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Jin L, Yao Y, Yang Y, Liu S. Effect of individualized comprehensive physiotherapy versus hyaluronic acid therapy in older patients with temporomandibular joint osteoarthritis. J Prosthet Dent 2024:S0022-3913(24)00444-X. [PMID: 39054169 DOI: 10.1016/j.prosdent.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024]
Abstract
STATEMENT OF PROBLEM Few studies have compared the efficacy of physiotherapy and hyaluronic acid injection therapy on temporomandibular joint osteoarthritis (TMJ-OA). Research on older patients with TMJ-OA is also scarce. PURPOSE The purpose of this clinical study was to compare the efficacy of individualized comprehensive physiotherapy and intra-articular hyaluronic acid injection therapy in older patients with moderate or severe pain caused by TMJ-OA. MATERIAL AND METHODS Participants with TMJ-OA (aged ≥60 years) were enrolled. The improvements in the numeric rating scale pain score, maximum active mouth opening (MAO), joint sound, and jaw functional limitation scale (JFLS) were analyzed for between-group differences using the independent samples t test or Mann-Whitney U test (α=.05). RESULTS A total of 141 participants (physiotherapy, n=71; hyaluronic acid injection, n=70) were selected for the final analysis. Pain intensity, MAO, joint sound, and JFLS scores improved in both groups at the 2-week, 1-month, and 3-month follow-ups (P<.001). The injection group demonstrated greater improvement in mouth opening pain at the 2-week follow-up and in joint sound at the 3-month follow-up, whereas the physiotherapy group exhibited greater improvement in mastication pain at the 3-month follow-up. At the 2-week, 1-month, and 3-month follow-ups, the physiotherapy group showed higher improvement in MAO and JFLS scores compared with the injection group (P<.05). CONCLUSIONS Individualized comprehensive physiotherapy and intra-articular hyaluronic acid injection therapy significantly improved pain intensity, MAO, and JFLS scores in older participants with TMJ-OA. As a noninvasive therapy, individualized comprehensive physiotherapy provides better improvement in mastication pain control, mouth opening, and mandibular function.
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Affiliation(s)
- Lei Jin
- Junior Physiotherapist, Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yuan Yao
- Senior Physiotherapist, Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yang Yang
- Junior Physiotherapist, Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Shasha Liu
- Attending, Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
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Yamane M, Yoshida H, Iseki T, Uemura M. Establishment of a selective puncture method of the temporomandibular joint targeting the superior and inferior joint spaces using a human cadaver under the guidance of an ultrasound device. Oral Surg Oral Med Oral Pathol Oral Radiol 2024:S2212-4403(24)00321-3. [PMID: 38997908 DOI: 10.1016/j.oooo.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/29/2024] [Accepted: 06/01/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVE To investigate an ultrasound-guided selective puncture method for the temporomandibular joint (TMJ), targeting superior (SJS) and inferior joint spaces (IJS), using a human cadaver. STUDY DESIGN The study utilized five cadavers donated by members of our university. The cadaver's left side was aimed at the SJS, while the right side was at the IJS. Nonionic contrast was injected into each joint using a crossing technique, with the linear ultrasound probe placed parallel to the long axis of the mandibular branch and punctured perpendicularly into the joint cavity. Cone-beam computed tomography scans assessed both the TMJs examining discs and other components for damage using a gross anatomical technique. RESULTS Computed tomography images confirmed successful contrast agent injection into all joint spaces without damaging the articular discs or cartilage of the mandibular head. CONCLUSIONS Our findings suggest that the ultrasound device can selectively puncture the TMJ in the SJS and IJS. In the future, the success rate is expected to improve with additional cadaver punctures. We aim to establish this technique as a viable treatment method that can be performed by oral surgeons with limited clinical experience in cadaver surgery training and a surgical technique training program using human cadavers.
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Affiliation(s)
- Makoto Yamane
- Graduate School of Dentistry (Anatomy), Osaka Dental University, Osaka, Japan.
| | - Hiroaki Yoshida
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka, Japan
| | - Tomio Iseki
- First Department of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka, Japan
| | - Mamoru Uemura
- Department of Anatomy, Osaka Dental University, Osaka, Japan
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Turosz N, Chęcińska K, Chęciński M, Lubecka K, Bliźniak F, Chlubek D, Olszowski T, Sikora M. Temporomandibular Joint Injections and Lavage: An Overview of Reviews. J Clin Med 2024; 13:2855. [PMID: 38792396 PMCID: PMC11122581 DOI: 10.3390/jcm13102855] [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: 04/04/2024] [Revised: 04/27/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Objectives: This overview was conducted following the Preferred Reporting Items for Overviews of Reviews guidelines and aimed to collect and compare the results of systematic reviews on temporomandibular joint injection treatment. Methods: Systematic reviews of randomized clinical trials on temporomandibular disorders treated with lavage or intra-articular administrations were qualified for syntheses. The final searches were conducted on 27 February 2024, without time frame restrictions. Results: Of the 232 identified records, 42 systematic reviews were selected. The most evidence-based conclusions call into question the clinical differences between many therapeutic approaches, including the following: (1) injectable selection for the treatment of pain and hypomobility; (2) the method of performing arthrocentesis; (3) the use of imaging when rinsing the TMJ cavity; (4) the supplementation of the extracapsular administration of unprocessed blood with intracapsular deposition in the treatment of TMJ hypermobility. Conclusions: Systematic reviews based solely on randomized clinical trials proved the following differences: (1) in painful temporomandibular hypomobility, a better therapeutic effect is observed with arthrocentesis followed by I-PRF administration compared to lavage alone; (2) in painful temporomandibular hypomobility, inferior- or double-compartment injection leads to better results than superior-compartment injection; (3) in temporomandibular joint recurrent dislocation, hypertonic dextrose administration is superior to placebo, although (4) unprocessed blood has a better effect than hypertonic dextrose. PROSPERO registration number: CRD42024496142.
