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1.
Two-needle vs. single-needle technique for TMJ arthrocentesis plus hyaluronic acid injections: a comparative trial over a six-month follow up.
Guarda-Nardini, L, Ferronato, G, Manfredini, D
International journal of oral and maxillofacial surgery. 2012;(4):506-13
Abstract
The aim of the study was to compare the effectiveness of five weekly two-needle arthrocentesis plus hyaluronic injections vs. the same protocol performed with a single-needle technique in patients with inflammatory-degenerative disorders of the temporomandibular joint (TMJ). 80 patients with TMJ osteoarthritis were randomly assigned to the two-needle or single-needle protocol and followed up for 6 months after treatment. Several outcome parameters, such as maximum pain at rest and maximum pain on chewing, subjective chewing efficiency, limitation in jaw function, jaw range of motion in mm, were recorded at baseline and multiple follow up assessments. Both treatment groups recorded significant improvement with respect to baseline levels in almost all outcome variables. The rate of improvement was not significantly different between the treatment protocols in any of the outcome variables (p-values between 0.143 and 0.970). No between-group differences emerged for the perceived subjective efficacy (p=0.321) and the treatment tolerability (p=0.783). The present investigation did not support the existence of significant differences in the treatment effectiveness for inflammatory-degenerative TMJ disorders of a cycle of five weekly injections of arthrocentesis plus hyaluronic acid injections performed according to the classical two-needle or the single-needle technique.
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2.
Comparison of 2 hyaluronic acid drugs for the treatment of temporomandibular joint osteoarthritis.
Guarda-Nardini, L, Cadorin, C, Frizziero, A, Ferronato, G, Manfredini, D
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2012;(11):2522-30
Abstract
PURPOSE To compare the effectiveness of 2 treatment protocols providing 5 weekly temporomandibular joint (TMJ) arthrocenteses immediately followed by injections of 2 different molecular weight hyaluronic acid (HA) drugs to manage symptoms in patients with inflammatory-degenerative TMJ disease. MATERIALS AND METHODS Patients with a Research Diagnostic Criteria for Temporomandibular Disorders diagnosis of osteoarthritis were randomly assigned to 1 of 2 study groups receiving either low- or medium-molecular weight HA after arthrocentesis. The level of maximum pain at chewing was the primary outcome variable, and maximum pain at rest, subjective chewing efficiency, functional limitation, treatment tolerability, perceived treatment effectiveness, and jaw range-of-motion function in millimeters were the secondary outcomes. All variables were assessed and compared between groups at baseline, at the end of treatment, and 3 months later. RESULTS Forty subjects entered the study. At the end of the follow-up period, all the outcome variables improved in both groups of patients. A between-group comparison of changes over time showed that differences were not significant for any of the outcome variables, that is, pain at chewing (F = 0.056, P = .815), pain at rest (F = 0.383, P = .541), chewing efficiency (F = 0.050, P = .825), functional limitation (F = 0.268, P = .609), and mouth opening (F = 0.003, P = .954). In addition, no between-group differences were shown for perceived treatment effectiveness and treatment tolerability. CONCLUSIONS Similar positive effectiveness was shown for 2 treatment protocols for TMJ osteoarthritis (ie, 5-session single-needle arthrocentesis plus low- or medium-molecular weight HA).
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3.
Glutamate-induced temporomandibular joint pain in healthy individuals is partially mediated by peripheral NMDA receptors.
