Evidence for minimally invasive treatment-A systematic review on surgical management of disc displacement.

BACKGROUND: Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform minimal invasive interventions as first-line surgical treatment since there are no evidence on best surgical practice yet.

OBJECTIVE: The aim was to perform a complex systematic review (SR) on the topic-is there evidence for surgical treatment of TMJ DD?

METHODS: The PICO was defined as DD patients (population), treated with different surgical interventions including arthrocentesis (intervention), compared with other or no treatment (control) regarding the outcome variables mandibular function, mouth opening capacity, TMJ pain, etcetera (outcome). For identification of prospective controlled trials and SRs, a search strategy was developed for application in three databases.

RESULTS: The search yielded 4931 studies of which 56 fulfilled the stipulated PICO. Studies with low or moderate risk of bias were possible to include in meta-analyses. There were evidence suggesting arthrocentesis being more effective compared to conservative management (maximum interincisal opening (MIO): p < .0001, I2  = 22%; TMJ pain: p = .0003, I2  = 84%) and arthrocentesis being slightly more effective than arthrocentesis with an adjunctive hyaluronic acid injection (MIO: p = .04, I2  = 0%; TMJ pain: p = .28, I2  = 0%). Other treatment comparisons showed nonsignificant differences. The performed meta-analyses only included 2-4 studies each, which might indicate a low grade of evidence.

CONCLUSION: Although arthrocentesis performed better than conservative management the findings should be interpreted cautiously, and non-invasive management considered as primary measure. Still, several knowledge gaps concerning surgical methods of choice remains.