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Affiliation(s)
- Natalia Turosz
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, Wojska Polskiego 51, 25-375 Kielce, Poland; (N.T.); (M.S.)
| | - Kamila Chęcińska
- Department of Glass Technology and Amorphous Coatings, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, Mickiewicza 30, 30-059 Cracow, Poland;
| | - Maciej Chęciński
- Department of Oral Surgery, Preventive Medicine Center, Komorowskiego 12, 30-106 Cracow, Poland; (M.C.); (K.L.); (F.B.)
| | - Karolina Lubecka
- Department of Oral Surgery, Preventive Medicine Center, Komorowskiego 12, 30-106 Cracow, Poland; (M.C.); (K.L.); (F.B.)
| | - Filip Bliźniak
- Department of Oral Surgery, Preventive Medicine Center, Komorowskiego 12, 30-106 Cracow, Poland; (M.C.); (K.L.); (F.B.)
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Tomasz Olszowski
- Department of Hygiene and Epidemiology, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Maciej Sikora
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, Wojska Polskiego 51, 25-375 Kielce, Poland; (N.T.); (M.S.)
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
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De Nordenflycht D, Ayala A, Orellana L, Tesch RDS. Intra-articular injections in the TMJ inferior joint space: A scoping review. J Oral Rehabil 2023; 50:1316-1329. [PMID: 37323068 DOI: 10.1111/joor.13542] [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: 02/06/2023] [Revised: 06/04/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To perform a scoping review to identify the available evidence regarding intra-articular injections in the inferior joint space (IJS) of the temporomandibular joint (TMJ). METHODS An electronic search of the PubMed, Web of Science and Scopus databases was performed using the following terms: "Arthrocentesis", "injection", "joint injection", "technique", "Temporomandibular joint", "Temporomandibular joint disorder". Full-text articles were obtained from the records after applying the inclusion/exclusion criteria. Only articles with full-text access were included. RESULTS Thirteen articles were included for analysis-one technical note, three cadavers studies, one animal study, two case reports, five randomised clinical trials and one retrospective study; studies were classified as 'patients-based studies' and 'non-patients-based studies'. Most 'patients-based studies' show moderate or high risk of bias. Techniques were categorised as 'anatomical technique' and 'image-guided technique'. Most 'patients-based studies' show favourable outcomes such as pain reduction, increase in maximum mouth opening, improvement in quality of life and improvement in TMJ dysfunction indexes for the treatment of arthrogenic TMDs. Comparisons between superior and IJS injections are scarce. On the other hand, 'non-patients-based' studies show that image-guided or ultrasound-checked injection techniques achieved a higher effectiveness for needle location than anatomical (or blind) techniques. CONCLUSION The amount of available evidence is scarce, heterogeneous in design, and most 'patients-based studies' show moderate or high risk of bias, which demands the generation of new research to obtain definitive conclusions. The tendency observed suggests that intra-articular injections for the IJS of the TMJ are able to relieve TMJ pain, increase mouth opening and improve TMJ dysfunction, and image-guided injection techniques seem to be more effective than anatomical techniques to locate the needle in the IJS.
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Intra-Articular Injections into the Inferior versus Superior Compartment of the Temporomandibular Joint: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12041664. [PMID: 36836198 PMCID: PMC9967437 DOI: 10.3390/jcm12041664] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/30/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
This systematic review and meta-analysis aimed to validate the hypothesis that intra-articular injections into the inferior temporomandibular joint compartment are more efficient than analogous superior compartment interventions. Publications reporting differences between the above-mentioned techniques in the domains of revealing articular pain, decreasing the Helkimo index, and abolishing mandibular mobility limitation were included. Medical databases covered by the Bielefeld Academic Search Engine, Google Scholar, PubMed, ResearchGate, and Scopus engines were searched. The risk of bias was assessed using dedicated Cochrane tools (RoB2, ROBINS-I). The results were visualized with tables, charts, and a funnel plot. Six reports describing five studies with a total of 342 patients were identified. Of these, four trials on a total of 337 patients were qualified for quantitative synthesis. Each eligible report was at moderate risk of bias. From 19% to 51% improvement in articular pain, 12-20% lower Helkimo index, and 5-17% higher maximum mouth opening were observed. The evidence was limited by the small number of eligible studies, discrepancies regarding the substances used, possible biases, and the differences in observation times and scheduled follow-up visits. Despite the above, the advantage of inferior over superior compartment temporomandibular joint intra-articular injections is unequivocal and encourages further research in this direction.
