Evaluation Of the Efficacy Of Injectable Platelet Rich Fibrin (I-PRF) In The Management Of Clicking In Internal Temporomandibular Joint Disorders

Patients were asked to tell their own medical and dental history in his or her study visit which will spend 20 to 30 minutes. Observations were recorded in patient's medical examination forms, and the clicking was evaluated by the use of the Helkemo index. These values were recorded in a patient form before injecting the temporomandibular joint with injectable platelet rich fibrin. Clinical examination of the temporomandibular joint was conducted by the researcher and this study was based on a method called functional manual examination of the temporomandibular joint. This simple and comprehensive method was used to diagnose the symptoms of the temporomandibular joint with special emphasis on negating and neutralizing the effects of muscles in developing symptoms. For preparation of injectable platelet-rich fibrin, 20 mL peripheral blood was obtained from the ulnar vein and collected in sterile vacuum tubes used for one time. These tubes were put in a centrifuge at 700 rpm for 3 minutes. Thus, we got platelet concentrates in liquid form and not in the form of clots. This liquid is rich in white blood cells, platelets and growth factors. There were no additives. For injection technique, the surgical site of the temporomandibular joint was disinfected by oral surgeon with povidone. The entry point of needle tip was determined by delimiting the anatomical features of the entry point, which was suggested by McCain (Nitzan DW et al., 1991) We started with a line extending from the middle of the tragus to the lateral angle of the eye in the same side. The injection needle was entered about (10) mm from the middle of the pinna tragus and about (2) mm down the previously drawn line. An Insulin syringe was used and entered wholly (27 gauge in diameter, approximately 1 cm in length). The injection continued until a patient felt the pressure of the injection and the plunger turned back as the finger was removed. At this point, the injection was stopped and the needle was drawn immediately. The following injection protocol was used. Each patient was injected 1 mL twice one week apart. One week after the first injection, patients were examined, the results were recorded and the second injection was performed in the same joint and in the same method. Since the second injection patients were followed for a period of six months. The clicking was evaluated by Helkimo scale.