Anterior Disc Displacement Research Articles

The Accuracy of High Resolution Ultrasound in the Diagnosis of TMJ Disc Displacement in Comparison With MRI

Abstract Background The temporomandibular joint disorders (TMD) have been a major source of pathology. Being only second to chronic low back pain as a cause of pain and disability. MRI is currently considered the gold standard method for imaging of the TMJ. USG is a non-invasive, inexpensive procedure. And can provide a potential sensitive tool for diagnosis of anterior disc displacement. Aim of the work The aim of this study is to compare between the accuracy of ultrasound and MRI in diagnosis of TMJ disc displacement. Patients and Methods This study was carried out at the Radiology Department, Ain Shams University Hospitals. Twenty one patients with clinically suspected TMJ disc displacement underwent ultrasound (US) and MRI examination. Results The overall sensitivity of the US to diagnose disc displacement compared to MRI reached (94.7%), specificity (91.3%), Positive Predictive value (90.0%), Negative Predictive Value (95%) and accuracy (92.9%). The results indicated 1.8 mm was the most accurate cut-off distance between the articular capsule and the anterior surface of the mandibular condyle for diagnosis of MR positive disc displacement.

Dextrose prolotherapy versus BOTOX injection for the management of TMJ disc displacement with reduction

Background: Temporomandibular disc displacement is a widely faced clinical condition and the management options are vast with varying difficulty and success rates. This study aims to evaluate the use of Botulinum Toxin injection and dextrose prolotherapy for such cases. Methods: 20 joints were included in this study divided into 2 groups; Group 1 receiving 25% 3mL Dextrose injection (with local anesthetic and saline solution) into the retrodiscal region while group 2 received 35 U Botulinum Toxin – Type A injection in the lateral pterygoid muscle. Pain (according to the visual analogue scale), clicking and maximal interincisal opening were assessed preoperatively and at 4 months followup. Results: The results showed no statistically significant differences between the 2 groups. The click disappeared in 7/10 joints in group 1 and 9/10 in group 2. The maximal interincisal opening was regained and slightly increased in all participants of the study. All patients reported better pain scores at the end of the followup period. Conclusions: Within the limitations of this study, we conclude that both treatment options tested are considered acceptable in the management of TMJ anterior disc displacement with reduction. Moreover, the results do not allow recommending one over the other as no statistically significant differences were found.

COL5A1 RS12722 Is Associated with Temporomandibular Joint Anterior Disc Displacement without Reduction in Polish Caucasians.

Numerous reports describe the association between the single-nucleotide polymorphism (SNP) rs12722 and rs13946 in the COL5A1 gene and injuries, such as Achilles tendon pathology, anterior cruciate ligament (ACL) injuries, and tennis elbow. Hence, there were no studies investigating COL5A1 and temporomandibular joint (TMJ) pathology. The aim of this study is to evaluate the relationship between COL5A1 rs12722 and rs13946 SNPs and TMJ articular disc displacement without reduction (ADDwoR). In this case-control study, the study group consisted of 124 Caucasian patients of both sexes. Each patient had a history of ADDwoR no more than 3 months prior. The control group comprised 126 patients with no signs of TMD according to DC/TMD. Genotyping of the selected SNPs was performed by real-time PCR using TaqMan probes. The significance of the differences in the distribution of genotypes was analyzed using Pearson’s chi-square test. Logistic regression modeling was performed to analyze the influence of the 164 investigated SNPs on ADDwoR. The COL5A1 marker rs12722 turned out to be statistically significant (p-value = 0.0119), implying that there is a difference in the frequencies of TMJ ADDwoR. The distribution of rs12722 SNPs in the study group TT(66), CC(27), CT(31) vs. control group TT(45), CC(26), CT(51) indicates that patients with CT had an almost 2.4 times higher likelihood of ADDwoR (OR = 2.41) than those with reference TT (OR = 1), while rs13946 genotypes were shown to be insignificant, with a p-value of 0.1713. The COL5A1 rs12722 polymorphism is a risk factor for ADDwoR in the Polish Caucasian population.

