Conservative therapy versus arthrocentesis for the treatment of symptomatic disk displacement without reduction: a prospective randomized controlled study

Abstract

Disk displacement without reduction (DDwoR) results in pain and limited mouth opening, with negative impact on daily function. Noninvasive interventions are the standard primary treatment for DDwoR. This study compared the clinical outcomes from noninvasive (conservative) and minimally invasive (arthrocentesis) treatments in patients with DDwoR. Twenty-four patients with clinically diagnosed symptomatic closed lock were randomized to noninvasive (information, self-exercise, occlusal splints) intervention group and a minimally invasive (information, arthrocentesis with lavage, manipulation, postoperative self-exercise) intervention group. Maximal mouth opening (MMO) and pain (visual analogue scale [VAS]) were measured at baseline and at 3, 6, and 12 months after treatment. Both groups showed a successful outcome after 1 year. In the noninvasive group, the (mean ± SD) MMO value was 46.3 ± 7.2 mm, and the VAS score was 11 ± 17.1 in; and in the minimally invasive group, the MMO value was 42.7 ± 6.1 mm, and the VAS score was 10 ± 6.3. There were no significant differences between the 2 groups. Interestingly, a subgroup of patients who recovered spontaneously before treatment start had significantly higher MMO values at baseline (P = .028). Outcomes with the 2 interventions (noninvasive and minimally invasive) are similar, and patients with a higher baseline MMO are more likely to experience spontaneous recovery.