Meta-Analysis TMJ Disorders|Articles in Press

A systematic review and meta-analysis of randomized controlled trials comparing arthrocentesis with conservative management for painful temporomandibular joint disorder

Published:January 31, 2023DOI:


      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.


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        • Schiffman E.
        • Ohrbach R.
        • Truelove E.
        • Look J.
        • Anderson G.
        • Goulet J.P.
        • List T.
        • Svensson P.
        • Gonzalez Y.
        • Lobbezoo F.
        • Michelotti A.
        • Brooks S.L.
        • Ceusters W.
        • Drangsholt M.
        • Ettlin D.
        • Gaul C.
        • Goldberg L.J.
        • Haythornthwaite J.A.
        • Hollender L.
        • Jensen R.
        • John M.T.
        • De Laat A.
        • de Leeuw R.
        • Maixner W.
        • van der Meulen M.
        • Murray G.M.
        • Nixdorf D.R.
        • Palla S.
        • Petersson A.
        • Pionchon P.
        • Smith B.
        • Visscher C.M.
        • Zakrzewska J.
        • Dworkin S.F.
        • International RDC/TMD Consortium Network
        • International Association for Dental Research
        • Orofacial Pain Special Interest Group
        • International Association for the Study of Pain
        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
        • Slade G.D.
        • Ohrbach R.
        • Greenspan J.D.
        • Fillingim R.B.
        • Bair E.
        • Sanders A.E.
        • Dubner R.
        • Diatchenko L.
        • Meloto C.B.
        • Smith S.
        • Maixner W.
        Painful temporomandibular disorder: decade of discovery from OPPERA studies.
        J Dent Res. 2016; 95: 1084-1092
        • Park J.W.
        • Song H.H.
        • Roh H.S.
        • Kim Y.K.
        • Lee J.Y.
        Correlation between clinical diagnosis based on RDC/TMD and MRI findings of TMJ internal derangement.
        Int J Oral Maxillofac Surg. 2012; 41: 103-108
        • Laskin D.M.
        Arthroscopy versus arthrocentesis for treating internal derangements of the temporomandibular joint.
        Oral Maxillofac Surg Clin N Am. 2018; 30: 325-328
        • Nitzan D.W.
        • Dolwick M.F.
        • Martinez G.A.
        Temporomandibular joint arthrocentesis: a simplified treatment for severe, limited mouth opening.
        J Oral Maxillofac Surg. 1991; 49 (discussion 1168–1170): 1163-1167
        • Schiffman E.L.
        • Velly A.M.
        • Look J.O.
        • Hodges J.S.
        • Swift J.Q.
        • Decker K.L.
        • Anderson Q.N.
        • Templeton R.B.
        • Lenton P.A.
        • Kang W.
        • Fricton J.R.
        Effects of four treatment strategies for temporomandibular joint closed lock.
        Int J Oral Maxillofac Surg. 2014; 43: 217-226
        • La Touche R.
        • Boo-Mallo T.
        • Zarzosa-Rodríguez J.
        • Paris-Alemany A.
        • Cuenca-Martínez F.
        • Suso-Martí L.
        Manual therapy and exercise in temporomandibular joint disc displacement without reduction. A systematic review.
        Cranio. 2022; 40: 440-450
        • Minakuchi H.
        • Kuboki T.
        • Matsuka Y.
        • Maekawa K.
        • Yatani H.
        • Yamashita A.
        Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction.
        J Dent Res. 2001; 80: 924-928
        • Noma N.
        • Watanabe Y.
        • Shimada A.
        • Usuda S.
        • Iida T.
        • Shimada A.
        • Tanaka Y.
        • Oono Y.
        • Sasaki K.
        Effects of cognitive behavioral therapy on orofacial pain conditions.
        J Oral Sci. 2020; 63: 4-7
        • Vos L.M.
        • Huddleston Slater J.J.
        • Stegenga B.
        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
        • Bouchard C.
        • Goulet J.P.
        • El-Ouazzani M.
        • Turgeon A.F.
        Temporomandibular lavage versus nonsurgical treatments for temporomandibular disorders: a systematic review and meta-analysis.
        J Oral Maxillofac Surg. 2017; 75: 1352-1362
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • Mulrow C.
        • Gøtzsche P.C.
        • Ioannidis J.P.
        • Clarke M.
        • Devereaux P.J.
        • Kleijnen J.
        • Moher D.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339b2700
        • Baumann N.
        How to use the medical subject headings (MeSH).
        Int J Clin Pract. 2016; 70: 171-174
        • The EndNote Team
        EndNote. Clarivate, Philadelphia, PA2013
        • Sterne J.A.C.
        • Savović J.
        • Page M.J.
        • Elbers R.G.
        • Blencowe N.S.
        • Boutron I.
        • Cates C.J.
        • Cheng H.Y.
        • Corbett M.S.
        • Eldridge S.M.
        • Emberson J.R.
        • Hernán M.A.
        • Hopewell S.
        • Hróbjartsson A.
        • Junqueira D.R.
        • Jüni P.
        • Kirkham J.J.
        • Lasserson T.
        • Li T.
        • McAleenan A.
        • Reeves B.C.
        • Shepperd S.
        • Shrier I.
        • Stewart L.A.
        • Tilling K.
        • White I.R.
        • Whiting P.F.
        • Higgins J.P.T.
        RoB 2: a revised tool for assessing risk of bias in randomised trials.
        BMJ. 2019; 366l4898
      1. Microsoft Excel 2019. Redmond, WA: Microsoft Corporation, 2019.

