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Heo HA, Park S, Pyo SW, Yoon HJ. Clinical outcomes of patients with unilateral internal derangement of the temporomandibular joint following arthrocentesis and stabilization splint therapy. Maxillofac Plast Reconstr Surg 2024; 46:24. [PMID: 38976106 PMCID: PMC11231121 DOI: 10.1186/s40902-024-00436-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/02/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND The management of internal derangement (ID) of the TMJ is challenging because of multiple etiologic factors and varying degrees of severity. The aim of this study was to evaluate the clinical outcomes of patients with unilateral ID treated with arthrocentesis and stabilization splint therapy during a 6-month period. METHODS A total of 105 patients (87 females, 18 males) with unilateral ID were included in this study. Patients were divided into unilateral anterior disc displacement with reduction (ADDwR) and unilateral anterior disc displacement without reduction (ADDwoR). Patients with ADDwoR were subdivided according to the erosive bone changes. Objective parameters on mandibular movement and subjective parameters on pain were obtained and assessed. Their clinical outcomes before and after arthrocentesis and stabilization splint therapy were compared with the chi-square, Fisher's exact test, paired t-test, or Wilcoxon singed-rank test. RESULTS All objective parameters of unilateral ID patients significantly increased at the 6-month follow-up. The differences in mean visual analog scale (VAS) pain scores were statistically significant in all subjective variables (p < 0.01). In joints with ADDwoR, preoperative maximal mouth opening, and maximal protrusive movement in both groups, with erosive and non-erosive changes were significantly increased after 6 months (p < 0.01). However, right and left maximal lateral movement increased after treatment in both groups but without significant differences. All VAS pain scores on jaw movement and palpation of associated muscles showed a significant decrease regardless of erosive changes. CONCLUSIONS The combination of arthrocentesis and subsequent stabilization splint therapy was shown to be highly effective in pain reduction and improvement of mandibular movements in both unilateral ADDwR and ADDwoR, as well as in cases with both erosive and non-erosive bony changes associated with unilateral ADDwoR.
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Affiliation(s)
- Hyun-A Heo
- Department of Advanced General Dentistry, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Suhyun Park
- Department of Advanced General Dentistry, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Woon Pyo
- Department of Oral and Maxillofacial Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyun-Joong Yoon
- Department of Oral and Maxillofacial Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Al-Moraissi EA, Al-Otaibi K, Almaweri AA, Bastos RM, Haas Junior OL, Amran AG. Treatment of painful temporomandibular joint disc displacement without reduction: network meta-analysis of randomized clinical trials. Int J Oral Maxillofac Surg 2024; 53:584-595. [PMID: 38395688 DOI: 10.1016/j.ijom.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
There is currently no consensus on the best treatment for painful temporomandibular disc displacement without reduction (DDwoR), and no network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing all types of treatments for this condition has been conducted. The objective of this study was to compare and rank all treatments for DDwoR, including conservative treatments, occlusal splints, low-level laser therapy (LLLT), arthrocentesis (Arthro) alone, Arthro plus intra-articular injection (IAI) of platelet-rich plasma (PRP), Arthro plus IAI of hyaluronic acid (HA), Arthro with exercises, Arthro plus occlusal splints, and manipulative therapy. Outcome variables were pain intensity on a visual analogue scale (VAS) and maximum mouth opening (MMO, mm). The mean difference with 95% confidence interval was estimated using Stata software. The GRADE system was used to assess the certainty of the evidence. A total of 742 patients from 16 RCTs were included in the NMA. Both direct meta-analysis and NMA showed that Arthro with IAI of co-adjuvants provided better pain reduction in the short term (≤3 months) than Arthro alone. However, the quality of the evidence was very low. In the intermediate term, Arthro alone or combined with co-adjuvants provided better pain reduction than conservative treatment, but with low-quality evidence. Conservative treatment significantly increased MMO in the short term compared to other treatments. In conclusion, the results of this NMA suggest that arthrocentesis with intra-articular injection of adjuvant medications may be superior to conservative treatments in reducing pain intensity at long-term follow-up, while no significant differences were found for the MMO outcome. However, the quality of evidence was generally low to very low, and further RCTs are needed to confirm these findings.
