The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials
Abstract
Purpose Different treatment options for patients with arthrogenous Temporomandibular Disorders (TMDs) have been reported. However, evidence regarding the most effective intervention using network meta-analysis (NMA) has not been performed. Thus, we conducted a NMA of randomized clinical trials (RCTs) to identify the most effective treatment of arthrogenous TMDs with respect to pain reduction and improved mouth opening, and to generate a ranking according to their effectiveness. Material and methods An electronic search on three major databases was undertaken to identify RCTs published before August 2019, comparing up to fourteen different treatments against control/placebo patients for arthrogenous TMDs with respect to pain reduction and improved mouth opening. The treatment variables were controls/placebo, conservative treatment (muscle exercises and occlusal splint therapy), occlusal splint therapy alone, intraarticular injection (IAI) of hyaluronic acid (HA) or corticosteroid (CS), arthrocentesis with or without HA, CS and platelet-rich plasma (PRP), arthroscopy with or without HA and PRP, open joint surgery, and physiotherapy. Frequentist NMA was performed using STATA software. Studies meeting the inclusion criteria were divided according to the length of follow-up (short-term (≤5 months) and intermediate-term (≥6 months to 4 years) and type of TMJ arthrogenous disorders; internal derangement (ID) and TMJ osteoarthritis (OA). The standardized mean differences (SMD) in pos…
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There have been nine prior network meta-analyses of interventions for chronic temporomandibular disorder pain.
“There have been nine prior network meta-analyses (NMAs) of interventions for chronic TMD pain.[6][7][8][9][10][11][12][13][14]”
From Management of chronic pain secondary to temporomandibular disorders: a systematic review and network meta-analysis of randomised trials (2023) · cites this paper as [7]
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Youssef, S. A., Raghoebar, I., Helmers, R., de Lange, J., & Dubois, L. (2025) · Craniomaxillofacial Trauma & Reconstruction · doi:10.3390/cmtr18020025 · Cited by 8 · see citing works
Mota, M. M., Aguiar, I. H. A. E., de Lima, A. L. S., de Oliveira, O. B., da Silva, P. L. P., Moretti, E., & Lemos, G. (2024) · Current Pain and Headache Reports · doi:10.1007/s11916-024-01251-5 · Cited by 8 · see citing works
“Current scientific evidence has supported the use of conservative multimodal approaches [8, 9] and minimally invasive [7] for the initial management of patients with TMD. Conservative treatments have demonstrated significant effectiveness in reducing symptoms, in addition to presenting lower costs…”
Ferreira, N. R., Marto, C. M., de Sousa, B. M., Loureiro, M., de Oliveira, A. T., DosSantos, M. F. H., & Rodrigues, M. J. (2024) · Journal of Oral Rehabilitation · doi:10.1111/joor.13692 · Cited by 9 · see citing works
Comparison of the TMJ arthroscopy discopexy techniques: A systematic review and meta-analysis.
López, J., Orjuela, M. P., Díaz-Báez, D., & González, L. V. (2024) · Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery · doi:10.1016/j.jcms.2024.04.004 · Cited by 8
Al-Moraissi, E., Al-Maweri, A. A., Al-Tairi, N., Alkhutari, A. S., Grillo, R., & Christidis, N. (2023) · International Journal of Oral & Maxillofacial Surgery · doi:10.1016/j.ijom.2023.09.006 · Cited by 8 · see citing works
Self-citationÂngelo, D., Sanz, D., & Cardoso, H. (2023) · Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery · doi:10.1016/j.jcms.2023.09.010 · Cited by 8
Martins, I. S., Radaic, P., Marchi, L., Barreto, G., & Pastore, G. (2023) · Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery · doi:10.1016/j.jcms.2023.02.001 · Cited by 8
Memi̇s, S. (2022) · Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery · doi:10.1016/j.jcms.2022.07.003 · Cited by 8
Oren, D., Dror, A., Khalil, T. H., Zoabi, A., Zigron, A., Kablan, F., & Srouji, S. (2022) · Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery · doi:10.1016/j.jcms.2022.03.002 · Cited by 8
A Narrative Review of Therapeutic Peripheral Nerve Blocks for Chronic Orofacial Pain Conditions.
Renton, T., & Beke, A. (2022) · Journal of Oral and Facial Pain and Headache · doi:10.11607/ofph.3017 · Cited by 8
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Gil, F. M., Artal, P. M., de Llano, A. C. Q., Guerra, M. M., Ballester, D. G., Arcas, J. M. L., Cedrún, J. L. L., Pérez, J. G., Martín-Granizo, R., de Vera, J. L. D. C. P., et al. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13113319 · Cited by 7
“Arthroscopy of the TMJ can delay the need for open surgery in cases of advanced joint dysfunction [24,25].”
BackgroundDimitroulis, G. (2024) · Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery · doi:10.1016/j.jcms.2024.06.012 · Cited by 7 · see citing works
Bengtsson, M., & Fransson, P. (2021) · Journal of Stomatology Oral and Maxillofacial Surgery · doi:10.1016/j.jormas.2021.03.003 · Cited by 7
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Ângelo, D., Cardoso, H., Sanz, D., Maffìa, F., Sarkis, M., Mota, B., & Salvado, F. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14113750 · Cited by 6
Liu, S.-S., Wu, C., Yao, Y., Dong, X.-W., & Xu, L.-L. (2025) · Archives of Oral Biology · doi:10.1016/j.archoralbio.2025.106233 · Cited by 6
Jin, L., Yao, Y., Fang, Z.-Y., Fan, S., Cai, B., Xu, L.-L., & Liu, S.-S. (2024) · Journal of Oral Rehabilitation · doi:10.1111/joor.13865 · Cited by 6 · see citing works
- Authors
- Al-Moraissi, E. A., Wolford, L. M., Ellis, E., & Neff, A.
- Affiliations
- Baylor University Medical Center (US)
- The University of Texas at San Antonio Health Science Center (US)
- Universitätsklinikum Gießen und Marburg (DE)
- Venue
- Journal of Cranio-Maxillofacial Surgery
- Publisher
- Elsevier BV
- Published
- 2020-01
- Volume
- 48
- Issue
- 1
- Pages
- 9-23
- ISSN
- 1010-5182 (ISSN-L)
- OpenAlex
- W2984565522
- Cited by
- 266
- References
- 0
- Citations by year
- 2026: 38 · 2025: 39 · 2024: 51 · 2023: 46 · 2022: 43 · 2021: 37 · 2020: 10 · 2019: 1
- FWCI
- 5.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cranio-Maxillofacial Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Keywords
- temporomandibular joint osteoarthritis, internal derangement, intra-articular injection, hyaluronic acid, corticosteroids, platelet-rich plasma, arthroscopic surgery, arthrocentesis, occlusal splint, muscular exercise, physiotherapy, analgesia, mouth opening, treatment ranking
- MeSH terms
- Arthrocentesis, Humans, Injections, Intra-Articular, Temporomandibular Joint Disorders, Randomized Controlled Trials as Topic
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