Comparison of the effectiveness of temporomandibular joint osteoarthritis treatment with corticosteroids, hyaluronic acid, and platelet-rich plasma mono-therapy
DOI:
https://doi.org/10.14739/mmt.2024.2.300763Keywords:
osteoarthritis, temporomandibular joint, corticosteroids, hyaluronic acid, PRP, intra-articular injectionsAbstract
The prevalence of temporomandibular joint (TMJ) osteoarthritis is 18–85 % of all TMJ dysfunctional conditions. Most patients are elderly, especially women. Today, intra-articular injections are often used for treatment, so it is necessary to study the effectiveness of drug administration on the course of the disease. The number of studies on the effectiveness of certain drugs most commonly used to treat TMJ osteoarthritis is limited, that does not allow correct treatment planning in each individual case.
Aim: to evaluate the effectiveness of TMJ osteoarthritis treatment with monotherapy with hyaluronic acid, corticosteroids, and platelet-rich plasma.
Materials and methods. We included 90 patients who received intra-articular injections. Patients were randomly divided into 3 groups: group I, which received platelet-rich plasma (PRP, n = 30), group II, which received hyaluronic acid (HA, n = 30), group III, which received corticosteroids (CS, n = 30). To objectively evaluate the effectiveness of TMJ osteoarthritis treatment with monotherapy of hyaluronic acid, corticosteroids and platelet-rich plasma, the following indicators were used: filling in the visual analogue pain scale, maximum mouth opening (mm) and cortical plate density of the articular head of the mandible according to the Hounsfield scale using CBCT.
Results. PRP therapy demonstrated the highest efficacy in the form of monotherapy for all study parameters (p < 0.05). The fastest pain reduction was achieved with the use of corticosteroids (p < 0.05). In general, during the treatment period, the reduction of pain according to the visual analogue scale in group I was 85.71 %. In patients of group II (HA) and group III (CS) – by 71.42 %. Maximum mouth opening after treatment in group I increased by 24.32 %, in group II – by 15.79 %, in group III – by 18.92 %. The density of the articular head according to the Hounsfield scale after treatment in group I increased by 12.56 %, in group II – by 6.97 %, in group III – by 4.87 %.
Conclusions. All of the studied drugs demonstrated a positive effect on the treatment of TMJ osteoarthritis, but monotherapy with intra-articular PRP injections demonstrated the highest effectiveness according to the studied parameters (p < 0.05).
References
Shoukri B, Prieto JC, Ruellas A, Yatabe M, Sugai J, Styner M, et al. Mini¬mally Inva-sive Approach for Diagnosing TMJ Osteoarthritis. J Dent Res. 2019;98(10):1103-11. doi: https://doi.org/10.1177/0022034519865187
Valesan LF, Da-Cas CD, Réus JC, Denardin AC, Garanhani RR, Bonotto D, et al. Prevalence of temporomandibular joint disorders: a systematic review and meta-analysis. Clin Oral Investig. 2021;25(2):441-53. doi: https://doi.org/10.1007/s00784-020-03710-w
Chandra L, Goyal M, Srivastava D. Minimally invasive intraarticular platelet rich plasma injection for refractory temporomandibular joint dysfunction syndrome in comparison to arthrocentesis. J Family Med Prim Care. 2021;10(1):254-8. doi: https://doi.org/10.4103/jfmpc.jfmpc_1633_20
Abbadi W, Kara Beit Z, Al-Khanati NM. Arthrocentesis, Injectable Platelet-Rich Plasma and Combination of Both Protocols of Temporomandibular Joint Disorders Management: A Single-Blinded Randomized Clinical Trial. Cureus. 2022;14(11):e31396. doi: https://doi.org/10.7759/cureus.31396
Al-Moraissi EA, Wolford LM, Ellis E 3rd, Neff A. The hierarchy of different treat-ments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials. J Craniomaxillofac Surg. 2020;48(1):9-23. doi: https://doi.org/10.1016/j.jcms.2019.10.004
Ansar AS, Munna K, Iqbal A, Mohammad F, Naved A, Shamimul H. Prognostic cri-teria for the management of temporomandibular disorders using arthrocentesis with normal saline and arthrocentesis with normal saline and platelet-rich plasma. J Med Life. 2022;15(5):698-704. doi: https://doi.org/10.25122/jml-2021-0240
Zotti F, Albanese M, Rodella LF, Nocini PF. Platelet-Rich Plasma in Treatment of Temporomandibular Joint Dysfunctions: Narrative Review. Int J Mol Sci. 2019;20(2):277. doi: https://doi.org/10.3390/ijms20020277
Haddad C, Zoghbi A, El Skaff E, Touma J. Platelet-rich plasma injections for the treatment of temporomandibular joint disorders: A systematic review. J Oral Rehabil. 2023;50(11):1330-9. doi: https://doi.org/10.1111/joor.13545
