Next Article in Journal
The Incidence and Risk Factors of Medial and Inferior Orbital Wall Fractures in Korea: A Nationwide Cohort Study
Next Article in Special Issue
Repeated Intra-Articular Administration of Platelet-Rich Plasma (PRP) in Temporomandibular Disorders: A Clinical Case Series
Previous Article in Journal
Twisted Gastric Tube after Laparoscopic Sleeve Gastrectomy—An Unusual but Effective Surgical Approach to Achieve Full Recovery
Previous Article in Special Issue
Controversial Aspects of Diagnostics and Therapy of Arthritis of the Temporomandibular Joint in Rheumatoid and Juvenile Idiopathic Arthritis—An Analysis of Evidence- and Consensus-Based Recommendations Based on an Interdisciplinary Guideline Project
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
JCM
Volume 11
Issue 9
10.3390/jcm11092305
jcm-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Review

Treatment of Mandibular Hypomobility by Injections into the Temporomandibular Joints: A Systematic Review of the Substances Used

by
Maciej Chęciński
1,
Kamila Chęcińska
2,
Zuzanna Nowak
3,
Maciej Sikora
4,5 and
Dariusz Chlubek
5,*
1
Department of Oral Surgery, Preventive Medicine Center, Komorowskiego 12, 30-106 Cracow, Poland
2
Department of Glass Technology and Amorphous Coatings, Faculty of Materials Science and Ceramics, AGH University of Science and Technology, Mickiewicza 30, 30-059 Cracow, Poland
3
Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Traugutta 2, 41-800 Zabrze, Poland
4
Department of Maxillofacial Surgery, Hospital of the Ministry of Interior, Wojska Polskiego 51, 25-375 Kielce, Poland
5
Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2022, 11(9), 2305; https://doi.org/10.3390/jcm11092305
Submission received: 8 March 2022 / Revised: 13 April 2022 / Accepted: 19 April 2022 / Published: 20 April 2022
(This article belongs to the Special Issue "Temporomandibular Disorders": Functional and Conservative Treatment)
Browse Figures
Versions Notes

Abstract

:
Introduction: Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular abduction. The purpose of this review is to identify other injectable substances and to evaluate them in the above-mentioned domains. Material and methods: The review included articles describing clinical trials of patients treated with intra-articular injections with or without arthrocentesis. Results: The following emerging substances were initially evaluated to be effective in treating TMJ pain and increasing the amplitude of mandibular abduction: analgesics, dextrose with lidocaine, adipose tissue, nucleated bone marrow cells and ozone gas. Discussion: Better effects of intra-articular administration are achieved by preceding the injection with arthrocentesis. Conclusions: The most promising substances appear to be bone marrow and adipose tissue.

1. Introduction

Paired temporomandibular joints (TMJs) are responsible for mandibular mobility. An open surgical access to TMJ is challenging due to anatomical conditions. The TMJ is located in the aesthetic preaural area, and access to it is difficult due to the course of the branches of the delicate facial nerve [1]. Neither of the open surgical approaches is ideal as they balance between sufficient insight and safety of anatomical structures [1,2,3].
For some TMJ interventions, such as fixing a joint prosthesis, treatment of advanced forms of ankylosis, or reposition and stabilization of intracapsular fractures, an open surgical approach is currently the only option [3]. Nevertheless, there are TMJ diseases that limit the extent of surgical cuts and preparations. Inspection of the joint area, removal of adhesions and polishing of the articular surfaces can be performed endoscopically from two small skin cuts [4]. A further reduction in invasiveness leads to the conversion of two cuts into two needle punctures, which allows for effective rinsing of the joint cavity [5]. As a result, the content of inflammatory mediators in the joint cavity is reduced and adhesions are removed. The use of only one injection needle is an extreme limitation of the invasiveness of surgical intervention within TMJ [5]. Such an intervention still allows various substances to be administered into the joint cavity and even to perform arthrocentesis [5,6].
Among the minimally invasive puncture techniques within TMJ, lavage of the joint cavity, supplementation of hyaluronic acid (HA) and administration of corticosteroids (CS) are commonly known and used [5,6,7]. TMJ arthrocentesis is effective in the domains of pain relief and increases the extent of mandibular abduction [8,9,10,11]. The administration of HA complements the main component of the synovial fluid and is also referred to as viscosupplementation [6]. Intra-articular administration of HA has been shown to be effective both as a stand-alone treatment and in combination with prior rinsing of the joint cavity [12,13,14]. The effectiveness of intra-articular steroid injection is uncertain [15]. There are many known complications of steroid administration, including edema, hypoaesthesia, skin hypopogmentation and even skin atrophy [16,17]. In recent years, injections of platelet-rich plasma (PRP) into the TMJ cavities have become popular and found to be effective [7,18,19,20,21,22]. Apart from autologous PRP, other self-derived blood products are also used: plasma rich in growth factors (PRGF) and injectable platelet-rich fibrin (I-PRF) [7,23]. Injecting analgesics, which are a non-homogeneous group of drugs with differently assessed effectiveness in this application, is also considered [24]. There are scarce reports, and no systematic reviews, on the administration of autologous transplants other than the patient’s blood to TMJs and of drugs other than those described above.

2. Aim

The aim of this review is to compile and evaluate comparative and efficacy-only studies on the administration of injectable substances into the cavities of the temporomandibular joints in the treatment of mandibular hypomobility and joint pain.

3. Materials and Methods

This review was based on the PRISMA guidelines and submitted for registration in the PROSPERO database [25,26]. The inclusion and exclusion criteria were established according to the PICOTS scheme (Table 1) [27].
The medical databases of EBSCO, Embase, Emcare, PubMed, SCOPUS and Web of Science, gray literature using a Google search engine and references were searched on 3 April 2022. The following search strategy was applied: “(temporomandibular OR tmj) AND (injection OR injections OR puncture OR punctures OR arthrocentesis OR lavage OR rinse OR rinsing OR viscosupplementation OR hyaluronic OR HA OR hyaluronan OR steroid OR steroids OR corticosteroid OR corticosteroids OR blood OR platelet OR PRP OR PGRF OR PRF OR I-PRF OR IPRF OR adipose OR marrow OR analgesic OR analgesics OR nsaid OR nsaids OR opioid OR opioids OR buprenorphine OR tenoxicam OR piroxicam OR tramadol OR fentanyl OR butorphanol OR chitosan OR morphine OR ozone) AND (clinical OR randomized) AND (trial OR rct)”. The reports have been selected blindly, and the data they contained were collected by two of the authors of the article (M.C. and K.C.). The screening and eligibility stages were carried out using the Rayyan tool (Qatar Computing Research Institute, Doha, Qatar and Rayyan Systems, Cambridge, MA, USA) [28]. The following data was extracted: (1) year of publication; (2) the name of the first author; (3) diagnosis; (4) type of intervention (administration or rinse and administration); (5) name of the substance administered; (6) average initial value of mandibular abduction for the study group, measured using the method adopted by the authors of the report; (7) final value of mandibular abduction, mean for the test group measured by the same method; (8) initial value of joint pain, mean for the study group, calculated by the authors of the report on the basis of the values for individual patients in accordance with the adopted study methodology; (9) the final value of joint pain, mean for the study group, calculated analogously to the initial value. The data was synthesized in tabular form. The effectiveness of treatment expressed as a change in the extent of mandibular abduction and reduction in joint pain was calculated by the authors of this review according to the formula
e = f/i × 100%,
where e is the effectiveness resulting from the calculations for this study, f (7 or 9) is the final value given by the authors of the given report and i (6 or 8) is the initial value extracted from the same report. These calculations provided further data: (10) improvement in mandibular abduction; (11) reducing the value of joint pain [29,30,31,32]. In the case of mandibular mobility, values greater than 100% indicated good results of the therapy, and in the domain of pain, values less than 100% indicated a decrease in symptoms. Reports on hyaluronic acid, steroids and blood products were excluded from quantitative analysis due to the existence of the adequate systematic reviews mentioned in the introduction. The risk of bias for quantified trials was assessed by two authors (M.C. and K.C.) using the Revised Cochrane risk-of-bias tool for randomized trials, as all the studies were randomized trials. [33]. The analyses (including regression analysis) and graphic presentation of the data were performed with the use of Google office software (Google LLC, Mountain View, CA, USA).

