Treatment Effectiveness of Arthrocentesis Plus Hyaluronic Acid Injections in Different Age Groups of Patients With Temporomandibular Joint Osteoarthritis

Specific tissue engineering for temporomandibular joint disc perforation

BACKGROUND

The temporomandibular joint (TMJ) disc is a critical fibrocartilaginous structure with limited regenerative capacity in the oral system. Perforation of the TMJ disc can lead to osteoarthritis and ankylosis of the TMJ because of the lack of disc protection. Clinical treatments for TMJ disc perforation, such as discectomy, hyaluronic acid injection, endoscopic surgery and high position arthroplasty of TMJ, are questionable with regard to long-term outcomes, and only three fourths of TMJ disc perforations are repairable by surgery, even in the short-term. Tissue engineering offers the potential for cure of repairable TMJ disc perforations and regeneration of unrepairable ones.

OBJECTIVES

This review discusses the classification of TMJ disc perforation and defines typical TMJ disc perforation. Advancements in the engineering-based repair of TMJ disc perforation by stem cell therapy, construction of a disc-like scaffold and functionalization by offering bioactive stimuli are also summarized in the review, and the barriers developing engineering technologies need to overcome to be popularized are discussed.

Temporomandibular joint arthrocentesis: a single-center experience and review of the literature

BACKGROUND

The aim of this paper was to report our experience and to review the literature of arthrocentesis focusing on protocols and results.

METHODS

Arthrocentesis with supplemental hyaluronic acid was performed in patients with TMDs between January 2017 and December 2020 at the Division of Maxillofacial Surgery. The maximum interincisal opening (MIO) and pain score were recorded preoperatively (T0), 2 months postoperatively (T1), and 6 months postoperatively (T2). A literature search was performed to analyze the same parameters in patients with TMDs. Patient demographic, characteristics and treatment protocols used were also recorded.

RESULTS

This retrospective analysis enrolled 45 patients. Twenty-two patients (20 females, 2 males) with mean age of 37.13 years with internal derangement were included in study group A. Study group B included 23 patients with degenerative joint disease (19 females and 4 males) with mean age of 55.73 years. The outcomes trend of MIO and pain during the follow-up period showed a gradual improvement. Fifty articles meeting the proposed scientific criteria were selected for the literature revision. A range of clinical and procedural variables were analyzed by grouping the studies into two broad categories based on the diagnosis of TMD.

CONCLUSIONS

Based on our experience and on the basis of the most accredited scientific studies in the literature, intra-articular injections of HA are beneficial for the improvement of the pain and/or functional symptoms of TMDs.

Kinesio Taping as a Therapeutic Tool for Masticatory Myofascial Pain Syndrome-An Insight View

Myofascial pain syndrome (MPS) is thought to stem from masticatory muscle hypersensitivity. Masticatory myofascial pain syndrome (MMPS) is characterized by multiple trigger points (MTrPs), also known as hyperirritable points, in taut bands of affected muscles, regional muscle pain, or referred pain to nearby maxillofacial areas like teeth, masticatory muscles or the temporomandibular joint (TMJ). Muscle stiffness, reduced range of motion, muscle weakening without atrophy, and autonomic symptoms may accompany regional discomfort. Multiple treatments have been utilized to reduce trigger points and mandibular function restrictions. As a result of these incapacitating symptoms, MMPS can significantly impair many elements of quality of life. The application of Kinesio tape (KT) is a non-invasive method of treating dormant myofascial trigger points. Utilizing the body's innate capacity for self-repair, this technique entails taping specific regions of the skin. KT alleviates discomfort, decreases swelling and inflammation, enhances or suppresses motor function in the muscles, stimulates proprioception, promotes lymphatic drainage, stimulates blood flow, and expedites tissue recovery. However, studies conducted to assess its effects have frequently yielded contradictory results. To the best of our knowledge, just a few research has looked into the therapeutic effects of KT on MMPS. The purpose of this review is to determine the efficacy of KT as a therapeutic tool for regular treatment or as an adjunct to existing therapy for MMPS based on the evidence presented in this review. To establish KT as a reliable independent treatment option, additional research is necessary to confirm the efficacy of KT techniques and applications, specifically randomized clinical trials.

