General Characteristics, Biomedical and Dental Application, and Usage of Chitosan in the Treatment of Temporomandibular Joint Disorders: A Narrative Review

Challenges in Optimizing Nanoplatforms Used for Local and Systemic Delivery in the Oral Cavity

In this study, we focused on innovative approaches to improve drug administration in oral pathology, especially by transmucosal and transdermal pathways. These improvements refer to the type of microneedles used (proposing needles in the saw), to the use of certain enhancers such as essential oils (which, besides the amplifier action, also have intrinsic actions on oral health), to associations of active substances with synergistic action, as well as the use of copolymeric membranes, cemented directly on the tooth. We also propose a review of the principles of release at the level of the oral mucosa and of the main release systems used in oral pathology. Controlled failure systems applicable in oral pathology include the following: fast dissolving films, mucoadhesive tablets, hydrogels, intraoral mucoadhesive films, composite wafers, and smart drugs. The novelty elements brought by this paper refer to the possibilities of optimizing the localized drug delivery system in osteoarthritis of the temporomandibular joint, neuropathic pain, oral cancer, periodontitis, and pericoronitis, as well as in maintaining oral health. We would like to mention the possibility of incorporating natural products into the controlled failure systems used in oral pathology, paying special attention to essential oils.

Analysis of the Curative Effect of Temporomandibular Joint Disc Release and Fixation Combined with Chitosan Injection in the Treatment of Temporomandibular Joint Osteoarthrosis

OBJECTIVE

Temporomandibular joint osteoarthritis (TMJ-OA) is common in clinic. The purpose of this study was to evaluate the efficacy of disc release, fixation and chitosan injection in the treatment of TMJ-OA.

METHODS

From March 2021 to March 2022, 32 patients who underwent the unilateral reduction and fixation of temporomandibular joint disc release were retrospectively studied. All patients were diagnosed with TMJ-OA and were treated with chitosan injection. This group of patients was analyzed by the visual analog scale (VAS) for pain and improvement of maximum comfortable mouth opening before treatment and 6 months after treatment. A paired t-test was used to evaluate the treatment effect, and p < 0.05 indicated that the difference was statistically significant.

RESULTS

All 32 patients were successfully treated by surgery and chitosan injection in the second week after operation. The duration of disease in this group ranged from 1 to 10 months, with an average of 5.7 months. After 6 months of follow up, 30 patients were satisfied with the treatment and two were unsatisfied. The difference in the treatment effect was found to be statistically significant (p < 0.05).

CONCLUSIONS

Temporomandibular joint disc release and fixation combined with chitosan injection is effective in the treatment of TMJ-OA.

Chitosan Based Materials in Cosmetic Applications: A Review

This review provides a report on the properties and recent advances in the application of chitosan and chitosan-based materials in cosmetics. Chitosan is a polysaccharide that can be obtained from chitin via the deacetylation process. Chitin most commonly is extracted from cell walls in fungi and the exoskeletons of arthropods, such as crustaceans and insects. Chitosan has attracted significant academic interest, as well as the attention of the cosmetic industry, due to its interesting properties, which include being a natural humectant and moisturizer for the skin and a rheology modifier. This review paper covers the structure of chitosan, the sources of chitosan used in the cosmetic industry, and the role played by this polysaccharide in cosmetics. Future aspects regarding applications of chitosan-based materials in cosmetics are also mentioned.

Drug delivery systems for treatment of temporomandibular joint osteoarthritis

The number of people suffering from temporomandibular joint osteoarthritis (TMJOA) has been increasing. TMJOA cause joint noise, pain on TMJ and/or masticatory muscles, and restricted mandibular movement, which disturb eating, laughing and conversation, and impose serious lifestyle impediments. Chondrocyte apoptosis, extracellular matrix degradation, synovitis, and subchondral bone remodeling are the main pathological features of TMJOA. Various drug delivery systems are developed to controlled release at specific activation sites with high bioactivity and inhibit rapid dilution to enable long-term therapeutic response, which present great potential for the treatment of TMJOA. This review focuses on recently developed drug delivery systems by different administration in the TMJOA treatment, and summarizes their effects, duration, safety, and limitations, which would pave the way for development of TMJOA therapy.

Evaluation of the efficacy of platelet rich fibrin (I-PRF) intra-articular injections in the management of internal derangements of temporomandibular joints - a controlled preliminary prospective clinical study

Background

The temporomandibular joint (TMJ) is one of the most complex joints in the body. Temporomandibular disorders (TMD) are among the most troublesome disorders for patients, as they can cause pain, affect oral functions and disturb dentists on the level of diagnosis and treatment. The most common symptoms of temporomandibular joint disorders are articulated sounds (such as clicking or TMJ crepitation), joint pain in comfort and function situations (jaw movements), pain or strain in masseter and jaw muscles and or restricted mandibular movements. One of the most modern biocompatible substances used to treat joint disorders, including the TMJ, is platelet-rich plasma (PRP) and injectable platelet-rich fibrin (I-PRF). This study aims to evaluate the efficacy of platelet-rich fibrin (I-PRF) intra-articular injections in managing internal derangements of temporomandibular.

Methods

Twenty patients suffering from a unilateral click due to temporomandibular disorders were individually injected with 1 mL of (I-PRF) twice 1 week apart into the superior joint space of the TMJ with the internal disorder. Data were recorded and evaluated by the Helkimo index. This evaluation was conducted three times; 1 week after the first injection, 1 week after the second injection, and 6 months after the first injection.

Results

The clicking disappeared entirely in 14 out of 20 patients after 1 week of getting the first injection, and in all patients after 1 week of getting the second injection, and returned to two of them after a six-month since the first injection.

Conclusion

Preliminary results showed the efficacy of the Injectable Platelet-Rich Fibrin (I-PRF) in managing articular clicking in patients with internal disorders of the temporomandibular joint. Injectable Platelet Rich Fibrin has significant clinical efficacy in treating the articular clicking resulting from internal temporomandibular joint disorders.