Treatment Of Internal Derangement Research Articles

Comparison of Arthroscopy and Arthrocentesis in the Management of Internal Derangement in TMJ Disorders: A Systematic Review

The aim of the systematic review is to shed some light on comparison of Arthroscopy and arthrocentesis in the management of internal derangement in temporomandibular joint (TMJ) disorders. A comprehensive electronic search was conducted with no date or language constraints. Human research, such as randomized or quasi-randomized controlled trials, controlled clinical trials, and retrospective studies comparing arthrocentesis and arthroscopy in the treatment of internal derangements in TMJ disorders, was included in this study. After considering the exclusion and inclusion criteria, seven studies were being included in the systematic review. Because all trials employed the same scale, the weighted mean difference (WMD) was used to compute the Maximum inter-incisal opening (MIO) (in millimeters) and pain in the continuous data (by visual analog scale). The improvement in MIO following arthroscopy was greater than that following arthrocentesis. The difference in pain reduction between arthroscopy and arthrocentesis patients was statistically significant (fixed: WMD = 0.42, 95% CI: 0.54–0.30; P = 0.00001). When compared to arthrocentesis, arthroscopy lysis and lavage were shown to be more effective in improving MIO and lowering pain.

Evaluating the Effect of the Injectable PRF in comparison with the hyaluronic acid as an Intra-articular Medication Following Arthrocentesis in the Treatment of Internal Derangement

Background: Internal derangement (ID) is the most common cause for TMDs. Various invasive, minimally invasive, andnon-invasive treatment modalities have been attempted. Arthrocentesis as a minimally invasive maneuver either if followedwith various intra-articular medications or not has been attempted to treat ID. Hyaluronic acid (HA) has been used as an intraarticularmedication due to its lubricant effect that improves joint movement and mechanically reduces friction pain. However,the i-PRF had both anti-inflammatory action to reduce the level of the cytokines; aided by the regenerative capacity to the tornand degenerated tissues of the joint including the synovial tissue.Purpose: The current study aimed at comparing both factors.Materials and Methods: Forty TMJs from thirty patients were randomly divided into two equal groups. In group I, arthrocentesiswas followed by intra-articular injection of AH; however, in group II, arthrocentesis was followed i-PRF injection.Results: In general, group II patients recorded better results with respect to clicking, pain, and movement limitation. Superiorresults of i-PRF might be the result of the regenerative capability that not only reduced the existing inflammatory mediators;but also replaced the degenerated cytokines-releasing tissues by healthy synovial fluid-releasing tissues provides endogenoussustained source of HA.Conclusion: Although both treatments are acceptable, i-PRF was a rather recommended treatment.

Is There a Relationship Between Age, Personal Factors or Surgical Findings, and Outcome After Temporomandibular Joint Arthroscopy?

The variables involved in prognosis after treatment of internal derangement (ID) of the temporomandibular joint (TMJ) are unclear. The purpose of this study was to estimate the frequency and identify which factors are associated with treatment success (or failure) among patients with ID managed with arthroscopy. A retrospective cohort study was carried out of patients undergoing TMJ arthroscopy over a 9-year-period. The predictor variable was composed of a set of demographic, clinical, and operative findings, including, as primary variable, the patient's age. The primary outcome variable was based on the American Association of Oral and Maxillofacial Surgery (AAOMS) criteria of pain (measured by visual analogue scale (VAS)) and maximal interincisal opening (MIO) defined as VAS ≤ 3 and MIO greater 35mm and grouped as success or failure. The improvement in pain and functional values were compared with the age by using the Pearson correlation coefficient, whereas categorical variables were tested using chi-squared analysis, and mean values were compared with Student t-test or ANOVA. Subsequently, a logistic regression model was used, and the odds ratios (OR) of the evaluated comparisons were calculated. A total of 212 patients were included in this study. In terms of arthroscopic findings, the presence of severe chondromalacia, adhesions or disc perforation (P<.001), was related with older patients. However, there was no statistically significant correlation between age and the postoperative improvement referred to pain or MIO. According to the AAOMS criteria, the procedure was successful in 54.24% of the cases. Two factors were related with a favorable outcome in the adjusted regression analysis: a higher presurgical MIO (OR 0.91, P<.001) and the presence of adhesions (OR 0.41, P=.003). Age has no influence on the outcome after arthroscopy. A higher presurgical MIO and the presence of adhesions provide, in the long-term, a favorable prognosis.

