Reduction Of Temporomandibular Joint Research Articles

Is there a superiority between arthrocentesis and stabilizing occlusal splint for the treatment of anterior disc displacement with reduction and intermittent block and anterior disc displacement without reduction in TMJ? Randomized clinical trial

Is there a superiority between arthrocentesis and stabilizing occlusal splint for the treatment of anterior disc displacement with reduction and intermittent block and anterior disc displacement without reduction in TMJ? Randomized clinical trial

Preliminary MRI evaluation of anterior repositioning splint in treatment of disc displacement with reduction of temporomandibular joint

Objective: MRI images were used to study the efficacy of anterior repositioning splint (ARS) in the treatment of different types of disc displacement with reduction (DDWR) in temporomandibular joint. Methods: From September 2020 to December 2021, 26 patients with DDWR were enrolled in the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Zhengzhou University. There were 5 males and 21 females with an average age of (20.8±5.8) years. ARS was used for 3-6 months. The changes of joint clicking, opening type and joint pain before and after treatment were compared. The changes of disc position, disc-condyle angle and condylar bone mass before and after treatment were compared by MRI. Paired t-test was performed on the disc-condyle angle before and after treatment, Fisher's exact test was performed on the change of disk position, and other count data were expressed as rate (%). Results: After ARS treatment, the effective rates of joint clicking,abnormal opening, joint pain and disc displacement were 97%(35/36), 14/18, 7/9 and 95%(36/38). MRI analysis found that there was a significant difference between the disc position before and after treatment (P<0.001), MRI analysis showed that the anterior disc displacement (48%, 25/52) and the anterolateral disc displacement (17%, 9/52) were the most common before treatment. In contrast, the normal superior disc (75%, 39/52) and the anterior disc displacement (17%, 9/52) were the most common after treatment, no significant changes were seen after treatment in the anteromedial disc displacement. The disc-condylar angle was (36.09±19.02) ° before ARS treatment and (3.94±10.12) ° after ARS treatment(t=9.23, P<0.001). After treatment, 46% (12/16) of the patients showed new bone formation, and the height of the condyle recovered. Conclusions: The clinical efficacy of ARS in the treatment of anterior disc displacement and anterolateral displacement of temporomandibular joint is remarkable, which can restore the disc-condylar relationship of most patients with indications.

Short-term effects of range-of-motion exercise on temporomandibular joints of patients who undergo disc displacement with reduction of temporomandibular joint.

[Purpose] We investigated the short-term effects of an exercise therapy program that combined a range-of-motion exercise for the temporomandibular joint with self-traction therapy for patients with temporomandibular joint disorders who undergo disc displacement with reduction of the painful temporomandibular joint. [Participants and Methods] The program involved 31 patients with moderate or higher functional pain. The range-of-motion exercise for the temporomandibular joint was performed at the first visit by the therapist, and the patients were instructed to perform self-traction therapy in the morning and while bathing for the next 2 weeks, until their next visit. The maximum mouth opening distance and the visual analog scale scores at the first consultation and 2 weeks later were compared to assess the changes in pain on motion and mastication as well as the impact of the program on daily activities. [Results] All symptoms of the patients showed significant improvements after 2 weeks of starting the treatment. [Conclusion] The results of this study suggest that an exercise therapy program combining range-of-motion exercises for the temporomandibular joint and self-traction therapy may be an effective conservative therapy for reducing the pain and obstacles experienced by patients with temporomandibular joint disorders who undergo disc displacement with reduction of the painful temporomandibular joint.

