Treatment Of Disc Displacement Research Articles

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.

Efficacy of intra-articular liquid phase concentrated growth factor injection in treatment of disc displacement with reduction: A clinical study

Abstract: Objectives: to evaluate the efficiency of intra-articular concentrated growth factor (CGF) injection in comparison with conventional arthrocentesis in the treatment of TMD. Subjects and Methods: Twenty patients suffering from TMD were included in the study diagnosed according to The Research Diagnostic Criteria for Temporomandibular disorders (RDC/TMD) and divided into two groups as follow; ten patients underwent intra-articular injections of 2 ml CGF into the temporomandibular joint (TMJ) (group I) and the other ten patients were treated by the conventional arthrocentesis (group II). The patients were clinically evaluated preoperatively and postoperatively at the intervals of 1 month, 3, and 6 months. Results: The differences between the two groups in all the measured parameters were statistically insignificant throughout the postoperative period. But CGF group showed superior result than arthrocentesis group regarding pain, mouth opening and inferior result in clicking. Conclusion: CGF injection is a safe and effective method in the treatment of TMDs.

Is arthrocentesis plus hyaluronic acid superior to arthrocentesis alone in the treatment of disc displacement without reduction in patients with bruxism?

PurposeThis study was designed to investigate the efficacy of arthrocentesis with and without intra-articular injection of hyaluronic acid (HA) in the treatment of disc displacement without reduction (DDwoR) in patients with bruxism. Materials and methodsA retrospective cohort study was conducted using the files of patients with DDwoR, limited mouth opening, and bruxism. Patients were divided into two groups according to the treatment method: arthrocentesis alone (group 1) and arthrocentesis plus intra-articular HA injection (group 2). To evaluate the clinical outcomes for the groups, maximum mouth opening (MMO) and visual analog scale (VAS) values before treatment, immediately after the operation, and at 1, 3, 6, 9, and 12 months postoperatively were analyzed. ResultsThe study consisted of 40 patients (34 female and 6 male, mean age 36.0 ± 11.95 years). MMO values increased and VAS scores decreased in both groups at all follow-ups after the treatment compared with pretreatment values (p < 0.001). The increase in MMO in group 2 was greater than in group 1 only at 3 and 6 months postoperatively (p = 0.013 and 0.009, respectively). ConclusionsIntra-articular HA injection is not a relevant addition when arthrocentesis is performed and a stabilizing splint is used.

Manual therapy and exercise in temporomandibular joint disc displacement without reduction. A systematic review

ABSTRACT Objective The aim of this systematic review was to analyze the effectiveness of exercise and manual therapy interventions in patients with disc displacement without reduction. Method The authors performed a systematic review of Medline, EMBASE, PEDro, CINAHL, and Google Scholar databases. Two independent reviewers conducted the eligibility and quality assessment of studies. Interventions based on exercise and manual therapy regarding pain intensity and maximum mouth opening as primary outcomes were examined. Results Ten articles were included, according to the inclusion criteria. Most of the interventions showed statistically significant improvements in the primary outcomes. Conclusion Results show that interventions based on therapeutic exercise or manual therapy may be beneficial and play a role in the treatment of disc displacement without reduction. Limited evidence suggests that exercise significantly improves mouth opening in comparison to splints. Due to the heterogeneity of the included studies, these results should be interpreted with caution.

Hyaluronic acid application vs arthroscopy in treatment of internal temporomandibularjoint disorders.

The goal of this study was to compare the treatment outcome after two different treatment modalities in cases of disc displacement of the temporomandibular joint diagnosed via magnetic resonance technique, namely surgical procedure in form of arthroscopic lysis and lavage vs. hyaluronic acid superior joint space application. Magnetic resonance imaging was performed before and one year after treatment. Simultaneously, pre- and post-treatment visual analogue scales and maximal mouth opening distance were documented. In our study, out of the total of 145 patients who were initially diagnosed with magnetic resonance imaging to have internal derangements and treated with arthroscopic lysis and lavage or hyaluronic acid application, we observed progression of internal derangement in 27 cases (18.6 %), improvement in 37 cases (25.5 %) and stationary state in 81 patients (55.9 %). Both treatment methods significantly improved the followed maximal mouth opening distance and visual analogue scale, as confirmed upon the 12‑month follow-up examination. Maximal mouth opening was 4.7mm for hyaluronic acid application and 12.2mm for arthroscopic lysis and lavage (p<0.005). The mean visual analogue scale values decreased from 6.2 to 2.1 for hyaluronic acid application and from 6.9 to 1.2 for arthroscopic lysis and lavage (p<0.005). Our study shows that both arthroscopic lysis and lavage and hyaluronic acid injections are effective and safe in the treatment of disc displacement in the temporomandibular joint (Tab. 3, Ref. 30).

Arthroscopic sclerotherapy and suturing for the treatment of disc displacement of TMJ

Arthroscopic sclerotherapy is one of the methods to treat disc displacement of the temporomandibular joint (TMJ). However, results are not always satisfactory, as scars can occur in the retrodiscal tissue after one week or more. A new method of discal traction suture is suggested with posterior sclerotherapy and anterior release to achieve early and long-term stability of the disc. 30 patients, with 15 joints with disc displacement with reduction and 16 joints with disc displacement without reduction, were treated using this method. The mean follow-up period was 27 months, ranging from 6 to 39 months. The interincisal distance on maximum mouth opening and the pain level, using a standard 100 mm visual analog scale, were recorded. An 8-item jaw pain questionnaire and a 5-item jaw function questionnaire were analyzed. The overall success rate was 74.2% (23/31). The success rate was 93.3% (14/15) in patients with disc displacement with reduction, and 56.4% (9/16) in those with disc displacement without reduction. It is concluded that TMJ arthroscopic disc traction suture with posterior sclerotherapy and anterior release is effective in correcting disc displacement. Steve G. F. Shen