Injectable Platelet Rich Fibrin (i-PRF) for Joint Sounds and Clinical Signs of Disc Displacement by DC/TMD: A Randomized Controlled Trial
DOI:
https://doi.org/10.58600/eurjther2853Keywords:
joint sounds, intra-articular injections, disc displacement, platelet rich fibrin, randomized controlled trial, temporomandibular joint, temporomandibular joint disordersAbstract
Objective: To evaluate the efficacy of injectable platelet-rich fibrin (i-PRF) versus a control solution (lactated Ringer’s) in modulating joint sounds and resolving clinical signs of disc displacement in patients with articular temporomandibular disorder (TMD).
Methods: This prospective, randomized, double blind controlled clinical trial enrolled 36 patients with articular TMD. Participants were allocated to two groups: the i-PRF Group (n = 18), which received three monthly intra-articular injections of i-PRF, and the Control Group (n = 18), which received lactated Ringer’s solution. The primary outcome was joint sound intensity measured on a visual analogue scale (VAS). Secondary outcomes were clinical diagnoses of disc displacement with and without reduction (DDWR/DDWoR) based on DC/TMD criteria, evaluated at baseline (T0) and six months post-intervention (T3).
Results: The i-PRF group showed a significantly greater reduction in joint sound intensity than the control group (mean reduction: 83.2% vs. 38.7%; p < 0.001). I-PRF also produced a significant resolution of DDWR (66.7% to 16.7%; p = 0.008) and DDWoR (33.3% to 5.6%; p = 0.041). At T3, the proportion of patients with clinical signs of disc displacement was significantly lower in the i-PRF group (p < 0.05 for both DDWR and DDWoR).
Conclusion: Intra-articular i-PRF therapy was superior to lactated Ringer’s in reducing joint sounds and resolving clinical signs of disc displacement in patients with articular TMD. I-PRF represents a safe, biologically active intervention for mechanical dysfunction of the temporomandibular joint.
References
[1] Kapos FP, Exposto FG, Oyarzo JF, Durham J (2020) Temporomandibular disorders: a review of current concepts in aetiology, diagnosis and management. Oral Surg. 13:321-334. https://doi.org/10.1111/ors.12473
[2] De Leeuw R, Klasser GD (2018) Orofacial pain: Guidelines for assessment, diagnosis, and management. 6th ed. Quintessence Publishing.
[3] Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE, Dubner R, Maixner W, Diatchenko L (2016) Painful temporomandibular disorder: Decade of discovery from OPPERA studies. J Dent Res. 95(10):1084-1092. https://doi.org/10.1177/0022034516653743
[4] Tanaka E, Detamore MS, Mercuri LG (2008) Degenerative disorders of the temporomandibular joint: etiology, diagnosis, and treatment. J Dent Res. 87(4):296-307. https://doi.org/10.1177/154405910808700406
[5] Wright EF, North SL (2009) Management and treatment of temporomandibular disorders: a clinical perspective. J Man Manip Ther. 17(4):247-54. https://doi.org/10.1179/106698109791352184
[6] Kacker T, Pouya S, Arman S (2025) Effects of intra-articular corticosteroid injection on the temporomandibular joint: a narrative review. J Oral Maxillofac Anesth. 4. Available from: https://joma.amegroups.org/article/view/7303
[7] Metello Neves LB, Lima BC, de Mello RC, Baldessarini BL, Peres RV (2025) Intra-articular therapies for synovial joint dysfunction: a comprehensive integrative review. Oral Surg Oral Med Oral Pathol Oral Radiol. https://doi.org/10.1016/j.oooo.2025.10.026
[8] Miron RJ, Fujioka-Kobayashi M, Hernandez M, Kandalam U, Zhang Y, Ghanaati S, Choukroun J (2017) Injectable platelet rich fibrin (i-PRF): opportunities in regenerative dentistry? Clin Oral Investig. 21(8):2619-2627. https://doi.org/10.1007/s00784-017-2063-9
