Comparative efficacy of arthrocentesis combined with different drug injections for arthrogenic temporomandibular disorders: a network meta-analysis of randomized trials

To compare the efficacy of intra articular injectable agents following arthrocentesis for arthrogenous TMDs and assess evidence certainty using GRADE. Systematic searches of 6 databases up to July 9, 2025 identified RCTs comparing injectable agents after arthrocentesis. Risk of bias was assessed with RoB 2 and evidence certainty with CINeMA/GRADE. Network meta analyses were performed at 1, 3, 6, and 12 months for pain (VAS) and MMO. Nineteen RCTs (783 patients) were included. For VAS, iPRF was associated with greater pain reduction than placebo at 1 month (MD = 1.36, 95% CI: 0.51 to 2.21), 3 months (MD = 1.59, 95% CI: 0.66 to 2.52), and 12 months (MD = 1.60, 95% CI: 0.14 to 3.07), though confidence intervals were wide and the 12 month estimate barely reached significance. PRP showed a similar benefit at 3 months. For MMO, only high molecular weight HA was associated with improvement at 6 months vs placebo (MD = -8.07, 95% CI: -11.14 to -5.00) and PRP (MD = 5.62, 95% CI: 2.78 to 8.45). iPRF showed statistically significant pain reduction at 1, 3, and 12 months, but the clinical importance remains uncertain given marginal effect sizes and wide confidence intervals.