4. Results

All medical database searches performed gave a total of 649 records (Figure 1). Of these, 162 out-of-date entries were automatically deleted and 182 duplicates were manually removed. 305 records have been qualified for blind screening by two authors. At this stage, 267 reports were rejected, most of them relating to the wrong group of patients, including wrong diagnoses or non-human studies. Review papers and case reports were also discarded at this stage. Authors’ compliance at the screening phase was 98.5% (Cohen’s k: 0.89). A search of websites and references yielded another 10 results suitable for full-text analysis. Full content of all proceeded reports was acquired. At the stage of eligibility, eight papers listed in Table 2 were rejected. Thus, 40 reports containing 52 studies meeting the assumed criteria for systematic review were qualified for synthesis (Table 3). The study of injectables other than HA, CS and blood products was assessed for the risk of bias as shown in Table 4.
In line with the assumptions of the review, a total of 15 substances and combinations of substances injected into the cavities of the temporomandibular joints were identified. The most commonly studied over the past 10 years have been HA (40.4%), CS (19.2%), and blood products (21.2%) with or without prior arthrocentesis (Figure 2 and Figure 3). In one study a combination of HA and CS reduced TMJ pain in 91% and increased mandibular abduction in 60% of patients who initially reported these complaints. [75]. Among blood products, PRP is the most commonly used (15.4% of all substances).
The conducted review allowed for the identification of other, less popularly tested injectables, such as autogenous transplants, monosaccharide in combination with an anesthetic, analgesics and gas (Table 5). With regard to the effect on the extent of mandibular abduction, the bone marrow showed the greatest efficacy (154%) of the rarely used substances (Figure 4). The action of dextrose with lidocaine, morphine and tramadol did not increase the mobility of the mandible by more than 15%. The results of mandibular lateral mobility and protrusive mobility have not been reported for any of these substances. Baseline pain, defined as 100% for the purposes of the analysis, significantly decreased in each of the studies (Figure 5). Strong pain-reducing effect was achieved by analgesics and autografts: morphine (16% of initial complaints), adipose tissue (17%), tramadol (21%), bone marrow (23%) and tenoxicam (23%). Dextrose with lidocaine gave very divergent results in different studies (from 33% to 76% of initial pain). It was not possible to evaluate ozone gas in any of the two domains due to different outcome measures.
Among the substances other than those already assessed in the previously published meta-analyzes, only the administration of dextrose with lidocaine was documented in more than one report, which limited the possibility of the meta-analysis to this one substance [12,18,20,21,24,44,49,62]. The amplitude of mandibular abduction was reported only in two of the three reports, which precludes any statistical analysis. The three initial and three final pain values obtained from the study allowed for fitting a linear regression model of pain intensity of the formula −3.2x + 7.7 with standard deviations of 0.5 and 2.0 for the initial and final TMJ pain intensity, respectively (Figure 6).

5. Discussion

5.1. Hyaluronic Acid

In primary studies indexed as clinical trials in the last 10 years, HA injections dominate. This substance is either used alone or administered after arthrocentesis. Both of these methods result in an increase in the mobility of the mandible [6,7,78]. The intra-articular administration of HA was the only procedure used in the following diagnoses: internal derangement, disk displacement with reduction, degenerative disorders Administration of HA associated with arthrocentesis was used in all the above indications and additionally in the treatment of osteoarthritis, disk displacement without reduction and unspecified joint pain [47,52,58]. The current systematic review of the efficacy of intra-articular hyaluronic acid in the treatment of reduced mobility and pain in TMJ suggests that the second and subsequent administrations of the drug are less effective than the first [12].

5.2. Corticosteroids

Arthrocentesis combined with CS administration was effective in increasing mouth opening range in the following diagnoses: internal derangement, osteoarthritis, disk displacement without reduction, degenerative disorders, and unspecified joint pain [43,52,56,58,68,73]. The fact that arthrocentesis with CS administration increases the mobility of the mandible, may however be the result of the joint lavage itself [7,48]. A single study involving the administration of CS alone did not show any significant increase in the extent of mandibular abduction [48]. It was observed in a group of patients with a common feature of joint pain diagnosis [48]. On the other hand, preceding the administration of CS with arthrocentesis is effective in the analyzed domain [43,52,56,58,68,73]. It cannot be ruled out that the improvement in the mouth opening occurs due to the benefits of rinsing of the joint cavity, not from the drug administration [7,48]. However, this issue requires separate research.

5.3. Blood Products

Among the various blood products used in medicine, PRP, I-PRF and PRGF have been identified for injection into TMJs [40,76,77,78,79,80,81,82,83]. The effectiveness of blood products results, among others, from the content of platelets, cytokines and growth factors, which are successfully used in supporting wound healing, among others in dentistry [81,82,83,84,85]. PRP is used both alone and in combination with arthrocentesis [60,63,64,67,80]. Both approaches are known to be beneficial in terms of increasing the mobility of the mandible [7,19,21,86]. In the material collected for the review, osteoarthritis was treated in both ways [60,63,64]. PRP administration as the only procedure was effective in terms of increasing mandibular abduction amplitude in the diagnoses of disk displacement with reduction and not specified joint pain. I-PRF was used only after arthrocentesis, and PRGF was used without rinsing the joint [38,40,79]. Data on the use of the latter substance are derived from only one report, describing a study without a control group [79].

5.4. Analgesics

In the course of the literature search, it was found that the TMJs cavities are therapeutically administered with morphine, tramadol, tenoxicam and lidocaine as an additive to dextrose [44,49,52,66,87]. A systematic review of the effectiveness of intra-articular analgesics by Liu et al., in 2021 showed divergent results for the NSAIDs and opioids [24]. These authors noted the lack of statistical significance in relation to the control groups in the results of NSAID treatment, which questioned the effectiveness of the administration of these drugs [24]. Compared to opioids, in the course of the analysis in this review, tenoxicam gave the final results of mandibular mobilization not much worse than tramadol and an approximately four-fold decrease in pain, similar to tramadol [52,66]. This effect may be largely attributed to prior arthrocentesis [24,66]. For opioids, there are likely to be statistically significant differences between the groups treated with drugs in combination with arthrocentesis and the joint lavage alone [24,87,88,89,90,91].

5.5. Dextrose

Dextrose solution is administered intra-articularly with the addition of lidocaine, which is referred to as prolotherapy. In the study by Zarate et al., a decrease in pain symptoms was shown to the level of 33% of the initial value, which, however, was not confirmed in the other two reports (76–65%) [44,49,62]. The increase in mandibular mobility did not exceed 12% in the analyzed studies [44,49]. The obtained results are clearly worse than in the case of administering analgesics or transplants, which perhaps should be explained by the lack of arthrocentesis before the prolotherapy [39,44,45,49,62]. Sit et al., indicate that a review of studies on dextrose injection shows statistically significant results in favor of prolotherapy in relation to the control groups [92].

5.6. Transplants

Self-derived transplants constitute a non-homogeneous group of injectables. These include, first of all, the blood products already discussed. Apart from them, there are the first experimental and clinical studies on intra-articular administration of adipose tissue and bone marrow cells [39,45,93,94,95]. The promising results of these therapies do not exempt them from caution in their implementation [39,45].

5.7. Ozone Gas

Ozone at the tissue level is anti-inflammatory and stimulates the immune system [71,96,97,98]. The research conducted so far on ozone administration into TMJs cavities is insufficient to draw conclusions on this subject [97]. The Daif et al. study analyzed in this systematic review cannot be compared with other therapies due to different outcome measures [71].

5.8. Differential Diagnosis

Apart from intra-articular injections, physiotherapy, pharmacotherapy, splint therapy and injections into the masticatory muscles are also used in the treatment of temporomandibular joint dysfunctions [6,99,100,101]. The latter are applicable when it is possible to diagnose that the pain and movement restrictions are of muscle origin, not articular [6,99]. The limitation of the mobility of the mandible may also result from a mechanical obstruction, including trauma, various stages of ankylosis of the temporomandibular joint (mainly traumatic) and hyperplasia of the coronoid processes [3,102,103,104]. A thorough subjective and physical examination as well as three-dimensional imaging of the temporomandibular joints can therefore prevent implementation of an inadequate therapy.

