1
|
Grossmann E, Poluha RL. Comparative study of arthrocentesis with concentric-needle cannula with classic concentric needle: A randomized single-blind controlled clinical trial. J Craniomaxillofac Surg 2024; 52:850-854. [PMID: 38724289 DOI: 10.1016/j.jcms.2024.04.009] [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: 12/16/2023] [Revised: 03/31/2024] [Accepted: 04/27/2024] [Indexed: 07/23/2024] Open
Abstract
This study aimed to assess and compare the efficacy of two distinct single-puncture techniques in temporomandibular joint (TMJ) arthrocentesis for managing disk displacement without reduction (DDwoR). Sixty patients with DDwoR were randomly and blindly assigned to two treatment groups (n = 30 each): group 1 - TMJ arthrocentesis with the classic concentric needle; and group 2 - TMJ arthrocentesis with the concentric needle-cannula system. The following variables were recorded and compared across the groups: patient's pain perception (visual analog scale - VAS, 0-10); maximal interincisal distance (MID, mm); facial edema (FE, presence or absence); and operation duration (OP, minutes). Patients in group 2 presented significantly lower values of VAS score and presence of FE (p < 0.05) when examining the data at 24 and 48 h after the arthrocentesis. They also showed an increase in MID values (p = 0.024) after 6 months. With regard to OP, no significant difference was observed between the groups. Performing a single-puncture TMJ arthrocentesis using a concentric needle-cannula system significantly reduced the patients' pain perception, and mitigated the presence of facial edema during the immediate postoperative period (at 24 and 48 h). Furthermore, it resulted in a notable increase in the MID after 6 months.
Collapse
Affiliation(s)
- Eduardo Grossmann
- Dentistry Faculty, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | |
Collapse
|
2
|
Grossmann E, Poluha RL. The benefits of performing temporomandibular joint arthrocentesis with catheters and a vacuum pump: A randomized control trial. J Craniomaxillofac Surg 2024; 52:369-373. [PMID: 38253472 DOI: 10.1016/j.jcms.2024.01.020] [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: 06/28/2023] [Revised: 11/13/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
This study aims to compare the effectiveness of two different techniques of double puncture arthrocentesis with and without the addition of catheters and a vacuum pump for management of temporomandibular joint (TMJ) disc displacement without reduction (DDWOR). A total of 48 patients with DDWOR were randomly and blindly allocated into two treatment groups (N = 24): Group 1, TMJ arthrocentesis with the addition of catheters and a vacuum pump to the second needle; Group 2, TMJ arthrocentesis without any addition device. The following variables were registered and compared between groups: patient's pain perception (visual analogue scale [VAS; 0-10]); maximal interincisal distance [MID; mm]; joint effusion (JE, presence or absence); facial edema (FE; presence or absence); and the operation duration (OP; minutes). Patients in Group 1 presented with significantly lower VAS scores (p < 0.001) and presence of FE (p = 0.03) in the post-operative period, also an increase in MID values (p = 0.026), and a reduction in JE (p = 0.022) after 3 months. Besides that, in this group, the procedure was performed significantly faster (p < 0.001). Performing arthrocentesis with the addition of a vacuum pump makes the procedure faster and yields better results in terms of pain, facial swelling, mouth opening and joint effusion.
Collapse
Affiliation(s)
- Eduardo Grossmann
- Federal University of Rio Grande Do Sul, Coronel Corte Real Street, 130, 90630-080, Porto Alegre, Brazil.
| | - Rodrigo Lorenzi Poluha
- Department of Dentistry, State University of Maringá, Mandacaru Avenue, 1550, 87080-000, Maringá, Brazil.
| |
Collapse
|
3
|
Asquini G, Devecchi V, Borromeo G, Viscuso D, Morato F, Locatelli M, Falla D. Predictors of pain reduction following a program of manual therapies for patients with temporomandibular disorders: A prospective observational study. Musculoskelet Sci Pract 2022; 62:102634. [PMID: 35939919 DOI: 10.1016/j.msksp.2022.102634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/04/2022] [Accepted: 07/22/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Clinical guidelines recommend conservative treatment for the management of temporomandibular disorders (TMD), and manual therapy (MT) is commonly applied to reduce pain and improve function. OBJECTIVES To identify predictors of pain reduction and functional improvement following a program of manual therapies (MTP) in patients with TMD and develop a first screening tool that could be used in clinical practice to facilitate decision-making. DESIGN A cohort of 102 adults with a diagnosis of TMD were treated with four weekly sessions within a MTP applied to craniomandibular structures. Candidate predictors were demographic variables, general health variables, psychosocial features, TMD characteristics and related clinical tests. A reduction of pain intensity by at least 30% after the MTP was considered a good outcome. Logistic regression was adopted to develop the predictive model and its performance was assessed considering the explained variance, calibration, and discrimination. Internal validation of the prediction models was further evaluated in 500 bootstrapped samples. RESULTS Patients experiencing pain intensity greater than 2/10 during mouth opening, positive expectations of outcome following a MTP, pain localized in the craniocervical region, and a low Central Sensitization Inventory score obtained a good outcome following the MTP. Predictive performance of the identified physical and psychological variables was characterized by high explained variance (R2 = 58%) and discrimination (AUC = 89%) after internal validation. A preliminary screening clinical tool was developed and presented as a nomogram. CONCLUSIONS The high discrimination of the prediction model revealed promising findings, although these need to be externally validated in future research. TRIAL REGISTRATION NUMBER NCT03990662.
