Treatment Of Temporomandibular Joint Osteoarthritis Research Articles

Isolate or combined use of platelet-rich plasma in the treatment of temporomandibular joint osteoarthritis: a concise systematic review

Introduction: In the context of temporomandibular disorders (TMD), temporomandibular joint osteoarthritis (TMJOA) is a common disease in the oral and maxillofacial regions, as well as being the most severe type. The incidence of TMD is high, affecting approximately 5%-12% of the population. There is evidence for the potential superiority of intra-articular platelet-rich plasma (PRP) injections in patients with TMJOA. Objective: This study aimed to carry out a systematic review to highlight the main clinical outcomes of the minimally invasive treatment of osteoarthritis of the temporomandibular joint through the injectable use of platelet-rich plasma. Methods: The research and development of the work were carried out from December 2022 to March 2023 in the Scopus, PubMed, Science Direct, and Scielo databases, using scientific articles from 2011 to 2022, following the PRISMA rules. The quality of the studies was based on the GRADE instrument and the risk of bias by the Cochrane instrument (Funnel Plot). Results and Conclusion: It was found 134 studies that underwent eligibility analysis. The final sample had 48 eligible studies and only 25 studies were described in the systematic review. Most studies showed homogeneity in their results, with X2 =91.2% >50%, with p<0.05. The symmetrical funnel plot did not suggest a risk of bias among studies with small sample sizes. Based on the objective of the present study, important clinical outcomes of the treatment of osteoarthritis of the temporomandibular joint were evidenced through the injectable use of platelet-rich plasma, alone or in combination with other types of treatment. However, it was observed that despite the extensive literature on the use of PRP in the treatment of joint disorders, its application in TMD is still largely unexplored.

Intra-articular treatment of temporomandibular joint osteoarthritis by injecting actively-loaded meloxicam liposomes with dual-functions of anti-inflammation and lubrication

Temporomandibular joint (TMJ) osteoarthritis is a common osteochondral degenerative disease which can severely affect patient's mouth opening and mastication. Meloxicam (MLX), one of the most widely used non-steroidal anti-inflammatory drugs, is the main clinical therapy for the treatment of TMJ osteoarthritis. However, the clinical effect is greatly compromised because of its poor water solubility and high lipophilicity. In the present study, we developed an actively-loaded liposomal formulation, namely MLX-Ca(AC)2Lipo, using meglumine to enhance aqueous solubility and divalent metal (Ca2+) solution to improve encapsulation efficiency. By the formation of the nano-bowl shaped MLX-Ca precipitates inside the liposomes, MLX-Ca(AC)2Lipo successfully achieved an optimal encapsulation efficiency as high as 98.4% compared with previous passive loading method (60.6%). Additionally, MLX-Ca(AC)2Lipo maintained stable, and the slow drug release not only prolonged the duration of drug efficacy but also improved bioavailability. It was shown in the in vitro and in vivo tests that MLX-Ca(AC)2Lipo downregulated the synthesis of the inflammatory factors (such as prostaglandin-E2) and as a consequence reduced chondrocytes apoptosis and extracellular matrix degeneration. Furthermore, the intra-articular injection of MLX-Ca(AC)2Lipo enhanced bioinspired lubrication of TMJ, protecting the cartilage from progressive wear. In summary, MLX-Ca(AC)2Lipo with dual-functions of anti-inflammation and lubrication is a promising nanomedicine for the treatment of TMJ osteoarthritis by intra-articular injection.

Does intra-articular injection of tenoxicam after arthrocentesis heal outcomes of temporomandibular joint osteoarthritis? A randomized clinical trial

BackgroundTemporomandibular joint osteoarthritis (TMJ-OA) is a degenerative disease and manifests itself with pain and limitation of movement in the jaws. Arthrocentesis alone or in combination with intraarticular injections is one of the most commonly used treatment methods in these patients. The aim of the study is to examine the effectiveness of arthrocentesis plus tenoxicam injection and to compare it with arthrocentesis alone in patients with TMJ-OA.MethodsThirty patients with TMJ-OA who were treated randomly with either arthrocentesis plus tenoxicam injection (TX group) or arthrocentesis alone (control group) were examined. Maximum mouth opening (MMO), visual analog scale (VAS) pain values, and joint sounds were the outcome variables, which were evaluated at pre-treatment and at 1, 4, 12, and 24 weeks after treatment. Statistical significance was set at p < 0.05.ResultsThe gender distribution and mean age were not significantly different between the two groups. Pain values (p < 0.001), MMO (p < 0.001), and joint sounds (p < 0.001) improved significantly in both groups. However, there was no significant difference between the groups in terms of outcome variables [pain (p = 0.085), MMO (p = 0.174), joint sounds (p = 0.131)].ConclusionsArthrocentesis plus tenoxicam injection showed no better outcomes in terms of MMO, pain, and joint sounds compared with arthrocentesis alone in patients with TMJ-OA.Trial registrationInjection of Tenoxicam Versus Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis, NCT05497570. Registered 11 May 2022.Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000CD7A&selectaction=Edit&uid=U0006FC4&ts=6&cx=f3anuq

