Non-Cochrane · intervention · PM41816993
Efficacy and Safety of Intra-Articular Therapies for Temporomandibular Disorders: A Systematic Review and Meta-Analysis.
Dos Santos Mateus Gaya, da Rosa Wellington Luiz de Oliveira, Sbardelotto Cristian, et al. · Oral diseases · 2026 · PubMed · doi:10.1111/odi.70284
Findings
Population Adults with painful articular TMD (TMJ osteoarthritis and/or internal derangement)
19 findings
| Intra-articular hyaluronic acid (HA), alone or with arthrocentesis | Baseline (pre-treatment, T0) | Maximum mouth opening (MMO) 6 months (T6) versus baseline (T0) | MD 8.32 [5.58, 11.06] Low Downgraded: risk of bias, imprecision 4 studies · 81 participants |
| Intra-articular hyaluronic acid (HA), alone or with arthrocentesis | Baseline (pre-treatment, T0) | Pain intensity (VAS) 6 months (T6) versus baseline (T0) | MD 4.85 [3.99, 5.71] Low Downgraded: risk of bias, imprecision 4 studies · 81 participants |
| Intra-articular HA combined with platelet-rich plasma (PRP), with arthrocentesis | Baseline (pre-treatment, T0) | Maximum mouth opening (MMO) 6 months (T6) versus baseline (T0) | MD 10.1 [8.31, 11.89] Low Downgraded: risk of bias, imprecision 1 study · 10 participants |
| Intra-articular HA combined with platelet-rich plasma (PRP), with arthrocentesis | Baseline (pre-treatment, T0) | Pain intensity (VAS) 6 months (T6) versus baseline (T0) | MD 5.1 [4.52, 5.68] Low Downgraded: risk of bias, imprecision 1 study · 10 participants |
| Intra-articular PRP, with arthrocentesis | Baseline (pre-treatment, T0) | Maximum mouth opening (MMO) 6 months (T6) versus baseline (T0) | MD 10.46 [6.02, 14.89] Moderate Downgraded: risk of bias, imprecision 2 studies · 40 participants |
| Intra-articular PRP, with arthrocentesis | Baseline (pre-treatment, T0) | Pain intensity (VAS) 6 months (T6) versus baseline (T0) | MD 4.99 [3.13, 6.85] Moderate Downgraded: imprecision 2 studies · 40 participants |
| Intra-articular opioids (morphine and tramadol), with arthrocentesis | Baseline (pre-treatment, T0) | Pain intensity (VAS) 6 months (T6) versus baseline (T0) | MD 5.93 [5.03, 6.83] GRADE not reported 1 study · 20 participants |
| Intra-articular opioids (morphine and tramadol), with arthrocentesis | Baseline (pre-treatment, T0) | Maximum mouth opening (MMO) 6 months (T6) versus baseline (T0) | MD 3.34 [-0.87, 7.65] Low Downgraded: imprecision, inconsistency 1 study · 20 participants |
| Intra-articular 10% dextrose (prolotherapy) | Baseline (pre-treatment, T0) | Pain intensity (VAS) 6 months (T6) versus baseline (T0) | MD 3.07 [2.47, 3.67] GRADE not reported 1 study · 22 participants |
| Intra-articular 10% dextrose (prolotherapy) | Pre-treatment baseline (T0), within-group comparison | Pain intensity (VAS), reduction from baseline 6 months (T6) vs baseline (T0) · TMJ, minimally invasive procedures · Ultrasound-guided injection (US+) | MD 3.57 [2.36, 4.78] GRADE not reported 1 study · 11 participants |
| Intra-articular 10% dextrose (prolotherapy) | Pre-treatment baseline (T0), within-group comparison | Pain intensity (VAS), reduction from baseline 6 months (T6) vs baseline (T0) · TMJ, minimally invasive procedures · Non-ultrasound-guided injection (US-) | MD 2.91 [2.22, 3.60] GRADE not reported 1 study · 11 participants |
| Intra-articular tenoxicam (NSAID), with arthrocentesis | Baseline (pre-treatment, T0) | Maximum mouth opening (MMO) 6 months (T6) versus baseline (T0) | MD 11.5 [7.53, 15.47] Low Downgraded: risk of bias, imprecision 1 study · 16 participants |
| Intra-articular tenoxicam (NSAID), with arthrocentesis | Baseline (pre-treatment, T0) | Pain intensity (VAS) 6 months (T6) versus baseline (T0) | MD 7.44 [6.28, 8.6] GRADE not reported 1 study · 16 participants |
| Arthrocentesis with Ringer's lactate (RL) | Baseline (pre-treatment, T0) | Maximum mouth opening (MMO) 6 months (T6) versus baseline (T0) | MD 8.09 [4.41, 11.76] Low Downgraded: risk of bias, imprecision 4 studies · 69 participants |
| Arthrocentesis with Ringer's lactate (RL) | Baseline (pre-treatment, T0) | Pain intensity (VAS) 6 months (T6) versus baseline (T0) | MD 4.84 [4.39, 5.29] Low Downgraded: risk of bias, imprecision 4 studies · 69 participants |
| Arthrocentesis and/or intra-articular injection with any substance (all pooled) | Baseline (pre-treatment, T0) | Pain intensity (VAS) 6 months (T6) versus baseline (T0) | MD 4.97 [4.45, 6.46] GRADE not reported 7 studies · 258 participants |
