{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:25:23Z","timestamp":1792805123207,"version":"4.5.0"},"reference-count":19,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T00:00:00Z","timestamp":1763942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Lithuanian University of Health Sciences science fund","id":[{"id":"https:\/\/ror.org\/0069bkg23","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Disorders of the temporomandibular joint (TMJ) affect millions worldwide and rank among the most frequent causes of orofacial pain unrelated to dental disease. Beyond discomfort, they can restrict mandibular motion and impair chewing efficiency. Arthrocentesis has been adopted as a favored surgical approach after conservative therapy fails since joint lavage can reduce inflammation and restore mobility with minimal invasiveness. A variety of irrigants are available for this procedure, including normal saline, Ringer\u2019s lactate, and ozonated water, each offering potential therapeutic advantages. However, the comparative effectiveness of these solutions in terms of pain reduction and functional recovery has not been clearly established, warranting systematic evaluation. Materials and Methods: Following PRISMA recommendations, a literature search was conducted in PubMed and ScienceDirect between 10 October and 14 November 2024. The search focused on studies published in English within the past ten years that examined arthrocentesis for temporomandibular joint disorders using normal saline, Ringer\u2019s lactate, or ozonated water as the irrigant. Results: Seven clinical trials involving 220 patients were included, of which three provided data suitable for meta-analysis. Qualitative synthesis indicated that all irrigants reduced pain (VAS) and improved maximum mouth opening (MMO), with ozonated water showing the greatest mean improvements (VAS reduction 6.2 points; MMO gain 12.9 mm). Ringer\u2019s lactate and saline also demonstrated clinically relevant effects. Quantitative analysis revealed no baseline group differences (VAS p = 0.800; MMO p = 0.935). Short-term (\u22641 month) random effects models showed non-significant changes for VAS (Fisher\u2019s z = 1.32; 95% CI \u22122.64 to 0.00) and MMO (z = 0.04; 95% CI \u22120.14 to 0.21). At 3\u20136 months, ozonated water produced a statistically significant reduction in pain (z = \u22120.34; 95% CI \u22120.53 to \u22120.15), whereas MMO remained unchanged (z = 0.05; 95% CI \u22120.13 to 0.22). Conclusions: Arthrocentesis with any irrigant improves TMD symptoms. Ozonated water demonstrated the strongest long-term analgesic effect, but MMO improvements did not reach significance. Larger, standardized randomized trials are required to validate these findings.<\/jats:p>","DOI":"10.3390\/jcm14238327","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T16:31:54Z","timestamp":1764088314000},"page":"8327","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Effectiveness of Different Irrigation Agents in Temporomandibular Arthrocentesis: Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9064-2446","authenticated-orcid":false,"given":"Migl\u0117","family":"Mi\u0161kinyt\u0117","sequence":"first","affiliation":[{"name":"Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, J. 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Luk\u0161os-Daumanto 2, LT-50106 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1177-0479","authenticated-orcid":false,"given":"Juozas","family":"\u017dilinskas","sequence":"additional","affiliation":[{"name":"Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, J. Luk\u0161os-Daumanto 2, LT-50106 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7641-3333","authenticated-orcid":false,"given":"Marijus","family":"Leketas","sequence":"additional","affiliation":[{"name":"Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, J. Luk\u0161os-Daumanto 2, LT-50106 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Zieli\u0144ski, G. (2025). Quo Vadis Temporomandibular Disorders? By 2050, the Global Prevalence of TMD May Approach 44%. J. Clin. Med., 14.","DOI":"10.3390\/jcm14134414"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1007\/s00784-020-03710-w","article-title":"Prevalence of Temporomandibular Joint Disorders: A Systematic Review and Meta-analysis","volume":"25","author":"Valesan","year":"2021","journal-title":"Clin. Oral Investig."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Tik, D., Li, S., Leung, Y.Y., and Almeida, E. (2021). Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management. Diagnostics, 11.","DOI":"10.3390\/diagnostics11030459"},{"key":"ref_4","first-page":"211","article-title":"Classification and Diagnosis of Temporomandibular Disorders and Temporomandibular Disorder Pain","volume":"67","author":"Klasser","year":"2023","journal-title":"Dent. Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1002235","DOI":"10.1155\/2023\/1002235","article-title":"Accurate Diagnosis and Treatment of Painful Temporomandibular Disorders: A Literature Review Supplemented by Own Clinical Experience","volume":"2023","author":"Garstka","year":"2023","journal-title":"Pain Res. Manag."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.coms.2021.08.001","article-title":"Pharmacologic Treatment for Temporomandibular and Temporomandibular Joint Disorders","volume":"34","author":"Andre","year":"2022","journal-title":"Oral Maxillofac. Surg. Clin."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez-S\u00e1nchez, B., Garc\u00eda Monterey, P., Ram\u00edrez-Dur\u00e1n Mdel, V., Garrido-Ardila, E.M., Rodr\u00edguez-Mansilla, J., and Jim\u00e9nez-Palomares, M. (2023). Temporomandibular Joint Dysfunctions: A Systematic Review of Treatment Approaches. J. Clin. Med., 12.","DOI":"10.3390\/jcm12124156"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"17","DOI":"10.11607\/ofph.2606","article-title":"Arthrocentesis of the Temporomandibular Joint: Systematic Review and Clinical Implications of Research Findings","volume":"35","author":"Ferronato","year":"2021","journal-title":"J. Oral Fac. Pain Headache"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.cxom.2022.06.008","article-title":"Athrocentesis: What, when, and why?","volume":"30","author":"Nitzan","year":"2022","journal-title":"Atlas Oral Maxillofac. Surg. Clin. N. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e238e241","DOI":"10.1097\/SCS.0000000000009085","article-title":"The Efficacy of Ozonized Water Versus Ringer Lactate Arthrocentesis for the Treatment of Temporomandibular Joint Internal Derangement","volume":"34","author":"Hassan","year":"2023","journal-title":"J. Craniofacial Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3133","DOI":"10.21608\/edj.2017.76111","article-title":"Efficiency of Temporomandibular Joint Arthrocentesis with Ozonated Water in Management of Anterior Disc Displacement without Reduction: A Randomized Clinical Trial","volume":"63","author":"Shabaan","year":"2017","journal-title":"Egypt. Dent. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3165","DOI":"10.21608\/edj.2018.78529","article-title":"A Novel Treatment for Temporomandibular Joint Internal Derangement: A Randomized Controlled Clinical Study","volume":"64","author":"Elskolhamy","year":"2018","journal-title":"Egypt. Dent. J."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Bayramoglu, Z., Yavuz, G.Y., Keskinruzgar, A., Koparal, M., and Kaya, G.S. (2023). Does intra-articular injection of tenoxicam after arthrocentesis heal outcomes of temporomandibular joint osteoarthritis? A randomized clinical trial. BMC Oral Health, 23.","DOI":"10.1186\/s12903-023-02852-z"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.jcms.2014.11.002","article-title":"Intra-articular platelet-rich plasma injection for the treatment of temporomandibular disorders and a comparison with arthrocentesis","volume":"43","author":"Hanci","year":"2015","journal-title":"J. Cranio-Maxillofac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"160","DOI":"10.21608\/adjalexu.2015.59142","article-title":"Comparative Study of Arthrocentesis with or without Using Piroxicam in the Management of Temporomandibular Joint Disorders","volume":"40","year":"2015","journal-title":"Alex. Dent. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"217","DOI":"10.4103\/njms.NJMS_26_16","article-title":"Comparison of efficacy of sodium hyaluronate and normal saline arthrocentesis in the management of internal derangement of temporomandibular joints\u2014A prospective study","volume":"10","author":"Rao","year":"2019","journal-title":"Natl. J. Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2046-4053-4-1","article-title":"Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement","volume":"4","author":"Moher","year":"2015","journal-title":"Syst. Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1097\/ACM.0000000000000786","article-title":"Appraising the quality of medical education research methods: The Medical Education Research Study Quality Instrument and the Newcastle-Ottawa Scale-Education","volume":"90","author":"Cook","year":"2015","journal-title":"Acad. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8327\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T16:49:10Z","timestamp":1764089350000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/23\/8327"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,24]]},"references-count":19,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14238327"],"URL":"https:\/\/doi.org\/10.3390\/jcm14238327","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,24]]}}}