Analysis of the Curative Effect of Temporomandibular Joint Disc Release and Fixation Combined with Chitosan Injection in the Treatment of Temporomandibular Joint Osteoarthrosis

Temporomandibular joint osteoarthritis (TMJ-OA) is common in clinic. The purpose of this study was to evaluate the efficacy of disc release, fixation and chitosan injection in the treatment of TMJ-OA. From March 2021 to March 2022, 32 patients who underwent the unilateral reduction and fixation of temporomandibular joint disc release were retrospectively studied. All patients were diagnosed with TMJ-OA and were treated with chitosan injection. This group of patients was analyzed by the visual analog scale (VAS) for pain and improvement of maximum comfortable mouth opening before treatment and 6 months after treatment. A paired t-test was used to evaluate the treatment effect, and p < 0.05 indicated that the difference was statistically significant. All 32 patients were successfully treated by surgery and chitosan injection in the second week after operation. The duration of disease in this group ranged from 1 to 10 months, with an average of 5.7 months. After 6 months of follow up, 30 patients were satisfied with the treatment and two were unsatisfied. The difference in the treatment effect was found to be statistically significant (p < 0.05). Temporomandibular joint disc release and fixation combined with chitosan injection is effective in the treatment of TMJ-OA.

A new frontier in temporomandibular joint osteoarthritis treatment: Exosome-based therapeutic strategy.

Temporomandibular joint osteoarthritis (TMJOA) is a debilitating degenerative disease with high incidence, deteriorating quality of patient life. Currently, due to ambiguous etiology, the traditional clinical strategies of TMJOA emphasize on symptomatic treatments such as pain relief and inflammation alleviation, which are unable to halt or reverse the destruction of cartilage or subchondral bone. A number of studies have suggested the potential application prospect of mesenchymal stem cells (MSCs)-based therapy in TMJOA and other cartilage injury. Worthy of note, exosomes are increasingly being considered the principal efficacious agent of MSC secretions for TMJOA management. The extensive study of exosomes (derived from MSCs, synoviocytes, chondrocytes or adipose tissue et al.) on arthritis recently, has indicated exosomes and their specific miRNA components to be potential therapeutic agents for TMJOA. In this review, we aim to systematically summarize therapeutic properties and underlying mechanisms of MSCs and exosomes from different sources in TMJOA, also analyze and discuss the approaches to optimization, challenges, and prospects of exosome-based therapeutic strategy.

Efficacy analysis of splint combined with platelet-rich plasma in the treatment of temporomandibular joint osteoarthritis.

Objective: To evaluate the efficacy of splints combined with PRP for the treatment of temporomandibular joint osteoarthritis. Methods: Thirty-one patients with temporomandibular joint osteoarthritis who were treated with splints combined with platelet-rich plasma (PRP) from January 2021 to June 2021 at the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University (Shenyang, China) were retrospectively reviewed. The VAS scores of all the patients were recorded before and 6 months after treatment, and the maximum comfortable mouth opening was recorded. All data were analyzed by the paired t-test using SPSS software, and a p-value < 0.05 indicated statistically significant differences. Results: Splint + PRP treatment was successful in 31 patients. The mean pretreatment VAS score was 6.1, and the mean VAS score 6 months posttreatment was 4.1. The posttreatment VAS score was significantly lower than the preoperative VAS score (p < 0.05). The mean pretreatment maximum comfortable mouth opening (MCMO) was 27.6mm, and the mean MCMO 6months posttreatment was 34.8mm. The MCMO was significantly increased (p < 0.05). Conclusion: Splint + PRP is an effective treatment for temporomandibular joint osteoarthritis.

Drug delivery systems for treatment of temporomandibular joint osteoarthritis.