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Affiliation(s)
- E A Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Thamar University, Thamar, Yemen.
| | - K Al-Otaibi
- Department of Maxillofacial Surgery and Diagnostics Sciences, College of Dentistry, Qassim University, Qassim, Saudi Arabia
| | - A A Almaweri
- Department of Oral Medicine, Thamar University, Thamar, Yemen
| | - R M Bastos
- Department of Oral and Maxillofacial Surgery, Hospital São Lucas of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - O L Haas Junior
- Department of Oral and Maxillofacial Surgery, Hospital São Lucas of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - A G Amran
- Department of Periodontolgy, Thamar University, Thamar, Yemen
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3
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Bhattacharjee B, Bera RN, Verma A, Soni R, Bhatnagar A. Efficacy of Arthrocentesis and Stabilization Splints in Treatment of Temporomandibular Joint Disc Displacement Disorder Without Reduction: A Systematic Review and Meta-analysis. J Maxillofac Oral Surg 2023; 22:83-93. [PMID: 36703686 PMCID: PMC9871120 DOI: 10.1007/s12663-021-01675-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background Temporomandibular joint disc displacement disorders are a group of temporomandibular disorders beside from other inflammatory disorders and growth related disorders of joint. The purpose of this analysis was to evaluate the efficacy of arthrocentesis procedure in comparison with stabilization splints used for disc displacement disorders without reduction. Materials and Methods A systematic search was done in electronic databases (PubMed, Cochrane Central, Web of Science). In addition to this hand search of references and grey literatures was done. Qualities of randomized controlled clinical trials were assessed by Cochrane's tool for Systematic Reviews of Interventions and the Newcastle-Ottawa Scale was followed to assess the prospective and retrospective studies. Outcome variables pain (VAS) and maximum mouth opening were assessed by the software review manager 5.03. Results A total of five studies were included in the review. Three studies showed greater improvement of symptoms in patients of arthrocentesis group in terms of maximum mouth opening, pain (VAS) value. Two other studies found no significant advantage of arthrocentesis over the other treatment protocol. The meta-analysis resulted in statistically significant difference between outcome variables favouring arthrocentesis group (VAS 1-10) (Mean Difference: 3.10; 95% CI 1.74, 4.45; P ≤ .00001, Mean difference: 2.00; 95% CI 0.29, 3.71; P = 0.02). Conclusion Arthrocentesis showed effective result in terms of increase in mouth opening and reduction of pain level compared to stabilization splint and other non-invasive approaches in patients with disc displacement disorders without reduction. Overall, results supported the rationale of using arthrocentesis in patients with disc displacement disorders without reduction.
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Affiliation(s)
- Bappaditya Bhattacharjee
- Unit of Prosthodontics, Faculty of Dental Sciences, Banaras Hindu University, Lanka, Varanasi, Uttar Pradesh 221005 India
| | - Rathindra Nath Bera
- Unit of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Banaras Hindu University, Lanka, Varanasi, Uttar Pradesh 221005 India
| | - Arju Verma
- Unit of Prosthodontics, Faculty of Dental Sciences, Banaras Hindu University, Lanka, Varanasi, Uttar Pradesh 221005 India
| | - Romesh Soni
- Unit of Prosthodontics, Faculty of Dental Sciences, Banaras Hindu University, Lanka, Varanasi, Uttar Pradesh 221005 India
| | - Atul Bhatnagar
- Unit of Prosthodontics, Faculty of Dental Sciences, Banaras Hindu University, Lanka, Varanasi, Uttar Pradesh 221005 India
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Evaluation of Patient Comfort and Impact of Different Anesthesia Techniques on the Temporomandibular Joint Arthrocentesis Applications by Comparing Gow-Gates Mandibular Block Anesthesia with Auriculotemporal Nerve Block. Pain Res Manag 2022; 2022:4206275. [PMID: 36090766 PMCID: PMC9453085 DOI: 10.1155/2022/4206275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
Aim Temporomandibular disorders (TMDs) are clinical situations that are characterized by pain, sound, and irregular movements of the temporomandibular joints. The most common method in the treatment of TMDs is arthrocentesis. This study aims to compare the effect of conventional extraoral auriculotemporal nerve block (ANB) and Gow-Gates (GG) mandibular anesthesia techniques on patient comfort in an arthrocentesis procedure. Materials and Methods We performed this study on 40 patients who underwent TMJ arthrocentesis with ANB (n = 20) or GG (n = 20) mandibular anesthesia techniques at the Marmara University Faculty of Dentistry between 2016 and 2019. The predictor variable was the type of an anesthesia technique, and the outcome variables included were pain, maximum mouth opening (MMO), and protrusive movement (PM). They were compared at the preoperative period and 3rd and 6th month periods. Statistical analysis included means with standard deviations, a one-way ANOVA for continuous data, and the results were evaluated at the significance level of p < 0.05. Results No statistically significant difference was observed between the VAS values, MMO, and PM averages of preoperative, 3rd and 6th months of ANB and GG (p=0.142, p=0.209, and p=0.148). Conclusion Both anesthesia techniques have provided effective results in terms of pain and functional jaw movements in the postoperative period in arthrocentesis treatment.
