Sillmann Y M, Monteiro J L G C, Haugstad M, Burris B, Keith D A, Handa S, Guastaldi F P S
Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard School of Dental Medicine, Boston, MA, USA.
Wellman Center for Photomedicine, Harvard Medical School, Boston, MA, USA.
Int J Oral Maxillofac Surg. 2025 Jul;54(7):624-638. doi: 10.1016/j.ijom.2025.01.008. Epub 2025 Jan 30.
Temporomandibular joint (TMJ) osteoarthritis (OA) leads to pain, limited jaw function, and bite changes. When non-invasive treatments fail, minimally invasive procedures like TMJ arthrocentesis with saline and hyaluronic acid (HA) injections are commonly used. Orthobiologics, including platelet-rich plasma (PRP) and cell-derived products, have gained attention for their potential to enhance tissue healing. This review aimed to compare the outcomes of orthobiologic injections with HA injections following arthrocentesis in TMJ-OA treatment. A systematic search, following PRISMA guidelines, identified nine studies (403 patients). Risk of bias was assessed using the Cochrane Risk of Bias Tool. PRP and cell-derived products showed potential benefits in reducing TMJ pain and improving maximum mouth opening (MMO). However, three of four studies comparing PRP with HA found no significant difference between the two. In contrast, cell-derived orthobiologics demonstrated significantly greater improvements in TMJ pain and MMO compared to HA. Risk of bias varied, with some studies showing moderate to high levels. This review highlights the potential but inconsistent benefits of orthobiologics in treating TMJ-OA. While cell-derived orthobiologics appear promising, PRP did not demonstrate superiority over HA. Further high-quality studies are needed to validate these findings.
颞下颌关节（TMJ）骨关节炎（OA）会导致疼痛、下颌功能受限和咬合改变。当非侵入性治疗失败时，常用的微创程序如用生理盐水和透明质酸（HA）注射进行TMJ关节穿刺术。包括富血小板血浆（PRP）和细胞衍生产品在内的骨科生物制剂因其增强组织愈合的潜力而受到关注。本综述旨在比较在TMJ-OA治疗中关节穿刺术后骨科生物制剂注射与HA注射的效果。按照PRISMA指南进行系统检索，确定了9项研究（403例患者）。使用Cochrane偏倚风险工具评估偏倚风险。PRP和细胞衍生产品在减轻TMJ疼痛和改善最大开口度（MMO）方面显示出潜在益处。然而，四项比较PRP与HA的研究中有三项发现两者之间无显著差异。相比之下，与HA相比，细胞衍生的骨科生物制剂在TMJ疼痛和MMO方面有显著更大的改善。偏倚风险各不相同，一些研究显示为中度至高度。本综述强调了骨科生物制剂在治疗TMJ-OA方面的潜在但不一致的益处。虽然细胞衍生的骨科生物制剂似乎很有前景，但PRP并未显示出优于HA的效果。需要进一步的高质量研究来验证这些发现。