Derwich M, Mitus-Kenig M, Pawlowska E. Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Tem-poromandibular Joint Osteoarthritis-A Systematic Review. Int J Mol Sci. 2021;22(14):7405. doi: https://doi.org/10.3390/ijms22147405
Liu SS, Xu LL, Fan S, Lu SJ, Jin L, Liu LK, et al. Effect of platelet-rich plasma in-jection combined with individualised comprehensive physical therapy on temporo-mandibular joint osteoarthritis: A prospective cohort study. J Oral Rehabil. 2022;49(2):150-9. doi: https://doi.org/10.1111/joor.13261
Kim SY, Yoo DM, Kwon MJ, Kim JH, Kim JH, Byun SH, et al. Increased Risk of Temporomandibular Joint Disorder in Osteoporosis Patients: A Longitudinal Study. Front Endocrinol (Lausanne). 2022;13:835923. doi: https://doi.org/10.3389/fendo.2022.835923
Derwich M, Mitus-Kenig M, Pawlowska E. Interdisciplinary Approach to the Tem-poromandibular Joint Osteoarthritis-Review of the Literature. Medicina (Kaunas). 2020;56(5):225. doi: https://doi.org/10.3390/medicina56050225
Embree M, Ono M, Kilts T, Walker D, Langguth J, Mao J, et al. Role of subchondral bone during early-stage experimental TMJ osteoarthritis. J Dent Res. 2011;90(11):1331-8. doi: https://doi.org/10.1177/0022034511421930
Gurung T, Singh RK, Mohammad S, Pal US, Mahdi AA, Kumar M. Efficacy of ar-throcentesis versus arthrocentesis with sodium hyaluronic acid in temporomandibular joint osteoarthritis: A comparison. Natl J Maxillofac Surg. 2017;8(1):41-9. doi: https://doi.org/10.4103/njms.NJMS_84_16
Kapugi M, Cunningham K. Corticosteroids. Orthop Nurs. 2019;38(5):336-9. doi: https://doi.org/10.1097/NOR.0000000000000595
Liu Y, Wu J, Fei W, Cen X, Xiong Y, Wang S, Tang Y, Liang X. Is There a Difference in Intra-Articular Injections of Corticosteroids, Hyaluronate, or Placebo for Tem-poromandibular Osteoarthritis? J Oral Maxillofac Surg. 2018;76(3):504-14. doi: https://doi.org/10.1016/j.joms.2017.10.028
Pötter N, Westbrock F, Grad S, Alini M, Stoddart MJ, Schmal H, et al. Evaluation of the influence of platelet-rich plasma (PRP), platelet lysate (PL) and mechanical load-ing on chondrogenesis in vitro. Sci Rep. 2021;11(1):20188. doi: https://doi.org/10.1038/s41598-021-99614-0
Cecerska-Heryć E, Goszka M, Serwin N, Roszak M, Grygorcewicz B, Heryć R, et al. Applications of the regenerative capacity of platelets in modern medicine. Cytokine Growth Factor Rev. 2022;64:84-94. doi: https://doi.org/10.1016/j.cytogfr.2021.11.003
Everts P, Onishi K, Jayaram P, Lana JF, Mautner K. Platelet-Rich Plasma: New Per-formance Understandings and Therapeutic Considerations in 2020. Int J Mol Sci. 2020;21(20):7794. doi: https://doi.org/10.3390/ijms21207794
Manafikhi M, Ataya J, Heshmeh O. Evaluation of the efficacy of platelet rich fibrin (I-PRF) intra-articular injections in the management of internal derangements of tem-poromandibular joints – a controlled preliminary prospective clinical study. BMC Musculoskelet Disord. 2022;23(1):454. doi: https://doi.org/10.1186/s12891-022-05421-7
Pietruszka P, Chruścicka I, Duś-Ilnicka I, Paradowska-Stolarz A. PRP and PRF-Subgroups and Divisions When Used in Dentistry. J Pers Med. 2021;11(10):944. doi: https://doi.org/10.3390/jpm11100944
Li F, Wu C, Sun H, Zhou Q. Effect of Platelet-Rich Plasma Injections on Pain Reduc-tion in Patients with Temporomandibular Joint Osteoarthrosis: A Meta-Analysis of Randomized Controlled Trials. J Oral Facial Pain Headache. 2020;34(2):149-156. doi: https://doi.org/10.11607/ofph.2470
Li FL, Wu CB, Sun HJ, Zhou Q. Comparison of Autologous Platelet-Rich Plasma and Chitosan in the Treatment of Temporomandibular Joint Osteoarthritis: A Retro-spective Cohort Study. J Oral Maxillofac Surg. 2021;79(2):324-32. doi: https://doi.org/10.1016/j.joms.2020.09.016
Diaz-Rodriguez P, Mariño C, Vázquez JA, Caeiro-Rey JR, Landin M. Targeting joint inflammation for osteoarthritis management through stimulus-sensitive hyaluronic ac-id based intra-articular hydrogels. Mater Sci Eng C Mater Biol Appl. 2021;128:112254. doi: https://doi.org/10.1016/j.msec.2021.112254
Kim YS, Guilak F. Engineering Hyaluronic Acid for the Development of New Treatment Strategies for Osteoarthritis. Int J Mol Sci. 2022;23(15):8662. doi: https://doi.org/10.3390/ijms23158662
Attia AA, Awad SS. Hyaluronic Acid and Platelet-Rich Plasma Mixture Versus Hya-luronic Acid and Corticosteroid in the Treatment of Temporomandibular Joint Internal Derangement: A Comparative Randomized Study. J Maxillofac Oral Surg. 2023;23(2):1-7. doi: https://doi.org/10.1007/s12663-023-01907-6
