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Comparative Efficacy of Needling and Non-Needling Therapies for Temporomandibular Disorders: A Bayesian Network
Xingji Ding1,2, Suping Liao1,2, Ting Li3
1State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, People's Republic of China.
Objective:
To compare the efficacy of dry needling therapy (DNT), traditional acupuncture (TAT), acupuncture-based combined therapy (ACT), and other interventions for temporomandibular disorders (TMD), focusing on pain relief, functional improvement, and treatment efficacy.
Methods:
Following the PICOS framework, we systematically searched PubMed, Embase, Cochrane Library, Web of Science, and CNKI up to July 2025 for randomized controlled trials (RCTs) enrolling adults with TMD. Interventions included seven conservative treatments-TAT, DNT, ACT, cognitive behavioral therapy (CBT), comprehensive physiotherapy (CPT), pharmacologic injection therapy (PIT), and control interventions (CTRL). Primary outcomes were pain intensity (VAS) and functional indices, and secondary outcomes included maximal mouth opening (MMO) and effective rate. Bayesian network meta-analysis was used to estimate comparative efficacy, and risk of bias was assessed using RoB 2.0.
Results:
This network meta-analysis included 37 randomized controlled trials with a total of 2581 participants. DNT exhibited the strongest analgesic effect (MD vs control: -1.61, 95% CI: -2.81 to -0.4), outperforming TAT (MD: -1.56) and pharmacological injection (MD: -1.41). ACT showed superior multimodal efficacy: significant reductions in PI (MD vs TAT: -0.13) and CMI, plus the highest treatment efficacy rate (RR: 1.8 vs control). For DI, ACT demonstrated marginal improvement over TAT (MD: -0.065, CI near zero). No intervention significantly improved MMO. Importantly, the pain reduction achieved by DNT and ACT met the minimal clinically important difference (MCID) threshold for TMD (VAS 0-1.9), indicating clinically meaningful benefit. Cumulative ranking (SUCRA) confirmed DNT and ACT as top-tier for pain and function, respectively.
Conclusion:
DNT and ACT appear to be the most effective interventions for TMD, offering complementary benefits in pain relief and functional recovery. These findings support their potential inclusion in multimodal management strategies, though interpretation should remain cautious given the predominance of Chinese studies and limited long-term and safety data.
