Improvement In Mouth Opening Research Articles

Arthrocentesis of Temporomandibular Joints—A Clinical Comparative Study

The objective of this study was to compare single-needle arthrocentesis with the conventional two-needle arthrocentesis, as well as the additional intracapsular injection of hyaluronic acid or platelet-rich fibrin. A total of 96 patients with established osteoarthritis (OA) (n = 48) or with internal de-arrangement (DD) (n = 48) were assigned single-needle arthrocentesis with distension of the joint or conventional two-needle arthrocentesis with or without intracapsular injection of the medication (hyaluronic acid (HA) or platelet-rich plasma (PRP)) performed every month over a period of 6 months. The maximum mouth opening and pain, as measured by the visual analog scale (VAS), were compared. Each group exhibited significant improvement, i.e., a decrease in pain and an increase in mouth opening. The single-puncture technique provided similar pain reduction as the two-needle approach but provided significantly better results in terms of maximum mouth opening. The reduction in pain was similar when comparing the OA and DD cohorts; however, patients with disc displacement achieved significantly better mouth opening than OA. Intracapsular application of medication contributed to a significant decrease in pain in both HA and PRP groups, with platelet-rich fibrin being significantly superior to HA in terms of mouth opening improvement.

The Role of Coronoidectomy in Complex Mandibular Reconstruction With Free Fibular Flap

Introduction: Complex mandibular reconstruction is at risk of postoperative restricted mouth opening. Temporomandibular joint pseudoankylosis can cause significant disability, leading to restricted mouth opening and an inability to create a proper seal with the mouth. Treating this condition often requires aggressive surgical intervention, primarily restoring the structure and functionality of the mandible. Coronoidectomy plays a vital role in improving mouth opening capacity. Case Presentation: Four patients with temporomandibular joint pseudoankylosis were included in this case series. The patients reported being unable to move their remaining lower jaw, having a perpetually open mouth, and constant drooling. All patients had a history of reconstructive surgery due to tumor or malignancy and could only open the mouth less than 10 mm. They underwent coronoidectomy followed by free fibular flap reconstruction. Postoperatively, all 4 patients exhibited a movable mandible and achieved proper occlusion. The maximum mouth opening increased by 25 to 45 mm; all flaps appeared vital, sutures remained intact, and no active bleeding. Discussion: Coronoidectomy is crucial for enhancing the ability to open the mouth. All of the patients underwent a coronoidectomy surgery followed by free fibular flap reconstruction. Immediately after the surgery, the mandibular projection appears nearly symmetrical, the patient opens their mouth, and occlusion is achieved subjectively. From our presented cases, after coronoidectomy, all patients had movable mandibula, and mouth opening was achieved. Coronoid process resection frees the mandible from the temporalis. Coronoidectomy and separation of the temporalis muscle from the mandible have excellent clinical efficacy for improving mouth opening and movement. Conclusion: Coronoidectomy followed by a free fibular flap should be considered the best surgical option for patients with restricted mouth opening after complex mandibular reconstruction.

Effect of Kangfuxin liquid combined with triamcinolone acetonide in oral submucosal fibrous degeneration

Purpose: To investigate the effect of Kangfuxin liquid combined with triamcinolone acetonide in the treatment of oral submucous fibrous degeneration. Methods: A total of 140 patients with oral submucosal fibrous degeneration admitted to the outpatient clinic of Haiyan County Stomatological Hospital, China from June 2020 to June 2023 were divided equally into study and control groups. The study group received Kangfuxin liquid in addition to 1 mL triamcinolone acetonide (40 mg/mL) while the control group received 1 mL triamcinolone acetonide; therapeutic effects were compared after 4 weeks of treatment. Visual analogue scale (VAS) score, serum transforming growth factor (TGF-β1), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) levels were determined. Also, whole blood viscosity (WBV), plasma viscosity (PV), erythrocyte sedimentation rate (ESR), and incidence of adverse reactions were evaluated. Result: The study group showed significantly reduced pain levels compared to the control group, as well as lower mucosal damage areas and improved mouth opening after 4 weeks of treatment compared to control group (p < 0.05). Also, the study group showed significantly lower TGF-β1, TNF-α and IL-6 compared to control group after treatment (p < 0.05). It showed significantly lower WBV, PV, and ESR compared to control group (p < 0.05). Furthermore, the study group showed significantly lower incidence of adverse reactions than the control group (p < 0.05). Conclusion: Kangfuxin liquid, when combined with triamcinolone acetonide, lowers pain, reduces the levels of STGF-β1, improves hemorheology, and produces minimal adverse effects compared to triamcinolone alone. Future studies should focus on long-term outcomes to better assess the therapeutic potential of this combined regimen.

