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

OBJECTIVE: To compare the efficacy of intra articular injectable agents following arthrocentesis for arthrogenous TMDs and assess evidence certainty using GRADE. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.