Objective To compare effects of intra-articular injection of corticosteroid or viscoelastic agent alone or a combination of the two drugs for treatment of temporomandibular joint disorders. Methods A prospective quasirandomized controlled trial was conducted to compare 3 treatment protocols of intra-articular injections in the upper compartment of the joint immediately following arthrocentesis repeatedly every 10 days: ① triamcinolone 8 mg alone for 3 times, ② 1% hyaluronate 1 ml alone for 4 times, and ③ triamcinolone 8 mg for 2 times then 1% hyaluronate 1 ml for 2 times. Clinical examinations were done at baseline, 1, 12, and 24 months after end of the treatments. According to improvement of the symptoms and clinical signs, the effectiveness was graded in 3 classes: excellent, better, no change, or worse. The first two were classified as effective. Effective rates of the treatments and subgroups were compared statistically. Results Five hundred and sixty four patients with temporomandibular disorders were included and randomly allocated to 3 groups with 188 patients in each group. The rate of lost follow up at 24 months was 6.9% to 10.1%. At one month after treatment, the triamcinolone group had a better effective rate at 92.0%. At 12 and 24 months of follow up, effective rates of the hyaluronate group were better than those in the triamcinolone alone group (84.6% vs. 54.1% and 83.4% vs. 40.4%). Effective rates of combining triamcinolone and hyaluronate group at 12 and 24 months were 90.4% and 66.3% respectively. Conclusion Intra-articular injection of corticosteroid has better results in a short term and hyaluronate has better results in a long term in the treatment of temporomandibular joint disorders.
Objective To assess the effectiveness of intraarticular injection of hyaluronate (HA) on temporomandibular disorders (TMD). Methods Searching various databases available, handsearching 15 Chinese dental journals to find articles, abstracts and unpublished literature with randomized or quasi-randomized design on the effects of intraarticular injection of HA on TMD.Data extraction, appraisal, and the methods for Meta-analysis were conducted based on the Cochrane guidelines. Results 12 RCTs and 2 CCT on TMD and 1 RCT on rheumatoid arthritis involving temporomandibular joints (TMJ) were located, 10 of them fulfilled inclusion criteria in which 561 patients were reported.Except 71 cases with only qualitative data, 490 cases could be calculated in Meta-analysis: 277 on HA, 113 on placebo or non-treatment (PL) and 100 on corticosteroids (CO). In comparison with PL, HA injection showed no statistically significant effect on short and long term improvement of symptoms, and short term improvement of VAS as well. But it presented significant better effects than PL in short and long term improvement of clinical signs, especially mouth opening. When sensitivity analysis was conducted for improvement of short term signs, the conclusion was not stable. Comparison of the effect between HA and CO showed the same efficacy levels. Adverse reactions of HA were mild and transient. Conclusions HA may improve short and long term clinical signs of TMD and have only mild and transient adverse reactions. However, more RCTs are needed to confirm its therapeutic effect.