Ultrasound-Guided Vs Non-Guided Prolotherapy for Internal Derangement of Temporomandibular Joint. A Randomized Clinical Trial.

OBJECTIVES: This randomized clinical trial study aims to compare ultrasound-guided versus non-guided Dextrose 10% injections in patients suffering from internal derangement in the temporomandibular joint (TMJ). MATERIAL AND METHODS: The study population included 22 patients and 43 TMJs suffering from unilateral or bilateral TMJ painful clicking, magnetic resonance imaging (MRI) proved disc displacement with reduction (DDWR), refractory to or failed conservative treatment. The patients were divided randomly into two groups (non-guided and ultrasound (US)-guided groups). The procedure involved injection of 2 mL solution of a mixture of 0.75 mL 0.9% normal saline solution, 0.3 mL 2% lidocaine and 0.75 mL dextrose 10% using a 25G needle in the joint and 1 mL intramuscular injection to the masseter muscle at the most tender point. The Visual Analogue Score (VAS) was used to compare joint pain intensity over four different periods, beginning with pre-injection, 1-, 2-, and 6-months postinjection. RESULTS: Twenty-two patients 5 males (n = 5/22, 22.7%) and 17 females (n = 17/22, 77.2%) were included in this study. The mean age was 27.3 ± 7.4 years (30.2 ± 7.0) for the non-guided group and 24.3 ± 6.9 for the US-guided group. The dextrose injection reduced intensity over time in both groups with statistically significant improvement (P value <.05) at 2 and 6 months in both groups. There was no statistically significant difference in VAS assessment between both groups. CONCLUSION: Intra-articular injection of dextrose 10% for patients with painful clicking and DDWR resulted in reduced pain intensity in both US-guided and non-guided groups with significant symptomatic improvement over time in both groups. US guidance allowed accurate anatomical localization and safe procedure with a single joint puncture.

Artificial intelligence in musculoskeletal imaging: realistic clinical applications in the next decade.

This article will provide a perspective review of the most extensively investigated deep learning (DL) applications for musculoskeletal disease detection that have the best potential to translate into routine clinical practice over the next decade. Deep learning methods for detecting fractures, estimating pediatric bone age, calculating bone measurements such as lower extremity alignment and Cobb angle, and grading osteoarthritis on radiographs have been shown to have high diagnostic performance with many of these applications now commercially available for use in clinical practice. Many studies have also documented the feasibility of using DL methods for detecting joint pathology and characterizing bone tumors on magnetic resonance imaging (MRI). However, musculoskeletal disease detection on MRI is difficult as it requires multi-task, multi-class detection of complex abnormalities on multiple image slices with different tissue contrasts. The generalizability of DL methods for musculoskeletal disease detection on MRI is also challenging due to fluctuations in image quality caused by the wide variety of scanners and pulse sequences used in routine MRI protocols. The diagnostic performance of current DL methods for musculoskeletal disease detection must be further evaluated in well-designed prospective studies using large image datasets acquired at different institutions with different imaging parameters and imaging hardware before they can be fully implemented in clinical practice. Future studies must also investigate the true clinical benefits of current DL methods and determine whether they could enhance quality, reduce error rates, improve workflow, and decrease radiologist fatigue and burnout with all of this weighed against the costs.

The influence of open disc repositioning surgery on the internal derangement of the contralateral temporomandibular joint: a prospective study of 96 patients.

