Intra-articular injection of orthobiologics for temporomandibular joint osteoarthritis: a systematic review of randomized controlled trials.

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.