Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20190032
Brazilian Journal of Pain
Review Article

Effects of the hyaluronic acid infiltration in the treatment of internal temporomandibular joint disorders

Efeitos da infiltração de ácido hialurônico no tratamento das desordens internas da articulação temporomandibular

Liliane Emilia Alexandre de Oliveira; Jandenilson Alves Brígido; Aline Dantas Diógenes Saldanha

Downloads: 1
Views: 253

Abstract

BACKGROUND AND OBJECTIVES: The primary protocol for the control of temporomandibular disorders prioritizes reversible and less invasive measures. However, conservative treatment is sometimes ineffective. Therefore, the use of hyaluronic acid has been suggested as a therapeutic alternative to verify the effectiveness of the hyaluronic acid in patients who are not responsive to the most conservative treatments, helping them in the control of pain. This article aims to perform a literature review on the efficacy of this substance in the treatment of internal changes of the temporomandibular joint.

CONTENTS: The search strategy used the Pubmed portal and the Web of Science database for the last 10 years. We included articles in English that evaluated the efficacy of the hyaluronic acid in the intra-articular disorders of temporomandibular joint, and excluded articles from literature review, clinical case reports, theses, and dissertations. Fifteen studies, classified as randomized clinical trials, prospective and retrospective studies, case-control, pilot study, and systematic reviews were selected. The hyaluronic acid is of fundamental importance in the function and lubrication of joint tissues due to its high molecular weight. When degenerative and inflammatory changes are present, their concentration and molecular weight are diminished, and the injection of this acid raises these levels, which can generate pain relief.

CONCLUSION: Intra-articular therapy with hyaluronic acid is effective in the reduction of symptomatologic levels and the functional restoration of the temporomandibular joint.

Keywords

Hyaluronic acid, Intra-articular injections, Viscossupplementation, Temporomandibular joint disorder

Resumo

JUSTIFICATIVA E OBJETIVOS: O protocolo primário de controle das disfunções temporomandibulares prioriza as medidas reversíveis e menos invasivas. Entretanto, o tratamento conservador mostra-se, algumas vezes, ineficaz, e como alternativa terapêutica, tem sido sugerido o uso de ácido hialurônico para com isso, verificar a sua efetividade em pacientes não responsivos aos tratamentos mais conservadores e poder ajudá-los no controle da dor. O objetivo deste estudo foi rever na literatura a eficácia dessa substância no tratamento das alterações internas da articulação temporomandibular.

CONTEÚDO: A estratégia de busca utilizou o portal eletrônico Pubmed e a base de dados Web of Science, nos últimos 10 anos. Foram incluídos artigos em inglês que avaliaram a eficácia do ácido hialurônico nas desordens intra-articulares da articulação temporomandibular, e excluídos artigos de revisão de literatura, relatos de casos clínicos, teses e dissertações. Foram selecionados 15 estudos, classificados como ensaios clínicos randomizados, estudos prospectivos e retrospectivos, caso-controle, estudo piloto e revisões sistemáticas. O ácido hialurônico tem importância fundamental na função e lubrificação dos tecidos articulares, devido ao seu alto peso molecular. Quando alterações degenerativas e inflamatórias estão presentes, sua concentração e peso molecular estão diminuídos, e a injeção desse ácido eleva esses níveis, o que pode gerar alívio da dor.

CONCLUSÃO: A terapia intra-articular com ácido hialurônico é efetiva na diminuição dos níveis sintomatológicos e no restabelecimento funcional da articulação temporomandibular.

Palavras-chave

Ácido hialurônico, Injeções intra-articulares, Viscossuplementação, Transtornos da articulação temporomandibular

References

Okeson JP, de Leeuw R. Differential diagnosis of temporomandibular disorders and other orofacial pain disorders. Dent Clin North Am. 2011;55(1):105-20.

Guarda-Nardini L, Ferronato G, Manfredini D. Two-needle vs. single-needle technique for TMJ arthrocentesis plus hyaluronic acid injections: a comparative trial over a six-month follow up. Int J Oral Maxillofac Surg. 2012;41(4):506-13.

Guarda-Nardini L, Ferronato G, Favero L, Manfredini D. Predictive factors of hyaluronic acid injections short-term effectiveness for TMJ degenerative joint disease. J Oral Rehabil. 2011;38(5):315-20.

Escoda-Francolí J, Vázquez-Delgado E, Gay-Escoda C. Scientific evidence on the usefulness of intraarticular hyaluronic acid injection in the management of temporomandibular dysfunction. Med Oral Patol Oral Cir Bucal. 2010;15(4):e644-8.

Long X, Chen G, Cheng AH, Cheng Y, Deng M, Cai H. A randomized controlled trial of superior and inferior temporomandibular joint space injection with hyaluronic acid in treatment of anterior disc displacement without reduction. J Oral Maxillofac Surg. 2009;67(2):357-61.