OBJECTIVE: To assess the influence of unilateral open disc repositioning surgery (ODRS) of the temporomandibular joint (TMJ) on the internal derangement (ID) of the contralateral joint. METHODS: Patients with bilateral ID of TMJ who underwent unilateral ODRS were enrolled and followed-up for one year. They were divided into two groups based on the contralateral disease: the anterior disc displacement with reduction (ADDWR) and without reduction (ADDWoR). Postoperative evaluation included clinical and MRI evaluation. Indices measured were unilateral intermaxillary distance (UID), visual analogue scale (VAS), disc length (DL), condylar height (CH), and disc-condyle angle (DCA). Paired t tests were used to compare the clinical and MRI indices between different time points. RESULTS: Ninety-six patients were enrolled, including 47 in the ADDWR group and 49 in the ADDWoR group. One-year post-surgery, ODRS led to significant increases in MMO, DL, and CH, and decrease in VAS and DCA on the operated side (P < 0.05). In ADDWR group, UID, DL, and CH increased significantly, and VAS decreased (P < 0.05), with no significant change in DCA (P > 0.05). In ADDWoR group, clinical and MRI variables worsened slightly, except for UID, which remained unchanged (P > 0.05). CONCLUSIONS: ODRS is a promising method for correcting TMJ ID and may improve condition of ADDWR and decrease progress of ADDWoR at the contralateral joint. Preoperative bilateral TMJ evaluation is essential for better outcomes. CLINICAL RELEVANCE: ODRS can effectively treat TMJ ID and produce adaptive changes in the contralateral ID, for which continuous monitoring of the contralateral joint is essential.

Invasive surgical procedures for the management of internal derangement of the temporomandibular joint: a systematic review and meta-analysis regarding the effects on pain and jaw mobility.

OBJECTIVES: This systematic review compared minimally and invasive surgical procedures to manage arthrogenous temporomandibular joint (TMJ). MATERIALS AND METHODS: The review included clinical trials assessing surgical procedures of arthrogenous temporomandibular disorder (TMD) management by carrying out comparisons within the same surgical procedure (pre- and post-treatment) as well as between different surgical procedures. Meta-analyses were conducted only for similar comparison reporting the same outcome measures, visual analog scale (VAS) values to evaluate pain and maximum incisal opening (MIO) values. RESULTS: Of the 1,015 studies identified by the search strategy, 26 were selected for full-text reading, and 19 were included in the review. Of these, 16 studies were included in the meta-analysis and 3 in the qualitative analysis. The VAS scores showed significantly lower values after discectomies (p < 0.001) and discoplasties (p < 0.001) in the within-group comparison. Moreover, significantly lower VAS scores and higher MIO values were observed after discectomy compared to arthroscopy, eminectomy, and discoplasty (p < 0.05). CONCLUSION: The findings of this systematic review suggest that although significantly lower VAS scores and higher MIO values were observed after discectomy, the currently available scientific evidence is unclear, and the use of invasive surgical procedures should not be implemented as an efficient first-line treatment option for arthrogenous TMD management. CLINICAL SIGNIFICANCE: VAS and MIO outcomes could be insufficient to describe the success or failure of open surgical procedures like discectomy and discoplasty.

Promising minimally invasive treatment modalities for symptomatic temporomandibular joint disc displacement with reduction: a randomized controlled clinical trial.

BACKGROUND: Pain and clicking are the primary complaints in patients suffering from temporomandibular joint disc displacement with reduction (DDwR), negatively affecting the patients' quality of life, making the treatment essential. This prospective randomized controlled trial (RCT) was conducted to evaluate the effectiveness of botulinum toxin type-A (BTX-A) and low level laser therapy (LLLT) in comparison to anterior repositioning appliance (ARA) for the treatment of DDwR. METHODS: A total of 27 patients were randomly allocated to 3 groups; ARA (control group), BTX-A, and LLLT; with 9 patients each. All patients were evaluated before and 3 months after the treatment using a visual analogue scale (VAS) and magnetic resonance imaging (MRI). RESULTS: At 3 months follow-up, all groups showed a significant reduction in pain assessed by VAS (P = 0.007). Measured on MRI, there was a significant improvement in disc position and joint space index (JSI) in BTX-A group (P < 0.001, P = 0.011) and LLLT group (P = 0.002, P = 0.017) in comparison to the control group (P = 0.087, P = 0.066) respectively. As for time of recovery, a statistically significant difference was observed in BTX-A group (P < 0.001) and LLLT (P < 0.001) group in comparison to ARA group, which showed the most prolonged duration for reduction of DDwR symptoms. CONCLUSION: We concluded that BTX-A and LLLT could be considered effective alternative treatment modalities to ARA regarding reducing joint pain, clicking, and improving disc position in patients with symptomatic DDwR. TRIAL REGISTRATION: This prospective double-blinded RCT has been registered at ClinicalTrials.gov with identification number: NCT05194488, 18/1/2022.