The number of people suffering from temporomandibular joint osteoarthritis (TMJOA) has been increasing. TMJOA cause joint noise, pain on TMJ and/or masticatory muscles, and restricted mandibular movement, which disturb eating, laughing and conversation, and impose serious lifestyle impediments. Chondrocyte apoptosis, extracellular matrix degradation, synovitis, and subchondral bone remodeling are the main pathological features of TMJOA. Various drug delivery systems are developed to controlled release at specific activation sites with high bioactivity and inhibit rapid dilution to enable long-term therapeutic response, which present great potential for the treatment of TMJOA. This review focuses on recently developed drug delivery systems by different administration in the TMJOA treatment, and summarizes their effects, duration, safety, and limitations, which would pave the way for development of TMJOA therapy.

Recent Advances in Animal Models, Diagnosis, and Treatment of Temporomandibular Joint Osteoarthritis.

Temporomandibular joint osteoarthritis (TMJOA) is a gradual degenerative jaw joint condition. Until recent years, TMJOA is still relatively unrecognized and ineffective to be treated. Appropriate animal models with reliable detection methods can help researchers understand the pathophysiology of TMJOA and find therapeutic options. In this study, we summarized common animal models of TMJOA created by chemical, surgical, mechanical, and genetical approaches. The relevant pathological symptoms and induction mechanisms were outlined. In addition, different pathological indicators, furthermore, emerging therapeutic regimens, such as intra-articular drug delivery and tissue engineering-based approaches to treat TMJOA based on these animal models, were summarized and updated. Understanding the physiology and pathogenesis of the TMJOA, together using various ways to diagnose the TMJOA, were elaborated, including imaging techniques, molecular techniques for detecting inflammatory cytokines, histochemical staining, and histomorphometry measures. A more reliable diagnosis will enable the development of new prevention and more effective treatment strategies and thereby improve the quality of life of TMJOA patients. Impact statement Temporomandibular joint osteoarthritis (TMJOA) affects 8 to 16 percent of the population worldwide. However, TMJOA is still relatively unrecognized and ineffective to be treated in the clinic. Appropriate animal models with reliable diagnostic methods can help researchers understand the pathophysiology of TMJOA and find therapeutic options. We herein summarized common animal models of TMJOA and various ways to diagnose the TMJOA. More importantly, emerging therapeutic regimens to treat TMJOA based on these animal models were summarized. With the aid of strategies listed, more effective treatment strategies will be developed and thereby improve the life quality of TMJOA patients.

Clinical effect and analysis of exercise treatment for temporomandibular joint osteoarthritis

Objective: To explore the clinical efficacy of (stomatognathic system functional exercise(SSFE) in the treatment of temporomandibular joint osteoarthritis (TMJOA), and to provide reference for the clinical treatment of TMJOA. Methods: Choose between January 2020 and June 2020 in the Affiliated Hospital of Qingdao University of Temporomandibular Disorder (TMD) Clinics, pain in the temporomandibular joint (TMJ), limited openings for complained of symptoms of TMD patients, diagnosed by clinical examination and cone beam CT (CBCT) examination of TMJOA patients 60 patients (64 joints), including 20 males and 45 females, the age was (42.6±2.5) years (33-47 years old). The patients were randomly divided into the experimental group (30 cases, 34 joints) and the control group (30 cases, 30 joints) according to the odd and even numbers of their treatment numbers. The experimental group was treated with SSFE method. The control group was treated with maxillary full dentition occlusal splint. Visual analogue score (VAS), natural mouth opening and maximal mouth opening (MMO) of each patient in each group were recorded at initial diagnosis, 2 weeks, 3 and 6 months after treatment, and CBCT imaging was compared for the changes of condylar bone at initial diagnosis, 3 and 6 months after treatment. Results: VAS values of the experimental groups were (2.90±1.42), (0.90±0.37), (0.87±0.23) at 2 weeks, 3 and 6 months after treatment, respectively. The VAS values of the control group were (4.57±1.94), (4.17±2.09), (3.73±2.21), respectively. The VAS score of the experimental group was significantly lower than that of the control group (F=42.93, P<0.001). Before SSFE treatment, all the patients in the experimental group had different degrees of restricted opening and characteristic abnormal opening and closing pattern. Two weeks after SSFE treatment, the opening degree of the patients was (37.69±2.4)mm, the opening shape "↓" and the closing shape "↑" were normal. At 3 and 6 months after treatment, the oral opening was (38.98±1.08) mm and (39.73±1.76) mm, respectively. The opening degree of control group was (36.85±2.33) mm 2 weeks after treatment, and the characteristic abnormal opening and closing pattern still existed. The opening degree of control group was (37.82±1.85) mm and (37.40±1.75) mm 3 and 6 months after treatment, respectively. The characteristic abnormal opening and closing pattern (stuffy, awkward, deliberate, unnatural) did not improve significantly. The openness of the experimental group was significantly higher than that of the control group (F=25.20, P<0.001). In the experimental group, 82.4% (28/34) had benign remodeling of condylar bone 6 months after treatment, and 17.6% (6/34) had no change of condylar bone. There was no significant change in condylar bone in control group. CBCT scores of the experimental group were (2.43±1.74) and (1.70±1.26) at 3 and 6 months after treatment, respectively. CBCT scores of the control group at 3 and 6 months after treatment were (4.23±1.50) and (4.10±1.37), they were significantly lower in the experimental group than in the control group (F=27.20, P<0.001). Conclusions: Full dentition occlusal splint can alleviate the pain in the joint area of TMJOA patients, but can not improve the characteristic abnormal mandibular movement, and the condyle bone repair is not obvious. SSFE can effectively relieve the symptoms and signs of TMJOA patients, especially improve the abnormal characteristic mandibular movement, and promote the normal reconstruction and repair of condylar bone.

