Management Of Temporomandibular Joint Research Articles

Early Arthrocentesis for Temporomandibular Joint Arthralgia: A Superiority Trial

The aim of this superiority trial was to investigate the clinical outcomes of arthrocentesis as an early treatment supported by use of an occlusal splint vs use of an occlusal splint only in the management of temporomandibular joint (TMJ) arthralgia. Ninety-five adults presenting with TMJ arthralgia were recruited into the study and randomised into 2 groups: Group 1 received arthrocentesis as an early treatment supported by use of an occlusal splint, whereas group 2 received treatment with an occlusal splint only. Seventy-four patients (group 1: n = 37; group 2: n = 37) completed the 1-year follow-up schedule and were included in the final analysis. Reduction of pain intensity measured by a numeric rating scale and increase in mouth opening distance (unassisted maximal, assisted maximal, and pain-free) was seen in both treatment groups. In group 1, pain intensity significantly decreased at 6 weeks and all subsequent time points compared with group 2. In terms of mouth opening distance, a significant improvement was observed in both groups during the course of treatment, but statistical significance was not seen between the 2 treatment groups. Early arthrocentesis supported by use of an occlusal splint is superior to use of an occlusal splint alone in the treatment of TMJ arthralgia. Arthrocentesis with occlusal splint support could be discussed as first-line treatment for arthralgia of the TMJ, which may co-occur with various painful and nonpainful conditions of TMJ disorders.

Cone-Beam Computed Tomographic Evaluation of Hyoid Bone Positioning in Temporomandibular Joint Management – A Pilot Study

Background: Hyoid bone plays an important role in craniomandibular functions through its unique interaction with other structures. The effects of temporomandibular disorder (TMD) on the craniocervical posture and position of hyoid bone were considered, although the results endure inconclusive. Objective: The objective is the comparison of the position of the hyoid bone in patients with the temporomandibular joint disorder of pre- and post-neuromuscular orthotics utilizing cone-beam computed tomography (CBCT). Treatment using ultra-low-frequency transcutaneous electric nerve stimulation was administered, and a myocentric bite was registered, with which an orthotic was fabricated and delivered to the patient for full-time wear. Materials and Methods: The hyoid bone position of 14 TMD patients of pre- and post-treatment was observed using CBCT, and symptom severity score, joint pain, joint sounds, and limited mouth opening were studied pre- and post-treatment clinically. Results: All patients had relief of symptom severity score post treatment and no significant improvement in the anteroposterior direction of hyoid bone with no statistical significance with P value < 0.001. The majority of the patients had an inferiorly positioned hyoid bone post intervention with a P value less than 0.001. Conclusion: Neuromuscular orthotics resulted in a decrease in the symptom severity score of the patients along with an anteriorly and inferiorly positioned hyoid bone.

Orthodontic diagnosis and management of TMJ – A case report

Temporomandibular joint (TMJ) problems can be challenging and cause a myriad of complaints.The orthodontist can play a crucial role in identification and resolution of the same. The management through orthodontic treatment aims not merely at ideal positioning of the teeth but also ensuring synchrony between the condylar position and occlusion, often helping in re-establishing the lost equilibrium of the joint and muscles, often associated with malocclusion. This case report puts forth the diagnosis and orthodontic management of TMJ aberrations, wherein silent signs are manifested in the dentition. The case report, further, aims to provide insight on bridging the gap in treating minor TMJ aberrations by treating the probable root cause – malocclusion. A 20-year-old female patient presented with attrition of the lower incisors and deflection of the mandible on maximum mouth opening, suggestive of silent signs of temporomandibular disorder. Cone-beam computed tomography evaluation revealed erosion of the condylar head bilaterally.

