***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The authors compared the efficacy of bilateral balanced and canine guidance ( occlusal ) splints in the treatment of temporom and ibular joint ( TMJ ) pain in subjects who experienced joint clicking with a nonoccluding splint in a double-blind , controlled r and omized clinical trial . METHODS The authors r and omly assigned 57 people with signs of disk displacement and TMJ pain into three groups according to the type of splint : bilateral balanced , canine guidance and nonoccluding . The authors followed the groups for six months using analysis of a visual analog scale ( VAS ) , palpation of the TMJ and masticatory muscles , m and ibular movements and joint sounds . They used repeated analysis of variance and a chi(2 ) test to test the hypothesis . RESULTS The type of guidance used did not influence the pain reduction , yet both occlusal splints were superior to the nonoccluding splint , on the basis of the VAS . Despite similar outcomes in relation to opening , left lateral and protrusive movements , TMJ and muscle pain on palpation , subjects who used the occlusal splints had improved clinical outcomes . The frequency of joint noises decreased over time , with no significant differences among groups . Subjects in the groups using the occlusal splints reported more comfort . CONCLUSION The type of lateral guidance did not influence the subjects ' improvement . All of the subjects had a general improvement on the VAS , though subjects in the occlusal splint groups had better results that did subjects in the nonoccluding splint group ABSTRACT Therapeutic exercise is a new concept of treatment for patients with clicking due to anterior disk displacement with reduction ( ADDWR ) . In order to investigate the efficacy of the exercise , we design ed a r and omized controlled clinical trial to compare with no-treatment controls . The subjects were patients who complained of painless unilateral reciprocal clicking and were diagnosed as having ADDWR by Magnetic Resonance Imaging ( MRI ) . Forty-two patients were r and omly assigned . Three months after the r and omization , the success rate was 61.9 % ( 13/21 joints ) in the exercise group and 0 % ( 0/21 joints ) in the control group , with a significant difference between the two groups ( p=0.0001 ) . However , captured disks in the successful cases were seen in only 23.1 % on MRI examination . In conclusion , the therapeutic exercise for clicking due to ADDWR is significantly effective in reducing the clicking , and thought to be much more conservative and cost-effective than splint therapy or surgery PURPOSE Hyaluronic acid ( HA ) injections and occlusal splints have been suggested in the treatment of temporom and ibular joint ( TMJ ) derangements , but no sufficient data are available from controlled clinical trials comparing HA injection with another treatment modality . This study compared the effectiveness of a single HA injection , a double HA injection , and splint therapy for the treatment of TMJ disc displacement with reduction ( DDR ) . MATERIAL S AND METHODS A prospect i ve clinical trial was design ed . The study sample included patients with TMJ DDR . The primary predictor variable was treatment method . Patients were divided into 4 groups : control , single HA injection , double HA injection , and stabilization splint therapy . Patients were r and omly assigned to 1 of 3 treatment groups . The control group was self-selected . The primary outcome variable was pain at rest and during mastication . The secondary outcome variables were TMJ noise , quality of life , and level of jaw movements . Clinical symptoms and jaw movements were evaluated at baseline and at 6-month follow-up . Descriptive , comparative , correlation , and multivariate analyses were conducted . RESULTS The sample included 51 patients ( 66 TMJs ) 18 to 48 years old . All treatment groups showed significant improvement compared with baseline values for pain , TMJ noise , quality of life , and maximum mouth opening ( MMO ) at 6-month follow-up ( P < .05 ) . However , the 2 HA injection groups indicated superior improvement for pain , MMO , and quality of life compared with the stabilization splint group ( P < .05 ) . CONCLUSIONS The results of this study showed that HA injection and stabilization splinting are acceptably successful treatment modalities to alleviate the clinical signs and symptoms of TMJ DDR Objective The benefit of the use of some intraoral devices in arthrogenous temporom and ibular disorders ( TMD ) patients is still unknown . This study assessed the effectiveness of the partial use of intraoral devices and counseling in the management of patients with disc displacement with reduction ( DDWR ) and arthralgia . Material s and Methods A total of 60 DDWR and arthralgia patients were r and omly divided into three groups : group I ( n=20 ) wore anterior repositioning occlusal splints ( ARS ) ; group II ( n=20 ) wore the Nociceptive Trigeminal