1
|
Ulmner M, Bjørnland T, Rosén A, Berge TI, Olsen-Bergem H, Lund B. Evidence for minimally invasive treatment-A systematic review on surgical management of disc displacement. J Oral Rehabil 2024; 51:1061-1080. [PMID: 38400536 DOI: 10.1111/joor.13661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform minimal invasive interventions as first-line surgical treatment since there are no evidence on best surgical practice yet. OBJECTIVE The aim was to perform a complex systematic review (SR) on the topic-is there evidence for surgical treatment of TMJ DD? METHODS The PICO was defined as DD patients (population), treated with different surgical interventions including arthrocentesis (intervention), compared with other or no treatment (control) regarding the outcome variables mandibular function, mouth opening capacity, TMJ pain, etcetera (outcome). For identification of prospective controlled trials and SRs, a search strategy was developed for application in three databases. RESULTS The search yielded 4931 studies of which 56 fulfilled the stipulated PICO. Studies with low or moderate risk of bias were possible to include in meta-analyses. There were evidence suggesting arthrocentesis being more effective compared to conservative management (maximum interincisal opening (MIO): p < .0001, I2 = 22%; TMJ pain: p = .0003, I2 = 84%) and arthrocentesis being slightly more effective than arthrocentesis with an adjunctive hyaluronic acid injection (MIO: p = .04, I2 = 0%; TMJ pain: p = .28, I2 = 0%). Other treatment comparisons showed nonsignificant differences. The performed meta-analyses only included 2-4 studies each, which might indicate a low grade of evidence. CONCLUSION Although arthrocentesis performed better than conservative management the findings should be interpreted cautiously, and non-invasive management considered as primary measure. Still, several knowledge gaps concerning surgical methods of choice remains.
Collapse
Affiliation(s)
- Mattias Ulmner
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Tore Bjørnland
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Annika Rosén
- Department of Oral and Maxillofacial Surgery, Folktandvården Stockholm Eastmaninstitutet, Stockholm, Sweden
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Trond Inge Berge
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Heming Olsen-Bergem
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Bodil Lund
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
2
|
Li J, Chen H. Intra-articular injection of platelet-rich plasma vs hyaluronic acid as an adjunct to TMJ arthrocentesis: A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101676. [PMID: 37923134 DOI: 10.1016/j.jormas.2023.101676] [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: 09/22/2023] [Revised: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE We aimed to find out if there is any difference in outcomes with the use of platelet-rich plasma (PRP) or hyaluronic acid (HA) intra-articular injections after temporomandibular joint arthrocentesis. METHODS A systematic search of the electronic databases of PubMed, Embase, and Scopus was undertaken up to 5th May 2023. Randomized controlled trials (RCTs) comparing PRP with HA after TMJ arthrocentesis were included. RESULTS Seven RCTs were eligible. Pooled analysis failed to demonstrate any significant difference in MMO between PRP and HA groups at 1 month (MD: 0.21 95 % CI: -1.29, 1.70), 3 months (MD: 0.92 95 % CI: -2.96, 4.80), and 6 months (MD: -0.05 95 % CI: -2.08, 1.97). The inter-study heterogeneity was high with I2 values of 85 %, 98 %, and 81 % respectively. Similarly, there was no statistically significant difference in pain scores between the PRP and HA groups at 1 month (MD: 0.42 95 % CI: -2.25, 3.10), 3 months (MD: 0.90 95 % CI: -1.60, 3.41), and 6 months (MD: 0.06 95 % CI: -0.92, 1.04) with inter-study heterogeneity of 99 %, 99 %, and 92 % respectively. CONCLUSION Intra-articular use of PRP or HA after TMJ arthrocentesis may lead to comparable clinical outcomes. The current evidence is low-quality and fraught with high heterogeneity.
