Disc Displacement Without Reduction Research Articles

Comparison of intraarticular injection of platelet-rich plasma following arthrocentesis, with sodium hyaluronate and conventional arthrocentesis for management of internal derangement of temporomandibular joint

Aim:The aim of the study is to compare the efficacy of platelet-rich plasma (PRP) for the management of internal derangement of temporomandibular joint (TMJ).Settings and Design:Thirty-three patients were selected from the pool of patients visiting the department of oral and maxillofacial surgery. Simple randomization was done.Subjects and Methods:Patients with anterior disc displacement without reduction (DDWOR) were indicated for arthrocentesis. Group A patients are treated with PRP, Group B patients with sodium hyaluronate following arthrocentesis, and Group C patients were treated with arthrocentesis alone. Postoperative pain and maximal incisal opening are the primary outcomes evaluated.Statistical Analysis Used:The collected data were analyzed with IBM. SPSS statistics software 23.0 version and the one-way ANOVA with Tukey's post hoc test were used.Results:The mean age is 33 years, with female predominance. The statistical significant differences (P < 0.05) in pain and MIO between the 3 groups at the end of 3rdweek, 4thweek, and 3rd month postoperatively are seen in PRP group comparative to other groups.Conclusions:Our study has concluded that the intraarticular injection of PRP is an effective management for anterior DDWOR of TMJ than intraarticular injection of sodium hyaluronate and arthrocentesis in, reducing the pain and improving the interincisal distance in patients with DDWOR, thus providing a rapid recovery and improved quality of life.

Condyle bone destruction: the association between temporomandibular joint vibration and finite element analysis.

The objective of the study is to investigate the stress distributions of condyle and articular disc at different mandibular plane angles and the association between the temporomandibular joint (TMJ) vibration and anatomical relationship. Data from 195 untreated patients were analyzed. Patients were, respectively, divided into 3 groups, based on cone-beam computed tomography (CBCT): Group 0 presenting normal condyles, Group 1 presenting mild bone change, and Group 2 presenting severe bone change; based on magnetic resonance imaging (MRI): normal disc position (N), disc displacement with reduction (DDR) and disc displacement without reduction (DDNR); based on the mandibular plane angle: low, normal and high. (1) According to peak frequency, average amplitude, and occurrence phase, association was assessed between TMJ condition and TMJ vibration; (2) A three-dimensional finite element model of masticatory system was established and the relationship between mandibular plane angle and condyle bone destruction was described. The average amplitude of TMJ vibration negatively correlated with pathological condition of the articular disc (p < 0.01). The angle of SN-MP was strongly relevant to bone destruction of condyle (p < 0.01), and the biomechanical analysis showed that with the increase of SN-MP angle, the area of stress concentration in the posterior slope of condyle rose. The average amplitude of TMJ vibration decreased with the pathological position state of articular disc, and condyle bone destruction was positively associated with SN-MP angle.

Positional and dimensional TMJ characteristics in different temporomandibular disorders: A cross-sectional comparative study

ABSTRACT Objective To investigate the morphological and positional temporomandibular joint (TMJ) characteristics of different temporomandibular disorders (TMDs). Methods One hundred forty-three TMD patients were divided into three groups: Group 1: Myalgia (M), Group 2: Disc displacement with reduction (DDWR), and Group 3: Disc displacement without reduction (DDWOR). Three-dimensional positional and dimensional parameters of the TMJ, including mandibular fossa, condyle, and TMJ spaces were evaluated using cone beam computed tomography (CBCT). The significance level was p < 0.05. Results Mandibular condyles were significantly positioned in more vertical, posterior, and medial directions, with the reduced condylar width in the DD groups (p < 0.001). Anterior joint space was significantly higher in the DDWR group than the myalgia group; the superior joint spaces were more reduced in DD groups than the myalgia group. Conclusion Patients diagnosed with disc displacement showed significantly different condylar positions and joint spaces compared to the myalgia group in a skeletally comparable sample.

RECIPROCAL CLICKING LOCATION ANALYSIS IN THE INTRAARTICULAR TEMPOROMANDIBULAR DISORDERS AFTER AXIOGRAPHY INVESTIGATION.

