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Alhaj Kheder MB, Kandil NM, El-Ghareeb T, Abdel Aziz OM, Zeitoun R. Ultrasound Guided Vs Non-Guided Prolotherapy for Internal Derangement of Temporomandibular Joint. A Randomized Clinical Trial. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 38581185 DOI: 10.1002/jum.16462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/16/2024] [Accepted: 03/24/2024] [Indexed: 04/08/2024]
Abstract
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.
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Affiliation(s)
| | - Nour Mohamed Kandil
- Diagnostic and Interventional Radiology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Tarek El-Ghareeb
- Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | | | - Rania Zeitoun
- Diagnostic and Interventional Radiology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Bouloux GF, Chou J, DiFabio V, Ness G, Perez D, Mercuri L, Chung W, Klasser GD, Bender SD, Kraus S, Crago CA. Guidelines for the Management of Patients With Orofacial Pain and Temporomandibular Disorders. J Oral Maxillofac Surg 2024:S0278-2391(24)00200-3. [PMID: 38643965 DOI: 10.1016/j.joms.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Gary F Bouloux
- Family Professor, Division Chief, Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA.
| | - Joli Chou
- Associate Professor, Department Of Oral and Maxillofacial Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Vince DiFabio
- Associate Clinical Professor, Oral and Maxillofacial Surgery, University of Maryland School of Dentistry, University of Maryland Medical Center, Baltimore, MD
| | - Greg Ness
- Emeritus Professor-Clinical, The Ohio State University, Private Practice, Oral and Facial Surgery for Adults and Children, Columbus, OH
| | - Daniel Perez
- Associate Professor and Program Director, Oral and Maxillofacial Surgery, University Texas Health Sciences San Antonio, San Antonio, TX
| | - Louis Mercuri
- Visiting Professor, Department of Orthopedic Surgery, Rush University Medical Center, Adjunct Professor, Department of Bioengineering, University of Illinois Chicago, Chicago, IL
| | - William Chung
- Clinical Professor, Residency Program Director, Indiana University School of Dentistry and Hospital Medicine, Indianapolis, IN
| | - Gary D Klasser
- Certificate Orofacial Pain, Professor, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, LA
| | - Steven D Bender
- Clinical Associate Professor, Director, Clinical Center for Facial Pain and Sleep Medicine, Department of Oral and Maxillofacial Surgery, Texas A&M School of Dentistry, Dallas, TX
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Christidis N, Al-Moraissi EA, Barjandi G, Svedenlöf J, Jasim H, Christidis M, Collin M. Pharmacological Treatments of Temporomandibular Disorders: A Systematic Review Including a Network Meta-Analysis. Drugs 2024; 84:59-81. [PMID: 38103150 PMCID: PMC10789663 DOI: 10.1007/s40265-023-01971-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE Temporomandibular disorders (TMD) comprise a cluster of conditions with a wide range of etiological factors that causes pain and discomfort in the masticatory muscles (TMD-M) and temporomandibular joints (TMD-J). More than 50% of the patients with TMD report regular usage of drugs. However, there is still no consensus, nor is there any evidence-based support for clinicians when choosing between different drugs. Therefore, this systematic review, including a network meta-analysis (NMA), aimed to evaluate the scientific evidence and discuss the pharmacological treatment options available to treat painful TMD. METHOD An electronic search was undertaken to identify randomized controlled trials (RCTs) investigating pharmacological treatments for TMD-M and/or TMD-J, published until 6 April 2023. Since only 11 articles could be used for an NMA regarding TMD-M, a narrative synthesis was also performed for all 40 included RCTs. The quality of evidence was rated according to Cochrane's tool for assessing risk of bias, while the certainty of evidence was rated according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS When it comes to TMD-M, evidence arises for wet needling therapies with BTX-A, granisetron, and PRP as well as muscle relaxants. For TMD-J, evidence points toward pharmacological treatment approaches including non-steroidal antiinflammatory drugs (NSAIDs) and glucocorticosteriods (for inflammatory conditions) as well as hyaluronic acid and dextrose. CONCLUSIONS The evidence clearly indicates that the pharmacological treatment approaches differ between TMD-M and TMD-J. Therefore, it is of great importance to first try to uncover each patient's individual and multifactorial etiology and then employ a multifaceted treatment strategy, including pharmacological treatment approaches.
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Affiliation(s)
- Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden.
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
| | - Golnaz Barjandi
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
| | - Johanna Svedenlöf
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
| | - Hajer Jasim
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
- Department of Orofacial Pain and Jaw Function, Public Dental Services, Folktandvården Stockholms län AB, SE-102 31, Eastmaninstitutet Stockholm, Sweden
| | - Maria Christidis
- The Institute of Health Sciences, The Swedish Red Cross University, SE-141 21, Huddinge, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-14183, Huddinge, Sweden
| | - Malin Collin
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
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Lubecka K, Chęcińska K, Bliźniak F, Chęciński M, Turosz N, Michcik A, Chlubek D, Sikora M. Intra-Articular Local Anesthetics in Temporomandibular Disorders: A Systematic Review and Meta-Analysis. J Clin Med 2023; 13:106. [PMID: 38202113 PMCID: PMC10779637 DOI: 10.3390/jcm13010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/17/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
This systematic review with meta-analysis was conducted to evaluate the effectiveness of local anesthetic administration into temporomandibular joint cavities in relieving pain and increasing mandibular mobility. Randomized controlled trials were included with no limitation on report publication dates. Final searches were performed on 15 October 2023, using engines provided by the US National Library, Bielefeld University, and Elsevier Publishing House. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Articular pain and mandible abduction values and their mean differences were summarized in tables and graphs. Eight studies on a total of 252 patients evaluating intra-articular administration of articaine, bupivacaine, lidocaine, and mepivacaine were included in the systematic review. None of the eligible studies presented a high risk of bias in any of the assessed domains. An analgesic effect of intra-articular bupivacaine was observed for up to 24 h. In the long-term follow-up, there were no statistically significant changes in quantified pain compared to both the baseline value and the placebo group, regardless of the anesthetic used (articaine, bupivacaine, and lidocaine). There is no scientific evidence on the effect of intra-articular administration of local anesthesia on the range of motion of the mandible. Therefore, in the current state of knowledge, the administration of local anesthetics into the temporomandibular joint cavities can only be considered as a short-term pain relief measure.