5.9. Limitations

The limitation of this review is the difficulty in formulating a strategy to search for substances whose names we want to identify, which may have resulted in the overlooking of other injectables. Therefore it seems justified to undertake further reviews aimed at individual identified substances.

6. Conclusions

52 studies on injection into the cavities of the temporomandibular joints in 40 reports compliant with the adopted systematic review criteria were identified. Intra-articular administrations of hyaluronic acid (40.4%), corticosteroids (19.2%) and blood products (21.2%) dominated. Emerging methods of treatment of mandibular hypomobility are intra-articular injections of analgesics, dextrose, self-derived transplants and ozone gas (17.3% in total). The most promising substances are self-derived transplants: bone marrow and adipose tissue. Among these substances, better results in mandibular mobility and reduction in joint pain have been achieved with therapies including pre-injection arthrocentesis.

Author Contributions

Conceptualization, M.C. and M.S.; Methodology, M.C. and D.C.; Investigation, M.C. and K.C.; Resources, K.C. and Z.N.; Data Curation, M.C. and K.C.; Writing—Original Draft Preparation, M.C., K.C. and Z.N.; Writing—Review and Editing, M.S. and D.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

No consent was obtained as this study did not include any intervention in humans.

Data Availability Statement

Availability of data, code and other materials: The protocol of the systematic review is available in the PROSPERO database under the number CRD42022318742. The entirety of the collected data is presented in the content of this article.

Conflicts of Interest

The authors of this research declare no conflict of interest.

