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JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL

Is dextrose prolotherapy superior to placebo for the treatment of temporomandibular joint hypermobility? A randomized clinical trial

S Cömert Kiliç, M Güngörmüş
International Journal of Oral and Maxillofacial Surgery 2016, 45 (7): 813-9
26846795
A randomized clinical trial involving adult patients with bilateral temporomandibular joint (TMJ) hypermobility referred for treatment was implemented. The sample comprised 30 consecutive patients, who were divided randomly into two groups. The TMJ hypermobility was treated with either saline (placebo group) or dextrose injections (study group). The solution was injected into five different TMJ areas in three sessions at monthly intervals. The predictor variable was the treatment technique. The outcome variables were visual analogue scale (VAS) evaluations and maximum inter-incisal opening (MIO). Outcome variables were recorded preoperatively and at 12 months postoperatively. Descriptive and bivariate statistics were computed, and significance was set at a P-value of <0.05. The follow-up sample comprised 26 subjects: 12 in the placebo group and 14 in the study group. Masticatory efficiency increased and general pain complaints and joint sounds decreased significantly in both groups. MIO decreased significantly only in the study group. Insignificant changes in the other parameters were found for both groups. After estimating differences between follow-up and baseline outcomes, the mean change in primary outcome variables showed no statistically significant difference between the two groups. These findings suggest that dextrose prolotherapy is no more effective than placebo treatment for any of the outcome variables of TMJ hypermobility assessed.

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noel peterson

An excellent study. However, proliferative benefit is expected from the localized trauma and release of wound repair and growth factors. Trained prolotherapists use an aggressive needling technique and understand the benefits of aggressive needling. Therefore, placebo needling in 5 TMJ locations would induce proliferation and repair. The observation that both groups improved is not surprising. The observed greater improvement in the dextrose group, including the statistically significant increased MIO, would be accounted for by the additive benefit of dextrose.
The suggestion that dextrose prolotherapy is no more effective than placebo treatment for any of the outcome variables ignores the statistical benefits in MIO.
True placebo would require that the injector not be blinded, and that placebo needling and injection not enter into either the TMJ or the supportive connective tissue.

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