Does the Hyaluronic Acid Dosage During Arthrocentesis Influence Pain Reduction and Maximal Incisal Opening?

Abstract

Background: The efficacy of hyaluronic acid (HA) after arthrocentesis in temporomandibular joint (TMJ) disorders is recognized, but the therapeutic effect of different HA doses remains unclear. Purpose: The study purpose was to measure and compare the therapeutic efficacy of different HA doses among patients with intra-articular pain and dysfunction undergoing arthrocentesis. Study Design, Setting, Sample: Subjects with intra-articular pain and dysfunction presented to Afyonkarahisar University of Health Sciences between September 2022 and December 2023 were screened for study inclusion. The inclusion criteria were over 18 years of age, with magnetic resonance imaging-confirmed disc displacement without reduction, and classified as stage 3 to 4 according to Wilke's classification. The exclusion criteria were the presence of systemic disease, pregnancy, TMJ ankylosis, myofascial pain, hypersensitivity to local anesthetics, and a history of TMJ surgery. Predictor Variable: The predictor variable was HA dose. Subjects were randomly assigned to receive 10 mg/ml (HA10) or 20 mg/ml (HA20). Outcome Variable: The primary outcome variable was the therapeutic effect, which was assessed using visual analog scale (VAS) and maximum incisal opening (MIO). The secondary outcomes were lateral excursions, protrusion, and joint sounds. All measurements were recorded at baseline (T0), month 1 (T1), and month 3 (T2). Covariates: The covariates were demographics (age and sex), perioperative (Wilke's classification), and side of the arthrocentesis procedure (unilateral or bilateral). Analyses: Statistical analysis using IBM SPSS included Mann-Whitney U test, chi(2) test, and Fisher's exact test for group comparisons, with significance at P < .05. Results: The study sample was composed of 36 subjects with a mean age of 32.78 (SD = 9.53), and 29 (80.6%) were female. There were 18 subjects in each study group. For the TMJ, VAS scores decreased from 7.33 +/- 2.06 to 0.97 +/- 1.24 in HA10 and from 7.78 +/- 3.26 to 1.82 +/- 2.11 in HA20 (P = .3 at T0, P = .07 at T2). MIO increased from 37.44 +/- 8.3 to 45.06 +/- 6.8 in HA10 and from 37 +/- 10.84 to 42.94 +/- 10.54 in HA20 (P = .9 at T0, P = .5 at T2). No statistically significant differences were found between the groups in VAS and MIO at any time point. Conclusions and Relevance: The results suggest that HA dose is not associated with therapeutic efficacy. As such, the lower price HA option is adequate. (c) 2025 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 83:1344-1350, 2025