Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis-A Systematic Review

Marcin Derwich, Maria Mitus-Kenig, Elzbieta Pawlowska, Marcin Derwich, Maria Mitus-Kenig, Elzbieta Pawlowska

Abstract

Temporomandibular joint osteoarthritis (TMJ OA) is a low-inflammatory disorder with multifactorial etiology. The aim of this review was to present the current state of knowledge regarding the mechanisms of action and the efficacy of hyaluronic acid (HA), corticosteroids (CS) and platelet-rich plasma (PRP) in the treatment of TMJ OA.: The PubMed database was analyzed with the keywords: "(temporomandibular joint) AND ((osteoarthritis) OR (dysfunction) OR (disorders) OR (pain)) AND ((treatment) OR (arthrocentesis) OR (arthroscopy) OR (injection)) AND ((hyaluronic acid) OR (corticosteroid) OR (platelet rich plasma))". After screening of 363 results, 16 studies were included in this review. Arthrocentesis alone effectively reduces pain and improves jaw function in patients diagnosed with TMJ OA. Additional injections of HA, either low-molecular-weight (LMW) HA or high-molecular-weight (HMW) HA, or CS at the end of the arthrocentesis do not improve the final clinical outcomes. CS present several negative effects on the articular cartilage. Results related to additional PRP injections are not consistent and are rather questionable. Further studies should be multicenter, based on a larger group of patients and should answer the question of whether other methods of TMJ OA treatment are more beneficial for the patients than simple arthrocentesis.

Keywords: arthrocentesis; corticosteroids; hyaluronic acid; intraarticular injections; platelet-rich plasma; temporomandibular joint disorders; temporomandibular joint osteoarthritis.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram for review of the literature.
Figure 2
Figure 2
Schematic relationship between the TMJ intraarticular pressure and HA conformations on the basis of the literature [14]. HA—hyaluronic acid, TMJ—temporomandibular joint.
Figure 3
Figure 3
Schematic genomic action of glucocorticoid receptor on the basis of the literature [40,41]. GR—glucocorticoid receptor, hsp90 and p23—chaperone proteins.

References

    1. Schiffman E., Ohrbach R., Truelove E., Look J., Anderson G., Goulet J.-P., List T., Svensson P., Gonzalez Y., Lobbezoo F., et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group. J. Oral Facial Pain Headache. 2014;28:6–27. doi: 10.11607/jop.1151.
    1. Mercuri L.G., Abramowicz S. Arthritic Conditions Affecting the Temporomandibular Joint. In: Farah C., Balasubramaniam R., McCullough M., editors. Contemporary Oral Medicine. Springer; Cham, Switzerland: 2017.
    1. Glyn-Jones S., Palmer A.J., Agricola R., Price A.J., Vincent T.L., Weinans H., Carr A.J. Osteoarthritis. Lancet. 2015;386:376–387. doi: 10.1016/S0140-6736(14)60802-3.
    1. Hunter D.J., Bierma-Zeinstra S. Osteoarthritis. Lancet. 2019;393:1745–1759. doi: 10.1016/S0140-6736(19)30417-9.
    1. Wang X.D., Zhang J.N., Gan Y.H., Zhou Y.H. Current understanding of pathogenesis and treatment of TMJ osteoarthritis. J. Dent. Res. 2015;94:666–673. doi: 10.1177/0022034515574770.
    1. Tanaka E., Detamore M.S., Mercuri L.G. Degenerative disorders of the temporomandibular joint: Etiology, diagnosis, and treatment. J. Dent. Res. 2008;87:296–307. doi: 10.1177/154405910808700406.
    1. Derwich M., Mitus-Kenig M., Pawlowska E. Orally Administered NSAIDs-General Characteristics and Usage in the Treatment of Temporomandibular Joint Osteoarthritis-A Narrative Review. Pharmaceuticals. 2021;14:219. doi: 10.3390/ph14030219.
    1. Derwich M., Mitus-Kenig M., Pawlowska E. Interdisciplinary Approach to the Temporomandibular Joint Osteoarthritis-Review of the Literature. Medicina. 2020;56:225. doi: 10.3390/medicina56050225.