Masticatory Function in Individuals with Temporomandibular Disorders: A Systematic Review and Meta-Analysis

The literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol in the PubMed, Cochrane Library, LILACS, EBSCO, Scielo, between 2012 and 2022. The methodological quality was assessed by using the Newcastle-Ottawa Study Quality Assessment Scale. Mean differences and 95% confidence intervals were calculated and combined in meta-analyses. A total of 1202 participants were included in this systematic review (690 with TMD; 512 without TMD), with 22 articles being included in the qualitative analysis. Only three studies enabled the comparative analysis of the results. Ten articles showed a high methodological quality and a low risk of bias, and twelve had a low methodological quality and an increased risk of bias. The meta-analysis showed that the differences between the intervention and control groups were not statistically significant for the percentage overlapping coefficient of the anterior temporal muscle, for the masseter, and for the torque coefficient. The parameters analyzed with the compound technique for chewing showed altered mandibular functions in individuals with TMD. With the EMG method, it was possible to suggest that TMD in adult individuals causes compensatory muscle behaviors, and several changes in the masticatory function were found.

Temporomandibular joint arthroscopy in advanced stages of internal derangement: a retrospective cohort study on the influence of age

The aim of this investigation was to evaluate the outcomes of patients with advanced internal derangement of the temporomandibular joint who underwent operative arthroscopy, according to age stratified into two groups: <45 years and ≥45 years. The study included a series of 194 patients. Outcome variables were pain intensity and mandibular mobility. Additionally, the difference in arthroscopic findings in these age groups was studied. The data analysis included the paired t-test, χ² test, and two-way analysis of variance, with a P-value <0.05 indicating statistical significance. A significant reduction in pain and an improvement in maximum inter-incisal opening (MIO) was observed in both groups starting at 1 month of follow-up (P < 0.01). However, the results for MIO were worse in the ≥45 years group (P=0.036) at 12- and 18-months follow-up. Regarding arthroscopic findings, the study showed a higher prevalence of severe chondromalacia in the ≥45 years group (P = 0.031) and disc displacement without reduction in the <45 years group (P = 0.020). Analysis of variance showed a greater pain reduction if no obliteration of the articular space was observed (P = 0.039). In young and older patients, operative arthroscopy can be useful for short-term treatment in advanced stages of internal derangement of the temporomandibular joint.

Prognostic indicators of arthroscopic discopexy for management of temporomandibular joint closed lock

In order to optimize patient selection for temporomandibular joint (TMJ) arthroscopic discopexy to achieve favorable outcomes, prognostic indicators impacting the results are important to analyze. This longitudinal retrospective study aimed to analyze various prognostic factors impacting surgical outcomes following arthroscopic discopexy for management of TMJ closed lock using success criteria based on pain, maximal interincisal opening, diet, and quality of life. Furthermore, a quantitative MRI assessment was performed pre- and post-operatively. Multivariate analysis was used to evaluate various prognostic variables including gender, age, side, duration of illness, Wilkes staging, parafunctional habits, splint therapy and orthodontic treatment. A total of 147 patients (201 joints) were included. The outcome was categorized as excellent (n = 154/76.61%), good (n = 34/16.91%), or poor (n = 13/6.46%) with a success rate of 93.54%. Patients aged > 30 years old (p = 0.048), longer duration of illness (12–24 months: p = 0.034) and (> 24 months: p = 0.022), and patients with Wilkes stage IV (p = 0.002) were all significantly more likely to be in the poor outcome group. Finally, orthodontic treatment showed a significant association with excellent outcomes (p = 0.015). Age, duration of illness, Wilkes staging, and orthodontic treatment are considered significant prognostic factors that can predict the outcomes following the arthroscopic discopexy for management of TMJ closed lock.

An additional lysis procedure during arthrocentesis of the temporomandibular joint

BACKGROUND

Arthrocentesis of the temporomandibular joint (TMJ) is an easy, highly efficient, minimally invasive procedure for treating temporomandibular joint disorders (TMDs). However, in some cases of mouth opening limitation (MOL), routine arthrocentesis is ineffective due to severe fibrotic adhesion in the superior joint space of the TMJ. In this condition, mechanical lysis of the adhesions might be needed to resolve the MOL, as well as other symptoms, such as chronic pain. Currently, this can be achieved by arthroscopic surgery or open TMJ surgery. The objective of this study was to introduce and evaluate our trial of the adhesion lysis procedure during arthrocentesis of the TMJ using normal 18-gauge needles.

