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Objectives: This randomized clinical trial study aims to compare ultrasound‐guided versus non‐guided Dextrose 10% injections in patients suffering from internal derangement in the temporomandibular joint (TMJ). Material and Methods: The study population included 22 patients and 43 TMJs suffering from unilateral or bilateral TMJ painful clicking, magnetic resonance imaging (MRI) proved disc displacement with reduction (DDWR), refractory to or failed conservative treatment. The patients were divided randomly into two groups (non‐guided and ultrasound (US)‐guided groups). The procedure involved injection of 2 mL solution of a mixture of 0.75 mL 0.9% normal saline solution, 0.3 mL 2% lidocaine and 0.75 mL dextrose 10% using a 25G needle in the joint and 1 mL intramuscular injection to the masseter muscle at the most tender point. The Visual Analogue Score (VAS) was used to compare joint pain intensity over four different periods, beginning with pre‐injection, 1‐, 2‐, and 6‐months postinjection. Results: Twenty‐two patients 5 males (n = 5/22, 22.7%) and 17 females (n = 17/22, 77.2%) were included in this study. The mean age was 27.3 ± 7.4 years (30.2 ± 7.0) for the non‐guided group and 24.3 ± 6.9 for the US‐guided group. The dextrose injection reduced intensity over time in both groups with statistically significant improvement (P value <.05) at 2 and 6 months in both groups. There was no statistically significant difference in VAS assessment between both groups. Conclusion: Intra‐articular injection of dextrose 10% for patients with painful clicking and DDWR resulted in reduced pain intensity in both US‐guided and non‐guided groups with significant symptomatic improvement over time in both groups. US guidance allowed accurate anatomical localization and safe procedure with a single joint puncture. [ABSTRACT FROM AUTHOR]

Background: Understanding the pathogenesis of temporomandibular joint disorder (TMD) is important for diagnosis and treatment planning. Thus, biochemical analysis is usually used for the detection of tissue damage. Objective: In this study, we aimed to investigate the serum asporin levels in patients with TMD. Methods: Our study was planned to be performed on 43 healthy individuals (control group) without any joint problems and 43 patients with temporomandibular joint internal derangement (TMJ‐ID; patients group) according to the Wilkes classification (stages 3, 4 and 5). Serum asporin levels were determined by the enzyme‐linked immunosorbent assay (ELISA) method and compared between groups. Asporin levels were analysed according to the demographic and clinical characteristics of the patients, and the differences between them were demonstrated. Results: Asporin levels were found to be significantly increased in the patients group compared to control group (p =.0303). The age and gender distributions of the samples in the control and patients groups were homogeneous, and there was no statistically significant difference between the groups. In addition, while there was no significant change in asporin levels in females in the patients group compared with the control group, the asporin levels were significantly increased in males in the patients group (p =.0403). Conclusions: Consequently, asporin seems to be an important biomarker in the pathobiology of TMJ‐ID as it is significantly upregulated in these patients. [ABSTRACT FROM AUTHOR]

