Botulinum Toxin Versus Dextrose Prolotherapy: Which is More Effective for Temporomandibular Joint Subluxation? A Randomized Clinical Trial.

PURPOSE: Botulinum toxin type A (BTX-A) therapy or dextrose prolotherapy (DP) has been used to treat temporomandibular joint (TMJ) disorders. However, the superiority of one method over the other has not been studied in patients with TMJ subluxation. Therefore, this study aims to answer the following clinical question: among patients with TMJ subluxation, do those undergoing BTX-A injection into lateral pterygoid muscles, compared to those undergoing intra- and periarticular DP injections, have better outcomes in terms of locking episodes and patient satisfaction? METHODS: A randomized clinical trial was implemented in adult patients with TMJ subluxation. The sample was composed of patients with TMJ subluxation with painful open-locking during wide mouth opening and/or yawning at baseline. The subjects were treated randomly with one of two treatment techniques with equal numbers as follows: one-session BTX-A injection into lateral pterygoid muscles (BTX-A group) or three sessions of dextrose injections around TMJ (prolotherapy group). The predictor variable was the treatment technique (BTX-A or prolotherapy injections). The primary outcome variable was the frequency of locking episodes. The secondary outcome variable was patient satisfaction. The primary outcome variable was recorded at baseline and 8-12 months following the injections. The secondary outcome variable was recorded only 8-12 months following the injections. Descriptive and bivariate statistics were computed. The data were analyzed with the Wilcoxon and Mann-Whitney U tests. RESULTS: The baseline sample was composed of 30 patients with TMJ subluxation. However, the follow-up sample comprised 25 subjects: 11 (9 females, 2 males; 25.64 years) in the BTX-A group and 14 (10 females, 4 males; 32.37 years) in the prolotherapy group. Locking episodes decreased significantly in the two groups with no significant difference (P < .01). Seven patients in the BTX-A group (7 of 11 patients; 63.6 percent) and eight (8 of 14 patients; 57.1 percent) in the prolotherapy group reported no complaint of locking at the end of follow-up, with no significant difference between the groups (P > .05). Patient satisfaction showed no significant difference between the groups (P > .05). CONCLUSION: These findings suggested that BTX-A injection is no more effective than DP for any outcome variables of TMJ subluxation assessed.

Does glucosamine, chondroitin sulfate, and methylsulfonylmethane supplementation improve the outcome of temporomandibular joint osteoarthritis management with arthrocentesis plus intraarticular hyaluronic acid injection. A randomized clinical trial.

The purpose of this study was to compare clinical outcomes obtained with the use of glucosamine, chondroitin sulfate, and methylsulfonylmethane (GCM) supplementation after arthrocentesis plus intraarticular hyaluronic acid (HA) injection. A randomized clinical trial was implemented with adult participants with TMJ-OA who were referred to the author's clinic between February 2014 and May 2015. The sample was entirely composed of patients with TMJ-OA who were treated randomly with a one-session arthrocentesis plus intraarticular HA injection only (control group), or an initial one-session arthrocentesis plus intraarticular HA injection followed by 3 months of GCM supplementation (study group). The predictor variable was management (treatment) technique. The outcome variables were visual analog scale evaluations (masticatory efficiency, pain complaint, joint sound) and mandibular mobility (maximal interincisal opening [MIO], and lateral and protrusive motions of the mandible). The outcome variables were recorded preoperatively and 12 months postoperatively. Thirty-one participants were enrolled in the study. Five were lost during follow-up. The final study sample consisted of 26 participants (age 28.35 ± 10.85 y): 14 in the control group (age 28.71 ± 10.94 y); and 12 in the study group (age 27.92 ± 11.20 y). Pain complaints (p < 0.001) and joint sounds (p = 0.030 for the control group; p = 0.023 for the study group) showed statistically significant decreases. Masticatory efficiency (p < 0.001 for the control group; p = 0.040 for the study group) and lateral mandibular motion (p = 0.040 for the control group; p = 0.004 for study group) showed statistically significant increases in both groups, whereas MIO and protrusive mandibular motion showed no significant changes in either group (p > 0.05). After estimating the differences between the follow-up and baseline outcomes, the mean changes in the primary outcome variables (VAS scores, MIO, and mandibular motion) showed no statistically significant differences between the two groups (p > 0.05). Progressions (reparative remodeling) of hard-tissue TMJ structures were observed on CBCT scans of some participants in both groups. These findings suggested that the use of GCM supplementation after arthrocentesis plus intraarticular HA injection produced no additional clinical benefits or improvements for patients with TMJ-OA compared with arthrocentesis plus intraarticular HA injection alone.

Histologic and histomorphometric assessment of sinus-floor augmentation with beta-tricalcium phosphate alone or in combination with pure-platelet-rich plasma or platelet-rich fibrin: A randomized clinical trial.