Comparison And Evaluation Of Interferential Current Therapy And Transcutaneous Electrical Nerve Stimulation In Temporomandibular Joint Disorders: A Prospective Interventional Study

Aim: This study evaluated the effectiveness of transcutaneous electrical nerve stimulation (TENS) and interferential current therapy (IFT) to decrease jaw pain and muscle tenderness, improve maximum vertical mouth opening, and compare intra-operative patient comfort. Methodology: This comparative study was conducted in the outpatient oral and maxillofacial surgery department of the SRM Kattankulathur Dental College and Hospital. Twenty participants with chronic or recurrent jaw pain were randomly assigned to either Group A or Group B for the study. IFT and TENS were administered to Groups A and B. They were evaluated for intra-operative comfort, muscle tenderness, mouth opening, and pain over three treatment sessions. Results: Both groups showed improvement in pain, muscle tenderness, and mouth opening after three follow-up sessions. Compared to TENS, IFT significantly improved patient comfort (p<0.05). While there was no significant difference in pain and muscle tenderness reduction between the two groups at 5% significance level (p<0.05), IFT demonstrated slightly better improvement in vertical mouth opening. Conclusion: IFT is frequently employed to treat musculoskeletal disorders; however, its effectiveness in alleviating pain associated with temporomandibular disorders is still poorly understood. This study observed significant pain reduction in both IFT and TENS groups, along with a decrease in masticatory muscle and TMJ tenderness and improvement in mouth opening. Compared to TENS, IFT provided superior intra-operative comfort hence overcoming the drawback associated with TENS. These findings suggest that IFT may serve as an effective therapeutic option for temporomandibular disorder

The impact of different timing of mouth opening exercises on trismus in postoperative radiotherapy patients with oral cancer

ObjectiveTo compare the effects of starting mouth opening exercises at two different times on trismus in postoperative radiotherapy patients with oral cancer. MethodsThrough a prospective randomized controlled trial, purposive sampling was used to select 76 patients undergoing postoperative radiotherapy for oral cancer from March 2023 to January 2024 at the Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Patients were randomly divided into an experimental group (n = 38) and a control group (n = 38) using a random number table at a ratio of 1:1. The experimental group began mouth opening exercises in the second week after surgery (before radiotherapy), while the control group began in the fourth week after surgery (at the start of radiotherapy). The primary outcome measure was maximum interincisal opening (MIO). Secondary outcome measures included pain visual analog scale (VAS) scores and quality of life scores (UW-QOL), assessed at baseline, the second week post-surgery (before radiotherapy), the fourth week post-surgery (at the start of radiotherapy), the ninth week post-surgery (end of radiotherapy), and the twelfth week post-surgery (three weeks after the end of radiotherapy). ResultsA total of 72 patients completed all assessments, with 36 in each group, resulting in an overall sample attrition rate of 5.26 % (less than 15 %). There were no statistically significant differences in general demographic and clinical characteristics between the two groups. Repeated measures ANOVA showed significant differences in MIO, VAS, and UW-QOL scores between groups, over time, and in group-time interactions (P < 0.001). From the fourth week post-surgery (at the start of radiotherapy), the experimental group had significantly higher MIO (P < 0.001), significantly lower VAS scores (P < 0.001), and significantly higher UW-QOL scores (P < 0.001) compared to the control group. These differences persisted at subsequent assessment points. ConclusionInitiating mouth opening exercises in the second week post-surgery (before radiotherapy) can significantly improve mouth opening, reduce pain, and enhance the quality of life in postoperative radiotherapy patients with oral cancer. This provides important evidence for clinical practice, although further research is needed to verify the long-term effects.

