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Raveggi E, Ramieri G, Bosco GF, Zavattero E. Temporomandibular joint arthrocentesis: a single-center experience and review of the literature. Minerva Dent Oral Sci 2023; 72:69-76. [PMID: 37052194 DOI: 10.23736/s2724-6329.22.04653-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
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.
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Affiliation(s)
- Elisa Raveggi
- Division of Maxillofacial Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Guglielmo Ramieri
- Division of Maxillofacial Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giovanni F Bosco
- Division of Maxillofacial Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Emanuele Zavattero
- Division of Maxillofacial Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy -
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Bayramoglu Z, Yavuz GY, Keskinruzgar A, Koparal M, Kaya GS. Does intra-articular injection of tenoxicam after arthrocentesis heal outcomes of temporomandibular joint osteoarthritis? A randomized clinical trial. BMC Oral Health 2023; 23:131. [PMID: 36890529 PMCID: PMC9996841 DOI: 10.1186/s12903-023-02852-z] [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: 08/19/2022] [Accepted: 03/01/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Temporomandibular joint osteoarthritis (TMJ-OA) is a degenerative disease and manifests itself with pain and limitation of movement in the jaws. Arthrocentesis alone or in combination with intraarticular injections is one of the most commonly used treatment methods in these patients. The aim of the study is to examine the effectiveness of arthrocentesis plus tenoxicam injection and to compare it with arthrocentesis alone in patients with TMJ-OA. METHODS Thirty patients with TMJ-OA who were treated randomly with either arthrocentesis plus tenoxicam injection (TX group) or arthrocentesis alone (control group) were examined. Maximum mouth opening (MMO), visual analog scale (VAS) pain values, and joint sounds were the outcome variables, which were evaluated at pre-treatment and at 1, 4, 12, and 24 weeks after treatment. Statistical significance was set at p < 0.05. RESULTS The gender distribution and mean age were not significantly different between the two groups. Pain values (p < 0.001), MMO (p < 0.001), and joint sounds (p < 0.001) improved significantly in both groups. However, there was no significant difference between the groups in terms of outcome variables [pain (p = 0.085), MMO (p = 0.174), joint sounds (p = 0.131)]. CONCLUSIONS Arthrocentesis plus tenoxicam injection showed no better outcomes in terms of MMO, pain, and joint sounds compared with arthrocentesis alone in patients with TMJ-OA. TRIAL REGISTRATION Injection of Tenoxicam Versus Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis, NCT05497570. Registered 11 May 2022. Retrospectively registered, https://register. CLINICALTRIALS gov/prs/app/action/SelectProtocol?sid=S000CD7A&selectaction=Edit&uid=U0006FC4&ts=6&cx=f3anuq.
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Affiliation(s)
- Zeynep Bayramoglu
- Department of Oral, Dental and Maxillofacial Surgery, Ataturk University, Erzurum, Turkey.
| | - Günay Yapici Yavuz
- Department of Oral, Dental and Maxillofacial Surgery, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Aydın Keskinruzgar
- Department of Oral, Dental and Maxillofacial Surgery, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Mahmut Koparal
- Department of Oral, Dental and Maxillofacial Surgery, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Göksel Simsek Kaya
- Department of Oral, Dental and Maxillofacial Surgery, Faculty of Dentistry, Akdeniz University, Antalya, Turkey
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Dhiman NK, Jaiswara C, Hirani MS, Chauhan N, Mahajan AD, Krishnan A. Efficacy of arthrocentesis with intra-articular injection of hyaluronic acid and corticosteroid in the treatment of internal derangement of temporomandibular joint. Natl J Maxillofac Surg 2023; 14:93-100. [PMID: 37273422 PMCID: PMC10235751 DOI: 10.4103/njms.njms_8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/11/2022] [Accepted: 06/22/2022] [Indexed: 06/06/2023] Open
Abstract
Introduction Various techniques have been used to treat internal temporomandibular joint derangements (TMJ ID), with arthrocentesis one of the most successful in reducing symptoms and promoting function. In cases of TMJ ID, this research study compares and evaluates the efficacy of arthrocentesis with injections of corticosteroids (CS) or hyaluronic acid (HA). Methods This prospective randomized, non-blinded study involving 91 patients with symptoms of TMJ ID treated by arthrocentesis followed by intra articular injection of 1 ml of either corticosteroid (group A) or HA (group B) . Maximum mouth opening, lateral excursive movements, TMJ pain at rest and during function, masticatory efficiency, pre-treatment functional TMJ limitation and subjective judgment of efficacy of treatment were assessed with millimeter scale. All the parameters measured before the procedure and further followed at 1st week, 1st month, 3rd month and 6th month post-procedure. Results Maximum mouth opening post procedure improved significantly in Group B at follow up visits (P < 0.05). Subjects in group B showed significant reduction in pain at rest (P = 0.001) at 1 week and 1 month follow up & increased masticatory efficiency at 6 months (P = 0.042) as compared to that of group A subjects. Conclusion Injection of HA post-TMJ arthrocentesis is found be comparatively more effective method of treating TMD IDs with resultant decrease in pain & improved functionality of the jaw. TMJ arthrocentesis along with injection of HA could serve as a possible alternative to treat chronic TMJ pain sufferers who are unresponsive to conservative medical therapies.
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Affiliation(s)
- Neeraj K. Dhiman
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Chandresh Jaiswara
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Mehul S. Hirani
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Nishtha Chauhan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Arjun D. Mahajan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Aswathi Krishnan
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Intra-articular injection of hyaluronic acid versus platelet-rich plasma following single puncture arthrocentesis for the management of internal derangement of TMJ: A double-blinded randomised controlled trial. J Craniomaxillofac Surg 2022; 50:825-830. [PMID: 36372680 DOI: 10.1016/j.jcms.2022.10.002] [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: 12/10/2021] [Revised: 07/17/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022] Open
Abstract
The present study aimed to compare the efficacies of intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) following single needle arthrocentesis in patients with TMJ internal derangement. This double-blinded randomised controlled trial involved the enrolment of patients diagnosed with unilateral TMD, falling into either Wilkes' stages II or III. In Group A, single needle arthrocentesis was performed using Ringer's lactate serving as a control group; in Group B, intra-articular injection of 1 ml hyaluronic acid injection was given following arthrocentesis; and in Group C, autologous intraarticular injections of 1 ml of PRP was given after arthrocentesis, twice in two weeks' interval. The primary outcome variables were maximum mouth opening and pain, while TMJ clicking sounds formed the secondary outcome variable. All the outcome variables were assessed preoperatively (T0) and postoperatively after the second dose of injection at one month (T1), three months (T2), and six months (T3). The alpha level was set to p < 0.05. Ninety patients (N = 90) comprised the final sample size of the study with thirty patients(n = 30) in each treatment group. A statistically significant decrease in the management in mean pain scores was noted between T0 [mean scores were 7.30 ± 1.05 (Group A), 7.63 ± 1.12 (Group B), and 7.56 ± 1.04(Group C)] and T3 [mean scores were 2.66 ± 0.88 (Group A), 2.4 ± 0.72 (Group B), and 1.66 ± 0.66 (Group C)] time intervals between Group A and C(p < 0.001). Significant improvement was noted in preoperative maximum mouth opening (MMO) of Group A, B, and C which was 22.83 ± 3.58, 22.17 ± 4.07, and 21.37 ± 3.69, respectively to 28.90 ± 2.72, 32.17 ± 3.97, and 34.10 ± 3.80 mm, respectively at six months postoperatively (p < 0.001). A significant decrease in joint sounds was evident for all three groups(p = 0.003 for Group A, p < 0.001 for Group B, and p < 0.001 for Group C) across the time intervals. Moreover, Group C showed a significant decrease in the prevalence of joint sound compared to the other two groups at all-time intervals postoperatively when equated to baseline (p = 0.02 at T1, p = 0.009 at T2, and p = 0.002 at T3). Within the limitations of the present study, it can be concluded that intra-articular PRP may be preferable over HA whenever appropriate, following single needle arthrocentesis in the treatment of TMJ internal derangement.
