Temporomandibular Eklem Osteoartritlerinde Güncel Tedavi Yaklaşımları

Abstract

Temporomandibular eklem bozuklukları popülasyonda sıklıkla görülen ve orofasiyal ağrının dişle ilgili olmayan en yaygın nedenlerinden biri olan rahatsızlıklardır. Bu bozukluklardan biri olan temporomandibular eklem osteoartriti, matriks anabolizmasının durması ve inflamasyonun şiddetlenmesiyle ortaya çıkan, şiddetli ağrı ve eklem fonksiyonunda bozulma ile sonuçlanan dejeneratif bir hastalıktır. Bu derlemenin amacı temporomandibular eklem osteoartriti olan hastalar için önerilen güncel tedavi yöntemlerini ve bu tedavilerin etkinliklerini literatüre dayanarak eleştirel olarak değerlendirmektir. Bu amaçla PubMed ve Scopus veritabanlarında 2013-2023 yılları arasında sınırlama yapılarak (temporomandibular joints) VE (osteoarthritis) VE (treatment) anahtar kelimeleri kullanılarak analiz edildi. 514 sonucun taranmasından sonra 53 çalışma bu incelemeye dahil edildi. İncelenen makalelerin analizi sonucunda mevcut tedavi yöntemlerinin esas olarak eklem tahribatları üzerinde sınırlı onarıcı etkiye sahip olduğu ve semptomların hafifletilmesine katkıda bulundukları tespit edildi. Yeni geliştirilen tedavi yöntemleri ve multidisipliner çalışma ekibi ile umut vaat edici sonuçlar elde edileceği sonucunda ulaşıldı.

Keywords

• hyalüronik asit
• non-steroidal anti-enflamatuar ilaç
• oklüzal splint
• osteoartrit
• temporomandibular eklem

Current Treatment Approaches in Temporomandibular Joint Osteoarthritis

Abstract

Temporomandibular joint disorders, one of the most common non-dental causes of orofacial pain, are frequently seen in the population. Temporomandibular joint osteoarthritis, one of these disorders, is a degenerative disease with the cessation of matrix anabolism and aggravation of inflammation, which results in severe pain and impaired joint function. The aim of this review was to critically assess the current treatment methods recommended for patients with temporomandibular joint osteoarthritis and the effectiveness of these treatments on the basis of the literature. For this purpose, PubMed and Scopus databases were analyzed by making a limitation between 2013-2023 with the keywords (temporomandibular joints) AND (osteoarthritis) AND (treatment). After the screening of 514 results, 53 studies have been included in this review. As a result of the analysis of the reviewed articles, it was determined that existing treatment methods mainly have a limited repairing effect on joint destructions and contribute to the relief of symptoms. It was concluded that promising results would be achieved with newly developed treatment methods and a multidisciplinary working team.

Keywords

• hyaluronic acid
• non-steroidal anti-inflammatory drug
• occlusal splint
• osteoarthritis
• temporomandibular joint

References

1. Savage J, Lababidi E, McCullough M, Dimitroulis G. Microbiological investigation of the mandibular condyle in patients with advanced osteoarthritis of the temporomandibular joint. J Cranio-Maxillofac Surg 2019;47:1262–5.
2. Okeson JP. Management of temporomandibular disorders and occlusion. 2019, 8th ed. Elsevier, Inc.
3. Yotsuya M, Iriarte-Diaz J, A Reed D. Temporomandibular joint hypofunction secondary to unilateral partial discectomy attenuates degeneration in murine mandibular condylar Cartilage. Bull Tokyo Dent Coll 2020;61:9–19.
4. de Alcântara Camejo F, Azevedo M, Ambros V, Caporal KST, Doetzer AD, Almeida LE, vd. Interleukin-6 expression in disc derangement of human temporomandibular joint and association with osteoarthrosis. J Cranio-Maxillofac Surg 2017;45:768–74.
5. Izawa T, Hutami IR, Tanaka E. Potential role of rebamipide in osteoclast differentiation and mandibular condylar cartilage homeostasis. Curr Rheumatol Rev 2018;14:62–9.
6. Orfanidou T, Malizos KN, Varitimidis S, Tsezou A. 1,25-Dihydroxyvitamin D(3) and extracellular inorganic phosphate activate mitogen-activated protein kinase pathway through fibroblast growth factor 23 contributing to hypertrophy and mineralization in osteoarthritic chondrocytes. Exp Biol Med (Maywood) 2012;237:241–53.
7. Dumbuya A, Gomes AF, Marchini L, Zeng E, Comnick CL, Melo SLS. Bone changes in the temporomandibular joints of older adults: A conebeam computed tomography study. Spec Care Dent 2020;40:84–9.
8. Bindu S, Mazumder S, Bandyopadhyay U. Nonsteroidal anti-inflammatory drugs (NSAIDs) and organ damage: A current perspective Biochem Pharmacol 2020;180:114147.

