Cell Therapies in the Treatment of Temporomandibular Osteoarthritis: A Systematic Review of the Literature

Abstract

Therapeutic strategies for the management of temporomandibular osteoarthritis ideally involve the improvement in pain and functional disability, as well as delay the progression and promote the repair of joint cartilage defects. Cell therapies have emerged as a new, minimally invasive therapeutic modality that allows for the use of autologous cell transplantation, and may involve adult undifferentiated mesenchymal stem/stromal cells (MSC) or differentiated cell lineage,like condrocytes.The aim of this study was to review the existing controlled clinical trials that evaluate the efficacy and safety of these different types of cell therapy in adult patients with temporomandibular joint(TMJ) osteoarthritis. The parameters used to search the literature and retrieve these studies, as well as the assessments of eligibility criteria,have followed the recommendations of the PRISMA Statement. A highly sensitive search strategy was held in the Medline (1966-2013)and Central Register of Controlled Trials(1960-2013)databases. The latest search was carried out on Dec 27,2013. Different combinations of keywords were used, temporomandibular joint, temporomandibular disorders, craniomandibular dysfunction, stem cells, mesenchymal cells and autologous condrocytes, yielded 101 clinical trials. Most of these trials, however, were related to osteoarthitis of the knees. No clinical trials were conducted in patients with TMJ osteoarthritis. There is no evidence from randomized controlled trials to demonstrate the safety and effectiveness of different types of cellular therapies for the treatment of osteoarthritis of the TMJ. There is an urgent need to perform clinical trials in this area in order to benefit patients with advanced processes who are refractory to conservative or conventional minimally invasive therapeutic modalities.