1
|
Taşkesen F, Cezairli B. Efficacy of prolotherapy and arthrocentesis in management of temporomandibular joint hypermobility. Cranio 2023; 41:423-431. [PMID: 33326351 DOI: 10.1080/08869634.2020.1861887] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of dextrose prolotherapy in conjunction with arthrocentesis and dextrose prolotherapy alone in the management of symptomatic TMJ hypermobility. METHODS Twenty-four patients suffering from TMJ symptomatic hypermobility received 10% dextrose injections for three sessions at four-week intervals. Twelve patients (P group) received prolotherapy alone; the other 12 (PA group) also underwent a single arthrocentesis session. Patients were evaluated for maximal incisal opening, maximal incisal opening without pain, pain at rest, pain during chewing function, TMJ sound, and locking episode frequency. RESULTS Pain scores were significantly reduced in both groups, and the locking episode frequency was decreased to a greater extent in the PA than the P group, at both the short and long terms. CONCLUSION Prolotherapy is effective in the management of TMJ hypermobility. However, prolotherapy with arthrocentesis may be superior to prolotherapy alone in the management of TMJ hypermobility.
Collapse
Affiliation(s)
- Fatih Taşkesen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Burak Cezairli
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ordu University, Ordu, Turkey
| |
Collapse
|
2
|
Cömert Kiliç S, Kiliç N, Güngörmüş M. Botulinum Toxin Versus Dextrose Prolotherapy: Which is More Effective for Temporomandibular Joint Subluxation? A Randomized Clinical Trial. J Oral Maxillofac Surg 2023; 81:389-395. [PMID: 36693543 DOI: 10.1016/j.joms.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE Botulinum toxin type A (BTX-A) therapy or dextrose prolotherapy (DP) has been used to treat temporomandibular joint (TMJ) disorders. However, the superiority of one method over the other has not been studied in patients with TMJ subluxation. Therefore, this study aims to answer the following clinical question: among patients with TMJ subluxation, do those undergoing BTX-A injection into lateral pterygoid muscles, compared to those undergoing intra- and periarticular DP injections, have better outcomes in terms of locking episodes and patient satisfaction? METHODS A randomized clinical trial was implemented in adult patients with TMJ subluxation. The sample was composed of patients with TMJ subluxation with painful open-locking during wide mouth opening and/or yawning at baseline. The subjects were treated randomly with one of two treatment techniques with equal numbers as follows: one-session BTX-A injection into lateral pterygoid muscles (BTX-A group) or three sessions of dextrose injections around TMJ (prolotherapy group). The predictor variable was the treatment technique (BTX-A or prolotherapy injections). The primary outcome variable was the frequency of locking episodes. The secondary outcome variable was patient satisfaction. The primary outcome variable was recorded at baseline and 8-12 months following the injections. The secondary outcome variable was recorded only 8-12 months following the injections. Descriptive and bivariate statistics were computed. The data were analyzed with the Wilcoxon and Mann-Whitney U tests. RESULTS The baseline sample was composed of 30 patients with TMJ subluxation. However, the follow-up sample comprised 25 subjects: 11 (9 females, 2 males; 25.64 years) in the BTX-A group and 14 (10 females, 4 males; 32.37 years) in the prolotherapy group. Locking episodes decreased significantly in the two groups with no significant difference (P < .01). Seven patients in the BTX-A group (7 of 11 patients; 63.6 percent) and eight (8 of 14 patients; 57.1 percent) in the prolotherapy group reported no complaint of locking at the end of follow-up, with no significant difference between the groups (P > .05). Patient satisfaction showed no significant difference between the groups (P > .05). CONCLUSION These findings suggested that BTX-A injection is no more effective than DP for any outcome variables of TMJ subluxation assessed.
