Comparison of intraarticular injection of platelet-rich plasma following arthrocentesis, with sodium hyaluronate and conventional arthrocentesis for management of internal derangement of temporomandibular joint

Does intra-articular injection of platelet-rich plasma/platelet-rich fibrin improve outcomes after temporomandibular joint arthrocentesis? A systematic review and meta-analysis

Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) have been used as adjuncts to temporomandibular joint (TMJ) arthrocentesis but without any high-quality evidence. This systematic review collated data from published randomised controlled trials (RCTs) to provide level-1 evidence on its efficacy. Trials published on the databases of PubMed, Scopus, Embase, CENTRAL, and Web of Science up to 4 August 2023 and comparing intra-articular PRP/PRF with control after TMJ arthrocentesis were eligible. Primary outcomes were pain and maximal mouth opening (MMO). Twelve RCTs were included. Pooled analysis showed that pain scores were significantly reduced with the use of PRP/PRF as compared with control at one month (MD: -0.96 95% CI: -1.58 to -0.35 I2 = 86%), three months (MD: -1.22 95% CI: -1.86 to -0.59 I2 = 85%), and ≥six months (MD: -1.61 95% CI: -2.22 to -1.00 I2 = 88%). Similarly, MMO was significantly improved in the PRP/PRF group at one month (MD: 2.40 95% CI: 1.02 to 3.77 I2 = 88%), three months (MD: 3.17 95% CI: 1.63 to 4.72 I2 = 91%), and ≥six months (MD: 2.98 95% CI: 1.86 to 4.10 I2 = 75%) as compared with the control group. Subgroup analysis for PRP and PRF failed to show any difference in outcomes. Moderate quality evidence suggests that PRP and PRF may significantly improve pain and MMO when used as adjuncts to TMJ arthrocentesis. Due to the small effect size, the clinical significance of the results is questionable. The high heterogeneity in PRP/PRF preparation methods is a significant limitation.

Systematic review of intervention descriptions in randomised controlled trials with injectable agents for temporomandibular disorder using TIDieR and PEDro scales

The effectiveness of healthcare depends on clinical trials in which the benefits and harms of interventions are assessed and accurately reported. The aim of this study was to evaluate the quality of the description of randomised controlled trial (RCT) interventions with injectable substances in painful temporomandibular joint disorder after arthrocentesis. RCTs with patients aged ≥ 18 years old, with temporomandibular disorder that analysed the use of intra-articular substances after arthrocentesis, comparisons with arthrocentesis/other injectable techniques, with joint pain and mandibular movement limitation were included. Non-randomised controlled trials, and RCTs in patients with systemic disorders were excluded. The search was performed in the PubMed, Embase, Scopus, Web of Science, Cochrane, and Google Scholar databases. The study description quality was evaluated by Template for intervention Description and Replication (TIDieR). The methodological quality was performed using the Physiotherapy Evidence Database's PEDro scale. The data were submitted to the Spearman correlation test to evaluate the direction and magnitude of the association between the quality of the intervention description and the methodological quality of the RCTs. A total of 9,793 articles were identified, of which 113 were eligible studies and 19 were included. The mean (SD) ratings by TIDieR = 8 (1.07). Absent items in all RCTs that negatively impacted the TIDieR score were: 'Were there adaptations?', 'Were there modifications?' and 'Assessment of adherence'. Other topics were not satisfactorily described: 'Who performed the intervention?' (52.63%), and 'Where it was performed' (36.84%). There was no correlation between TIDieR and PEDro (r=0.009). RCTs with good methodological quality do not contemplate all the TIDieR items and the scale's proper use would contribute to more detailed reports and more faithful reproduction of therapies in clinical research and practice. Complete reports facilitate the understanding of the evidence obtained and serve as a guide in the reproduction of the research in future studies and in clinical application.

Which of the autologous blood products administered simultaneously with arthrocentesis is more effective in terms of clinical outcomes?