References

  1. Yang, S.H.; Park, H.; Yoo, D.S.; Joo, W.; Rhoton, A. Microsurgical anatomy of the facial nerve. Clin. Anat. 2021, 34, 90–102. [Google Scholar] [CrossRef] [PubMed]
  2. Sikora, M.; Chęciński, M.; Chlubek, D. Retro-Auricular Approach to the Fractures of the Mandibular Condyle: A Systematic Review. J. Clin. Med. 2021, 10, 230. [Google Scholar] [CrossRef] [PubMed]
  3. Sikora, M.; Chęciński, M.; Nowak, Z.; Chlubek, D. Variants and Modifications of the Retroauricular Approach Using in Temporomandibular Joint Surgery: A Systematic Review. J. Clin. Med. 2021, 10, 2049. [Google Scholar] [CrossRef] [PubMed]
  4. Bengtsson, M.; Fransson, P. Do patient-reported outcome measures correlate with clinical follow-up after arthroscopic treatment of internal derangement of the temporomandibular joint? J. Stomatol. Oral Maxillofac. Surg. 2021, 122, e21–e26. [Google Scholar] [CrossRef]
  5. Kumar, A.; Gupta, A.; Ghosh, R.; Pandey, R.; Kumar, S. A Comparative Study between Concentric Single-Needle Puncture Technique and Conventional 2-Needle Technique for Temporomandibular Joint Arthrocentesis Plus Corticosteroid Injections. Craniomaxillofac. Trauma Reconstr. 2020, 13, 99–104. [Google Scholar] [CrossRef]
  6. Sikora, M.; Czerwińska-Niezabitowska, B.; Chęciński, M.A.; Sielski, M.; Chlubek, D. Short-Term Effects of Intra-Articular Hyaluronic Acid Administration in Patients with Temporomandibular Joint Disorders. J. Clin. Med. 2020, 9, 1749. [Google Scholar] [CrossRef]
  7. Liapaki, A.; Thamm, J.R.; Ha, S.; Monteiro, J.L.G.C.; McCain, J.P.; Troulis, M.J.; Guastaldi, F.P.S. Is there a difference in treatment effect of different intra-articular drugs for temporomandibular joint osteoarthritis? A systematic review of randomized controlled trials. Int. J. Oral Maxillofac. Surg. 2021, 50, 1233–1243. [Google Scholar] [CrossRef]
  8. Nagori, S.A.; Bansal, A.; Jose, A.; Roychoudhury, A. Comparison of outcomes with the single-puncture and double-puncture techniques of arthrocentesis of the temporomandibular joint: An updated systematic review and meta-analysis. J. Oral Rehabil. 2021, 48, 1056–1065. [Google Scholar] [CrossRef]
  9. Guarda-Nardini, L.; De Almeida, A.M.; Manfredini, D. Arthrocentesis of the Temporomandibular Joint: Systematic Review and Clinical Implications of Research Findings. J. Oral Facial Pain Headache 2021, 35, 17–29. [Google Scholar] [CrossRef]
  10. Li, D.T.S.; Wong, N.S.M.; Li, S.K.Y.; McGrath, C.P.; Leung, Y.Y. Timing of arthrocentesis in the management of temporomandibular disorders: An integrative review and meta-analysis. Int. J. Oral Maxillofac. Surg. 2021, 50, 1078–1088. [Google Scholar] [CrossRef]
  11. Derwich, M.; Mitus-Kenig, M.; Pawlowska, E. Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis—A Systematic Review. Int. J. Mol. Sci. 2021, 22, 7405. [Google Scholar] [CrossRef] [PubMed]
  12. Chęciński, M.; Sikora, M.; Chęcińska, K.; Nowak, Z.; Chlubek, D. The Administration of Hyaluronic Acid into the Temporomandibular Joints’ Cavities Increases the Mandible’s Mobility: A Systematic Review and Meta-Analysis. J. Clin. Med. 2022, 11, 1901. [Google Scholar] [CrossRef] [PubMed]
  13. Goker, F.; Russillo, A.; Taschieri, S.; Giannì, A.B.; Mortellaro, C.; Colletti, L.; Manfredi, B.; Rovati, M.; Biagi, R.; Del Fabbro, M. Evaluation of Arthrocentesis with hyaluronic acid injections for management of temporomandibular disorders: A systematic review and case series. J. Biol. Regul. Homeost. Agents 2021, 35, 21–35. [Google Scholar] [CrossRef] [PubMed]
  14. Sàbado-Bundó, H.; Sánchez-Garcés, M.; Camps-Font, O.; Gay-Escoda, C. Intraarticular injections of hyaluronic acid in arthrocentesis and arthroscopy as a treatment of temporomandibular joint disorders: A systematic review. CRANIO 2021, 1–10. [Google Scholar] [CrossRef]
  15. Stoustrup, P.; Kristensen, K.D.; Verna, C.; Küseler, A.; Pedersen, T.K.; Herlin, T. Intra-articular steroid injection for temporomandibular joint arthritis in juvenile idiopathic arthritis: A systematic review on efficacy and safety. Semin. Arthritis Rheum. 2013, 43, 63–70. [Google Scholar] [CrossRef]
  16. Parra, D.A.; Chan, M.; Krishnamurthy, G.; Spiegel, L.; Amaral, J.G.; Temple, M.J.; John, P.R.; Connolly, B.L. Use and accuracy of US guidance for image-guided injections of the temporomandibular joints in children with arthritis. Pediatr. Radiol. 2010, 40, 1498–1504. [Google Scholar] [CrossRef]
  17. Skármeta, N.P.; Hormazábal, F.A.; Alvarado, J.; Rodriguez, A.M. Subcutaneous Lipoatrophy and Skin Depigmentation Secondary to TMJ Intra-Articular Corticosteroid Injection. J. Oral Maxillofac. Surg. 2017, 75, 2540.e1–2540.e5. [Google Scholar] [CrossRef]
  18. Al-Hamed, F.S.; Hijazi, A.; Gao, Q.; Badran, Z.; Tamimi, F. Platelet Concentrate Treatments for Temporomandibular Disorders: A Systematic Review and Meta-analysis. JDR Clin. Transl. Res. 2020, 6, 174–183. [Google Scholar] [CrossRef]
  19. Gutiérrez, I.Q.; Sábado-Bundó, H.; Gay-Escoda, C. Intraarticular Injections of Platelet Rich Plasma and Plasma Rich in Growth Factors with Arthrocenthesis or Arthroscopy in the Treatment of Temporomandibular Joint Disorders: A Systematic Review. J. Stomatol. Oral Maxillofac. Surg. 2021. [Google Scholar] [CrossRef]
  20. Haigler, M.C.; Abdulrehman, E.; Siddappa, S.; Kishore, R.; Padilla, M.; Enciso, R. Use of platelet-rich plasma, platelet-rich growth factor with arthrocentesis or arthroscopy to treat temporomandibular joint osteoarthritis. J. Am. Dent. Assoc. 2018, 149, 940–952.e2. [Google Scholar] [CrossRef]
  21. Chung, P.-Y.; Lin, M.-T.; Chang, H.-P. Effectiveness of platelet-rich plasma injection in patients with temporomandibular joint osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2019, 127, 106–116. [Google Scholar] [CrossRef] [PubMed]
  22. Bousnaki, M.; Bakopoulou, A.; Koidis, P. Platelet-rich plasma for the therapeutic management of temporomandibular joint disorders: A systematic review. Int. J. Oral Maxillofac. Surg. 2018, 47, 188–198. [Google Scholar] [CrossRef] [PubMed]
  23. Albilia, J.; Herrera-Vizcaíno, C.; Weisleder, H.; Choukroun, J.; Ghanaati, S. Liquid platelet-rich fibrin injections as a treatment adjunct for painful temporomandibular joints: Preliminary results. CRANIO 2020, 38, 292–304. [Google Scholar] [CrossRef] [PubMed]
  24. Liu, S.; Hu, Y.; Zhang, X. Do intra-articular injections of analgesics improve outcomes after temporomandibular joint arthrocentesis?: A systematic review and meta-analysis. J. Oral Rehabil. 2020, 48, 95–105. [Google Scholar] [CrossRef]
  25. Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021, 372, 105906. [Google Scholar] [CrossRef]
  26. Page, M.J.; Shamseer, L.; Tricco, A.C. Registration of systematic reviews in PROSPERO: 30,000 records and counting. Syst. Rev. 2018, 7, 32. [Google Scholar] [CrossRef]
  27. Chiappelli, F.; Kasar, V.R.; Balenton, N.; Khakshooy, A. Quantitative Consensus in Systematic Reviews: Current and Future Challenges in Translational Science. Bioinformation 2018, 14, 86–92. [Google Scholar] [CrossRef] [Green Version]
  28. Ouzzani, M.; Hammady, H.; Fedorowicz, Z.; Elmagarmid, A. Rayyan—A web and mobile app for systematic reviews. Syst. Rev. 2016, 5, 210. [Google Scholar] [CrossRef] [Green Version]
  29. Rodhen, R.M.; de Holanda, T.A.; Barbon, F.J.; de Oliveira da Rosa, W.L.; Boscato, N. Invasive surgical procedures for the management of internal derangement of the temporomandibular joint: A systematic review and meta-analysis regarding the effects on pain and jaw mobility. Clin. Oral Investig. 2022, 26, 3429–3446. [Google Scholar] [CrossRef]
  30. Woodford, S.C.; Robinson, D.L.; Mehl, A.; Lee, P.V.S.; Ackland, D.C. Measurement of normal and pathological mandibular and temporomandibular joint kinematics: A systematic review. J. Biomech. 2020, 111, 109994. [Google Scholar] [CrossRef]
