. Kilic N, Kiki A. Condylar asymmetry in unilateral
106. Wolford LM, Mehra P, Reiche-Fischel O, Morales- posterior crossbite patients. Am J Orthod Dento
Ryan CA, Garcia-Morales P. Efficacy of high con facial Orthop 2008;133:382- 387.
dylectomy for management of condylar hyperpla 118. Dimitroulis, G. Fortnightly review: temporo
sia. Am J Orthod Dentofacial Orthop 2002;121: mandibular disorders: a clinical update. BMJ
136-151. 1998;317:190- 194.
107. Moloney F, Howard JA. Internal derangements of 119. Marie SS, Powers M , Sheridan JJ. Vibratory
the temporomandibular joint: anterior reposition stimulation as a method of reducing pain after
ing splint therapy. Aust Dent J 1986;31:30- 39. orthodontic appliance adjustment. J Clin Orthod
108. Clark GT. The TM J repositioning appliance: a tech 2003;37:205- 208.
nique for construction, insertion, and adjustment. 120. Gatchel RJ, Stowell AW, Wildenstein L, Riggs
J Craniomandibular Pract 1986;4:37- 46. R, Ellis E III. Efficacy of an early intervention for
109. Clark GT. Classification, causation, and treat patients with acute temporomandibular disorder-
ment of masticatory myogenous pain and dys related pain. J Am D en t Assoc 2006;137:
function. Oral Maxiofacial Surg Clin North Am 339- 347.
2008;20:145- 157. 121. Turk D, Zaki H, Rudy T. Effects of intraoral appli
110. Forssell H, Kalso E, Koskela P, Vehmanen R, ance and biofeedback/ stress management alone
Puukka P, Alanen P. Occlusal treatments in tem and in combination in treating pain and depres
poromandibular disorders: a qualitative system sion in TM D patients. J Prosthet Dent 1993;70:
atic review of randomized controlled trials. Pain 158-164.
1999;83:549- 560. 122. Turk DC, Rudy , Kubinski JA, Zake HS, Greco
111. Koh H, Robinson PG. Occlusal adjustment for CM . Dysfunctional patients with temporoman
treating and preventing temporomandibular joint dibular disorders: evaluating the efficacy of a
disorders. J Oral Rehabil 2004;31:287- 292. tailored treatment protocol. J Consult Clin Psychol
112. Bakke M . Jaw muscle disorders. In: Klineberg I, 1996;64:139- 146.
Jagger R (eds). Occlusion and Clinical Practice: 123. Rudy , Turk DC, Kubinski JA, Zaki HS. Differ
An Evidence-based Approach. London: Wright, ential treatment response of TM D patients as
2004:81. a function of psychological characteristics. Pain
113. Seligman DA, Okeson JP. Orthodontics, occlusion, 1995;61:103- 112.
and temporomandibular disorders. In: McNamara 124. Greco CM , Rudy , Turk DC, Andrew H, Zaki HS.
JA Jr, Brudon W L. Orthodontics and Dentofacial Traumatic onset of temporomandibular disorders:
Orthopedics. Ann Arbor, M l: Needham Press, positive effects of a standardized conservative
2001:519- 543. treatment program. Clin J Pain 1997;13:337- 347.
114. Pellizoni SEP, Salioni M AC, Juliano Y, Guimaraes 125. Turk DC. Psychosocial and behavioral assessment of
AS, Alonso LG. Temporomandibular joint disc po patients with temporomandibular disorders: diagnos
sition and configuration in children with functional tic and treatment implication. Oral Surg Oral Med
unilateral posterior crossbite: a magnetic resonance Oral Pathol Oral Radiol Endod 1997;83:65-71.
imaging evaluation. Am J Orthod Dentofacial
Orthop 2006;129:785- 793.

Глава ЗО
Эфраим Винокур и Фрэнк Лоббезоо
20 %

.
,
.1 ,
, -
. 8 %

. .
( )
( ).2 .6 ,

- ,
. , .7
,
( ,
, ,
)
, .
, ,
.3 Winocur .45 ,
, , -
,
,
. , .
,
,
, . . ,
. .

. , , -

. 30-3.
. 30-4. . 30-5. . 30-6.
,
. . . ,

, ,
.8
.9 ,
,
.
, , De Leeuw,1
, .9 ,
Lavigne .,9
, ,
.
, ,
, , ,
. .
,

( ) ,
,
, .10

, -

. 30-7.
1
. 30-8. 1
. 30-9.
,
, .111
, -

. . ,
,

,
. .
2007 .

( . 30-1 National Library of M edicine's Medical
30-2). Subject Headings (M eSH) PubM ed.12
177 ,
( . 30-3 40 ,
30-4), 135. ,
135
( . 30-5-30-9).
. 13 %
.
7. ,
, 30 %

. ( , )
, ( . 30-1).
,
.

,
. .12

,
, ,
,
, . .13 ,

.
,

( ,
.12 ,
, , ,
) , -
30-1.
-
1 3
1 3
1 3
2 1

1 2 ,
3 2
,
NTI- tss 2 2- 3 (

3)
1- ; 2- ; 3- ;
1- ; 2- ; 3-
(NTI-tss - Nociceptive Trigeminal Inhibition Clenching
Suppression System); -
460
,
. ,

.12

.
. 30-10. ,
.13

13 ,

6

42 %. ,
.1617 Dube .16
(44%).
2
( . 30-10), , a Van der Zaag .17
, 4
. ,
2 ( 83 %).
Harada .,18
. ( ) ,

, .
.
,
. , ,
,

, -
.6 , . Okeson
, ,13
( ),
. Gagnon .15 , 10 ,
.
,
, , .
. ,
,
8 10 ,
. -

.
,
. , ,
,
,
,
.12 ( )
.

,23
(Nociceptive Trigeminal ,
Inhibition Clenching Suppression System ,
NTI-tss). , .
,
.
,
,
. NTI-tss
.

.
.
Becker .20
,
, ,

,7

, .
( . 30-2). ,
NTI-tss,21 ,
, .
,
. , , Winocur .6
, , : «
6
.
.
, -
NTI-tss, ,
,22 ,

,
.

