Condylar repair and regeneration in adolescents/young adults with early‐stage degenerative temporomandibular joint disease: A randomised controlled study

Abstract

Background Anterior repositioning splint (ARS) can facilitate regenerative condylar remodelling. Objective To determine the effect of ARS on osseous condylar changes in adolescents/young adults with early‐stage degenerative joint disease (DJD). Methods Sixty‐nine patients with early‐stage temporomandibular joint (TMJ) DJD based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and cone beam computed tomography (CBCT) imaging were recruited and randomly allocated to two treatment groups: (a) conservative therapy with ARS and (b) conservative therapy without ARS. Subjects with acute TMJ closed‐lock had their displaced discs physically reduced by mandibular manipulation prior to ARS therapy. Clinical and CBCT data of 59 patients (86.4% females, mean age 17.95 ± 4.53 years, 67 joints) were attained pre‐ and at 6 or 12 months post‐treatment. Osseous changes after treatment were categorised into (a) progressed, (b) unchanged, (c) repaired (remodelled without new bone formation) and (d) regenerated (remodelled with new bone formation). Statistical analysis including chi‐square test, independent samples t test or Mann‐Whitney U test was conducted. Results About 85.5% of patients (59/69) completed the study, with 28 subjects (32 joints) in the splint group and 31 (35 joints) in the control group. The occurrence of condylar repair and regeneration was significantly higher with ARS (78.1%/[25/32] of joints) when compared to control group (48.6%/[17/35]) (P < 0.05). Moreover, condylar regeneration was exclusively observed in 50%/(16/32) of joints with ARS. For the 14 joints in splint group that received physical TMJ closed‐lock reduction, 85.7%/(12/14) exhibited condylar regeneration. The splint group (3.1%/[1/32]) also had significantly lower incidence of progressive TMJ degeneration than the control (37.1%/[13/35]) (P < 0.001). Conclusion Condylar repair and regeneration in early‐stage TMJ DJD are possible, and ideal spatial disc‐condyle relationship appears important. The possibility of restoring TMJ form/structure by ARS therapy presents an attractive area of new basic science and clinical research (Bone defect repair in early osteoarthrosis of temporomandibular joint by joint distraction therapy: A randomized controlled trial/ChiCTR‐TRC‐14005172).

Long-term Changes of Temporomandibular Joint Osteoarthritis on Computed Tomography

“…Occlusal splints are known to relieve mechanical overloading and guard the condyle from recurrent hypoxia 57 . Favorable treatment responses have been verified in TMJ OA 10,21,51,[58][59][60] . By combining the 2 treatment modalities it could be possible to physically reduce excessive loading on the condyle and chemically remove inflammatory mediators leading to efficient improvement of bony changes occurring in the TMJ condyle.…”

“…Due to the relatively longer follow-up period, resolution of the destructive changes in the TMJ condyle could be observed in many cases (42% of total evaluated joints). Lei et al reported a 62.7% (42/67) regeneration rate of the TMJ condyle in young adults with early stage OA; 78.1% of the anterior repositioning splint treatment group (25/32) and 48.6% of the control group (17/35) 21 . Such results show that TMJ condyles with erosive surfaces can gradually recover and regain intact cortical lining over a long period of time which generally appears as sclerosis and flattening of the condyle morphology on radiographic imaging.…”

Artificial Intelligence in Detecting Temporomandibular Joint Osteoarthritis on Orthopantomogram

“…Because bene t of high sensitivity may exceed loss of low speci city in diagnosis of TMJOA where early detection is important, it would be clinically more bene cial for a screening tool for TMJOA to read indeterminate OA as OA. In a randomized controlled study, osseous condylar changes in adolescents/young adults with early-stage TMJOA showed repair and even regeneration after conservative and splint therapy 26 , which may emphasize early detection and management.…”

Application of Auriculotemporal Nerve Block and Dextrose Prolotherapy in Exercise Therapy of TMJ Closed Lock in Adolescents and Young Adults

“…Adolescents and young adults may be particularly vulnerable to consequences of degenerative joint disease since normal condylar formation could be hindered. [26] Early diagnosis and intervention is thus prudent to improve the possibility of condylar repair and regeneration to restore TMJ form/structure in adolescents/young adults. [27] TMJ closed lock start from "mechanical" joint disorder, in which a displaced disc obstructs the forward condylar translation resulting in restricted mouth opening.…”