Conservative versus invasive approaches in temporomandibular disc displacement: A systematic review of randomized controlled trials

Abstract

Background: Temporomandibular disorders (TMD) are common causes of orofacial pain and disfunction. Treatment options range from conservative therapies to invasive surgical procedures. The aim of this study was to analyze and compare the efficacy and safety profiles of conservative, minimally invasive interventions, and surgical procedures in patients diagnoses with TMD and disc displacement. Methods: According to PRISMA recommendations, PubMed, Scopus, and Web of Science databases were searched for randomized clinical trials. Risk of bias was evaluated with the ROB 2 tool. Results: 38 randomized controlled clinical trials were selected. Conservative approaches, including physical therapy and occlusal devices, were generally effective and lead to an improvement of symptoms and function. Physical agents, apart from pulsed electromagnetic fields, were shown to be helpful during treatment. Pharmacological treatments, namely NSAIDs, demonstrated effectiveness in reducing pain and improving function, however, they can have undesirable side effects. Minimally invasive and invasive treatments also demonstrated efficacy, although most trials did not demonstrate their superiority to conservative treatments. Conclusion: The primary approach to TMD should be a conservative, multimodal treatment plan, tailored to patient complains and characteristics. Treatment goals should be centered on symptom control and functional recovery. Surgical treatments should be reserved for moderate to severe cases that cannot be managed solely by conservative therapy.