Manipulation of TMJ closed-lock: a systematic review of unlocking techniques
Mohammed Al-Baghdadi1* and Justin Durham2
1 BDS, MSc, PhD. Oral Surgery Unit, Al-Noor Specialized Dental Care Centre, Ministry of Health, Baghdad, Iraq. * mohammed.k.albaghdadi@gmail.com
2 BDS, PhD, MFDS RCS (Edin), FDS RCS (OS). Centre for Oral Health Research and Institute of Health & Society, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
Abstract
Background: Manual manipulation of the mandible is an accepted initial diagnostic/therapeutic approach used in patients suffering from a persistent, or intermittent, closed lock caused by temporomandibular joint disc displacement. Various manipulation techniques have been described in the literature, …show more content…
The majority of the reported techniques have two sequential steps in common: distraction the affected joint by a downward-upward movement; reduction the displaced disc by a forward-inward movement. The reported techniques differed in: person delivering manipulation (patient, clinician); force application (intra-oral, extra-oral); adjunctive use of anaesthetic modalities; assisted joint pumping or lavage. The oldest technique reported by Farrar was the most commonly used in the literature (15 studies).
Conclusion: Mandibular manipulation is a simple, safe, quick, inexpensive, and non-invasive first-line management of TMJ closed lock. The effectiveness of the reviewed techniques, however, is unclear because most of the techniques were examined in non-controlled studies. Future high-quality randomized controlled trials on large sample and long-term follow-up with pre- and post-manipulation imaging are needed to investigate the effect of these techniques in order to determine the most effective and appropriate technique to use for patients with closed lock.
Keywords: Mandibular manipulation, jaw mobilization, joint distraction, disc recapturing, disc displacement, temporomandibular
Mohammed Al-Baghdadi1* and Justin Durham2
1 BDS, MSc, PhD. Oral Surgery Unit, Al-Noor Specialized Dental Care Centre, Ministry of Health, Baghdad, Iraq. * mohammed.k.albaghdadi@gmail.com
2 BDS, PhD, MFDS RCS (Edin), FDS RCS (OS). Centre for Oral Health Research and Institute of Health & Society, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
Abstract
Background: Manual manipulation of the mandible is an accepted initial diagnostic/therapeutic approach used in patients suffering from a persistent, or intermittent, closed lock caused by temporomandibular joint disc displacement. Various manipulation techniques have been described in the literature, …show more content…
The majority of the reported techniques have two sequential steps in common: distraction the affected joint by a downward-upward movement; reduction the displaced disc by a forward-inward movement. The reported techniques differed in: person delivering manipulation (patient, clinician); force application (intra-oral, extra-oral); adjunctive use of anaesthetic modalities; assisted joint pumping or lavage. The oldest technique reported by Farrar was the most commonly used in the literature (15 studies).
Conclusion: Mandibular manipulation is a simple, safe, quick, inexpensive, and non-invasive first-line management of TMJ closed lock. The effectiveness of the reviewed techniques, however, is unclear because most of the techniques were examined in non-controlled studies. Future high-quality randomized controlled trials on large sample and long-term follow-up with pre- and post-manipulation imaging are needed to investigate the effect of these techniques in order to determine the most effective and appropriate technique to use for patients with closed lock.
Keywords: Mandibular manipulation, jaw mobilization, joint distraction, disc recapturing, disc displacement, temporomandibular