Alstergren, P, Ernberg, M, Nilsson, M, Hajati, AK, Sessle, BJ, Kopp, S
Journal of orofacial pain. 2010;(2):172-80
Abstract
AIM: To determine if glutamate injected into the healthy temporomandibular joint (TMJ) evokes pain through peripheral N-methyl-D-aspartate (NMDA) receptors and if such pain is influenced by sex or sex steroid hormones. METHODS Sixteen healthy men and 36 healthy women were included and subjected to two randomized and double-blind intra-articular injections of the TMJ. Experimental TMJ pain was induced by injection of glutamate (1.0 mol/L) and NMDA block was achieved by co-injection of the NMDA antagonist ketamine (10 mmol/L). The TMJ pain intensity in the joint before and during a 25-minute postinjection period was continuously recorded on an electronic visual analog scale (0 to 10). Estradiol, progesterone, and testosterone levels in serum were analyzed. RESULTS Glutamate-induced pain showed a median (25/75 percentile) duration of 8.3 (5.2/12.2) minutes. The peak pain intensity was 6.1 (4.2/8.2), the time to peak was 50 (30/95) seconds, and the area under the curve was 59 (29/115) arbitrary units. The women reported higher maximum pain intensity than the men and shorter time to peak. The sex hormone levels were not significantly related to the glutamate-induced TMJ pain. NMDA block significantly reduced the glutamate-induced TMJ pain, mainly in the women. There were no significant correlations between sex hormone levels and the effects of NMDA block for any pain variable. CONCLUSION Glutamate evokes immediate pain in the healthy human TMJ that is partly mediated by peripheral NMDA receptors in the TMJ.
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4.
Effects of intra-articular administration of sodium hyaluronate on plasminogen activator system in temporomandibular joints with osteoarthritis.
Tang, YL, Zhu, GQ, Hu, L, Zheng, M, Zhang, JY, Shi, ZD, Liang, XH
Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics. 2010;(4):541-7
Abstract
OBJECTIVE The aim of this study was to investigate the effect of intra-articular sodium hyaluronate (SH) injections on the main components of plasminogen activator (PA) system in the synovial fluid of temporomandibular joint (TMJ) osteoarthritis (OA). STUDY DESIGN Forty patients diagnosed with TMJ OA and 20 healthy control subjects were included in this study. Synovial fluid was collected in the OA group and the healthy group at baseline. The OA patients were randomly divided into 2 groups (20 patients for each group): One group received 5 injections of SH, and the other received 5 injections of physiologic saline solution in the upper joint space at weekly intervals. Synovial fluid was collected before and after treatment. Urokinase-type PA (uPA), soluble uPA receptor (suPAR) and PA inhibitor 1 (PAI-1) levels in synovial fluid were quantified by enzyme-linked immunosorbent assay. RESULTS The OA patients had significantly higher uPA activity and levels of uPA (median 80.01 ng/L), suPAR (median 7.54 ng/L), and PAI-1 (median 54.9 ng/mL) than the healthy control subjects (median 20.47 ng/L uPA, 2.34 ng/L suPAR, and 19.9 ng/mL PAI-1; (P < .05). The uPA activity and levels of uPA, suPAR, and PAI-1 were significantly decreased after SH injections in TMJs of OA patients (P < .05), and there was no difference after saline injection. Visual analog pain score reduction correlated with changes in uPA and uPAR levels as well as uPA activity. CONCLUSION The effects of SH on PA system provide new insight into a possible underlying mechanism by which SH alleviates pain of patients with TMJ OA.
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5.
Comparison of gap arthroplasty with and without a temporalis muscle flap for the treatment of ankylosis.
Danda, AK, S, R, Chinnaswami, R
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2009;(7):1425-31
Abstract
PURPOSE The purpose of this study was to compare gap arthroplasty with and without a temporalis muscle flap for the treatment of ankylosis. MATERIALS AND METHODS Sixteen patients with temporomandibular joint ankylosis from 2001 to 2006 were included in the study, of which 7 were female and 9 were male. Fourteen patients had unilateral ankylosis and 2 patients had bilateral ankylosis. Sixteen patients were divided into 2 groups with 8 patients in each group. In group I patients, gap arthroplasty was performed with a mean follow-up of 20.3 months and in group II patients, interpositional arthroplasty with temporalis myofacial flap was performed with a mean follow-up of 23.1 months. All patients were assessed for mouth opening, diet consistency, and weight postoperatively. All patients were subjected to postoperative mouth opening exercises from the second postoperative day. RESULTS There is no significant difference in postoperative mouth opening, diet consistency, and weight of the patients in both groups. Reankylosis occurred in 1 patient in both groups. CONCLUSIONS We conclude that there is no significant difference in maximal interincisal opening, diet scores, and weight of the patients in both groups. The overall outcome of the treatment depends on patient cooperation, active physiotherapy, and regular follow-up.
