Relationship between occlusion and temporomandibular disorders: Implications for the gnathologist

咬合与颞下颌关节紊乱之间的关系：对牙科医生的影响

Rudolf Slavicek  鲁道夫-斯拉维切克

Vienna, Austria  奥地利维也纳

TThe succession of hominids about 5 or 6 million years ago led to continuous development that culminated in Нотo. The first Homo, also known by the basic designation of Homo habilis, appeared about 2 million years ago. Some reasons for anthropogenesis include posture, speech, brain development, and social behavior. The decisive step in evolution occurred when the new phase of linguistic communication emerged-ie, descriptive language. In a discussion between a Nobel prize winner and one of the greatest philosophers of the twentieth century, namely Konrad Lorenz and Karl Raimund Popper, the following statement emerged: “Brain is language, and language is brain.” Popper took things farther, claiming that brain is speech, and speech is brain, and that man created himself by descriptive speech. 

 Indeed, the brain developed with drastic speed, and the evolution culminated in Homo sapiens. The masticatory organ and occlusion are at the center of this link to the development of the brain, because linguistic communication occurred through this new function.

大约五六百万年前，类人猿相继出现，并不断发展，*终形成了Нотo。*早的智人，也是*基本的称谓 "Homo habilis"，出现于大约 200 万年前。人类进化的一些原因包括姿势、语言、大脑发育和社会行为。进化的决定性一步出现在语言交流的新阶段，即描述性语言。在诺贝尔奖获得者和二十世纪*伟大的哲学家之一康拉德-洛伦兹（Konrad Lorenz）与卡尔-雷蒙德-波普尔（Karl Raimund Popper）的讨论中，出现了以下说法："大脑就是语言，语言就是大脑"波普尔更进一步，声称大脑就是语言，语言就是大脑，人类通过描述性的语言创造了自己。 

 的确，大脑以惊人的速度发展，进化到智人。咀嚼器官和咬合器是大脑发展的中心环节，因为语言交流是通过这一新功能实现的。

CYBERNETICS AND ORGANISMS

控制论与有机体

In 1948, Wiener published a provocative scientific book that first described the concept of networking in biology. He stated that cybernetic thinking is the link in the “no man’s land” between the recognized sciences. 1 describe an organism from the cybernetic point of view as a highly complex and self-contained system that is unified by a common (external and internal) flow of information, which compels all internally dependent subsystems to undergo reactive changes, and is therefore in a state of permanent unstable homeostasis. The permanent reactive adaptation of an organism to maintain

1948 年，维也纳出版了一本具有启发性的科学著作，首次描述了生物学中的网络概念。他指出，控制论思维是公认科学之间 "无人区 "的纽带。1 从控制论的角度将生物体描述为一个高度复杂和自足的系统，它由一个共同的（外部和内部）信息流统一起来，迫使所有内部依赖的子系统发生反应性变化，因此处于永久不稳定的平衡状态。生物体的永久性反应适应以维持

homeostasis can be termed “life.” The main purpose of an organism is survival. Adaptation and habituation were first elaborated upon by Jean-Baptiste Lamarck in his second thesis, which discussed the genetic outcome if both sexes are habituated. This definition might also be viewed from the perspective of the second main theorem of thermodynamics.

平衡可被称为 "生命"。生物的主要目的是生存。 

 让-巴蒂斯特-拉马克（Jean-Baptiste Lamarck）在他的第二篇论文中首次阐述了适应和习性，其中讨论了如果两性都习性化的遗传结果。也可以从热力学第二大定理的角度来看待这一定义。

Biologic systems are open systems with a time direction. Here, Prigogine described the so-called dissipative structures in general for open systems and thus also for biologic systems. Processes in biologic systems are “irreversible.” A major aspect of open systems is that all interventions (also therapy) are irreversible. From the perspective of evidence-based medicine, when we separate teeth with occlusal aids and then remove the appliance, a condition of restitutio ad integrum can be achieved. From a scientific point of view, this is absolutely incorrect.

    生物系统是有时间方向的开放系统。普里高金描述了开放系统中所谓的耗散结构,因此也适用于生物系统。生物系统中的过程是"不可逆的"。开放系统的一个主要特点是所有干预措施(包括治疗)都是不可逆的。从循证医学的角度来看,当我们用咬合装置分开牙齿后再将其去除时,可以达到完全恢复的状态。从科学角度来看,这是完全错误的。

Uexkül initiated a further major modification in biology when he described his new viewpoint about organisms in their environment. If an organism is confronted with a problem in its environment, the organism recognizes the problem, states its importance, reacts, and arrives at a solution to the problem. This reaction is received by the environment as a new reality. The problem is solved both directly and cognitively!

