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Titolo
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
Autor(es)
Director(es)
Soggetto
Tesis y disertaciones académicas
Universidad de Salamanca (España)
Academic dissertations
Articulación temporomandibular
Enfermedades
Hialuronato de sodio
Plasma rico en plaquetas
Clasificación UNESCO
3213.04 Cirugía de Huesos
Fecha de publicación
2020
Resumen
[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)
URI
DOI
10.14201/gredos.145224
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