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Ritto FG, Cueto AP, Dos Santos Canellas JV, Zuniga JR, Tiwana PS, Pimentel T, Medeiros PJ. Arthrocentesis versus nonsurgical methods in the management of temporomandibular joint closed lock and pain: a double-blind randomized controlled trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:369-376. [PMID: 34373214 DOI: 10.1016/j.oooo.2021.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The present double-blind randomized clinical trial aimed to compare the efficacy of conservative treatment and articular lavage, either alone or combined, to reduce joint pain and improve mandibular opening. STUDY DESIGN The sample consisted of patients presenting with limited mouth opening and joint pain. The diagnosis was made according to the diagnostic criteria for temporomandibular disorders guideline and confirmed by magnetic resonance imaging. Sixty patients were selected and randomly allocated to 4 groups of 15 patients each with different treatments: group A (conservative), group B (conservative + medication), group C (arthrocentesis), and group D (arthrocentesis + medication). The groups were compared in terms of maximal interincisal opening and pain. RESULTS The average age of the patients was 34.17 ± 13.1 years, 88.1% were women, 72.9% had internal derangement, 54% had joint sounds, and 55.9% presented with locking. Clinical improvement was noted in all parameters compared with baseline in all groups (P < .005), but no significant differences were observed when the groups were compared (P > .05). CONCLUSIONS Both arthrocentesis and conservative modalities were efficient treatments to reduce joint pain and increase mandibular opening.
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Affiliation(s)
- Fabio G Ritto
- Department of Oral and Maxillofacial Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil.
| | - Alexander Pomares Cueto
- Department of Oral and Maxillofacial Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - John R Zuniga
- Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Paul S Tiwana
- Department of Oral and Maxillofacial Surgery, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Thais Pimentel
- Department of Oral and Maxillofacial Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Jose Medeiros
- Department of Oral and Maxillofacial Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Hardy RS, Bonsor SJ. The efficacy of occlusal splints in the treatment of bruxism: A systematic review. J Dent 2021; 108:103621. [PMID: 33652054 DOI: 10.1016/j.jdent.2021.103621] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Bruxism is a commonly reported oral parafunctional activity characterised by excessive tooth grinding or clenching outside normal functional activity. The present systematic review aims to examine the available literature to determine the effectiveness of occlusal splints in the treatment of bruxism compared to no treatment and alternative treatment modalities. DATA Data extraction was undertaken in conjunction with quality of evidence assessment. SOURCES A literature search of the following databases was undertaken: MEDLINE via OVID, Pubmed (Medline), Cochrane Oral Health Group's Trials, The Cochrane Central Register of Controlled Trials and EMBASE. STUDY SELECTION Randomised Controlled Trials (RCT) and quasi-RCTs which met the inclusion criteria were selected for analysis. These included studies comparing occlusal splints to no treatment or other interventions. RESULTS Twenty-two studies were identified for review with fourteen meeting the inclusion criteria. Only a small number of studies were available in each comparison (one or two for some) all of which had a medium to high risk of bias. CONCLUSIONS There is insufficient evidence to determine whether occlusal splint therapy for the treatment of bruxism provides a benefit over no treatment, other oral appliances, TENS, behavioural or pharmacological therapy. Furthermore, there is a lack of studies in each comparison with many suffering from a high risk of bias. There is a need for further research in this area and improvement in trial quality. CLINICAL SIGNIFICANCE STATEMENT This systematic review aimed to determine the effectiveness of occlusal splints in the treatment of bruxism. It found there was insufficient evidence to recommend occlusal splint therapy over no treatment or other treatment modalities. This is relevant to dental clinicians who may provide such appliances and cautions them in treatment provision.
