Intra-Articular Injections as a Treatment Option for Internal Derangement of the Temporomandibular Joint: A Review

Abstract

Internal derangement (ID) of the temporomandibular joint (TMJ) is one of the most prevalent intra-articular disorders of the masticatory system and is characterized by an abnormal positional or functional relationship between the articular disc, mandibular condyle, and temporal component. Patients commonly present with pain, joint sounds, restricted mouth opening, and functional impairment. While conservative management remains the first-line approach, a considerable proportion of patients fail to achieve sustained symptom relief and require minimally invasive interventions. Intra-articular (IA) injections have gained significant attention as effective intermediate therapeutic options that bridge the gap between conservative therapy and surgical intervention. Over recent years, advances in regenerative medicine have expanded IA treatment modalities beyond traditional corticosteroids to include hyaluronic acid (HA), platelet-rich plasma (PRP), and other biologically active agents. This comprehensive review elaborates on the pathophysiology of TMJ internal derangement, critically analyzes the mechanisms of action, clinical efficacy, safety profiles, and comparative outcomes of commonly used IA injectables, and highlights the adjunctive role of arthrocentesis. Evidence from randomized controlled trials, systematic reviews, and recent clinical studies till 2025 suggests that PRP and HA provide superior medium‑ to long‑term outcomes compared with corticosteroids, which are best reserved for short‑term inflammatory control. Botulinum toxin A (BoNT‑A) remains investigational for intra-articular use. A thorough understanding of indications, limitations, and biological rationale is essential for evidence-based management of TMJ internal derangement.