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Hyder A, Tawfik BE, Elmohandes W. Efficacy of computer-guided versus conventional sodium hyaluronate injection in superior joint space in treatment of temporomandibular joint (TMJ) internal derangement: Comparative randomized controlled trial. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e321-e326. [PMID: 35545190 DOI: 10.1016/j.jormas.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/23/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES evaluate the feasibility and clinical outcomes of computer-guided sodium hyaluronate injection in superior joint space compared to conventional injection for the treatment of TMJ Internal Derangement (TMJ-ID). PATIENTS AND METHODS Randomized controlled trial conducted on 40 patients diagnosed with bilateral TMJ-ID divided into two groups. Group A treated with four computer-guided sodium hyaluronate injections in superior TMJ space with one-week intervals. Group B received similar injections but with the conventional method. The intraoperative assessment included total procedural time and patient convenience during the injection. The postoperative evaluation included maximum unassisted mouth opening (MUMO), modified Helkimo's clinical dysfunction index, and pain intensity on a visual analog scale (VAS). RESULTS Group A showed better improvement in maximum mouth opening and pain intensity than group B after a week of the second, third and fourth injection. At the six months, group A continued to show better improvement regarding maximum mouth opening, while improvement in pain and TMJ dysfunction was similar in both groups. There were differences between both groups regarding procedural time and patient convenience across the study except the time of the first injection, which was similar in both groups CONCLUSION: Using the virtual planning and injection guide for intra-articular TMJ injection is considered promising to increase the accuracy and efficacy of injectable material securing faster results besides rendering the procedure easily reproducible and simpler to both clinicians and patients. However, the authors could not ensure the long-term superiority of the computer-guided injection technique over the conventional one in light of the results of this study.
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Affiliation(s)
- AbdElKader Hyder
- Assistant Lecturer of Oral and Maxillofacial Surgery, Faculty of Dentistry, Al-Azhar University, 11884, ElNasr Road, Nasr City, Cairo, Egypt.
| | - Bahaa Eldin Tawfik
- Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Al-Azhar University, Cairo, Egypt
| | - Wael Elmohandes
- Professor of Oral and Maxillofacial Surgery, Faculty of Dentistry, Al-Azhar University, Cairo, Egypt
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Sultana Shuborna N, Khoo LK, Bhattarai BP, Chaiyasamut T, Kiattavorncharoen S, Pairuchvej V, Wongsirichat N. Intra-socket application of Hyaluronic acid reduces pain and swelling following wisdom teeth removal. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2022. [DOI: 10.1051/mbcb/2021038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Hyaluronic acid (HA) has the potential to promote wound healing. Pain and swelling with trismus are common sequalae post wisdom teeth removal. This study aims to investigate the effectiveness of intra-socket HA solution to reduce these uncomfortable post-operative events. Materials and methods: 30 patients underwent bilateral extractions of mandibular wisdom teeth for this study. Intra-socket application of 0.7 ml 20 mg/2 ml HA solution (Hyalgun) with Gel foam as a scaffold in study site versus Gel foam only on control site was conducted via a split mouth study design. Data collection of five facial reference points for swelling and maximum mouth opening was recorded during the pre-operative period and post-operative 2nd and 7th day. The VAS pain score at post-op 1st, 2nd and 3rd day and the number of analgesics for the 7-day post-operative duration were evaluated. Results: The HA group demonstrated statistically significant less swelling, trismus and analgesia consumption on the 2 and 7 days after surgery. VAS scores on day 1, 2 and 3 after surgery (P = 0.05) were significantly less in the HA group compared to the control group. Conclusion: The application of intra-socket HA has a positive effect for reducing postoperative pain and swelling with trismus after the lower third molar intervention (LTMI).
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Does glucosamine, chondroitin sulfate, and methylsulfonylmethane supplementation improve the outcome of temporomandibular joint osteoarthritis management with arthrocentesis plus intraarticular hyaluronic acid injection. A randomized clinical trial. J Craniomaxillofac Surg 2021; 49:711-718. [PMID: 33685850 DOI: 10.1016/j.jcms.2021.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/03/2020] [Accepted: 02/16/2021] [Indexed: 01/13/2023] Open
Abstract
The purpose of this study was to compare clinical outcomes obtained with the use of glucosamine, chondroitin sulfate, and methylsulfonylmethane (GCM) supplementation after arthrocentesis plus intraarticular hyaluronic acid (HA) injection. A randomized clinical trial was implemented with adult participants with TMJ-OA who were referred to the author's clinic between February 2014 and May 2015. The sample was entirely composed of patients with TMJ-OA who were treated randomly with a one-session arthrocentesis plus intraarticular HA injection only (control group), or an initial one-session arthrocentesis plus intraarticular HA injection followed by 3 months of GCM supplementation (study group). The predictor variable was management (treatment) technique. The outcome variables were visual analog scale evaluations (masticatory efficiency, pain complaint, joint sound) and mandibular mobility (maximal interincisal opening [MIO], and lateral and protrusive motions of the mandible). The outcome variables were recorded preoperatively and 12 months postoperatively. Thirty-one participants were enrolled in the study. Five were lost during follow-up. The final study sample consisted of 26 participants (age 28.35 ± 10.85 y): 14 in the control group (age 28.71 ± 10.94 y); and 12 in the study group (age 27.92 ± 11.20 y). Pain complaints (p < 0.001) and joint sounds (p = 0.030 for the control group; p = 0.023 for the study group) showed statistically significant decreases. Masticatory efficiency (p < 0.001 for the control group; p = 0.040 for the study group) and lateral mandibular motion (p = 0.040 for the control group; p = 0.004 for study group) showed statistically significant increases in both groups, whereas MIO and protrusive mandibular motion showed no significant changes in either group (p > 0.05). After estimating the differences between the follow-up and baseline outcomes, the mean changes in the primary outcome variables (VAS scores, MIO, and mandibular motion) showed no statistically significant differences between the two groups (p > 0.05). Progressions (reparative remodeling) of hard-tissue TMJ structures were observed on CBCT scans of some participants in both groups. These findings suggested that the use of GCM supplementation after arthrocentesis plus intraarticular HA injection produced no additional clinical benefits or improvements for patients with TMJ-OA compared with arthrocentesis plus intraarticular HA injection alone.
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Köhnke R, Ahlers MO, Birkelbach MA, Ewald F, Krueger M, Fiedler I, Busse B, Heiland M, Vollkommer T, Gosau M, Smeets R, Rutkowski R. Temporomandibular Joint Osteoarthritis: Regenerative Treatment by a Stem Cell Containing Advanced Therapy Medicinal Product (ATMP)-An In Vivo Animal Trial. Int J Mol Sci 2021; 22:E443. [PMID: 33466246 PMCID: PMC7795212 DOI: 10.3390/ijms22010443] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 12/19/2022] Open
Abstract
Temporomandibular joint osteoarthritis (TMJ-OA) is a chronic degenerative disease that is often characterized by progressive impairment of the temporomandibular functional unit. The aim of this randomized controlled animal trial was a comparative analysis regarding the chondroregenerative potency of intra-articular stem/stromal cell therapy. Four weeks after combined mechanical and biochemical osteoarthritis induction in 28 rabbits, therapy was initiated by a single intra-articular injection, randomized into the following groups: Group 1: AB Serum (ABS); Group 2: Hyaluronic acid (HA); Group 3: Mesenchymal stromal cells (STx.); Group 4: Mesenchymal stromal cells in hyaluronic acid (HA + STx.). After another 4 weeks, the animals were euthanized, followed by histological examination of the removed joints. The histological analysis showed a significant increase in cartilage thickness in the stromal cell treated groups (HA + STx. vs. ABS, p = 0.028; HA + ST.x vs. HA, p = 0.042; STx. vs. ABS, p = 0.036). Scanning electron microscopy detected a similar heterogeneity of mineralization and tissue porosity in the subchondral zone in all groups. The single intra-articular injection of a stem cell containing, GMP-compliant advanced therapy medicinal product for the treatment of iatrogen induced osteoarthritis of the temporomandibular joint shows a chondroregenerative effect.