Regulating Fibrocartilage Stem Cells via TNF-α/Nf-κB in TMJ Osteoarthritis

In this study, we investigate harnessing fibrocartilage stem cell (FCSC) capacities by regulating tumor necrosis factor α (TNF-α) signaling for cartilage repair in temporomandibular joint osteoarthritis (TMJOA). Stem cell specifics for FCSCs were characterized in the presence of TNF-α. Etanercept as a TNF-α inhibitor and BAY 11-7082 as an Nf-κB inhibitor were used to study TNF-α regulation of FCSCs. Lineage tracing was performed in Gli1-CreERT+;Tmfl/fl mice when etanercept (1 mg/kg, every 3 d) or isometric vehicle was subcutaneously injected to trace specific changes in FCSCs. Surgically induced TMJOA Sprague-Dawley rats were generated with BAY 11-7082 (5 mg/kg, every 3 d) or vehicle subcutaneous injection to investigate the functional role of TNF-α/Nf-κB in TMJOA. Anterior disc displacement (ADD) rabbits were used to analyze the therapeutic effect of etanercept as a TMJOA intra-articular treatment with etanercept (0.02 mg in 100 μL, every 2 wk) or isometric vehicle. In vitro, TNF-α inhibited proliferation of FCSCs and increased FCSC apoptosis. TNF-α activation interfered with osteogenic and chondrogenic differentiation of FCSCs, while etanercept could partially recover FCSC specificity from TNF-α. FCSC lineage tracing in Gli1-CreERT+;Tmfl/fl mice showed that the chondrogenic capacity of Gli1+ cell lineage was markedly suppressed in osteoarthritis cartilage, the phenotype of which could be significantly rescued by etanercept. Specifically blocking the Nf-κB pathway could significantly weaken the regulatory effect of TNF-α on FCSC specificity in vitro and in TMJOA rats in vivo. Finally, intra-articular etanercept treatment efficiently rescued TMJ cartilage degeneration and growth retardation in ADD rabbits. Inhibition of TNF-α signaling reduced Nf-κB transcripts and recovered FCSC specificities. In vivo, etanercept treatment effectively rescued the osteoarthritis phenotype in TMJOA mice and ADD rabbits. These data suggest a novel therapeutic mechanism whereby TNF-α/Nf-κB inhibition promotes FCSC chondrogenic capacity for cartilage transformation in TMJOA.

Treatment of temporomandibular joint disc displacement using arthrocentesis combined with injectable platelet rich fibrin versus arthrocentesis alone

Background/purposeTemporomandibular joint disc displacement is the most frequently reported temporomandibular disorder that may severely impair quality of life and can be challenging to treat. This study aimed to evaluate and compare the efficiency of intra-articular injection of injectable platelet rich fibrin (i-PRF) following arthrocentesis or arthrocentesis alone in treatment of patients with TMJ disc displacement with reduction. Materials and methodsForty patients for a total of forty joints with reducible anterior disc displacement, as confirmed by Magnetic Resonance Imaging (MRI) were selected and divided into 2 equal groups. In group I (control group), arthrocentesis alone was performed with Ringer solution. In group II (study group), a combination of arthrocentesis and intra-articular injection with 1.5 ml i-PRF was performed. The outcome variables included pain intensity evaluated with a visual analogue scale, inter-incisal opening, lateral movement evaluated in millimeters, and clicking. Assessments were done pre-operatively, and 1 week, 3 months, and 6 months postoperatively. ResultsThere was statistically significant reduction in pain intensity and clicking sound and increase in mouth opening and lateral movement in i-PRF group when compared to arthrocentesis group. In addition, the differences between preoperative and postoperative status in all the measured parameters were statistically significant within the study and the control group throughout the postoperative period. ConclusionThe combination of i-PRF with arthrocentesis is a safe and effective method in the treatment of TMJ disc displacement with reduction.

