PRP for TMJ Disorders: Evidence-Based Recommendation
Based on current evidence, PRP injections can be offered as a treatment option for TMJ disorders, particularly for pain reduction and functional improvement, though the evidence quality remains limited and standardization is severely lacking. 1, 2
Evidence Quality and Guideline Perspective
The International Society on Thrombosis and Haemostasis rates PRP for maxillofacial injuries as uncertain (median expert score of 5.5 out of 9), reflecting the lack of high-quality evidence in this specific application. 1 This uncertainty stems from the severe lack of standardization in PRP preparation methods, terminology, purity, content, and quality control across all regenerative medicine applications. 1
Clinical Efficacy for TMJ Disorders
Despite guideline uncertainty, research specific to TMJ shows:
Pain reduction: PRP demonstrates significant pain reduction compared to hyaluronic acid at long-term follow-up (6-12 months), with better maintenance of improvements over time. 3
Functional improvement: PRP increases maximum mouth opening (interincisal distance) and reduces joint sounds, with median mouth opening reaching 41.0 mm at 12-month follow-up. 3
Clicking resolution: Injectable platelet-rich fibrin (I-PRF) eliminated articular clicking in all 20 patients after two injections, with only 2 patients experiencing recurrence at 6 months. 4
Comparative effectiveness: A systematic review of 8 randomized controlled trials found PRP/PRGF demonstrated "slightly better clinical results but of little significance" compared to controls, earning only a C-level recommendation based on evidence-based dentistry principles. 2
Safety Profile
PRP is clinically safe when prepared using autologous or allogeneic sterile techniques, with minimal immunogenicity risk due to its autologous nature. 1, 5, 6 No serious adverse effects have been reported in TMJ applications. 2
Critical Implementation Requirements
If proceeding with PRP for TMJ disorders, you must address these standardization issues:
Preparation method: Use anticoagulated blood (citrate or ACD preferred; avoid EDTA) with gravitational centrifugation techniques and standard cell separators. 1, 5
Product characterization: Document platelet concentration, yield, purity (RBC and WBC contamination levels), and activation status prior to clinical use. 1
Dosing protocol: Based on available research, administer 1 mL injections into the superior joint space, typically 2-3 sessions spaced 1 week apart. 4, 7, 3
Timing: Inject within the first few months of conservative treatment failure for optimal results. 3
Clinical Decision Algorithm
First-line: Exhaust conservative management (NSAIDs, physical therapy, occlusal splints) before considering PRP. 2
Patient selection: Consider PRP for patients with TMJ osteoarthritis, internal derangement with clicking, or pain not responding to conservative treatment (RDC/TMD group II/III). 7, 3
Alternative comparison: Arthrocentesis shows higher success rates for pain elimination, while PRP is more effective for correcting joint noise and jaw deviation—choose based on predominant symptom. 7
Combination approach: PRP can be administered simultaneously with or after arthrocentesis/arthroscopy, though evidence for synergistic benefit is limited. 2
Important Caveats
The field suffers from poor standardization that directly impacts clinical efficacy—different preparation techniques result in significant variations in platelet yields, concentration, purity, viability, and activation status. 1, 6 Many trials fail to fully define the content and biological properties of platelet preparations used, making it impossible to replicate successful protocols. 1
Set realistic patient expectations: while PRP shows promise for TMJ disorders, the evidence base consists primarily of small trials with methodological limitations, not large-scale definitive studies. 2 The C-level recommendation reflects this evidence gap. 2