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Diagnostics (Basel, Switzerland) Oct 2022The aim of this study was to investigate the most effective lavage volume of arthrocentesis in the management of temporomandibular disorders. A comprehensive electronic... (Review)
Review
The aim of this study was to investigate the most effective lavage volume of arthrocentesis in the management of temporomandibular disorders. A comprehensive electronic search, based on the PRISMA guidelines, was performed, which included a computer search with specific keywords, a reference list search and a manual search. The inclusion criteria were the following: a randomized controlled trial, at least 20 subjects who underwent arthrocentesis, mention of the irrigation materials used for the arthrocentesis, mention of the irrigation volumes used for the arthrocentesis, MMO and pain measured as VAS or NRS, were reported as outcome figures, mention of a specific diagnosis or signs and symptoms, and inclusion of the data on the MMO or VAS/NRS at 6-month follow-up. Sixteen publications were enrolled in the meta-analysis, comparing arthrocentesis with a lavage volume <150 mL and arthrocentesis with a lavage volume ≥150 mL, in the efficacy of the improvement in the mouth opening and pain reduction. The results revealed the group with a lavage volume <150 mL had a greater improvement in the mouth opening and pain reduction. However, results are to be interpreted with caution, due to the paucity of the randomized controlled literature and other confounding factors. Further high-quality studies are required to provide a better conclusion to the treatment outcomes of the different lavage volumes.
PubMed: 36359466
DOI: 10.3390/diagnostics12112622 -
Rheumatology International Feb 2023Steroid injections in joints are commonly administered for the management of inflammatory or degenerative conditions. There is substantial controversy as to whether to... (Meta-Analysis)
Meta-Analysis Review
Steroid injections in joints are commonly administered for the management of inflammatory or degenerative conditions. There is substantial controversy as to whether to continue warfarin when undertaking joint injection or aspiration. To assess the rate of bleeding complications in patients on warfarin undergoing joint injection/aspiration. Systematic review and meta-analysis. A literature search of 3 online databases was conducted by 2 reviewers using the Cochrane methodology for systematic reviews. Eligibility criteria were any study that reported bleeding complication rates in adult patients on warfarin undergoing a joint injection/aspiration whilst taking warfarin anticoagulation. Studies reporting on less than 5 patients were excluded. Meta-analysis was conducted using a random effects model. The search of databases resulted in a total of 1547 articles. After screening, 8 articles were deemed suitable for inclusion in the analysis, involving 871 injection/aspiration procedures. There were only 5 reported cases of bleeding. On meta-analysis the estimated bleeding complication rate was 1.5% (95% CI 0.5-4.5%). This meta-analysis shows that it is safe to perform joint injection and aspiration in patients on warfarin without routine prior testing of INR. Level of evidence: Level 4.
Topics: Humans; Warfarin; Anticoagulants; Hemorrhage; Injections, Intra-Articular
PubMed: 36322144
DOI: 10.1007/s00296-022-05232-y -
Journal of Stomatology, Oral and... Feb 2023Arthrocentesis is being widely used as an invasive treatment modality for managing temporomandibular joint (TMJ) disorders. The current review aimed to assess if... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Arthrocentesis is being widely used as an invasive treatment modality for managing temporomandibular joint (TMJ) disorders. The current review aimed to assess if arthrocentesis as the first line of therapy leads to better outcomes as compared to conservative management of TMJ disorders.
METHODS
PubMed, Scopus, Embase, Web of Science, and CENTRAL were searched up to 20th June 2022 for randomized controlled trials comparing TMJ arthrocentesis vs conservative management as first-line therapy for TMJ disorders.
RESULTS
Eight trials were included. Our analysis indicated significantly reduced pain scores in patients undergoing TMJ arthrocentesis as compared to conservative therapy at 1 month (MD: -0.82 95% CI: -1.43, -0.20 I=56% p = 0.01) and 6 months (MD: -1.38 95% CI: -2.45, -0.32 I=86% p = 0.01), but not at 3 months of follow-up (MD: -0.66 95% CI: -1.68, 0.37 I=82% p = 0.21). The results were not stable on sensitivity analysis. There was no difference in MMO between the TMJ arthrocentesis and conservative therapy groups at 1 month (MD: -0.06 95% CI: -3.67, 3.54 I=88% p = 0.97), 3 months (MD: -0.35 95% CI: -3.95, 3.25 I=89% p = 0.85) and 6 months (MD: 0.00 95% CI: -3.34, 3.34 I=86% p = 0.10).
