Non-Cochrane · intervention · PM42920771
Efficacy of combined therapies on degenerative joint disease of the temporomandibular joint: A systematic review and meta-analysis.
Sousa Uva Rodrigo, Januzzi Eduardo, De Pedro Miguel, et al. · Osteoarthritis and cartilage open · 2026 · PubMed · doi:10.1016/j.ocarto.2026.100885
Findings
Population Adults with advanced temporomandibular joint degenerative disease
14 findings
| Orthobiologics | Hyaluronic acid | Maximum mouth opening Latest consistent timepoint | MD 3.04 [1.4, 4.68] GRADE not reported 6 studies |
| Orthobiologics | Hyaluronic acid | Pain (VAS) Latest consistent timepoint | MD -0.71 [-1.11, -0.32] GRADE not reported 6 studies |
| Orthobiologics | Arthrocentesis alone | Pain (VAS) Latest consistent timepoint | MD -1.57 [-2.11, -1.04] GRADE not reported 6 studies |
| Orthobiologics | Arthrocentesis alone | Maximum mouth opening Latest consistent timepoint | MD 3.46 [2.31, 4.62] GRADE not reported 6 studies |
| Microfragmented adipose tissue | Hyaluronic acid | Pain (VAS) Latest consistent timepoint · Orthobiologic class | MD -0.97 [-2.05, 0.12] GRADE not reported 2 studies |
| Microfragmented adipose tissue | Hyaluronic acid | Maximum mouth opening Latest consistent timepoint · Orthobiologic class | MD 3.23 [1.37, 5.1] GRADE not reported 2 studies |
| Platelet-rich plasma, including HA + PRP | Hyaluronic acid | Pain (VAS) Latest consistent timepoint · Orthobiologic class | MD -0.55 [-1.28, 0.18] GRADE not reported 3 studies |
| Platelet-rich plasma, including HA + PRP | Hyaluronic acid | Maximum mouth opening Latest consistent timepoint · Orthobiologic class | MD 2.76 [-0.21, 5.72] GRADE not reported 3 studies |
| Injectable platelet-rich fibrin, including PRP + i-PRF | Arthrocentesis alone | Pain (VAS) Latest consistent timepoint · Orthobiologic class | MD -1.68 [-2.45, -0.9] GRADE not reported 4 studies |
| Injectable platelet-rich fibrin, including PRP + i-PRF | Arthrocentesis alone | Maximum mouth opening Latest consistent timepoint · Orthobiologic class | MD 2.76 [1.72, 3.8] GRADE not reported 4 studies |
| Platelet-rich plasma | Arthrocentesis alone | Maximum mouth opening Latest consistent timepoint · Orthobiologic class | MD 5.29 [3.71, 6.88] GRADE not reported 2 studies |
| Platelet-rich plasma | Arthrocentesis alone | Pain (VAS) Latest consistent timepoint · Orthobiologic class | MD -1.47 [-2.53, -0.41] GRADE not reported 2 studies |
| Intra-articular orthobiologics in dual joint space | Hyaluronic acid | Outcome NR Dual joint space | no estimate extracted No studies found 0 studies |
| Intra-articular orthobiologics in dual joint space | Arthrocentesis alone | Outcome NR Dual joint space | no estimate extracted No studies found 0 studies |
Included primary studies 35
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Abbadi 2022 Arthrocentesis, Injectable Platelet-Rich Plasma and Combination of Both Protocols of Temporomandibular Joint Disorders Management: A… PMID:36523721 | 2022 | 2 other reviews | not stated | not extracted yet |
| 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 | not stated | not extracted yet |
| Ângelo 2025 Double-Puncture Arthrocentesis in Arthrogenous TMJ Disorders: Bioviscosupplementation vs. Viscosupplementation a Randomized Controlled… PMID:40507514 | 2025 | 1 other review | not stated | 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 | not stated | not extracted yet |
| Fayed 2024 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Işık 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 | not stated | not extracted yet |
| Kumar 2025 Evaluation of injectable platelet-rich fibrin (I-PRF) as a treatment in internal derangement of temporomandibular joint. PMID:40510726 | 2025 | 1 other review | not stated | not extracted yet |
