Viscosupplementation of the Upper and Lower Compartments of Temporo-mandibular Articulation (TMJ) - Osteoarthritis and Osteoarthrosis Control

Objectives: The Objective of the present study was to describe the effects observed after conservative treatment of TMJ osteoarthritis and osteoarthrosis. The procedure consisted of stabilization(1) using occlusal appliance and physiotherapy(2-4) for functional recovery and restoration of joint biomechanics. These interventions were associated with minimally invasive treatment injecting hyaluronic acid (5-9), (AH) into the upper and lower joint space and the results evaluated by cone beam computed tomography (CBCT).
Materials and methods: 60 year old man, diagnosed using DC/TMD with myofascial pain, osteoarthritis, osteoarthrosis, and presumption of diagnosis of disc displacement without reduction, of the two temporo-mandibular joints associated with primary or idiopathic(9-12) wake and sleep bruxism, was submitted to a sequential protocol of injection of medium molecular weight HA(13) (Osteonil plus-TRB pharma) in the posterosuperior compartment and low molecular weight HA (Hylart-Bagó pharma) interspersed with Osteonil plus-TRB pharma for the anteroinferior compartment of both TMJs, monthly for 4 months (13,14) . Evaluation with CBCT was performed before treatment and six months after the last infiltration. The patient underwent physiotherapy after each viscosupplementation session and the following week, home oriented exercises(2,15) and monthly clinical evaluation with measurement of oral opening amplitude (ROM) with therabite and pain using the visual analogue scale (VAS)(16). The patient was instructed to use applications for mobile phone to control bruxism while awake and occlusal split to control sleep bruxism (17,18).
Results: Significant structural gain seen in shape and volume of the mandible head in both TMJs, functional joint improvement, with increased amplitude of oral opening, The initial opening was 30 mm and after the end of treatment 44 mm, absence of pain at the end of treatment with obvious improvement in activities of daily living such as eating or speaking.
Conclusions: Sequential viscosupplementation with AH of the two joint compartments associated with conservative treatment and control of awake and sleep bruxism, were effective in the treatment of osteoarthritis and osteoarthrosis of patient TMJs.