CONCLUSION
Analysis of a small number of trials with high inter-study heterogeneity indicates that first line TMJ arthrocentesis may result in a significant but small improvement in pain scores but without any additional improvement in MMO as compared to conservative therapies. Current evidence does not provide strong support for the use of TMJ arthrocentesis as the first line of therapy for TMDs.
Topics: Humans; Arthrocentesis; Conservative Treatment; Treatment Outcome; Temporomandibular Joint Disorders; Pain
PubMed: 36084892
DOI: 10.1016/j.jormas.2022.09.004 -
Oral and Maxillofacial Surgery Dec 2023To assess the impact of different types of anesthesia on the outcomes of arthrocentesis of the TMJ. (Review)
Review
PURPOSE
To assess the impact of different types of anesthesia on the outcomes of arthrocentesis of the TMJ.
METHODS
Electronic databases were searched to identify peer-reviewed studies, followed by reference list search and further hand-searching. Randomized clinical trials and controlled studies were considered for inclusion when comparing at least two anesthetic approaches. The risk of bias was assessed using the Cochrane risk of bias tool.
RESULTS
Of a total of 506 potentially eligible studies, only a randomized controlled clinical trial and an observational study were included. The former compared some outcomes of arthrocentesis under local and general anesthesia and the latter under sedation and general anesthesia. Moreover, both studies were judged as "high risk of bias."
CONCLUSIONS
In general, there appears to be a slight trend toward better outcomes of arthrocentesis for internal TMJ derangements (Wilkes grades I to III) when performed under general anesthesia; however, given that the available evidence is remarkably limited and a high risk of bias was detected within the included studies, a definitive statement cannot be made.
Topics: Humans; Arthrocentesis; Temporomandibular Joint Disorders; Anesthetics; Treatment Outcome; Temporomandibular Joint; Range of Motion, Articular; Randomized Controlled Trials as Topic; Observational Studies as Topic
PubMed: 35835924
DOI: 10.1007/s10006-022-01100-y -
The British Journal of Oral &... Oct 2022The aim of this systematic review and network meta-analysis was to comprehensively evaluate and compare the effectiveness of diverse therapies for disc displacement (DD)... (Meta-Analysis)
Meta-Analysis Review
The aim of this systematic review and network meta-analysis was to comprehensively evaluate and compare the effectiveness of diverse therapies for disc displacement (DD) of the temporomandibular joint (TMJ). An electronic search of PubMed, Embase, the Cochrane Library, the China Academic Journals full-text database (CNKI), and Wanfang databases was performed to identify relevant studies available up to 31 July 2021. Study selection, data extraction, and quality assessment were performed for all included studies, while the outcomes of interest contained post-therapeutic maximum mouth opening and pain intensity. Interventions consisted of arthrocentesis, injections with diverse drugs, occlusal splints, or a combination of two to three of the above. Controls were regarded as oral analgesics, self-exercise, massage, or health instruction. Twenty-six studies appeared to meet the inclusion criteria and were subjected to further examination. Our data of the entire network showed that the most invasive therapies performed better than non-invasive therapies, while arthrocentesis + platelet-rich plasma injection and platelet-rich plasma injection in Grade I performed well in both mouth opening improvement and pain alleviation. Platelet-rich plasma injection is probably the best treatment overall for patients with DD owing to its anti-inflammatory, analgesic, and lubricating effects.
Topics: Analgesics; Anti-Inflammatory Agents; Arthrocentesis; Humans; Network Meta-Analysis; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 35803786
DOI: 10.1016/j.bjoms.2022.04.004 -
Journal of Clinical Medicine Apr 2022Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular... (Review)
Review
INTRODUCTION
Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular abduction. The purpose of this review is to identify other injectable substances and to evaluate them in the above-mentioned domains.
