Is injectable platelet rich fibrin beneficial in managing intracapsular temporomandibular disorders? A systematic review and meta-analysis.

抄録

Objective: To highlight the current knowledge of the effectiveness of injectable platelet rich fibrin (i-PRF) in the management of temporomandibular joint internal derangement (TMJ-ID) and temporomandibular joint osteoarthritis (TMJ-OA).Methodology: A "Population, Intervention, Comparison, Outcome" (PICO) strategy was implemented by performing a systematic search through Cochrane databases, PubMed/MEDLINE, and Google Scholar from their commencement to November 2024. Randomized clinical trials (RCTs) addressing the management of TMJ-ID and TMJ-OA with i-PRF were included. Two reviewers independently evaluated the suitability of the RCTs, followed by data extraction.Results: The electronic search revealed 274 articles, but only 6 studies were deemed suitable for selection, with a total of 270 subjects; 75% were females, and 25% were males. Meta-analysis revealed a significant reduction in pain levels with i-PRF compared to controls (pooled SMD = - 2.16; 95% CI = - 3.43 to - 0.89; P < 0.001). Significant improvement was also observed in maximum mouth opening (SMD = 2.46; 95% CI = 0.56 to 4.36; P = 0.02). i-PRF significantly enhanced lateral mandibular movements compared with controls (SMD = 1.35; 95% CI = 0.03 to 2.67; P = 0.048), whereas no significant difference was found for protrusive movements (SMD = 1.76; 95% CI = - 0.97 to 4.48; P = 0.11). Improvements in joint sounds and disc position were qualitatively reported in smaller subsets of studies. Substantial heterogeneity (I² = 83-93%) was observed across outcomes, reflecting variability in study design and treatment protocols.Conclusion: Current evidence suggests that i-PRF provides improvements in TMJ pain, joint sounds, and mandibular movements for up to 12 months. However, more RCTs are needed.