Benefits of the combination of digital and analogic tools as a strategy to control possible awake bruxism: A randomised clinical trial.

BACKGROUND: Awake Bruxism (AB) management includes cognitive and behavioural changes. Digital and analogic tools can be used to remind the individual to control/avoid AB behaviours. However, no study addressed both tools together. OBJECTIVE: To compare the efficacy of the combination of digital (smartphone application) and analogic (adhesive reminders) tools versus digital tool alone for AB management. METHODS: Seventy-two individuals diagnosed with probable AB were divided into 3 groups: Group 1 (n = 24), used both digital and analogic tools during 30 days; Group 2 (n = 24), used only a digital tool during 30 days and Group 3 (n = 24), used only a digital tool for the first 15 days and then added the analogic tool for 15 days. The AB frequency was measured in real-time with a smartphone app, which sent alerts asking the individuals if they were doing any AB behaviours (bracing, teeth contact, clenching or grinding). Groups were compared using one-way ANOVA and before-after adding an analogic tool (group 3) by paired t-test, considering α = 0.05. RESULTS: All groups showed a decrease in AB behaviours at the end of the evaluation period. Group 1 (digital and analogic tools) showed the lowest average of AB behaviours among all groups; however, statistically significant differences were found only for the comparison between groups 1 and 2. In group 3, a significantly greater reduction in AB behaviours was found after combining both approaches. CONCLUSION: The combination of digital and analogic tools showed the greatest reduction of AB frequency and can be recommended for AB control.

Comparison of the Effectiveness of Different Methods for Pain Reduction During Injection Procedures in the Frontalis Muscle.

BACKGROUND: Forehead aesthetic injections are a well-known source of discomfort, and many analgesic non-invasive techniques have been proposed to ameliorate pain. However, no study has compared all these techniques for aesthetic purposes. Therefore, this study aimed to compare the effectiveness of topical cream anesthesia, vibratory stimulus, cryotherapy, pressure, and even no intervention, on pain during and immediately after injection, when considering aesthetic injections in the forehead. METHODS: Seventy patients were selected and had their foreheads divided into 5 parts, which received four different analgesic techniques, and one control zone was added. A numeric rating scale was used to assess pain, two direct questions were asked to evaluate patients' preference and discomfort with the techniques, and the adverse events were quantified. The injections were performed in the same sequence, with three minutes of rest between them and in a single session. Comparisons among analgesic methods for pain relief were performed by the one-way analysis of variance (ANOVA), considering a significance level of 5%. RESULTS: No significant differences were found among the analgesic methods, and between the methods and the control zone, both during and immediately after the injections (p > 0.05). The preferred method for pain relief was the use of topical anesthetic cream (47%), while the most uncomfortable technique was manual distraction (pressure) (36%). Only one patient reported an adverse event. CONCLUSIONS: No analgesic method to diminish pain was superior to the others or was better than no method. Nevertheless, the topical anesthetic cream was the preferred technique, causing less discomfort. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Temporalis Muscle Changes Following Botulinum Toxin A Injections in Masseter Hypertrophy Patients: A Randomized Triple-Blinded Trial.

BACKGROUND: This study aimed to elucidate the effects of botulinum toxin A (BoNT-A) treatment for patients diagnosed with masseter hypertrophy on the temporalis muscle, with a particular focus on assessing alterations in muscle thickness, electromyographic (EMG) activity, and the development of muscle pain. METHODS: The present randomized triple-blinded clinical trial enrolled 26 female participants aged between 25 and 50 years complaining about masseter hypertrophy. Participants received 75U of BoNT-A (abobotulinumtoxinA) in both masseter muscles and after three months were randomized to receive a second treatment session of saline solution (S-BoNT-A) or BoNT-A (M-BoNT-A). Longitudinal assessments included temporalis muscle thickness through ultrasound, EMG activity, subjective pain, and masseter prominence severity after one, three, and six months of the first injection session. Muscle thickness, EMG, and subjective pain were analysed using two-way ANOVA with repeated measures and post hoc Sidak test, and for masseter prominence severity, Friedman and Mann-Whitney tests were used. RESULTS: Regarding inter-group comparisons, a higher muscle thickness (p < 0.02) and a higher EMG activity (p < 0.01) were found in the M-BoNT-A group at the 6-month follow-up. For subjective pain assessments, inter-group comparisons showed a higher prevalence of painful regions in M-BoNT-A group at the 6-month follow-up (p < 0.02). No significant differences were found in masseter prominence severity at the 6 months assessment between groups. CONCLUSION: BoNT-A treatment for masseter hypertrophy lead to structural and functional changes in the temporalis muscle, presenting higher changes after multiple injections of this treatment. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

