Evaluation of the efficiency of hyaluronic acid, PRP and I-PRF intra-articular injections in the treatment of internal derangement of the temporomandibular joint: A prospective clinical study

This study aimed to evaluate the clinical effects of hyaluronic acid (HA), platelet-rich plasma (PRP), and platelet-rich fibrin (I-PRF) injections in the internal derangement of the temporomandibular joint. 68 adult patients, with a total of 109 joints, who had failed to respond to nonsurgical treatments were treated and evaluated. The mean age was 53 ± 16 years. Preoperative MRI and further clinical examinations were performed on all patients. The patients were divided into three treatment groups according to the given substance: HA administered three times in a row on a weekly basis, a single dose of PRP, or that of I-PRF. Clinical assessment was performed preoperatively and 6 and 12 months after the treatment, including maximal mouth opening (MMO) and pain level (Visual Analog Scale). Low and high molecular weight (HAL, HAH) hyaluronic acid forms were also compared. According to this study's results, all methods are efficient techniques. The statistical analysis showed a significant improvement in MMO in the HA group (p < 0.01). The pain level significantly decreased in all treatment groups (pHA,PRP,I-PRF<0.01). Comparing HAL and HAH forms, no significant difference was found in the evaluation of MMO and VAS values. Due to the similar effects of HA and the autologous blood substances, the platelet concentrates should be preferred in the intra-articular treatment in order to reduce the risk of possible adverse effects.