Abstract
The aim of this study was to determine whether arthrocentesis is superior to conservative
treatment in the management of painful temporomandibular joint disorders with restricted
opening. A systematic review was undertaken of prospective randomized controlled trials
(RCT) comparing arthrocentesis to conservative management, identified in the MEDLINE
and PubMed databases. Inclusion criteria included a 6-month follow-up, with clinical
assessment of the patients and painful restricted mouth opening. Data extracted included
pain measured on a visual analogue scale and maximum mouth opening measured in millimetres.
Risk of bias was assessed using the Cochrane Risk of Bias Tool 2 for RCTs, and a meta-analysis
with the random-effects model was undertaken. Of 879 records retrieved, seven met
the inclusion criteria; these RCTs reported the results at 6 months for 448 patients.
One study had a low risk of bias, four studies had an uncertain risk, and two had
a high risk of bias. In the meta-analysis, arthrocentesis was statistically superior
to conservative management at 6 months for an increase in maximum mouth opening (1.12 mm,
95% confidence interval 0.45–1.78 mm; P = 0.001; I2 = 87%) and borderline superior for pain reduction (−1.09 cm, 95% confidence interval
−2.19 to 0.01 cm; P = 0.05; I2 = 100%). However, these differences are unlikely to be clinically relevant.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to International Journal of Oral and Maxillofacial SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network* and Orofacial Pain Special Interest Group†.J Oral Facial Pain Headache. 2014; 28: 6-27
- Painful temporomandibular disorder: decade of discovery from OPPERA studies.J Dent Res. 2016; 95: 1084-1092
- Correlation between clinical diagnosis based on RDC/TMD and MRI findings of TMJ internal derangement.Int J Oral Maxillofac Surg. 2012; 41: 103-108
- Arthroscopy versus arthrocentesis for treating internal derangements of the temporomandibular joint.Oral Maxillofac Surg Clin N Am. 2018; 30: 325-328
- Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening.J Oral Maxillofac Surg. 1991; 49 (discussion 1168–1170): 1163-1167
- Effects of four treatment strategies for temporomandibular joint closed lock.Int J Oral Maxillofac Surg. 2014; 43: 217-226
- Manual therapy and exercise in temporomandibular joint disc displacement without reduction. A systematic review.Cranio. 2022; 40: 440-450
- Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction.J Dent Res. 2001; 80: 924-928
- Effects of cognitive behavioral therapy on orofacial pain conditions.J Oral Sci. 2020; 63: 4-7
- Lavage therapy versus nonsurgical therapy for the treatment of arthralgia of the temporomandibular joint: a systematic review of randomized controlled trials.J Orofac Pain. 2013; 27: 171-179
- Temporomandibular lavage versus nonsurgical treatments for temporomandibular disorders: a systematic review and meta-analysis.J Oral Maxillofac Surg. 2017; 75: 1352-1362
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.BMJ. 2009; 339b2700
- How to use the medical subject headings (MeSH).Int J Clin Pract. 2016; 70: 171-174
- EndNote. Clarivate, Philadelphia, PA2013
- RoB 2: a revised tool for assessing risk of bias in randomised trials.BMJ. 2019; 366l4898
Microsoft Excel 2019. Redmond, WA: Microsoft Corporation, 2019.
Review Manager (RevMan 5.4). The Cochrane Collaboration, 2020.
- Dealing with substantial heterogeneity in Cochrane reviews. Cross-sectional study.BMC Med Res Methodol. 2011; 1122
- Effect of simultaneous application of arthrocentesis and occlusal splint versus splint in management of non-reducing TMJ disc displacement.J Dent Sci. 2021; 16: 732-737
- Evaluation of the effects of occlusal splint, trigger point injection and arthrocentesis in the treatment of internal derangement patients with myofascial pain disorders.J Craniomaxillofac Surg. 2018; 46: 916-922
- Therapeutic effects of arthrocentesis in treatment of temporomandibular joint disorders.Bratisl Lek Listy. 2019; 120: 235-239
- Intramuscular botulinum toxin injection additional to arthrocentesis in the management of temporomandibular joint pain.Oral Surg Oral Med Oral Pathol Oral Radiol. 2016; 122: e99-e106
- Short-term treatment outcome study for the management of temporomandibular joint closed lock. A comparison of arthrocentesis to nonsurgical therapy and arthroscopic lysis and lavage.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995; 80: 253-257
- Arthrocentesis versus nonsurgical methods in the treatment of temporomandibular disc displacement without reduction.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 108: 3-8
- A comparison of the outcomes of four minimally invasive treatment methods for anterior disc displacement of the temporomandibular joint.Int J Oral Maxillofac Surg. 2017; 46: 1403-1410
- Comparison of the effectiveness of three different treatment methods for temporomandibular joint disc displacement without reduction.Int J Oral Maxillofac Surg. 2017; 46: 603-609
- Evaluation of the efficacy of different treatment modalities for painful temporomandibular disorders.Int J Oral Maxillofac Surg. 2020; 49: 628-635
- Arthrocentesis as initial treatment for temporomandibular joint arthropathy: a randomized controlled trial.J Craniomaxillofac Surg. 2014; 42: e134-e139
- Conservative therapy versus arthrocentesis for the treatment of symptomatic disk displacement without reduction: a prospective randomized controlled study.Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 128: 18-24
- Arthrocentesis versus nonsurgical methods in the management of temporomandibular joint closed lock and pain: a double-blind randomized controlled trial.Oral Surg Oral Med Oral Pathol Oral Radiol. 2022; 133: 369-376
Article info
Publication history
Published online: January 31, 2023
Accepted:
December 9,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
