DOI QR코드

DOI QR Code

Evaluation of the effects of prolotherapy on condyles in temporomandibular joint hypermobility using fractal dimension analysis

  • Memis, Sadi (Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kocaeli University)
  • Received : 2021.11.06
  • Accepted : 2022.01.03
  • Published : 2022.02.28

Abstract

Objectives: Prolotherapy is a method that has gained popularity in recent years and has been reported to have positive short-term and long-term clinical results in maxillofacial surgery, especially temporomandibular joint (TMJ) hypermobility. This study aimed to evaluate the changes in the trabecular structure of mandibular condyles in patients who underwent prolotherapy due to TMJ hypermobility using the fractal analysis method. Materials and Methods: Forty-five patients who received dextrose prolotherapy at a concentration of 20% and fifteen control patients were included in the study. All patients had panoramic radiographs just before (T0) and six months after treatment (T1). The patients who received treatment were divided into three groups according to the number of prolotherapy injections. The regions of interest were selected from bone areas close to the articular surfaces of the condyles. The fractal dimension (FD) values were calculated. Results: The main effect of time on the FD value was significant [F (1, 56)=86.176, P<0.001]. This effect was qualified by a significant time×group interaction effect [F (3, 56)=9.023, P<0.001]. The decreases in FD values in all treatment groups between T0 and T1 times were significant (P=0.004). However, changes in FD values were not significant in the control group (P=0.728). Conclusion: Dextrose prolotherapy without the effect of the number of injections caused a decrease in FD values in the mandibular condyles over time.