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6.
Low intensity laser therapy in temporomandibular disorder: a phase II double-blind study.
Carrasco, TG, Mazzetto, MO, Mazzetto, RG, Mestriner, W
Cranio : the journal of craniomandibular practice. 2008;(4):274-81
Abstract
The purpose of this study was to evaluate the analgesic effect of Low Intensity Laser Therapy (LILT) and its influence on masticatory efficiency in patients with temporomandibular dysfunction (TMD). This study was performed using a random, placebo-controlled, and double-blind research design. Fourteen patients were selected and divided into two groups (active and placebo). Infrared laser (780 nm, 70 mw, 60s, 105J/cm2) was applied precisely and continuously into five points of the temporomandibular joint (TMJ) area: lateral point (LP), superior point (SP), anterior point (AP), posterior point (PP), and posterior-inferior point (PIP) of the condylar position. This was performed twice per week, for a total of eight sessions. To ensure a double-blind study, two identical probes supplied by the manufacturer were used: one for the active laser and one for the inactive placebo laser. They were marked with different letters (A and B) by a clinician who did not perform the applications. A Visual Analogue Scale (VAS) and a colorimetric capsule method were employed. Data were obtained three times: before treatment (Ev1), shortly after the eighth session (Ev2), and 30 days after the first application (Ev3). Statistical tests revealed significant differences at one percent (1%) likelihood, which implies that superiority of the active group offered considerable TMJ pain improvement. Both groups presented similar masticatory behavior, and no statistical differences were found. With regard to the evaluation session, Ev2 presented the lowest symptoms and highest masticatory efficiency throughout therapy. Therefore, low intensity laser application is effective in reducing TMD symptoms, and has influence over masticatory efficiency [Ev2 (0.2423) and Ev3 (0.2043), observed in the interaction Evaluations x Probes for effective dosage].
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7.
Prospective multicenter comparison of 4 temporomandibular joint operations.
Hall, HD, Indresano, AT, Kirk, WS, Dietrich, MS
Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 2005;(8):1174-9
Abstract
PURPOSE This study was designed to compare the outcomes of 4 operations used for the treatment of painful temporomandibular joints with an internal derangement. PATIENTS AND METHODS A prospective, controlled study of arthroscopy, condylotomy, discectomy, and disc repositioning was conducted at 3 sites. All sites used the same inclusion and exclusion criteria. Trained, independent examiners assessed pain, diet, and range of motion before operation and 1 month and 1 year after operation. RESULTS There were statistically significant reductions in the amount of pain ( P < .001) and daily time in pain ( P < .001) that were similar for all 4 operations 1 month and 1 year after the procedures. The degrees of change after each of the 4 procedures were not statistically different from each other (amount: P = .453 and time: P = .416). Ability to chew, as measured by diet visual analog scale, was substantially improved 1 year after operation ( P < .001). The degrees of change for diet at 1 year also were not different from each other ( P = .314). There were, however, statistically significant differences ( P < .05) in range of motion that varied with procedure. CONCLUSIONS All 4 operations were followed by marked improvements in pain and diet. The amounts of improvement varied slightly by operation, but these differences were not statistically significant. There were small but statistically significant differences between procedures for range of motion. If these findings are confirmed, they have an important implication for procedure selection.
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8.
Use of Theraflex-TMJ topical cream for the treatment of temporomandibular joint and muscle pain.