  31. Pinheiro, P.F., Jr.; Da Cunha, D.A.; Filho, M.G.D.; Caldas, A.S.; Melo, T.M.A.; Da Silva, H.J. The Use of Electrognathography in Jaw Movement Research: A Literature Review. CRANIO 2012, 30, 293–303. [Google Scholar] [CrossRef] [PubMed]
  32. Nitecka-Buchta, A.; Proba, T.; Proba, P.; Stefanski, K.; Baron, S. Functional Assessment of the Stomatognathic System, after the Treatment of Edentulous Patients, with Different Methods of Establishing the Centric Relation. Pain Res. Manag. 2018, 2018, 1572037. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  33. Sterne, J.A.C.; Savović, J.; Page, M.J.; Elbers, R.G.; Blencowe, N.S.; Boutron, I.; Cates, C.J.; Cheng, H.Y.; Corbett, M.S.; Eldridge, S.M.; et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ 2019, 366, l4898. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  34. Barrette, L.-X.; Connolly, J.; Romeo, D.; Ng, J.; Moreira, A.G.; Rajasekaran, K. Quality appraisal of clinical practice guidelines for temporomandibular joint disorders using the AGREE II instrument. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2021, 133, 402–411. [Google Scholar] [CrossRef]
  35. Warburton, G.; Patel, N.; Anchlia, S. Current Treatment Strategies for the Management of the Internal Derangements of the Temporomandibular Joint: A Global Perspective. J. Maxillofac. Oral Surg. 2021, 21, 1–13. [Google Scholar] [CrossRef]
  36. International Classification of Orofacial Pain, 1st edition (ICOP). Cephalalgia 2020, 40, 129–221. [CrossRef] [Green Version]
  37. Schiffman, E.; Ohrbach, R.; Truelove, E.; Look, J.; Anderson, G.; Goulet, J.-P.; List, T.; Svensson, P.; Gonzalez, Y.; Lobbezoo, F.; et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J. Oral Facial Pain Headache 2014, 28, 6–27. [Google Scholar] [CrossRef]
  38. Ghoneim, N.I.; Mansour, N.A.; Elmaghraby, S.A.; Abdelsameaa, S.E. Treatment of temporomandibular joint disc displacement using arthrocentesis combined with injectable platelet rich fibrin versus arthrocentesis alone. J. Dent. Sci. 2021, 17, 468–475. [Google Scholar] [CrossRef]
  39. Sembronio, S.; Tel, A.; Tremolada, C.; Lazzarotto, A.; Isola, M.; Robiony, M. Temporomandibular Joint Arthrocentesis and Microfragmented Adipose Tissue Injection for the Treatment of Internal Derangement and Osteoarthritis: A Randomized Clinical Trial. J. Oral Maxillofac. Surg. 2021, 79, 1447–1456. [Google Scholar] [CrossRef]
  40. Karadayi, U.; Gursoytrak, B. Randomised controlled trial of arthrocentesis with or without PRF for internal derangement of the TMJ. J. Cranio-Maxillofac. Surg. 2021, 49, 362–367. [Google Scholar] [CrossRef]
  41. Jacob, S.M.; Bandyopadhyay, T.K.; Chattopadhyay, P.K.; Parihar, V.S. Efficacy of Platelet-Rich Plasma Versus Hyaluronic Acid Following Arthrocentesis for Temporomandibular Joint Disc Disorders: A Randomized Controlled Trial. J. Maxillofac. Oral Surg. 2021, 20, 1–6. [Google Scholar] [CrossRef]
  42. Singh, A.K.; Sharma, N.K.; Kumar, P.G.N.; Singh, S.; Mishra, N.; Bera, R.N. Evaluation of Arthrocentesis with and Without Platelet-Rich Plasma in the Management of Internal Derangement of Temporomandibular Joint: A Randomized Controlled Trial. J. Maxillofac. Oral Surg. 2019, 20, 252–257. [Google Scholar] [CrossRef] [PubMed]
  43. Dolwick, M.F.; Diaz, D.; Freburg-Hoffmeister, D.L.; Widmer, C.G. A Randomized, Double-Blind, Placebo-Controlled Study of the Efficacy of Steroid Supplementation After Temporomandibular Joint Arthrocentesis. J. Oral Maxillofac. Surg. 2020, 78, 1088–1099. [Google Scholar] [CrossRef] [PubMed]
  44. Zarate, M.A.; Frusso, R.D.; Reeves, K.D.; Cheng, A.-L.; Rabago, D. Dextrose Prolotherapy Versus Lidocaine Injection for Temporomandibular Dysfunction: A Pragmatic Randomized Controlled Trial. J. Altern. Complement. Med. 2020, 26, 1064–1073. [Google Scholar] [CrossRef]
  45. De Riu, G.; Vaira, L.A.; Carta, E.; Meloni, S.M.; Sembronio, S.; Robiony, M. Bone marrow nucleated cell concentrate autograft in temporomandibular joint degenerative disorders: 1-year results of a randomized clinical trial. J. Cranio-Maxillofac. Surg. 2018, 47, 1728–1738. [Google Scholar] [CrossRef] [PubMed]
  46. Yilmaz, O.; Korkmaz, Y.T.; Tuzuner, T. Comparison of treatment efficacy between hyaluronic acid and arthrocentesis plus hyaluronic acid in internal derangements of temporomandibular joint. J. Cranio-Maxillofac. Surg. 2019, 47, 1720–1727. [Google Scholar] [CrossRef]
  47. Bergstrand, S.; Ingstad, H.K.; Møystad, A.; Bjørnland, T. Long-term effectiveness of arthrocentesis with and without hyaluronic acid injection for treatment of temporomandibular joint osteoarthritis. J. Oral Sci. 2019, 61, 82–88. [Google Scholar] [CrossRef] [Green Version]
  48. Isacsson, G.; Schumann, M.; Nohlert, E.; Mejersjö, C.; Tegelberg, Å. Pain relief following a single-dose intra-articular injection of methylprednisolone in the temporomandibular joint arthralgia—A multicentre randomised controlled trial. J. Oral Rehabil. 2018, 46, 5–13. [Google Scholar] [CrossRef]
  49. Louw, W.F.; Reeves, K.D.; Lam, S.K.; Cheng, A.-L.; Rabago, D. Treatment of Temporomandibular Dysfunction with Hypertonic Dextrose Injection (Prolotherapy): A Randomized Controlled Trial with Long-term Partial Crossover. Mayo Clin. Proc. 2019, 94, 820–832. [Google Scholar] [CrossRef] [Green Version]
  50. Kutuk, S.G.; Gökçe, G.; Arslan, M.; Özkan, Y.; Kütük, M.; Arikan, O.K. Clinical and Radiological Comparison of Effects of Platelet-Rich Plasma, Hyaluronic Acid, and Corticosteroid Injections on Temporomandibular Joint Osteoarthritis. J. Craniofacial Surg. 2019, 30, 1144–1148. [Google Scholar] [CrossRef]
  51. Diaz, D.; Dolwick, M.; Freburg-Hoffmeister, D.; Widmer, C. Double-Blind, Randomized, Placebo Controlled Clinical Trial Examining the Efficacy of Steroid Supplementation after TMJ Arthrocentesis. J. Oral Maxillofac. Surg. 2019, 77, e50–e51. [Google Scholar] [CrossRef]
  52. Yapici-Yavuz, G.; Simsek-Kaya, G.; Ogul, H. A comparison of the effects of Methylprednisolone Acetate, Sodium Hyaluronate and Tenoxicam in the treatment of non-reducing disc displacement of the temporomandibular joint. Med. Oral Patol. Oral Cir. Bucal 2018, 23, e351–e358. [Google Scholar] [CrossRef] [PubMed]
  53. Ozdamar, S.M.; Alev, B.; Yarat, A. The impact of arthrocentesis with and without hyaluronic acid injection in the prognosis and synovial fluid myeloperoxidase levels of patients with painful symptomatic internal derangement of temporomandibular joint: A randomised controlled clinical trial. J. Oral Rehabil. 2017, 44, 73–80. [Google Scholar] [CrossRef] [PubMed]
  54. Gorrela, H.; Prameela, J.; Srinivas, G.; Reddy, B.V.B.; Sudhir, M.; Arakeri, G. Efficacy of Temporomandibular Joint Arthrocentesis with Sodium Hyaluronate in the Management of Temporomandibular Joint Disorders: A Prospective Randomized Control Trial. J. Maxillofac. Oral Surg. 2016, 16, 479–484. [Google Scholar] [CrossRef]
  55. Gurung, T.; Singh, R.K.; Mohammad, S.; Pal, U.S.; Mahdi, A.A.; Kumar, M. Efficacy of arthrocentesis versus arthrocentesis with sodium hyaluronic acid in temporomandibular joint osteoarthritis: A comparison. Natl. J. Maxillofac. Surg. 2017, 8, 41–49. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  56. Kiliç, S.C. Does Injection of Corticosteroid After Arthrocentesis Improve Outcomes of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial. J. Oral Maxillofac. Surg. 2016, 74, 2151–2158. [Google Scholar] [CrossRef]
  57. Patel, P.; Idrees, F.; Newaskar, V.; Agrawal, D. Sodium hyaluronate: An effective adjunct in temporomandibular joint arthrocentesis. Oral Maxillofac. Surg. 2016, 20, 405–410. [Google Scholar] [CrossRef]
