Hyaluronic acid injections for pain relief and functional improvement in patients with temporomandibular disorders: An umbrella review of systematic reviews

Abstract

BackgroundTemporomandibular disorders (TMD) are the main cause of chronic facial pain, and intra‐articular (IA) injections of hyaluronic acid (HA) are commonly performed.ObjectivesThis umbrella review of systematic reviews aimed at analysing the effectiveness of HA injections on pain and functional outcomes in patients affected by TMD.MethodsPubMed, Cochrane Library and PEDro were systematically searched from inception until 17 January 2023 to identify systematic reviews evaluating the effects on pain and functional outcomes of HA IA injections. PROSPERO registration number: CRD42022382586.ResultsOut of 316 papers suitable for title/abstract screening, 18 articles were included in the umbrella review. Thirteen studies included only randomized controlled clinical trials (RCTs). The included systematic reviews reported no statistically significant differences between HA and corticosteroids, whereas platelet derivates seem to have good results in pain relief. The literature did not show severe adverse events, except for mild pain in the site of injection. Concerning the quality assessment of the 18 systematic reviews, 2 (11.11%) had a high quality, 3 (16.67%) a moderate quality, 7 (38.89%) a low quality and 6 (33.33%) a critically low quality.ConclusionsTaken together, findings of this umbrella review showed intriguing effects of IA HA injections in terms of reduction of pain intensity and improvement of functioning in patients affected by TMD. Furthermore, there is no agreement on the effectiveness of a combination of arthrocentesis or arthroscopy with IA HA injections. Although the literature showed these positive results after IA HA injections, the overlapping of primary studies in the systematic reviews included might have affect our results, such as the very low quality of the papers. Thus, further RCTs are needed to confirm the efficacy of IA injections of HA on pain relief in patients with TMD.

Progress in the Study of Temporomandibular Joint Lavage in Temporomandibular Joint Disorder

“… 55 Some scholars have studied the effect of Hyaluronic Acid (HA), Corticosteroids (CS) or Platelet-rich Plasma (PRP) injected at the time of lavage on the rehabilitation of patients. 56 The results show that there is no difference in the rehabilitation outcome after 2 years between the addition of HA or CS and the simple lavage, but it can reduce pain and inflammation for a month to 3 months after the irrigation is completed. 35 At the same time, some scholars have proposed that intra-articular steroid injection after surgery, although there is a trend of improvement, its therapeutic response is very dependent on the patient’s own conditions and is affected by many variables, so it is not the best method to use.…”

The relationship of ALPK1, hyaluronic acid and M1 macrophage polarization in the temporomandibular joint synovitis

“…LMW‐HA promotes M1 macrophage polarization, 24 while HMW‐HA attenuates synovitis by promoting M2 macrophage polarization 25 . It has been demonstrated that HMW‐HA is effective in the treatment of TMJ inflammation in animal experiments 26 and clinical 27 . However, the relationship of HA, ALPK1 and macrophage polarization in TMJ synovitis remains unclear.…”

“… 25 It has been demonstrated that HMW‐HA is effective in the treatment of TMJ inflammation in animal experiments 26 and clinical. 27 However, the relationship of HA, ALPK1 and macrophage polarization in TMJ synovitis remains unclear.…”

Causal effects of educational attainment on temporomandibular disorders and the mediating pathways: A Mendelian randomization study

“…Conservative strategies should be advocated as the primary approach for the initial treatment of TMDs, covering physical therapies, self‐management with disease elucidation, occlusal splint therapy and psychological interventions 6 . Additional therapeutic strategies, such as intra‐articular injections of hyaluronic acid and plasma‐rich platelets, have demonstrated efficacy in alleviating pain and improving functionality among patients with TMDs 7 . Despite these therapeutic advancements, the aetiology of TMDs remains incompletely elucidated, underscoring the ongoing need for further exploration 1…”