A型ボツリヌス毒素を用いた機能障害治療における咬合力測定

Measurement of occlusal forces in the therapy of functional disorders with the use of botulinum toxin type A.

抄録

顎口腔系の機能障害には、下顎内転筋によって発生する咬合力が病的に増大する機能障害が含まれます。これらの咬合力は、歯の病的な磨耗、緊張型頭痛、顎関節領域の痛みなど、咀嚼器官における多くの障害の原因となっている。本研究の目的は、A型ボツリヌス毒素（筋弛緩を引き起こす薬剤）を用いた有痛性機能障害の治療過程における咬合力を評価することである。本研究の対象は、クラクフのヤギェウォ大学医科大学歯学研究所大学病院で有痛性機能障害を呈した24～42歳の成人患者である。患者は、咀嚼器官の専門家による機能検査の結果に基づいて本研究に適格とされ、さらに咬筋と顎関節の痛みの評価にはVAS（Visual Analogue Scale）が用いられた。受診者の最大咬合力測定は、歯科検査用の特別な測定器（特許番号P 334933）を用いて、すべての受診者の両側の中切歯と第一大臼歯の領域で実施した。検査は、治療開始前、A型ボツリヌス毒素を片側の咬筋に対して21マウスユニット-Uの用量で筋肉内投与した10日後および16週間後に行った。最初の検査、すなわち治療開始前の検査で得られた最大咬合力の検査結果は、生理学的値を著しく超えていた。対照試験では、有意な持続的咬合力低下が認められた。

Functional disorders of the stomatognathic system include dysfunctions leading to pathological increase of the occlusal forces generated by mandibular adductors. High values of these forces are the cause of numerous disorders within the masticatory organ such as pathological abrasion of the teeth, tension headaches and pain in the region of the temporomandibular joints. The aim of this study was assessment of occlusal forces in the course of the therapy of painful types of functional disorders with the use of botulinum toxin type A - the drug causing muscle relaxation. The material for the study comprised adult patients aged 24-42 years who presented with a painful type of functional disorders in the University Hospital, Institute of Dentistry Jagiellonian University Medical College in Cracow. The patients were qualified to the study on the basis of the results of specialist functional examination of the masticatory organ in which additionally the VAS (Visual Analogue Scale) was used for pain assessment of the masseters and temporomandibular joints. The measurement of maximal occlusal forces in the examined patients was carried out in all patients in the region of the central incisors and first molars on the both side with the use of a special measuring instrument for dental examination, specially constructed (patent number P 334933). The examinations were performed before the beginning of the treatment, 10 days and 16 weeks after intramuscular administration of botulinum toxin type A at a dosage of 21 mouse units - U for one masseter. The results of the examination of maximal occlusal forces obtained in the first examination, that is, before the beginning of the treatment, markedly exceeded the physiological values. In the control examinations, significant, persistent decrease of the studied forces has been noted.