Evaluation of mouth opening exercise after pumping of the temporomandibular joint in patients with nonreducing disc displacement

Comparison of efficacy of sodium hyaluronate and normal saline arthrocentesis in the management of internal derangement of temporomandibular joints - A prospective study

Purpose:

The aim of the present study was to evaluate the efficacy of arthrocentesis with and without sodium hyaluronate (SH) injection in the treatment of patients with temporomandibular joint (TMJ) internal derangement.

Materials and Methods:

The study consisted of 20 patients with chief complaints of limited mouth opening, TMJ pain, and jaw deviation. Patients with disc displacement with reduction and closed lock were randomly divided into two groups. In Group 1, only arthrocentesis was performed, and in Group 2, arthrocentesis plus intra-articular injection of SH was performed. Arthrocentesis was performed under aseptic conditions using normal saline. Clinical evaluation was done for maximum mouth opening (MMO), TMJ pain, and jaw deviation before the procedure and 1 week, 2 weeks, 1 month, and 3 months following arthrocentesis.

Results:

The mean visual analog scale (VAS) score change was statistically significant in Group 1 and Group 2 for within the group analysis. There was statistically significant difference in VAS score between Group 1 and Group 2 at all time intervals postoperatively. The increase in MMO from preoperative to 3 months postoperatively was statistically significant for within the group analysis. There was a reduction in mandibular deviation in both Group 1 and Group 2, but the difference was not statistically significant. There was no statistically significant difference in deviation between the two groups.

Conclusion:

Arthrocentesis with SH is superior to arthrocentesis alone in treating patients suffering with TMJ internal derangement, who are refractory to conservative treatment.

The efficacy of a specific stabilization splint

BACKGROUND

The use of a Tanner type stabilization splint, fabricated on a leaf gauge articulation for the treatment of patients with disc displacement without reduction, is lacking in the literature.

OBJECTIVES

The purpose of the study is to collect non-controlled, therapy-related observations; in other words, to demonstrate the efficacy of this appliance for the treatment of patients with disc displacement without reduction.

METHODS

The study enrolled 55 patients, 5 men, and 50 women, with the clinical diagnosis disc displacement without reduction, 42 with and 13 without limited mouth opening. All patients received a splint in the musculoskeletally stable centric relation (CR) position. Mouth opening, clinical performance, and the timeframe of splint treatment were assessed.

RESULTS

For 37 patients with a disc displacement without reduction with limited opening, the largest increase in mouth opening (9.5 +/- 5.6 mm) occurred in the first week (7.9 +/- 2.5 days). No occlusal adjustment of the splint was needed during the treatment sequence. For three patients, treatment took up to 3 months (8.1%), for 13 patients, between 3 and 6 months (35.1%), and for 17 patients, within a year (45.9%), making a total of 89.1% successfully treated patients. Out of 50 patients, 29 had a total resolution of signs and symptoms, whereas 21 patients still suffered from solitary temporomandibular disorder (TMD) signs.

CONCLUSION

A Tanner type stabilization splint, fabricated in the musculoskeletally stable CR position, appears to be an effective and efficient means for the treatment of patients with disc displacement without reduction. Its efficacy makes it eligible to be tested in a randomized controlled trial.

CLINICAL IMPLICATIONS

The efficacy of this specific splint, fabricated in the musculoskeletally stable CR position, makes it a promising tool to treat TMD patients with disc displacement without reduction.

Timing interventions in relation to temporomandibular joint closed lock duration: a systematic review of 'locking duration'

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.

Exercícios terapêuticos nas desordens temporomandibulares: uma revisão de literatura

A articulação temporomandibular faz parte do sistema estomatognático que, junto com os dentes, periodonto, coluna cervical, crânio e cintura escapular, é responsável pela mastigação, fonação, deglutição, respiração e expressão facial. Exercícios terapêuticos têm sido empregados na reabilitação e prevenção das disfunções temporomandibulares (DTM). Este estudo teve como objetivo revisar a literatura a respeito, verificando a eficácia dos exercícios terapêuticos nas DTM. Foram examinados periódicos do período entre 1991 e agosto de 2008, nas bases de dados Medline, Lilacs e Pubmed, utilizando as palavras-chave "desordem temporomandibular", "terapia por exercícios" e as correspondentes em inglês. Foram selecionados relatos de caso, artigos de revisão e ensaios clínicos com mais de 20 pacientes, num total de 53 artigos. A maioria relatou efeitos positivos na redução da dor, melhora da mobilidade e dos aspectos psicológicos, sugerindo que os exercícios podem contribuir no tratamento da DTM. Entretanto, o tipo, tempo de duração, número de repetições, freqüência e intensidade dos exercícios não está bem descrita. A falta de padronização das pesquisas, bem como da forma de avaliar, dificultam a comparação dos resultados. Mais estudos com métodos padronizados devem ser estimulados.