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Affiliation(s)
- Robert S Hardy
- Edinburgh Postgraduate Dental Institute, University of Edinburgh, Edinburgh, UK..
| | - Stephen J Bonsor
- Edinburgh Postgraduate Dental Institute, University of Edinburgh, Edinburgh, UK.; Institute of Dentistry, University of Aberdeen, Aberdeen, UK..
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Bilgir E, Yıldırım D, Șenturk MF, Orhan H. Clinical and ultrasonographic evaluation of ultrasound-guided single puncture temporomandibular joint arthrocentesis. Cranio 2020:1-10. [PMID: 33267750 DOI: 10.1080/08869634.2020.1853889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To evaluate the effects of successful TMJ treatment on relief of pain, improvement of mandibular movement and capsular width with clinical and ultrasonography (US) findings. In this study, TMJ changes were evaluated by clinical and US examination after US-guided single-puncture arthrocentesis, which represents a novel approach.Methods: Clinical measurements were obtained before each procedure and at 1 day, 7 days, and 3 months thereafter. Capsular width was measured via the US at the 3-month follow-up.Results: Significant improvements were evident at the short term of 3 months post-arthrocentesis with supportive treatment, including splint therapy and jaw exercises.Conclusion: Arthrocentesis in conjunction with splint therapy and jaw exercises demonstrated significant clinical improvement at the short-term follow-up of 3 months. US imaging can be helpful for follow-up evaluation of the pre- and post-treatment capsule width. Longer follow-up studies are necessary to validate the effectiveness of this treatment protocol.
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Affiliation(s)
- Elif Bilgir
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Derya Yıldırım
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey
| | - Mehmet Fatih Șenturk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Hikmet Orhan
- Department of Biostatistics and Medical Informatics, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
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8
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Hosgor H. Is arthrocentesis plus hyaluronic acid superior to arthrocentesis alone in the treatment of disc displacement without reduction in patients with bruxism? J Craniomaxillofac Surg 2020; 48:1023-1027. [DOI: 10.1016/j.jcms.2020.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/11/2020] [Accepted: 07/19/2020] [Indexed: 12/21/2022] Open
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Heo HA, Yoon HJ. Clinical outcomes of patients with bilateral anterior disc displacement without reduction and erosive change of the temporomandibular joint after performance of unilateral arthrocentesis and stabilisation splint therapy. J Oral Rehabil 2019; 47:307-312. [PMID: 31557342 DOI: 10.1111/joor.12897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 08/21/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
Abstract
The efficacy of a combination treatment of arthrocentesis and stabilisation splint for patients with bilateral anterior disc displacement without reduction (ADDWoR) and erosive change of the TMJ remains controversial. To evaluate clinical outcomes of patients with ADDWoR and erosive change of the TMJ after performance of unilateral arthrocentesis and stabilisation splint therapy. A retrospective study of 44 patients (37 females, 7 males, mean age of 34 years) with bilateral ADDWoR and erosive change of the TMJ were included in this study. Their clinical outcomes before and after arthrocentesis and stabilisation splint therapy were compared. Evaluation criteria were as follows: (a) Maximal mouth opening (MMO); (b) Right and left maximal lateral movement (RLM, LLM) and maximal protrusive movement (PM); (c) Visual analog scale (VAS) pain score during MMO, RLM, LLM and PM; and (d) VAS pain score during palpation of masticatory muscles. Wilcoxon signed-rank test, Mc Nemar test and paired t test were used for statistical analysis. Differences in VAS pain score between arthrocentesis and non-arthrocentesis sites were not statistically significant except MMO and LLM (P < .05) after 6 months. Differences in mean VAS pain scores for all variables between before arthrocentesis and 6 months follow-up in the arthrocentesis site were statistically significant. (P < .01). Unilateral arthrocentesis on more symptomatic TMJ and subsequent stabilisation splint therapy was highly successful for pain and achievement of normal range of mandibular movements in patients with both ADDWoR and bony change.
