Efficacy of arthrocentesis, splint therapy and MRI assessment in management of patients with temporomandibular joint disorders

To evaluate clinical biochemical and imaging assessment of the efficacy of lavage [arthrocentesis] of proinflammatory cytokines in the synovial fluid in symptomatic TMJ with or without the use of anterior repositioning splint. Radiodiagnosis Department. Faculty of Medicine, Alexandria University, Maxillofacial surgery, Prosthodentics and Oral surgery Departments, Faculty of Dentistry, Alexandria University. 20 patients [12 females and 8 males] with symptoms of TMJ pain, joint noise, limitation of joint opening, tenderness located in the articular region. all patients underwent full clinical examination and diagnostic imaging [panoramic radiographs] and MRI. patients were grouped into two; [group I] those treated by arthrocentesis of TMJ [the proinflammatory cytokines alone] and [group 2] those were treated by arthrocentesis and anterior repositioning splint therapy. arthrocentesis were done two times with interval of 6 weeks. MRI were done before treatment and after two months from treatment. the patients were divided into two groups both groups were treated with anhrocenzesis mandibular hard acrylic resin repositioning splint constructed for group 2 and was worn after arthrocentesis. clinical, biochemical and radiological imaging [MRI] evaluations were carried out to assess the efficacy of arthrocentesis [lavage] of the inflammatory cytokines in the synovial fluid of the symptomatic TMJ disc position and erosions can be fully assessed by MRI and both groups demonstrated marked clinical improvements after treatment mainly of group 2 and this match with the improvement of the disc position identified by MRI. patients with disc erosions were the least to improve. 1. the combination treatment of arthrocentesis of TMJ and mandibular repositioning splint give the advantages of pain relief and considered as the treatment modality of choice before surgical intervention to avoid the morbidity associated with surgery. 2. MRI is the only direct objective, very sensitive and accurate imaging modility to test the validity and effect as well as the prognosis of lavage [arthrocentesis] and prothesis treatment [splint therapy] of TMJ disorders. 3. erosion of the disc is a sign of bad omen in the way of anatomical repositioning of the disc after different modalities of treatment

Histological study of the tempro-mandibular joint after partial loss of teeth, experimental study

Twelve dogs were included in the persent work. They were divided into six groups according to the extracted teeth. Microscopical study of the TMJ was done to detect the histopathological changes following loss of teeth. The following conclusions may be drawn: The degree of TMJ disturbance was directly related to the severity of the intermaxillary disturbance. Considerable disturbances occur as a result of disharmony in the relation of the remaining teeth and TMJ. Change in force or direction of stress, especially after loss of posterior teeth causes structural changes. These are characterized by degeneration and destruction of the articular surface of the condyle and disc. Pressure of the mandibular condyle may lead to compression of the different structures with consequent impaired function. Fibrous ankylosis of the condyle could occur following destruction of the condylar cartilage and its replacement by fibrous tissue. The presence of teeth is essential to the normal functional occlusion that is in harmony with the neuromuscular system and TMJ. Therefore preservation of function is best served by conservation and protection of the natural dentition whenever possible. It is recommended to restore the extracted teeth as early as possible to avoid any damage to the TMJ