Antisense Oligonucleotide-Based Therapy on miR-181a-5p Alleviates Cartilage Degradation of Temporomandibular Joint Osteoarthritis via Promoting SIRT1.

Temporomandibular joint osteoarthritis (TMJOA) condylar cartilage degeneration and abnormal subchondral bone pathological remodeling induce pain and joint dysfunction, and cartilage degeneration is considered irreversible. Very few therapeutic approaches are administrated in practice. Nucleotides have demonstrated considerable potential as a next-generation medication, and they have been applied in several models of osteoarthritis. There is a need to establish an effective protocol for TMJOA gene therapy. In the current study unilateral anterior crossbite (UAC) surgery was used to simulate mechanical stress-induced TMJOA in mice. Degeneration of condylar cartilage and destruction of subchondral bone were observed in damaged joints, and miR-181a-5p was elevated in chondrocytes. Intra-articular injection of miR-181a-5p antisense oligonucleotide (ASO) could reduce the cartilage damage and alleviate UAC-induced TMJOA progression, but it did not restore injured subchondral bone. Mechanically, miR-181a-5p evidently targeted the 3’ untranslated region of Sirt1 directly, resulting in inhibition of silent information regulator 1 expression and promoting apoptosis by elevating p53-dependent signaling, indicating that miR181a-5p ASO promoted chondrocyte survival. The present study suggests that ASO-based gene therapy may be an effective TMJOA treatment.

Efficacy Analysis of Splint Combined with PRP Injection in the Treatment of Temporomandibular Joint Osteoarthritis

Objective: To investigate the effect of splint combined with PRP injection in the treatment of temporomandibular joint osteoarthritis. Methods: Ninety-three patients with temporomandibular joint osteoarthritis were retrospectively analysed. They were divided into three groups according to different treatment methods: splint group, PRP group, and splint + PRP group. All patients were asked to have VAS scores before and 6 months after treatment and the maximum comfortable mouth opening was recorded either. All data were analysed by R×C test, and P＜0.05 indicated statistically significant differences. Results: The maximum comfortable opening was significantly improved, and the VAS scores were decreased (P &lt; 0.05). Conclusion: The treatment of splint+PRP is superior to the treatment of single splint or single PRP.

An Updated View on Temporomandibular Joint Degeneration: Insights from the Cell Subsets of Mandibular Condylar Cartilage.

The high prevalence of temporomandibular joint osteoarthritis (TMJOA), which causes joint dysfunction, indicates the need for more effective methods for treatment and repair. Mandibular condylar cartilage (MCC), a typical fibrocartilage that experiences degenerative changes during the development of TMJOA, has become a research focus and therapeutic target in recent years. MCC is composed of four zones of cells at various stages of differentiation. The cell subsets in MCC exhibit different physiological and pathological characteristics during development and in TMJOA. Most studies of TMJOA are mainly concerned with gene regulation of pathological changes. The corresponding treatment targets with specific cell subsets in MCC may provide more accurate and reliable results for cartilage repair and TMJOA treatment. In this review, we summarized the current research progress on the cell subsets of MCC from the perspective of MCC development and degeneration. We hope to provide a reference for further exploration of the pathological process of TMJOA and improvement of TMJOA treatment.