What is the image appearance of juvenile idiopathic arthritis in MRI, CT, and CBCT of TMJ? A systematic review.

OBJECTIVE: We performed a systematic review to investigate the appearance of imaging signs on magnetic resonance imaging (MRI), cone-beam computed tomography (CBCT), and conventional computed tomography (CT) scans of the temporomandibular joints (TMJs) of patients with juvenile idiopathic arthritis (JIA). MATERIALS AND METHODS: We performed electronic searches of the PubMed, Embase, Web of Science, Scopus, Lilacs, and the Cochrane Library databases to identify studies investigating JIA and its related imaging findings. Inclusion criteria were as follows: original article studies based on humans and systematic reviews, studies enrolling patients under 18 years of age with a diagnostic of JIA, the use of International League of Associations for Rheumatology (ILAR) criteria and one type of medical imaging (MRI, CBCT, or CT), and papers published in the English language. RESULTS: A total of six studies met the inclusion criteria, four involving MRI and two involving CBCT. Additionally, all six studies analyzed the imaging findings of pathological TMJ affected by JIA. The results showed that synovial membrane enhancement, condylar erosions, and condylar flattening were the most prevalent imaging findings in JIA. CONCLUSION: MRI examinations are more specific for detecting anomalies in the TMJ than CBCT and CT. Additionally, these results must be correlated with clinical signs to verify the correct diagnosis. CLINICAL RELEVANCE: This study identified the most prevalent imaging signs of JIA to provide an early and correct diagnosis of the disease.

Who is the individual that will complain about temporomandibular joint clicking?

BACKGROUND: Understanding the profile of the individual complaining of TMJ clicking can help in the clinical approach of these patients. OBJECTIVE: To identify clinical variables associated with individuals who complain about and seek treatment for TMJ clicking. METHODS: Seventy-two individuals, composed the sample: Group 1 - patients with a complaint of TMJ clicking who sought treatment; (n = 36); Group 2 - individuals with TMJ clicking who have no complaints about it (n = 36). Three categories of data were evaluated: clinical (gender; age; side of TMJ clicking; TMJ pain; self-reported level of bother; previous TMJ clicking information); somatosensory (mechanical pain threshold [MPT], wind-up ratio [WUR], pressure pain threshold [PPT]); and, psychosocial (Pain Vigilance and Awareness Questionnaire [PVAQ]; Pain Catastrophising Scale [PCS]; Tampa Scale for Kinesiophobia for Temporomandibular Disorders [TSK/TMD]); The Perceived Stress Scale (PSS); The State-Trait Anxiety Inventory (STAI). RESULTS: Group 1 was composed mostly of female patients, with TMJ pain, without previous orientation about the condition, bothered by the clicking, with lower PPT and higher scores in the PVAQ, PCS, TKS/TMD, PSS and STAI scales than Group 2. The groups did not differ significantly for side of TMJ clicking, age, MPT and WUR. CONCLUSION: Individuals who have a TMJ clicking complaint and seek treatment are mostly female, have TMJ pain, have not received previous orientation about TMJ clicking, are bothered by the clicking, have a lower pain threshold and higher scores of hypervigilance, catastrophising, kinesiophobia, stress and anxiety than people with TMJ clicking who do not report it.

Clinical variables associated with the presence of articular pain in patients with temporomandibular joint clicking.