Asporin levels in patients with temporomandibular joint disorders.

BACKGROUND: Understanding the pathogenesis of temporomandibular joint disorder (TMD) is important for diagnosis and treatment planning. Thus, biochemical analysis is usually used for the detection of tissue damage. OBJECTIVE: In this study, we aimed to investigate the serum asporin levels in patients with TMD. METHODS: Our study was planned to be performed on 43 healthy individuals (control group) without any joint problems and 43 patients with temporomandibular joint internal derangement (TMJ-ID; patients group) according to the Wilkes classification (stages 3, 4 and 5). Serum asporin levels were determined by the enzyme-linked immunosorbent assay (ELISA) method and compared between groups. Asporin levels were analysed according to the demographic and clinical characteristics of the patients, and the differences between them were demonstrated. RESULTS: Asporin levels were found to be significantly increased in the patients group compared to control group (p = .0303). The age and gender distributions of the samples in the control and patients groups were homogeneous, and there was no statistically significant difference between the groups. In addition, while there was no significant change in asporin levels in females in the patients group compared with the control group, the asporin levels were significantly increased in males in the patients group (p = .0403). CONCLUSIONS: Consequently, asporin seems to be an important biomarker in the pathobiology of TMJ-ID as it is significantly upregulated in these patients.

Comparison of outcomes with the single-puncture and double-puncture techniques of arthrocentesis of the temporomandibular joint: An updated systematic review and meta-analysis.

OBJECTIVE: To compare intra-operative and postoperative outcomes between the single-puncture and the standard double-puncture techniques of arthrocentesis. METHODS: PubMed, Embase, ScienceDirect and CENTRAL databases were searched from inception up to 31st August 2020. Randomised controlled trials (RCTs), prospective and retrospective studies conducted on patients with temporomandibular joint disorders comparing any type of single-puncture arthrocentesis with standard double-puncture arthrocentesis and reporting intra-operative/postoperative outcomes were included. Assessment of the risk of bias was done with the Cochrane Collaboration risk assessment tool. RESULTS: Thirteen studies were included (12 were RCTs). Analysis of a limited number of studies indicated no difference in pain or maximal mouth opening (MMO) between the single-puncture type-1 or type-2 and the double-puncture technique at various follow-up intervals. Pooled analysis (four studies) demonstrated that the single-puncture type-2 technique requires significantly less operating time as compared to the double-puncture method. No such difference was noted between single-puncture type-1 and double-puncture techniques. Analysis of two studies indicated significantly reduced intra-operative needle relocations with the single-puncture techniques. Studies were not of high quality with concerns of bias in randomisation, allocation concealment and blinding. CONCLUSIONS: Limited data indicate no difference in pain or MMO with single- or double-puncture techniques of arthrocentesis. Amongst the three techniques, the single-puncture type-2 technique has the advantages of significantly lower operating time and reduced intra-operative needle relocations and it may be the preferred method of TMJ arthrocentesis in clinical practice.

Using Deep Learning to Accelerate Knee MRI at 3 T: Results of an Interchangeability Study.