Effects of Mandibular Protrusion and Lateral Shift Glide on Disc Displacement with Reduction of Temporomandibular Joint: A Case Study

Effects of Mandibular Protrusion and Lateral Shift Glide on Disc Displacement with Reduction of Temporomandibular Joint: A Case Study

Evaluation of Effect of Glucosamine-Chondroitin Sulfate, Tramadol, and Sodium Hyaluronic Acid on Expression of Cytokine Levels in Internal Derangement of Temporomandibular Joint

Evaluation of the effect of glucosamine-chondroitin combination, tramadol, and sodium hyaluronic acid in temporomandibular joint (TMJ) disorders and its impact on the expression of various cytokines such as IL-6, IL-1β, TNF-α, and PGE2. The present study was conducted on 60 patients (males-30, females-30) suffering from internal derangement such as disc displacement with reduction of TMJ. The patients were divided into three groups of 20 each. Group I received a combination of 1.5g of glucosamine and 1.2 g of chondroitin sulfate per day and group II received 50 mg tramadol HCL peroral. Group III received sodium hyaluronate 10 mg/mL, 2 mL injection syringe on each joint. Pain (VAS) scale and maximum mouth opening (MMO) was measured. The level of IL-6, IL-1β, TNF-α, and PGE2 levels were measured using Enzyme-linked immuno sorbent assay (ELISA). There was an improvement in maximum mouth opening in all three groups (p < 0.05). There was a reduction in pain in all groups. IL- 1β, TNF-α, and PGE2 leve ls showed reduction while IL-6 showed an increase in value in group II and III. The efficacy of glucosamine chondroitin sulfate , tramadol and hyaluronic acid in TMJ disorders has been found to be effective. IL-6, IL-1β, TNF-α, and PGE2 levels indicate the risk of TMJ disorders. Thus earlier assessment of their levels helps in diagnosis, and better management may be done.

The Leverage Method: A Novel Technique for Difficult Temporomandibular Joint Reduction

The Leverage Method: A Novel Technique for Difficult Temporomandibular Joint Reduction

The images of osteoarthrosis associated with anterior disc displacement without reduction detected by cone-beam CT

Objective: To analyze the radiological characteristics of the condylar bone in patients with anterior disc displacement without reduction of temporomandibular joint using cone-beam CT (CBCT), and to further investigate the clinical factors possibly associated with the early-stage osteoarthritic changes. Methods: Two hundred and four individuals (≤30 years old) diagnosed as unilateral anterior disc displacement without reduction (disease duration≤1 year) were recruited. CBCT images of bilateral condyles were independently evaluated by two assessors and documented. Correlation between the early-stage osteoarthritic (OA) changes and gender, age, disease duration and mouth opening were analyzed using SPSS 21.0 software. Results: About sixty percent were presented with OA changes in the symptomatic joints, and most of them (47.1%) (96/204) were early-stage OA changes characterized by loss of continuity of articular cortex (Ⅰ) and/or surface erosion (Ⅱ). Logistics regression analyses indicated that disease duration (P =0.000) and mouth opening (P =0.002) were correlated significantly with early-stage OA changes. Conclusions: Disc displacement without reduction was closely related to OA occurrence. OA changes occurred in more than half of the patients after one month of the joint locked and more possibly in patients with increased mouth opening.

Efficiency of pivot splints as jaw exercise apparatus in combination with stabilization splints in anterior disc displacement without reduction: a retrospective study.

ObjectiveTo evaluate efficiency of pivot splints in jaw exercises, in combination with stabilization splints, in cases of anterior disc displacement without reduction of temporomandibular joint.Subjects and methodsTwenty-three patients who referred to the prosthodontics clinic in 1995–1997 were included in the study, where anterior disc displacement without reduction of temporomandibular joint was diagnosed using magnetic resonance imaging and clinical examination. Pivot splints were used for jaw exercises for five minutes long; five times/day and stabilization splints were used at all other times. The patients were followed for 24 weeks. Lateral and protrusive excursions along with maximum mouth opening and were evaluated at each control. Bilateral palpation of temporal, masseter, sternocleidomastoid muscles and TMJ was assessed for pain perception before and after treatment. Data were statistically analyzed using Paired sample t-test and Independent Samples t-test (p < .05).ResultsMean mandibular range of motion measurements increased from 28.74 mm prior to 49.17 mm on maximum opening; right/left lateral excursion from 7.61 mm to 12.04 mm and 4.09 mm to 7.3 mm on protrusion after treatment. All changes observed before and after treatment were found to be statistically significant. (p < .001) Pain symptoms were eliminated at the end of 24 weeks of treatment in all patients.ConclusionUsing pivot splints as an exercise regimen along with a stabilization splint may be a viable treatment option for patients with anterior disc displacement without reduction; as normal mandibular range of motion was established and pain was eliminated.