    1. Gauer R.L., Semidey M.J. Diagnosis and treatment of temporomandibular disorders. Am. Fam. Physician. 2015;91:378–386.
    1. Al-Moraissi E.A., Wolford L.M., Ellis E 3rd Neff A. The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials. J. Craniomaxillofac. Surg. 2020;48:9–23. doi: 10.1016/j.jcms.2019.10.004.
    1. Lin W., Liu Z., Kampf N., Klein J. The Role of Hyaluronic Acid in Cartilage Boundary Lubrication. Cells. 2020;9:1606. doi: 10.3390/cells9071606.
    1. Seror J., Merkherm Y., Kampf N., Collinson L., Day A.J., Maroudas A., Klein J. Articular cartilage proteoglycans as boundary lubricants: Structure and frictional interaction of surface-attached hyaluronan and hyaluronan—Aggrecan complexes. Biomacromolecules. 2011;12:3432–3443. doi: 10.1021/bm2004912.
    1. Guarda-Nardini L., Masiero S., Marioni G. Conservative treatment of temporomandibular joint osteoarthrosis: Intra-articular injection of sodium hyaluronate. J. Oral Rehabil. 2005;32:729–734. doi: 10.1111/j.1365-2842.2005.01505.x.
    1. Cascone P., Fonzi Dagger L., Aboh I.V. Hyaluronic acid’s biomechanical stabilization function in the temporomandibular joint. J. Craniofac. Surg. 2002;13:751–754. doi: 10.1097/00001665-200211000-00006.
    1. Manfredini D., Piccotti F., Guarda-Nardini L. Hyaluronic acid in the treatment of TMJ disorders: A systematic review of the literature. Cranio. 2010;28:166–176. doi: 10.1179/crn.2010.023.
    1. Ferreira N., Masterson D., Lopes de Lima R., de Souza Moura B., Oliveira A.T., Kelly da Silva Fidalgo T., Carvalho A.C.P., DosSantos M.F., Grossmann E. Efficacy of viscosupplementation with hyaluronic acid in temporomandibular disorders: A systematic review. J. Craniomaxillofac. Surg. 2018;46:1943–1952. doi: 10.1016/j.jcms.2018.08.007.
    1. Iwanaga T., Shikichi M., Kitamura H., Yanase H., Nozawa-Inoue K. Morphology and functional roles of synoviocytes in the joint. Arch. Histol. Cytol. 2000;63:17–31. doi: 10.1679/aohc.63.17.
    1. Shinohara T., Izawa T., Mino-Oka A., Mori H., Iwasa A., Inubushi T., Yamaguchi Y., Tanaka E. Hyaluronan metabolism in overloaded temporomandibular joint. J. Oral Rehabil. 2016;43:921–928. doi: 10.1111/joor.12443.
    1. Siiskonen H., Oikari S., Pasonen-Seppänen S., Rilla K. Hyaluronan synthase 1: A mysterious enzyme with unexpected functions. Front. Immunol. 2015;6:43. doi: 10.3389/fimmu.2015.00043.
    1. Faust H.J., Sommerfeld S.D., Rathod S., Rittenbach A., Ray Banerjee S., Tsui B.M.W., Pomper M., Amzel M.L., Singh A., Elisseeff J.H. A hyaluronic acid binding peptide-polymer system for treating osteoarthritis. Biomaterials. 2018;183:93–101. doi: 10.1016/j.biomaterials.2018.08.045.
    1. Seror J., Zhu L., Goldberg R., Day A.J., Klein J. Supramolecular synergy in the boundary lubrication of synovial joints. Nat. Commun. 2015;6:6497. doi: 10.1038/ncomms7497.
    1. Zhu L., Seror J., Day A.J., Kampf N., Klein J. Ultra-low friction between boundary layers of hyaluronan-phosphatidylcholine complexes. Acta Biomater. 2017;59:283–292. doi: 10.1016/j.actbio.2017.06.043.
    1. Das S., Banquy X., Zappone B., Greene G.W., Jay G.D., Israelachvili J.N. Synergistic interactions between grafted hyaluronic acid and lubricin provide enhanced wear protection and lubrication. Biomacromolecules. 2013;14:1669–1677. doi: 10.1021/bm400327a.
