Temporomandibular joint arthrocentesis: an evidence-based review

Abstract

Temporomandibular joint (TMJ) intracapsular pain can sometimes persist after pursuing reversible techniques. TMJ pain reduction may require a more focused treatment approach such as arthrocentesis to remove intracapsular inflammatory mediators. Evidence of efficacy for treating TMJ pain and mandibular mobility using TMJ arthrocentesis is available from a small number of high-quality evidence randomized controlled trials (RCTs). However, there still remains a lack of high-quality evidence to test the efficacy of various supplements that have been proposed to further enhance the outcomes after arthrocentesis. The purpose of this review was to examine published RCTs to determine the efficacy of TMJ arthrocentesis alone and with supplementation by steroids, hyaluronic acid and platelet-rich plasma growth factors. Thirty-one RCTs were identified from the literature with most of the studies having low to medium quality evidence. Most of the RCTs suffered from a lack of controlling experimental bias, lack of inclusion and exclusion criteria, lack of pain source validation, lack of stratification by sex and inclusion of bilateral TMJ arthrocentesis procedures that can confound the interpretation of the results of the procedure. Some RCTs were single or double blind studies, but the majority did not use a blinded experimental design. Low to medium quality evidence RCTs that focused on a comparison of TMJ arthrocentesis alone to post-arthrocentesis supplementation found no differences in resting pain intensity or mandibular mobility. However, one high-quality evidence RCT that evaluated steroid supplementation (triamcinolone acetonide) found a significant improvement and normalization of chewing pain and the normalization of mandibular mobility at 12 weeks post-arthrocentesis compared to the control group. Hyaluronic acid has been evaluated by medium quality evidence RCTs and these studies did not find differences between supplementation and control groups for pain or mandibular mobility. Finally, platelet-rich plasma has been used as a supplement and one study with medium quality evidence found significant differences between groups for pain, mandibular mobility and chewing efficiency. The paucity of high-quality evidence RCTs has not allowed a consensus for the efficacy of TMJ post-arthrocentesis supplements and further studies are required to guide the practicing clinician on their use.