Evaluating the Effect of Dextrose Prolotherapy on Temporomandibular Disorders by Choosing Different Injection Sites- A Comparative Clinical Study

Abstract

Introduction: Prolotherapy is a minimally invasive technique used in the treatment of temporomandibular disorders. Prolotherapy agent induces an inflammatory process in the joint, stimulates fibroblast proliferation, hence facilitates the healing process and strengthens the joint and associated ligaments and tendons. The main aim of this article was to study the effect of 25% dextrose prolotherapy on temporomandibular joint pain, clicking and maximum mouth opening by using different injection sites. Material and methods: Sixty patients with established diagnosis of unilateral disc displacement with reduction who complained of unilateral symptoms (pain and clicking) were included in the study. They were randomly allocated to three groups (Group A, Group B and Group C) of 20 patients each. Group A patients received intra-articular injections into the superior joint space, Group B patients received injections into the inferior joint space where as Group C patients were given injections into the retrodiscal tissues. Each group received subsequent injections at first, second and third weeks at the respective sites. Pain, clicking and maximum mouth opening (MMO) was recorded pre-operatively, post-operatively at 3 weeks and 2 months. Results: Group B and Group C patients showed a significant decrease in the pain score at 3 weeks and 2 months postoperatively while as no significant pain relief was observed in Group A. Maximum mouth opening improved significantly in Group B and Group C patients at 3 weeks and 2 months and was highest in Group C. Reduction in clicking was best seen in Group C. Conclusion: Prolotherapy is more effective when injection site is selected as per the type of symptoms of the patients with temporomandibular disorders.

Efficacy of dextrose prolotherapy for the management of chronic temporomandibular disorders

“…The mean value of mouth opening of the present study for the prolotherapy group was 34.5 mm preoperatively and become 36.5 mm at 2 months, so the degree of improvement of mouth opening was 2.05 mm after 2 months, these results come in agreement with that of (Younis et al, 2020), the degree of mouth opening was 33.2 mm preoperatively and 33.8 mm at 2 months follow up periods, which mean that the improvement of mouth opening was only 0.6 mm. The results also agreed with that of (Shehata, 2019), the mean of degree of mouth opening preoperatively was 33.7 mm and postoperatively was 36.5 mm, there is barely a significant difference ( p = 0.05).…”

“…The number of patients with clicking in prolotherapy group decreased from 14 to 3 after two months of treatment, this come in consistence with the study of (Elwerfelli et al, 2019), 14% of patients still have clicking after six weeks follow up period. The results disagree with that of (Ungor et al, 2013), the clicking sounds disappeared only in 50% of patients in the last follow up period which is 3 months, the results also disagree with that of (Younis et al, 2020), 20 patients received dextrose injection into the superior joint space, only 3 patients show improvement of clicking. The reason for this difference from their results is because in the present study injection has been given into the area of insertion of lateral pterygoid muscle to the disc (in addition to the other points) this leads to harmonization and returning of the disc to normal position.…”

“…The loosening of the tendons and ligaments of the TMJ is the main cause of musculoskeletal pain, dysfunction and clicking of the TMJ so the injection of dextrose will lead to mild inflammation in the region which will lead to proliferation of fibroblast that will enforce the joint and the associated tendons and ligaments (Younis, Shah, & Rashid, 2020). Hypertonic dextrose is the most commonly used solution because it is obtainable, cheap, water soluble, biocompatible and safe (Haggag, Al-Belasy, & Ahmed, 2022), but it still has some adverse effect that related to the injection procedure itself like discomfort, fullness of the tissue after injection, pain during 72 hours after injection also detected in about 10% of cases, light headache, nerve injury or infection (Rabago, Reeves, Doherty, & Fleck, 2019).…”

Effectiveness of electromyography guided botulinum toxin injection and dextrose prolotherapy in recurrent TMJ dislocation (radiographic and clinical study)

“…Condyle dislocation (or hypermobility) of TMJ is one of the most frequent TMJ disorders in humans. In the case of hypermobility, the condyle reaches a position in front of the articular tubercle at wide mouth opening, which can be caused by abnormalities in the shape of the joints, by ligament looseness or by reduced muscle tension (12). There have been reports of therapeutic intra-articular injections into the superior joint space of viscoelastic solution, steroids, antiinflammatory medicines, and local anaesthetics (4-6 , 1 3 ) .…”