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Affiliation(s)
- Robert Köhnke
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (R.K.); (M.A.B.); (T.V.); (M.G.); (R.S.)
| | - Marcus Oliver Ahlers
- Department of Prosthetic Dentistry School of Dental Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
- CMD-Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Moritz Alexander Birkelbach
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (R.K.); (M.A.B.); (T.V.); (M.G.); (R.S.)
| | - Florian Ewald
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg Eppendorf, 20246 Hamburg, Germany;
| | | | - Imke Fiedler
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (I.F.); (B.B.)
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (I.F.); (B.B.)
| | - Max Heiland
- Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Oral and Maxillofacial Surgery, 14197 Berlin, Germany;
| | - Tobias Vollkommer
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (R.K.); (M.A.B.); (T.V.); (M.G.); (R.S.)
| | - Martin Gosau
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (R.K.); (M.A.B.); (T.V.); (M.G.); (R.S.)
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (R.K.); (M.A.B.); (T.V.); (M.G.); (R.S.)
- Department of Oral and Maxillofacial Surgery, Division of Regenerative Orofacial Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Rico Rutkowski
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (R.K.); (M.A.B.); (T.V.); (M.G.); (R.S.)
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Singh J, Bhardwaj B. Treatment of Temporomandibular Joint Arthritis with Triamcinolone Acetonide and Hyaluronic Acid Injection: An Observational Study. Indian J Otolaryngol Head Neck Surg 2020; 72:403-410. [PMID: 33088766 PMCID: PMC7544749 DOI: 10.1007/s12070-019-01738-3] [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] [Received: 09/15/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022] Open
Abstract
Temporomandibular joint (TMJ) arthritis is a common cause of orofacial pain with distressing symptoms. The patients most commonly females are often anxious and worried due to the typical gritty sound produced during chewing moments. In other cases there is pain followed by decreased mouth opening. Currently the treatment is not standardised though the clinicians are treating these disorders either by oral medications; splintage or by injections. Though local injection of Triamcinolone acetonide and Hyaluronic acid is an innovative therapy yet it is elusive of much research. The main aim of the present study is to evaluate the efficacy of with Triamcinolone acetonide and Hyaluronic acid in treating temporomandibular joint arthritis. The present study is a prospective non randomized clinical trial of 100 patients in a tertiary referral centre. The patients diagnosed with temporomandibular joint arthritis were treated with local infiltration of 40 mg triamcinolone acetonide along with 20 mg of hyaluronic acid; one injection every week for 4 weeks. The pre-treatment and post-treatment data was compared using student paired t test and Mann-Whitney U test. Majority of the patients showed relief in symptoms like pain (87/96) and clicking sounds (81/88) and the difference was statistically significant (p < 0.05). Though other symptoms like restrictive mouth opening; discomfort on lateral and medial movement were also relieved in 9/15 patients and 21/23 patients respectively however the difference was not statistically significant. We highly recommend the use of Triamcinolone acetonide and hyaluronic acid injection in TMJ arthritis as it helps in relieving pain and clicking of sound in majority of the patients. The treatment is an out-patient department procedure with almost no side effects in most of the patients. The cost effectiveness of the treatment is another benefit.
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Affiliation(s)
- Jaskaran Singh
- Sri Guru Ram Das Institute of Health Sciences and Research Amritsar, HIG 202 Sector 71, Mohali, 160071 India
| | - Bhanu Bhardwaj
- Sri Guru Ram Das Institute of Health Sciences and Research Amritsar, 27-C, Sant Avenue, The Mall, Amritsar, 143001 India
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Willekens I, Fares A, Devos H, Shahabpour M, Lenchik L, Buls N, De Maeseneer M. Prevalence of chondrocalcinosis in the temporomandibular joint in patients with chondrocalcinosis of the knee or wrist. Dentomaxillofac Radiol 2020; 49:20190450. [PMID: 32479114 DOI: 10.1259/dmfr.20190450] [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] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence of TMJ chondrocalcinosis on head CT scans in patients with chondrocalcinosis of the knee or wrist. METHODS AND MATERIALS 227 patients with radiological evidence of calcifications on knee or wrist radiographs had a head CT scan obtained for unrelated purposes. CT scans were retrospectively reviewed for the presence of temporomandibular crystal deposition. Prevalence, bilaterality, age and gender distribution were determined. RESULTS 41 of 227 (18%) of patients had TMJ chondrocalcinosis. TMJ chondrocalcinosis was more common in females (17%) than males (1%). It was more commonly unilateral (68%) than bilateral (32%). CONCLUSION In patients with peripheral calcific disease, the TMJ is more commonly involved than previously reported and this is more common in females compared to males.
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Affiliation(s)
- Inneke Willekens
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Abdallah Fares
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Hannes Devos
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Leon Lenchik
- Wake Forest University Medical School, Winston-Salem, USA
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
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Arthrocentesis and Sodium Hyaluronate Infiltration in Temporomandibular Disorders Treatment. Clinical and MRI Evaluation. J Funct Morphol Kinesiol 2020; 5:jfmk5010018. [PMID: 33467234 PMCID: PMC7739436 DOI: 10.3390/jfmk5010018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 11/25/2022] Open
Abstract
Arthrocentesis in temporomandibular joint disorders can be associated with the intra-articular infiltration of various drugs with the objective of increase treatment efficacy. The aim of this study was to evaluate the clinical indexes variation in patients affected by temporomandibular joint disorders treated with arthrocentesis and sodium hyaluronate (SH) injections. A total of 28 patients suffering from temporomandibular joint disorders underwent one cycle of five arthrocentesis and infiltrations of sodium hyaluronate. Spontaneous mouth opening improved from 36.3 ± 7.5 mm to 45.1 ± 1.9 mm at six months follow-up. A significant reduction in the pain at rest and during mastication mean values emerged at follow-up (p < 0.0001). The mean masticatory efficiency, evaluated through a visual analogic scale, showed improvement at the follow-up period, highlighted by the increase of mean value from a baseline of 3.1 ± 1.2 to a mean value of 8.5 ± 1.2 (p < 0.0001). The mean severity of the joint damage at baseline time was 2.4 ± 0.9 and decreased to 0.4 ± 0.3 at the end of the follow-up period. The decrease in values is confirmed by statistical test (p < 0.05). Our data show how arthrocentesis integrated with sodium hyaluronate infiltrations performed under local anesthesia is a valid method of treating temporomandibular joint disorders.
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Polat ME, Yanik S, Odabasi O. Retrospective evaluation of the duration of arthrocentesis in the treatment of temporomandibular joint diseases. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:201-205. [PMID: 32109596 DOI: 10.1016/j.jormas.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study investigated the duration of arthrocentesis in treatment of patients with different diagnoses of temporomandibular disorders. METHODS This retrospective study evaluated the duration of arthrocentesis used for 65 patients who were diagnosed with osteoarthritis (OA), disc displacement with reduction (DDWR), or disc displacement without reduction (DDWoR), in accordance with the Research Diagnostic Criteria for Temporomandibular Disorders protocol. RESULTS Mean operation times were 423.79 (± 66.77) seconds in OA patients, 459.92 (± 56.67) seconds in DDWR patients, and 609.00 (± 106.88) seconds in DDWoR patients; these significantly differed among groups (P < 0.001). In addition, post hoc analyses revealed statistically significant differences in mean operation times between DDWoR and OA (P<0.05) and DDWoR and DDWR (P<0.05). CONCLUSION The appropriate duration of arthrocentesis may vary among joint disorders, and the duration of arthrocentesis in DDWoR treatment is longer than that in DDWR and OA treatments. In addition there was no relationship between the age or gender and operation time of the patients. Changes in anatomic structures due to temporomandibular diseases are presumed to influence the duration of arthrocentesis treatment.
