Clinical and biochemical assessment of different injection materials following arthrocentesis for the treatment of internal derangement of the temporomandibular joint: A comparative study

Abstract

Objectives The present study was performed to evaluate and compare the effect of ozonized water lavage followed by ozone injection with that of lactated Ringer lavage followed by either corticosteroid or sodium hyaluronate injection. Materials and methods A total of 27 patients suffering from internal derangement of the temporomandibular joint and not responding to conservative therapy were randomly classified into three groups. In group A joint lavage was performed using ozonized water followed by injection of ozone. In group B joint lavage was performed using lactated Ringer solution followed by corticosteroid injection. In group C joint lavage was performed using lactated Ringer solution followed by sodium hyaluronate injection. The treatment outcome was evaluated biochemically by measuring the change in tumor necrosis factor-α (TNF-α) level in the synovial fluid preoperatively and 1 week postoperatively. Clinical measurements of maximal mouth opening and lateral and protrusive excursions were taken preoperatively and at 1 week, 1, and 3 months postoperatively. Pain was measured using the Visual Analogue Scale at the study intervals. These data were statistically analyzed. Results The three groups showed significant improvement (P ≤ 0.05) in all biochemical and clinical measurements. However, joint lavage using ozonized water followed by ozone injection provided more favorable results compared with treatment with sodium hyaluronate, which in turn was more superior to corticosteroid treatment with respect to maximal mouth opening. All of the study groups showed significant reduction (P ≤ 0.05) in TNF-α level in the synovial fluid. Group A had the highest reduction of TNF-α level with significant difference (P ≤ 0.05) between its results and those of groups B and C, whereas groups B and C showed nonsignificant difference between their results (P ≥ 0.05). Conclusion Data from our study suggested more favorable outcomes from ozonized water lavage followed by ozone injection with regard to the clinical and biochemical parameters.