No abstract

Background. Disk displacement without reduction (DDwoR) is one of the most common temporomandibular joint disorders (TMDs); it can manifest itself in joint pain and limited mouth opening. Nowadays, many arthrocentesis techniques are used with no consensus on which technique is optimal. Objectives. The aim of this study was to investigate the efficacy of 3 techniques in the treatment of TMD known as DDwoR and to compare them in order to determine whether one is superior to the others. Material and methods. A prospective study was conducted between May 2015 and June 2018. The sample consisted of 30 adult patients (6 males and 24 females; mean age: 38.87 ±6.40 years) with DDWoR, confirmed with magnetic resonance imaging (MRI). The patients were randomly divided into 3 groups according to the treatment technique applied: arthrocentesis only (control); arthrocentesis plus hyaluronic acid (HA); and arthrocentesis plus platelet-rich plasma (PRP). The maximum mouth opening (MMO) as well as pain intensity and masticatory efficiency on a visual analog scale (VAS) were measured at the time of diagnosis (baseline) and at 1-month, 3-month, 6-month, and 9-month follow-up appointments. The significance level was set at 0.05 for all statistical tests. Results. The 3 techniques resulted in significant improvement in MMO and all VAS parameters. The one-way analysis of variance (ANOVA) revealed significant differences (p < 0.05) in the variables between the 3 groups. The increase in MMO in the PRP and HA groups was significantly greater than in the case of the control group, whereas no significant difference was found between the PRP and HA groups. The pain intensity and masticatory efficiency results were significantly better in the PRP group than in the HA group or the control group; at the same time, no significant differences were noted between the HA group and the control group. Conclusions. Despite the fact that patients benefited from all of the 3 techniques, arthrocentesis plus PRP appeared to be superior to arthrocentesis plus HA or arthrocentesis alone.

The current review aimed to critically and systematically evaluate the available evidence regarding the effectiveness of periodontally accelerated osteogenic orthodontics (PAOO) in accelerating orthodontic tooth movement and supporting the alveolar bone. Additionally, this review aimed to analyze the untoward effects of this procedure and the patient-reported outcome measures. A comprehensive electronic search was performed on 10 databases in addition to a manual search to retrieve all relevant studies. Randomized controlled trials (RCTs) were only included in this review. The interventional group was the PAOO procedure, whereas the control group was either a non-accelerated traditional fixed orthodontic treatment or an accelerated treatment using any other intervention. The Cochrane risk of bias tool for randomized controlled trials (RoB 2) was employed to estimate the risk of bias in the included studies. The current review included eight RCTs evaluating 175 participants (63 males and 112 females) with a mean age ranging from 18.8 to 29.6 years. Five of them assessed the effectiveness of PAOO versus traditional orthodontic treatment, i.e. without any adjuvant surgical intervention. At the same time, the remaining three studies evaluated the effectiveness of PAOO versus corticotomy-only as an adjunctive procedure. The PAOO accelerated the leveling and alignment stage from 39% to 47% and accelerated the retraction of the upper anterior teeth from 41% to 61% compared to conventional orthodontic treatment. One study only indicated that PAOO reduced treatment time by 30.3% versus a corticotomy-only as an adjunctive procedure. No significant side effects have been reported with the PAOO procedure. The PAOO procedure was effective in accelerating orthodontic movement and tended to increase the thickness of the alveolar bone. But most periodontal outcome measures regarding PAOO application were not comprehensively covered in the included trials.

Introduction Botulinum toxin (Botox®) is considered an effective treatment for nocturnal bruxism when injected into the masseter muscle. Several studies have used different dosages of Botox for this purpose. The objective was to determine whether 10 MU of botulinum toxin type A (BTXA) injections into the masseter muscle could lessen nocturnal bruxism. Material and methods The sample consisted of 22 patients who suffered from pain in the masseter muscle and sensitivity of the teeth as a result of its wear due to nocturnal bruxism. The sample was randomly divided into two groups. The Botox (BO) group included 11 patients injected with 10 MU of BTXA, and the placebo (PL) group included 11 patients who received a sham intervention. Pain perception was assessed on visual analogue scales, whereas muscle activity was recorded by electromyography (EMG) to evaluate the effectiveness of this treatment protocol on nocturnal bruxism. Results A total of 20 patients entered data analysis with one dropout from each group. The differences in the perceived pain values between the BO and the PL groups before and after the injection were statistically significant (p<0.05). In the BO group, the changes in the perceived pain values over time were statistically significant (p<0.05). The pain levels significantly decreased at two weeks, one month, and three months following the injection. However, the levels increased again at the fourth- and sixth-month assessment times with statistically significant differences (p>0.05). The differences in the EMG recorded values were statistically significant between the two groups (p<0.05). Conclusions Within the current study's limitations, injecting 10 MU of BTXA into the masseter muscle reduced muscular activity in this muscle, resulting in decreased muscle spasms and pain symptoms associated with nocturnal bruxism for about three months before symptoms gradually relapsed.

The pain and discomfort associated with orthodontic treatment are considered undesirable complications which may negatively affect the patient's cooperation and reduce the efficiency of orthodontic treatment. This trial aimed to assess patient-centered outcomes in the treatment of class I malocclusion with severe crowding using self-ligating brackets (SLBs) with or without an acceleration procedure (piezocision) compared to the traditional brackets (TBs) in a three-arm trial. Materials and MethodsSixty-six patients (51 females, 15 males; mean age ± SD: 20.08 ± 2.61 years) attending the Department of Orthodontics, the University of Damascus, Damascus (Syria) from April 2019 to October 2020 participated in this study. The patients were randomly allocated to three groups: the TBs s group (n = 22; mean age ± SD: 18.72 ± 2.42), the SLBs group (n = 22; mean age ± SD: 20.48 ± 2.84), and the SLBs with the piezocision group (SLBs+P; n = 22; mean age ± SD: 19.17 ± 2.59). Patient-centered outcomes were assessed using two standardized questionnaires depending on visual analog scales (VAS) for the majority of the questions and a binary scale (Yes/No) for the last two questions in the second questionnaire. The levels of pain, discomfort, swelling, difficulties with mastication, swallowing, and jaw movement restriction were measured at five assessment times: one day (T1), 3 days (T2), 7 days (T3), 14 days (T4), and 28 days (T5) after the beginning of treatment. The satisfaction levels, acceptance to undergo the applied treatment again, and willingness to advise a friend to receive similar treatment were measured at the last assessment time (T5). One-way ANOVA test or its alternative nonparametric test (i.e., Kruskal-Wallis test) was utilized to compare the three groups. ResultsThere were statistically significant differences between the three groups regarding pain, discomfort, swelling, difficulties with mastication, problems with swallowing, and jaw movement restriction during the first three assessment times only (T1, T2, and T3; P < 0.001). The differences were mainly between the SLBs+P group and the other two groups, where the mean values were greater in the SLBs+P group. Otherwise, there were no significant statistical differences between the SLBs and the TBs groups. Concerning patients' satisfaction with the provided treatment, a statistically significant difference between the three groups was detected after 28 days (T5; P < 0.001). The SLBs+P group showed the lowest mean values, whereas there were no significant differences between the two other groups. ConclusionThe levels of pain and discomfort, swelling, difficulties in mastication and swallowing, and restriction of jaw movement were greater in SLBs with the piezocision group compared to the sole use of SLBs or TBs in the first week only. The patients showed a high level of satisfaction with the applied therapeutic procedures, which means that SLBs alone or in combination with piezocision can be an accepted treatment modality by patients in the acceleration of orthod...