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Affiliation(s)
- Hyun-A Heo
- Department of Advanced General Dentistry, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun-Joong Yoon
- Department of Oral and Maxillofacial Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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10
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Baş B, Aksoy A, Atmaca E, Öz AA, Kaya Ö, Kazan D, Yılmaz E, Kütük N. Effect of occlusal splint on interleukin 6, malondialdehyde and 8-hydroxydeoxyguanosine levels in the synovial fluid of patients with temporomandibular disorders. Int J Oral Maxillofac Surg 2019; 48:1558-1563. [PMID: 31109746 DOI: 10.1016/j.ijom.2019.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/27/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
The actual role of splint therapy in preventing excessive loading of the temporomandibular joint (TMJ) is still debated. Lower intra-articular pressure levels have been measured in patients wearing occlusal splints, which may also reduce oxidative stress in the articular spaces. The aim of this study was to determine whether splint therapy reduces oxidative stress and inflammation in TMJ internal derangement patients by measuring interleukin 6 (IL-6), malondialdehyde (MDA), and 8-hydroxydeoxyguanosine (8-OHdG) levels in the synovial fluid (SF). Twenty-four patients with a temporomandibular disorder (TMD) were included in the study. TMJ SF samples were obtained prior to arthrocentesis. Twelve patients used a 2-mm hard acrylic, maxillary stabilization-type splint for 3 months after arthrocentesis. Twelve patients had no treatment after the SF aspiration. Second SF samples were obtained from all patients at 3 months post arthrocentesis. IL-6, MDA, and 8-OHdG levels in the samples were evaluated. All patients showed a significant symptomatic improvement after treatment (P < 0.005). No statistical correlation was found between the two groups concerning pre-treatment and 3-month SF levels of MDA, 8-OHdG, and IL-6. Although splint therapy was found to be successful in eliminating clinical symptoms of TMD, the results showed no beneficial effect on inflammation and oxidative stress markers in the synovial fluid.
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Affiliation(s)
- B Baş
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
| | - A Aksoy
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - E Atmaca
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - A A Öz
- Department of Orthodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Ö Kaya
- Private Dental Clinic, Izmir, Turkey
| | - D Kazan
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey.
| | - E Yılmaz
- Private Dental Clinic, Samsun, Turkey
| | - N Kütük
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem Vakif University, Istanbul, Turkey
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Nagori SA, Jose A, Roy Chowdhury SK, Roychoudhury A. Is splint therapy required after arthrocentesis to improve outcome in the management of temporomandibular joint disorders? A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2019; 127:97-105. [DOI: 10.1016/j.oooo.2018.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/09/2018] [Accepted: 09/24/2018] [Indexed: 11/28/2022]
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12
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Nagori SA, Roy Chowdhury SK, Thukral H, Jose A, Roychoudhury A. Single puncture versus standard double needle arthrocentesis for the management of temporomandibular joint disorders: A systematic review. J Oral Rehabil 2018; 45:810-818. [DOI: 10.1111/joor.12665] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2018] [Indexed: 01/18/2023]
Affiliation(s)
| | - S. K. Roy Chowdhury
- Division of Oral and Maxillofacial Surgery; Armed Forces Medical College; Pune India
| | - H. Thukral
- Department of Oral and Maxillofacial Surgery; Army Dental Centre (Research & Referral); Delhi Cantt-10; New Delhi India
| | - A. Jose
- Department of Oral and Maxillofacial Surgery; Army Dental Centre (Research & Referral); Delhi Cantt-10; New Delhi India
| | - A. Roychoudhury
- Department of Oral and Maxillofacial Surgery; All India Institute of Medical Sciences; New Delhi India
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13
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Yapici-Yavuz G, Şimşek-Kaya G, Oğul H. A comparison of the effects of Methylprednisolone Acetate, Sodium Hyaluronate and Tenoxicam in the treatment of non-reducing disc displacement of the temporomandibular joint. Med Oral Patol Oral Cir Bucal 2018; 23:e351-e358. [PMID: 29680845 PMCID: PMC5945235 DOI: 10.4317/medoral.22237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/18/2018] [Indexed: 12/03/2022] Open
