Temporomandibular Arthritis
Conditions
Brief summary
Which is more effective in the treatment of nonspecific temporomandibular osteoarthritis: platelet-rich plasma (PRP), hyaluronic acid, or triamcinolone acetonide?
Detailed description
Osteoarthritis is a degenerative condition that affects the TMJ. This condition may affect other joints in the hands, feet, or spine. The progressive destruction of the fibrocartilage layers with or without bone destruction and loss of the synovial fluid leads eventually to the accumulation of the inflammatory mediators. And when the episodes of destruction exceed that of healing, the patients start to encounter cycles of pain, inflammation, earache, limitation of mouth opening, and loss of function. Many treatment modalities have been illustrated in the literature for the treatment of osteoarthritis. One of the most effective treatment modalities used is intra-articular injections. The first treatment strategy in this research is intra-articular injections of hyaluronic acid. Hyaluronic acid is a high molecular weight glycosaminoglycan composed of repeated chains of disaccharides. HLA is considered a normal component of numerous body structures and body fluids, like the synovial fluid, and is conjugated with many processes, like tissue repair and inflammation. So many authors advocate its usefulness in the treatment of temporomandibular dysfunction and myofascial pain without any complications or adverse effects. The second treatment arm will be used for corticosteroids as intra-articular injections, and that's because of their long-standing and powerful anti-inflammatory properties alone or with local anesthetics for relief or treatment of temporomandibular joint symptoms. Platelet-rich plasma is concentrated from the patient's own blood sample by centrifugation. It was first introduced in maxillofacial and plastic surgery in 1990. It's claimed that it has many advantages because of its healing potential, cell recruitment, proliferation, and differentiation, which lead eventually to tissue repair. In this research, we are going to compare the effectiveness of three treatment arms: platelet-rich plasma, hyaluronic acid, and triamcinolone acetonide.
Interventions
OTHERplatelet rich plasma and triamcinolone acetonide and hyaluronic acid and saline intra articular injection
* An 18-gauge needle of a 10 ml plastic syringe loaded with normal saline solution will be inserted into the superior joint compartment (SJC). The injection-ejection process was repeated 10 times. Then the SJC will be injected with 1 ml of PRP in group I, 1 ml of triamcinolone acetonide 40 mg/ml in group II, 1 ml of hyaluronic acid (Hyalgan 20 mg/2 ml) in group III, or 1 ml of normal saline in group IV. * Patients will be evaluated after one week and 1 month, then at 3 months and 6 months.
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Only the outcome assessor is blinded because the injected materials have different form and physical characteristics.
Intervention model description
* The surgical field will be prepared using alcohol before injection. * The entrance point for intraarticular injection is located along the canthotragal line, 10 mm from the middle of the tragus and 2 mm below the line. * Auriculotemporal nerve block anesthesia will be performed. * An 18-gauge needle of a 10 ml plastic syringe loaded with normal saline solution will be inserted into the superior joint compartment (SJC). The injection-ejection process was repeated 10 times. Then the SJC will be injected with 1 ml of PRP in group I, 1 ml of triamcinolone acetonide 40 mg/ml in group II, 1 ml of hyaluronic acid (Hyalgan 20 mg/2 ml) in group III, or 1 ml of normal saline in group IV. * Patients will be evaluated after one week, 1 month, and then at 3 months and 6 months.
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
Yes
Inclusion criteria
* 1\. Patients with temporomandibular joint osteoarthritis with or without disc displacement. * 2\. Age ≥ 18 years \< 50
Exclusion criteria
* 1\. Previous TMJ surgery * 2\. Medical history of blood-derived illness or any medication known to affect platelet function or concentration for a minimum of two weeks prior to treatment. * 3\. specific osteoarthritis like rheumatoid arthritis or psoriatic arthritis. * 4\. pregnant women or breastfeeding ones
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| pain intensity | preoperative as baseline then after one week, 1 month, 3 months and 6 months | The patient's temporomandibular joint pain was felt by the patient on the visual analog scale from numbers 1 to 10. |
| pain-free mouth opening | preoperative as baseline then after one week, 1 month, 3 months and 6 months | The maximum mouth opening measured with a caliper in millimeters. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| crepitus sounds | preoperative as baseline then after one week, 1 month, 3 months and 6 months | asking the patient at every appointment |
Countries
Egypt
Contacts
PRINCIPAL_INVESTIGATORMohamed MA el saadany, master
mohamed_mostafa@dentistry.cu.edu.eg
Outcome results
None listed