Collapse
Affiliation(s)
- Songül Cömert Kiliç
- Associate Professor. Atatürk University, Dentistry of Faculty, Atatürk University, Erzurum, Turkey.
| | - Nihat Kiliç
- Professor. Atatürk University, Dentistry of Faculty, Atatürk University, Erzurum, Turkey
| | - Metin Güngörmüş
- Professor. Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| |
Collapse
|
3
|
Vaidyanathan A, Haidry N, Sinha U, Singh A, Salahudheen A. Evaluation of the Effects of Polidocanol Injection in the Treatment of Temporomandibular Joint Hypermobility - A Prospective Study. Ann Maxillofac Surg 2022; 12:166-172. [PMID: 36874776 PMCID: PMC9976867 DOI: 10.4103/ams.ams_138_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Sclerosing agents have been used for temporomandibular joint (TMJ) hypermobility since decades, some of which are ethanolamine oleate, and OK-432, sodium psylliate (sylnasol), but there are no studies on the usage of polidocanol - a well-known sclerosing agent which does not have much side effects and is inexpensive. Hence, this study evaluates the effect of polidocanol injection in the treatment of TMJ hypermobility. Methodology This was a prospective observational study in which patients with chronic TMJ hypermobility were included. Out of the 44 patients who had symptoms of clicking and pain of the TMJ, 28 were diagnosed as internal derangement of the TMJ. The final analysis included 15 patients in whom multiple injections of polidocanol were given on the basis of post-operative parameters. The sample size was calculated based on a significance level of 0.05 and a power of 80%. Results Overall, a success rate of 86.6% (13/15) was encountered at the end of three months, with seven patients not reporting any further episodes of dislocation after one injection and six patients not reporting any episode of dislocation after two injections. Discussion Polidocanol sclerotherapy can be used as a treatment modality for chronic recurrent dislocation of the TMJ, rather than opting for more invasive procedures for the same.
Collapse
Affiliation(s)
- Aiswarya Vaidyanathan
- Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Naqoosh Haidry
- Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Upasna Sinha
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Abhishek Singh
- Department of Dentistry, Government Medical College, Saharanpur, Uttar Pradesh, India
| | - Ameera Salahudheen
- Department of Dentistry, All India Institute of Medical Sciences, Patna, Bihar, India
| |
Collapse
|
4
|
Haggag MA, Al-Belasy FA, Said Ahmed WM. Dextrose prolotherapy for pain and dysfunction of the TMJ reducible disc displacement: A randomized, double-blind clinical study. J Craniomaxillofac Surg 2022; 50:426-431. [DOI: 10.1016/j.jcms.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 01/08/2022] [Accepted: 02/27/2022] [Indexed: 11/29/2022] Open
|
5
|
Memiş S. Evaluation of the effects of prolotherapy on condyles in temporomandibular joint hypermobility using fractal dimension analysis. J Korean Assoc Oral Maxillofac Surg 2022; 48:33-40. [PMID: 35221305 PMCID: PMC8890968 DOI: 10.5125/jkaoms.2022.48.1.33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/24/2021] [Accepted: 01/03/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives Prolotherapy is a method that has gained popularity in recent years and has been reported to have positive short-term and long-term clinical results in maxillofacial surgery, especially temporomandibular joint (TMJ) hypermobility. This study aimed to evaluate the changes in the trabecular structure of mandibular condyles in patients who underwent prolotherapy due to TMJ hypermobility using the fractal analysis method. Materials and Methods Forty-five patients who received dextrose prolotherapy at a concentration of 20% and fifteen control patients were included in the study. All patients had panoramic radiographs just before (T0) and six months after treatment (T1). The patients who received treatment were divided into three groups according to the number of prolotherapy injections. The regions of interest were selected from bone areas close to the articular surfaces of the condyles. The fractal dimension (FD) values were calculated. Results The main effect of time on the FD value was significant [F (1, 56)=86.176, P<0.001]. This effect was qualified by a significant time×group interaction effect [F (3, 56)=9.023, P<0.001]. The decreases in FD values in all treatment groups between T0 and T1 times were significant (P=0.004). However, changes in FD values were not significant in the control group (P=0.728). Conclusion Dextrose prolotherapy without the effect of the number of injections caused a decrease in FD values in the mandibular condyles over time.
