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Effectiveness of hialuronic acid in temporomandibular disorders treatment. A systematic review

Abstract:

Temporomandibular disorders (TMD) embraces a number of clinical problems involving the masticatory muscles, the temporomandibular joint (TMJ) and associated structures. TMD treatment options include hyaluronic acid (HA) injections that have been used with different concentrations, molecular weight and injection protocol, which could vary the efficacy profile in the TMD treatment results. Objective: Discover through a systematic review the best HA application protocol for the treatment of TMD. Method: A search was performed in Pubmed, Medline, Scopus, Cochrane, Dentistry & Oral Science Source, Complementary Index and Academic search complete, The search included terms such as “hyaluronic acid”, “temporomandibular disorders”, and “arthrocentesis with hyaluronic acid” in randomized clinical trials with human subjects from up to ten years ago. Of the 71 articles screened, 22 articles were included in the PRISMA flow-diagram and were assessed with the Jadad scale. Results: Treatment modalities consisted of the following: four studies in HA versus other types of medications such as non-steroidal anti-inflammatory drugs (NSAIDs), betamethasone, tenoxicam or oral glucosamine; two studies in arthrocentesis plus HA versus arthrocentesis with platelet rich plasma (PRP); and one study in plasma rich in growth factor (PRFC); four studies in arthrocentesis plus HA versus arthrocentesis with saline or ringer’s lactate solution; three studies in arthrocentesis plus HA versus arthrocentesis alone; six studies in cyclic applications of HA; and two studies in cycles of HA injections versus occlusal splint therapy. The follow-up period for most studies was up to 12 months. Conclusion: The protocols based on cyclic applications of injections of HA, demonstrated better results in the relief of long-term symptoms of TMD.