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Affiliation(s)
- Karolina Lubecka
- Department of Oral Surgery, Preventive Medicine Center, Komorowskiego 12, 30-106 Cracow, Poland; (K.L.); (F.B.); (M.C.)
| | - Kamila Chęcińska
- Department of Glass Technology and Amorphous Coatings, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, Mickiewicza 30, 30-059 Cracow, Poland;
| | - Filip Bliźniak
- Department of Oral Surgery, Preventive Medicine Center, Komorowskiego 12, 30-106 Cracow, Poland; (K.L.); (F.B.); (M.C.)
| | - Maciej Chęciński
- Department of Oral Surgery, Preventive Medicine Center, Komorowskiego 12, 30-106 Cracow, Poland; (K.L.); (F.B.); (M.C.)
| | - Natalia Turosz
- Institute of Public Health, Jagiellonian University Medical College, Skawińska 8, 31-066 Cracow, Poland;
| | - Adam Michcik
- Department of Maxillofacial Surgery, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 Gdańsk, Poland;
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
| | - Maciej Sikora
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland;
- Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, Wojska Polskiego 51, 25-375 Kielce, Poland
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Taşkesen F, Cezairli B. Efficacy of prolotherapy and arthrocentesis in management of temporomandibular joint hypermobility. Cranio 2023; 41:423-431. [PMID: 33326351 DOI: 10.1080/08869634.2020.1861887] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of dextrose prolotherapy in conjunction with arthrocentesis and dextrose prolotherapy alone in the management of symptomatic TMJ hypermobility. METHODS Twenty-four patients suffering from TMJ symptomatic hypermobility received 10% dextrose injections for three sessions at four-week intervals. Twelve patients (P group) received prolotherapy alone; the other 12 (PA group) also underwent a single arthrocentesis session. Patients were evaluated for maximal incisal opening, maximal incisal opening without pain, pain at rest, pain during chewing function, TMJ sound, and locking episode frequency. RESULTS Pain scores were significantly reduced in both groups, and the locking episode frequency was decreased to a greater extent in the PA than the P group, at both the short and long terms. CONCLUSION Prolotherapy is effective in the management of TMJ hypermobility. However, prolotherapy with arthrocentesis may be superior to prolotherapy alone in the management of TMJ hypermobility.
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Affiliation(s)
- Fatih Taşkesen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Burak Cezairli
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ordu University, Ordu, Turkey
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Bhargava D, Sivakumar B, Bhargava PG. A Comparative Preliminary Randomized Clinical Study to Evaluate Heavy Bupivacaine Dextrose Prolotherapy (HDP) and Autologous Blood Injection (ABI) for Symptomatic Temporomandibular Joint Hypermobility Disorder. J Maxillofac Oral Surg 2023; 22:110-118. [PMID: 36703672 PMCID: PMC9871094 DOI: 10.1007/s12663-022-01738-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/01/2022] [Indexed: 01/29/2023] Open
Abstract
Purpose Temporomandibular joint (TMJ) sub-luxation can have a significant psycho-social impact on a patients' well-being. Several treatment modalities have been described in the literature for the same. The present study was undertaken to investigate the efficacy of heavy bupivacaine-dextrose prolotherapy (HDP) for the peri-articular tissues, superior joint space and the retro-discal area in the patients with symptomatic chronic sub-luxation. Materials and Methods A preliminary clinical study was conducted among 60 patients diagnosed with chronic painful sub-luxation of the TMJ. Patients were divided into control group (CG), n = 30, where autologous blood was injected in the superior joint space, peri-capsular tissues and retro-discal area bilaterally as per the predetermined protocol; and the study group (SG), n = 30 patients were administered heavy bupivacaine-dextrose injection bilaterally in the peri-articular tissues, superior joint space and retro-discal area. The efficacy of the treatment was evaluated by assessing pain, maximum inter-incisal opening (MIO), changes in computed tomography scan, magnetic resonance imaging study, number and need for subsequent injections in both the groups. Result Among the 60 patients, majority of the patients exhibited successful outcome after both the interventions, ABI and HDP. There was statistically significant reduction in recorded pain score with reduced MIO post-treatment. No morphological changes were noted in the condyle in both the groups. No complications were recorded among the study population. Conclusion HDP is a safe and simple modality for treating symptomatic sub-luxation with predictable clinical outcome. Heavy bupivacaine-dextrose can be considered as a prolotherapeutic agent for symptomatic chronic temporomandibular joint sub-luxation with the pharmacological benefit of local anaesthesia and proliferent delivery through the same injection.
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Affiliation(s)
- Darpan Bhargava
- Maxillofacial Surgery & TMJ Consultancy Services, H-3/2, BDA Col, Lalghati, Airport Road, Bhopal, Madhya Pradesh India
- Oral & Maxillofacial Surgery, People’s University, Bhopal, Madhya Pradesh India
| | - Beena Sivakumar
- Department Oral & Maxillofacial Surgery, Meenakshi Ammal Dental College & Hospital, Chennai, Tamil Nadu India
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Cömert Kiliç S, Kiliç N, Güngörmüş M. Botulinum Toxin Versus Dextrose Prolotherapy: Which is More Effective for Temporomandibular Joint Subluxation? A Randomized Clinical Trial. J Oral Maxillofac Surg 2023; 81:389-395. [PMID: 36693543 DOI: 10.1016/j.joms.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE Botulinum toxin type A (BTX-A) therapy or dextrose prolotherapy (DP) has been used to treat temporomandibular joint (TMJ) disorders. However, the superiority of one method over the other has not been studied in patients with TMJ subluxation. Therefore, this study aims to answer the following clinical question: among patients with TMJ subluxation, do those undergoing BTX-A injection into lateral pterygoid muscles, compared to those undergoing intra- and periarticular DP injections, have better outcomes in terms of locking episodes and patient satisfaction? METHODS A randomized clinical trial was implemented in adult patients with TMJ subluxation. The sample was composed of patients with TMJ subluxation with painful open-locking during wide mouth opening and/or yawning at baseline. The subjects were treated randomly with one of two treatment techniques with equal numbers as follows: one-session BTX-A injection into lateral pterygoid muscles (BTX-A group) or three sessions of dextrose injections around TMJ (prolotherapy group). The predictor variable was the treatment technique (BTX-A or prolotherapy injections). The primary outcome variable was the frequency of locking episodes. The secondary outcome variable was patient satisfaction. The primary outcome variable was recorded at baseline and 8-12 months following the injections. The secondary outcome variable was recorded only 8-12 months following the injections. Descriptive and bivariate statistics were computed. The data were analyzed with the Wilcoxon and Mann-Whitney U tests. RESULTS The baseline sample was composed of 30 patients with TMJ subluxation. However, the follow-up sample comprised 25 subjects: 11 (9 females, 2 males; 25.64 years) in the BTX-A group and 14 (10 females, 4 males; 32.37 years) in the prolotherapy group. Locking episodes decreased significantly in the two groups with no significant difference (P < .01). Seven patients in the BTX-A group (7 of 11 patients; 63.6 percent) and eight (8 of 14 patients; 57.1 percent) in the prolotherapy group reported no complaint of locking at the end of follow-up, with no significant difference between the groups (P > .05). Patient satisfaction showed no significant difference between the groups (P > .05). CONCLUSION These findings suggested that BTX-A injection is no more effective than DP for any outcome variables of TMJ subluxation assessed.