OBJECTIVE. Deep learning (DL) image reconstruction has the potential to disrupt the current state of MRI by significantly decreasing the time required for MRI examinations. Our goal was to use DL to accelerate MRI to allow a 5-minute comprehensive examination of the knee without compromising image quality or diagnostic accuracy. MATERIALS AND METHODS. A DL model for image reconstruction using a variational network was optimized. The model was trained using dedicated multisequence training, in which a single reconstruction model was trained with data from multiple sequences with different contrast and orientations. After training, data from 108 patients were retrospectively undersampled in a manner that would correspond with a net 3.49-fold acceleration of fully sampled data acquisition and a 1.88-fold acceleration compared with our standard twofold accelerated parallel acquisition. An interchangeability study was performed, in which the ability of six readers to detect internal derangement of the knee was compared for clinical and DL-accelerated images. RESULTS. We found a high degree of interchangeability between standard and DL-accelerated images. In particular, results showed that interchanging the sequences would produce discordant clinical opinions no more than 4% of the time for any feature evaluated. Moreover, the accelerated sequence was judged by all six readers to have better quality than the clinical sequence. CONCLUSION. An optimized DL model allowed acceleration of knee images that performed interchangeably with standard images for detection of internal derangement of the knee. Importantly, readers preferred the quality of accelerated images to that of standard clinical images.

Painful clicking jaw: a pictorial review of internal derangement of the temporomandibular joint.

Temporomandibular joint disorders are a common cause of chronic musculoskeletal pain worldwide. Among these, internal disc derangement is the most frequent type of disorder. Internal derangement is defined as an abnormal positional and functional relationship between the disc and articulating surfaces. Common clinical symptoms include pain and clicking. Imaging plays a key role in diagnosing temporomandibular joint disorders. It is important for the radiologist to detect early imaging signs of internal derangement, thereby avoiding the evolution of this condition to degenerative joint disease. The aim of this article is to familiarise the reader with the spectrum of imaging findings that are encountered at different stages of the disease.

Vitamin D receptor gene polymorphisms (Apa1 and Taq1) in temporomandibular joint internal derangement/osteoarthritis in a group of Turkish patients.

Genetic variations might play a role in susceptibility to temporomandibular joint internal derangement (TMJ-ID) and osteoarthritis of the joint (TMJOA). Vitamin D receptor (VDR) polymorphisms have been shown to be associated with disc degeneration-linked pathologies, particularly osteoarthritis (OA). The aim of this study was to evaluate whether VDR polymorphisms present susceptibility to TMJ-ID/TMJOA. The study included 49 unrelated TMJ-ID patients with OA (31.7 ± 7.9) that were grouped and evaluated as having anterior disk displacement with reduction (ADDwR, n = 24) (31.58 ± 8.25) and without reduction (ADDwoR, n = 25) (31.8 ± 7.53) and 70 healthy controls (28.22 ± 5.9). DNA was extracted from blood samples using the standard proteinase K/phenol-chloroform method. Apa1 and Taq1 polymorphisms were investigated using a polymerase chain reaction-based restriction fragment length polymorphism assay. When TMJ-ID patients, ADDwR cases and ADDwoR cases versus healthy controls were compared, Apa1 Aa genotype compared to AA genotype had odds ratios of 1.65, 1.79 and 1.64 respectively (p > 0.05). In TMJ-ID women versus healthy women Aa genotype had 2.06 fold (p = 0.15) odds compared to AA genotype. Taq1 results showed that in TMJ-ID patients and ADDwoR cases the Tt genotype had odds ratios of 0.63 and 0.44 fold (p > 0.05) respectively. In TMJ-ID women the Tt and tt genotypes had odds ratios of 0.53 and 0.73 (p > 0.05). Combined VDR genotypes revealed that AATT had a 3.3 fold (p = 1.21) odds ratio while AATt had a 2.0 fold odds ratio (p = 0.29) (OR 0.59, 95% CI 0.23-1.49, p = 0.26) compared to AaTt. Although our results do not confirm susceptibility of VDR polymorphisms to TMJ-ID/TMJOA ,this relation needs to be further evaluated in a large cohort study.

Traumatic knee injury: correlation of radiographic effusion size with the presence of internal derangement on magnetic resonance imaging.