30-2.
-
3 3
3 3
1-2 3
2 2
1 2
1 1-2
2 1
,

1- ; 2- ;3-
1- ; 2- ; 3-
( )
, .
».
,
(Buspirone) .8
.

. -
, ,
, ,
.8 -
- ,26
- ,
, , ,
,
-
. .

,
( 20-30 %)
.24 Nishioka .25 .27
19 %


,
,
. ,
, ,
, ,
, , .12
, Tan Janko vic32
18 ,
, , - - .
.
, ,
-

, . .
,

. ,
- -

Clostridium botulinum. .

-
, ,
(3-4 )
, - - .33
.
,
,
( - .
- - , ; - ; Botox).
- - -A
,
30 %.28 ,

- - - .29 .

- -
.30
, - - , Manfredini
Guarda-Nardini.34
,
( ) ,
.31 - -
,
- -
. ,35

. - -
- - - , - - -B,
,
FDA.
.
, - - . ,
- -
,36
-
( ), -
- -
, ,

, . FDA
, .
- -
,
, .36
.29

(Food and Drug Administration,
( . 30-3)
FDA)
- - . ,
. Vanderas .37
, ,
. -
30-3.
-
? 1
7 1(
)? ,
( ) ( );

7 1
;

? 1
?- ; 1- ;2- ;3-
?- ; 1- ; 2- ; 3-
-

, ,
. ,
,
.
. Restrepo .38 ,
,

.

, .
, ,
.12 , « »

, ,

, , , .
, , ,
.
,
.

, ,
( )
( ).39 . ,
,
,
, .” ,

. ,
,
, .12
. ( ) Morin .,40
, ,
6 . ,
( , )
,
. ,
, ,
. ,
. ,

.41 ,
( ), , ,
, .
.

.
Lobbezoo .12
, .
. Ackerman42 , .
,
. ,
,
, , .
. Ackerman ,
Huynh .45
.42 Quinn43 , ,
,
, ,
. Knutson44
.

,
6- . .
, -
,
,
. ,
, ,
,
.9 -
,
- ( - ; Pro-Fono
Facial Exerciser, Pro-Fono),12 , ,

,

. .
-
.
,
Huynh .45
: , , Lobbezoo
, ( ), .12
( ). - , : plates (
), pep talk ( ) pills (
. ).
, . ,


. 4. Winocur E, Gavish A, Volfin G, Halachmi M, Gazit E.
Oral motor parafunctions among heavy drug ad
,
dicts and their effects on signs and symptoms
, of temporomandibular disorders. J Orofac Pain
2001;15:56- 63.
. 5. Winocur E, Hermesh H, Littner D, Shiloh R, Peleg L,
Eli I. Signs of bruxism and temporomandibular dis
- orders among psychiatric patients. Oral Surg Oral
, Med Oral Pathol Oral Radiol Endod 2007;103:60-
63.
. 6. Lavigne GJ, Khoury S, Abe T, Yamaguchi T, Raphael
K. Bruxism physiology and pathology: an overview
for clinicians. J Oral Rehabil 2008:35;476- 494.
. 7. Lobbezoo F, Naeije M . Bruxism is mainly regu
lated centrally, not peripherally. J Oral Rehabil
2001;28:1085- 1091.
,
8. Winocur E, Gavish A, Voicobich M , Emodi-Perlman
. A, Eli I. Effects of drugs on bruxism: A critical review.
J Orofac Pain 2003;17:99- 111.
9. Winocur E. M anagement of sleep bruxism. In:
Lavigne GJ, Cistulli PA, Smith M T (eds). Sleep M edi
.
cine for Dentists: A Practical Overview. Chicago, IL:
Quintessence, 2009:133- 144.
. 10. Johansson A, Johansson AK, Omar R, Carlsson GE.
Rehabilitation of the worn dentition. J Oral Rehabil
2008;35:548- 566
11. Svensson P, Jadidi F, ArimaT, Baad-Hansen L, Sessle
BJ. Relationships between craniofacial pain and
, bruxism. J Oral Rehabil 2008;35:524- 547.
12. Lobbezoo F, Van Der Zaag J, Van Seims M KA,
Hamburger HL, Naeije M . Principles for the man
. agement of bruxism. J Oral Rehabil 2008;35:
509- 523.
, 13. Okeson JP (ed). M anagement of Temporomandibu
lar Disorders and Occlusion, ed 5. St. Louis, M O:
CV Mosby, 2003:507- 536.
, 14. Landry M -L, Rompre PH, M anzini C, Guitard F,
de Grandmont P, Lavigne GJ. Reduction of sleep
bruxism using a mandibular advancement device:
an experimental controlled study. Int J Prosthodont
,
2006;19:549- 556.
. 15. Gagnon Y, Morisson F, Rompre PH, Lavigne GJ. Ag
gravation of respiratory disturbances by the use of
an occlusal splint in apneic patients: a pilot study.
16. Dube C, Rompre PH, Manzini C, Guitard F, de
Grandmont P, Lavigne GJ. Quantitative polygraph
ic controlled study on efficacy and safety of oral
1. De Leeuw R (ed). Orofacial Pain: Guidelines for As splint devices in tooth-grinding subjects. J Dent Res
sessment, Diagnosis and M anagement, ed 4. Chi 2004;83:398- 403.
cago, IL: American Academy of Orofacial Pain and 17. Van Der Zaag J, Lobbezoo F, Wicks DJ, Visscher
Quintessence Publishing, 2008:132, 152, 263. CM , Hamburger HL, Naeije M . Controlled assess
2. Lavigne GJ, Huynh N, Kato T, Okura K, Adachi K, ment of the efficacy of occlusal stabilization splints
Yao D et al. Genesis of sleep bruxism: motor and on sleep bruxism. J Orofac Pain 2005;19:151- 158.
autonomic-cardiac interactions. Arch Oral Biol 18. Harada T, Ichiki R, Tsukiyama Y, Koyano K. The ef
2007;52:381- 384. fect of oral splint devices on sleep bruxism: a 6-week
3. Lavigne GJ, M anzine C. Bruxism. In: Kryger M H, observation with an ambulatory electromyographic
Roth T, Dement WC (eds). Principles and Practice of recording device. J Oral Rehabil 2006;33:482- 488.
Sleep Medicine, ed 3. Philadelphia, PA: WB Saun
ders, 2000:773- 785.

