Arthrocentesis versus non-surgical intervention as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial with long-term follow-up

Tang, Y.H.; Vos, Lukas M.; Tuin, A.J.; Slater, J.J.R. Huddleston; Gareb, Barzi; Bakelen, N. B. van; Spijkervet, Frederik

doi:10.1016/j.ijom.2022.08.018

Cited by 7 publications

(3 citation statements)

References 27 publications

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“…Some studies have shown that arthrocentesis is significantly more effective than conservative treatment for both pain reduction and improvement of MMO, and they suggested the use of arthrocentesis as an efficient first-line treatment [ 20 – 22 ]. In Tang et al’s study with over 5 years of long-term follow-up, arthrocentesis was also found to provide greater pain relief and functional improvement compared to nonsurgical interventions as initial treatment for TMJ arthralgia [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of patients with unilateral internal derangement of the temporomandibular joint following arthrocentesis and stabilization splint therapy

Heo,

Park,

Pyo

et al. 2024

Maxillofac Plast Reconstr Surg

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Background The management of internal derangement (ID) of the TMJ is challenging because of multiple etiologic factors and varying degrees of severity. The aim of this study was to evaluate the clinical outcomes of patients with unilateral ID treated with arthrocentesis and stabilization splint therapy during a 6-month period. Methods A total of 105 patients (87 females, 18 males) with unilateral ID were included in this study. Patients were divided into unilateral anterior disc displacement with reduction (ADDwR) and unilateral anterior disc displacement without reduction (ADDwoR). Patients with ADDwoR were subdivided according to the erosive bone changes. Objective parameters on mandibular movement and subjective parameters on pain were obtained and assessed. Their clinical outcomes before and after arthrocentesis and stabilization splint therapy were compared with the chi-square, Fisher’s exact test, paired t-test, or Wilcoxon singed-rank test. Results All objective parameters of unilateral ID patients significantly increased at the 6-month follow-up. The differences in mean visual analog scale (VAS) pain scores were statistically significant in all subjective variables (p < 0.01). In joints with ADDwoR, preoperative maximal mouth opening, and maximal protrusive movement in both groups, with erosive and non-erosive changes were significantly increased after 6 months (p < 0.01). However, right and left maximal lateral movement increased after treatment in both groups but without significant differences. All VAS pain scores on jaw movement and palpation of associated muscles showed a significant decrease regardless of erosive changes. Conclusions The combination of arthrocentesis and subsequent stabilization splint therapy was shown to be highly effective in pain reduction and improvement of mandibular movements in both unilateral ADDwR and ADDwoR, as well as in cases with both erosive and non-erosive bony changes associated with unilateral ADDwoR.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of patients with unilateral internal derangement of the temporomandibular joint following arthrocentesis and stabilization splint therapy

Heo,

Park,

Pyo

et al. 2024

Maxillofac Plast Reconstr Surg

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“…The surgeon must exercise caution to prevent potential risks such as vascular and nerve injuries, brain damage, particularly by avoiding perforation of the glenoid fossa, or ear lesions [8]. These treatment options, especially TMJ arthrocentesis and arthroscopy, showed faster, more effective clinical results and long-term results over conservative approaches in managing arthrogenous TMD to reduce pain and improve mouth opening [9][10][11][12]. TMJ double-puncture arthrocentesis is a simple but technically challenging, office-based procedure performed most of the time under local anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Temporomandibular Joint Minimally Invasive Procedures in the Pediatric Population: A Prospective Study

