Advances in Clinical and Experimental Medicine
2015, vol. 24, nr 4, July-August, p. 731–735
Publication type: review article
The Basic Conservative Treatment of Temporomandibular Joint Anterior Disc Displacement Without Reduction – Review
1 Department of Prosthetic Dentistry, Wroclaw Medical University, Poland
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.
TMD, closed lock, conservative treatment.
- Dworkin SF, LeResche L: Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992, 6, 301–355.
- Manfredini D, Guarda-Nardini L, Wincour E, Piccotti F, Ahlberg J, Lobbezoo F: Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011, 112, 453–462.
- Peroz I, Tai S: Masticatory performance in patients with anterior disc displacement without reduction in comparison with symptoms-free volunteers. Eur J Oral Sci 2002, 110, 341–344.
- Katzberg RW, Westesson PL, Tallents RH, Drake CM: Anatomic disoredrs of the temporomandibular joint disc in asymptomatic subjects. J Oral Maxillofac Surg 1996, 54, 147–153.
- Wongwatana S, Kronman JH, Clark RE, Kabani S, Mehta N: Anatomic basis for disk displacement in temporomandibular joint (TMJ) dysfunction. Am J Orthod Dentofacial Orthop 1994, 105, 257–264.
- Kavuncu V, Sahin S, Kamanli A, Karan A, Aksoy C: The role of systemic hypermobility and condylar hypermobility in temporomandibular joint dysfunction syndrome. Rheumatol Int 2006, 26, 257–260.
- Garcia R Jr, Arrington JA: The relationship between cervical whiplash and temporomandibular joint injuries: an MRI study. Cranio 1996, 14, 233–239.
- Pérez del Palomar A, Doblaré M: An accurate simulation model of anteriorly displaced TMJ discs with and without reduction. Med Eng Phys 2007, 29, 216–226.
- Kurita K, Westesson PL, Yuasa H, Toyama M, Machida J, Ogi N: Natural course of untreated symptomatic temporomandibular joint disc displacement without reduction. J Dent Res 1998, 77, 361–365.
- Imirzalioglu P, Biler N, Agildere AM: Clinical and radiological follow-up results of patients with untreated TMJ closed lock. J Oral Rehabil 2005, 32, 326–331.
- Cai XY, Jin JM, Yang C: Changes in disc position, disc length, and condylar height in the temporomandibular joint with anterior disc displacement: a longitudinal retrospective magnetic resonance imaging study. J Oral Maxillofac Surg 2011, 69, 340–346.
- Dimitroulis G: The prevalence of osteoarthrosis in cases of advanced internal derangement of the temporomandibular joint: a clinical, surgical and histological study. Int J Oral Maxillofac Surg 2005, 34, 345–349.
- Yura S: Natural course of acute closed lock of the temporomandibular joint. Br J Oral Maxillofac Surg 2012, 50, 646–649.
- Schiffman EL, Velly AM, Look JO, Hodges JS, Swift JQ, Decker KL, Anderson QN, Templeton RB, Lenton PA, Kang W, Fricton JR: Effects of four treatment strategies for temporomandibular joint closed lock. Int J Oral Maxillofac Surg 2014, 43, 217–226.
- Schiffman EL, Look JO, Hodges JS, Swift JQ, Decker KL, Hathaway KM, Templeton RB, Fricton JR: Randomized effectiveness study of four therapeutic strategies for TMJ closed lock. J Dent Res 2007, 86, 58–63.
- Minakuchi H, Kuboki T, Matsuka Y, Maekawa K, Yatani H, Yamashita A: Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction. J Dent Res 2001, 80, 924–928.
- Craane B, Dijkstra PU, Stappaerts K, De Laat A: Randomized controlled trial on physical therapy for TMJ closed lock. J Dent Res 2012, 91, 364–369.
- Jagger RG: Mandibular manipulation of anterior disc displacement without reduction. J Oral Rehabil 1991, 18, 497–500.
- Kurita H, Kurashina K, Ohtsuka A: Efficacy of a mandibular manipulation technique in reducing the permanently displaced temporomandibular joint disc. J Oral Maxillofac Surg 1999, 57, 784–787.
- Foster ME, Gray RJ, Davies SJ, Macfarlane TV: Therapeutic manipulation of the temporomandibular joint. Br J Oral Maxillofac Surg 2000, 38, 641–644.