Abstract
Background This clinical study aimed to radiologically and clinically compare the effect of intra-articular injection of methylprednisolone, sodium hyaluronate or tenoxicam following arthrocentesis with that of arthrocentesis alone in patients with non-reducing disc displacement. Material and Methods A total of 44 patients radiographically diagnosed with non-reducing disc displacement of the temporomandibular joint (TMJ) were randomly divided into four treatment groups, as follows: Group 1, arthrocentesis alone; Group 2, arthrocentesis plus methylprednisolone acetate; Group 3, arthrocentesis plus sodium hyaluronate; Group 4, arthrocentesis plus tenoxicam. Maximum mouth opening (MMO), lateral movement, pain severity and tenderness of TMJ and muscles of mastication on palpation were measured before treatment and at 1 week and 1, 3 and 6 months after treatment. Disc position, presence or absence of disc reduction, level of effusion, joint movement and joint space were also evaluated using magnetic resonance imaging (MRI) before treatment and 6 months after treatment. Results No significant differences in treatment success were found among the four groups. MRI findings did not vary significantly among the groups, but pre- and post-operative MRI findings varied significantly within all four groups (p<0.001). Conclusions According to the data from this study, it may be concluded that either arthrocentesis alone or arthrocentesis with methylprednisolone acetate or sodium hyaluronate or tenoxicam intra-articular injections are similarly effective and promising methods in the treatment of TMJ with non-reducing disc displacement. Key words:Non-reduction disc displacement, arthrocentesis, methylprednisolone, sodium hyaluronate, tenoxicam.
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Affiliation(s)
- G Yapici-Yavuz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey,
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14
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Comparison of the effectiveness of three different treatment methods for temporomandibular joint disc displacement without reduction. Int J Oral Maxillofac Surg 2017; 46:603-609. [DOI: 10.1016/j.ijom.2017.01.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 10/25/2016] [Accepted: 01/23/2017] [Indexed: 11/19/2022]
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15
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Kim YH, Jeong TM, Pang KM, Song SI. Influencing factor on the prognosis of arthrocentesis. J Korean Assoc Oral Maxillofac Surg 2014; 40:155-9. [PMID: 25247144 PMCID: PMC4170662 DOI: 10.5125/jkaoms.2014.40.4.155] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 12/02/2022] Open
Abstract
Objectives The purpose of this article is to evaluate factors influencing prognosis of arthrocentesis in patients with temporomandibular joint (TMJ) disorder. Materials and Methods The subjects included 145 patients treated with arthrocentesis at the Dental Center of Ajou University Hospital from 2011 to 2013 for the purpose of recovering mouth opening limitation (MOL) and pain relief. Prognosis of arthrocentesis was evaluated 1 month after the operation. Improvement on MOL was defined as an increase from below 30 mm (MOL ≤30 mm) to above 40 mm (MOL ≥40 mm), and pain relief was defined as when a group with TMJ pain with a visual analog scale (VAS) score of 4 or more (VAS ≥4) decreased to a score of 3 or more. The success of arthrocentesis was determined when either mouth opening improved or pain relief was fulfilled. To determine the factors influencing the success of arthrocentesis, the patients were classified by age, gender, diagnosis group (the anterior disc displacement without reduction group, the anterior disc displacement with reduction group, or other TMJ disorders group), time of onset and oral habits (clenching, bruxism) to investigate the correlations between these factors and prognosis. Results One hundred twenty out of 145 patients who underwent arthrocentesis (83.4%) were found to be successful. Among the influencing factors mentioned above, age, diagnosis and time of onset had no statistically significant correlation with the success of arthrocentesis. However, a group of patients in their fifties showed a lower success rate (ANOVA P=0.053) and the success rate of the group with oral habits was 71% (Pearson's chi-square test P=0.035). Conclusion From this study, we find that factors influencing the success of arthrocentesis include age and oral habits. We also conclude that arthrocentesis is effective in treating mouth opening symptoms and for pain relief.