The aim: To investigate the peculiarities of hinge axis trajectories in patients with condyle-disc complex intraarticular Temporomandibular Disorders (TMD) and determine the average coordinates of the reciprocal clicking location by axiography. Materials and methods: The results of axiographic examination of 151 patients (108 females and 43 males) with TMD confirmed by MRI were analyzed. This population included 44 persons with disc displacement with reduction (DDR), 45 persons with disc displacement with reduction and intermittent locking (DDRI), 62 persons with disc displacement without reduction (DDWR). Axiographic examination was carried out using CADIAX diagnostic device. Analysis of hinge axis movements was performed and the coordinates of articular disc reduction were determined. Results: The quality of hinge axis trajectories in persons with DDR, DDRI was defined mainly as average and in patients with DDWR as poor. Quantitative indicators of trajectories during protrusion-retrusion movements were not beyond the average level. The length of the mouth opening-closing trajectory in patients with DDRI and DDWR has shown a tendency to decrease. We found that on average the reciprocal closing clicking (disc reduction) occurs at a distance of 0-1.4 mm on the X-axis, 0.1-2.9 mm on the Z-axis, and 0-0.85 mm on the Y-axis. Conclusions: The obtained wide range of reciprocal clicking location parameters indicates the priority of a personalized approach when planning preliminary treatment in order to restore the disc-condylar complex of TMJ.

Is single puncture arthrocentesis superior to double puncture arthrocentesis in TMJ disc displacement without reduction?

Purpose: The aim of the study was to compare the effectiveness of single puncture arthrocentesis type-1 (SPA Type-1) and double puncture arthrocentesis (DPA) in patients with disc displacement without reduction (DDwoR) of the temporomandibular joint (TMJ). Materials and Methods: This randomized prospective study included 36 consecutive patients who had TMJ arthrocentesis either with DPA or SPA Type-1. Several outcome parameters, such as pain on function, maximum mouth opening, and chewing efficiency were recorded at baseline and multiple follow-up assessments. Additionally, treatment tolerability, easiness and duration of the procedures and analgesics required postoperatively were also evaluated. The difference between the groups at each time point and percentages of sixth month-baseline changes were determined by the Mann-Whitney U test. Wilcoxon test was used for intra-group evaluation of variables according to baseline. Statistical significance level was accepted as p <0.05. Results: The rates of improvement of the outcome variables were not significantly different between the two groups (𝑝>0.05). However, the duration of the DPA technique was significantly shorter than the SPA Type-1 (p˂0.0001). The ease of the procedure was statistically significantly higher in SPA Type-1 (p<0.001). Treatment tolerability was statistically higher in DPA than SPA Type-1 in one day and one-week period however was similar in the one-month period. Conclusion: Both SPA Type-1 and DPA techniques are similarly effective in DDwoR. SPA Type-1 may be considered the first treatment modality in DDwoR due to its advantages over DPA as low morbidity and easiness.

A retrospective study of oral pathoses in Israeli military divers and non-divers: 2011-2020.

Self-contained underwater breathing apparatus (SCUBA) diving has grown tremendously as a recreational sport over the past decade. The pain divers experience due to barometric changes is referred to as barodontalgia, and it is known to cause various oral pathoses. Furthermore, divers suffer more frequently from temporomandibular disorders than non-divers. The aim of the study was to characterize oral pathoses between military divers and military non-divers. Data from the dental files of healthy Israel Defense Forces (IDF) soldiers aged 18-40years were collected retrospectively for the years 2011-2020. The data for subjects exposed to diving were compared to commando and special forces soldiers. The study population was composed of 6398 soldiers, which included 1036 divers and 5362non-divers. All participants were male, with a median age of22years (mean=22.1 years). Overall, higher rates of faulty dental restorations were seen among divers than non-divers (9.3% vs. 6.7% p=.006). Temporomandibular disorders were more prevalent among divers, specifically Disc Displacement Without Reduction (DDWOR) (0.4% vs. 0.1% p=.003). While dental fractures showed no significant difference between divers and non-divers (3.8% vs. 3.5% p=0.8), other oral injuries were nine times more prevalent among divers versus non-divers. Military divers are, overall, at a higher risk of oral pathoses than non-divers. This may be related to the characteristics and intensity of their military service.

Pre-surgical radiographic and clinical features as predictors for temporomandibular joint discectomy prognosis.