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El-Sayed LK, Elsharaawy E, Elsholkamy M, Tawfik MK. Clinical Evaluation of Intra-Articular Injection of Chondroitin Sulfate and Sodium Hyaluronate in the Management of Degenerative Osteoarthritis of Temporomandibular Joint. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.11078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIM: This study aims to evaluate the effectiveness of intra-articular injection of chondroitin sulfate and sodium hyaluronate in cases of temporomandibular joint (TMJ) degenerative osteoarthritis.
MATERIAL AND METHODS: Thirty patients ASA I of both sexes, who were selected from outpatient clinic of Oral Surgery Department, Faculty of Dentistry – Suez Canal University, complaining of painful TMJ, presence of unilateral or bilateral TMJ pain, impairment of jaw movements, and joint sounds. Clinical examination was performed to all patients and pre-operative measurements of visual analog scale (VAS) for morning pain, pain with movement and spontaneous pain, maximum mouth opening, and presence or absence of clicking. Patients were randomly divided into two groups; (a) Study group consisted of 15 patients, they had intra-articular injection of chondroitin sulfate and sodium hyaluronate once weekly for 3 weeks and (b) control group consisted of 15 patients, they had intra-articular injection of sodium hyaluronate once weekly for 3 weeks. Post-operative measurements of VAS for previous pain types, maximum mouth opening, and clicking were obtained at 1 month, 3 months, and 6 months post-injection.
RESULTS: There was a statistically significant reduction of all types of pain in the study group compared to the control group at all time intervals (p ≤ 0.05), for maximum mouth opening, there was a significant improvement in mouth opening in the study group for all time intervals (p ≤ 0.05), but for the clicking, there was not statistically significant difference between the study and control groups after 1 month, 3 months, and 6 months. The difference between groups was barely statistically significant (p = 0.05).
CONCLUSION: Intra-articular injection of a combination of chondroitin sulfate and sodium hyaluronate is an effective tool in reducing pain, clicking, limited mouth opening, and other symptoms associated with degenerative TMJ diseases.
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Januzzi E, Cunha TCA, Silva G, Souza BDM, Duarte ASB, Zanini MRS, Andrade AM, Pedrosa AR, Custódio ALN, Castro MAA. Viscosupplementation in the upper and lower compartments of the temporomandibular joint checked by ultrasonography in an ex vivo and in vivo study. Sci Rep 2022; 12:17976. [PMID: 36289252 PMCID: PMC9606122 DOI: 10.1038/s41598-022-21781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/04/2022] [Indexed: 01/24/2023] Open
Abstract
Viscosupplementation (VS) of the temporomandibular joint (TMJ) aims to treat temporomandibular dysfunction (TMD) by stimulating synovial cells to improve intracapsular lubrication. The purpose of the present study was to assess a VS protocol planned with the aid of cone-beam computed tomography (CBCT) and checked by ultrasonography (US). The study was carried out in 3 stages. The first was to check the correspondence between the proposed facial reference points and the osseous components of the joint by means of CBCT. In the second stage, the upper and lower compartments of 20 TMJs of fresh frozen cadavers were injected with coloured liquids, and the accuracy of the technique was confirmed by dissecting the anatomical specimens. The third stage consisted of VS in 10 patients (20 TMJs), with real-time verification of the location of the needle tip by means of ultrasonography. CBCT confirmed the correct locations of the marked points used in the proposed VS protocol. The dissections showed that 13 of the 14 injections effectively reached the upper and lower compartments. The location of the needle tip was effectively verified by ultrasonography, confirming the correct access to both compartments. The proposed protocol was effective for accessing the upper and lower compartments of the TMJ. The evaluated protocol proved to be accurate, safe and clinically reproducible means of VS in the upper and lower compartments of the TMJ.