Efficacy of Proprioceptive Neuromuscular Facilitation on Jaw Function in Bruxism Among Post Stroke Survivor: A Case Study

A 49-year-old male who was a known case of Type 2 diabetes mellitus and hypertensive had a history of an acute infarct in the left ganglia capsular region and a chronic infarct in the left parieto-occipital lobe, which was conservatively managed and was referred for physiotherapy rehabilitation for strengthening the right upper and lower limb. During the physiotherapy intervention, abnormal teeth grinding was observed, and the patient was asked about parafunctional behaviour. Upon examination, there was a restriction in the jaw range of motion assessed by measuring the jaw range using the vernier caliper and tightness in the masticatory muscle, as evidenced by palpating the masseter muscle. Proprioceptive neuromuscular facilitation and ultrasound therapy were given for 1 session per week for 2 weeks to treat bruxism along with standardized stroke protocol. At the end of 2 weeks after the intervention, there was an increase in jaw opening and reduced masticatory muscle activity. Jaw opening was measured using a vernier caliper, and masticatory activity was measured using electromyography of the masseter and temporalis muscles. This study suggests the importance of treating bruxism to prevent complications related to it. It concludes that proprioceptive neuromuscular facilitation and ultrasound therapy were effective in improving mouth opening and reducing the masticatory activity in bruxism among stroke patients with ganglia capsular involvement.

A case report of arthrocentesis in temporomandibular joint internal derangement

In this case report, a 56-year-old male presented to our department of oral and maxillofacial surgery with a chief complaint of pain during mouth opening on the left joint region. The patient also complained of limited mouth opening and temporomandibular joint (TMJ) pain. Arthrocentesis was performed under aseptic conditions. Clinical evaluation of the patients was done before the procedure, 1 week, 1 month, and 4 months postoperatively. Intensity of TMJ pain and maximal mouth opening were recorded at each follow-up visit. There was a significant improvement in mouth opening and a reduction in pain scores in the postoperative period. Arthrocentesis is a simple and safe procedure for patients with internal derangement with a closed lock for improving mouth opening and decreasing pain.

Comparison of the effects of acupuncture methods on the temporomandibular disorder: A network meta-analysis.

A network meta-analysis (NMA) was applied to compare the therapeutic effect of different acupuncture methods on temporomandibular disorder (TMD). A computer retrieval was carried out in the English databases of Cochrane, PubMed, Embase and Web of Science, as well as the Chinese databases of CNKI, Wanfang and VIP for randomized controlled trials on the effect of acupuncture on TMD, with a retrieval deadline of January 21, 2024. Data analysis was conducted using R software and Bayesian method. The pain score served as the primary outcome measure, with the mouth opening as the secondary outcome measure. Thirty-five articles were included in the analysis, involving 1937 TMD patients. The NMA results suggested that DN-PT had the best effect on relieving pain and improving mouth opening. (Description of all abbreviations in Supplementary Material S3). Based on the available evidence, the results of the NMA suggest that DN-PT is most effective in relieving TMD pain and increasing mouth opening. However, due to the fact that some acupuncture therapies are only reported in a small number of research reports, this may lead to an increase in the randomness of the results and a decrease in the reliability.