19. Okeson JP. The effects of hard and soft occlusal 32. Tan EK, Jankovic J. Treating severe bruxism with
splints on nocturnal bruxism. J Am Dent Assoc botulinum toxin. J Am Dent Assoc 2000;131:
1987;114:788- 791. 211- 216.
20. Becker I, Tarantola G, Zambrano J, Spitzer S, 33. Guarda-Nardini L, Manfredini D, Salamone M ,
Oquendo D. Effect of a prefabricated anterior bite Salmaso L, Tonello S, Ferronato G. Efficacy of botu
stop on electromyographic activity of masticatory linum toxin in treating myofascial pain in bruxers:
muscles. J Prosthet Dent 1999;82:22- 26. a controlled placebo pilot study. Cranio 2008;26:
21. Magnusson T, Adiels AM , Nilsson HL, Helkimo M . 126-135.
Treatment effect on signs and symptoms of tem 34. Manfredini D, Guarda-Nardini L. Botulinum toxin in
poromandibular disorders-comparison between the treatment of bruxism. In: Paesani D (ed). Brux
stabilization splint and a new type of splint (NTI), a ism: Theory and Practice. Berlin: Quintessence Pub
pilot study. Swed Dent J 2004;28:11-20. lishing 2010:467- 476.
22. Baad-Hansen L, Jadidi F, Castrillon E, Thomsen
PB, Svensson P. Effect of a nociceptive trigeminal 35. Ihde SKA, Konstantinovic VS. The therapeutic use
inhibitory splint on electromyographic activity in of botulinum toxin in cervical and maxillofacial con
jaw dosing muscles during sleep. J Oral Rehabil ditions: an evidence-based review. Oral Surg Oral
2007;34:105- 111. Med Oral Pathol Oral Radiol Endod 2007;104:e1-
23. Macedo CR, Silva AB, Machado M A, Saconato H, e11.
Prado GF. Occlusal splints for treating sleep brux 36. FDA. Early communication about an ongoing safety
ism (tooth grinding). Cochrane Database Syst Rev review: Botox and Botox Cosmetic (botulinum t ox
2007(4):CD005514. in type A) and Myobloc (botulinum toxin type B).
24. Lobbezoo F, Soucy JP, Hartman NG, Montplaisir JV, At: http:/ / www.fda.gov/ m edwatch/ safety/ 2008/
Lavigne GJ. Effects of the D2 receptor agonist bro safety08.htm#botox (accessed 19 July 2008).
mocriptine on sleep bruxism: report of two single-pa 37. Vanderas AP, Menena-Kou M , KouimtzisTH, Papa-
tient clinical trials. J Dent Res 1997;76:1610-1615. giannoulis L. Urinary catecholamine levels and brux
25. Nishioka GJ, Montgomery M , Boutros N, Haslam S. ism in children. J Oral Rehabil 1999;26:103- 110.
Dopaminergic modulation of nocturnal masticatory 38. Restrepo CC, Alvarez E, Jaramillo C, Velez C, Valen
muscle EMG activity and sleep [abstract]. J Dent cia I. Effects of psychological techniques on brux
Res 1989;68:391 (abstract 1679). ism in children with primary teeth. J Oral Rehabil
26. Saletu A, Parapatics S, Saletu B, Anderer P, Prause 2001 ;28:354- 360.
W, Putz H et al. On the pharmacotherapy of sleep 39. Ommerborn M A, Schneider Ch, Giraki M , Schafer
bruxism: placebo-controlled polysomnographic and R, Handschel J, Franz M et al. Effects of an oc
psychometric studies with clonazepam. Neuropsy clusal splint compared with cognitive-behavioral
chobiology 2005;51:214- 225. treatment on sleep bruxism activity. Eur J Oral Sci
27. Huynh NT, Lavigne GJ, Lanfranchi PA, Montplaisir 2007;115:7- 14.
JY, de Champlain J. The effect of 2 sympatholytic 40. Morin CM . Psychological and behavioral treatments
medications - propranolol and clonidine - on sleep for primary insomnia. In: Kryger M , Roth T, Dement
bruxism: experimental randomized controlled stud W C (eds). Principles and Practice of Sleep Medicine.
ies. Sleep 2006;29:307- 316. Philadelphia, PA: Elsevier Saunders, 2005:726- 737.
28. To EW, Ahuja AT, Ho WS, King WW, Wong WK, 41. Lavigne GJ, Kato T, Kolta A, Sessle BJ. Neurobiologi-
Pang PC et al. A prospective study of the effect of cal mechanisms involved in sleep bruxism. Crit Rev
botulinum toxin on masseteric muscle hypertrophy Oral Biol Med 2003;14:30- 46.
with ultrasonographic and electromyographic mea 42. Ackerman JB. A new approach in the treatment
surement. Br J Plast Surg 2001 ;54:197- 200. of bruxism and bruxomania. N Y State Dent J
29. Ward AB, Molenaers G, Colosimo C, Berardelli A. 1966;32:259- 261.
Clinical value of botulinum toxin in neurological in 43. Quinn JH. Treating bruxism and clenching. J Am
dications. Eur J Neurol 2006;13(Suppl 4):20- 26. Dent Assoc 2000;131:723.
30. Balash Y, Giladi N. Efficacy of pharmacological treat 44. Knutson GA. Vectored upper cervical manipulation
ment of dystonia: evidence-based review including for chronic sleep bruxism, headache, and cervical
meta-analysis of the effect of botulinum toxin and spine pain in a child. J Manipulative Physiol Ther
other cure options. Eur J Neurol 2004;11:361- 370. 2003;26:E16.
31. Bhidayasiri R, Cardoso F, Truong DD. Botulinum 45. Huynh NT, Rompre PH, Montplaisir JY, Manzini
toxin in blepharospasm and oromandibular dysto CH, Okura K, Lavigne GJ. Comparison of various
nia: comparing different botulinum toxin prepara treatments for sleep bruxism using determinants of
tions. Eur J Neurol 2006;13(Suppl 1):21- 29. number needed to treat and effect size. Int J Prost
hodont 2006; 19: 435- 441.