Therapeutic application of 3B-PEG injectable hydrogel/Nell-1 composite system to temporomandibular joint osteoarthritis

This study aims to construct a composite system of the tri-block polyethylene glycol injectable hydrogel (3B-PEG IH) and neural epithelial growth factor-like protein 1 (Nell-1), and to analyze its therapeutic effect on temporomandibular joint osteoarthritis (TMJOA). Sol-gel transition temperature was measured via inverting test. The viscoelastic modulus curves was measured by rheometer. Degradation and controlled release profiles of 3B-PEG IH were drawn in vitro. In vivo gel retention and biocompatibility were completed subcutaneously on the back of rats. After primary chondrocytes were extracted and identified, the cell viability in 3B-PEG IH was measured. Evaluation of gene expression in hydrogel was performed by real-time polymerase chain reaction. TMJOA rabbits were established by intra-articular injection of type II collagenase. Six weeks after composite systems being injected, gross morphological score, micro-CT, histological staining and grading were evaluated. The rusults showed that different types of 3B-PEG IH all reached a stable gel state at 37 °C and could support the three-dimensional growth of chondrocytes, but poly(lactide-co-caprolactone)-block-poly(ethyleneglycol)-block-poly(lactide-co-caprolactone) (PLCL-PEG-PLCL) hydrogel had a wider gelation temperature range and better hydrolytic stability for about 4 weeks. Its controlled release curve is closest to the zero-order release kinetics. In vitro, PLCL-PEG-PLCL/Nell-1 could promote the chondrogenic expression and reduce the inflammatory expression. In vivo, TMJOA rabbits were mainly characterized by the disorder of cartilage structure and the destruction of subchondral bone. However, PLCL-PEG-PLCL/Nell-1 could reverse the destruction of the subchondral trabecula, restore the fibrous and proliferative layers of the surface, and reduce the irregular hyperplasia of fibrocartilage layer. In conclusion, by comparing the properties of different 3B-PEG IH, 20 wt% PLCL-PEG-PLCL hydrogel was selected as the most appropriate material. PLCL-PEG-PLCL/Nell-1 composite could reverse osteochondral damage caused by TMJOA, Nfatc1-Runx3 signaling pathway may play a role in it. This study may provide a novel, minimally-invasive therapeutic strategy for the clinical treatment of TMJOA.

Effect of platelet-rich plasma injection combined with individualised comprehensive physical therapy on temporomandibular joint osteoarthritis: A prospective cohort study.

The effectiveness of platelet-rich plasma (PRP) injection combined with physical therapy for the treatment of temporomandibular joint osteoarthritis (TMJ-OA) has not been studied. To assess the effectiveness of PRP injection combined with individualised comprehensive physical therapy for the treatment of TMJ-OA. This prospective cohort study included 40 patients with TMJ-OA who received PRP injection or PRP injection combined with individualised comprehensive physical therapy. Pain intensity, maximum mouth opening, temporomandibular joint sounds, and the Jaw Functional Limitation Scale (JFLS) scores and imaging findings were compared before treatment and during follow-up. The pain intensity, maximum mouth opening, and temporomandibular joint sounds of the two groups significantly improved with an increase in treatment time (p<.05). The pain improvement in the combined treatment group was greater than that in the PRP injection group at 3 and 6months (p<.05). The improvement of mouth opening was better in the combined treatment group, whereas the improvement of joint sounds was better in the PRP injection group. The improvement in JFLS scores in the combined treatment group was greater than that in the PRP injection group at 6months (p<.05). The imaging improvement rates of the two groups were similar. Platelet-rich plasma injection can significantly improve pain, mouth opening, abnormal joint sound, and mandibular function in patients with TMJ-OA and has good repair effect on condylar bone defects. PRP injection combined with individualised comprehensive physical therapy can effectively control the medium- and long-term pain of patients.

Molecular signaling in temporomandibular joint osteoarthritis.

