Turkiye Klinikleri Journal of Dental Sciences

.: ORIGINAL RESEARCH
Comparison of the Efficacy of Hyaluronic Acid and Platelet-Rich Plasma Applied Together and Alone with Arthrocentesis in the Treatment of Temporomandibular Joint Internal Irregularities: A Prospective Clinical Study
Temporomandibular Eklem İç Düzensizliklerinin Tedavisinde Artrosentez ile Birlikte ve Tek Başına Uygulanan Hyalüronik Asit ve Trombositten Zengin Plazmanın Etkinliklerinin Karşılaştırılması: Bir Prospektif Klinik Çalışma
Rojdan Ferman GÜNEŞ UYSALa , Rezzan GÜNERa , Beyza KAYAa , Ersin UYSALb
aDicle University Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Diyarbakır, Türkiye
bDicle University Diyarbakır Vocational School of Technical Sciences, Department of Computer Technologies, Diyarbakır, Türkiye
Turkiye Klinikleri J Dental Sci. 2024;30(4):549-56
doi: 10.5336/dentalsci.2024-103562
Article Language: EN
Full Text
ABSTRACT
 Objective: This clinical study aims to determine the effectiveness of hyaluronic acid (HA) and platelet-rich plasma (PRP) injections alone and with arthrocentesis on pain, maximum mouth opening (MMO) and lateral and protrusive movements of the mandible in non-reduction disc displacement temporomandibular joint (TMJ) disorders. Material and Methods: This research is a randomized, single-blind and prospective study. 60 adult patients diagnosed clinically and radiographically with non-reducing disc displacement were included in the study. Initial and postoperative pain levels of all patients were measured using the 10-unit Visual Analog Scale (VAS). The amount of lateral and protrusive movement of mandible and MMO was also noted before and after the procedure. The patients were randomly divided into four groups: Group 1 (HA), Group 2 (arthrocentesis + HA), Group 3 (PRP), Group 4 (arthrocentesis+PRP). Results: According to this study, there was no statistically significant relationship between Group 1 and Group 3 and Group 2 and Group 4 in all time intervals and all symptoms. At the end of the 6th month, a significant relationship was found in VAS and MMO values between Group 4 and Group 1 and Group 3. Although there was no significant relationship between Group 4 and Group 2, the average values were found to be higher in the PRP group. Conclusion: It was observed that the results were more successful in the groups in which injections were applied after arthrocentesis than in the groups in which injections were applied without arthrocentesis. PRP injection has shown very successful results in the treatment of TMJ with disc displacement without reduction.

Keywords: Temporomandibular joint; arthrocentesis; platelet-rich plasma; hyaluronic acid
ÖZET
 Amaç: Bu klinik çalışma, redüksiyonsuz disk deplasmanlı temporomandibular eklem (TME) rahatsızlıklarında hyaluronik asit (HA) ve trombositten zengin plazma [platelet-rich plasma (PRP)] enjeksiyonlarının tek başına ve artrosentez işlemi ile uygulamalarının ağrı, maksimum ağız açıklığı (MAA) ve mandibulanın lateral ve protrüsiv hareketleri üzerinde etkinliğini karşılaştırmayı amaçlamaktadır. Gereç ve Yöntemler: Bu araştırma randomize, tek kör ve prospektif bir çalışmadır. Klinik ve radyografik olarak redüksiyonsuz disk deplasmanı teşhisi konulan ve konservatif tedavilerden sonuç alınamayan erişkin 60 hasta araştırmaya dâhil edilmiştir. Bütün hastaların başlangıç ve postoperatif ağrı derecesi 10 birimlik Görsel Analog Skala kullanılarak ölçülmüştür. MAA ve mandibulanın lateral ve protrüziv hareket miktarları da işlem öncesi ve işlem sonrası not edilmiştir. Hastalar rastlantısal olarak Grup 1 (HA enjeksiyonu), Grup 2 (artrosentez + HA enjeksiyonu), Grup 3 (PRP enjeksiyonu), Grup 4 (artrosentez + PRP enjeksiyonu) olmak üzere 4 gruba ayrılmıştır. Bulgular: Bu çalışmaya göre tüm zaman aralıklarında ve tüm semptomlarda Grup 1 ve Grup 3 ile Grup 2 ve Grup 4 arasında istatistiksel olarak anlamlı bir ilişki bulunmamıştır. 6. ayın sonunda Grup 4 ile Grup 1 ve Grup 3 arasında VAS ve MAA değerlerinde anlamlı bir ilişki bulunmuştur, Grup 4 ile Grup 2 arasında ise anlamlı bir ilişki bulunmamakla birlikte PRP grubunda ortalama değerlerin daha yüksek olduğu görülmüştür. Sonuç: Artrosentez sonrası enjeksiyonların uygulandığı grupların, artrosentez yapılmaksızın enjeksiyonların uygulandığı gruplara göre daha başarılı olduğu görülmüştür. Redüksiyonsuz disk deplasmanlı temporomandibular eklem tedavisinde PRP enjeksiyonu oldukça başarılı sonuçlar göstermiştir.

