A prospective cohort study on the efficacy of conservative and surgical treatments for patients with ADDwoR of the temporomandibular joint.

Abstract

Background: The treatment options for anterior disc displacement without reduction (ADDwoR) of the temporomandibular joint are conservative and surgical treatments; however, current therapeutic strategies for ADDwoR remain highly heterogeneous. This study aimed to evaluate the effectiveness of these two treatment options in symptom alleviation and orofacial functional restoration.

Methods: The age of the patients was 18 years or older, and they underwent treatment for ADDwoR of the temporomandibular joint from December 2022 to February 2024, with patients providing 12-month follow-up data on pain, mouth-opening capacity and chewing efficiency. The difference in the change in joint pain levels between the two methods was assessed from the baseline to the 12-month follow-up period. Mouth-opening capacity and chewing efficiency were assessed by pain-free maximum mouth opening (MMO) and the temporomandibular joint chewing function self-test.

Results: A total of 218 participants (mean [SD] age = 31.9 [12.9] years; 195 [89%] women) were included in this study, and the conservative treatment group and surgical treatment group included 123 individuals (mean [SD] age = 32.9 [12.7] years; 113 [92%] women) and 95 individuals (mean [SD] age = 30.6 [13.1] years; 82 [86%] women), respectively. Both the conservative treatments (mean change = - 2.45 [95% CI = - 3.031 to -1.864] points) and surgical treatments (mean change = - 2.24 [95% CI -2.867 to -1.603] points) resulted in a clinically important pain reduction at 12 months. However, there was no significant difference in the effects of conservative and surgical treatments on pain reduction (P = 0.5737). The results of the secondary outcomes were mostly in line with those of the primary outcomes. Interestingly, among middle-aged and elderly patients with limited mouth opening, surgical treatments demonstrated a superior restoration of mouth-opening capacity compared to conservative treatments (P = 0.0049).

Conclusions: In this cohort study of individuals with ADDwoR of the temporomandibular joint, both conservative and surgical treatments significantly improved clinically relevant pain, mouth-opening capacity and chewing efficiency in patients. And surgical intervention demonstrated superior efficacy in enhancing mouth opening among middle-aged and elderly patient.