31
(
, , )
-
( )
. ,8
20 ,
,
, ,
.1 910
, ." ,
,
,
, ,12
-
( ).2
,
,
, .

( . 31-1).
, 1.
.4
, .
2.
.
. 3. ,
, ,
.1'4-7 .
,


31-1.

,

,
,
,

,

,
,
,
.

, ( .
20).
,
. .
,
,
, ,
. ,
.
.
,13
14 ( . ,
8), .1516
, ,
. , ,
, ,
.
,
.
, -
, ,

.
, .17 ,

.18
. ,
, ,
,
25
,
( . 10 13).
, ( / ).26
/
. , 1992 ., ,
,
,1920 10 .
PubMed
,
.21-23 / ( . 31-1).
,
/ .27-29
/
,
(
. , ,
, , ,
, ),
,
, 30-32
. 33 ,
.
/ (
. , ,
)
, ,

. , .

- (American Academy of
, , Orofacial Pain).6
,
70-80 % .24 19.

,
,
.

,
.

. 31-1. ,
/ (1992- 2008)
,
.34
,

, ,
. ,
,
.
«
» , ,
PubM ed. ,
,
.
.

, ,
, ,
.
(
. ) ,
,

, 10
, .
, ,
,
. ,
, , ,
« » .

31-2. , .
,
?
, ?

?
,
?
, , ,

?
,36
,
( . 31-4).
,
-
, ,
.
. ,

, ,
.
, . 31-2. ,
,
,
,
. ,

. 31-3. .
,
, ,
,37
,
.35 .3-38'41
,


31-3.
1
. , ,
,
( , ,
)
2 ,
( ) .
( )
3 , ,
( )
4 ,
.
,
5
,
7
8
9 ,
10
11
31-4. PubM ed (9
2009 , : - .
. : 12 786):
,

,
2039
.
1309
554 ,
466 ,
234 ,

,
128 ( . 32).
23
20
10

. ,
,

,43
,
.44'46 ,
. ,
.

,
. . (
. , -
, , ), ( ,
, , . .).
,
.

« .
»
.
,
, .
,
.
,

, ,
,
. , , ,

.
,

, , ,
.

,
.42
, .
, , ,
:
, •
, ,

, 10. Jankelson B. Neuromuscular aspects of occlusion:
effects of occlusal position on the physiology and
,
dysfunction of the mandibular musculature. Dent
, Clin North Am 1979;23:157- 168.
. 11. Gonzalez YM , Greene CS, Mohl ND. Technologi
• , cal devices in the diagnosis of temporomandibu
lar disorders. Oral M axillofac Surg Clin North Am
, 2008;20:211- 220.
, , 12. Cooper BC, Kleinberg I. Establishment of temporo
, mandibular physiological state with neuromuscular
orthosis treatment affects reduction of TM D symp

