To compare the clinical effectiveness of ultrasound-guided versus arthroscopic guided platelet rich fibrin injection in the management of anterior disc displacement with reduction of the temporomandibular joint, in terms of pain reduction, improvement of mandibular function, and patient-reported outcomes.

Internal derangements of the temporomandibular joint, particularly disc displacement with reduction, represent a significant proportion of temporomandibular disorders. Conventional conservative treatments may not always achieve satisfactory symptom resolution, leading to increased interest in minimally invasive interventions. PRF has gained attention for its ability to promote tissue regeneration, reduce inflammation, and enhance healing through the sustained release of growth factors. Image-guided injection techniques are essential for ensuring accurate delivery of PRF into the targeted joint structures. Arthroscopic-guided injection allows direct visualization of intra-articular anatomy but is invasive, technically demanding, and associated with higher cost and procedural complexity. In contrast, ultrasound-guided injection is a non-invasive, radiation-free, and cost- effective technique that enables real-time visualization of soft tissues and needle placement. Despite these advantages, the comparative clinical efficacy of ultrasound-guided versus arthroscopic-guided PRF injection remains inadequately explored, particularly in patients with TMJ disc displacement with reduction.

Inclusion Criteria:

• Patients aged 18-60 years.
• Clinically and radiographically diagnosed temporomandibular joint disc displacemet with reduction.
• Presence of TMJ pain exacerbated by mandibular movement.
• Limited mandibular function and/or reduced maximum mouth opening.
• Symptoms persisting for at least 3 months.
• Failure of conservative treatment (e.g. occlusal splint, physiotherapy, NSAIDs). -Ability to understand the study protocol and provide informed consent.

Exclusion Criteria:

• Previous TMJ surgery or arthroscopic intervention.
• Intra-articular injection in the TMJ within the last 6 months.
• Systemic inflammatory or autoimmune joint diseases.
• Coagulation disorders or current anticoagulant therapy.
• Active local infection at the injection site.
• Pregnancy or lactation.
• Severe degenerative joint disease (advanced osteoarthritis).
• Known allergy or contraindication to ( PRF) preparation.

No IPD sharing plan at this time due to data sensitivity, ongoing sponsor review, and lack of established infrastructure.