Evaluation of lignocaine HCl as a therapeutic and diagnostic tool in myofascial pain dysfunction syndrome and internal derangement

Background: Myofascial pain syndrome MPS is one of the most common causes of chronic musculoskeletal pain. It clinically presents with hypersensitive points in the muscle called “trigger points”. Most of the time it remains undiagnosed/undertreated and this leads to severity in symptoms. Deactivation/elimination of trigger points (TrPs) remains the cornerstone of myofascial pain dysfunction syndrome (MPDS) management. The most commonly employed techniques clinically are dry needling of the TrP, local anesthetics or saline injections into TrP, spray and stretch, and ultrasound/electrogalvanic stimulation. Although peripheral nerve blocks are widely used for chronic pain management, their role in myofascial pain dysfunction syndrome is not yet well established. Our study aims to demonstrate the role of mandibular nerve block using lignocaine hydrochloride in the management of MPDS. Materials and Method: Our study is a single-centered randomized control trial performed to evaluate the diagnostic and therapeutic role of mandibular nerve block in treating myofascial pain dysfunction syndrome. A total of 20 subjects fulfilling the inclusion criteria were enrolled in the study. Clinical parameters (pain, mouth opening, and mandibular deviation) were assessed at each follow-up appointment. Result: All of our patients had significant pain relief at the end of 1 month (P &lt; 0.001), and a substantial improvement in mouth opening is also noted (P &lt; 0.001). There was a significant improvement in deviation immediately after nerve block, and further gradual improvement was observed during each follow-up. Conclusion: Our study confirmed the role of mandibular nerve block in myofascial pain management. The diagnostic value of mandibular nerve block in differentiating MPDS from internal derangement is also highlighted.

Assessment of the Efficacy of Orally Administered Lycopene in Improving the Mean Maximum Incisal Opening in Individuals Suffering from Oral Submucous Fibrosis

Objective: To compare the effectiveness of orally administered lycopene versus a placebo in increasing mean maximum incisal opening in patients with oral submucous fibrosis (OSF). Methodology: This randomized controlled trial, conducted at the Oral and Maxillofacial Surgery Department of Lahore Medical and Dental College from January to July 2020, enrolled 68 eligible patients. Two groups were formed: Group 1 (received oral lycopene) and Group 2 (received placebo). A block size of 4 was utilized for patient allocation, alternating between groups until the sample size was met. Both groups underwent a comprehensive 3-month treatment plan, including habit cessation and daily physiotherapy involving tongue spatula insertion between teeth (with spatula replacement). Only Group 1 received an additional 40mg oral lycopene daily. Follow-up appointments occurred monthly for 3 months, measuring maximal incisal opening with a Vernier Caliper. Results: Baseline incisal opening was 25.39 ± 2.92 mm in Group 1 and 25.23 ± 3.03 mm in Group 2. At the 3-month mark, Group 1 showed an incisal opening of 31.71 ± 2.84 mm, while Group 2 had 28.31 ± 2.98 mm. The mean change in incisal opening was 6.32 ± 0.96 mm for Group 1 and 3.08 ± 0.90 mm for Group 2. Group 1 exhibited a significantly higher mean change in incisal opening compared to Group 2 (p=&lt;0.001). Conclusion: Lycopene administration is more effective than a placebo in improving mouth opening in OSF patients. Therefore, lycopene should be considered as a treatment option to enhance maximal incisal opening and improve the quality of life for individuals with OSF. Keywords: Maximum incisal opening, Oral submucous fibrosis, lycopene orally, Nutt eating

Effects of botulinum toxin type A in patients with painful temporomandibular joint disorders: a systematic review and meta-analysis.