OBJECTIVE: To study and estimate the impact of clinical, somatosensory, and psychosocial variables associated with the concomitant presence of temporomandibular joint (TMJ) pain in patients with TMJ clicking. MATERIALS AND METHODS: Ninety-three individuals composed the sample: patients with painful TMJ clicking (n = 47) and patients with painless TMJ clicking (n = 46). Four categories of data were evaluated: clinical features (gender, maximal interincisal distance (MID), side of complaint, age); bruxism (sleep bruxism (SB), awake bruxism (AB)); somatosensory (mechanical pain threshold (MPT), wind-up ratio (WUR), pressure pain threshold (PPT), conditioned pain modulation (CPM)); and psychosocial (Pittsburgh Sleep Quality Index (PSQI), pain vigilance and awareness questionnaire (PVAQ), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK/TMD), Oral Behaviors (OBs)). RESULTS: Female gender, AB, WUR, CPM, PSQI, PCS, and OBs significantly (p < 0.05) increased the chance of the concomitant presence of TMJ pain in patients with TMJ clicking. On the other hand, MID, MPT, and PPT significantly (p < 0.05) decreased this chance. The other variables had no association. CONCLUSION: It can be concluded that being a woman, having AB, hyperalgesia in WUR, less efficient CPM, poor sleep quality, pain catastrophizing, and harmful OBs significantly increased the chance of the concomitant presence of TMJ pain in patients with TMJ clicking. In the opposite, high figures of MID, MPT, and PPT decreased the chance. CLINICAL RELEVANCE: Most patients with TMJ clicking usually postpone seeking treatment until the clicking truly disturbs or there is a concomitant presence of TMJ pain. Understanding the variables associated with this concomitance can be important in clinical practice.

The effectiveness of microwave disinfection in treating Candida-associated denture stomatitis: a systematic review and metaanalysis.

OBJECTIVE: To evaluate the effectiveness of microwave disinfection in treating Candida-associated denture stomatitis (CADS). MATERIALS AND METHODS: The PubMed/MEDLINE, Embase, and Scopus databases were searched for reports on randomized clinical trials (RCTs) published in English until May 2020 (PROSPERO CRD42020192062) that evaluated the treatment of CADS by using microwave disinfection. The main outcomes were the improvement of clinical signs and/or the decrease in the residual yeast present on the dentures and palatal mucosa. The mean differences, standard deviations, risk ratio, and 95% confidence interval were calculated by using the random-effects model. Heterogeneity was assessed by using Cochran's Q test and I2 values. The level of significance was set at α = 0.05. RESULTS: Five RCTs with 245 participants were included. The descriptive investigations demonstrated that microwave disinfection was as effective (p > 0.05) as 0.2% chlorhexidine, 0.02% sodium hypochlorite, and topical nystatin (100.000 IU/mL), and was superior to topical miconazole in treating CADS. The metaanalysis did not show a statistical difference between microwave disinfection and nystatin (100.000 IU/mL) treatment in terms of mycological counts, cure, and recurrence rates (p > 0.05). CONCLUSION: Microwave disinfection showed comparable results with those of conventional therapies for treating CADS. In addition, treatment with 650 W for 3 min once a week for 14 days had better cost-effect results, indicating both the prevention and treatment of CADS. CLINICAL RELEVANCE: Our findings provide evidence regarding the treatment of CADS using microwave disinfection, and also indicating the best cost-effective option for this treatment modality.

Somatosensory and psychosocial profile of patients with painful temporomandibular joint clicking.

