Timing interventions in relation to temporomandibular joint closed lock duration: a systematic review of ‘locking duration’

Abstract

Temporomandibular joint (TMJ) 'closed lock' (CL) is a clinical condition causing TMJ pain and limited mouth opening (painful locking) that is mostly attributed to disc displacement without reduction (DDwoR), or less commonly to anchored disc phenomenon (ADP). Both conditions are described clinically as CL that can be 'acute' or 'chronic' depending on the duration of locking. There is, however, no consensus about the duration of locking that defines the acute state and its effect on the success of interventions. This review paper, therefore, aims to provide: (i) a narrative review of the pathophysiological need for early intervention in DDwoR and the clinical implications of acute/chronic CL stages on the management pathway; (ii) a systematic review investigating the effects of locking duration on the success of interventions for CL management. Electronic and manual searches until mid-August 2013 were conducted for English-language studies of any design investigating the effects of non-surgical and surgical interventions for acute or chronic CL (DDwoR or ADP). A total of 626 records were identified, and 113 studies were included. Data extraction and quality assessment were completed for all included studies. Included studies were, however, heterogeneous and mostly of poor-quality leading to contradictory and inconsistent evidence on the effect of the duration of locking on treatment outcomes. Future high-quality trials investigating the effect of CL duration on treatment outcome are needed. At present, early intervention by 'unlock' mandibular manipulation seems to be the most practical and realistic approach that can be attempted first in every CL patient as an initial diagnostic/therapeutic approach.

Synovial tissue cytokine profile in disc displacement of the temporomandibular joint

“…Treatment of symptomatic DD is primarily conservative, such as orthotic splint, medication and physiotherapy 4,5 . Surgical intervention might be considered when non‐invasive therapeutic modalities fail.…”

Evaluation of success criteria for temporomandibular joint arthrocentesis

“…For this reason, these criteria were applied in this study. The AAOMS defines diagnostic and treatment criteria for maxillofacial surgery that many researchers use as a reference1536. For this reason, the AAOMS criteria for the success of arthrocentesis were also evaluated in this study.…”

Next steps in development of the diagnostic criteria for temporomandibular disorders (DC/TMD): Recommendations from the International RDC/TMD Consortium Network workshop

“…Community sampling suggests some joint disorders are relatively common; for example, disc displacements are estimated to occur in 18–35% of the non‐clinical population . However, epidemiological data are not available for all disorders, including those variables that may be important in aetiology and progression, such as age of onset, sex, pain, range of mandibular movement, frequency of symptoms, and stage and degree of morphological and pathological changes in the disc/condyle complex .…”