A Scoping Review of the Use of Pioglitazone in the Treatment of Temporo-Mandibular Joint Arthritis

Effects of Hyaluronic Acid (HA) and Platelet-Rich Plasma (PRP) on Mandibular Mobility in Temporomandibular Joint Disorders: A Controlled Clinical Trial

Hyaluronic acid (HA) is a glycosaminoglycan composed of D-glucuronic acid and N-acetylglucosamine with an up-to-several-million-Daltons chain-length responsible for the lubricating properties of the temporomandibular joint (TMJ) synovial fluid. Arthritis results in the predominance of HA degradation over synthesis leading to temporomandibular disorders (TMDs). TMD injection treatments are divided into HA supplementation and platelet-rich plasma (PRP) inflammation suppression. We questioned whether either approach lubricated the TMJ better and answered it in a two-arm equal-allocation trial with a non-concurrent active treatment control (two groups of 39 patients each). HA statistically significantly improved (p < 0.01) and PRP did not statistically significantly change (0.06 ≤ p ≤ 0.53) articular mobility compared to baselines in 128 TMJs. Statistically significant inter-group discrepancies were observed for abduction (MD = -4.05 mm; SE = 1.08; p = 0.00; d = -0.85) and protrusion (MD = -0.97 mm; SE = 0.43; p = 0.03; d = -0.51) but not for rightward (MD = -0.21; SE = 0.43; p = 0.63; d = -0.11) and leftward (MD = -0.30; SE = 0.42; p = 0.47; d = -0.16) movements. HA supplementation proved superior to PRP autografting in ad hoc TMJ lubrication and hence is more appropriate in hypomobile TMD cases of symptomatic treatment.

A Review of Proposed Mechanisms in Rheumatoid Arthritis and Therapeutic Strategies for the Disease

Rheumatoid arthritis (RA) is characterized by synovial edema, inflammation, bone and cartilage loss, and joint degradation. Patients experience swelling, stiffness, pain, limited joint movement, and decreased mobility as the condition worsens. RA treatment regimens often come with various side effects, including an increased risk of developing cancer and organ failure, potentially leading to mortality. However, researchers have proposed mechanistic hypotheses to explain the underlying causes of synovitis and joint damage in RA patients. This review article focuses on the role of synoviocytes and synoviocytes resembling fibroblasts in the RA synovium. Additionally, it explores the involvement of epigenetic regulatory systems, such as microRNA pathways, silent information regulator 1 (SIRT1), Peroxisome proliferatoractivated receptor-gamma coactivator (PGC1-α), and protein phosphatase 1A (PPM1A)/high mobility group box 1 (HMGB1) regulators. These mechanisms are believed to modulate the function of receptors, cytokines, and growth factors associated with RA. The review article includes data from preclinical and clinical trials that provide insights into potential treatment options for RA.

Injectable Platelet-Rich Fibrin (I-PRF) Administered to Temporomandibular Joint Cavities: A Scoping Review

The aim of this review was to systematically map the research on the intra-articular administration of injectable platelet-rich fibrin (I-PRF) to the temporomandibular joints (TMJs). Medical databases covered by the ACM, BASE, Google, NLM, and ResearchGate were searched on 23 February 2023. The assessment of the level of evidence was based on the Oxford Center for Evidence-Based Medicine 2011 scale. The risk of bias was assessed for randomized controlled trials with the RoB2 tool. Extracted data were tabulated, and the changes in effect values were calculated. A total of eight studies qualified, of which five trials on 213 patients were randomized and controlled (RCTs). In each of the RTC study groups, arthrocentesis was performed, and 1-2 mL per joint of I-PRF (700 rpm/3 min/60 g centrifugation) was administered. Articular pain in three months decreased to 0-25% of the initial pre-interventional values in the study and 38-50% in the control groups. Mandible mobility increased to 121-153% and 115-120% in the I-PRF groups and controls, respectively. The main limitations of the evidence were the small number of RCTs and the lack of any RCT study groups receiving I-PRF without prior arthrocentesis. In conclusion, supplementing the temporomandibular joint rinsing with I-PRF administration further relieves pain and improves mandible mobility. The lack of RCTs on the intra-articular administration of I-PRF as a stand-alone procedure encourages further research. This research received no external funding. The review protocol has not been previously published.

Intra-Articular Injections into the Inferior versus Superior Compartment of the Temporomandibular Joint: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to validate the hypothesis that intra-articular injections into the inferior temporomandibular joint compartment are more efficient than analogous superior compartment interventions. Publications reporting differences between the above-mentioned techniques in the domains of revealing articular pain, decreasing the Helkimo index, and abolishing mandibular mobility limitation were included. Medical databases covered by the Bielefeld Academic Search Engine, Google Scholar, PubMed, ResearchGate, and Scopus engines were searched. The risk of bias was assessed using dedicated Cochrane tools (RoB2, ROBINS-I). The results were visualized with tables, charts, and a funnel plot. Six reports describing five studies with a total of 342 patients were identified. Of these, four trials on a total of 337 patients were qualified for quantitative synthesis. Each eligible report was at moderate risk of bias. From 19% to 51% improvement in articular pain, 12-20% lower Helkimo index, and 5-17% higher maximum mouth opening were observed. The evidence was limited by the small number of eligible studies, discrepancies regarding the substances used, possible biases, and the differences in observation times and scheduled follow-up visits. Despite the above, the advantage of inferior over superior compartment temporomandibular joint intra-articular injections is unequivocal and encourages further research in this direction.

Complicated Relationships between Anterior and Condylar Guidance and Their Clinical Implications-Comparison by Cone Beam Computed Tomography and Electronic Axiography-An Observational Cohort Cross-Sectional Study

A complex prosthodontic treatment is believed to be more successful when the condylar path is replicated using the articulator. However, there is an ongoing major disagreement between the researchers as the exact relationship between the posterior and anterior determinants has not been clear. The purpose of this study was to investigate whether the protrusive movement of the mandible does correlate with the temporomandibular joint (TMJ) anatomy or with incised features. Subjects (15 males and 15 females) were qualified for this study based on an initial interview including the following criteria: age 21-23 (+/-1), no history of trauma, orthodontic treatment, or temporomandibular disorders (TMD). For each patient, the angle of the condylar path, incisal guidance angle (IGA), interincisal angle, as well as overbite and overjet were measured on cone beam computed tomography (CBCT). This was followed by the examination with the Modjaw^® electronic axiograph recording and calculating the functional sagittal condylar guidance angle (SCGA) for the right and left TMJ during the protrusion. The results show that the mean functional axiographic measurement of SCGA in protrusion significantly correlates with the TMJ anatomy presented on CBCT. Moreover, a significant correlation was found between the values of SCGA in the functional and anatomical measurements in all its variants. It turned out that, statistically, the AB measurement was the most accurate. Finally, results showed that incisal relationships of permanent teeth such as overbite, overjet, incisal guidance angle and interincisal angle do not correlate with TMJ anatomy, and therefore, regarding an analyzed study group, do not affect the TMJ formation in young adults.