LONG-TERM EFFECTIVENESS OF CONSERVATIVE THERAPY IN PATIENTS WITH ANTERIOR DISC DISPLACEMENT WITHOUT REDUCTION

Abstract

Aims. The purpose of this study is to evaluate the effectiveness of treatment with pivot appliance, adapted according to an original method, in chronic disc displacement without reduction (ADDwor).
Patients and methods. 100 patients randomly selected with Magnetic Resonance Imaging (MRI) with anterior disc displacement without reduction were examined for symptoms and signs of temporomandibular disorder (TMD) according to the Research Diagnostic Criteria and exclusively treated with a pivot appliance. The patients had been suffering from temporomandibular disorders pain, registered on a numeric pain intensity scale (NPIS) and the subjective effects of the therapy registered on a verbal scale (1= ineffectual; 2=effective; 3= very effective). It was also recorded the presence of a reduction in mouth opening and lateral movement without dental contact. Treatment outcomes were evaluated at 6 weeks and their maintenance at 2-years. The research was approved by our local institutional review board.
Results. At 6 week follow-up 94 patients had benefited from treatment with a reduction in the pain score of 87.5% and of these 68 (72%) achieved a pain reduction to zero while 23 (24.4%) reported a value of a pain as one, 2 patients (2.12%) two and one of the three. At 2 years follow-up 93 (98,9%) patients declare zero pain while 1 (1.06%) patient remained a value of two, then in 2 years pain reduced in 93.5% of the responding patients. In 6 patients who have not responded to treatment, at 6 weeks, the pain was reduced by 16.2% which was considered insufficient because these patients had pain at the beginning of treatment of 2.2 higher than the average of the other (7.6 compared with 5.4 in NPIS) and so were sent to the surgeon for arthrocentesis or arthroscopy. The average mouth opening at the beginning of treatment was 37.2 mm, at 6-week follow-up was 42.3 mm, an increase of 13.7% in 95 patients because a non-responders improved only in openness but not in pain. At 2 years follow-up, the opening has reached 43.5 mm improving by 16.9%. According to verbal scales, 90% of all patients have judge the therapy very effective, in particular, 4% effective and 6% not effective.
Conclusion. The pivot appliance has demonstrated a good efficiency in pain controlling and improving the reduction of mouth opening in both, short term and long term. The pivot appliance can, therefore, be recommended as a conservative therapy of ADDwor.