Management of Temporomandibular Joint Osteoarthritis: A Systematic Review of Minimally Invasive Interventions

Background: Temporomandibular joint (TMJ) osteoarthritis is a prevalent, debilitating degenerative joint disease characterized by localized pain, restricted mandibular range of motion, and structural joint degradation. When conservative treatments fail, minimally invasive procedures such as TMJ arthrocentesis are indicated to clear pro-inflammatory mediators via joint lavage. To augment clinical efficacy, various intra-articular pharmacological and biological adjuncts are frequently utilized, though controversy persists regarding the optimal therapeutic protocol. Objectives: This systematic review aims to evaluate the biological mechanisms and clinical efficacy of minimally invasive interventions, directly comparing exclusive arthrocentesis against combined protocols utilizing intra-articular adjuncts such as hyaluronic acid, corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), platelet-rich plasma (PRP), and platelet-rich fibrin (PRF). Methods: Following PRISMA guidelines, an exhaustive literature search was conducted across PubMed, Web of Science, Embase, and Scopus to identify randomized controlled trials (RCTs) evaluating adult patients diagnosed with TMJ osteoarthritis undergoing arthrocentesis. The primary clinical outcomes analyzed were maximum mouth opening (MMO) in millimeters and subjective pain perception. Results: From an initial identification of 181 records, a synthesized evaluation of rigorous RCTs indicates that exclusive arthrocentesis is fundamentally effective as a baseline mechanical intervention. Pharmacological adjuncts (such as corticosteroids and NSAIDs) fail to demonstrate long-term superiority over simple mechanical lavage in pain reduction, and the benefits of hyaluronic acid are largely confined to short-term follow-ups. Conversely, autologous blood concentrates—specifically PRP and PRF—yield statistically significant, sustained long-term improvements in both pain reduction and maximum mouth opening at 12-month follow-ups, driven by the prolonged release of regenerative growth factors. Conclusions: While conventional arthrocentesis serves as an effective primary intervention, therapeutic outcomes in TMJ osteoarthritis are significantly enhanced by specific biological augmentations. Combining arthrocentesis with autologous blood derivatives like platelet-rich plasma and platelet-rich fibrin provides the most robust, sustained long-term clinical improvements in joint mobility and pain relief.