Collapse
Affiliation(s)
- Sadi Memiş
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University, Kocaeli, Turkey
| |
Collapse
|
6
|
Efficacy of hypertonic dextrose injection (prolotherapy) in temporomandibular joint dysfunction: a systematic review and meta-analysis. Sci Rep 2021; 11:14638. [PMID: 34282199 PMCID: PMC8289855 DOI: 10.1038/s41598-021-94119-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023] Open
Abstract
Hypertonic dextrose prolotherapy (DPT) has been reported to be effective for temporomandibular disorders (TMDs) in clinical trials but its overall efficacy is uncertain. To conduct a systematic review with meta-analysis of randomized controlled trials (RCTs) to synthesize evidence on the effectiveness of DPT for TMDs. Eleven electronic databases were searched from their inception to October, 2020. The primary outcome of interest was pain intensity. Secondary outcomes included maximum inter-incisal mouth opening (MIO) and disability score. Studies were graded by “Cochrane risk of bias 2” tool; if data could be pooled, a meta-analysis was performed. Ten RCTs (n = 336) with some to high risk of bias were included. In a meta-analysis of 5 RCTs, DPT was significantly superior to placebo injections in reducing TMJ pain at 12 weeks, with moderate effect size and low heterogeneity (Standardized Mean Difference: − 0.76; 95% CI − 1.19 to − 0.32, I2 = 0%). No statistically significant differences were detected for changes in MIO and functional scores. In this systematic review and meta-analysis, evidence from low to moderate quality studies show that DPT conferred a large positive effect which met criteria for clinical relevance in the treatment of TMJ pain, compared with placebo injections. Protocol registration at PROSPERO: CRD42020214305.
Collapse
|
7
|
Chung MW, Hsu CY, Chung WK, Lin YN. Effects of dextrose prolotherapy on tendinopathy, fasciopathy, and ligament injuries, fact or myth?: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23201. [PMID: 33181700 PMCID: PMC7668443 DOI: 10.1097/md.0000000000023201] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/30/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Prolotherapy or proliferative therapy is a treatment option for damaged connective tissues involving the injection of a solution (proliferant) which theoretically causes an initial cell injury and a subsequent "proliferant" process of wound healing via modulation of the inflammatory process. Nonetheless, the benefits of dextrose prolotherapy have not been adequately evaluated. Therefore, the present study assesses the effectiveness and superiority of prolotherapy separately in treating dense fibrous connective tissue injuries. METHODS PubMed, Scopus, and Embase were searched from the earliest record to February 18, 2019. This study included randomized controlled trials whichBoth analysis at individual studies level and pooled meta-analysis were performed. RESULTS Ten trials involving 358 participants were included for review. At study level, the majority of comparisons did not reveal significant differences between dextrose prolotherapy and no treatment (or placebo) regarding pain control. The meta-analysis showed dextrose prolotherapy was effective in improving activity only at immediate follow-up (i.e., 0-1 month) (standardized mean difference [SMD]: 0.98; 95% confidence interval [CI]: 0.40-1.50; I = 0%); and superior to corticosteroid injections only in pain reduction at short-term follow-up (i.e., 1-3 month) (SMD: 0.70; 95% CI: 0.14-1.27; I = 51%). No other significant SMDs were found in this analysis. CONCLUSIONS There is insufficient evidence to support the clinical benefits of dextrose prolotherapy in managing dense fibrous tissue injuries. More high-quality randomized controlled trials are warranted to establish the benefits of dextrose prolotherapy. REVIEW REGISTRATION PROSPERO (CRD42019129044).
