[Seite 128↓]

11  Summary

This work presents four studies dealing with disk displacement without reduction, its treatment and long-term effects.

Study 1

This study evaluats the pathogenesis of disk displacement without redution and treatment effects of stabilization splints. The study has a prospective follow-up design. Inclusion criteria were an MRI-based diagnosis of anterior disk displacement without reduction, limited mouth opening and / or pain in one or both joints. All patients were treated by stabilization splints. The follow-up examination was about 13 months after the baseline examination of the patients. Subjective parameters, evaluated by a questionnaire and rated by visual analog scale and objective data, evaluted by the functional examination during baseline examination were compared to the follow-up data. -Disk displacement without reduction seemed to develop from disk displacement with reduction, mostly initiated by trauma. Disk displacement without reduction occured bilateral in one third of the patients. Within the conservative treatment, Pain releaved and mouth opening reached a significant larger extend. But the symptoms were rarely resolved. The patients felt more restricted by pain than by limited mouth opening. Comparing these results with studies reexamining patients who did not undergo any treatment, the therapeutic effect of splints is questionable.

Study 2

Pulsed electromagnetic fields (PEMF) is a conservative treatment method known in orthopedic disorders but not yet used to treat TMD. As studies proofed an therapeutic effect of PEMF on cartilogenous growth, these treatment was used in patients with disk displacement without reduction and osteoarthrosis, with the intend to support adaptive process. All patients had MRI-based diagnosis of disk displacement without reduction or osteoarthrosis accompanied by pain and / or limited mouth opening. After assessing objective and subjective baseline parameters the patients were [Seite 129↓]reexamined three times after treatment with PEMF up to a period of 4 months. The study design was a randomized controlled douple blinded one. The results showed no specific effect of PEMF on the subjective or objective parameters. Significant improvements of maximum mouth opening or pain intensity occured independently from active or mock treatment. Therefore improvements seemed to be effects of adaptation process or change of habits or placebo effects. As PST had no specific effect on disk displacement without reduction or osteoarthrosis it can not be recommended in treatment of these temporomandibular disorders.

Study 3

Disk displacements typically results in pain during chewing. Therefore chewing efficiency of patients with disk displacements without reduction should be evaluated. The study included a control group of age and gender matched volunteers. Artificial test food was chewed within 60 strokes, gathered, washed, dried and fractioned by a sieving device. The fractions due to weight were measured and - by the Rosin-Rammler equation - the median sieving aperture could be calculated through which half of the artifical test food would be fallen. These median sieving aperture was the parameter to compare patients and controls. Patients had a significantly reduced chewing efficiency, which was not correlated to treatment but to the time since onset of the disorder. The chewing efficiency improved over time but was nevertheless reduced compared to a control group without TMJ-disorders.

Study 4

Whereas clinical parameters seem to improve in patients with disk displacement without reduction, morphologic changement can be seen in MRIs. Therefore a group of patients with MRI-based diagnosis of disk displacement without reduction was reexamined after an average time of 2 years by MRI. Again clinical parameters improved: the extent of mouth opening increased significantly and pain on muscle palption was reduced. Therefore the Helkimo-Index improved as well, which is a score of several clinical parameters. By MRI degenerative changements could be seen, [Seite 130↓]especially involving the condyle and the disk. After the observation period of two years however the grade of Internal Derangment according to WIKLES did not change significantly. In concordance to the clinical improvement of the extend of mouth opening the translation of the condyle improved significantly. High signal areas as a sign of effusion disappeared over time. The structural changements could be interpreted as a self limiting adaptative process.

In conclusion of all studies following statements could be drawn.

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