      2. Review Manager (RevMan 5.4). The Cochrane Collaboration, 2020.

        • Schroll J.B.
        • Moustgaard R.
        • Gøtzsche P.C.
        Dealing with substantial heterogeneity in Cochrane reviews. Cross-sectional study.
        BMC Med Res Methodol. 2011; 1122
        • Altaweel A.A.
        • Ismail H.A.
        • Fayad M.I.
        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
        • Bilici I.Ş.
        • Emes Y.
        • Aybar B.
        • Yalçın S.
        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
        • Malachovsky I.
        • Statelova D.
        • Stasko J.
        • Mikuskova K.
        • Smatanova M.
        • Janickova M.
        Therapeutic effects of arthrocentesis in treatment of temporomandibular joint disorders.
        Bratisl Lek Listy. 2019; 120: 235-239
        • Ivask O.
        • Leibur E.
        • Akermann S.
        • Tamme T.
        • Voog-Oras Ü.
        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
        • Murakami K.
        • Hosaka H.
        • Moriya Y.
        • Segami N.
        • Iizuka T.
        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
        • Diraçoğlu D.
        • Saral I.B.
        • Keklik B.
        • Kurt H.
        • Emekli U.
        • Ozçakar L.
        • Karan A.
        • Aksoy C.
        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
        • Hosgor H.
        • Bas B.
        • Celenk C.
        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
        • Tatli U.
        • Benlidayi M.E.
        • Ekren O.
        • Salimov F.
        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
        • Abbasgholizadeh Z.S.
        • Evren B.
        • Ozkan Y.
        Evaluation of the efficacy of different treatment modalities for painful temporomandibular disorders.
        Int J Oral Maxillofac Surg. 2020; 49: 628-635
        • Vos L.M.
        • Huddleston Slater J.J.
        • Stegenga B.
        Arthrocentesis as initial treatment for temporomandibular joint arthropathy: a randomized controlled trial.
        J Craniomaxillofac Surg. 2014; 42: e134-e139
        • Öhrnell Malekzadeh B.
        • Johansson Cahlin B.
        • Widmark G.
        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
        • Ritto F.G.
        • Cueto A.P.
        • Dos Santos Canellas J.V.
        • Zuniga J.R.
        • Tiwana P.S.
        • Pimentel T.
        • Medeiros P.J.
        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