OSTEOARTRİTİK EKLEMLERDE HİPERTONİK DEKSTROZ PROLOTERAPİNİN KLİNİK ETKİNLİĞİNİN DEĞERLENDİRİLMESİ

Amaç: Bu çalışmada temporomandibular eklem (TME) osteoartriti ve TME hipermobilitesi olan erişkin hastalarda dekstroz proloterapinin uzun dönemde klinik etkinliği değerlendirilmiştir. Gereç ve Yöntem: Bu çalışma, hem klinik inceleme ile hem de konik ışınlı bilgisayarlı tomografi (CBCT) ile teşhis edilen, 14 dejeneratif ve hipermobil ekleme sahip 11 erişkin hasta üzerinde yürütülmüştür. 2 ml %30’luk dekstroz, 2 ml salin ve 1 ml % 2’lik artikain veya mepivakain karışımlarından oluşan 1 ml dekstroz enjeksiyonları aylık olarak toplamda 3 seans olarak üst eklem boşluğu, üst ve alt kapsüler ligament, posterior disk ligamenti ve stylomandibular ligament olmak üzere 5 ayrı alana enjekte edildi. Sonuç değişkenlerini görsel analog skala (VAS) değerlendirmeleri ve maksimum interinsizal açıklık (MIA) değerleri oluşturmaktadır. Klinik değerlendirmeler, tedavi başlangıcında (T0), son enjeksiyon tedavisinden hemen sonra (T1) ve 12 ay sonra (T2) kaydedildi. Bulgular: Eklem sesi, MIA ve ağrı şikayetleri tedavi- den hemen sonra önemli ölçüde azalmıştır. MIA değer- leri, tedavi sonrası 12 aylık takip periyodunda başlangıç değerlerine geri dönmüştür. Çiğneme etkinliğinde tedavi sonrasında ve takip periyodu süresince istatistiksel olarak anlamlı bir fark görülmemiştir. Sonuç: Bu çalışma bulguları, TME osteoartriti ve TME hipermobilitesine sahip semptomatik hastalarda, tekrarlayan dekstroz proloterapi enjeksiyonlarının eklem sesi ve ağrı şikâyetlerinde önemli klinik iyileşmeler sağlayabildiğini göstermiştir. Anahtar Kelimeler: Dekstroz proloterapi, TME hipermobilitesi, TME Osteoartriti AN ASSESSMENT OF CLINICAL EFFICACY OF HYPERTONIC DEXTROSE PROLOTHERAPY ON OSTEOARTHRITIC TEMPOROMANDIBULAR JOINTS ABSTRACT Aim: In this study, long-term clinical efficacy of hypertonic dextrose prolotherapy was assessed on patients with both temporomandibular joint osteoarthritis and hypermobility. Material and Method: This study was carried out on 11 adult patients, whom had 14 temporomandibular joint with both osteoarthritis and hypermobility diagnosed with clinical examination and CBCT evaluations. Participants received 1- ml injections of dextrose solution in each of the five injection areas at three sessions, each a month apart; this solution consisted of 2 ml 30% dextrose, 2 ml saline, and 1 ml 2% articaine or mepivacaine. The prepared solutions were injected into five areas according to the treatment protocol, in the following order: posterior disk attachment, superior joint space, superior and inferior capsular attachments, and stylo-mandibular ligament. The outcome variables were visual analogue scale (VAS) evaluations and maximum inter-incisal opening (MIO). Outcome variables were recorded preoperatively, immediately after injection and at 12 months postoperatively. Results: MIO, general pain complaints and joint sounds decreased significantly in after injections, but MIO returned to baseline values after 12 months postoperatively. Masticatory efficiency showed insignificant changes after injection and during 12 months follow-up period. Conclusion: Findings of the present study suggest that repeating dextrose prolotherapy may provide improvements on general pain complaints and joint sounds of the patients had both temporomandibular joint osteoarthritis and hypermobility Key Words: Dextrose prolotherapy, TME hypermobility, TME Osteoarthritis

Anahtar Kelimeler:

