Estudio comparativo entre tratamiento con infiltraciones intraarticulares de betametasona, hialuronato de sodio y plasma rico en plaquetas en pacientes con artralgia de la articulación temporomandibular

Abstract

[EN] Temporomandibular disorders (TMD) or Craniomandibular dysfunction are collective terms that cover a wide spectrum of clinical problems of the tempormandibular joint and the masticatory muscles in the orofacial area. These dysfunctions are mainly characterized by pain, sounds in the joint and limited and irregular function of the jaw. TMD are considered a subgroup apart from musculoskeletal and rheumatic disorders, and represent a major cause of orofacial pain of non-dental origin. (1-3). Temporomandibular disorders are highly prevalent in the general population. According to several studies, and based on the populations studied, the rates and criteria used for the diagnosis, the prevalence of TMD varies from 16 to 45 per cent of the population. (4,5) It is widely accepted that temporomandibular disorders are a group of highly prevalent, often poorly or late diagnosed pathologies which mainly affect adults, young people and women. The temporomandibular joint (TMJ) is the joint that connects the mandible through its condyle to the temporal bone of the skull. It is in an anterior position of the ear bilaterally and is highly significant, because it is responsible for the movements of the mouth and, therefore, chewing, phonation and facial expression. It is a joint with very special characteristics, but obviously has a similar behavior to that of other joints in our body. The etiology of temporomandibular disorders is complex and multifactorial. Biomechanical, neuromuscular, biopsychosocial and biological factors may be present. On the other hand, under different circumstances, there are individual factors that interfere with an individual's risk of developing or not developing dysfunction. Data from the National Health Interview Survey show that 5% of the US population reported orofacial pain in the last 3 months. Other studies have shown that Temporomandibular disorders are essentially a condition affecting young and middle-aged people, to the detriment of children and the elderly, and is approximately twice more common among women than in men. (6) According to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), the TMD can be divided into three large groups: the muscular group, disc displacements and osteoarthritis/osteoarthritis.

The success of any treatment requires a correct diagnosis and all treatment plans must take into account the patient's individual needs and expectations for correct outcomes. A transversal therapeutic attitude to almost all types of TMD is cognitive-behavioral therapy and muscle relaxation measures. (7-10) There is still a great variety of treatments that we must choose depending on each case and patient. The most important are: cognitive behavioral therapy, physical therapy, dry needling, occlusal adjustments, surgery, bite splints, pharmacotherapy, and intraarticular injections that were the object of this study. The products administered were Betamethasone, sodium hyaluronate and platelet-rich plasma. Intraarticular drug injections are a common therapy, mainly in orthopedic and/or rheumatological disorders associated with pain, and cartilaginous, bone and joint capsule inflammation, as well as fibrous adhesions. Intraarticular infiltrations with corticosteroids have been used with very good results for the treatment of different temporomandibular joint pathologies (11-15), despite the presence of some adverse effects such as the progression of a pre-existing joint injury (13). Sodium hyaluronate, a high molecular weight polysaccharide, which is a sodium salt of hyaluronic acid, a physiological component of the synovial fluid, responsible for joint lubrication, has also been used in the temporomandibular joint, either to promote increased viscosupplementation or as anti-inflammatory, and the results have been very promising (12,13,16-20). Platelet-rich plasma is a therapeutic agent composed of a platelet concentrate and associated growth factors, taken and centrifuged from a patient's own blood sample. It was initially introduced in the field of Dentistry/Oral and Maxillofacial Surgery/ Plastic and Reconstructive Surgery in the 90's, and their clinical use is due to its wound healing properties potentially by the recruitment, proliferation, and differentiation of cells and, therefore, tissue remodeling. (21-23)