| Arthrocentesis and/or intra-articular injection with any substance (all pooled) | Baseline (pre-treatment, T0) | Maximum mouth opening (MMO) 6 months (T6) versus baseline (T0) | MD 8.58 [7.01, 10.14] GRADE not reported 6 studies · 236 participants |
| One intra-articular HA injection | Baseline (pre-treatment, T0) | Pain intensity (VAS) 6 months (T6) versus baseline (T0) · one HA injection | MD 4.95 [3.33, 6.58] GRADE not reported 3 studies · 38 participants |
| Two intra-articular HA injections | Baseline (pre-treatment, T0) | Pain intensity (VAS) 6 months (T6) versus baseline (T0) · two HA injections | MD 4.71 [3.58, 5.84] GRADE not reported 2 studies · 43 participants |
Included primary studies 30
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Karadayi 2021 Randomised controlled trial of arthrocentesis with or without PRF for internal derangement of the TMJ. PMID:33581954 | 2021 | 4 other reviews | not stated | not extracted yet |
| Comert Kilic and Gungormus 2016b Is arthrocentesis plus platelet-rich plasma superior to arthrocentesis plus hyaluronic acid for the treatment of temporomandibular joint… PMID:27364372 | 2016 | 3 other reviews | not stated | not extracted yet |
| Isik 2022 Injectable platelet-rich fibrin as treatment for temporomandibular joint osteoarthritis: A randomized controlled clinical trial. PMID:35798596 | 2022 | 3 other reviews | not stated | not extracted yet |
| Bayramoglu 2023 Does intra-articular injection of tenoxicam after arthrocentesis heal outcomes of temporomandibular joint osteoarthritis? A randomized… PMID:36890529 | 2023 | 2 other reviews | not stated | not extracted yet |
| Bergstrand 2019 Long-term effectiveness of arthrocentesis with and without hyaluronic acid injection for treatment of temporomandibular joint… PMID:30814387 | 2019 | 2 other reviews | not stated | not extracted yet |
| Comert Kilic 2015 Is Arthrocentesis Plus Platelet-Rich Plasma Superior to Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis? A… PMID:25976690 | 2015 | 2 other reviews | not stated | not extracted yet |
| Comert Kilic 2021 Does glucosamine, chondroitin sulfate, and methylsulfonylmethane supplementation improve the outcome of temporomandibular joint… PMID:33685850 | 2021 | 2 other reviews | not stated | not extracted yet |
| Dasukil 2022 Intra-articular injection of hyaluronic acid versus platelet-rich plasma following single puncture arthrocentesis for the management of… PMID:36372680 | 2022 | 2 other reviews | not stated | not extracted yet |
| Isik 2023 Does the Use of Injectable Platelet-Rich Fibrin After Arthrocentesis for Disc Displacement Without Reduction Improve Clinical Outcomes? PMID:36924792 | 2023 | 2 other reviews | not stated | not extracted yet |
| Alhaj Kheder 2024 Ultrasound-Guided Vs Non-Guided Prolotherapy for Internal Derangement of Temporomandibular Joint. A Randomized Clinical Trial. PMID:38581185 | 2024 | 1 other review | not stated | not extracted yet |
| Asadpour 2022 Combined Platelet-Rich Plasma and Hyaluronic Acid can Reduce Pain in Patients Undergoing Arthrocentesis for Temporomandibular Joint… PMID:35679902 | 2022 | 1 other review | not stated | not extracted yet |
| Bertolami 1993 Use of sodium hyaluronate in treating temporomandibular joint disorders: a randomized, double-blind, placebo-controlled clinical trial. PMID:8445463 | 1993 | 1 other review | not stated | not extracted yet |
| Comert Kilic and Gungormus 2016a Is dextrose prolotherapy superior to placebo for the treatment of temporomandibular joint hypermobility? A randomized clinical trial. PMID:26846795 | 2016 | 1 other review | not stated | not extracted yet |
| Hegab 2015 Platelet-Rich Plasma Injection as an Effective Treatment for Temporomandibular Joint Osteoarthritis. PMID:25882438 | 2015 | 1 other review | not stated | not extracted yet |
| Isacsson 2019 Pain relief following a single-dose intra-articular injection of methylprednisolone in the temporomandibular joint arthralgia-A… PMID:30240024 | 2019 | 1 other review | not stated | not extracted yet |
| Olsen-Bergem 2014 A cohort study of patients with juvenile idiopathic arthritis and arthritis of the temporomandibular joint: outcome of arthrocentesis with… PMID:24794763 | 2014 | 1 other review | not stated | not extracted yet |