Dekstroz proloterapi, TME hipermobilitesi

PDF

___

1. Kummoona R. Surgical reconstruction of thetemporomandibular joint for chronic subluxation and dislocation. Int J Oral Maxillofac Surg 2001;30:344–8.
2. Khamis MM, Medra A, Gauld J. Clinical evaluation of a newly designed single-stage craniofacial implant: a pilot study. J Prosthet Dent 2008;100:375–83.
3. Huang IY, Chen CM, Kao YH, Wu CW. Manage- ment of long-standing mandibular dislocation. Int J Oral Maxillofac Surg 2011;40:810–4.
4. Triantafillidou K, Venetis G, Markos A. Short-term results of autologous blood injection for treatment of habitual TMJ luxation. J Craniofac Surg 2012;23: 689–92.
5. Akinbami BO. Evaluation of the mechanism and principles of management of temporomandibular joint dislocation. Systematic review of literature and a proposed new classification of temporo- mandibular joint dislocation. Head Face Med 2011;7:10.
6. Kuttenberger JJ, Hardt N. Long-term results following miniplate eminoplasty for the treatment of recurrent dislocation and habitual luxation of the temporomandibular joint. Int J Oral Maxillofac Surg 2003;32:474–9.
7. Tekel N, Kahraman S. Temporomandibular eklem bozukluklarinin tedavisinde oklüzal splintlerin kullanimi. Atatürk Üniv. Diş Hek. Fak. Derg. Suppl. 1, 2006: 61-69
8. Kummoona R. Surgical managements of subluxation and dislocation of the temporoman- dibular joint: clinical and experimental studies. J Craniofac Surg 2010;21: 1692–7.
9. Refai H, Altahhan O, Elsharkawy R. The efficacy of dextrose prolotherapy for temporomandibular joint hypermobility: a preliminary prospective, rando- mized, doubleblind, placebo-controlled clinical trial. J Oral Maxillofac Surg 2011;69:2962–70.
10. Fu KY, Chen HM, Sun ZP, Zhang ZK, Ma XC. Long-term efficacy of botulinum toxin type A for the treatment of habitual dislocation of the temporomandibular joint. Br J Oral Maxillofac Surg 2010;48:281–4.
11. de Felicio CM, Freitas RL, Bataglion C. The effects of orofacial myofunctional therapy combined with an occlusal splint on signs and symptoms in a man with TMD-hyper- mobility: case study. Int J Orofac Myol 2007;33:21–9.
12. Liu F, Steinkeler A. Epidemiology, diagnosis, and treatment of temporomandibular disorders. Dent Clin North Am 2013; 57: 465-79.
13. Cömert Kılıç S, Kılıç N, Sümbüllü MA: Temporomandibular joint osteoarthritis: cone beam computed tomography findings, clinical features, and correlations. Int J Oral Maxillofac Surg 2015; 44(10): 1268-74.
14. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders Review, criteria, examinations and specifications, critique. Journal of craniomandibular disorders : facial & oral pain 1992;6: 301-55.
15. Schultz LW. A treatment of subluxation of the temporomandibular joint. JAMA 1937;109:1032–5.
16. Reeves KD, Hassanein K. Randomized, prospective, placebo-controlled double-blind study of dextrose prolotherapy for osteoar- thritic thumb and finger (DIP, PIP, and trapeziometacarpal) joints: evidence of clinical efficacy. J Altern Complement Med 2000;6:311–20.
17. Eslamian F, Amouzandeh B. Therapeutic effects of prolotherapy with intra-articular dextrose injection in patients with moderate knee osteoarthritis: a singlearm study with 6 months follow up. Ther Adv Musculoskel Dis 2015, Vol. 7(2) 35– 44.
18. Rabago D, Kijowski R, Woods M, Patterson JJ, Mundt M, Zgierska A, Grettie J, Lyftogt J, Fortney L. Association between disease-specific quality-of-life and magnetic resonance imaging outcomes in a clinical trial of prolotherapy for knee osteoarthritis. Arch Phys Med Rehabil. 2013 November ; 94(11).
19. Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine (Phila Pa 1976) 2004;29:9–16.
20. Hackett GS, Huang TC, Raftery A. Prolother- apy for headache. Pain in the head and neck, and neuritis. Headache 1962;2:20–8.
21. Zhou H, Hu K, Ding Y. Modified dextrose prolotherapy for recurrent temporomandibu- lar joint dislocation. Br J Oral Maxillofac Surg 2014;52:63–6.
22. Ungor C, Atasoy KT, Taskesen F, Cezairli B, Dayisoylu EH, Tosun E, et al. Short-term results of prolotherapy in the management of temporomandibular joint dislocation. J Craniofac Surg 2013;24:411–5.
23. Cömert Kiliç S, Güngörmüş M. Is dextrose prolotherapy superior to placebo for the treatment of temporomandibular joint hypermobility? A randomized clinical trial. Int J Oral Maxillofac Surg. 2016 Jul;45:813-9.
24. Topol GA, Podesta LA, Reeves KD, Giraldo MM, Johnson LL, Grasso R, et al. Chondrogenic Effect of Intra-articular Hypertonic-Dextrose (Prolotherapy) in Severe Knee Osteoarthritis. PM&R. 2016; 8: 1072-82.
25. Penarrocha-Oltra D, Ata-Ali J, Ata-Ali F, Penarrocha-Diago MA, Penarrocha M. Treatment of orofacial pain in patients with stylomandibular ligament syndrome (Ernest syndrome). Neurologia 2013;28:294–8.
26. Hakala RV. Prolotherapy (proliferation therapy) in the treatment of TMD. Cranio 2005;23:283–8.
27. Sit RW, Chung VCh, Reeves KD, Rabago D, Chan KK, Chan DC, et al. Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: A systematic review and metaanalysis. Sci Rep. 2016; 6: 25247. doi: 10.1038/srep25247.
28. Jensen KT, Rabago DP, Best TM, Patterson JJ, Vanderby Jr R. Early inflammatory response of knee ligaments to prolotherapy in a rat model. J Orthop Res 2008;26: 816–23.
29. Lam S, van der Geest RN, Verhagen NA, van Nieuwenhoven FA, Blom IE, Aten J, et al. Connective tissue growth factor and IGF-I are produced by human renal fibroblasts and cooperate in the induction of collagen production by high glucose. Diabetes 2003;52: 2975–83.