Is the Combine Prolotherapy More Effective Than the Traditional Prolotherapy in Patients With Temporomandibular Joint Hypermobility?
Summary
1. Diagnosis and Indication You have been diagnosed with temporomandibular joint (TMJ) hypermobility and/or dysfunction, characterized by symptoms such as jaw clicking, locking, pain in the joint area, or difficulty in opening and closing the mouth. After clinical and radiographic evaluation, the recommended treatment includes arthrocentesis and prolotherapy, either alone or in combination. 2. Description of Procedures A. TMJ Arthrocentesis: This is a minimally invasive procedure in which small needles are inserted into the TMJ space to irrigate the joint using sterile fluid (e.g., Ringer's solution). The procedure aims to eliminate inflammatory mediators, release joint adhesions, and improve mandibular mobility. It is generally performed under local anesthesia in an outpatient setting. B. Prolotherapy: Prolotherapy involves the injection of an irritant solution (typically dextrose combined with a local anesthetic) into the joint capsule, ligaments, or surrounding tissue. The goal is to stimulate the body's natural healing response, promoting collagen production and tissue regeneration to improve joint stability and function. C. Combined Approach: In certain cases, both treatments may be performed during the same session to maximize clinical benefit-arthrocentesis addresses inflammation and mobility, while prolotherapy enhances long-term stabilization. 3. Benefits and Expected Outcomes Reduction in TMJ pain and joint clicking Improved jaw function and range of motion Stabilization of the joint and reduced recurrence of dislocation or subluxation Minimally invasive and generally well-tolerated 4. Possible Risks and Complications Although these procedures are generally safe, potential risks may include but are not limited to: Mild pain or swelling at the injection site Temporary facial numbness or weakness (rare and usually self-resolving) Dizziness or light-headedness Joint stiffness or infection (very rare) Allergic reaction to anesthetic or injected substances 5. Alternatives to the Proposed Procedure You have the right to consider other treatment options, which may include: Physical therapy or jaw exercises Oral splints or bite guards Medication (analgesics, muscle relaxants) Surgical interventions (if conservative methods fail) 6. Patient Instructions and Post-Procedure Care Avoid wide mouth opening, yawning, or chewing hard foods for several days Use only recommended medications (e.g., acetaminophen/paracetamol); avoid anti-inflammatory drugs unless advised otherwise Apply cold compresses to reduce swelling if necessary Attend all scheduled follow-up appointments Notify your doctor immediately if you experience severe pain, prolonged numbness, fever, or signs of infection
Timeline
- Start
- 2019-01-01
- Primary completion
- 2022-01-01
- Completion
- 2025-01-01
Publications
- Results Comert Kilic S, Gungormus M. Is dextrose prolotherapy superior to placebo for the treatment of temporomandibular joint hypermobility? A randomized clinical trial. Int J Oral Maxillofac Surg. 2016 Jul;45(7):813-9. doi: 10.1016/j.ijom.2016.01.006. Epub 2016 Feb 2.
- Results Dasukil S, Shetty SK, Arora G, Degala S. Efficacy of Prolotherapy in Temporomandibular Joint Disorders: An Exploratory Study. J Maxillofac Oral Surg. 2021 Mar;20(1):115-120. doi: 10.1007/s12663-020-01328-9. Epub 2020 Jan 13.
- Results Taskesen F, Cezairli B. Efficacy of prolotherapy and arthrocentesis in management of temporomandibular joint hypermobility. Cranio. 2023 Sep;41(5):423-431. doi: 10.1080/08869634.2020.1861887. Epub 2020 Dec 16.
- Results Cezairli B, Sivrikaya EC, Omezli MM, Ayranci F, Seyhan Cezairli N. Results of Combined, Single-Session Arthrocentesis and Dextrose Prolotherapy for Symptomatic Temporomandibular Joint Syndrome: A Case Series. J Altern Complement Med. 2017 Oct;23(10):771-777. doi: 10.1089/acm.2017.0068. Epub 2017 Oct 10.
- Results 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 Nov 11;14(11):e31396. doi: 10.7759/cureus.31396. eCollection 2022 Nov.
- Results Dagenais S, Wooley J, Hite M, Green R, Mayer J. Acute toxicity evaluation of proliferol: a dose-escalating, placebo-controlled study in swine. Int J Toxicol. 2009 May-Jun;28(3):219-29. doi: 10.1177/1091581809336478.
- Results Refai H. Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint: a single-arm study with 1-4 years' follow up. Br J Oral Maxillofac Surg. 2017 Jun;55(5):465-470. doi: 10.1016/j.bjoms.2016.12.002. Epub 2017 Apr 29.
- Results Gibaly A, Abdelmoiz M, Alghandour AN. Evaluation of the effect of dextrose prolotherapy versus deep dry needling therapy for the treatment of temporomandibular joint anterior disc displacement with reduction: (a randomized controlled trial). Clin Oral Investig. 2024 Aug 8;28(9):475. doi: 10.1007/s00784-024-05830-z.
- Results Zhou H, Hu K, Ding Y. Modified dextrose prolotherapy for recurrent temporomandibular joint dislocation. Br J Oral Maxillofac Surg. 2014 Jan;52(1):63-6. doi: 10.1016/j.bjoms.2013.08.018. Epub 2013 Sep 21.
- Results Ungor C, Atasoy KT, Taskesen F, Cezairli B, Dayisoylu EH, Tosun E, Senel FC. Short-term results of prolotherapy in the management of temporomandibular joint dislocation. J Craniofac Surg. 2013 Mar;24(2):411-5. doi: 10.1097/SCS.0b013e31827ff14f.
- Results Nagori SA, Jose A, Gopalakrishnan V, Roy ID, Chattopadhyay PK, Roychoudhury A. The efficacy of dextrose prolotherapy over placebo for temporomandibular joint hypermobility: A systematic review and meta-analysis. J Oral Rehabil. 2018 Dec;45(12):998-1006. doi: 10.1111/joor.12698. Epub 2018 Aug 3.
- Results Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009 Nov;37(11):2259-72. doi: 10.1177/0363546509349921.
- Results Distel LM, Best TM. Prolotherapy: a clinical review of its role in treating chronic musculoskeletal pain. PM R. 2011 Jun;3(6 Suppl 1):S78-81. doi: 10.1016/j.pmrj.2011.04.003.
- Results Nitzan DW, Dolwick MF, Martinez GA. Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening. J Oral Maxillofac Surg. 1991 Nov;49(11):1163-7; discussion 1168-70. doi: 10.1016/0278-2391(91)90409-f.
- Results Rabago D, Slattengren A, Zgierska A. Prolotherapy in primary care practice. Prim Care. 2010 Mar;37(1):65-80. doi: 10.1016/j.pop.2009.09.013.
- Results Mustafa R, Gungormus M, Mollaoglu N. Evaluation of the Efficacy of Different Concentrations of Dextrose Prolotherapy in Temporomandibular Joint Hypermobility Treatment. J Craniofac Surg. 2018 Jul;29(5):e461-e465. doi: 10.1097/SCS.0000000000004480.
- Results de Farias JF, Melo SL, Bento PM, Oliveira LS, Campos PS, de Melo DP. Correlation between temporomandibular joint morphology and disc displacement by MRI. Dentomaxillofac Radiol. 2015;44(7):20150023. doi: 10.1259/dmfr.20150023. Epub 2015 Mar 25.
- Results Majumdar SK, Krishna S, Chatterjee A, Chakraborty R, Ansari N. Single Injection Technique Prolotherapy for Hypermobility Disorders of TMJ Using 25 % Dextrose: A Clinical Study. J Maxillofac Oral Surg. 2017 Jun;16(2):226-230. doi: 10.1007/s12663-016-0944-0. Epub 2016 Jul 25.
- Results Refai H, Altahhan O, Elsharkawy R. The efficacy of dextrose prolotherapy for temporomandibular joint hypermobility: a preliminary prospective, randomized, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg. 2011 Dec;69(12):2962-70. doi: 10.1016/j.joms.2011.02.128. Epub 2011 Jul 16.
- Results Torres DE, McCain JP. Arthroscopic electrothermal capsulorrhaphy for the treatment of recurrent temporomandibular joint dislocation. Int J Oral Maxillofac Surg. 2012 Jun;41(6):681-9. doi: 10.1016/j.ijom.2012.03.008. Epub 2012 Apr 7.
- Ates H, Sivrikaya EC. Is the combine prolotherapy more effective than the traditional prolotherapy in patients with temporomandibular joint hypermobility? J Craniomaxillofac Surg. 2025 Dec;53(12):2238-2244. doi: 10.1016/j.jcms.2025.10.008. Epub 2025 Nov 3.
Drugs
| Evaluation | Drug | Modality | Dose | Route |
|---|---|---|---|---|
| Subject | Dextrose | Unknown | 20 % | Other |