    1. Iturriaga V., Vásquez B., Bornhardt T., Del Sol M. Effects of low and high molecular weight hyaluronic acid on the osteoarthritic temporomandibular joint in rabbit. Clin. Oral Investig. 2021 doi: 10.1007/s00784-020-03763-x.
    1. Campo G.M., Avenoso A., Nastasi G., Micali A., Prestipino V., Vaccaro M., D’Ascola A., Calatroni A., Campo S. Hyaluronan reduces inflammation in experimental arthritis by modulating TLR-2 and TLR-4 cartilage expression. Biochim. Biophys. Acta. 2011;1812:1170–1181. doi: 10.1016/j.bbadis.2011.06.006.
    1. Herzog M., Li L., Galla H.J., Winter R. Effect of hyaluronic acid on phospholipid model membranes. Colloids Surf. B Biointerfaces. 2019;173:327–334. doi: 10.1016/j.colsurfb.2018.10.006.
    1. McKee C.M., Penno M.B., Cowman M., Burdick M.D., Strieter R.M., Bao C., Noble P.W. Hyaluronan (HA) fragments induce chemokine gene expression in alveolar macrophages. The role of HA size and CD44. J. Clin. Investig. 1996;98:2403–2413. doi: 10.1172/JCI119054.
    1. Csoka A.B., Frost G.I., Stern R. The six hyaluronidase-like genes in the human and mouse genomes. Matrix Biol. 2001;20:499–508. doi: 10.1016/S0945-053X(01)00172-X.
    1. Greenwald R.A., Moy W.W. Effect of oxygen-derived free radicals on hyaluronic acid. Arthritis Rheum. 1980;23:455–463. doi: 10.1002/art.1780230408.
    1. Takahashi T., Tominaga K., Takano H., Ariyoshi W., Habu M., Fukuda J., Maeda H. A decrease in the molecular weight of hyaluronic acid in synovial fluid from patients with temporomandibular disorders. J. Oral Pathol. Med. 2004;33:224–229. doi: 10.1111/j.0904-2512.2004.00024.x.
    1. Guo X., Watari I., Ikeda Y., Yang W., Ono T. Effect of functional lateral shift of the mandible on hyaluronic acid metabolism related to lubrication of temporomandibular joint in growing rats. Eur. J. Orthod. 2020;42:658–663. doi: 10.1093/ejo/cjaa012.
    1. Meszaros M., Kis A., Kunos L., Tarnoki A.D., Tarnoki D.L., Lazar Z., Bikov A. The role of hyaluronic acid and hyaluronidase-1 in obstructive sleep apnoea. Sci. Rep. 2020;10:19484. doi: 10.1038/s41598-020-74769-4.
    1. Tolba Y.M., Omar S.S., Nagui D.A., Nawwar M.A. Effect of high molecular weight hyaluronic acid in treatment of osteoarthritic temporomandibular joints of rats. Arch. Oral Biol. 2020;110:104618. doi: 10.1016/j.archoralbio.2019.104618.
    1. Duygu G., Güler N., Cam B., Kürkçü M. The effects of high molecular weight hyaluronic acid (Hylan G-F 20) on experimentally induced temporomandibular joint osteoartrosis: Part II. Int. J. Oral Maxillofac. Surg. 2011;40:1406–1413. doi: 10.1016/j.ijom.2011.07.909.
    1. Lemos G.A., Rissi R., Pimentel E.R., Palomari E.T. Effects of high molecular weight hyaluronic acid on induced arthritis of the temporomandibular joint in rats. Acta Histochem. 2015;117:566–575. doi: 10.1016/j.acthis.2015.05.003.
    1. Kapugi M., Cunningham K. Corticosteroids. Orthop. Nurs. 2019;38:336–339. doi: 10.1097/NOR.0000000000000595.
    1. Freire V., Bureau N.J. Injectable Corticosteroids: Take Precautions and Use Caution. Semin. Musculoskelet. Radiol. 2016;20:401–408. doi: 10.1055/s-0036-1594286.