Uexkül 在生物学中引发了进一步的重大修改，当他描述了关于有机体与其环境之间新观点时。如果有机体在其环境中遇到了一个问题，有机体就会识别这个问题，评估其重要性，作出反应，并找到解决问题的方法。这种反应被环境视为新的现实。问题不仅得到了直接的解决，还在认知上得到了解决！

Humans are a suprasystem with a strong relationship between the soma and the psyche. Based upon self-consciousness, the human being creates his or her own individual reality. Because of social structures, education, conventions, inhibited aggression, or the unwillingness to be aggressive, problems are usually not solved directly but, rather, in a delayed manner, or they remain unresolved. We name this psychic behavior suppression. Thus, the psyche becomes a dumping ground for unresolved problems that remain concealed and cognitively inaccessible.

人类是一个高级系统， soma（ soma 是拉丁语“身体”的意思，在此可能指身体）与心理之间关系密切。基于自我意识，人类创造了自己独特的现实。
由于社会结构、教育、习俗、抑制的攻击性或不愿意攻击，问题通常不是直接解决，而是延迟解决，或者无法解决。我们称这种心理行为为抑郁。

In summary, the masticatory organ of Homo sapiens is an entirely new evolutionary concept with newly networked functional spheres-ie, a “new organ.” In our individual ontogenesis, we must rediscover and relearn the phylogenetic new functions.
总之，人类的咀嚼器官是一个全新的进化概念，具有新网络化的功能领域——即一个“新器官”。在我们的个体发生过程中，我们必须重新发现和重新学习系统发育的新功能。
ONTOGENESIS OF THE MASTICATORY ORGAN
咀嚼器官的起源
Before erupting into the oral cavity, the dental crowns are complete morphologic structures, which 1 define in genetic terms as the 1 structure of the human body that can be altered only by destruction. Due to the sequence of ontogenesis, 1 prefer to speak in terms of functional periods rather than use the usual classification of growth periods: the postnatal period, breathing and communication, ingestion and digestion, preparation of the spine, changing nutrition, and mastication and swallowing.
牙冠在长入口腔之前，是完整的形态结构，在遗传学上，它被定义为只有通过破坏才能改变的人体结构。由于个体发育的顺序，我更喜欢用功能期来说话，而不是使用通常的生长期分类：出生后时期，呼吸和交流，摄食和消化，脊柱的准备，改变营养，咀嚼和吞咽。

Uprighting  直立
Man’s ontogenetic uprighting caused a massive change in the region of the temporal bone. Because of the position of the organ of balance and the archways, the pyramid had to rotate in the opposite direction during uprighting. Counterrotation concerned not only the temporal bone but also all bones of the cranium. 
人类的直立在颞骨区域引起了巨大的变化。由于平衡器官牙弓的位置，在直立过程中必须向相反的方向旋转。反向旋转不仅涉及颞骨，还涉及头盖骨的所有骨骼。
During the period of the deciduous dentition, the following typically occur: full development of communicative speech, general learning, social adjustment, psychic stress management through the masticatory organ, and abrasion of the deciduous dentition. Malfunction and malocclusion form during this period. The phase of the mature deciduous dentition is the longest and most effective learning period in life. Therefore, it is a period of extreme psychic narrowing and loading. At this age, bruxing is a normal function to unload the psyche. The resulting abrasion favors the required protrusive advancement of the mandible.
在乳牙期，通常会出现以下情况：语言交流能力的全面发展、一般学习能力、社会适应能力、通过咀嚼器官调节心理压力以及乳牙磨损。在这一时期会形成功能障碍和错颌畸形。成熟乳牙期是人生中*长、*有效的学习期。因此，这是一个心理上极度狭窄和负荷极重的时期。在这个年龄段，磨牙是一种正常的心理卸载功能。 由此产生的磨擦有利于下颌的向前伸出。
First period of the mixed dentition
混合牙列的第一个时期