RESULTS

In this study, 40 patients with MOL due to disc derangement underwent conventional arthrocentesis at first and then physical detachment was conducted using the same needle. The change in maximum mouth opening (MMO) and the pain at the TMJ were recorded before, during, and after treatment according to our protocol. The mean increase in MMO after conventional arthrocentesis was 6.6 ± 4.2mm. The mean increase in MMO after the detachment procedure with the same needle was 4.2 ± 2.0 mm. The MMO in ten patients was significantly increased after the detachment procedure than after arthrocentesis alone. In all cases, the pain intensity in the TMJ significantly decreased over time, whereas the MMO increased over time. No adverse effect was observed in all joints during our observation periods.

CONCLUSION

We confirmed that our simple lysis procedure with the same needle of the arthrocentesis of the TMJ could not only improve the MMO more than after a conventional arthrocentesis but also resolve severe adhesion of the joint space that was ineffective by conventional arthrocentesis. Although this additional lysis procedure is simple, it might reduce the number of cases of more invasive procedures such as arthroscopic surgery or open TMJ surgery.

LncRNA GAS5 upregulates Smad4 to suppress the apoptosis of chondrocytes induced by lipopolysaccharide

BACKGROUND

Osteoarthritis (OA) is closely correlated with inflammation. It has been reported that lncRNA GAS5 plays an important role in inflammation, indicating the potential involvement of GAS5 in OA. This study was carried out to investigate the function of GAS5 in OA.

METHODS

Expression levels of GAS5 in synovial fluid from 45 OA patients and 45 healthy controls were measured by RT-qPCR. Cell transfections were performed to explore the potential interactions among GAS5, miR-146a, and Smad4 in chondrocytes. Lipopolysaccharide (LPS)-induced cell apoptosis after overexpression of GAS5, miR-146a, and Smad4 was analyzed by cell apoptosis assay.

RESULTS

GAS5 was downregulated in OA. Moreover, LPS treatment downregulated GAS5 in chondrocytes. Interaction between GAS5 could with miR-146a was predicted by bioinformatics analysis and further confirmed by RNA-RNA pulldown assay. However, overexpression of GAS5 and miR-146a did not affect the expression of each other. GAS5 overexpression increased Smad4 expression in chondrocytes. In contrast, miR-146a overexpression downregulated Smad4 in chondrocytes. Moreover, GAS5 and Smad4 overexpression inhibited LPS- induced chondrocytes apoptosis, while miR-146a overexpression played an opposite role and attenuated the effects of GAS5 and Smad4 overexpression on cell apoptosis.

CONCLUSION

GAS5 might sponge miR-146a to upregulate Smad4, thereby suppressing LPS- induced chondrocytes apoptosis.

Evaluation of Arthrocentesis with and Without Platelet-Rich Plasma in the Management of Internal Derangement of Temporomandibular Joint: A Randomized Controlled Trial

PURPOSE

The purpose of this study was to compare the efficacy of intra-articular injection of platelet-rich plasma after arthrocentesis versus arthrocentesis alone as a treatment modality in patients with internal derangement of temporomandibular joint.

METHODS

Twenty-four patients suffering from internal derangement of temporomandibular joint were included in the study. The patients were randomly divided into two groups as follows-twelve patients underwent arthrocentesis followed by intra-articular injection of platelet-rich plasma (study group) and the other twelve were treated by arthrocentesis alone (control group). Pain intensity was recorded on visual analogue scale (VAS); maximum mouth opening and joint sound were measured before and after intervention. The patients were clinically evaluated at the intervals of 1 month, 3 and 6 months subsequently.

RESULTS

There was no statistically significant difference in all the parameters between the groups. Intra-group analysis showed statistically significant improvement in all the parameters.

CONCLUSION

In both groups, improvement of pain, maximum mouth opening and TMJ sound were observed at all intervals, but there was no statistically significant improvement in arthrocentesis with PRP group when compared with arthrocentesis alone.

