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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (2): 338-344. doi: 10.19723/j.issn.1671-167X.2024.02.022

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Preliminarily study of arthrocentesis combined with liquid phase concentrated growth factor injection in the treatment of unilateral temporomandibular joint osteoarthritis

Hongguang LI1,Weihua HAN1,Xun WU1,Jiling FENG2,Gang LI2,Juanhong MENG1,3,*()   

  1. 1. Department of Oral and Maxillofacial Surgery, Beijing 100081, China
    2. Department of Oral and Maxillofacial Radiology, Beijing 100081, China
    3. Center for Temporomandibular Joint Disorder and Orofacial Pain, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2023-10-09 Online:2024-04-18 Published:2024-04-10
  • Contact: Juanhong MENG E-mail:jhmeng@263.com

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Abstract:

Objective: To observe the clinical effect of arthrocentesis combined with liquid phase concentrated growth factor (CGF) injection in the treatment of unilateral temporomandibular joint osteoarthritis (TMJOA), in order to provide a new treatment option for TMJOA patients. Methods: In this non-randomized controlled study, patients diagnosed with unilateral TMJOA who visited the center for temporomandibular joint disorder and orofacial pain of Peking University School and Hospital of Stomatology from June 2021 to January 2023 were selected as research objects. The patients were divided into experimental group and control group, which were selected by patients themselves. The experimental group received arthrocentesis combined with liquid phase CGF injection and the control group received arthrocentesis combined with HA injection. Both groups were treated 3 times, once every two weeks. The clinical effect was evaluated by the maximum mouth opening, pain value and the degree of mandibular function limitation 6 months after treatment. The change of condylar bone was evaluated by cone beam CT (CBCT) image fusion technology before and after treatment. Results: A total of 20 patients were included in the experimental group, including 3 males and 17 females, with an average age of (34.40±8.41) years. A total of 15 patients were included in the control group, including 1 male and 14 females, with an average age of (32.20±12.00) years. There was no statistical difference in general information between the two groups (P > 0.05). There were no statistical differences in the mouth opening, pain value and the degree of jaw function limitation between the two groups before treatment (P > 0.05), and all of them improved 6 months after treatment compared with before treatment (P < 0.05). However, the mouth opening of experimental group was significantly higher than that of control group 6 months after treatment (P < 0.05), and the degree of jaw function limitation was significantly lower than that of control group (P < 0.05). CBCT 2D images showed that the condylar bone of both groups was smoother after treatment than before treatment, and image fusion results showed that 10 patients (50.0%) in the experimental group and 5 patients (33.3%) in the control group had reparative remodeling area of condylar bone, and there was no statistical difference between them (P > 0.05). Except for one CGF patient, the other patients in both groups had some absorption areas of condylar bone. Conclusion: The arthrocentesis combined with liquid phase CGF injection can improve the clinical symptoms and signs of unilateral TMJOA patients in short term, and is better than HA in increasing mouth opening and improving jaw function. CBCT fusion images of both patient groups show some cases of condylar bone reparative remodeling and its relevance to treatment plans still requires further study.

Key words: Temporomandibular joint, Osteoarthritis, Concentrated growth factor, Hyaluronic acid, Intra-articular injection

CLC Number: 

  • R782.6

Table 1

Changes of maximum mouth opening (MMO) before and after treatment"

Items Experimental group Control group t P
Before treatment/mm, ${\bar x}$±s 31.20±4.72 30.06±4.70 0.704 0.486
After treatment/mm, ${\bar x}$±s 41.85±5.86 36.00±6.21 2.849 0.007
Mean change/mm, ${\bar x}$±s 10.65±5.53 5.93±7.11 2.211 0.034
t －8.616 －3.234
P ＜0.001 0.006

Table 2

Changes of visual analogue scale (VAS) before and after treatment"

Items Experimental group Control group t P
Before treatment, ${\bar x}$±s 62.25±22.39 57.33±16.24 0.719 0.477
After treatment, ${\bar x}$±s 11.50±10.89 17.33±9.42 －1.659 0.107
Mean change, ${\bar x}$±s －50.75±26.72 －40.00±19.91 －1.308 0.200
t 8.495 7.781
P ＜0.001 ＜0.001

Table 3

Changes of mean jaw functional limitation scale (JFLS) scores before and after treatment"