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Affiliation(s)
- M E Polat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Harran University, 63300 Sanlıurfa, Turkey.
| | - S Yanik
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Harran University, 63300 Sanlıurfa, Turkey.
| | - O Odabasi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Yildirim Beyazit University, 06010 Ankara, Turkey.
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13
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De Riu G, Vaira LA, Carta E, Meloni SM, Sembronio S, Robiony M. Bone marrow nucleated cell concentrate autograft in temporomandibular joint degenerative disorders: 1-year results of a randomized clinical trial. J Craniomaxillofac Surg 2019; 47:1728-1738. [DOI: 10.1016/j.jcms.2018.11.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/12/2018] [Accepted: 11/28/2018] [Indexed: 12/24/2022] Open
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14
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Yilmaz O, Korkmaz YT, Tuzuner T. Comparison of treatment efficacy between hyaluronic acid and arthrocentesis plus hyaluronic acid in internal derangements of temporomandibular joint. J Craniomaxillofac Surg 2019; 47:1720-1727. [DOI: 10.1016/j.jcms.2019.07.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/13/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022] Open
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Marzook HAM, Abdel Razek AA, Yousef EA, Attia AAMM. Intra-articular injection of a mixture of hyaluronic acid and corticosteroid versus arthrocentesis in TMJ internal derangement. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 121:30-34. [PMID: 31121331 DOI: 10.1016/j.jormas.2019.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/06/2019] [Accepted: 05/10/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Internal derangements are the commonest disorders of temporomandibular joint (TMJ). Different treatment modalities have been proposed to treat this disorder. Arthrocentesis and intra-articular injection are gaining popularity in the treatment of internal derangement of TMJ. PURPOSE The aim of this study was to compare between the effect of arthrocentesis and intra-articular injection using a mixture of hyaluronic acid and corticosteroid in the management of TMJ internal derangement. MATERIALS AND METHODS Sixteen patients with TMJ internal derangement were selected and divided into 2 equal groups. In group I, arthrocentesis was performed with Ringer solution. In group II, intra-articular injection was performed with a mixture of 0.5ml hyaluronic acid and 0.5ml corticosteroid. Assessment of pain, maximum mouth opening, lateral movement and clicking was done before the treatment, one week, one month and three months after the treatment. All parameters were subjected to statistical analysis. RESULTS All studied parameters showed improvements. There was no statistically significant difference between the two groups regarding intensity of pain, maximum mouth opening, lateral movement and joint sound. CONCLUSIONS TMJ arthrocentesis and intra-articular injection of a mixture of hyaluronic acid and corticosteroid have been found to be effective for treatment of TMJ internal derangement with reduction. Nevertheless, the simplicity of intra articular injection makes it the treatment of choice.
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Affiliation(s)
- H A M Marzook
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.
| | - A A Abdel Razek
- Diagnostic Radiology & Medical Imaging, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - E A Yousef
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - A A M M Attia
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
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16
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Is Repeated Arthrocentesis Beneficial in the Treatment of Temporomandibular Disorders: A Retrospective Study. J Oral Maxillofac Surg 2019; 77:1359-1364. [PMID: 30825439 DOI: 10.1016/j.joms.2019.01.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/20/2019] [Accepted: 01/24/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE Arthrocentesis is an effective, simple, and minimally invasive treatment in patients with temporomandibular joint (TMJ) closed lock (CL). The aim of this study was to compare the effectiveness of 1- versus 2-session arthrocentesis procedures in the management of TMJ CL. MATERIALS AND METHODS A retrospective cohort study was conducted using the files of patients with TMJ CL according to diagnostic criteria for temporomandibular disorders. Patients who underwent 1- or 2-session arthrocentesis were included in the study. The decision of whether to undergo 1- or 2-session arthrocentesis was made by the patients: Those who accepted a second arthrocentesis procedure were assigned to group 1 (repeated arthrocentesis group), and those who did not accept, to group 2 (arthrocentesis group). The primary predictor variable was treatment method. TMJ pain (scored on a visual analog scale) and maximum mouth opening (MMO) were selected as the outcome variables. To evaluate the clinical outcomes of 1- or 2-session arthrocentesis, MMO and pain score (on a visual analog scale) before treatment and at 1, 3, and 6 months' follow-up were analyzed. Descriptive, comparative, correlation, and multivariate analyses were conducted. RESULTS A total of 30 patients (25 female and 5 male patients) with TMJ disc displacement without reduction were enrolled in the study. Each group consisted of 15 patients. Statistically significant decreases in pain scores and increases in MMO values were observed in both treatment groups at 3 and 6 months (P < .05). At 6 months, MMO values were significantly higher and pain levels were significantly lower in patients who received 2 arthrocentesis procedures. CONCLUSIONS Repeated arthrocentesis is more successful at reducing pain and improving MMO than a single intervention in the treatment of TMJ CL.
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Middendorf J, Albahrani S, Bonassar LJ. Stribeck Curve Analysis of Temporomandibular Joint Condylar Cartilage and Disc. J Biomech Eng 2019; 141:1066041. [PMID: 31654071 DOI: 10.1115/1.4045283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Indexed: 12/29/2022]
Abstract
Temporomandibular joint (TMJ) diseases such as osteoarthritis and disc displacement have no permanent treatment options, but lubrication therapies, used in other joints, could be an effective alternative. However, the healthy TMJ contains fibrocartilage, not hyaline cartilage as is found in other joints. As such, the effect of lubrication therapies in the TMJ is unknown. Additionally, only a few studies have characterized the friction coefficient of the healthy TMJ. Like other cartilaginous tissues, the TMJ condyles and discs are subject to changes in friction coefficient due to fluid pressurization. In addition, the friction coefficient of the TMJ is affected by the sliding direction and anatomic location. However, these previous findings have not been able to identify how all 3 of these parameters (anatomic location, sliding direction, and fluid pressurization) influence changes in friction coefficient. This study used Stribeck curves to identify differences in the friction coefficients of TMJ condyles and discs based on anatomic location, sliding direction, and amount of fluid pressurization (friction mode). Friction coefficients were measured using a cartilage on glass tribometer. Both TMJ condyle and disc friction coefficients were well described by Stribeck curves. These curves changed based on anatomic location, but very few differences in friction coefficients were observed based on sliding direction. TMJ condyles had similar boundary mode and elastoviscous mode friction coefficients to the TMJ disc, and both were lower than hyaline cartilage in other joints. The observed differences here indicate that the surface characteristics of each anatomic region cause differences in friction coefficients.
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Affiliation(s)
- Jill Middendorf
- Sibley School of Mechanical and Aerospace Engineering Cornell University, Ithaca, NY
| | - Shaden Albahrani
- Department of Chemical Engineering, Virginia Polytechnic Institute and University, Blacksburg, VA
| | - Lawrence J Bonassar
- Sibley School of Mechanical and Aerospace Engineering Cornell University, Ithaca, NY; Meinig School of Biomedical Engineering Cornell University, Ithaca, NY
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Bergstrand S, Ingstad HK, Møystad A, Bjørnland T. Long-term effectiveness of arthrocentesis with and without hyaluronic acid injection for treatment of temporomandibular joint osteoarthritis. J Oral Sci 2019; 61:82-88. [PMID: 30814387 DOI: 10.2334/josnusd.17-0423] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This study evaluated the long-term effectiveness of intra-articular temporomandibular joint arthrocentesis for patients with osteoarthritis and compared arthrocentesis/lavage alone with arthrocentesis/lavage and injected hyaluronic acid. Forty patients met the inclusion criteria, and 37 completed long-term follow-up (approximately 4 years). The patients were randomly allocated to two groups: arthrocentesis with lavage alone (A-group, n = 17) or combined with hyaluronic acid treatment (AS-group, n = 20). Standard two-needle arthrocentesis was performed. Pain and joint sounds were measured at baseline and approximately 4 years after treatment. Reported pain, as indicated by visual analogue scale (VAS) score, significantly decreased from baseline to the final follow-up examination in both groups. Mean VAS score decreased from 64 to 16 (P < 0.001) in the A-group and from 63 to 25 (P < 0.001) in the AS-group. Average maximum incisor opening increased significantly in both groups but did not significantly differ between groups (P = 0.223). Joint sounds did not significantly improve within groups (A-group, P = 0.495; AS-group, P = 0.236). Both methods resulted in significant long-term improvements in pain and jaw function.
