Temporomandibular Joint Hypermobility Research Articles

Efficacy of dextrose prolotherapy for temporomandibular joint hypermobility: A systematic review and meta-analysis

ABSTRACT Objective We reviewed the efficacy of dextrose prolotherapy versus placebo and other active interventions, like autologous blood injection (ABI) and botulinum toxin (BTX), in improving the outcomes of temporomandibular joint (TMJ) hypermobility. Methods We searched PubMed, the Cochrane CENTRAL library, Embase, Scopus, and Web of Science databases to identify randomized controlled trials (RCTs) . Maximal mouth opening (MMO), pain, and frequency of dislocations were analyzed. Results Eight RCTs were included. In comparison with placebo, dextrose prolotherapy was associated with significantly reduced pain and MMO. Comparison of dextrose with ABI revealed no significant difference in MMO. Qualitative analysis showed no significant difference in outcomes in patients who received dextrose prolotherapy and BTX. Conclusions Low-quality evidence suggests that dextrose prolotherapy may reduce MMO and improve pain scores compared to placebo in patients with TMJ hypermobility. Low-quality evidence also suggests that there may be minimal difference in outcomes between dextrose vs ABI and BTX.

Efficacy of Intra-articular Platelet-rich Plasma versus Hydrocortisone with Local Anaesthetic Injection in Temporomandibular Joint Disorders - A Prospective Study

Abstract Introduction: Temporomandibular joint (TMJ) is subjected to many disorders commonly termed temporomandibular disorders (TMDs) which include TMJ hypermobility, ankylosis and internal derangement. In the past, many non-invasive conservative treatment modalities were tried out for their treatment which include joint unloading, the use of anti-inflammatory agents and physiotherapy. In recent times, injections of corticosteroids and platelet-rich plasma (PRP) into the TMJ have been proposed as alternative therapeutic methods. The main objective of the prospective study was to compare the efficacy of intra-articular injection of PRP and hydrocortisone with local anaesthetic agents in reducing the symptoms in patients with TMDs. Materials and Methods: This prospective study included 30 patients with TMDs, out of which 15 patients (Group I) received PRP injections and 15 patients (Group II) received hydrocortisone with local anaesthetics for arthrocentesis in their affected joints. The patients were assessed for pain, maximum interincisal mouth opening, TMJ sound and disc displacement. Results: The pain was markedly reduced in patients who received PRP injections (Group I) as compared to those who received hydrocortisone injection (Group II). An increase in mouth opening was similar in both the groups, and TMJ sounds were reduced in patients who received PRP. Magnetic resonance imaging also showed that PRP-treated patients showed better articular disc repair than patients treated with hydrocortisone. Discussion: PRP increases chondrocyte proliferation and production of matrix molecules and helps maintain the integrity of the chondral surface, thereby facilitating joint movement, whereas corticosteroids are more potent anti-inflammatory agents and they act by inhibiting prostaglandin synthesis which is the mediator of inflammation. Thus, the use of PRP has been proven to show better results in reducing the symptoms of TMDs and also helped in articular disc repair.

High prevalence of orofacial pain in juvenile fibromyalgia as detected by a novel tool specifically devised for children and adolescents.

To examine the prevalence of temporomandibular disorders (TMD) in patients with juvenile fibromyalgia syndrome (JFS) and identify TMD characteristics specifically associated to JFS. Signs and symptoms of TMD were assessed using a novel clinical tool specifically devised for children that consists of: 1. a self-report multiple-choice questionnaire; 2. a protocol for the clinical examination of the orofacial region. Multivariate logistic regression model was used to identify TMD features associated with JFS. Thirty JFS patients (median age 15.5 years) and 45 healthy controls (median age 15.0 years) were included in this cross-sectional study. Orofacial pain was reported by 26 of 30 JFS patients (86.7%) and by 3 of 45 controls (6.7%; p<0.001). Pain on TMJ palpation was present in 18 of 30 JFS patients (60%) and in 5 of 45 controls (11.1%; p<0.001). Median values of maximum spontaneous mouth opening, voluntary active opening and assisted passive opening were significantly higher in JFS patients than in controls. On multiple regression analysis spontaneous orofacial pain (OR: 21.0; p=0.005), diffuse tenderness on palpation of the masticatory muscles (OR: 14.9; p=0.026) and TMJ hypermobility (OR 1.42; p=0.008) were independently associated with JFS. The high prevalence of TMD in JFS highlights the need for a broader interdisciplinary evaluation of JFS patients. TMJ hypermobility, in addition to orofacial and masticatory muscle pain, is an important clue for the diagnosis of TMD in adolescents with JFS. Elucidating the link between these disorders will advance individualised management and improve treatment efficacy.