Arthrocentesis of Temporomandibular Joint- Bridging the Gap Between Non-Surgical and Surgical Treatment

The temporomandibular joint forms one of the most fascinating and complex synovial joints in the body. Movements of the temporomandibular joint are regulated by an intricate neurological controlling mechanism, which is essential for the system to function normally and efficiently. Lack of such harmony may cause disruptive muscle behavior or structural damage to any of the components. The management of refractory pain and dysfunctions in the temporomandibular joint poses challenge both to the oral physician and maxillofacial surgeon. Arthrocentesis is a simple, minimally invasive technique that can be used instead of more invasive procedures in patients with pain that fails to respond to conventional conservative measures. This review provides a full comprehensive overview of the literature about the various technical and prognostic aspects in relation to arthrocentesis of the temporomandibular joint, and every clinician must take into account this consideration when performing this procedure in treating patients with temporomandibular disorders.

Temporomandibular Joint Arthrocentesis: A Prospective Study and Audit of 500 Joints of Central India

Aim and Objectives:

Aim of this study was to compare prospective effectiveness of arthrocentesis of temporomandibular joint by single- and double-needle technique in central India population.

Materials and Methods:

Out of 230 patients, 500 joints were included in the study and were randomly selected into two groups: single needle and double needle. Follow-up of patients were done as 1 week, 1 and 3 months. (The statistical analysis was done using SPSS [Statistical Package for Social Sciences] Version 15.0 Statistical Analysis Software).

Results:

Both techniques were equally effective at reducing pain and increasing the maximal mouth opening. The single-needle technique was easier to perform and required a shorter operative time (P < 0.01).

Conclusion:

The results obtained indicate that single versus double arthrocentesis techniques were equally effective in reducing the pain and increasing the mouth opening and reducing the clicking sound. However, single-needle technique was easier to perform and required a shorter operative time.

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

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.

Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short Term for Improving Function and Quality of Life After Arthrocentesis? Part 2

PURPOSE

Although arthrocentesis has been used for the management of patients with temporomandibular joint pain, the benefit of hyaluronic acid (HA) or corticosteroid (CS) remains uncertain. The purpose of this study was to assess the efficacy of HA, CS, and lactated Ringer solution (LR; placebo) after arthrocentesis for changes in quality of life (QoL), jaw function (Jaw Function Limitation Scale [JFLS] score), and maximum incisal opening (MIO).

MATERIALS AND METHODS

This was a prospective multicenter double-blinded randomized clinical trial. Consecutive patients presenting to the oral and maxillofacial departments at Emory University, the University of Pennsylvania, the University of California-Los Angeles, the University of Cincinnati, and the Oregon Health Sciences University were enrolled in the study. Patients were randomized to HA, CS, or LR. All patients underwent arthrocentesis and then instillation of HA, CS, or LR. All patients were evaluated clinically at 1 and 3 months. The outcome variables were QoL, JFLS score, and MIO. Univariate, bivariate, and multivariate statistics were computed, with a P value less than .05 considered significant.

RESULTS

One hundred two patients were enrolled in the study. Four were lost to follow-up, leaving 98 patients for analysis of data at 1 month. An additional 51 were lost to follow-up at 3 months, leaving 51 patients for data analysis at this time point. There was no difference among groups for QoL Mental Health Composite score at 1 month (P = .70) or 3 months (P = .69). There was no difference among groups for JFLS score at 1 month (P = .71) or 3 months (P = .98). There was no difference among groups for MIO at 1 month (P = .47) or 3 months (P = .31). All groups showed within-group improvements in JFLS score and MIO at 1 and 3 months.

CONCLUSION

Arthrocentesis alone is as efficacious as arthrocentesis with HA or CS in improving jaw function and MIO at 1 and 3 months. QoL is not improved with arthrocentesis alone or in combination with CS or HA.

Kinesio Taping for temporomandibular disorders: Single-blind, randomized, controlled trial of effectiveness

BACKGROUND

Data regarding the effectiveness of Kinesio Taping in temporomandibular disorders (TMD) is scarce.

OBJECTIVE

To determine the efficacy of Kinesio Taping (KT) in patients with TMD.

METHODS

Patients with TMDs were randomized into experimental and control groups. The experimental group (n= 14) received KT in combination with counseling and jaw exercise, whilst controls (n= 14) were given the regimen of counseling and exercise alone. Jaw movements, Visual analogue scale (VAS) scores and self-reported measures (functional limitation and masticatory efficiency) were evaluated at baseline, first and sixth weeks of the treatment. Biobehavioral questionnaire was filled out at baseline and at sixth week.

