Clinical and Magnetic Resonance Imaging Evaluation of Efficacy of a Novel Mixture of Injectable Platelet Rich Fibrin and Hyaluronic Acid for Management of Temporomandibular Joint Internal Derangement

The jaw is a surprisingly complex hinge, a joint that allows us to speak, eat, and express emotion with fluid motion. Deep inside this joint, between the lower jawbone and the skull, sits a small, shock-absorbing cushion called an articular disc. This disc acts as a spacer and a lubricant, ensuring the bones glide smoothly past one another. When this disc slips out of its proper alignment, a condition known as internal derangement occurs. The result is often a painful, stiff jaw that clicks or locks, making simple acts like opening the mouth for a meal difficult and uncomfortable. For years, doctors have treated these issues by flushing the joint with saline to wash away irritants, followed by an injection of a thick, slippery fluid called hyaluronic acid to restore lubrication. While this approach helps many, researchers have long wondered if adding a biological healing agent could do even more to repair the joint from the inside out.

A team of researchers at Suez Canal University in Egypt set out to test exactly this idea. They focused on a specific biological material known as injectable platelet-rich fibrin, or I-PRF. This substance is derived directly from a patient's own blood. When blood is spun in a centrifuge, it separates into layers; the middle layer contains platelets and growth factors that are the body's natural repair crew. The researchers hypothesized that mixing this healing fluid with the standard lubricating injection would provide a superior treatment for patients suffering from a slipped disc in the jaw joint. To find out, they recruited thirty adults, mostly women between the ages of eighteen and thirty-five, who were experiencing pain, limited movement, and clicking sounds in their jaws. None of these patients had found relief through standard conservative care like medication or physical therapy, making them ideal candidates for this new approach.

The study was designed as a direct comparison. The thirty participants were randomly split into two equal groups. Both groups received the same initial procedure: a thorough washing of the joint space with saline solution to clear out inflammation and free up any stuck tissues. After this cleaning, the control group received the standard treatment: a single injection of one milliliter of hyaluronic acid. The second group, the study group, received a slightly different cocktail: half a milliliter of the same hyaluronic acid mixed with half a milliliter of the patient's own I-PRF. The researchers then tracked these patients closely over a period of six months, checking their progress at one, three, and six months after the procedure. They measured how wide the patients could open their mouths, how much pain they felt on a scale of zero to ten, and whether the annoying clicking sound had disappeared. They also used magnetic resonance imaging, a powerful type of scan that creates detailed pictures of the soft tissues inside the joint, to see if the disc itself had moved back into place.

The results showed a clear advantage for the group that received the mixture. By the third and sixth months, patients who got the combination of healing fluid and lubricant could open their mouths significantly wider than those who received only the lubricant. On average, the mixed-treatment group opened their mouths to nearly forty-eight millimeters, while the control group reached just under forty-four millimeters. The difference was not just a matter of a few millimeters; it was a statistically significant improvement that suggested the addition of the blood-derived fluid made a real difference in function. Pain levels also told a similar story. While both groups felt better over time, the group receiving the I-PRF mixture reported significantly less pain by the six-month mark, with many reporting almost no discomfort at all. Perhaps most notably, the troublesome clicking sound that often accompanies a displaced disc vanished more consistently in the mixed-treatment group. By the end of the study, nearly all patients in the I-PRF group had lost the clicking sound, compared to a smaller percentage in the control group.

However, the story was not one of total structural repair. When the researchers looked at the magnetic resonance images taken six months after the treatment, they found that the position of the articular disc had not changed in either group. The discs remained displaced, just as they were before the procedure. This finding is crucial because it clarifies what the treatment actually achieved. The mixture of I-PRF and hyaluronic acid did not physically push the disc back into its original slot. Instead, it appears to have improved the environment inside the joint so effectively that the jaw could move freely and painlessly despite the disc being out of place. The researchers suggest that the growth factors in the I-PRF likely reduced inflammation and helped the surrounding tissues heal, while the hyaluronic acid reduced friction. Together, they created a smoother, less painful experience for the patient, even though the underlying anatomical misalignment remained.

The study concludes that while the injection of hyaluronic acid alone is a safe and effective way to manage jaw pain and stiffness, adding a small amount of the patient's own platelet-rich fibrin creates a more powerful treatment. This combination offers better relief from pain, greater mouth opening, and a higher chance of stopping the clicking sound. The findings suggest that for patients suffering from this specific type of jaw disorder, the body's own healing potential, when harnessed and delivered directly into the joint, can enhance the benefits of standard care. The researchers noted that their study had a limitation in its duration, as six months is a relatively short time to see if the joint structure might eventually remodel. Nevertheless, the evidence gathered over those months points to a promising, minimally invasive option that combines the best of lubrication and biological healing to restore quality of life for those living with a painful, clicking jaw.