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Clinical Evaluation of Arthrocentesis, Combination of Platelet-Rich Plasma and Cyclooxygenase Enzyme-2 Inhibitor in Treatment of Temporo-Mandibular Joint Anterior Displacement
The internal derangement (ID) of the TMJ is an improper functional and positional connection between the articular components of the joint. It has been estimated that 80% of TMD patients have ID, which is typically classified into two classes: disc displacement with reduction and disc displacement without reduction.
The ID of the TMJ was often accompanied by the increased expression of COX-2 in both synovium and synovial fluid. This allows the accumulation of prostaglandins in synovial fluid, accompanied by peripheral Vaso permeability, that may lead to swollen synovium. Patients may become suffering from limited jaw motion and associated pain around the TMJ in this stage.
Arthrocentesis reduces the pain through removing the adherences, eliminates the negative pressure in the joint, washes the inflammatory mediators, distends the joint space, recovering the space of the joint disc and fossa, changes the viscosity of the synovial liquid.
Reducing discomfort, restoring normal mandibular motions, and enhancing patients' quality of life are all necessary components of effective treatment for arthrogenous TMDs.
Treatment of TMJ-ID with arthrocentesis, either alone or in conjunction with intraarticular injections, is quite successful. It enhances jaw motions, promotes mouth opening, and lessens discomfort. For intra-articular injections, hyaluronic acid, platelet-rich plasma, corticosteroids and non-steroidal anti-inflammatory medications (NSAIDS) are used.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| patients with anterior disc displacement with reduction | Active Comparator | 10 cases with anterior disc displacement with reduction were injected after arthrocentesis by combination of PRP and meloxicam (Mobitil 15mg). |
|
| patients with anterior disc displacement without reduction | Active Comparator | 10 cases with anterior disc displacement without reduction were injected after arthrocentesis by combination of PRP and meloxicam (Mobitil 15mg). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Inject Combination of Platelet-Rich Plasma and Cyclooxygenase Enzyme-2 Inhibitor after arthrocentesis | Combination Product | Inject Combination of Platelet-Rich Plasma and Cyclooxygenase Enzyme-2 Inhibitor meloxicam (Mobitil 15mg) after arthrocentesis |
| Measure | Description | Time Frame |
|---|---|---|
| Mandibular Movements: measured in millimeters using a ruler or digital caliper. | Mandibular Movements: Including maximum mouth opening (MMO), right and left lateral movements, and protrusive movement, measured in millimeters using a ruler or digital caliper. | immediately, one, three and six months postoperatively |
| pain assessed by visual analogue scale | Pain: Assessed using a Visual Analogue Scale ranging from 0 to 10 over the TMJ area [ 0 is given when there is no pain, 1-3 mild pain, 4-6 moderate pain, 7-9 severe pain, 10 the worst pain]. | preoperatively, one, three and six months postoperatively |
| Joint Clicking: Evaluated using a stethoscope and recorded as either present or absent. | Joint Clicking: Evaluated using a stethoscope and recorded as either present or absent. | immediately, one, three, six months postoperatively |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| hossni elshahat hossni, postgraduate student | Suez Canal University | Principal Investigator |
| Suez Canal University | Suez Canal University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| faculty of dentistry Suez Canal university | Ismailia | Egypt |
it is secret to patient
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This study was conducted on adults between the age of 18-40 years old with temporomandibular joint internal derangement (20 cases) requiring arthrocentesis, the patients were divided to 10 cases with anterior disc displacement with reduction and 10 cases with anterior disc displacement without reduction, and the two groups will be injected after arthrocentesis by combination of PRP and Cyclooxygenase Enzyme-2 Inhibitor.
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