Comparison of the Efficacy of Botulinum Toxin, Local Anesthesia, and Platelet-Rich Plasma Injections in Patients With Myofascial Trigger Points in the Masseter Muscle.

PURPOSE: Masticatory myofascial trigger points (TrP) are one of the major causes of nondental pain in the orofacial region. Intramuscular injections are considered the first-line treatment for myofascial TrPs. The objectives of this study were to evaluate and compare the effectiveness of local anesthesia (LA), botulinum toxin (BTX), and platelet-rich plasma (PRP) injections for the treatment of myofascial TrPs in the masseter muscle. METHODS: In this retrospective study, the sample was composed of patients with myofascial TrPs in masseter muscle who were treated between 2016 and 2019. Patients were divided into 3 groups according to treatment methods: group I (LA injection), group II (BTX injection), and group III (PRP injection). Primary outcome variable was the average pain level at rest and while chewing, and pressure pain intensity (PPI), Jaw Functional Limitation Scale (JFLS) value, and quality-of-life (measured using Oral Health Impact Profile-14 (OHIP-14)) were secondary outcomes. The outcome variables were assessed at diagnosis, and 1, 3, and 6 months post-treatment. RESULTS: The study consisted of 82 patients (group I, 27; group II, 26; group III, 29). At 1 and 3 months, improvement in all parameters was recorded in all groups. Groups I and II showed superior improvement in all parameters compared with group III at 3 months. Improvements in VAS pain, JFLS, and OHIP-14 values were significantly better in group II than group I at 3 months (P = .009; P = .004; P = .002). At 6 months, significant improvement in VAS pain, JFLS, and OHIP-14 (P = .008; P < .001; P < .01) values was recorded only in group II. CONCLUSIONS: All procedures successfully improved the symptoms of TrPs in the masseter muscle at 1 and 3 months. However, BTX injection seemed superior at the 3-month follow-up and remained effective up to 6 months.

Results of Combined, Single-Session Arthrocentesis and Dextrose Prolotherapy for Symptomatic Temporomandibular Joint Syndrome: A Case Series.

OBJECTIVE: Arthrocentesis and prolotherapy are nonsurgical treatments for temporomandibular joint (TMJ) diseases. This study aimed to evaluate the treatment of hypermobility, pain, and displacement of the TMJ by consecutively performing arthrocentesis and prolotherapy in the same session. MATERIALS AND METHODS: In this study, 10 adults with disc displacement and painful, hypermobile TMJ were selected. Arthrocentesis and prolotherapy were consecutively performed using a 30% dextrose solution that was simultaneously injected into five areas: posterior disc attachment, superior joint space, superior and inferior capsular attachments, and stylomandibular ligament. Paired t-test, McNemar test, and chi-square test were used to assess the maximum mouth opening, clicking sounds, pain, and subluxation of the TMJ. Patients with rheumatoid arthritis and parafunctional habits such as teeth clenching and grinding and biting of the cheeks or any other objects and those who had undergone surgery were excluded from this study. RESULTS: A total of 10 participants (36.20 ± 7.06 years old, 7 women and 3 men) received a single treatment session of combined arthrocentesis and prolotherapy at the same office visit. Subluxation frequency and pain significantly decreased after the first week of treatment (p < 0.05). Subluxation also decreased at the 3-month follow-up (p < 0.05). Clicking sound values did not significantly change at any of the follow-up time points. Maximum mouth opening values decreased at all follow-up time points compared to baseline (p < 0.05). CONCLUSION: A single session of combined arthrocentesis and prolotherapy to treat symptomatic TMJ safely and significantly improved the subluxation and pain after 1 week and subluxation after 3 months compared to baseline status. The maximum mouth opening significantly decreased at all follow-up time points. Future studies assessing multiple treatment sessions are warranted.