Arthrocentesis, Injectable Platelet-Rich Plasma and Combination of Both Protocols of Temporomandibular Joint Disorders Management: A Single-Blinded Randomized Clinical Trial

Abstract

Introduction Osteoarthritis is one of the most common disorders of the temporomandibular joint (TMJ). The complex etiopathogenesis of the temporomandibular disorders (TMDs), and the variability of symptoms make it difficult to adopt standardized therapeutic protocols. Recently, platelet-rich plasma (PRP) injections have been applied into the TMJ in patients with TMJ osteoarthritis. On the other hand, arthrocentesis has received a widespread acceptance, as a minimally-invasive surgical procedure for TMDs. This study aimed to assess and compare the effect of each of these protocols (arthrocentesis, PRP injection, combination of them) in the management of TMJ osteoarthritis. Methods A single-blinded randomized clinical trial was conducted on a sample of 33 participants with limited mouth opening, pain on function and joint sounds due to TMJ osteoarthritis. Participants were assigned randomly into three groups: Arthrocentesis with PRP group; PRP group; Arthrocentesis group. Maximum mouth opening (MMO), pain and joint sounds were re-evaluated during a six-month observation period. Intra- and inter-group comparisons regarding these variables were performed. Results Participants in all study groups showed statistically significant improvement in terms of MMO and pain during the six-month postoperative period (p<0.05), and showed no significant improvements regarding joint sounds (p>0.05). Pain evaluations showed better outcomes in arthrocentesis with PRP group in comparison to arthrocentesis or injectable PRP alone after six months of follow-up (p<0.05). There were no significant differences in the outcomes of MMO and joint sounds evaluations between the three groups after six months. Conclusions Within the limitations of this study, it can be concluded that the three assessed treatment protocols were effective in improving limited mouth opening and pain in patients with TMJ osteoarthritis. A combination of TMJ arthrocentesis and PRP intra-articular injections showed the best outcomes regarding pain symptoms. None of the tested treatment protocols showed improvement in terms of articular sounds.

Keywords: arthralgia; arthrocentesis; degenerative disease; joint crepitation; limited mouth opening; osteoarthritis; platelet-rich plasma; prolotherapy; temporomandibular disorders; temporomandibular joint.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2022, Abbadi et al.

Figures

Figure 1. Surface landmarks and mark-points for intra-articular access in temporomandibular joint arthrocentesis and/or intra-articular platelet-rich plasma injection procedures.

Canthal-tragus line (blue line); Preauricular line (orange line); Half distance from tragus tip to the intersecting point of blue and orange lines (point A); 10mm away from point A on the blue line (Point B); 10mm away from point B on the blue line (Point C); 2mm below point B (Point D); 10mm below point C (Point E); Auriculotemporal nerve block access point (Point F). This illustration is created by the authors of this study.

Figure 2. Flowchart presenting participants recruitment, allocation, follow-up, and analysis stages of this randomized clinical trial.

A total of 57 patients (n=57) were assessed for eligibility: 24 patients (n=24) were excluded; five patients (n=5) declined to participate; 19 patients (n=19) did not meet the eligibility criteria (bilateral joint symptoms (n=7), symptoms improvement after non-invasive treatment protocol prior to enrollment (n=6), baseline maximum mouth opening of more than 40mm (n=4), and age less than 18 years (n=2)). A total of 33 participants (n=33) were included in all study phases.