Splint therapy for disc displacement with reduction of the temporomandibular joint. Part I: Modified mandibular splint therapy

The aims of this preliminary study were to present a modified mandibular splint together with a treatment regimen and to evaluate their effects on the treatment of reciprocal joint sounds of the temporomandibular joint (TMJ). The study participants were recruited from 312 consecutive patients in the temporomandibular disorder clinic of a medical center in Taiwan from January 2003 to December 2003. From among these, 59 cases with typical reciprocal clicking were selected for this study. All participants were treated with a modified mandibular splint and then followed up for 6 months. Successful treatment was defined as leading to the disappearance of the joint sounds of TMJ, as described by patients. Based on clinical evaluation, the overall success rate was 71.2% (42/59) with minimal temporary complications. Patients with clicking at less than 3.5 cm of interincisal opening had a success rate of 92.5%, which was higher than the success rate of patients with clicking at a mouth opening of 3.5 cm or more. This study showed that a modified mandibular splint can be used to treat reciprocal clicking of the TMJ effectively and encouraged us to conduct further study on the efficacy of this splint to treat disc displacement with reduction of TMJ using magnetic resonance imaging examination.

Occlusal Change as a Sequela of Anterior Disc Displacement without Reduction of Temporomandibular Joint: Case Reports

We report 4 patients who developed change of occlusion which seemed to be related to anterior disc dislocation without reduction, but there was no distinct evidence of condylar destruction or collapse. They experienced sudden occurrence of occlusal change, anterior open bite in 2 patients, lateral CR-CO discrepancy in 1 patient, and anteroposterior CR-CO discrepancy in 1 patient. Also, this report is to find out if there is a relation between sudden occurrence of occlusal change and anterior disc dislocation without reduction.

Discectomy as the Primary Surgical Option for Internal Derangement of the Temporomandibular Joint

The goal of this study was to evaluate outcomes of patients who underwent temporomandibular joint (TMJ) discectomy without replacement as the primary treatment for internal derangement after failure of nonsurgical therapy. Thirty consecutive patients with TMJ internal derangement were treated with discectomy from 2001 to 2007. Four patients were lost to follow-up, and 2 were excluded because of prior joint surgery. Using the standardized Helkimo Anamnestic and Clinical Dysfunction Indexes, 24 patients, or 32 joint surgeries, were evaluated postoperatively, with an average follow-up of 30.8 months (range, 2 to 60 months). All 24 patients showed improvement in mandibular mobility and joint function, as well as reduction in TMJ and muscular facial pain, represented by a clinical dysfunction index of DiO, DiI, or DiII. Preoperatively, all patients had an anamnestic index of AiII, which represented moderate to severe pain in the TMJ and masticatory muscles, and/or locking of the joint before surgery. Postsurgically, 20 of the 24 patients scored an index of DiO or DiI, which correlated with a clinically symptom-free state or only a small, minor dysfunction. TMJ pain, muscle pain, and pain with mobility scored the lowest point index, indicating a subjectively successful outcome. Discectomy of the TMJ as a primary surgical option significantly reduces pain and improves function.

A Randomized Controlled Trial of Superior and Inferior Temporomandibular Joint Space Injection With Hyaluronic Acid in Treatment of Anterior Disc Displacement Without Reduction

