Combined Arthrocentesis And Splint Therapy For Treatment Of Temporomandibular Joint Anterior Disk Displacement Without Reduction

Objective: Recent studies have suggested that arthrocentesis is an effective treatment modality in patients with the diagnosis of disk displacement without reduction(DDw/oR), normal range of motion thereby being restored and pain of the temporomandibular joint reduced. And, various splints traditionally as a non-surgical methods have also been used to treat TMJ disorders. Muscular position splint is a new type of splint which was proposed by Hui yun Wang. In view of the fact that no studies have been performed regarding the use of muscular splint following arthrocentesis, the aim of this study was to evaluate the effect of the use of muscular position splint following TMJ arthrocentesis for treatment of anterior disk displacement without reduction .Methods: one hundreds and thirty one patients were enrolled in this single-blind prospective study, each of whom was assigned a clinical unilateral temporomandibular joint diagnosis of internal derangement(ID) type III with the magnetic resonance imaging (MRI) evidence of anterior disc displacement without reduction. Clinical diagnoses were made according to the Clinical Diagnostic Criteria for Temporomandibular Disorders. Bilateral sagittal and coronal magnetic resonance images were obtained immediately preoperatively. We performed arthrocentesis as an initial treatment in all patients. Following arthrocentesis muscular position splints were fabricated for combined group, and another group without splint served as control. After the procedure, penicillins was prescribed. A clinical examination of maximal mouth opening (MMO) and a visual analog scale (VAS) were used for evaluation of mandibular range of motion and pain before arthrocentesis. Repeat measurements were performed on the first week, first month,third month, and sixth month following treatments.Results: Arthrocentesis group consisted of 68 individuals (57 female, 11 male), and the multiple treatment group consisted of 63 individuals (58 female, 5 male). The mean age values of the groups were 33.4 years (range 15-68 years) and 36.3 years (range 16-64 years), respectively. The average duration was 4 months(range 1week-2years). Baseline VAS and MMO values of the arthrocentesis and multiple treatment groups were similar (P>0.05). Improvement in mouth opening was significant as well as decrease in pain in both groups (all P<0.05). The analyses between the groups showed arthrocentesis of TMJ followed by muscular splints seemed to be superior in achieving rapid effect in pain control and motion improvement (all P<0.05).Conclusions: We conclude that the treatment either with multiple methods or with arthrocentesis alone is beneficial in DDw/oR. However, arthrocentesis in combination with muscular position splint seems to be superior regarding pain management and the maximal mouth opening improvement. Therefore, muscular position splint may be a choice after arthrocentesis .