Background Pain and clicking are the primary complaints in patients suffering from temporomandibular joint disc displacement with reduction (DDwR), negatively affecting the patients' quality of life, making the treatment essential. This prospective randomized controlled trial (RCT) was conducted to evaluate the effectiveness of botulinum toxin type-A (BTX-A) and low level laser therapy (LLLT) in comparison to anterior repositioning appliance (ARA) for the treatment of DDwR. Methods A total of 27 patients were randomly allocated to 3 groups; ARA (control group), BTX-A, and LLLT; with 9 patients each. All patients were evaluated before and 3 months after the treatment using a visual analogue scale (VAS) and magnetic resonance imaging (MRI). Results At 3 months follow-up, all groups showed a significant reduction in pain assessed by VAS (P = 0.007). Measured on MRI, there was a significant improvement in disc position and joint space index (JSI) in BTX-A group (P < 0.001, P = 0.011) and LLLT group (P = 0.002, P = 0.017) in comparison to the control group (P = 0.087, P = 0.066) respectively. As for time of recovery, a statistically significant difference was observed in BTX-A group (P < 0.001) and LLLT (P < 0.001) group in comparison to ARA group, which showed the most prolonged duration for reduction of DDwR symptoms. Conclusion We concluded that BTX-A and LLLT could be considered effective alternative treatment modalities to ARA regarding reducing joint pain, clicking, and improving disc position in patients with symptomatic DDwR. Trial registration This prospective double-blinded RCT has been registered at ClinicalTrials.gov with identification number: NCT05194488, 18/1/2022.

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INTRODUCTION: Temporomandibular disorders (TMD) is an umbrella term embracing a set of conditions that affect the masticatory muscles and the temporomandibular joint (TMJ) .Internal derangements, specifically disc displacement with reduction (DDr), are one of the major findings in TMD. For the treatment of DDr, occlusal appliances and some pharmacological agents were suggested. Several studies were done evaluating the therapeutic use of Botulinum Toxin Type A (BTX-A) in TMD of myogenic origin. But only few studies investigated its effect in the management of TMD of arthrogenic origin. OBJECTIVES: This study was done to evaluate the effect of Botulinum Toxin Type A (BTX-A) injection in the lateral pterygoid muscle (LPM) with and without anterior repositioning appliance (ARA) as a treatment modality for DDr. MATERIALS AND METHODS: Eighteen patients with anterior disc displacement with reduction (DDr) as diagnosed clinically using Research Diagnostic Criteria (RDC/TMD) and confirmed by MRI were enrolled in this study. Patients were randomly assigned into three groups each comprising 6 patients. Group I received ARA, group II received BTX-A while group III received both treatment modalities. After 3 months, evaluation was done subjectively through Helkimo Anamnestic index (Ai) and objectively through electromyography (EMG) as well as MRI. RESULTS: Clinically, there was significant improvement in TMD symptoms in the three studied groups, while disc position was significantly improved in groups II and III as proved by MRI. CONCLUSIONS: Anterior repositioning appliance is effective in treating patients with disc displacement with reduction; however, BTX-A with and without ARA proved to be a more valuable treatment modality in the management of disc displacement with reduction.

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