| Sielski 2025 Single intra-articular administration of injectable platelet-rich fibrin (I-PRF) in alleviating temporomandibular joint pain: A pilot… DOI:10.17219/dmp/188273 | 2025 | 1 other review | not stated | not extracted yet |
| Torul 2021 The efficacy of intra-articular injectable platelet-rich fibrin application in the management of Wilkes stage III temporomandibular joint… PMID:33771436 | 2021 | 1 other review | not stated | not extracted yet |
| Vingender 2023 Evaluation of the efficiency of hyaluronic acid, PRP and I-PRF intra-articular injections in the treatment of internal derangement of the… DOI:10.1016/j.jcms.2023.01.017 | 2023 | 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… DOI:10.1016/j.joms.2022.05.002 | 2022 | this review only | not stated | not extracted yet |
| Chaulagain 2025 Does Combining Arthrocentesis With Injectable Platelet-Rich Fibrin Outperform Arthrocentesis or Injectable Platelet-Rich Fibrin Alone in… PMID:40058764 | 2025 | this review only | 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… DOI:10.1016/j.jcms.2022.10.002 | 2022 | this review only | not stated | not extracted yet |
| Fayed 2024 Bone marrow aspirate concentrate – A novel approach to alter the course of temporomandibular joint osteoarthritis (a clinical study) DOI:10.1016/j.jormas.2023.101644 | 2024 | this review only | not stated | not extracted yet |
| Harba 2021 Evaluation of the participation of hyaluronic acid with platelet-rich plasma in the treatment of temporomandibular joint disorders DOI:10.17219/dmp/127446 | 2021 | this review only | not stated | not extracted yet |
| Harba 2021 Evaluation of the participation of hyaluronic acid with platelet-rich plasma in the treatment of temporomandibular joint disorders. PMID:33847473 | 2021 | this review only | not stated | not extracted yet |
| Hegab 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Januzzi 2025 Outcomes of modified arthrocentesis using concentric needle and cannula technique with sequential viscosupplementation and orthobiologics… DOI:10.1038/s41598-025-06715-1 | 2025 | this review only | not stated | not extracted yet |
| Januzzi 2025 Outcomes of modified arthrocentesis using concentric needle and cannula technique with sequential viscosupplementation and orthobiologics… PMID:40721423 | 2025 | this review only | not stated | not extracted yet |
| Jia 2024 A randomized controlled clinical trial of concentrated growth factor combined with sodium hyaluronate in the treatment of… DOI:10.1186/s12903-024-04258-x | 2024 | this review only | not stated | not extracted yet |
| Jing 2026 Injection of Adipose-Derived Mesenchymal Stem Cell-Enriched Adipose Extract for Temporomandibular Joint Osteoarthritis: A Randomised… DOI:10.1016/j.identj.2026.109604 | 2026 | this review only | not stated | not extracted yet |
| Jing 2026 Injection of Adipose-Derived Mesenchymal Stem Cell-Enriched Adipose Extract for Temporomandibular Joint Osteoarthritis: A Randomised… PMID:42134190 | 2026 | this review only | not stated | not extracted yet |
| Li 2024 DOI:10.19723/j.issn.1671-167x.2024.02.022 | NR | this review only | not stated | not extracted yet |
| Li 2024 [Preliminarily study of arthrocentesis combined with liquid phase concentrated growth factor injection in the treatment of unilateral… PMID:38595255 | 2024 | this review only | not stated | not extracted yet |
| Liu 2023 Platelet-rich plasma therapy for temporomandibular joint osteoarthritis: A randomized controlled trial DOI:10.1016/j.jcms.2023.09.014 | 2023 | this review only | not stated | not extracted yet |
| Mohanty 2026 Does concentrated growth factor provide better outcomes than platelet-rich fibrin or arthrocentesis in the management of temporomandibular… DOI:10.1016/j.ijom.2026.04.012 | 2026 | this review only | not stated | not extracted yet |
| Ramírez-Suarez 2025 Efecto y seguridad del plasma rico en plaquetas ozonizado en pacientes con osteoartritis temporomandibular //Effect and safety of ozonized… DOI:10.52979/raoa.1130813.1299 | 2025 | this review only | not stated | not extracted yet |
