الفهرس 
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Abstract
The aim of this study was to compare the effect of intra- articular injection of HD with a
SA and the intra- articular injection of 2 ml of LPCGF with a SA as a prolotherapy for
patients with limited mouth opening associated with DDwR. In addition, to investigate the
effectiveness of such treatment protocols on a clinical level as well as a molecular one
regarding MPO levels in SF.
With strictly identified inclusion and exclusion criteria, patients were examined and
selected using the DC/TMDs. Twenty-four patients identified as DC/TMDs Axis I group II.b;
DDwR with limited mouth opening, and further confirmed through MRI were assigned to the
study.
According to the therapeutic interventions, selected patients were randomly allocated to
one of the two study groups; 12 in each:
group I: received an intra-articular injection of 12.5% HD solution and a maxillary
CAD/CAM full–arch hard clear SA.
group II: received a single intra-articular injection of LPCGF and a maxillary
CAD/CAM full–arch hard clear SA.
Patients were informed to wear SA it at night for 6 months. All intra -articular injections
were done under US-guidance. All patients were evaluated clinically through Ai and MMO
was measured at baseline, 1 week, 1month, 3 months, and 6 months post-intervention.
Furthermore, assessment was done by MRI in addition to biochemical analysis by ELISA
pre-treatment as well as 6 months post-treatment.
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The data were collected then entered into the personal computer and analyzed statistically. In
the light of the findings and results of the present study, the following conclusions can be
viewed:
1. There was significant relief of TMD symptoms and increase in MMO within 1 week
after 2 ml. of LPCGF were injected intra-articular.
2. Significant improvement in MMO was achieved after administration of 12.5% of HD
in the superior joint space of the TMJ.
3. The use of ultrasound in guidance of injection made the procedure more predictable.
4. MPO enzyme, an inflammatory biomarker, is associated with irreducible disc
displacement.
5. Both interventions could be considered alternative treatment protocols in patients with
DDwR as it was effective in terms of relieving TMD symptoms with an increase in
the MMO and a decrease in inflammatory biomarker inside the joint as well.
6. SA is an essential auxiliary treatment in management of DDwR.