Analysis of the correlation between chewing side preference and disc displacement types and clinical symptoms in patients with anterior disc displacement of temporomandibular joint

Objective: To analyze the clinical symptoms and types of disc displacement of patients with anterior disc displacement (ADD) of temporomandibular joint (TMJ) and to explore the correlation between chewing side preference (CSP) and the clinical symptoms and types of disc displacement of ADD patients. Methods: This was a cross-sectional study of the ADD patients diagnosed by clinical symptoms and MRI findings of TMJ in the Department of Stomatology, General Hospital of Chinese PLA from January 2018 to December 2019. A total of 111 ADD patients [33 males and 78 females, aged(31.0±10.9) years old] were included. The patients were divided into two groups according to whether they had CSP: non-CSP group (n=40) and CSP group (n=71). The clinical symptoms and types of ADD were observed and recorded. According to the specific side of CSP in the CSP group, the patients were further divided into the ipsilateral side and the contralateral side of CSP. The pain, TMJ sounds and the ADD types were also observed. Chi square test was used to compare the pain, TMJ sounds, limited mouth opening and ADD types of the two groups. Binary Logistic regression model was used to analyze the correlation between CSP and clinical symptoms and ADD characteristics. Results: The incidence of pain in the CSP group [89% (63/71)] was significantly higher than that in the non-CSP group [70% (28/40)] (P<0.05). In CSP patients, the incidences of pain and joint sounds on the ipsilateral side of CSP were significantly higher than that on the contralateral side (P<0.05). MRI showed that the incidence of bilateral ADD in the CSP group [58%(41/71)] was significantly higher than that in the non-CSP group [37%(15/40)] (P<0.05).There were significant differences in the incidences of no disc displacement (DD), anterior disk displacement with reduction(ADDwR) and anterior disk displacement without reduction (ADDwoR) between ipsilateral and contralateral joints of the CSP patients (P<0.05). There were no significant differences in the incidences of no DD, ADDwR and ADDwoR between left and right joints of the non-CSP patients (P>0.05). The incidence of ADDwoR in ipsilateral side of the CSP patients was significantly higher than that in contralateral side (P<0.05). Pain (OR=3.375) and the side of disc displacement (OR=2.278) in patients with ADD were positively correlated with CSP (P<0.05). Conclusions: The clinical symptoms and types of disc displacement between patients with and without CSP were significantly different. The incidences of pain and bilateral disc displacement in the CSP group were significantly higher than those in the non-CSP group. In addition, the incidences of pain, TMJ sounds and anterior disk displacement without reduction on the ipsilateral side of patients with CSP were significantly higher than those on the contralateral side. The pain symptoms and side of disc displacement were positively related to CSP.

Automatic segmentation of the temporomandibular joint disc on magnetic resonance images using a deep learning technique.

The aims of the present study were to construct a deep learning model for automatic segmentation of the temporomandibular joint (TMJ) disc on magnetic resonance (MR) images, and to evaluate the performances using the internal and external test data. In total, 1200 MR images of closed and open mouth positions in patients with temporomandibular disorder (TMD) were collected from two hospitals (Hospitals A and B). The training and validation data comprised 1000 images from Hospital A, which were used to create a segmentation model. The performance was evaluated using 200 images from Hospital A (internal validity test) and 200 images from Hospital B (external validity test). Although the analysis of performance determined with data from Hospital B showed low recall (sensitivity), compared with the performance determined with data from Hospital A, both performances were above 80%. Precision (positive predictive value) was lower when test data from Hospital A were used for the position of anterior disc displacement. According to the intra-articular TMD classification, the proportions of accurately assigned TMJs were higher when using images from Hospital A than when using images from Hospital B. The segmentation deep learning model created in this study may be useful for identifying disc positions on MR images.

