Hyaluronic Acid and I-PRF Mixture for TMJ Disc Displacement Management

Evaluation of Hyaluronic Acid and I-PRF Mixture for Intra-articular Injection Following Arthrocentesis in The Management of TMJ Reducible Disc Displacement: A Four Arm Comparative Trial

The aim of this study is to evaluate the efficacy of hyaluronic acid and I-PRF mixture for intra-articular injection following arthrocentesis in the management of TMJ reducible disc displacement.

The purpose of this four-arm comparative clinical trial is to evaluate the efficacy of a combined intra-articular injection of Hyaluronic Acid (HA) and Injectable Platelet-Rich Fibrin (i-PRF) following arthrocentesi in patients suffering from temporomandibular joint (TMJ) reducible disc displacement.

All eligible participants will undergo standard TMJ arthrocentesis using Ringer's lactate solution to flush out inflammatory mediators and disrupt intra-articular adhesions.

Patients will be randomly assigned to one of four treatment protocols to compare therapeutic outcomes:

Group I: Arthrocentesis alone (Control). Group II: Arthrocentesis followed by intra-articular injection of Hyaluronic Acid only.

Group III: Arthrocentesis followed by intra-articular injection of a Hyaluronic Acid and Betamethasone mixture.

Group IV: Arthrocentesis followed by intra-articular injection of a Hyaluronic Acid and I-PRF mixture (Experimental).

Clinical outcomes include changes in maximum pain-free mouth opening, lateral/protrusive jaw movements, subjective pain intensity scores and presence or absence of clicking Clinical outcomes will be monitored and evaluated over a 6-month post-operative follow-up period to assess which intervention provides the most effective relief and functional restoration.

Inclusion Criteria:

1. Age: 18 - 45 years.
2. Patients with disc displacement with reduction in any of the TMJs.
3. arthralgia.
4. Limited unassisted mouth opening.
5. Co-operative patients.

Exclusion Criteria:

1. Patients with previous history of TMJ minimally invasive interventions.
2. Patients with autoimmune or connective tissue diseases affecting the joints.
3. Patients with neurological disorders.
4. Patients with a history of condylar fractures or ankylosis.
5. Patients with psychological problems.
6. Patients receiving non-steroidal anti-inflammatory drugs within 48 hours preoperatively, or systemic use of corticosteroids within 2 weeks.
7. Patients on anticoagulants, suffering from platelet function disorders or fibrinogen deficiency.
8. Patients with moderate to severe myogenic pain.