The aim of the study is to evaluate the applicability, accuracy, benefits and the efficacy of 3-dimensional, printed, patient-specific guides to direct TMJ access for arthrocentesis when performed in contrast with conventional arthrocentesis of TMJ.

Inclusion Criteria:

• Patients who complain from signs and symptoms of internal derangements and were diagnosed by the RDC/TMD as having disc displacement with/ without reduction with / without limitation associated with arthralgia or as having disc displacement with reduction associated with arthralgia in a presence or absence of joint sounds.
• Patients who did not responded to conservative treatment for a minimum of 3 months.
• Obtaining written informed consents signed by the patients.

Exclusion Criteria:

• Patients suffering from any muscular disorders as myofascial pain or myofascial pain with limitations
• If the disc was not visible in the MRI examination.
• Patients who previously received intra-articular injection of any medication or exposed to any other TMJ invasive procedure.
• Patients who suffer from any connective tissue diseases as rheumatoid arthritis or neurologic disorders.
• Patients with history of major jaw trauma, bisphosphonate-derived drug use, pregnancy, alcohol or drug dependence.
• Patients with gross mechanical restrictions or history of adhesion (fibrous or bony).
• Patients with psychiatric disease or substance abuse or have an allergy to the substance used in the study.