A comparative study of the effects of the anterior disc displacement with reduction and without reduction on the components of the temporomandibular joint by using magnetic resonance imaging – A Retrospective study

Background: Internal derangement of the temporomandibular joint (TMJ) results in anterior disc displacement with reduction (ADDR), the disc is ante- riorly displaced in the closed position whereas in the opened position the disc returns to its normal location. In anterior disc displacement without reduction (AD- DWR), the disc is anteriorly displaced in the closed po- sition but does not return to its original location in the opened position. Here we studied and compared the effects of the ADDR and the ADDWR on the components of the TMJ by using the magnetic resonance imaging technique (MRI). Methods and materials: From the archival MRI records, 214 joints from 107 patients were included. The selec- tion criteria for the patients complaints as TMJ pain, clicking, limited mouth opening, headache, jaw tenderness and difficulty in eating. MRI records with sequences Proton Density (PD), PD FAT SAT and T2* gradient in the closed position and T2* gradient echo in the opened position. Data analysis and frequency distribution of explanatory variables by disc position in the open state was performed using chi-square test Results: Statistically significant differences were observed between the variables such as the joint space (closed position), disc morphology (closed position) and range of movement (opened position) among the ADDR and the ADDWR. In ADDWR, 20.3% demonstrated narrowed joint space and 1.6% with widened joint space, while in ADDR, 2.5% of joints had narrowed joint space and 0% widened joint space. Same was observed with abnormal disc morphology and rang of movement. Conclusion: The disc deformity is more in ADDWR compared to ADDR which can be seen as an alteration in the signal intensity. The malaligned disc could lead to the narrowing of the joint space and decreased range of movement in the ADDWR affected individuals.

Association between Condylar Bone Density and Disk Displacement in the Temporomandibular Joint

Measuring bone density (BD) is a common method of determining bone quality; however, the relationship between condylar BD and the occurrence of temporomandibular joint (TMJ) disorders has not been investigated. To address this knowledge gap, we aimed to investigate condylar BD in terms of TMJ disk displacement (TMJ DD) using computed tomography (CT) and magnetic resonance imaging (MRI). We classified TMJ MRI results according to the position of the disk: normal disk position (Normal), anterior disk displacement with reduction (ADDR), and anterior disk displacement without reduction (ADDNR). After retrospectively evaluating 86 female condyles, we determined the total, cortical, and trabecular BD in the upper-joint portion of the condyle and the whole condyle using CT data. To standardize condylar BD, we calculated the BD ratios by dividing the condylar BD by the cervical axis BD. The Kruskal-Wallis test analyzed the differences in BD measurements in the TMJ DD patient groups and showed significant between-group differences in condylar BD. The total and trabecular BD was significantly higher in ADDNR condyles than in Normal or ADDR condyles (Normal = ADDR < ADDNR). However, there was no significant difference in the cortical BD among the three TMJ DD groups. The BD ratios showed a similar tendency with condylar BD. These results suggest that increased condylar BD – specifically total and trabecular BD – may be significantly associated with ADDNR condyles. Our findings will help clinicians determine the course of treatment for patients with disk-related TMJ disorders.

Assessing Evaluating and Correlating the Clinical Findings of Temporomandibular Joint Pathology with Orthopantomogram and Magnetic Resonance Imaging – A Cross-Sectional Study