PURPOSE: Traumatic knee injury is a common clinical presentation. However, knee internal derangement often goes undiagnosed on physical exam. The authors hypothesize that patients with suprapatellar joint effusion greater than 10 mm anteroposterior diameter on lateral radiograph have a high likelihood of knee internal derangement on magnetic resonance imaging. MATERIALS AND METHODS: A retrospective review of knee radiographs and magnetic resonance imaging in 198 patients age 18-40 years with acute knee injury was performed. Suprapatellar effusion diameter on lateral radiography was correlated to the presence of internal derangement on magnetic resonance imaging. Magnetic resonance imaging anteroposterior effusion size at four locations was correlated to radiographic suprapatellar effusion measurements. RESULTS: Logistic regression showed a positive correlation between radiographic effusion size and the presence of internal derangement on magnetic resonance exams (p value < 0.001). Radiographic effusion > 10 mm was established as a positive test, yielding test sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 55, 96, 93, 71, and 77%, respectively. Statistical analysis showed the radiographic anteroposterior effusion diameter most closely approximated the magnetic resonance effusion diameter at the lateral patellofemoral recess. CONCLUSIONS: This study shows that knee radiography is a highly specific screening test for internal derangement in patients less than 40 years old with acute knee injury. In this patient population, knee effusion > 10 mm on lateral radiograph should prompt consideration for knee magnetic resonance examination. Adopting this approach as a clinical guideline has the potential to decrease delayed diagnosis, improve patient outcomes, and decrease cost-associated disability.

Patient symptoms and magnetic resonance imaging correlation in temporomandibular joint internal derangement

Background/aim: Temporomandibular joint (TMJ) internal derangements consist of reduced and nonreduced disc dislocations and are often diagnosed by magnetic resonance imaging (MRI). The main symptom of these derangements is TMJ pain. This study aimed to evaluate whether there is a correlation between TMJ pain and disc dislocation. Materials and methods: One hundred and four patients experiencing pain were evaluated retrospectively with the examination charts that we use routinely in our clinics and MRI. Patients were separated into two main groups as MRI(+) and MRI(-) groups according to their internal derangement findings in MRI. Mean VAS levels were compared between these two groups. Results: There were no significant differences between the MRI(+) and MRI(-) groups and no differences between the reduced disc dislocation group and nonreduced disc dislocation group. Conclusion: Although pain is maybe the most irritating symptom for TMJ patients, it cannot take the diagnostic place of MRI and MRI is still the gold standard method to make the exact diagnose of internal derangement.

Subjects with temporomandibular joint disc displacement do not feature any peculiar changes in body posture.

The presence of body posture changes among patients with temporomandibular disorders (TMD) has been a controversial topic in dentistry. Based on that, the aim of this study was to assess postural features of pain-free subjects with internal derangement of the temporomandibular joint (TMJ), viz. disc displacement, when compared to subjects with normal disc position. A total of 21 subjects with unilateral, pain-free TMJ disc displacement (DD) and 21 subjects without any TMD signs of symptoms were assessed for body posture changes by means of posturographic evaluation of several body segments and postural balance reactions through the centre of mass during jaw movements using a balance platform. Posturographic measurements showed the absence of any significant differences between the two groups in any of the outcome parameters. Similarly, all balance platform responses to mandibular movements were not different between groups. There are no significant differences in body posture between subjects with and without unilateral disc displacement in the temporomandibular joint. Such observations, indicating a well-preserved postural balance in the presence of TMJ internal derangement, put into serious question the potential influence of TMJ disorders on whole body posture and viceversa.

The role of molecular pain biomarkers in temporomandibular joint internal derangement.