MATERIAL AND METHODS
The review included articles describing clinical trials of patients treated with intra-articular injections with or without arthrocentesis.
RESULTS
The following emerging substances were initially evaluated to be effective in treating TMJ pain and increasing the amplitude of mandibular abduction: analgesics, dextrose with lidocaine, adipose tissue, nucleated bone marrow cells and ozone gas.
DISCUSSION
Better effects of intra-articular administration are achieved by preceding the injection with arthrocentesis.
CONCLUSIONS
The most promising substances appear to be bone marrow and adipose tissue.
PubMed: 35566431
DOI: 10.3390/jcm11092305 -
Clinical Oral Investigations Apr 2022This systematic review compared minimally and invasive surgical procedures to manage arthrogenous temporomandibular joint (TMJ). (Meta-Analysis)
Meta-Analysis Review
Invasive surgical procedures for the management of internal derangement of the temporomandibular joint: a systematic review and meta-analysis regarding the effects on pain and jaw mobility.
OBJECTIVES
This systematic review compared minimally and invasive surgical procedures to manage arthrogenous temporomandibular joint (TMJ).
MATERIALS AND METHODS
The review included clinical trials assessing surgical procedures of arthrogenous temporomandibular disorder (TMD) management by carrying out comparisons within the same surgical procedure (pre- and post-treatment) as well as between different surgical procedures. Meta-analyses were conducted only for similar comparison reporting the same outcome measures, visual analog scale (VAS) values to evaluate pain and maximum incisal opening (MIO) values.
RESULTS
Of the 1,015 studies identified by the search strategy, 26 were selected for full-text reading, and 19 were included in the review. Of these, 16 studies were included in the meta-analysis and 3 in the qualitative analysis. The VAS scores showed significantly lower values after discectomies (p < 0.001) and discoplasties (p < 0.001) in the within-group comparison. Moreover, significantly lower VAS scores and higher MIO values were observed after discectomy compared to arthroscopy, eminectomy, and discoplasty (p < 0.05).
CONCLUSION
The findings of this systematic review suggest that although significantly lower VAS scores and higher MIO values were observed after discectomy, the currently available scientific evidence is unclear, and the use of invasive surgical procedures should not be implemented as an efficient first-line treatment option for arthrogenous TMD management.
CLINICAL SIGNIFICANCE
VAS and MIO outcomes could be insufficient to describe the success or failure of open surgical procedures like discectomy and discoplasty.
Topics: Arthroscopy; Humans; Pain; Range of Motion, Articular; Retrospective Studies; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 35291030
DOI: 10.1007/s00784-022-04428-7 -
International Journal of Environmental... Feb 2022Learning modifications particularly increased due to the SARS-CoV-2 pandemic, which made it necessary to offer distance health education for many months. Social media... (Review)
Review
Learning modifications particularly increased due to the SARS-CoV-2 pandemic, which made it necessary to offer distance health education for many months. Social media allows students to have interactive activities such as discussing specific subjects or sharing data with each other, and also to have interactions with their teachers and tutors. So, we aimed to compare the effects of the use of social media on knowledge, skills and perceptions in health students compared to other methods. We performed a systematic review on PubMed, ScienceDirect and Embase about comparative learning methods using social media. The search followed PRISMA guidelines, and the quality assessment of the studies was performed using the Medical Education Research Quality instrument (MERSQI). Eight studies were analyzed including 1014 participants. Mean age ranged from 19.9 to 23.4 years, and 70% were females. About 54.4% of the participants were medical students and 20.9% were dental students. The mean MERSQI was 11.7 ± 2.6. Various subjects were included-anatomy, cultural competences, sterile surgical techniques, radiology, arthrocentesis, medical pathologies and cariology. As far as knowledge evaluation was concerned, we found that the use of social media may have had a positive effect from a short-term point of view but results concerning skills were less consistent across studies. Students usually had a positive perception of the use of social media as a complementary method but not as a complete alternative so it is not excluded that this effect might result from an increase in working time. The impact on patient care should also be assessed in future studies.
