Hypertonic Dextrose or Concentrated Growth Factors Reduce Pain and Inflammation in Temporomandibular Disc Displacement
Background
Irreducible temporomandibular disc displacement (DDwoR) is a critical subtype of internal derangement of the temporomandibular joint (TMJ-ID), often leading to significant pain and functional impairment. Current standard-of-care approaches may fall short in addressing the underlying pathogenesis and long-term resolution. Regenerative injection therapies, such as prolotherapy, are emerging as promising alternatives for TMJ-ID by aiming to stimulate tissue repair. This study investigates the impact of hypertonic dextrose (HD) and concentrated growth factors (CGF) on pain, jaw function, and the inflammatory biomarker myeloperoxidase (MPO) in the synovial fluid.
Study Design
This double-blinded parallel randomized clinical trial enrolled 24 patients suffering from DDwoR, randomly assigning them to two equal groups. Group I received hypertonic dextrose (HD) injections, while Group II received concentrated growth factors (CGF) injections, both in conjunction with a stabilization occlusal appliance (SA). Injections were administered in the superior joint space. Patients were assessed before treatment, 1 week, 4 weeks, and 24 weeks post-treatment using the Visual Analogue Scale of Pain (VAS) and assisted maximum mouth opening (MMO). Synovial fluid (SF) samples were collected before and 6 months after treatment for Myeloperoxidase enzyme (MPO) level analysis.
Results
Both treatment groups demonstrated significant pain relief, observed at 1 month and sustained up to 6 months post-operatively (p < 0.001). Assisted MMO also significantly increased in both groups (p < 0.001). Crucially, synovial fluid MPO enzyme levels were significantly reduced in both groups by 6 months following the intra-articular injection (p = 0.002). Although pre-injection MPO concentrations were significantly higher than post-injection levels, no statistically significant difference was found between the HD and CGF groups regarding MPO reduction. This indicates comparable anti-inflammatory effects.
Both hypertonic dextrose and concentrated growth factors injections significantly reduced pain and improved jaw function, alongside a significant decrease in the inflammatory biomarker myeloperoxidase in the synovial fluid.
Key Findings
- Both HD and CGF injections significantly relieved pain in DDwoR patients (p < 0.001).
- Assisted maximum mouth opening (MMO) significantly increased in both treatment groups (p < 0.001).
- Synovial fluid myeloperoxidase (MPO) levels significantly decreased by 6 months post-injection in both groups (p = 0.002).
- No statistically significant difference in MPO reduction was observed between HD and CGF groups.
Why It Matters
This study provides compelling evidence that both hypertonic dextrose and concentrated growth factors are valuable treatment options for DDwoR, offering significant pain relief and improved jaw function. For clinicians and patients struggling with TMJ-ID, this expands the regenerative medicine toolkit beyond traditional interventions. The reduction in MPO levels suggests a direct anti-inflammatory effect within the joint, not just symptomatic relief. While a usable protocol for these injections is already established, this data supports their efficacy and mechanism. Consider these regenerative injections for refractory TMJ disc displacement, as they offer a positive impact on both symptoms and underlying inflammation.
temporomandibular-joint
tmj-disorder
regenerative-medicine
hypertonic-dextrose
concentrated-growth-factors
inflammation