Collapse
Affiliation(s)
| | - Chih-Yang Hsu
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University
| | - Wen-Kuei Chung
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
8
|
Zarate MA, Frusso RD, Reeves KD, Cheng AL, Rabago D. Dextrose Prolotherapy Versus Lidocaine Injection for Temporomandibular Dysfunction: A Pragmatic Randomized Controlled Trial. J Altern Complement Med 2020; 26:1064-1073. [PMID: 32780636 DOI: 10.1089/acm.2020.0207] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: Several intraarticular injections, including dextrose and lidocaine, are reported to reduce pain and dysfunction in temporomandibular dysfunction (TMD) and increase maximal jaw opening; our goal was to determine whether dextrose/lidocaine outperforms sterile water/lidocaine for TMD. Design: Pragmatic randomized controlled trial. Setting: Outpatient clinic. Subjects: Chronic (≥3 months) of moderate-to-severe (≥6/10) jaw or facial pain meeting research-specific TMD criteria. Intervention: Blinded intraarticular dextrose prolotherapy (DPT) (20% dextrose/0.2% lidocaine) versus intraarticular lidocaine (0.2% lidocaine in sterile water) at 0, 1, and 2 months. Participants were then unblinded and offered DPT by request for 9 additional months. Main outcome measures: Primary: Numerical Rating Scale (0-10 points) score for facial pain and jaw dysfunction; percentage achieving ≥50% improvement in pain and dysfunction (0, 3, and 12 months). Secondary: Maximal interincisal opening (MIO; 0 and 3 months). Intention-to-treat analysis was by joint using mixed-model regression. Results: Randomization of 29 participants (25 female, 47 ± 17 years, 43 joints) produced similar groups. Three-month pain and dysfunction improvements were similar, but more DPT-treated joints improved by ≥50% in pain (17/22 vs. 6/21; p = 0.028). The MIO improved in both groups (5.6 ± 5.8 mm vs. 5.1 ± 7.0 mm; p = 0.70). From 3 to 12 months, minimal DPT was received by original DPT and lidocaine recipients, 0.5 ± 0.9 and 0.6 ± 1.5 injections, respectively, with only 2 out of 21 joints in the original lidocaine group receiving more than 1 dextrose injection after 3 months. Twelve-month analysis revealed that joints in the original DPT group improved more in jaw pain (4.8 ± 2.4 points vs. 2.6 ± 2.9 points; p = 0.026) and jaw dysfunction (5.3 ± 2.6 points vs. 2.7 ± 2.3 points; p = 0.013). More DPT than lidocaine-treated joints improved by ≥50% in both pain (19/22 vs. 5/21; p = 0.003) and dysfunction (17/22 vs. 7/21; p = 0.040). There were no adverse events; satisfaction was high. Conclusions: Intraarticular DPT resulted in clinically important and statistically significant improvement in pain and dysfunction at 12 months compared to lidocaine injection (ClinicalTrials.gov identifier NCT01617356).
Collapse
Affiliation(s)
- Miguel Angel Zarate
- Private Practice Family Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Daniel Frusso
- Private Practice Family Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - David Rabago
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
9
|
Treatment of temporomandibular joint luxation: a systematic literature review. Clin Oral Investig 2019; 24:61-70. [DOI: 10.1007/s00784-019-03126-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
Abstract
Objectives
To evaluate the effectiveness of surgical and nonsurgical treatment of temporomandibular joint (TMJ) luxation.
Materials and methods
This systematic literature review searched PubMed, the Cochrane Library, and Web of Science databases to identify randomized controlled trials on TMJ luxation treatment published between the inception of each database and 26 March 2018.
Results
Two authors assessed 113 unique abstracts according to the inclusion criteria and read nine articles in full text. Eight articles comprising 338 patients met the inclusion criteria, but none of these evaluated surgical techniques. Three studies including 185 patients concerned acute treatment with manual reduction of luxation while five studies including 153 patients evaluated minimally invasive methods with injection of autologous blood or dextrose prolotherapy for recurrent TMJ luxation. These studies reported that mouth opening after treatment was reduced and that independent of type of injection, recurrences of TMJ luxation were rare in most patients.
Conclusions
In the absence of randomized studies on surgical techniques, autologous blood injection in the superior joint space and pericapsular tissues with intermaxillary fixation seems to be the treatment for recurrent TMJ luxation that at present has the best scientific support. Well-designed studies on surgical techniques with sufficient numbers of patients, long-term follow-ups, and patient experience assessment are needed for selection of the optimal surgical treatment methods.
Clinical relevance
Autologous blood injection combined with intermaxillary fixation can be recommended for patients with recurrence of TMJ luxation.
