Optimizing arthrocentesis: the contribution of i-PRF in internal derangements of the TMJ

The treatment of internal derangements (ID) of the temporomandibular joint constitutes a daily challenge for the practitioner, particularly when conservative approaches fail. While arthrocentesis by lavage of the upper joint space is a proven technique for eliminating inflammatory mediators and removing adhesions, the addition of platelet concentrates such as injectable platelet-rich fibrin (i-PRF) is generating increasing interest for its regenerative properties.

This prospective comparative study, conducted on 40 patients, specifically aims to evaluate the clinical efficacy of i-PRF as a complement to arthrocentesis. The objective was to compare the results obtained between arthrocentesis alone and a procedure combined with an intra-articular injection of i-PRF, focusing on pain reduction (VAS scale) and improvement in maximum mouth opening.

The authors tested the null hypothesis that there is no significant difference between these two treatment modalities. For the practitioner, the challenge is to determine whether the addition of this autologous concentrate, rich in growth factors and cytokines, offers a tangible and lasting therapeutic benefit in the management of these complex musculoskeletal pathologies.

Methodology

This prospective comparative clinical study included 40 patients (aged 18 to 55 years) suffering from unilateral internal derangement of the TMJ, diagnosed according to DC/TMD Axis I criteria (Group IIIb). Participants were sequentially divided into two groups of 20 individuals: group A (arthrocentesis alone) and group B (arthrocentesis followed by intra-articular injection of i-PRF).

• Operative protocol: Arthrocentesis consisted of lavage of the superior joint space with 100 to 300 ml of Ringer's lactate. For group B, 1 to 1.5 ml of i-PRF was injected immediately afterwards.
• Preparation of i-PRF: The autologous concentrate was obtained by centrifugation of 9 ml of venous blood at 700 rpm for 3 minutes (RCF ≈ 60 g).
• Clinical follow-up: Evaluations were performed at baseline, then at 1 week, 1, 2, 3, and 6 months postoperatively. Outcome measures included pain (VAS scale), maximum mouth opening, and joint sounds (clicking).
• Data analysis: Statistical processing was performed using SPSS software version 25. Analyses utilized repeated measures ANOVA tests and t-tests for parametric data, as well as Mann-Whitney U, Friedman, Chi-square, and Cochran Q tests for non-parametric data (significance threshold p < 0.05).

Results: Accelerated healing kinetics

The study involved 40 patients (75% female) equally divided between Group I (arthrocentesis alone, n=20) and Group II (arthrocentesis + i-PRF, n=20). The mean age was 28.65 ± 9.05 years for Group I and 34.30 ± 12.24 years for Group II (p > 0.05). Clinically, 65% of the subjects presented with Wilkes stage III and 35% with stage II, with no significant intergroup disparity.

Evolution of pain (VAS)

Although Visual Analogue Scale (VAS) pain scores were comparable at baseline (p > 0.05), both protocols induced a significant reduction in pain over time (p < 0.05). However, Group II (i-PRF) showed marked statistical superiority during the intermediate follow-up phase.

Qualitative evaluation and clinical success

Qualitative analysis confirms this trend: from the first week, patients in Group II mostly reported "mild" pain, compared to "moderate" pain in Group I (p < 0.05). At 2 and 3 months, a significantly higher proportion of patients was completely asymptomatic in the combined group.

At the final 6-month follow-up, the gap between the two groups narrowed, showing that arthrocentesis alone eventually achieves significant results, albeit more slowly. No major adverse effects were reported, confirming the safety of intra-articular injection of i-PRF prepared at 700 rpm for 3 minutes.

Conclusion

This prospective study demonstrates that the addition of i-PRF to arthrocentesis significantly accelerates functional recovery and pain sedation compared to arthrocentesis alone, particularly during the first post-operative trimester.

Clinical analysis and impact on practice

The results of this prospective study demonstrate that the addition of i-PRF to arthrocentesis optimizes the early management of internal derangements of the TMJ (Wilkes stages II and III). While arthrocentesis alone is effective in eliminating inflammatory mediators, the intra-articular injection of i-PRF (obtained at 700 rpm for 3 min) significantly accelerates pain reduction. VAS scores are markedly lower in the i-PRF group between the 1st and 3rd postoperative months (p < 0.05), providing faster quality of life comfort for the patient.

However, the study highlights a convergence of long-term results. At 6 months, 90% of patients treated with i-PRF were pain-free, compared to 80% in the arthrocentesis-only group, a difference that then loses its statistical significance. This suggests that i-PRF acts primarily as a healing catalyst thanks to the sustained release of growth factors, without radically altering the final therapeutic outcome compared to rigorous joint lavage.

Several limitations must temper these conclusions: the absence of MRI or CBCT imaging to objectively determine disc position, the sequential allocation of patients (non-randomized), and the lack of double-blinding. Furthermore, the influence of parafunctional habits such as bruxism was not quantified, which could induce intergroup variability.

In concrete terms, for the practitioner:

• Accelerate comfort: Prioritize i-PRF as an adjunct to arthrocentesis for patients whose priority is rapid symptom relief from the first week.
• Optimize your protocol: Use a short centrifugation (3 min at 60 g) to obtain an autologous concentrate rich in cytokines, easily injectable immediately after joint lavage.
• Manage expectations: If i-PRF boosts the initial phase, be aware that arthrocentesis alone remains a robust technique with comparable 6-month results for Wilkes stages II and III.

Technical lexicon of the study

Arthrocentesis: Minimally invasive procedure consisting of a lavage of the superior joint space (100–300 ml of Ringer's lactate) coupled with mandibular manipulation, aimed at eliminating inflammatory mediators and releasing intracapsular adhesions.

i-PRF (Injectable Platelet-Rich Fibrin): Autologous platelet concentrate obtained by slow centrifugation (700 rpm for 3 min, RCF ≈ 60 g), releasing growth factors and cytokines to promote intra-articular tissue regeneration.

Internal Derangement (ID): Intra-articular disorder of the TMJ involving an abnormal structural relationship between the articular disc and the mandibular condyle, clinically manifesting as joint sounds and functional limitations.

DC/TMD Axis I (Diagnostic Criteria): Standardised classification system used in this study (Group IIIb) to establish the clinical diagnosis of musculoskeletal TMD without systematic recourse to advanced imaging.

McCain method: Precise anatomical landmarking protocol used to determine cutaneous entry points during puncture of the superior joint space for arthrocentesis.

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