To compare the outcome of inferior and superior joint space injection of sodium hyaluronate in patients with disc displacement without reduction of the temporomandibular joint (TMJ). One hundred twenty patients with disc displacement without reduction of TMJ were randomized into 2 experimental groups. One group of patients received superior joint space injections of sodium hyaluronate and the other group was treated with inferior joint space injections. Patient's TMJ status and clinical symptoms were evaluated at the 3 and 6 month follow-up appointments. The clinical parameters recorded were maximal mouth opening (MMO), pain intensity on a visual analog scale (VAS), and modified Helkimo's clinical dysfunction index and analyzed with ANCOVA. Fifty of the superior and 54 of the inferior joint space injection therapy group returned for the 3 and 6 month evaluations; 86.67% of the patients were retained in the follow-up. MMO, VAS, and Helkimo's index of both groups improved at the 3 and 6 month follow-ups. The results of MMO changes and TMJ function were almost the same in both groups at 3 month follow-up. However, there was a significant reduction in TMJ pain in the inferior joint injection group at 3 month follow-up compared with the superior joint injection group (P< .001). There were also significant differences between the inferior joint injection group and superior joint injection group in MMO (P< .005), VAS (P< .001), and Helkimo's index (P< .001) at 6 month follow-up. This study showed that inferior joint space injection with sodium hyaluronate is a valid method of treating disc displacement without reduction of TMJ and a long-term study will be needed to assess the effect of inferior joint injection on the morphologic changes of the TMJ.

Correlation between MRI evidence of degenerative condylar surface changes, induction of articular disc displacement and pathological joint sounds in the temporomandibular joint

The relationship of bony changes in the condylar surfaces in articular disc displacement without reduction in temporomandibular joint (TMJ) was investigated using diagnostic imaging. The study also evaluated whether the bony changes in the condylar surfaces limit disc and condyle motion, and produce pathological joint sounds. Thirty-seven joints in 28 patients diagnosed with degenerative bony changes in the condylar surfaces radiographically and anterior disc displacement without reduction using magnetic resonance imaging (MRI) were studied. The bony changes were assessed by radiographic examination and classified into two types: pathological bone changes (PBCs) including erosion, osteophyte formation and deformity, and adaptive bone changes (ABCs) including flattening and concavity. MRI was performed on the TMJ to examine the configuration and position of the discs. Joint sounds in the TMJ were determined using electrovibratograghy with a joint vibration analysis. The articular disc motion to the condyle in the PBC group was smaller than in the ABC group irrespective of the configuration of the disc, even though there were no significant differences between the two types of bony changes in the disc position during jaw closing. The joint vibration analysis of the TMJ showed that joint sounds with a higher frequency were observed in the PBC group than in the ABC group. High energy levels needed to produce the higher frequencies (over 300 Hz) were observed only in the PBC group.

Non‐surgical treatment of sports‐related temporomandibular joint disorders in basketball players

In this study, 18 basketball players (11 female, seven male; age range 14-32 years) with temporomandibular joint (TMJ) problems who had a history of sport injuries related to head or jaw region were evaluated and the results of the treatment were presented. A standardized functional examination of the masticatory system was performed including measurement of maximal jaw movements, recording of joint sounds, pain on movement of the jaw as well as tenderness to palpation of the both TMJ or masticatory muscles. Patients were also evaluated periodontally. Diagnosis was made according the criteria, described by Okeson, and appropriate treatment was applied using different kind of splints. At the end of treatment only one patient continued with right TMJ reduction with slight pain. Except for that patient, none of the patients had pain after treatment. The maximum opening of the jaws and the maximal jaw movements were statistically increased after treatment. Patients with TMJ problems also showed periodontal problems, most likely due to inadequate oral hygiene because of the limited jaw movements and pain. Periodontal parameters including probing depth (PD), Plaque index (PI), and Sulcus Bleeding Index (SBI) improved after treatment. Sports-related TMJ injuries may result in complex problems such as pain, TMJ sounds, limitation in maximal jaw movements and maximum opening of the mouth, difficulty in chewing. With the appropriate diagnosis this could be treated non-surgically in 6-8 months. This study also showed that the TMJ disorders may cause periodontal problems, which may affect all teeth and also the general health of the athlete.

Prognostic indicators of the outcome of arthrocentesis: a short-term follow-up study.