ObjectiveTemporomandibular joint (TMJ) osteoarthritis (OA) is a type of TMJ disorders with clinical symptoms of pain, movement limitation, cartilage degeneration and joint dysfunction. This review article is aiming to summarize recent findings on signaling pathways involved in TMJ OA development and progression.MethodsMost recent findings in TMJ OA studies have been reviewed and cited.ResultsTMJ OA is caused by inflammation, abnormal mechanical loading and genetic abnormalities. The molecular mechanisms related to TMJ OA have been determined using different genetic mouse models. Recent studies demonstrated that several signaling pathways are involved in TMJ OA pathology, including Wnt/β-catenin, TGF-β and BMP, Indian Hedgehog, FGF, NF-κB, and Notch pathways, which are summarized in this review article. Alterations of these signaling pathways lead to the pathological changes in TMJ tissues, affecting cartilage matrix degradation, catabolic metabolism and chondrocyte apoptosis.ConclusionMultiple signaling pathways were involved in the pathological process of TMJ OA. New therapeutic strategies, such as stem cell application, gene editing and other techniques may be utilized for TMJ OA treatment.The translational potential of this articleTMJ OA is a most important subtype of TMJ disorders and may lead to substantial joint pain, dysfunction, dental malocclusion, and reduced health-related quality of life. This review article summarized current findings of signaling pathways involved in TMJ OA, including Wnt/β-catenin, TGF-β and BMP, Indian Hedgehog, FGF, NF-κB, and Notch pathways, to better understand the pathological mechanisms of TMJ OA and define the molecular targets for TMJ OA treatment.

Mechanisms of Action and Efficacy of Hyaluronic Acid, Corticosteroids and Platelet-Rich Plasma in the Treatment of Temporomandibular Joint Osteoarthritis-A Systematic Review.

Temporomandibular joint osteoarthritis (TMJ OA) is a low-inflammatory disorder with multifactorial etiology. The aim of this review was to present the current state of knowledge regarding the mechanisms of action and the efficacy of hyaluronic acid (HA), corticosteroids (CS) and platelet-rich plasma (PRP) in the treatment of TMJ OA.: The PubMed database was analyzed with the keywords: “(temporomandibular joint) AND ((osteoarthritis) OR (dysfunction) OR (disorders) OR (pain)) AND ((treatment) OR (arthrocentesis) OR (arthroscopy) OR (injection)) AND ((hyaluronic acid) OR (corticosteroid) OR (platelet rich plasma))”. After screening of 363 results, 16 studies were included in this review. Arthrocentesis alone effectively reduces pain and improves jaw function in patients diagnosed with TMJ OA. Additional injections of HA, either low-molecular-weight (LMW) HA or high-molecular-weight (HMW) HA, or CS at the end of the arthrocentesis do not improve the final clinical outcomes. CS present several negative effects on the articular cartilage. Results related to additional PRP injections are not consistent and are rather questionable. Further studies should be multicenter, based on a larger group of patients and should answer the question of whether other methods of TMJ OA treatment are more beneficial for the patients than simple arthrocentesis.

Efectividad del ácido hialurónico en el tratamiento de enfermedades degenerativas de la articulación temporomandibular. Revisión de Literatura

Objetive:The degenerative diseases of the tempo-romandibular joint (TMJ) are characterized by a progressive destruction of the articular tissues of the condyle and the glenoid fossa. The main aim of this review is to describe the effectiveness of the hyaluronic acid (HA) in the treatment of degenerative diseases of the TMJ in accordance with the available scientific evidence. Material and Methods: A literature search was made in the following databases EBSCO, Pubmed, Cochrane and Trip Database, using the keywords hyaluronic, hyaluronan, NaH, hyaluronate, TMJ, TMD, CMD, craniomandibular, orofacial pain and temporomandibular. There were no date or language restrictions applied. Results: After applying inclusion and exclusion criteria, 14 studies were included in this review (11 randomized controlled clinical trials and 3 non-randomized clinical trials). Conclusion: The studies reported a decrease in pain and improvement in functional parameters after treatment of TMJ osteoarthritis with HA. The use of arthrocentesis associated with the administration of HA provides effects synergistic, reaching a superiority the protocols with multiple injections with respect to those of a single session. The adverse effects related to the injection of HA with or without associated arthrocentesis were minor and transitory.

An Update on Mesenchymal Stem Cell-Centered Therapies in Temporomandibular Joint Osteoarthritis.