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Affiliation(s)
- Eduardo Januzzi
- grid.414826.d0000 0004 0496 9134Orofacial Pain Center of the Mater Dei Hospital, Belo Horizonte, Minas Gerais Brazil
| | | | | | | | | | | | | | | | - Antônio Luís Neto Custódio
- grid.8430.f0000 0001 2181 4888Biological Sciences Institute of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - Maurício Augusto Aquino Castro
- grid.8430.f0000 0001 2181 4888Department of Dental Clinics, Oral Pathology and Oral Surgery of the Faculty of Dentistry of the Federal University of Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais CEP: 31.270-901 Brazil
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Ramakrishnan D, Kandamani J, Nathan KPS. Comparison of intraarticular injection of platelet-rich plasma following arthrocentesis, with sodium hyaluronate and conventional arthrocentesis for management of internal derangement of temporomandibular joint. Natl J Maxillofac Surg 2022; 13:254-261. [PMID: 36051804 PMCID: PMC9426706 DOI: 10.4103/njms.njms_94_20] [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: 05/21/2020] [Revised: 09/02/2020] [Accepted: 05/18/2021] [Indexed: 11/07/2022] Open
Abstract
Aim: The aim of the study is to compare the efficacy of platelet-rich plasma (PRP) for the management of internal derangement of temporomandibular joint (TMJ). Settings and Design: Thirty-three patients were selected from the pool of patients visiting the department of oral and maxillofacial surgery. Simple randomization was done. Subjects and Methods: Patients with anterior disc displacement without reduction (DDWOR) were indicated for arthrocentesis. Group A patients are treated with PRP, Group B patients with sodium hyaluronate following arthrocentesis, and Group C patients were treated with arthrocentesis alone. Postoperative pain and maximal incisal opening are the primary outcomes evaluated. Statistical Analysis Used: The collected data were analyzed with IBM. SPSS statistics software 23.0 version and the one-way ANOVA with Tukey's post hoc test were used. Results: The mean age is 33 years, with female predominance. The statistical significant differences (P < 0.05) in pain and MIO between the 3 groups at the end of 3rdweek, 4thweek, and 3rd month postoperatively are seen in PRP group comparative to other groups. Conclusions: Our study has concluded that the intraarticular injection of PRP is an effective management for anterior DDWOR of TMJ than intraarticular injection of sodium hyaluronate and arthrocentesis in, reducing the pain and improving the interincisal distance in patients with DDWOR, thus providing a rapid recovery and improved quality of life.
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Gutiérrez IQ, Sábado-Bundó H, Gay-Escoda C. Intraarticular injections of platelet rich plasma and plasma rich in growth factors with arthrocenthesis or arthroscopy in the treatment of temporomandibular joint disorders: A systematic review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:e327-e335. [PMID: 34906730 DOI: 10.1016/j.jormas.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/28/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022]
Abstract
Intra-articular platelet rich plasma injections [PRP] or platelet rich growth factors [PRGF] injections have been used as therapeutic treatment options for patients with temporomandibular joint disorder [TMD] in recent years. The purpose of this paper is to evaluate the level of the available scientific evidence in the current literature on the benefits of applying PRP or PRGF injections to patients with TMD simultaneously or after arthrocentesis or arthroscopy to reduce post-operative pain and improve temporomandibular joint function. This systematic review was conducted according to PRISMA criteria and an electronic database search was carried out in the PubMed, Scopus and Cochrane databases during May 2021. The patients in the study group were injected with intra-articular PRP or PRGF simultaneously or after arthrocentesis or arthroscopy while the patients in the control group had arthrocentesis or arthroscopy without an intra-articular injection or received an injection of hyaluronic acid or Ringer's lactate solution. Eight randomised controlled clinical trials were selected. The PRP and PRGF intra-articular injections demonstrated significant differences in terms of pain reduction in three studies and improved mandibular function in two. The treatment with PRP or PRGF intra-articular injections demonstrated slightly better clinical results but of little significance in comparison with the control group. Evidence of their effectiveness is crucial to establish them as non-invasive treatments and as an affordable option for treating some types of TMDs. In accordance with Evidence-based dentistry principles, this review has been assigned a C recommendation.
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Affiliation(s)
- Ismael Quijada Gutiérrez
- Fellow in Master's Degree Program in Oral Surgery [EFHRE International University/FUCSO], Barcelona, Spain
| | - Helena Sábado-Bundó
- Fellow in Master's Degree of Oral Surgery and Implantology. Faculty of Medicine and Health Sciences, Dental School, University of Barcelona, Barcelona, Spain.
| | - Cosme Gay-Escoda
- Chairman and Professor of Oral and Maxillofacial Surgery, Faculty of Medicine and Health Sciences. Dental School University of Barcelona. Director of the Master's Degree Program in Oral Surgery and Implantology [EFHRE International University/FUCSO]. Coordinator/Researcher of the IDIBELL Institute. Head of the Oral Surgery, Implantology and Maxillofacial Surgery Department of the Teknon Medical Centre, Barcelona, Spain
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Ultrasonography-guided arthrocentesis versus conventional arthrocentesis in treating internal derangement of temporomandibular joint: a systematic review. Clin Oral Investig 2020; 24:3771-3780. [PMID: 32594307 DOI: 10.1007/s00784-020-03408-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This systematic review assessed the clinical question: 'Does ultrasonography (USG)-guided arthrocentesis provide better outcomes than conventional arthrocentesis in patients with temporomandibular disorder (TMD)?' MATERIALS AND METHODS The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An initial search was performed on electronic databases-including Medline, PubMed, and Cochrane Library-followed by manual and reference searches until the date September 27, 2019. The articles selected were evaluated for study and patient characteristics, arthrocentesis procedure details, and treatment outcomes (post-operative pain, maximum mouth opening (MMO), procedure time, and attempts of needle positioning). Risk of bias was assessed with the Cochrane Consumers and Communication Review Group's data extraction template and Critical Appraisal Skills Programme (CASP). RESULTS Out of the 325 initially identified articles, four studies with 144 patients were included in the final qualitative analysis. No significant differences were found in pain reduction and improved MMO between sample groups receiving conventional arthrocentesis and USG-guided arthrocentesis. Needle positioning attempts and procedural times were conflicting between the two groups. CONCLUSIONS This systematic review found that the outcomes of USG-guided arthrocentesis were not superior to conventional arthrocentesis. Conflicting data was found in the attempts of needle positioning and procedural time. Standardized treatment protocols and data from well-designed USG-guided arthrocentesis randomized clinical trials were lacking. CLINICAL RELEVANCE Arthrocentesis with or without USG guidance are both effective for treating patients with TMD to reduce pain and to improve MMO. USG-guided arthrocentesis was not found to be superior to conventional arthrocentesis.
