TMJ & Jaw Joint
Ostenil & i-PRF — TMJ Adjunctive Therapy
Information about the adjunctive injections used at the end of TMJ arthroscopic lavage — Ostenil (hyaluronic acid) and injectable platelet-rich fibrin (i-PRF) — what they are, why they are used, and what to expect.
Why Injections Are Used After TMJ Lavage
TMJ arthroscopic lavage is highly effective at clearing the inflammatory chemicals and adhesions inside your joint. However, the washing process can temporarily reduce the joint's natural hyaluronic acid — the substance that lubricates and protects the joint surfaces. The lavage procedure also does not directly stimulate the biological repair processes needed for long-term recovery.
Two adjunctive injections — Ostenil and injectable platelet-rich fibrin (i-PRF) — are placed into the joint space at the end of your procedure to address these limitations and prolong the benefit of the surgery. Your surgeon will discuss which is most appropriate for you.
Ostenil (Hyaluronic Acid)
Ostenil is a purified, high-molecular-weight hyaluronic acid solution. Hyaluronic acid occurs naturally in healthy joint fluid and cartilage — it acts as a lubricant and shock absorber. Ostenil is injected directly into the joint space at the end of your arthroscopic procedure, before the instruments are removed. In some cases, additional clinic-based injections may be arranged at 2–4 weekly intervals after surgery if clinically beneficial.
What it does
- Restores joint lubrication depleted by the lavage procedure
- Protects cartilage surfaces from mechanical wear
- Reduces inflammation within the joint
- Attenuates pain via receptor-mediated pathways
- Stimulates the joint's own hyaluronic acid production over time
Safety
- CE-marked as a medical device for joint disorders — excellent safety record
- Adverse effects are rare and usually limited to mild, temporary soreness around the joint for 24–48 hours
- No systemic (whole-body) side effects
- Not suitable if there is an active joint infection or known hypersensitivity to hyaluronate — your surgeon will advise
Injectable Platelet-Rich Fibrin (i-PRF)
Injectable platelet-rich fibrin (i-PRF) is prepared from a small sample of your own blood — approximately 10 mL — drawn on the morning of your surgery. The blood is spun in a centrifuge to concentrate the healing cells, growth factors, and proteins naturally present in your blood. This liquid is then injected into your joint space at the end of the procedure. Additional injections at 4–6 week intervals may be arranged after surgery where a greater regenerative response is needed.
What it does
- Delivers a concentrated dose of natural growth factors directly to the damaged joint tissues
- Promotes repair of the articular disc, joint capsule, and cartilage
- Reduces inflammation and pain over the weeks following surgery
- Stimulates new blood vessel formation to improve tissue nutrition
- Provides sustained pain relief — effects typically develop over 4–8 weeks and may last 6–12 months or longer
Safety
- Entirely autologous — made only from your own blood with no added chemicals or foreign proteins
- No serious adverse events reported in published clinical trials
- Not suitable for patients with certain platelet disorders, those on anticoagulant therapy, or those with active blood cancers
- Requires a small blood draw (approximately 10 mL) on the day of surgery
Because i-PRF is made entirely from your own blood, there is no risk of allergic reaction, immune response, or disease transmission.
Using Ostenil and i-PRF Together
Ostenil and i-PRF work in complementary ways. Ostenil provides immediate lubrication and cartilage protection; i-PRF provides a sustained biological stimulus for tissue repair. When used together, the hyaluronic acid in Ostenil may help retain the growth factors from i-PRF within the joint space for longer, enhancing the overall effect.
Published research supports a clinical advantage for the combination — particularly for longer-term pain reduction and improvement in jaw opening — compared with either injection alone.
- Ostenil provides immediate post-lavage lubrication and chondroprotection
- i-PRF provides a sustained biological regenerative stimulus
- Together they address both the mechanical and tissue repair deficits following joint lavage
- May be particularly beneficial in more advanced internal derangement or early osteoarthritis
- Combination may reduce the number of repeat injections required
What to Expect After the Injection
- Mild soreness around the joint for 24–48 hours after surgery is normal — this is a temporary local response to the injection
- The beneficial effects of both treatments typically develop gradually over 4–8 weeks
- Pain reduction and improvement in jaw opening may continue to improve for 6–12 months or longer
- Further injections can be arranged in clinic if needed
- Continue all post-operative instructions given for your arthroscopic lavage — soft diet, jaw exercises, wound care — as directed
The Evidence
The use of both Ostenil and i-PRF following TMJ arthroscopic lavage is supported by a growing body of clinical research, including multiple randomised controlled trials and systematic reviews. Key findings include:
A 2025 systematic review and meta-analysis (Nemeth et al., BMC Oral Health) of six randomised trials and 270 patients found a statistically significant and clinically meaningful reduction in pain with i-PRF. Multiple systematic reviews confirm that hyaluronic acid (Ostenil) improves pain and jaw opening compared with controls, with effects lasting up to 12 months. Both treatments have excellent safety profiles across all published studies.
When to Seek Urgent Help
Please contact the team immediately or attend your nearest Emergency Department if you experience any of the following after your procedure:
- Fever above 38°C / 100.4°F
- Rapidly increasing swelling or redness around the joint
- Significant pain not controlled by prescribed analgesia
- Difficulty breathing or swallowing
- Weakness or drooping of your face
- Any symptom that concerns you
If you have any questions or concerns before or after your surgery, please do not hesitate to contact us.
This information sheet is intended to complement, and not replace, a personal consultation with your surgeon. © MaxFac London