With the eruption and coupling of the permanent first molars, the anterior permanent teeth are also exchanged, intercuspal positions are defined, structural limitations are established, functional adaptations (chewing and speech) occur, and the structural adaptation of the temporomandibular joint begins. During this period, the temporomandibular joint adapts just as rapidly. The initial adaptation is functional but is followed by structural adaptation. This means that occlusion dictates adaptation. This ability to adapt functionally as well as structurally persists throughout life, but in a less pronounced manner. As early as this point in time, the morphology of the first molars structurally determines the lateral and retral pattern of the craniomuscular system. The position and rotation of

随着第一恒磨牙的萌出和连接，前恒牙也开始交换，牙间位置确定，结构限制建立，功能适应（咀嚼和说话）发生，颞下颌关节的结构适应开始。在此期间，颞下颌关节的适应也同样迅速。*初的适应是功能性的，但随后是结构性的适应。这意味着咬合决定了适应。这种功能上和结构上的适应能力会持续一生，但不那么明显。早在这一时期，第一磨牙的形态就在结构上决定了颅肌系统的侧向和后向模式。第一磨牙的位置和旋转

the molars determine the movement pattern of the mandible. 

磨牙决定下颌骨的运动模式。 

Compensation of sagittal and transverse discrepancies occurs during this time. The first main factor of compensation during ontogenesis is dentoalveolar development. The second main factor to compensate skeletal discrepancies is vertical development. The third main factor, especially in skeletal Class 11 malrelationships, is articular compensation (temporomandibular joint). Malocclusion in the early mixed dentition must be recognized.

矢状面和横向差异的补偿就发生在这个时期。个体发育过程中的第一个主要补偿因素是牙槽骨的发育。补偿骨骼差异的第二个主要因素是垂直发育。第三个主要因素是关节补偿（颞下颌关节），尤其是在骨骼11类错位中。必须认识到早期混合牙列的错合畸形。

Second functional period of the changing dentition

变化牙列的第二个功能期

During the second functional period of the changing dentition, the premolars erupt, there is narrowing of lateral control, retrusive control in the first premolar occurs, and the psychic stress of the beginning of puberty starts. The morphology of the premolars-especially that of the first premolar- is the most important preparatory basis for the final dynamics of lateral, retrusive, and protrusive mandibular movements. From the orthodontic point of view, extractions in this region are functionally critical. 

在牙列变化的第二个功能期，前磨牙萌出，侧向控制变窄，第一前磨牙出现后退控制，青春期开始时的心理压力开始出现。前磨牙的形态，尤其是第一前磨牙的形态，是下颌侧向、后退和前突运动*终动态的*重要的准备基础。从正畸的角度来看，在这一区域拔牙将对功能上产生很大影响。 

During the maturation of the dentition, the position of the mandible is determined 3 -dimensionally by the occlusion of the teeth.

在牙列成熟的过程中，下颌骨的位置是由牙齿咬合的三维空间决定的。

Functional period of maturation

功能成熟期

During the functional period of maturation, canine dominance 

 is established, the craniomuscular system matures into the reference position, second molar intercuspation develops, and there is increasing psychic loading with puberty and increased social integration.

在功能成熟期，犬科动物的优势地位得以确立，颅-肌肉系统成熟到参考位置，第二磨牙牙间隙发育，随着青春期的到来和社会融合度的提高，精神负担越来越重。

In conclusion, during the maturation of the dentition, the position of the mandible is determined 3-dimensionally by the occlusion of the teeth. It is habituated and controlled proprioceptively, while closing the jaw. The joints are secured vertically by the teeth. 