  58. Bouloux, G.F.; Chou, J.; Krishnan, D.; Aghaloo, T.; Kahenasa, N.; Smith, J.A.; Giannakopoulos, H. Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short Term for Improving Function and Quality of Life After Arthrocentesis? Part 2. J. Oral Maxillofac. Surg. 2016, 75, 63–72. [Google Scholar] [CrossRef]
  59. Bouloux, G.F.; Chou, J.; Krishnan, D.; Aghaloo, T.; Kahenasa, N.; Smith, J.A.; Giannakopoulos, H. Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short-Term Reduction of Temporomandibular Joint Pain After Arthrocentesis? Part 1. J. Oral Maxillofac. Surg. 2016, 75, 52–62. [Google Scholar] [CrossRef] [Green Version]
  60. Kiliç, S.C.; Güngörmüş, M. Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis plus hyaluronic acid for the treatment of temporomandibular joint osteoarthritis: A randomized clinical trial. Int. J. Oral Maxillofac. Surg. 2016, 45, 1538–1544. [Google Scholar] [CrossRef]
  61. Korkmaz, Y.T.; Altıntas, N.Y.; Korkmaz, F.M.; Candırlı, C.; Coskun, U.; Durmuslar, M.C. Is Hyaluronic Acid Injection Effective for the Treatment of Temporomandibular Joint Disc Displacement with Reduction? J. Oral Maxillofac. Surg. 2016, 74, 1728–1740. [Google Scholar] [CrossRef] [PubMed]
  62. Lam, S.K.; Reeves, K.D.; Rabago, D. Dextrose Prolotherapy for Chronic Temporomandibular Pain and Dysfunction: Results of a Pilot-Level Randomized Controlled Study. Arch. Phys. Med. Rehabil. 2016, 97, e139. [Google Scholar] [CrossRef]
  63. Kiliç, S.C.; Güngörmüş, M.; Sümbüllü, M.A. Is Arthrocentesis Plus Platelet-Rich Plasma Superior to Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial. J. Oral Maxillofac. Surg. 2015, 73, 1473–1483. [Google Scholar] [CrossRef] [PubMed]
  64. Hegab, A.F.; Ali, H.E.; Elmasry, M.; Khallaf, M.G. Platelet-Rich Plasma Injection as an Effective Treatment for Temporomandibular Joint Osteoarthritis. J. Oral Maxillofac. Surg. 2015, 73, 1706–1713. [Google Scholar] [CrossRef]
  65. Guarda-Nardini, L.; Rossi, A.; Arboretti, R.; Bonnini, S.; Stellini, E.; Manfredini, D.; Guarda-Nardini, L.; Rossi, A.; Arboretti, R.; Bonnini, S.; et al. Single- or multiple-session viscosupplementation protocols for temporomandibular joint degenerative disorders: A randomized clinical trial. J. Oral Rehabil. 2015, 42, 521–528. [Google Scholar] [CrossRef] [PubMed]
  66. Sipahi, A.; Satilmis, T.; Basa, S. Comparative study in patients with symptomatic internal derangements of the temporomandibular joint: Analgesic outcomes of arthrocentesis with or without intra-articular morphine and tramadol. Br. J. Oral Maxillofac. Surg. 2015, 53, 316–320. [Google Scholar] [CrossRef]
  67. Hancı, M.; Karamese, M.; Tosun, Z.; Aktan, T.M.; Duman, S.; Savaci, N. Intra-articular platelet-rich plasma injection for the treatment of temporomandibular disorders and a comparison with arthrocentesis. J. Cranio-Maxillofac. Surg. 2015, 43, 162–166. [Google Scholar] [CrossRef]
  68. Tabrizi, R.; Karagah, T.; Arabion, H.; Soleimanpour, M.R.; Soleimanpour, M. Outcomes of Arthrocentesis for the Treatment of Internal Derangement Pain: With or without corticosteroids? J. Craniofacial Surg. 2014, 25, e571–e575. [Google Scholar] [CrossRef]
  69. Bustaman, F.; Torroni, A.; Samman, N. The efficacy of intra-articular hyaluronic acid in chronic symptomatic temporomandibular joints: A randomized controlled trial. Int. J. Oral Maxillofac. Surg. 2013, 42, 1370. [Google Scholar] [CrossRef]
  70. Guarda-Nardini, L.; Cadorin, C.; Frizziero, A.; Ferronato, G.; Manfredini, D. Comparison of 2 Hyaluronic Acid Drugs for the Treatment of Temporomandibular Joint Osteoarthritis. J. Oral Maxillofac. Surg. 2012, 70, 2522–2530. [Google Scholar] [CrossRef]
  71. Daif, E.T. Role of intra-articular ozone gas injection in the management of internal derangement of the temporomandibular joint. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2012, 113, e10–e14. [Google Scholar] [CrossRef] [PubMed]
  72. Guarda-Nardini, L.; Ferronato, G.; Manfredini, D. Two-needle vs. single-needle technique for TMJ arthrocentesis plus hyaluronic acid injections: A comparative trial over a six-month follow up. Int. J. Oral Maxillofac. Surg. 2012, 41, 506–513. [Google Scholar] [CrossRef] [PubMed]
  73. Manfredini, D.; Rancitelli, D.; Ferronato, G.; Guarda-Nardini, L. Arthrocentesis with or without additional drugs in temporomandibular joint inflammatory-degenerative disease: Comparison of six treatment protocols. J. Oral Rehabil. 2011, 39, 245–251. [Google Scholar] [CrossRef] [PubMed]
  74. Huddleston Slater, J.J.; Vos, L.M.; Stroy, L.P.; Stegenga, B. Randomized Trial on the Effectiveness of Dexamethasone in TMJ Arthrocentesis. J. Dent. Res. 2011, 91, 173–178. [Google Scholar] [CrossRef] [Green Version]
  75. Singh, J.; Bhardwaj, B. Treatment of Temporomandibular Joint Arthritis with Triamcinolone Acetonide and Hyaluronic Acid Injection: An Observational Study. Indian J. Otolaryngol. Head Neck Surg. 2019, 72, 403–410. [Google Scholar] [CrossRef]
  76. Giacomello, M.; Mortellaro, C.; Viganoni, C.; Crimella, A.; Fossati, J.; Lauritano, D. PRGF® endoret injections for temporomandibular joint osteoarthritis treatment: A one-year follow-up. J. Biol. Regul. Homeost. Agents 2020, 33, 215–222. [Google Scholar]
  77. Pihut, M.; Szuta, M.; Ferendiuk, E.; Zeńczak-Więckiewicz, D. Evaluation of Pain Regression in Patients with Temporomandibular Dysfunction Treated by Intra-Articular Platelet-Rich Plasma Injections: A Preliminary Report. BioMed Res. Int. 2014, 2014, 132369. [Google Scholar] [CrossRef] [Green Version]
  78. Fernández Sanromán, J.; Fernández Ferro, M.; Costas López, A.; Arenaz Bua, J.; López, A. Does injection of plasma rich in growth factors after temporomandibular joint arthroscopy improve outcomes in patients with Wilkes stage IV internal derangement? A randomized prospective clinical study. Int. J. Oral Maxillofac. Surg. 2016, 45, 828–835. [Google Scholar] [CrossRef]
  79. Fernández-Ferro, M.; Fernández-Sanromán, J.; Blanco-Carrión, A.; Costas-López, A.; López-Betancourt, A.; Arenaz-Bua, J.; Stavaru Marinescu, B. Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of temporomandibular dysfunction: A randomised prospective study. J. Craniomaxillofac. Surg. 2017, 45, 449–454. [Google Scholar] [CrossRef]
  80. Rajput, A.; Bansal, V.; Dubey, P.; Kapoor, A. A Comparative Analysis of Intra-articular Injection of Platelet-Rich Plasma and Arthrocentesis in Temporomandibular Joint Disorders. J. Maxillofac. Oral Surg. 2022, 21, 168–175. [Google Scholar] [CrossRef]
  81. Masuki, H.; Okudera, T.; Watanabe, T.; Suzuki, M.; Nishiyama, K.; Okudera, H.; Nakata, K.; Uematsu, K.; Su, C.-Y.; Kawase, T. Growth factor and pro-inflammatory cytokine contents in platelet-rich plasma (PRP), plasma rich in growth factors (PRGF), advanced platelet-rich fibrin (A-PRF), and concentrated growth factors (CGF). Int. J. Implant Dent. 2016, 2, 19. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  82. Antonelli, A.; Giudice, A.; Muraca, D.; Fortunato, L. Usefulness of advanced-platelet rich fibrin (A-PRF) and injectable-platelet rich fibrin (i-PRF) in the management of a massive medication-related osteonecrosis of the jaw (MRONJ): A 5-years follow-up case report. Indian J. Dent. Res. 2020, 31, 813–818. [Google Scholar] [CrossRef] [PubMed]
  83. Giudice, A.; Esposito, M.; Bennardo, F.; Brancaccio, Y.; Buti, J.; Fortunato, L. Dental extractions for patients on oral antiplatelet: A within-person randomised controlled trial comparing haemostatic plugs, advanced-platelet-rich fibrin (A-PRF+) plugs, leukocyte- and platelet-rich fibrin (L-PRF) plugs and suturing alone. Int. J. Oral Implant. 2019, 12, 77–87. [Google Scholar]
  84. Koyuncu, B.; Işık, G.; Yüce, M.; Günbay, S.; Günbay, T. Effect of concentrated growth factors on frequency of alveolar Osteitis following partially-erupted mandibular third molar surgery: A randomized controlled clinical study. BMC Oral Health 2020, 20, 222. [Google Scholar] [CrossRef]