BACKGROUND: The potential effects of adding pure platelet-rich plasma (P-PRP) or platelet-rich fibrin (PRF) to beta-tricalcium phosphate (ß-TCP) graft substitute on bone formation and regeneration after maxillary sinus-floor elevation remains unclear. PURPOSE: To compare the histologic and histomorphometric outcomes of maxillary sinus-floor augmentation among ß-TCP alone, P-PRP-mixed ß-TCP, and PRF-mixed ß-TCP. MATERIAL AND METHODS: In this randomized clinical trial, elevated sinus cavities were grafted with ß-TCP (the control group), P-PRP-mixed ß-TCP (the P-PRP group), and PRF-mixed ß-TCP (PRF group). The sample was composed of 26 patients: 9 subjects in control and P-PRP groups, and 8 subjects in PRF group. After a 6-month, healing period, bone graft biopsies were harvested prior to implant placement, and the specimens were analyzed. The main outcome variables included findings of histologic and histomorphometric analyses of the bone graft biopsies. The data were analyzed by ANOVA and Tukey HSD tests. RESULTS: The mean percentages of new bone formations were 33.40 ± 10.43%, 34.83 ± 10.12%, and 32.03 ± 6.34% in control, P-PRP, and PRF groups, respectively, with no significant differences (P > .05). Mean percentages of residual graft particle area were 30.39 ± 10.29%, 28.98 ± 7.94%, and 32.66 ± 7.46% in control, P-PRP, and PRF groups, respectively, with no significant differences (P > .05). The mean percentages of soft-tissue area were 36.21 ± 10.59%, 36.19 ± 13.94%, and 35.31 ± 10.81% in control, P-PRP, and PRF groups, respectively, with no significant differences (P > .05). Mean densities of osteoblasts, osteoclasts, osteocytes, and capillary vessels showed insignificant difference between groups (P > .05), but osteoprogenitor cells were lower and inflammatory cells were higher in the PRF group than those in other groups (P < .01). Biopsies of P-PRP, PRF, and control groups showed similar composition and distribution of histologic structures. CONCLUSION: These findings suggested that adding P-PRP or PRF to ß-TCP graft substitute was not beneficial on new bone formation and regeneration, and P-PRP plus ß-TCP or PRF plus ß-TCP is not superior to ß-TCP alone.

Does Injection of Corticosteroid After Arthrocentesis Improve Outcomes of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial.

PURPOSE: The purpose of this study is to answer the following clinical question: Among patients with temporomandibular joint (TMJ) osteoarthritis (OA), do those undergoing arthrocentesis and corticosteroid (CS) injection, when compared with those undergoing arthrocentesis alone, have better outcomes in terms of range of motion and clinical symptoms? MATERIALS AND METHODS: A randomized clinical trial in adult patients with TMJ OA referred to our clinic between May 2012 and September 2013 was implemented. The sample was composed of 24 consecutive patients with TMJ OA treated randomly with either arthrocentesis alone (control group) or arthrocentesis plus CS injection (CS group). The outcome variables were visual analog scale evaluations (ie, masticatory efficiency, joint sounds, and pain complaints), maximal interincisal opening, and mandibular motions. The outcome variables were recorded at baseline and at 12 months postoperatively. The Mann-Whitney U test was used for intergroup comparison. The paired t test and Wilcoxon signed rank test were used for intragroup comparisons. RESULTS: The sample was composed of 32 joints in 24 patients with TMJ OA (15 joints in 12 patients with a mean age of 35.08 ± 14.84 years comprising the control group and 17 joints in 12 adult patients with a mean age of 32.58 ± 9.58 years comprising the CS group). Pain complaints and joint sounds showed statistically significant decreases (P < .01) in both groups, whereas painless interincisal opening showed a statistically significant increase (P < .001) in only the CS group. After estimation of differences between the follow-up and baseline outcomes, the mean change in the primary outcome variables showed no statistically significant differences between the 2 groups (P > .05). CONCLUSIONS: These findings suggest that arthrocentesis plus intra-articular CS injection produced no better outcomes in terms of range of motion and clinical symptoms in patients with TMJ OA, as compared with those undergoing arthrocentesis alone.

Is Arthrocentesis Plus Platelet-Rich Plasma Superior to Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial.

PURPOSE: To compare the long-term clinical and radiologic outcomes of temporomandibular joint osteoarthritis (TMJ-OA) treated with arthrocentesis plus platelet-rich plasma (PRP) versus arthrocentesis alone. MATERIALS AND METHODS: A randomized clinical trial in adult patients with TMJ-OA referred to the authors' clinic from May 2012 through July 2013 was implemented. The sample was composed of 30 consecutive patients with TMJ-OA treated randomly with arthrocentesis alone (control group) or initial arthrocentesis plus PRP injection and then 4 consecutive PRP injections (study group). The predictor variable was treatment technique. The outcome variables were visual analog scale evaluations (masticatory efficiency, joint sounds, and pain complaints), maximal interincisal opening, and cone-beam computed tomographic (CBCT) findings. Outcome variables were recorded preoperatively and 12 months postoperatively. Descriptive and bivariate statistics were computed, and significance was set at a P value less than .05. The paired t and Student t tests were used for intragroup and intergroup comparisons, respectively. RESULTS: The sample was composed of 47 joints of 30 patients with OA (control group: 15 joints of 12 patients; mean age, 35.08 ± 14.84 yr; study group: 32 joints of 18 patients; mean age, 32.22 ± 14.32 yr). Joint sounds and general pain complaints decreased statistically in the 2 groups, whereas masticatory efficiency, painless interincisal opening, and lateral motion increased statistically only in the study group. However, only masticatory efficiency showed statistically greater improvement in the study group compared with the control group. CBCT evaluations showed that reparative remodeling of the osseous abnormalities occurred at rates of 87.5 and 46.6% in the study and control groups, respectively. CONCLUSIONS: These findings suggested that arthrocentesis and PRP injections constitute a safe and promising method for the treatment of TMJ-OA that is superior to arthrocentesis alone.