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

  • M. Bousnaki
    Department of Prosthodontics, Faculty of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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  • A. Bakopoulou
    Department of Prosthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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  • P. Koidis
    Address: P. Koidis, Department of Prosthodontics, Faculty of Dentistry, Aristotle University of Thessaloniki, University Campus, Dentistry Building, Thessaloniki GR-54124, Greece. Tel.: +30 2310 999659, Fax: +30 2310 999531.
    Department of Prosthodontics, Faculty of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Published:October 20, 2017DOI:


      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.

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        • Zarb G.A.
        • Carlsson G.E.
        • Sessle B.J.
        • Mohl N.D.
        Temporomandibular joint and masticatory muscle disorders.
        Second edition. Munksgaard, Copenhagen1994 (48–65, 128–155)
        • Farrar W.B.
        • McCarty Jr., W.L.
        The TMJ dilemma.
        J Ala Dent Assoc. 1979; 63: 19-26
        • Manfredini D.
        • Chiappe G.
        • Bosco M.
        Research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnoses in an Italian patient population.
        J Oral Rehabil. 2006; 33: 551-558
        • Abrahamsson C.
        • Ekberg E.
        • Henrikson T.
        • Nilner M.
        • Sunzel B.
        • Bondemark L.
        TMD in consecutive patients referred for orthognathic surgery.
        Angle Orthod. 2009; 79: 621-627
        • John M.T.
        • Reissmann D.R.
        • Schierz O.
        • Wassell R.W.
        Oral health related quality of life in patients with temporomandibular disorders.
        J Orofac Pain. 2007; 21: 46-54
        • Zarb G.A.
        • Carlsson G.E.
        Temporomandibular disorders: osteoarthritis.
        J Orofac Pain. 1999; 13: 295-306
        • Tanaka E.
        • Detamore M.S.
        • Mercuri L.G.
        Degenerative disorders of the temporomandibular joint: etiology, diagnosis, and treatment.
        J Dent Res. 2008; 87: 296-307
        • Kai S.
        • Kai H.
        • Tabata O.
        • Shiratsuchi Y.
        • Ohishi M.
        Long-term outcomes of nonsurgical treatment in nonreducing anteriorly displaced disk of the temporomandibular joint.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998; 85: 258-267
        • de Leeuw R.
        • Boering G.
        • Stegenga B.
        • de Bont L.G.
        Symptoms of temporomandibular joint osteoarthrosis and internal derangement 30 years after non-surgical treatment.
        Cranio. 1995; 13: 81-88
        • Stiesch-Scholz M.
        • Kempert J.
        • Wolter S.
        • Tschernitschek H.
        • Rossbach A.
        Comparative prospective study on splint therapy of anterior disc displacement without reduction.
        J Oral Rehabil. 2005; 32: 474-479
        • Dolwick M.F.
        The role of temporomandibular joint surgery in the treatment of patients with internal derangement.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 83: 150-155
        • Nitzan D.W.
        • Price A.
        The use of arthrocentesis for the treatment of osteoarthritic temporomandibular joints.
        J Oral Maxillofac Surg. 2001; 59: 1154-1159
        • Nitzan D.W.
        The process of lubrication impairment and its involvement in temporomandibular joint disc displacement: a theoretical concept.
        J Oral Maxillofac Surg. 2001; 59: 36-45
        • Nitzan D.W.
        • Nitzan U.
        • Dan P.
        • Yedgar S.
        The role of hyaluronic acid in protecting surface-active phospholipids from lysis by exogenous phospholipase A(2).
        Rheumatology (Oxford). 2001; 40: 336-340
        • Escoda-Francolí J.
        • Vázquez-Delgado E.
        • Gay-Escoda C.
        Scientific evidence on the usefulness of intraarticular hyaluronic acid injection in the management of temporomandibular dysfunction.
        Med Oral Patol Oral Cir Bucal. 2010; 15: e644-e648
        • Gencer Z.K.
        • Özkiriş M.
        • Okur A.
        • Korkmaz M.
        • Saydam L.
        A comparative study on the impact of intra-articular injections of hyaluronic acid, tenoxicam and betametazon on the relief of temporomandibular joint disorder complaints.
        J Craniomaxillofac Surg. 2014; 42: 1117-1121
        • Manfredini D.
        • Piccotti F.
        • Guarda-Nardini L.
        Hyaluronic acid in the treatment of TMJ disorders: a systematic review of the literature.
        Cranio. 2010; 28: 166-176
        • Pietrzak W.S.
        • Eppley B.L.
        Platelet rich plasma: biology and new technology.
        J Craniofac Surg. 2005; 16: 1043-1054
        • Eppley B.L.
        • Woodell J.E.
        • Higgins J.
        Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing.
        Plast Reconstr Surg. 2004; 114: 1502-1508
        • Marx R.E.
