Effectiveness of arthrocentesis versus other therapeutic modalities in patients with temporomandibular disorders. Systematic review and meta-analysis.

Background: Temporomandibular disorders (TMD) are a heterogeneous group of conditions frequently associated with pain and functional impairment. Arthrocentesis has been proposed as a minimally invasive therapeutic option; however, its comparative effectiveness versus other treatments remains uncertain. Objective: To evaluate the effectiveness of arthrocentesis compared with other therapeutic modalities in patients with TMD, focusing on pain relief and mandibular functional outcomes. Methods: A systematic review and meta-analysis were conducted following PRISMA 2020 guidelines. Randomized controlled trials comparing arthrocentesis with other therapeutic interventions for TMD were included. Comparator interventions included conservative therapies (e.g., occlusal splints, physiotherapy, and pharmacological treatment), intra-articular injections, arthroscopy, and alternative arthrocentesis-based protocols. Primary outcomes were pain intensity assessed by visual analogue scale (VAS) and mandibular functional outcomes, including maximum mouth opening (MMO), maximum incisal opening (MIO), masticatory efficiency, mandibular movements, and overall joint mobility. Pooled estimates were calculated using mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI). Certainty of evidence was assessed using the GRADE approach. Results: Thirty-two randomized controlled trials were included in the quantitative synthesis. No statistically significant difference in pain reduction was observed between arthrocentesis and comparator interventions (MD = -0.25; 95% CI -1.09-0.59; p = 0.55), with very high heterogeneity (I² = 96%). No statistically significant differences were found for maximum incisal opening (MIO), mandibular movements, or overall joint mobility. Masticatory efficiency showed a small statistically significant improvement favoring arthrocentesis (SMD = 1.15; 95% CI 0.22-2.08), based on very low-certainty evidence. Overall, the certainty of evidence ranged from low to very low across outcomes, and heterogeneity was substantial in most analyses. Conclusions: Arthrocentesis may provide modest symptomatic improvement in selected patients with TMD; however, it does not demonstrate superiority over alternative therapeutic modalities for most functional outcomes. Given the substantial heterogeneity and low certainty of the available evidence, these findings should be interpreted cautiously. Further well-designed randomized controlled trials with standardized diagnostic criteria, clearly defined comparators, and longer follow-up are required to better define the role of arthrocentesis in the management of temporomandibular disorders. Clinical significance: Current evidence does not demonstrate clear superiority of arthrocentesis over alternative therapeutic modalities for pain reduction or functional improvement in temporomandibular disorders. While arthrocentesis may be considered as a minimally invasive approach in selected patients, particularly those who do not respond to conservative management, its clinical benefits remain uncertain due to substantial heterogeneity and low certainty of evidence. Therefore, arthrocentesis should be interpreted as a potential adjunctive option within a stepwise treatment strategy rather than as a definitive or superior intervention.