    1. Yaftali N.A., Weber K. Corticosteroids and Hyaluronic Acid Injections. Clin. Sports Med. 2019;38:1–15. doi: 10.1016/j.csm.2018.08.006.
    1. MacMahon P.J., Eustace S.J., Kavanagh E.C. Injectable corticosteroid and local anesthetic preparations: A review for radiologists. Radiology. 2009;252:647–661. doi: 10.1148/radiol.2523081929.
    1. Ramamoorthy S., Cidlowski J.A. Corticosteroids: Mechanisms of Action in Health and Disease. Rheum. Dis. Clin. N. Am. 2016;42:15–31. doi: 10.1016/j.rdc.2015.08.002.
    1. Barnes P.J. Anti-inflammatory actions of glucocorticoids: Molecular mechanisms. Clin. Sci. (Lond.) 1998;94:557–572. doi: 10.1042/cs0940557.
    1. Ingawale D.K., Mandlik S.K. New insights into the novel anti-inflammatory mode of action of glucocorticoids. Immunopharmacol. Immunotoxicol. 2020;42:59–73. doi: 10.1080/08923973.2020.1728765.
    1. Quatrini L., Ugolini S. New insights into the cell- and tissue-specificity of glucocorticoid actions. Cell. Mol. Immunol. 2021;18:269–278. doi: 10.1038/s41423-020-00526-2.
    1. Vandevyver S., Dejager L., Tuckermann J., Libert C. New insights into the anti-inflammatory mechanisms of glucocorticoids: An emerging role for glucocorticoid-receptor-mediated transactivation. Endocrinology. 2013;154:993–1007. doi: 10.1210/en.2012-2045.
    1. Panettieri R.A., Schaafsma D., Amrani Y., Koziol-White C., Ostrom R., Tliba O. Non-genomic Effects of Glucocorticoids: An Updated View. Trends Pharmacol. Sci. 2019;40:38–49. doi: 10.1016/j.tips.2018.11.002.
    1. Buttgereit F. Glucocorticoids: Surprising new findings on their mechanisms of actions. Ann. Rheum. Dis. 2021;80:137–139. doi: 10.1136/annrheumdis-2020-218798.
    1. Kondo T., Kitazawa R., Yamaguchi A., Kitazawa S. Dexamethasone promotes osteoclastogenesis by inhibiting osteoprotegerin through multiple levels. J. Cell. Biochem. 2008;103:335–345. doi: 10.1002/jcb.21414.
    1. Monseau A.J., Nizran P.S. Common injections in musculoskeletal medicine. Prim. Care. 2013;40:987–1000. doi: 10.1016/j.pop.2013.08.012.
    1. Céleste C., Ionescu M., Robin Poole A., Laverty S. Repeated intraarticular injections of triamcinolone acetonide alter cartilage matrix metabolism measured by biomarkers in synovial fluid. J. Orthop. Res. 2005;23:602–610. doi: 10.1016/j.orthres.2004.10.003.
    1. Murray R.C., DeBowes R.M., Gaughan E.M., Zhu C.F., Athanasiou K.A. The effects of intra-articular methylprednisolone and exercise on the mechanical properties of articular cartilage in the horse. Osteoarthr. Cartil. 1998;6:106–114. doi: 10.1053/joca.1997.0100.
    1. Dragoo J.L., Danial C.M., Braun H.J., Pouliot M.A., Kim H.J. The chondrotoxicity of single-dose corticosteroids. Knee Surg Sports Traumatol. Arthrosc. 2012;20:1809–1814. doi: 10.1007/s00167-011-1820-6.
    1. Pietrzak W.S., Eppley B.L. Platelet rich plasma: Biology and new technology. J. Craniofac. Surg. 2005;16:1043–1054. doi: 10.1097/.
    1. Chung P.Y., Lin M.T., Chang H.P. Effectiveness of platelet-rich plasma injection in patients with temporomandibular joint osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2019;127:106–116. doi: 10.1016/j.oooo.2018.09.003.
