INTRODUCTION: Temporomandibular disorders (TMD) is an umbrella term embracing a set of conditions that affect the masticatory muscles and the temporomandibular joint (TMJ) .Internal derangements, specifically disc displacement with reduction (DDr), are one of the major findings in TMD . For the treatment of DDr, occlusal appliances and some pharmacological agents were suggested. Several studies were done evaluating the therapeutic use of Botulinum Toxin Type A (BTX-A) in TMD of myogenic origin. But only few studies investigated its effect in the management of TMD of arthrogenic origin. OBJECTIVES: This study was done to evaluate the effect of Botulinum Toxin Type A (BTX-A) injection in the lateral pterygoid muscle (LPM) with and without anterior repositioning appliance (ARA) as a treatment modality for DDr. MATERIALS AND METHODS: Eighteen patients with anterior disc displacement with reduction (DDr) as diagnosed clinically using Research Diagnostic Criteria (RDC/TMD) and confirmed by MRI were enrolled in this study. Patients were randomly assigned into three groups each comprising 6 patients. Group I received ARA, group II received BTX-A while group III received both treatment modalities. After 3 months, evaluation was done subjectively through Helkimo Anamnestic index (Ai) and objectively through electromyography (EMG) as well as MRI. RESULTS: Clinically, there was significant improvement in TMD symptoms in the three studied groups, while disc position was significantly improved in groups II and III as proved by MRI. CONCLUSIONS: Anterior repositioning appliance is effective in treating patients with disc displacement with reduction; however, BTX-A with and without ARA proved to be a more valuable treatment modality in the management of disc displacement with reduction.