Objective: To compare intra‐operative and postoperative outcomes between the single‐puncture and the standard double‐puncture techniques of arthrocentesis. Methods: PubMed, Embase, ScienceDirect and CENTRAL databases were searched from inception up to 31st August 2020. Randomised controlled trials (RCTs), prospective and retrospective studies conducted on patients with temporomandibular joint disorders comparing any type of single‐puncture arthrocentesis with standard double‐puncture arthrocentesis and reporting intra‐operative/postoperative outcomes were included. Assessment of the risk of bias was done with the Cochrane Collaboration risk assessment tool. Results: Thirteen studies were included (12 were RCTs). Analysis of a limited number of studies indicated no difference in pain or maximal mouth opening (MMO) between the single‐puncture type‐1 or type‐2 and the double‐puncture technique at various follow‐up intervals. Pooled analysis (four studies) demonstrated that the single‐puncture type‐2 technique requires significantly less operating time as compared to the double‐puncture method. No such difference was noted between single‐puncture type‐1 and double‐puncture techniques. Analysis of two studies indicated significantly reduced intra‐operative needle relocations with the single‐puncture techniques. Studies were not of high quality with concerns of bias in randomisation, allocation concealment and blinding. Conclusions: Limited data indicate no difference in pain or MMO with single‐ or double‐puncture techniques of arthrocentesis. Amongst the three techniques, the single‐puncture type‐2 technique has the advantages of significantly lower operating time and reduced intra‐operative needle relocations and it may be the preferred method of TMJ arthrocentesis in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Temporomandibular disorders (TMD) cover a wide spectrum of disorder; myalgic, arthralgic and psychogenic. The procedure of TMJ arthrocentesis has a role in managing patients with arthralgic pain and limitation if they fail to respond to non-surgical therapy.Method: The patient records of a single private specialist OMS were searched over the 9-year period of 2006-2014 to identify patients who had arthrocentesis as part of their multidisciplinary management. The detailed demographic, diagnosis, pre and post arthrocentesis procedure were identified and put on a database. Appropriate statistics were performed.Results: Seventy-six patients had 115 arthrocentesis procedures performed in the study period. Fifty of 76 had improvement in their pain and 16 of 41 had an increased jaw opening of more than 10 mm. There were no complications or morbidity. Analysis of patient variables generally showed no correlations.Conclusions: Temporomandibular joint arthrocentesis has a role in the multidisciplinary, multimodality treatment of arthralgic TMD. [ABSTRACT FROM AUTHOR]

There is evidence that low-grade inflammation may be responsible for pain and development of degenerative changes in temporomandibular joint internal derangement. This article reviews the current knowledge of the molecular mechanisms behind TMJ internal derangements. A non-systematic search was carried out in PubMed, Embase and the Cochrane library for studies regarding pathophysiological mechanisms behind internal derangements focusing on pain-mediating inflammatory and cartilage-degrading molecules. Recent data suggest that release of cytokines may be the key event for pain and cartilage destruction in TMJ internal derangements. Cytokines promote the release of matrix metalloproteinases ( MMPs), and due to hypoxia, vascular endothelial growth factor ( VEGF) is released. This activates chondrocytes to produce MMPs and reduce their tissue inhibitors ( TIMPs) as well as the recruitment of osteoclasts, ultimately leading to cartilage and bone resorption. Also, proteoglycans have an important role in this process. Several cytokines, MMPs, TIMPs and VEGF have been identified in higher concentrations in the TMJ synovial fluid of patients with painful internal derangements and shown to be associated with the degree of degeneration. Other molecules that show elevated levels include hyaluronic acid synthase, disintegrin and metalloproteinase with thrombospondin motifs ( ADAMTs), aggrecan, fibromodulin, biglycan and lumican. Taken together, more or less pronounced inflammation of TMJ structures with release of cytokines, MMPs and other molecular markers that interact in a complex manner may be responsible for tissue degeneration in internal derangements. As internal derangements may be symptom-free, the degree of inflammation, but also other mechanisms, may be important for pain development. [ABSTRACT FROM AUTHOR]

The presence of body posture changes among patients with temporomandibular disorders ( TMD) has been a controversial topic in dentistry. Based on that, the aim of this study was to assess postural features of pain-free subjects with internal derangement of the temporomandibular joint ( TMJ), viz. disc displacement, when compared to subjects with normal disc position. A total of 21 subjects with unilateral, pain-free TMJ disc displacement ( DD) and 21 subjects without any TMD signs of symptoms were assessed for body posture changes by means of posturographic evaluation of several body segments and postural balance reactions through the centre of mass during jaw movements using a balance platform. Posturographic measurements showed the absence of any significant differences between the two groups in any of the outcome parameters. Similarly, all balance platform responses to mandibular movements were not different between groups. There are no significant differences in body posture between subjects with and without unilateral disc displacement in the temporomandibular joint. Such observations, indicating a well-preserved postural balance in the presence of TMJ internal derangement, put into serious question the potential influence of TMJ disorders on whole body posture and viceversa. [ABSTRACT FROM AUTHOR]