This study aimed to determine which of the autologous blood products administered simultaneously with arthrocentesis is more effective on clinical outcomes in patients with temporomandibular joint disorder. The study included 116 patients who underwent arthrocentesis alone, i-PRF (injectable- Platelet Rich Fibrin) with arthrocentesis, and PRP (Platelet Rich Plasma) with arthrocentesis. A total of 35 patients underwent arthrocentesis (Group A), 47 patients underwent arthrocentesis with i-PRF (Group APRF) and 34 patients underwent arthrocentesis with PRP (Group APRP). All patients received local anaesthesia before the procedure, and then the upper joint cavity was irrigated with approximately 100 mL of saline solution. Subsequently, patients in Group APRF and Group APRP were administered 2 ml of autologous blood product. All patients' pain and maximum mouth opening values were compared statistically at each time point: before the procedure, 1 week, 1 month, 3 months, and 6 months after the procedure. The results demonstrated no significant difference among the groups in terms of pain. Nevertheless, in terms of maximum mouth opening, superior outcomes were observed in the early postoperative period in the PRP group, while superior outcomes were observed in the late postoperative period in the i-PRF group.

Hyaluronic Acid/Platelet-Rich Plasma Mixture Improves Temporomandibular Joint Biomechanics: A Systematic Review

Hyaluronic acid (HA) is the main component of the temporomandibular joint (TMJ) synovial fluid. Arthritis in temporomandibular disorders (TMDs) disrupts HA metabolism, resulting in shorter polymeric chain predominance and increased friction. Intra-articular injections of HA supplement the larger molecules of this glycosaminoglycan, and the platelet-rich plasma (PRP) delivered in this way releases growth factors, suppressing inflammation. This PRISMA-compliant PROSPERO-registered (CRD42024564382) systematic review aimed to assess the validity of mixing HA with PRP in the injectable treatment of TMJ disorders. We searched the medical literature for eligible randomized clinical trials using BASE, Google Scholar, PubMed and Scopus engines on 9 May 2024, with no time frame limit. Selected reports were assessed for risk of bias using the Cochrane RoB2 tool. Numerical data were collected on articular pain and mandibular mobility. We provided mean differences from baseline and between study and control groups at each observation point. The efficacy of TMD treatment with HA/PRP versus HA or PRP alone was assessed meta-analytically. Of 171 identified records, we selected 6 studies. In the 6-month follow-up, the mean advantage of PRP supplementation with HA was 2.52 (SE = 2.44; d = 0.83) mm and the benefit of adding PRP to HA was 1.47 (SE = 2.68; d = 0.34) mm in mandibular abduction. The pain-improvement scores were -1.33 (SE = 1.02; d = -1.05) and -1.18 (SE = 0.92; d = 0.80), respectively. Presumably, the HA/PRP range of therapeutic efficiency includes cases non-respondent to HA or PRP alone.

Treatment of painful temporomandibular joint disc displacement without reduction: network meta-analysis of randomized clinical trials

There is currently no consensus on the best treatment for painful temporomandibular disc displacement without reduction (DDwoR), and no network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing all types of treatments for this condition has been conducted. The objective of this study was to compare and rank all treatments for DDwoR, including conservative treatments, occlusal splints, low-level laser therapy (LLLT), arthrocentesis (Arthro) alone, Arthro plus intra-articular injection (IAI) of platelet-rich plasma (PRP), Arthro plus IAI of hyaluronic acid (HA), Arthro with exercises, Arthro plus occlusal splints, and manipulative therapy. Outcome variables were pain intensity on a visual analogue scale (VAS) and maximum mouth opening (MMO, mm). The mean difference with 95% confidence interval was estimated using Stata software. The GRADE system was used to assess the certainty of the evidence. A total of 742 patients from 16 RCTs were included in the NMA. Both direct meta-analysis and NMA showed that Arthro with IAI of co-adjuvants provided better pain reduction in the short term (≤3 months) than Arthro alone. However, the quality of the evidence was very low. In the intermediate term, Arthro alone or combined with co-adjuvants provided better pain reduction than conservative treatment, but with low-quality evidence. Conservative treatment significantly increased MMO in the short term compared to other treatments. In conclusion, the results of this NMA suggest that arthrocentesis with intra-articular injection of adjuvant medications may be superior to conservative treatments in reducing pain intensity at long-term follow-up, while no significant differences were found for the MMO outcome. However, the quality of evidence was generally low to very low, and further RCTs are needed to confirm these findings.

