Intra-Articular PRP Versus Dexamethasone for TMJ Internal Derangement

Evaluation of the Efficacy of Intra-Articular Injection of Platelet-Rich Plasma Versus Dexamethasone With Local Anaesthetic in the Treatment of Internal Derangement of the Temporomandibular Joint: A Randomised Controlled Trial

This study looked at whether an injection into the jaw joint (temporomandibular joint, or TMJ) can help people who have pain, clicking, and difficulty opening their mouth due to a slipped joint disc. Thirty patients were randomly assigned to receive one of three injections: platelet-rich plasma (PRP, made from the patient's own blood), a steroid medication (dexamethasone) with a local anesthetic, or a saline (salt water) injection as a comparison. Pain, joint clicking, and mouth opening were measured before the injection and one week later. The study found that both PRP and the steroid injection reduced pain and clicking more than saline, and PRP also improved how wide patients could open their mouth.

Study Overview

• Status: Completed
• Conditions: Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome; Temporomandibular Joint Internal Derangement
• Intervention / Treatment: Biological: Platelet-Rich Plasma (PRP); Drug: Dexamethasone with Local Anaesthetic; Other: Normal Saline (Placebo)

Detailed Description

This was a prospective, parallel-group, three-arm randomised controlled trial conducted at the outpatient clinics of the Maxillofacial and Oral Surgery Division, College of Dentistry, University of Anbar, Ramadi, Iraq. Thirty temporomandibular joints (30 patients) with clinically diagnosed disc displacement with reduction, per DC/TMD Axis I criteria, were randomised 1:1:1 by an independent statistician using a computer-generated sequence, with allocation concealed via sequentially numbered opaque envelopes. The outcome assessor was blinded to treatment allocation throughout follow-up. Patients in the dexamethasone and saline arms were not informed of their specific assignment; full blinding was not feasible for the PRP arm due to the visible blood draw and processing required. All three injections used an identical preauricular approach, injection site, needle gauge, and volume (1 mL) to standardise the procedural experience across groups. Within- and between-group differences were analysed using the Wilcoxon signed-rank test and Kruskal-Wallis test with Dunn post-hoc comparisons. This trial was registered retrospectively after enrolment and follow-up were complete.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Iraq
  • Al Najaf
    • Ramadi, Al Najaf, Iraq, 54001
      • College of Dentistry, University of Anbar

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Inclusion Criteria:
• Skeletally mature patients aged 18 years or older
• Symptomatic TMJ internal derangement in the form of disc displacement with reduction (DDwR), diagnosed using DC/TMD Axis I clinical criteria
• TMJ arthralgia confirmed by pain reproduced on palpation or provoked by jaw movement
• Clicking sound detectable on palpation or auscultation during opening and closing movements
• Elimination or marked reduction of the click on mouth opening from a protruded position

Exclusion Criteria:

• Intra-articular injection within the previous six months
• Systemic inflammatory arthropathy
• Coagulopathy
• Active local infection
• Low platelet count
• Ongoing antiplatelet or anticoagulant therapy
• Pregnancy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: PRP; Single intra-articular injection of 0.6 mL leukocyte-poor platelet-rich plasma (PRP) into the superior joint space via a preauricular approach.	Biological: Platelet-Rich Plasma (PRP); Autologous platelet-rich plasma (1 mL) prepared from the patient's own venous blood by centrifugation, injected into the superior joint space of the temporomandibular joint under a standardised preauricular approach.
Active Comparator: Dexamethasone + Local Anaesthetic; Single intra-articular injection of dexamethasone 4 mg (0.5 mL) combined with lidocaine 2% (0.5 mL), total 1 mL, into the superior joint space.	Drug: Dexamethasone with Local Anaesthetic; Intra-articular injection (1 mL) of dexamethasone combined with a local anaesthetic, delivered into the superior joint space of the temporomandibular joint using the same standardised preauricular approach as the other study arms.
Placebo Comparator: Normal Saline (Control); Single intra-articular injection of 1 mL sterile 0.9% sodium chloride into the superior joint space, replicating the full procedural experience without an active agent.	Other: Normal Saline (Placebo); Intra-articular injection (1 mL) of normal saline solution into the superior joint space of the temporomandibular joint, serving as the placebo control, using the same standardised preauricular approach as the other study arms.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Pain Intensity (VAS)	Pain intensity rated on a 10-cm visual analogue scale (0=no pain, 10=worst imaginable pain), reflecting the most intense pain during function.	Baseline and 1 week post-injection

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Joint Sound (Clicking)	Joint sound graded by a blinded assessor on a 3-point ordinal scale: 0=no clicking, 1=clicking detectable on palpation only, 2=clearly audible clicking.	Baseline and 1 week post-injection
Change in Maximum Interincisal Opening (MIO)	Maximum interincisal opening measured in millimetres between upper and lower central incisors at maximum voluntary mouth opening.	Baseline and 1 week post-injection

Collaborators and Investigators

• Sponsor: University Of Anbar
• Investigators: Principal Investigator: Sabah Alheeti, BDS, CABMS, FIBMS, Oral and Maxillofacial Surgery Department / College of Dentistry / University of Anbar

Study record dates

Study Major Dates

• Study Start (Actual): December 10, 2025
• Primary Completion (Actual): April 9, 2026
• Study Completion (Actual): April 9, 2026

Study Registration Dates

• First Submitted: July 2, 2026
• First Submitted That Met QC Criteria: July 2, 2026
• First Posted (Actual): July 9, 2026

Study Record Updates

• Last Update Posted (Actual): July 9, 2026
• Last Update Submitted That Met QC Criteria: July 2, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Randomized Controlled Trial; Dexamethasone; TMJ; Intra-articular Injection; Platelet-Rich Plasma
• Additional Relevant MeSH Terms: Musculoskeletal Diseases; Stomatognathic Diseases; Muscular Diseases; Joint Diseases; Jaw Diseases; Mandibular Diseases; Craniomandibular Disorders; Myofascial Pain Syndromes; Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome; Pharmaceutical Preparations; Polycyclic Compounds; Pregnadienes; Pregnanes; Steroids; Fused-Ring Compounds; Steroids, Fluorinated; Crystalloid Solutions; Isotonic Solutions; Solutions; Anesthesia and Analgesia; Pregnadienetriols; Anesthesia, Conduction; Anesthesia; Dexamethasone; Saline Solution; Anesthesia, Local
• Other Study ID Numbers: UoAnbar-TMJ-PRP-2025; 141 (Other Identifier: University of Anbar Ethical Approval Committee)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: "The dataset supporting the conclusions of this article may be requested from the corresponding author"

Drug and device information, study documents

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