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Does Guidance Technique Influence Success? A Double-Blind Randomized Controlled Trial Comparing the Precision and
K Pazhanivel1, Vasumathi Thiruvengadam2, Balaji Sivalingam3
1Department of Oral Medicine and Radiology, Thai Moogambigai Dental College and Hospital, Dr M.G.R Educational and Research Institute, Chennai, Tamil Nadu, India.
Objective:
To compare the precision, clinical efficacy, and patient-reported outcomes of ultrasound-guided (USG) versus palpation-guided (PG) platelet-rich plasma (PRP) injections for temporomandibular joint (TMJ) disorders.
Materials And Methods:
In this randomized, double-blind, controlled trial, 64 patients with TMJ osteoarthritis or disc displacement without reduction were allocated to receive a single PRP injection via either USG (n = 32) or PG (n = 32) technique. The primary outcome was injection accuracy, confirmed by immediate fluoroscopic contrast verification. Secondary outcomes included maximal mouth opening (MMO), pain intensity on a visual analog scale (VAS), Mandibular Function Impairment Questionnaire (MFIQ) scores, and Global Perceived Effect (GPE) assessed at baseline 1, 3, and 6 months.
Results:
Injection accuracy was significantly higher in the USG group (100%) compared to the PG group (68.8%, P < 0.001). A significant time-by-group interaction was found for MMO (P = 0.012) and VAS pain (P = 0.023). While both groups improved from baseline at all follow-ups (P < 0.001), the USG group demonstrated significantly greater improvement in MMO at 3 months (41.5 vs. 38.4 mm, P = 0.038) and 6 months (42.8 vs. 39.0 mm, P = 0.009). The USG group also reported significantly lower VAS pain and MFIQ scores and higher GPE ratings at 6 months (all P < 0.05). No serious adverse events occurred.
Conclusion:
USG ensures perfect intra-articular PRP placement and is associated with significantly superior medium-term functional outcomes and patient satisfaction compared to the PG technique. USG should be considered the preferred method for administering biologic injections into the TMJ.