This study aimed to identify potential clinical and radiological predictors associated with the outcome of discectomies. In this retrospective observational study, the material comprised preoperative CBCT images and medical records of 62 patients with disc derangement disorders, who had undergone discectomy because of disc displacement with reduction (DDwR), disc displacement without reduction (DDwoR), systemic arthritis (SA), or joint hypermobility. Clinical and radiographic variables were analysed in relation to success rate determined by subjective, objective and combined outcomes. The success odds ratio was 11 times higher in patients with painful DDwR versus that of SA (p=0.03), and even 25.9 times higher when considering solely objective outcome (p=0.03). In the absence of subchondral pseudocyst, there were 5.2 times higher odds to have a successful subjective outcome (p=0.04). Extensive bone apposition on the temporal joint component indicated a 9.3 times higher likelihood of a failed objective outcome (p=0.04). There is a significant higher risk for combined outcome failure for the diagnosis SA involving the TMJ compared with DDwR. Predictors of importance based on CBCT findings related to the objective outcome failure were extensive bone apposition on the temporal joint component and condylar subchondral pseudocysts for the subjective outcome failure.

COL12A1 Single Nucleotide Polymorphisms rs240736 and rs970547 Are Not Associated with Temporomandibular Joint Disc Displacement without Reduction.

Temporomandibular disorders (TMDs) may affect up to 25% of the population, with almost 70% of these TMD cases developing malpositioning of the disc over time in what is known as internal derangement (ID). Despite significant efforts, the molecular mechanism underlying disease progression is not yet very well known. In this study, the role of COL12A1 rs970547 and rs240736 polymorphisms as potential genetic factors regulating ID was investigated. The study included 124 Caucasian patients of both sexes after disc displacement without reduction (DDwoR) in either one or two temporomandibular joints (TMJs), either of which meet the criteria for this condition. All patients underwent clinical examination and 3D digital imaging. The COL12A1 rs970547 and rs240736 polymorphisms were evaluated. There were no statistically significant differences in the chi-square test between the study group and healthy controls. The examined COL12A1 rs240736 and rs970547 polymorphisms do not contribute to DDwoR in Polish Caucasians.

Analysis of three-dimensional imaging findings and clinical symptoms in patients with temporomandibular joint disorders.

The purpose of this study was to analyze cone-beam computed tomography (CBCT) and magnetic resonance imaging (MRI) findings in temporomandibular joint disorder (TMD) patients and to comprehensively assess the relationships between these imaging findings and clinical symptoms. A total of 754 temporomandibular joints (TMJs) in 377 patients with clinical symptoms of TMD who underwent both CBCT and MRI examinations were retrospectively reviewed. Clinical symptoms included TMJ pain, TMJ sound, and limitation of mouth opening. Oral radiologists evaluated osseous changes of the condylar head on CBCT, as well as the disc configuration, internal derangement, and joint effusion on MRI. The frequency of CBCT and MRI findings and the mean and standard deviation of age were analyzed. Logistic regression analysis was used to identify associations between these imaging findings and clinical symptoms using SPSS version 25.0 for Windows (IBM Corp., Armonk, NY, USA). The model fit was evaluated using the Hosmer and Lemeshow test. TMD patients consisted of 294 females and 83 males, and the age group of 20-39 accounted for 47.2% of the patients. Normal findings regarding osseous changes of the condylar head on CBCT were found in 65.1% of the patients. On MRI, a change in disc configuration was found in 54.9% of the patients, internal derangement in 62.6%, and joint effusion in 46.0%. TMJ pain was significantly associated with sclerosis [odds ratio (OR): 3.81], disc displacement without reduction (DDWOR) (OR: 3.22), grade 2 joint effusion (OR: 2.33), and grade 3 joint effusion (OR: 5.54). TMJ sound was significantly associated with disc displacement with reduction (DDWR) (OR: 3.04), DDWOR (OR: 2.50), grade 2 joint effusion (OR: 2.37), and grade 3 joint effusion (OR: 3.23). Limitation of mouth opening was significantly associated with flattened disc configuration (OR: 2.08), folded disc configuration (OR: 2.30), and grade 3 joint effusion (OR: 2.85). CBCT findings had little to do with clinical symptoms. In contrast, MRI findings, including disc configuration, internal derangement, and joint effusion, were associated with clinical symptoms. These results suggest that MRI should be recommended over CBCT for the proper diagnosis of TMD patients.

