咬合不全を伴った重度変形性顎関節症症例

患者は68歳の女性であり，初診約10年前に自律神経失調症の診断を受けた。同時期より頸部の違和感のために週2回程度，カイロプラクティックで施術を受けていた。4～5年前から嚙みにくさを自覚し，右側で嚙めなくなったため，2013年に開業歯科医で下顎右側臼歯部に暫間被覆冠が装着された。経過観察されていたが，右側臼歯部の離開が進むため，2015年に徳島大学病院に紹介された。臨床所見としては，左側顎関節雑音を認め，開口制限や頭頸部の圧痛は認めなかった。パノラマエックス線写真では，両側下顎頭の吸収と下顎枝の短縮を認め，CT画像では両側下顎頭と下顎窩の著しい形態異常を認めた。かかりつけ内科の検査ではリウマトイド因子は陰性で，本院整形外科においても軽度頸椎症の診断であった。両側変形性顎関節症と診断し，スタビライゼーション型スプリントを装着し，経過観察後，歯冠修復を行った。本症例ではスプリントを用いた咬合接触の安定化と段階的な補綴治療が咬合状態の改善に効果的であった。

The patient was a 68-year-old female who had been diagnosed with autonomic dysfunction and had been attending a chiropractic clinic twice a week for 10 years for treatment of neck discomfort. She had experienced a loss of occlusal function in the right molar region starting 4-5 years before the first visit. In 2013, her right mandibular molar was temporarily restored at a dental clinic to improve her occlusion on the right side. This was not successful and her right-side occlusal function was not restored. The dental clinic referred her to Tokushima University Hospital in 2015 for right-side molar open bite. She presented with crepitus in the left TMJ, but did not exhibit significant symptoms such as pain or difficulty in mouth opening. Panoramic radiography revealed resorption of the mandibular head and shortened mandibular ramus on both sides. CT images exhibited severe deformation of the left TMJ. No rheumatoid factors were found in the physician's examination, and a diagnosis of slight cervical spondylosis of the neck was made by the orthopedist of the University Hospital. We diagnosed her symptoms as bilateral osteoarthritis of the TMJ. A stabilization splint was fitted to restore occlusal function. This was followed by a step-by-step approach for prosthodontic treatment of the final molar restorations.