Regenerative Medicine · Maxillofacial
Temporomandibular joint in Brescia: pain, clicking and regenerative therapies.
“Temporomandibular disorders” (TMD) is the term for a group of more than 30 conditions that cause pain and difficulty moving the jaw joint and the chewing muscles. They are common, many go away on their own, and the treatments recommended first are conservative ones.
When the problem starts inside the joint and does not improve with conservative care, Dr. Luana Salvagni, a specialist in Maxillofacial Surgery, assesses minimally invasive treatments at Palazzo Manzoni: washing out the joint (arthrocentesis) and, in selected cases, injections of hyaluronic acid, PRP or adipose tissue.
Very common
Around 31% of adults have a TMJ disorder, most often a clicking disc
Simple care first
Exercises, physiotherapy and education come first
Minimally invasive
Arthrocentesis uses small needles, with no incisions
Maxillofacial
A specialist in the anatomy of the jaw and face
The Joint
Two joints that always work as a pair.
The temporomandibular joints, one on each side, connect the lower jaw to the skull. Between the head of the lower jaw (the condyle) and its socket in the temporal bone lies a small disc of cartilage shaped like a biconcave lens, which accompanies every movement.
When we open our mouth, the joint does two things: first it rotates, then it slides forward. And because the two joints are linked by the same lower jaw, they have to move in a coordinated way: that is why the consultation always assesses both sides.
The most common disorder is disc displacement with reduction, which you notice as a “click” when you open or close your mouth. It often causes no other problems; it becomes significant when it comes with pain, locking or limited opening.
Did you know?
You can feel them straight away: place your fingers just in front of your ears and slowly open your mouth. The movement you feel under your fingertips is the temporomandibular joint. According to a meta-analysis of 21 studies, around 31% of adults and older people have a TMJ disorder diagnosed with standardised criteria.
Sources: NIDCR, National Institutes of Health; Valesan LF et al., Clinical Oral Investigations 2021
The Signs
When it is worth seeing a specialist
Many temporomandibular disorders are short-lived and go away on their own. A specialist consultation is useful when symptoms persist, get worse or limit everyday life.
Some facial pain can mimic a TMJ disorder: that is why diagnosis is always the first step, before any treatment.
01
Pain
In the chewing muscles or in front of the ear, either on its own or when you chew, talk or yawn.
02
Joint noises
Clicking, popping or grating when you open or close your mouth, especially if painful.
03
Restriction or locking
Difficulty opening your mouth fully, or a jaw that “locks” open or closed.
04
Pain that lasts
Pain present for more than 3 months is considered chronic and calls for a structured care pathway.
05
Warning signs
New pain after the age of 50, or pain that is progressive and different from usual, should always be assessed carefully, because it may have other causes.
The Stepped Approach
From conservative care to regenerative therapies
Guidelines recommend starting with conservative treatments and avoiding those that permanently alter the joint, the teeth or the bite. Minimally invasive procedures are considered when the problem lies in the joint and initial care does not bring a clear benefit.
→Conservative care
education, home exercises, guided exercises for the jaw and posture, physiotherapy and, for chronic pain, cognitive behavioural therapy: these are the treatments with the strongest recommendations.
→Imaging
when needed, CT shows the bones of the joint in detail, while MRI shows the disc and soft tissues.
→Arthrocentesis
small needles are inserted into the joint to flush through a fluid that removes debris and inflammatory substances. It is a low-risk procedure, performed under local anaesthetic.
→Injections after the washout
hyaluronic acid, PRP or PRF (platelet-rich fibrin, a similar platelet concentrate) may be injected at the end of arthrocentesis, in selected cases. About PRP
→Adipose tissue
in selected patients, autologous adipose tissue harvested by Dr. Stefano Di Nonno and injected into the joint after arthrocentesis. About adipose tissue
Open surgery on the joint is reserved for a small number of selected cases, once the other options have been tried.
What the Research Says
Minimally invasive and regenerative TMJ therapies: evolving evidence
There are many studies on these treatments, but they are often small, and their conclusions do not yet agree. Here is an honest overview.
→Minimally invasive procedures
In disorders originating in the joint, a network meta-analysis found minimally invasive procedures, especially when combined with injections, more effective than conservative care for pain and mouth opening, with evidence ranging from very low to moderate quality. Al-Moraissi 2020
→In chronic pain
A 2023 international guideline, by contrast, makes a conditional recommendation against arthrocentesis and hyaluronic acid for chronic pain lasting at least 3 months, in favour of exercise and behavioural therapies. Busse 2023
→PRP, PRF and hyaluronic acid
A network meta-analysis of 12 studies found all three more effective than placebo, with an advantage for PRF in the long term; another, on osteoarthritis, found no difference compared with placebo. Xu 2023; Xie 2022
→Adipose tissue
In Udine, in a randomised study of 40 patients, microfragmented adipose tissue after arthrocentesis had a higher success rate than hyaluronic acid; the authors, who include the founder of the company that makes the technology used, describe the results as preliminary. Sembronio 2021
→And the cartilage?
In a study from Sassari and Udine, bone marrow cells gave more relief than hyaluronic acid, but MRI showed no regeneration of the cartilage. De Riu 2019
That is why we offer regenerative TMJ therapies only in selected cases, explaining clearly the expected benefits and the limits of the evidence.