Anahtar Kelimeler: Temporomandibular eklem; artrosentez; trombositten zengin plazma; hyaluronik asit
REFERENCES:
  1. Buescher JJ. Temporomandibular joint disorders. Am Fam Physician. 2007;76(10):1477-82. [PubMed] 
  2. Nitzan DW. The process of lubrication impairment and its involvement in temporomandibular joint disc displacement: a theoretical concept. J Oral Maxillofac Surg. 2001;59(1):36-45. [Crossref]  [PubMed] 
  3. Zhu P, Lin H, Zhou Q, Lv J, Zhang Z, Xu Y. Dynamic evaluation of lavage efficacy in upper compartment of the temporomandibular joint. J Oral Maxillofac Surg. 2017;75(2):276-83. [Crossref]  [PubMed] 
  4. Cömert Kiliç S, Güngörmüş M. Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis plus hyaluronic acid for the treatment of temporomandibular joint osteoarthritis: a randomized clinical trial. Int J Oral Maxillofac Surg. 2016;45(12):1538-44. [Crossref]  [PubMed] 
  5. Giacomello M, Giacomello A, Mortellaro C, Gallesio G, Mozzati M. Temporomandibular joint disorders treated with articular injection: the effectiveness of plasma rich in growth factors-Endoret. J Craniofac Surg. 2015;26(3):709-13. [Crossref]  [PubMed] 
  6. Wilkes CH. Internal derangements of the temporomandibular joint. Pathological variations. Northwest Dent. 1990;69(2):25-32. [PubMed] 
  7. Sato S, Kawamura H. Evaluation of mouth opening exercise after pumping of the temporomandibular joint in patients with nonreducing disc displacement. J Oral Maxillofac Surg. 2008;66(3):436-40. [Crossref] 
  8. Ungor C, Atasoy KT, Taskesen F, Pirpir C, Yilmaz O. Long-Term Outcome of Arthrocentesis Plus Hyaluronic Acid Injection in Patients With Wilkes Stage II and III Temporomandibular Joint Internal Derangement. J Craniofac Surg. 2015;26(7):2104-8. [Crossref]  [PubMed] 
  9. Frost DE, Kendell BD. Part II: The use of arthrocentesis for treatment of temporomandibular joint disorders. J Oral Maxillofac Surg. 1999;57(5):583-7. [Crossref]  [PubMed] 
  10. Karadayi U, Gursoytrak B. Randomised controlled trial of arthrocentesis with or without PRF for internal derangement of the TMJ. J Craniomaxillofac Surg. 2021;49(5):362-7. [Crossref]  [PubMed] 
  11. Nitzan DW, Svidovsky J, Zini A, Zadik Y. Effect of arthrocentesis on symptomatic osteoarthritis of the temporomandibular joint and analysis of the effect of preoperative clinical and radiologic features. J Oral Maxillofac Surg. 2017;75(2):260-7. [Crossref]  [PubMed] 
  12. Diraçoğlu D, Saral IB, Keklik B, Kurt H, Emekli U, Ozçakar L, et al. Arthrocentesis versus nonsurgical methods in the treatment of temporomandibular disc displacement without reduction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;108(1):3-8. [Crossref]  [PubMed] 
  13. Dasukil S, Arora G, Shetty S, Degala S. Impact of prolotherapy in temporomandibular joint disorder: a quality of life assessment. Br J Oral Maxillofac Surg. 2021;59(5):599-604. [Crossref]  [PubMed] 
  14. Dasukil S, Shetty SK, Arora G, Degala S. Efficacy of Prolotherapy in Temporomandibular Joint Disorders: An Exploratory Study. J Maxillofac Oral Surg. 2021;20(1):115-120. [Crossref] 
