Intra-Articular Ozone Injections for Temporomandibular Joint Disorders: A Systematic Review

Objectives: Temporomandibular joint (TMJ) disorders are an increasingly common problem affecting patients. This systematic review aimed to analyze the available literature regarding the effectiveness of intra-articular ozone gas injections and their effects on pain reduction and jaw mobility. Methods: The review was conducted in accordance with PRISMA 2020 guidelines. Bielefeld Academic Search Engine, Cochrane Library, Google Scholar, PubMed, and references were searched (October 2025). Randomized controlled trials evaluating intra-TMJ gas injection compared to other intra-articular administration were included in the review. Analyses were performed both within and between groups. Risk of bias was assessed using the Cochrane RoB-2 tool, and the certainty of evidence was assessed using the GRADE approach. Results: Five studies out of 180, including a total of 230 patients, were included in the review. The studies reported using ozone at concentrations of 10-30 μg/mL. All included studies reported reductions in pain and improvements in mandibular mobility after treatment. In some comparisons, ozone-based interventions showed more favorable outcomes than control interventions; however, the findings were not consistent across outcomes, and the certainty of evidence was limited. Conclusions: Current evidence is insufficient to determine the effectiveness of intra-articular ozone injections for TMJ disorders. Some studies suggest possible short-term benefits in pain reduction and jaw mobility; however, the evidence is limited by high risk of bias, heterogeneity in treatment protocols, and very low certainty, particularly for longer-term outcomes. More rigorous and standardized randomized trials are required.