Systematic Review
TMJ Disorders
Platelet-rich plasma for the therapeutic management of temporomandibular joint disorders: a systematic review

https://doi.org/10.1016/j.ijom.2017.09.014Get rights and content

Abstract

This systematic review aimed to investigate whether intra-articular injections of platelet-rich plasma (PRP) are beneficial for the treatment of degenerative temporomandibular disorders, such as temporomandibular joint osteoarthritis (TMJ-OA) and disc displacement with osteoarthritic lesions, when compared to other treatments, such as injections of hyaluronic acid (HA) or saline. An electronic search of the MEDLINE and Scopus databases was performed using combinations of the terms “temporomandibular” and “platelet rich plasma”, to identify studies reported in English and published up until May 2017. A hand-search of relevant journals and the reference lists of selected articles was also performed. The initial screening identified 153 records, of which only six fulfilled the inclusion criteria and were included in this review. Of these studies, three compared PRP with HA, while three compared PRP with Ringer’s lactate or saline. Four of the studies found PRP injections to be superior in terms of improvements in mandibular range of motion and pain intensity up to 12 months after treatment, while the remaining two studies found similar results for the different treatments. There is slight evidence for the potential benefits of intra-articular injections of PRP in patients with TMJ-OA. However, a standardized protocol for PRP preparation and application needs to be established.

Section snippets

Materials and methods

The aim of this review was to test the null hypothesis that the treatment of degenerative TMD with intra-articular injections of PRP is not superior to intra-articular injection of another substance.

A systematic literature review was performed following the guidelines of the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)26. The first step in the systematic review was to use the PICO format to define a clinical question: the population (P) was patients with

Search results

The search strategy used identified 153 records, 143 from the MEDLINE database and 14 from Scopus. Following the removal of duplicates, 140 results remained. The abstracts of the remaining articles were screened against the inclusion criteria, with 10 then chosen for further analysis. Of the 10 full-text articles examined, only six fulfilled the inclusion criteria (PRISMA flow diagram, Fig. 1). The studies reported in the other four articles were not RCTs and by extension were not included in

Discussion

This systematic review gathered and analyzed the existing literature on the therapeutic management of degenerative TMD with PRP injections. It was limited to RCTs in order to include studies of high methodological quality and to provide the highest level of evidence on the subject. However, due to the lack of homogeneity among the studies included, a meta-analysis could not be performed. The studies included shared a common philosophy for the application of PRP as a treatment modality in

Funding

This study was conducted with a scholarship from the Greek State Scholarship Foundation (IKY), which was funded by the action “Enhancing Human Research Potential through Doctoral Research” from the resources of the European Program “Development of Human Potential, Education and Lifelong Learning”, 2014–2020, with funds from European Social Fund (ESF) and national resources.

Competing interests

The authors declare that they have no conflict of interest.

Ethical approval

Not required.

Patient consent

Not required.

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      PRP injection was found to be superior to the traditional arthrocentesis procedure.13 In 2017, a systematic review by Bousnaki et al aimed to investigate whether intrajoint PRP injection can be beneficial for treating degenerative TMDs, especially TMJ-OA.2 Of the 153 identified studies, only 6 fulfilled the inclusion criteria and were reviewed.

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