BACKGROUND: Determining the somatosensory and psychosocial profile of patients with painful temporomandibular joint (TMJ) clicking can help to understand the pain mechanisms in cases of TMJ clicking. OBJECTIVE: To characterise the somatosensory and psychosocial profile of patients with painful TMJ clicking when compared to patients with painless TMJ clicking and healthy control group. METHODS: Somatosensory and psychosocial functions were assessed in 90 individuals: patients with painful TMJ clicking (n = 30); patients with painless TMJ clicking (n = 30); and healthy controls (n = 30). Somatosensory profile included: mechanical pain threshold (MPT); wind-up ratio (WUR); pressure pain threshold (PPT); and conditioned pain modulation (CPM). Psychosocial profile included some questionnaires: Pittsburgh Sleep Quality Index (PSQI); Pain Vigilance-Awareness Questionnaire (PVAQ); Pain Catastrophizing Scale (PCS); Tampa Scale for Kinesiophobia (TSK); Perceived Stress (PSS); and State-Trait Anxiety Inventory (STAI). All variables were compared among all groups. RESULTS: Higher values of MPT and WUR; lower PPT; less efficient CPM; and higher scores of PSQI, PVAQ, PCS, and TSK were found in patients with painful TMJ clicking when compared to the other two groups (P < .001). Patients with painless TMJ clicking showed lower PPT and higher scores of PVAQ and TKS than the healthy control group. PSS and STAI data had no differences. CONCLUSION: Patients with painful TMJ clicking had abnormalities in the somatosensory profile, with a significant somatosensory gain of function (more sensitive) to mechanical pain tests and less efficient CPM. Poor sleep quality along with higher levels of hypervigilance, pain catastrophising, and kinesiophobia were features of psychosocial profile of these patients.

Oral Rehabilitation With Dental Implants and the Importance of a Preventive Evaluation for Osteonecrosis of the Jaws Associated With Medications.

Osteonecrosis of the jaw is a possible oral complication resulting from antiresorptive therapies, such as bisphosphonates (Bfs). Although the etiology is not entirely clear, it has been shown to be dependent on several factors, with the traumatic stimulation caused by the placement of teeth implants indicated as one of the predisposing factors to this pathology. The indications and preventive methods for performing these procedures have been questioned, making it essential to determine the proper protocols. Thus, the present study aims to discuss the risks of the development of osteonecrosis in patients undergoing dental implant surgery who use Bfs as well as to discuss related local and systemic factors and possible methods for preventing this side effect. The study also aims to present a clinical case of an osteopenic patient who used Bfs and underwent rehabilitation through implants according to specific protocols, which resulted in successful treatment.

Botulinum toxin type A applications for masticatory myofascial pain and trigeminal neuralgia: what is the evidence regarding adverse effects?

OBJECTIVES: The objective of the study was to conduct a systematic review of literature assessing botulinum toxin type A (BoNT-A) safety and adverse effects in the treatment of myofascial pain (MFP) and trigeminal neuralgia (TN). MATERIALS AND METHODS: The search for articles by two specific researchers involved the PubMed, EMBASE, Web of Science, and Scopus databases. Specific terms were used, and no publication time and language restrictions were applied. Clinical trials that investigated the effects of BoNT-A among participants with myofascial pain in masticatory muscles or trigeminal neuralgia were considered eligible for this systematic review. Data for each study were extracted and analyzed according to a PICO-like structured reading. RESULTS: The search strategy provided 436 citations. After analysis, 16 citations were included, seven for MFP and nine for TN. In all studies, BoNT-A was well tolerated and improved pain. The most common adverse effects were temporary regional weakness, tenderness over the injection sites, and minor discomfort during chewing. Most studies reported a spontaneous resolution of adverse effect. CONCLUSIONS: It can be concluded that BoNT-A treatment is well tolerated, since minor adverse effects were the most frequently reported; however, it is recommended that future studies aim to assess the safety and possible adverse effects of multiples applications or high doses of this treatment. CLINICAL RELEVANCE: BoNT-A has been increasingly diffused in dentistry, being used for the management of masticatory myofascial pain and trigeminal neuralgia. Nonetheless, there is no consensus about its efficacy and adverse effects that could occur when this treatment is applied.

The benefits of performing temporomandibular joint arthrocentesis with catheters and a vacuum pump: A randomized control trial.

