Abstract
Disk displacement without reduction (DDwoR) is one of the most common temporomandibular joint disorders (TMDs); it can manifest itself in joint pain and limited mouth opening. Nowadays, many arthrocentesis techniques are used with no consensus on which technique is optimal. The aim of this study was to investigate the efficacy of 3 techniques in the treatment of TMD known as DDwoR and to compare them in order to determine whether one is superior to the others. A prospective study was conducted between May 2015 and June 2018. The sample consisted of 30 adult patients (6 males and 24 females; mean age: 38.87 ±6.40 years) with DDWoR, confirmed with magnetic resonance imaging (MRI). The patients were randomly divided into 3 groups according to the treatment technique applied: arthrocentesis only (control); arthrocentesis plus hyaluronic acid (HA); and arthrocentesis plus platelet-rich plasma (PRP). The maximum mouth opening (MMO) as well as pain intensity and masticatory efficiency on a visual analog scale (VAS) were measured at the time of diagnosis (baseline) and at 1-month, 3-month, 6-month, and 9-month follow-up appointments. The significance level was set at 0.05 for all statistical tests. The 3 techniques resulted in significant improvement in MMO and all VAS parameters. The one-way analysis of variance (ANOVA) revealed significant differences (p < 0.05) in the variables between the 3 groups. The increase in MMO in the PRP and HA groups was significantly greater than in the case of the control group, whereas no significant difference was found between the PRP and HA groups. The pain intensity and masticatory efficiency results were significantly better in the PRP group than in the HA group or the control group; at the same time, no significant differences were noted between the HA group and the control group. Despite the fact that patients benefited from all of the 3 techniques, arthrocentesis plus PRP appeared to be superior to arthrocentesis plus HA or arthrocentesis alone.
Highlights
Disc displacement without reduction (DDwoR) accounts for 35.7% of temporomandibular joint disorders (TMDs).[1]
The pain intensity and masticatory efficiency results were significantly better in the platelet-rich plasma (PRP) group than in the hyaluronic acid (HA) group or the control group; at the same time, no significant differences were noted between the HA group and the control group
From a descriptive point of view, it was evident that the mean values of maximum mouth opening (MMO), pain intensity and masticatory efficiency increased during the 9 months of follow-up for each of the 3 arthrocentesis techniques (Table 2)
Summary
Disc displacement without reduction (DDwoR) accounts for 35.7% of temporomandibular joint disorders (TMDs).[1] The articular disc is displaced relative to the condyle when the mouth is open or closed, and the symptoms include severe pain in the temporomandibular joint (TMJ), limitation of mouth opening and, in unilateral displacements, deviation of the mandible to the painful side.[2]. The pathogenesis of this temporomandibular joint dysfunction has pointed to biochemical factors, separate from the disc displacement theory.[3] For example, inflammatory reactions that occur in TMJ are essential for the development and progression of the disease, including high levels of inflammatory mediators in the synovial fluid, such as interleukin 1 beta (IL-1β), tumor necrosis factor alpha (TNF-α) and others. Many arthrocentesis techniques are used with no consensus on which technique is optimal
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