An In-vivo Study to Evaluate the Onset of Relief from Ibuprofen, Placebo and Occlusal Splint in Patients with Acute Myalgia in Muscles Related to Temporomandibular Joint: A Comparative Pilot Study

Purpose: The treatment priority in management of Temporomandibular Joint (TMJ) pain is directed towards the causative factor along with symptomatic treatment. In this process many times psychological aspect is overlooked. Hence with this pilot study, importance of psychological aspect of Temporomandibular Joint Disorder (TMD) is emphasised. Methods and Material: 15 patients suffering from pain in TMD region who qualify under myalgia pain in DC/TMD Axis I category were selected. Patients were divided into 3 groups; Ibuprofen, placebo and occlusal splint with 5 patients in each group. Pain assessment was done at the first visit, 7th day visit and 14th day visit using a VAS scale. Statistical Analysis Used: Friedman Test was applied to determine overall relief from pain in the three groups. Wilcoxon sign rank test evaluated pain relief between each time interval. Kruskal Wallis Test compared different groups for relief from pain at each time interval. Key Finding: Wilcoxon sign rank test showed a significant pain relief in all three groups from I day to I follow up day and I day to II follow up day. However Pain relief from I follow up to II follow up day was significant only in placebo group. Conclusions: Management of TMD myalgia requires a comprehensive understanding of physical and psychological aspect. This will aid us in formulating a treatment plan comprising pharmacotherapy, placebo or physical therapy or combination of any of these.

Prognostic indicators of arthroscopic discopexy for management of temporomandibular joint closed lock

In order to optimize patient selection for temporomandibular joint (TMJ) arthroscopic discopexy to achieve favorable outcomes, prognostic indicators impacting the results are important to analyze. This longitudinal retrospective study aimed to analyze various prognostic factors impacting surgical outcomes following arthroscopic discopexy for management of TMJ closed lock using success criteria based on pain, maximal interincisal opening, diet, and quality of life. Furthermore, a quantitative MRI assessment was performed pre- and post-operatively. Multivariate analysis was used to evaluate various prognostic variables including gender, age, side, duration of illness, Wilkes staging, parafunctional habits, splint therapy and orthodontic treatment. A total of 147 patients (201 joints) were included. The outcome was categorized as excellent (n = 154/76.61%), good (n = 34/16.91%), or poor (n = 13/6.46%) with a success rate of 93.54%. Patients aged > 30 years old (p = 0.048), longer duration of illness (12–24 months: p = 0.034) and (> 24 months: p = 0.022), and patients with Wilkes stage IV (p = 0.002) were all significantly more likely to be in the poor outcome group. Finally, orthodontic treatment showed a significant association with excellent outcomes (p = 0.015). Age, duration of illness, Wilkes staging, and orthodontic treatment are considered significant prognostic factors that can predict the outcomes following the arthroscopic discopexy for management of TMJ closed lock.

Controversies in the management of temporomandibular joint ankylosis using distraction osteogenesis - A systematic review

Background:The three commonly employed sequences of distraction osteogenesis (DO) in the management of temporomandibular joint (TMJ) ankylosis with dentofacial deformities include post-arthroplastic distraction osteogenesis (PAD), simultaneous arthroplastic distraction osteogenesis (SAD), and pre-arthroplastic distraction osteogenesis (PrAD).Objective:The aim of this systematic review is to compare the effectiveness of various sequences of DO in the management of TMJ ankylosis with micrognathia/and obstructive sleep apnea syndrome (OSAS).Data Sources:A comprehensive online and manual search of English language literature with no date restrictions was done on March 2020.Eligibility Criteria:Inclusion criteria were case series and prospective and retrospective studies involving adult/paediatric human subjects with unilateral/bilateral TMJ ankylosis and micrognathia/OSAS treated with DO.Study Appraisal and Synthesis Methods:Of 73 studies identified, only 10 were included in the qualitative synthesis. The outcomes assessed were as follows: maximum mouth opening (MMO), posterior airway space (PAS), polysomnography variables, reankylosis, mandibular length, and chin and mandible position.Results:All the included studies showed high risk of bias. MMO and mandibular length increased, chin and mandibular position improved by the end of treatment in all the three sequences, and polysomnography variables and PAS significantly improved in PrAD compared to PAD and improved in SAD compared to baseline. Reankylosis was significantly less in PrAD.Conclusion:More well-designed studies comparing the three sequences of DO should be carried out to arrive at a consensus.

