Arthrocentesis with iPRF, PRP + hyaluronic acid, or saline in arthrogenic TMD: 12-month outcomes from a retrospective cohort study

INTRODUCTION: Arthrocentesis improves pain and function in arthrogenic temporomandibular disorders (TMD), but the added value of biologics such as injectable platelet-rich fibrin (iPRF), platelet-rich plasma (PRP), and hyaluronic acid (HA) is uncertain. MATERIALS AND METHODS: This retrospective cohort study included 44 patients (33 females, 11 males) with arthrogenic TMD who underwent arthrocentesis between 2022 and 2024. Patients received iPRF (n = 18), PRP-HA (n = 12), or saline (NaCl; n = 14). The primary endpoint was pain at rest (VAS 0-10). Secondary outcomes included pain on mastication (VAS) and palpation (temporomandibular joint (TMJ), temporalis, masseter and lateral pterygoid muscle; binary), maximum interincisal distance (MID), and TMJ noises. Follow-up was performed at 1 week, 1, 3, 6, and 12 months after surgery. RESULTS: All groups showed significant postoperative improvements in pain at rest and during mastication, with no differences between groups for the primary endpoint. In secondary outcomes, PRP-HA was associated with the lowest prevalence of TMJ noises in the first week (8.3%), first and 12 month (8.3% and 10%, respectively; p < 0.0001) and with the most consistent MID values over follow-up. It also showed the most sustained absence of temporalis muscle pain at the whole 12 months period (p < 0.0001). By contrast, iPRF was linked to transiently higher muscle tenderness; saline showed greater variability including late lateral pterygoid pain. CONCLUSION: Arthrocentesis provides durable pain relief in arthrogenic TMD independent of the adjunctive injectate. While no differences were observed for the primary endpoint, secondary outcomes indicate that PRP-HA may be associated with favorable effects on joint noises and muscle tenderness, warranting further investigation.