TMJ Disc Displacement With Reduction
Conditions
Keywords
temporomandibular joint, Tmj disc displacement, PRF
Brief summary
To compare the clinical effectiveness of ultrasound-guided versus arthroscopic guided platelet rich fibrin injection in the management of anterior disc displacement with reduction of the temporomandibular joint, in terms of pain reduction, improvement of mandibular function, and patient-reported outcomes.
Detailed description
Internal derangements of the temporomandibular joint, particularly disc displacement with reduction, represent a significant proportion of temporomandibular disorders. Conventional conservative treatments may not always achieve satisfactory symptom resolution, leading to increased interest in minimally invasive interventions. PRF has gained attention for its ability to promote tissue regeneration, reduce inflammation, and enhance healing through the sustained release of growth factors. Image-guided injection techniques are essential for ensuring accurate delivery of PRF into the targeted joint structures. Arthroscopic-guided injection allows direct visualization of intra-articular anatomy but is invasive, technically demanding, and associated with higher cost and procedural complexity. In contrast, ultrasound-guided injection is a non-invasive, radiation-free, and cost- effective technique that enables real-time visualization of soft tissues and needle placement. Despite these advantages, the comparative clinical efficacy of ultrasound-guided versus arthroscopic-guided PRF injection remains inadequately explored, particularly in patients with TMJ disc displacement with reduction.
Interventions
DEVICEultrasound guided platelet rich fibrin injection
1. A high-frequency linear ultrasound probe will be used to identify the TMJ space. 2. A sterile syringe containing 1 mL of PRF will be inserted into the superior joint space under real-time ultrasound guidance. 3. PRF will be injected slowly with continuous confirmation of needle position.
DEVICEArthroscopic guided platelet rich Fibrin injection
1. TMJ arthroscopy will be performed under local or general anesthesia following standard aseptic preparation. 2. The superior joint space will be visualized using a 1.9 mm arthroscope. 3. A sterile syringe containing 1 mL of PRF will be introduced through a lateral portal under direct arthroscopic visualization. 4. PRF will be injected slowly into the superior joint space.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged 18-60 years. * Clinically and radiographically diagnosed temporomandibular joint disc displacemet with reduction. * Presence of TMJ pain exacerbated by mandibular movement. * Limited mandibular function and/or reduced maximum mouth opening. * Symptoms persisting for at least 3 months. * Failure of conservative treatment (e.g. occlusal splint, physiotherapy, NSAIDs). -Ability to understand the study protocol and provide informed consent.
Exclusion criteria
* Previous TMJ surgery or arthroscopic intervention. * Intra-articular injection in the TMJ within the last 6 months. * Systemic inflammatory or autoimmune joint diseases. * Coagulation disorders or current anticoagulant therapy. * Active local infection at the injection site. * Pregnancy or lactation. * Severe degenerative joint disease (advanced osteoarthritis). * Known allergy or contraindication to ( PRF) preparation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum mouth opening | 6 months | Maximum interincisal distance measured using digital caliper in millimeters (mm) between upper and lower central incisors, Unit of measure: millimeters (mm). Minimum value: 0 mm. Maximum value: 60 mm. Higher values represent a better outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Pain intensity | 6 months | Pain intensity assessed using 100 mm Visual Analog Scale (VAS). 0 = no pain; 10 = worst pain imaginable. Unit of measure: points (0-10). Minimum value: 0. Maximum value: 10. Higher scores represent a worse outcome. |
Contacts
CONTACTSami Faiz Kahwaji, DDS
CONTACTKhalid Atef Elhayes, PhD
Outcome results
None listed