Efficacy and Safety of Intra-Articular Therapies for Temporomandibular Disorders: A Systematic Review and Meta-Analysis
Abstract
Objective: This systematic review and meta-analysis aimed to evaluate the most effective minimally invasive intra-articular procedure for reducing pain and improving maximum mouth opening (MMO) in individuals diagnosed with painful articular TMD, specifically TMJ osteoarthritis and/or internal derangement.
Materials and methods: Only randomized clinical trials (RCTs) assessing the efficacy of minimally invasive procedures, such as arthrocentesis and intra-articular injection (IAI), were included. The meta-analysis included seven studies with a 6-month follow-up, while 23 studies with different follow-up periods were evaluated qualitatively.
Results: The meta-analysis showed that IAI with tenoxicam was the most effective procedure for pain reduction, with the highest [7.44 mean difference (MD); 6.28-8.60 confidence interval (CI)], followed by opioids (5.93; 5.03-6.83), the combination of hyaluronic acid (HA) with platelet-rich plasma (PRP) (5.10; 4.52-5.68), and PRP alone (4.99; 3.13-6.85). For improvement in MMO, tenoxicam had the highest MD (+11.50 mm; 15.47-7.53), followed by PRP (+10.46 mm; 14.89-6.02) and the HA-PRP combination (+10.10 mm; 11.89-8.31).
Conclusions: Tenoxicam showed promising results for pain reduction and improvement in MMO, although the evidence remains limited, followed by opioids and the combination of HA and PRP with arthrocentesis. Further high-quality studies are needed to confirm their clinical applicability.
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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