总之，在牙列成熟的过程中，下颌的位置是由牙齿的咬合三维决定的。 在下颌闭合时，下颌的位置由本体感觉来习惯和控制。关节位置由牙齿垂直高度决定。 

In the phase of bolus formation, mastication should be more of a translatory process. There should be minimum rotation. In modern man, optimum dynamic mastication is achieved when the rows of teeth are as close to each other as possible without functional interferences.  Hence, occlusion is undoubtedly the major and dominant factor of the system. Occlusion and articulation determine the functional patterns of mandibular movement.在食团形成阶段，咀嚼应该更多地是一种咀嚼过程。应该有*低限度的轮换。在现代人中，当牙齿排尽可能靠近而没有功能干扰时，可以实现*佳的动态咀嚼。因此，咬合无疑是该系统的主要和主导因素。咬合和关节运动决定了下颌运动的功能模式。The term “disclusion” in our modern occlusal concepts is a perversion of the central significance of the masticatory organ: to cut food efficiently. The quality of intercuspation is important for the physiology of chewing. Chewing is concluded by the act of swallowing. Intercuspation should be achieved without interference. The difference between retral contact position and intercuspation in chewing and deglutition is of minor importance. Chewing and swallowing are patterns adapted to the quality of food and controlled proprioceptively during the sequence of mastication.在我们现代的咬合概念中，“disclusion”一词扭曲了咀嚼器官的核心意义：有效地切割食物。咬合接触的质量对于咀嚼的生理功能很重要。咀嚼在吞咽动作完成后结束。咬合接触应无干扰地实现。咀嚼和吞咽中的后牙接触位置与咬合接触位置之间的差异在咀嚼和吞咽过程中影响较小。咀嚼和吞咽是根据食物质量适应的模式，并在咀嚼序列过程中通过本体感受进行控制。

The necessary information is provided by individual tooth contacts during chewing. The front teeth are avoided in mastication. Functional interferences in occlusion can cause avoidance patterns. Avoidance patterns during mastication and swallowing might be a reason for temporomandibular disorders.

在咀嚼过程中，单个牙齿的接触会提供必要的信息。前牙在咀嚼时被避让。咬合中的功能性干扰可导致避让机制。咀嚼和吞咽时的避让机制可能是颞下颌关节紊乱的原因之一。

Speech  语言

Communication is the main function of the masticatory organ, and pronunciation is predominantly related to the anterior teeth. Other teeth and occlusion might create avoidance patterns causing TMD.

交流是咀嚼器官的主要功能，而发音主要与前牙有关。其他牙齿和咬合可能会产生导致 TMD 的避让机制。

Bruxing and clenching (the role of teeth in stress management)

磨牙和咬紧牙（牙齿在压力管理中的作用）

The limbic system is the complex system belonging to the archaeocerebellum, located between the brain stem and the neocortex, which is considered to be responsible for emotion and instinctive behavior. Humanization leads to proportional shifts, which cause aggressive behavior. In the evolution of the primate, a strong shift in balance occurs in the region of the amygdaloid nucleus. The centromedial portions (aggression) are markedly reduced compared with the centrobasolateral (pleasure-oriented) portions.

边缘系统是属于小脑的复杂系统，位于脑干和新皮层之间，被认为负责情绪和本能行为。人性化会导致比例变化，从而导致攻击性行为。在灵长类动物的进化中，杏仁核核区域发生了平衡的强烈变化。与中心外侧（以愉悦为导向）部分相比，中心内侧部分（攻击性）明显减少。

Kail stated in her dissertation on our bruxing patients in the Department of Prosthetic Dentistry at the Dental University of Vienna, Austria, that any deficiency or disability in direct aggressive behavior could be a reason to use the masticatory organ for reducing stress through bruxism. As a result of her research, she found that the total group of 98 bruxers had significantly reduced general well-being. Furthermore, the personality structures in the study were significantly different from standard random samples of matched groups in regard to general aggressive behavior. In addition, both spontaneous and reactive aggressive behaviors were markedly less than in the control group. In the lives of the subjects, problem solving frequently occurs either in a delayed manner or by way of

凯尔在她关于奥地利维也纳牙科大学修复牙科系磨牙患者的论文中指出，任何直接攻击行为的缺陷或残疾都可以成为通过磨牙使用咀嚼器官减轻压力的理由。研究结果表明，98 名磨牙患者的总体幸福感明显降低。此外，在一般攻击性行为方面，研究中的人格结构与标准随机样本的匹配群体有明显差异。此外，自发性和反应性攻击行为都明显少于对照组。在受试者的生活中，问题的解决经常是以延迟的方式或通过以下方式进行的

compromises or not at all. Such “no solving” of problems is deposited in the garbage dump of the psyche and can be realized at the somatic level through nonpurpose-related emotions.

妥协或根本不妥协。这种对问题的 “无解” 被存放在心灵的垃圾堆中，并且可以通过与目的无关的情绪在躯体层面上实现。

If chronic pressers and grinders use their masticatory organ as a psychic stress valve, then grinding and pressing might be assigned to the normal functions of the masticatory organ. For these people, decrying parafunction in the treatment of the masticatory organ would signify an additional restriction. What is the role of occlusion in coping with stress? This discussion must be conducted unemotionally on the basis of scientific findings and conclusions. Grinding and clenching are expressions of psychic stress assimilation and are controlled by the neuromuscular system and occlusion. 

