Evaluation of Arthrocentesis With and Without PRP Injection in Patients With Disc Displacement With Reduction.

Evaluation of Arthrocentesis With and Without Platelet Rich Plasma Injection in Patients With Disc Displacement With Reduction.

This study is aiming to evaluate whether large volume of irrigation alone or combined with PRP injection is sufficient for improvement of clinical signs and symptoms

Study Overview

• Status: Recruiting
• Conditions: TMJ Disc Disorder
• Intervention / Treatment: Procedure: arthrocentesis without PRP; Procedure: arthrocentesis with PRP

Detailed Description

The main aim is to determine whether large arthrocentesis volumes with and without PRP will affect the treatment outcome of arthrocentesis , in relation to pain , mouth opening , improves jaw movement, disc position and patients satisfaction . PICO

(P): population : patient with TMD and have clinical signs of disc displacement (I): Intervention: arthrocentesis with normal saline (C): Comparison: two groups 200 ml of normal saline lavage and 200 ml arthrocentesis with PRP (O):Outcome :

Interventions: All patients involved in this study will be divided in to two different groups, one group will receive arthrocentesis with PRP and other group received arthrocentesis only

A through medical and dental history followed by clinical examination was carried out for all patients. Clinical measurements were taken to ensure patient adherence to our initial inclusion criteria prior to further investigations. A preoperative digital panoramic radiograph with 1:1 magnification was taken for each patient as a primary survey in order to exclude the presence of any lesion at the area of interest and MRI to evaluate disc position

Intra operative procedures for 2 groups:

This clinical report describes 2 different manipulations of arthrocentesis with or without PRP

• In two group: infiltration of plain anesthesia was administered using mepivacaine HCl (3%) to anaesthetizing the auriculotemporal nerve followed by posterior deep

temporal and masseter nerves.. Injection to control pain . Scrubbing and draping of the patient was carried out in a standard fashion using betadine surgical scrub.

A straight line is drawn from the medial portion of the ear tragus to the lateral corner of the eye. In this line, two needle insertion points are marked. The first, more posterior point will be at a distance of 10 mm from the tragus and 2 mm below the canthus tragus line. This is the approximate area of the maximum concavity of the glenoid fossa. The distance is about 25mm from skin to the centre of the joint space .The second point will be 20 mm in front of tragus and 10 mm below this same line.

This marking indicates the site of the eminence of the TMJ. After the points of insertion for the two needles have been marked, local anaesthetic is injected at the planned entrance points. Two 19 gauge needles are inserted in the anterior and posterior recesses of the upper joint space . Through one needle, normal saline 200 ml is injected into the superior joint space. The second needle acts as an outflow portal, which allows lavage of the joint cavity

• in the control group:
• in the 1 st study group: The lavage will be 200 ml of normal saline
• in the 2 nd study group: The lavage will be 200 ml of normal saline +PRP

Follow up Patients will be evaluated at day of arthrocentesis and weekly there after for the first month and then after 6 month. clinical assessment will be achieved postoperatively to calculate and assessment of mouth opening , pain and jaw movement.

Recruitment:

1. Patients' data will be enrolled in database of the Outpatient clinics of the Department of Oral & maxillofacial surgery, Faculty of Dentistry, Cairo University
2. If there is a potential eligibility, the patient will be examined thoroughly as described before.
3. Consecutive sampling is done through screening of patients. This will continue until the target population is achieved.
4. Identifying and recruiting potential subjects is achieved through patient database Assignment of interventions

Allocation:

1. Randomization:

   assistant supervisor will carry out the randomization process using a software www.rand.org with a ratio of 1:1.

2. Allocation concealment mechanism:

   All patients who give consent for participation and who fulfill the inclusion criteria will be randomized. Funded patient files in a dark sealed envelope will be the method for allocation concealment.

3. Implementation The supervisors are responsible of division the sealed envelopes into four groups and implementation for patients allocation. Enrolling and helping participants to interventions will by researcher

   Masking/blinding:

   Each patient will be given a code by the researcher and the observers will be blind to which group this case belong. Patients, evaluators and statistician will be blinded.

   Data collection, management, and analysis:

   Data collection methods Primary Outcome: The researcher and assistant supervisor. will calculate and assessment of mouth opening , pain and jaw movement for TWO groups.

   Plans to promote participant retention and complete follow- up:

   Participant Retention:

   A periodic regular follow up recalls will be planned .

   Participant Withdrawal:

   The patient is allowed to drop at any time from the study Participant withdrawal will be recorded and the patient will be excluded from the study. A percentage in the sample size is calculated to make up for any losses. The investigator also may withdraw participants from the study under strict certain conditions and only if the proposed therapy were considered harmful to the patient.

   Data management:

   Data forms and data entry

   All these procedures will be done by Supervisor :

   All data will be entered electronically. Patient files are to be stored in numerical order and stored in secure and accessible place. All data will be maintained in storage for 1 year after completion of the study.

   The electronic data and the scans of the patient will be backed up on a Drop box file for ensuring back up and ease of accessibility. Data Transmission and editing The assessor data entry will be transmitted from the assessors to database officer in the blind separate datasheets who in return record them in participant chart before sending them to the statistician. Security and Back-up of data All forms of the procedures related to study data will be kept in the project secure folder. Access to the study data will be restricted only to database officer. A complete back up of the primary database will be performed twice a month. Back-ups of periodic data analysis file will be kept.

   Statistical methods:

   Data will be coded and entered using the statistical package SPSS version 22. Data will be summarized using mean and standard deviation. Data will be explored for normality using kolmogorov smirnov test. Comparisons between two groups for normally distributed data will be done using analysis of variance (ANOVA), while for non-normally distributed numeric variable will be done by kruskal wallis test. Categorical data will be analyzed using chi square test. P value less than or equal to 0.05 will be considered statistically significant. All test will be two tailed.