RESULTS

Active mouth opening improved more in the experimental group than controls (p= 0.003). In the experimental group, VAS for temporomandibular joint, masticatory efficiency and functional limitation improved significantly at the sixth week when compared to baseline (p= 0.011, p= 0.001 and p= 0.001, respectively), but not in controls. Subjective treatment efficacy was higher in the experimental group than that of controls (p= 0.000). Pain, depression and disability scores reduced significantly in the experimental group (p= 0.001, p= 0.006 and p= 0.01, respectively), but not in controls.

CONCLUSION

In conclusion, KT in combination with counseling and exercise is more effective than counseling and exercise alone in TMDs.

Upregulation of lncRNA HOTAIR contributes to IL-1β-induced MMP overexpression and chondrocytes apoptosis in temporomandibular joint osteoarthritis

Temporomandibular joint osteoarthritis (TMJ OA) is a common and heterogeneous disease that causes painful and progressive joint degeneration, which restricts daily activities, including talking and chewing. Long noncoding RNAs (lncRNAs) are an important class of genes involved in various physiological and pathological functions, including osteoarthritis (OA).The present study aimed to identify the lncRNAs that are important in TMJ OA and their potential functions. Here, we found that HOTAIR was significantly upregulated in the synovial fluid of TMJ OA patients compared with that of normal controls. Increased HOTAIR was similarly observed in the synovial fluid of TMJ OA rabbits as compared to control rabbits. Furthermore, in interleukin-1β (IL-1β)-induced TMJ OA in vitro model (primary rabbit condylar chondrocytes), the expressions of matrix metalloproteinase (MMP)-1, MMP3, MMP9 and HOTAIR were all dramatically increased. Most importantly, knockdown of HOTAIR in IL-1β-induced TMJ OA in vitro model could not only reverse the IL-1β-stimulated expressions of MMP1, MMP3 and MMP9, but also significantly decrease the apoptosis rate induced by IL-1β in primary rabbit condylar chondrocytes. Our data provides new insight into the mechanisms of chondrocytes destruction in TMJ OA.

Pharmacologic Treatment for Temporomandibular Disorders

Pharmacologic agents play an integral role in the overall management of temporomandibular joint disorder. The general dentist should be familiar with the different classes of drugs currently in use for dealing with this often complex medical/dental problem.

Does injection of plasma rich in growth factors after temporomandibular joint arthroscopy improve outcomes in patients with Wilkes stage IV internal derangement? A randomized prospective clinical study

The aim of this study was to evaluate the efficacy of injection of plasma rich in growth factors (PRGF) after temporomandibular joint (TMJ) arthroscopy in patients with Wilkes stage IV internal derangement. Ninety-two patients were randomized to two experimental groups: group A (42 joints) received injections of PRGF, group B (50 joints) received saline injections. Pain intensity on a visual analogue scale (VAS) and maximum mouth opening (MMO, mm) were measured before and after surgery and compared by analysis of variance (ANOVA). The mean age of patients was 35.8 years (range 17-67 years); 86 were female. Significant reductions in pain were noted in both groups after surgery: VAS 7.9 preoperative and 1.4 at 24 months postoperative. Significantly better clinical results were achieved in group A than in group B only at 6 and 12 months postoperative; no significant difference was noted at 18 or 24 months after the surgical intervention. MMO increased after surgery in both groups: 26.2mm preoperative and 36.8mm at 24 months postoperative. No significant differences in MMO were found when the two groups of patients were compared. In conclusion, the injection of PRGF does not add any significant improvement to clinical outcomes at 2 years after surgery in patients with advanced internal derangement of the TMJ.

