TMJ Disc Displacement without Reduction: A Randomized Clinical Trial

Objectives: This randomized clinical trial evaluates four treatment strategies for patients with TMJ disc displacement without reduction: 1) medical management; 2) comprehensive nonsurgical rehabilitation; 3) arthroscopic surgery with post-operative rehabilitation; and 4) disc repositioning surgery with post-operative rehabilitation. Methods: Ninety-six patients had their diagnosis confirmed with MRIs and accepted their treatment assignment. Follow-up data collections are done at 3, 6, 9, 12, 18, 24, 36, 48, and 60 months with 93, 88, 88, 95, 88, 89, 84, 77 and 85 subjects having completed each interval, respectively. Follow-up is ongoing with the current lost-to-follow-up rate of 7% at 2 years and 11% at 5 years. Each follow-up evaluation consists of questionnaires and examination by a blinded examiner. Results: The results reported at this time summarize data up to the 60 month interval. The primary outcome measures are the Craniomandibular Index (CMI) and the Symptom Severity Index for TMJ pain (SSI-JT). Within-group (paired t-test) and between-group (ANOVA, Tukey Kramer post-hoc test) mean change from baseline comparisons were performed for the above outcome measures. This analysis used initial treatment assignment. Conclusion: ANOVA detected no significant differences between groups for these measures at baseline. Statistically significant within-group improvement was observed in all groups for those outcome measures beginning at the 3 month follow-up and was maintained at all follow-ups (p< 0.01). No statistically significant between-group differences were observed in CMI or SSI-JT at any follow-up interval (p< 0.01). Taking account of crossover from Group I, this study suggests that about 60% of subjects treated with medical management (Group I) responded as effectively as subjects in the other groups, and nonsurgical treatments (Group 1 and 2) were as effective as surgery for all but 2 subjects. This study was supported by NIH grants 5R29DE08668-05, P30-DE09737, and grants from Allina and HealthPartners of MN.