Temporomandibular Joint Injections and Lavage: An Overview of Reviews.

Objectives: This overview was conducted following the Preferred Reporting Items for Overviews of Reviews guidelines and aimed to collect and compare the results of systematic reviews on temporomandibular joint injection treatment. Methods: Systematic reviews of randomized clinical trials on temporomandibular disorders treated with lavage or intra-articular administrations were qualified for syntheses. The final searches were conducted on 27 February 2024, without time frame restrictions. Results: Of the 232 identified records, 42 systematic reviews were selected. The most evidence-based conclusions call into question the clinical differences between many therapeutic approaches, including the following: (1) injectable selection for the treatment of pain and hypomobility; (2) the method of performing arthrocentesis; (3) the use of imaging when rinsing the TMJ cavity; (4) the supplementation of the extracapsular administration of unprocessed blood with intracapsular deposition in the treatment of TMJ hypermobility. Conclusions: Systematic reviews based solely on randomized clinical trials proved the following differences: (1) in painful temporomandibular hypomobility, a better therapeutic effect is observed with arthrocentesis followed by I-PRF administration compared to lavage alone; (2) in painful temporomandibular hypomobility, inferior- or double-compartment injection leads to better results than superior-compartment injection; (3) in temporomandibular joint recurrent dislocation, hypertonic dextrose administration is superior to placebo, although (4) unprocessed blood has a better effect than hypertonic dextrose. PROSPERO registration number: CRD42024496142.

Efficacy of Dextrose Prolotherapy Combined with Intermaxillary Fixation in the Treatment of Temporomandibular Joint Hypermobility

Efficacy of Dextrose Prolotherapy Combined with Intermaxillary Fixation in the Treatment of Temporomandibular Joint Hypermobility

Radiologic Changes in Patients with Temporomandibular Joint Hypermobility: A Cone Beam Computed Tomography Study

Radiologic Changes in Patients with Temporomandibular Joint Hypermobility: A Cone Beam Computed Tomography Study

Different modalities in management of temporomandibuolar joint dislocation

The pathophysiology of mandibular dislocation involves the combination of three factors: loosening of the capsule and the TMJ ligaments, a prominent eminence, and muscular spasm.Initially, loosening of the capsule and ligaments allows the condyle to perform non-physiological and excessive motions, bypassing the articular eminence. This condition can be seen during simple activities such as laughing and yawning, during long dental consultations, during orotracheal intubation, and in episodes of vomiting. The treatment of chronic symptomatic TMJ hypermobility may be organized into; bony alteration, alteration of associated musculature and alteration of the ligaments.

Prognostic criteria for the management of temporomandibular disorders using arthrocentesis with normal saline and arthrocentesis with normal saline and platelet-rich plasma.