There is evidence that low-grade inflammation may be responsible for pain and development of degenerative changes in temporomandibular joint internal derangement. This article reviews the current knowledge of the molecular mechanisms behind TMJ internal derangements. A non-systematic search was carried out in PubMed, Embase and the Cochrane library for studies regarding pathophysiological mechanisms behind internal derangements focusing on pain-mediating inflammatory and cartilage-degrading molecules. Recent data suggest that release of cytokines may be the key event for pain and cartilage destruction in TMJ internal derangements. Cytokines promote the release of matrix metalloproteinases (MMPs), and due to hypoxia, vascular endothelial growth factor (VEGF) is released. This activates chondrocytes to produce MMPs and reduce their tissue inhibitors (TIMPs) as well as the recruitment of osteoclasts, ultimately leading to cartilage and bone resorption. Also, proteoglycans have an important role in this process. Several cytokines, MMPs, TIMPs and VEGF have been identified in higher concentrations in the TMJ synovial fluid of patients with painful internal derangements and shown to be associated with the degree of degeneration. Other molecules that show elevated levels include hyaluronic acid synthase, disintegrin and metalloproteinase with thrombospondin motifs (ADAMTs), aggrecan, fibromodulin, biglycan and lumican. Taken together, more or less pronounced inflammation of TMJ structures with release of cytokines, MMPs and other molecular markers that interact in a complex manner may be responsible for tissue degeneration in internal derangements. As internal derangements may be symptom-free, the degree of inflammation, but also other mechanisms, may be important for pain development.

Comparison of TMJ vibration frequencies under different joint conditions.

OBJECTIVE: To compare 10 Hz wide segments of the 0 to 1000 Hz frequency distributions of vibrations recorded from five stages of internally deranged and asymptomatic temporomandibular joints (TMJs). METHODS: TMJ vibrations were recorded from 236 patients with five stages of TMJ dysfunction: (1) reducing partial disc displacement (PDDR, n=39); (2) acute reducing complete disc displacement (A-DDR, n=39); (3) chronic reducing complete disc displacement (C-DDR, n=55); (4) un-adapted, non-reducing, complete disc displacement (DDUA, n=57); and (5) well adapted, non-reducing, complete disc displacement (DDWA, n=46). A totally asymptomatic control group with quiet TMJs (AQ, n=43) and a group with vibrating TMJs (AWV, n=93), but otherwise asymptomatic were also recorded. Frequency distributions were calculated for each group using discrete Fourier transform methods in 10 Hz increments (0-10 Hz, 10-20 Hz,…, 990-1000 Hz). The 10 Hz segments were compared between the seven groups using Student's t test with Bonferroni adjustment. RESULTS: There were significant differences (P<0.05) in all 21 comparisons for the three segments between 80 Hz and 110 Hz, in 20 of 21 comparisons between 180 and 200 Hz, in 19 of 21 comparisons between 110 and 180 Hz and between 50 and 80 Hz. DISCUSSION: The segments of the frequency distributions from 80 to 110 Hz provided the best differentiation between all seven groups.

Internal derangements of the temporomandibular joint: A review of the anatomy, diagnosis, and management.

Internal derangements of the temporomandibular joint are conditions in which the articular disc has become displaced from its original position the condylar head. Relevant anatomic structures and their functional relationships are briefly discussed. The displacement of the disc can result in numerous presentations, with the most common being disc displacement with reduction (with or without intermittent locking), and disc displacement without reduction (with or without limited opening). These are described in this article according to the standardized Diagnostic Criteria for Temporomandibular Disorders, as well as the less common posterior disc displacement. Appropriate management usually ranges from patient education and monitoring to splints, physical therapy, and medications. In rare and select cases, surgery may be necessary. However, in for the majority of internal derangements, the prognosis is good, particularly with conservative care.

Unlocking the jaw: advanced imaging of the temporomandibular joint.

