Cochrane · intervention · CD004973

Arthrocentesis and lavage for treating temporomandibular joint disorders

Cochrane Database of Systematic Reviews · 2009 · Cochrane Library

Oral Health Oral and maxillofacial surgery Temporomandibular disorders and sleep2 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

as reported

No studies 5 · 50%Ungraded 5 · 50%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	All adult patients (>18 years) with temporomandibular joint disorders, regardless of race, gender, profession or residence; diagnoses such as synovitis, disc displacement with or without reduction, degenerative pathology or osteoarthritis of the temporomandibular joint (to be subjected to subgroup analyses)	81 patients with temporomandibular joint disorders (internal derangement: anterior disc displacement with and without reduction) across 2 RCTs; all had previously failed conservative therapy (n=81)
Intervention	Arthrocentesis and lavage for temporomandibular joint disorders	Arthrocentesis and lavage (n=37)
Comparison	Any other therapy for temporomandibular joint disorders (arthroscopy; physiotherapy; splint therapy; psychological interventions; oral medication) or no treatment/placebo	Arthroscopy (n=44)
Outcomes	Primary: relief of pain in the temporomandibular joint and masticatory muscles (evaluated short term <3 months and long term >=3 months); other clinical outcomes (headaches; joint sounds/crepitus; Helkimo anamnestic/dysfunction index). Secondary: patient subjective assessments (pain on face and jaw; joint clicking; dysfunction); clinical examination (maximum interincisal opening; lateral movement/protrusion; tenderness on palpation of TMJ and masticatory muscles; joint sounds); biochemical/physical indicators; quality of life; adverse events; withdrawals	Pain/VAS (n=62); Improvement in pain (n=62); Maximum incisal opening (n=81); Overall success compound score (n=19); Adverse reactions (n=62)
Study designs	All randomised controlled trials (RCTs), including quasi-randomised clinical trials	2 randomised arthroscopy-controlled trials (Fridrich 1996; Goudot 2000) (n=2)
Timing	Short term (<3 months) and long term (>=3 months)	Follow-up 6 to 24 months (mean 12.9 months) in Fridrich 1996; 1 year in Goudot 2000

Search date: 2009-08. Databases: Cochrane Oral Health Group's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (OVID); EMBASE (OVID); OpenSIGLE; Chinese Biomedical Literature Database (CBMdisc); Chinese Medical Library

Questions and results

Current version only

Arthrocentesis and lavage vs Arthroscopy

Population: Adults with temporomandibular joint disorders (internal derangement; anterior disc displacement with or without reduction) whose symptoms and/or clinical signs had not improved after conservative therapy

CD004973.PUB2 (current) · 10 questions

Outcome	Effect	Evidence	Status / GRADE
Adverse reactions 1 year same question in other reviews	Only Goudot 2000 reported adverse reactions. Arthroscopy group: one transient frontal palsy (during 3 months); one cervico-facial oedema requiring prolonged intubation (12 hours). Arthrocentesis group: two severe…	1 study · 62 participants	Ungraded
Quality of life same question in other reviews	No data about quality of life were reported by the included trials.	0 studies	No studies
Deviation of the mandible same question in other reviews	To date, no randomised controlled trial in this area reported deviation of the mandible.	0 studies	No studies
Pain (VAS) 24 months same question in other reviews	MD -1.00 [-2.12, 0.12]	1 study · 62 participants	Ungraded
Muscular tenderness same question in other reviews	To date, no randomised controlled trial in this area reported muscular tenderness.	0 studies	No studies
Overall success (compound score combining pain and MIO) 6 to 24 months same question in other reviews	RR 0.92 [0.56, 1.49]	1 study · 19 participants	Ungraded
Temporomandibular joint tenderness same question in other reviews	To date, no randomised controlled trial in this area reported temporomandibular joint tenderness.	0 studies	No studies
Maximum bite force same question in other reviews	To date, no randomised controlled trial in this area reported maximum bite force.	0 studies	No studies
Maximum incisal (mouth) opening (MIO) 6 to 24 months (Fridrich); 12 months (Goudot) same question in other reviews	MD -5.28 [-7.10, -3.46]	2 studies · 81 participants	Ungraded
Improvement in pain (proportion of participants improved/healed) 1 year same question in other reviews	RR 1.09 [0.87, 1.38]	1 study · 62 participants	Ungraded

Arthrocentesis and lavage vs Any other therapy for TMD (physiotherapy; psychological interventions; splint therapy; pharmacological interventions) or no treatment/placebo

Population: Adult patients (>18 years) with temporomandibular disorders (TMD), regardless of race, gender, profession or residence; diagnoses including synovitis, disc displacement with or without reduction, degenerative pathology or osteoarthritis of the TMJ

CD004973 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	no estimate extracted	0 studies	No studies