Background: Because of the anatomic complexity of the temporomandibular joint (TMJ) clinician cannot arrive at the accurate diagnosis only by clinical evaluation of TMJ hence would require some special imaging methods and techniques which would facilitate the accurate clinical diagnosis. One such imaging method is orthopantomography (OPG) of TMJ. Even though OPG has various limitations, it provides valuable information of TMJ and seems to be the primary choice of imaging modality for the diagnosis of TMJ pathologies. Magnetic Resonance Imaging (MRI) is considered to be the one of the best imaging technology to assess the soft tissue structures surrounding the TMJ and evolved as the best imaging modality for the diagnosis of disc displacement of TMJ. Aim: The aim of the study is to evaluate the clinical findings of the TMJ pathologies and to compare the findings of the OPG and MRI of the TMJ pathologies. Methodology: This is a cross-sectional observational study with comprised of multi-ethnic groups, selected from amongst those attending our dental c. Fifty subjects reporting to the Department of Oral Medicine and Radiology with TMJ pathologies were selected. Radiological bone changes were evaluated for flattening (flat bony contour deviating from normal convex form) and erosion (area of decreased density of cortical bone and adjacent subcortical bone) by OPG. After that, MRI of TMJ been taken and changes in the disk position was recorded with the help of radiologist. Statistical Analysis: Statistical presentation and analysis of the present study were done using the p value and Chi-square test by SPSSV20. Results: Result obtained from our study showed that pain was present in 28 (56%) patients and only 44% patients having chief complain other than pain such as noise in front of ear while mastication or restricted mouth opening [Table 1] Out of 28 patients with a chief complain of pain, 22 patients (78.57%) were having abnormal/flattened condylar head surface but out of 22 patients with a chief complain other than pain 18 patients (81.82%) were having abnormal/flattened condylar head surface [Table 2]. Out of 28 patients with a chief complain of pain, 18 patients (64.28%) were with an shortened condylar neck and also out of 22 patients with a chief complain other than pain 16 patients (72.72%) were having shortened condylar neck. The result showed statistically non-significant (P &gt; O.05) [Table 3]. Results also showed that 40% patients with Anterior Disc Displacement With Reduction (ADDR) and 50% with Anterior disc displacement without reduction (ADDWR) had abnormal condylar head surface [Table 4]. About 47.05% patients with ADDR and 41.17% with ADDWR had abnormal condylar neck [Table 5]. Even though there was a positive correlation between the OPG and MRI findings of the TMJ pathologies with the clinical findings of TMJ pathologies, result was not statistically significant which might be due to the reduced sample size. Conclusion: Based on the observation, it can be concluded that OPG and MRI provide valuable information regarding the temporomandibular disorders (TMD) and can play a key role in arriving at accurate clinical diagnosis of complex TMJ pathologies. It also makes the clinical diagnosis easy by correlating the clinical findings of the TMD with this imaging modality and helps clinician to arrive at the proper diagnosis and treatment plan at the earliest. This type of studies should be done on large scale in future based on specific parameters for early diagnosis and treatment planning for patients suffering with TMD to provide quality treatment to the patients at initial stage.

Occlusal Splints versus Ultrasound therapy in management of Anterior Disc Displacement with Reduction. A Randomized clinical trial.

Purpose: To compare the effect of Stabilization Splint (SS), Anterior repositioning splint (ARS), and Ultrasound (US) therapy in improving pain, limited mouth opening and clicking in patients with Anterior Disc Displacement with Reduction (ADDwR). Materials and Methods: 30 subjects were enrolled in this randomized clinical trial. Participants were randomly allocated into one of the three study groups of 10 patients each; Group I received a SS, Group II received ARS and Group III were treated with US. All the patients were recalled at baseline (before treatment), 1m, 3m and 6m follow-up periods to evaluate pain, maximum mouth opening (MMO) and clicking. Pain level was evaluated using Visual Analogue Score (VAS). MMO was measured in mm. as the distance between maxillary and mandibular incisors. Detection of TMJ sounds was performed on opening or closing and was recorded. Results: There was a significant decrease in the pain scores in the three groups with P Conclusion:The use of occlusal splints in the management of painful ADDwR is a successful mode of treatment and helps in decreasing pain, improving MMO and clicking yet, is better to be used in combination with other treatment modalities.

Splint Therapy for treatment of Anterior Disc Displacement with reduction

The aim of the study is to assess the efficacy of the Lingual Ring Splint (LS), anterior repositioning splint (ARS) and stabilizing splint (SS) in management of anterior disc displacement with reduction (DDWR) for the relief of pain and improving mandibular movements. Thirty patients diagnosed with DDWR were included in this study. The participants were randomly assigned into one of three equal groups using a computer-generated randomization schedule receiving the assigned splint for each group, with specific instructions regarding the time of using it and exercises. Follow up was made after 1 and 6 months to test pain score and mandibular range of motion. Pain score improved in all 3 groups with statistical significance with better results is SS group than other two splints. Also, there was an increase in maximum mouth opening (MMO) with the highest measurements in SS group with statistical significance difference. There was no statistical difference regarding lateral excursion between all groups.

