PRP and temporomandibular joint disorders (TMD): a new treatment perspective?

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How the regenerative power of platelet-rich plasma (PRP) offers new hope for patients with temporomandibular joint disorders.

Temporomandibular disorders (TMD) are a common cause of orofacial pain and dysfunction affecting the temporomandibular joint (TMJ) and surrounding muscles. Those affected often suffer from symptoms such as jaw pain, limited mouth opening, joint noises and sometimes headaches or earaches. Treatment options for TMD range from conservative approaches such as physiotherapy to invasive surgical procedures, but there is still a large group of patients who have persistent symptoms despite these treatments.

In recent years, Platelet-Rich Plasma (PRP) therapy has emerged as a promising, minimally invasive option for the treatment of TMD. But what exactly is PRP, how does it work and what do the latest scientific studies say about its effectiveness?

What is PRP?

PRP is an autologous blood product that is obtained by centrifuging the patient's own blood. The process concentrates the platelets, which are rich in growth factors such as platelet-derived growth factor (PDGF), transforming growth factor (TGF-β) and vascular endothelial growth factor (VEGF). These growth factors promote the healing of soft tissues and joints by stimulating cell proliferation and tissue repair.

The use of PRP has already established itself in many areas of medicine, particularly in orthopaedics, to support the healing of tendons, ligaments and cartilage. Due to its anti-inflammatory and regenerative properties, PRP is now increasingly being investigated in the treatment of TMD.

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How does PRP work with TMD?

The exact mode of action of PRP in the treatment of TMD is not yet fully understood, but studies suggest that the growth factors contained in PRP play a key role in tissue repair in the TMJ. PRP can:

Reduce inflammation: By inhibiting pro-inflammatory cytokines, swelling and pain in the joint is reduced.
Promote cartilage regeneration: PRP supports the repair and regeneration of damaged cartilage tissue, which is commonly affected in patients with TMJ arthritis.
Pain relief: Several studies have shown that patients who receive PRP injections experience significant pain relief and an improvement in jaw function.

Current state of research

Research into the use of PRP for TMD is still relatively new, but there are already promising results from clinical studies. Here is an overview of some of the most important studies:

Randomized controlled trials have shown that PRP injections following arthrocentesis (irrigation of the TMJ) result in significant improvement in mouth opening and pain relief compared to hyaluronic acid or saline solutions (Haddad et al., 2023). Patients reported sustained improvements up to 12 months after treatment.
Comparative studies between PRP and hyaluronic acid (Liu et al., 2023) have shown PRP to be superior in terms of pain relief and joint function. PRP resulted in a greater improvement in maximum mouth opening and a reduction in clicking sounds in the temporomandibular joint.
Systematic reviews (Quijada Gutiérrez et al., 2022) have shown that PRP injections after minimally invasive procedures such as arthroscopy or arthrocentesis can lead to better clinical outcomes, although the difference with control groups (e.g. hyaluronic acid) was small in some cases. However, it should be noted that the study situation is not yet sufficient to determine a standardized protocol application.
Long-term studies of PRP therapy (Mathpati et al., 2024) have shown that pain relief and functional improvement in young adults with mild TMD was significantly better after PRP injections than placebo controls. These results suggest that PRP may be an effective, minimally invasive option for the treatment of TMD.

Advantages of PRP therapy for TMD

PRP treatment has several advantages over other therapies:

Minimally invasive: unlike surgical procedures, PRP does not require extensive surgery and therefore involves fewer risks and a shorter recovery time.
Biological and autologous: As PRP is obtained from the patient's own blood, there is no risk of an allergic reaction or rejection.
Long-term effect: Studies show that the positive effects of PRP injections can last up to a year.

Challenges and unanswered questions

Despite the promising results, there are some challenges that still need to be solved in the application of PRP in TMD:

Standardization: there are currently no uniform protocols for the preparation and application of PRP. Different centrifugation methods and PRP concentrations could influence the efficacy of the treatment.
Long-term studies: Although the studies to date are promising, large-scale, long-term studies are still lacking to better understand the long-term effects and potential complications of PRP therapy.
Cost: PRP treatments are currently still relatively expensive, which could limit accessibility for patients.

Conclusion: PRP as a pioneering treatment for TMD?

Studies to date on the use of PRP in TMD show that this therapy could represent a promising, minimally invasive alternative to conventional treatments. Especially for patients whose symptoms are not sufficiently relieved by conservative measures, PRP could be an effective option to reduce pain and improve joint function.

However, further research is needed to develop standardized protocols and confirm the long-term safety and efficacy of PRP therapy for TMD. However, given the positive results to date, PRP could play a firm role in the treatment of TMJ disorders in the near future.

References

Haddad C, Zoghbi A, El Skaff E, Touma J. Platelet-rich plasma injections for the treatment of temporomandibular joint disorders: A systematic review. J Oral Rehabil. 2023 Nov;50(11):1330-1339. https://pubmed.ncbi.nlm.nih.gov/37341166/
Comparative effectiveness of hyaluronic acid, platelet-rich plasma, and platelet-rich fibrin in treating temporomandibular disorders: a systematic review and network meta-analysis https://head-face-med.biomedcentral.com/articles/10.1186/s13005-023-00369-y
Evaluation of the Effect of Platelet-Rich Plasma on Temporomandibular Joint Disorders: A Split-Match Randomized Clinical Trial https://jrdms.dentaliau.ac.ir/browse.php?a_id=280&slc_lang=en&sid=1&ftxt=1&html=1
Platelet-rich plasma therapy for temporomandibular joint osteoarthritis: A randomized controlled trial https://www.sciencedirect.com/science/article/abs/pii/S1010518223001890
Liu S-S, Xu L-L, Liu L-K, Lu S-J, Cai B. Platelet-rich plasma therapy for temporomandibular joint osteoarthritis: A randomized controlled trial. J Cranio-Maxillofac Surg. 2023 Nov;51(11):668-674. https://pubmed.ncbi.nlm.nih.gov/37852892/.
Quijada Gutiérrez I, Sábado-Bundó H, Gay-Escoda C. Intraarticular injections of platelet rich plasma and plasma rich in growth factors with arthrocenthesis or arthroscopy in the treatment of temporomandibular joint disorders: A systematic review. J Stomatol Oral Maxillofac Surg. 2022 Oct;123(5):e327-e335. https://pubmed.ncbi.nlm.nih.gov/34906730/
Efficacy analysis of splint combined with platelet-rich plasma in the treatment of temporomandibular joint osteoarthritis https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.996668/full

Mathpati SK, Jain G, Mishra V, et al. Platelet-Rich Plasma in the Management of Temporomandibular Joint Pain in Young Adults With Temporomandibular Disorder. Cureus. 2024 Mar;16(3):e55609. https://www.cureus.com/articles/229836-platelet-rich-plasma-in-the-management-of-temporomandibular-joint-pain-in-young-adults-with-temporomandibular-disorder#!/

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