Clinical and Radiographic evaluation of the efficacy of Injectable PRF (platelet- rich fibrin) in management of Temporomandibular joint Internal Derangement: A Randomized Controlled Clinical Study

The jaw joint, known as the temporomandibular joint, is a complex hinge that allows us to speak, chew, and yawn. When this joint malfunctions, a condition called internal derangement can occur, where the soft cushioning disc inside the joint slips out of its proper place. This misalignment often leads to painful clicking, a feeling of the jaw locking, and a significant reduction in how wide a person can open their mouth. For years, doctors have treated these issues with conservative measures like special diets and physical therapy. When those fail, they often turn to a minimally invasive procedure called arthrocentesis, which involves flushing the joint with fluid to wash away inflammatory chemicals and break up sticky adhesions. To make this flushing even more effective, physicians sometimes inject substances directly into the joint space afterward, such as hyaluronic acid, a gel-like lubricant, or newer biological materials derived from the patient's own blood.

A recent study from Egypt sought to compare two of these injectable treatments to see which one offers better relief for patients suffering from this painful condition. The researchers focused on a material called injectable platelet-rich fibrin, or I-PRF. This substance is created by taking a small amount of the patient's own blood, spinning it in a centrifuge to separate the components, and collecting the liquid layer rich in platelets and growth factors. Unlike older blood treatments that require chemical additives to work, this new liquid form is prepared without anticoagulants, aiming to create a natural healing environment within the joint. The team wanted to know if injecting this natural blood product after flushing the joint would be more effective at reducing pain and improving jaw movement than the standard lubricating gel, hyaluronic acid.

To find the answer, the researchers recruited twenty female patients who had tried conservative treatments without success and were experiencing significant pain and limited jaw movement. These patients were randomly divided into two groups. One group received the standard treatment: after their joints were flushed with saline solution, they were injected with two milliliters of hyaluronic acid. The other group received the same flushing procedure but was injected with two milliliters of the liquid platelet-rich fibrin. The doctors then tracked the patients' progress over six months, measuring how much pain they felt, how wide they could open their mouths, and whether the annoying clicking sound in their joints had stopped. They also used magnetic resonance imaging, a type of scan that uses magnetic fields to create detailed pictures of the inside of the body, to see if the position of the displaced disc had changed or if swelling had gone down.

The results showed that both treatments were successful in helping patients feel better. In the months following the procedure, everyone experienced a significant drop in pain and a noticeable increase in how wide they could open their mouths. By the six-month mark, the average opening for both groups had improved from about 35 millimeters before treatment to roughly 43 millimeters, a change that was statistically significant for both groups. However, when the researchers looked closely at the pain levels, a subtle difference emerged. While both groups saw their pain scores drop dramatically, the group receiving the platelet-rich fibrin reported slightly less pain at the six-month follow-up compared to the group that received the hyaluronic acid gel. This suggests that the blood-derived treatment might offer a small, long-term advantage in managing discomfort.

The study also examined the clicking sounds that often accompany this condition. Both treatments were effective at reducing the frequency of these clicks, though the hyaluronic acid group showed a slightly more consistent reduction in the sound over time. When the researchers looked at the MRI scans, they found something interesting about the anatomy of the joint. Despite the clinical improvements in pain and movement, the actual position of the displaced disc did not change in either group. The disc remained in its displaced state on the scans, even though the patients felt much better and could move their jaws more freely. This indicates that the treatments did not physically push the disc back into its original spot, but rather reduced the inflammation and swelling that were causing the pain and stiffness. The scans also confirmed that the fluid buildup, or swelling, inside the joint disappeared completely in all patients by the six-month mark.

The researchers concluded that injecting platelet-rich fibrin is a safe and effective way to treat this type of jaw joint disorder, particularly for reducing pain and resolving swelling. While it did not dramatically outperform the standard hyaluronic acid treatment in terms of jaw opening or stopping the clicking, it did show a slight edge in long-term pain relief. The study highlights that patients can achieve significant clinical improvement even if the underlying structural issue of the displaced disc remains visible on an MRI. The authors suggest that this blood-based treatment is a promising option for patients who need relief from jaw pain and locking, noting that it is derived from the patient's own body and carries a low risk of allergic reaction. They recommend further studies with larger groups of people and longer follow-up periods to fully understand how this treatment compares to others over time.