Non-Cochrane · intervention · PM42306021
Arthrocentesis Plus Injectable Platelet-Rich Fibrin in Patients With Temporomandibular Joint Dysfunction: An Updated Meta-Analysis With Trial Sequential Analysis.
Bader Alzamanan Maryam, Mohammed Alhajri Dhari, Hamed Alduaij Fay, et al. · Cureus · 2026 · PubMed · doi:10.7759/cureus.110871
Findings
Population Patients with temporomandibular joint dysfunction (internal derangement, disc displacement or osteoarthritis)
30 findings
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Sharma 2023 | MD -1.86 [-2.35, -1.37] GRADE not reported 7 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Maximum mouth opening (MMO), change from baseline Follow-up 3 to 12 months · Not specified | MD 5.03 [2.99, 7.07] 5.03 [2.99, 7.07] mm Moderate Downgraded: imprecision 7 studies · 270 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Not specified · Not specified · Pain type: overall of chewing, jaw movement and palpation pain (6 effect sizes from 2 trials) | MD -1.59 [-1.88, -1.3] GRADE not reported 2 studies · 112 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Nasef 2024 | MD -1.64 [-2.41, -0.86] GRADE not reported 7 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Maximum mouth opening (MMO), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Karadayi 2021 | MD 5.12 [2.87, 7.37] GRADE not reported 6 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline 9-12 months · Not specified · Follow-up 9-12 months | MD -1.13 [-2.13, -0.12] GRADE not reported 3 studies · 140 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Isık 2022 | MD -1.68 [-2.46, -0.91] GRADE not reported 7 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Right lateral excursion, change from baseline Follow-up 3 to 12 months · Not specified | MD 2.05 [-0.63, 4.74] 2.05 [-0.63, 4.74] mm Moderate Downgraded: imprecision 2 studies · 70 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Karadayi 2021 | MD -1.5 [-2.18, -0.81] GRADE not reported 7 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline 3 months · Not specified · Follow-up 3 months | MD -2.13 [-3.75, -0.51] GRADE not reported 3 studies · 88 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline 6 months · Not specified · Follow-up 6 months | MD -1.83 [-2.43, -1.24] GRADE not reported 2 studies · 70 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Follow-up 3 to 12 months · Not specified | MD -1.62 [-2.28, -0.96] -1.62 [-2.28, -0.96] VAS points Moderate Downgraded: imprecision 8 studies · 298 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Ghoneim 2022 | MD -1.55 [-2.33, -0.77] GRADE not reported 7 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Isık 2023 | MD -1.57 [-2.36, -0.78] GRADE not reported 7 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Maximum mouth opening (MMO), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Ghoneim 2022 | MD 3.94 [3.14, 4.73] GRADE not reported 6 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Not specified · Not specified · Pain type: palpation pain | MD -1.66 [-2.18, -1.14] GRADE not reported 2 studies · 112 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Contralateral excursion, change from baseline Follow-up 3 to 12 months · Not specified | MD 0.94 [0.41, 1.48] 0.94 [0.41, 1.48] mm Moderate Downgraded: imprecision 3 studies · 144 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Maximum mouth opening (MMO), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Chaulagain 2025 | MD 4.85 [2.33, 7.38] GRADE not reported 6 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Follow-up 3 to 12 months · Not specified · Meta-regression on baseline MMO (mm) | Meta-regression coefficient 0.0232 [-0.2078, 0.2542] GRADE not reported 8 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Yilmaz 2026 | MD -1.73 [-2.41, -1.05] GRADE not reported 7 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Left lateral excursion, change from baseline Follow-up 3 to 12 months · Not specified | MD 0.68 [-1.57, 2.94] 0.68 [-1.57, 2.94] mm Moderate Downgraded: imprecision 2 studies · 70 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Maximum mouth opening (MMO), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Yilmaz 2026 | MD 5.39 [3.29, 7.5] GRADE not reported 6 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Not specified · Not specified · Pain type: pain during jaw movements | MD -1.61 [-2.26, -0.95] GRADE not reported 2 studies · 112 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Maximum mouth opening (MMO), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Nasef 2024 | MD 4.99 [2.5, 7.48] GRADE not reported 6 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Maximum mouth opening (MMO), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Isık 2022 | MD 5.51 [3.06, 7.96] GRADE not reported 6 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Protrusive movement, change from baseline Follow-up 3 to 12 months · Not specified | MD 1.08 [0.48, 1.69] 1.08 [0.48, 1.69] mm Moderate Downgraded: imprecision 3 studies · 144 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Maximum mouth opening (MMO), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Isık 2023 | MD 5.31 [2.66, 7.96] GRADE not reported 6 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Quality of life (OHIP-14), change from baseline Follow-up 3 to 12 months · Not specified | MD -3.61 [-10.87, 3.65] -3.61 [-10.87, 3.65] OHIP-14 points Moderate Downgraded: imprecision 2 studies · 52 participants |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Follow-up 3 to 12 months · Not specified · Leave-one-out sensitivity analysis, omitting Chaulagain 2025 | MD -1.44 [-2.06, -0.81] GRADE not reported 7 studies |