Temporomandibular joint disorders (TMDs) are ailments affecting the jaws and allied structures, resulting in many pathologies (TMJ hypermobility, internal disc derangement, bone changes, degenerative disorders, and ankylosis). Pain, clicking or crepitus, restricted range of motion, deranged jaw function, and deflected or deviated mouth opening and closing are the commonly observed manifestations in TMDs. Internal derangement refers to an aberrant relation of the articular disc to the condyle and fossa, respectively. Conventional therapies highlight the role of non-invasive conservative treatment strategies, namely joint unloading, anti-inflammatory drugs, and physiotherapy. Current literature has emphasized the use of corticosteroids and platelet-rich plasma (PRP) as treatment strategies in TMDs. This study aimed to evaluate whether intra-articular injection of PRP after normal saline lavage in TMJ minimizes the symptoms of TMDs, as compared to injection of normal saline. Thirty patients with TMD according to research diagnostic criteria (RDC) were selected. One group received arthrocentesis with normal saline, and the other group received arthrocentesis with PRP injection. The patients were assessed for pain, maximum inter-incisal mouth opening, bite force, and TMJ sounds. TMDs treated by PRP injection had slightly better results. More studies are required to substantiate the outcome. Injections of PRP were more effective in reducing the symptoms than arthrocentesis with normal saline.

Is Dextrose Prolotherapy Superior to Placebo for Treatment of TMJ Hypermobility: Comparison of Pain Changes at Masseter, Lateral Pterygoid, Sternocleidomastoid and Trapezius Muscles

Is Dextrose Prolotherapy Superior to Placebo for Treatment of TMJ Hypermobility: Comparison of Pain Changes at Masseter, Lateral Pterygoid, Sternocleidomastoid and Trapezius Muscles

Evaluation of the effects of prolotherapy on condyles in temporomandibular joint hypermobility using fractal dimension analysis.

ObjectivesProlotherapy is a method that has gained popularity in recent years and has been reported to have positive short-term and long-term clinical results in maxillofacial surgery, especially temporomandibular joint (TMJ) hypermobility. This study aimed to evaluate the changes in the trabecular structure of mandibular condyles in patients who underwent prolotherapy due to TMJ hypermobility using the fractal analysis method.Materials and MethodsForty-five patients who received dextrose prolotherapy at a concentration of 20% and fifteen control patients were included in the study. All patients had panoramic radiographs just before (T0) and six months after treatment (T1). The patients who received treatment were divided into three groups according to the number of prolotherapy injections. The regions of interest were selected from bone areas close to the articular surfaces of the condyles. The fractal dimension (FD) values were calculated.ResultsThe main effect of time on the FD value was significant [F (1, 56)=86.176, P<0.001]. This effect was qualified by a significant time×group interaction effect [F (3, 56)=9.023, P<0.001]. The decreases in FD values in all treatment groups between T0 and T1 times were significant (P=0.004). However, changes in FD values were not significant in the control group (P=0.728).ConclusionDextrose prolotherapy without the effect of the number of injections caused a decrease in FD values in the mandibular condyles over time.

Evaluation of the Effects of Polidocanol Injection in the Treatment of Temporomandibular Joint Hypermobility - A Prospective Study.

Sclerosing agents have been used for temporomandibular joint (TMJ) hypermobility since decades, some of which are ethanolamine oleate, and OK-432, sodium psylliate (sylnasol), but there are no studies on the usage of polidocanol - a well-known sclerosing agent which does not have much side effects and is inexpensive. Hence, this study evaluates the effect of polidocanol injection in the treatment of TMJ hypermobility. This was a prospective observational study in which patients with chronic TMJ hypermobility were included. Out of the 44 patients who had symptoms of clicking and pain of the TMJ, 28 were diagnosed as internal derangement of the TMJ. The final analysis included 15 patients in whom multiple injections of polidocanol were given on the basis of post-operative parameters. The sample size was calculated based on a significance level of 0.05 and a power of 80%. Overall, a success rate of 86.6% (13/15) was encountered at the end of three months, with seven patients not reporting any further episodes of dislocation after one injection and six patients not reporting any episode of dislocation after two injections. Polidocanol sclerotherapy can be used as a treatment modality for chronic recurrent dislocation of the TMJ, rather than opting for more invasive procedures for the same.

A Novel Method of Temporomandibular Joint Hypermobility Diagnosis Based on Signal Analysis.