Second metatarsal free transfer in total temporomandibular joint reconstruction for ankylosis in a child: 10-year follow-up

The management of temporomandibular joint (TMJ) ankylosis requires complete removal of the ankylosed block and the prevention of recurrence. For this purpose, the ramus–condyle unit can be reconstructed with a second metatarsal free flap. This article reports the use of this flap in a young patient treated for left TMJ ankylosis, post costochondral graft for the treatment of hemifacial microsomia. Data from the 10-year follow-up are reported. The glenoid fossa was reconstructed with a graft of the second metatarsal base, enabling the juxtaposition of two cartilaginous joint surfaces, with the aim of optimizing the functional result and preventing the recurrence of ankylosis. At the 10-year follow-up after this surgery, there was no recurrence of the ankylosis and no articular disorder, and the morphological result was satisfactory. Bone fixation was stable over the 10-year period and the metatarsal head was still in place. Quantitative measurements obtained by computed tomography scan did not show any growth of the second metatarsal free flap compared to the right unaffected condylar process.

A Clinical and Radiological Investigation of the Use of Dermal Fat Graft as an Interpositional Material in Temporomandibular Joint Ankylosis Surgery.

Management of temporomandibular joint (TMJ) ankylosis is mainly through surgical intervention. Interpositional materials are a necessity when it comes to prevention of TMJ re-ankylosis after arthroplasty. Early aggressive postoperative physiotherapy is essential for the prevention or treatment of TMJ hypomobility or ankyloses. Recently, it has been shown that abdominal dermis fat helps promote smooth, pain-free joint function and it is stable after interposition and less prone to fragmentation. The purpose of this study was to assess that whether dermal fat is a good choice of interpositional material when it comes to decreased pain perception during aggressive physiotherapy after release of ankyloses thus ensuring good compliance by the patient. We also assessed the fate of the graft material on computed tomography to evaluate any volume changes if occurred after interposition.

A BIOCHEMICAL STUDY OF THE EFFECT OF HIGH MOLECULAR WEIGHT HYALURONIC ACID IN MANAGEMENT OF TEMPOROMANDIBULAR JOINT OSTEOARTHRITIS IN RATS

INTRODUCTION: Osteoarthritis is one of the most common degenerative diseases affecting the joints. Adjuvant- induced arthritis (AIA) is an experimental model of polyarthritis which has been widely used for preclinical testing of several anti-arthritic agents and investigating the pathogenesis of arthritis. A modified model of AIA was used in this study, where the disease was induced in one joint. Hyaluronic acid deals with the degenerative effects of arthritis from 3 different aspects: mechanically by maintaining lubrication, metabolically by providing nutritional materials to the articular disc and biologically by decreasing inflammatory effects. OBJECTIVES: to study the biochemical actions of high molecular weight hyaluronic acid (HMWHA) in management of temporomandibular joint (TMJ) adjuvant induced arthritis by detecting matrix metalloproteinase-3 (MMP3) concentration in TMJ tissue extract. MATERIALS AND METHODS: 14 male albino rats were divided into 2 equal groups and in each group a split mouth design was used. •Study I: Arthritis was induced in 7 animals through a single intra-articular injection of Complete Freund's Adjuvant (CFA) in the left TMJs. (50µl) •Study II: Arthritis was induced in the other 7 animals through a single intra-articular injection of CFA and treated with an intra-articular injection of HMWHA into their left TMJs, once a week for total of three injections. 7 animals were sacrificed on day 7 of the disease while the other 7 animals were sacrificed one week after the last injection of HMWHA. Elisa test was performed to detect MMP 3 which is considered as a biomarker of the disease progression RESULTS: The concentration of MMP-3 of study I (diseased group) on day 7 was found to be significantly higher than that of study II (treated group) on day 28. CONCLUSIONS: High molecular weight hyaluronic acid is capable of management of osteoarthritic TMJs.

