Arthrocentesis vs conservative therapy for the management of TMJ disorders: A systematic review and meta-analysis

Arthrocentesis is being widely used as an invasive treatment modality for managing temporomandibular joint (TMJ) disorders. The current review aimed to assess if arthrocentesis as the first line of therapy leads to better outcomes as compared to conservative management of TMJ disorders.

PubMed, Scopus, Embase, Web of Science, and CENTRAL were searched up to 20th June 2022 for randomized controlled trials comparing TMJ arthrocentesis vs conservative management as first-line therapy for TMJ disorders.

Eight trials were included. Our analysis indicated significantly reduced pain scores in patients undergoing TMJ arthrocentesis as compared to conservative therapy at 1 month (MD: -0.82 95% CI: -1.43, -0.20 I²=56% p = 0.01) and 6 months (MD: -1.38 95% CI: -2.45, -0.32 I²=86% p = 0.01), but not at 3 months of follow-up (MD: -0.66 95% CI: -1.68, 0.37 I²=82% p = 0.21). The results were not stable on sensitivity analysis. There was no difference in MMO between the TMJ arthrocentesis and conservative therapy groups at 1 month (MD: -0.06 95% CI: -3.67, 3.54 I²=88% p = 0.97), 3 months (MD: -0.35 95% CI: -3.95, 3.25 I²=89% p = 0.85) and 6 months (MD: 0.00 95% CI: -3.34, 3.34 I²=86% p = 0.10).

Analysis of a small number of trials with high inter-study heterogeneity indicates that first line TMJ arthrocentesis may result in a significant but small improvement in pain scores but without any additional improvement in MMO as compared to conservative therapies. Current evidence does not provide strong support for the use of TMJ arthrocentesis as the first line of therapy for TMDs.