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Taşkesen F, Cezairli B. Comparing anxiety levels and patient comfort during single- and double-puncture arthrocentesis. Cranio 2024; 42:372-378. [PMID: 34719355 DOI: 10.1080/08869634.2021.1992211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare the comfort and anxiety levels of patients undergoing two different temporomandibular joint (TMJ) arthrocentesis techniques. METHODS Fifty female patients were randomly assigned into two groups of 25 based on the treatment modality: Group 1, single-puncture Type-1 arthrocentesis (SPA); Group 2, conventional double-puncture arthrocentesis (DPA). Preoperative and postoperative anxiety was scored with the State-Trait Anxiety Inventory-S (STAI-S) questionnaire. Blood pressure and heart rate were assessed preoperatively during the application of local anesthesia and at needle insertion into the joint cavity, the 5th and 10th minute of the procedure, and end of the procedure. RESULTS STAI-S scores were lower postoperative than preoperative in both groups. Heart rate and mean arterial pressure were highest during anesthesia and needle insertion (p < 0.005). Changes in heart rate, mean arterial pressure, and STAI-S scores were statistically similar between the groups. CONCLUSION DPA and SPA were tolerated similarly by the patients.
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Affiliation(s)
- Fatih Taşkesen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erzincan Binali Yildirim University, Erzincan, TURKEY
| | - Burak Cezairli
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ordu University, Ordu, TURKEY
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Ferreira NR, Marto CM, de Sousa BM, Loureiro M, Oliveira AT, DosSantos MF, Rodrigues MJ. Synthesis of temporomandibular disorders management intervention outcomes for development of core outcome sets: A systematic review. J Oral Rehabil 2024; 51:1303-1319. [PMID: 38572886 DOI: 10.1111/joor.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 02/12/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION The selection of appropriate outcomes in clinical trials and systematic reviews is a crucial factor in determining the results that are useful, reliable, and relevant for both patients and healthcare professionals. Clinicians and researchers have been encouraged to develop and apply core outcome sets (COS) to minimise the discrepancy between studies. AIM This systematic review is the first phase of the COS development project for clinical trials in temporomandibular disorders (COS-TMD). It aims to identify and synthesise the outcomes used in the randomised controlled trials (RCT) that evaluated the effectiveness of interventions used in TMD management. MATERIALS AND METHODS An electronic search was performed in several databases: MEDLINE (via PubMed), Scopus, Web of Science, Cochrane Library and EMBASE. The eligibility criteria comprised RCT that applied any intervention to treat temporomandibular joint disorders or masticatory muscle disorders. The identified outcomes were categorised according to domains of the Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT). RESULTS The electronic search resulted in 1606 studies. After removing duplicates and applying the eligibility criteria, 106 RCT were included. A total of 43 studies evaluated masticatory muscle disorders, 27 evaluated temporomandibular joint disorders, and 36 analysed mixed TMD. CONCLUSIONS The evaluation showed significant variability in the types of outcomes and their measurement instruments. In addition, some domains such as physical and emotional functioning, participant ratings of global improvement and adverse events have been neglected when determining the effectiveness of treatments for TMD.
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Affiliation(s)
- N R Ferreira
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
| | - C M Marto
- Faculty of Medicine, Institute of Experimental Pathology, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra, CACC, Coimbra, Portugal
| | - B M de Sousa
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
| | - M Loureiro
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
| | - A T Oliveira
- Postgraduate Program in Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - M F DosSantos
- Postgraduate Program in Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Laboratory of Mechanical Properties and Cell Biology (PropBio) School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - M J Rodrigues
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
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Zieliński G, Gawda P. Analysis of the Use of Sample Size and Effect Size Calculations in a Temporomandibular Disorders Randomised Controlled Trial-Short Narrative Review. J Pers Med 2024; 14:655. [PMID: 38929876 PMCID: PMC11204826 DOI: 10.3390/jpm14060655] [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: 05/17/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Temporomandibular disorder (TMD) is the term used to describe a pathology (dysfunction and pain) in the masticatory muscles and temporomandibular joint (TMJ). There is an apparent upward trend in the publication of dental research and a need to continually improve the quality of research. Therefore, this study was conducted to analyse the use of sample size and effect size calculations in a TMD randomised controlled trial. METHODS The period was restricted to the full 5 years, i.e., papers published in 2019, 2020, 2021, 2022, and 2023. The filter article type-"Randomized Controlled Trial" was used. The studies were graded on a two-level scale: 0-1. In the case of 1, sample size (SS) and effect size (ES) were calculated. RESULTS In the entire study sample, SS was used in 58% of studies, while ES was used in 15% of studies. CONCLUSIONS Quality should improve as research increases. One factor that influences quality is the level of statistics. SS and ES calculations provide a basis for understanding the results obtained by the authors. Access to formulas, online calculators and software facilitates these analyses. High-quality trials provide a solid foundation for medical progress, fostering the development of personalized therapies that provide more precise and effective treatment and increase patients' chances of recovery. Improving the quality of TMD research, and medical research in general, helps to increase public confidence in medical advances and raises the standard of patient care.