  15. Giraddi GB, Siddaraju A, Kumar A, Jain T. Comparison Between Betamethasone and Sodium Hyaluronate Combination with Betamethasone Alone After Arthrocentesis in the Treatment of Internal Derangement of TMJ-Using Single Puncture Technique: A Preliminary Study. J Maxillofac Oral Surg. 2015;14(2):403-9. [Crossref]  [PubMed]  [PMC] 
  16. Gurung T, Singh RK, Mohammad S, Pal US, Mahdi AA, Kumar M. Efficacy of arthrocentesis versus arthrocentesis with sodium hyaluronic acid in temporomandibular joint osteoarthritis: A comparison. Natl J Maxillofac Surg. 2017;8(1):41-9. [Crossref]  [PubMed]  [PMC] 
  17. De Riu G, Stimolo M, Meloni SM, Soma D, Pisano M, Sembronio S, Tullio A. Arthrocentesis and temporomandibular joint disorders: clinical and radiological results of a prospective study. Int J Dent. 2013;2013:790648. [Crossref]  [PubMed]  [PMC] 
  18. Hegab AF, Ali HE, Elmasry M, Khallaf MG. Platelet-rich plasma injection as an effective treatment for temporomandibular joint osteoarthritis. J Oral Maxillofac Surg. 2015;73(9):1706-13. [Crossref]  [PubMed] 
  19. Cömert Kiliç S, Güngörmüş M, Sümbüllü MA. Is Arthrocentesis Plus Platelet-Rich Plasma Superior to Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial. J Oral Maxillofac Surg. 2015;73(8):1473-83. [Crossref]  [PubMed] 
  20. Fernández Sanromán J, Fernández Ferro M, Costas López A, Arenaz Bua J, López A. Does injection of plasma rich in growth factors after temporomandibular joint arthroscopy improve outcomes in patients with Wilkes stage IV internal derangement? A randomized prospective clinical study. Int J Oral Maxillofac Surg. 2016;45(7):828-35. [Crossref]  [PubMed] 
  21. Haigler MC, Abdulrehman E, Siddappa S, Kishore R, Padilla M, Enciso R. Use of platelet-rich plasma, platelet-rich growth factor with arthrocentesis or arthroscopy to treat temporomandibular joint osteoarthritis: Systematic review with meta-analyses. J Am Dent Assoc. 2018;149(11):940-52.e2. [Crossref]  [PubMed] 
  22. Alpaslan C, Alpaslan G, Güner B. Erken dönem temporomandibuler internal düzensizliklerinde farklı tedavi yöntemlerinin etkinliklerinin karşılaştırmalı olarak incelenmesi [Comparative evaluation of the efficacy of different treatment modalities in early stage temporomandibular joint internal derangements]. Acta Odontologica Turcica. 2000;17(2):7-12. [Link] 
  23. Bouloux GF, Chou J, Krishnan D, Aghaloo T, Kahenasa N, Smith JA, et al. Is Hyaluronic Acid or Corticosteroid Superior to Lactated Ringer Solution in the Short-Term Reduction of Temporomandibular Joint Pain After Arthrocentesis? Part 1. J Oral Maxillofac Surg. 2017;75(1):52-62. [Crossref]  [PubMed] 
  24. Dasukil S, Arora G, Boyina KK, Jena AK, Jose A, Das S. Intra-articular injection of hyaluronic acid versus platelet-rich plasma following single puncture arthrocentesis for the management of internal derangement of TMJ: A double-blinded randomised controlled trial. J Craniomaxillofac Surg. 2022;50(11):825-30. [Crossref]  [PubMed] 
  25. Egemen A, Kesmezacar H, Akgun I. Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World Journal of Orthopedics. 2014;5(3):351-61. [Crossref] 
  26. Wroblewski AP, Mejia HA, Wright VJ. Application of platelet-rich plasma to enhance tissue repair. Operative Techniques in Orthopaedics. 2010;20(2):98-105. [Crossref] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com