Collapse
Affiliation(s)
- Jian Li
- Department of Stomatology, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, China.
| | - Hongyi Chen
- Department of Stomatology, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang, China.
| |
Collapse
|
3
|
Sàbado-Bundó H, Sánchez-Garcés M, Camps-Font O, Gay-Escoda C. Intraarticular injections of hyaluronic acid in arthrocentesis and arthroscopy as a treatment of temporomandibular joint disorders: A systematic review. Cranio 2024; 42:122-131. [PMID: 34027829 DOI: 10.1080/08869634.2021.1925029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the benefits of hyaluronic acid intraarticular injection (HA IAI), in conjunction with minimally invasive surgery (arthrocentesis or arthroscopy), as a therapeutic option for temporomandibular joint disorders. METHODS An electronic search in PubMed, Cochrane Library, and Scopus databases was conducted in order to answer the following PICOS question: "In clinical trials with patients treated with arthroscopy or arthrocentesis, did the subsequent use of HA IAI provide a better control of postoperative pain and temporomandibular joint function compared to those patients who did not receive it?" RESULTS Following PRISMA criteria, six randomized controlled clinical trials were selected. HA IAI showed significant differences in terms of pain reduction in three of them and improvement of mandibular function in two, compared to the control group. CONCLUSION Based on scientific evidence, the level of recommendation found regarding this type of intervention is type B (recommendation based on inconsistent or limited-quality patient-oriented evidence).
Collapse
Affiliation(s)
- Helena Sàbado-Bundó
- Department of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - MaÁngeles Sánchez-Garcés
- Master's Degree Program in Oral Surgery and Implantology, University of Barcelona, Barcelona, Spain
- Researcher of the IDIBELL Institute, Barcelona, Spain
| | - Octavi Camps-Font
- Department of Oral Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Researcher of the IDIBELL Institute, Barcelona, Spain
| | - Cosme Gay-Escoda
- Oral and Maxillofacial Surgery, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Oral Surgery and Implantology, FUCSO, Implantology and Maxillofacial Surgery Department, EFHRE International University, Teknon Medical Center, Barcelona, Spain
| |
Collapse
|
4
|
Al-Moraissi EA, Almaweri AA, Al-Tairi NH, Alkhutari AS, Grillo R, Christidis N. Treatments for painful temporomandibular disc displacement with reduction: a network meta-analysis of randomized clinical trials. Int J Oral Maxillofac Surg 2024; 53:45-56. [PMID: 37802670 DOI: 10.1016/j.ijom.2023.09.006] [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: 04/05/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
There is currently no consensus on the best treatment for painful temporomandibular disc displacement with reduction (DDwR), and no network meta-analysis of randomized clinical trials (RCTs) comparing all types of treatment for this condition has been conducted. The objective of this study was to compare and rank all treatments for DDwR, including conservative treatments, occlusal splints, low-level laser therapy (LLLT), manual therapy, no treatment (control), arthrocentesis (Arthro) alone, Arthro plus intra-articular injection of platelet-rich plasma (Arthro-PRP) or hyaluronic acid (Arthro-HA), and Arthro plus occlusal splint. Predictor variables were pain intensity and maximum mouth opening (MMO). The mean difference with 95% confidence interval was estimated using Stata software. The GRADE system was used to assess the certainty of the evidence. Twenty RCTs reporting 1107 patients were identified in the literature search; 980 of these patients were included in the network meta-analysis. Direct meta-analysis showed that Arthro-PRP significantly reduced pain intensity compared to Arthro alone, while occlusal splint and manual therapy were superior to conservative treatment (all very low quality evidence). Arthro with intra-articular injection of PRP/HA ranked as the most effective treatment in terms of pain reduction, whereas LLLT ranked the best choice for increasing MMO for patients with DDwR. However, it is important to note that the evidence for the superiority of these treatments is generally of very low quality. Therefore, further high-quality research is needed to confirm these findings and provide more reliable recommendations for the treatment of DDwR.
