Repeated arthrocentesis with injection of Hyaluronic Acid every cycle vs in the last cycle for TMJ Derangement with mild osteoarthritis Randomized comparative study

Introduction: Temporomandibular Derangement (TMD) can be managed by arthrocentesis with or without injection of different materials. The comparison of the final result is best measured by the successes of the treatment protocol, in addition to the low morbidity associated with the joint. Hyaluronic acid (HA) injections are commonly used for TMD management. Repeated HA 3-5 injections proved to be safe but of high cost. Aim: This study aims to evaluate the effectiveness of five cycles of arthrocentesis with immediate injection of low molecular weight HA using a single needle versus the same protocol performed with injection of HA in the last cycle only in patients with (TMD) + mild joint degeneration disease. Patients and methods: 60 patients with TMD were randomly assigned to the two protocols and followed up for 6 months after treatment. Several assessment parameters, such as pain at rest and pain of chewing, limitation in jaw function, and jaw range of motion in millimeters, were recorded at baseline and at one, three-, and six-months’ post-operative. Also, patients' complaints after every session were reported. Results: Both groups showed significant improvement from baseline levels without significant differences between them in all parameters of outcome results. Conclusion: Both techniques are effective, and the technique of five cycles of arthrocentesis with a single HA injection at the last cycle seems to be more economic.