Arthrocentesis with or without additional drugs in the treatment of inflammatory-degenerative temporomandibular joint disease: A clinical study

Objectives. The aim of this study was to define the most effective protocol for temporomandibular joint arthrocentesis through comparative efficacy analysis of three different treatment protocols involving joint lavage with or without the use of drugs to manage symptoms of intracapsular disorders. Materials and methods. The study sample consisted of 31 consecutively enrolled patients with unilateral intracapsular pathology and pain lasting more than 6 months. Criteria for inclusion in the study were the presence of functional limitation and pain that were refractory to conservative treatments and a diagnosis of osteoarthritis based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD, Axis I, Group IIIb). The study design provided a single arthrocentesis procedure associated with single-needle joint lavage using normal saline, low molecular weight hyaluronic acid, or corticosteroids. Results. Marked improvements were reported for all variables, regardless of the drug injected. Hyaluronic acid produced slightly better outcomes, but the differences with respect to steroids were not statistically significant, except the one regarding improved masticatory efficiency (p = 0.043). Conclusions. Single-needle viscosupplementation with hyaluronic acid was only slightly more effective that joint lavage with corticosteroids or with normal saline alone. Further investigation is needed to obtain deeper insight into the clinical significance of these findings. © 2011 Elsevier Srl.