Temporomandibular joint osteoarthritis (TMJOA) is a degenerative disease characterized by cartilage degeneration, disrupted subchondral bone remodeling, and synovitis, seriously affecting the quality of life of patients with chronic pain and functional disabilities. Current treatments for TMJOA are mainly symptomatic therapies without reliable long-term efficacy, due to the limited self-renewal capability of the condyle and the poorly elucidated pathogenesis of TMJOA. Recently, there has been increased interest in cellular therapies for osteoarthritis and TMJ regeneration. Mesenchymal stem cells (MSCs), self-renewing and multipotent progenitor cells, play a promising role in TMJOA treatment. Derived from a variety of tissues, MSCs exert therapeutic effects through diverse mechanisms, including chondrogenic differentiation; fibrocartilage regeneration; and trophic, immunomodulatory, and anti-inflammatory effects. Here, we provide an overview of the therapeutic roles of various tissue-specific MSCs in osteoarthritic TMJ or TMJ regenerative tissue engineering, with an additional focus on joint-resident stem cells and other cellular therapies, such as exosomes and adipose-derived stromal vascular fraction (SVF). Additionally, we summarized the updated pathogenesis of TMJOA to provide a better understanding of the pathological mechanisms of cellular therapies. Although limitations exist, MSC-centered therapies still provide novel, innovative approaches for TMJOA treatment.

Polydopamine nanoparticles as dual-task platform for osteoarthritis therapy: A scavenger for reactive oxygen species and regulator for cellular powerhouses

• Excellent antioxidative/anti-inflammatory dual-task nanoplatform based on PDA NPs. • PDA NPs not only scavenge reactive oxygen species but also reduce their production. • PDA NPs increase cellular respiratory efficiency, thereby reducing oxidative stress. • Injectable PDA NPs serve as minimal invasive therapeutic agents for osteoarthritis. Because of the obscure etiology of osteoarthritis (OA) and unsatisfactory treatment outcomes, new effective and minimally invasive therapies are urgently needed. Oxidative stress elicited by excessive reactive oxygen species (ROS) accumulation has historically been considered a potential trigger of OA. Polydopamine (PDA), an emerging versatile biopolymer produced by self-polymerization of dopamine, has attracted considerable attention in biomedical applications by virtue of its excellent biocompatibility and intriguing ROS-scavenging capacity. Herein, an antioxidative/anti-inflammatory dual-task nanoplatform based on PDA nanoparticles (NPs) is introduced for the treatment of temporomandibular joint osteoarthritis (TMJ-OA). In addition to directly reacting with ROS as a reducing agent, PDA NPs also regulate ROS generation in mitochondria which are considered cellular powerhouses. Specifically, the efficiency of mitochondrial oxidative phosphorylation (OXPHOS) is significantly increased in the presence of PDA NPs, indicating that PDA NPs may increase the efficiency of mitochondrial respiration, hence reducing ROS production. This intriguing dual-antioxidative mechanism may account for the remarkable antioxidative capacity of PDA NPs. Moreover, the anti-inflammatory capacity of PDA NPs is revealed both in vitro and in vivo . This work not only opens a new avenue for OA treatment but also provides valuable insights into the design of biomaterials with multiple biomedical applications via regulation of cellular energy metabolism.

Orally Administered NSAIDs-General Characteristics and Usage in the Treatment of Temporomandibular Joint Osteoarthritis-A Narrative Review.

Background: Temporomandibular joint osteoarthritis (TMJ OA) is a degenerative joint disease. The aim of this review was to present the general characteristics of orally administered nonsteroidal anti-inflammatory drugs (NSAIDs) and to present the efficacy of NSAIDs in the treatment of TMJ OA. Methods: PubMed database was analyzed with the keywords: “(temporomandibular joint) AND ((disorders) OR (osteoarthritis) AND (treatment)) AND (nonsteroidal anti-inflammatory drug)”. After screening of 180 results, 6 studies have been included in this narrative review. Results and Conclusions: Nonsteroidal anti-inflammatory drugs are one of the most commonly used drugs for alleviation of pain localized in the orofacial area. The majority of articles predominantly examined and described diclofenac sodium in the treatment of pain in the course of TMJ OA. Because of the limited number of randomized studies evaluating the efficacy of NSAIDs in the treatment of TMJ OA, as well as high heterogeneity of published researches, it seems impossible to draw up unequivocal recommendations for the usage of NSAIDs in the treatment of TMJ OA. However, it is highly recommended to use the lowest effective dose of NSAIDs for the shortest possible time. Moreover, in patients with increased risk of gastrointestinal complications, supplementary gastroprotective agents should be prescribed.