Temporomandibular disorders ( TMD) are defined as clinical conditions that involve the masticatory muscles, temporomandibular joint ( TMJ) or both. The aim of this study was to evaluate serum 17β-oestradiol and progesterone levels in menstruating women affected by internal derangement of the TMJ. A total of 142 women (mean age 30·2 ± 6·7) who referred to medical diagnostic laboratory of Iranian Academic Centre for Education, Culture and Research ( ACECR), Mashhad Branch, were enrolled during 2007 and 2008. Forty-seven individuals had disc displacement with reduction (Group IIa) according to Research Diagnostic Criteria ( RDC)/ TMD Axis I diagnosis. Radioimmunoassay was used for the detection of serum 17β-oestradiol and progesterone levels in all 142 subjects. The mean progesterone level was significantly higher in control group (11·6 ± 10·4 ng mL−1) compared to women with TMD (8·4 ± 6·8 ng mL−1, P = 0·03). No significant difference was found in two groups regarding 17β-oestradiol level. Lower progesterone level in women with TMD can suggest the more important role of this hormone in the development of the disorder. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The normal disc configuration is biconcave; however, the deformed disc can be found in internal derangement (ID) of the temporomandibular joint (TMJ). The purpose of this study was to evaluate the relationship between the transformation patterns of TMJ disc configuration during mouth opening and disc displacement status, disc reduction ability and TMJ clinical symptoms. Methods: TMJ MR images from volunteers and ID patients were analyzed for closed and open mouth positions. MR images of ID patients were classified into 4 groups: symptomatic joint with anterior disc displacement with or without reduction (ADW or ADWo) and asymptomatic joint with ADW or ADWo. The disc configurations in both positions were categorized as biconcave, biplanar, convex or folded; then the patterns of transformation were observed. Results: For the ADW group, the most common disc configuration for closed and open mouth positions were biplanar (66.7%) and biconcave (86.3%). The transformation pattern was significantly related to disc reduction ability (p <0.05). Conclusions: The transformation patterns of disc configuration during opening were related to anterior disc displacement and disc reduction ability. [Copyright &y& Elsevier]

J Oral Pathol Med (2012) 41: 642-647 Background: Internal derangement is the most frequent arthropathy affecting the temporomandibular joint, where its commonest form is anterior disc displacement with or without reduction. Despite the frequency of the disorder, the biochemical features of displaced discs are still unclear. Methods: We investigated the expression pattern and localization of aquaporin-1, an important channel protein involved in plasma membrane water permeability, in patients with anterior disc displacement (both with and without reduction), with a view to assessing the characteristics of local tissue responses to the microenvironmental changes induced by abnormal mechanical loading of the displaced disc. Protein expression was studied by immunohistochemistry in different areas of discs from 18 patients with anterior disc displacement with or without reduction and in four normal controls. Results: A greater proportion of cells immunopositive for aquaporin-1 were detected in diseased than in normal discs. Whereas protein expression was substantially similar in the different areas of normal discs, a significantly larger number of immunopositive cells were detected in the posterior band of displaced discs without reduction and in the anterior and intermediate bands of those with reduction. Conclusions: These findings suggest that aquaporin-1 is expressed and upregulated in temporomandibular joint with anterior disc displacement (both with and without reduction). [ABSTRACT FROM AUTHOR]