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Affiliation(s)
- Songül Cömert Kiliç
- Associate Professor. Atatürk University, Dentistry of Faculty, Atatürk University, Erzurum, Turkey.
| | - Nihat Kiliç
- Professor. Atatürk University, Dentistry of Faculty, Atatürk University, Erzurum, Turkey
| | - Metin Güngörmüş
- Professor. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
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Vaidyanathan A, Haidry N, Sinha U, Singh A, Salahudheen A. Evaluation of the Effects of Polidocanol Injection in the Treatment of Temporomandibular Joint Hypermobility - A Prospective Study. Ann Maxillofac Surg 2022; 12:166-172. [PMID: 36874776 PMCID: PMC9976867 DOI: 10.4103/ams.ams_138_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Sclerosing agents have been used for temporomandibular joint (TMJ) hypermobility since decades, some of which are ethanolamine oleate, and OK-432, sodium psylliate (sylnasol), but there are no studies on the usage of polidocanol - a well-known sclerosing agent which does not have much side effects and is inexpensive. Hence, this study evaluates the effect of polidocanol injection in the treatment of TMJ hypermobility. Methodology This was a prospective observational study in which patients with chronic TMJ hypermobility were included. Out of the 44 patients who had symptoms of clicking and pain of the TMJ, 28 were diagnosed as internal derangement of the TMJ. The final analysis included 15 patients in whom multiple injections of polidocanol were given on the basis of post-operative parameters. The sample size was calculated based on a significance level of 0.05 and a power of 80%. Results Overall, a success rate of 86.6% (13/15) was encountered at the end of three months, with seven patients not reporting any further episodes of dislocation after one injection and six patients not reporting any episode of dislocation after two injections. Discussion Polidocanol sclerotherapy can be used as a treatment modality for chronic recurrent dislocation of the TMJ, rather than opting for more invasive procedures for the same.
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Affiliation(s)
- Aiswarya Vaidyanathan
- Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Naqoosh Haidry
- Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Upasna Sinha
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Abhishek Singh
- Department of Dentistry, Government Medical College, Saharanpur, Uttar Pradesh, India
| | - Ameera Salahudheen
- Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
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Haggag MA, Al-Belasy FA, Said Ahmed WM. Dextrose prolotherapy for pain and dysfunction of the TMJ reducible disc displacement: A randomized, double-blind clinical study. J Craniomaxillofac Surg 2022; 50:426-431. [DOI: 10.1016/j.jcms.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/08/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022] Open
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10
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Memiş S. Evaluation of the effects of prolotherapy on condyles in temporomandibular joint hypermobility using fractal dimension analysis. J Korean Assoc Oral Maxillofac Surg 2022; 48:33-40. [PMID: 35221305 PMCID: PMC8890968 DOI: 10.5125/jkaoms.2022.48.1.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/24/2021] [Accepted: 01/03/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives Prolotherapy is a method that has gained popularity in recent years and has been reported to have positive short-term and long-term clinical results in maxillofacial surgery, especially temporomandibular joint (TMJ) hypermobility. This study aimed to evaluate the changes in the trabecular structure of mandibular condyles in patients who underwent prolotherapy due to TMJ hypermobility using the fractal analysis method. Materials and Methods Forty-five patients who received dextrose prolotherapy at a concentration of 20% and fifteen control patients were included in the study. All patients had panoramic radiographs just before (T0) and six months after treatment (T1). The patients who received treatment were divided into three groups according to the number of prolotherapy injections. The regions of interest were selected from bone areas close to the articular surfaces of the condyles. The fractal dimension (FD) values were calculated. Results The main effect of time on the FD value was significant [F (1, 56)=86.176, P<0.001]. This effect was qualified by a significant time×group interaction effect [F (3, 56)=9.023, P<0.001]. The decreases in FD values in all treatment groups between T0 and T1 times were significant (P=0.004). However, changes in FD values were not significant in the control group (P=0.728). Conclusion Dextrose prolotherapy without the effect of the number of injections caused a decrease in FD values in the mandibular condyles over time.
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Affiliation(s)
- Sadi Memiş
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
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11
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Ertas U, Ascl YE, Yalcin E, Urvasizoglu G. Evaluation of Intermaxillary Fixation (IMF) Screw Therapy with Craniomandibular Index Analysis for Chronic Recurrent Dislocation in the Temporomandibular Joint. Niger J Clin Pract 2022; 25:12-20. [PMID: 35046189 DOI: 10.4103/njcp.njcp_107_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Temporomandibular joint (TMJ) hypermobility is classified as a subluxation, complete (luxation), unilateral, or bilateral, acute, chronic protracted, or chronic recurrent dislocation. Aims This controlled randomized clinical study aims to evaluate the effectiveness of intermaxillary fixation (IMF) screw application and autologous blood injections in the treatment of chronic recurrent dislocation of TMJ in comparison with the placebo group. Patients and Methods The patients who were admitted to the Faculty of Dentistry of the Atatürk University between October 2018 and January 2020 were evaluated. Three hundred patients diagnosed with bilateral chronic recurrent dislocation of TMJ based on clinical findings and radiographs were included in the study. The patients were randomly divided into three groups according to the evaluation criteria. Group 1 received IMF, group 2 received autologous blood injection, and group 3 (placebo group) received an intraarticular saline injection. Results The results of the patients who received IMF, autologous blood injection, and saline injection were evaluated by the craniomandibular index. The IMF group showed significant improvement after 1 month and 6 months (P < 0.001), while the patients who received autologous blood injection and saline injection showed no significant improvement (P > 0.05). The data were analyzed with IBM SPSS V23. The significance level was P < 0.05. Conclusion In our study, the IMF gave the best results among all the study groups. The IMF technique can be used in patients with protracted chronic recurrent dislocation in whom autologous blood injection has failed.