如果慢性压迫者和磨牙者将咀嚼器官作为精神压力阀，那么磨牙和压迫就可能被归为咀嚼器官的正常功能。 对于这些人来说，在治疗咀嚼器官时抨击副功能将意味着额外的限制。咬合在应对压力方面的作用是什么？这一讨论必须以科学发现和结论为基础，不能感情用事。磨牙和咬紧牙是心理压力同化的表现，受神经肌肉系统和咬合的控制。 

Therapy of occlusion: Goals and concepts

咬合治疗：目标和概念

Interventions in the structure of occlusion are irreversible. This is based on the widely accepted axioms of the natural sciences. All assertions of reversibility are scientifically unfounded. Therapeutic interventions must have a causal reason. The purpose should be defined, and the aim should concur with the purpose. This is applicable to restorative and prosthetic interventions in equal measure as it is to orthodontic and maxillofacial surgical corrections. After completion of the treatment, the result should be biologically stable. So-called retentions might be indicated in the phase of stabilization, but a general retention of the occlusal outcome is incorrect. Defensive assertions to the effect that therapeutic interventions can have no negative consequences are absurd.

对咬合结构的干预是不可逆的。这是基于广为接受的自然科学公理。所有关于可逆性的断言都是没有科学依据的。治疗干预必须有因果关系。目的应当明确，目标应当与目的一致。这一点同样适用于修复和修复性干预，就像适用于正畸和颌面外科矫正一样。治疗完成后，结果应具有生物稳定性。 在稳定阶段可能会有所谓的保留，但对咬合结果的一般保留是不正确的。认为治疗干预不会产生负面影响的辩护性断言是荒谬的。

“Gnathology” is defined as "the science that treats the biology of the masticatory mechanism as a whole: morphology, anatomy, histology, physiology, and therapeutics of the jaws or masticatory system and the teeth as they relate to the health of the whole body, including applicable diagnostic, therapeutic, and rehabilitation procedures. The conceptual dogmatism of the term gnathology in earlier days was a problem or cause that split occlusionists from nonocclusionists. But dogmatic wars are counterproductive. Independent from skeletal individuality, human teeth are nearly morphologically the same. Canines and anterior teeth are controlling and/or guiding; posterior teeth support and disclude. The modern gnathologic concept is clearly proven and can be recommended. Any other concept in orthodontics must be defined but must fit with the natural morphology of teeth and must be verified by scientific data. 

"咬合学 "被定义为 "将咀嚼机制的生物学作为一个整体进行研究的科学：颌骨或咀嚼系统和牙齿的形态学、解剖学、组织学、生理学和治疗学，因为它们与整个身体的健康有关，包括适用的诊断、治疗和康复程序。早期，"gnathology "一词在概念上的教条主义是导致咬合学家与非咬合学家分裂的一个问题或原因。但教条主义之争只会适得其反。与骨骼的个性无关，人类的牙齿在形态上几乎是相同的。尖牙和前牙起控制和/或引导作用；后牙起支持和阻挡作用。现代咬合学概念已得到明确验证，值得推荐。正畸学中的任何其他概念都必须加以定义，但必须符合牙齿的自然形态，而且必须经过科学数据的验证。 

CONCLUSIONS  结 论

The teeth occlude and determine the motion pattern of the mandible. Furthermore, motion patterns occur in the neuromuscular system and are regulated proprioceptively. The signals of proprioception occur in the teeth, the periodontal ligament, the temporomandibular joints, and the muscles themselves. Intact teeth provide the most rapid information to the brain in monosynaptic fashion. The functions of the masticatory organ are entirely different and closely networked with the somatic and psychic functions of the brain. Of course, there are adaptability and a compensatory capacity. However, the masticatory organ and the psyche are strongly linked.

牙齿咬合决定了下颌骨的运动模式。此外，运动模式发生在神经肌肉系统中，并通过本体感觉进行调节。本体感觉信号发生在牙齿、牙周韧带、颞下颌关节和肌肉本身。完整的牙齿以单突触方式向大脑提供*快速的信息。咀嚼器官的功能完全不同，与大脑的躯体和精神功能紧密相连。当然，咀嚼器官也有适应能力和代偿能力。然而，咀嚼器官和心理是紧密相连的。

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