Arthrocentesis of the temporomandibular joint (TMJ) is purported to be an effective modality in the treatment of patients with closed-lock symptoms. The purpose of this study was to determine whether the clinical findings of disk displacement without reduction associated with pain in the TMJ are related to the discovery of TMJ osteoarthrosis (OA) through the use of magnetic resonance (MR) imaging and whether the presence of OA affects the treatment outcome of patients who undergo arthrocentesis of the TMJ. The study population consisted of 38 patients with TMJ pain who were assigned a clinical diagnosis of unilateral internal derangement (ID) of the TMJ, type III (disk displacement without reduction), in combination with capsulitis/synovitis (C/S) and an MR imaging diagnosis of disk displacement without reduction in the painful TMJ only. Before the patients underwent arthrocentesis, bilateral sagittal and coronal MR images were obtained to confirm the presence or absence of ID and OA. The preoperative and postoperative levels of TMJ function with respect to pain and mandibular range of motion were evaluated and compared. Multiple logistic regression analysis was used to compute the odds ratios for successful outcomes for OA (n = 24) versus unsuccessful outcomes for TMJs (n = 14). The preoperative data revealed a significant relationship between the clinical diagnosis of TMJ ID type III with C/S and the discovery of OA on MR images (P =.048). At the 2-month follow-up, a clinical evaluation revealed a significant reduction in TMJ pain during function (P =.000); a significant reduction in the clinical diagnoses of ID type III (P =.000), and C/S (P =.000); and a significant increase in the mandibular range of motion (P =.000). The patients with successful outcomes were more likely to be associated with an MR imaging finding of OA than were the patients with unsuccessful outcomes. (10.4 odds ratio; P =.016). Our preliminary findings suggest that the presence of OA revealed on MR images is related to clinical pain; furthermore, OA proved to be an important prognostic determinant of successful arthrocentesis.

Effect of arthrocentesis and hydraulic distension on the temporomandibular joint disk position

Objective. Recent studies have suggested arthrocentesis and hydraulic distension as an effective treatment modality in patients demonstrating clinical findings consistent with the diagnosis of disk displacement without reduction, normal range of motion thereby being restored and pain of the temporomandibular joint reduced. In view of the fact that only a few studies have been performed to verify the biologic concept of disk displacement without reduction as a diagnostic and therapeutic approach in patients with “closed-lock” symptoms, the purpose of this study was to investigate whether temporomandibular joint–related variable disk position might be linked to cessation of related signs and symptoms associated with the performance of arthrocentesis and hydraulic distension. Study design. The study compared 15 patients, each of whom was assigned a clinical unilateral temporomandibular joint–related diagnosis of internal derangement (ID) type III (disk displacement without reduction) in combination with capsulitis/synovitis. Clinical diagnoses were made according to the Clinical Diagnostic Criteria for Temporomandibular Disorders. Bilateral sagittal and coronal magnetic resonance images were obtained immediately preoperatively and at 2-month follow-up to establish the presence or absence of associated types of ID. Temporomandibular joint–related pain, level of function, and mandibular range of motion were assessed preoperatively and the data were compared with the respective 2-month follow-up findings. Results. Comparison of the pretreatment temporomandibular joint side–related data revealed the temporomandibular joint side with an ID-III in combination with capsulitis/synovitis to be associated with significantly more magnetic resonance imaging diagnoses of ID than of an absence of ID ( P < .001) and with significantly more disk displacement without reduction than disk displacement with reduction ( P < .001). At the 2-month follow-up, clinical evaluation showed a significant reduction in temporomandibular joint–related pain during function ( P < .001), a significant reduction in the prevalence of temporomandibular joint–related diagnoses of capsulitis/synovitis ( P < .001) and ID-III ( P < .01), and a significant increase in mandibular range of motion ( P < .01). There was no change in the prevalence rates of associated temporomandibular joint side–related IDs. Conclusions. The results confirm the concept of disk displacement as a diagnostic approach but not as a therapeutic approach for patients presenting with signs and symptoms of unilateral ID-III in combination with capsulitis/synovitis. In terms of clinical decision-making in temporomandibular disorder–related instances of ID, magnetic resonance imaging may be used as a diagnostic method for identifying the diagnostic validity of the variable “disk-condyle relationship.” (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:271-7)

Disc repositioning therapeutic exercise for disk anterior displacement with reduction in Temporomandibular joint

Disc repositioning therapeutic exercise for disk anterior displacement with reduction in Temporomandibular joint