To assess the therapeutic efficacy of botulinum toxin type A (BTX-A) for managing myofascial pain related to temporomandibular disorders (TMDs). This study was conducted according to the PRISMA 2020 statement guidelines. The PubMed, Embase, and Cochrane Library databases were searched. Only randomized controlled trials were included. The primary outcome was a pain score on the visual analog scale, and the secondary outcomes were maximum mouth opening and adverse effects. The Cochrane risk of bias tool was used to assess risk bias. A meta-analysis of studies with the same interventions, controls, assessment methods, and follow-up durations was performed. A total of 519 studies were retrieved, of which 20 randomized controlled trials were included in the qualitative analysis and six were included in the meta-analysis. The results showed that, compared with placebo, BTX-A injection was more effective at relieving myofascial pain, and its effect was similar to that of conventional methods. However, there was no difference in maximum mouth opening between the two groups. After the study assessment with the RoB 2.0 tool, six studies showed a low risk of bias, 13 studies showed some concerns regarding the reported results, and only one study showed a high risk of bias. Adverse effects of BTX-A injection were observed in four studies. In conclusion, BTX-A is effective at relieving pain in TMD patients but does not improve mouth opening. To minimize adverse effects, we recommend a low dose of BTX-A for TMD patients who do not experience complete pain relief from conservative treatments.

Does Piroxicam have an Added Benefit on Arthrocentesis in the Management of Internal Derangement in Female Patients?: A Randomized Clinical Trial

Background: Arthrocentesis is an accepted treatment modality for internal derangement. Piroxicam is an NSAID that can be injected into the TMJ. Purpose: The primary objective of this study was to improve mouth opening, and the secondary objective was to decrease TMD-associated pain. Methods: A randomized controlled trial (RCT) was performed on patients suffering from anterior disk displacement with reduction. Patients were divided into 2 groups: a study in which patients underwent arthrocentesis followed by an injection of 20 mg of piroxicam. Independent and paired sample t-tests were used to assess mouth opening. The χ2 test was used to assess the pain data; the P value was fixed at 0.05. Results: Twenty female patients were included in the current study. To ensure that covariables did not affect the study results, an intergroup assessment using Student’s t-test for unassisted mouth opening without pain preoperatively showed that the maximum unassisted opening without pain was 20.8±3.9 mm in the control group, and the average maximum unassisted opening without pain was 19.7±1.1 mm in the case study group. The unassisted mouth opening in the control group was 30.9±3.4 mm and 31.8±3.6 mm, respectively, and there was no significant difference (P=0.6, 95% CI: −2.5 to 4.32). There was no significant difference in pain between the study and control groups (P=0.3). Conclusion and Recommendation: Based on the results of the present study, arthrocentesis using piroxicam does not have any benefit over conventional arthrocentesis.

Clinical Outcome of Open Reduction and Internal Fixation of Mandibular Condyle Fracture: A Prospective Observational Study

Introduction: Condyle of mandible plays crucial role in functioning of jaw. Untimely and inadequate treatment leads to deformity of face along with range of complications. The purpose of this study was to assess outcomes of open reduction and internal fixation of mandibular condyle fractures in terms of mouth opening, facial nerve function and occlusion.Methods: This was a prospective observational study conducted at Chitwan Medical College. Thirty-two patients of mandibular condyle fracture were treated by open reduction and internal fixation via retromandibular approach and evaluated for mouth opening, facial nerve function, and occlusion on 2nd day, 10th day and 25th day postoperatively. All collected data were entered on SPSS version 21 and analyzed using descriptive statistical methods. The results were presented as graphs and tables.Results: Of 32 patients, 7 patients show abnormal occlusion while 25 patients show normal occlusion. A gradual improvement in mouth opening and facial nerve function was also seen on 25th day.Conclusion: Open reduction and internal fixation gives superior clinical outcomes in terms of mouth opening, facial nerve function and occlusion. It also allows good anatomical repositioning and early function.Keywords: Facial nerve function, Mouth opening, Occlusion, Open reduction internal fixation Layman summary: The mandible is largest and strongest bone of face. However, it is also most common facial bone that is fractured. Condyle of the mandible is highly prevalent site of mandibular fracture. The fracture of mandible is managed by open or closed reduction. Both of the methods have their own merits and demerits. In this study, we planned to assess the outcomes of open reduction and internal fixation of mandibular condyle fractures at a tertiary care center of Nepal. We found that ORIF has a good clinical outcome in mandibular fracture in terms of mouth opening, facial nerve function and occlusion.

