Comparison between injectable platelet rich fibrin with vitamin C and injectable platelet rich fibrin alone in the management of painful anterior disc displacement with reduction of the temporomandibular joint.

Background: Vitamin C (Vit.C) at defined concentrations induces epigenetic demethylation, driving cellular de-differentiation/multipotency with enhanced reparative/regenerative properties. These changes may result in decreased pain in patients suffering from intraarticular pain and dysfunction (IPD) of the temporomandibular joint (TMJ).Objective: The study’s purpose was to measure and compare pain among patients with IPD associated with anterior disc displacement with reduction (ADDWR, painful-click), treated with TMJ-injections of I-PRF with Vit.C or I-PRF alone.Material and Methods: The trial randomized double-blinded clinical trial. Subjects with IPD and anterior disc displacement with reduction who presented to Oral and Maxillofacial Surgery Department, Faculty of Dentistry, Cairo University between 17 and 40 years were screened and enrolled. Exclusion criteria were autoimmune diseases, major limitation in mouth opening, benign/malignant TMJ lesions, neurological diseases, blood dyscrasias or myofascial pain/dysfunction (MPD). Subjects were randomized to receiving either three weekly I-PRF injections with Vit.C (test-group) or I-PRF alone (control-group).Results: The sample was composed of 40 subjects (20 subjects; 4 males (20%) and 16 females (80%) per group), with a mean age of 25.8±6.22 years in test-group and 29.05 ±7.04 in control-group (p=0.13). No statistically significant differences in pain reduction were evident between both groups, with reduction in pain-scores of 4.8±1.0 and 5.0±0.6 in test- and control-group, respectively (p=0.2). No statistically significant difference between pre- and postoperative change in disc-position (p=1), MMO (p=0.1) or lateral-excursion (p=0.7) were evident. Conclusions: Vit.C augmentation of I-PRF does not provide additional pain reduction in TMJ of patients with IPD.