Arthroscopy versus arthrocentesis in the management of internal derangement of the temporomandibular joint: a systematic review and meta-analysis

The aim of this study was to assess whether arthroscopy or arthrocentesis is most effective and feasible in the management of internal derangement of the temporomandibular joint (TMJ), specifically in relation to joint movement and pain. A comprehensive electronic search without date or language restrictions was performed in January 2014. Inclusion criteria were the following: study in humans; randomized or quasi-randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies; comparison of arthrocentesis and arthroscopy in the treatment of internal derangement. Six publications were included in the review, two RCTs, two CCTs, and two retrospective studies. Two studies showed a low risk of bias and four studies showed a moderate risk of bias. There were statistically significant differences between arthrocentesis and arthroscopy with regard to maximal inter-incisal opening and pain reduction, but no difference between the two groups for postoperative complications. The results of this meta-analysis on the management of internal derangement of the TMJ revealed arthroscopy to have superior efficacy to arthrocentesis in increasing joint movement and decreasing pain. Both arthroscopy and arthrocentesis have comparable postoperative complication rates. However, the current meta-analysis is incomplete due to the paucity of good quality studies in the high-impact, peer-reviewed literature; therefore, further better-designed studies are required to address this important question before final conclusions can be drawn as to the true comparative outcomes of TMJ arthrocentesis versus TMJ arthroscopy.