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Affiliation(s)
- Sara Bergstrand
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo
| | - Hanne K Ingstad
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo
| | - Anne Møystad
- Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo
| | - Tore Bjørnland
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo
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Yapici-Yavuz G, Şimşek-Kaya G, Oğul H. A comparison of the effects of Methylprednisolone Acetate, Sodium Hyaluronate and Tenoxicam in the treatment of non-reducing disc displacement of the temporomandibular joint. Med Oral Patol Oral Cir Bucal 2018; 23:e351-e358. [PMID: 29680845 PMCID: PMC5945235 DOI: 10.4317/medoral.22237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 02/18/2018] [Indexed: 12/03/2022] Open
Abstract
Background This clinical study aimed to radiologically and clinically compare the effect of intra-articular injection of methylprednisolone, sodium hyaluronate or tenoxicam following arthrocentesis with that of arthrocentesis alone in patients with non-reducing disc displacement. Material and Methods A total of 44 patients radiographically diagnosed with non-reducing disc displacement of the temporomandibular joint (TMJ) were randomly divided into four treatment groups, as follows: Group 1, arthrocentesis alone; Group 2, arthrocentesis plus methylprednisolone acetate; Group 3, arthrocentesis plus sodium hyaluronate; Group 4, arthrocentesis plus tenoxicam. Maximum mouth opening (MMO), lateral movement, pain severity and tenderness of TMJ and muscles of mastication on palpation were measured before treatment and at 1 week and 1, 3 and 6 months after treatment. Disc position, presence or absence of disc reduction, level of effusion, joint movement and joint space were also evaluated using magnetic resonance imaging (MRI) before treatment and 6 months after treatment. Results No significant differences in treatment success were found among the four groups. MRI findings did not vary significantly among the groups, but pre- and post-operative MRI findings varied significantly within all four groups (p<0.001). Conclusions According to the data from this study, it may be concluded that either arthrocentesis alone or arthrocentesis with methylprednisolone acetate or sodium hyaluronate or tenoxicam intra-articular injections are similarly effective and promising methods in the treatment of TMJ with non-reducing disc displacement. Key words:Non-reduction disc displacement, arthrocentesis, methylprednisolone, sodium hyaluronate, tenoxicam.
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Affiliation(s)
- G Yapici-Yavuz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey,
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20
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Kumar S, Kiran K, Yadav A. Temporomandibular Joint Arthrocentesis: A Prospective Study and Audit of 500 Joints of Central India. J Int Soc Prev Community Dent 2018; 8:124-129. [PMID: 29780737 PMCID: PMC5946520 DOI: 10.4103/jispcd.jispcd_361_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/23/2018] [Indexed: 11/21/2022] Open
Abstract
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.
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Affiliation(s)
- Shailesh Kumar
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kamini Kiran
- Department of Oral and Maxillofacial Pathology and Microbiology, Seema Dental College, Rishikesh, Uttarakhand, India
| | - Anurag Yadav
- Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow, Utter Pradesh, India
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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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Are intra-articular injections of hyaluronic acid effective for the treatment of temporomandibular disorders? A systematic review. Int J Oral Maxillofac Surg 2016; 45:1531-1537. [DOI: 10.1016/j.ijom.2016.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/14/2016] [Accepted: 06/06/2016] [Indexed: 11/19/2022]
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Clinical assessment of intra-articular fentanyl injection following arthrocentesis for management of temporomandibular joint internal derangement. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.fdj.2016.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Guarda-Nardini L, Cadorin C, Frizziero A, Masiero S, Manfredini D. Interrelationship between temporomandibular joint osteoarthritis (OA) and cervical spine pain: Effects of intra-articular injection with hyaluronic acid. Cranio 2016; 35:276-282. [PMID: 27638344 DOI: 10.1080/08869634.2016.1232788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate cervical spine pain and function after five sessions of viscosupplementation with hyaluronic acid (HA) in patients with temporomandibular joint (TMJ) osteoarthritis. METHODS Forty-nine patients, (79% females, aged between 43-81 years), affected by TMJ osteoarthritis and concurrent cervical spine pain and limited function were recruited. All patients underwent a cycle of five weekly arthrocenteses and viscosupplementation with 1 ml of medium molecular weight HA according to the single-needle arthrocentesis technique. Outcome variables were TMJ pain (VAS), cervical active ranges of motion, cervical disability (NPDS), and presence of painful palpation sites. Assessments were carried out at baseline and at one, three and six months after the end of treatment protocol. RESULTS A significant reduction over time was shown both in TMJ pain levels and in NPDS values with respect to baseline (p < 0.001). Most parameters of active cervical range of motion showed an improvement with time. Benefits remained stable throughout six months after the viscosupplementation protocol. CONCLUSIONS A protocol of TMJ intra articular arthrocentesis and viscosupplementation improved cervical function and reduced disability in patients with concurrent cervical spine pain. These findings add to the complex amount of literature on the relationship between temporomandibular disorders and cervical spine disorders.
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Affiliation(s)
- Luca Guarda-Nardini
- a TMD Clinic, Department of Neuroscience , University of Padua , Padova , Italy.,b Section of Dentistry and Maxillofacial Surgery , Hospital of Treviso , Treviso , Italy
| | - Cristina Cadorin
- c Department of Physical and Rehabilitation Medicine , University of Padua , Padova , Italy
| | - Antonio Frizziero
- c Department of Physical and Rehabilitation Medicine , University of Padua , Padova , Italy
| | - Stefano Masiero
- c Department of Physical and Rehabilitation Medicine , University of Padua , Padova , Italy
| | - Daniele Manfredini
- a TMD Clinic, Department of Neuroscience , University of Padua , Padova , Italy.,d School of Dentistry , University of Padova , Padova , Italy
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Gorrela H, Prameela J, Srinivas G, Reddy BVB, Sudhir M, Arakeri G. Efficacy of Temporomandibular Joint Arthrocentesis with Sodium Hyaluronate in the Management of Temporomandibular Joint Disorders: A Prospective Randomized Control Trial. J Maxillofac Oral Surg 2016; 16:479-484. [PMID: 29038631 DOI: 10.1007/s12663-016-0955-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 08/31/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study was designed to investigate the efficacy of the temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate (SH) in the treatment of temporomandibular joint disorders. PATIENTS AND METHODS A total of sixty two TMJs in 34 males and 28 females aged 20-65 years comprised the study material. The patients' complaints were limited mouth opening, TMJ pain, and joint noises during function. Patients were randomly divided into 2 groups in which arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in 1 group and only arthrocentesis was performed in the other group. Both groups contained patients with disc displacement with reduction and without reduction. Clinical evaluation of the patients was done before the procedure, immediately after the procedure, at 1 week and 1, 3 and 6 months postoperatively. Intensity of TMJ pain was assessed using visual analog scales. Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit. RESULTS Both techniques increased maximal mouth opening, lateral movements, and function, while reducing TMJ pain and noise. CONCLUSIONS Although patients benefitted from both techniques, arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone.
