Efficiency of Temporomandibular Joint Arthrocentesis With Ozonated Water in Management of Anterior Disc Displacement Without Reduction: A Randomized Clinical Trial

Abstract

Objective: The aim of the study was to evaluate the efficiency of temporomandibular joint arthrocentesis with ozonated water versus ringer lactate in treatment of anterior disc displacement without reduction (closed lock) and to evaluate the effect of both procedures on the level of interleukin-6 (IL-6) in the joint space. Patients and methods: Forty patients with bilateral anterior disc displacement without reduction were included in the study. Patients were randomly allocated into 2 groups. Group I performed arthrocentesis using ozonated water while group II underwent the same procedure using sodium ringer lactate. Clinical evaluation of the patients was done preoperative, immediately ostoperative, at 1 week and 1, 3 and 6 months postoperatively. The pain was assessed using visual analog scales. Maximal mouth opening (MMO) was recorded at each follow-up visit. Synovial fluid sample was collected to detect the level of IL-6, preoperative, immediately postoperative and at six months postoperative Results: Both groups showed improvement in clinical parameters. Concerning maximal mouth opening, there was no statistically significant difference between the two groups pre-operatively, after 1 week as well as after 1 month. After 3 months and 6 months, Group I showed statistically significant higher mean MMO than Group II. the pain score assessment showed no statistical significant difference between the two groups pre-operatively. Through all other periods, Group I showed statistically significantly lower mean VAS scores than Group II. The interleukin-6 levels showed no statistically significant difference between the two groups pre-operatively. Immediately post-operative as well as after 6 months, Group I showed statistically significantly lower mean IL-6 level than Group II. Conclusion: Arthrocentesis using ozonated water proved to have superior results in treatment of TMJ anterior disc displacement without reduction. Interleukin-6 level in the TMJ synovial fluid has direct correlation with the dysfunction symptoms.

The Efficacy of Ozonized Water Versus Ringer Lactate Arthrocentesis for the Treatment of Temporomandibular Joint Internal Derangement

“…At T4 group A, illustrated a slightly higher increase in mouth opening than Group B. The findings in the present study came in accordance with the study done by Shabaan and Sabry13 in 2017, as they registered an improvement in both groups. The mean of mouth opening jumped from 18 mm preoperatively to 40 mm after 12 weeks of treatment by ozonized water and from 17 mm to 37 mm for patients treated with ringer lactate and the comparison between percentage increases in mouth opening revealed that there was no statistically significant difference between the 2 groups through all periods.…”

Ozone for the treatment of temporomandibular joint disorders

“…Finally, Yamaner et al 17 reported no significant differences between treatments. On the other hand, concerning arthrocentesis with ozone, another three studies 20 21 22 reported an improvement in MMO in TMD treated with OT.…”

“…Then, 10 full-text articles were retrieved, 2 of which were excluded with reasons. Eight articles 16 17 18 19 20 21 22 23 reported the use of OT for the treatment of TMD and the data extracted from these studies are listed in Additional Table 1 . No gray literature matched the eligibility criteria.…”

“…The patients received 2 mL of ozonized water with 70 μg/mL. 20 21 22 Finally, Daif 23 injected 2 mL of ozone gas concentration at 10 μg/mL into the articular fossa of the TMJ. The injections were repeated twice per week for 3 weeks.…”

“…Both studies reported improvement of pain with OT after 1 year. Also, Shabaan and Sabry 21 assessed VAS in TDM patients with anterior disc displacement without reduction. The control group receives arthrocentesis with 2 mL of Ringer lactate.…”