Conservative and Minimally Invasive Interventions for Temporomandibular Disorders: A Systematic Review and...

Temporomandibular disorders (TMD) are managed with interventions ranging from conservative physiotherapy to minimally invasive procedures, but their comparative effectiveness is unclear. We conducted a systematic review and meta-analysis of randomized trials to quantify treatment effects on pain and function. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we included randomized/quasi-randomized TMD trials reporting pre-/post-procedure and between-group outcomes. Ten trials (~500 participants) were pooled. Pain (Visual Analog Score (VAS) and Numerical Rating Scale (NRS)) was the primary outcome while maximal mouth opening (MMO) was the secondary outcome. Medians, interquartile ranges (IQRs) and standard errors (SEs) were converted to mean/standard deviation (SD) where needed. RevMan 5.4 (inverse-variance, random-effects) was used for statistical analysis. Subgroups contrasted minimally invasive (arthrocentesis/lavage±injectates) versus conservative/physical therapy (manual therapy, low-level laser therapy (LLLT) vs transcutaneous electrical nerve stimulation (TENS), ultrasound vs splints). Small-study effects were explored using funnel plots. Active interventions improved pain more than controls. In conservative care, adding manual therapy enhanced exercise/education, photobiomodulation outperformed TENS, and ultrasound gave modest early benefit. Invasive protocols (arthrocentesis) yielded faster pain relief than non-surgical comparators, with small differences across lavage agents/volumes. Both strategies produced clinically meaningful pooled benefits, with slightly greater effects for minimally invasive care. Heterogeneity was moderate; funnel plot symmetry suggested little publication bias. Excluding the retracted sodium 2-mercaptoethanesulfonate (MESNA) trial did not change the findings. Both conservative and minimally invasive approaches yield meaningful short-term pain reductions in TMD. Benefits are greatest with multimodal conservative programs and arthrocentesis as escalation. Publication bias was limited. Future randomized controlled trials (RCTs) should standardize outcomes and clarify escalation criteria.