Combined Platelet-Rich Plasma and Hyaluronic Acid can Reduce Pain in Patients Undergoing Arthrocentesis for Temporomandibular Joint Osteoarthritis

Nazanin Asadpour; Zahra Shooshtari; Mozhgan Kazemian; Mahdi Gholami; Negin Vatanparast; Sahand Samieirad

doi:10.1016/j.joms.2022.05.002

Combined Platelet-Rich Plasma and Hyaluronic Acid can Reduce Pain in Patients Undergoing Arthrocentesis for Temporomandibular Joint Osteoarthritis

J Oral Maxillofac Surg. 2022 Sep;80(9):1474-1485. doi: 10.1016/j.joms.2022.05.002. Epub 2022 May 16.

Authors

Nazanin Asadpour¹, Zahra Shooshtari², Mozhgan Kazemian³, Mahdi Gholami⁴, Negin Vatanparast², Sahand Samieirad⁵

Affiliations

¹ Resident, Oral and Maxillofacial Surgery Department, Student Research Committee, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
² Dentist, Research Assistant, Dental Research Center, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran.
³ Assistant Professor, Oral and Maxillofacial Surgery Department, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran.
⁴ Associate Professor, Oral and Maxillofacial Surgery Department, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran.
⁵ Associate Professor, Oral and Maxillofacial Surgery Department, Mashhad Dental School, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address: samieerads@mums.ac.ir.

PMID: 35679902
DOI: 10.1016/j.joms.2022.05.002

Abstract

Purpose: The benefit of adjuvant medications, such as platelet-rich plasma (PRP) and hyaluronic acid (HA), following arthrocentesis remains controversial. The purpose of this study was to evaluate the efficacy of PRP and HA injection following arthrocentesis in subjects with symptomatic temporomandibular joint osteoarthritis (TMJ-OA).

Methods and materials: The authors implemented a prospective randomized single-blinded pilot clinical study. Healthy adults diagnosed with TMJ-OA who were treated with nonsurgical treatments initially, but failed to respond, participated in this study. Subjects were randomly allocated to HA, PRP, or combined HA+PRP groups following arthrocentesis. The primary outcome variable was the change in pain at 1 and 6 months postoperatively, using the Visual Analogue Scale (VAS). The secondary outcome variables were the changes in maximum mouth opening (MMO), lateral and protrusive mandibular movements, and pathologic TMJ sounds at 1 and 6 months postoperatively. Descriptive and bivariate statistics were computed. The significance level was set at P value < .05, using SPSS 19.

Results: A total of 30 consecutive patients (15 males and 15 females) with a mean age of 29.63 ± 8.34 years were followed for 6 months in this study. The mean reduction in pain at 6 months was 4.1 ± 0.9, 4.1 ± 1.1, and 5.1 ± 1.0 for HA, PRP, and HA/PRP, respectively (P < .05). In all 3 treatment groups, mean VAS parameters had significantly reduced after treatment and these postoperative values were significantly lower in the PRP+HA group (P < .001). The mean increase of MMO after 6 months was 8.0 ± 2.8, 8.0 ± 3.0, and 10.1 ± 3.3 for HA, PRP, and HA/PRP, respectively (P < .05). MMO, lateral, and protrusive mandibular movements significantly improved after treatment in all 3 groups (P < .001). TMJ noises were significantly reduced in all treatment groups (P < .001), but the PRP+HA group exhibited a greater reduction.

Conclusion: Combined HA and PRP injection following arthrocentesis is more effective than HA or PRP alone in the management of TMJ-OA.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Arthrocentesis / methods
Female
Humans
Hyaluronic Acid / therapeutic use
Injections, Intra-Articular
Male
Osteoarthritis* / drug therapy
Osteoarthritis* / surgery
Pain
Pain Management
Platelet-Rich Plasma*
Prospective Studies
Temporomandibular Joint
Temporomandibular Joint Disorders* / drug therapy
Temporomandibular Joint Disorders* / surgery
Treatment Outcome
Young Adult

Substances

Hyaluronic Acid