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Affiliation(s)
- Grzegorz Zieliński
- Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | - Piotr Gawda
- Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland
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Xie Q, Li P, Yang C, Chen M, Li H, Bai G, Ma Z, Shen P, Liu Z. Feasibility of simultaneous TMJ arthroscopy in ADDwoR patients undergoing orthognathic surgery for jaw deformity. J Craniomaxillofac Surg 2024; 52:347-354. [PMID: 38368209 DOI: 10.1016/j.jcms.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 10/26/2023] [Accepted: 01/16/2024] [Indexed: 02/19/2024] Open
Abstract
This study evaluated the feasibility of simultaneous temporomandibular joint (TMJ) arthroscopy and orthognathic surgery as a new treatment strategy for anterior disc displacement without reduction (ADDwoR) patients with severe jaw deformities. Twelve ADDwoR patients with facial deformities who underwent arthroscopy and orthognathic surgery between September 2015 and December 2019 were retrospectively evaluated. Pre- and postoperative maximum incisal opening (MIO) and joint pain were recorded. Computed tomography (CT) and three-dimensional cephalometric analysis were performed at 3 (T1) and ≥6 (T2) months postoperatively. Magnetic resonance imaging (MRI) of the TMJ was performed before, ≤7 days after and ≥6 months after surgery. The lateral profile radiological findings, the symmetry of the maxilla and mandible, and the MRI measurements were compared. Anterior disc displacement did not recur, and the maximum incisal opening (MIO) increased from 27.4 mm to 32.7 mm after surgery (p < 0.05). No significant differences were found in the lateral profile, symmetry indices or condylar height via MRI between T1 and T2. Joint morphology and the position of both the maxilla and mandible remained stable during postoperative follow-up, while joint symptoms were markedly relieved and facial appearance was noticeably improved. Combined arthroscopy and orthognathic surgery is effective and recommended for ADDwoR patients with jaw deformities.
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Affiliation(s)
- Qianyang Xie
- Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Rd., Shanghai, 200011, China
| | - Peilun Li
- Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Rd., Shanghai, 200011, China
| | - Chi Yang
- Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Rd., Shanghai, 200011, China.
| | - Minjie Chen
- Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Rd., Shanghai, 200011, China.
| | - Hui Li
- Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Rd., Shanghai, 200011, China.