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Cha Y, O J, Park JK, Yang HM, Kim S. Ultrasound-guided versus blind temporomandibular joint injections: a pilot cadaveric evaluation. Int J Oral Maxillofac Surg 2019; 48:540-545. [DOI: 10.1016/j.ijom.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/16/2018] [Accepted: 09/05/2018] [Indexed: 11/27/2022]
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Sun H, Su Y, Song N, Li C, Shi Z, Li L. Clinical Outcome of Sodium Hyaluronate Injection into the Superior and Inferior Joint Space for Osteoarthritis of the Temporomandibular Joint Evaluated by Cone-Beam Computed Tomography: A Retrospective Study of 51 Patients and 56 Joints. Med Sci Monit 2018; 24:5793-5801. [PMID: 30122753 PMCID: PMC6113854 DOI: 10.12659/msm.908821] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of this study was to determine the clinical effects of sodium hyaluronate injection into the superior and inferior joint space for osteoarthritis of the temporomandibular joint (TMJ) and to evaluate the joint changes using cone-beam computed tomography (CBCT). MATERIAL AND METHODS A retrospective observational clinical study included 51 patients and 56 TMJs, with a diagnosis of osteoarthritis. All patients received sodium hyaluronate injections into the superior and inferior TMJ joint spaces (articular cavities). At baseline and post-treatment the condylar bony changes were evaluated by CBCT. To evaluate TMJ function, maximum mouth opening (MMO), and Helkimo's index was used, which included an anamnestic index (Ai) and a clinical dysfunction index (Di). Patients were divided into short-term (one year) follow-up groups. RESULTS In both patient follow-up groups, sodium hyaluronate injection of the superior and inferior TMJ space significantly improved MMO, the Ai, and the Di (P<0.05). There were no significant differences between the two groups in condylar bony changes of the TMJ seen by CBCT (sclerosis, erosion, hyperplasia, and flattening) (P>0.05). CBCT showed a good predictive ability on post-treatment symptom relief following sodium hyaluronate injection into the superior and inferior TMJ space in patients with osteoarthritis of the TMJ (P=0.024). CONCLUSIONS The findings of this clinical and CBCT imaging study showed that sodium hyaluronate injection into the superior and inferior TMJ space in patients with osteoarthritis improved clinical symptoms, but did not control the progression of osteoarthritic joint destruction.
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Affiliation(s)
- Haibin Sun
- Department of Head and Neck Oncology, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Yi Su
- Department of Head and Neck Oncology, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China (mainland).,Department of Oral and Maxillofacial Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China (mainland)
| | - Ning Song
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Chunjie Li
- Department of Head and Neck Oncology, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Zongdao Shi
- Department of Head and Neck Oncology, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Longjiang Li
- Department of Head and Neck Oncology, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China (mainland)
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Abstract
Imaging of the temporomandibular joint in pediatric patients is a critical component in the evaluation and treatment of children with temporomandibular joint symptoms. MRI can provide detailed joint anatomy and identify inflammation, sometimes before symptom onset. Ultrasound scan is a convenient emerging modality to evaluate the joint and guide therapeutic injections. Radiography and computed tomography offer osseous detail to recognize early morphologic changes of the mandibular condyle and provide operative planning. Imaging promises to direct treatment to prevent future joint destruction and maintain function.
