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Title Efficacy Of Conservative Therapy, Arthrocentesis, And Arthroscopic Surgery On Reducing TMJ Pain
Clinical Question In patients with TMJ disc displacement without reduction, how effective are conservative therapies at relieving pain compared to arthrocentesis or arthroscopic surgery?
Clinical Bottom Line Conservative therapy, arthrocentesis, and arthroscopic surgery were all effective in reducing pain in patients with TMJ disc displacement without reduction. However, because of its efficacy, lower cost, and non-invasive nature, conservative therapy techniques should be used as the primary treatment for patients with TMJ disc displacement without reduction. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 17189464Schiffman/2007106Single blind Randomized control trial
Key resultsMedical management, rehabilitation, arthroscopic surgery, and arthroplasty all showed a significant reduction of symptoms (pain) in patients with disc displacement without reduction. There were no between group differences in the efficacy of treatment. Since all treatments had similar outcome, use of medical management and rehabilitation should be used in order to avoid unnecessary surgical procedures.
#2) 20978727Martins-Junior/2010124Case Series
Key resultsPain was the chief complaint for 92.7 percent of the patients. Conservative therapy techniques had a 91.7 percent success rate at reducing TMJ pain.
#3) 21365840Han/201090Randomized Control Trial
Key resultsAfter arthrocentesis, significant pain reduction was noted in patients with TMJ disk displacement without reduction. There was no significant difference in pain reduction between patients who received normal arthrocentesis therapy compared to those who received post therapy intra-articular corticosteroid injections.
Evidence Search TMJ therapeutic strategies, TMD Conservative Therapy, TMJ disorder treatment
Comments on
The Evidence
The groups started each study with similar symptoms, were compliant with therapy, and had adequate follow up. There should not have been any competing interests for the patients. In each study, the patients presented with pain and would have no motivation to report a post-therapy reduction in pain if it was not true.
Applicability Patients that present with pain and a diagnosis of TMJ disc displacement without reduction should first be treated with conservative therapy techniques in order to improve their symptoms and avoid unnecessary surgery.
Specialty/Discipline (General Dentistry)
Keywords TMD, disc displacement, pain, arthrocentesis, conservative therapy
ID# 798
Date of submission: 03/31/2011spacer
E-mail brazilc@uthscsa.edu
Author Cohl Brazil
Co-author(s) e-mail
Faculty mentor/Co-author Edward F. Wright, DDS, MS
Faculty mentor/Co-author e-mail WrightE2@uthscsa.edu
Basic Science Rationale
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Comments and Evidence-Based Updates on the CAT
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by Tim Kozelsky, DDS (San Antonio, TX) on 06/29/2011
The CAT concept is a speedy service for reference of a tough topic like TMJ Disfunction in Dentistry. Three studies listed are consistent with my own efforts/findings researching the topic. Would be interesting to know the effects of occlusal equilibration and success/failure in treatment of TMJ pain patients.

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