Proceedings From the Clinical and Scientific Innovations in Oral and Maxillofacial Surgery Conference 2019

Proceedings From the Clinical and Scientific Innovations in Oral and Maxillofacial Surgery Conference 2019

Use of blood and blood products in the management of temporomandibular joint (TMJ) disorders: A systematic review

Use of blood and blood products in the management of temporomandibular joint (TMJ) disorders: A systematic review

Single puncture versus standard double needle arthrocentesis for the management of temporomandibular joint disorders: A systematic review

The aim of this systematic review was to investigate the current evidence in order to assess the efficacy of single puncture arthrocentesis vs standard double needle arthrocentesis in the management of temporomandibular joint(TMJ) disorders. An electronic search of the PubMed, Scopus, Cochrane CENTRAL and Google Scholar databases was performed to identify English studies published up until October 2017. Eligible studies were selected based on inclusion criteria and included randomised controlled trials(RCTs) comparing single puncture arthrocentesis and standard double needle arthrocentesis for the management TMJ disorders. The initial screening identified 984 records, of which only 5 fulfilled the inclusion criteria. A high degree of heterogeneity was found in the 5 studies with each reporting different sample selection and arthrocentesis protocol. All 5 studies reported no difference in reduction in pain intensity and improvement in maximal mouth opening between the single puncture technique and standard double needle technique. This review provides some evidence that single puncture arthrocentesis is clinically as efficacious as standard double needle arthrocentesis. There is a need of well-designed RCT with standard protocol of arthrocentesis comparing different single puncture techniques and standard double needle technique for the management of TMJ disorders.

Efficacy of ultrasound massage therapy as an adjuvant pain control modality in TMDs: A clinical study

Background: Temporomandibular disorders (TMDs) are a collection of medical and dental conditions that affect the muscles of mastication along with transmittable tissue components. Physical modality such as ultrasound (US) therapy is considered to be an important treatment to relieve musculoskeletal pain, to reduce inflammation, and to restore oral motor function. Settings and Design: It was a prospective study and was carried out in the Department of Oral Medicine and Radiology at Teerthanker Mahaveer Dental College and Research Centre, Moradabad, to evaluate the efficacy of therapeutic US massage therapy in management of temporomandibular joint (TMJ) disorders. Aims and Objective: To determine the effectiveness of US massage therapy in patients with TMDs. Materials and Methods: This study included 10 patients with TMDs, according to research diagnostic criteria (RDC), within the age group of 18–50 years. All the patients were treated with US, once a week for 4 weeks for 8 min and pain intensity was evaluated using visual analog scale, at every sitting. Statistical Analysis Used: SPSS version 22 software was used and Student's t-test value was used. Results and Discussion: A significant pain reduction was found in US massage therapy. There was a decrease in pain in TMJ from 7.30 ± 1.70 to 4.00 ± 2.53 and mouth opening improved from 40.40 ± 6.50 to 41.80 ± 5.97 which was statistically significant. This therapy appears to be a valuable physiotherapy method for pain reduction in TMDs. Conclusion: US massage therapy appears to be useful in relieving pain and improves subsequent mouth opening, and hence can be considered as a valuable physiotherapy method. Thus, US massage therapy serves as a potent and independent therapeutic modality in TMDs.

Lateral Arthroplasty as an Optimal Treatment for Surgical Management of Unilateral Temporomandibular Joint Ankylosis Type III in Children