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Affiliation(s)
- Harsha Gorrela
- MNR Dental College and Hospital, Sangareddy, Telangana India
| | - J Prameela
- MNR Dental College and Hospital, Sangareddy, Telangana India
| | - G Srinivas
- MNR Dental College and Hospital, Sangareddy, Telangana India
| | | | - Mvs Sudhir
- MNR Dental College and Hospital, Sangareddy, Telangana India
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Marty P, Louvrier A, Weber E, Dubreuil PA, Chatelain B, Meyer C. [Arthrocentesis of the temporomandibular joint and intra-articular injections : An update]. ACTA ACUST UNITED AC 2016; 117:266-72. [PMID: 27554488 DOI: 10.1016/j.revsto.2016.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Arthocentesis of the temporomandibular joint combined with intra-articular washout and, more recently, intra-articular injection of pharmacological agents has been developed from the 1990s and is nowadays extensively in use for the treatment of temporomandibular dysfunctions (TMDs). The goal of our work was to answer 3 questions: 1. Is intra-articular washout effective for the treatment of TMDs ? 2. What kind of pharmacological agents may nowadays be injected in addition to washout and are these injections useful ? 3. What is the place of these treatments in the treatment strategies of TMDs ? MATERIAL AND METHODS A bibliographic research has been carried out in the PubMed database using following keywords arthrocentesis, temporomandibular joint. The 27 articles published between 1991 and 2016, indicating patient's inclusion criterions and objectively evaluating the clinical results (mouth opening, intra-articular noises, pain) were selected. Pharmacological agents were noticed when used. RESULTS 1. All authors concluded to the efficacy of intra-articular washout. No prognostic factor for arthrocentesis efficacy could be identified. 2. Main pharmacological agents used were steroids, hyaluronic acid, morphine-based drugs and platelet rich plasma. Superiority of ith-injection protocols failed to win unanimous support. All authors who compared with- and without-injection protocols concluded to the superiority of with-injection protocols, whatever the agent. DISCUSSION Numerous studies have proven the efficacy of intra-articular washout for the treatment of TMDs resistant to noninvasive treatments. The advantage of any kind of pharmacological agent is not clear. Mechanisms of action are not all elucidated. No pharmacological agent showed any superiority over another. Study methodologies are often defective: imprecise inclusion criterions, short follow-up, confounding variables not taken into account, few comparison between pharmacological agents.
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Affiliation(s)
- P Marty
- Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France.
| | - A Louvrier
- Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - E Weber
- Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - P-A Dubreuil
- Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - B Chatelain
- Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - C Meyer
- Service de chirurgie maxillo-faciale, de stomatologie et d'odontologie hospitalière, CHU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; Nanomedicine Lab, Imagery and Therapeutics-UFR SMP, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
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Bouloux GF, Chou J, Krishnan D, Aghaloo T, Kahenasa N, Smith JA, Giannakopoulos H. Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short-Term Reduction of Temporomandibular Joint Pain After Arthrocentesis? Part 1. J Oral Maxillofac Surg 2016; 75:52-62. [PMID: 27632069 DOI: 10.1016/j.joms.2016.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 07/27/2016] [Accepted: 08/06/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE Arthrocentesis has been used for the management of patients with temporomandibular joint (TMJ) pain, with good success. The additional use of hyaluronic acid (HA) or corticosteroid (CS) remains controversial. The purpose of this study was to compare HA, CS, and lactated Ringer solution (LR; placebo) after arthrocentesis. 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 the instillation of HA, CS, or LR. Patients were evaluated clinically at 1 and 3 months. The primary outcome variable was pain at 1 month (by visual analog scale). Secondary outcome variables were pain at 3 months and analgesic consumption. 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 the final analysis. The mean age of patients in the HA, CS, and LR groups was 39.6, 44.3, and 51.8 years, respectively (P = .02). There was no difference among groups in time to follow-up at 1 month (P = .11). The mean decrease in pain in the CS group was 19% for right-side procedures (P = .12) and 36% for left-side procedures (P = .02). The mean decrease in pain in the HA group was 31% for right-side procedures (P = .01) and 34% for left-side procedures (P = .01). The mean decrease in pain in the LR group was 43% for right-side procedures (P < .01) and 37% for left-side procedures (P < .01). There was no difference in pain decrease among groups (P = .55). There was no difference in the use of narcotic (P = .52) or nonsteroidal anti-inflammatory drugs (P = .71) among groups. CONCLUSION Arthrocentesis alone is as efficacious as arthrocentesis with HA or CS in decreasing TMJ pain.
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Affiliation(s)
- Gary F Bouloux
- Associate Professor, Department of Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Jolie Chou
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University Buffalo New York, Buffalo, NY; formerly, University of Pennsylvania, Philadelphia, PA
| | - Deepak Krishnan
- Associate Professor, Department of Oral and Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH
| | - Tara Aghaloo
- Professor, Department of Oral and Maxillofacial Surgery, University of California-Los Angeles, Los Angeles, CA
| | - Nora Kahenasa
- Clinical Assistant Professor, Department of Oral and Maxillofacial Surgery, University of California-Los Angeles, Los Angeles, CA
| | - Julie Ann Smith
- Associate Professor, Department of Oral and Maxillofacial Surgery, Oregon Health and Science University, Portland, OR
| | - Helen Giannakopoulos
- Associate Professor, Department of Oral and Maxillofacial Surgery, University of Pennsylvania, Philadelphia, PA
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Cömert Kiliç S, Güngörmüş M. Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis plus hyaluronic acid for the treatment of temporomandibular joint osteoarthritis: a randomized clinical trial. Int J Oral Maxillofac Surg 2016; 45:1538-1544. [PMID: 27364372 DOI: 10.1016/j.ijom.2016.06.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/23/2016] [Accepted: 06/13/2016] [Indexed: 01/26/2023]
Abstract
A randomized clinical trial was implemented in adult patients with temporomandibular joint osteoarthritis (TMJ OA). The sample comprised 49 osteoarthritic joints in 31 consecutive patients. Patients were divided randomly into two groups according to the treatment technique applied: the platelet-rich plasma (PRP) group patients underwent initial arthrocentesis plus PRP injection and then four consecutive PRP injections; the hyaluronic acid (HA) group patients underwent one session of arthrocentesis plus HA injection. The predictor variable was the treatment technique. The outcome variables included visual analogue scale (VAS) evaluations and maximum inter-incisal opening (MIO) measurements. Outcome variables were recorded preoperatively and at 12 months postoperative. Descriptive and bivariate statistics were computed and significance was set at P<0.05. The PRP group included 32 joints in 18 subjects, and the HA group included 17 joints in 13 subjects. No statistically significant difference was observed between the groups for any of the changes in VAS parameters or MIO measurements. Both treatment techniques resulted in significant clinical improvements in all VAS parameters and painless MIO. These findings suggest that arthrocentesis plus PRP injections is not superior to arthrocentesis plus a single HA injection; thus PRP injection should not be considered as the first line treatment. Arthrocentesis plus HA injection would appear to be more acceptable for patients.
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Affiliation(s)
- S Cömert Kiliç
- Ministry of Health, Department of Oral and Maxillofacial Surgery, Centre for Oral and Dental Health, Erzurum, Turkey.
| | - M Güngörmüş
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
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Long-Term Outcome of Arthrocentesis Plus Hyaluronic Acid Injection in Patients With Wilkes Stage II and III Temporomandibular Joint Internal Derangement. J Craniofac Surg 2016; 26:2104-8. [PMID: 26468791 DOI: 10.1097/scs.0000000000002078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Arthrocentesis is a minimally invasive procedure used to manage temporomandibular joint (TMJ) internal derangement (ID). This study evaluated the outcome of arthrocentesis in patients with Wilkes stage II and III TMJ ID. PATIENTS AND METHODS This retrospective study enrolled 50 patients who underwent arthrocentesis in 2011 and 2012 at the Karadeniz Technical University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Turkey. In total, 43 patients underwent unilateral arthrocentesis, whereas 7 patients had bilateral arthrocentesis. The clinical parameters recorded were pain (visual analogue scale [VAS] 0-100 mm during movement), chewing function efficacy (VAS 0-100), clicking sounds, and mandibular movements, including maximum interincisal opening (MIO), lateral excursion, and protrusion. All the parameters were recorded preoperatively, and 1, 3, 6, and 24 months after treatment. RESULTS The MIO, lateral excursion, and protrusion were significantly greater than preoperatively in all the patients. Pain declined significantly postoperatively. The patients in Wilkes III group had greater improvement in mandibular movement and pain than the patients in Wilkes II group. CONCLUSION Arthrocentesis was reliable for treating both Wilkes II and III TMJ ID, and the treatment results were better in Wilkes III patients.