THE EFFICACY OF HIGH CONDYLECTOMY IN INTERNAL DERANGMENT OF THE TEMPOROMANDIBULAR JOINT

Background: Temporomandibular joint (TMJ) is a giglymoarthroidal Joint; it is the only mobile joint in the entire maxillofacial region and is a part of craniomandibular articulation.&#x0D; Methods: All the patients with internal derangement of temporomandibular joint having anterior disc displacement without reduction with complaints of pain and limited opening of mouth, of all age group reporting to the Department of Oral &amp; Maxillofacial Surgery, GDC Jaipur were included in the study.&#x0D; Results: At one month follow up out of 20 patients 13 patients were not satisfied and at 6 month follow up 2 patients were not satisfied at all.&#x0D; Conclusion: We conclude that surgical treatment for internal derangement of the TMJ is required; this technique is effective to improve pain and mouth opening without complications. Although this study has a short follow up period and small sample size.&#x0D; Keywords: Mandible, Maxilla, TMJ.

Combination of trypsin, rutoside, bromelain and diclofenac sodium in the management of internal derangement of temporomandibular joint: A randomized clinical trial

Background: Internal derangement of temporomandibular joint (TMJ) is a chronic disease which causes a considerable amount of pain and reduced chewing ability and thus compromising patients eating ability and lifestyle. Aims: This study was carried out to evaluate the clinical effectiveness of enzymes like trypsin, rutoside, bromelain, and diclofenac combination against the use of diclofenac alone in the treatment of internal derangement (ID) of TMJ. Settings and Design: This study was done in the OPD of Oral Medicine and Radiology department at dental institute and is a randomized case-controlled clinical trial. Methods and Materials: 30 subjects were enrolled in the study by simple random sampling and were diagnosed clinically as ID and radiographically screened. They were divided into 2 groups of 15 each. Group I was given oral diclofenac sodium and group II was given an oral combination of trypsin, rutoside, bromelain, and diclofenac sodium for a span of 14 days. Statistical Analysis: It was done by comparing the mean, median, and standard deviation of each variable. Comparative analysis was done using the Mann–Whitney U test, Friedman's test, Chi-square test, Student's t-test, and ANOVA to find the P- value and confidence interval. Results: Both the groups had reduced pain, improved chewing ability and mouth opening, and reduction in joint noise and jerky mandibular movements. Group I, patients had better results when compared to group I and the differences were highly significant. Conclusion: We recommend the use of a combination of enzymes and diclofenac for the management of ID of TMJ.

Efficacy of splint theraphy on Pain in the Treatment of Internal Derangement of TMJ-A clinical study

Purpose: This study was designed to investigate the efficacy of splint theraphy on pain in the treatment of temporomandibular joint (TMJ) internal derangement patients.&#x0D; Materials and Methods: 15 males and 25 females aged between 18 to 37 years comprised the study material in the Dental Implant and Faciomaxillary centre at Bandipore (India). The patients’ complaints were limited mouth opening and TMJ pain . Splints were given to the patients suffering from internal derangement. Clinical evaluation of the patients was done before the procedure, and 1 week and 3 months after postoperatively. Intensity of TMJ pain was recorded at each follow-up visit.&#x0D; Results: There was significant reduction in pain scores in the post-operative period.&#x0D; Conclusions: Splint therapy is simple and safe procedure for the patients of internal derangement with closed lock for improving mouth opening and decreasing pain.

Efficacy of Hyaluronic Acid in the Treatment of Internal Derangement – Clinical Study

Introduction: Hyaluronic acidis known as Sodium hyaluronate or hyaluronan is an essential component of the synovial fluid. It enables the fluid to act as a lubricant, a shock absorber and a filter controlling the movement of cells and large molecules within the joint.The present study presents a case series on the efficacy of hyaluronic acid injections for the treatment of temporomandibular joint pain by providing patient evaluations. Study Design: Thirty-one temporomandibular joints in 23 patients were evaluated in this study. Six males and 17 females aged 18 to 55 years with chief complaints of limited mouth opening, TMJ pain, and clicking sounds in the TMJ. The TMJ was examined clinically and radiographically. Patients were randomly divided into two groups, were one group received only arthrocentesis and the other group received arthrocentesis plus hyaluronic acid. Both the groups contained patients with disc displacement with reduction with closed lock. Results: Descriptive analysis showed improvements which were maintained over time for all the study parameters. Permutation tests evidenced the significance of changes which occurred in many clinical parameters over three months. Differences with baseline levels remained significant at the end of the follow-up period, particularly for the jaw movements, masticatory efficiency, clicking and pain at mastication parameters. Conclusion: Data from the clinical study support findings from studies on other joints, which prove the efficacy of hyaluronic acid after arthrocentesis to reduce symptoms of osteoarthritis and to maintain improvements over time.