Collapse
|
10
|
Louw WF, Reeves KD, Lam SKH, Cheng AL, Rabago D. Treatment of Temporomandibular Dysfunction With Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial With Long-term Partial Crossover. Mayo Clin Proc 2019; 94:820-832. [PMID: 30878157 DOI: 10.1016/j.mayocp.2018.07.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/10/2018] [Accepted: 07/03/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess the efficacy and longer-term effectiveness of dextrose prolotherapy injections in participants with temporomandibular dysfunction. PATIENTS AND METHODS A randomized controlled trial with masked allocation was conducted from January 14, 2013, through December 19, 2015. Forty-two participants (with 54 joints) meeting temporomandibular dysfunction criteria were randomized (1:1) to 3 monthly intra-articular injections (20% dextrose/0.2% lidocaine or 0.2% lidocaine) followed by as-needed dextrose/0.2% lidocaine injections through 1 year. Primary and secondary outcome measures included a 0 to 10 Numerical Rating Scale score for facial pain and jaw dysfunction; maximal interincisal opening (MIO) measured in millimeters, percentage of joints with 50% or more change (improvement) in pain and function, and satisfaction. RESULTS Randomization produced a control group with more female participants (P=.03), longer pain duration (P=.01), and less MIO (P=.01). Upon 3-month analysis, including pertinent covariates, dextrose group participants reported decreased jaw pain (4.3±2.9 points vs 1.8±2.7 points; P=.02), jaw dysfunction (3.5±2.8 points vs 1.0±2.1 points; P=.008), and improved MIO (1.5±4.1 mm vs -1.8±5.1 mm; P=.006). Control group participants received dextrose injections beginning at 3 months. No between-group differences were noted at 12 months; pooled data suggested that jaw pain, jaw function, and MIO improved by 5.2±2.7 points (68%), 4.1±2.8 points (64%), and 2.1±5.5 mm, respectively. Pain and dysfunction improved by at least 50% in 38 of 54 (70%) and 39 of 54 (72%) jaws, respectively. CONCLUSION Intra-articular dextrose injection (prolotherapy) resulted in substantial improvement in jaw pain, function, and MIO compared with masked control injection at 3 months; clinical improvements endured to 12 months. Satisfaction was high. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01706172.
Collapse
Affiliation(s)
- Wynand Francois Louw
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - K Dean Reeves
- Private Practice, Physical Medicine and Rehabilitation, Roeland Park, KS.
| | - Stanley K H Lam
- Department of Family Medicine, Chinese University of Hong Kong, Hong Kong
| | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, Kansas City, MO
| | - David Rabago
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|
11
|
Evaluation of the Efficacy of Different Concentrations of Dextrose Prolotherapy in Temporomandibular Joint Hypermobility Treatment. J Craniofac Surg 2018. [PMID: 29533255 DOI: 10.1097/scs.0000000000004480] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aim of this study was to compare and evaluate the efficacy of different concentrations of dextrose prolotherapy for the treatment of temporomandibular joint (TMJ) hypermobility. PATIENTS AND METHODS A prospective, randomized clinical trial including patients with subluxation or dislocation was performed. The study comprised 40 patients. Patients were randomly divided into 4 groups: control group, 10% dextrose, 20% dextrose, and 30% dextrose group. Patients in all groups received injections into 4 different areas of each TMJ in 4 sessions at monthly intervals. Visual analog scale of TMJ pain intensity, maximum mouth opening (MMO), joint sounds, and frequency of luxations were recorded preoperatively and postoperatively after 1 month of last injection. The collected data were then statistically analyzed. RESULTS Each group showed postoperatively significant improvement in TMJ pain, significant decrease in both MMO and joint sound. Besides that, TMJ locking was not observed in any patient during the follow-up period. There were no statistically significant differences throughout the study intervals between the groups. CONCLUSION It was concluded that there was no significant difference between control group and dextrose groups and there is no superiority of any concentration of dextrose over the others in TMJ prolotherapy, and all treatment procedures were efficient in improvement of clinical symptoms related to TMJ hypermobility. If dextrose is used as a proliferant, it can be said that 10% dextrose can be sufficient in TMJ hypermobility treatment.
Collapse
|
12
|
Fouda AA. Change of site of intra-articular injection of hypertonic dextrose resulted in different effects of treatment. Br J Oral Maxillofac Surg 2018; 56:715-718. [PMID: 30107954 DOI: 10.1016/j.bjoms.2018.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/26/2018] [Indexed: 11/30/2022]
Abstract
Most minimally invasive treatments for dysfunction of the temporomandibular joint (TMJ) are empirical, and aimed at the painful trigger points with the purpose of preventing muscular spasm and restoring normal function. In this prospective study I investigated whether the choice of site of injection of hypertonic dextrose affected the benefits of treatment of internal derangement and pain. I studied 72 patients with pain and clicking as a result of dysfunction of the TMJ. Patients were divided into four groups with four separate sites for intra-articular injection. Dextrose was injected into the superior joint space, inferior joint space, retrodiscal tissue, and anterior capsule injection. Results showed that the retrodiscal site was the most effective for reducing clicking and subsequently improving derangement, while the inferior joint space was the best site for the relief of pain, and the extracapsular site should be used in cases of hypermobility. In conclusion, the injection site should be selected according to the symptoms being treated, and could be used as an adjunct to other sites to improve outcome.