Collapse
Affiliation(s)
- E A Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Thamar University, Thamar, Yemen.
| | - A A Almaweri
- Department of Oral Medicine, Thamar University, Thamar, Yemen
| | - N H Al-Tairi
- Department of Oral and Maxillofacial Surgery, Thamar University, Thamar, Yemen
| | - A S Alkhutari
- Department of Oral and Maxillofacial Surgery, Thamar University, Thamar, Yemen
| | - R Grillo
- Department of Oral and Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil; Department of Oral and Maxillofacial Surgery, Faculdade São Leopoldo Mandic, Campinas, Brazil
| | - N Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| |
Collapse
|
5
|
Liu SS, Xu LL, Liu LK, Lu SJ, Cai B. Platelet-rich plasma therapy for temporomandibular joint osteoarthritis: A randomized controlled trial. J Craniomaxillofac Surg 2023; 51:668-674. [PMID: 37852892 DOI: 10.1016/j.jcms.2023.09.014] [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: 07/29/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023] Open
Abstract
The study aimed to compare the efficacy of platelet-rich plasma (PRP) injections for the treatment of temporomandibular joint osteoarthritis (TMJ-OA) with hyaluronic acid (HA) therapy. This randomized controlled trial included 70 patients with TMJ-OA, randomly divided into either a PRP or HA group. The pain intensity, maximum mouth opening (MMO), TMJ sound score, and proportion of crepitus were recorded and compared at baseline and at 1, 3, and 6 months. Both groups showed statistically significant improvements in pain intensity, MMO, TMJ sound, and scale scores during the 6-month follow-up period. The improvements in pain intensity during mouth opening at 1 month, MMO at 1, 3, and 6 months, TMJ sound score at 1 and 3 months, and GAD-7 score at 6 months in the PRP group were greater than in the HA group (p < 0.05). Compared with the HA group, imaging improvement in the PRP group was also higher (p < 0.05). Within the limitations of the study it seems that the application of PRP therapy in TMJ-OA is should be considered whenever possible.
Collapse
Affiliation(s)
- Sha-Sha Liu
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Rehabilitation Medicine, Sijing Hospital of the Songjiang District of Shanghai, Shanghai, China
| | - Li-Li Xu
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Rehabilitation Medicine, Sijing Hospital of the Songjiang District of Shanghai, Shanghai, China
| | - Li-Kun Liu
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shen-Ji Lu
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Rehabilitation Medicine, Sijing Hospital of the Songjiang District of Shanghai, Shanghai, China
| | - Bin Cai
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
6
|
Chęciński M, Chęcińska K, Turosz N, Brzozowska A, Chlubek D, Sikora M. Current Clinical Research Directions on Temporomandibular Joint Intra-Articular Injections: A Mapping Review. J Clin Med 2023; 12:4655. [PMID: 37510770 PMCID: PMC10380303 DOI: 10.3390/jcm12144655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
This mapping review aims to identify and discuss current research directions on intracavitary temporomandibular joints (TMJs) injections. The inclusion criteria allowed studies published in the last full six years, based on patients diagnosed with temporomandibular joint disorders (TMDs), treated by TMJ intra-articular injections. Medical databases covered by the Association for Computing Machinery, Bielefeld Academic Search Engine, PubMed, and Elsevier Scopus engines were searched. The results were visualized with tables, charts, and diagrams. Of the 2712 records identified following the selection process, 152 reports were qualified for review. From January 2017, viscosupplementation with hyaluronic acid (HA) was the best-documented injectable administered into TMJ cavities. However, a significant growing trend was observed in the number of primary studies on centrifuged blood preparations administrations that surpassed the previously leading HA from 2021.