Strategies to manage anterior disc displacement without reduction of temporomandibular joint: a case report

Introduction Articular disc displacement is the most common temporomandibular joint (TMJ) arthropathy [1]. Disc displacement without reduction (DDwoR) is an intracapsular biomechanical disorder involving the condyle-disc complex [1] and can cause TMJ pain, limited mouth opening [2] and a change in the opening pattern of the patient. At first, the treatment for DDwoR should be reversible and conservative and include drugs, interocclusal devices and physiotherapy (PT) [3]. Moreover, minimally invasive techniques such as viscosupplementation (VS) seems to reduce pain and symptoms associated with internal derangement and improve quality of life [4]. The aim of this study is to report the efficacy of a combined protocol (PT and VS) in the control of signs and symptoms of a patient with temporomandibular disorder (TMD). Materials and methods Female patient, 38 years, with signs and symptoms of TMD presents a clinical diagnosis of right TMJ DDwoR and left TMJ subluxation, according with the Diagnostic Criteria for Temporomandibular Disorders protocol (DC/TMD). The initial pain free opening (PFO) was 31 mm with an uncorrected deviation to the right side in terms of opening pattern. Interdisciplinary team composed by two dentists and two physiotherapists decided the following strategy: assessment of PFO and opening pattern (DC/TMD examination form) before and after any intervention. After the initial assessment we had the first session of PT to prepare for the VS composed of behavioural and cognitive therapy, manual therapy, motor control exercises and prescription of home exercises. One week after we performed the first session of VS with 1 ml of high molecular weight hyaluronic acid bilaterally in the TMJ followed by another session of PT. Two sessions were performed, once a week, in two consecutive weeks. All the assumptions of the Helsinki Declaration have been fulfilled and an informed consent for clinical case of Clínica Dentária Egas Moniz approved by the ethic commission of Instituto Universitário Egas Moniz. Results Data was collected before and after any intervention. In first session of PT, PFO measurements increased from 31 mm to 38 mm and opening pattern remained a right uncorrected deviation. After the VS and second PT session the PFO increased from 35 mm at the beginning of the intervention to 45 mm at the end and the opening pattern changed to a straight opening pattern. Discussion and conclusions VS has been proven to be effective for knee and other large joints [4]. Studies suggest that adding VS to PT and therapeutic exercise may increase functionality [5]. No significant differences between non-invasive conservative interventions and minimally invasive or invasive surgical interventions for TMJ DDwoR [2] so primary treatment should consist of conservative strategies [6] carried out by a multidisciplinary team in order to improve range of motion, restore biomechanics, dynamic lubrification and function. This case report suggest the effectiveness of the combined protocol (PT and VS) in the control of signs and symptoms of TMD reinforcing the role of the interdisciplinary team. However, further studies should be done with an increased sample.

Multidisciplinary team in temporomandibular disorders

Introduction The temporomandibular disorders (TMD) are one of the main concerns regarding orofacial pathologies and there are an ascending number of cases. They are characterised as a group of pathological conditions that may affect the temporomandibular joint (TMJ), the masticatory musculature and/or other adjacent anatomical structures, leading to pain and dysfunction [1]. The multifactorial aetiology of TMD affects a relatively large number of the world population and requires a multidisciplinary evaluation and diagnosis by the clinical team [2]. Among the various elements that constitute the multidisciplinary team we highlight the dentist and the physiotherapist. The dentist as a first-line professional, most of the time is responsible for the identification of patients potentially at risk and for the follow-up of those who already present the disease [3]. On the other hand, the physiotherapist aims to reduce musculoskeletal pain, promote muscle relaxation, reduce muscle hyperactivity, improve function by restoring the quality and quantity of mandibular movements and maximise joint mobility [4]. Description of the clinical case A 24-year-old female patient with a history of temporomandibular disorder and bruxism she presented an non-assisted mouth opening (UMO) of 28 mm and an assisted mouth opening with pain in the masseter and TMJ bilaterally of 29 mm, after the clinical assessment with the DC/TMD protocol we arrived at a diagnosis of disc displacement without reduction (DDwR) with limited opening, degenerative joint disease in the left TMJ, arthralgia (II), myofascial pain (III) in the masseter with pain referred to other anatomical regions. All the assumptions of the Helsinki Declaration have been fulfilled and an informed consent for clinical case of Clinica Dentária Egas Moniz approved by the ethic commission of Instituto Universitário Egas Moniz. The treatment plan consisted of cognitive behavioural therapy (CBT), prescription of muscle relaxants, occlusal splint especially for reduction of overload due to bruxism, infiltration with 1 ml of hyaluronic acid of high molecular weight in the TMJ bilaterally followed by articular mobilisation techniques and neuromuscular and myofascial techniques. The patient was instructed to continue with the physiotherapy. Results The follow up was made 2 months after with 8 sessions of physiotherapy and 1 more hyaluronic acid infiltration bilaterally as protocoled session, we could observe an absence of temporomandibular joint pain, UMO of 42 mm, decreased crepitation, decreased intensity of myofascial pain (I) and (DDwR) without limited opening. Discussion and conclusion The multidisciplinary dentist-physiotherapist team combines inputs from different professions with the aim of promoting the best patient care and represents an added value for the management of the signs/symptoms of patients with temporomandibular dysfunction.

