Evaluating the additional effects of arthrocentesis on the condylar pathways of temporomandibular joint in patients with internal derangement treated with stabilizing splint

Efficacy of Arthrocentesis and Anterior Repositioning Splints in Treatment of Internal Derangement of TMJ: A Prospective Clinical Study

The aim of this study is to assess the efficacy of double puncture arthrocentesis and anterior repositioning splints in the treatment of internal derangement of temporomandibular joint. 35 patients with mean age of 36.6 years ± 10.2 years diagnosed with unilateral TMD who fell into Wilkes stage 2 and disc displacement with reduction with intermittent locking described by RDC/TMD were treated with Nitzan's double puncture arthrocentesis and were given a anterior repositioning hard splint. The parameters following parameters were assessed at intervals of 1 week, 2 weeks, 1 month, 3 months and 6 months: pain, maximum inter-incisal mouth opening, Joint noise/click. Statistically significant (p < 0.001) improvements were seen at all recorded intervals in all observed parameters. Simultaneous arthrocentesis and anterior repositioning splint therapy is effective in alleviating pain and improving mouth opening without discomfort in patients with unilateral painful TMD showing disc displacement with reduction with intermittent locking.

Literature Review of an Anterior Deprogrammer to Determine the Centric Relation and Presentation of Cases

The increasing demand for dental aesthetics, articulation corrections, and solutions for pain and frequent bruxism demands quick and effective restorative dental management. The biomedical research aimed to create a beneficial, ecological, and readily available anterior deprogrammer to determine the centric relation (CR) of cases. This medical device is additively manufactured from a biocompatible material. Size is customizable based on the width of the patient's anterior central incisors. This is a pilot study with two subjects. The task was to develop a complete data protocol for the production process, computer-aided design (CAD), and three-dimensional (3D) printing of the anterior deprogrammers. The research focused on creating simple and practically applicable tools for the dentist's prescription (anterior deprogrammer in three sizes), and secondly for the communication between the dentist and the patient (computer application). The tested hypothesis was whether, according to these novel tools, it is possible to produce functional occlusal splints, which could be manufactured using current technologies. This study compared a traditional splint with a digitally designed and 3D-printed one. The tested hypothesis was whether manufactured occlusal splints differ in patients' subjective perception of comfort. Each conservative treatment was monitored for ten weeks. Initial results are promising; no statistically significant difference was found between the productive technologies.

Efficacy of Arthrocentesis and Stabilization Splints in Treatment of Temporomandibular Joint Disc Displacement Disorder Without Reduction: A Systematic Review and Meta-analysis

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.

Randomised controlled trial of arthrocentesis with or without PRF for internal derangement of the TMJ

This prospective randomised clinical study aims to evaluate different treatments in patients with temporomandibular disorder. Control group (C) patients underwent arthrocentesis and experimental group (E) patients underwent injectable platelet-rich fibrin (İ-PRF) in addition to arthrocentesis. Helkimo Clinical Dysfunction Score (HCDS) examinations and VAS scores of the patients were recorded at the end of the 10th day, 1 month and 3 months. 36 patients (17 females, 19 males), 18 in the experimental and 18 in the control group, aged between 18 and 64 years and in groups 3, 4 and 5 according to Wilke's classification were included in this study. Improvement of VAS (E mean: 5,83, E standard deviation: 2,550, C mean: 2,94, C standard deviation: 2,043, p<0.001) and HCDS (E mean: 13,61, E standard deviation: 5,158, C mean: 9,22, C standard deviation: 6,916, p:0.039) of the experimental group patients was significantly higher than control group at the end of the third month. As a result of this study, the combination of i-PRF with arthrocentesis gave a much better outcome than arthrocentesis alone. Additional PRF injection should be preferred for severe dysfunction. Further studies with long-term follow-up are needed to better understand the effects of i-PRF.