RESUMO
Objectives: This overview was conducted following the Preferred Reporting Items for Overviews of Reviews guidelines and aimed to collect and compare the results of systematic reviews on temporomandibular joint injection treatment. Methods: Systematic reviews of randomized clinical trials on temporomandibular disorders treated with lavage or intra-articular administrations were qualified for syntheses. The final searches were conducted on 27 February 2024, without time frame restrictions. Results: Of the 232 identified records, 42 systematic reviews were selected. The most evidence-based conclusions call into question the clinical differences between many therapeutic approaches, including the following: (1) injectable selection for the treatment of pain and hypomobility; (2) the method of performing arthrocentesis; (3) the use of imaging when rinsing the TMJ cavity; (4) the supplementation of the extracapsular administration of unprocessed blood with intracapsular deposition in the treatment of TMJ hypermobility. Conclusions: Systematic reviews based solely on randomized clinical trials proved the following differences: (1) in painful temporomandibular hypomobility, a better therapeutic effect is observed with arthrocentesis followed by I-PRF administration compared to lavage alone; (2) in painful temporomandibular hypomobility, inferior- or double-compartment injection leads to better results than superior-compartment injection; (3) in temporomandibular joint recurrent dislocation, hypertonic dextrose administration is superior to placebo, although (4) unprocessed blood has a better effect than hypertonic dextrose. PROSPERO registration number: CRD42024496142.
RESUMO
This systematic review with meta-analysis was conducted to evaluate the effectiveness of local anesthetic administration into temporomandibular joint cavities in relieving pain and increasing mandibular mobility. Randomized controlled trials were included with no limitation on report publication dates. Final searches were performed on 15 October 2023, using engines provided by the US National Library, Bielefeld University, and Elsevier Publishing House. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Articular pain and mandible abduction values and their mean differences were summarized in tables and graphs. Eight studies on a total of 252 patients evaluating intra-articular administration of articaine, bupivacaine, lidocaine, and mepivacaine were included in the systematic review. None of the eligible studies presented a high risk of bias in any of the assessed domains. An analgesic effect of intra-articular bupivacaine was observed for up to 24 h. In the long-term follow-up, there were no statistically significant changes in quantified pain compared to both the baseline value and the placebo group, regardless of the anesthetic used (articaine, bupivacaine, and lidocaine). There is no scientific evidence on the effect of intra-articular administration of local anesthesia on the range of motion of the mandible. Therefore, in the current state of knowledge, the administration of local anesthetics into the temporomandibular joint cavities can only be considered as a short-term pain relief measure.