toms in 313 patients. Cranio 2008;26:104- 117.
. 13. Stohler CS. Chronic orofacial pain: is the puzzle un
• raveling? J Dental Educ 2001;65:1383- 1392.
14. M u rr a y C M , Peck CC. Orofacial pain and jaw m u scle
activity: a new model. J Orofac Pain 2007;21:263-
,
278.
15. Dao TTT, Lavigne GJ, Feine JS, Tanguay R, Lund JP.
Power and sample size calculations for clinical tri
. als of myofascial pain of jaw muscles. J Dent Res
1991;70:118- 122.
16. Manfredini D, Tognini F, Biondi K, Bosco M . Sample
size calculation for studies on temporomandibular
disorders. M inerva Stomatol 2003;52:309- 319.
17. Rollmann GB, Gillespie JM . The role of psychosocial
factors in temporomandibular disorders. Curr Rev
Pain 2000;4:71- 81.
1. Stohler CS, Zarb . On the management of tem 18. Kafas P, Leeson R. Assessment of pain in tem
poromandibular disorders: a plea for a low-tech, poromandibular disorders: the bio-psychosocial
high-prudence therapeutic approach. J Orofac Pain complexity. Int J Oral M axillofac Surg 2006;35:
1999;13:255- 261. 145-149.
2. Pullinger AC, Seligman DA. Quantification and vali 19. M a g n u sso n T, Egermark I, Carlsson GE. A prospec
dation of predictive values of occlusal variables in tive investigation over two decades on signs and
temporomandibular disorders using a multifactorial symptoms of temporomandibular disorders and as
analysis. J Prosthet Dent 2000;83:66- 75. sociated variables: a final summary. Acta Odontol
3. Greene C. The etiology of temporomandibular dis Scand 2005;63:99- 109.
orders: implications for treatment. J Orofac Pain 20. Glaros AG, Williams K, Lausten L. Diurnal varia
2001;15:93- 105. tion in pain reports in temporomandibular disor
4. McNeill C. M anagement of temporomandibular der patients and control subjects. J Orofac Pain
disorders: concepts and controversies. J Prosthet 2008;22:115- 121.
Dent 1997;77:510- 522. 21. De Bont LGM , Dijkgraaf LC, Stegenga B. Epide
5. Greene C. Concepts of TM D etiology: effects on miology and natural progression of articular tem
diagnosis and treatment. In: Laskin DM , Greene poromandibular disorders. Oral Surg Oral Med Oral
CS, Hylander W L (eds). TM Ds: An Evidence-based Pathol Oral Radiol Endod 1997;83:72- 76.
Approach to Diagnosis and Treatment. Chicago, IL: 22. Stohler CS. Phenomenology, epidemiology, and
Quintessence Publishing, 2006:219- 228. natural progression of the muscular temporoman
6. The Am erican Academy of Orofacial Pain. De dibular disorders. Oral Surg Oral Med Oral Pathol
Leeuw R (ed). Orofacial Pain: Guidelines for Assess Oral Radiol Endod 1997;83:77- 81.
ment, Diagnosis, and M a n a g em en t Chicago, IL: 23. De Leeuw R. Internal derangements of the tem
Quintessence Publishing, 2008 poromandibular joint. Oral M axillofac Surg Clin
7. Okeson JP. M anagement of temporomandibular North Am 2008;20:159- 168.
disorders and occlusion, ed 6. St. Louis, M O: Elsevi- 24. Turp JC, Jokstad A, Motschall E, Schindler HJ,
er-Mosby, 2008. Windecker-Getaz I, Ettlin DA. Is there a superior
8. Hammad IA, Nassif NJ, Salameh ZA. Full-mouth ity of multimodal as opposed to simple therapy
rehabilitation following treatment of temporoman in patients with temporomandibular disorders? A
dibular disorders and teeth-related signs and symp qualitative systematic review of literature. Clin Oral
toms. Cranio 2005;23:289- 296. Implants Res 2007;18(Suppl 3):138- 150.
9. Weinberg LA. Role of condylar position in TMJ 25. Schmitter M , Ohlmann B, John MT, Hirsch C, Ram
dysfunction-pain syndrome. J Prosthet Dent melsberg P. Research Diagnostic Criteria for tem-
1979;41:636- 643. poromandibulardisorders:acalibration and reliability
study. J Craniomandibular Pract 2005;23:212- 218.
478
26. Dworkin SF, LeResche L. Research diagnostic criteria 35. Durack D. The weight of medical knowledge. New
for temporomandibular disorders: review, criteria, Engl J Med 1978;278:773- 775.
examinations and specifications, critique. J Crani 36. Greenhalgh T. Papers that summarise other pa
omandib Disord 1992;6:301- 355. pers (systematic reviews and meta-analyses). BMJ
27. Lobbezoo F, van Seims M K, John MT, Huggins K, 1997;315:672- 675.
Ohrbach R, Visscher CM . Use of the research di 37. Svensson P, Fejerskov O, Mikkelsen J. Editorial. Spe
agnostic criteria for temporomandibular disorders cial issue: Bruxism - current status on pathophysiol
for multinational research: translation efforts and ogy and implications for oral rehabilitation. J Oral
reliability assessments in The Netherlands. J Orofac Rehabil 2008;35:475.
Pain 2005;19:301- 308. 38. Kato T, Thie N, Huynh N, M iyawaki S, Lavigne GJ.
28. John MT, Hirsch C, ReiberT, Dworkin SF. Translating Topical review: sleep bruxism and the role of pe
the Research Diagnostic Criteria for temporoman ripheral sensory influences. J Orofac Pain 2003;17:
dibular disorders into German: evaluation of con 191-213.
tent and process. J Orofac Pain 2006;20:43- 52. 39. Winocur E, Gavish A, Volkovitch M , Emodi-Peri-
29. Khoo SP, Yap AUJ, Chan YH, Bulgiba AM . Translat mam A, Eli I. Drugs and bruxism: a critical review.
ing the Research Diagnostic Criteria for Temporo J Orofac Pain 2003;17:99- 111.
mandibular disorders into M alay: evaluation of con 40. Lobbezoo F, Drangsholt M , Peck C, Sato H, Kopp
tent and process. J Orofac Pain 2008;22:131- 138. S, Svensson P. Topical review: new insights into the
30. List T, Dworkin SF. Comparing TM D diagnoses and pathology and diagnosis of the temporomandibular
clinical findings at Swedish and US TM D center us joint. J Orofac Pain 2004;18:181- 191.
ing research diagnostic criteria for temporomandib 41. Guarda-Nardini L, Manfredini D, Ferronato G. In
ular disorders. J Orofac Pain 1996;10:240- 253. vited review paper. Temporomandibular joint total
31. Yap AJU, Dworkin SF, Chua EK, List T, Tan KBC, replacement prosthesis: current knowledge and
Tan HH. Prevalence of temporomandibular disor considerations for the future. Int J Oral M axillofac
ders subtypes, psychologic distress and psycho Surg 2008;37:103- 110.
social dysfunction in Asian patients. J Orofac Pain 42. Clarkson JE, Turner S, Grimshaw JM , Ramsay CR,
2003;17:21- 28. Johnston M , Scott A et al. Changing clinicians' be
32. Manfredini D, Chiappe G, Bosco M . Research di havior: a randomized controlled trial of fees and
agnostic criteria for temporomandibular disorders education. J Dent Res 2008;87:640- 644.
(RDC/ TM D) axis I diagnosis in an Italian patient 43. Okeson JP. The classification of orofacial pains. Oral
population. J Oral Rehabil 2006;33:551- 558. M axillofac Surg Clin North Am 2008;20:133- 144.
33. Rantala M AI, Ahlberg J, Savolainen A, Kdnonen M. 44. Ogi N, Nagao T, Toyama M , Ariji E. Chronic dental
Symptoms, signs, and clinical diagnoses according infections mimicking temporomandibular disorders.
to research diagnostic criteria for temporomandibu Aust Dent J 2002;47:63- 65.
lar disorders among Finnish multiprofessional media 45. Herrera AF, Mercuri LG, Petruzzelli G, Rajan P.
personnel. J Orofac Pain 2003;17:21- 28. Simultaneous occurrence of 2 different low-grade
34. Greene CS. Science transfer in orofacial pain. In: malignancies mimicking temporomandibular joint
Lund JP, Lavigne GJ, Dubner R, Sessle BJ (eds). dysfunction. J Oral M axillofac Surg 2007;65:1353-
Orofacial Pain: From Basic Science to Clinical M an 1358.
agement. Chicago, IL: Quintessence Publishing,
2006:281- 286.

32

.1'2
. XX

, . ,
.

. .3 «
»

.
.
, ,
,
,

. , .
, .
, ,
, ,
.4"6

.
-
,
.

, ,
, ,
.78

32-1. :
-
.
•
,
•

. ,
•
,
•
.910
•

( ,
)
•

•
,

.

