Effectiveness of treatments for temporomandibular joint osteoarthritis: a systematic review and meta-analysis

To evaluate the effectiveness of minimally invasive interventions (arthrocentesis and intra-articular injections) versus conservative therapies for temporomandibular joint osteoarthritis (TMJ OA).

This systematic review included randomized controlled and prospective or observational studies involving patients with TMJ OA. A comprehensive search of five databases was conducted up to November 2024. Pain intensity (VAS) and maximum mouth opening (MMO) were analyzed via meta-analysis, with risk of bias assessed using ROB 2 and ROBINS-I tools, and certainty of evidence using GRADE. The significance level adopted for the analysis was set at α = 0.05.

Sixteen studies (901 patients) were included. Arthrocentesis, alone or with adjuvants such as PRP, i-PRF, corticosteroids, or NSAIDs, significantly improved pain (MD − 5.50; 95%CI: − 6.61 to − 4.39) and MMO (MD 6.97 mm; 95%CI: 1.96 to 11.98) versus baseline and between groups. Intra-articular hyaluronic acid, with or without glucosamine, showed clinical benefit over time, but its superiority over conservative care was inconsistent. Substantial heterogeneity was observed, mainly in injection-based protocols. GRADE indicated high certainty of evidence for most comparisons, except one (MMO, moderate certainty).

Minimally invasive therapies, especially arthrocentesis with biological adjuvants, seems to be effective for TMJ OA management. However, due to heterogeneity and methodological limitations, their superiority over conservative strategies remains uncertain.

Minimally invasive therapies, particularly arthrocentesis with or without biological agents, may reduce pain and improve jaw function in TMJ OA, offering a potential alternative to conservative treatments over a 3- to 12-month period.