الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The continued debate over the therapeutic outcome of
different treatment modalities in ID, either invasive or non invasive
has considerably affected the TMJ research. This led to a major shift
in the treatment modalities during the last two decades, from
aggressive open surgical procedures to the less invasive
arthrocentesis and arthroscopy.
Arthrocentesis or blind lysis and lavage of the TMJ were first
reported by Nitzan in 1991 as a modification of arthroscopy which is
less invasive but with nearly the same therapeutic outcomes. Alkan
stated that the use of arthrocentesis in the management of ID proved
reasonable degree of success ranging from 75% to 100%. Intra
articular injection using different medication is used in combination
with arthrocentesis to enhace the clinical outcome and improves long
term results. Corticosteroids which are a potent anti-inflammatory
drug and Sodium Hyaluronate which is highly viscous lubricant
material are the most commonly used ones.
The RDC/TMD is one of the heavily cited dental publications
in the dental literature. It is a dual axis diagnostic system for TMDs
supported by a well-designed history and clinical examination
protocol which provide specific reliable, reproducible and valid
criteria with high sensitivity and specificity to define the most
common types of TMDs. Selecting a specific subtypes of ID
diagnosed by RDC/TMD and confirmed by MRI should yield a more
homogenous patient subgroups which is essential for a valid
comparative study We aimed to investigate the effectiveness of arthrocentesis
either alone or with subsequent intrajoint medications as HA or
corticosteroids.
This study was conducted on the patients who were referred
to the TMD clinic in oral and maxillofacial department, Faculty of
Dentistry, Ain Shams University. These patients were examined by
only one examiner trained on using the RDC/TMD as the basic
research diagnostic system. In concurrence with the RDC/TMD, a
standardized clinical head and neck examination was established to
select subjects of the study. This clinical examination included site of
pain, pattern of jaw movement, measurements of the range of mouth
opening, lateral excursions, protrusion, joint noises and palpation of
the muscles involved in mastication.
To confirm the diagnosis reached by the RDC/TMD
supplemental MRIs were ordered for all the patients. After being
diagnosed, all the patients were exposed to a period of non surgical
treatment and those who were not responsive to these non surgical
therapies comprised the sample on which our clinical trial was
conducted. Patients were then assigned into three groups. The first
group which is the control group received arthrocentesis only. The
second and third groups received arthrocentesis followed by intraarticular
injection of HA and corticosteroids respectively. The
primary efficacy parameters included VAS of pain, maximum
painless unassisted mouth opening, lateral excursions and protrusion
as measured in millimeters. We included 18 patients in our study with a total of 34 joints
(16 bilateral & 2 unilateral). The first group is made of 6 patients
with a total of 10 joints, while the second and third groups are made
of 6 patients and a total of 12 joints for each group.
Although all groups showed significant improvements as
regard to the four outcome parameters , there was no statistically
significant difference when comparing the three groups as regard to
the four outcome parameters (VAS of pain, maximum painless
opening , lateral excursions , and protrusion ) at the scheduled follow
up intervals ( 1 week , 1month , 3 months , and 6 months ) .