Redüksiyonsuz Disk Deplasmanı Olan Hastalarda Stabilizasyon Splinti ile ve Splintsiz Artrosentez Uygulamalarının Karşılaştırmalı Sonuçları

Abstract

Amaç: Bu retrospektif çalışmanın amacı, redüksiyonsuz disk deplasmanı (RDD) tanısı alan hastalarda artrosentezin tek başına uygulanması ve artrosentez ile birlikte stabilizasyon splint (SS) tedavisi kombinasyonunun uzun dönem etkinliğini karşılaştırmaktır. Gereç ve Yöntemler: 2018–2022 yılları arasında tedavi edilen 49 hastaya (57 TMJ) ait tıbbi kayıtlar retrospektif olarak incelendi. Hastalar sadece artrosentez uygulananlar (AO, n=26) ve artrosentezle birlikte stabilizasyon splinti uygulananlar (A+SS, n=23) olmak üzere iki gruba ayrıldı. Ağrı şiddeti görsel analog skala (pVAS) ile, maksimum interinsizal açıklık (MIA) ise tedavi öncesi (T0), 1 ay (T1) ve 12 ay (T2) sonrası ölçüldü. Grup içi ve gruplar arası karşılaştırmalar, veri dağılımına uygun istatistiksel testlerle yapıldı. Bulgular: Her iki grupta da zaman içinde pVAS ve MIA değerlerinde anlamlı iyileşmeler gözlendi (p<0.001). T1’de, AO grubunda ağrı düzeyinde daha fazla azalma görülürken (p<0.05), A+SS grubunda MIA artışı daha belirgindi (p<0.05). Ancak T2 zaman noktasında, her iki parametre açısından gruplar arasında anlamlı fark bulunmadı (p>0.05). Sonuç: Artrosentezin tek başına uygulanması ve artrosentezin stabilizasyon splinti ile birlikte uygulanması, RDD hastalarında benzer uzun dönem sonuçlar sağlamaktadır. Kombine tedavi kısa vadede fonksiyonel faydalar sunsa da, bu avantajlar 1 yıllık takipte kalıcı olmamıştır. Sadece artrosentez, RDD tedavisinde pratik ve etkili bir tedavi seçeneği olarak değerlendirilebilir.

Keywords

• Artralji
• Eklem hastalıkları
• Oklüzal splintler
• Temporomandibuler eklem

Supporting Institution

YOK

Ethical Statement

Hamidiye Bilimsel Araştırmalar Etik Kurul Komisyonu tarafından etik açıdan uygun bulunmuştur. (Kayıt no 25/286, Karar no 7/25, Toplantı tarihi 27.03.2025)

Thanks

YOK

Comparative Outcomes of Arthrocentesis with and without Stabilization Splints in Patients with Disc Displacement without Reduction

Abstract

Objective: This retrospective study aimed to compare the longterm effectiveness of arthrocentesis alone versus arthrocentesis combined with stabilization splint (SS) therapy in patients diagnosed with disc displacement without reduction (DDwoR). Materials and Methods: Medical records of 49 patients (57 TMJs) treated between 2018 and 2022 were retrospectively analyzed. Patients were divided into two groups: those who received arthrocentesis only (AO, n=26) and those who received arthrocentesis combined with a stabilization splint (A+SS, n=23). Pain intensity was evaluated using a visual analogue scale (pVAS), and maximum interincisal opening (MIO) was measured at baseline (T0), 1 month (T1), and 12 months (T2) post-treatment. Intragroup and intergroup comparisons were performed using appropriate statistical tests based on data distribution. Results: Both groups showed significant improvements in pVAS and MIO over time (p<0.001). At T1, the AO group demonstrated greater pain reduction (p<0.05), while the A+SS group showed greater MIO improvement (p<0.05). However, no significant differences were observed between groups at T2 for either parameter (p>0.05). Conclusion: Arthrocentesis alone and in combination with a stabilization splint provided similar long-term outcomes in patients with DDwoR. Although the combined therapy yielded early functional benefits, these advantages were not sustained at the 1-year follow-up. Arthrocentesis appears to be a practical and effective standalone treatment option for DDwoR.

Keywords

• Arthralgia
• Joint disorders
• Occlusal splints
• Temporomandibular joint

Supporting Institution

None

Ethical Statement

Received approval from the Hamidiye Scientific Research Ethics Committee (registration number 25/286, decision number 7/25, decision date 27.03.2025)