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Migliore A, Bizzi E, De Lucia O, Delle Sedie A, Tropea S, Bentivegna M, Mahmoud A, Foti C. Differences Regarding Branded HA in Italy, Part 2: Data from Clinical Studies on Knee, Hip, Shoulder, Ankle, Temporomandibular Joint, Vertebral Facets, and Carpometacarpal Joint. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2016; 9:117-31. [PMID: 27279754 PMCID: PMC4898442 DOI: 10.4137/cmamd.s39143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/06/2016] [Accepted: 04/13/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The aim of the current study is to collect scientific data on all branded hyaluronic acid (HA) products in Italy that are in use for intra-articular (IA) injection in osteoarthritis (OA) compared with that reported in the leaflet. METHODS An extensive literature research was performed for all articles reporting data on the IA use of HA in OA. Selected studies were taken into consideration only if they are related to products based on HAs that are currently marketed in Italy with the specific joint indication for IA use in patients affected by OA. RESULTS Sixty-two HA products are marketed in Italy: 30 products are indicated for the knee but only 8 were proved with some efficacy; 9 products were effective for the hip but only 6 had hip indication; 7 products proved to be effective for the shoulder but only 3 had the indication; 5 products proved effective for the ankle but only one had the indication; 6 products were effective for the temporomandibular joint but only 2 had the indication; only 2 proved effective for vertebral facet joints but only 1 had the indication; and 5 products proved effective for the carpometacarpal joint but only 2 had the indication. CONCLUSIONS There are only a few products with some evidences, while the majority of products remain without proof. Clinicians and regulators should request postmarketing studies from pharmaceuticals to corroborate with that reported in the leaflet and to gather more data, allowing the clinicians to choose the adequate product for the patient.
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Affiliation(s)
- A Migliore
- Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - E Bizzi
- Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - O De Lucia
- Division and Chair of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | | | - S Tropea
- Rete Reumatologica, ASP 7 RG, Ragusa, Italy
| | - M Bentivegna
- Rete Reumatologica Coordinator, ASP 7 RG, Ragusa, Italy
| | - A Mahmoud
- Physical Medicine, Rheumatology and Rehabilitation Department, Ain Shams University, Cairo, Egypt.; Physical and Rehabilitation Medicine, Tor Vergata University, Rome, Italy
| | - C Foti
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
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Abstract
TMDs are a group of conditions affecting the joint and or the muscles of mastication.TMDs consist of three main groups of conditions: myofascial pain; disc disorders; TMJ arthritides.The gold standard diagnostic criteria for research involving TMDs are the Research Diagnostic Criteria for TMDs (RDC/TMD). A pragmatic clinically applicable alternative is the Clinical examination protocol for TMDs (CEP-TMD).Signs and symptoms can include: pain in masticatory musculature and or the joint; noises associated with joint movements; locking; headache; otalgia.TMDs' aetiology is multifactorial and biopsychosocial in nature.Reversible conservative management as defined by the American Association of Dental Research is the initial management of choice for all subgroups of TMDs.
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Affiliation(s)
- J Durham
- NIHR Academic Clinical Lecturer in Oral Surgery
| | - R W Wassell
- Senior Lecturer/Hon Consultant in Restorative Dentistry School of Dental Sciences, Newcastle University. United Kingdom
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Platelet-Rich Plasma Injection as an Effective Treatment for Temporomandibular Joint Osteoarthritis. J Oral Maxillofac Surg 2015; 73:1706-13. [DOI: 10.1016/j.joms.2015.03.045] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/14/2015] [Accepted: 03/14/2015] [Indexed: 11/21/2022]
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Efficacy of hyaluronic acid injections in patients with osteoarthritis of the temporomandibular joint. A comparative study. J Craniofac Surg 2015; 24:2006-9. [PMID: 24220392 DOI: 10.1097/scs.0b013e3182a30566] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the present study was to report the 1-year therapeutic outcome of intra-articular injections of high-molecular-weight hyaluronic acid (HA) without arthrocentesis in a group of 25 patients with osteoarthritis (OA) of the temporomandibular joint (TMJ). The results were compared with those of a group of 10 patients with OA of the TMJ, treated with nonsteroidal anti-inflammatory drugs.Twenty-five patients (group A) underwent a cycle of 5 injections of HA into the TMJ. Ten patients (group B) underwent a therapy with nonsteroidal anti-inflammatory drugs for 1 month. The follow-up assessments after the end of treatment were at 1, 3, 6, and 12 months.Regarding the first follow-up (1 month), statistical analysis for all clinical parameters showed no significant differences (ie, beneficial effect for 2 groups) between groups A and B (P > 0.001). Significant statistical differences (ie, encouraging effect for group A) for all clinical parameters were recorded 1 year after the end of treatment between groups A and B (P < 0.001).A cycle of 5 intra-articular injections of HA without arthrocentesis for patients with OA of the TMJ is considered successful at 1-year follow-up period.
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Guarda-Nardini L, Rossi A, Arboretti R, Bonnini S, Stellini E, Manfredini D. Single- or multiple-session viscosupplementation protocols for temporomandibular joint degenerative disorders: a randomized clinical trial. J Oral Rehabil 2015; 42:521-8. [DOI: 10.1111/joor.12282] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2015] [Indexed: 11/28/2022]
Affiliation(s)
- L. Guarda-Nardini
- Department of Maxillofacial Surgery; Temporomandibular Disorders Clinic; University of Padova; Padova Italy
| | - A. Rossi
- Department of Maxillofacial Surgery; Temporomandibular Disorders Clinic; University of Padova; Padova Italy
| | - R. Arboretti
- Department of Land Use and AgriForestal Systems; University of Padova; Padova Italy
| | - S. Bonnini
- Department of Economics and Management; University of Ferrara; Ferrara Italy
| | - E. Stellini
- School of Dentistry; University of Padova; Padova Italy
| | - D. Manfredini
- Department of Maxillofacial Surgery; Temporomandibular Disorders Clinic; University of Padova; Padova Italy
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Guarda-Nardini L, Rossi A, Ramonda R, Punzi L, Ferronato G, Manfredini D. Effectiveness of treatment with viscosupplementation in temporomandibular joints with or without effusion. Int J Oral Maxillofac Surg 2014; 43:1218-23. [DOI: 10.1016/j.ijom.2014.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/01/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022]
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Li C, Long X, Deng M, Li J, Cai H, Meng Q. 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. J Oral Maxillofac Surg 2014; 73:232-44. [PMID: 25579006 DOI: 10.1016/j.joms.2014.08.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 08/21/2014] [Accepted: 08/25/2014] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Cheng Li
- Resident, Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Xing Long
- Professor, Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China.
| | - Mohong Deng
- Professor, Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Jian Li
- Associate Professor, Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Hengxing Cai
- Associate Professor, Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
| | - Qinggong Meng
- Associate Professor, Department of Oral and Maxillofacial Surgery, The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China
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Su N, Yang X, Liu Y, Huang Y, Shi Z. Evaluation of arthrocentesis with hyaluronic acid injection plus oral glucosamine hydrochloride for temporomandibular joint osteoarthritis in oral-health-related quality of life. J Craniomaxillofac Surg 2014; 42:846-51. [DOI: 10.1016/j.jcms.2013.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 09/24/2013] [Accepted: 12/17/2013] [Indexed: 01/25/2023] Open
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Cooper BC, Adib F. An assessment of the usefulness of Kinesiograph as an aid in the diagnosis of TMD: a review of Manfredini et al.'s studies. Cranio 2014; 33:46-66. [PMID: 25115950 DOI: 10.1179/2151090314y.0000000010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
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.