Ângelo,

Lopes,

Sanz

et al. 2024

JCM

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Over recent years, temporomandibular joint (TMJ) minimally invasive procedures, such as arthrocentesis and arthroscopy, have been appointed as an initial TMJ intra-articular treatment. Both procedures present safe and effective clinical results in managing temporomandibular disorders (TMD) by reducing pain and improving mouth opening. The use of these techniques in adults is validated in the literature. However, data on the safety and effectiveness of minimally invasive TMJ interventions in pediatric patients are scarce. This study aims to investigate the effectiveness of TMJ arthrocentesis and arthroscopy in the pediatric population. A prospective study was conducted at Instituto Português da Face (IPF) in Lisbon, Portugal, including patients treated for TMD from 1 June 2019 to 30 June 2023. In the present study, 26 patients (17 female and 9 male) were included, representing a total of 48 joints operated. A statistically significant reduction was observed in the primary outcome, TMJ pain, from 3.93 ± 2.80 preoperatively (mean ± SD) to 0.50 ± 1.53 (mean ± SD) postoperatively (p < 0.05). An improvement in the secondary outcome, maximum mouth opening, from 36.92 ± 8.79 preoperatively to 42.96 ± 5.07 postoperatively, was observed (p < 0.05). The overall success rate was 84.62%. This prospective study showed that TMJ arthrocentesis and arthroscopy appear to benefit pediatric patients with TMD, significantly lowering pain and improving MMO without relevant postoperative complications.

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“…A systematic review of randomized controlled trials of lavage therapy versus nonsurgical therapy in the treatment of arthralgia found that the former is slightly more effective at reducing pain [11]. A subsequent randomized controlled trial confirmed these results and even found that undertaking lavage therapy as the initial treatment reduces pain and functional impairment more rapidly than nonsurgical therapy [12,13]. The relative rapid improvement after arthrocentesis can be explained by the immediate removal of deleterious inflammatory cells and their secreted products such as pro-inflammatory cytokines, matrix-degrading enzymes, reactive oxygen species, and degeneration products, as well as molecules like prostaglandin E2 (PGE2).…”

Section: Introductionmentioning

confidence: 99%

Intra-Articular Injection of Adipose-Derived Stromal Vascular Fraction in Osteoarthritic Temporomandibular Joints: Study Design of a Randomized Controlled Clinical Trial

Schipper,

Tuin,

van Dongen

et al. 2024

Bioengineering

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Introduction: Temporomandibular joint (TMJ) osteoarthritis is a degenerative disease of the TMJ. It is characterized by progressive degradation of the extracellular matrix components of articular cartilage, with secondary inflammatory components leading to pain in the temporomandibular region and reduced mouth opening. Current treatments do not halt disease progression, hence the need for new therapies to reduce inflammation and, consequently, improve symptoms. The aim of our randomized controlled clinical trial protocol is to investigate the efficacy of adjuvant intra-articular injections of autologous tissue-like stromal vascular fraction (tSVF), compared to arthrocentesis alone, in reducing pain and improving mouth opening in TMJ osteoarthritis patients. Materials and Methods: The primary endpoint analysis will consist of the visual analogue scale (VAS) for pain. The secondary endpoint analyses will include maximal interincisal mouth opening measurements; assessment of oral health and mandibular function based on the oral health impact profile (OHIP) questionnaire and mandibular functional impairment questionnaire (MFIQ); complications during the follow up; synovial cytokine analysis at baseline and after 26 weeks; and nucleated cells and tSVF (immuno)histochemistry analyses of the intervention group. Discussion: Our randomized clinical trial protocol will be applied to evaluate the efficacy of a new promising tSVF injection therapy for TMJ osteoarthritis. The safety of intra-articular injections of tSVF has been proven for knee osteoarthritis. However, since a tSVF injection is considered a heterologous application of cell therapy, the regulatory requirements are strict, which makes medical ethical approval challenging.

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Arthrocentesis versus non-surgical intervention as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial with long-term follow-up

Cited by 7 publications

References 27 publications

Clinical outcomes of patients with unilateral internal derangement of the temporomandibular joint following arthrocentesis and stabilization splint therapy

Clinical outcomes of patients with unilateral internal derangement of the temporomandibular joint following arthrocentesis and stabilization splint therapy

Temporomandibular Joint Minimally Invasive Procedures in the Pediatric Population: A Prospective Study

Intra-Articular Injection of Adipose-Derived Stromal Vascular Fraction in Osteoarthritic Temporomandibular Joints: Study Design of a Randomized Controlled Clinical Trial

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