  85. Brancaccio, Y.; Antonelli, A.; Barone, S.; Bennardo, F.; Fortunato, L.; Giudice, A. Evaluation of local hemostatic efficacy after dental extractions in patients taking antiplatelet drugs: A randomized clinical trial. Clin. Oral Investig. 2020, 25, 1159–1167. [Google Scholar] [CrossRef]
  86. Lin, S.L.; Tsai, C.C.; Wu, S.L.; Ko, S.Y.; Chiang, W.F.; Yang, J.W. Effect of arthrocentesis plus platelet-rich plasma and platelet-rich plasma alone in the treatment of temporomandibular joint osteoarthritis: A retrospective matched cohort study (A STROBE-compliant article). Medicine 2018, 97, e0477. [Google Scholar] [CrossRef]
  87. Gopalakrishnan, V.; Nagori, S.A.; Roy Chowdhury, S.K.; Saxena, V. The use of intra-articular analgesics to improve outcomes after temporomandibular joint arthrocentesis: A review. Oral Maxillofac. Surg. 2018, 22, 357–364. [Google Scholar] [CrossRef]
  88. Al-Kibsi, T.A.; Elsharrawy, E.A.; Ghanem, W.A.; El Sholkamy, M.A.; Tawfik, M.K. Clinical assessment of intra-articular injection of butorphanol in management of temporomandibular joint internal derangement. Egypt. J. Oral Maxillofac. Surg. 2017, 8, 83–87. [Google Scholar] [CrossRef]
  89. Fayed, H.T.A.M.; Elsharrawy, E.A.; Hamed, T.A.; Abd-Allah, A.-E. Clinical assessment of intra-articular fentanyl injection following arthrocentesis for management of temporomandibular joint internal derangement. Future Dent. J. 2016, 2, 86–90. [Google Scholar] [CrossRef]
  90. El-Gerby, Y.M.; El-Sholkamy, M.A.; El-Sharrawy, E.A. Comparativestudy between Tramadol Hydrochloride and Sodium Hyaloronatefor Management of Tempromandibular Joint Internal Derangement. Adv. Surg. Sci. 2015, 3, 19–26. [Google Scholar] [CrossRef]
  91. Escoda, C.G.; Hanna, M.; Montero, A.; Dietrich, T.; Milleri, S.; Giergiel, E.; Zoltán, T.B.; Varassi, G. Tramadol/dexketoprofen (TRAM/DKP) compared with tramadol/paracetamol in moderate to severe acute pain: Results of a randomised, double-blind, placebo and active-controlled, parallel group trial in the impacted third molar extraction pain model (DAVID study). BMJ Open 2019, 9, e023715. [Google Scholar] [CrossRef] [Green Version]
  92. Sit, R.W.-S.; Reeves, K.D.; Zhong, C.C.; Wong, C.H.L.; Wang, B.; Chung, V.C.-H.; Wong, S.Y.-S.; Rabago, D. Efficacy of hypertonic dextrose injection (prolotherapy) in temporomandibular joint dysfunction: A systematic review and meta-analysis. Sci. Rep. 2021, 11, 14638. [Google Scholar] [CrossRef] [PubMed]
  93. El Qashty, R.M.N.; Mohamed, N.N.; Radwan, L.R.S.; Ibrahim, F.M.M. Effect of bone marrow mesenchymal stem cells on healing of temporomandibular joints in rats with induced rheumatoid arthritis. Eur. J. Oral Sci. 2018, 126, 272–281. [Google Scholar] [CrossRef] [PubMed]
  94. Carboni, A.; Amodeo, G.; Perugini, M.; Arangio, P.; Orsini, R.; Scopelliti, D. Temporomandibular Disorders Clinical and Anatomical Outcomes After Fat-Derived Stem Cells Injection. J. Craniofacial Surg. 2019, 30, 793–797. [Google Scholar] [CrossRef] [PubMed]
  95. Behdin, S.; Alqahtani, H.M.; Bissada, N.F. Therapeutic potential of adipose tissue stem cells for periodontal regeneration. J. Periodontol. 2019, 91, 732–733. [Google Scholar] [CrossRef]
  96. Sen, S.; Sen, S. Ozone therapy a new vista in dentistry: Integrated review. Med. Gas Res. 2020, 10, 189–192. [Google Scholar] [CrossRef]
  97. Oshaghi, S.; Haghighat, S. Effectiveness of ozone injection therapy in temporomandibular disorders. Adv. Biomed. Res. 2020, 9, 73. [Google Scholar] [CrossRef]
  98. de Sire, A.; Marotta, N.; Ferrillo, M.; Agostini, F.; Sconza, C.; Lippi, L.; Respizzi, S.; Giudice, A.; Invernizzi, M.; Ammendolia, A. Oxygen-Ozone Therapy for Reducing Pro-Inflammatory Cytokines Serum Levels in Musculoskeletal and Temporomandibular Disorders: A Comprehensive Review. Int. J. Mol. Sci. 2022, 23, 2528. [Google Scholar] [CrossRef]
  99. Nowak, Z.; Chęciński, M.; Nitecka-Buchta, A.; Bulanda, S.; Ilczuk-Rypuła, D.; Postek-Stefańska, L.; Baron, S. Intramuscular Injections and Dry Needling within Masticatory Muscles in Management of Myofascial Pain. Systematic Review of Clinical Trials. Int. J. Environ. Res. Public Health 2021, 18, 9552. [Google Scholar] [CrossRef]
  100. Melis, M.; Di Giosia, M.; Zawawi, K.H. Oral myofunctional therapy for the treatment of temporomandibular disorders: A systematic review. CRANIO 2019, 40, 41–47. [Google Scholar] [CrossRef]
  101. Montinaro, F.; Nucci, L.; D’Apuzzo, F.; Perillo, L.; Chiarenza, M.C.; Grassia, V. Oral nonsteroidal anti-inflammatory drugs as treatment of joint and muscle pain in temporomandibular disorders: A systematic review. CRANIO 2022, 1–10. [Google Scholar] [CrossRef] [PubMed]
  102. Al-Moraissi, E.A.; El-Sharkawy, T.M.; Mounair, R.M.; El-Ghareeb, T.I. A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis. Int. J. Oral Maxillofac. Surg. 2015, 44, 470–482. [Google Scholar] [CrossRef] [PubMed]
  103. Sikora, M.; Chęciński, M.; Chlubek, D. Non-shortening fracture of the mandibular head resulting in severe mouth opening disorder operated on via the retroauricular approach—A case report. Pomeranian J. Life Sci. 2021, 67, 15–20. [Google Scholar] [CrossRef]
  104. Farronato, M.; Lucchina, A.G.; Mortellaro, C.; Fama, A.; Galbiati, G.; Farronato, G.; Maspero, C. Bilateral Hyperplasia of the Coronoid Process in Pediatric Patients: What is the Gold Standard for Treatment? J. Craniofacial Surg. 2019, 30, 1058–1063. [Google Scholar] [CrossRef]
Jcm 11 02305 g001 550
Figure 1. Studies selection process.
Figure 1. Studies selection process.
Jcm 11 02305 g001
Jcm 11 02305 g002 550
Figure 2. Use of individual substances: HA—hyaluronic acid; CS—corticosteroids.
Figure 2. Use of individual substances: HA—hyaluronic acid; CS—corticosteroids.
Jcm 11 02305 g002
Jcm 11 02305 g003 550
Figure 3. Number of studies with and without prior arthrocentesis (three most popular substances): A—administration; R—rinse; HA—hyaluronic acid; CS—corticosteroids.
Figure 3. Number of studies with and without prior arthrocentesis (three most popular substances): A—administration; R—rinse; HA—hyaluronic acid; CS—corticosteroids.
Jcm 11 02305 g003
Jcm 11 02305 g004 550
Figure 4. Improvement in mandibular abduction (the greater the value, the better the result).
Figure 4. Improvement in mandibular abduction (the greater the value, the better the result).
Jcm 11 02305 g004
Jcm 11 02305 g005 550
Figure 5. Final TMJ pain values after treatment with individual injectables expressed as a percentage (the pain value before treatment was 100% in each case).
Figure 5. Final TMJ pain values after treatment with individual injectables expressed as a percentage (the pain value before treatment was 100% in each case).
Jcm 11 02305 g005
Jcm 11 02305 g006 550
Figure 6. Linear regression model of pain intensity in dextrose and lidocaine therapy.
Figure 6. Linear regression model of pain intensity in dextrose and lidocaine therapy.
Jcm 11 02305 g006
Table
Table 1. Criteria for including and excluding studies from the review.
Table 1. Criteria for including and excluding studies from the review.
Inclusion CriteriaExclusion Criteria
Patient descriptionTemporomandibular joint (TMJ) diseaseAnimal studies
Intervention descriptionTMJ injection with or without arthrocentesisTMJ injection as part of a more complex treatment; any additional intervention
Comparators descriptionPlacebo or other injectable group with a similar size (+/−10%) and assessed for the same outcomes as the study group or no control groupNone
Outcomes descriptionPrimary outcome: (1) improvement of mandibular abduction; secondary outcomes: (2) improvement of mandibular lateral mobility, (3) improvement of mandibular protrusion, (4) pain relief of TMJNone