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Rinchuse DJ, Greene CS. Scoping review of systematic review abstracts about temporomandibular disorders: Comparison of search years 2004 and 2017. Am J Orthod Dentofacial Orthop 2018; 154:35-46.e9. [DOI: 10.1016/j.ajodo.2017.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/07/2023]
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Oral Glucosamine Hydrochloride Combined With Hyaluronate Sodium Intra-Articular Injection for Temporomandibular Joint Osteoarthritis: A Double-Blind Randomized Controlled Trial. J Oral Maxillofac Surg 2018; 76:2066-2073. [PMID: 29864430 DOI: 10.1016/j.joms.2018.04.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 04/22/2018] [Accepted: 04/23/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE Temporomandibular joint (TMJ) disorders occur in many people and osteoarthritis (OA) is a severe form of this disease. Glucosamine has been used to treat OA of the large joints for many years and has been proved effective. A double-blinded randomized controlled trial was designed to investigate the effectiveness and safety of oral glucosamine hydrochloride pills combined with hyaluronate sodium intra-articular injection in TMJ OA. PATIENTS AND METHODS One hundred forty-four participants with TMJ OA were randomized to 4 hyaluronate sodium injections and oral glucosamine hydrochloride (1.44 g/day) for 3 months (group A) or 4 hyaluronate sodium injections and oral placebo for 3 months (group B). All participants were followed for 1 year. Eighteen participants were lost to follow-up. RESULTS The intention-to-treat analysis showed that group A had similar maximal interincisal mouth opening and pain intensity during TMJ function at months 1 and 6 (P > .05). However, during long-term follow-up, group A had significantly greater maximal interincisal mouth opening compared with group B at month 12 (41.5 vs 37.9 mm; P < .001). For pain intensity, group A showed obviously lower visual analog scale scores than group B at month 6 (20.6 vs 29.2 mm; P = .007) and month 12 (17.4 vs 28.6 mm; P = .001). Twenty-four participants had gastrointestinal tract side effects, fatigue, and rash. Of these, 23 had slight side effects that were not correlated with glucosamine. There was no significant difference between the 2 groups (P > .05). CONCLUSION The results of this study suggest that, compared with hyaluronate sodium injection alone, glucosamine hydrochloride pills added to hyaluronate sodium injection had no meaningful effect on TMJ OA in the short-term but did relieve the pain caused by TMJ OA and improved TMJ functions in the long-term.
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Davoudi A, Khaki H, Mohammadi I, Daneshmand M, Tamizifar A, Bigdelou M, Ansaripoor F. Is arthrocentesis of temporomandibular joint with corticosteroids beneficial? A systematic review. Med Oral Patol Oral Cir Bucal 2018; 23:e367-e375. [PMID: 29680840 PMCID: PMC5945232 DOI: 10.4317/medoral.21925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/26/2018] [Indexed: 11/20/2022] Open
Abstract
Background Temporomandibular disorders (TMDs) are musculoskeletal conditions that can inhibit the normal function of temporomandibular joints (TMJs) and affect the patient’s quality of life, negatively. Arthrocentesis (AC) is a minimally invasive surgical procedure used for treating TMDs. The aim of present paper is to evaluate the advantages of administrating corticosteroid (CS) during AC by reviewing high quality released articles. Material and Methods Searching on Cochrane Library, Web of Science, Google Scholar, PubMed, ProQuest, and Scopus databases were performed with focusing on proper key words. Related titles and abstracts, up to December 2017, were screened and selected based on inclusion criteria. The full text of all randomized controlled trials (RCTs) was extensively read and subjected to quality assessments. Results After initial search, a total of 2067 articles were included into the study. Finally, 7 studies were reliable enough in methodology and randomization to be included into the study. All of the observed studies showed improvements in jaw functions and pain relief with no statistical differences in both AC and control groups. One study reported painless maximum incisal opening in CS group than the control group. Conclusions Based on available RCTs, the AC of TMJ with CS seems to result in similar findings to other therapeutic drugs, with no significant differences. Key words:Arthrocentesis, corticosteroid, temporomandibular joints, temporomandibular joint disorders.
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Affiliation(s)
- A Davoudi
- Vakilabad Blvd, Azadi Sqr, Mashhad University of Medical Sciences, Mashad, Iran,
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Gil-Martínez A, Paris-Alemany A, López-de-Uralde-Villanueva I, La Touche R. Management of pain in patients with temporomandibular disorder (TMD): challenges and solutions. J Pain Res 2018; 11:571-587. [PMID: 29588615 PMCID: PMC5859913 DOI: 10.2147/jpr.s127950] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Thanks to advances in neuroscience, biopsychosocial models for diagnostics and treatment (including physical, psychological, and pharmacological therapies) currently have more clinical support and scientific growth. At present, a conservative treatment approach prevails over surgery, given it is less aggressive and usually results in satisfactory clinical outcomes in mild–moderate temporomandibular disorder (TMD). The aim of this review is to evaluate the recent evidence, identify challenges, and propose solutions from a clinical point of view for patients with craniofacial pain and TMD. The treatment we propose is structured in a multi-modal approach based on a biobehavioral approach that includes medical, physiotherapeutic, psychological, and dental treatments. We also propose a new biobehavioral model regarding pain perception and motor behavior for the diagnosis and treatment of patients with painful TMD.