This study aims to compare the effectiveness of two different techniques of double puncture arthrocentesis with and without the addition of catheters and a vacuum pump for management of temporomandibular joint (TMJ) disc displacement without reduction (DDWOR). A total of 48 patients with DDWOR were randomly and blindly allocated into two treatment groups (N = 24): Group 1, TMJ arthrocentesis with the addition of catheters and a vacuum pump to the second needle; Group 2, TMJ arthrocentesis without any addition device. The following variables were registered and compared between groups: patient's pain perception (visual analogue scale [VAS; 0-10]); maximal interincisal distance [MID; mm]; joint effusion (JE, presence or absence); facial edema (FE; presence or absence); and the operation duration (OP; minutes). Patients in Group 1 presented with significantly lower VAS scores (p < 0.001) and presence of FE (p = 0.03) in the post-operative period, also an increase in MID values (p = 0.026), and a reduction in JE (p = 0.022) after 3 months. Besides that, in this group, the procedure was performed significantly faster (p < 0.001). Performing arthrocentesis with the addition of a vacuum pump makes the procedure faster and yields better results in terms of pain, facial swelling, mouth opening and joint effusion.

Comparative study of arthrocentesis with concentric-needle cannula with classic concentric needle: A randomized single-blind controlled clinical trial.

This study aimed to assess and compare the efficacy of two distinct single-puncture techniques in temporomandibular joint (TMJ) arthrocentesis for managing disk displacement without reduction (DDwoR). Sixty patients with DDwoR were randomly and blindly assigned to two treatment groups (n = 30 each): group 1 - TMJ arthrocentesis with the classic concentric needle; and group 2 - TMJ arthrocentesis with the concentric needle-cannula system. The following variables were recorded and compared across the groups: patient's pain perception (visual analog scale - VAS, 0-10); maximal interincisal distance (MID, mm); facial edema (FE, presence or absence); and operation duration (OP, minutes). Patients in group 2 presented significantly lower values of VAS score and presence of FE (p < 0.05) when examining the data at 24 and 48 h after the arthrocentesis. They also showed an increase in MID values (p = 0.024) after 6 months. With regard to OP, no significant difference was observed between the groups. Performing a single-puncture TMJ arthrocentesis using a concentric needle-cannula system significantly reduced the patients' pain perception, and mitigated the presence of facial edema during the immediate postoperative period (at 24 and 48 h). Furthermore, it resulted in a notable increase in the MID after 6 months.

Botulinum toxin-A effects on pain, somatosensory and psychosocial features of patients with refractory masticatory myofascial pain: a randomized double-blind clinical trial.

The antinociceptive effect of BoNT-A have been well documented in animal studies; however, results of few but well-designed randomized placebo-controlled clinical trials about BoNT-A efficacy in masticatory myofascial pain (MFP) are inconsistent. Therefore, the present randomized, double-blind, placebo-controlled clinical trial evaluated the efficacy of BoNT-A in patients with refractory MFP. Twenty-eight patients with pain reduction of less than 30% despite conservative treatment and with an average pain intensity of > 50 mm on the visual analogue scale (VAS) participated. Patients were randomly assigned to receive a total of 80 U of BoNT-A or saline solution (SS) injected into the masseter and anterior temporalis muscles. Pain intensity (VAS), quantitative sensory testing (QST), conditioned pain modulation (CPM), and psychosocial status were examined. Follow-up was performed at 1 and 6 months. For repeated-measure comparisons between evaluation times, Friedman test with Bonferroni correction was used for pain and somatosensory variables and the Wilcoxon test for the psychosocial variables. The Mann-Whitney test was used for all comparisons between groups. The BoNT-A group had a significant decrease in pain intensity at follow-ups compared with the SS group (p < 0.001). QST assessment revealed higher pressure pain threshold values in the masseter muscle for BoNT-A group compared to SS (p < 0.03) at all follow-ups. No differences were found for mechanical pain threshold and wind-up ratio values (p > 0.05) in the entire study. The BoNT-A group presented the most efficient CPM effect (p < 0.03) only at the 1 month follow-up in the masseter muscle. There was a significant time effect for BoNT-A in all psychosocial variables (p < 0.05) and a drug effect in the Central Sensitization Inventory (p < 0.01), Pittsburgh Sleep Quality Index (p < 0.004), and Healthy Survey 36 (p < 0.05) at 6 months follow-up. The study demonstrates that a single injection-session of BoNT-A has positive effects on the hall pain spectrum of patients with refractory masticatory myofascial pain.