TimelinePapers published from 1 January 2012 to 3 April 2022
SettingsClinical trialsNo abstract available
Table
Table 2. Records excluded at the eligibility stage.
Table 2. Records excluded at the eligibility stage.
ReportPICOS CriterionReason for Exclusion
Cömert Kılıç, S. Does glucosamine, chondroitin sulfate, and methylsulfonylmethane supplementation improve the outcome of temporomandibular joint osteoarthritis management with arthrocentesis plus intra-articular hyaluronic acid injection. A randomized clinical trial. J. Craniomaxillofac. Surg. 2021, 49, 711–718.InterventionOral administration
Haghighat, S.; Oshaghi, S. Effectiveness of Ozone Injection Therapy in Temporomandibular Disorders. Adv. Biomed. Res. 2020, 28, 73.SettingsReview article
Sakalys, D.; Dvylys, D.; Simuntis, R,.; Leketas, M. Comparison of Different Intraarticular Injection Substances Followed by Temporomandibular Joint Arthroscopy. J. Craniofac. Surg. 2020, 31, 637–641.InterventionAdditional intervention
Özkan, H.S.; Irkören, S.; Karaca, H.; Yıldırım, T.D.; Çiçek, K.; Tataroğlu, C. Effects of Intra-Articular Platelet-Rich Plasma Administration in Temporomandibular Joint Arthritis: An Experimental Study. Meandros Med. Dent. J. 2018, 19, 198–204PatientAnimal studies
Buendía-López, D.; Medina-Quirós, M.; Fernández-Villacañas Marín, M.Á. Clinical and radiographic comparison of a single LP-PRP injection, a single hyaluronic acid injection and daily NSAID administration with a 52-week follow-up: a randomized controlled trial. J. Orthop. Traumatol. 2018, 19, 3.PatientWrong joint
Campbell, B.K.; Fillingim, R.B.; Lee, S.; Brao, R.; Price, D.D.; Neubert, J.K. Effects of High-Dose Capsaicin on TMD Subjects: A Randomized Clinical Study. JDR Clin. Trans. Res. 2017, 2, 58–65.InterventionTransdermal administration
Baker, Z.; Eriksson, L.; Englesson Sahlström, L.; Ekberg, E. Questionable effect of lavage for treatment of painful jaw movements at disc displacement without reduction: a 3-year randomised controlled follow-up. J. Oral. Rehabil. 2015, 42, 742–750.InterventionExtra-articular administration
Sahlström, L.E.; Ekberg, E.C.; List, T.; Petersson, A.; Eriksson, L. Lavage treatment of painful jaw movements at disc displacement without reduction. A randomized controlled trial in a short-term perspective. Int. J. Oral Maxillofac Surg. 2013, 42, 356–363.InterventionExtra-articular administration
Table
Table 3. Results. ID—internal derangement [34,35]; P—TMJ pain according to ICOP [34,36]; OA—osteoarthritis [34,37]; DDwR—disk displacement with reduction [34,37]; DDworR—disk displacement without reduction [34,37]; DD—degenerative disorders [34,37]; R—rinse; A—administration; HA—hyaluronic acid; CS—corticosteroids; PRP—platelet rich plasma; I-PRF—injectable platelet rich fibrin; PRGF—plasma rich in growth factors *—randomized controlled trial.
Table 3. Results. ID—internal derangement [34,35]; P—TMJ pain according to ICOP [34,36]; OA—osteoarthritis [34,37]; DDwR—disk displacement with reduction [34,37]; DDworR—disk displacement without reduction [34,37]; DD—degenerative disorders [34,37]; R—rinse; A—administration; HA—hyaluronic acid; CS—corticosteroids; PRP—platelet rich plasma; I-PRF—injectable platelet rich fibrin; PRGF—plasma rich in growth factors *—randomized controlled trial.
Section 1: Comparative Studies
Publication YearFirst AuthorDiagnosisInterventionSubstanceComparison Group
2022Ghoneim [38]DDwRR+AI-PRFR *
2021Sembronio [39]ID, OAR+AAdipose tissueR+HA *
2021Sembronio [39]ID, OAR+AHAR+Adipose tissue *
2021Karadayi [40]IDR+AI-PRFR *
2021Jacob [41]DDwR, DDwoRR+APRPR *
2021Jacob [41]DDwR, DDwoRR+AHAR *
2021Singh [42]IDR+APRPR *
2020Dolwick [43]PR+ACSR+Placebo *
2020Zarate [44]PADextrose+LidocaineLidocaine *
2019De Riu [45]DDR+AHAR+Bone marrow *
2019De Riu [45]DDR+ABone marrowR+HA *
2019Yilmaz [46]IDAHAR+HA *
2019Yilmaz [46]IDR+AHAHA *
2019Bergstrand [47]OAR+AHAR *
2019Isacsson [48]PACSPlacebo *
2019Louw [49]PADextrose+LidocaineLidocaine *
2019Gokçe Kutuk [50]PAHACS *
2019Gokçe Kutuk [50]PACSHA *
2019Gokçe Kutuk [50]PAPRPCS *
2019Diaz [51]PR+ACSR+Placebo *
2018Yapici-Yavuz [52]DDwoRR+ACSR *
2018Yapici-Yavuz [52]DDwoRR+AHAR *
2018Yapici-Yavuz [52]DDwoRR+ATenoxicamR *
2017Ozdamar [53]IDR+AHAR *
2017Gorrela [54]DDwR, DDwoRR+AHAR *
2017Gurung [55]OAR+AHAR *
2016Cömert Kiliç [56]OAR+ACSR *
2016Patel [57]IDR+AHAR *
2016Bouloux [58,59]PR+ACSR *
2016Bouloux [58,59]PR+AHAR *
2016Cömert Kiliç [60]OAR+APRPR+HA *
2016Korkmaz [61]DDwRAHASplint therapy *
2016Lam [62]PADextrose+LidocaineLidocaine *
2015Cömert Kiliç [63]OAR+APRPR *
2015Hegab [64]OAAHAPRP *
2015Hegab [64]OAAPRPHA *
2015Guarda-Nardini [65]DDAHAR+HA *
2015Sipahi [66]IDR+AMorphineR+Placebo *
2015Sipahi [66]IDR+ATramadolR+Placebo *
2014Hancı [67]DDwRAPRPR *
2014Tabrizi [68]IDR+ACSR *
2013Bustaman [69]OAAHAPlacebo *
2012Guarda-Nardini [70]DDR+AHAHA*
2012Daif [71]IDAOzone gasOral drugs *
2012Guarda-Nardini [72]DDR+AHAHA *
2012Manfredini [73]DDR+ACSR *
2012Manfredini [73]DDR+AHAR *
2012Huddleston Slater [74]PR+ACSR *
Section 2: before-and-after studies
PublicationFirst authorDiagnosisInterventionSubstance
2020Singh [75]OAACS+HA
2020Sikora [6]PAHA
2019Giacomello [76]OAAPRGF
2014Pihut [77]PAPRP
Table
Table 4. Risk of bias assessment: Domain 1—Risk of bias arising from the randomization process; Domain 2—Risk of bias due to deviations from the intended interventions; Domain 3—Missing outcome data; Domain 4—Risk of bias in measurement of the outcome; Domain 5—Risk of bias in selection of the reported result; Overall—Overall risk of bias.
Table 4. Risk of bias assessment: Domain 1—Risk of bias arising from the randomization process; Domain 2—Risk of bias due to deviations from the intended interventions; Domain 3—Missing outcome data; Domain 4—Risk of bias in measurement of the outcome; Domain 5—Risk of bias in selection of the reported result; Overall—Overall risk of bias.
First AuthorDomain 1Domain 2Domain 3Domain 4Domain 5Overall
Sembronio [39]LowModerateLowLowLowModerate
Zarate [44]LowLowLowLowLowLow
De Riu [45]LowModerateLowLowLowModerate
Louw [49]LowLowLowLowLowLow
Yapici-Yavuz [52]LowModerateLowLowLowModerate
Lam [62]LowLowLowLowLowLow
Daif [71]LowModerateLowLowLowModerate
Table
Table 5. Quantitative analysis.
Table 5. Quantitative analysis.
First AuthorSubstanceInitial AbductionFinal AbductionInitial PainFinal PainAbduction ImprovementPain Improvement
Sembronio [39]Adipose tissue30.742.47.21.2138%17%
Zarate [44]Dextrose+Lidocaine38.743.47.22.4112%33%
De Riu [45]Bone marrow2233.88.21.9154%23%
Louw [49]Dextrose+Lidocaine43.4457.85.1104%65%
Yapici-Yavuz [52]Tenoxicam25.333.57.51.7132%23%
Lam [62]Dextrose+Lidocaine 8.26.2 76%
Sipahi [66]Morphine37.7417.31.2109%16%
Sipahi [66]Tramadol34.6387.11.5110%21%
Daif [71]Ozone gasNo dataNo dataNo dataNo dataNo dataNo data
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Chęciński, M.; Chęcińska, K.; Nowak, Z.; Sikora, M.; Chlubek, D. Treatment of Mandibular Hypomobility by Injections into the Temporomandibular Joints: A Systematic Review of the Substances Used. J. Clin. Med. 2022, 11, 2305. https://doi.org/10.3390/jcm11092305

AMA Style

Chęciński M, Chęcińska K, Nowak Z, Sikora M, Chlubek D. Treatment of Mandibular Hypomobility by Injections into the Temporomandibular Joints: A Systematic Review of the Substances Used. Journal of Clinical Medicine. 2022; 11(9):2305. https://doi.org/10.3390/jcm11092305

Chicago/Turabian Style

Chęciński, Maciej, Kamila Chęcińska, Zuzanna Nowak, Maciej Sikora, and Dariusz Chlubek. 2022. "Treatment of Mandibular Hypomobility by Injections into the Temporomandibular Joints: A Systematic Review of the Substances Used" Journal of Clinical Medicine 11, no. 9: 2305. https://doi.org/10.3390/jcm11092305

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop