Intra-articular platelet-rich plasma injection for the treatment of temporomandibular disorders and a comparison with arthrocentesis☆
Introduction
Temporomandibular joint disorders (TMD) affect the jaw joints and related structures and includes painful myofacial problems, internal derangement of joint space, abnormalities of bony components, and degenerative and rheumatologic problems. TMD is characterized by pain, joint noise, a limited range of motion, impaired jaw function, deviation or deflection upon mouth opening, malocclusion, and closed or open locking (Gencer et al., 2014, Leeuw, 2008).
Internal derangements that result in progressive displacement of the articular disc are present in a proportion of TMD cases. Anterior disc displacement with reduction refers to an unnatural forward movement of the disc during opening, which reduces on closing. When there is a tear in the back part of the joint capsule, called a retrodiscal ligament, the articular disc may be displaced forwards (anterior disc displacement). The upper head of the lateral pterygoid muscle normally acts to stabilize the disc, however the disc displacement makes it ineffective and the lower head tries to compensate, thus producing abnormal muscle activity during mouth closure. Anterior disc displacement without reduction refers to an unnatural forward positioning of the articular disc, which does not reduce when the mouth is closed. The articular surfaces of the bones are exposed to a greater degree of wear, which may progress to osteoarthritis in later life (Scully, 2008).
Primary goals of the treatment for TMD are to increase the range of motion and relieve the functional pain of the temporomandibular joint (TMJ). The current conservative treatments suggested for TMD include patient behavioral education, resting the jaw, soft diet, analgesic agents, splints, and physiotherapy; surgical interventions include arthrocentesis, disc repositioning, or discectomy for patients with resistant internal derangement (Talley et al., 1990, Dimitroulis et al., 1995).
Platelet-rich plasma (PRP) is a concentrate of platelets and associated growth factors (GFs) obtained through withdrawal and centrifugation of a sample of the patient's blood. PRP was initially introduced in maxillofacial and plastic surgery in the 1990s and its clinical use has surged due to its potential healing properties through the recruitment, proliferation, and differentiation of cells and the tissue remodeling (Anitua et al., 2004, Frank et al., 1997, Marx, 2004).
The aim of this prospective study was to assess whether the intra-articular injection of PRP into the temporomandibular joint in patients with anterior disc displacement with reduction helps to minimize the symptoms that were unresponsive to conservative treatments and to assess how these results compare with arthrocentesis.
Section snippets
Patients
A randomized prospective study with a 6-month follow-up period was designed. The study was approved by the institutional ethics committee (Clinical Research Ethics Committee of Selcuk University Experimental Medicine Research and Application Center; 2011/212). Patients were informed about the study and provided written consent. Twenty patients who had anterior disc dislocation with reduction causing functional disability and pain and who had not responded to conservative treatment were included
Results
No significant complications were reported. Patients experienced temporary swelling and soreness over the TMJ for the first day following procedures. Detailed data about patient demographics and outcomes are presented in Table 1, Table 2.
Discussion
This study showed that arthrocentesis and intra-articular PRP injection helps pain reduction, increases mouth opening, and reduces joint sound when treating patients with anterior disc dislocation with reduction. It was also found that intra-articular PRP injection was more effective than arthrocentesis in patients in this study.
Currently it is known that pain or TMJ dysfunction is related to alteration in the joint intra-articular pressure and biochemical components of the synovial fluid
Conclusion
Our study shows that intra-articular PRP injection for the treatment of TMDs is a more effective management method than arthrocentesis and has several potential theoretical advantages, including faster recovery and improved functional outcomes. To the patient, these benefits will allow an earlier return to regular activities and improved quality of life. The beneficial effects persist at least for a period of 6 months after injection without the presence of pronounced side effects.
Although
Ethical approval
This study was conducted with approval from the Local Ethics Committee. (Clinical Research Ethics Committee of Selcuk University Experimental Medicine Research and Application Center; 2011/212).
Funding
None.
Conflicts of interest
None declared.
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This study was accepted as an oral paper for 34th Annual Congress of the Turkish Society of Plastic Reconstructive and Aesthetic Surgeons and was presented on 3rd November 2012, in Antalya, Turkey. Awarded with Residents Best Presentation-Clinical (Second Prize).