Intra-Articular Injection of Injectable Platelet-Rich Fibrin (i-PRF) for the Management of Internal Derangement of the Temporomandibular Joint: A Case Series.

Internal derangement (ID) of the temporomandibular joint (TMJ) is a common condition that is characterized by an abnormal relationship between the articulating disc and the mandibular condyle, often resulting in pain during jaw movements, joint sounds, and restricted mouth opening. Etiology of ID of TMJ is often multifactorial, involving functional, mechanical and biological factors that disturb the normal relationship between the disc and the condyle. Management strategies range widely from conservative therapy, minimally invasive procedures, to invasive surgical procedures. Arthrocentesis is a procedure that is minimally invasive, involving lavage of the superior joint space of the TMJ using needles to remove inflammatory mediators and release adhesions of the disc to the mandibular fossa. Also, there is an increasing interest in minimally invasive regenerative approaches that can heal the injured disc and attachments of the articular disc. Injectable platelet-rich fibrin (i-PRF), which is an autologous blood product, is rich in growth factors and has shown very promising results in reducing inflammation and promoting tissue repair. i-PRF can easily be produced by centrifuging autologous blood at 700 rpm for a very short time of 3 minutes. This case series evaluates the clinical outcomes of arthrocentesis followed by intra-articular i-PRF injections into the upper joint space in three patients diagnosed with TMJ internal derangement. All three patients presented with pain, limited mouth opening, and joint sounds. MRI investigation was done, and found one patient with an anteriorly displacing disc with reduction during opening and closing the mouth, and two patients with an anteriorly displacing disc without the disc reducing during opening and closing the mouth. Clinical parameters like intensity of pain measured by the visual analogue scale (VAS), joint sounds, maximum mouth opening (MMO), functional limitation and patient satisfaction were assessed preoperatively and during follow-up at one week, one month and three months postoperatively. The results demonstrated a significant reduction in pain scores, with mean VAS decreasing from 5.67 preoperatively to 0 at three months post-treatment. Mean maximum mouth opening improved from 32 mm to 39.3 mm, and joint sounds were eliminated in all cases at three months post-intervention. No complications or adverse effects were observed during and after the procedure. All three patients were satisfied with the treatment outcome. These findings suggest that arthrocentesis, which is followed by intra-articular injection of i-PRF, is a safer and effective treatment option for TMJ internal derangement, providing significant symptomatic relief and functional improvement. Further studies with larger sample sizes, post-intervention MRI scan evaluation after three months and longer follow-up periods were recommended to validate these outcomes.