Effectiveness of extracorporeal shock wave therapy for temporomandibular disorders: a systematic review and meta-analysis

Background: Extracorporeal shock wave therapy (ESWT) is commonly employed for treating various musculoskeletal disorders; however, its effectiveness in managing temporomandibular disorders (TMD) remains inconclusive. This study aimed to assess the effectiveness of ESWT for TMD by reviewing randomized clinical trials. Methods: Systematic searches were conducted across seven databases from inception to April 2025 to identify randomized clinical trials (RCTs) evaluating ESWT in patients with TMD. Eligible studies were required to report at least one of the following outcomes: visual analog scale (VAS) for pain or maximum mouth opening (MMO). A meta-analysis was performed, categorizing results by treatment type (ESWT alone vs. ESWT combined with other treatments). The risk of bias and study quality were assessed using Review Manager version 5.4.1, and all analyses were conducted using R v.4.4.3 (R Project for Statistical Computing). Results: Fourteen RCTs (n = 1107 participants) were included. Compared to active controls, ESWT did not result in significant improvements (VAS: mean difference (MD) = −0.81; 95% confidence interval (CI) =−1.77 to 0.16; p = 0.06, I2 = 0.0%; MMO: Standardized Mean Difference (SMD) = −1.84; 95% CI = −18.43 to 14.74; p = 0.39, I2 = 97.5%). However, when used as an adjunctive therapy, ESWT significantly improved pain intensity and mouth opening (VAS: MD = 0.94; 95% CI = 0.61 to 1.26; p < 0.0001, I2 = 19.5%; MMO: SMD = 0.69; 95% CI = 0.48 to 0.90; p < 0.0001, I2 = 45.5%). Conclusions: ESWT, when used as an adjunctive therapy for TMD, significantly alleviates pain and improves mouth opening. However, these results should be interpreted with caution due to the generally low quality of the included studies and the absence of long-term follow-up data. This meta-analysis synthesizes the available evidence, highlights critical research gaps, and provides cautious recommendations for clinical practice. The PROSPERO Registration: CRD42025631405.

Extracorporeal shock wave therapy; Temporomandibular disorders; Systematic review; Meta-analysis

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