Lobo, SL, Mehta, N, Forgione, AG, Melis, M, Al-Badawi, E, Ceneviz, C, Zawawi, KH
Cranio : the journal of craniomandibular practice. 2004;(2):137-44
Abstract
This randomized, double-blind study was designed to evaluate the effectiveness of the topical cream Theraflex-TMJ (NaBob/Rx, San Mateo, CA) in patients with masseter muscle pain and temporomandibular joint (TMJ) pain. Fifty-two subjects (5 males and 47 females) were instructed to apply a cream over the afflicted masseter muscle(s) or over the jaw joint(s) twice daily for two weeks. Theraflex-TMJ cream was used by the experimental group, while a placebo cream was used by the control group. The means of pain ratings were calculated prior to the application of the cream (baseline), after ten days of tx (period 1), and 15 days of tx (period 2) days of treatment and five days after stopping the treatment (follow-up). There was a significant decrease in reported pain levels from baseline in the experimental group for period 1 (p < 0.01), period 2 (p < 0.001), and follow-up (p < 0.01). For the control group, no significant differences were found between the different time periods (p > 0.05). There was evidence of minor side effects such as skin irritation and/or burning on the site of the application in two subjects in the experimental as well as two subjects in the control groups. The data strongly suggest that Theraflex-TMJ topical cream is safe and effective for reducing pain in the masseter muscle and the temporomandibular joint.
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9.
[Influence of intra-articular injections of sodium hyaluronate on clinical features and synovial fluid nitric oxide levels of temporomandibular osteoarthritis].
Guarda Nardini, L, Oliviero, F, Ramonda, R, Ferronato, G
Reumatismo. 2004;(4):272-7
Abstract
OBJECTIVE This study was designed to assess the effect of intra-articular injection of sodium hyaluronate (SH) on clinical findings of temporomandibular osteoarthritis (OA) and on synovial fluid (SF) levels of nitric oxide (NO). METHODS Twenty seven patients (7 men, 20 women, mean (SD) age 53.9 (11.8) years) with OA of the temporomandibular joint were randomly allocated to receive an injection of either SH (2 ml, Hyalgan, Fidia SpA, Abano T., P.M. 500-700.000, 20 mg/2 ml; once a week for 5 weeks) or a Ringer's lactate solution (once a week for 3 weeks). Clinical evaluation was done before each procedure, and at 1 week, 1, 3 and 6 months post-injection. Intensity of temporomandibular joint pain, jaw function, maximal mouth opening and lateral jaw movements were recorded at each visit. NO was measured on SF collected by rinsing the joint with saline 1 ml before the treatment. RESULTS Injection of SH caused significant improvement in the main clinical symptoms until the last follow-up which was carried out 6 months after last injection. Among patients who received SH injection, those who reached a good outcome showed the lowest basal levels of NO. CONCLUSIONS The results of this study showed that intra-articular injections of SH lead to a lasting improvement in the clinical symptoms of temporomandibular OA. Furthermore, our findings suggest that low NO levels in SF are related to a better outcome of temporomandibular OA among patients treated with SH intra-articular injection.
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10.
Comparison of moist and dry heat penetration through orofacial tissues.
Poindexter, RH, Wright, EF, Murchison, DF
Cranio : the journal of craniomandibular practice. 2002;(1):28-33
Abstract
Application of superficial moist heat has been shown to have a beneficial effect on Temporomandibular Disorder (TMD) symptoms and is often recommended for patients with this disorder. A review of the literature shows that few studies have compared the effects of moist to dry heat. Throughout this study, moist and dry heat were applied through a commercial heating pad alternately for 20 minute intervals. The application sequence was randomized and all individuals received both moist and dry modalities. Intraoral and extraoral thermocouples were positioned on the mid-cheek area of 46 volunteers to record temperature readings. Dry and moist heat applications were equally effective in both maximum tissue temperature rise and the rate of thermal transfer (p> 0.05). However, in a small number of subjects moist heat was preferred. As there seems to be little difference between using moist rather than dry heat, patients may be counseled to employ the superficial heating option that: 1. is an individual's personal preference or 2. improves convenience and optimizes compliance.