- ,
(FDI)
: ,
• , . .
.

;
• ,
.
.
, .

. ,
( ) .
, ,
.2
, ,

( 32-1). , ,
, .11


' .

.
,
.12-14
, . .
,

. , ,
,
. .

, ,

(
)
.
, .
. ,
,
.

.
, ,
,
, , ,
,
, .

.
, ,

. .15
,
, .
, ,
,
,
, , .
, 11 21. ,


,
,
,16
, .

,
. ,
. ,

.
. ,
.
,
, ,

,
. .
,

, ,
.
,
.
.

.1718 , .
,

, ,
,
.19
.

,
, ,

.
,
,
,
,
. , .
, ,

,
, ,
, ,
, . . . . ,
, -

, .23
, - ,
.20
, , - ,
. -

, ,
, .24

.2122 ,
.
, ,
9 19.
,
.
,
. ,
,
.

.

. - . ,
, ,
,
,
,
,

. , ( ,
,
, ,
. , ). ,
,
.

,
. - .

, .
.26

, . , .
,

,
.

. .
,
,
, ,
( , , ,
, .
) ,
.
, ,
, ,
.
.
,
.
,
, . .
,
,
,
,
,
: .
,
,
,
-
. , , ,

, , ,


. , ,
,
,
.29 ,
, . .
, ,
, ,
.
. ,
.
,
,
, -
.
,

,
.
. ,
,17
, .30
. ,
,
. . ,
( ,

),
.26 .
- 28 29.
, ,

,

.27 ,
( ) .
,
,
- .28
, ( ).

. ,
, ,
( ), -

.
,
,

.
( ,

) (
,

)
.34

.

. 32-1. ( )
- . ,
. .
,
.

,31 , .35
,
32 ,
,
, ,
( . 32-1).
, -
(
). , -
.
.33
,
.

,
.

J
\
, -
- -
(
\
/ -
/ -
. 32-2. . ,
,
, ,
,
.3637 ,
, ,
98 % ,
-
.38'39 , , -

.
.
.
,
48 -
. ,
.40’41
.
,
,
. ,

, .
.

35 % .
30 % , ,
, -

.4243 ,
,4445 ,

( . 32-2). .

-
. 32-3. .
(. .
( ) ), -
,

( . 32-3).
,
-

.
.
.46-48 ,
1965 . , .
,

.49 .
,
« ».
, , ,

.50 ( 32-2).51-53
. -
,
490
-
32-2.
,

.
•
, или
•
.54
•
- 32-3.
1.
2. -
,
3.
. 4. (
)
, 5.
6.
- 7.
. , ,
, -
,

.
.
, -
,
( 32-3). ,
,
, ,
-
.
-
.

,
,
. ,
.
491
,
.
-
.
: ( , ,
), ( -
, ), .
,
,
,
. ,
,
. ,
,
,
, - .
.

/ ,
, .
, , ,
.

.
. ,

.
.

, , .

.
( 32-2).
,
.
- ( ) ,
.
,
. ,
, ,
,
.
492
Выводы
. . ,

- ,
, ,
, . ,
.

.

,
.
1
,
.

,
6-12 .
.
, -
,
,
.
75 %
. , ,
96 % ,
, .
2 .55 ,
,
: , .
-
,
.56
.