Botulinum Toxin-A for the Treatment of Myogenous Temporomandibular Disorders: An Umbrella Review of Systematic Reviews.

OBJECTIVE: Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs. METHOD: An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included. RESULTS: In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments. CONCLUSION: The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.

Sociodemographic Profile: A Forgotten Factor in Temporomandibular Disorders? A Scoping Review.

The literature on Temporomandibular Disorders (TMD) incidence commonly reports sociodemographic factors such as gender and age. However, the role and prevalence of other sociodemographic factors in TMD are not well defined. Therefore, this scoping review aimed to report the prevalence of sociodemographic factors in TMD patients. A systematic search was conducted in the PubMed and Web of Science databases to identify clinical trials in adult populations, using the Research Diagnostic Criteria for TMD (RDC/TMD) or the Diagnostic Criteria for TMD (DC/TMD) and reporting sociodemographic data in TMD patients. Twenty-seven studies meeting the criteria were included in this review. The most commonly reported sociodemographic factors assessed in the included studies were age, race, education, job, income, and marital status. TMD prevalence was observed to be higher among younger and divorced individuals among the included studies. However, conflicting results were found for education level, and employment was not considered a risk factor for TMD. Although this review has methodological limitations, it suggests an association between TMD incidence and certain sociodemographic factors; nevertheless, further studies are needed to establish this relationship more conclusively.

Catastrophizing and Hypervigilance Influence Subjective Sleep Quality in Painful TMD Patients

Aims: To determine sleep quality and associated factors in a group of patients with painful TMDs. Methods: The medical records of 80 patients with arthralgia and/or myofascial pain were reviewed and compared to a healthy control group. Data about sex, age, subjective pain, physical activity, social activity, subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI]), pain vigilance (Pain Vigilance and Awareness Questionnaire [PVAQ]), and pain catastrophizing (Pain Catastrophizing Scale [PCS]) were collected. Relationships between PSQI, age, pain intensity, PVAQ, and PCS in the TMD group were also analyzed. Data from the control group were used to transform the PSQI results into T-scores, which were then used to divide the TMD group into two subgroups: normal and impaired sleep. Results: TMD patients presented a significantly higher (P < .001) PSQI score than the control group. Also, in the TMD group, there was a low to moderate correlation between PSQI and pain intensity and a significant correlation between PVAQ and PCS. The impaired sleep group presented a significantly higher (P < .001) PSQI T-score than the normal sleep group. Univariate analysis showed that subjective pain, social activity, and the PCS total and subscale scores differed significantly between the different PSQI T-score groups. The comparison between TMD pain patients and control subjects showed a significantly higher prevalence of T-score discordance in almost all PSQI components in TMD patients with impaired sleep. Conclusion: Subjective sleep quality in painful TMD patients could be associated with and influenced by psychosocial factors (catastrophizing and hypervigilance), social activity, and pain intensity.

Double-Puncture Versus Single-Puncture Arthrocentesis: A Randomized Controlled Trial with 3 Years of Follow-Up.

AIMS: To compare the clinical effectiveness of conventional double-puncture vs single-puncture type 2 arthrocentesis for management of temporomandibular joint (TMJ) disc displacement without reduction (DDWOR) after 3 years of follow-up. METHODS: A total of 26 patients with DDWOR were randomly and blindly allocated into two treatment groups (n = 13 each): group 1 = conventional double-puncture arthrocentesis; group 2 = single-puncture type 2 arthrocentesis. Data on gender, side of painful joint complaint, age (years), duration of joint pain (months), maximum interincisal distance (MID, mm), and pain intensity (self-reported with a 0-10 visual analog scale [VAS]) were collected. VAS scores and MID were measured before (baseline) and 3 years after (final) the arthrocentesis. RESULTS: Twenty-three patients completed the study (group 1, n = 11; group 2, n = 12). Both techniques resulted in significantly reduced VAS scores and increased MID (P = .001) after the 3 years of follow-up; however, there were no statistically significant differences between techniques (P > 0.05). CONCLUSION: The two arthrocentesis methods tested were both effective in reducing VAS scores and increasing MID in patients with DDWOR.