In-house tooth-supported guide for the injection of botulinum toxin into the lateral pterygoid muscle using Blue Sky Plan software: A technical note

Hyperactivity of the lateral pterygoid muscle (LPM) is one of the theories postulated to explain anterior disc displacement, which can result in difficulty in jaw opening, jaw protrusion, or jaw-deviation dystonias and interferes with mastication, speech, and swallowing. Injection of botulinum toxin of the LPM is considered a conservative therapeutic modality for this condition.The LPM is a deep facial structure and several techniques have been described that use magnetic resonance imaging, arthroscopic, or electromyographic guidance to perform intramuscular botulinum toxin injection safely this to prevent incorrect injection or complications, such arterial bleeding. This study provided a described step-by-step description of the computer-aided design and manufacturing procedure for the fabrication of an in-house guide to simplify the method of botulinum toxin injection in the LPM and ensure accuracy and safety in medical office.

The temporomandibular joints disorders in patients with osteoporosis.

Background:Osteoporosis is a skeletal and progressive behavioral disease with physically and psychologically significant consequences.Aims of the Study:Evaluate the presence and effects of Temporomandibular Joints Disorders in osteoporotic patients.Materials and Methods:Fifty-eight (58) patients with osteoporosis participated in this study as they were already diagnosed by Rheumatologists, physical and sport Rehabilitation physicians in Merjan Medical city/Babylon – Iraq between period February and August 2019.Results:Twenty-seven (27) patients with T. M. J clicking as anterior disk displacements, Seventeen (17) patients with spasm in muscles of mastication, and then finally Fourteen (14) out of 58 patients with subluxation and dislocation.Conclusions:Osteoporosis can have a significant impact on oral health.

Determining the optimal magnetic resonance imaging sequences for the efficient diagnosis of temporomandibular joint disorders.

To compare and analyze nine MRI sequences of the TMJ and determine the optimum sequence for the rapid diagnosis of TMDs so as to develop new clinical guidelines. Twenty young volunteers (a total of 40 joints) aged 22-26 years were recruited. Three basic sequences, T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and proton density-weighted imaging (PDWI), together with three positions, oblique sagittal (OSag) with closed mouth, oblique coronal (OCor) with closed mouth, and OSag with opened mouth, were selected in combination for testing. In the OCor position, four regions of interest (ROIs), the condyle (C), the disc (D), the disc outside (DO), and fat (F), were analyzed. For the OSag with closed mouth position and the OSag with opened mouth position sequences, the four ROIs were the condyle (C), the disc (D), the disc ahead (DA), and the disc rear (DR). The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and signal intensity ratio (SIR) were calculated and analyzed using independent sample t-tests and one-way analysis of variance. Two senior radiologists scored the images of the nine MRI sequences subjectively and selected three optimal sequences. Using the three selected sequences, 1479 patients with anterior disc displacement with reduction (ADDwR) or anterior disk displacement without reduction (ADDwoR) were evaluated by comparing the preoperative TMJ MRI with the outcomes of the maxillofacial arthroscopy or open surgery. The T1WI sequence showed the highest SNR while the T2WI group had the lowest SNR. The ROIs of the T2WI group had the highest CNR and SIR values in the OCor and OSag sequences. In the OCor sequence, the value for the SIR F/DO group was higher than the SIR C/D and SIR C/DO values. Using subjective analysis to evaluate the quality of the scans, the highest total scores were obtained for the OSag T2WI with opened mouth and OSag PDWI with closed mouth sequences. From the objective and subjective analysis, the three optimal sequences selected were OSag PDWI, OCor T2WI with closed mouth, and OSag T2WI with opened mouth. In patients with anterior disc displacement, the comparisons of the surgery and the selected MRI sequences indicated that the total diagnostic accuracy of the MRI was 96.3% (1,425/1,479 cases). For patients with ADDwoR, the diagnostic accuracy was 98.5% (1,372/1,393 cases), and for those with ADDwR it was 61.6% (53/86 cases). There were significant differences between the ADDwoR and ADDwR groups (χ2=312.92, P<0.01). The three optimal MRI sequences for the rapid and efficient diagnosis of TMD were determined to be OSag PDWI, OCor T2WI with closed mouth, and OSag T2WI with opened mouth.

