Effect of intraarticular drug injection in patients with temporomandibular joint disorders with limited mouth opening: a system review and network meta-analysis

Background: This network meta-analysis (NMA) aims to evaluate the comparative efficacy of 13 intra-articular pharmacologic interventions in improving maximal mouth opening (MMO), pain relief, and functional recovery in patients with temporomandibular disorders (TMD) and restricted jaw mobility. Methods: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, and Web of Science to identify randomized controlled trials (RCTS) evaluating the effects of 13 intra-articular drug injections in patients with limited mouth opening TMD. The methodological quality of the included studies was assessed using the risk of bias (ROB) tool, and data were independently extracted by two researchers. Primary outcomes included maximum mouth opening (MMO) and pain intensity; secondary outcomes included joint lateral and protrusive movements. Results: A total of 38 RCTs involving 1533 TMD patients were included. Thirteen different agents (including HA: hyaluronic acid, PRF: platelet-rich fibrin, PDGF: platelet-derived growth factor, PRP: platelet-rich plasma, MOR: morphine, LA: local anesthetic, MA: micro-fragment fat, TRA: tramadol, SAL: Saline, GC: glucocorticoid, GLU: glucose, NS: non-steroidal, and ARTH: arthrocentesis only) were evaluated. NMA results showed that PRF injection after arthrocentesis significantly improved the maximum temporomandibular joint opening (surface under the cumulative ranking curve (SUCRA): 99.1%) compared with arthrocentesis alone. MA injection following arthrocentesis was most effective for pain reduction (SUCRA: 84.7%), followed by PRF (SUCRA: 78.2%). PRF also led to significant improvements in lateral jaw movement (SUCRA: 95.5%) and protrusive movement (SUCRA: 63.5%) compared to arthrocentesis alone. Conclusions: Based on the network ranking chart, PRF injection after arthrocentesis offers the greatest benefits for functional recovery in TMD patients. However, additional rigorous literature is required to validate this assertion. Clinical Trial Registration: Registration number is INPLASY202450107.

Articular cavity injection of drugs; Network meta-analysis; Platelet-rich fibrin; Temporomandibular joint disorders

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