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Guarda-Nardini L, Manfredini D, Olivo M, Ferronato G. Long-Term Symptoms Onset and Heterotopic Bone Formation around a Total Temporomandibular Joint Prosthesis: a Case Report. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2014; 5:e6. [PMID: 24800055 PMCID: PMC4007372 DOI: 10.5037/jomr.2014.5106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 03/28/2014] [Indexed: 11/16/2022]
Abstract
Background The literature on total alloplastic
temporomandibular joint (TMJ) reconstructions is encouraging, and
studies on total alloplastic TMJ replacements outcomes showed acceptable
improvements in terms of both pain levels and jaw function.
Nevertheless, some adverse events, such as heterotopic bone formation
around the implanted prosthesis, may occur. In consideration of that,
the present manuscript describes a case of heterotopic bone formation
around a total temporomandibular joint prosthesis, which occurred
several years after the implant. Methods The present manuscript describes a case of
heterotopic bone formation around a total TMJ prosthesis, which occurred
several years after the implant in patients, who previously underwent
multiple failed TMJ surgeries. Results Ten years after the surgical TMJ replacement to solve
an ankylotic bone block, the patient came to our attention again
referring a progressive limitation in mouth opening. A computerized
tomography showed evidence of marked heterotopic bone formation in the
medial aspects of the joint, where a new-born ankylotic block occupied
most part of the gap created by resecting the coronoid process at the
time of the TMJ prosthesis insertion. Conclusions Despite
this adverse event has been sometimes described in the literature, this is the
first case in which its occurrence happened several years after the
temporomandibular joint replacement. It can be suggested that an accurate
assessment of pre-operative risk factors for re-ankylosis (e.g., patients with
multiple failed temporomandibular joint surgeries) and within-intervention
prevention (e.g., strategies to keep the bone interfaces around the implant
separated) should be better standardized and define in future studies.
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Affiliation(s)
| | | | - Marco Olivo
- Department of Maxillofacial Surgery, University of Padova Italy
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Manfredini D, Piccotti F, Guarda-Nardini L. Hyaluronic Acid In the Treatment of TMJ Disorders: A Systematic Review of the Literature. Cranio 2014; 28:166-76. [DOI: 10.1179/crn.2010.023] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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PERCEIVING PAIN. J Am Dent Assoc 2013; 144:982, 984. [DOI: 10.14219/jada.archive.2013.0222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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MONITORING TM DISORDERS. J Am Dent Assoc 2013; 144:979-80. [DOI: 10.14219/jada.archive.2013.0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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An assessment of the usefulness of jaw kinesiography in monitoring temporomandibular disorders. J Am Dent Assoc 2013; 144:397-405. [DOI: 10.14219/jada.archive.2013.0133] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Manfredini D, Favero L, Del Giudice A, Masiero S, Stellini E, Guarda-Nardini L. Axis II psychosocial findings predict effectiveness of TMJ hyaluronic acid injections. Int J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.ijom.2012.10.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tuncel U. Repeated sodium hyaluronate injections following multiple arthrocenteses in the treatment of early stage reducing disc displacement of the temporomandibular joint: A preliminary report. J Craniomaxillofac Surg 2012; 40:685-9. [DOI: 10.1016/j.jcms.2011.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 12/19/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022] Open
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Treatment Effectiveness of Arthrocentesis Plus Hyaluronic Acid Injections in Different Age Groups of Patients With Temporomandibular Joint Osteoarthritis. J Oral Maxillofac Surg 2012; 70:2048-56. [DOI: 10.1016/j.joms.2012.05.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/07/2012] [Accepted: 05/14/2012] [Indexed: 11/30/2022]
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Guarda-Nardini L, Cadorin C, Frizziero A, Ferronato G, Manfredini D. Comparison of 2 hyaluronic acid drugs for the treatment of temporomandibular joint osteoarthritis. J Oral Maxillofac Surg 2012; 70:2522-30. [PMID: 22939642 DOI: 10.1016/j.joms.2012.07.020] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 07/08/2012] [Accepted: 07/09/2012] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the effectiveness of 2 treatment protocols providing 5 weekly temporomandibular joint (TMJ) arthrocenteses immediately followed by injections of 2 different molecular weight hyaluronic acid (HA) drugs to manage symptoms in patients with inflammatory-degenerative TMJ disease. MATERIALS AND METHODS Patients with a Research Diagnostic Criteria for Temporomandibular Disorders diagnosis of osteoarthritis were randomly assigned to 1 of 2 study groups receiving either low- or medium-molecular weight HA after arthrocentesis. The level of maximum pain at chewing was the primary outcome variable, and maximum pain at rest, subjective chewing efficiency, functional limitation, treatment tolerability, perceived treatment effectiveness, and jaw range-of-motion function in millimeters were the secondary outcomes. All variables were assessed and compared between groups at baseline, at the end of treatment, and 3 months later. RESULTS Forty subjects entered the study. At the end of the follow-up period, all the outcome variables improved in both groups of patients. A between-group comparison of changes over time showed that differences were not significant for any of the outcome variables, that is, pain at chewing (F = 0.056, P = .815), pain at rest (F = 0.383, P = .541), chewing efficiency (F = 0.050, P = .825), functional limitation (F = 0.268, P = .609), and mouth opening (F = 0.003, P = .954). In addition, no between-group differences were shown for perceived treatment effectiveness and treatment tolerability. CONCLUSIONS Similar positive effectiveness was shown for 2 treatment protocols for TMJ osteoarthritis (ie, 5-session single-needle arthrocentesis plus low- or medium-molecular weight HA).
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Affiliation(s)
- Luca Guarda-Nardini
- TMD Clinic, Department of Maxillofacial Surgery, University of Padova, Padua, Italy
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Monje-Gil F, Nitzan D, González-Garcia R. Temporomandibular joint arthrocentesis. Review of the literature. Med Oral Patol Oral Cir Bucal 2012; 17:e575-81. [PMID: 22322493 PMCID: PMC3476018 DOI: 10.4317/medoral.17670] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 06/26/2011] [Indexed: 11/05/2022] Open
Abstract
The treatment of the temporomandibular joint (TMJ) is still controversial. TMJ arthrocentesis represents a form of minimally invasive surgical treatment in patients suffering from internal derangement of the TMJ, especially closed lock. It consists of washing the joint with the possibility of depositing a drug or other therapeutic substance. Resolution of symptoms is due to the removal of chemical inflammatory mediators and changes in intra-articular pressure. Numerous clinical studies regarding this technique have been published. The goal of this paper is to review all clinical articles that have been published with regard to the critique of this technique. 19 articles with different designs fulfilling selection guidelines were chosen. A series of clinical and procedure variables were analyzed. Although the mean of improvement was higher that 80%, further research is needed to determine more homogeneous indications for TMJ athrocentesis.
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Affiliation(s)
- Florencio Monje-Gil
- Department of Oral and Maxillofacial Surgery, University Hospital Infanta Cristina, Private practice, Spain.
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Guarda-Nardini L, Ferronato G, Manfredini D. Two-needle vs. single-needle technique for TMJ arthrocentesis plus hyaluronic acid injections: a comparative trial over a six-month follow up. Int J Oral Maxillofac Surg 2012; 41:506-13. [DOI: 10.1016/j.ijom.2011.11.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 11/08/2011] [Indexed: 10/14/2022]
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