        Platelet-rich plasma: evidence to support its use.
        J Oral Maxillofac Surg. 2004; 62: 489-496
        • Kon E.
        • Buda R.
        • Filardo G.
        • Di Martino A.
        • Timoncini A.
        • Cenacchi A.
        • Fornasari P.M.
        • Giannini S.
        • Marcacci M.
        Platelet-rich plasma: intraarticular knee injections produced favorable results on degenerative cartilage lesions.
        Knee Surg Sports Traumatol Arthrosc. 2010; 4: 472-479
        • Fortier L.A.
        • Hackett C.H.
        • Cole B.J.
        The effects of platelet-rich plasma on cartilage: basic science and clinical application.
        Oper Tech Sports Med. 2011; 19: 154-159
        • Vaquerizo V.
        • Plasencia M.A.
        • Arribas I.
        • Seijas R.
        • Padilla S.
        • Orive G.
        • Anitua E.
        Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus Durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial.
        Arthroscopy. 2013; 29: 1635-1643
        • Smyth N.
        • Murawski C.
        • Fortier L.
        • Cole B.
        • Kennedy J.
        Platelet-rich plasma in the pathologic processes of cartilage: review of basic scientific evidence.
        Arthroscopy. 2013; 29: 1399-1409
        • Zhu Y.
        • Yuan M.
        • Meng H.Y.
        • Wang A.Y.
        • Guo Q.Y.
        • Wang Y.
        • Peng J.
        Basic science and clinical application of platelet-rich plasma for cartilage defects and osteoarthritis: a review.
        Osteoarthritis Cartilage. 2013; 21: 1627-1637
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        Ann Intern Med. 2009; 151 (W64): 264-269
        • Higgins J.A.
        • Altman D.G.
        • Sterne J.
        Assessing risk of bias in included studies.
        in: Higgins J. Altman D. Sterne J. Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration, 2011
        • Jadad A.R.
        • Moore R.A.
        • Carroll D.
        • Jenkinson C.
        • Reynolds D.J.
        • Gavaghan D.J.
        • McQuay H.J.
        Assessing the quality of reports of randomized clinical trials: is blinding necessary.
        Control Clin Trials. 1996; 17: 1-12
        • Hancı M.
        • Karamese M.
        • Tosun Z.
        • Aktan T.M.
        • Duman S.
        • Savaci N.
        Intra-articular platelet-rich plasma injection for the treatment of temporomandibular disorders and a comparison with arthrocentesis.
        J Craniomaxillofac Surg. 2015; 43: 162-166
        • Cömert Kiliç S.
        • Güngörmüş M.
        • Sümbüllü M.A.
        Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis alone in the treatment of temporomandibular joint osteoarthritis? A randomized clinical trial.
        J Oral Maxillofac Surg. 2015; 73: 1473-1483
        • Hegab A.F.
        • Ali H.E.
        • Elmasry M.
        • Khallaf M.G.
        Platelet-rich plasma injection as an effective treatment for temporomandibular joint osteoarthritis.
        J Oral Maxillofac Surg. 2015; 73: 1706-1713
        • Cömert Kiliç S.
        • Güngörmüş M.
        Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis plus hyaluronic acid for the treatment of temporomandibular joint osteoarthritis: a randomized clinical trial.
        Int J Oral Maxillofac Surg. 2016; 45: 1538-1544
        • Fernández Sanromán J.
        • Fernández Ferro M.
        • Costas López A.
        • Arenaz Bua J.
        • López A.
        Does injection of plasma rich in growth factors after temporomandibular joint arthroscopy improve outcomes in patients with Wilkes stage IV internal derangement? A randomized prospective clinical study.
        Int J Oral Maxillofac Surg. 2016; 45: 828-835
        • Fernández-Ferro M.
        • Fernández-Sanromán J.
        • Blanco-Carrión A.
        • Costas-López A.
        • López-Betancourt A.
        • Arenaz-Bua J.
        • Stavaru Marinescu B.
        Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of temporomandibular dysfunction: a randomised prospective study.
        J Craniomaxillofac Surg. 2017; 45: 449-454
        • Al-Delayme R.M.
        • Alnuamy S.H.
        • Hamid F.T.
        • Azzamily T.J.
        • Ismaeel S.A.
        • Sammir R.
        • Hadeel M.
        • Nabeel J.
        • Shwan R.
        • Alfalahi S.J.
        • Yasin A.
        The efficacy of platelets rich plasma injection in the superior joint space of the temporomandibular joint guided by ultra sound in patients with non-reducing disk displacement.
        J Maxillofac Oral Surg. 2017; 16: 43-47
        • Pihut M.
        • Szuta M.
        • Ferendiuk E.
        • Zeńczak-Więckiewicz D.
        Evaluation of pain regression in patients with temporomandibular dysfunction treated by intra-articular platelet-rich plasma injections: a preliminary report.