Management of temporomandibular joint (TMJ) ankylosis described in the literature showed many surgical techniques. Purpose: The aim of this study was to evaluate the lateral TMJ arthroplasty as a surgical technique for treatment of type III Sawhney’s TMJ ankylosis in children both clinically and radiographically. In that surgical technique the need of a costochondral graft for reconstructive arthroplasty is avoided with its potential complications (as a donor site) and the unpredictable growth pattern. Materials & Methods: Eight children with unilateral type III Sawheny ankylosis (ankylosis on the lateral aspect of the medially displaced condyle) were included in this research. They all underwent lateral TMJ arthroplasty with the aid of panoramic and coronal C.T views. Evaluation was done both clinically and radiographically regarding interincisal distance, lateral TMJ movement, protrusive movements, postoperative pain, patient’s satisfaction and hazards of facial nerve injury. All patients were seen weekly for 4 weeks, at three and six months then at one year. Results: The used surgical technique of lateral arthroplasty had greatly achieved the desired goals of treating TMJ ankylosis during a follow up period of one year. Those achieved goals include restoration of full mandibular function and free movements of the joint with adequate mouth opening and a mean interincisal distance of 35 mm, maintaining acceptable occlusion and ramus height and obviates the need of any autogenous chondro-osseous graft (commonly costochondral) with potential complications of the donor sites. Conclusion: The surgical procedure of lateral arthroplasty is an easy and safe technique. It is considered as an effective treatment modality in treatment of type III TMJ ankylosis especially in children.

Conventional versus Modified Preauricular Incision Approaches to the Management of Temporomandibular Joint Ankylosis in Sana’a City, Yemen: A Comparative Clinical Study

Objective: To compare between the conventional and modified preauricular incision approaches to the management of temporomandibular joint (TMJ) ankylosis among Yemeni patients in Sana’a city, Yemen.
 Methods: This comparative clinical study recruited ten patients (7 males and 3 females; age range: 6–35 years) with true fully or partially bony or fibrous TMJ ankylosis. These patients were admitted to and followed up in the Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Science and Technology Hospital in Sana’a in the period from May 2013 to February 2016. Five patients with condylar capsule ankylosis were subjected to the conventional preauricular approach, while the other five cases with ankylosis that extends beyond the condylar capsule and reaches the zygomatic arch were subjected to the modified preauricular approach. Both approaches were evaluated and compared for the time required, intra- and post-operative complications and aesthetic results.
 Results: The mean times required to carry out the operations were 4.45 and 3.20 hours for conventional and modified preauricular approaches, respectively.Facial nerve injury was present in two patients undergoing the conventional preauricular approach, but this reversed to normal after four to five months. Patient of both groups experienced no facial paralysis or post-operative auriculotemporal syndrome. Intra-operative bleeding was mild to moderate among the patients of both approaches, and none of the patients required blood transfusion intra- or post-operatively. Major blood vessels were injured in three cases undergoing the conventional preauricular approach. All patients subjected to both approaches showed satisfactory aesthetic end results.
 Conclusions: Conventional and modified preauricular approaches provide excellent accessibility and visibility to the surgical field during the management of TMJ ankylosis among Yemeni patients, with the latter being slightly superior. In addition, the modified preauricular approach is associated with fewer complications, absence of facial nerve injury and reduced surgical time compared to the conventional approach.

Senior Oral and Maxillofacial Surgery Resident Confidence in Performing Invasive Temporomandibular Joint Procedures

The purpose of this study was to evaluate the level of confidence that senior-level oral and maxillofacial surgery (OMS) residents have in the management of temporomandibular joint (TMJ) disorders, determine their exposure to various invasive TMJ procedures during training, and assess their confidence in performing those procedures on completion of residency. A questionnaire was designed, and a link to a University of Illinois at Chicago Qualtrics Survey platform (Qualtrics, Provo, UT) was e-mailed to all program directors at Commission on Dental Accreditation-accredited OMS training programs in the United States.The program directors were asked to forward the 20-multiple-choice question anonymous survey to their senior-level residents for completion. The survey included the program's demographic characteristics, resident's confidence in assessing and managing patients with temporomandibular disorders (TMDs), resident's experience performing various invasive TMJ procedures, and whether the resident believed he or she had received sufficient education and clinical experience in the management of TMJ disorders. The data were collected and summarized by use of a standard spreadsheet analysis, as well as appropriate descriptive and analytical statistical tests. The response rate was 28.0%. Of the 56 respondents, 52 (92.9%) reported having received instruction in nonsurgical management of TMDs. All respondents confirmed that invasive TMJ procedures were performed in their program. The most commonly performed procedure was TMJ arthrocentesis (mean rating, 3.11), followed by open TMJ surgery (mean rating, 2.82).The least-performed invasive surgical procedure was autogenous total TMJ replacement surgery (mean rating, 1.39). Eighty percent of residents reported being comfortable managing the TMD patient. The only procedure with which the respondents were highly confident was TMJ arthrocentesis (mean rating, 3.89). This study suggests that confidence levels in the management of the TMD patient are related directly to the invasive TMJ procedure experience obtained during residency. This finding may have implications on the practice patterns of OMS surgeons as it relates to access to care for the TMD patient.