Collapse
Affiliation(s)
- Maciej Chęciński
- Department of Oral Surgery, Preventive Medicine Center, Komorowskiego 12, 30-106 Cracow, Poland
| | - Kamila Chęcińska
- Department of Glass Technology and Amorphous Coatings, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, Mickiewicza 30, 30-059 Cracow, Poland
| | - Natalia Turosz
- Institute of Public Health, Jagiellonian University Medical College, Skawińska 8, 31-066 Cracow, Poland
| | - Anita Brzozowska
- Preventive Medicine Center, Komorowskiego 12, 30-106 Kraków, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Maciej Sikora
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, Wojska Polskiego 51, 25-375 Kielce, Poland
| |
Collapse
|
7
|
de Almeida AM, Botelho J, Machado V, Mendes JJ, Manso C, González-López S. Comparison of the Efficacy of Two Protocol Treatments in Patients with Symptomatic Disc Displacement without Reduction: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12093228. [PMID: 37176666 PMCID: PMC10179338 DOI: 10.3390/jcm12093228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
The aim of this study was to compare the effectiveness of arthrocentesis followed by hyaluronic acid infiltration treatment (ASH) and mandibular exercise therapy (MET) in patients with symptomatic disc displacement without reduction (DDwoR) by examining pain intensity (VAS), mandibular range of motion (MO), and quality of life (QoL). Fifty-two patients were randomly allocated into two groups, MET (N = 26) and ASH (N = 26), and therapy was applied at the baseline and one month after. Patients were followed up at 1 and 12 months after the baseline assessment. Clinical and patient-reported outcomes were compared at the baseline, 1-month follow-up, and 12-month follow-up. The study found no significant differences in VAS and MO between the ASH and MET groups at the baseline. However, while not significant, it was noted that the ASH group showed higher values for MO. Regarding OHIP-14 at 1 month of follow-up, the ASH group showed significant improvements in physical pain (p > 0.01), physical and psychological disability (p = 0.043 and p = 0.029), and handicap (p = 0.033). At the 12-month follow-up, the ASH group showed significant improvements in functional limitation, psychological discomfort, psychological disability, and handicap (p = 0.008, p = 0.001, p = 0.001, p = 0.005, respectively). ASH treatment did not reduce pain or improve mandibular range of motion more than physical therapy in patients with symptomatic DDwoR. However, ASH could be preferable given its positive long-term effects on patients' quality of life. The clinician's main objective is to prioritize the treatment plan order with a focus on the patient's quality of life. Accordingly, healthcare professionals should consider ASH as a treatment option for patients with symptomatic DDwoR who desire long-term improvement in their quality of life.
Collapse
Affiliation(s)
- André Mariz de Almeida
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, 2829-511 Almada, Portugal
- Sams Mais-Centro Clinico, 1070-128 Lisboa, Portugal
- School of Dentistry, Campus de Cartuja, University of Granada, Colegio Maximo s/n, 18011 Granada, Spain
| | - João Botelho
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, 2829-511 Almada, Portugal
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
| | - Vanessa Machado
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, 2829-511 Almada, Portugal
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
| | - José João Mendes
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, 2829-511 Almada, Portugal
- Evidence-Based Hub, Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz-Cooperativa de Ensino Superior, Caparica, 2829-511 Almada, Portugal
| | - Cristina Manso
- Clinical Research Unit (CRU), Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, 2829-511 Almada, Portugal
- Sams Mais-Centro Clinico, 1070-128 Lisboa, Portugal
| | - Santiago González-López
- School of Dentistry, Campus de Cartuja, University of Granada, Colegio Maximo s/n, 18011 Granada, Spain
| |
Collapse
|
8
|