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Affiliation(s)
- Alfonso Gil-Martínez
- Department of Physiotherapy.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid.,Hospital La Paz Institute for Health Research, IdiPAZ
| | - Alba Paris-Alemany
- Department of Physiotherapy.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid.,Hospital La Paz Institute for Health Research, IdiPAZ.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Physiotherapy.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid.,Hospital La Paz Institute for Health Research, IdiPAZ
| | - Roy La Touche
- Department of Physiotherapy.,Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid.,Hospital La Paz Institute for Health Research, IdiPAZ.,Institute of Neuroscience and Craniofacial Pain (INDCRAN), Madrid, Spain
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Al-Delayme RMA, Alnuamy SH, Hamid FT, Azzamily TJ, Ismaeel SA, Sammir R, Hadeel M, Nabeel J, Shwan R, Alfalahi SJ, Yasin A. The Efficacy of Platelets Rich Plasma Injection in the Superior Joint Space of the Tempromandibular Joint Guided by Ultra Sound in Patients with Non-reducing Disk Displacement. J Maxillofac Oral Surg 2017; 16:43-47. [PMID: 28286383 PMCID: PMC5328864 DOI: 10.1007/s12663-016-0911-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 04/18/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine average improvement during the rest and active mouth opening after ultrasound guided platelets rich plasma injection in the tempromandibular superior joint space for the patients complaining from non-reducing disk displacement. PATIENTS AND METHODS Thirty-four patients with non-reducing disk displacement underwent guided ultrasound injection of platelet rich plasma to the upper joint space. The extent of maximal mouth opening, chewing efficiency, sound intensity of the TMJ, and tenderness of the TMJ and the masticatory muscles at rest, motion and mastication were thoroughly assessed at the beginning of the study and scheduled for next follow-up at 1st, 3rd, and 6th months. RESULTS Injection with platelets rich plasma was significantly more effective in improvements of the extent of maximal mouth opening, statistics result demonstrated a significant reduction in the VAS values of pain at rest, motion and mastication compared to the baseline VAS values. CONCLUSION PRP injection to the upper temporomandibular joint space provided improvement in signs and symptoms of patient with non-reducing disk displacement of the temporomandibular joint.
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Affiliation(s)
- Ra’ed M. Ayoub Al-Delayme
- Faculty of Dentistry, Dijlah University College, Baghdad, Iraq
- Oral and Maxillofacial Surgery Department, AL-Yarmuk Teaching Hospital, Baghdad, Iraq
- Eastman Institute for Oral Health, University of Rochester, New York, USA
| | | | | | | | | | | | | | | | | | | | - Alaa Yasin
- Periodontics Department University of Washington, Washington, USA
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Fernández-Ferro M, Fernández-Sanromán J, Blanco-Carrión A, Costas-López A, López-Betancourt A, Arenaz-Bua J, Stavaru Marinescu B. Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of temporomandibular dysfunction: A randomised prospective study. J Craniomaxillofac Surg 2017; 45:449-454. [PMID: 28237253 DOI: 10.1016/j.jcms.2017.01.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/13/2016] [Accepted: 01/09/2017] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The main objective of our study was to evaluate the effectiveness of the injection of plasma rich in platelet-derived growth factors (PRGF) versus hyaluronic acid (HA) following arthroscopic surgery in patients diagnosed with internal derangement of the temporomandibular joint (TMJ) with osteoarthritis (OA). MATERIALS AND METHODS A total of 100 patients were randomised into two study groups. Group A (n = 50) received an injection of PRGF, and Group B (n = 50) received an injection of HA. The mean age was 35.5 years (range 18-77 years), and 88% of the patients were women. The pain intensity (visual analogue scale) and the extent of maximum mouth opening before and after the procedure were statistically analysed. RESULTS Better results were observed in the group treated with PRGF, with a significant reduction in pain at 18 months, compared with HA treatment. Regarding mouth opening, an increase was observed in both groups, with no significant difference. CONCLUSIONS The injection of PRGF following arthroscopy is more effective than the injection of HA with respect to pain in patients with advanced internal derangement of the TMJ.
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Affiliation(s)
| | | | - Andrés Blanco-Carrión
- School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | - Jorge Arenaz-Bua
- Department of Oral and Maxillofacial Surgery, Hospital Povisa, Vigo, Spain
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De Rossi SS, Greenberg MS, Liu F, Steinkeler A. Temporomandibular disorders: evaluation and management. Med Clin North Am 2014; 98:1353-84. [PMID: 25443680 DOI: 10.1016/j.mcna.2014.08.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Temporomandibular disorders remain a common cause of visits to primary care physicians, internists, pediatricians, and emergency departments. Advances in the clinical diagnosis, radiographic imaging, and classification of these disorders have improved long-term management. There are several types of disorders of the masticatory muscles and the temporomandibular joint as well as associated structures and each may have a complex cause, clinical course, and response to therapy. Host susceptibility plays a role at several stages of these disorders. Future research offers greater possibility in defining this heterogeneous group of disorders and providing more focused and effective treatment strategies.