The effect of oral massage intervention on oral hygiene at home care.

Oral hygiene for individuals with disabilities living at home heavily relies on caregiver assistance. This study investigates differences in mouth opening, dental plaque index and halitosis grade among home-dwelling individuals with and without oral massage intervention. It is important to consider that extended bedridden periods, the presence of nasogastric tubes and difficulties in mouth opening can affect caregivers' oral cleaning effectiveness. This single-blind controlled experiment spanned 12 weeks. Primary caregivers underwent a 15- to 20-min demonstration. The experimental group received guidance on the Bass brushing method, instructions for using oral cleaning tools and training in oral massage. The control group received guidance on the Bass brushing method and instructions for oral cleaning tools. Measurement tools included basic participant information, oral examination records, mouth opening assessments, dental plaque index evaluations and halitosis ratings. The study included 38 subjects, all over 80 years old with disabilities. Dental plaque index significantly improved after massage (p = 0.001). Compared to their pre-massage conditions, the experimental group showed significant improvements in maximum mouth opening (11.65-20.71 mm, p = 0.001), dental plaque index (98.04%-59.74%, p < 0.0001) and halitosis rating (4.12-3.76, p = 0.034). Oral massage effectively improved mouth opening, reduced the dental plaque index and lowered halitosis ratings in the experimental group, underscoring its positive impact on oral hygiene. The study's insights can significantly benefit oral care for individuals with disabilities living at home.

Efficacy of massage versus massage with post isometric relaxation in temporomandibular disorders: a randomized controlled trial

BackgroundTemporomandibular joint disorder (TMD) is a common condition affecting the masticatory muscles and joint mobility.ObjectivesThe primary objective was to compare the effects of massage therapy alone and massage therapy combined with post-isometric relaxation exercises in patients with TMD for pain and maximal mouth opening.DesignAssessor-blinded randomized controlled trial.SettingSir Ganga Ram Hospital, Chaudhry Muhammad Akram Dental Hospital, Lahore Medical and Dental Hospital.SubjectsTemporomandibular joint disorder patients.InterventionGroup A (n = 23) received conventional treatment including massage and therapeutic exercises consecutively for 2 weeks. Group B (n = 23) received post-isometric relaxation technique along with conventional treatment for consecutive 2 weeks.Main measuresThe main outcome measures were pain and maximal mouth opening. Pain was measured using the Visual Analogue Scale (VAS) and maximal mouth opening (MMO) was measured using the TheraBite Scale.ResultsBoth groups demonstrated significant improvements in pain and MMO scores post-treatment. However, Group B (massage with post-isometric relaxation exercises) showed significantly better outcomes compared to Group A (massage alone). There was a statistically significant difference in post-treatment pain scores (P = 0.000) and MMO scores (P = 0.000) between the two groups.ConclusionThe results suggest that massage therapy combined with post-isometric relaxation is more effective than massage therapy alone in managing pain and improving mouth opening in TMD patients. The study provides evidence supporting the use of these therapies in TMD management.Trial registry numberNCT05810831. Date of registration/First submission: 15 March 2023.

Efficacy of TENS Therapy, Therapeutic Ultrasound and Stabilization Splint as an Adjuvant to Pharmacotherapy for Temporomandibular Disorders