Three-dimensional morphological changes in the temporomandibular joints of patients with anterior disc displacement with reduction

To investigate the differences in the temporomandibular joints (TMJs) between patients with anterior disc displacement with reduction (ADDwR) and asymptomatic subjects by using 3D morphometric measurements. A total of 15 patients with ADDwR and 10 asymptomatic subjects were enrolled. Then, 3D models of the maxilla and mandible were reconstructed using MIMICS 20.0. Nine morphologic parameters of TMJs on both sides were measured on the 3D solid model. The differences in the parameters were analyzed between the patients and the asymptomatic subjects and between the left and right sides of each group. The horizontal and coronal condylar angles on the ipsilateral side of the patients were significantly greater than those of the asymptomatic subjects (P<0.01). Meanwhile, the sagittal ramus angle (SRA), medial joint space, lateral joint space, superior joint space, anterior joint space, and posterior joint space in the patients were significantly lower than those in the asymptomatic subjects (P<0.01). ADDwR will increase the condylar angles to be significantly greater than the normal level and decrease SRA and articular spaces to be significantly smaller than the normal level. The condyles will be displaced upward, closer to the fossa.

Clinical outcomes in TMD patients after arthrocentesis with lysis, lavage and viscossuplementation

Introduction Temporomandibular disorders (TMD) affect a considerable part of the population [1]. Its most prominent symptoms are restricted joint function with limited maximum mouth opening (MMO), pain and headache, with an important impact on Quality of Life [2,3]. The aim of this study is to evaluate the effect of Arthrocentesis with Lysis, Lavage and Viscosupplementation (ALLV) with hyaluronic acid in the treatment of pain related to TMJ internal derangements. Materials and methods Thirty patients diagnosed with internal derangement of the temporomandibular joint through magnetic resonance imaging were submitted to ALLV, after 6 months of ineffective conservative treatment. A classic, single session, two-needle technique arthrocentesis was performed in all cases, encompassing the injection of 200–300 mL of Ringer lactate solution to the superior joint compartment for lysis and lavage, followed by intra-articular injection of 1 mL of hyaluronic acid for viscossuplementation [4,5]. Patients were prescribed a simple program of physical exercises to be repeated daily at home for one month. Evaluation was carried pre-operatively on the day of surgery and post-operatively at 1 week, 1 month, 3 months, 6 months and 12 months after the procedure. Evaluated clinical parameters included: pain (at rest and in function) – Visual Analogic Scale (VAS); maximum mouth opening (MMO) – millimetres (mm); mastication efficiency – VAS. Overall tolerability of the procedure (Likert scale: 0–4) was evaluated at 1-week post-operative time. Data was collected between September 2016 and May 2019. Statistical significance was set at p < .05. Paired t-tests were used to compare pre- and post-operative pain, MMO and mastication efficiency. Statistical procedures were performed using IBM® SPSS® Statistics – Version 24 and Microsoft® Excel for Mac – Version 16.15. Results Twenty-six of the selected patients were women and mean age was 38.86 ± 17.5 years old. In all cases a single side TMJ was treated − 14 left and 16 right. MRI had shown anterior disc displacement (ADD) with complete reduction on opening in 15 patients, without reduction in 9 and with partial reduction in 6. Results show an improvement in pain, both at rest and in function, MMO and mastication efficiency at a statistically significant level, up to 12 months post-operative. The procedure was considered well tolerated (mean Likert: 3.15 ± 1.13) and no adverse events were reported. Discussion and conclusions: ALLV is a safe, well tolerated and cost-effective minimally invasive procedure, which proves to reduce pain and functional impairment up to 12 months post-operative, with little or no complications [6,7].

