Prolotherapy for temporomandibular joint disorders: an updated comprehensive review

Temporomandibular joint disorders (TMDs) comprise multifactorial conditions involving pain, joint noises, and restricted mandibular motion. Prolotherapy, involving intra-articular or periarticular injection of proliferative agents such as hypertonic dextrose or polydeoxyribonucleotide (PDRN), has recently gained attention as a regenerative therapy for refractory TMDs. This review summarizes current evidence and biological mechanisms underlying prolotherapy in temporomandibular joint (TMJ) disorders. Literature searches identified clinical and experimental studies evaluating efficacy, safety, and treatment protocols. Prolotherapy promotes fibroblast activation, collagen synthesis, and ligamentous stabilization. Dextrose remains the most validated proliferant, while PDRN provides comparable efficacy with less discomfort and shorter treatment intervals. Clinical data consistently show reduced pain and improved maximum mouth opening across chronic and degenerative TMJ cases, with preliminary imaging evidence of subchondral bone remodeling. Reported adverse events are minimal and transient. Prolotherapy appears to be a regenerative approach that may be regarded as one of the conservative treatment modalities for TMDs. Further controlled studies are needed to validate its long-term clinical and structural outcomes.