Cömert Kiliç Songül, Kiliç Nihat, Güngörmüş Metin
Associate Professor. Atatürk University, Dentistry of Faculty, Atatürk University, Erzurum, Turkey.
Professor. Atatürk University, Dentistry of Faculty, Atatürk University, Erzurum, Turkey.
J Oral Maxillofac Surg. 2023 Apr;81(4):389-395. doi: 10.1016/j.joms.2022.12.023. Epub 2023 Jan 21.
Botulinum toxin type A (BTX-A) therapy or dextrose prolotherapy (DP) has been used to treat temporomandibular joint (TMJ) disorders. However, the superiority of one method over the other has not been studied in patients with TMJ subluxation. Therefore, this study aims to answer the following clinical question: among patients with TMJ subluxation, do those undergoing BTX-A injection into lateral pterygoid muscles, compared to those undergoing intra- and periarticular DP injections, have better outcomes in terms of locking episodes and patient satisfaction?
A randomized clinical trial was implemented in adult patients with TMJ subluxation. The sample was composed of patients with TMJ subluxation with painful open-locking during wide mouth opening and/or yawning at baseline. The subjects were treated randomly with one of two treatment techniques with equal numbers as follows: one-session BTX-A injection into lateral pterygoid muscles (BTX-A group) or three sessions of dextrose injections around TMJ (prolotherapy group). The predictor variable was the treatment technique (BTX-A or prolotherapy injections). The primary outcome variable was the frequency of locking episodes. The secondary outcome variable was patient satisfaction. The primary outcome variable was recorded at baseline and 8-12 months following the injections. The secondary outcome variable was recorded only 8-12 months following the injections. Descriptive and bivariate statistics were computed. The data were analyzed with the Wilcoxon and Mann-Whitney U tests.
The baseline sample was composed of 30 patients with TMJ subluxation. However, the follow-up sample comprised 25 subjects: 11 (9 females, 2 males; 25.64 years) in the BTX-A group and 14 (10 females, 4 males; 32.37 years) in the prolotherapy group. Locking episodes decreased significantly in the two groups with no significant difference (P < .01). Seven patients in the BTX-A group (7 of 11 patients; 63.6 percent) and eight (8 of 14 patients; 57.1 percent) in the prolotherapy group reported no complaint of locking at the end of follow-up, with no significant difference between the groups (P > .05). Patient satisfaction showed no significant difference between the groups (P > .05).
These findings suggested that BTX-A injection is no more effective than DP for any outcome variables of TMJ subluxation assessed.
A型肉毒毒素（BTX-A）疗法或葡萄糖注射疗法（DP）已被用于治疗颞下颌关节（TMJ）紊乱。然而，在TMJ半脱位患者中，一种方法相对于另一种方法的优越性尚未得到研究。因此，本研究旨在回答以下临床问题：在TMJ半脱位患者中，与接受关节内和关节周围DP注射的患者相比，接受BTX-A注射到翼外肌的患者在锁定发作和患者满意度方面是否有更好的结果？
对成年TMJ半脱位患者进行了一项随机临床试验。样本由在基线时大口开口和/或打哈欠时有疼痛性开口锁定的TMJ半脱位患者组成。受试者被随机分为两种治疗技术之一，每组人数相等：单次BTX-A注射到翼外肌（BTX-A组）或在TMJ周围进行三次葡萄糖注射（注射疗法组）。预测变量是治疗技术（BTX-A或注射疗法注射）。主要结局变量是锁定发作的频率。次要结局变量是患者满意度。主要结局变量在基线时和注射后8 - 12个月记录。次要结局变量仅在注射后8 - 12个月记录。计算描述性和双变量统计量。数据用Wilcoxon和Mann-Whitney U检验进行分析。
基线样本由30例TMJ半脱位患者组成。然而，随访样本包括25名受试者：BTX-A组11名（9名女性，2名男性；25.64岁），注射疗法组14名（10名女性，4名男性；32.37岁）。两组的锁定发作均显著减少，无显著差异（P <.01）。BTX-A组7例患者（11例患者中的7例；63.6%）和注射疗法组8例患者（14例患者中的8例；57.1%）在随访结束时报告无锁定主诉，两组之间无显著差异（P >.05）。两组患者满意度无显著差异（P >.05）。
这些发现表明，对于评估的TMJ半脱位的任何结局变量，BTX-A注射并不比DP更有效。
