A comparison of the effects of Methylprednisolone Acetate, Sodium Hyaluronate and Tenoxicam in the treatment of non-reducing disc displacement of the temporomandibular joint

Abstract

BackgroundThis clinical study aimed to radiologically and clinically compare the effect of intra-articular injection of methylprednisolone, sodium hyaluronate or tenoxicam following arthrocentesis with that of arthrocentesis alone in patients with non-reducing disc displacement.Material and MethodsA total of 44 patients radiographically diagnosed with non-reducing disc displacement of the temporomandibular joint (TMJ) were randomly divided into four treatment groups, as follows: Group 1, arthrocentesis alone; Group 2, arthrocentesis plus methylprednisolone acetate; Group 3, arthrocentesis plus sodium hyaluronate; Group 4, arthrocentesis plus tenoxicam. Maximum mouth opening (MMO), lateral movement, pain severity and tenderness of TMJ and muscles of mastication on palpation were measured before treatment and at 1 week and 1, 3 and 6 months after treatment. Disc position, presence or absence of disc reduction, level of effusion, joint movement and joint space were also evaluated using magnetic resonance imaging (MRI) before treatment and 6 months after treatment.ResultsNo significant differences in treatment success were found among the four groups. MRI findings did not vary significantly among the groups, but pre- and post-operative MRI findings varied significantly within all four groups (p<0.001).ConclusionsAccording to the data from this study, it may be concluded that either arthrocentesis alone or arthrocentesis with methylprednisolone acetate or sodium hyaluronate or tenoxicam intra-articular injections are similarly effective and promising methods in the treatment of TMJ with non-reducing disc displacement. Key words:Non-reduction disc displacement, arthrocentesis, methylprednisolone, sodium hyaluronate, tenoxicam.

Do intra‐articular injections of analgesics improve outcomes after temporomandibular joint arthrocentesis?: A systematic review and meta‐analysis

“…However, the authors reported no statistically significant difference in pain or MMO between the two groups at any time intervals ( P ‐values not reported). Yavuz et al 18 conducted a similar trial with two additional groups of methylprednisolone and sodium hyaluronate. The authors reported significant improvement in pain and MMO for all groups ( P < .05).…”

“…15 A total of nine studies were included in this systematic review. 10,[16][17][18][19][20][21][22][23] Details of the included studies are presented in Table 1. The sample size of the trials varied from seven to a maximum of 20 patients per arm.…”

“…Five studies used opioids 10,[19][20][21][22] while four used NSAIDs. 11,17,18,23 Only three studies specified the number of operators involved in the arthrocentesis procedure. 10,18,21 In the trials of Sipahi et al 21 and Yavuz et al, 18 a single operator was involved in all procedures while two operators performed the arthrocentesis in the study of Prager et al 10 For this review, we extracted outcome data for 1 week, 1, 3, and 6 months of follow-ups.…”

“…Of the four studies 11,17,18,23 evaluating post-arthrocentesis NSAID injections, Aktas et al 11 did not report pain and MMO outcomes as mean and standard deviation. The authors were contacted via email but no response was received.…”

“…However, the authors reported no statistically significant difference in pain or MMO between the two groups at any time intervals (P-values not reported). Yavuz et al 18…”