[9] Mourão CFAB, Valiense H, Melo ER, Mourão NBMF, Maia MDC (2015) Obtention of injectable platelets rich-fibrin (i-PRF) and its polymerization with bone graft: technical note. Rev Col Bras Cir. 42(6):421-423. https://doi.org/10.1590/0100-69912015006013
[10] Gupta S, Paliczak A, Delgado D (2021) Evidence-based indications of platelet-rich plasma therapy. Expert Rev Hematol. 14(1):97-108. https://doi.org/10.1080/17474086.2021.1860002
[11] Kumar V, Haidry N, Salahudheen A, Shivhare P, Mokhtar EA, Basannavar A (2025) Evaluation of injectable platelet-rich fibrin (I-PRF) as a treatment in internal derangement of temporomandibular joint. Natl J Maxillofac Surg. 16(1):63-70. https://doi.org/10.4103/njms.njms_209_23
[12] Işık G, Kenç S, Özveri Koyuncu B, Günbay S, Günbay T (2022) Injectable platelet-rich fibrin as treatment for temporomandibular joint osteoarthritis: A randomized controlled clinical trial. J Craniomaxillofac Surg. 50(7):576-582. https://doi.org/10.1016/j.jcms.2022.06.006
[13] Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P, Gonzalez Y, Lobbezoo F, Michelotti A, Brooks SL, Ceusters W, Drangsholt M, Ettlin D, Gaul C, Goldberg LJ, Haythornthwaite JA, Hollender L, Jensen R, John MT, De Laat A, de Leeuw R, Maixner W, van der Meulen M, Murray GM, Nixdorf DR, Palla S, Petersson A, Pionchon P, Smith B, Visscher CM, Zakrzewska J, Dworkin SF (2014) Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 28(1):6-27. https://doi.org/10.11607/jop.1151
[14] Schiffman EL, Truelove EL, Ohrbach R, Anderson GC, John MT, List T, Look JO (2010) The Research Diagnostic Criteria for Temporomandibular Disorders. I: overview and methodology for assessment of validity. J Orofac Pain. 24(1):7-24.
[15] Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG (2012) CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. Int J Surg. 10(1):28-55. https://doi.org/10.1016/j.ijsu.2011.10.001
[16] Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 39(2):175-191. https://doi.org/10.3758/bf03193146
[17] Guarda-Nardini L, De Almeida AM, Manfredini D (2021) Arthrocentesis of the Temporomandibular Joint: Systematic Review and Clinical Implications of Research Findings. J Oral Facial Pain Headache. 35(1):17-29. https://doi.org/10.11607/ofph.2606
[18] Sielski M, Chęcińska K, Chęciński M, Sikora M (2023) Injectable Platelet-Rich Fibrin (I-PRF) Administered to Temporomandibular Joint Cavities: A Scoping Review. J Clin Med. 12(9):3326. https://doi.org/10.3390/jcm12093326
[19] Agostini F, Ferrillo M, Bernetti A, Finamore N, Mangone M, Giudice A, Paoloni M, de Sire A (2023) Hyaluronic acid injections for pain relief and functional improvement in patients with temporomandibular disorders: An umbrella review of systematic reviews. J Oral Rehabil. 50(12):1518-1534. https://doi.org/10.1111/joor.13571
[20] Tsai JH, Tam KW, Yang JD, Hsu TH (2025) Effectiveness of platelet-rich plasma for treating temporomandibular joint disorders: a systematic review and meta-analysis of randomized controlled trials. Pain Med. 26(10):655-672. https://doi.org/10.1093/pm/pnaf042
[21] Omami G, Miller CS (2024) Imaging Evaluation of the Temporomandibular Joint. Dent Clin North Am. 68(2):357-373. https://doi.org/10.1016/j.cden.2023.10.001
[22] Luo Y, Liu M, Jiang Y, Ma K, Chen Z (2025) Global research trends in MRI of temporomandibular disorders: a bibliometric study and visualization analysis via Cite Space. J Oral Facial Pain Headache. 39(4):150-164. https://doi.org/10.22514/jofph.2025.072
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Copyright (c) 2026 Leonardo Brigido Metello Neves, Bernardo Correia Lima, Rafael Coutinho Mello Machado, Bruno Luiz Baldessarini, Bruno Oliceira Bergamin, Marcelo Guerino Pereira Couto, Rafael Vidal Peres
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