A Link with History
PRP has a long history in maxillofacial surgery.
Many people think of PRP as a sports medicine or aesthetic treatment. In fact, after its first uses in cardiac surgery in the late 1980s, a decisive stage in its clinical history was oral and maxillofacial surgery, where it was used to help bone grafts heal.
TMJ arthrocentesis also has a relatively recent history: it was described as a simplified treatment in the early 1990s and has since become one of the most widely used minimally invasive procedures for disorders of the jaw joint.
Did you know?
In 1998 Robert Marx and colleagues, oral and maxillofacial surgeons, described platelet-rich plasma as an enhancer of bone grafts: the platelet concentration reached 338% and grafts with PRP matured on X-rays 1.62 to 2.16 times faster. Seven years earlier, in 1991, Nitzan and colleagues had described TMJ arthrocentesis in 17 patients whose mouth opening had suddenly become locked.
Sources: Marx RE et al., Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontics 1998; Nitzan DW et al., Journal of Oral and Maxillofacial Surgery 1991
The Lead Specialist
Dr. Luana Salvagni
Specialist in Maxillofacial Surgery in the plastic surgery department of Palazzo Manzoni. In the regenerative medicine division she focuses in particular on the temporomandibular joint.
Specialisation
Maxillofacial Surgery, a specialty with its own dedicated training in the lower jaw, the upper jaw and the face
Other areas
aesthetic medicine
TMJ
assessment of joint disorders and minimally invasive and regenerative treatments
Team
with Dr. Stefano Di Nonno for harvesting adipose tissue, when indicated
Your Journey
How we approach a TMJ disorder in Brescia
Step 01
The consultation
A history of your symptoms and an examination of mouth opening, joint noises and chewing muscles, following international diagnostic criteria.
Step 02
The tests
When the consultation is not enough, MRI for the disc and soft tissues or CT for the bones.
Step 03
The plan
In most cases we start with conservative care; if the problem lies in the joint and persists, minimally invasive procedures are considered.
Step 04
The treatment
Arthrocentesis under local anaesthetic, possibly followed by an injection of hyaluronic acid, PRP or adipose tissue.
Step 05
Follow-up
Pain and mouth opening are measured over time, alongside exercises and physiotherapy.
Frequently Asked Questions
Frequently asked questions
about the temporomandibular joint
What is the temporomandibular joint (TMJ)?
It is the joint that connects the lower jaw to the skull, just in front of the ear; we have two, one on each side, and they work as a pair. Inside it, a small disc of cartilage accompanies the rotating and sliding movements we use to open and close our mouth.
What are the symptoms of TMJ disorders?
The most common is pain in the chewing muscles or in the joint. There may also be clicking, popping or grating when opening or closing the mouth, difficulty opening fully or locking of the jaw. They are more common in women.
Is a clicking jaw serious?
Often not. The most common disorder is disc displacement with reduction, which shows itself precisely as a click and in many cases causes no other problems. It is worth having it checked if it comes with pain, limited opening or locking.
When is an MRI scan needed?
When the consultation alone is not enough to make a diagnosis. International criteria allow the most common painful conditions to be recognised clinically, but many internal disorders of the joint require imaging: MRI shows the disc and soft tissues, CT shows the bones.
What is TMJ arthrocentesis?
It is a minimally invasive procedure: using small needles, under local anaesthetic, a fluid is flushed through the joint to remove debris and inflammatory substances. Complications, generally mild and temporary, occur in about 11% of procedures; significant ones are rare.
Does PRP work for the TMJ?
The evidence is conflicting. One network meta-analysis finds PRP and PRF more effective than placebo, with an advantage for PRF in the long term; others find no difference compared with placebo or judge the evidence too weak, and PRP has not been shown to be superior to hyaluronic acid. We offer it only in selected cases, after arthrocentesis.
Can adipose tissue be used in the TMJ?
Yes, in selected cases: fat taken from the patient can be prepared and injected into the joint after arthrocentesis. An Italian randomised study of 40 patients showed encouraging results for pain and mouth opening, but it is small and preliminary, and its authors include the founder of the company that makes the technology used; in another Italian study, using bone marrow cells, MRI showed no regeneration of the cartilage.
Do I need surgery?
Rarely. Many temporomandibular disorders go away on their own, and guidelines recommend starting with conservative care; minimally invasive procedures are considered when the problem lies in the joint and persists. Open surgery is reserved for a small number of selected cases.
How much does TMJ treatment cost?
It depends on the tests needed and the treatment chosen. After the consultation you will receive a detailed written quote.
Take the Next Step
Your next step starts
with a conversation
At Palazzo Manzoni in Brescia, every consultation is personal, unhurried, and designed to give you clarity about your next step.
Address
Via dei Mille 14, 25122 Brescia, Italia
Phone
Hours
Mon-Fri 8:30-18:30 · Sat 9:00-13:00
01
Get in touch
Call, email, WhatsApp, or book online.
02
Meet your specialist
A personal consultation to understand your situation.
03
Your plan, your pace
Together you decide the best path forward.
Content reviewed by Dr. Luana Salvagni, specialist in Maxillofacial Surgery.