An Analysis of the Efficacy of Platelet-Rich Plasma Injections on the Treatment of Internal Derangement of a Temporomandibular Joint

An Analysis of the Efficacy of Platelet-Rich Plasma Injections on the Treatment of Internal Derangement of a Temporomandibular Joint

Retrospective evaluation of three different joint surgeries for internal derangements of the temporomandibular joint

PurposeTo compare the outcomes achieved with eminectomy, discectomy alone, and discectomy with an abdominal dermis fat graft (D + ADFG) in the treatment of internal derangements (IDs) of the temporomandibular joint (TMJ), and to briefly discuss the failed cases in which a second operation was needed. Patients and methodsThis was a retrospective study of 31 patients (27 females, 4 males) who were unresponsive to conservative therapy and therefore underwent eminectomy (group A, n = 6), discectomy alone (group B, n = 8), or D + ADFG (group C, n = 17). All of the IDs of the TMJ were unilateral. Functional mandibular pain intensity on a visual analog scale (VAS) and maximum interincisal opening (MIO) were recorded preoperatively and at the latest postoperative examination (average, 30 months). The preoperative and postoperative results were compared between and within each group. ResultsOverall, patients in groups B and C had better outcomes than those in group A in terms of TMJ symptom relief. Postoperative increases in MIO were statistically significant in groups A, B, and C (P < 0.027, P < 0.017, and P < 0.000, respectively). Patients with discectomized joints (groups B and C) had significantly improved pain scores (P < 0.05) at the latest follow-up. In 6 of the 31 (19.3%) patients (3 eminectomy, 1 discectomy, and 2 D + ADFG), the procedure was deemed unsuccessful because of persistent symptoms and a second operation was performed. ConclusionsDiscectomy with or without ADFG was clearly superior to eminectomy in reducing pain and improving joint function. But there were no significant differences in the two-discectomy groups with respect to symptom improvement.

Clinical and biochemical assessment of different injection materials following arthrocentesis for the treatment of internal derangement of the temporomandibular joint: A comparative study

Objectives The present study was performed to evaluate and compare the effect of ozonized water lavage followed by ozone injection with that of lactated Ringer lavage followed by either corticosteroid or sodium hyaluronate injection. Materials and methods A total of 27 patients suffering from internal derangement of the temporomandibular joint and not responding to conservative therapy were randomly classified into three groups. In group A joint lavage was performed using ozonized water followed by injection of ozone. In group B joint lavage was performed using lactated Ringer solution followed by corticosteroid injection. In group C joint lavage was performed using lactated Ringer solution followed by sodium hyaluronate injection. The treatment outcome was evaluated biochemically by measuring the change in tumor necrosis factor-α (TNF-α) level in the synovial fluid preoperatively and 1 week postoperatively. Clinical measurements of maximal mouth opening and lateral and protrusive excursions were taken preoperatively and at 1 week, 1, and 3 months postoperatively. Pain was measured using the Visual Analogue Scale at the study intervals. These data were statistically analyzed. Results The three groups showed significant improvement (P ≤ 0.05) in all biochemical and clinical measurements. However, joint lavage using ozonized water followed by ozone injection provided more favorable results compared with treatment with sodium hyaluronate, which in turn was more superior to corticosteroid treatment with respect to maximal mouth opening. All of the study groups showed significant reduction (P ≤ 0.05) in TNF-α level in the synovial fluid. Group A had the highest reduction of TNF-α level with significant difference (P ≤ 0.05) between its results and those of groups B and C, whereas groups B and C showed nonsignificant difference between their results (P ≥ 0.05). Conclusion Data from our study suggested more favorable outcomes from ozonized water lavage followed by ozone injection with regard to the clinical and biochemical parameters.

Efficacy of Arthrocentesis with Injection of Hyaluronic Acid in the Treatment of Internal Derangement of Temporomandibular Joint

Efficacy of Arthrocentesis with Injection of Hyaluronic Acid in the Treatment of Internal Derangement of Temporomandibular Joint

English

In today's world high velocity road traffic accidents, sports activities and increased fitness awareness, ACL injuries is a common clinical problem. Once upon a time ACL rupture led to a relatively safe existence and was thought to be of less significance. Now with improved knee kinematics and clinical skills, it has been established that post ACL injury, the prevalence of clinically significant meniscal damage increases with time and is associated with increasing disability and arthrosis. Ligament reconstruction has not been shown to prevent arthrosis, but studies show that it appears to reduce the risk of subsequent meniscal injury and improve anteroposterior knee motion and facilitates return to high level sporting activities. As surgical techniques like Arthroscopy improve the ability to tackle complex problems, complex decisions regarding Meniscal repair and transplantation, Cartilage repair and regeneration are now commonplace, as are decisions regarding the need for Osteotomies in Arthritically unstable knees. Arthroscopic reconstruction of the Anterior Cruciate Ligament with patellar bone - tendon - bone graft is minimally invasive and is relatively quick and simple to perform, although attention to detail as required for good results. Thus arthroscopy helps in diagnosis and treatment of internal derangement and on extra articular reconstruction. Thus this procedure consists of a combined procedure of arthroscopy for diagnosis and treatment of internal derangement and an extra articular reconstruction by means of bone- patellar tendon-bone graft by minimally invasive, quick and simple surgery. Although attention to detail is required for good results.

Biomechanical strength analysis of mini anchors for the temporomandibular joint

The usage of mini anchors for the treatment of internal derangements of the temporomandibular joint (TMJ) is considered an innovative treatment, and it has presented excellent clinical results in the stabilization of the articular disc. This study aimed to evaluate, through mechanical tensile testing, the resistance of mini anchors for TMJ articular disc repositioning. Ten thermoplastic polymer poly-ether-ether-ketone (PEEK) mini anchors were tested in artificial polyurethane blocks with a pullout test in a mechanical Instron™ machine, model 4411. The mini anchors were pulled out until failure and the force and displacement were recorded for each specimen. A small standard deviation was noted, which indicated reproducibility. The findings indicate that Cillen™ mini anchors presented a mean force at failure up to 46.1 N with similar values in the scientific literature. Nevertheless, further studies should be conducted for a comparison of PEEK mini anchors with other commercially available anchors, in addition to studies related to PEEK, a scarcely known material in the dentistry field.

Efficacy of Arthrocentesis with Injection of Hyaluronic Acid in the Treatment of Internal Derangement of Temporomandibular Joint

This cross-sectional study was designed to find out the effect of arthrocentesis with injection hyaluronic acid in the treatment of internal derangement of temporomandibular joint (TMJ ID) for the restoration of TMJ function. The study included 25 patients, aged 13 to 50 years with symptoms of TMJ pain and clicking during function and limited mouth opening. TMJ ID was assessed with clinical examination and conformed with MRI. Arthrocentesis was done with insertion of two 21gauze needles in the upper joint compartment and joint lavaged with 200 ml of ringer’s lactate solution and at the end 1ml of hyaluronic acid was injected. Intensity of TMJ pain and clicking was assessed using visual analog scale, maximum mouth opening, lateral jaw movement and protrusion were assessed with millimeter scale. All the parameters were measured before the procedure , immediately after the procedure then after 2 weeks, 1 month , 3 months and 6 months procedure. During 6 months follow-up, clinical examination and comparison of the results showed 84% reduction in TMJ pain, 92% improvement in mouth opening and clicking disappear in 80% of patients. Key words: TMJ pain; clicking; internal derangement; arthrocentesis; hyaluronic acid. DOI: 10.3329/bsmmuj.v3i1.5509 BSMMU J 2010; 3(1): 18-22

P.440 Megacoronoid: a cause of temporomandibular joint dysfunction

To compare the outcomes achieved with eminectomy, discectomy alone, and discectomy with an abdominal dermis fat graft (D + ADFG) in the treatment of internal derangements (IDs) of the temporomandibular joint (TMJ), and to briefly discuss the failed cases in which a second operation was needed.This was a retrospective study of 31 patients (27 females, 4 males) who were unresponsive to conservative therapy and therefore underwent eminectomy (group A, n = 6), discectomy alone (group B, n = 8), or D + ADFG (group C, n = 17). All of the IDs of the TMJ were unilateral. Functional mandibular pain intensity on a visual analog scale (VAS) and maximum interincisal opening (MIO) were recorded preoperatively and at the latest postoperative examination (average, 30 months). The preoperative and postoperative results were compared between and within each group.Overall, patients in groups B and C had better outcomes than those in group A in terms of TMJ symptom relief. Postoperative increases in MIO were statistically significant in groups A, B, and C (P < 0.027, P < 0.017, and P < 0.000, respectively). Patients with discectomized joints (groups B and C) had significantly improved pain scores (P < 0.05) at the latest follow-up. In 6 of the 31 (19.3%) patients (3 eminectomy, 1 discectomy, and 2 D + ADFG), the procedure was deemed unsuccessful because of persistent symptoms and a second operation was performed.Discectomy with or without ADFG was clearly superior to eminectomy in reducing pain and improving joint function. But there were no significant differences in the two-discectomy groups with respect to symptom improvement.

Poster 075: Office-Based Temporomandibular Joint Arthroscopy: Its Use in the Treatment of Internal Derangement

Poster 075: Office-Based Temporomandibular Joint Arthroscopy: Its Use in the Treatment of Internal Derangement

Degenerative Disorders of the Temporomandibular Joint: Etiology, Diagnosis, and Treatment

Temporomandibular joint (TMJ) disorders have complex and sometimes controversial etiologies. Also, under similar circumstances, one person's TMJ may appear to deteriorate, while another's does not. However, once degenerative changes start in the TMJ, this pathology can be crippling, leading to a variety of morphological and functional deformities. Primarily, TMJ disorders have a non-inflammatory origin. The pathological process is characterized by deterioration and abrasion of articular cartilage and local thickening. These changes are accompanied by the superimposition of secondary inflammatory changes. Therefore, appreciating the pathophysiology of the TMJ degenerative disorders is important to an understanding of the etiology, diagnosis, and treatment of internal derangement and osteoarthrosis of the TMJ. The degenerative changes in the TMJ are believed to result from dysfunctional remodeling, due to a decreased host-adaptive capacity of the articulating surfaces and/or functional overloading of the joint that exceeds the normal adaptive capacity. This paper reviews etiologies that involve biomechanical and biochemical factors associated with functional overloading of the joint and the clinical, radiographic, and biochemical findings important in the diagnosis of TMJ-osteoarthrosis. In addition, non-invasive and invasive modalities utilized in TMJ-osteoarthrosis management, and the possibility of tissue engineering, are discussed.

Arthroscopic disc repositioning and suturing: an effective treatment to TMJ internal derangement

Purpose: To introduce an arthroscopic disc repositioning and suturing technique for stabilizing anteriorly displaced discs. Methods: 1037 patients (1252 joints) diagnosed as to V stages of ID based on clinical examination and MRI were undergone arthroscopic disc repositioning and suturing from May 2001 to December 2006. Two hundred and fifty-six males and 781 females with mean age of 39.73 years (range from 12 to 74 years old), and the mean duration is 10.08 months (range from 0.5 to 60 months). Postoperative MRIs were taken at varying intervals between 1 and 7 days. Results: Postoperative MRI confirmed that 92.25% (1155/1252) of all joints was excellent; 2.08% (26/1252) of all joints was partial improvement, and only 5.67% (71/1252) was poor, which were carried out in arthroscopic surgery once more or open surgery. Conclusion: This procedure has provided successful results in the treatment of internal derangements, although the evaluation is only short term. It was concluded that arthroscopic disc suturing technique was an effective treatment method for internal derangement refractory to non-surgical treatments. It has obvious advantages such as little trauma to TMJ, short operating time and rapidly recovery for the patients, but difficult to perform and widespread easily.

An inquiry into the results of the operative treatment of internal derangement of the knee-joint.

An inquiry into the results of the operative treatment of internal derangement of the knee-joint.

Efficacy of temporomandibular joint arthrocentesis with and without injection of sodium hyaluronate in treatment of internal derangements

Purpose: This study was designed to investigate the efficacy of arthrocentesis with and without injection of sodium hyaluronate (SH) into the upper joint space in the treatment of temporomandibular joint (TMJ) internal derangements. Patients and Methods: Forty-one TMJs in 5 males and 26 females aged 14 to 53 years comprised the study material. The patients' complaints were limited mouth opening, TMJ pain and tenderness, and joint noises during function. Patients were randomly divided into 2 groups in which only arthrocentesis was performed in 1 group and arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in the other group. Both groups contained patients with disc displacement with reduction and with closed lock. Clinical evaluation of the patients was done before the procedure, immediately after the procedure, on postoperative day 1, and at 1, 2, 3, 4, 5, 6, 9, 12, 18, and 24 months postoperatively. Intensity of TMJ pain, jaw function, and clicking sounds in the TMJ were assessed using visual analog scales. Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit. Results: Both techniques increased maximal mouth opening, lateral movements, and function, while reducing TMJ pain and noise. Conclusions: Although patients benefitted from both techniques, arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone. © 2001 American Association of Oral and Maxillofacial Surgeons