Sonographically-Guided Regenerative Injections for Management of Temporomandibular Joint Internal Derangements

Objectives: This prospective randomized clinical trial (RCT) was conducted to evaluate the effectiveness of intra-articular injection of hypertonic dextrose prolotherapy (HDP) and that of liquid phase concentrated growth factors (LPCGF) in conjugation with a stabilization appliance (SA) in the management of patients with disc displacement without reduction (DDwoR).
Methods: Twenty-four patients with DDwoR and limited mouth opening were enrolled in the study. The patients were randomly allocated to 2 groups; HDP + SA (Group I) and LPCGF+ SA (Group II). All intra-articular injections were sonographically guided. All patients received a maxillary 3D-printed SA. The patients’ symptoms were assessed clinically through Helkimo Anamnestic dysfunction index (Ai), and the maximum mouth opening (MMO) was measured at baseline, 1 week, 1 month, 3 months, and 6 months post-treatment. Synovial fluid (SF) was collected for biochemical analysis of the Myeloperoxidase enzyme (MPO).
Results: In both groups, there was significant relief in symptoms at the 1-month, 3-month, and 6-month follow-up periods. In group I, the mean of MMO at baseline was 30.83 mm (range, 27– 36 mm; SD, 3.93), while 1-week post-injection, it was significantly increased (p <0.001). In group II, the mean of MMO at baseline was 31.75 mm (range, 28– 37 mm; SD, 4.0). By 6 months post-treatment, the mean of MMO was significantly increased to 39.33 mm (range, 37– 43 mm; SD, 2.19; p <0.001). Pre-treatment, MPO was detected in the SF in both groups (938.3 pg/ml, 799.8 pg/ml, respectively). After 6 months post-treatment, the mean was significantly reduced in both groups (59.6 pg/ml, 61.9 pg/ml; p=0.002, respectively).
Conclusions: Intra-articular injections of HDP or LPCGF could be a treatment protocol in patients with DDwoR. Both effectively relieved symptoms with an increase in the MMO and decreased inflammatory biomarker inside the joint.