Collapse
Affiliation(s)
- A A Fouda
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Cairo University, Giza 12111, Egypt.
| |
Collapse
|
13
|
Nagori SA, Jose A, Gopalakrishnan V, Roy ID, Chattopadhyay PK, Roychoudhury A. The efficacy of dextrose prolotherapy over placebo for temporomandibular joint hypermobility: A systematic review and meta-analysis. J Oral Rehabil 2018; 45:998-1006. [PMID: 30024045 DOI: 10.1111/joor.12698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/01/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the systematic review was to analyse the available evidence in order to assess the efficacy of dextrose prolotherapy in improving outcomes in temporomandibular joint (TMJ) hypermobility patients as compared to placebo. METHODS An electronic search of PubMed, Scopus, CENTRAL and Google scholar databases was performed for English language papers published up to February 2018. Randomised clinical trials (RCTs) and controlled clinical trials (CCTs) comparing dextrose prolotherapy with placebo for TMJ hypermobility were included. RESULTS Three RCTs were included in the review. Frequency of subluxation/dislocation was reported by two trials which found no difference between dextrose and placebo. A statistical significant difference in reduction of MMO with the use of dextrose prolotherapy was seen on pooling of data (random: MD = -3.32, 95% CI -5.26 to -1.28; P = 0.0008; I2 = 0%). A statistical significant difference in pain reduction was also seen with dextrose as compared to placebo (random: MD = -1, 95% CI -1.58 to -0.42; P = 0.0007; I2 = 0%). CONCLUSION Within the limitations of the study, dextrose prolotherapy may cause significant reduction in mouth opening and pain associated with TMJ hypermobility. Conclusions with regard to reduction of episodes of subluxation/dislocation cannot be drawn. There is a need of more high-quality RCTs with larger sample size and homogenous prolotherapy protocol to draw stronger conclusions on the effect of dextrose prolotherapy in patients with TMJ hypermobility.
Collapse
Affiliation(s)
| | - Anson Jose
- Division of Oral and Maxillofacial Surgery, Army Dental Centre (Research & Referral), New Delhi, India
| | | | - Indranil Deb Roy
- Division of Oral and Maxillofacial Surgery, Army Dental Centre (Research & Referral), New Delhi, India
| | - Probodh K Chattopadhyay
- Division of Oral and Maxillofacial Surgery, Army Dental Centre (Research & Referral), New Delhi, India
| | - Ajoy Roychoudhury
- Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
14
|
Renapurkar SK, Laskin DM. Injectable Agents Versus Surgery for Recurrent Temporomandibular Joint Dislocation. Oral Maxillofac Surg Clin North Am 2018; 30:343-349. [DOI: 10.1016/j.coms.2018.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
15
|
Zaki AA, Zaghloul M, Helal ME, Mansour NA, Grawish ME. Impact of Autologous Bone Marrow-Derived Stem Cells on Degenerative Changes of Articulating Surfaces Associated With the Arthritic Temporomandibular Joint: An Experimental Study in Rabbits. J Oral Maxillofac Surg 2017; 75:2529-2539. [PMID: 28576669 DOI: 10.1016/j.joms.2017.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/02/2017] [Accepted: 05/02/2017] [Indexed: 12/11/2022]
|
16
|
Cezairli B, Sivrikaya EC, Omezli MM, Ayranci F, Seyhan Cezairli N. Results of Combined, Single-Session Arthrocentesis and Dextrose Prolotherapy for Symptomatic Temporomandibular Joint Syndrome: A Case Series. J Altern Complement Med 2017; 23:771-777. [DOI: 10.1089/acm.2017.0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Burak Cezairli
- Department of Oral Maxillofacial Surgery, Ordu University, Ordu, Turkey
| | - Efe Can Sivrikaya
- Department of Oral Maxillofacial Surgery, Ordu University, Ordu, Turkey
| | | | - Ferhat Ayranci
- Department of Oral Maxillofacial Surgery, Ordu University, Ordu, Turkey
| | | |
Collapse
|
17
|
Refai H. Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint: a single-arm study with 1-4 years' follow up. Br J Oral Maxillofac Surg 2017; 55:465-470. [PMID: 28460873 DOI: 10.1016/j.bjoms.2016.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/01/2016] [Indexed: 12/26/2022]
Abstract