    1. Bousnaki M., Bakopoulou A., Koidis P. Platelet-rich plasma for the therapeutic management of temporomandibular joint disorders: A systematic review. Int. J. Oral Maxillofac. Surg. 2018;47:188–198. doi: 10.1016/j.ijom.2017.09.014.
    1. Al-Hamed F.S., Hijazi A., Gao Q., Badran Z., Tamimi F. Platelet Concentrate Treatments for Temporomandibular Disorders: A Systematic Review and Meta-analysis. JDR Clin. Trans. Res. 2021;6:174–183. doi: 10.1177/2380084420927326.
    1. Foster T.E., Puskas B.L., Mandelbaum B.R., Gerhardt M.B., Rodeo S.A. Platelet-rich plasma: From basic science to clinical applications. Am. J. Sports Med. 2009;37:2259–2272. doi: 10.1177/0363546509349921.
    1. Le A.D.K., Enweze L., DeBaun M.R., Dragoo J.L. Current Clinical Recommendations for Use of Platelet-Rich Plasma. Curr. Rev. Musculoskelet. Med. 2018;11:624–634. doi: 10.1007/s12178-018-9527-7.
    1. Harrison T.E., Bowler J., Levins T.N., Reeves K.D., Cheng A.L. Platelet-Rich Plasma Centrifugation Changes Leukocyte Ratios. Cureus. 2021;13:e14470. doi: 10.7759/cureus.14470.
    1. Gremmel T., Frelinger A.L., 3rd, Michelson A.D. Platelet Physiology. Semin. Thromb. Hemost. 2016;42:191–204. doi: 10.1055/s-0035-1564835.
    1. King S.M., Reed G.L. Development of platelet secretory granules. Semin. Cell. Dev. Biol. 2002;13:293–302. doi: 10.1016/S1084952102000599.
    1. Nazaroff J., Oyadomari S., Brown N., Wang D. Reporting in clinical studies on platelet-rich plasma therapy among all medical specialties: A systematic review of Level I and II studies. PLoS ONE. 2021;16:e0250007. doi: 10.1371/journal.pone.0250007.
    1. Grambart S.T. Sports medicine and platelet-rich plasma: Nonsurgical therapy. Clin. Podiatr. Med. Surg. 2015;32:99–107. doi: 10.1016/j.cpm.2014.09.006.
    1. Akeda K., An H.S., Okuma M., Attawia M., Miyamoto K., Thonar E.J., Lenz M.E., Sah R.L., Masuda K. Platelet-rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis. Osteoarthr. Cartil. 2006;14:1272–1280. doi: 10.1016/j.joca.2006.05.008.
    1. Anitua E., Fernández-de-Retana S., Alkhraisat M.H. Platelet rich plasma in oral and maxillofacial surgery from the perspective of composition. Platelets. 2021;32:174–182. doi: 10.1080/09537104.2020.1856361.
    1. Medina-Porqueres I., Ortega-Castillo M., Muriel-Garcia A. Effectiveness of platelet-rich plasma in the management of hip osteoarthritis: A systematic review and meta-analysis. Clin. Rheumatol. 2021;40:53–64. doi: 10.1007/s10067-020-05241-x.
    1. Bergstrand S., Ingstad H.K., Møystad A., Bjørnland T. Long-term effectiveness of arthrocentesis with and without hyaluronic acid injection for treatment of temporomandibular joint osteoarthritis. J. Oral Sci. 2019;61:82–88. doi: 10.2334/josnusd.17-0423.
    1. Guarda-Nardini L., Cadorin C., Frizziero A., Ferronato G., Manfredini D. Comparison of 2 hyaluronic acid drugs for the treatment of temporomandibular joint osteoarthritis. J. Oral Maxillofac. Surg. 2012;70:2522–2530. doi: 10.1016/j.joms.2012.07.020.
    1. Tang Y.L., Zhu G.Q., Hu L., Zheng M., Zhang J.Y., Shi Z.D., Liang X.H. Effects of intra-articular administration of sodium hyaluronate on plasminogen activator system in temporomandibular joints with osteoarthritis. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2010;109:541–547. doi: 10.1016/j.tripleo.2009.11.007.