| Ozdamar 2017 The impact of arthrocentesis with and without hyaluronic acid injection in the prognosis and synovial fluid myeloperoxidase levels of… PMID:27973684 | 2017 | 1 other review | not stated | not extracted yet |
| Sipahi 2015 Comparative study in patients with symptomatic internal derangements of the temporomandibular joint: analgesic outcomes of arthrocentesis… PMID:25623934 | 2015 | 1 other review | not stated | not extracted yet |
| Yilmaz 2019 Comparison of treatment efficacy between hyaluronic acid and arthrocentesis plus hyaluronic acid in internal derangements of… PMID:31451342 | 2019 | 1 other review | not stated | not extracted yet |
| Ayesh 2008 Effects of intra-articular ketamine on pain and somatosensory function in temporomandibular joint arthralgia patients. PMID:17923328 | 2008 | this review only | not stated | not extracted yet |
| Castano-Joaqui 2021 TMJ arthroscopy with hyaluronic acid: A 12-month randomized clinical trial. PMID:32609918 | 2021 | this review only | not stated | not extracted yet |
| Fernandez-Ferro 2017 Comparison of intra-articular injection of plasma rich in growth factors versus hyaluronic acid following arthroscopy in the treatment of… PMID:28237253 | 2017 | this review only | not stated | not extracted yet |
| Guarda-Nardini 2015 Single- or multiple-session viscosupplementation protocols for temporomandibular joint degenerative disorders: a randomized clinical trial. PMID:25704621 | 2015 | this review only | not stated | not extracted yet |
| Haggag 2022 Dextrose prolotherapy for pain and dysfunction of the TMJ reducible disc displacement: A randomized, double-blind clinical study. PMID:35501215 | 2022 | this review only | not stated | not extracted yet |
| Hegab 2023 Synergistic effect of platelet rich plasma with hyaluronic acid injection following arthrocentesis to reduce pain and improve function in… PMID:36414172 | 2023 | this review only | not stated | not extracted yet |
| Hepguler 2002 The efficacy of intra-articular sodium hyaluronate in patients with reducing displaced disc of the temporomandibular joint. PMID:11844036 | 2002 | this review only | not stated | not extracted yet |
| Huddleston Slater 2012 Randomized trial on the effectiveness of dexamethasone in TMJ arthrocentesis. PMID:22157100 | 2012 | this review only | not stated | not extracted yet |
| Korkmaz 2016 Is Hyaluronic Acid Injection Effective for the Treatment of Temporomandibular Joint Disc Displacement With Reduction? PMID:27058964 | 2016 | this review only | not stated | not extracted yet |
| Mustafa 2018 Evaluation of the Efficacy of Different Concentrations of Dextrose Prolotherapy in Temporomandibular Joint Hypermobility Treatment. PMID:29533255 | 2018 | this review only | not stated | not extracted yet |
| Patel 2016 Sodium hyaluronate: an effective adjunct in temporomandibular joint arthrocentesis. PMID:27714459 | 2016 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Individuals diagnosed with painful articular TMD (TMJ osteoarthritis and/or internal derangement; DC/TMD, Wilkes, Helkimo or Hegab criteria) | Patients with TMJ osteoarthritis or internal derangement who had failed conservative treatment (30 RCTs; 71% women, mean age 32 years in the meta-analysis) |
| Intervention | Minimally invasive TMJ procedures: any intra-articular injection alone or with arthrocentesis | HA (n=81 pooled), HA + PRP (n=10), PRP (n=40), opioids morphine and tramadol (n=20), dextrose 10% (n=22), tenoxicam (n=16), Ringer's lactate (n=69); qualitative: ketamine, corticosteroids, saline, PRF/PRGF, dextrose 20% to 30% |
| Comparison | Pre-treatment (baseline, T0) versus post-treatment within-group comparisons | Baseline (T0) within-group; between-group comparisons only described qualitatively |
| Outcomes | Pain intensity (VAS) and maximum mouth opening (MMO); adverse events when reported | VAS pain (7 RCTs pooled) and MMO (6 RCTs pooled) at 6 months; adverse events (Table 2) |
| Study designs | Randomized clinical trials | 30 RCTs (7 in meta-analysis, 23 qualitative); RoB 2: 60% low risk, 40% some concerns |
| Timing | Follow-up of at least 1 month; meta-analysis restricted to 6-month follow-up (T0 vs T6) | 6 months for meta-analysis; 24 hours to 47 months in qualitative studies |