The aim was to analyse the short-term and long-term therapeutic efficacy of dextrose prolotherapy for dislocation or subluxation (hypermobility) of the temporomandibular joint (TMJ). Sixty-one patients with symptomatic hypermobility of the TMJ were included in this single-arm prospective study, in which they were each given four sessions of intra-articular and pericapsular injections six weeks apart. Each injection comprised 10% dextrose/mepivacaine solution 3ml. Clinical outcomes including severity of pain on movement according to the numerical rating scale (NRS), maximal interincisal opening, clicking, and frequency of locking were measured before treatment (T1), during treatment (T2) (just before the third session of injections), at the short-term follow-up (T3) (three months after treatment), and at the long-term follow-up (T4) (1-4 years after treatment). Condylar translation and osseous changes of each joint were evaluated at T1 and T4 using tomography. There was significant reduction in all variables by T2 (p<0.001, p<0.001, p=0.006, and p<0.001). The pain scores (p<0.001) and clicking (p<0.001) had decreased significantly by T3. Linear tomograms of each joint at T1 and T4 showed no alteration in the morphology of the bony components of the joint, and at T4, tomographic open views of all joints showed condylar hypertranslation. Dextrose prolotherapy provided significant and sustained reduction of pain and recovery of constitutional symptoms associated with symptomatic hypermobility of the TMJ without changing either the position of the condyle or the morphology of the bony components of the joint.
Collapse
Affiliation(s)
- H Refai
- Department of Oral and Maxillofacial Surgery, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt.
| |
Collapse
|
18
|
Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2016; 9:139-59. [PMID: 27429562 PMCID: PMC4938120 DOI: 10.4137/cmamd.s39160] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/20/2016] [Accepted: 05/03/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to systematically review dextrose (d-glucose) prolotherapy efficacy in the treatment of chronic musculoskeletal pain. DATA SOURCES Electronic databases PubMed, Healthline, OmniMedicalSearch, Medscape, and EMBASE were searched from 1990 to January 2016. STUDY SELECTION Prospectively designed studies that used dextrose as the sole active prolotherapy constituent were selected. DATA EXTRACTION Two independent reviewers rated studies for quality of evidence using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs, for level of evidence using a modified Sackett scale, and for clinically relevant pain score difference using minimal clinically important change criteria. Study population, methods, and results data were extracted and tabulated. DATA SYNTHESIS Fourteen RCTs, 1 case–control study, and 18 case series studies met the inclusion criteria and were evaluated. Pain conditions were clustered into tendinopathies, osteoarthritis (OA), spinal/pelvic, and myofascial pain. The RCTs were high-quality Level 1 evidence (Physiotherapy Evidence Database ≥8) and found dextrose injection superior to controls in Osgood–Schlatter disease, lateral epicondylitis of the elbow, traumatic rotator cuff injury, knee OA, finger OA, and myofascial pain; in biomechanical but not subjective measures in temporal mandibular joint; and comparable in a short-term RCT but superior in a long-term RCT in low back pain. Many observational studies were of high quality and reported consistent positive evidence in multiple studies of tendinopathies, knee OA, sacroiliac pain, and iliac crest pain that received RCT confirmation in separate studies. Eighteen studies combined patient self-rating (subjective) with psychometric, imaging, and/or biomechanical (objective) outcome measurement and found both positive subjective and objective outcomes in 16 studies and positive objective but not subjective outcomes in two studies. All 15 studies solely using subjective or psychometric measures reported positive findings. CONCLUSION Use of dextrose prolotherapy is supported for treatment of tendinopathies, knee and finger joint OA, and spinal/pelvic pain due to ligament dysfunction. Efficacy in acute pain, as first-line therapy, and in myofascial pain cannot be determined from the literature.
