Cömert Kiliç Songül, Babayev Umid, Kiliç Nihat
Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Atatürk University, Erzurum, Turkey.
Specialist, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Atatürk University, Erzurum, Turkey.
J Oral Maxillofac Surg. 2025 Sep;83(9):1068-1077. doi: 10.1016/j.joms.2025.05.009. Epub 2025 May 26.
Temporomandibular joint osteoarthritis (TMJ-OA) results in pain, limited function, and reduced quality of life. Medical ozone (MO) has been used to reduce TMJ pain and improve maximum incisal opening (MIO). However, it remains unclear whether intra-articular (IA) hyaluronic acid (HA), corticosteroid (CS), or platelet-rich plasma (PRP) injection following IA MO injection alone is superior to IA MO injection alone.
The purpose of this study was to measure and compare pain reduction and improved MIO in subjects with TMJ-OA who underwent IA injections with MO, MO + HA, MO + CS, and MO + PRP.
The researchers implemented a randomized clinical trial in adult patients with TMJ-OA, Wilkes IV and V, referred to the author's clinic from January 2022 through December 2024.
The predictor variables were the agents for IA injection. Subjects were randomized to one of 4 injection groups: MO, MO + HA, MO + CS, or MO + PRP.
The outcome variables were changes in the pain measured using the visual analog scale and range of motion (MIO) from baseline (T0) to 6 months (T2) postoperatively.
Covariates were age and sex.
The data were analyzed using repeated-measure analysis of variance and the Tukey-HSD test with significance set at P < .05.
The final study sample included 49 patients (mean age, 32.25 ± 13.17 years), with higher female prevalence: 11 (84.6%) in the MO group, 12 (100%) in the MO + HA group, and 11 (91.7%) in the MO + CS and the MO + PRP groups (P = .6). Pain reduced (p˂0.001), and MIO improved (p˂0.01) significantly in all groups. However, after estimating differences between 6 months and baseline outcomes, mean changes in the primary outcome variables showed no statistically significant differences among the 4 groups (pain, P = .6; MIO, P = .2).
Within the limitations of this study, combining treatments of HA, CS, or PRP with MO was not statistically significantly associated with therapeutic effects in reducing pain or improving jaw function in patients with TMJ-OA.
颞下颌关节骨关节炎（TMJ - OA）会导致疼痛、功能受限和生活质量下降。医用臭氧（MO）已被用于减轻颞下颌关节疼痛并改善最大切牙开口度（MIO）。然而，单独关节内（IA）注射MO后，关节内注射透明质酸（HA）、皮质类固醇（CS）或富血小板血浆（PRP）是否优于单独IA注射MO仍不清楚。
本研究的目的是测量和比较接受IA注射MO、MO + HA、MO + CS和MO + PRP的TMJ - OA患者的疼痛减轻情况和改善的MIO。
研究人员对2022年1月至2024年12月转诊至作者诊所的Wilkes IV和V级成年TMJ - OA患者进行了一项随机临床试验。
预测变量是IA注射的药物。受试者被随机分为4个注射组之一：MO、MO + HA、MO + CS或MO + PRP。
结局变量是从基线（T0）到术后6个月（T2）使用视觉模拟量表测量的疼痛变化和运动范围（MIO）。
协变量是年龄和性别。
使用重复测量方差分析和Tukey - HSD检验对数据进行分析，显著性设定为P <.05。
最终研究样本包括49名患者（平均年龄，32.25±13.17岁），女性患病率较高：MO组11名（84.6%），MO + HA组12名（100%），MO + CS组和MO + PRP组各11名（91.7%）（P =.6）。所有组的疼痛均显著减轻（p˂0.001），MIO均显著改善（p˂0.01）。然而，在估计6个月与基线结局之间的差异后，主要结局变量的平均变化在4组之间无统计学显著差异（疼痛，P =.6；MIO，P =.2）。
在本研究的局限性内，将HA、CS或PRP与MO联合治疗在减轻TMJ - OA患者疼痛或改善颌功能方面与治疗效果无统计学显著关联。
