Temporomandibular Joint Disorders, Temporomandibular Joint Dysfunction Syndrome, Temporomandibular Joint Internal Derangement
Conditions
Keywords
Dexamethasone, Platelet-Rich Plasma, Intra-articular Injection, TMJ, Randomized Controlled Trial
Brief summary
This study looked at whether an injection into the jaw joint (temporomandibular joint, or TMJ) can help people who have pain, clicking, and difficulty opening their mouth due to a slipped joint disc. Thirty patients were randomly assigned to receive one of three injections: platelet-rich plasma (PRP, made from the patient's own blood), a steroid medication (dexamethasone) with a local anesthetic, or a saline (salt water) injection as a comparison. Pain, joint clicking, and mouth opening were measured before the injection and one week later. The study found that both PRP and the steroid injection reduced pain and clicking more than saline, and PRP also improved how wide patients could open their mouth.
Detailed description
This was a prospective, parallel-group, three-arm randomised controlled trial conducted at the outpatient clinics of the Maxillofacial and Oral Surgery Division, College of Dentistry, University of Anbar, Ramadi, Iraq. Thirty temporomandibular joints (30 patients) with clinically diagnosed disc displacement with reduction, per DC/TMD Axis I criteria, were randomised 1:1:1 by an independent statistician using a computer-generated sequence, with allocation concealed via sequentially numbered opaque envelopes. The outcome assessor was blinded to treatment allocation throughout follow-up. Patients in the dexamethasone and saline arms were not informed of their specific assignment; full blinding was not feasible for the PRP arm due to the visible blood draw and processing required. All three injections used an identical preauricular approach, injection site, needle gauge, and volume (1 mL) to standardise the procedural experience across groups. Within- and between-group differences were analysed using the Wilcoxon signed-rank test and Kruskal-Wallis test with Dunn post-hoc comparisons. This trial was registered retrospectively after enrolment and follow-up were complete.
Interventions
BIOLOGICALPlatelet-Rich Plasma (PRP)
Autologous platelet-rich plasma (1 mL) prepared from the patient's own venous blood by centrifugation, injected into the superior joint space of the temporomandibular joint under a standardised preauricular approach.
DRUGDexamethasone with Local Anaesthetic
Intra-articular injection (1 mL) of dexamethasone combined with a local anaesthetic, delivered into the superior joint space of the temporomandibular joint using the same standardised preauricular approach as the other study arms.
OTHERNormal Saline (Placebo)
Intra-articular injection (1 mL) of normal saline solution into the superior joint space of the temporomandibular joint, serving as the placebo control, using the same standardised preauricular approach as the other study arms.
Sponsors
University Of Anbar
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
"Outcome assessor was fully blinded throughout follow-up. Participants in the dexamethasone and saline arms were blinded to allocation; full blinding was not feasible in the PRP arm due to the visible blood-draw and processing procedure
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Inclusion Criteria: * Skeletally mature patients aged 18 years or older * Symptomatic TMJ internal derangement in the form of disc displacement with reduction (DDwR), diagnosed using DC/TMD Axis I clinical criteria * TMJ arthralgia confirmed by pain reproduced on palpation or provoked by jaw movement * Clicking sound detectable on palpation or auscultation during opening and closing movements * Elimination or marked reduction of the click on mouth opening from a protruded position
Exclusion criteria
* Intra-articular injection within the previous six months * Systemic inflammatory arthropathy * Coagulopathy * Active local infection * Low platelet count * Ongoing antiplatelet or anticoagulant therapy * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Pain Intensity (VAS) | Baseline and 1 week post-injection | Pain intensity rated on a 10-cm visual analogue scale (0=no pain, 10=worst imaginable pain), reflecting the most intense pain during function. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Joint Sound (Clicking) | Baseline and 1 week post-injection | Joint sound graded by a blinded assessor on a 3-point ordinal scale: 0=no clicking, 1=clicking detectable on palpation only, 2=clearly audible clicking. |
| Change in Maximum Interincisal Opening (MIO) | Baseline and 1 week post-injection | Maximum interincisal opening measured in millimetres between upper and lower central incisors at maximum voluntary mouth opening. |
Countries
Iraq
Contacts
PRINCIPAL_INVESTIGATORSabah Alheeti, BDS, CABMS, FIBMS
Oral and Maxillofacial Surgery Department / College of Dentistry / University of Anbar
Outcome results
None listed