الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
TMDs are collection of medical and dental conditions affecting the joint and muscles of mastication, as well as contiguous tissue components.
One of the most common types of disorders is internal derangement of the disc.
It may present with a numerous of overlapping signs and symptoms including pain in the joint, limitation of mandibular movements (e.g., locking), TMJ sounds and occasionally headaches.
The primary goal in the treatment of TMDs is to alleviate pain and to restore mandibular function (mastication &speech) initially using conservative measures, which will resolve symptoms in over 80% patients.
Surgical intervention is typically employed only after failure of non surgical treatment.
Arthrocentesis and TMJ arthroscopy have been found to be minimally invasive effective treatment for articular TMJ disorders by decreasing pain and increasing mandibular range of motion.
Arthrocentesis is the first-line surgical intervention in TMD/DDwoR patients who do not respond to conservative management.
Although the use of arthrocentesis in management of TMJ internal derangement proved reasonable degree of success ranging from 75 to 100%. Intra-articular injection using different medication was used in combination with arthrocentesis to enhance the clinical outcome and improve long term results.
PRP injection focuses on the induction of functional recovery by means of regenerating weakened tissues, and its anabolic effect on synoviocytes lead to restore HA levels there by enhancing cartilage protection and joint lubrication.
The RDC/TMD is a dual axis diagnostic system for TMDs that 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.
In our study we aimed to investigate the effectiveness of arthrocentesis either alone or with subsequent intrajoint medications as PRP.
This study was conducted on the patients who were affiliated to the TMD clinic. These patients were examined by by 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 that 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.
We included 14 patients in our study with a total of 20 joints (6 bilateral & 8 unilateral). Each of the first and second group was made of 7 patients with a total of 10 joints in each group.
All 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 two groups. The control group received arthrocentesis only. The study group received arthrocentesis followed by intra-articular injection of PRP respectively. The primary efficacy parameters included VAS of pain, maximum painless unassisted mouth opening, lateral excursions and protrusion as measured in millimeters.
In our study we assumed that arthrocentesis procedure followed by PRP injection would decrease pain and improve function by removing catabolites of inflammation by the action of lavage and PRP injection would remove pain inducers and provide a microenvironmental repair of disc, capsule, and retrodiscal pad. Consequently, our hypothesis was that arthrocentesis associated with PRP injection would be more effective in decreasing pain and improving function when compared to arthrocentesis done alone in patients with internal derangement. However, the results of this single blind randomized controlled trial found no evidence for a superior treatment effect on on painful DDwoR by using arthrocentesis and PRP injection compared to using arthrocentesis alone regarding pain intensity and physical functioning 6 months after treatment.
Although all groups showed significant improvements as regard to the four outcome parameters, there was no statistically significant difference when comparing both groups as regard to the four outcome parameters (VAS of pain, maximum painless opening, lateral excursions, and protrusion) at the scheduled follow up intervals (1month and 6 months).