Effectiveness of Arthrocentesis and the Occlusal Splint in Treatment of the TMJ
Condition: Temporomandibular Joint Disc Displacement; Anterior Disc Displacement
Study type: Interventional

Summary: 
      The goal of this clinical trial is to compare occlusal splint and arthrocentesis in patients
      with disc displacement with/without reduction. The main question it aims to answer are:

      • Is there a more effective treatment for this cases?

      Participants will answer a questionary about pain and functional limitations.

      Researchers will compare Group 1(occlusal plate) and Gruoup 2 (arthrocentesis) to see if
      there is pain reduction and functional improvement in patients with disc displacement
      with/without reduction
    

Detailed description: 
      Introduction: Temporomandibular joint disc displacement is a disorder in which the articular
      disc is anteriorly displaced from its correct position in relation to the mandibular condyle
      and mandibular fossa. Traditionally, the initial treatment of disc displacements involves
      several conservative measures, among them, the stabilizing interocclusal splint. However, in
      cases where there is associated opening limitation, such as intermittent lock and
      closed-lock, arthrocentesis has been suggested as another initial treatment modality due to
      its faster effect in preventing disease progression to a more advanced stage, in addition to
      reducing the chances of pain chronicity and central sensitization. Objectives: The present
      study aimed to compare and analyze the effectiveness and benefits of performing
      arthrocentesis as the initial treatment in patients with DDWR with intermittent lock and in
      patients with DDWoR, compared to the stabilizing interocclusal splint. Additionally, it had
      as secondary objectives to characterize the sample according to demographic, systemic, local
      and psychosocial factors in both groups and to correlate the clinical characteristics of the
      included patients with the imaging findings of the MRI scans. Methods: A randomized,
      prospective, longitudinal pilot study was performed. The sample was obtained by convenience
      from a demand through consultations and referral, among patients treated at the Oral and
      Maxillofacial Surgery Service of HCFMUSP, from June 2021 to July 2023. Patients with
      diagnoses of: DDWR intermittent lock and DDWoR with opening mouth limitation. Study patients
      underwent an initial assessment using a clinical questionnaire (DC/TMD) and underwent an
      initial TMJ MRI. Then, they were randomly divided into two groups according to the treatment
      to which they would be submitted: stabilizing inter-occlusal splint (group 1) or
      arthrocentesis (group 2). After treatment was instituted, patients were evaluated at 1, 2, 3
      and 6 months regarding clinical parameters of pain, functionality and psychosocial status.
    

Intervention name(s): Occlusal splint; Arthrocentesis
Intervention type(s): Procedure; Procedure
Intervention description(s): a stabilizing maxillary acrylic occlusal splint was made, flat, total and adjusted in central relation (RC).; The patient then underwent arthrocentesis of the temporomandibular joint itself, following the Nitzan technique.
Intervention MeSH terms: Salicylic Acid
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Stabilizing interocclusal plate (IOP): a stabilizing maxillary acrylic occlusal plate was made, flat, total and adjusted in central relation (RC). Advice and guidance on the disease.
Arthrocentesis: Delimitation of a corner-tragus line to mark points A (10mm in front of the tragus and 2mm below the CT line) and B (20mm in front of the tragus and 10mm below the CT line); Local intra- and extra-oral antisepsis with aqueous chlorhexidine 0.12% and 0.2%, respectively; Local anesthesia of the auriculotemporal and intra-capsular nerve with mepivacaine 2% + Epinephrine 1:100,000; Insertion of the first 30x0.8 mm needle at point A and injection of 2-3 mL of Lactated Ringer; Insert the second 30x0.8 mm needle into point B Wash with 100-200mL of Ringer Lactate; Removal of the second needle; Injection of 1mL of 20mg Triamcinolone diluted in 0.9% saline solution (1:1) through the needle at point A.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Temporomandibular joint; Anterior disc displacement; Arthrocentesis; Interocclusal stabilizing splint.