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Aim:  We compared the osseous changes in the temporomandibular joint (TMJ), assessed on computed tomography (CT) examinations, before and after two intra‐articular TMJ injections of sodium hyaluronate or corticosteroid, in patients with osteoarthritis of the TMJ and related these to the clinical findings of pain, function and complications. Material and methods:  Forty patients were randomly allocated into two groups for two intra‐articular injections with the two drugs. The effect of treatment was evaluated before and 6 months after the injections. Bilateral TMJ examinations with high resolution CT were obtained in 36 patients before and 6 months after treatment. Treated and contralateral TMJs were evaluated for the presence of osteoarthritic osseous abnormalities by two reviewers independently. Results:  Injection with sodium hyaluronate was significantly more effective in decreasing pain intensity than corticosteroid. Progression, regression and no change of osseous abnormalities were demonstrated in 14, 10 and 12 TMJs, respectively, 6 months after treatment. Decreased pain intensity and increased vertical mandibular opening were observed in the majority of patients where progression of osseous changes was observed on CT. Conclusions:  Injections in the TMJ with sodium hyaluronate or corticosteroid may reduce pain and improve function in patients with osteoarthritis. Progression, regression and no changes were observed in treated as well as untreated TMJs. Radiological evaluation of progression of osteoarthritis does not always reflect the clinical signs and symptoms.

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