    1. Bouloux G.F., Chou J., Krishnan D., Aghaloo T., Kahenasa N., Smith J.A., Giannakopoulos H. Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short-Term Reduction of Temporomandibular Joint Pain After Arthrocentesis? Part 1. J. Oral Maxillofac. Surg. 2017;75:52–62. doi: 10.1016/j.joms.2016.08.006.
    1. Bouloux G.F., Chou J., Krishnan D., Aghaloo T., Kahenasa N., Smith J.A., Giannakopoulos H. Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short Term for Improving Function and Quality of Life After Arthrocentesis? Part 2. J. Oral Maxillofac. Surg. 2017;75:63–72. doi: 10.1016/j.joms.2016.08.008.
    1. Huddleston Slater J.J., Vos L.M., Story L.P., Stegenga B. Randomized trial on the effectiveness of dexamethasone in TMJ arthrocentesis. J. Dent. Res. 2012;91:173–178. doi: 10.1177/0022034511431260.
    1. Manfredini D., Rancitelli D., Ferronato G., Guarda-Nardini L. Arthrocentesis with or without additional drugs in temporomandibular joint inflammatory-degenerative disease: Comparison of six treatment protocols*. J. Oral Rehabil. 2012;39:245–251. doi: 10.1111/j.1365-2842.2011.02265.x.
    1. Bjørnland T., Gjaerum A.A., Møystad A. Osteoarthritis of the temporomandibular joint: An evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate. J. Oral Rehabil. 2007;34:583–589. doi: 10.1111/j.1365-2842.2007.01759.x.
    1. Møystad A., Mork-Knutsen B.B., Bjørnland T. Injection of sodium hyaluronate compared to a corticosteroid in the treatment of patients with temporomandibular joint osteoarthritis: A CT evaluation. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2008;105:e53–e60. doi: 10.1016/j.tripleo.2007.08.024.
    1. Isacsson G., Schumann M., Nohlert E., Mejersjö C., Tegelberg Å. Pain relief following a single-dose intra-articular injection of methylprednisolone in the temporomandibular joint arthralgia-A multicentre randomised controlled trial. J. Oral Rehabil. 2019;46:5–13. doi: 10.1111/joor.12718.
    1. Cömert Kiliç S. Does Injection of Corticosteroid After Arthrocentesis Improve Outcomes of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial. J. Oral Maxillofac. Surg. 2016;74:2151–2158. doi: 10.1016/j.joms.2016.05.027.
    1. Cömert Kiliç S., Güngörmüş M. Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis plus hyaluronic acid for the treatment of temporomandibular joint osteoarthritis: A randomized clinical trial. Int. J. Oral Maxillofac. Surg. 2016;45:1538–1544. doi: 10.1016/j.ijom.2016.06.009.
    1. Cömert Kiliç S., Güngörmüş M., Sümbüllü M.A. Is Arthrocentesis Plus Platelet-Rich Plasma Superior to Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial. J. Oral Maxillofac. Surg. 2015;73:1473–1483. doi: 10.1016/j.joms.2015.02.026.
    1. Hegab A.F., Ali H.E., Elmasry M., Khallaf M.G. Platelet-Rich Plasma Injection as an Effective Treatment for Temporomandibular Joint Osteoarthritis. J. Oral Maxillofac. Surg. 2015;73:1706–1713. doi: 10.1016/j.joms.2015.03.045.
    1. Fernández Sanromán J., Fernández Ferro M., Costas López A., Arenaz Bua J., López A. Does injection of plasma rich in growth factors after temporomandibular joint arthroscopy improve outcomes in patients with Wilkes stage IV internal derangement? A randomized prospective clinical study. Int. J. Oral Maxillofac. Surg. 2016;45:828–835. doi: 10.1016/j.ijom.2016.01.018.
    1. Fernández-Ferro M., Fernández-Sanromán J., Blanco-Carrión A., Costas-López A., López-Betancourt A., Arenaz-Bua J., Stavaru Marinescu B. Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of temporomandibular dysfunction: A randomised prospective study. J. Craniomaxillofac. Surg. 2017;45:449–454. doi: 10.1016/j.jcms.2017.01.010.

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