[Statistical tests in medical research: traditional methods vs. multivariate NPC permutation tests]

Statistical tests in medical research: traditional methods vs. multivariate npc permutation tests.Within medical research, a useful statistical tool is based on hypotheses testing in terms of the so-called null, that is the treatment has no effect, and alternative hypotheses, that is the treatment has some effects. By controlling the risks of wrong decisions, empirical data are used in order to possibly reject the null hypotheses in favour of the alternative, so that demonstrating the efficacy of a treatment of interest. The multivariate permutation tests, based on the nonparametric combination - NPC method, provide an innovative, robust and effective hypotheses testing solution to many real problems that are commonly encountered in medical research when multiple end-points are observed. This paper discusses the various approaches to hypothesis testing and the main advantages of NPC tests, which consist in the fact that they require much less stringent assumptions than traditional statistical tests. Moreover, the related results may be extended to the reference population even in case of selection-bias, that is non-random sampling. In this work, we review and discuss some basic testing procedures along with the theoretical and practical relevance of NPC tests showing their effectiveness in medical research. Within the non-parametric methods, NPC tests represent the current "frontier" of statistical research, but already widely available in the practice of analysis of clinical data.

Osteoarthritic changes after superior and inferior joint space injection of hyaluronic acid for the treatment of temporomandibular joint osteoarthritis with anterior disc displacement without reduction: a cone-beam computed tomographic evaluation

PURPOSE

This study compared the effect of superior and inferior joint space injections of hyaluronic acid (HA) and evaluated osteoarthritic changes in patients diagnosed with temporomandibular joint (TMJ) anterior disc displacement without reduction (ADDw/oR) in association with osteoarthritis (OA) by cone-beam computed tomography (CBCT).

MATERIALS AND METHODS

One hundred forty-one patients with research diagnostic criteria for ADDw/oR in association with TMJ OA were randomly assigned to 1 of 2 study groups that received superior or inferior joint space injection of HA. CBCT and clinical examination were performed before treatment and at 3 and 9 months after treatment.

RESULTS

One hundred twenty-six patients returned for the 3-month evaluations, and 74 returned for the 9-month evaluations. Condylar remodeling and TMJ function showed improvement in most patients after treatment. At 3 months, remodeling scores in the superior and inferior groups were 2.14 ± 3.16 and 4.08 ± 3.82, respectively, and scores were 4.80 ± 3.36 and 7.47 ± 3.90 at 9 months. There were significant differences between the superior and inferior groups at 3 and 9 months after treatment (3-month, P = .002; 9-month, P = .002). The Helkimo index of the inferior group was significantly lower than that of superior group at 3 and 9 months (3-month, P = .008; 9-month, P = .028). There were no significant differences in maximal mouth opening between the 2 groups at 3 and 9 months (3-month, P = .82; 9-month, P = .20).

CONCLUSION

Superior and inferior joint space injections of HA are effective methods for the treatment of ADDw/oR in association with TMJ OA. The injection of HA within the inferior joint space appears to result in better condylar reparative remodeling and improvement in jaw function.

Influencing factor on the prognosis of arthrocentesis

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.

An assessment of the usefulness of Kinesiograph as an aid in the diagnosis of TMD: a review of Manfredini et al.'s studies

AIM

Performing a literature review of publications by Dr. Manfredini et al. related to their temporomandibular joint (TMJ) injection therapy outcome with conclusions on the clinical utility of computerized measurement devices used in the management of temporomandibular disorders (TMDs). In addition, reviewing their published opinion on an occlusion: TMD versus a biopsychosocial paradigm for TMD. Manfredini et al. authored an article published in the Journal of the American Dental Association (JADA) 2013, "An Assessment of the usefulness of jaw kinesiography in monitoring temporomandibular disorders," the most recent of 12 articles. In all studies, subjects received TMJ injections with an objective measurement outcome criterion; increased maximum mouth opening (MMO) and subjective symptom improvement of pain and chewing function. In the 2013 JADA article, the Mandibular Kinesiograph, referred to as KG, measured MMO before and after therapy. In 11 prior articles, all subject groups with limited mouth opening exhibited very significant increased MMO post-treatment, documenting treatment success using the same 2013 protocol. The 2013 study showed a 1·1 mm improved MMO, described as insignificant. The authors did not critique or explain the aberrant, skewed 2013 outcome data contrasted with their prior studies, which showed overwhelmingly significant increased MMO. Instead, they concluded that the MMO recording device was clinically useless. This motivated a literature review of the authors' TMD publications.

CONCLUSION

The publications by Manfredini et al. recognized proponents of the psychosocial model of TMD, including the 2013 article, appear to be part of a campaign denying an occlusion: TMD relationship and disparaging the specific computerized measurement devices and the dentists using them in the management of their TMD patients using neuromuscular occlusion dental treatment.