Temporomandibular Joint Disorders Treated With Articular Injection

Abstract

The objective of this study was to evaluate the effectiveness of the temporomandibular joint (TMJ) osteoarthritis treatment through articular injections of plasma rich in growth factors (PGRF)-Endoret. Thirteen patients (median age, 47.64 y; SD, 7.51; range, 40-64 y; male-female ratio, 2:11) with osteoarthritis of TMJ associated to chronic pain have been selected. They were treated with articular injections of PRGF-Endoret, measuring the maximum mouth opening and pain level before the first injection (t0), 30 days after just before the second (t1), and after 6 months (t2). Data were analyzed using the paired Student's t-test data. The visual analogue scale score at t0 is 7.69 (range, 4-10; SD, 1.9), whereas that at t1 is 1.54 (range, 0-5; SD, 1.74) and that at t2 is 0.23 (range, 0-2; SD, 0.65). These differences in the results are statistically highly significant (P < 0.0001 comparison t0-t1 and t0-t2 and P < 0.01 comparison t1-t2). In terms of maximum mouth opening, it reduced from 30.15 mm at t0 (range, 26-40 mm; SD, 4.44) to 37.54 mm at t1 (range, 31-51 mm; SD, 5.10), with an increase of 7.38 mm (range, 4-11 mm; SD, 2.02) and a highly significant difference (P < 0.0001). At t2, it was 39.54 mm (range, 34-51; SD, 4.55) with an increase of 9.38 mm (range, 5-12 mm; SD, 2.21) compared with t0 and that of 2.00 mm compared with t1. Both differences in the results are statistically significant (P < 0.0001 and P < 0.01, respectively). The articular injections of PRGF-Endoret represent a very efficient method to control pain and to improve the TMJ mobility.

Clinical efficacy of a centric relation occlusal splint and intra-articular liquid phase concentrated growth factor injection for the treatment of temporomandibular disorders

“…After 1.5 to 2 mL PRP was injected once every other month and twice in total over 6 months of observation, it was discovered that the VAS pain score dropped from 7.69 ± 1.9 to 0.23 ± 0.65 ( P  < 0.0001), and MIO increased from preinjection 30.15 ± 4.44 to 39.54 ± 4.55 mm ( P  < 0.0001) at the 6th postinjection month, which improved by 9.38 ± 2.21 mm in total. [15] The above 3 studies by Pihut et al, Machon et al, and Giacomello et al have all been mentioned in their inclusion conditions. Their groups under investigation have all undergone treatment by occlusal splint without any improvement.…”

Effect of arthrocentesis plus platelet-rich plasma and platelet-rich plasma alone in the treatment of temporomandibular joint osteoarthritis

“…At 6 months post-treatment, the VAS pain score decreased from 7.69 ± 1.9 to 0.23 ± 0.65 ( P < .0001), and the MIO improved by 9.38 ± 2.21 mm from the pretreatment level of 30.15 ± 4.44 mm to 39.54 ± 4.55 mm ( P < .0001). [ 11 ] The study conducted by Hegab et al enrolled 50 TMJ-OA patients who never received any treatment for TMDs, in which 25 patients in the study group received 3 injections of 1 mL of PRP following arthrocentesis with 50 mL of Ringer's lactate solution over 1-week intervals. At 12 months post-treatment, the VAS pain score decreased from 7.36 ± 1.11 to 0.4 ± 0.76 (power = 97%), and the MIO improved from 33.88 ± 3.09 mm to 41.56 ± 2.31 mm.…”

“…In the studies mentioned above, the PRP treatment was inconsistent and varied greatly in the injection dose and times, including 0.5 mL once; [ 6 ] 0.6 mL once; [ 12 ] 1 mL once every 2 weeks, twice; [ 13 ] 1.5 – 2 mL once a month, twice; [ 11 ] 1 mL once every week, 3 times; [ 1 ] or 1 mL once a month, 4 times, [ 10 ] but none of them provided explanations regarding their selection of injection dose and frequency. The injection volume of 2 mL that was used in this study due to a deduction that 2 mL might be the most efficient volume because it is the maximal volume of the joint space.…”

A Young Patient with Temporomandibular Joint Osteoarthritis: Case Report

“…application of PRGF in the joint did not give significantly different results compared to conservative, non-invasive methods. After PRGF application, Giacomello et al an increase of 9.38 mm in the range of mouth opening after 6 months was found ( 10 ). Patient presented in our study, presented the increase in the range of, mouth opening of 13 mm.…”

“…Minimally invasive procedures include methods that comprise application of corticosteroids, local anesthetics, plasma rich growth factors (PRGF) ( 10 , 11 ) into the joint, as well as artrocentesis (removal of inflammatory exudate) in combination with hyaluronic acid injections. Invasive or surgical therapy plays a small but important role in the treatment of OA, particularly in patients who do not respond to less invasive therapies.…”