Low-level laser therapy: A novel therapeutic approach to temporomandibular disorder - A randomized, double-blinded, placebo-controlled trial.

The objective of this study was to assess the effectiveness of low-level laser therapy (LLLT)/low intensity laser therapy (LILT) in the management of temporomandibular joint (TMJ) pain in a random and double-blind research design. TMJ pain patients, randomly assigned into two groups: Group 1 (n = 20) and Group 2 (n = 20), received 2-3 treatments per week for 8 sessions of active LILT with diode laser (gallium aluminum arsenide, 810 nm, 0.1 W). Measures of TMJ pain during function were evaluated at baseline, after completion of 8 sessions of laser treatment, and 30 days after the final laser therapy. At the final treatment point, within-group, pain reduction was observed in both active LLLT and placebo groups at day 0 (P = 0.000), 8th session (P = 0.000), and 1 month (P = 0.001). Between the groups, there is no significant difference at day 0 (P = 0.214), 8th session (P = 0.806), and 1 month (P = 0.230). Significant increased mouth opening was observed in both Group 1 and Group 2 (P = 0.006 and P = 0.021, respectively) after treatment. However, no significant difference was found between the two groups (P = 0.330). Furthermore, significant improvement in clicking was recorded before and after treatment both in Group 1 (P = 0.000) and Group 2 (P = 0.001). The study suggests that LLLT is not better than placebo at reducing TMJ pain during function. It may be assumed that a more tailored application of LLLT should be developed to take into account the multifactorial aspect of the disorder.

Magnetic Resonance Imaging Findings following Intraarticular Infliximab Therapy for Refractory Temporomandibular Joint Arthritis among Children with Juvenile Idiopathic Arthritis

To evaluate the involvement of intraarticular (IA) infliximab (IFX) in the management of temporomandibular joint (TMJ) arthritis associated with juvenile idiopathic arthritis (JIA) that is refractory to systemic treatment and IA corticosteroid therapy. Ours was a retrospective study of children with JIA who received IA IFX into the TMJ. The effectiveness of treatment on the progression of acute and chronic changes was assessed by a quantitative magnetic resonance imaging scoring system. Median acute and chronic scores worsened by 0.25 and 0.75, respectively. In multivariate analysis, worsening acute scores and passage of time predicted worsening of the chronic scores. IA IFX allowed for progression of refractory TMJ arthritis in most but not all children with JIA.

Fate of Costochondral Graft in Temporomandibular Joint Reconstruction: A Histological Study.

To asses the fate of the costochondral graft (CCG) used to stimulate mandibular growth in the management of Temporomandibular joint (TMJ) reconsrtuction in ankylosis-histologically. Ten patients who had undergone CCG grafting for TMJ ankylosis between 1994-2009 in the department of Oral & Maxillofacial Surgery, Tamil Nadu Govt Dental College and Hospital, Chennai and had come back with reankylosis, were surgically explored and the graft along with the ankylotic mass was excised and evaluated histologically. There is no documented human study and clinically it is not possible. Histological evaluation revealed the presence of osseous tissue, fibrous tissue and osteocytes but no evidence of any chondroid tissue. Our study showing the absence of chondroid tissue raises the question on the rationale of CCG in TMJ reconstruction when other interpositional gap arthroplasty can achieve a disease free joint.

Management of temporomandibular joint with anterior disc displacement with reduction by two different techniques

Management of temporomandibular joint with anterior disc displacement with reduction by two different techniques