Collapse
Affiliation(s)
- Ross A Hauser
- Caring Medical Regenerative Medicine Clinics, Oak Park, IL, USA
| | | | | | - David K Harris
- Center for Healing and Regenerative Medicine, Austin, TX, USA
| |
Collapse
|
19
|
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. [PMID: 27364372 DOI: 10.1016/j.ijom.2016.06.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/23/2016] [Accepted: 06/13/2016] [Indexed: 01/26/2023]
Abstract
A randomized clinical trial was implemented in adult patients with temporomandibular joint osteoarthritis (TMJ OA). The sample comprised 49 osteoarthritic joints in 31 consecutive patients. Patients were divided randomly into two groups according to the treatment technique applied: the platelet-rich plasma (PRP) group patients underwent initial arthrocentesis plus PRP injection and then four consecutive PRP injections; the hyaluronic acid (HA) group patients underwent one session of arthrocentesis plus HA injection. The predictor variable was the treatment technique. The outcome variables included visual analogue scale (VAS) evaluations and maximum inter-incisal opening (MIO) measurements. Outcome variables were recorded preoperatively and at 12 months postoperative. Descriptive and bivariate statistics were computed and significance was set at P<0.05. The PRP group included 32 joints in 18 subjects, and the HA group included 17 joints in 13 subjects. No statistically significant difference was observed between the groups for any of the changes in VAS parameters or MIO measurements. Both treatment techniques resulted in significant clinical improvements in all VAS parameters and painless MIO. These findings suggest that arthrocentesis plus PRP injections is not superior to arthrocentesis plus a single HA injection; thus PRP injection should not be considered as the first line treatment. Arthrocentesis plus HA injection would appear to be more acceptable for patients.
Collapse
Affiliation(s)
- S Cömert Kiliç
- Ministry of Health, Department of Oral and Maxillofacial Surgery, Centre for Oral and Dental Health, Erzurum, Turkey.
| | - M Güngörmüş
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gaziantep University, Gaziantep, Turkey
| |
Collapse
|
20
|
Does Injection of Corticosteroid After Arthrocentesis Improve Outcomes of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial. J Oral Maxillofac Surg 2016; 74:2151-2158. [PMID: 27376184 DOI: 10.1016/j.joms.2016.05.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/16/2016] [Accepted: 05/29/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study is to answer the following clinical question: Among patients with temporomandibular joint (TMJ) osteoarthritis (OA), do those undergoing arthrocentesis and corticosteroid (CS) injection, when compared with those undergoing arthrocentesis alone, have better outcomes in terms of range of motion and clinical symptoms? MATERIALS AND METHODS A randomized clinical trial in adult patients with TMJ OA referred to our clinic between May 2012 and September 2013 was implemented. The sample was composed of 24 consecutive patients with TMJ OA treated randomly with either arthrocentesis alone (control group) or arthrocentesis plus CS injection (CS group). The outcome variables were visual analog scale evaluations (ie, masticatory efficiency, joint sounds, and pain complaints), maximal interincisal opening, and mandibular motions. The outcome variables were recorded at baseline and at 12 months postoperatively. The Mann-Whitney U test was used for intergroup comparison. The paired t test and Wilcoxon signed rank test were used for intragroup comparisons. RESULTS The sample was composed of 32 joints in 24 patients with TMJ OA (15 joints in 12 patients with a mean age of 35.08 ± 14.84 years comprising the control group and 17 joints in 12 adult patients with a mean age of 32.58 ± 9.58 years comprising the CS group). Pain complaints and joint sounds showed statistically significant decreases (P < .01) in both groups, whereas painless interincisal opening showed a statistically significant increase (P < .001) in only the CS group. After estimation of differences between the follow-up and baseline outcomes, the mean change in the primary outcome variables showed no statistically significant differences between the 2 groups (P > .05). CONCLUSIONS These findings suggest that arthrocentesis plus intra-articular CS injection produced no better outcomes in terms of range of motion and clinical symptoms in patients with TMJ OA, as compared with those undergoing arthrocentesis alone.
Collapse
|