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Affiliation(s)
- U Ertas
- Department of Oral, Maxillofacial Surgery, Atatürk University Faculty of Dentistry, Erzurum, Turkey
| | - Y E Ascl
- Department of Oral, Maxillofacial Surgery, Atatürk University Faculty of Dentistry, Erzurum, Turkey
| | - E Yalcin
- Department of Oral, Maxillofacial Surgery, Atatürk University Faculty of Dentistry, Erzurum, Turkey
| | - G Urvasizoglu
- Department of Oral, Maxillofacial Surgery, Atatürk University Faculty of Dentistry, Erzurum, Turkey
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12
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Efficacy of hypertonic dextrose injection (prolotherapy) in temporomandibular joint dysfunction: a systematic review and meta-analysis. Sci Rep 2021; 11:14638. [PMID: 34282199 PMCID: PMC8289855 DOI: 10.1038/s41598-021-94119-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023] Open
Abstract
Hypertonic dextrose prolotherapy (DPT) has been reported to be effective for temporomandibular disorders (TMDs) in clinical trials but its overall efficacy is uncertain. To conduct a systematic review with meta-analysis of randomized controlled trials (RCTs) to synthesize evidence on the effectiveness of DPT for TMDs. Eleven electronic databases were searched from their inception to October, 2020. The primary outcome of interest was pain intensity. Secondary outcomes included maximum inter-incisal mouth opening (MIO) and disability score. Studies were graded by “Cochrane risk of bias 2” tool; if data could be pooled, a meta-analysis was performed. Ten RCTs (n = 336) with some to high risk of bias were included. In a meta-analysis of 5 RCTs, DPT was significantly superior to placebo injections in reducing TMJ pain at 12 weeks, with moderate effect size and low heterogeneity (Standardized Mean Difference: − 0.76; 95% CI − 1.19 to − 0.32, I2 = 0%). No statistically significant differences were detected for changes in MIO and functional scores. In this systematic review and meta-analysis, evidence from low to moderate quality studies show that DPT conferred a large positive effect which met criteria for clinical relevance in the treatment of TMJ pain, compared with placebo injections. Protocol registration at PROSPERO: CRD42020214305.
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Zarate MA, Frusso RD, Reeves KD, Cheng AL, Rabago D. Dextrose Prolotherapy Versus Lidocaine Injection for Temporomandibular Dysfunction: A Pragmatic Randomized Controlled Trial. J Altern Complement Med 2020; 26:1064-1073. [PMID: 32780636 DOI: 10.1089/acm.2020.0207] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: Several intraarticular injections, including dextrose and lidocaine, are reported to reduce pain and dysfunction in temporomandibular dysfunction (TMD) and increase maximal jaw opening; our goal was to determine whether dextrose/lidocaine outperforms sterile water/lidocaine for TMD. Design: Pragmatic randomized controlled trial. Setting: Outpatient clinic. Subjects: Chronic (≥3 months) of moderate-to-severe (≥6/10) jaw or facial pain meeting research-specific TMD criteria. Intervention: Blinded intraarticular dextrose prolotherapy (DPT) (20% dextrose/0.2% lidocaine) versus intraarticular lidocaine (0.2% lidocaine in sterile water) at 0, 1, and 2 months. Participants were then unblinded and offered DPT by request for 9 additional months. Main outcome measures: Primary: Numerical Rating Scale (0-10 points) score for facial pain and jaw dysfunction; percentage achieving ≥50% improvement in pain and dysfunction (0, 3, and 12 months). Secondary: Maximal interincisal opening (MIO; 0 and 3 months). Intention-to-treat analysis was by joint using mixed-model regression. Results: Randomization of 29 participants (25 female, 47 ± 17 years, 43 joints) produced similar groups. Three-month pain and dysfunction improvements were similar, but more DPT-treated joints improved by ≥50% in pain (17/22 vs. 6/21; p = 0.028). The MIO improved in both groups (5.6 ± 5.8 mm vs. 5.1 ± 7.0 mm; p = 0.70). From 3 to 12 months, minimal DPT was received by original DPT and lidocaine recipients, 0.5 ± 0.9 and 0.6 ± 1.5 injections, respectively, with only 2 out of 21 joints in the original lidocaine group receiving more than 1 dextrose injection after 3 months. Twelve-month analysis revealed that joints in the original DPT group improved more in jaw pain (4.8 ± 2.4 points vs. 2.6 ± 2.9 points; p = 0.026) and jaw dysfunction (5.3 ± 2.6 points vs. 2.7 ± 2.3 points; p = 0.013). More DPT than lidocaine-treated joints improved by ≥50% in both pain (19/22 vs. 5/21; p = 0.003) and dysfunction (17/22 vs. 7/21; p = 0.040). There were no adverse events; satisfaction was high. Conclusions: Intraarticular DPT resulted in clinically important and statistically significant improvement in pain and dysfunction at 12 months compared to lidocaine injection (ClinicalTrials.gov identifier NCT01617356).
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Affiliation(s)
- Miguel Angel Zarate
- Private Practice Family Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Daniel Frusso
- Private Practice Family Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - David Rabago
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Treatment of temporomandibular joint luxation: a systematic literature review. Clin Oral Investig 2019; 24:61-70. [DOI: 10.1007/s00784-019-03126-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
Abstract
Objectives
To evaluate the effectiveness of surgical and nonsurgical treatment of temporomandibular joint (TMJ) luxation.
Materials and methods
This systematic literature review searched PubMed, the Cochrane Library, and Web of Science databases to identify randomized controlled trials on TMJ luxation treatment published between the inception of each database and 26 March 2018.
Results
Two authors assessed 113 unique abstracts according to the inclusion criteria and read nine articles in full text. Eight articles comprising 338 patients met the inclusion criteria, but none of these evaluated surgical techniques. Three studies including 185 patients concerned acute treatment with manual reduction of luxation while five studies including 153 patients evaluated minimally invasive methods with injection of autologous blood or dextrose prolotherapy for recurrent TMJ luxation. These studies reported that mouth opening after treatment was reduced and that independent of type of injection, recurrences of TMJ luxation were rare in most patients.
Conclusions
In the absence of randomized studies on surgical techniques, autologous blood injection in the superior joint space and pericapsular tissues with intermaxillary fixation seems to be the treatment for recurrent TMJ luxation that at present has the best scientific support. Well-designed studies on surgical techniques with sufficient numbers of patients, long-term follow-ups, and patient experience assessment are needed for selection of the optimal surgical treatment methods.
Clinical relevance
Autologous blood injection combined with intermaxillary fixation can be recommended for patients with recurrence of TMJ luxation.
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Louw WF, Reeves KD, Lam SKH, Cheng AL, Rabago D. Treatment of Temporomandibular Dysfunction With Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial With Long-term Partial Crossover. Mayo Clin Proc 2019; 94:820-832. [PMID: 30878157 DOI: 10.1016/j.mayocp.2018.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/10/2018] [Accepted: 07/03/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the efficacy and longer-term effectiveness of dextrose prolotherapy injections in participants with temporomandibular dysfunction. PATIENTS AND METHODS A randomized controlled trial with masked allocation was conducted from January 14, 2013, through December 19, 2015. Forty-two participants (with 54 joints) meeting temporomandibular dysfunction criteria were randomized (1:1) to 3 monthly intra-articular injections (20% dextrose/0.2% lidocaine or 0.2% lidocaine) followed by as-needed dextrose/0.2% lidocaine injections through 1 year. Primary and secondary outcome measures included a 0 to 10 Numerical Rating Scale score for facial pain and jaw dysfunction; maximal interincisal opening (MIO) measured in millimeters, percentage of joints with 50% or more change (improvement) in pain and function, and satisfaction. RESULTS Randomization produced a control group with more female participants (P=.03), longer pain duration (P=.01), and less MIO (P=.01). Upon 3-month analysis, including pertinent covariates, dextrose group participants reported decreased jaw pain (4.3±2.9 points vs 1.8±2.7 points; P=.02), jaw dysfunction (3.5±2.8 points vs 1.0±2.1 points; P=.008), and improved MIO (1.5±4.1 mm vs -1.8±5.1 mm; P=.006). Control group participants received dextrose injections beginning at 3 months. No between-group differences were noted at 12 months; pooled data suggested that jaw pain, jaw function, and MIO improved by 5.2±2.7 points (68%), 4.1±2.8 points (64%), and 2.1±5.5 mm, respectively. Pain and dysfunction improved by at least 50% in 38 of 54 (70%) and 39 of 54 (72%) jaws, respectively. CONCLUSION Intra-articular dextrose injection (prolotherapy) resulted in substantial improvement in jaw pain, function, and MIO compared with masked control injection at 3 months; clinical improvements endured to 12 months. Satisfaction was high. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01706172.
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Affiliation(s)
- Wynand Francois Louw
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - K Dean Reeves
- Private Practice, Physical Medicine and Rehabilitation, Roeland Park, KS.
| | - Stanley K H Lam
- Department of Family Medicine, Chinese University of Hong Kong, Hong Kong
| | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, MO
| | - David Rabago
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Moreno-Hay I, Okeson JP. Single event versus recurrent luxation of the temporomandibular joint. J Am Dent Assoc 2019; 150:225-229. [PMID: 30803494 DOI: 10.1016/j.adaj.2018.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 11/25/2022]
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Evaluation of the Efficacy of Different Concentrations of Dextrose Prolotherapy in Temporomandibular Joint Hypermobility Treatment. J Craniofac Surg 2018. [PMID: 29533255 DOI: 10.1097/scs.0000000000004480] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study was to compare and evaluate the efficacy of different concentrations of dextrose prolotherapy for the treatment of temporomandibular joint (TMJ) hypermobility. PATIENTS AND METHODS A prospective, randomized clinical trial including patients with subluxation or dislocation was performed. The study comprised 40 patients. Patients were randomly divided into 4 groups: control group, 10% dextrose, 20% dextrose, and 30% dextrose group. Patients in all groups received injections into 4 different areas of each TMJ in 4 sessions at monthly intervals. Visual analog scale of TMJ pain intensity, maximum mouth opening (MMO), joint sounds, and frequency of luxations were recorded preoperatively and postoperatively after 1 month of last injection. The collected data were then statistically analyzed. RESULTS Each group showed postoperatively significant improvement in TMJ pain, significant decrease in both MMO and joint sound. Besides that, TMJ locking was not observed in any patient during the follow-up period. There were no statistically significant differences throughout the study intervals between the groups. CONCLUSION It was concluded that there was no significant difference between control group and dextrose groups and there is no superiority of any concentration of dextrose over the others in TMJ prolotherapy, and all treatment procedures were efficient in improvement of clinical symptoms related to TMJ hypermobility. If dextrose is used as a proliferant, it can be said that 10% dextrose can be sufficient in TMJ hypermobility treatment.
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Fouda AA. Change of site of intra-articular injection of hypertonic dextrose resulted in different effects of treatment. Br J Oral Maxillofac Surg 2018; 56:715-718. [PMID: 30107954 DOI: 10.1016/j.bjoms.2018.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/26/2018] [Indexed: 11/30/2022]
Abstract
Most minimally invasive treatments for dysfunction of the temporomandibular joint (TMJ) are empirical, and aimed at the painful trigger points with the purpose of preventing muscular spasm and restoring normal function. In this prospective study I investigated whether the choice of site of injection of hypertonic dextrose affected the benefits of treatment of internal derangement and pain. I studied 72 patients with pain and clicking as a result of dysfunction of the TMJ. Patients were divided into four groups with four separate sites for intra-articular injection. Dextrose was injected into the superior joint space, inferior joint space, retrodiscal tissue, and anterior capsule injection. Results showed that the retrodiscal site was the most effective for reducing clicking and subsequently improving derangement, while the inferior joint space was the best site for the relief of pain, and the extracapsular site should be used in cases of hypermobility. In conclusion, the injection site should be selected according to the symptoms being treated, and could be used as an adjunct to other sites to improve outcome.
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Affiliation(s)
- A A Fouda
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Cairo University, Giza 12111, Egypt.
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Nagori SA, Jose A, Gopalakrishnan V, Roy ID, Chattopadhyay PK, Roychoudhury A. The efficacy of dextrose prolotherapy over placebo for temporomandibular joint hypermobility: A systematic review and meta-analysis. J Oral Rehabil 2018; 45:998-1006. [PMID: 30024045 DOI: 10.1111/joor.12698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/01/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the systematic review was to analyse the available evidence in order to assess the efficacy of dextrose prolotherapy in improving outcomes in temporomandibular joint (TMJ) hypermobility patients as compared to placebo. METHODS An electronic search of PubMed, Scopus, CENTRAL and Google scholar databases was performed for English language papers published up to February 2018. Randomised clinical trials (RCTs) and controlled clinical trials (CCTs) comparing dextrose prolotherapy with placebo for TMJ hypermobility were included. RESULTS Three RCTs were included in the review. Frequency of subluxation/dislocation was reported by two trials which found no difference between dextrose and placebo. A statistical significant difference in reduction of MMO with the use of dextrose prolotherapy was seen on pooling of data (random: MD = -3.32, 95% CI -5.26 to -1.28; P = 0.0008; I2 = 0%). A statistical significant difference in pain reduction was also seen with dextrose as compared to placebo (random: MD = -1, 95% CI -1.58 to -0.42; P = 0.0007; I2 = 0%). CONCLUSION Within the limitations of the study, dextrose prolotherapy may cause significant reduction in mouth opening and pain associated with TMJ hypermobility. Conclusions with regard to reduction of episodes of subluxation/dislocation cannot be drawn. There is a need of more high-quality RCTs with larger sample size and homogenous prolotherapy protocol to draw stronger conclusions on the effect of dextrose prolotherapy in patients with TMJ hypermobility.