| | - Guo Bai
- Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Rd., Shanghai, 200011, China
| | - Zhigui Ma
- Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Rd., Shanghai, 200011, China
| | - Pei Shen
- Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, and Shanghai Key Laboratory of Stomatology and Shanghai Research Institute of Stomatology, No. 639, Zhizaoju Rd., Shanghai, 200011, China
| | - Zhiyang Liu
- Shanghai Xuhui District Dental Center, Shanghai, 200032, China
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Navaneetham R, Navaneetham A, Nagaraj V, Gnapika N, Sankarnarayan G. Single-Puncture Versus Double-Puncture Technique Arthrocentesis in the Treatment of Internal Derangement of TM Joint-A Comparative Clinical Study. J Maxillofac Oral Surg 2023; 22:1060-1065. [PMID: 38105816 PMCID: PMC10719202 DOI: 10.1007/s12663-023-01986-5] [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: 06/05/2023] [Accepted: 07/23/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Tempormandibular Joint (TMJ) Disorders require early diagnosis with a prompt and effective treatment. Arthrocentesis has been found to be a valuable treatment aid for patients with early stage internal derangement of temporomandibular joints. The use of this procedure has been well documented in literature and had been performed for decades. Arthrocentesis under local anaesthesia can be performed in two different techniques i.e Single puncture and Double puncture techniques. Aims and Objectives Our study was done to show the effectiveness of each of these techniques in aiding the patient as well as time taken to perform this procedure. Our study compares the two techniques to allow us to draw a proper conclusion on which can be put to use for better and less traumatic treatment of these patients. Materials and Method For this study 50 patients with Internal Derangement, group A was 25 patients that were treated with Arthrocentesis of 200 ml RL using OnePrick TMJ Arthrocentesis System with Single Puncture technique and group B consisted of 25 patients who were treated with Arthrocentesis of 200 ml RL using Double Puncture technique. Result We found a significant increase in maximal mouth opening in patients undergoing arthrocentesis regardless of the technique. Comparison of mean duration of surgery performed among different groups were assessed using sample T test. Mean duration of technique A is around 17.18 minutes whereas for technique B is 20.90 minutes. The mean difference for two techniques performed is -3.722 with P value of 0.001. In technique A 24% of subjects needed additional lavage whereas in techniques B it is 20 %. On an average, total of 22 % of subjects needed additional lavage for better results. The resultant p value is around 0.733. Discussion The traditional double puncture technique involves the insertion of two needles into the upper joint space. Difficulties in accurate triangulation, positioning of the needle, and frequent intraoperative needle dislocations lead to longer operating times and are often encountered with the double puncture technique. On comparing the two arthrocentesis techniques in terms of easiness to operator a study done showed the group treated with single needle techniques found it easier than the double needle technique. The difference between groups was significant. The mean difference for two techniques performed was seen to be above three minutes in our study which was statistically significant. Conclusion Single needle technique is advantageous in the fact that it takes a shorter duration to perform, is less invasive and easier for the operator to complete successfully.
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Affiliation(s)
- Romir Navaneetham
- Department of Maxillofacial Surgery, Mathrusri Ramabai Ambedkar Dental College and Hospital, 1, 36, Cline Rd, Balaji Layout, Cooke Town, Bengaluru, Karnataka 560005 India
- Comprehensive Dental and Implant Centre, 11, Cornwell Road Langford Gardens, Bangalore, 560025 India
| | - Anuradha Navaneetham
- Comprehensive Dental and Implant Centre, 11, Cornwell Road Langford Gardens, Bangalore, 560025 India
| | - Vaibhav Nagaraj
- Department of Maxillofacial Surgery, Mathrusri Ramabai Ambedkar Dental College and Hospital, 1, 36, Cline Rd, Balaji Layout, Cooke Town, Bengaluru, Karnataka 560005 India
| | - N. Gnapika
- Comprehensive Dental and Implant Centre, 11, Cornwell Road Langford Gardens, Bangalore, 560025 India
| | - Gayitri Sankarnarayan
- Department of Maxillofacial Surgery, Mathrusri Ramabai Ambedkar Dental College and Hospital, 1, 36, Cline Rd, Balaji Layout, Cooke Town, Bengaluru, Karnataka 560005 India