Proteomic Expression Profile in Human Temporomandibular Joint Dysfunction.

Temporomandibular joint dysfunction (TMD) is a multifactorial condition that impairs human’s health and quality of life. Its etiology is still a challenge due to its complex development and the great number of different conditions it comprises. One of the most common forms of TMD is anterior disc displacement without reduction (DDWoR) and other TMDs with distinct origins are condylar hyperplasia (CH) and mandibular dislocation (MD). Thus, the aim of this study is to identify the protein expression profile of synovial fluid and the temporomandibular joint disc of patients diagnosed with DDWoR, CH and MD. Synovial fluid and a fraction of the temporomandibular joint disc were collected from nine patients diagnosed with DDWoR (n = 3), CH (n = 4) and MD (n = 2). Samples were subjected to label-free nLC-MS/MS for proteomic data extraction, and then bioinformatics analysis were conducted for protein identification and functional annotation. The three TMD conditions showed different protein expression profiles, and novel proteins were identified in both synovial fluid and disc sample. TMD is a complex condition and the identification of the proteins expressed in the three different types of TMD may contribute to a better comprehension of how each pathology develops and evolutes, benefitting the patient with a focus–target treatment.

Validity of IL-6 and Arthrocentesis in the Cause and Management of Internal Derangement of TMJ.

The aim of this clinical study was to evaluate the level of Interleukine-6 (IL-6), pre and post arthrocentesis to validate it as a biomarker in the Internal Derangement (ID) of TMJ. This study included 30 patients (20 females and 10 males) of Temporo-Mandibular Dysfunction (TMD) with Disc displacement without reduction (DDwoR) Wilkes stage III, who were refractory to conservative management. Arthrocentesis was performed as a therapeutic modality. Synovial fluid aspirates were obtained prior to arthrocentesis and post arthrocentesis with 300ml of Ringer Lactate solution into the superior joint compartment for the assessment of level of IL-6. The clinical parameters used for correlating the level of IL-6 were degree of pain (VAS I), chewing ability (VAS II), Maximal Mouth Opening (MMO) in both pre and post op phase with the follow-up period of 01day, 01week, 01month, 03month and 06month and the results were compared. ELISA was performed to analyze the levels of IL-6 in the aspirates. The clinical parameters and the level of IL-6 were recorded and analyzed statistically. The study showed ID of TMJ (Wilkes stage III) s are more prevalent in females especially in the fourth decades of life with the mean age of 38.4 years. The post operative assessment in terms of pain, maximum mouth opening, lateral movements of the mandible and the levels of IL-6 were found to be statistically significant with a P value <0.01. This study validates the role of IL-6 as a definitive biomarker for the pathogenesis of ID of TMJ Wilkes stage III and arthrocentesis proved to be a minimally invasive therapeutic modality for its management.

Impact of temporomandibular joint arthroscopic discopexy on condylar growth in adolescents: a retrospective cohort study

Objective: To compare changes of condylar height, disc length and displaced distance in adolescent temporomandibular joint (TMJ) disc displacement with or without arthroscopic discopexy. Methods: From September 2015 to November 2018, adolescents with magnetic resonance image (MRI) comfirmed disc displacement without reduction (DDwoR) were recruited in operation group (OG) and control group (CG) and were classified into five subgroups according to age (11-14 years, 15-16 years, 17-18 years, 19-20 years and 21-24 years). Changes of condylar height, disc length and displaced distance were measured before and after follow-up MRI. Student's t-test, Welch's t-test, Mann-Whitney U test, Wilcoxon signed-rank test, One-way ANOVA and Kruskal-Wallis test were used; P-value less than 0.05 was considered statistically significant. Results: One hundred and seventy two patients were recruited in the present study. One hundred and twenty six cases patients (183 joints, 17 males, 109 females, mean age 17.4±3.0 years) were in OG and 119 patients (175 joints, 20 male, 99 females, mean age 17.1±3.1) in CG. The mean follow-up time were 8.4 (2.7-22.0) and 9.5 (3.0-22.1) months respectively. Average condylar height changes of OG were significantly greater than CG (1.3±1.8 mm vs -0.6±1.5 mm, P<0.001) and differences were also seen in each age group (P<0.001). In terms of age variations, average increase of condylar height in OG were (2.4±2.2) mm, (1.3±1.7) mm, (1.6±1.7) mm, (0.8±1.9) mm, (0.4±1.1) mm respectively (P<0.001), differences were observed between 11-14 years vs 19-20 years (P<0.05), 11-14 years vs 21-24 years (P<0.01) and 17-18 years vs 21-24 years (P<0.01) subgroups; and average changes in CG were (-0.7±1.6) mm, (-0.4±1.6) mm, (-0.8±1.5) mm, (-0.3±1.4) mm and (-0.9±1.5) mm respectively (P>0.05). After follow-up in CG, further displaced disc was observed (P<0.05) while disc length remained unchanged (P>0.05). Conclusions: DDwoR in adolescents resulted in decreased TMJ condylar height while arthroscopic discopexy restored growth potential and promoted condylar new bone formation which was most prominent during growth period.

Symptoms, disc position, occluding pairs, and facial skeletal characteristics of older patients with temporomandibular disorders.

ObjectiveTo describe the proportions of different osseous diagnoses in older patients with temporomandibular disorders (TMD) and to analyze the symptoms, disc position, occluding pairs, and facial skeletal characteristics of patients with bilateral osteoarthrosis (BOA) and bilateral normal joints (BNJ).MethodsThis retrospective cross-sectional study constituted 88 older patients (age ≥60 years). The osseous diagnosis, symptoms, disc position, occluding pairs, and facial skeletal characteristics were evaluated. Variables in BOA patients and BNJ patients were compared using the t-test and chi-square test.ResultsForty-eight patients had BOA, 7 had unilateral osteoarthrosis, 11 had intermediate osteoarthrosis, and 22 had BNJ. The prevalence of disc displacement without reduction (DDw/oR) in BOA patients was significantly higher than in BNJ patients. BOA patients exhibited greater ANB angle, PP-MP, U1-NPo, L1-NPo, and facial convexity angle; shorter posterior cranial base; and decreased ramus height.ConclusionBOA patients with associated DDw/oR had more complaints of orofacial pain and exhibited a shorter posterior cranial base, and greater mandibular retrusion, anterior tooth protrusion, and protruded profile than BNJ patients.

Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis.

The aim of this systematic review was to evaluate the prevalence of temporomandibular joint disorders (TMJD) among the general population. Five main electronic databases and three grey literature were searched to identify observational studies in which TMJD was diagnosed using the research diagnostic criteria (RDC/TMD) or diagnostic criteria (DC/TMD). The studies were blindly selected by two reviewers based on eligibility criteria. Risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist, and the "R" Statistics software was used to perform meta-analyses. From 2741 articles, 21 were included. Ten studies were judged at low RoB, seven at moderate, and four at high. The TMJD investigated were as follows: arthralgia, disk displacement (DDs) with reduction (DDwR), DDwR with intermittent locking, DDs without reduction (DDwoR) with limited opening, DDwoR without limited opening, degenerative joint disease (DJD), osteoarthritis, osteoarthrosis, and subluxation. The main results from prevalence overall meta-analyses for adults/elderly are as follows: TMJD (31.1%), DDs (19.1%), and DJD (9.8%). Furthermore, for children/adolescents are as follows: TMJD (11.3%), DDs (8.3%), and DJD (0.4%). Considering the individual diagnosis meta-analyses, the most prevalent TMJD is DDwR for adults/elderly (25.9%) and children/adolescents (7.4%). The overall prevalence of TMJD was approximately 31% for adults/elderly and 11% for children/adolescents, and the most prevalent TMJD was DDwR. Knowledge about the frequency of TMJD can encourage dentists to consider appropriate strategies for early and correct diagnosis and, if need be, correct management.

Double-Needle Arthrocentesis with Viscosupplementation in Patients with Temporomandibular Joint Disc Displacement without Reduction

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.

Effect of Disc Position for Acute Closed Lock of the Temporomandibular Joint

In this manuscript, the authors have studied the Disc Displacement (DD) status of patients with acute Closed Lock (CL) to determine differences between DD with Reduction (DDwR) and DD without Reduction (DDwoR). Among the acute CL patients who visited our hospital within 2 weeks of the onset of CL, we studied 10 patients whose CL was released (DDwR) and 13 patients whose CL was not released (DDwoR). The DDwoR group was significantly older than the DDwR group. Although the mouth opening distance was significantly greater in the DDwoR group than in the DDwR group, the two groups were identical in the duration of CL. Sagittal MRI images showed no significant differences between the two groups in disc length and disc thickness (anterior band, intermediate zone, and posterior band). Multisection sagittal and coronal images identified lateral DD in 7 of the 10 patients in the DDwR group, although no specific direction of the DD was observed in the DDwoR group. Furthermore, deformation of the medial disc was common in the DDwoR group but uncommon in the DDwR group.

Internal derangement of the temporomandibular joint: Can clinical and magnetic resonance imaging features predict the prognosis?

Purpose: To evaluate the role of magnetic resonance imaging (MRI) in the diagnosis of internal derangement and to assess the complimentary role of MRI and clinical assessment in prognostication. To assess the role of MRI in demonstrating disc displacement and reduction. Methods: A total of 34 patients (28 cases and 6 controls) with clinical features of temporomandibular joint (TMJ) internal derangement underwent a dedicated MRI at our institution. MRI was assessed for disc displacement, morphology, and reduction on open-mouth imaging. For analysis, the patients were divided into those with disc displacement with reduction (WR) and those without reduction (WOR). Clinical and MRI grading of internal derangement were done in all patients and correlated with each other. Prognostication was attempted using the clinical and MRI features, and patients were followed up over a mean period of 6 months. Results: Most of the patients were females (n = 20 71%) in the child-bearing age group (third decade). MRI demonstrated disc displacement in all but two patients in whom disc was not visible. Fourteen (54%) patients were placed in WR group, whereas 10 (38%) were in WOR group. In two (8%) patients, stuck disc was diagnosed. Patients in WR group responded to conservative treatment alone while those in WOR group needed conservative management in some (n = 8 57%) and surgical intervention in others (n = 6 43%). Both patients with stuck disc failed conservative management. Conclusion: MRI is an essential component of TMJ evaluation and helps in diagnosing and staging internal derangement together with disc assessment. Patients with disc displacement WOR and those with higher grades of derangement on MRI including stuck disc require surgical intervention if conservative management fails.

Relationship between menton deviation and temporomandibular disc displacement in adult patients

ABSTRACT Purpose: This study investigated the relationships among characteristics of maxillomandibular asymmetry in patients with menton deviation and temporomandibular joint (TMJ) disc conditions, including normal disc position (NDP), anterior disc displacement with reduction (ADDwR), rotational disc displacement with reduction (RDDwR), and anterior and/or rotational disc displacement without reduction (DDwoR). Materials and methods: Eighty-six patients with menton deviation (62 female patients and 24 male patients) were included. The TMJ magnetic resonance images were categorized into four groups: bilateral-NDP (n = 15), ADDwR (n = 13), RDDwR (n = 19) and DDwoR (n = 39). The characteristics of menton deviation and maxillomandibular asymmetry were determined using posteroanterior and lateral cephalograms. Differences in cephalometric variables among the groups were statistically analysed. Results: Patients with menton deviation under Skeletal Class I, and Skeletal Class II relationship showed a higher rate of DDwoR on lateral cephalograms. Significant differences were detected among groups on posteroanterior cephalograms with respect to the cant of the frontal mandibular plane and menton deviation. These two variables were significantly greater in the DDwoR group than in the bilateral-NDP group. Conclusion: The anteroposterior jaw relatioship and mandibular deviation may be associated with the severity of TMJ disc displacement.