OBJECTIVE: Temporomandibular joint (TMJ) dysfunction is a common condition, affecting up to 28% of the population. The TMJ can be affected by abnormal dynamics of the disk-condyle complex, degenerative arthritis, inflammatory arthritis, and crystal arthropathy. Less commonly, neoplasms and abnormal morphologic features of the condyle are causes of TMJ symptoms. Cross-sectional imaging is frequently used for diagnosis. CONCLUSION: Knowledge of the normal imaging appearance of the TMJ, its appearance on radiological examination, and interventional techniques are useful for providing a meaningful radiologic contribution. This article will review normal TMJ anatomy; describe the normal ultrasound, CT, and MRI appearances of TMJ; provide imaging examples of abnormal TMJs; and illustrate imaging-guided therapeutic TMJ injection.

Intra-articular injection of platelet-rich plasma vs hyaluronic acid as an adjunct to TMJ arthrocentesis: A systematic review and meta-analysis.

OBJECTIVE: We aimed to find out if there is any difference in outcomes with the use of platelet-rich plasma (PRP) or hyaluronic acid (HA) intra-articular injections after temporomandibular joint arthrocentesis. METHODS: A systematic search of the electronic databases of PubMed, Embase, and Scopus was undertaken up to 5th May 2023. Randomized controlled trials (RCTs) comparing PRP with HA after TMJ arthrocentesis were included. RESULTS: Seven RCTs were eligible. Pooled analysis failed to demonstrate any significant difference in MMO between PRP and HA groups at 1 month (MD: 0.21 95 % CI: -1.29, 1.70), 3 months (MD: 0.92 95 % CI: -2.96, 4.80), and 6 months (MD: -0.05 95 % CI: -2.08, 1.97). The inter-study heterogeneity was high with I2 values of 85 %, 98 %, and 81 % respectively. Similarly, there was no statistically significant difference in pain scores between the PRP and HA groups at 1 month (MD: 0.42 95 % CI: -2.25, 3.10), 3 months (MD: 0.90 95 % CI: -1.60, 3.41), and 6 months (MD: 0.06 95 % CI: -0.92, 1.04) with inter-study heterogeneity of 99 %, 99 %, and 92 % respectively. CONCLUSION: Intra-articular use of PRP or HA after TMJ arthrocentesis may lead to comparable clinical outcomes. The current evidence is low-quality and fraught with high heterogeneity.

Comparison of outcomes with intra-articular hyaluronic acid vs corticosteroids after TMJ arthrocentesis: a systematic review and meta-analysis.

OBJECTIVE: This review aimed to examine differences in outcomes with the use of intra-articular hyaluronic acid vs corticosteroids after temporomandibular joint arthrocentesis. METHOD AND MATERIALS: Studies were searched on PubMed, Embase, Web of Science, and Google Scholar up to 15th January 2024. Randomized controlled trials comparing hyaluronic acid with corticosteroids after TMJ arthrocentesis were included. The outcomes were pain and maximal mouth opening. RESULTS: Ten articles corresponding to nine randomized clinical trials were included. There was no statistically significant difference in pain scores at 1 week (mean difference [MD] -0.30, 95% CI -1.25 to 0.65, I2 = 0%), 1 month (MD -0.55, 95% CI -1.23 to 0.13, I2 = 0%), and 6 months (MD -0.57, 95% CI -2.10 to 0.96, I2 = 58%) between the two groups. However, pain scores were found to be significantly lower in the hyaluronic acid group at 3 months (MD -1.07, 95% CI -1.84 to -0.31, I2 = 0%). No statistically significant difference was noted in maximal mouth opening at 1 week (MD 0.78, 95% CI -1.79 to 3.35, I2 = 0%), 1 month (MD 0.32, 95% CI -1.83 to 2.46, I2 = 0%), and 3 months (MD -0.41, 95% CI -3.90 to 3.07, I2 = 0%) between the two groups. Descriptive analysis for studies not included in the meta-analysis also presented similar results. CONCLUSIONS: Low-quality evidence suggests that both intra-articular hyaluronic acid and corticosteroids have similar efficacy in improving pain scores and maximal mouth opening after temporomandibular joint arthrocentesis.