| Arthrocentesis plus injectable platelet-rich fibrin (i-PRF) | Control interventions (mainly arthrocentesis alone) | Pain (VAS), change from baseline Not specified · Not specified · Pain type: chewing pain | MD -1.49 [-1.99, -0.99] GRADE not reported 2 studies · 112 participants |
Included primary studies 9
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 DOI:10.1016/j.jcms.2021.01.018 | 2021 | 2 other reviews | Pain (VAS), change from baseline; Maximum mouth opening (MMO), change from baseline | not extracted yet |
| Chaulagain 2025 Does Combining Arthrocentesis With Injectable Platelet-Rich Fibrin Outperform Arthrocentesis or Injectable Platelet-Rich Fibrin Alone in… DOI:10.1016/j.joms.2025.02.006 | 2025 | 1 other review | Pain (VAS), change from baseline; Maximum mouth opening (MMO), change from baseline; Contralateral excursion, change from baseline; Protrusive movement, change from baseline; Quality of life (OHIP-14), change from baseline | not extracted yet |
| Isik 2022 Injectable platelet-rich fibrin as treatment for temporomandibular joint osteoarthritis: A randomized controlled clinical trial DOI:10.1016/j.jcms.2022.06.006 | 2022 | 1 other review | Pain (VAS), change from baseline; Maximum mouth opening (MMO), change from baseline; Contralateral excursion, change from baseline; Protrusive movement, change from baseline | not extracted yet |
| Sharma 2023 A comparative analysis between intra articular injections of injectable platelet rich fibrin versus platelet rich plasma in the management… PMID:37661973 | 2023 | 1 other review | Pain (VAS), change from baseline | not extracted yet |
| Ghoneim 2022 Treatment of temporomandibular joint disc displacement using arthrocentesis combined with injectable platelet rich fibrin versus… DOI:10.1016/j.jds.2021.07.027 | 2022 | this review only | Pain (VAS), change from baseline; Maximum mouth opening (MMO), change from baseline; Right lateral excursion, change from baseline; Left lateral excursion, change from baseline | not extracted yet |
| Isik 2023 Does the Use of Injectable Platelet-Rich Fibrin After Arthrocentesis for Disc Displacement Without Reduction Improve Clinical Outcomes? DOI:10.1016/j.joms.2023.02.014 | 2023 | this review only | Pain (VAS), change from baseline; Maximum mouth opening (MMO), change from baseline; Contralateral excursion, change from baseline; Protrusive movement, change from baseline | not extracted yet |
| Metello Neves 2026 Injectable Platelet Rich Fibrin (i-PRF) for Joint Sounds and Clinical Signs of Disc Displacement by DC/TMD: A Randomized Controlled Trial DOI:10.58600/eurjther2853 | 2026 | this review only | not stated | not extracted yet |
| Nasef 2024 Evaluation of intra-articular injection of injectable platelet-rich fibrin, anterior repositioning splint and arthrocentesis in treatment… DOI:10.1016/j.bjoms.2024.05.002 | 2024 | this review only | Pain (VAS), change from baseline; Maximum mouth opening (MMO), change from baseline; Right lateral excursion, change from baseline; Left lateral excursion, change from baseline | not extracted yet |
| Yilmaz 2026 Efficacy of injectable platelet-rich fibrin and concentrated platelet-rich fibrin injections combined with arthrocentesis in the… DOI:10.1016/j.jcms.2026.104447 | 2026 | this review only | Pain (VAS), change from baseline; Maximum mouth opening (MMO), change from baseline; Quality of life (OHIP-14), change from baseline | 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 | Patients diagnosed with symptomatic TMD internal derangement | TMD patients with internal derangement (Wilkes I-V), disc displacement with or without reduction, or osteoarthritis (n=320 patients, 374 joints) |
| Intervention | Arthrocentesis of the upper joint space followed by intra-articular injection of i-PRF | Arthrocentesis plus i-PRF (n=9 RCTs); one trial used i-PRF without arthrocentesis |
| Comparison | Arthrocentesis alone or conservative/no active treatment | Arthrocentesis alone (most trials), PRP after arthrocentesis (n=1), Ringer lactate without arthrocentesis (n=1) |
| Outcomes | Primary: change in pain VAS. Secondary: MMO, contralateral, right and left lateral excursion, protrusive movement, QoL (OHIP-14) | Pain VAS (n=8); MMO (n=7); contralateral excursion (n=3); right lateral excursion (n=2); left lateral excursion (n=2); protrusive movement (n=3); QoL OHIP-14 (n=2) |
| Study designs | RCTs; observational studies, reviews and conference abstracts excluded | RCTs, parallel-group (n=9) |
| Timing | Not specified | Follow-up 3 to 12 months |
AMSTAR 2 items
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | No | No | yes |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | No | Partial Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |