Comparative Efficacy of Non-Invasive Therapies in Temporomandibular Joint Dysfunction: A Systematic Review.

Temporomandibular disorder (TMD) is a multifaceted disorder impacting the temporomandibular joint (TMJ), causing substantial discomfort and functional limitations. This systematic review aims to comprehensively assess the effectiveness of non-invasive treatment modalities for TMJ dysfunction, prioritizing a definitive protocol to ensure patient safety and enhance quality of life. Employing the PRISMA guidelines, we meticulously analyzed 20 studies from a pool of 1,417 articles sourced from databases such as PubMed, Google Scholar, ScienceDirect, and Medline. These studies underscore the multifarious nature of TMD and the varied responses to treatments such as physical therapy, laser therapy, ultrasound and electrical stimulation, splint therapy, injections, and arthrocentesis. Notably, the review highlights the paramount importance of precise diagnosis, often through surface electromyography, followed by a tailored treatment approach integrating manual therapy, counseling, and splint therapy. The systematic analysis revealed that while certain treatments such as transcutaneous electrical nerve stimulation and low-level laser therapy showed limited efficacy, combination therapies, especially those involving manual therapy, counseling, and splint therapy, demonstrated substantial improvement in reducing pain, depression, and anxiety. The findings advocate for a non-invasive, patient-centric approach, emphasizing education and symptom management before considering more invasive procedures such as injections and arthrocentesis. The review identifies the need for more comprehensive, longitudinal studies to establish a standardized, evidence-based treatment protocol for TMJ dysfunction, aiming to improve patient outcomes holistically.

Platelet-Rich Plasma in the Management of Temporomandibular Joint Pain in Young Adults With Temporomandibular Disorder.

BACKGROUND: Temporomandibular disorder (TMD) encompasses a range of conditions affecting the temporomandibular joint (TMJ) and associated structures, with TMJ pain being a prevalent symptom. Conventional management strategies have limitations, which require the exploration of innovative interventions. Platelet-rich plasma (PRP), known for its regenerative properties, presents a potential therapeutic avenue. This study aims to investigate the effectiveness of PRP in reducing the pain associated with mild TMJ in young adults. METHODOLOGY: Participants (n = 128) aged 18 to 35 years with mild TMD were evenly randomized into PRP treatment and placebo control groups. PRP was prepared using a standardized protocol, and intra-articular injections were administered. Placebo injections mimic PRP. Follow-up evaluations were carried out at four and eight weeks after the intervention. RESULTS: The study successfully randomized comparable groups, and the PRP treatment group experienced a significant reduction in TMJ pain (visual analog scale [VAS] score: 6.8 ± 1.2 to 2.1 ± 1.0 at eight weeks, P < 0.001). The PRP treatment also increased the largest opening of the mouth (from 38.2 ± 2.5 to 43.5 ± 3.1, P < 0.001) and the number of lateral movements (12.3 ± 1.5 to 14.9 ± 2.0, P < 0.001), while the placebo group had very few changes. Positive patient-reported outcomes on daily activities were observed, with no serious complications reported in either group. CONCLUSIONS: This study provides evidence supporting the efficacy of PRP in reducing TMJ pain, improving jaw function, and improving quality of life in young adults with mild TMD. The results underscore the potential of PRP as a minimally invasive intervention for TMJ disorders.

Did temporomandibular gap arthroplasty with temporalis interpositional flap improve function and pain in patients with end-stage joint disease? A 5-year retrospective follow-up.

The primary aim of this study was to investigate whether patients with end-stage temporomandibular joint (TMJ) disease treated with gap arthroplasty with temporalis interpositional flap (GAT) had improved maximal interincisal opening (MIO) and TMJ pain in a long-term perspective. All patients with severe osteoarthritis, or fibrous or bony ankyloses, and subjected to GAT between 2008 and 2015 were included. The criteria of treatment success were TMJ pain VAS score ≤4 and MIO ≥30 mm. Reoperation was considered as a failure. Forty-four patients (mean age 47 years) were included in this retrospective descriptive case series and followed up for up to 7 years (mean 4.5). Comorbidities were frequent (n = 34) and most commonly rheumatic disease (n = 17). The indications for surgery were ankylosis (n = 32) or severe osteoarthritis (n = 12). Of the 44 included patients, 84% (n = 37) had a history of earlier TMJ surgery. The preoperative mean values for TMJ pain and MIO (VAS 7 and 23 mm, respectively) changed significantly (p < 0.001) to postoperative means of VAS 3 and 34 mm, respecitvely. The success rate was 59% (n = 26). When compared with a previous 2-year follow-up, the success rate was found to have decreased over time (p = 0.0097). The rate of successful treatment outcome in terms of MIO alone was 82% (n = 36). The most common reason for treatment failure was residual pain. In conclusion, the success-rate after GAT did not show long-term stability and continued to drop over time in this patient cohort. TMJ pain seems to be the main reason for failure.

Use of High Condylectomy and Abdominal Dermis Fat Grafting for an Acromegaly Induced Bilateral Condylar Hyperplasia: A Case Report.

Acromegaly is a disorder characterized by hypersecretion of growth hormone, resulting in morbidities associated with multiple systems. Although most of the morbidities are reversed following control of the underlying disease, it may take several weeks to months for the symptoms to subside. One of the most noticeable effects of acromegaly is changes in facial features and jawbone growth, which can lead to severe pain and discomfort. This report describes a case of a 31-year-old patient with acromegaly induced bilateral condylar hyperplasia who presented with severe temporomandibular joint (TMJ), facial pain, and degenerative changes in TMJ. The patient was treated by trans-sphenoidal excision of pituitary adenoma, medications, and radiotherapy, but his hormonal levels were persistently high. Considering the refractory nature of the disease, the patient underwent bilateral high condylectomy, right articular disc removal, and abdominal dermis fat grafting. The surgery arrested the progressive mandibular enlargement and prevented further degenerative changes of TMJ. Although there was some reduction in TMJ pain, the myogenous pain and headache persisted after surgery. TMJ surgery may be selectively used for refractory cases of acromegaly and those requiring discectomy or total joint replacement. This case report describes the role of TMJ surgery in the management of morbidities and symptoms associated with TMJ in acromegaly until biochemical normalcy is achieved.

Temporomandibular Disorder Treated With Chiropractic Therapy.

Temporomandibular disorders (TMDs) are common and affect the temporomandibular joint (TMJ) and surrounding musculoskeletal tissues. Although traditional rehabilitative treatments such as physiotherapy, occlusal splints, orthodontics, and electrotherapy effectively manage TMDs, chiropractic therapy is emerging as a promising non-invasive treatment option. We report a 39-year-old female patient with TMD who underwent chiropractic therapy, including spinal adjustments, soft tissue therapy, and exercise rehabilitation. After four weeks of treatment, the patient reported a complete resolution of symptoms and an improved quality of life score. Thereafter, the patient continued chiropractic treatment monthly for six months, during which she reported no symptoms and demonstrated improvements in her spinal range of motion, open-mouth anatomy, and cervical lordosis. This case study highlights the efficacy of applying an interdisciplinary approach to treating TMD and the potential of chiropractic therapy as a valuable treatment option for managing TMD.

A Comparative Analysis of Intra-articular Injection of Platelet-Rich Plasma and Arthrocentesis in Temporomandibular Joint Disorders.

Objectives: Temporomandibular joint disorders (TMDs) are progressive disorders which lead to development of arthralgia and functional disabilities of temporomandibular joint. The treatment of the TMDs is controversial; noninvasive and minimally invasive therapies have shown a success rate of 70 to 85% for its management. The objective of present study is to evaluate and compare the efficacy of intra-articular platelet-rich plasma (PRP) and arthrocentesis in management of TMDs. Materials and Methods: Twenty-four patients with complaint of reduced mouth opening, joint noise, pain, jaw deviation, not responding to medicinal treatment and coming under group II/III of RDC/TMD were included. Patients were randomly and equally divided in two groups. In group A, arthrocentesis was performed, whereas group B patients underwent intra-articular injections of PRP. Patients were clinically evaluated preoperatively to 12 months postoperatively. Result: Both the groups showed significant improvement in painless mouth opening (P < 0.01), lateral movements towards unaffected side (P < 0.05) and reduction in pain complaint (P < 0.01). Arthrocentesis group also showed significant improvement in maximum mouth opening (P < 0.01). Conclusion: On comparison, both groups were found to have effective treatment modality. However, arthrocentesis has higher success rate for pain elimination, and PRP is more effective in correction of joint noise and jaw deviation.

A retrospective study of oral pathoses in Israeli military divers and non-divers: 2011-2020.

BACKGROUND/AIM: Self-contained underwater breathing apparatus (SCUBA) diving has grown tremendously as a recreational sport over the past decade. The pain divers experience due to barometric changes is referred to as barodontalgia, and it is known to cause various oral pathoses. Furthermore, divers suffer more frequently from temporomandibular disorders than non-divers. The aim of the study was to characterize oral pathoses between military divers and military non-divers. MATERIAL AND METHODS: Data from the dental files of healthy Israel Defense Forces (IDF) soldiers aged 18-40 years were collected retrospectively for the years 2011-2020. The data for subjects exposed to diving were compared to commando and special forces soldiers. RESULTS: The study population was composed of 6398 soldiers, which included 1036 divers and 5362 non-divers. All participants were male, with a median age of 22 years (mean = 22.1 years). Overall, higher rates of faulty dental restorations were seen among divers than non-divers (9.3% vs. 6.7% p = .006). Temporomandibular disorders were more prevalent among divers, specifically Disc Displacement Without Reduction (DDWOR) (0.4% vs. 0.1% p = .003). While dental fractures showed no significant difference between divers and non-divers (3.8% vs. 3.5% p = 0.8), other oral injuries were nine times more prevalent among divers versus non-divers. CONCLUSION: Military divers are, overall, at a higher risk of oral pathoses than non-divers. This may be related to the characteristics and intensity of their military service.

Case report: Anterior open bite correction treatment by dental treatment and physical therapy through craniocervical mandibular and occlusal stabilization.

BACKGROUND: The opinion on whether a patient with an anterior open bite should be treated surgically or not is controversial. These patients generally suffer from associated discomfort due to their occlusal instability and musculoskeletal pain. CLINICAL PRESENTATION: A 60-year-old woman visited the clinic with dental mobility of her upper central incisors as her chief complaint. She had a severe anterior open bite, with a history of continuous grinding and multiple dental restorations in poor condition. Additionally, she suffered neck pain with movement restrictions. CONCLUSION: Dentists can evaluate and treat patients with an anterior open bite using this integrative model (physical therapy/dentistry) as a possible alternative as part of the treatment for anterior open bite patients.

Bifid Mandibular Condyle as the Hidden Cause for Temporomandibular Joint Disorder.

Bifid mandibular condyle is a rare occurrence, more frequently unilateral. The etiology of this condition is controversial. Bifid mandibular condyles of developmental origin are mostly asymptomatic and discovered incidentally through imaging. Here, we report a 38-year-old male patient, previously in good health, presented with progressive pain in his right temporomandibular joint and restricted joint movements. MRI of the bilateral temporomandibular joints revealed mild degenerative disc on the right side and bifid mandibular condyle on the left side. Conservative treatment comprising a series of soft, medium, and hard splint therapy in combination with analgesics showed symptomatic improvement initially but did not improve the condition in the long term. He subsequently underwent arthrocentesis of the right temporomandibular joint and perceived a good clinical improvement until he developed progressive pain in the left temporomandibular joint and radiating to the left side of the face. He underwent partial condylectomy and discopexy following which all of his symptoms improved; which drives us to question if bifid mandibular condyle is the hidden cause for bilateral temporomandibular joint pain.

Is there a difference in treatment effect of different intra-articular drugs for temporomandibular joint osteoarthritis? A systematic review of randomized controlled trials.

A systematic review based on the PRISMA guidelines was conducted to investigate and compare treatment with hyaluronic acid (HA), corticosteroids, and blood products in patients with temporomandibular joint osteoarthritis (TMJOA). The MEDLINE/PubMed, Embase, and Cochrane Library databases were searched for articles published until September 25, 2019. Articles met the inclusion criteria if they reported patients with TMJOA, a comparison group, and a follow-up period of at least 6 months. The mean and standard deviation for TMJ pain and maximum mouth opening (MMO) were reported. Nine studies involving 443 patients were included. Injectables and Ringer's lactate solution or normal saline were reported to significantly improve TMJ pain and MMO. Regarding TMJ pain, two studies showed a significant superiority of plasma rich in growth factors (PRGF)/platelet-rich plasma (PRP) injections with or without arthrocentesis over HA, but HA showed a significant improvement compared to corticosteroids. For MMO, no injectable was found to be superior to Ringer's lactate or a normal saline control, but arthrocentesis + PRP resulted in MMO improvement compared to arthrocentesis + HA. Overall, all injectables in conjunction with arthrocentesis were efficient in alleviating pain and improving MMO in TMJOA patients; however, a meta-analysis was not possible due to heterogeneity across studies.

Technique for achieving a stable position of the condylar process during injection into the temporomandibular joint.

Our purpose was to develop a reproducible and easy-to-use technique to establish the best place to inject the temporomandibular joint (TMJ) that ensured stable positioning of the condylar process. We implemented a 3-dimensional process to treat osteoarthritis of the TMJ with hyaluronic acid that was guided by cone-beam computed tomography (CT), and stabilised with a maxillomandibular wax bite block. Two wax rims (fabricated from previously-taken impressions) were attached together securely to stabilise the condyles during imaging and to fix the maxillomandibular position. The use of 3-dimensional cone-beam CT increased the accuracy of the injection. The point, angle, and depth were ascertained precisely, which was intended to ensure safety and give the physician confidence, even when treating patients with anatomical anomalies. The procedure had good stability (the displacing effect of muscle contraction was eliminated) and it presented an easy and reproducible 3-dimensional method for injecting the TMJ that was safer than the conventional one.

TMJ Arthrocentesis Alone and in Combination with Duloxetine in Temporomandibular Joint Pain.

PURPOSE: The purpose of the study was to compare the efficacy of arthrocentesis alone and arthrocentesis with duloxetine in patients with TMJ pain. MATERIALS AND METHODS: This study comprised of 20 patients. Patients with TMJ pain as confirmed by RDC/TMD and with pain duration of at least 3 months were included in the study. Patients were randomly divided into two groups, group A in which patients were treated with arthrocentesis alone and group B in which patients were treated with arthrocentesis followed by duloxetine 30 mg twice daily for 12-week therapy. Patients were followed up at regular interval at day 1, day 5, day 7, week 4, week 6 and week 12. Outcome assessment of pain, swelling, maximal mouth opening, painful/pain-free lateral or protrusive jaw movement was done. Hospital anxiety and depression (HAD) scale was used to assess pre- and post-treatment anxiety and depression. Radiologic assessment was done based on OPG and CBCT. Biochemical assessment of IL-6 in lavage fluid between groups A and B was done pre-operatively and postoperatively. RESULTS: There was significant reduction of pain in both groups, but reduction of pain was more in group B than in group A at week 4, week 6 and week 12. Mouth opening was significantly higher in group B than in group A patients. Reduced painful lateral and protrusive movements were seen in group B than in group A patients. There was no significant difference in hospital anxiety and depression scale among the groups at pre-operative and at 4th week post-operative. Though a significant reduction of IL-6 levels was seen post-operatively, there was no significant difference between the two groups. CONCLUSION: Arthrocentesis is an effective procedure for relieving symptoms in patients with temporomandibular disorders. In this study, combination of duloxetine with arthrocentesis gave much better outcome than arthrocentesis alone. Further studies with large sample size required to evaluate the effect of arthrocentesis plain or in combination with duloxetine in providing permanent relief to the patient.

Unresolving trismus following third molar surgery: Report of a case of fibrodysplasia ossificans progressiva with review of literature.

BACKGROUND: Trismus is a problem commonly encountered by the dental practitioner. It has a number of potential causes, and its treatment will depend on the cause. However, there are very few reports of trismus due to fibrodysplasia ossificans progressiva (FOP) following third molar surgery. CLINICAL PRESENTATION: FOP is a rare human genetic disorder with characteristic clinical features like progressive formation of extraskeletal bone or heterotopic ossification and congenital malformation of the great toes. CLINICAL SIGNIFICANCE: It is troublesome to the maxillofacial surgeon, that minimal manipulation and minor surgery can induce bone formation in soft tissues of the head and neck region, particularly the masticatory muscles and the temporomandibular joint. This paper presents a case of severe trismus following third molar extraction, intractable by routine treatment methods, which was later diagnosed as FOP.

Characteristics of temporomandibular joint in patients with temporomandibular joint complaint.

INTRODUCTION: This study was to investigate whether there was statistical difference between the bilateral temporomandibular joint (TMJ) in patients with unilateral TMJ pain or joint sounds, using cone beam computed tomography (CBCT). METHODS: TMJ CBCT images of 123 cases were used to preliminarily determine the indicators suitable for the measuring method. TMJ CBCT image reconstruction was performed and 19 indicators were measured. Thirty-six cases without TMJ complaint served as controls. The comparison of bilateral TMJs was analyzed by paired t-test to find out the indicators without statistical significance. Twenty-nine patients with unilateral TMJ pain or joint sounds who underwent CBCT at the hospital were enrolled for the comparative study. The measured values were analyzed by paired t-test to determine the indicators with statistical difference. RESULTS: In the control group, only radius value of bilateral TMJ was different statistically (P < 0.05). In the TMJ complaint group, the vertical 60° joint space of the bilateral TMJ was statistically different (P < 0.05) and the rest of the measured values showed no statistical difference. CONCLUSIONS: In the patients with unilateral TMJ pain or joint sounds, the vertical 60° joint space of the symptomatic side was significantly increased comparing with the asymptomatic side.

Arthrocentesis A Minimally Invasive Method for TMJ Disc Disorders - A Prospective Study.

BACKGROUND: Temporomandibular joint (TMJ) disc disorders are one of the major concerns to the mankind and doctors in day to day life due to its complex nature and failure to treat these kinds of conditions successfully. OBJECTIVES: The aim of the present study was to evaluate the efficacy of arthrocentesis in patients suffering from TMJ disc disorders. MATERIALS AND METHODS: A total of 50 subjects suffering from TMJ disc disorders were selected and treated by arthrocentesis. The subjects were followed up for a period of one year. RESULTS: The mean maximal mouth opening prior to arthro-centesis was 32.13mm and after the procedure the mean maximal mouth opening was 46.6mm. The mean right and left lateral movements before arthrocentesis were 7.15mm and 7.59mm respectively, and the mean right and left lateral movements of 9.49 and 9.31 respectively were present after the procedure. The mean degree of pain before arthrocentesis was 8.7, and after the procedure the mean degree of pain was 1.13 as per the visual analogue scale. CONCLUSION: The findings of this study suggested potential utility of arthrocentesis in the management of TMJ disc disorders.

Influence of defective complete dentures renewal on TMD; an MRI and clinical controlled prospective study.

BACKGROUND: The influence of complete denture occlusion on temporomandibular disorder (TMD) is controversial. Some studies found that defective occlusion contributes to the development of TMD, while others found no correlation. OBJECTIVE: This prospective controlled study evaluated the relationship between renewal of old defective complete dentures and TMD as evidenced both by clinical examination and magnetic resonance imaging (MRI) findings. MATERIALS AND METHODS: The study included 25 complete denture patients with signs and symptoms of TMD and 21 asymptomatic controls. Clicking was a common finding in all symptomatic joints. All selected participants needed complete denture renewal. MRI and clinical assessment following research diagnostic criteria for TMD guidelines (RDC/TMD) were carried out at baseline and 2 years after new complete denture insertion. Temporomandibular joint (TMJ) pain, muscle pain, clicking and movement limitation were the assessed signs and symptoms. MRIs were conducted to evaluate the TMJs for disc displacement, disc morphology and joint effusion. RESULTS: Complete denture renewal significantly improved the signs and symptoms of TMD in symptomatic group (p < 0.01). Only in the symptomatic group, treatment resulted in a significant increase in joints displaying superior (normal) disc position (symptomatic p < 0.001; asymptomatic p = 0.157). New dentures did not affect disc morphology in both groups (p = 0.5 for both groups) but significantly reduced joint effusion in the symptomatic group (symptomatic p < 0.001; asymptomatic p = 0.5). Relationship between clinical and MRI findings was not one to one. CONCLUSIONS: New complete dentures had a positive impact on TMD signs and symptoms, disc position and joint effusion but not on disc morphology.

Arthrocentesis followed by intra-articular autologous blood injection for the treatment of recurrent temporomandibular joint dislocation.

Temporomandibular joint (TMJ) dislocation is an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. This study was conducted to assess autologous blood injection to the TMJ for the treatment of chronic recurrent TMJ dislocation. Fifteen patients with bilateral chronic recurrent condylar dislocation were included in the study. Bilateral TMJ arthrocentesis was performed on each patient, followed by the injection of 2ml of autologous blood into the superior joint compartment and 1ml onto the outer surface of the joint capsule. Preoperative and postoperative assessment included a thorough history and physical examination to determine the maximal mouth opening, presence of pain and sounds, frequency of luxation, recurrence rate, and presence of facial nerve paralysis. Eighty percent of the subjects (12 patients) had a successful outcome with no further episodes of dislocation and required no further treatment at their 1-year follow-up, whereas three patients had recurrent dislocation as early as 2 weeks after treatment. Autologous blood injection is a safe, simple, and cost-effective treatment for chronic recurrent TMJ dislocation.

Unilateral condylar hyperplasia: A case report and review of literature.

Condylar hyperplasia is (CH) an uncommon malformation of the mandible involving change in size and morphology of the condylar neck and head. CH is an anomaly that usually occurs unilaterally and equally affects in both men and women. Hyperplasia of the condyle 'differentiated into hemimandibular hyperplasia, hemimandibular elongation and CH. Here, we are presenting a case of 17-year-old male patient with unilateral CH and its review of the literature.

Prospective assessment of outcomes following disposable arthroscopy of the temporomandibular joint.

Temporomandibular disorder (TMD) is a common cause of chronic facial pain that is often treated successfully without operation, but when no improvement is seen arthroscopy may be considered as a therapeutic and diagnostic tool. We prospectively assessed the outcome of 115 arthroscopic procedures to assess the effectiveness and reliability of a 1.2mm disposable arthroscope (OnPoint, Biomet Microfixation, Jacksonville, USA). All patients included had not improved after standard conservative management. Discharge from clinic was classed as a successful outcome. Measurements taken before, during, and after operation included mouth opening and lateral deviations (mm). Pain was assessed before and after operation using a 10 cm visual analogue scale. Mean improvement in pain scores was 69% and in mouth opening was 19%, and overall success was 76%. Compared with a previous study using a 1.9 mm scope there were fewer complications after arthroscopy with the small diameter scope.