Early Arthrocentesis for Temporomandibular Joint Arthralgia: A Superiority Trial

Overview

Journal Int Dent J

Publisher Elsevier

Specialty Dentistry

Date 2024 Jun 9

PMID 38851933

Authors

Dion Tik Shun Li

Lai Ying Luo

Kar Yan Li

Yu-Xiong Su

Justin Durham

Yiu Yan Leung

Affiliations

Soon will be listed here.

Abstract

Objectives: The aim of this superiority trial was to investigate the clinical outcomes of arthrocentesis as an early treatment supported by use of an occlusal splint vs use of an occlusal splint only in the management of temporomandibular joint (TMJ) arthralgia.

Methods: Ninety-five adults presenting with TMJ arthralgia were recruited into the study and randomised into 2 groups: Group 1 received arthrocentesis as an early treatment supported by use of an occlusal splint, whereas group 2 received treatment with an occlusal splint only. Seventy-four patients (group 1: n = 37; group 2: n = 37) completed the 1-year follow-up schedule and were included in the final analysis. Reduction of pain intensity measured by a numeric rating scale and increase in mouth opening distance (unassisted maximal, assisted maximal, and pain-free) was seen in both treatment groups.

Results: In group 1, pain intensity significantly decreased at 6 weeks and all subsequent time points compared with group 2. In terms of mouth opening distance, a significant improvement was observed in both groups during the course of treatment, but statistical significance was not seen between the 2 treatment groups.

Conclusions: Early arthrocentesis supported by use of an occlusal splint is superior to use of an occlusal splint alone in the treatment of TMJ arthralgia. Arthrocentesis with occlusal splint support could be discussed as first-line treatment for arthralgia of the TMJ, which may co-occur with various painful and nonpainful conditions of TMJ disorders.

References

Huddleston Slater J, Vos L, Stroy L, Stegenga B . Randomized trial on the effectiveness of dexamethasone in TMJ arthrocentesis. J Dent Res. 2011; 91(2):173-8. DOI: 10.1177/0022034511431260. View

Schulz K, Altman D, Moher D . CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010; 340:c332. PMC: 2844940. DOI: 10.1136/bmj.c332. View

Monje-Gil F, Nitzan D, Gonzalez-Garcia R . Temporomandibular joint arthrocentesis. Review of the literature. Med Oral Patol Oral Cir Bucal. 2012; 17(4):e575-81. PMC: 3476018. DOI: 10.4317/medoral.17670. View

Bouchard C, Goulet J, El-Ouazzani M, Turgeon A . Temporomandibular Lavage Versus Nonsurgical Treatments for Temporomandibular Disorders: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg. 2017; 75(7):1352-1362. DOI: 10.1016/j.joms.2016.12.027. View

Nitzan D, Naaman H . Athrocentesis: What, When, and Why?. Atlas Oral Maxillofac Surg Clin North Am. 2022; 30(2):137-145. DOI: 10.1016/j.cxom.2022.06.008. View

Rajapakse S, Ahmed N, Sidebottom A . Current thinking about the management of dysfunction of the temporomandibular joint: a review. Br J Oral Maxillofac Surg. 2017; 55(4):351-356. DOI: 10.1016/j.bjoms.2016.06.027. View

Al-Moraissi E, Wolford L, Ellis 3rd E, Neff A . The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials. J Craniomaxillofac Surg. 2019; 48(1):9-23. DOI: 10.1016/j.jcms.2019.10.004. View

Vos L, Huddleston Slater J, Stegenga B . Arthrocentesis as initial treatment for temporomandibular joint arthropathy: a randomized controlled trial. J Craniomaxillofac Surg. 2013; 42(5):e134-9. DOI: 10.1016/j.jcms.2013.07.010. View

Nitzan D, Dolwick M, Martinez G . Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening. J Oral Maxillofac Surg. 1991; 49(11):1163-7; discussion 1168-70. DOI: 10.1016/0278-2391(91)90409-f. View

10.

Farrar J, Polomano R, Berlin J, Strom B . A comparison of change in the 0-10 numeric rating scale to a pain relief scale and global medication performance scale in a short-term clinical trial of breakthrough pain intensity. Anesthesiology. 2010; 112(6):1464-72. PMC: 2884191. DOI: 10.1097/ALN.0b013e3181de0e6d. View

11.

Tang Y, Vos L, Tuin A, Huddleston Slater J, Gareb B, Van Bakelen N . Arthrocentesis versus non-surgical intervention as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial with long-term follow-up. Int J Oral Maxillofac Surg. 2022; 52(5):595-603. DOI: 10.1016/j.ijom.2022.08.018. View

12.

Yura S, Totsuka Y . Relationship between effectiveness of arthrocentesis under sufficient pressure and conditions of the temporomandibular joint. J Oral Maxillofac Surg. 2005; 63(2):225-8. DOI: 10.1016/j.joms.2004.06.053. View

13.

Altaweel A, Ismail H, Fayad M . Effect of simultaneous application of arthrocentesis and occlusal splint versus splint in management of non-reducing TMJ disc displacement. J Dent Sci. 2021; 16(2):732-737. PMC: 8025137. DOI: 10.1016/j.jds.2020.08.008. View

14.

Abbasgholizadeh Z, Evren B, Ozkan Y . Evaluation of the efficacy of different treatment modalities for painful temporomandibular disorders. Int J Oral Maxillofac Surg. 2019; 49(5):628-635. DOI: 10.1016/j.ijom.2019.08.010. View

15.

Nitzan D, Samson B, Better H . Long-term outcome of arthrocentesis for sudden-onset, persistent, severe closed lock of the temporomandibular joint. J Oral Maxillofac Surg. 1997; 55(2):151-7; discussion 157-8. DOI: 10.1016/s0278-2391(97)90233-0. View

16.

Li D, Wong N, Li S, McGrath C, Leung Y . Timing of arthrocentesis in the management of temporomandibular disorders: an integrative review and meta-analysis. Int J Oral Maxillofac Surg. 2021; 50(8):1078-1088. DOI: 10.1016/j.ijom.2021.01.011. View

17.

Von Korff M, Ormel J, Keefe F, Dworkin S . Grading the severity of chronic pain. Pain. 1992; 50(2):133-149. DOI: 10.1016/0304-3959(92)90154-4. View

18.

Dworkin R, Turk D, Wyrwich K, Beaton D, Cleeland C, Farrar J . Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2007; 9(2):105-21. DOI: 10.1016/j.jpain.2007.09.005. View

19.

Guarda-Nardini L, de Almeida A, Manfredini D . Arthrocentesis of the Temporomandibular Joint: Systematic Review and Clinical Implications of Research Findings. J Oral Facial Pain Headache. 2021; 35(1):17-29. DOI: 10.11607/ofph.2606. View

20.

Kaneyama K, Segami N, Nishimura M, Suzuki T, Sato J . Importance of proinflammatory cytokines in synovial fluid from 121 joints with temporomandibular disorders. Br J Oral Maxillofac Surg. 2002; 40(5):418-23. View