Arthrocentesis Plus Injectable Platelet-Rich Fibrin in Patients With Temporomandibular Joint Dysfunction: An Updated Meta-Analysis With Trial Sequential Analysis

Temporomandibular joint (TMJ) dysfunction (TMD) is a common disorder associated with chronic pain, impaired mandibular movement, and reduced quality of life (QoL). Arthrocentesis is widely used as a minimally invasive treatment for symptomatic TMD; however, incomplete symptom resolution remains common. Injectable platelet-rich fibrin (i-PRF) has recently emerged as a biologic adjunctive therapy with potential regenerative and anti-inflammatory effects. Therefore, we conducted an updated systematic review and meta-analysis to evaluate the efficacy of arthrocentesis combined with i-PRF in patients with TMD. A comprehensive literature search was performed using PubMed, Scopus, Web of Science (WoS), and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to May 1, 2026. Randomized controlled trials (RCTs) comparing arthrocentesis plus i-PRF with control interventions were included. The primary outcome was the change in pain score measured using the Visual Analogue Scale (VAS). Secondary outcomes included maximum mouth opening (MMO), lateral excursion, protrusive movement, and QoL. Pooled estimates were calculated using a random-effects model and expressed as mean differences (MDs) with 95% confidence intervals (CIs). Nine RCTs involving 320 patients (374 joints) were included. Arthrocentesis combined with i-PRF significantly reduced pain scores compared with control interventions (MD -1.62, 95% CI: -2.28 to -0.96; p<0.001; I2= 73.55%). TSA confirmed the conclusive and sufficient confidence levels of the results. Significant improvements were also observed in MMO (MD 5.03 mm, 95% CI: 2.99 to 7.07; p<0.001; I2= 84.87), contralateral excursion (MD 0.94 mm, 95% CI: 0.41 to 1.48; p<0.001), and protrusive movement (MD 1.08 mm, 95% CI: 0.48 to 1.69; p<0.001). No significant differences were observed in right or left lateral excursion or overall QoL. Arthrocentesis combined with i-PRF appears to significantly improve pain and mandibular functional outcomes in patients with TMD. The available evidence supports i-PRF as a promising adjunctive minimally invasive therapy; however, larger RCTs with longer follow-up durations are warranted to confirm long-term efficacy and establish standardized treatment protocols.