9. Song H, Lee JY, Huh KH, Park JW. Long-term changes of temporomandibular joint osteoarthritis on computed tomography. Sci Rep 2020;10:6731.
10. Moore N. Coronary risks associated with diclofenac and other NSAIDs: An Update. Drug Saf 2020;43:301–18.
11. Ta LE, Dionne RA. Treatment of painful temporomandibular joints with a cyclooxygenase-2 inhibitor: A randomized placebocontrolled comparison of celecoxib to naproxen. Pain 2004;111:13–21.
12. Ok SM, Jeong SH, Ahn YW, Kim YI. Effect of stabilization splint therapy on glenoid fossa remodeling in temporomandibular joint osteoarthritis. J Prosthodont Res 2016;60:301-7.
13. Kim TH, Kim YJ, Song YH, Tae I, Lim HK, Jung SK. Assessment of Morphologic Change of Mandibular Condyle in Temporomandibular Joint Osteoarthritis Patients with Stabilization Splint Therapy: A Pilot Study. Healthcare (Basel). 2022;10:1939.
14. Lan KW, Chen JM, Jiang LL, Feng YF, Yan Y. Treatment of condylar osteophyte in temporomandibular joint osteoarthritis with muscle balance occlusal splint and long-term follow-up: A case report. World J Clin Cases. 2022;10:4264-4272.
15. Wu CB, Sun NN, Zhang D, Wang Q, Zhou Q. Efficacy analysis of splint combined with platelet-rich plasma in the treatment of temporomandibular joint osteoarthritis. Front Pharmacol. 2022; 14;13:996668.
16. Nicolakis P, Burak EC, Kollmitzer J, Kopf A, Piehslinger E, Wiesinger GF, vd. An investigation of the efectiveness of exercise and manual therapy in treating symptoms of TMJ osteoarthritis. Cranio 2001;19(1):26-32.
17. Macías-Hernández SI, Morones-Alba JD, Tapia- Ferrusco I, Vélez-Gutiérrez OB, Hernández-Diaz C, Nava-Bringas TI, Cruz-Medina E, Toro LC, Soria- Bastida MLA. A home-based exercise program for temporomandibular joint osteoarthritis: pain, functionality, and joint structure. J Korean Assoc Oral Maxillofac Surg. 2022;48:50-58.
18. Liu S, Fan S, Li G, Cai B, Yao Y, Jin L, Zhang Y, Zhang X, Xu L. Short term effects of a novel combined approach compared with physical therapy alone among older patients with temporomandibular degenerative joint disease: a prospective cohort study. BMC Oral Health. 2023;23:173.
19. Liu SS, Xu LL, Fan S, Lu SJ, Jin L, Liu LK, Yao Y, Cai B. Effect of platelet-rich plasma injection combined with individualised comprehensive physical therapy on temporomandibular joint osteoarthritis: A prospective cohort study. J Oral Rehabil. 2022;49:150-159.
20. Bouloux GF, Chou J, Krishnan D, Aghaloo T, Kahenasa N,Smith J A, Giannakopoulos H. Is hyaluronic acid or corticosteroid superior to lactated ringer solution in the short-term reduction of temporomandibular joint pain after arthrocentesis? Part 1.J Oral Maxillofac Surg 2017;75:52–62.
21. Gencer ZK, Özkiri M, Okur A, Korkmaz M, Saydam L. A comparative study on the impact of intraarticular injections of hyaluronic acid, tenoxicam and betametazon on the relief of temporomandibular joint disorder complaints. J Craniomaxillofac Surg 2014;42:1117–21.
22. Li C, Long X, Deng M, Li J, Cai H, Meng Q. Osteoarthritic changes after superior and inferior joint space injection of hyaluronic acid for the treatment of temporomandibular joint osteoarthritis with anterior disc displacement without reduction: A cone-beam computed tomographic evaluation. J Oral Maxillofac Surg 2015;73:232–44.
23. Cen X, Liu Y, Wang S, Yang X, Shi Z, Liang X. Glucosamine oral administration as an adjunct to hyaluronic acid injection in treating temporomandibular joint osteoarthritis. Oral Dis 2018;24:404–11.
24. Isacsson G, Schumann M, Nohlert E, Mejersjö C, Tegelberg Å. Pain relief following a single-dose intra-articular injection of methylprednisolone in the temporomandibular joint arthralgia-A multicentre randomised controlled trial. J Oral Rehabil 2019;46:5–13.
25. Bjørnland T, Gjaerum AA, Møystad A. Osteoarthritis of the temporomandibular joint: An evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate. J Oral Rehabil 2007;34: 583–9.
26. Møystad A, Mork-Knutsen BB, Bjørnland T. Injection of sodium hyaluronate compared to a corticosteroid in the treatment of patients with temporomandibular joint osteoarthritis: A CT evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e53– 60.
27. Gokçe Kutuk S, Gökçe G, Arslan M, Özkan Y, Kütük M, Kursat Arikan O. Clinical and radiological comparison of effects of platelet-rich plasma, hyaluronic acid, and corticosteroid injections on temporomandibular joint osteoarthritis. J Craniofac Surg 2019;30:1144–8.