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Affiliation(s)
| | - Anson Jose
- Division of Oral and Maxillofacial Surgery, Army Dental Centre (Research & Referral), New Delhi, India
| | | | - Indranil Deb Roy
- Division of Oral and Maxillofacial Surgery, Army Dental Centre (Research & Referral), New Delhi, India
| | - Probodh K Chattopadhyay
- Division of Oral and Maxillofacial Surgery, Army Dental Centre (Research & Referral), New Delhi, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
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Renapurkar SK, Laskin DM. Injectable Agents Versus Surgery for Recurrent Temporomandibular Joint Dislocation. Oral Maxillofac Surg Clin North Am 2018; 30:343-349. [DOI: 10.1016/j.coms.2018.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cezairli B, Sivrikaya EC, Omezli MM, Ayranci F, Seyhan Cezairli N. Results of Combined, Single-Session Arthrocentesis and Dextrose Prolotherapy for Symptomatic Temporomandibular Joint Syndrome: A Case Series. J Altern Complement Med 2017; 23:771-777. [DOI: 10.1089/acm.2017.0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Burak Cezairli
- Department of Oral Maxillofacial Surgery, Ordu University, Ordu, Turkey
| | - Efe Can Sivrikaya
- Department of Oral Maxillofacial Surgery, Ordu University, Ordu, Turkey
| | | | - Ferhat Ayranci
- Department of Oral Maxillofacial Surgery, Ordu University, Ordu, Turkey
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Refai H. Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint: a single-arm study with 1-4 years' follow up. Br J Oral Maxillofac Surg 2017; 55:465-470. [PMID: 28460873 DOI: 10.1016/j.bjoms.2016.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/01/2016] [Indexed: 12/26/2022]
Abstract
The aim was to analyse the short-term and long-term therapeutic efficacy of dextrose prolotherapy for dislocation or subluxation (hypermobility) of the temporomandibular joint (TMJ). Sixty-one patients with symptomatic hypermobility of the TMJ were included in this single-arm prospective study, in which they were each given four sessions of intra-articular and pericapsular injections six weeks apart. Each injection comprised 10% dextrose/mepivacaine solution 3ml. Clinical outcomes including severity of pain on movement according to the numerical rating scale (NRS), maximal interincisal opening, clicking, and frequency of locking were measured before treatment (T1), during treatment (T2) (just before the third session of injections), at the short-term follow-up (T3) (three months after treatment), and at the long-term follow-up (T4) (1-4 years after treatment). Condylar translation and osseous changes of each joint were evaluated at T1 and T4 using tomography. There was significant reduction in all variables by T2 (p<0.001, p<0.001, p=0.006, and p<0.001). The pain scores (p<0.001) and clicking (p<0.001) had decreased significantly by T3. Linear tomograms of each joint at T1 and T4 showed no alteration in the morphology of the bony components of the joint, and at T4, tomographic open views of all joints showed condylar hypertranslation. Dextrose prolotherapy provided significant and sustained reduction of pain and recovery of constitutional symptoms associated with symptomatic hypermobility of the TMJ without changing either the position of the condyle or the morphology of the bony components of the joint.
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Affiliation(s)
- H Refai
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt.
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Majumdar SK, Krishna S, Chatterjee A, Chakraborty R, Ansari N. Single Injection Technique Prolotherapy for Hypermobility Disorders of TMJ Using 25 % Dextrose: A Clinical Study. J Maxillofac Oral Surg 2016; 16:226-230. [PMID: 28439165 DOI: 10.1007/s12663-016-0944-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 07/15/2016] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Hypermobility disorders of the Temporomandibular joint (TMJ) can be treated by both conservative and surgical approaches. Conservative approaches should be considered as first line treatment for such disorders. Prolotherapy with 25 % dextrose being injected into the posterior pericapsular tissues is one such treatment modality with favorable outcomes. AIM To study the efficacy of single injection of 25 % dextrose in pericapsular tissues in the management of hypermobility joint disorders of TMJ as first line treatment. PATIENTS AND METHODS We have studied a total of 23 patients suffering from either chronic recurrent dislocation or subluxation of the TMJ who were treated with the single injection technique prolotherapy with 25 % dextrose into the pericapsular tissues along with auriculotemporal nerve block and found encouraging results. RESULTS Overall success rate in our study was 91.3 % (21/23) with a minimum follow up period of 13.9 months. Number of successfully treated patients requiring one injection was 7 (30.4 %), two injections was 8 (34.7 %) and requiring three injections was 6 (26.1 %). There were no permanent complications. CONCLUSION Hence the use of 25 % dextrose as a proliferant to treat hypermobilty disorders of the TMJ is recommended by us as a first line treatment option as it is safe, economical and an easy procedure associated with minimal morbidity.
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Affiliation(s)
- S K Majumdar
- Department of Oral and Maxillofacial Surgery, Dr. R. Ahmed Dental College and Hospital, 144 A.J.C. Bose Road, Kolkata, West Bengal 700014 India
| | - Shreya Krishna
- Department of Oral and Maxillofacial Surgery, Dr. R. Ahmed Dental College and Hospital, 144 A.J.C. Bose Road, Kolkata, West Bengal 700014 India
| | - Aritra Chatterjee
- Department of Oral and Maxillofacial Surgery, Dr. R. Ahmed Dental College and Hospital, 144 A.J.C. Bose Road, Kolkata, West Bengal 700014 India
| | - Rajib Chakraborty
- Department of Oral and Maxillofacial Surgery, Dr. R. Ahmed Dental College and Hospital, 144 A.J.C. Bose Road, Kolkata, West Bengal 700014 India
| | - Nazrealam Ansari
- Department of Oral and Maxillofacial Surgery, Dr. R. Ahmed Dental College and Hospital, 144 A.J.C. Bose Road, Kolkata, West Bengal 700014 India
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Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2016; 9:139-59. [PMID: 27429562 PMCID: PMC4938120 DOI: 10.4137/cmamd.s39160] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/20/2016] [Accepted: 05/03/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to systematically review dextrose (d-glucose) prolotherapy efficacy in the treatment of chronic musculoskeletal pain. DATA SOURCES Electronic databases PubMed, Healthline, OmniMedicalSearch, Medscape, and EMBASE were searched from 1990 to January 2016. STUDY SELECTION Prospectively designed studies that used dextrose as the sole active prolotherapy constituent were selected. DATA EXTRACTION Two independent reviewers rated studies for quality of evidence using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs, for level of evidence using a modified Sackett scale, and for clinically relevant pain score difference using minimal clinically important change criteria. Study population, methods, and results data were extracted and tabulated. DATA SYNTHESIS Fourteen RCTs, 1 case–control study, and 18 case series studies met the inclusion criteria and were evaluated. Pain conditions were clustered into tendinopathies, osteoarthritis (OA), spinal/pelvic, and myofascial pain. The RCTs were high-quality Level 1 evidence (Physiotherapy Evidence Database ≥8) and found dextrose injection superior to controls in Osgood–Schlatter disease, lateral epicondylitis of the elbow, traumatic rotator cuff injury, knee OA, finger OA, and myofascial pain; in biomechanical but not subjective measures in temporal mandibular joint; and comparable in a short-term RCT but superior in a long-term RCT in low back pain. Many observational studies were of high quality and reported consistent positive evidence in multiple studies of tendinopathies, knee OA, sacroiliac pain, and iliac crest pain that received RCT confirmation in separate studies. Eighteen studies combined patient self-rating (subjective) with psychometric, imaging, and/or biomechanical (objective) outcome measurement and found both positive subjective and objective outcomes in 16 studies and positive objective but not subjective outcomes in two studies. All 15 studies solely using subjective or psychometric measures reported positive findings. CONCLUSION Use of dextrose prolotherapy is supported for treatment of tendinopathies, knee and finger joint OA, and spinal/pelvic pain due to ligament dysfunction. Efficacy in acute pain, as first-line therapy, and in myofascial pain cannot be determined from the literature.
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Affiliation(s)
- Ross A Hauser
- Caring Medical Regenerative Medicine Clinics, Oak Park, IL, USA
| | | | | | - David K Harris
- Center for Healing and Regenerative Medicine, Austin, TX, USA
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Cömert Kiliç S, Güngörmüş M. Is dextrose prolotherapy superior to placebo for the treatment of temporomandibular joint hypermobility? A randomized clinical trial. Int J Oral Maxillofac Surg 2016; 45:813-9. [DOI: 10.1016/j.ijom.2016.01.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/14/2015] [Accepted: 01/13/2016] [Indexed: 02/03/2023]
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Conservative Management of Second Metatarsophalangeal Joint Instability in a Professional Dancer: A Case Report. J Orthop Sports Phys Ther 2016; 46:114-23. [PMID: 26755404 DOI: 10.2519/jospt.2016.5824] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Professional ballet and modern dancers spend an inordinate amount of time on demi pointe (rising onto their forefeet), placing excessive force on the metatarsophalangeal joints and putting them at risk of instability. Surgical treatment of this condition is well described in the literature. However, studies describing conservative management, particularly in dance populations, are lacking. CASE DESCRIPTION A 33-year-old dancer presented with insidious onset of medial arch and second and third metatarsophalangeal joint pain. Functional deficits included the inability to walk barefoot, perform demi relevé, or balance on demi pointe. Imaging studies revealed osteoarthritis of the first metatarsophalangeal joint, second metatarsophalangeal joint calcification, capsulitis, and plantar plate rupture, leading to a diagnosis of instability. The dancer underwent a treatment program that included taping, padding, physical therapy, a series of prolotherapy injections, and activity modification. OUTCOMES The dancer was seen for a total of 37 physical therapy sessions over the 16-week rehabilitation period. At the time of discharge, the patient had returned to full duty and performed all choreography with taping and padding. Repeated single-leg jumps and turns on the right foot, however, still caused discomfort. At her 6-month follow-up, the dancer's total Dance Functional Outcome Survey (DFOS) score had improved from 16% to 86%, and her Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) physical scores improved from 24 to 47. One year after discharge, the dancer reported pain-free dancing with no taping or padding. DISCUSSION This case report describes early diagnosis and a multimodal treatment approach in a professional dancer with significant disability secondary to metatarsophalangeal joint instability. LEVEL OF EVIDENCE Therapy, level 4.
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Castori M, Morlino S, Ghibellini G, Celletti C, Camerota F, Grammatico P. Connective tissue, Ehlers-Danlos syndrome(s), and head and cervical pain. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2015; 169C:84-96. [DOI: 10.1002/ajmg.c.31426] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. Open Orthop J 2014; 8:326-45. [PMID: 25328557 PMCID: PMC4200875 DOI: 10.2174/1874325001408010326] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/07/2014] [Accepted: 08/17/2014] [Indexed: 12/26/2022] Open
Abstract
The use of conventional modalities for chronic neck pain remains debatable, primarily because most treatments have had limited success. We conducted a review of the literature published up to December 2013 on the diagnostic and treatment modalities of disorders related to chronic neck pain and concluded that, despite providing temporary relief of symptoms, these treatments do not address the specific problems of healing and are not likely to offer long-term cures. The objectives of this narrative review are to provide an overview of chronic neck pain as it relates to cervical instability, to describe the anatomical features of the cervical spine and the impact of capsular ligament laxity, to discuss the disorders causing chronic neck pain and their current treatments, and lastly, to present prolotherapy as a viable treatment option that heals injured ligaments, restores stability to the spine, and resolves chronic neck pain. The capsular ligaments are the main stabilizing structures of the facet joints in the cervical spine and have been implicated as a major source of chronic neck pain. Chronic neck pain often reflects a state of instability in the cervical spine and is a symptom common to a number of conditions described herein, including disc herniation, cervical spondylosis, whiplash injury and whiplash associated disorder, postconcussion syndrome, vertebrobasilar insufficiency, and Barré-Liéou syndrome. When the capsular ligaments are injured, they become elongated and exhibit laxity, which causes excessive movement of the cervical vertebrae. In the upper cervical spine (C0-C2), this can cause a number of other symptoms including, but not limited to, nerve irritation and vertebrobasilar insufficiency with associated vertigo, tinnitus, dizziness, facial pain, arm pain, and migraine headaches. In the lower cervical spine (C3-C7), this can cause muscle spasms, crepitation, and/or paresthesia in addition to chronic neck pain. In either case, the presence of excessive motion between two adjacent cervical vertebrae and these associated symptoms is described as cervical instability. Therefore, we propose that in many cases of chronic neck pain, the cause may be underlying joint instability due to capsular ligament laxity. Currently, curative treatment options for this type of cervical instability are inconclusive and inadequate. Based on clinical studies and experience with patients who have visited our chronic pain clinic with complaints of chronic neck pain, we contend that prolotherapy offers a potentially curative treatment option for chronic neck pain related to capsular ligament laxity and underlying cervical instability.