| Sembronio 2021 Temporomandibular Joint Arthrocentesis and Microfragmented Adipose Tissue Injection for the Treatment of Internal Derangement and… DOI:10.1016/j.joms.2021.01.038 | 2021 | this review only | not stated | not extracted yet |
| Shukla 2026 Effectiveness of liquid Platelet Rich Fibrin (i-PRF) in treatment of Temporomandibular disorders (TMD)- A randomized non-blinded, 2 arm,… DOI:10.1016/j.jobcr.2026.101443 | 2026 | this review only | not stated | not extracted yet |
| Shynchukovskyi 2024 Comparison of the effectiveness of temporomandibular joint osteoarthritis treatment with corticosteroids, hyaluronic acid, and… DOI:10.14739/mmt.2024.2.300763 | 2024 | this review only | not stated | not extracted yet |
| Siewert 2024 Arthrocentesis of Temporomandibular Joints-A Clinical Comparative Study. PMID:39768302 | 2024 | this review only | not stated | not extracted yet |
| Singh 2026 Efficacy of arthrocentesis and PRP in TMJ osteoarthritis patients. PMID:42109382 | 2026 | this review only | not stated | not extracted yet |
| Torul 2021 The efficacy of intra-articular injectable platelet-rich fibrin application in the management of Wilkes stage III temporomandibular joint… DOI:10.1016/j.ijom.2021.03.004 | 2021 | this review only | not stated | not extracted yet |
| Zhao 2025 The influence of platelet-rich fibrin combined with hydroxychloroquine on the inflammatory response; bone metabolism; and cell… PMID:42775313 | 2026 | this review only | not stated | not extracted yet |
| Zheng 2026 Concentrated growth factor as treatment for temporomandibular joint osteoarthritis: A randomized controlled clinical trial DOI:10.1016/j.jcms.2026.104504 | 2026 | 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 | Adults with advanced TMJ degenerative disease (osteoarthritis) confirmed by CBCT/MRI or advanced Wilkes stage; disc displacement without degenerative change and early-stage disease excluded | Advanced TMJ degenerative disease (n=28 studies; 18 RCTs with about 862 patients; 12 pooled RCTs with 574 patients); incomplete degenerative anchoring in Abbadi, Chaulagain, Harba, Dasukil |
| Intervention | Intra-articular orthobiologics (PRP, i-PRF, CGF, BMAC, MFAT), with or without concomitant arthrocentesis | PRP (n=8 RCTs, including HA combinations), i-PRF (n=3), CGF (n=3), MFAT (n=2), BMAC (n=1), PRP+i-PRF (n=1) |
| Comparison | Standard active control: arthrocentesis alone or hyaluronic acid (any type or molecular weight, by amendment) | Hyaluronic acid with or without arthrocentesis (n=6 pooled); arthrocentesis alone (n=6 pooled) |
| Outcomes | Primary: pain (VAS 0 to 10) and maximum mouth opening (MMO); secondary: other functional or structural outcomes (structural bone gain); pain-free opening analysed separately; MCID 1.55 VAS points and 5 mm MMO | Pain VAS (n=12 pooled RCTs: 6 vs HA, 6 vs arthrocentesis alone); MMO (n=12 pooled RCTs); structural imaging gain (exploratory cross-tabulation across 28 studies, not pooled) |
| Study designs | RCTs for quantitative synthesis; non-randomised, comparative or single-arm studies and head-to-head orthobiologic comparisons for narrative synthesis; published 2020 to June 2026 | 18 RCTs (12 pooled, 6 not pooled) and 10 non-randomised or narrative studies |
| Timing | Primary timepoints 3 and 6 months; 12 months exploratory | Each study's latest consistent timepoint (best available); follow-up 3 to 18 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 | Yes | Yes | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | No | no |
| 7List of excluded studies with reasonscritical | Yes | No | no |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · 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 | Yes | no |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Critically Low | no |