   Data monitoring:

   Monitoring The main supervisor will be responsible for data monitoring to evaluate the outcome measures and any possible side effects that might affect the outcome.

   Audit Auditing of the study design will be done by the assistant supervisor

   Ethics and dissemination

   Research ethics approval This protocol and the template informed consent form will be reviewed by the Ethics Committee of Scientific Research - Faculty of Dentistry - Cairo University

   Protocol amendments Any modifications to the protocol which may impact on the conduct of the study, potential benefit of the patient or may affect patient safety, including changes of study objectives, study design, sample sizes, study procedures, or significant administrative aspects will require a formal amendment to the protocol. Such amendment will be agreed upon by the Council of oral and maxillofacial surgery department.

   Informed consent Researcher M.A will introduce and discuss the trial to patients who will be shown a video regarding the main aspects of the trial. Patients will then be able to have an informed discussion with the participating consultant. Researcher will obtain written consent from patients willing to participate in the trial. All consent forms will be translated into Arabic.

   Confidentiality All study-related information such as photos, panoramic x-ray, forms, charts will be stored in a password protected folder on the department database. The password will be available to the study team. But any personal information related to the patient's ID will be stored in and will acquire a coded ID with access only to the database officer.

   Declaration of interest The study is self-funded and there is no conflict of interest to declare.

   Access to data All the research team will have access to the data sets. All data sets will be password protected. To ensure confidentiality, data dispersed to project team members will be blinded of any identifying participant information and the participant will be only identified by patient number.

   Post-trial care All patients will have the primary research contact number in case there is any emergency. Follow up will continue until all patients are satisfied.

   Dissemination policy Study results will be published as partial fulfillment of the requirements for master's degree in Oral and maxillofacial surgery. Topics suggested for presentation or publication will be circulated to the authors

• Study Type: Interventional
• Enrollment (Estimated): 74
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Mohammad IM Alhoor, BSc; Phone Number: +2 01014253972; Email: mohammad.alhoor@dentistry.cu.edu.eg
• Study Contact Backup: Name: Enas FM Eldaour, BSc; Phone Number: +2 0101667613; Email: enas.fadel@dentistry.cu.edu.eg

Study Locations

• Egypt
  • Manial
    • Cairo, Manial, Egypt, 11511
      • Recruiting
      • Faculty of dentistry Cairo Universty
      • Contact: Faculty OD Universty; Phone Number: +2 0223634965; Email: dentmail@dentistry.cu.edu.eg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Chronic pain with good range of motion and anterior disk displacement with reduction
• Degenerative osteoarthritis
• patients with painful joint noises occurring during mouth opening and/or closing

Exclusion Criteria:

• psychiatric
• pathology, fibrous and osseous ankylosis
• multiply operated joints
• regional infectious disease and tumors of the joint
• Immunosuppressed or immunocompromised
• Patients participating in other studies, if the present protocol could not be properly followed.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: 200 ml of normal saline lavage; in the first arm will be used 200 ml of normal saline lavage alone without PRP	Procedure: arthrocentesis without PRP; 200 ml arthrocentesis without PRP
Active Comparator: 200 ml arthrocentesis with PRP; in the second arm will be used 200 ml of normal saline arthrocentesis with PRP	Procedure: arthrocentesis with PRP; 200 ml arthrocentesis with PRP

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
TMJ pain	pain will be measured by Numerical rating scale from 0-10 (0 the lowest pain , 10 the greatest pain) ,will be measured before intervention , immediately after intervention and on follow up ( 1 week , 1 month , 6 month after intervention )	first day , after 1 week , after 1 month and after 6 months of procedure
mouth opening improves	mouth opening improves will be measured by ruler (millimeter) ,will be measured before inervention , immediately after intervention and on follow up ( 1 week , 1 month , 6 month after intervention )	first day , after 1 week , after 1 month and after 6 months of procedure
Jaw movement	Jaw movements has long been used as a measure for clinical diagnosis and assessment quantifying the movements of opening/closing, protrusion and laterotrusion of the mandible , if there any deviation or any abnormality of movement ,will be assessment before intervention, immediately after intervention and on follow up ( 1 week , 1 month , 6 month after intervention)	first day , after 1 week , after 1 month and after 6 months of procedure
Disc position on TMJ	Disc position will by Magnetic resonance imaging (MRI) assessment if their anterior disc displacement with reduction , before intervention and after 6 month of intervention for any improvement with disc position	before procedure and after 6 months of procedure

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient satisfaction	Patient satisfaction will be assessment by Numerical rating scale from 1-10 ( 1 the best, 10 the worst)	after 6 months of intervention

Collaborators and Investigators

• Sponsor: Cairo University
• Investigators: Study Director: Yasmine AA Nassar, Cairo University

Publications and helpful links

General Publications

• Abbadi W, Kara Beit Z, Al-Khanati NM. Arthrocentesis, Injectable Platelet-Rich Plasma and Combination of Both Protocols of Temporomandibular Joint Disorders Management: A Single-Blinded Randomized Clinical Trial. Cureus. 2022 Nov 11;14(11):e31396. doi: 10.7759/cureus.31396. eCollection 2022 Nov.

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2023
• Primary Completion (Actual): March 1, 2024
• Study Completion (Estimated): April 1, 2024

Study Registration Dates

• First Submitted: July 13, 2023
• First Submitted That Met QC Criteria: August 7, 2023
• First Posted (Actual): August 9, 2023

Study Record Updates

• Last Update Posted (Actual): April 2, 2024
• Last Update Submitted That Met QC Criteria: March 31, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: anterior disc displacment with reduction
• Other Study ID Numbers: arthrocentesis and PRP on TMJ

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No