Items Experimental group Control group t P
Before treatment, ${\bar x}$±s 2.66±0.88 2.42±0.71 0.883 0.384
After treatment, ${\bar x}$±s 0.44±0.37 0.72±0.27 －2.477 0.019
Mean change, ${\bar x}$±s －2.23±1.00 －1.70±0.54 －2.108 0.043
t 9.913 11.118
P ＜0.001 ＜0.001

Figure 1

Image of condylar bone reparative remodeling after CGF intra-articular injection in a patient Axial (A), oblique coronal (B) and oblique sagittal (C) view of the before treatment CBCT images; Axial (D), oblique coronal (E), and oblique sagittal (F) view of the after treatment CBCT images; Axial (G), oblique coronal (H), and oblique sagittal (I) view of the fused sectional CBCT images. The gray area pointed by the red arrow indicates reparative remodeling of the bone. Figure J to L fused 3D images in different view angles. The red area pointed by the red arrow indicates reparative remodeling of the bone. CGF, concentrated growth factor; CBCT, cone beam CT."

Figure 2

Image of condylar bone partial resorption after CGF intra-articular injection in a patient Axial (A), oblique coronal (B), and oblique sagittal (C) view of the before treatment CBCT images; Axial (D), oblique coronal (E), and oblique sagittal (F) view of the after treatment CBCT images; Axial (G), oblique coronal (H), and oblique sagittal (I) view of the fused sectional CBCT images. The gray area pointed by the red arrow indicates partial resorption of the bone. Figure J to L fused 3D images in different view angles. The red area pointed by the red arrow indicates partial resorption of the bone, but the surface of condylar bone is smoother than before treatment. CGF, concentrated growth factor; CBCT, cone beam."

