Clinical Assessment of Adjunctive Use of Sodium Hyaluronate with Arthrocentesis for Temporo-mandibular Joint Anterior Disk Displacement with Reduction

Abstract

The continued debate over the therapeutic outcome of different treatment modalities in ID, either invasive or non-invasive has considerably affected the TMJ research. This led to a major shift in the treatment modalities during the last two decades, from aggressive open surgical procedures to the less invasive arthrocentesis and arthroscopy.

Arthrocentesis or blind lysis and lavage of the TMJ were first reported by Nitzan in 1991 as a modification of arthroscopy which is less invasive but with nearly the same therapeutic outcomes. Alkan stated that the use of arthrocentesis in the management of ID proved reasonable degree of success ranging from 75% to 100%. Intra-articular injection of SH into the TMJ were first reported by Kopp in 1979. Since then several studies applying SH alone or in combination with other remedies injected once or repeatedly in the inferior or superior joint space for patients suffering TMD have been conducted.

Intra-articular injection using different medication is used in combination with arthrocentesis to enhance the clinical outcome and improves long term results. A potent anti-inflammatory drug such as Sodium Hyaluronate which also serves as a highly viscous lubricant material is the most commonly used remedy in TMJ intracapsular injection.

The RDC/TMD is one of the heavily cited dental publications in the dental literature. It is a dual axis diagnostic system for TMDs supported by a well-designed history and clinical examination protocol which provide specific and reliable valid criteria to define the most common types of TMDs. Selecting a specific subtypes of ID diagnosed by RDC/TMD and confirmed by MRI should yield a more homogenous patient subgroups which is essential for a valid comparative study.

We aimed to investigate the effectiveness of arthrocentesis either alone or with subsequent intra-joint medication as SH.

This study was conducted on the patients who were referred to the TMD clinic in oral and maxillofacial department, Faculty of Dentistry, Ain Shams University from the period of 12-2014 till 8-2016. These patients were examined by only one examiner trained on using the RDC/TMD as the basic research diagnostic system. Simultaneously with the RDC/TMD, a standardized clinical head and neck examination was done to select patients of the study. This clinical examination included site of pain, pattern of jaw movement, measurements of the range of mouth opening, lateral excursions, protrusion, joint noises and palpation of the muscles involved in mastication.

To confirm the diagnosis reached by the RDC/TMD, MRIs were requested for all the patients. After confirming the diagnosis, all the patients were submitted to a period of non-surgical treatment