ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title In A Patient Suffering From Chronic Closed Locked TMJ, There Are No Statistical Differences In Postoperative Pain Or Maximal Incisal Opening Values In Comparing Arthroscopic Lysis And Lavage Techniques With Arthroscopic Operative Surgery
Clinical Question In treating a patient suffering from chronic closed locked TMJ, how effective is arthroscopic lysis and lavage in comparison with arthroscopic operative surgery, in alleviating the pain and allowing for improved maximal incisal opening?
Clinical Bottom Line Both lysis and lavage and operative arthroscopy are viable options to treat patients with CCL of the TMJ. According to this study, there is no statistical difference in postoperative pain or mean incisal opening when comparing the effectiveness of both procedures.
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) 18583095Gonzalez-Garcia/2008257 SubjectsRandomized Controlled Trial
Key resultsA group of 23 patients received lysis and lavage treatment for one TMJ and arthroscopy for the other TMJ. 234 patients received only lysis and lavage or operative arthroscopy for either one TMJ or both. There was no statistical difference in preoperative pain scores between the group of TMJ’s treated with lysis and lavage and those treated with operative arthroscopy (53.24 ± 23.04 versus 52.17 ± 23.70 (p = 0.87)). Additionally, there was no difference in the maximal incisal opening (MIO) values (25.15 ± 5.11 versus 24.26 ± 4.66 (p = 0.86)). The following data was acquired (mean values) when comparing isolated lysis and lavage with operative arthroscopy respectively: 32.65/34.10, 31.5/29.50, 28.71/23.25, 19.81/25.43, 22.70/18.84, and 18.52/14.55 at 1, 3, 6, 9, 12 and 24 months post operatively. In relation to MIO (mm), the following paired data (mean values) were obtained comparing isolated lysis and lavage with operative arthroscopy: 29.86/27.40, 31.79/30.42, 34.91/34.55, 34.34/34.06, 34.92/35.43, and 37.40/37.81 at 1, 3, 6, 9, 12 and 24 months post operatively. In conclusion, no statistical differences were observed between the two arthroscopic techniques when considering postoperative pain or MIO.
Evidence Search ("Temporomandibular Joint Dysfunction Syndrome"[Mesh]) AND "Arthroscopy"[Mesh]
Comments on
The Evidence
All patients were treated the same with the results predictable and stable for at least 2 years. There was adequate follow up, compliance, and recall bias seemed unlikely.
Applicability For patients afflicted with CCL of the TMJ either arthroscopic lysis and lavage or operative arthroscopy reduces pain and improves MIO with no difference in effectiveness when comparing the two procedures.
Specialty/Discipline (General Dentistry)
Keywords TMD, TMJ, lysis and lavage, arthroscopy
ID# 2378
Date of submission: 02/27/2013spacer
E-mail vabreo@gmail.com
Author Viren Abreo
Co-author(s)
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
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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