Management of patients with disk displacement without reduction of the temporomandibular joint by arthrocentesis alone, plus hyaluronic acid or plus platelet-rich plasma

Abstract

Background. Disk displacement without reduction (DDwoR) is one of the most common temporomandibular joint disorders (TMDs); it can manifest itself in joint pain and limited mouth opening. Nowadays, many arthrocentesis techniques are used with no consensus on which technique is optimal. Objectives. The aim of this study was to investigate the efficacy of 3 techniques in the treatment of TMD known as DDwoR and to compare them in order to determine whether one is superior to the others. Material and methods. A prospective study was conducted between May 2015 and June 2018. The sample consisted of 30 adult patients (6 males and 24 females; mean age: 38.87 ±6.40 years) with DDWoR, confirmed with magnetic resonance imaging (MRI). The patients were randomly divided into 3 groups according to the treatment technique applied: arthrocentesis only (control); arthrocentesis plus hyaluronic acid (HA); and arthrocentesis plus platelet-rich plasma (PRP). The maximum mouth opening (MMO) as well as pain intensity and masticatory efficiency on a visual analog scale (VAS) were measured at the time of diagnosis (baseline) and at 1-month, 3-month, 6-month, and 9-month follow-up appointments. The significance level was set at 0.05 for all statistical tests. Results. The 3 techniques resulted in significant improvement in MMO and all VAS parameters. The one-way analysis of variance (ANOVA) revealed significant differences (p < 0.05) in the variables between the 3 groups. The increase in MMO in the PRP and HA groups was significantly greater than in the case of the control group, whereas no significant difference was found between the PRP and HA groups. The pain intensity and masticatory efficiency results were significantly better in the PRP group than in the HA group or the control group; at the same time, no significant differences were noted between the HA group and the control group. Conclusions. Despite the fact that patients benefited from all of the 3 techniques, arthrocentesis plus PRP appeared to be superior to arthrocentesis plus HA or arthrocentesis alone.

Platelet Concentrate Treatments for Temporomandibular Disorders: A Systematic Review and Meta-analysis

“…MMO was calculated by measuring the distance between the upper and lower central incisors, during nonforced MMO. Only 2 out of 9 studies showed significant improvement in MMO in PC group compared to HA (Hegab et al 2015) or saline (Toameh et al 2019) injections. The meta-analysis results showed nonsignificant difference between the PC group compared to HA at 3- and 12-mo follow-up, respectively [weighted mean difference (WMD), 0.97 (−0.68 to 2.63; P = 0.25), 0.23 (−3.53 to 3.99; P = 0.91) [random-effect model]].…”

“…The full text of the related studies was read by 2 researchers for potential inclusion. Of the 34 full-text studies reviewed, 9 studies met the inclusion criteria (Machon et al 2013; Comert Kilic et al 2015; Hanci et al 2015; Hegab et al 2015; Comert Kilic and Gungormus 2016; Fernandez Sanroman et al 2016; Fernandez-Ferro et al 2017; Singh et al 2019; Toameh et al 2019). The other 25 articles were excluded as they did not meet the inclusion criteria.…”

Timing of Arthrocentesis in the Management of Temporomandibular Disorders:A Systematic Review and Meta-analysis

“…The standard deviation of the post-operative MMO and VAS were assumed to be the same as the pre-operative values. In 3 of the studies, arthrocentesis was performed as the initial treatment for TMDs [20][21][22][23] , in 2 of the studies, arthrocentesis was done within 3 months of failing conservative treatment 24,25 , and in 5 of the studies, arthrocentesis was performed after at least 3 months of conservative treatment [26][27][28][29][30] . Both random effects model and fixed effects models were used for construction of forest plots, due to the intention of generalization inference and the high heterogeneity found in the included studies, but also because of the small number of studies included in the meta-analysis.…”

“…In 2 of the studies 24,25 , arthrocentesis was performed within 3 months of failing conservative treatment (2 weeks and 1 month). In the other 5 studies [26][27][28][29][30] , arthrocentesis…”

“…Assessment of the quality of the studies was done. Two studies 22,24 showed a low risk of bias, 5 studies 20,21,26,27,29 showed a moderate risk of bias, and 4 studies 23,25,28,30 showed a high risk of bias. (Table 2)…”