الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Summary
The continued debate over the therapeutic outcome of different treatment modalities in ID, either invasive or non invasive has considerably affected the TMJ research. This led to a major shift in the treatment modalities during the last two decades, from aggressive open surgical procedures to the less invasive arthrocentesis and arthroscopy.
Arthrocentesis or blind lysis and lavage of the TMJ were first reported by Nitzan in 1991 as a modification of arthroscopy which is less invasive but with nearly the same therapeutic outcomes. Alkan stated that the use of arthrocentesis in the management of ID proved reasonable degree of success ranging from 75% to 100%. Intra articular injection using different medication is used in combination with arthrocentesis to enhace the clinical outcome and improves long term results. Corticosteroids which are a potent anti-inflammatory drug and Sodium Hyaluronate which is highly viscous lubricant material are the most commonly used ones.
The RDC/TMD is one of the heavily cited dental publications in the dental literature. It is a dual axis diagnostic system for TMDs supported by a well-designed history and clinical examination protocol which provide specific reliable, reproducible and valid criteria with high sensitivity and specificity to define the most common types of TMDs. selecting a specific subtypes of ID diagnosed by RDC/TMD and confirmed by MRI should yield a more homogenous patient subgroups which is essential for a valid comparative study.
We aimed to investigate the effectiveness of arthrocentesis either alone or with subsequent intrajoint medications as HA or corticosteroids.
This study was conducted on the patients who were referred to the TMD clinic in oral and maxillofacial department, Faculty of Dentistry, Ain Shams University. These patients were examined by only one examiner trained on using the RDC/TMD as the basic research diagnostic system. In concurrence with the RDC/TMD, a standardized clinical head and neck examination was established to select subjects of the study. This clinical examination included site of pain, pattern of jaw movement, measurements of the range of mouth opening, lateral excursions, protrusion, joint noises and palpation of the muscles involved in mastication.
To confirm the diagnosis reached by the RDC/TMD supplemental MRIs were ordered for all the patients. After being diagnosed, all the patients were exposed to a period of non surgical treatment and those who were not responsive to these non surgical therapies comprised the sample on which our clinical trial was conducted. Patients were then assigned into three groups. The first group which is the control group received arthrocentesis only. The second and third groups received arthrocentesis followed by intra-articular injection of HA and corticosteroids respectively. The primary efficacy parameters included VAS of pain, maximum painless unassisted mouth opening, lateral excursions and protrusion as measured in millimeters.
We included 18 patients in our study with a total of 34 joints (16 bilateral & 2 unilateral). The first group is made of 6 patients with a total of 10 joints, while the second and third groups are made of 6 patients and a total of 12 joints for each group.
Although all groups showed significant improvements as regard to the four outcome parameters , there was no statistically significant difference when comparing the three groups as regard to the four outcome parameters (VAS of pain, maximum painless opening , lateral excursions , and protrusion ) at the scheduled follow up intervals ( 1 week , 1month , 3 months , and 6 months ) .