Asian Journal of Dental Sciences

Background: Arthrocentesis of the temporomandibular joint is widely used for painful intra-articular temporomandibular disorders, particularly disc displacement without reduction with limited mouth opening, arthralgia and osteoarthritis. Its evidence base has expanded rapidly, yet systematic reviews, network meta-analyses and an international clinical practice guideline have reached divergent conclusions about whether the procedure, with or without intra-articular adjuncts, offers clinically meaningful benefit beyond conservative care.

Purpose and Scope: This critical narrative review examines pain and jaw function at approximately six months after arthrocentesis in adults with arthrogenous temporomandibular disorders. It focuses on the size and durability of effects relative to conservative management, the incremental value of corticosteroids, hyaluronic acid, platelet concentrates, analgesics and cell-based preparations, the influence of technique and patient factors, and the methodological quality of the six-month evidence.

Approach: Randomised and non-randomised comparative studies, systematic reviews, network meta-analyses, natural-history cohorts and measurement studies were identified through structured searching of biomedical and open scholarly sources, citation tracking and verification of every bibliographic record. Evidence was appraised qualitatively and synthesised thematically.

Principal Findings: Within-group improvement in pain and mouth opening by six months is consistent across arthrocentesis trials, but comparable improvement occurs with conservative care and during the untreated natural course of disc displacement without reduction. Between-group advantages for arthrocentesis at six months are most consistent for pain, are small to moderate in magnitude and approach accepted thresholds of clinical importance only in some syntheses, whereas differences in mouth opening generally fall below the measurement error of the outcome. Corticosteroids add little at six months. Platelet concentrates show statistically favourable pooled estimates and hyaluronic acid shows inconsistent effects, but both bodies of evidence derive from small, heterogeneous, frequently single-centre trials, and platelet preparation protocols vary widely. Technique refinements change procedural efficiency more clearly than six-month outcomes.

Unresolved Questions: Sham-controlled comparisons, phenotype-stratified effects, standardised core outcomes and durability beyond one year remain inadequately addressed.

Implications and Conclusion: Arthrocentesis is a low-risk option that probably accelerates early recovery and may modestly reduce pain at six months, but current evidence does not justify confident claims of clinically important functional superiority or of added value from biological adjuncts.