Collapse
Affiliation(s)
- Giacomo Asquini
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham Birmingham, B15 2TT, UK; Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy
| | - Valter Devecchi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham Birmingham, B15 2TT, UK
| | - Giulia Borromeo
- Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy
| | - Domenico Viscuso
- Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy; University of Cagliari, Department of Surgical Sciences, Dental Service, Via Università 40 Cagliari, Italy
| | - Federico Morato
- Italian Stomatologic Institute, Craniomandibular Physiotherapy Service, Via Pace 21, 20122, Milan, Italy
| | - Matteo Locatelli
- IRCCS San Raffaele Scientific Institute, Via Olgettina Milano 60, 20132, Milano, Italy
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham Birmingham, B15 2TT, UK.
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Bilgir E, Yıldırım D, Șenturk MF, Orhan H. Clinical and ultrasonographic evaluation of ultrasound-guided single puncture temporomandibular joint arthrocentesis. Cranio 2020:1-10. [PMID: 33267750 DOI: 10.1080/08869634.2020.1853889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Objective: To evaluate the effects of successful TMJ treatment on relief of pain, improvement of mandibular movement and capsular width with clinical and ultrasonography (US) findings. In this study, TMJ changes were evaluated by clinical and US examination after US-guided single-puncture arthrocentesis, which represents a novel approach.Methods: Clinical measurements were obtained before each procedure and at 1 day, 7 days, and 3 months thereafter. Capsular width was measured via the US at the 3-month follow-up.Results: Significant improvements were evident at the short term of 3 months post-arthrocentesis with supportive treatment, including splint therapy and jaw exercises.Conclusion: Arthrocentesis in conjunction with splint therapy and jaw exercises demonstrated significant clinical improvement at the short-term follow-up of 3 months. US imaging can be helpful for follow-up evaluation of the pre- and post-treatment capsule width. Longer follow-up studies are necessary to validate the effectiveness of this treatment protocol.
Collapse
Affiliation(s)
- Elif Bilgir
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Derya Yıldırım
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey
| | - Mehmet Fatih Șenturk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Hikmet Orhan
- Department of Biostatistics and Medical Informatics, Süleyman Demirel University Faculty of Medicine, Isparta, Turkey
| |
Collapse
|
6
|
Bas B, Yuceer E, Kazan D, Gurbanov V, Kutuk N. Clinical and intra-operative factors affecting the outcome of arthrocentesis in disc displacement without reduction: A retrospective study. J Oral Rehabil 2019; 46:699-703. [PMID: 31044441 DOI: 10.1111/joor.12808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/05/2019] [Accepted: 04/25/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Temporomandibular disorder (TMD) is a group of disease which affects the temporomandibular joint (TMJ) and supporting tissues of the musculoskeletal structures. Arthrocentesis is an effective treatment modality for TMD, especially in patients who suffer from pain and limited mouth opening. OBJECTIVE The aim of this study was to investigate the effects of pre-operative and intra-operative variables on the clinical outcome of arthrocentesis therapy. METHODS The records of 83 patients diagnosed as disc displacement (DD) without reduction according to DC/TMD, and treated with arthrocentesis were selected. Sex, age, bruxism history, pain intensity and maximum mouth opening (MMO) were recorded as pre-operative variables. Extravasation and the amount of irrigation were recorded as intra-operative variables. The success of the arthrocentesis procedure was determined as MMO <35 mm and pain intensity lower than 3, at third-month follow-up. RESULTS At 3-month follow-up, clinical evaluation showed a significant reduction in TMJ pain and an increase in MMO (P < 0.05). It was found that patients with an unsuccessful outcome are those who had a more restricted MMO and severe pain before the procedure. Extravasation was found to be a significant factor that affects the success of the procedure. CONCLUSION The success of arthrocentesis in TMJ DD without reduction is adversely affected by the severity of the pre-operative clinical symptoms. Extravasation is also a factor that has a negative effect on the success of the procedure.
Collapse
Affiliation(s)
- Burcu Bas
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ondokuz Mayis University, Samsun, Turkey
| | - Ezgi Yuceer
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ondokuz Mayis University, Samsun, Turkey
| | - Dilara Kazan
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ondokuz Mayis University, Samsun, Turkey
| | | | - Nukhet Kutuk
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Bezmialem University, Istanbul, Turkey
| |
Collapse
|
7
|
Grossmann E, Poluha RL, Iwaki LCV, Santana RG, Iwaki Filho L. The use of arthrocentesis in patients with temporomandibular joint disc displacement without reduction. PLoS One 2019; 14:e0212307. [PMID: 30759144 PMCID: PMC6374052 DOI: 10.1371/journal.pone.0212307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/31/2019] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to evaluate the efficacy of the use of the arthrocentesis in patients with disc displacement without reduction (DDWOR). Two hundred and thirty-four (234) patients with DDWOR were evaluated and the following data collected: gender; affected side; age (years); duration of the pain (months); patient's perception of pain (measured by Visual Analogue Scale [VAS 0-10]); maximal interincisal distance (MID) (mm); and joint disc position, determined by magnetic resonance imaging. Data were obtained in two different moments: before the arthrocentesis (M1) and three or four months later (M2). Paired t-Student Test, Scores Test and Wilcoxon Test showed a statistical significant difference (p<0.0001) between the M1 and M2 for the variables VAS and MID. There was an alteration in the joint disc position in 93.88% of the cases after arthrocentesis. There was no association between the general characteristics of the patients on the M1 and the results of the arthrocentesis (p>0.05). It can be concluded that the arthrocentesis is efficient in reducing the pain, in increasing interincisal distance, and altering the joint disc position in patients with DDWOR regardless gender, age side and pain duration.
Collapse
Affiliation(s)
- Eduardo Grossmann
- Department of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail: ,
| | | | | | | | - Liogi Iwaki Filho
- Department of Dentistry, State University of Maringá, Maringá, Paraná, Brazil
| |
Collapse
|