Clinical and MRI Evaluation of Orthodontic Mini Screws as a Modified Suture Anchor for Disc Repositioning in Internal Derangement Of TMJ A Prospective Study

Abstract

ABSTRACT newlineThe study was a prospective interventional trial to assess the clinical and imaging outcomes of surgical disc repositioning of internal derangement using the modified disc repositioning technique using an orthodontic mini screw to plicate the disc.Post-operative outcomes were assessed in improvement of mouth opening, absence of joint noises, decreases pain and dysfunction and terms of anamnestic and clinical dysfunction indices and imaging outcomes as assessed for a period of 01 year. A significant improvement in the average post-operative mouth opening was noted, although there was no significant improvement in lateral and protrusive movements of the mandible. Post-operative evaluation of TMJ dysfunction using the modified Helkimo clinical dysfunction index showed initial improvement of pain and dysfunction as assessed at the end of 01 month with mild worsening of symptoms over a period of one year.Post-operative evaluation MRI evaluation at 6 months revealed surgical stability in the disc position in majority of the cases.Intra operative complications included minor disk fraying, breakage of the suture and post-operative complication in terms of transient facial nerve paresis involving the temporal and zygomatic branches were noted. Though there was immediate benefit seen in terms of reduction of pain and dysfunction in majority of the patients, localized and referred pain and muscle pain post-surgery continued to affect the many patients requiring supportive conservative therapy. Results indicated that the procedure may be beneficial in cases of non-reducing disc displacement with limited opening not amenable to conservative therapy. The titanium mini screw was used to plicate and provide additional anchorage and stabilization of the displaced articular disc. Based on the present study the application of mini screw appears a cost-effective solution for in a small subset of patients with localized signs and symptoms not amenable to conservative therapy. newline newline