- Chiba M, Echigo S: Longitudinal MRI follow-up of temporomandibular joint internal derangement with closed lock after successful disk reduction with mandibular manipulation. Dentomaxillofac Radiol 2005, 34, 106–111.
- Alves BM, Macedo CR, Januzzi E, Grossmann E, Atallah AN, Peccin S: Mandibular manipulation for the treatment of temporomandibular disorder. J Craniofac Surg 2013, 24, 488–493.
- Farrar WB: Characteristics of the condylar path in internal derangements of the TMJ. J Prosthet Dent 1978, 39, 319–323.
- Pihut M, Wiśniewska G, Majewski S: Active repositioning of temporomandibular disc displacement without reduction. J Stoma, 2013, 66, 650–662.
- Haketa T, Kino K, Sugisaki M, Takaoka M, Ohta T: Randomized clinical trial of treatment for TMJ disc displacement. J Dent Res 2010, 89, 1259–1263.
- Shoji YN: Nonsurgical treatment of anterior disk displacement of the temporomandibular joint: a case report on the relationship between condylar rotation and translation. Cranio 1995, 13, 270–273.
- Schmitter M, Zahran M, Duc JM, Henschel V, Rammelsberg P: Conservative therapy in patients with anterior disc displacement without reduction using 2 common splints: a randomized clinical trial. J Oral Maxillofac Surg 2005, 63, 1295–1303.
- Stiesch-Scholz M, Kempert J, Wolter S, Tschernitschek H, Rossbach A: Comparative study on splint therapy of anterior disc displacement without reduction. J Oral Rehabil 2005, 32, 474–479.
- Ohnuki T, Fukuda M, Nakata A, Nagai H, Takahashi T, Sasano T, Miyamoto Y: Evaluation of the position, mobility, and morphology of the disc by MRI before and after four different treatments for temporomandibular joint disorders. Dentomaxillofac Radiol 2006, 35, 103–109.
- Stiesch-Scholz M, Tschernitschek H, Rossbach A: Early begin of splint therapy improves treatment outcome in patients with temporomandibular joint disk displacement without reduction. Clin Oral Investig 2002, 6, 119–123.
- Lee HS, Baek HS, Song DS., Kim HC, Kim HG, Kim BJ, Kim MS, Shin SH, Jung SH, Kim CH: Effect of simultaneous therapy of arthrocentesis and occlusal splints on temporomandibular disorders: anterior disc displacement without reduction. J Korean Assoc Oral Maxillofac Surg 2013, 39, 14–20.
- Kai S, Kai H, Tabata O, Shiratsuchi Y, Ohishi M: Long-term outcomes of nonsurgical treatment in nonreducing anteriorly displaced disk of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998, 85, 258–267.
- Lundh H, Westesson PL, Eriksson L, Brooks SL: Temporomandibular joint disk displacement without reduction. Oral Surg Oral Med Oral Pathol 1992, 73, 655–658.
- Eberhard D, Bantleon HP, Steger W: The efficacy of anterior repositioning splint therapy studied by magnetic resonance imaging. Eur J Orthod 2002, 24, 343–352.
- Simmons HC 3rd, Gibbs SJ: Recapture of temporomandibular joint disks using anterior repositioning appliances: an MRI study. Cranio 1995, 13, 227–237.
- Komatsu K, Yamaguchi T, Ohata N: A new training device for rehabilitation of lateral mandibular movements: a pilot study. Cranio 2002, 20, 198–203.
- Nicolakis P, Erdogmus B, Kopf A, Ebenbichler G, Kollmitzer J, Piehslinger E, Fialka-Moser V: Effectiveness of exercise therapy in patients with internal derangement of the temporomandibular joint. J Oral Rehabil 2001, 28, 1158–1164.
- Yoshida H, Kashiwagi K, Sakata T, Tanaka M, Kawazoe T, Morita S: Prognostic factor of mandibular condylar movement exercise for patients with internal derangement of the temporomandibular joint on initial presentation: Preliminary report. J Craniomanillofac Surg 2013, 41, 356–358.
- Yoshida H, Sakata T, Hayashi T, Shirao K, Oshiro N, Morita S: Evaluation of mandibular condylar movement exercise for patients with internal derangement of the temporomandibular joint on initial presentation. Br J Oral Maxillofac Surg 2011, 49, 310–313.
- Muhtaroğullari M, Ertan AA, Demiralp B, Canay S: Correlation between clinical and magnetic resonance imaging findings in the treatment of anterior disc displacement. Int J Prosthodont 2013, 26, 138–142.