Intra-articular injection of platelet-rich plasma vs hyaluronic acid as an adjunct to TMJ arthrocentesis: A systematic review and meta-analysis

OBJECTIVE

We aimed to find out if there is any difference in outcomes with the use of platelet-rich plasma (PRP) or hyaluronic acid (HA) intra-articular injections after temporomandibular joint arthrocentesis.

METHODS

A systematic search of the electronic databases of PubMed, Embase, and Scopus was undertaken up to 5th May 2023. Randomized controlled trials (RCTs) comparing PRP with HA after TMJ arthrocentesis were included.

RESULTS

Seven RCTs were eligible. Pooled analysis failed to demonstrate any significant difference in MMO between PRP and HA groups at 1 month (MD: 0.21 95 % CI: -1.29, 1.70), 3 months (MD: 0.92 95 % CI: -2.96, 4.80), and 6 months (MD: -0.05 95 % CI: -2.08, 1.97). The inter-study heterogeneity was high with I2 values of 85 %, 98 %, and 81 % respectively. Similarly, there was no statistically significant difference in pain scores between the PRP and HA groups at 1 month (MD: 0.42 95 % CI: -2.25, 3.10), 3 months (MD: 0.90 95 % CI: -1.60, 3.41), and 6 months (MD: 0.06 95 % CI: -0.92, 1.04) with inter-study heterogeneity of 99 %, 99 %, and 92 % respectively.

CONCLUSION

Intra-articular use of PRP or HA after TMJ arthrocentesis may lead to comparable clinical outcomes. The current evidence is low-quality and fraught with high heterogeneity.

Platelet-rich plasma therapy for temporomandibular joint osteoarthritis: A randomized controlled trial

The study aimed to compare the efficacy of platelet-rich plasma (PRP) injections for the treatment of temporomandibular joint osteoarthritis (TMJ-OA) with hyaluronic acid (HA) therapy. This randomized controlled trial included 70 patients with TMJ-OA, randomly divided into either a PRP or HA group. The pain intensity, maximum mouth opening (MMO), TMJ sound score, and proportion of crepitus were recorded and compared at baseline and at 1, 3, and 6 months. Both groups showed statistically significant improvements in pain intensity, MMO, TMJ sound, and scale scores during the 6-month follow-up period. The improvements in pain intensity during mouth opening at 1 month, MMO at 1, 3, and 6 months, TMJ sound score at 1 and 3 months, and GAD-7 score at 6 months in the PRP group were greater than in the HA group (p < 0.05). Compared with the HA group, imaging improvement in the PRP group was also higher (p < 0.05). Within the limitations of the study it seems that the application of PRP therapy in TMJ-OA is should be considered whenever possible.

Current Clinical Research Directions on Temporomandibular Joint Intra-Articular Injections: A Mapping Review

This mapping review aims to identify and discuss current research directions on intracavitary temporomandibular joints (TMJs) injections. The inclusion criteria allowed studies published in the last full six years, based on patients diagnosed with temporomandibular joint disorders (TMDs), treated by TMJ intra-articular injections. Medical databases covered by the Association for Computing Machinery, Bielefeld Academic Search Engine, PubMed, and Elsevier Scopus engines were searched. The results were visualized with tables, charts, and diagrams. Of the 2712 records identified following the selection process, 152 reports were qualified for review. From January 2017, viscosupplementation with hyaluronic acid (HA) was the best-documented injectable administered into TMJ cavities. However, a significant growing trend was observed in the number of primary studies on centrifuged blood preparations administrations that surpassed the previously leading HA from 2021.