Despite the temporomandibular joint (TMJ) being a well-known anatomical structure its diagnosis may become difficult because physiological sounds accompanying joint movement can falsely indicate pathological symptoms. One example of such a situation is temporomandibular joint hypermobility (TMJH), which still requires comprehensive study. The commonly used official research diagnostic criteria for temporomandibular disorders (RDC/TMD) does not support the recognition of TMJH. Therefore, in this paper the authors propose a novel diagnostic method of TMJH based on the digital time–frequency analysis of sounds generated by TMJ. Forty-seven volunteers were diagnosed using the RDC/TMD questionnaire and auscultated with the Littmann 3200 electronic stethoscope on both sides of the head simultaneously. Recorded TMJ sounds were transferred to the computer via Bluetooth® for numerical analysis. The representation of the signals in the time–frequency domain was computed with the use of the Python Numpy and Matplotlib libraries and short-time Fourier transform. The research reveals characteristic time–frequency features in acoustic signals which can be used to detect TMJH. It is also proved that TMJH is a rare disorder; however, its prevalence at the level of around 4% is still significant.

ОЦЕНКА РЕЗУЛЬТАТОВ ОБСЛЕДОВАНИЯ ПАЦИЕНТОВ С ДИСФУНКЦИЕЙ ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА В ЗАВИСИМОСТИ ОТ ТИПА ПРИВЫЧНОЙ ДВИГАТЕЛЬНОЙ АКТИВНОСТИ

Subject. The study of the results of the examination of the patients with the temporomandibular joint dysfunction depending on the habitual physical activity type.&#x0D; The aim of the study is to estimate the results of the examination of the patients with the temporomandibular joint dysfunction depending on the habitual physical activity type. &#x0D; Methodology. 105 patients (18 male patients and 87 female patients) aged 20-35 with the occlusive temporomandibular joint dysfunction (K07.6 Diseases of temporomandibular joint) living in Tyumen and in Tyumen region were examined. The study was carried out at “the Regional stomatological polyclinic” in Tyumen. &#x0D; Results. The study of the peculiarities of temporomandibular joint dysfunction depending on the habitual physical activity type was carried out. The clinical results of the dynamic observation and complex functional study in 105 patients aged 20-35 having occlusive temporomandibular joint dysfunction were given. &#x0D; Conclusion. The results showed that there was a direct connection between the changes in dentomandibular system and the physical activity level in 105 patients aged 20-35 with occlusive temporomandibular joint dysfunction living in Tyumen and Tyumen region.&#x0D; In the studied subjects, with a a low level of habitual motor activi 8.43% more defects in the dentition were found in comparison with a high level of habitual motor activity, and by 6.02% more than in comparison with an average level of habitual motor activity, the pathological abrasion of the teeth was almost 2 times higher compared with a high level of habitual motor activity.&#x0D; An additional examination method based on computed tomography showed a violation of the articular relationship in 67.3% of cases, signs of TMJ hypermobility one and two-sided in 28.2%, changes in the position of the condyles in the joint in 33.33% of cases, in the group with a low level of habitual motor activity.

Efficacy of prolotherapy and arthrocentesis in management of temporomandibular joint hypermobility

ABSTRACT Objective The aim of this study was to compare the efficacy of dextrose prolotherapy in conjunction with arthrocentesis and dextrose prolotherapy alone in the management of symptomatic TMJ hypermobility. Methods Twenty-four patients suffering from TMJ symptomatic hypermobility received 10% dextrose injections for three sessions at four-week intervals. Twelve patients (P group) received prolotherapy alone; the other 12 (PA group) also underwent a single arthrocentesis session. Patients were evaluated for maximal incisal opening, maximal incisal opening without pain, pain at rest, pain during chewing function, TMJ sound, and locking episode frequency. Results Pain scores were significantly reduced in both groups, and the locking episode frequency was decreased to a greater extent in the PA than the P group, at both the short and long terms. Conclusion Prolotherapy is effective in the management of TMJ hypermobility. However, prolotherapy with arthrocentesis may be superior to prolotherapy alone in the management of TMJ hypermobility.