Topics: Adult; COVID-19; Education, Medical; Female; Humans; SARS-CoV-2; Social Media; Students, Medical; Young Adult
PubMed: 35206401
DOI: 10.3390/ijerph19042205 -
The Journal of Arthroplasty Apr 2022Total knee arthroplasty (TKA) provides successful results in most patients. Periprosthetic joint infection (PJI) accounts for up to 25% of failed TKAs needing revision.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Total knee arthroplasty (TKA) provides successful results in most patients. Periprosthetic joint infection (PJI) accounts for up to 25% of failed TKAs needing revision. In clinical practice, consensus in diagnostic strategy for excluding or diagnosing PJI is still lacking. In this systematic review and meta-analysis, we aim to provide a simplified data-driven diagnostic strategy for aseptic knee and hip revision surgeons to rule out PJI in the outpatient clinic phase.
METHODS
A literature search in EMBASE, MEDLINE, PubMed, and Cochrane was conducted. Studies involving the diagnosis of PJI in patients with failed TKAs and total hip arthroplasties needing revision were identified. Only studies using the Musculoskeletal Infection Society criteria were included. Quality was assessed using MINORS criteria. Meta-analysis was performed for each diagnostic test identified in the included studies. Pooled estimates of diagnostic accuracy measures were calculated using a bivariate model and plotted in summary receiver-operator characteristic curves. Positive and negative predictive values were calculated in a hypothetical sample of patients with a given disease prevalence.
RESULTS
Twenty-four studies met the inclusion criteria, describing a total of 2974 patients. Quality scores ranged from 13 to 19. Meta-analysis could be performed on 7 unique diagnostic tests. Highest pooled sensitivity and specificity were demonstrated for α-defensin with values of 86% and 96.6%, respectively. α-defensin and white blood cell count in synovial fluid demonstrate highest negative predictive value values.
CONCLUSIONS
We recommend, in a clinical setting with low-intermediate prevalence of PJI, performing arthrocentesis and joint fluid analysis using α-defensin and/or white blood cell count before revision TKA and revision total hip arthroplasty surgery to rule out PJI.
Topics: Arthritis, Infectious; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biomarkers; Humans; Prosthesis-Related Infections; Sensitivity and Specificity; Synovial Fluid; alpha-Defensins
PubMed: 34952165
DOI: 10.1016/j.arth.2021.12.020 -
Journal of Stomatology, Oral and... Oct 2022Intra-articular platelet rich plasma injections [PRP] or platelet rich growth factors [PRGF] injections have been used as therapeutic treatment options for patients with...
Intraarticular injections of platelet rich plasma and plasma rich in growth factors with arthrocenthesis or arthroscopy in the treatment of temporomandibular joint disorders: A systematic review.
Intra-articular platelet rich plasma injections [PRP] or platelet rich growth factors [PRGF] injections have been used as therapeutic treatment options for patients with temporomandibular joint disorder [TMD] in recent years. The purpose of this paper is to evaluate the level of the available scientific evidence in the current literature on the benefits of applying PRP or PRGF injections to patients with TMD simultaneously or after arthrocentesis or arthroscopy to reduce post-operative pain and improve temporomandibular joint function. This systematic review was conducted according to PRISMA criteria and an electronic database search was carried out in the PubMed, Scopus and Cochrane databases during May 2021. The patients in the study group were injected with intra-articular PRP or PRGF simultaneously or after arthrocentesis or arthroscopy while the patients in the control group had arthrocentesis or arthroscopy without an intra-articular injection or received an injection of hyaluronic acid or Ringer's lactate solution. Eight randomised controlled clinical trials were selected. The PRP and PRGF intra-articular injections demonstrated significant differences in terms of pain reduction in three studies and improved mandibular function in two. The treatment with PRP or PRGF intra-articular injections demonstrated slightly better clinical results but of little significance in comparison with the control group. Evidence of their effectiveness is crucial to establish them as non-invasive treatments and as an affordable option for treating some types of TMDs. In accordance with Evidence-based dentistry principles, this review has been assigned a C recommendation.
Topics: Arthroscopy; Humans; Hyaluronic Acid; Injections, Intra-Articular; Platelet-Rich Plasma; Ringer's Lactate; Temporomandibular Joint Disorders
PubMed: 34906730
DOI: 10.1016/j.jormas.2021.12.006