Comparative study of the use of arthrocentesis and arthrocentesis in addition with platelet rich plasma in management of temporomandibular joint internal derangement

Abstract

Background: Disc derangement disorders of the TMJ are a group of intra-articular biomechanical disorders in which there is an abnormal relationship in the functional 'articular cartilaginous' condyle-disc complex. Platelet-rich plasma (PRP) is a blood product that allows in a simple, low cost, and minimally invasive way to obtain a concentration of many growth factors when activated. Aim: To compare the use of arthrocentesis alone and arthrocentesis in addition with platelet rich plasma in management of TMJ internal derangement. Materials and Methods: fourteen patients with DDwOR were included in the study diagnosed according to The Research Diagnostic Criteria for Temporomandibular disorders (RDC/TMD) and divided into two groups as follow; seven patients underwent intra-articular injections of 2 ml PRP after arthrocentesis (study group) and the other seven patients were treated by the conventional arthrocentesis using Ringer's solution (control group). The patients were clinically evaluated preoperatively and postoperatively at the intervals of 1 month and 6 months. Results: The differences between the two groups in all the measured parameters were statistically insignificant throughout the postoperative period. Conclusion: injection is a safe and effective method in the treatment of TMDs.

Comparison of Arthrocentesis Plus Platelet Rich Plasma With Arthrocentesis Alone in the Treatment of Temporomandibular Joint Dysfunction

“…TMD patients are difficult to manage and it is a therapeutic challenge due to multiple associated contributing factors 5,6 . It can be subdivided into two types: muscular and articular 2,5 . The difference between the two is crucial in the management.…”

“…Conversely, refractory cases require surgical interventions from minimally invasive arthrocentesis, arthroscopy and intra-articular injections to aggressive surgeries like disc repair, discetomy or total joint replacement 3,4 . It is suggested in literature that 60-80% of patients benefit from conservative therapy 2,5 .…”

“…TMJ arthrocentesis is a minimally invasive treatment option between conservative management and invasive surgery. It is considered superior treatment option after the failure of conservative management of TMD patients 5,10,13 . It functions by flushing out inflammatory mediators, degraded proteins from superior joint space with sterile solution as they are the main cause of pain.…”

“…Conservative treatment modalities are the first line treatment and surgical intervention is indicated only in patients not responding to them 1 . Surgical interventions range from minimally invasive procedures like arthrocentesis, arthroscopy and intra-articular injections of platelet rich plasma to complex open joint surgical procedures 3,4,5 .…”

“…PRP was first introduced in oral surgery procedures by Whitman et al 4 . It is used as a healing aide on oral surgical procedures including bone grafts, implants and maxillofacial reconstructions, sinus lift procedures, ridge augmentation, alveolar cleft repair and oral/nasal fistula repair 5 .…”