The Use Of Injectable Platelet Rich Fibrin In The Treatment Of Tempromandibular Joint Hypermobility

Purpose: A prospective consecutive case series study was performed during the period between December 2014 and July 2017, aimed to evaluate the effectiveness of the use of injectable platelet rich fibrin (PRF) in the treatment of tempromandibular joint hypermobility. Patients and methods: Twelve patients suffering from TMJ hypermobility were treated by PRF intra articular injection twice with one month interval. Patients underwent clinical investigation with complete assessment of pain, frequency of dislocation, range of motion and TMJ sounds, this was preformed pretreatment then on first, third, sixth, and ninth months post treatment. Pre and post radiological CBCT was performed to assess the degree of capsular and ligamental laxity (DCLL), and the Condylar position (CP) at maximum range of motion. Results: The results of the study showed that PRF had a highly significant positive effect on the clinical signs and symptoms of TMJ hypermobility over the first 6 months postoperatively, but at 9 months, the results were not sustained on the same clinical improvement level. Conclusion: The injection of PRF is an effective, minimally invasive method that could be used for treatment of TMJ hypermobility by improving capsular and ligamental integrity. Additionally, it significantly improves all signs and symptoms up to 6 months since the TMJ injection, so it is recommended to repeat the procedure yearly.

The efficacy of dextrose prolotherapy over placebo for temporomandibular joint hypermobility: A systematic review and meta-analysis.

The aim of the systematic review was to analyse the available evidence in order to assess the efficacy of dextrose prolotherapy in improving outcomes in temporomandibular joint (TMJ) hypermobility patients as compared to placebo. An electronic search of PubMed, Scopus, CENTRAL and Google scholar databases was performed for English language papers published up to February 2018. Randomised clinical trials (RCTs) and controlled clinical trials (CCTs) comparing dextrose prolotherapy with placebo for TMJ hypermobility were included. Three RCTs were included in the review. Frequency of subluxation/dislocation was reported by two trials which found no difference between dextrose and placebo. A statistical significant difference in reduction of MMO with the use of dextrose prolotherapy was seen on pooling of data (random: MD=-3.32, 95% CI -5.26 to -1.28; P=0.0008; I2 =0%). A statistical significant difference in pain reduction was also seen with dextrose as compared to placebo (random: MD=-1, 95% CI -1.58 to -0.42; P=0.0007; I2 =0%). Within the limitations of the study, dextrose prolotherapy may cause significant reduction in mouth opening and pain associated with TMJ hypermobility. Conclusions with regard to reduction of episodes of subluxation/dislocation cannot be drawn. There is a need of more high-quality RCTs with larger sample size and homogenous prolotherapy protocol to draw stronger conclusions on the effect of dextrose prolotherapy in patients with TMJ hypermobility.

Is dextrose prolotherapy superior to placebo for the treatment of temporomandibular joint hypermobility? A randomized clinical trial

A randomized clinical trial involving adult patients with bilateral temporomandibular joint (TMJ) hypermobility referred for treatment was implemented. The sample comprised 30 consecutive patients, who were divided randomly into two groups. The TMJ hypermobility was treated with either saline (placebo group) or dextrose injections (study group). The solution was injected into five different TMJ areas in three sessions at monthly intervals. The predictor variable was the treatment technique. The outcome variables were visual analogue scale (VAS) evaluations and maximum inter-incisal opening (MIO). Outcome variables were recorded preoperatively and at 12 months postoperatively. Descriptive and bivariate statistics were computed, and significance was set at a P-value of <0.05. The follow-up sample comprised 26 subjects: 12 in the placebo group and 14 in the study group. Masticatory efficiency increased and general pain complaints and joint sounds decreased significantly in both groups. MIO decreased significantly only in the study group. Insignificant changes in the other parameters were found for both groups. After estimating differences between follow-up and baseline outcomes, the mean change in primary outcome variables showed no statistically significant difference between the two groups. These findings suggest that dextrose prolotherapy is no more effective than placebo treatment for any of the outcome variables of TMJ hypermobility assessed.