J Oral Pathol Med (2011) : 103-110 Internal derangement (ID) of the temporomandibular joint (TMJ) is due to an abnormal relationship of the articular disc to the mandibular condyle, glenoid fossa and articular eminence. The two most common types of internal derangement are anterior disc displacement with (ADDwR) and without reduction (ADDwoR). Disc displacement is associated with degenerative tissue changes. The histological features of discs from patients with TMJ ID reflect a general remodelling caused by abnormal loading. A correlation has been demonstrated between TMJ ID and apoptosis. Few investigations have addressed the role of apoptosis or caspase activity in TMJ ID. The apoptosis activation process was studied in different areas of discs from 18 patients with ID (both ADDwR and ADDwoR) and four cadavers (controls), with emphasis on the expression of caspase 3, whose activation makes the death process irreversible. The results showed a greater proportion of caspase 3-positive cells in ADDwR and ADDwoR than in control discs. Immunopositivity also varied between disc areas; in particular, in ADDwoR sections labelled cells were significantly more numerous ( P < 0.01) in the posterior disc attachment than in the anterior and intermediate bands. In addition, a significantly greater proportion of labelled cells was seen in the anterior (+) and intermediate (++) band of ADDwR compared with ADDwoR discs both bands ( P < 0.05). These data suggest the importance of programmed cell death in the progression of TMJ ID. [ABSTRACT FROM AUTHOR]

Temporomandibular joint (TMJ) hypermobility is noted only when it interferes with smooth mandibular movements. These interferences (viz. clicking sounds and jerky mandibular movements) result from condylar dislocation in front of the eminence at wide mouth opening, or alternatively in front of the articular disc (posterior disc displacement). The aim of this study was to test the hypothesis that condyles of hypermobile persons are positioned more anterosuperiorly to the crest of the eminence during maximum mouth opening than those of persons without TMJ hypermobility. Possible posterior disc displacement was also evaluated. Nine persons with symptomatic hypermobility and nine control persons free of internal derangements were included, their diagnoses being based upon opto-electronic movement recordings. Condylar positions during maximum mouth opening were analysed on magnetic resonance images with two slightly different methods, showing the degree to which the condyles are displaced around the eminence. No posterior disc displacements were found in any of the magnetic resonance images. After excluding an outlier and using both measurement methods, a small difference in condylar position was found between the two groups of subjects. The condyles of all hypermobile persons travelled beyond the eminence; however, so were the condyles of nearly half of the non-hypermobiles. The large overlap between both groups suggests that condylar position alone is not a good predictor for symptomatic TMJ hypermobility. It is probably the combination of condylar location in front of the eminence with a particular line of action of the masticatory muscles, which gives rise to functional signs of hypermobility. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare clinical and radiological findings of untreated closed lock patients at least 22 months after initial diagnosis. Ten patients with closed lock in at least one joint who had received no treatment were included in the study. Clinically maximum mouth opening, joint pain and joint sounds were recorded. Radiologically position of the disc, disc morphology, bone degeneration and presence of fluid were determined on magnetic resonance imaging. Clinical and radiological examinations were repeated 2–5 years after initial examinations. Results were statistically compared using either the non-parametric McNemar test or the Wilcoxon signed-rank test. There were significant improvements in both mouth opening capacity and prevalence of joint pain, while no significant change in radiological examination. The results of this study suggested that closed lock patients undergo active adaptation in clinical symptoms. [ABSTRACT FROM AUTHOR]

The purpose of this study is to examine whether electromyographic activity (EMG) during chewing movement changes towards the control level spontaneously in the subsequent course after diagnosis in patients with non-reducing disc displacement of the temporomandibular joint (TMJ) who do not receive any treatment. In 15 such patients, EMG data were examined at initial visit and at a mean follow-up of 21·7 months. As a control, 23 persons who had no TMJ dysfunction were studied. The results of EMG were compared among patients at initial visit, those at follow-up, and controls. The patients’ clinical signs and symptoms were alleviated during the follow-up period. Duration of muscle contraction, cycle time and integrated EMG value (IEMG) at initial visit in patients were significantly different from those in the controls. In patients, IEMG for chewing-side masseter during chewing in the TMJ-affected side was greater at follow-up (14·2 ± 8·01 μV s) than that at initial visit (10·5 ± 3·69 μV s) (P < 0·05). In patients, duration of muscle contraction or cycle time at follow-up was not different from that at initial visit. Patients with non-reducing disc displacement of the TMJ showed spontaneous increasing of IEMG without any treatment in the subsequent course after diagnosis, coupled with improvement of clinical signs and symptoms. Duration of muscle contraction or cycle time did not change towards the control level. The results presented are useful as control data to understand the true effect of a particular treatment for patients with non-reducing disc displacement of the TMJ. [ABSTRACT FROM AUTHOR]