Işık G, Kenç S, Koyuncu BÖ, Günbay S, Günbay T. Does the Use of Injectable Platelet-Rich Fibrin After Arthrocentesis for Disc Displacement Without Reduction Improve Clinical Outcomes? J Oral Maxillofac Surg 2023:S0278-2391(23)00211-2. [PMID: 36924792 DOI: 10.1016/j.joms.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE Many studies have reported the role of arthrocentesis to alleviate symptoms of patients with disc displacement without reduction (DDWoR). Nevertheless, the benefit of injectable platelet-rich fibrin (i-PRF) remains unclear. The aim of this study was to answer the following question: among patients with DDWoR, do those treated with intra-articular injection of i-PRF after arthrocentesis, when compared to those treated with arthrocentesis only, have better clinical outcomes in terms of pain reduction and improvement of jaw movement? MATERIALS AND METHODS This single-blind randomized, controlled study included patients with diagnosed DDWoR, in the Department of Oral and Maxillofacial Surgery at the School of Dentistry, Ege University, who had localized joint pain and limited range of motion. Patients were treated either with arthrocentesis (AC group) or arthrocentesis in combination with intra-articular i-PRF injection (AC + i-PRF group). The predictor variable was treatment (ie, arthrocentesis with or without i-PRF). The primary outcome variable was pain (visual analog scale). The secondary outcome variables were maximum mouth opening, lateral and protrusive movements. Outcome variables were recorded at pretreatment and at the postoperative 1st, 2nd, 3rd, 6th, and 12th months. Statistical analysis was performed using the Brunner-Langer model, with a significance level P < .05. RESULTS This study comprised 76 patients (34 females/4 males, mean age 47.2 ± 9.1 for the AC + i-PRF group; 35 females/3 males, mean age 46.8 ± 10.2 for the AC group). The treatment success rate was 73.7% for the AC group and 100% for the AC + i-PRF group (P = .012). Pain levels in the AC + i-PRF group were found to decrease more than the AC group over 12 months postoperatively (palpation: -6.9 ± 1.2 vs -5.3 ± 1.3; chewing: -6.9 ± 1.5 vs -5.1 ± 1.7; jaw movements: -6.9 ± 1.1 vs -5.1 ± 1.4). This difference was statistically significant (P < .001). The degree of jaw movement in the AC + i-PRF group was found to increase more than the AC group over 12 months postoperatively (maximum mouth opening: 8.0 ± 2.1 vs 4.9 ± 2.0; contralateral: 1.8 ± 0.8 vs 0.2 ± 1.0; ipsilateral: 2.9 ± 1.3 vs 0.8 ± 1.5; protrusive: 2.6 ± 1.1 vs 0.8 ± 1.3). This difference was statistically significant (P < .001). CONCLUSION Intra-articular injection of i-PRF after arthrocentesis produced greater improvements in pain reduction and jaw movement when compared to arthrocentesis only. These results indicate that i-PRF used in combination with arthrocentesis is an effective adjunctive treatment.
Collapse
Affiliation(s)
- Gözde Işık
- Assistant Professor, Ege University, School of Dentistry, Department of Oral and Maxillofacial Surgery.
| | - Selin Kenç
- Research Assistant, Ege University, School of Dentistry, Department of Oral and Maxillofacial Surgery
| | - Banu Özveri Koyuncu
- Professor, Ege University, School of Dentistry, Department of Oral and Maxillofacial Surgery
| | - Sevtap Günbay
- Professor, Ege University, School of Dentistry, Department of Oral and Maxillofacial Surgery
| | - Tayfun Günbay
- Professor, Ege University, School of Dentistry, Department of Oral and Maxillofacial Surgery
| |
Collapse
|
9
|
Chęciński M, Chęcińska K, Nowak Z, Sikora M, Chlubek D. Treatment of Mandibular Hypomobility by Injections into the Temporomandibular Joints: A Systematic Review of the Substances Used. J Clin Med 2022; 11:2305. [PMID: 35566431 PMCID: PMC9102811 DOI: 10.3390/jcm11092305] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular abduction. The purpose of this review is to identify other injectable substances and to evaluate them in the above-mentioned domains. MATERIAL AND METHODS The review included articles describing clinical trials of patients treated with intra-articular injections with or without arthrocentesis. RESULTS The following emerging substances were initially evaluated to be effective in treating TMJ pain and increasing the amplitude of mandibular abduction: analgesics, dextrose with lidocaine, adipose tissue, nucleated bone marrow cells and ozone gas. DISCUSSION Better effects of intra-articular administration are achieved by preceding the injection with arthrocentesis. CONCLUSIONS The most promising substances appear to be bone marrow and adipose tissue.
