Does the Use of Injectable Platelet-Rich Fibrin Following Arthrocentesis for Disc Displacement Without Reduction Alleviate Pain?

Abstract

The role of adjunctive injection agents at the end of temporomandibular joint (TMJ) arthrocentesis remains controversial. This study aims to compare pain reduction in patients with disc displacement without reduction treated with arthrocentesis alone (AO), arthrocentesis with injectable platelet-rich fibrin (iPRF), and arthrocentesis with hyaluronic acid (HA). A single-center, retrospective cohort study was conducted at the affiliated hospital of Health Sciences University, Hamidiye Faculty of Dentistry. Inclusion criteria were female subjects aged 18-65, who underwent TMJ unilateral arthrocentesis, and diagnosed with disc displacement without reduction. Exclusion criteria were prior use of occlusal splints, accompanying diagnosis of myalgia and bilateral arthralgia which both of the joints exceeds or equal to 50mm visual analogue scale for pain (pVAS) value. The primary predictor variable was the adjunctive injection agent: iPRF, HA, or no injection (AO as control). Primary and secondary outcomes were measured preoperatively (T0), and at 1month (T1) and 6months (T2) postoperatively. The primary outcome was pain (pVAS) at T2. Secondary outcomes were pVAS at T1 and maximum interincisal opening at T1 and T2. Demographics, preoperative and perioperative data were collected. Descriptive, bivariate, and multivariate analyses were conducted. The P value was set at ≤.05. A total of 88 subjects completed the study. The mean age of the subjects in the AO (n=30), HA (n=29) and iPRF (n=29) groups was 36.8 (±10.2), 34.8 (±8.9) and 37.6 (±11.6) respectively (P>.05). The mean pVAS scores at T0 for the AO, HA and iPRF groups were 63.2 (±8.7), 66.7 (±9.6) and 66.2 (±9.6) respectively (P>.05). The mean pVAS scores at T1 were 36.5 (±10.8), 29.0(±11.5) and 35.9 (±9.8) respectively (P<.05). The mean pVAS scores at T2 were 34.8 (±16.3), 24.7 (±12.7) and 25.3 (±13.4) respectively (P<.05). There were no differences in maximum interincisal opening between the groups at any timepoint (P>.05). iPRF and HA injections are associated with greater pain relief compared to AO. No significant difference was observed between iPRF and HA, suggesting that the choice between them can be based on cost-effectiveness.