INTRODUCTIONThis study aims to assess the effectiveness of adjunctive treatments like transcutaneous electric nerve stimulation (TENS), therapeutic ultrasound (ThUs), and stabilization splint (SS) in combination with pharmacotherapy (PT) in enhancing pain relief, mouth opening, lateral excursion, joint sound reduction, muscle tenderness improvement, and jaw deflection in patients with temporomandibular disorders (TMDs), affecting the temporomandibular joint and masticatory muscles. MATERIAL AND METHODSThe study involved 90 patients divided into three groups. Pharmacotherapy (Tab. Myospaz) was prescribed to all patients, each group received either TENS, ThUs, or SS as adjunctive treatment. Outcomes were measured at baseline and various intervals post-treatment. RESULTSTMDs were more prevalent in younger age group (21-30 years) with female predilection (F:M =2.21:1). Significant differences were observed in pain scores, with TENS and ThUs groups showing greater reductions compared to SS. ThUs demonstrated superior results in mouth opening, while TENS showed better outcomes in lateral excursion and muscle tenderness reduction. CONCLUSIONThis study concluded that both TENS and therapeutic ultrasound effectively reduced pain with therapeutic ultrasound showing better results in improving mouth opening, and TENS demonstrating better results in lateral excursion and muscle tenderness reduction. No significant difference among three groups were found in reducing joint sounds and deviation/deflection.

Clinical effect of digitalized designed and 3D-printed repositioning splints in the treatment of anterior displacement of temporomandibular joint disc

ObjectiveTo compare the treatment effectiveness of digitized and 3D-printed repositioning splints with that of conventional repositioning splints in the treatment of anterior displacement of the temporomandibular joint disc.MethodsThis retrospective study included 96 patients with disc displacement of the anterior temporomandibular joint. They were treated with either digitally designed and 3D-printed repositioning splints or traditional splints and followed up for at least six months. Changes in signs and symptoms such as pain and mouth opening before and after treatment were recorded to evaluate treatment outcomes.ResultsDuring the first month of treatment, both the digitally designed and 3D-printed repositioning splint groups (Group B) and the traditional repositioning splint group (Group A) showed significant increases in mouth opening, with increases of 4.93 ± 3.06 mm and 4.07 ± 4.69 mm, respectively, and there was no significant difference between the two groups. Both groups had a significant reduction in visual analog scale (VAS) pain scores, with Group B showing a greater reduction of 1.946 ± 1.113 compared to 1.488 ± 0.978 in Group A (P < 0.05). By the sixth month, Group B’s mouth opening further improved to 38.65 ± 3.22 mm (P < 0.05), while Group A’s mouth opening did not significantly improve. Regarding pain, Group A’s VAS score decreased by 0.463 ± 0.778 after one month, and Group B’s score decreased by 0.455 ± 0.715; both groups showed significant reductions, but there was no significant difference between the two groups.ConclusionCompared with traditional repositioning splints, digitally designed and 3D-printed repositioning splints are more effective at reducing patient pain and improving mouth opening. 3D-printed repositioning splints are an effective treatment method for temporomandibular joint disc displacement and have significant potential for widespread clinical application.

Influence of preoperative anatomy and functional status on outcomes after total temporomandibular joint replacement with patient-specific endoprostheses: A retrospective cohort study.

Temporomandibular joint (TMJ) replacement may be indicated for various pathological conditions, and the type of condition can affect the surgical procedure and outcomes. The causes of limited range of motion after alloplastic TMJ replacement have not been extensively studied. The present study aimed to evaluate the impact of preoperative jaw anatomy and functional status on the immediate and long-term outcomes of total TMJ replacement using a two-component patient-specific TMJ endoprosthesis. This retrospective study included 31 patients who underwent total TMJ replacement surgery between 2016 and 2020. The main outcome variable was the maximal incisal opening (MIO) after treatment. Secondary outcome variables included MIO improvement and the presence and type of postoperative complications. The primary predictive variable was the preoperative initial MIO. Secondary predictive variables included sex, age, indications for TMJ replacement, preoperative occlusion, condition of the glenoid fossa and/or condyle, shortening of the mandibular ramus, sagittal mandible position, lateral chin deviation, shape of the coronoid process, and type of surgery. The mean preoperative MIO was 13.0 ±8.0 mm, while the mean MIO 1 month after surgery was 20.6 ±5.5 mm, which was not statistically significant. However, at a later follow-up, functional parameters showed a significant improvement (p = 0.003), with a mean MIO of 32.5 ±5.0 mm 3 years after surgery. Statistical analysis indicated that the initial mouth opening is the strongest predictor of long-term functional recovery after TMJ replacement. Postoperative complications occurred in 4 cases (12.9%) following patient-specific endoprosthesis (PSE) placement. The use of PSEs for TMJ replacement has enabled the restoration of anatomical relationships in complex clinical cases and an improvement in mouth opening. The preoperative MIO was the only factor that significantly influenced long-term functional outcomes.

Restorabite™: Phase II trial of jaw stretching exercises using a novel device for patients with trismus following head and neck cancer.

Patients treated for oral cancer, may experience restricted mouth opening (trismus). Barriers such as cost have limited the utilization of traditional jaw stretching devices, and consequently, patients experience problems with swallowing, oral care, communication, and cancer surveillance. The safety and efficacy of Restorabite™, a new device designed to overcome these barriers, is evaluated prospectively over 12 months. This phase II investigator-led trial included patients with chronic trismus underwent 10-weeks of trismus therapy using Restorabite™. Safety, adherence, changes in mouth opening, and patient-reported outcomes are presented. 114/120 participants with trismus completed the intervention, and 104 had their progress monitored for 12 months. Thirteen participants withdrew due to tumour recurrence. At the completion of the intervention, mouth opening improved by 10.4 mm (p < .001). This increased to 13.7 mm at 12 months (p < .001). Patient reported outcome all significantly improved and 47 participants were no longer classified as having trismus. There were no serious treatment related adverse events. In patients with trismus following head and neck cancer treatment, a 10-week programme of jaw stretching exercises using Restorbite™ safely improves mouth opening and associated quality of life outcomes with high adherence and the benefits are maintained for 12-months.

Is Diclofenac Transbuccal Mucoadhesive Patch Superior to Oral Diclofenac for the Management of Postoperative Sequelae After Third Molar Surgery?

Pain, swelling, and trismus are the most common sequalae following the surgical removal of mandibular third molars. They pose significant challenges for clinicians, prompting the exploration of efficacious management approaches. The purpose of this study was to assess the efficacy of transbuccal mucoadhesive patch of diclofenac sodium versus an oral tablet in controlling the aforesaid sequelae. A prospective split-mouth, single-blinded study was conducted in the Department of Oral and Maxillofacial Surgery at AMC Dental College and Hospital, Ahmedabad. The study sample included patients of either sex, aged 18 to 45years, requiring surgical removal of bilaterally symmetrical mandibular third molars under local anesthesia. Patients who had consumed analgesics within 24hours prior to the procedure were excluded. The primary predictor variable was the route of administration of nonsteroidal anti-inflammatory drug. The study group received transbuccal mucoadhesive patches containing 20mg diclofenac sodium, whereas the control group received oral tablets of 50mg. Postoperative pain, measured with visual analog scale, was the primary outcome variable, whereas swelling, mouth opening, onset of analgesic effect, and adverse events were assessed as secondary outcome variables. Two categories of covariates were considered. First, demographic: age and gender. Second, perioperative: pattern of impaction. Intergroup comparison was made using a paired sample t-test and an independent sample t-test, while intragroup differences were assessed with a one-way ANOVA and a paired t-test. P value ≤ .05 was considered statistically significant. Out of 146 patients screened initially, the final study sample included 37 subjects with a mean age of 26.08±5.09years (21 (56.75%) males and 16 (43.25%) females). The study group exhibited a significantly lower postoperative pain score compared to the control group on days 0, 1, 2, and 3 postoperatively (P≤.05). No statistically significant difference was observed in reduction of facial swelling and improvement in mouth opening on 1st, 2nd, and 3rd days postoperatively between both the groups (P≥.05). The mean onset of analgesia was statistically significant in the study group (19.96±5.40minutes) compared to the control group (52.56±6.33minutes) (P<.001). Transbuccal mucoadhesive patch of diclofenac sodium offers effective pain control with quicker analgesia and fewer side effects compared to an oral tablet.