Effectiveness of treatments for temporomandibular joint osteoarthritis: a systematic review and meta-analysis.
Systematic Review
To evaluate the effectiveness of minimally invasive interventions (arthrocentesis and intra-articular injections) versus conservative therapies for temporomandibular joint osteoarthritis (TMJ OA)./r/nThis systematic review included randomized controlled and prospective or observational studies involving patients with TMJ OA. A comprehensive search of five databases was conducted up to November 2024. Pain intensity (VAS) and maximum mouth opening (MMO) were analyzed via meta-analysis, with risk of bias assessed using ROB 2 and ROBINS-I tools, and certainty of evidence using GRADE. The significance level adopted for the analysis was set at α = 0.05./r/nSixteen studies (901 patients) were included. Arthrocentesis, alone or with adjuvants such as PRP, i-PRF, corticosteroids, or NSAIDs, significantly improved pain (MD - 5.50; 95%CI: - 6.61 to - 4.39) and MMO (MD 6.97 mm; 95%CI: 1.96 to 11.98) versus baseline and between groups. Intra-articular hyaluronic acid, with or without glucosamine, showed clinical benefit over time, but its superiority over conservative care was inconsistent. Substantial heterogeneity was observed, mainly in injection-based protocols. GRADE indicated high certainty of evidence for most comparisons, except one (MMO, moderate certainty)./r/nMinimally invasive therapies, especially arthrocentesis with biological adjuvants, seems to be effective for TMJ OA management. However, due to heterogeneity and methodological limitations, their superiority over conservative strategies remains uncertain./r/nMinimally invasive therapies, particularly arthrocentesis with or without biological agents, may reduce pain and improve jaw function in TMJ OA, offering a potential alternative to conservative treatments over a 3- to 12-month period.
