Evaluation of the efficiency of hyaluronic acid, PRP and I-PRF intra-articular injections in the treatment of internal derangement of the temporomandibular joint: A prospective study.

This study aimed to evaluate the clinical effects of hyaluronic acid (HA), platelet-rich plasma (PRP), and platelet-rich fibrin (I-PRF) injections in the internal derangement of the temporomandibular joint. Adult patients who had failed to respond to nonsurgical treatment were were included in the study. The patients were divided into three treatment groups according to the given substance: 1) HA administration three times in a row on a weekly basis, 2) a single dose of PRP, or 3) a single dose of I-PRF. Clinical assessment was performed preoperatively and 6 and 12 months after the treatment, including maximal mouth opening (MMO) and pain level (Visual Analog Scale). Low and high molecular weight (HAL, HAH) hyaluronic acid forms were also compared. 68 adult patients, with a total of 109 joints were included in the study. The mean age was 53 ± 16 years. The statistical analysis showed a significant improvement in MMO in the HA group (p < 0.01). The pain level significantly decreased in all treatment groups (pHA,PRP,I-PRF<0.01). Comparing HAL and HAH forms, no significant difference was found in the evaluation of MMO and VAS values. Within the limitations of the study it seems that due to the similar effects of HA and the autologous blood substances, the platelet concentrates should be preferred in the intra-articular treatment in order to reduce the risk of possible adverse effects.

[Intra-articular steroid and hyaluronic acid treatment of internal derangement of the temporomandibular joint]. / Az állkapocsízületi károsodás kezelése szteroiddal, illetve hialuronsavval.

INTRODUCTION: Derangement of the temporomandibular joint complicates everyday life, due to the masticatory malfunction and the continuous pain sensation of the head and facial region. The therapy is multidisciplinary and varying. In case of the inefficiency of conservative therapy, minimally invasive intervention is needed with intraarticular injection. AIM: The aim of our study was to examine whether hyaluronic acid injection is more beneficial compared to corticosteroid in 37 joints. We also examined whether the efficacy of the therapy is influenced by hyaluronic acid molecular weight and the used protocol. METHOD: Wilkes stage, maximal mouth opening and the Visual Analogue Scale were determined pre-operatively and 6 months later. Corticosteroid application was performed once, hyaluronic acid was injected on a weekly bases 3 times in a row, by use of low (6-10 × 105 dalton) or high molecular weight (24-36 × 105 dalton) preparations. RESULTS: The medical state of the patients treated with corticosteroid temporarily improved, but the symptoms returned. Due to hyaluronic acid treatment, significant improvement was revealed in all parameters (pwilkes<0.0001; pmouth-opening = 0.0002; pVAS<0.0001). There was no significant relapse (T = 2.05). The third administration of hyaluronic acid resulted in a significant improvement of the Visual Analogue Scale compared to the first and second injection (T3.-1. = 20.37; T3.-2. = 9.57). CONCLUSIONS: Comparing the two agents we can state that hyaluronic acid was significantly more effective and its application for three times seems to be the most effective treatment decreasing the symptoms. The high molecular weight solution was more effective in increasing mouth opening. In contrast to hyaluronic acid, corticosteroid had no prolonged effect in higher Wilkes stages. Orv Hetil. 2018; 159(36): 1475-1482.