,

for temporomandibular disorders: Review, criteria,
1. Hippocrates di Cos. Corpus Ippocraticum. V-IV sec. examinations and specifications, critique. J Crani
a. C. omandib Disord 1992;6:301- 355.
2. International Federation of Dentistry. Dental Ethics 22. The American Academy of Orofacial Pain. De
Manual. France: FDI World Dental Federation, 2007. Leeuw R (ed). Orofacial Pain: Guidelines for Assess
3. Sal g o v. Lel a n d St a n fo r d e t c , Bd. Trustees, 154 Cal. ment, Diagnosis, and M anagement. Chicago, IL:
App.2d 560 (Civ.No. 17045. First Dist., Div. One. Quintessence Publishing, 2008.
Oct. 22, 1957). 23. Bucci M B, De Santis M. La valutazione del danno
4. IADR Ethics Committee. International Association odontoiatrico: finalita del rapporto medico legale -
for Dental Research. Summary Code of Ethics; Jan/ odontoiatra [Italian]. Tagete 2007;1.
Feb 2000. 24. Bucci M B, De Santis M , Manfredini D. Odontoiatria
5. Italian Code of Medical Deontology [Italian]. Italy: legale: la consulenza tecnica di parte lesa [Italian], II
16 die 2006. Dentista Moderno 2007;10:64- 67.
6. Bucci M B. Prevenzione del contenzioso Odon- 25. Umani Ronchi G, Mastronardi V, Sommazzi A. Od
toiatra-Paziente. Attuaiita giuridiche e note etico ontoiatria Forense [Italian]. Turin, Italy: Ed. Cortina,
- comportamentali [Italian], II Dentista Moderno 2008.
2007;6:64- 69. 26. Mohl ND. Reliability and validity of diagnostic mo
7. Weinstock E. Informed consent. J Am Dent Assoc dalities for temporomandibular disorders. Adv Dent
2006;137:1060- 1064. Res 1993;7:113- 119.
8. Zinman EJ. Ethics versus legal informed consent 27. Manfredini D, M ontagna F, Bucci M B. Temporo
- a distinction with little difference. J Hist Dent mandibular disorders assessment in the medi
2007;55:134- 138, discussion 171-185. cal legal setting. Tagete Arch Legal Med Dent
9. Celbier S, Wright D, Bishop M . Ethics and den 2007;12:1- 20.
tistry. I: The meanings of ethics. Dent Update 28. Westesson P-L. Reliability and validity of imaging
2001;28:468- 473. diagnosis of temporomandibular joint disorders.
10. Ellen RP, Singleton R. Human rights and ethical con Adv Dent Res 1993;7:137- 151.
siderations in oral health research. J Can Dent Assoc 29. Kafas P, Leeson R. Assessment of pain in temporo
2008;74:439- 445. mandibular disorders: the bio-psychosocial complex
11. M ontagna F. Testo atlante di odontoiatria medico- ity. Int J Oral Maxillofac Surg 2006;35:145- 149.
legale [Italian]. M ilan: Masson-Elsevier, 2005. 30. M cNamara JA, Seligman DA, Okeson JP. Occlusion,
12. Chawla A, Gunderman RB. Defensive medicine: orthodontic treatment, and temporomandibular
prevalence, implications, and recommendations. disorders: a review. J Orofac Pain 1995;9:73- 90.
Acad Radiol 2008;15:948- 949. 31. Dimitroulis G. The role of surgery in the manage
13. Chen XY. Defensive medicine or economically mo ment of disorders of the temporomandibular joint:
tivated corruption? A confucian reflection on phy a critical review of the literature. Part 1. Int J Oral
sician care in China today. J Med Philos 2007;32: M axillofac Surg 2005;34:107- 113.
635- 648. 32. Klasser GD, Okeson J. The clinical usefulness of sur
14. Dekker SW. Criminalization of medical error: who face electromyography in the diagnosis and treat
draws the line? A N Z J Surg 2007;77:831- 837. ment of temporomandibular disorders. J Am D en t
15. Dworkin SF. Perspectives on the interaction of bio Assoc 2006;137:763- 771.
logical, psychological and social factors in TM D. 33. McNeill C. History and evolution of TM D concepts.
J Am Dent Assoc 1994;125:856- 863. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
16. Eysenck HJ, Eysenck SBG. The structure and mea 1997;83:51- 60.
surement of personality. London: Routledge and 34. Bucci M B, Bosco M . Traumatismi diretti e indiretti
Kegan Paul, 1969. dell’articolazione temporo-mandibolare (ATM ). Im-
17. Goldstein BH. Medical legal considerations in tem plicazioni in medicina legale e in odontoiatria [Ital
poromandibular disorders. Oral Surg Oral Med Oral ian], Tagete 2007; 1.
Pathol Oral Radiol Endod 1999;88:395- 399. 35. Goldberg M B. Posttraumatic temporomandibular
18. Simmons HC, Kilpatrick SR. A survey of dentists in disorders. J Orofac Pain 1999;13:291- 294.
the United States regarding a specialty in craniofa 36. Yucel E, Borkan U, Mollaoglu N, Erkmen E, Gu n -
cial pain. Cranio 2004;22:72- 76. ban O . Histological evaluation of changes in the
19. Bucci M B, Manfredini D. O don t oia t ria Legale: con- temporomandibular joint after direct and indirect
siderazioni di base sulla valutazione dei Disordini trauma: an experimental study. Dent Traumatol
Temporomandibolari [Italian], II Dentista Moderno 2002;18:212- 216.
2009;27:96- 101. 37. Tanaka E, Kawai N, Van Eijden T, Watanabe M,
20. Stohler CS, Zarb GA. On the management of tem Hanaoka K, Nishi M et al. Impulsive compression
poromandibular disorders: a plea for a low-tech, influences the viscous behavior of porcine tem
high-prudence therapeutic approach. J Orofac Pain poromandibular joint disc. Eur J Oral Sci 2003;111:
1999;13:255- 261. 353- 358.
494
38. Toyama , Kurita , Koga , Ogi N. Ankylosis of 48. Bucci M B. Odontoiatria Legale: rapporti tra colpo
the temporomandibular joint developing shortly di frusta cervicale e disordini temporo-mandibolari
after multiple facial fractures. Int J Oral M axillofac (DTM ) [Italian]. Tagete 2007;1.
Surg 2003;32:360- 362. 49. Frankel VFL Temporomandibular joint pain syn
39. Ferretti C, Bryant R, Becker P, Lawrence C. Tem drome following deceleration injury to the cervical
poromandibular joint morphology following post- spine. Bull Hosp Joint Dis 1965;26:47- 51.
traumatic ankylosis in 26 patients. Int J Oral M axil 50. Ferrari R, Leonard M S. Whiplash and temporoman
lofac Surg 2005;34:376- 381. dibular disorders: a critical review, J Am Dent Assoc
40. Harstall R, Gratz KW, Zwahlen RA. Mandibular 1998;129:1739- 1745.
condyle dislocation into the middle cranial fossa: 51. Bergman H, Andersson F, Isberg A. Incidence of
a case report and review of literature. J Trauma temporomandibular joint changes after whiplash
2005;59:1495- 1503. trauma: a prospective study using M R imaging. Am
41. Ohura N, Ichioka S, Sudo T, Nakagawa M , Kumaido J Roentgenol 1998;171:1237- 1243.
K, NakatsukaT. Dislocation of the bilateral mandib 52. M cKay DC, Christensen LV. Whiplash injuries of the
ular condyle into the middle cranial fossa: review of temporomandibular joint in motor vehicle accidents:
the literature and clinical experience. J Oral M axil speculations and facts. J Oral Rehabil 1998;25:
lofac Surg 2006;64:1165- 1172. 731- 746.
42. Cascone P, Leopardi R, Marino S, Carnemolla M E. 53. Ferrari R, Schrader FI. Prevalence of temporoman
Intracapsular fractures of mandibular condyle: diag dibular disorders associated with whiplash injury in
nosis, treatment, and anatomical and pathological Lithuania. Oral Surg Oral Med Oral Pathol Oral Ra
evaluations. J Craniofac Surg 2003;14:184- 191. diol Endod 1999;87:653- 657.
43. Ellis E, Throckmorton GS. Treatment of mandibu 54. Eriksson PO, Flaggman-Flenrikson B, Zafar H. Jaw-
lar condylar process fractures: biological consider neck dysfunction in whiplash associated disorders.
ations. J Oral M axillofac Surg 2005;63:115- 134. Arch Oral Biol 2007;52:404- 408.
44. Defabianis P. TM J fractures in children and ado 55. Probert TCS, Wiesenfeld D, Reade PC. Temporo
lescents: treatment guidelines. J Clin Pediatr Dent mandibular pain dysfunction disorders resulting
2003;27:191- 199. from road traffic accidents: an Australian study. Int J
45. Kempers KG, Quinn PD, Silverstein K. Surgical ap Oral M axillofac Surg 1994;23:338- 341.
proaches to mandibular condylar fractures: a re 56. Kolbinson D, Epstein JB, Burgess J, Senthilselvan A.
view. J Craniomaxillofac Trauma 1999;5:25- 30. Temporomandibular disorders, headaches, and neck
46. Bucci M B, Manfredini D, Salvetti G, Bosco M . pain after motor vehicle accidents: a pilot investiga
Temporomandibular joint whiplash: implicazioni tion of persistence and litigation effects. J Prosthet
medico-legali [Italian], Doctor Os 2006;17(Suppl Dent 1997;7:46- 53.
1):96- 99.
47. Bucci M B, Salvetti G, Manfredini D, Bosco M . Colpo
di frusta e disordini temporomandibolari [Italian].
Dental Cadmos 2007;2:51- 57.