Tang XL, Zhu GQ, Hu L, Zheng M, Zhang JY, Shi ZD. Effects of intra-articular administration of sodium hyaluronate on plasminogen activator system in temporomandibular joints with osteoarthritis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(4):541-7.

Manfredini D, Bonnini S, Arboretti R, Guarda-Nardini L. Temporomandibular joint osteoarthritis: an open label trial of 76 patients treated with arthrocentesis plus hyaluronic acid injections. Int J Oral Maxillofac Surg. 2009;38(8):827-34.

Pavelka K, Uebelhart D. Efficacy evaluation of highly purified intra-articular hyaluronic acid (Sinovial(®)) vs hylan GF-20 (Synvisc(®)) in the treatment of symptomatic knee osteoarthritis. A double-blind, controlled, randomized, parallel-group non-inferiority study. Osteoarthritis Cartilage. 2011;19(11):1294-300.

Korkmaz YT, Altintas NY, Korkmaz FM, Candirli C, Coskun U. Is hyaluronic acid injection effective for the treatment of temporomandibular joint disc displacement with reduction?. J Oral Maxillofac Surg. 2016;74(9):1728-40.

Guarda-Nardini L, Cadorin C, Frizziero A, Ferronato G, Manfredini D. Comparison of 2 hyaluronic acid drugs for the treatment of temporomandibular joint osteoarthritis. J Oral Maxillofac Surg. 2012;70(11):2522-30.

Li C, Long X, Deng M, Li J, Cai H, Meng Q. Osteoarthritic changes after superior and inferior joint space injection of hyaluronic acid for the treatment of temporomandibular joint osteoarthritis with anterior disc displacement without reduction: a cone-beam computed tomographic evaluation. J Oral Maxillofac Surg. 2015;73(2):232-44.

Bonotto D, Machado E, Cunali RS, Cunali PA. Viscosupplementation as a treatment of internal derangements of the temporomandibular joint: retrospective study. Rev Dor. 2014;15(1):2-5.

Goiato MC, da Silva EV, de Medeiros RA, Túrcio KH, Dos Santos DM. Are intra-articular injections of hyaluronic acid effective for the treatment of temporomandibular disorders? A systematic review. Int J Oral Maxillofac. Surg. 2016;45(12):1531-7.

Iturriaga V, Bornhardt T, Manterola P, Brebi P. Effect of hyaluronic acid on the regulation of inflammatory mediators in osteoarthritis of the temporomandibular joint: a systematic review. Int J Oral Maxillofac Surg. 2017;46(5):590-5.

Guarda-Nardini L, Manfredini D, Ferronato G. Short-term effects of arthrocentesis plus viscosupplementation in the management of signs and symptoms of painful TMJ disc displacement with reduction. A pilot study. Oral Maxillofac Surg. 2010;14(1):29-34.

Aktas S, Yalcin SS, Sencer S. Prognostic indicators of the outcome of arthrocentesis with and without sodium hyaluronate injection for the treatment of disc displacement without reduction: a magnetic resonance imaging study. Int J Oral Maxillofac Surg. 2010;39(11):1080-5.

Guarda-Nardini L, Rossi A, Ramonda R, Punzi L, Ferronato G, Manfredini D. Effectiveness of treatment with viscosupplementation in temporomandibular joints with or without effusion. Int J Oral Maxillofac Surg. 2014;43(10):1218-23.

Guarda-Nardini L, Cadorin C, Frizziero A, Masiero S, Manfredini D. Interrelationship between temporomandibular joint osteoarthritis (OA) and cervical spine pain: effects of intra-articular injection with hyaluronic acid. Cranio. 2017;35(5):276-82.

Guarda-Nardini L, Manfredini D, Stifano M, Staffieri A, Marioni G. Intra-articular injection of hyaluronic acid for temporomandibular joint osteoarthritis in elderly patients. Stomatologija. 2009;11(2):60-5.

Guarda-Nardini L, Rossi A, Arboretti R, Bonnini S, Stellini E, Manfredini D. Single- or multiple-session viscosupplementation protocols for temporomandibular joint degenerative disorders: a randomized clinical trial. J Oral Rehabil. 2015;42(7):521-8.

Manfredini D, Piccotti F, Guarda-Nardini L. Hyaluronic acid in the treatment of TMJ disorders: a systematic review of the literature. Cranio. 2010;28(3):166-76.

Manfredini D, Favero L, Gregorini G, Cocilovo F, Guarda-Nardini L. Natural course of temporomandibular disorders with low pain-related impairment: a 2-to-3-year follow up study. J Oral Rehabil. 2013;40(6):436-42.


Submitted date:
08/07/2018

Accepted date:
12/14/2018

5f21d8600e8825d42ae56d7d brjp Articles

BrJP

Share this page
Page Sections