Keywords

References

  1. Refai H, Altahhan O, Elsharkawy R. The efficacy of dextrose prolotherapy for temporomandibular joint hypermobility: a preliminary prospective, randomized, double-blind, placebo-controlled clinical trial. J Oral Maxillofac Surg 2011;69:2962-70. https://doi.org/10.1016/j.joms.2011.02.128
  2. Comert Kilic S, Gungormus M. Is dextrose prolotherapy superior to placebo for the treatment of temporomandibular joint hypermobility? A randomized clinical trial. Int J Oral Maxillofac Surg 2016;45:813-9. https://doi.org/10.1016/j.ijom.2016.01.006
  3. Albilia JB, Weisleder H, Wolford LM. Treatment of posterior dislocation of the mandibular condyle with the double Mitek mini anchor technique: a case report. J Oral Maxillofac Surg 2018;76:396.e1-9. https://doi.org/10.1016/j.joms.2017.09.017
  4. Agbara R, Fomete B, Obiadazie AC, Idehen K, Okeke U. Temporomandibular joint dislocation: experiences from Zaria, Nigeria. J Korean Assoc Oral Maxillofac Surg 2014;40:111-6. https://doi.org/10.5125/jkaoms.2014.40.3.111
  5. Refai H. Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint: a single-arm study with 1-4 years' follow up. Br J Oral Maxillofac Surg 2017;55:465-70. https://doi.org/10.1016/j.bjoms.2016.12.002
  6. 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. https://doi.org/10.1097/SCS.0b013e31827ff14f
  7. Majumdar SK, Krishna S, Chatterjee A, Chakraborty R, Ansari N. Single injection technique prolotherapy for hypermobility disorders of TMJ using 25 % dextrose: a clinical study. J Maxillofac Oral Surg 2017;16:226-30. https://doi.org/10.1007/s12663-016-0944-0
  8. Klein RG, Eek BC, DeLong WB, Mooney V. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord 1993;6:23-33. https://doi.org/10.1097/00002517-199302000-00005
  9. Zhou H, Hu K, Ding Y. Modified dextrose prolotherapy for recurrent temporomandibular joint dislocation. Br J Oral Maxillofac Surg 2014;52:63-6. https://doi.org/10.1016/j.bjoms.2013.08.018
  10. Demirbas AK, Ergun S, Guneri P, Aktener BO, Boyacioglu H. Mandibular bone changes in sickle cell anemia: fractal analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:e41-8. https://doi.org/10.1016/j.tripleo.2008.03.007
  11. Arsan B, Kose TE, Cene E, Ozcan I. Assessment of the trabecular structure of mandibular condyles in patients with temporomandibular disorders using fractal analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2017;123:382-91. https://doi.org/10.1016/j.oooo.2016.11.005
  12. Kursun-Cakmak ES, Bayrak S. Comparison of fractal dimension analysis and panoramic-based radiomorphometric indices in the assessment of mandibular bone changes in patients with type 1 and type 2 diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol 2018;126:184-91. https://doi.org/10.1016/j.oooo.2018.04.010
  13. Aktuna Belgin C, Serindere G. Fractal and radiomorphometric analysis of mandibular bone changes in patients undergoing intravenous corticosteroid therapy. Oral Surg Oral Med Oral Pathol Oral Radiol 2020;130:110-5. https://doi.org/10.1016/j.oooo.2019.12.009
  14. Bayrak S, Goller Bulut D, Orhan K, Sinanoglu EA, Kursun Cakmak ES, Misirli M, et al. Evaluation of osseous changes in dental panoramic radiography of thalassemia patients using mandibular indexes and fractal size analysis. Oral Radiol 2020;36:18-24. https://doi.org/10.1007/s11282-019-00372-7
  15. White SC, Rudolph DJ. Alterations of the trabecular pattern of the jaws in patients with osteoporosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:628-35. https://doi.org/10.1016/s1079-2104(99)70097-1
  16. Ugur Aydin Z, Toptas O, Goller Bulut D, Akay N, Kara T, Akbulut N. Effects of root-end filling on the fractal dimension of the periapical bone after periapical surgery: retrospective study. Clin Oral Investig 2019;23:3645-51. https://doi.org/10.1007/s00784-019-02967-0
  17. Heo MS, Park KS, Lee SS, Choi SC, Koak JY, Heo SJ, et al. Fractal analysis of mandibular bony healing after orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:763-7. https://doi.org/10.1067/moe.2002.128972
  18. Suer BT, Yaman Z, Buyuksarac B. Correlation of fractal dimension values with implant insertion torque and resonance frequency values at implant recipient sites. Int J Oral Maxillofac Implants 2016;31:55-62. https://doi.org/10.11607/jomi.3965
  19. Wilding RJ, Slabbert JC, Kathree H, Owen CP, Crombie K, Delport P. The use of fractal analysis to reveal remodelling in human alveolar bone following the placement of dental implants. Arch Oral Biol 1995;40:61-72. https://doi.org/10.1016/0003-9969(94)00138-2
  20. Zeytinoglu M, Ilhan B, Dundar N, Boyacioglu H. Fractal analysis for the assessment of trabecular peri-implant alveolar bone using panoramic radiographs. Clin Oral Investig 2015;19:519-24. https://doi.org/10.1007/s00784-014-1245-y
  21. Yasar F, Akgunlu F. Fractal dimension and lacunarity analysis of dental radiographs. Dentomaxillofac Radiol 2005;34:261-7. https://doi.org/10.1259/dmfr/85149245
  22. Priyadarshini S, Gnanam A, Sasikala B, Elavenil P, Raja Sethupathy Cheeman S, Mrunalini R, et al. Evaluation of prolotherapy in comparison with occlusal splints in treating internal derangement of the temporomandibular joint - a randomized controlled trial. J Craniomaxillofac Surg 2021;49:24-8. https://doi.org/10.1016/j.jcms.2020.11.004
  23. Louw WF, Reeves KD, Lam SKH, Cheng AL, Rabago D. Treatment of temporomandibular dysfunction with hypertonic dextrose injection (prolotherapy): a randomized controlled trial with long-term partial crossover. Mayo Clin Proc 2019;94:820-32. https://doi.org/10.1016/j.mayocp.2018.07.023
  24. Fouda AA. Change of site of intra-articular injection of hypertonic dextrose resulted in different effects of treatment. Br J Oral Maxillofac Surg 2018;56:715-8. https://doi.org/10.1016/j.bjoms.2018.07.022
  25. Abdullakutty A, Sidebottom A. Is dextrose prolotherapy effective in managing recurrent temporomandibular joint (TMJ) dislocations - a prospective study. Br J Oral Maxillofac Surg 2018;56:e93-4. https://doi.org/10.1016/j.bjoms.2018.10.261
  26. Mustafa R, Gungormus M, Mollaoglu N. Evaluation of the efficacy of different concentrations of dextrose prolotherapy in temporomandibular joint hypermobility treatment. J Craniofac Surg 2018;29:e461-5. https://doi.org/10.1097/SCS.0000000000004480
  27. Dagenais S, Wooley J, Hite M, Green R, Mayer J. Acute toxicity evaluation of proliferol: a dose-escalating, placebo-controlled study in swine. Int J Toxicol 2009;28:219-29. https://doi.org/10.1177/1091581809336478
  28. Rabago D, Mundt M, Zgierska A, Grettie J. Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: long term outcomes. Complement Ther Med 2015;23:388-95. https://doi.org/10.1016/j.ctim.2015.04.003
  29. Taskesen F, Cezairli B. Efficacy of prolotherapy and arthrocentesis in management of temporomandibular joint hypermobility. Cranio 2020. https://doi.org/10.1080/08869634.2020.1861887 [Epub ahead of print]
  30. Hakala RV, Ledermann KM. The use of prolotherapy for temporomandibular joint dysfunction. J Prolotherapy 2010;2:439-46.
  31. Kim SR, Stitik TP, Foye PM, Greenwald BD, Campagnolo DI. Critical review of prolotherapy for osteoarthritis, low back pain, and other musculoskeletal conditions: a physiatric perspective. Am J Phys Med Rehabil 2004;83:379-89. https://doi.org/10.1097/01.phm.0000124443.31707.74