Thanks

None

References

1. Reference1. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†. J Oral Facial Pain Headache 2014;28:6–27.
2. Reference2. Lazarin R deO., Previdelli ITS, Silva R dosS., Iwaki LCV, Grossmann E, Filho LI. Correlation of gender and age with magnetic resonance imaging findings in patients with arthrogenic temporomandibular disorders: a cross-sectional study. Int J Oral Maxillofac Surg 2016;45:1222–8.
3. Reference3. Nitzan DW, Franklin Dolwick M, Martinez GA. Temporomandibular joint arthrocentesis: A simplified treatment for severe, limited mouth opening. J Oral Maxillofac Surg 1991;49:1163–7.
4. Reference4. Hosgor H, Bas B, Celenk C. A comparison of the outcomes of four minimally invasive treatment methods for anterior disc displacement of the temporomandibular joint. Int J Oral Maxillofac Surg 2017;46:1403–10.
5. Reference5. Al-Moraissi EA, Wolford LM, Ellis E, Neff A. The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials. J Craniomaxillofac Surg 2020;48:9–23.
6. Reference6. Kuzmanovic Pficer J, Dodic S, Lazic V, Trajkovic G, Milic N, Milicic B. Occlusal stabilization splint for patients with temporomandibular disorders: Meta-analysis of short and long term effects. PLoS One 2017;12:1-21.
7. Reference7. Zhang C, Wu JY, Deng DL, He BY, Tao Y, Niu YM, et al. Efficacy of splint therapy for the management of temporomandibular disorders: a meta-analysis. Oncotarget 2016;51:84043–53.
8. Reference8. Huang I, Wu J, Kao Y, Chen C, Chen C, Yang Y. Splint therapy for disc displacement with reduction of the temporomandibular joint. Part I: Modified mandibular splint therapy. Kaohsiung J Med Sci 2011;8:323–9.

9. Reference9. Tatli U, Benlidayi ME, Ekren O, Salimov F. Comparison of the effectiveness of three different treatment methods for temporomandibular joint disc displacement without reduction. Int J Oral Maxillofac Surg 2017;5:603–9.
10. Reference10. Vos LM, Huddleston Slater JJR, Stegenga B. Arthrocentesis as initial treatment for temporomandibular joint arthropathy: A randomized controlled trial. J Craniomaxillofac Surg 2014;5:134– 9.
11. Reference11. Alpaslan C, Kahraman S, Güner B, Cula S. Does the use of soft or hard splints affect the short-term outcome of temporomandibular joint arthrocentesis? Int J Oral Maxillofac Surg 2008;5:424–7.
12. Reference12. Lee HS, Baek HS, Song DS, Kim HC, Kim HG, Kim BJ, et al. Effect of simultaneous therapy of arthrocentesis and occlusal splints on temporomandibular disorders: anterior disc displacement without reduction. J Korean Assoc Oral Maxillofac Surg 2013;1:14
13. Reference13. Altaweel AA, Ismail HA, Fayad MI. Effect of simultaneous application of arthrocentesis and occlusal splint versus splint in management of non-reducing TMJ disc displacement. J Dent Sci 2021;2:732–7.
14. Reference14. Okeson JP. Joint Intracapsular Disorders: Diagnostic and Nonsurgical Management Considerations. Dent Clin North Am 2007;1:85–103.
15. Reference15. Demir MG. The Effect of Arthrocentesis Treatment for Maximum Mouth Opening and Pain in Temporomandibular Joint Diseases and the Effect of Splint, Drug, and Physical Therapy on This Treatment. Medicina (B Aires) 2023;10:1-10.
16. Reference16. Osman MM, Hassan K. A comparison of combined therapy of arthrocentesis and bite splint versus arthrocentesis alone in case of nonreducing temporomandibular disc displacement. Egypt J Oral Maxillofac Surg 2016;3:81–5.
17. Reference17. Nagori SA, Jose A, Roy Chowdhury SK, Roychoudhury A. Is splint therapy required after arthrocentesis to improve outcome in the management of temporomandibular joint disorders? A systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2019;2:97–105.
18. Reference18. Dawoud BE, Tabbenor O, Crawford C, Bayoumi S. Arthrocentesis versus occlusal coverage splints in the management of disc displacement without reduction: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2024;9:779– 86.
19. Reference19. Corrêa-Silva M, de Carvalho TMI, Zambon CE, Peres MPS de M, Machado GG. Is there a superiority between arthrocentesis and stabilizing occlusal splint for the treatment of anterior disc displacement with reduction and intermittent block and anterior disc displacement without reduction in TMJ? Randomized clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2024;2:244–54.
20. Reference20. Ghanem WA. Arthrocentesis and stabilizing splint are the treatment of choice for acute intermittent closed lock in patients with bruxism. J Craniomaxillofac Surg 2011;4:256–60.
21. Reference21. Manfredini D, Ahlberg J, Aarab G, Bender S, Bracci A, Cistulli PA, et al. Standardised Tool for the Assessment of Bruxism. J Oral Rehabil 2024;1:29–58.
22. Reference22. Machon V, Hirjak D, Lukas J. Therapy of the osteoarthritis of the temporomandibular joint. J Craniomaxillofac Surg 2011;2:127–30.
23. Reference23. Wang S, Wang Z, Zhou G. Efficacy of added splint therapy after arthrocentesis vs arthrocentesis alone in the management of temporomandibular joint disorders: a systematic review and meta-analysis. Quintessence Int 2024;10:824–33.
24. Reference24. Yadav P, Kumar V, Yadav P. Efficacy of Various Lavaging Agents and Intraarticular Injections in Temporomandibular Joint Arthrocentesis: A Narrative Review. JCDR 2023;17:10-15.
25. Reference25. Siewert-Gutowska M, Pokrowiecki R, Kamiński A, Zawadzki P, Stopa Z. (2023). State of the Art in Temporomandibular Joint Arthrocentesis—A Systematic Review. J. Clin. Med. 2023;12:1-12.