Combined Arthrocentesis and Occlusal Splint Therapy for Closed Locks of the TMJ
Condition: Temporomandibular Joint Disorders
MeSH terms: Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome
Study type: Interventional

Summary: 
      The goal of this prospective cohort study is to evaluate the effectiveness of combined
      arthrocentesis and occlusal stabilization splint therapy in patients diagnosed with disc
      displacement without reduction of temporomandibular joint-induced closed locks. The main
      questions it aims to answer are:

        -  Is there a difference in the treatment response between chronic and acute closed-lock
           conditions?

        -  On which dimensions of pain did the treatment have positive effects? Participants will
           be preoperatively examined and assigned to one of the two study groups.

        -  All participants undergo a single session of TMJ arthrocentesis.

        -  Following the arthrocentesis session, all participants will use preoperatively
           fabricated occlusal splints.

        -  Participants will be recalled in one week to evaluate the outcomes. Researchers will
           compare acute and chronic closed-lock groups to see if there are differences between
           pain intensities and mouth-opening amounts postoperatively.
    

Detailed description: 
      The study sample constituted patients diagnosed with DDWoR with limited opening according to
      the Turkish version of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD Axis 1
      questionnaire and examination form). The included patients with DDWoR-induced complaints
      persisting for more than three months were considered chronic (Group 1), and those with a
      shorter duration were considered acute (Group 2). For clinical diagnosis of DDWoR,
      Significant limitation of mouth opening, less than 35 mm assisted mouth opening, less than 4
      mm increase in mouth opening with passive stretching, less than 7 mm contralateral movement
      of the mandible, and deviation of the mandible to the affected side during mouth opening was
      considered sufficient. The DC/TMD questionnaire and clinical examination diagnoses were
      confirmed by magnetic resonance images (MRI).

      Preoperative and postoperative clinical examinations consisted of recording demographic
      information, amount of maximum mouth opening (MMO), and determination of McGill Pain
      Questionnaire (MPQ) and Visual Analog Scale (VAS) scores. MMO values were determined as the
      distance between the incisal edges of upper and lower central teeth and recorded in
      millimeters. MPQ scores were obtained with the questionnaire form consisting of four
      subsections. In the first subsection of the questionnaire, besides the patient's demographic
      data, the location of the current pain and whether it comes from superficial or deep tissues
      are questioned. In the second subsection, there are 20-word groups containing 78 words that
      ask the Sensory (groups 1-10), Affective (groups 11-15), Evaluative (group 16), and
      Miscellaneous (groups 17-20) components of current pain. In the third subsection, the
      relationship of pain with time is questioned. There are word groups to determine the
      continuity of pain, its frequency, and factors that increase or reduce pain. In the fourth
      subsection, five-word groups ranging from "mild" pain to "unbearable" pain to determine the
      severity of the pain; There are also six questions to assess the severity of pain that the
      patient can accept or experience without discomfort, which is also defined as
      "experienceable=target pain." The obtainable MPQ scores range from 0 to 78. The higher the
      scores, the greater the pain. Also, preoperative and postoperative VAS scores were obtained
      by marking a point on a 10 cm line. The score was calculated as the distance in centimeters
      between the zero and the marked points.
    

Intervention name(s): Arthrocentesis of the temporomandibular joint
Intervention type(s): Procedure
Intervention description(s): Arthrocentesis of the temporomandibular joint is a minimally invasive method performed under local anesthesia to irrigate the upper temporomandibular joint cavity with biocompatible substances. The procedure aims to wash out intra-articular inflammatory substances, reduce pain and restore the function of the related joint.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Arthrocentesis; Closed lock; Stabilization splint