28. Li FL, Wu CB, Sun HJ, Zhou Q. Comparison of autologous platelet-rich plasma and chitosan in the treatment of temporomandibular joint osteoarthritis: A retrospective cohort study. J Oral Maxillofac Surg 2021;79:324–32.
29. Wu CB, Sun HJ, Sun NN, Zhou Q. Analysis of the curative effect of temporomandibular joint disc release and fixation combined with chitosan ınjection in the treatment of temporomandibular joint osteoarthrosis. J Clin Med 2023;12:1657.
30. Tang YH, Vos LM, Tuin AJ, Huddleston Slater JJR, Gareb B, van Bakelen NB, vd. Arthrocentesis versus non-surgical intervention as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial with long-term follow-up. Int J Oral Maxillofac Surg 2023; 52: 595–603.
31. Guarda-Nardini L, De Almeida AM, Manfredini D. Arthrocentesis of the Temporomandibular Joint: Systematic Review and Clinical Implications of Research Findings. J Oral Facial Pain Headache. 2021 Winter;35(1):17-29.
32. Bergstrand S, Ingstad HK, Møystad A, Bjørnland T. Long-term effectiveness of arthrocentesis with and without hyaluronic acid injection for treatment of temporomandibular joint osteoarthritis. J Oral Sci 2019; 61:82–8.
33. Gorrela H, Prameela J, Srinivas G, Reddy BVB, Sudhir M. Arakeri, G. Efficacy of temporomandibular joint arthrocentesis with sodium hyaluronate in the management of temporomandibular joint disorders: A prospective randomized control trial. J Maxillofac Oral Surg 2017;16:479–84.
34. Huddleston Slater JJ, Vos LM, Stroy LP, Stegenga B. Randomized trial on the effectiveness of dexamethasone in TMJ arthrocentesis. J Dent Res 2012;91:173-8.
35. Cömert Kiliç S. Does injection of corticosteroid after arthrocentesis improve outcomes of temporomandibular joint osteoarthritis? A randomized clinical trial. J Oral Maxillofac Surg 2016;74:2151–8.
36. Lin SL, Tsai CC, Wu SL, Ko SY, Chiang, WF, Yang JW. Effect of arthrocentesis plus plateletrich plasma and platelet-rich plasma alone in the treatment of temporomandibular joint osteoarthritis: A retrospective matched cohort study (A STROBEcompliant article). Medicine (Baltimore) 2018;97: e0477.
37. Abbadi W, Kara Beit Z, Al-Khanati NM. Arthrocentesis injectable platelet-rich plasma and combination of both protocols of temporomandibular joint disorders management: A single-blinded randomized clinical trial. Cureus 2022;14(11):e31396.
38. Cömert Kiliç S, Gungormus M. Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis plus hyaluronic acid for the treatment of temporomandibular joint osteoarthritis: A randomized clinical trial. Int J Oral Maxillofac Surg 2016;45:1538–44.
39. Kui A, Buduru S, Labunet A, Balhuc S. Negucioiu, M. Vitamin D and temporomandibular disorders: What do we know so far? Nutrients 2021;13:1286.
40. Hashemi M, Jalili P, Mennati S, Koosha A, Rohanifar R, Madadi F,vd. The effects of prolotherapy with hypertonic dextrose versus prolozone (intraarticular ozone) in patients with knee osteoarthritis. Anesth Pain Med 2015;5:e27585
41. Saraiva L, Konzen VDM, Batista JS, Jorge MSG, Garcia GS, Wibelinger LM. Treatment of rheumatoid arthritis with ozone therapy: Systematic review. Temas Saúde 2020;20:4–8.
42. Yu H, Huang Y, Yang L. Research progress in the use of mesenchymal stem cells and their derived exosomes in the treatment of osteoarthritis. Ageing Res Rev 2022;80:101684.
43. Matheus HR, Özdemir SD, Guastaldi FP. Stem cell-based therapies for temporomandibular joint osteoarthritis and regeneration of cartilage/osteochondral defects: A systematic review of preclinical experiments. Osteoarthr Cartil 2022;30:1174–85.
44. Khairy M, Abulmagd I, Sabry D. Evaluation of the therapeutic potentials of adipose Derived stem cells in comparison to hyaluronic acid in temporomandibular joint osteoarthritis A multi assessment study. Egypt J Oral Maxillofac Surg 2019;10:102–17.
45. Zhao Y, Xie L. An update on mesenchymal stem cell-centered therapies in temporomandibular joint osteoarthritisd. Stem Cells Int 2021:6619527
46. Waterman RS, Tomchuck SL, Henkle SL, Betancourt AM. A new mesenchymal stem cell (MSC) paradigm: polarization into a pro-inflammatory MSC1 or an Immunosuppressive MSC2 phenotype. PLoS One 2010;26:e10088.
47. Pan X, Cen X, Xiong X, Zhao Z, Huang X. miR- 17-92 cluster in osteoarthritis: Regulatory roles and clinical utility. Front Genet 2022;13:982008.
48. Shin SM, Choi JK. Effect of indomethacin phonophoresis on the relief of temporomandibular joint pain. Cranio 1997;15:345-8.
49. Lark MR, Gangarosa LP. Iontophoresis: an effective modality for the treatment of inflammatory disorders of the temporomandibular joint and myofascial pain. Cranio 1990;8:108-19.