Inhibition Clenching Suppression System devices ( NTI-tss ) ; and group III ( n=20 ) only received counseling for behavioral changes and self-care ( the control group ) . The first two groups also received counseling . Follow-ups were performed after 2 weeks , 6 weeks and 3 months . In these sessions , patients were evaluated by means of a visual analogue scale , pressure pain threshold ( PPT ) of the temporom and ibular joint ( TMJ ) , maximum range of motion and TMJ sounds . Possible adverse effects were also recorded , such as discomfort while using the device and occlusal changes . The results were analyzed with ANOVA , Tukey ’s and Fisher Exact Test , with a significance level of 5 % . Results Groups I and II showed improvement in pain intensity at the first follow-up . This progress was recorded only after 3 months in Group III . Group II showed an increased in joint sounds frequency . The PPT values , m and ibular range of motion and the number of occlusal contacts did not change significantly . Conclusion The simultaneous use of intraoral devices ( partial time ) plus behavioral modifications seems to produce a more rapid pain improvement in patients with painful DDWR . The use of NTI-tss could increase TMJ sounds . Although intraoral devices with additional counseling should be considered for the management of painful DDWR , dentists should be aware of the possible side effects of the intraoral device ’s design PURPOSE This study was design ed to investigate the efficacy of arthrocentesis with and without injection of sodium hyaluronate ( SH ) into the upper joint space in the treatment of temporom and ibular joint ( TMJ ) internal derangements . PATIENTS AND METHODS Forty-one TMJs in 5 males and 26 females aged 14 to 53 years comprised the study material . The patients ' complaints were limited mouth opening , TMJ pain and tenderness , and joint noises during function . Patients were r and omly divided into 2 groups in which only arthrocentesis was performed in 1 group and arthrocentesis plus intra-articular injection of sodium hyaluronate was performed in the other group . Both groups contained patients with disc displacement with reduction and with closed lock . Clinical evaluation of the patients was done before the procedure , immediately after the procedure , on postoperative day 1 , and at 1 , 2 , 3 , 4 , 5 , 6 , 9 , 12 , 18 , and 24 months postoperatively . Intensity of TMJ pain , jaw function , and clicking sounds in the TMJ were assessed using visual analog scales . Maximal mouth opening and lateral jaw movements also were recorded at each follow-up visit . RESULTS Both techniques increased maximal mouth opening , lateral movements , and function , while reducing TMJ pain and noise . CONCLUSIONS Although patients benefitted from both techniques , arthrocentesis with injection of SH seemed to be superior to arthrocentesis alone Temporom and ibular dysfunction ( TMD ) has been established as a therapeutic challenge in the plastic and maxillofacial clinics . The current treatment recommendations for TMD include resting the jaw , soft diet , and pain medication with nonsteroidal analgesic agents . If conservative and noninvasive techniques do not work , more invasive techniques may be considered . The main goal of this study was to assess the safety and clinical utility of intraarticular injection of sodium hyaluronate for the treatment of symptoms associated with internal derangement of the temporom and ibular joint ( TMJ ) . In this prospect i ve study , 40 TMJs of 33 patients who have TMD were treated with intraarticular sodium hyaluronate injections at weekly intervals for 3 weeks . Pre- and postinjection pain intensity , the presence of joint sounds , and interincisial distance were documented . The follow-up period was 12 months . There was a statistically significant reduction of pain intensity ( P < 0.01 ) and joint sound ( P < 0.05 ) in all patients . This study shows that intraarticular hyaluronic acid injection for the treatment of reducing and nonreducing disc displacement of TMJ is an effective and safe management The severity of symptoms of craniom and ibular disorders was studied during a 2-year period in 195 patients treated with conservative therapeutic schemes .  Results revealed a continuing improvement and a statistically significant tendency for the great majority of patients to become asymptomatic or show a decrease in the severity of symptoms . By the end of the 2 years , 66.7 % of the patients were symptom free , 25.6 % presented with slight symptomatology , and 3.1 % were recorded with a fluctuating recurrence of symptoms . This investigation provided the data to develop an exponential model for the hypothesis that stabilization of effectiveness of conservative treatment  is achieved between 6 months and 1 year after the initiation of treatment 
    Output:
    
Yet , long-term studies have shown the favorable progression of this condition , with no pain and /or jaw locking occurring in most of the patients