The Basic Conservative Treatment of TMJ Anterior Disc Displacement Without Reduction - Review

Abstract

Temporomandibular joint derangement is a common disorder of the stomatognathic system. One type of these disorders is disc displacement without reduction with limited mouth opening, characterized by pain in affected TMJ and a decreased range of mouth opening. The natural course of closed lock is self-limiting. However, if there is no significant improvement after 12 weeks of following natural course of disc displacement without reduction, this is an indication that the therapy should be implemented. The article presents a review of the most commonly applied methods of basic conservative closed lock treatment. The most commonly applied methods of closed lock conservative management are: education and counseling, mandibular manipulation, splint therapy, exercise therapy and pharmacotherapy. The first choice method of treatment should be minimally invasive. The surgical management should be considered after unsuccessful conservative therapy. All presented methods of closed lock treatment seem to be effective in decreasing pain and reestablishing physiological range of motion (Adv Clin Exp Med 2015, 24, 4, 731-735).Key words: TMD, closed lock, conservative treatment. Internal derangement in temporomandibular joint (TMJ) is a common dysfunction of the stomatognathic system. According to classification of Research Diagnostic Criteria for TMD there are 3 main types of internal TMJ derangement: disc displacement with reduction and disc displacement without reduction with or without limited mouth opening. The prevalence of disc displacement is about 41% in TMD patients. The most common type is disc displacement with reduction characterized by clicking in the temporomandibular joint. In about 5% of cases the disc displacement without reduction with limited mouth opening is observed. The main symptoms of closed lock are pain in affected joint and decreased range of mouth opening (≤ 35 mm), which deteriorate the function of the stomatognathic system and force the patient to look for professional help [1][2][3]. REVIEWSThe symptoms of closed lock are usually related to disc displacement without reduction. The etiology of disc displacement is not clear, but there are a few possible reasons playing a key role in changes of the TMJ structure, such as parafunctions (e.g. bruxism), anatomical factors, trauma or general hypermobility of the joints [4][5][6][7]. In the majority of cases the disc is displaced anteriorly, blocking mechanically translating movement of the condyle, resulting in restricted mouth opening. In addition the bilaminar zone becomes overloaded by direct contact with the condyle, which is the main reason of pain in the TMJ [8].It has been stated that the natural course of disc displacement without reduction is self-limiting. Significant improvement of clinical symptoms of closed lock is observed in 75% of patients in a 2.5 year follow-up. The MRI scans reveal permanently displaced and deformed disc in untreated closed lock patients. The reduction of restriction of mouth opening and pain is most probably...

Conservative Treatment Approaches of Temporomandibular Joint Disc Displacement Without Reduction

“…4 Ayrıca kilitlenmenin ilk periyodunda hastalara termoterapi (sıcak veya soğuk uygulamaları), yumuşak diyet ve hafif ağız açma egzersizleri tavsiye edilmelidir. 6 …”

“…TMD bulunan hastalarda disk deplasmanının görülme sıklığı %41'dir. 6 Klik ile karakterize redüksiyonlu disk deplasmanı en çok karşılaşılan formu olmakla birlikte, sonrasında bu durumu redüksiyonsuz disk deplasmanı takip eder. 6,7 Disk deplasmanı etyolojisi net değil-dir, fakat parafonksiyonel alışkanlıklar (bruksizm), anatomik faktörler, travma gibi etkenler TME yapısında değişikliklere neden olabilmektedir.…”

“…6 Klik ile karakterize redüksiyonlu disk deplasmanı en çok karşılaşılan formu olmakla birlikte, sonrasında bu durumu redüksiyonsuz disk deplasmanı takip eder. 6,7 Disk deplasmanı etyolojisi net değil-dir, fakat parafonksiyonel alışkanlıklar (bruksizm), anatomik faktörler, travma gibi etkenler TME yapısında değişikliklere neden olabilmektedir. 8,9 Redüksiyonsuz disk deplasmanında, retrodiskal laminanın elastikiyetini kaybetmesi sonucunda artiküler disk daima kondilin önünde yer alır.…”

Assessment of Occlusal Appliance in Repositioning of the Temporomandibular Joint Anterior Disc Displacement With Reduction: A 3 to 36 Months Follow-Up

“…В зависимости от взаимно-го положения диска и мыщелка при открывании рта различают передний вывих диска с репо-зицией и без репозиции [1]. Обычно пациенты с передним вывихом диска предъявляют жало-бы, которые серьезно мешают им в повседневной жизни, -суставной шум («щелканье»), боли в су-ставе, ограничение открывания рта, затруднения жевания, нарушение функции нижней челюсти и др.Несмотря на то что для лечения переднего вывиха диска предложено множество методов [2][3][4], например, функциональные шины, лекар-ственные препараты, физиотерапия, артроцентез и репозиция диска, мнения об оптимальном алго-ритме ведения переднего вывиха диска остаются Альманах клинической медицины. 2017 Сентябрь-октябрь; 45 (6): 478-485. doi: 10.18786/2072-0505-2017-45-6-478-485 478 Оригинальные статьи противоречивыми.…”

“…Несмотря на то что для лечения переднего вывиха диска предложено множество методов [2][3][4], например, функциональные шины, лекар-ственные препараты, физиотерапия, артроцентез и репозиция диска, мнения об оптимальном алго-ритме ведения переднего вывиха диска остаются Альманах клинической медицины. 2017 Сентябрь-октябрь; 45 (6): 478-485. doi: 10.18786/2072-0505-2017-45-6-478-485 478 Оригинальные статьи противоречивыми.…”