Ultrasonography-guided arthrocentesis versus conventional arthrocentesis in treating internal derangement of temporomandibular joint: a systematic review

Abstract

Objectives: This systematic review assessed the clinical question: ‘Does ultrasonography (USG)-guided arthrocentesis provide better outcomes than conventional arthrocentesis in patients with temporomandibular disorder (TMD)?’

Materials and methods: The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An initial search was performed on electronic databases—including Medline, PubMed, and Cochrane Library—followed by manual and reference searches until the date September 27, 2019. The articles selected were evaluated for study and patient characteristics, arthrocentesis procedure details, and treatment outcomes (post-operative pain, maximum mouth opening (MMO), procedure time, and attempts of needle positioning). Risk of bias was assessed with the Cochrane Consumers and Communication Review Group’s data extraction template and Critical Appraisal Skills Programme (CASP).

Results: Out of the 325 initially identified articles, four studies with 144 patients were included in the final qualitative analysis. No significant differences were found in pain reduction and improved MMO between sample groups receiving conventional arthrocentesis and USG-guided arthrocentesis. Needle positioning attempts and procedural times were conflicting between the two groups.

Conclusions: This systematic review found that the outcomes of USG-guided arthrocentesis were not superior to conventional arthrocentesis. Conflicting data was found in the attempts of needle positioning and procedural time. Standardized treatment protocols and data from well-designed USG-guided arthrocentesis randomized clinical trials were lacking.

Clinical relevance: Arthrocentesis with or without USG guidance are both effective for treating patients with TMD to reduce pain and to improve MMO. USG-guided arthrocentesis was not found to be superior to conventional arthrocentesis.