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Affiliation(s)
- Yoon Ho Kim
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Ajou University School of Medicine, Suwon, Korea
| | - Tae Min Jeong
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Ajou University School of Medicine, Suwon, Korea
| | - Kang Mi Pang
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Ajou University School of Medicine, Suwon, Korea
| | - Seung Il Song
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Ajou University School of Medicine, Suwon, Korea
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Emes Y, Arpınar I, Öncü B, Aybar B, Aktaş I, Al Badri N, Atalay B, İşsever H, Yalçın S. The next step in the treatment of persistent temporomandibular joint pain following arthrocentesis: A retrospective study of 18 cases. J Craniomaxillofac Surg 2014; 42:e65-9. [DOI: 10.1016/j.jcms.2013.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 06/05/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022] Open
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17
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Evaluating the additional effects of arthrocentesis on the condylar pathways of temporomandibular joint in patients with internal derangement treated with stabilizing splint. J Craniomaxillofac Surg 2014; 42:e86-90. [DOI: 10.1016/j.jcms.2013.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 01/23/2013] [Accepted: 07/02/2013] [Indexed: 11/18/2022] Open
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Al-Baghdadi M, Durham J, Steele J. Timing interventions in relation to temporomandibular joint closed lock duration: a systematic review of 'locking duration'. J Oral Rehabil 2014; 41:24-58. [PMID: 24393132 DOI: 10.1111/joor.12126] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2013] [Indexed: 11/30/2022]
Abstract
Temporomandibular joint (TMJ) 'closed lock' (CL) is a clinical condition causing TMJ pain and limited mouth opening (painful locking) that is mostly attributed to disc displacement without reduction (DDwoR), or less commonly to anchored disc phenomenon (ADP). Both conditions are described clinically as CL that can be 'acute' or 'chronic' depending on the duration of locking. There is, however, no consensus about the duration of locking that defines the acute state and its effect on the success of interventions. This review paper, therefore, aims to provide: (i) a narrative review of the pathophysiological need for early intervention in DDwoR and the clinical implications of acute/chronic CL stages on the management pathway; (ii) a systematic review investigating the effects of locking duration on the success of interventions for CL management. Electronic and manual searches until mid-August 2013 were conducted for English-language studies of any design investigating the effects of non-surgical and surgical interventions for acute or chronic CL (DDwoR or ADP). A total of 626 records were identified, and 113 studies were included. Data extraction and quality assessment were completed for all included studies. Included studies were, however, heterogeneous and mostly of poor-quality leading to contradictory and inconsistent evidence on the effect of the duration of locking on treatment outcomes. Future high-quality trials investigating the effect of CL duration on treatment outcome are needed. At present, early intervention by 'unlock' mandibular manipulation seems to be the most practical and realistic approach that can be attempted first in every CL patient as an initial diagnostic/therapeutic approach.
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Affiliation(s)
- M Al-Baghdadi
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Yang HJ, Kim DS, Yi WJ, Hwang SJ. Reduced joint distance during TMJ movement in the posterior condylar position. J Craniomaxillofac Surg 2013; 41:e159-64. [DOI: 10.1016/j.jcms.2012.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 11/26/2022] Open
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Candirli C, Esen A, Taskesen F, Celik S, Cakir B. Clinicoradiological evaluation of dermis-fat grafts after temporomandibular joint discectomy: A retrospective study. Natl J Maxillofac Surg 2013; 3:42-6. [PMID: 23251057 PMCID: PMC3513808 DOI: 10.4103/0975-5950.102152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose: The aim of this study was to compare the preoperative and 1-year postoperative clinical and radiological findings of the patients after unilateral temporomandibular joint (TMJ) discectomy with inter-positional abdominal dermis-fat graft. Materials and Methods: Fourteen patients underwent unilateral discectomy and dermis-fat grafting between 2008 and 2010. Preoperative and 1-year postoperative clinical parameters such as maximum mouth openings (MMO) and lateral movements (LM) of the mandible were recorded. Additionally, preoperative and postoperative magnetic resonance imagingwas obtained to determine the duration of operated TMJs. Results: All of the 14 patients showed the improvement in mandibular mobility and function. There was a significant increase in the MMO and LM during the follow-up period. Pain levels at follow-up were significantly lower than the preoperative levels. Radiologically, the dermis-fat graft was detected within the joint or surrounding the condyle in all 14 operated joints. The graft material that was found within the joint space was mainly grey in four joints. Ten joints showed heterogeneous material composed of fat interspersed with grey tissue. Conclusion: Discectomy and dermis-fat grafting appears to be a successful surgical option regarding to the clinical parameters. However, summed degenerative changes depending on surgical operation should be retained.
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Affiliation(s)
- Celal Candirli
- Department of Oral and Maxillofacial Surgery, Karadeniz Technical University, Faculty of Dentistry, Trabzon, Turkey
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