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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
18
1. A high-frequency linear ultrasound probe will be used to identify the TMJ space. 2. A sterile syringe containing 1 mL of PRF will be inserted into the superior joint space under real-time ultrasound guidance. 3. PRF will be injected slowly with continuous confirmation of needle position.
1. TMJ arthroscopy will be performed under local or general anesthesia following standard aseptic preparation. 2. The superior joint space will be visualized using a 1.9 mm arthroscope. 3. A sterile syringe containing 1 mL of PRF will be introduced through a lateral portal under direct arthroscopic visualization. 4. PRF will be injected slowly into the superior joint space.
Maximum mouth opening
Maximum interincisal distance measured using digital caliper in millimeters (mm) between upper and lower central incisors, Unit of measure: millimeters (mm). Minimum value: 0 mm. Maximum value: 60 mm. Higher values represent a better outcome.
Time frame: 6 months
Pain intensity
Pain intensity assessed using 100 mm Visual Analog Scale (VAS). 0 = no pain; 10 = worst pain imaginable. Unit of measure: points (0-10). Minimum value: 0. Maximum value: 10. Higher scores represent a worse outcome.
Time frame: 6 months
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