Collapse
Affiliation(s)
- Maciej Chęciński
- Department of Oral Surgery, Preventive Medicine Center, Komorowskiego 12, 30-106 Cracow, Poland;
| | - Kamila Chęcińska
- Department of Glass Technology and Amorphous Coatings, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, Mickiewicza 30, 30-059 Cracow, Poland;
| | - Zuzanna Nowak
- Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Traugutta 2, 41-800 Zabrze, Poland;
| | - Maciej Sikora
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, Wojska Polskiego 51, 25-375 Kielce, Poland;
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
| |
Collapse
|
10
|
Diverse therapies for disc displacement of temporomandibular joint: A systematic review and network meta-analysis. Br J Oral Maxillofac Surg 2022; 60:1012-1022. [DOI: 10.1016/j.bjoms.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/18/2022] [Accepted: 04/13/2022] [Indexed: 11/20/2022]
|
11
|
Rossini R, Grossmann E, Poluha RL, Setogutti ÊT, Dos Santos MF. Double-Needle Arthrocentesis with Viscosupplementation in Patients with Temporomandibular Joint Disc Displacement without Reduction. Clinics (Sao Paulo) 2021; 76:e2840. [PMID: 33909828 PMCID: PMC8050596 DOI: 10.6061/clinics/2021/e2840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Arthrocentesis is the simplest surgical intervention for the temporomandibular joint (TMJ). It can be performed on an outpatient basis at a low cost and with low morbidity. The objective is to release the articular disc by disrupting the adhesion formed between its surfaces and the mandibular fossa through hydraulic pressure generated by irrigation of the upper compartment of the TMJ. Viscosupplementation with hyaluronic acid during or after arthrocentesis improves clinical outcomes, increases mouth opening, and reduces pain levels. The aim of this study was to evaluate the efficiency of arthrocentesis plus hyaluronic acid viscosupplementation through clinical examination and preoperative magnetic resonance imaging in patients with unilateral disc displacement without reduction (DDwoR). METHODS This analytical retrospective cross-sectional study clinically and radiologically evaluated 72 patients of both sexes with unilateral DDwoR. The following data were collected: sex, pain, age, duration of pain, maximum mouth opening, and patient pain perception on a visual analog scale. TMJ arthrocentesis was performed only once for each of the indicated joints. Data were collected before arthrocentesis (baseline) and at 7, 14, 30, 60, 90, and 180 days after the procedure (final evaluation). RESULTS Between the baseline and final evaluation, there was a significant reduction in pain (p=0.001) and restoration of articular function. In addition, there was a significant increase in maximum mouth opening (p=0.001). CONCLUSION Patients with DDwoR undergoing arthrocentesis combined with hyaluronic acid injection showed significant improvement in the perceived pain and maximum mouth opening in the mid-term follow-up periods.
Collapse
Affiliation(s)
- Rafael Rossini
- Pos-Graduacao em Ciencias Cirurgicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| | - Eduardo Grossmann
- Departamento de Ciencias Morfologicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
- *Corresponding author. E-mail:
| | | | | | - Marcos Fabio Dos Santos
- Instituto de Ciencias Biomedicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BR
| |
Collapse
|
12
|
Monteiro JLGC, de Arruda JAA, Silva EDDOE, Vasconcelos BCDE. Is Single-Puncture TMJ Arthrocentesis Superior to the Double-Puncture Technique for the Improvement of Outcomes in Patients With TMDs? J Oral Maxillofac Surg 2020; 78:1319.e1-1319.e15. [PMID: 32343959 DOI: 10.1016/j.joms.2020.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 02/19/2020] [Accepted: 03/15/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Arthrocentesis is a common treatment for temporomandibular joint disorders. Although modifications of the standard double-puncture technique have been described, no consensus has been reached regarding which is the best. The aim of the present study was to compare the outcomes of the single- and double-puncture arthrocentesis techniques (SPT and DPT, respectively). MATERIALS AND METHODS A systematic review following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines was performed. Two independent reviewers conducted electronic searches in the MEDLINE/PubMed, Cochrane Library, and Scopus databases for relevant studies reported up to January 2019. Studies comparing type I SPT (only 1 cannula) or type II SPT (2 soldered cannulas) to conventional DPT were considered. Data regarding the maximal mouth opening (MMO), joint pain, and operative time were extracted for the meta-analysis. In the case of statistically significant heterogeneity (P < .10), a random effects model was used to assess the significance of the treatment effects. Otherwise, a fixed effects model was used. The included randomized controlled trials (RCTs) were assessed for methodologic quality using the Cochrane Collaboration tool. RESULTS Nine studies were included for qualitative synthesis. Two were suitable for quantitative synthesis per outcome. The meta-analysis did not find any differences between SPT and DPT in relation to the MMO. However, in relation to joint pain, the results slightly favored the use of DPT. No differences in operative time were found between type I SPT and DPT (P = .49). CONCLUSIONS The present study found no differences between the SPT and DPT in relation to the MMO, and no difference was found in operative time between the DPT and type I SPT. Because of the heterogeneity between studies, it might be interesting to conduct more homogeneous RCTs to elucidate which technique results in better clinical outcomes.
