Do intra‐articular injections of analgesics improve outcomes after temporomandibular joint arthrocentesis?: A systematic review and meta‐analysis

Abstract

Since its first description by Nitzan et al in 1991, 1 arthrocentesis of the temporomandibular joint (TMJ) has become a routine procedure for the management of temporomandibular joint disorders (TMDs). The procedure has been used for anchored disk phenomenon, closed lock, anterior disc displacement with/without reduction and osteoarthritis. 2 It has gained wide popularity worldwide owing to its simple, inexpensive and minimally invasive nature. 2 Clinicians usually employ arthrocentesis in patients not responding to conservative therapies like painkillers, occlusal splints and physical therapy. 3

Treatment of Mandibular Hypomobility by Injections into the Temporomandibular Joints: A Systematic Review of the Substances Used

“…With regard to the effect on the extent of mandibular abduction, the bone marrow showed the greatest efficacy (154%) of the rarely used substances (Figure 4). The action of dextrose with lidocaine, morphine and tramadol did Among the substances other than those already assessed in the previously published meta-analyzes, only the administration of dextrose with lidocaine was documented in more than one report, which limited the possibility of the meta-analysis to this one substance [12,18,20,21,24,44,49,62]. The amplitude of mandibular abduction was reported only in two of the three reports, which precludes any statistical analysis.…”

“…The three initial and three final pain values obtained from the study allowed for fitting a linear regression model of pain intensity of the formula −3.2x + 7.7 with standard deviations of 0.5 and 2.0 for the initial and final TMJ pain intensity, respectively (Figure 6). Among the substances other than those already assessed in the previously published meta-analyzes, only the administration of dextrose with lidocaine was documented in more than one report, which limited the possibility of the meta-analysis to this one substance [12,18,20,21,24,44,49,62]. The amplitude of mandibular abduction was reported only in two of the three reports, which precludes any statistical analysis.…”

“…In the course of the literature search, it was found that the TMJs cavities are therapeutically administered with morphine, tramadol, tenoxicam and lidocaine as an additive to dextrose [44,49,52,66,87]. A systematic review of the effectiveness of intra-articular analgesics by Liu et al, in 2021 showed divergent results for the NSAIDs and opioids [24]. These authors noted the lack of statistical significance in relation to the control groups in the results of NSAID treatment, which questioned the effectiveness of the administration of these drugs [24].…”

“…A systematic review of the effectiveness of intra-articular analgesics by Liu et al, in 2021 showed divergent results for the NSAIDs and opioids [24]. These authors noted the lack of statistical significance in relation to the control groups in the results of NSAID treatment, which questioned the effectiveness of the administration of these drugs [24]. Compared to opioids, in the course of the analysis in this review, tenoxicam gave the final results of mandibular mobilization not much worse than tramadol and an approximately four-fold decrease in pain, similar to tramadol [52,66].…”

“…Apart from autologous PRP, other self-derived blood products are also used: plasma rich in growth factors (PRGF) and injectable platelet-rich fibrin (I-PRF) [7,23]. Injecting analgesics, which are a non-homogeneous group of drugs with differently assessed effectiveness in this application, is also considered [24]. There are scarce reports, and no systematic reviews, on the administration of autologous transplants other than the patient's blood to TMJs and of drugs other than those described above.…”