Actual problems in dentistry Actual problems in dentistry Проблемы стоматологии 2077-7566 2412-9461 116711 10.18481/2077-7566-2026-22-1- ЛЕКЦИИ / ЛИТЕРАТУРНЫЕ ОБЗОРЫ LITERATURE REVIEW ЛЕКЦИИ / ЛИТЕРАТУРНЫЕ ОБЗОРЫ NEUROPHYSIOLOGICAL APPROACHES TO THE DIAGNOSIS OF TMJ DYSFUNCTION AND ORTHOPEDIC TREATMENT PLANNING: A SYSTEMATIC REVIEW НЕЙРОФИЗИОЛОГИЧЕСКИЕ ПОДХОДЫ К ДИАГНОСТИКЕ ДИСФУНКЦИИ ВНЧС И ПЛАНИРОВАНИЮ ОРТОПЕДИЧЕСКОГО ЛЕЧЕНИЯ: СИСТЕМАТИЧЕСКИЙ ОБЗОР Саперова Надежда Руслановна Saperova Nadezhda Ruslanovna saperova.n@mail.ru

кандидат медицинских наук;

candidate of medical sciences;

 Ткаченко Сергей Борисович Tkachenko Sergey B. Doc4200@yandex.ru

доктор медицинских наук;

doctor of medical sciences;

 Российская медицинская академия непрерывного профессионального образования Москва Россия Russian Medical Academy of Continuous Professional Education Moscow Russian Federation Российская медицинская академия непрерывного профессионального образования Москва Россия Russian Medical Academy of Continuous Professional Education Moscow Russian Federation 22 1 10 10 09 03 2026 https://dental-press.ru/en/nauka/article/116711/view

Предмет исследования – данные рандомизированных контролируемых испытаний (РКИ) и оригинальных клинических исследований, посвященных нейрофункциональным методам диагностики в ортопедической стоматологии. Цель – систематизировать современные научные данные о роли и клинической эффективности нейрофизиологических методов диагностики в ведении пациентов с дисфункцией височно-нижнечелюстного сустава (ДВНЧС) и нарушениями окклюзионных взаимоотношений. Материалы и методы. В соответствии с рекомендациями PRISMA был проведен систематический поиск в базах данных PubMed/MEDLINE, Web of Science, Cochrane Library и CyberLeninka за период 2020–2026 гг. Методологическое качество оценивалось с помощью инструмента Cochrane RoB 2. Дополнительный поиск включал просмотр списков цитирований в отобранных статьях и релевантных обзорах, а также ручной поиск в российской научной базе (КиберЛенинка) по ключевым терминам из предоставленного списка. Результаты. Установлено, что поверхностная ЭМГ является наиболее доступным и информативным методом для выявления гипертонуса, асимметрии и нарушения координации жевательных мышц. Ультразвуковая эластография демонстрирует высокую чувствительность к структурным изменениям мышц и коррелирует с выраженностью хронической боли. Исследование мигательного рефлекса и ЭНМГ эффективно дифференцируют миофасциальную и нейропатическую боль. Данные фМРТ подтверждают наличие центральной сенситизации и нейропластичности при ДВНЧС, а также положительное влияние ортопедической реабилитации, особенно при имплантационном протезировании. Выводы. Нейрофизиологические методы являются ключевым компонентом современной диагностики ДВНЧС, обеспечивая переход от симптоматической к патогенетически обоснованной модели лечения. Их использование повышает точность диагностики, способствует персонализации терапии и должно рассматриваться как обязательный элемент комплексного ортопедического подхода.

Subject. The study is based on data from randomized controlled trials (RCTs) and original clinical research dedicated to neurofunctional diagnostic methods in orthopedic dentistry. Objectives. The aim is to systematize the current scientific data on the role and clinical effectiveness of neurophysiological diagnostic methods in managing patients with temporomandibular joint (TMJ) dysfunction and occlusal disorders. Methods. In accordance with the PRISMA recommendations, a systematic search was conducted in the PubMed/MEDLINE, Web of Science, Cochrane Library, and CyberLeninka databases for the period 2020–2026. The methodological quality was assessed using the Cochrane RoB 2 tool. Results. It has been established that surface electroneuromyography (ENMG) is the most accessible and informative method for detecting hypertonicity, asymmetry, and impaired coordination of the masticatory muscles. Ultrasonic elastography demonstrates high sensitivity to structural changes in the muscles and correlates with the severity of chronic pain. The study of the blink reflex and ENMG effectively differentiates myofascial and neuropathic pain. fMRI data confirm the presence of central sensitization and neuroplasticity in TMD, as well as the positive effects of orthopedic rehabilitation, especially in implant prosthetics. Conclusion. Neurophysiological methods are a key component of modern TMJ diagnostics, ensuring the transition from a symptomatic to a pathogenetically based treatment model. Their use enhances diagnostic accuracy, promotes personalized therapy, and should be considered an essential element of a comprehensive orthopedic approach.

 нейрофизиологическая диагностика электромиография височно-нижнечелюстные нарушения прикус зубов имплантаты нейропластичность нейрофизиология ноцицептивная система тройничного нерва поверхностная электромиография neurophysiological diagnostics electromyography temporomandibular disorders dental occlusion implants neuroplasticity neurophysiology trigeminal nociceptive system surface electromyography

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