Глава 33
-
:
,
Фрэнк Лоббезоо, Корин Висхер и Махил Найджи

,
. ,
, ,
.
,
,
.
, , «
, , ».
,
.
XX .

,
.

. .
,
,
,
. ,
, . Bossuyt .1
- ,
(Standards for Reporting
of Diagnostic Accuracy, STARD)
, - . ,
,
,
.

- : ,
. STARD / ,
,
- ,
The British Medical Journal, The Annals of
Internal Medicine The Lancet. Visscher .4
,
/ .
, , ,
, STARD,
STARD.
,
, ,

. .

.
(
) ( )
. ,
(
) .
(
, ) .
( ) -
( I:
) -
( II:
, (Consolidated Standards of Reporting
, , Trials, CONSORT).
, Altman .5
) ,
. 1992 . Samuel Dworkin, Linda
LeResche .

- .
( / ),2 , ,
. ,
/ CONSORT, .

,
(Lobbezoo .3)
. / .

,
.
.
.
4 98
,
,
,
.
. .
,
,
. .
( ,
, ) ,
.
. ,

. .
,
.
, ,
,
, ,
. .
,

.
,
. ,

. .

,
(
). ,
, .

STARD,
, ,
,
. CONSORT.

,

. .

,
. / .

- : ,
,
.
1. Bossuyt PM , Reitsma JB, Bruns DE, Gatsonis CA,
Glasziou PP, Irwig LM et al. Towards complete and
« accurate reporting of studies of diagnostic accuracy:
, ». the STARD initiative. BMJ 2003;326:41- 44.
for temporomandibular disorders: review, criteria,
STARD CONSORT. 3. Lobbezoo F, van Seims M KA, John MT, Huggins K,
Ohrbach R, Visscher CM et al. Use of the research
diagnostic criteria for temporomandibular disorders
for multinational research: translation efforts and
reliability assessments in The Netherlands. J Orofac
Pain 2005;19:301- 308.
4. Visscher CM , Naeije M , De Laat A, Michelotti A,
Nilner M , Craane et al. Diagnostic accuracy of
TM D pain tests: a multicentre study. J Orofac Pain
2009;23:108- 114.
5. Altman DC, Schulz KF, M oher D, Egger M , Davidoff
F, Elbourne D et al. The revised CONSORT state
ment for reporting randomized trials: explanation
and elaboration. Ann Intern Med 2001 ;134:663-
694.
5 00
-
.
: . , . , . , .
:
. , . , . ,
. , . -
.
.
: . , .
.
.
70x100 1/16.
. 1000 .
. . 32,5

-

, -
( ) - .
,
.
,
- . ,
-
.
,
, ,
.
,
.
-
. ,
,
, ,
, .
,
,
,
, .
, D D S,
-
( )
60 , ,
- ,
, - .
,
, .

-

ВНЧС расстройства Манфредини PDF

Загружено:

Сведения о документе

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

ВНЧС расстройства Манфредини PDF

Загружено:

Авторское право:

Доступные форматы

• -

@dentistinfo первый стоматологический телеграм канал

QUIN TESSEN CE PUBLISHING

@dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал

Current concepts on temporomandibular disorders.

Copyright © 2010 by Quintessence Publishing Co. Ltd.

@dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал V

@dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал VII

10. .................................................................................. 179

11. ..................................................................... 191

12. - ......................................... 207

13. - ...................................................... 225

14. ............................................................................................................. 239

15. - .......................... 249

16. - .......................... 267

18. ................................................................................ 287

VIII @dentistinfo первый стоматологический телеграм канал

22. - ................................ 329

23. - ............................ 343

25. ........................................................................................................ 391

26. - ........................................... 401

30. ................................................................................................... 457

31. ................................... 471

32. ..................................................................... 481

@dentistinfo первый стоматологический телеграм канал IX

(Jan A. De Boever), DDS, DMD, - ( )

@dentistinfo первый стоматологический телеграм канал XI

(Antoon De Laat), DDS, (Ambra Michelotti), MD,

(Rachel . . Leeson), BDS, (Franco Mongini), MD

XII @dentistinfo первый стоматологический телеграм канал

(Daniel Paesani), DDS ( )

( ) (Jens . ), DDS, Dr Med Dent

- (Mauro Farella), DDS, PhD

@dentistinfo первый стоматологический телеграм канал XIII

(Hans J. Schindler), DDS,

XIV @dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал 3

4 @dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал 5

6 @dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал 7

8 @dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал 9

10 @dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал 11

12 @dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал 13

14 @dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал 15

@dentistinfo первый стоматологический телеграм канал

18 @dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал 19

20 @dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал 21

joint dysfunction and asymptomatic volunteers.

22 @dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал 23

71. Posselt U. Fisiologia de la oclusion rehabilitation, 76. Bermejo-Fenoll A, Gonzalez-Sequeros O, Gonzalez-

24 @dentistinfo первый стоматологический телеграм канал

@dentistinfo первый стоматологический телеграм канал 25

Reiter, 200645 115 (65

15. Nassif NJ, Al-Salleeh F, Al-Admawi M . The preva