Collapse
Affiliation(s)
- João Luiz Gomes Carneiro Monteiro
- Postgraduate Student, Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade de Pernambuco, Camaragibe, Brazil.
| | - José Alcides Almeida de Arruda
- Postgraduate Student, Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Emanuel Dias de Oliveira E Silva
- Adjunct Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Universidade de Pernambuco, Camaragibe, Brazil
| | | |
Collapse
|
13
|
Liu Y, Wu JS, Tang YL, Tang YJ, Fei W, Liang XH. Multiple Treatment Meta-Analysis of Intra-Articular Injection for Temporomandibular Osteoarthritis. J Oral Maxillofac Surg 2020; 78:373.e1-373.e18. [DOI: 10.1016/j.joms.2019.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/17/2019] [Accepted: 10/16/2019] [Indexed: 01/15/2023]
|
14
|
Al-Moraissi EA, Wolford LM, Ellis E, Neff A. The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials. J Craniomaxillofac Surg 2019; 48:9-23. [PMID: 31870713 DOI: 10.1016/j.jcms.2019.10.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/07/2019] [Accepted: 10/15/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Different treatment options for patients with arthrogenous Temporomandibular Disorders (TMDs) have been reported. However, evidence regarding the most effective intervention using network meta-analysis (NMA) has not been performed. Thus, we conducted a NMA of randomized clinical trials (RCTs) to identify the most effective treatment of arthrogenous TMDs with respect to pain reduction and improved mouth opening, and to generate a ranking according to their effectiveness. MATERIAL AND METHODS An electronic search on three major databases was undertaken to identify RCTs published before August 2019, comparing up to fourteen different treatments against control/placebo patients for arthrogenous TMDs with respect to pain reduction and improved mouth opening. The treatment variables were controls/placebo, conservative treatment (muscle exercises and occlusal splint therapy), occlusal splint therapy alone, intraarticular injection (IAI) of hyaluronic acid (HA) or corticosteroid (CS), arthrocentesis with or without HA, CS and platelet-rich plasma (PRP), arthroscopy with or without HA and PRP, open joint surgery, and physiotherapy. Frequentist NMA was performed using STATA software. Studies meeting the inclusion criteria were divided according to the length of follow-up (short-term (≤5 months) and intermediate-term (≥6 months to 4 years) and type of TMJ arthrogenous disorders; internal derangement (ID) and TMJ osteoarthritis (OA). The standardized mean differences (SMD) in post-treatment pain reduction and maximum mouth opening (MMO) were analysed. RESULTS Thirty-six RCTs were identified that performed comparative outcome assessments for pain and 33 RCTs for MMO. At the short term (≤5 months), IAI-HA (SMD = -2.8, CI: -3.7 to -1.8) and IAI-CS (SMD = -2.11, CI: -2.9 to -1.2) (all very low quality evidence) achieved a substantially greater pain reduction than control/placebo. At intermediate term (≥6 months), a statistically significant decrease in posttreatment pain intensity was observed following Arthroscopy-PRP (SMD = -3.5, CI: -6.2 to -0.82), Arthrocentesis-PRP (SMD = -3.08, CI: -5.44 to -0.71), Arthroscopy-HA (SMD = -3.01, CI: -5.8 to -0.12), TMJ surgery (SMD = -3, CI: -5.7 to -0.28), IAI-HA (SMD = -2.9, CI: -4.9 to -1.09) (all very low quality evidence), Arthroscopy-alone (SMD = -2.6, CI: -5.1 to -0.07, low quality evidence) and Arthrocentesis-HA (SMD = -2.3, CI: -4.5 to -018, moderate-quality evidence) when compared to the control/placebo groups. Relative to MMO, the most effective treatments for short- and intermediate-term improvement were the arthroscopy procedures (PRP > HA > alone, all very low-quality evidence) followed by Arthrocentesis-PRP (very low-quality evidence) and Arthrocentesis-HA (moderate-quality evidence). The non-invasive procedures of occlusal splint therapy, physical therapy, conservative therapy, placebo/control provided significantly lower quality outcomes relative to pain and MMO. CONCLUSION The results of the present meta-analysis support a paradigm shift in arthrogenous TMJ disorder treatment. There is a new evidence (though on a very low to moderate quality level) that minimally invasive procedures, particularly in combination with IAI of adjuvant pharmacological agents (PRP, HA or CS), are significantly more effective than conservative treatments for both pain reduction and improvement of MMO in both short (≤5 months) and intermediate term (6 months-4 years) periods. In contrast to traditional concepts mandating exhaustion of conservative treatment options, minimally invasive procedures, therefore, deserve to be implemented as efficient first-line treatments (e.g. IAIs and/or arthrocentesis) or should be considered rather early, i.e. as soon as patients do not show a clear benefit from an initial conservative treatment.