1 Cömert Kiliç S , Güngörmüȿ M , Sümbüllü MA . Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis alone in the treatment of temporomandibular joint osteoarthritis? A randomized clinical trial[J]. J Oral Maxillofac Surg, 2015, 73 (8): 1473- 1483.
doi: 10.1016/j.joms.2015.02.026
2 Bergstrand S , Ingstad HK , Møystad A , et al. Long-term effectiveness of arthrocentesis with and without hyaluronic acid injection for treatment of temporomandibular joint osteoarthritis[J]. J Oral Sci, 2019, 61 (1): 82- 88.
doi: 10.2334/josnusd.17-0423
3 Sikora M , Czerwińska-Niezabitowska B , Chęciński MA , et al. Short-term effects of intra-articular hyaluronic acid administration in patients with temporomandibular joint disorders[J]. J Clin Med, 2020, 9 (6): 1749.
doi: 10.3390/jcm9061749
4 Lee HM , Shen EC , Shen JT , et al. Tensile strength, growth factor content and proliferation activities for two platelet concentrates of platelet-rich fibrin and concentrated growth factor[J]. J Dent Sci, 2020, 15 (2): 141- 146.
doi: 10.1016/j.jds.2020.03.011
5 Tabatabaei F , Aghamohammadi Z , Tayebi L . In vitro and in vivo effects of concentrated growth factor on cells and tissues[J]. J Biomed Mater Res A, 2020, 108 (6): 1338- 1350.
doi: 10.1002/jbm.a.36906
6 汪淼, 程飚. 浓缩血小板在医学美容与组织再生中的临床应用[M]. 北京: 北京大学医学出版社, 2020: 272- 295.
7 Chung PY , Lin MT , Chang HP . Effectiveness of platelet-rich plasma injection in patients with temporomandibular joint osteoarthritis: A systematic review and meta-analysis of randomized controlled trials[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2019, 127 (2): 106- 116.
doi: 10.1016/j.oooo.2018.09.003
8 Yang JW , Huang YC , Wu SL , et al. Clinical efficacy of a centric relation occlusal splint and intra-articular liquid phase concen-trated growth factor injection for the treatment of temporomandibular disorders[J]. Medicine, 2017, 96 (11): 6302- 6308.
doi: 10.1097/MD.0000000000006302
9 Rodella LF , Favero G , Boninsegna R , et al. Growth factors, CD34 positive cells, and fibrin network analysis in concentrated growth factors fraction[J]. Microsc Res Tech, 2011, 74 (8): 772- 777.
doi: 10.1002/jemt.20968
10 傅开元. 2014年新版国际颞下颌关节紊乱病分类及诊断标准解读[J]. 中华口腔医学杂志, 2017, 52 (6): 374- 376.
doi: 10.3760/cma.j.issn.1002-0098.2017.06.010
11 孟娟红, 甘业华, 马绪臣. 颞下颌关节骨关节炎发病的分子机制及相关治疗的实验研究[J]. 北京大学学报(医学版), 2013, 45 (1): 5- 8.
12 Cömert Kiliç S , Güngörmüȿ M . Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis plus hyaluronic acid for the treatment of temporomandibular joint osteoarthritis: A randomized clinical trial[J]. Int J Oral Maxillofac Surg, 2016, 45 (12): 1538- 1544.
doi: 10.1016/j.ijom.2016.06.009
13 Kopp S , Wenneberg B , Haraldson T , et al. The short-term effect of intra-articular injections of sodium hyaluronate and corticosteroid on temporomandibular joint pain and dysfunction[J]. J Oral Maxillofac Surg, 1985, 43 (6): 429- 435.
doi: 10.1016/S0278-2391(85)80050-1
14 Guarda-Nardini L , Cadorin C , Frizziero A , et al. Comparison of 2 hyaluronic acid drugs for the treatment of temporomandibular joint osteoarthritis[J]. J Oral Maxillofac Surg, 2012, 70 (11): 2522- 2530.
doi: 10.1016/j.joms.2012.07.020
15 Gurung T , Singh RK , Mohammad S , et al. Efficacy of arthrocentesis versus arthrocentesis with sodium hyaluronic acid in temporomandibular joint osteoarthritis: A comparison[J]. Natl J Maxillofac Surg, 2017, 8 (1): 41- 49.
doi: 10.4103/njms.NJMS_84_16
16 Li C , Long X , Deng M , et al. Osteoarthritic changes after superior and inferior joint space injection of hyaluronic acid for the treatment of temporomandibular joint osteoarthritis with anterior disc displacement without reduction: A cone-beam computed tomographic evaluation[J]. J Oral Maxillofac Surg, 2015, 73 (2): 232- 244.
doi: 10.1016/j.joms.2014.08.034
17 Cömert Kiliç S . Does glucosamine, chondroitin sulfate, and methylsulfonylmethane supplementation improve the outcome of temporomandibular joint osteoarthritis management with arthrocentesis plus intraarticular hyaluronic acid injection. A randomized clinical trial[J]. J Craniomaxillofac Surg, 2021, 49 (8): 711- 718.
doi: 10.1016/j.jcms.2021.02.012
18 Altman RD , Manjoo A , Fierlinger A , et al. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: A systematic review[J]. BMC Musculoskelet Disord, 2015, 16 (1): 321- 330.
doi: 10.1186/s12891-015-0775-z
19 Ferreira N , Masterson D , Lopes de Lima R , et al. Efficacy of viscosupplementation with hyaluronic acid in temporomandibular disorders: A systematic review[J]. J Craniomaxillofac Surg, 2018, 46 (11): 1943- 1952.
doi: 10.1016/j.jcms.2018.08.007
20 Lin SL , Tsai CC , Wu SL , et al. Effect of arthrocentesis plus platelet-rich plasma and platelet-rich plasma alone in the treatment of temporomandibular joint osteoarthritis: A retrospective matched cohort study (A STROBE-compliant article)[J]. Medicine (Baltimore), 2018, 97 (16): 477- 484.
21 Gokçe Kutuk S , Gökçe G , Arslan M , et al. Clinical and radiological comparison of effects of platelet-rich plasma, hyaluronic acid, and corticosteroid injections on temporomandibular joint osteoarthritis[J]. J Craniofac Surg, 2019, 30 (4): 1144- 1148.
doi: 10.1097/SCS.0000000000005211
22 Zotti F , Albanese M , Rodella LF , et al. Platelet-rich plasma in treatment of temporomandibular joint dysfunctions: Narrative review[J]. Int J Mol Sci, 2019, 20 (2): 277- 290.
23 Marx RE , Harrell DB . Translational research: The CD34+ cell is crucial for large-volume bone regeneration from the milieu of bone marrow progenitor cells in craniomandibular reconstruction[J]. Int J Oral Maxillofac Implants, 2014, 29 (2): 201- 209.
doi: 10.11607/jomi.te56
24 Feng JL , Ma RH , Du H , et al. Diagnostic accuracy of fused CBCT images in the evaluation of temporomandibular joint condylar bone resorption[J]. Clin Oral Invest, 2023, 27 (3): 1277- 1288.
25 李红光, 吴训, 彭慧钰, 等. 基于CBCT的单侧颞下颌关节骨关节炎临床表现与髁突骨质改变类型的相关性分析[J]. 现代口腔医学杂志, 2022, 36 (3): 148- 152.
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