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Affiliation(s)
- Scott S De Rossi
- Oral Medicine, Oral Health & Diagnostic Sciences, Georgia Regents University, 1120, 15th Street, Augusta, GA 30912, USA; Dermatology, Georgia Regents University, 1120, 15th Street, Augusta, GA 30912, USA; Otolaryngology/Head & Neck Surgery, Georgia Regents University, 1120, 15th Street, Augusta, GA 30912, USA.
| | - Martin S Greenberg
- Department of Oral Medicine, Hospital Affairs, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Frederick Liu
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew Steinkeler
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Compliance of randomized controlled trials in trauma surgery with the CONSORT statement. J Trauma Acute Care Surg 2013; 75:562-72. [PMID: 24064867 DOI: 10.1097/ta.0b013e3182a5399e] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Randomized controlled trials (RCTs) are the criterion standard for assessing new interventions. However, bias can result from poor reporting, which also makes critical appraisal and systematic review challenging. The Consolidated Standards of Reporting Trials (CONSORT) criteria for nonpharmacological trials published in 2008 provided a set of 23 mandatory items that should be reported in an RCT. This is the first study to assess the compliance of RCTs in trauma with the CONSORT criteria for nonpharmacological trials. METHODS The MEDLINE database was searched using the MeSH term wounds and injuries for English-language articles published between January 2009 and December 2011. Relevant articles were scored by two reviewers and compared against surrogate markers of article quality (such as journal impact factor). RESULTS Eighty-three articles were deemed suitable for inclusion. The mean CONSORT score was 11.2 of 23 items (49%; range, 3.38-18.17). Compliance was poorest for items relating to the adherence of care providers (0%), abstract (5%), and implementation of randomization (6%). Only 40% declared conflicts of interest, 73% declared permission from an ethics review committee, 43% declared sources of funding, and 10% stated a trial registry number. There was a significant correlation between the CONSORT score and the impact factor of the publishing journal (ρ = 0.37, p = 0.0006) but not for the number of patients or authors or single versus multicentre trials CONCLUSION The reporting quality of RCTs in trauma surgery needs improvement. We suggest ways by which this could be improved including the following: better education, awareness, and a cohesive strategy among all stakeholders and the hard wiring of compliance through electronic journal submission systems.
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Abstract
Temporomandibular disorder (TMD) is a multifactorial disease process caused by muscle hyperfunction or parafunction, traumatic injuries, hormonal influences, and articular changes. Symptoms of TMD include decreased mandibular range of motion, muscle and joint pain, joint crepitus, and functional limitation or deviation of jaw opening. Only after failure of noninvasive options should more invasive and nonreversible treatments be initiated. Treatment can be divided into noninvasive, minimally invasive, and invasive options. Temporomandibular joint replacement is reserved for severely damaged joints with end-stage disease that has failed all other more conservative treatment modalities.
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Affiliation(s)
- Frederick Liu
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19103, USA.
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Progression of cartilage degradation, bone resorption and pain in rat temporomandibular joint osteoarthritis induced by injection of iodoacetate. PLoS One 2012; 7:e45036. [PMID: 22984604 PMCID: PMC3439407 DOI: 10.1371/journal.pone.0045036] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 08/11/2012] [Indexed: 12/18/2022] Open
Abstract
Background Osteoarthritis (OA) is an important subtype of temporomandibular disorders. A simple and reproducible animal model that mimics the histopathologic changes, both in the cartilage and subchondral bone, and clinical symptoms of temporomandibular joint osteoarthritis (TMJOA) would help in our understanding of its process and underlying mechanism. Objective To explore whether injection of monosodium iodoacetate (MIA) into the upper compartment of rat TMJ could induce OA-like lesions. Methods Female rats were injected with varied doses of MIA into the upper compartment and observed for up to 12 weeks. Histologic, radiographic, behavioral, and molecular changes in the TMJ were evaluated by light and electron microscopy, MicroCT scanning, head withdrawal threshold test, real-time PCR, immunohistochemistry, and TUNEL assay. Results The intermediate zone of the disc loosened by 1 day post-MIA injection and thinned thereafter. Injection of an MIA dose of 0.5 mg or higher induced typical OA-like lesions in the TMJ within 4 weeks. Condylar destruction presented in a time-dependent manner, including chondrocyte apoptosis in the early stages, subsequent cartilage matrix disorganization and subchondral bone erosion, fibrosis, subchondral bone sclerosis, and osteophyte formation in the late stages. Nociceptive responses increased in the early stages, corresponding to severe synovitis. Furthermore, chondrocyte apoptosis and an imbalance between anabolism and catabolism of cartilage and subchondral bone might account for the condylar destruction. Conclusions Multi-level data demonstrated a reliable and convenient rat model of TMJOA could be induced by MIA injection into the upper compartment. The model might facilitate TMJOA related researches.
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Ebrahim S. Methodological Limitations of a Systematic Review Evaluating Inferior or Double Joint Spaces Injection Versus Superior Joint Space Injection for Temporomandibular Disorders. J Oral Maxillofac Surg 2012; 70:504-5; author reply 505-6. [DOI: 10.1016/j.joms.2011.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 11/17/2011] [Indexed: 11/16/2022]
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