Collapse
Affiliation(s)
- Essam Ahmed Al-Moraissi
- Dept. of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
| | - Larry M Wolford
- Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University College of Dentistry, Baylor University Medical Center, Dallas, TX, USA
| | - Edward Ellis
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Andreas Neff
- Dept. of Oral and Maxillofacial Surgery, University Hospital Marburg UKGM GmbH, Marburg, Germany
| |
Collapse
|
15
|
Ferreira N, Masterson D, Lopes de Lima R, de Souza Moura B, Oliveira AT, Kelly da Silva Fidalgo T, Carvalho ACP, DosSantos MF, Grossmann E. Efficacy of viscosupplementation with hyaluronic acid in temporomandibular disorders: A systematic review. J Craniomaxillofac Surg 2018; 46:1943-1952. [PMID: 30249483 DOI: 10.1016/j.jcms.2018.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To perform a systematic review of the viscosupplementation effectiveness with hyaluronic acid (HA) in the articular Temporomandibular Dysfunctions (TMDs) clinical management. METHOD Electronic searches were performed in the following databases: MEDLINE (via PubMed), Scopus, Web of Science, Cochrane Library, EMBASE, LILACS, BBO, SIGLE (System for Information on Grey Literature in Europe), ClinicalTrials.gov, and the Brazilian Clinical Trials Registry (ReBec). Only randomized clinical trials that evaluated the intra-articular administration of HA or its derivatives in osteoarthritis and/or anterior displacement of the temporomandibular joint (TMJ) disc were included. The primary outcomes evaluated were patients' self-report of pain and/or discomfort in the TMJ. Each study was assessed for the risk of bias, using the Cochrane collaboration's risk of bias tool. RESULTS A total of 640 studies were obtained in the electronic search. After the application of the eligibility criteria, manual search, and duplicate removal, 21 articles were included. Five articles classified their volunteers with internal derangements of the TMJ, in 4 articles the treatment was directed to participants with disc displacement with reduction and the other articles evaluated HA therapy in osteoarthritis. The protocols presented heterogeneity, varying in the form of application, associated or not with arthrocentesis, number of applications, molecular weight, dose and concentration. Nine studies presented high risk of bias. CONCLUSION Due to the heterogeneity and methodological inconsistencies of the studies evaluated, it was not possible to establish the efficacy of HA in articular TMDs.
Collapse
Affiliation(s)
- Natália Ferreira
- Programa de Pós-Graduação em Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil.
| | - Danielle Masterson
- Biblioteca do Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Brazil.
| | - Rodrigo Lopes de Lima
- Laboratório de Morfogênese Celular (LMC), Instituto de Ciências Biomédicas (ICB), Universidade Federal do Rio de Janeiro, Brazil; Departamento de Ortodontia e Odontopediatria, Universidade Federal do Rio de Janeiro, Brazil.
| | - Brenda de Souza Moura
- Programa de Pós-Graduação em Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil.
| | - Aleli T Oliveira
- Departamento de Ortodontia e Odontopediatria, Universidade Federal do Rio de Janeiro, Brazil.
| | | | - Antônio C P Carvalho
- Programa de Pós-Graduação em Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil.
| | - Marcos F DosSantos
- Programa de Pós-Graduação em Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil; Laboratório de Morfogênese Celular (LMC), Instituto de Ciências Biomédicas (ICB), Universidade Federal do Rio de Janeiro, Brazil.
| | - Eduardo Grossmann
- Departamento de Ciências Morfológicas, Universidade Federal do Rio Grande do Sul, Brazil.
| |
Collapse
|