Molecular Biomarkers and Advanced Intra-Articular Therapeutics in Temporomandibular Disorders: A Comprehensive Systematic Review
DOI:
https://doi.org/10.54361/LJMR.20.2.59Keywords:
Temporomandibular Joint Disorders, Biomarkers; Platelet-Rich Fibrin (PRF, Platelet-Rich Plasma (PRP), Hyaluronic Acid, Arthrocentesis; Distraction Osteogenesis, Joint AnkylosisAbstract
Background: Temporomandibular disorders (TMDs) comprise a heterogeneous spectrum of musculoskeletal and neuromuscular pathologies impacting approximately 31% of the global adult population. Traditional diagnosis relies on static imaging and subjective tactile standards, which fail to capture real-time enzymatic and metabolic changes driving tissue degradation. This systematic review synthesises recent clinical evidence to clarify diagnostic biological fluid markers, contrast long-term injection outcomes, evaluate bioengineered hybrid scaffolds, and establish definitive architectural sequencing for major craniofacial reconstructive surgery. Methods: Conducted in strict compliance with PRISMA 2020 guidelines and registered with PROSPERO, a systematic literature search was executed across 9 international databases up to 2026. Studies were restricted to parallel-group randomised controlled trials (RCTs), prospective split-mouth trials, and longitudinal cohort studies. Methodological quality was appraised using RoB 2.0 and ROBINS-I instruments, with evidence certainty graded under the GRADE framework. Results: Eighteen core publications representing 1,540 patients were systematically compiled. Molecular mapping verified that synovial fluid pro-inflammatory cytokines (IL-1β, TNF-α) and matrix metalloproteinases (MMP-1, -3, -9) serve as highly sensitive parameters reflecting active chondrocyte apoptosis. High-molecular-weight HA provides immediate physical lubrication but undergoes accelerated enzymatic washout. PRP achieves superior, durable long-term (12-month) biological modulation. The i-PRF + arthroscopy conjugate yielded the highest long-term mean difference in functional jaw mobility. For end-stage ankylosis with severe micrognathia, the simultaneous arthroplastic distraction (SAD) sequence demonstrated complete dominance. Conclusion: The management of TMDs necessitates a transition toward personalised molecular medicine and combined mechano-biological therapeutics. Synovial and salivary biomarker tracking offers superior real-time diagnostic value over structural imaging. The simultaneous execution of joint arthroplasty and distraction osteogenesis (SAD) is mandatory for end-stage osseous fusion to ensure long-term stability and permanent posterior airway space expansion.
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