Timing of Arthrocentesis in the Management of Temporomandibular Disorders:A Systematic Review and Meta-analysis

Abstract

The aim of this study was to assess the best timing to perform arthrocentesis in the management of temporomandibular disorders with regards to conservative treatment. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, reference list search, and manual search was done. Relevant articles were selected after 3 search rounds for final review based on 6 predefined inclusion criteria, followed by a round of critical appraisal. Eleven publications, including 5 randomized controlled trials and 6 prospective clinical studies informed this review. The studies were divided into 3 groups based on the timing of arthrocentesis: 1). Arthrocentesis as the initial treatment, 2). Early arthrocentesis, and 3). Late arthrocentesis. Meta-analyses compared the efficacy of improvement in mouth opening and pain reduction in the 3 groups. The results were statistically significant and favoured early arthrocentesis, followed by late arthrocentesis in terms of both improvements in mouth opening and pain reduction. All 3 groups showed improvement in mouth opening and pain reduction. We conclude that early arthrocentesis may be able to produce the best clinical results, while arthrocentesis before attempting conservative treatment may produce less favourable outcomes.

Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management

“…In addition to the shift from open joint surgery to minimally invasive treatment for those cases not responsive to conservative treatment, recent literature seems to support that minimally invasive options may be attempted early for arthrogenous TMD [ 95 , 96 ], and this may represent a paradigm shift in the management protocol. A recent integrated review and meta-analysis performed by the authors of this article showed that arthrocentesis was beneficial, whether it was performed as an initial treatment, as an early or late treatment with regard to conservative treatment [ 97 ]. However, the best timing to perform arthrocentesis is still unclear due to the paucity of research on the topic, which warrants more future well-designed clinical trials [ 97 ].…”

“…A recent integrated review and meta-analysis performed by the authors of this article showed that arthrocentesis was beneficial, whether it was performed as an initial treatment, as an early or late treatment with regard to conservative treatment [ 97 ]. However, the best timing to perform arthrocentesis is still unclear due to the paucity of research on the topic, which warrants more future well-designed clinical trials [ 97 ].…”