Comparison of two needles arthrocentesis versus double needle cannula arthrocentesis in the treatment of temporomandibular disc displacement.

OBJECTIVE: To compare clinical and imaging results of two needles arthrocentesis (TNA) versus double-needle cannula arthrocentesis (DNCA) in the treatment of temporomandibular joint disc displacement (DD). METHODS: Twenty patients with DD were randomly divided into two groups: TNA and DNCA. Clinical data (pain scores; maximal interincisal distance [MID], and protrusion and laterality movements) were evaluated before and 24 months after the arthrocentesis. Disc and condyle position and joint effusion (JE) were evaluated by magnetic resonance exams. RESULTS: Both groups presented improvement in the MID, including pain reduction, modifications in disc and condyle positions, and reduction of the presence of JE, without difference between groups (p > 0.05). The DNCA was performed significantly faster (p = 0.0001). CONCLUSION: Both TNA and DNCA are efficient in promoting improvement in the MID: reduction in pain, modifications in disc and condyle positions, and, in part, may account for less JE, without difference between techniques.

Efficacy of Botulinum Toxin Type-A I in the Improvement of Mandibular Motion and Muscle Sensibility in Myofascial Pain TMD Subjects: A Randomized Controlled Trial.

This study assessed the effects of botulinum toxin type A (BoNT-A) in mandibular range of motion and muscle tenderness to palpation in persistent myofascial pain (MFP) patients (ReBEC RBR-2d4vvv). Eighty consecutive female subjects with persistent MFP, were randomly divided into four groups (n = 20): three BoNT-A groups with different doses and a saline solution group (placebo control group). Treatments were injected bilaterally in the masseter and anterior temporalis muscle in a single session. Clinical measurements of mandibular movements included: pain-free opening, maximum unassisted and assisted opening, and right and left lateral excursions. Palpation tests were performed bilaterally in the masseter and temporalis muscle. Follow-up occurred 28 and 180 days after treatment. For the statistical analysis the Mann-Whitney U-test with Bonferroni correction was used for groups comparisons. Regardless of dose, all parameters of mandibular range of motion significantly improved after 180 days in all BoNT-A groups, compared with the control group. Palpation pain over the masseter and temporalis muscles were significantly reduced in all BoNT-A groups regardless of dose, compared with the control group, after 28 and 180 days of treatment. Independent of doses, BoNT-A improved mandibular range of motion and muscle tenderness to palpation in persistent MFP patients.

Long-Term Effects of a Single Application of Botulinum Toxin Type A in Temporomandibular Myofascial Pain Patients: A Controlled Clinical Trial.

This study assessed the long-term effects of botulinum toxin type A (BoNT-A) in subjective pain, pain sensibility, and muscle thickness in persistent myofascial temporomandibular-disorder pain (MFP-TMD) patients. Fourteen female subjects with persistent MFP received BoNT-A treatment with different doses (10U-25U for temporalis muscle and 30U-75U for masseter muscle). The treatment was injected bilaterally in the masseter and anterior temporalis muscles in a single session. Clinical measurements included: self-perceived pain (VAS), pain sensibility (PPT), and muscles thickness (ultrasonography). Follow-up occurred 1, 3, 6, and 72 months after treatment for VAS and PPT and 1, 3, and 72 months for ultrasonography. For statistical analysis, the Friedman test with the Bonferroni test for multiple comparisons as a post hoc test was used for non-parametric repeated measures comparisons among the evaluation times. A 5% probability level was considered significant in all tests. VAS values presented a significant decrease throughout the study (p < 0.05). Regarding PPT values, a significant increase was found when comparing baseline data with post-treatment follow-ups (p < 0.05), and even though a significant decrease was found in muscle thickness when baseline values were compared with the 1- and 3-months assessments, no differences were found when compared with the 72 months follow-up (p > 0.05). A single injection of BoNT-A presents long-term effects in reducing pain in persistent MFP-TMD patients, and a reversibility of adverse effects on masticatory-muscle thickness.