Association between disc displacement without reduction and temporomandibular joint derangement observed on magnetic resonance imaging

O objetivo deste estudo foi avaliar possíveis associações entre os seguintes fatores: anatomia e posição do disco articular; morfologia da eminência articular e da cabeça da mandíbula; presença de derrame articular; mobilidade da cabeça da mandíbula; e inserção do músculo pterigoideo lateral. Foram avaliadas imagens de ressonância magnética de 33 articulações de pacientes sintomáticos. O disco articular foi classificado como normal, alongado ou dobrado; o deslocamento foi classificado como normal, lateral ou medial; a cabeça da mandíbula foi classificado como arredondado, convexo, achatado ou angulado; a eminência articular foi classificada como caixa, sigmoide, achatada ou deformada; a mobilidade da cabeça da mandíbula foi classificada como normal, hipomobilidade ou hipermobilidade; e o padrão de inserção do músculo pterigoideo lateral foi classificado como Tipo I, Tipo II ou Tipo III. As formas mais frequentes do disco articular, eminência articular e cabeça da mandíbula foram dobrado, achatada e achatado, respectivamente. Pode existir uma relação da mobilidade da ATM que tende a apresentar uma forma de disco normal (100%), hipomobilidade da ATM com forma do disco dobrado (48%); e hipermobilidade da ATM com forma de disco alongado (100%). A ressonância magnética permitiu a observação clara das estruturas articulares e não foi encontrada associação entre o padrão de inserção e a posição lateral do disco, a forma do disco e a forma da cabeça da mandíbula. Todos os casos em que o derrame articular estava presente estavam relacionados à hipomobilidade (100%).

Ehlers-Danlos syndrome

Ehlers-Danlos syndrome is a group of clinically and genetically heterogeneous inherited connective tissue disorders with widespread manifestations. The prevalence of this syndrome is 1:5000 worldwide without gender, racial or ethnic associations. This syndrome is characterized by joint hypermobility, dermal hyperelasticity and tissue fragility caused by mutations in genes encoding collagen type I, III, V and enzymes involved in the posttranslational modifications of collagen. The oral manifestations include increased mucosal fragility, delayed wound healing, early onset generalized periodontitis and temporomandibular joint hypermobility. Children presenting with this syndrome are often misdiagnosed for hematological problem as they present with bruising, malignancy and/or child abuse. A thorough assessment of the patient is, therefore, essential for early diagnosis and patient referral. This paper reviews current literature, oral manifestations, diagnostic investigations and effective dental management.

Investigating activity of masticatory muscles in patients with hypermobile temporomandibular joints by using EMG.

Background Temporomandibular joint hypermobility (TMJH) can manifest higher range of motions in mandible. The aim of this study was to investigate and compare the activity of masticatory muscle of TMJs in healthy individuals and patients with mild, moderate and severe TMJH. Material and Methods In this clinical study, 69 patients (between the ages of 22 to 42) with manifestation of TMJH were included. The patients were divided into three groups based on their maximum mouth opening (MMO): (light) with MMO of 50-55 mm; (moderate) with MMO between 55 to 65 mm; and (severe) with MMO >65 mm. Also, 20 healthy people with profiled tomography in the last 6 months were invited as control group (healthy) with normal MMO (<50 mm). All the groups subjected to electromyogram (EMG) in 2 steps: maximal voluntary clenching (MVC) of the jaws; and during chewing of bread by using one side of the jaws voluntary. The collected data were analyzed by Student T-test and Chi-Square tests using SPSS software version 15 at significant level of 0.05. Results Both TMJs of light, moderate and severe groups showed significant differences in frequency, time of activity and rest in comparison with healthy group during chewing and MVC (all p values < 0.01). Conclusions Masticatory muscles activity reduced in relation with the severity of TMJH and higher excessive mouth opening. Key words:Electromyography, joint hypermobility, mouth opening, tempormandibular joint.