Effectiveness of Occlusal Splints with Low-Level Laser Therapy on Anterior Disc Displacement of The Temporomandibular Joint

Effectiveness of Occlusal Splints with Low-Level Laser Therapy on Anterior Disc Displacement of The Temporomandibular Joint

MRI-Based Assessment of Masticatory Muscle Changes in TMD Patients after Whiplash Injury.

Objective: to investigate the change in volume and signal in the masticatory muscles and temporomandibular joint (TMJ) of patients with temporomandibular disorder (TMD) after whiplash injury, based on magnetic resonance imaging (MRI), and to correlate them with other clinical parameters. Methods: ninety patients (64 women, 26 men; mean age: 39.36 ± 15.40 years), including 45 patients with symptoms of TMD after whiplash injury (wTMD), and 45 age- and sex-matched controls with TMD due to idiopathic causes (iTMD) were included. TMD was diagnosed using the study diagnostic criteria for TMD Axis I, and MRI findings of the TMJ and masticatory muscles were investigated. To evaluate the severity of TMD pain and muscle tenderness, we used a visual analog scale (VAS), palpation index (PI), and neck PI. Results: TMD indexes, including VAS, PI, and neck PI were significantly higher in the wTMD group. In the wTMD group, muscle tenderness was highest in the masseter muscle (71.1%), and muscle tenderness in the temporalis (60.0%), lateral pterygoid muscle (LPM) (22.2%), and medial pterygoid muscle (15.6%) was significantly more frequent than that in the iTMD group (all p < 0.05). The most noticeable structural changes in the masticatory muscles occurred in the LPM with whiplash injury. Volume (57.8% vs. 17.8%) and signal changes (42.2% vs. 15.6%) of LPM were significantly more frequent in the wTMD group than in the iTMD group. The presence of signal changes in the LPM was positively correlated with the increased VAS scores only in the wTMD group (r = 0.346, p = 0.020). The prevalence of anterior disc displacement without reduction (ADDWoR) (53.3% vs. 28.9%) and disc deformity (57.8% vs. 40.0%) were significantly higher in the wTMD group (p < 0.05). The presence of headache, sleep problems, and psychological distress was significantly higher in the wTMD group than in the iTMD group. Conclusion: abnormal MRI findings and their correlations with clinical characteristics of the wTMD group were different from those of the iTMD group. The underlying pathophysiology may differ depending on the cause of TMD, raising the need for a treatment strategy accordingly.

Management of Internal Derangement of Temporomandibular Joint Disc Displacement with Reduction Using Two Different Lines of Treatment

Objetive: This study was to compare the effectiveness of arthrocentesis versus the insertion of anterior repositioning splint (ARS) in improving the mandibular range of motion (MRM) for patients with the temporomandibular joint (TMJ) anterior disc displacement with reduction (ADDwR). Methods: 36 patients diagnosed as ADDwR were recruited and divided randomly into two groups. The first group (G1) was treated by arthrocentesis, and the second (G2) was treated using ARS. All patients were reexamined after six months. Results: Except that for protrusive movement, there were significant differences between the two groups for the percentage changes of the MRM as measured by the amount of pain free opening, unassisted opening, maximum assisted opening, right lateral and left lateral movements (p &lt; 0.05). Conclusion: Within the context of the current study, the non-invasive, lower cost ARS, provided better results in improving the MRM when managing ADDwR cases. Keywords Arthrocentesis; Anterior repositioning splint; TMD; Internal derangement; Anterior disc displacement; Mandibular range of motion.