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Bhargava D. Is Single Puncture Superior to Double Puncture Arthrocentesis in Patients With Wilkes III Internal Derangement? J Oral Maxillofac Surg 2023; 81:1204-1214. [PMID: 37573887 DOI: 10.1016/j.joms.2023.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/06/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Arthrocentesis is a minimally invasive procedure with reported efficacy when used for lysis and lavage of the joint for symptomatic internal derangement, irrespective of the technique utilized. PURPOSE The purpose of the study was to determine if the single puncture arthrocentesis (SPA) is superior to double puncture arthrocentesis (DPA) with respect to pain reduction and improved maximal mouth opening (MMO) for subjects with acute disc displacement without reduction. STUDY DESIGN AND SETTING A single-blinded randomized prospective clinical trial was conducted at the tertiary referral center for temporomandibular joint disorders. All subjects were diagnosed with acute onset disc displacement without reduction based on history and magnetic resonance imaging findings. Subjects were randomized to SPA or DPA. PREDICTOR VARIABLE(S) The primary predictor variable was arthrocentesis technique (SPA vs DPA). MAIN OUTCOME VARIABLE(S) The primary outcome variables were pain and MMO, measured at 4 weeks. The duration for the procedure was recorded at the time of the surgery. COVARIATES Age, sex, and the side affected were recorded. ANALYSES Data were analyzed using analysis of variance to compare the primary outcome variables. Levene's, post hoc, and Bonferroni-Holm tests were used for intergroup comparisons with a P value of <0.05 being significant. RESULTS Forty subjects completed the study. The mean age for the SPA and DPA groups was 28.3 (±3.9) and 29.1 (±4.1), respectively (P = .52). The sex distribution was 60 and 55% female in the SPA and DPA groups, respectively. The mean pain reduction in the SPA and DPA groups was from 8.30 (±0.86) to 0.90 (±0.78) and from 8.00 (±0.79) to 0.95 (±0.82), respectively (P < .0001). There was no difference in pain reduction between the groups (P = .05). The mean increase in MMO was 34.6 (±2.34) and 33.4 (±2.35) in the SPA and DPA groups, respectively (P < .0001). The difference between the groups was not significant (P = .12). The procedural time in the SPA and DPA groups was 14.15 ± 1.72 and 17.55 ± 1.66, respectively (P < .0001). CONCLUSION SPA and DPA arthrocentesis appear to be equally efficacious for pain reduction and increasing MMO. SPA can be completed in less time than DPA and should be considered as a viable alternative to the conventional DPA technique.
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Affiliation(s)
- Darpan Bhargava
- Professor and Clinical Director, Oral and Maxillofacial Surgery, TMJ Consultancy Services, Bhopal, Madhya Pradesh, India; Director Research, DAMER India.
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Tsui HC, Lam CM, Leung YY, Li KY, Wong NSM, Li DTS. Lavage Volume of Arthrocentesis in the Management of Temporomandibular Disorders: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12112622. [PMID: 36359466 PMCID: PMC9689331 DOI: 10.3390/diagnostics12112622] [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: 08/30/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to investigate the most effective lavage volume of arthrocentesis in the management of temporomandibular disorders. A comprehensive electronic search, based on the PRISMA guidelines, was performed, which included a computer search with specific keywords, a reference list search and a manual search. The inclusion criteria were the following: a randomized controlled trial, at least 20 subjects who underwent arthrocentesis, mention of the irrigation materials used for the arthrocentesis, mention of the irrigation volumes used for the arthrocentesis, MMO and pain measured as VAS or NRS, were reported as outcome figures, mention of a specific diagnosis or signs and symptoms, and inclusion of the data on the MMO or VAS/NRS at 6-month follow-up. Sixteen publications were enrolled in the meta-analysis, comparing arthrocentesis with a lavage volume <150 mL and arthrocentesis with a lavage volume ≥150 mL, in the efficacy of the improvement in the mouth opening and pain reduction. The results revealed the group with a lavage volume <150 mL had a greater improvement in the mouth opening and pain reduction. However, results are to be interpreted with caution, due to the paucity of the randomized controlled literature and other confounding factors. Further high-quality studies are required to provide a better conclusion to the treatment outcomes of the different lavage volumes.