Internal derangement is one of the most common disorder of the temporomandibular joint (TMJ). The aim of this study was to investigate the associations of matrix metalloproteinase (MMP)-3 and -8 expression in articular condylar surface with different stages of TMJ internal derangement according to Wilkes (Minn Med, 1978;61: 645–52) and osteoarthrosis (OA) according to Dijkgraaf et al. (J Oral Maxillofac Surg, 1995;53: 1182–92).The study was based on 54 condylar specimens obtained during TMJ surgery. Immunohistochemistry using antibodies specific to MMP-3 and -8, represented in cartilage destruction, was carried out.In all tissue specimens, MMP-3 expression was intense in the surface layer but showed less intensive staining in the deeper layers. Some MMP-8 expression was also seen. The severity of TMJ internal derangement, however, did not seem to have a statistically significant correlation (P < 0.05) with the expression of these enzymes.The study confirms that distinct expression of MMP-3 and -8 is found in the condylar surface of TMJs with internal derangement.J Oral Pathol Med(2005)34: 39–45 [ABSTRACT FROM AUTHOR]

One of the most common symptoms of temporomandibular disorders is an internal derangement (ID). The aim of this study was to test the inter-observer reliability of the recognition of IDs by means of auscultation, palpation or both. To that end, 120 women and 100 men were screened by two trained examiners for the presence of IDs. Anterior disc displacement was diagnosed in 14% of the cases and hypermobility in 12%. In 4% of the cases, the ID was classified as‘other’. The inter-rater reliability (Cohen's kappa) was moderate for the presence of an ID for all techniques, while for the classification into type, an almost perfect reliability was found for the combined technique. It was concluded that the type of ID can best be established with the combination of auscultation and palpation; for the establishment of an ID as such, any of the three techniques would suffice. [ABSTRACT FROM AUTHOR]

