DOI:

10.37988/1811-153X_2024_2_140

Improvement of arthroscopic surgery based on the use of a PRGF-clot for treating patients with temporomandibular disorders

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Authors

  • D.V. Shipika 1, PhD in Medical Sciences, associate professor of the Maxillofacial and plastic surgery Department
    ORCID: 0000-0001-6335-3311
  • A.A. Ostashko 1, postgraduate at the Maxillofacial and plastic surgery Department
    ORCID: 0000-0001-5160-8698
  • E.A. Egorova 1, PhD in Medical Sciences, professor of the Radiology Department
    ORCID: 0000-0003-2580-5692
  • D.A. Lezhnev 1, PhD in Medical Sciences, full professor of the Radiology Department
    ORCID: 0000-0002-7163-2553
  • A.Yu. Drobyshev 1, PhD in Medical Sciences, full professor of the Maxillofacial and plastic surgery Department
    ORCID: 0000-0002-1710-6923
  • 1 Russian University of Medicine, 127473, Moscow, Russia

Abstract

The purpose of this study was to develop a method of using Plasma rich in growth factors (PRGF-clot) during arthroscopy in patients with internal derangements and TMJ osteoarthritis and evaluate it effectiveness.
Materials and methods.
A group of 30 patients with internal derangements and TMJ osteoarthritis underwent arthroscopy of the TMJ according to the developed algorithm using a navigation, cold plasma ablator, injection of PRGF-clot and 2% hyaluronic acid.
Results.
After surgery maximum mouth opening increased on 22,3% from 3.5±0.8 to 4.3±0.8 cm (p<0.001), The intensity of pain according to VAS decreased on average by 84.6% — from 6.5 to 1.0 points (p<0.001). According to CBCT, 6 months after surgery, in 19 cases (63.3%) there was remodeling of the heads of the temporomandibular joints with an improvement of the intraarticular elements. In 11 cases (36.6%) osteochondral changes remained at the preoperative level. According to MRI data 6 months after surgery, no fibrin substrate was visualized, in 18 cases (60.0%), stable correct position of the intra-articular disc was determined. In 7 cases (23.7%), the presence of ventral dislocation with reposition was determined. In 5 cases (16.7%) remained ventral disc dislocation without reposition. However, all patients reported clinical improvement. In cases where, according to MRI, we observed the persistence of ventral disc dislocation without reposition, according to objective examination methods, there was an increase in the maximum mouth opening, as well as a decrease in the pain according to VAS.
Conclusion.
The use of growth factor-enriched blood plasma products in the form of fibrin substrate with hyaluronic acid during TMJ arthroscopy with individual markings and the use of a cold-plasma ablator is a safe and effective procedure. The results in this study are supported by the improvement in the clinical examination and the condition of the TMJ structures as measured by CT and MRI. The positive preliminary results encourage further research in this area..

Key words:

plasma rich in growth factors, internal derangements, TMD, TMJ osteoarthritis, TMJ arthroscopy, PRGF-clot, adaptive centric relation.

For Citation

[1]
Shipika D.V., Ostashko A.A., Egorova E.A., Lezhnev D.A., Drobyshev A.Yu. Improvement of arthroscopic surgery based on the use of a PRGF-clot for treating patients with temporomandibular disorders. Clinical Dentistry (Russia).  2024; 27 (2): 140—149. DOI: 10.37988/1811-153X_2024_2_140

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Received

January 30, 2024

Accepted

May 21, 2024

Published on

June 28, 2024