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Affiliation(s)
| | - Chun Mo Lam
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Yiu Yan Leung
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Kar Yan Li
- Clinical Research Centre, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Natalie Sui Miu Wong
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Dion Tik Shun Li
- Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
- Correspondence:
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Şentürk MF, Yazıcı T, Baykul T. Evaluation of the effectiveness of different puncture points for second cannula in double puncture arthrocentesis of temporomandibular joint. J Craniomaxillofac Surg 2021; 49:1158-1161. [PMID: 34489156 DOI: 10.1016/j.jcms.2021.08.003] [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: 03/07/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
The study at checking if treatment outcomes in double puncture temporomandibular joint (TMJ) arthrocentesis (DPTMJA) changed when the puncture points of the second cannula punctate were changed. Using a retrospective cohort study design, the investigators enrolled a sample of temporomandibular joint disorder (TMD, internal derangement) patients receiving DPTMJA. The decision of whether to perform a modified or traditional arthrocentesis was made by the patients: Patients who accepted the close cannula relationship were evaluated as group 1 (modification group), and those who did not agree as group 2 (traditional group). The predictor variable was puncture points of the second cannula (close to vs. far from the first cannula; group 1 and 2, respectively). The main outcome variables included maximum mouth opening (MMO), and pain assessed using a Likert-type (0-10) visual analogue scale (VAS) before treatment and at 1st day and 3rd months intervals. Appropriate statistics were computed using P < .05 was considered significant. The study sample comprised 32 patients (93.8% females; 50% in each study arm) with an average age of 36.9 ± 15.3 years (range, 18-78). Although, patient age and gender, and baseline VAS in both groups were not significant different (P > .05), the baseline MMO in group 2 was significant higher than that in group 1 (P = .03). The within-group analyses demonstrated the significant improvement of both MMO and VAS at postoperative month 3 (P < .05). However, the between-group analyses rejected the significant differences between the 2 groups at day 1 and month 3 (P > .05). Within the limitations of the study the choice of one or the other technique should be left to the discretion of the surgeon.
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Affiliation(s)
- Mehmet Fatih Şentürk
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
| | - Tayfun Yazıcı
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
| | - Timuçin Baykul
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Süleyman Demirel University, Isparta, Turkey
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Li DTS, Leung YY. Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management. Diagnostics (Basel) 2021; 11:diagnostics11030459. [PMID: 33800948 PMCID: PMC8000442 DOI: 10.3390/diagnostics11030459] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/17/2022] Open
Abstract
Temporomandibular disorders (TMD) are a group of orofacial pain conditions which are the most common non-dental pain complaint in the maxillofacial region. Due to the complexity of the etiology, the diagnosis and management of TMD remain a challenge where consensus is still lacking in many aspects. While clinical examination is considered the most important process in the diagnosis of TMD, imaging may serve as a valuable adjunct in selected cases. Depending on the type of TMD, many treatment modalities have been proposed, ranging from conservative options to open surgical procedures. In this review, the authors discuss the present thinking in the etiology and classification of TMD, followed by the diagnostic approach and the current trend and controversies in management.
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Li DTS, Wong NSM, Li SKY, McGrath CP, Leung YY. Timing of arthrocentesis in the management of temporomandibular disorders: an integrative review and meta-analysis. Int J Oral Maxillofac Surg 2021; 50:1078-1088. [PMID: 33602649 DOI: 10.1016/j.ijom.2021.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/18/2020] [Accepted: 01/20/2021] [Indexed: 01/23/2023]
Abstract
The aim of this study was to assess the best timing to perform arthrocentesis in the management of temporomandibular disorders with regard to conservative treatment. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, reference list search, and manual search was performed. Relevant articles were selected after three search rounds for final review based on six predefined inclusion criteria, followed by a round of critical appraisal. Eleven publications, including eight randomized controlled trials and three prospective clinical studies, were included in the review. The studies were divided into three groups based on the timing of arthrocentesis: (1) arthrocentesis as the initial treatment; (2) early arthrocentesis; and (3) late arthrocentesis. Meta-analysis was carried out to compare the efficacy of improvement in mouth opening and pain reduction in the three groups. All three groups showed improvement in mouth opening and pain reduction, with forest plots suggesting that arthrocentesis performed within 3 months of conservative treatment might produce beneficial results. We conclude that there is a knowledge gap in the current literature regarding the preferable timing to perform arthrocentesis in the management of temporomandibular disorders, and more high-quality randomized controlled trials are required to shed light on this subject.
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Affiliation(s)
- D T S Li
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - N S M Wong
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - S K Y Li
- Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - C P McGrath
- Applied Oral Sciences & Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong
| | - Y Y Leung
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong.
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Nagori SA, Jose A, Roychoudhury A. Comparison of intraoperative outcomes with single and double puncture techniques of arthrocentesis of the temporomandibular joint. Br J Oral Maxillofac Surg 2020; 58:928-932. [DOI: 10.1016/j.bjoms.2020.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/08/2020] [Indexed: 10/23/2022]
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