Effectiveness of combined arthrocentesis with platelet-rich plasma, platelet rich-fibrin, hyaluronic acid, corticosteroids and non-steroidal anti-inflammatory drugs in temporomandibular joint osteoarthritis: a systematic review and meta-analysis of randomized clinical trials

Abstract

Objective: To stablish whether combined arthrocentesis with platelet-rich plasma, fibrin-rich plasma, hyaluronic acid, corticosteroids and non-steroidal anti-inflammatory drugs is more effective than exclusive arthrocentesis in patients with temporomandibular joint osteoarthritis. Study Design: A bibliographic search was conducted in Pubmed, Web of Science, Embase and Scopus in July 2024. RCTs were included. The PRISMA checklist was followed. The study is registered with PROSPERO, number CRD42024542631. Results: Six RCTs were included with a total of 179 patients. For the variable of maximum oral opening, a better response was observed in the combined arthrocentesis group than in the arthrocentesis group at 6 months (P = .011) and at 12 months (P < .001). For the pain variable, there were no significant differences between the groups at 6 months (P = .300) while at 12 months a better response was observed for the experimental group (P < .001). Conclusion: Combined arthrocentesis techniques show significant improvements in maximum mouth opening at six and twelve months and in pain at twelve months pos-treatment. However, the lack of protocol development and the scarcity of similar studies highlight the heterogeneity of the results.