Background: The molecular weight (MW) of hyaluronic acid (HA) in joints generally declines in inflammatory arthritis. As inflammation exists in certain temporomandibular disorders (TMD), we measured the MW of HA in synovial fluid (SF) recovered from patients with TMD and compared it with that from normal controls. Methods: Synovial fluid was obtained from patients with TMD (21 TMJs) and normal controls (5 TMJs). The MW of HA was measured using high-performance liquid chromatography (HPLC). Results: In the controls, the MW of HA in SF exceeded the detection limit, 3000 kDa. In contrast, 19 (90.5%) of 21 SF samples from patients showed a decreased MW of HA. The median MW of HA (1570 kDa) in TMD was significantly lower than that in the controls (P < 0.01). Conclusion: The MW of HA in SF from patients with TMD is decreased. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to investigate the expression of matrilin-1 in arthritic articular cartilage of the mandibular condyle by means of immunohistochemical methods.Methods: Condylar cartilage specimens were obtained from temporomandibular joints (TMJs) of 12 patients with arthritis (osteoarthritis and internal derangement) (mean age 51.8 years; age range 28-71 years) and four patients with TMJ ankylosis (mean age 44.0 years; age range 16-64 years), diagnosed clinically and with imaging examinations. Paraffin sections were immunostained with anti-matrilin-1 antibodies.Results: Matrilin-1 expression was detected in both patient groups with TMJ ankylosis and arthritis, and the level was remarkably higher in arthritic cartilage. The mean percentage of matrilin-1-producing cells to the total chondrocytes was significantly (P < 0.05) greater in the arthritic group (43.9 +/- 19.2%) than in subjects with TMJ ankylosis (28.0 +/- 8.7%).Conclusions: Articular chondrocytes in the TMJ condyle can express matrilin-1 and the expression is enhanced in arthritic cartilage, suggesting a presence of functional or adaptive remodeling in the condyle in response to degenerative changes in the TMJ structures. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the relationship between the disc positions of temporomandibular joints (TMJ), the vertical and lateral mandibular displacement (VMD and LMD, respectively) and age in female adolescents with signs and symptoms of the temporomandibular disorders (TMD). The VMD and LMD were assessed, using posteroanterior (PA) cephalograms. The disc positions were assessed by magnetic resonance imaging (MRI) and categorized as follows: normal disc position, functional disc displacement and functional disc dislocation. Excluding patients with osteoarthritis, the total number of subjects was 54 female adolescents who were grouped into three: the bilateral normal disc position group, the unilateral or bilateral functional disc displacement group, and the unilateral or bilateral functional disc dislocation group. We compared the extent of VMD and LMD between the three groups, and investigated their correlation with age. Results indicate that functional disc displacement and dislocation are related to mandibular displacement, and VMD did not correlate with age but LMD did correlate with age. This study suggests that the onset of disc displacement is related to the mandibular displacement and disturbs normal growth of the mandible three-dimensionally. [ABSTRACT FROM AUTHOR]

This report is a long-term evaluation of 211 patients (158 women, 53 men) with TMJ clicking and/or TMJ incoordination, treated at the University Hospital of Copenhagen, Denmark, in the years 1971-77. Information on present symptoms and the effect of the initial treatment was obtained from questionnaires. Standard treatment procedures had been used in 153 patients while 58 patients had had counseling only. In the actively treated group, 59% were still doing well, 30% had unchanged symptoms and 5% experienced aggravated symptoms. In the counseled group, 40% were free of symptoms, 50% had unchanged symptoms and 7% aggravated symptoms. A highly significant association was found between the absence or presence of symptoms at the end of treatment according to patient records and the evaluation of the initial effect of treatment 8-15 yr later, which indicates that reliable results can be expected from a long-term evaluation of TMJ dysfunction patients. In the sample as a whole, the frequency of TMJ sounds was unchanged compared to the time of treatment (64% vs 66%). A significantly higher frequency was, however, found in the untreated group, indicating that treatment might have a positive effect on TMJ sounds. The frequency of recurrent headache had increased considerably over the years (6% vs 34%), 32% still experienced pain/tenderness on mandibular movement, 24% suffered from impaired mandibular mobility and 82% were aware of bruxism/clenching of teeth. Furthermore, we found a significant association between headache before treatment and headache, awareness of bruxism and clenching of teeth at the time of evaluation. Headache thus seems to be a permanent problem which is also closely related to parafunctional habits in patients with internal TMJ derangement. [ABSTRACT FROM AUTHOR]

This report is a retrospective evaluation of 211 patients (75% women, 25% men) treated for TMJ clicking and/or TMJ incoordination at the University Hospital, Copenhagen, in 1971-77. In both sexes, the age group 20-30 yr dominated and the main part of the population belonged to the social middle class. The reasons for seeking treatment were mainly TMJ sounds, pain and impaired mandibular mobility. Neither subjective complaints nor objective signs of dysfunction were associated with dental/occlusal status or with the presence of malocclusions. The patients had been treated with reversible modalities (65%), occlusal adjustment (8%) and counseling alone (27%). Of the actively treated patients, 43% had experienced relief within 1 month and at the end of treatment 72% had reduced or no symptoms. It was not possible to demonstrate any association between the duration of symptoms before treatment and the duration of treatment/number of consultations. [ABSTRACT FROM AUTHOR]