        Biomed Res Int. 2014; 2014: 132369
        • Giacomello M.
        • Giacomello A.
        • Mortellaro C.
        • Gallesio G.
        • Mozzati M.
        Temporomandibular joint disorders treated with articular injection: the effectiveness of plasma rich in growth factors–Endoret.
        J Craniofac Surg. 2015; 26: 709-713
        • Yang J.W.
        • Huang Y.C.
        • Wu S.L.
        • Ko S.Y.
        • Tsai C.C.
        Clinical efficacy of a centric relation occlusal splint and intra-articular liquid phase concentrated growth factor injection for the treatment of temporomandibular disorders.
        Medicine (Baltimore). 2017; 96: e6302
        • Li F.
        • Li Y.
        • Qiao C.
        • Zhu J.
        • Chen J.
        • Zhang P.
        Topical use of platelet-rich plasma can improve the clinical outcomes after total knee arthroplasty: a systematic review and meta-analysis of 1316 patients.
        Int J Surg. 2017; 38: 109-116
        • Dohan Ehrenfest D.M.
        • Rasmusson L.
        • Albrektsson T.
        Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF).
        Trends Biotechnol. 2009; 27: 158-167
        • Ornetti P.
        • Nourissat G.
        • Berenbaum F.
        • Sellam J.
        • Richette P.
        • Chevalier X.
        • under the aegis of the Osteoarthritis Section of the French Society for Rheumatology (Société Française de Rhumatologie, SFR)
        Does platelet-rich plasma have a role in the treatment of osteoarthritis?.
        Joint Bone Spine. 2016; 83: 31-36
        • Luengo G.F.
        • Gatto S.
        • Ferro J.
        • Croxatto J.O.
        • Gallo J.E.
        Preparation of platelet-rich plasma as a tissue adhesive for experimental transplantation in rabbits.
        Thromb J. 2006; 4: 18
        • Kütük N.
        • Baş B.
        • Soylu E.
        • Gönen Z.B.
        • Yilmaz C.
        • Balcioğlu E.
        • Özdamar S.
        • Alkan A.
        Effect of platelet-rich plasma on fibrocartilage, cartilage, and bone repair in temporomandibular joint.
        J Oral Maxillofac Surg. 2014; 72: 277-284
        • Knop E.
        • Eduardo de Paula L.
        • Fuller R.
        Platelet-rich plasma for osteoarthritis treatment.
        Rev Bras Reumatol. 2016; 56: 152-164
        • Gaissmaier C.
        • Koh J.L.
        • Weise K.
        Growth and differentiation factors for cartilage healing and repair.
        Injury. 2008; 39: S88-S96
        • Patel S.
        • Dhillon M.S.
        • Aggarwal S.
        • Marwaha N.
        • Jain A.
        Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial.
        Am J Sports Med. 2013; 41: 356-364
        • Chang K.V.
        • Hung C.Y.
        • Aliwarga F.
        • Wang T.G.
        • Han D.S.
        • Chen W.S.
        Comparative effectiveness of platelet-rich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis.
        Arch Phys Med Rehabil. 2014; 95: 562-575
        • Lippross S.
        • Moeller B.
        • Haas H.
        • Tohidnezhad M.
        • Steubesand N.
        • Wruck C.J.
        • Kurz B.
        • Seekamp A.
        • Pufe T.
        • Varoga D.
        Intraarticular injection of platelet-rich plasma reduces inflammation in a pig model of rheumatoid arthritis of the knee joint.
        Arthritis Rheum. 2011; 63: 33443353
        • Woodall Jr., J.
        • Tucci M.
        • Mishra A.
        • Asfour A.
        • Benghuzzi H.
        Cellular effects of platelet rich plasma interleukin 1 release from PRP treated macrophages.
        Biomed Sci Instrum. 2008; 44: 489-494
        • van Buul G.M.
        • Koevoet W.L.
        • Kops N.
        • Bos P.K.
        • Verhaar J.A.
        • Weinans H.
        • Bernsen M.R.
        • van Osch G.J.
        Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes.
        Am J Sports Med. 2011; 39: 2362-2370
        • Tanaka E.
        • Iwabe T.
        • Dalla-Bona D.A.
        • Kawai N.
        • van Eijden T.
        • Tanaka M.
        • Kitagawa S.
        • Takata T.
        • Tanne K.
        The effect of experimental cartilage damage and impairment and restoration of synovial lubrication on friction in the temporomandibular joint.
        J Orofac Pain. 2005; 19: 331-336
        • Goiato M.C.
        • da Silva E.V.
        • de Medeiros R.A.
        • Túrcio K.H.
        • Dos Santos D.M.
        Are intra-articular injections of hyaluronic acid effective for the treatment of temporomandibular disorders? A systematic review.
        Int J Oral Maxillofac Surg. 2016; 45: 1531-1537