Arthrocentesis as initial treatment for temporomandibular joint arthropathy: A randomized controlled trial

Objective: To determine the effectiveness of arthrocentesis compared to conservative treatment as initial treatment with regard to temporomandibular joint pain and mandibular movement.

Patients and methods: In this randomized controlled trial, 80 patients with arthralgia of the TMJ (classified according to the Research Diagnostic Criteria for Temporomandibular Disorders) were randomly assigned to one of the two treatment groups. One group received arthrocentesis as initial treatment (n = 40), the other group received conventional treatment including soft diet, physical treatment and occlusal splint therapy (n = 40). Follow-up was after 3, 12 and 26 weeks post treatment. Prior to treatment, and at every follow-up assessment, pain intensity was measured (VAS 0-100 mm at rest, and VAS 0-100 mm during movement) and maximum mouth opening (MMO) (mm interincisor distance). Furthermore patients were asked to fill out several surveys concerning the impact of mandibular impairment on their daily life, and psychosocial aspects.

Results: After 26 weeks, the TMJ pain (mm VAS at rest, and mm VAS during movement) had declined comparably in both groups (arthrocentesis n = 36; conservative treatment n = 36) and MMO (mm interincisor distance) had slightly improved. GEE models showed significant differences between arthrocentesis as initial treatment and conservative treatment, indicating that the arthrocentesis group improved more rapidly with regard to TMJ pain (VAS at rest p = 0.008; regression coefficient beta = -8.90 (95% confidence interval -15.50, -2.31), VAS during movement p = 0.003; regression coefficient beta = -10.76 (95% confidence interval -17.75, -3.77)) and MMO (p = 0.045; regression coefficient beta = -2.70 (95% confidence interval -5.35, -0.06)) compared to conservative treatment.

Conclusions: Arthrocentesis as initial treatment reduces pain and functional impairment more rapidly compared to conservative treatment. However, after 26 weeks, both treatment modalities achieved comparable outcomes. (C) 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.