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Affiliation(s)
- Danielle Steilen
- Caring Medical and Rehabilitation Services, S.C., 715 Lake St., Ste. 600, Oak Park, IL 60301, USA
| | - Ross Hauser
- Caring Medical and Rehabilitation Services, S.C., 715 Lake St., Ste. 600, Oak Park, IL 60301, USA
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Basa S, Göçmen G, Varol A, Karataş B, Sipahi A. Does ultrasonic resorbable pin fixation offer predictable results for augmentation eminoplasty in recurrent dislocations? J Oral Maxillofac Surg 2014; 72:1468-74. [PMID: 25037183 DOI: 10.1016/j.joms.2014.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 03/20/2014] [Accepted: 03/27/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the outcome of interpositional calvarial block grafting fixed with an ultrasonic resorbable system (SonicWeld, KLS Martin, Mühlheim, Germany) for augmentation eminoplasty in chronic recurrent condylar dislocations. PATIENTS AND METHODS We designed and implemented a retrospective cohort study. Eight female patients (mean age 48 years) were treated. The primary predictor variable was time (preoperative vs postoperative). The primary outcome variable was cessation of dislocation. The secondary outcome variables were the height of the articular eminences (HAE), maximum interincisal opening, pain score (visual analog scale [VAS]), postoperative magnetic resonance imaging (MRI) findings, and facial nerve paralysis. RESULTS All 8 patients had been experiencing recurrent dislocations a mean of 10 times each month preoperatively. None of the patients had experienced a dislocation at 2 years postoperatively. The preoperative mean HAE was 5.75 and the VAS score for pain was 72.5. The mean vertical HAE was 15.75 mm, and the mean VAS score for pain was 11.2 at 12 months postoperatively. Complete resorption of the SonicWeld pins was observed on the first year follow-up computed tomography scans. Of the 8 patients, 3 presented with disc displacement without reduction and 2 with disc displacement with reduction on the postoperative MRI scan, and none of the patients had a facial nerve deficit at 24 months of follow-up. CONCLUSIONS Fixation of cortical calvarial grafts using the ultrasonic resorbable system for augmentation eminoplasty provided sufficient stabilization and favorable outcomes. Degradation of the osteosynthesis material and the absence of intermaxillary fixation were the most advantageous parts of the technique.
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Affiliation(s)
- Selçuk Basa
- Professor, Department of Oral and Maxillofacial Surgery, Marmara University Faculty of Dentistry, Istanbul, Turkey
| | - Gökhan Göçmen
- Resident, Department of Oral and Maxillofacial Surgery, Marmara University Faculty of Dentistry, Istanbul, Turkey.
| | - Altan Varol
- Associated Professor, Department of Oral and Maxillofacial Surgery, Marmara University Faculty of Dentistry, Istanbul, Turkey
| | - Berfin Karataş
- Resident, Department of Oral and Maxillofacial Surgery, Marmara University Faculty of Dentistry, Istanbul, Turkey
| | - Ayşegül Sipahi
- Resident, Department of Oral and Maxillofacial Surgery, Marmara University Faculty of Dentistry, Istanbul, Turkey
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Dautrey's procedure: an alternative for the treatment of recurrent mandibular dislocation in patients with pneumatization of the articular eminence. Int J Oral Maxillofac Surg 2014; 43:465-9. [DOI: 10.1016/j.ijom.2013.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 10/04/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022]
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Modified dextrose prolotherapy for recurrent temporomandibular joint dislocation. Br J Oral Maxillofac Surg 2014; 52:63-6. [DOI: 10.1016/j.bjoms.2013.08.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Accepted: 08/30/2013] [Indexed: 11/20/2022]
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Castori M. Ehlers-danlos syndrome, hypermobility type: an underdiagnosed hereditary connective tissue disorder with mucocutaneous, articular, and systemic manifestations. ISRN DERMATOLOGY 2012; 2012:751768. [PMID: 23227356 PMCID: PMC3512326 DOI: 10.5402/2012/751768] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 10/14/2012] [Indexed: 12/20/2022]
Abstract
Ehlers-Danlos syndrome, hypermobility type, constituting a phenotypic continuum with or, perhaps, corresponding to the joint hypermobility syndrome (JHS/EDS-HT), is likely the most common, though the least recognized, heritable connective tissue disorder. Known for decades as a hereditary condition with predominant rheumatologic manifestations, it is now emerging as a multisystemic disorder with widespread manifestations. Nevertheless, the practitioners' awareness of this condition is generally poor and most patients await years or, perhaps, decades before reaching the correct diagnosis. Among the various sites of disease manifestations, skin and mucosae represent a neglected organ where the dermatologist can easily spot diagnostic clues, which consistently integrate joint hypermobility and other orthopedic/neurologic manifestations at physical examination. In this paper, actual knowledge on JHS/EDS-HT is summarized in various sections. Particular attention has been posed on overlooked manifestations, including cutaneous, mucosal, and oropharyngeal features, and early diagnosis techniques, as a major point of interest for the practicing dermatologist. Actual research progresses on JH/EDS-HT envisage an unexpected link between heritable dysfunctions of the connective tissue and a wide range of functional somatic syndromes, most of them commonly diagnosed in the office of various specialists, comprising dermatologists.
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Affiliation(s)
- Marco Castori
- Division of Medical Genetics, Department of Molecular Medicine, San Camillo-Forlanini Hospital, Sapienza University, Circonvallazione Gianicolense, 87, 00152 Rome, Italy
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Castori M, Morlino S, Celletti C, Celli M, Morrone A, Colombi M, Camerota F, Grammatico P. Management of pain and fatigue in the joint hypermobility syndrome (a.k.a. Ehlers-Danlos syndrome, hypermobility type): principles and proposal for a multidisciplinary approach. Am J Med Genet A 2012; 158A:2055-70. [PMID: 22786715 DOI: 10.1002/ajmg.a.35483] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 04/15/2012] [Indexed: 02/03/2023]
Abstract
Joint hypermobility syndrome (JHS), or Ehlers-Danlos syndrome (EDS) hypermobility type (EDS-HT), is a underdiagnosed heritable connective tissue disorder characterized by generalized joint hypermobility and a wide range of visceral, pelvic, neurologic, and cognitive dysfunctions. Deterioration of quality of life is mainly associated with pain and fatigue. Except for the recognized effectiveness of physiotherapy for some musculoskeletal features, there are no standardized guidelines for the assessment and treatment of pain and fatigue. In this work, a practical classification of pain presentations and factors contributing in generating painful sensations in JHS/EDS-HT is proposed. Pain can be topographically classified in articular limb (acute/subacute and chronic), muscular limb (myofascial and fibromyalgia), neuropathic limb, back/neck, abdominal and pelvic pain, and headache. For selected forms of pain, specific predisposing characteristics are outlined. Fatigue appears as the result of multiple factors, including muscle weakness, respiratory insufficiency, unrefreshing sleep, dysautonomia, intestinal malabsorption, reactive depression/anxiety, and excessive use of analgesics. A set of lifestyle recommendations to instruct patients as well as specific investigations aimed at characterizing pain and fatigue are identified. Available treatment options are discussed in the set of a structured multidisciplinary approach based on reliable outcome tools.
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Affiliation(s)
- Marco Castori
- Division of Medical Genetics, Department of Molecular Medicine, Sapienza University, San Camillo-Forlanini Hospital, Rome, Italy.
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