Are there differences among TMJ arthroscopy discopexy techniques for pain and oral opening? A systematic review and Bayesian analysis.

Abstract

This study aims to determine which of the main arthroscopic discopexy techniques yields the best outcomes. A systematic review was conducted following the PRISMA guidelines. The inclusion criteria comprised studies reporting Visual Analogue Scale (VAS) scores and maximum interincisal opening (MIO) in patients who underwent temporomandibular joint (TMJ) discopexy. A Bayesian linear regression analysis was performed, considering pain reduction and increased mouth opening as dependent variables. The three primary technique groups were classified as rigid, semi-rigid, and non-rigid. A total of 1.400 discopexies performed were assessed on 849 female and 204 male patients. The most common diagnosis was Wilkes stage III, observed in 257 joints. The rigid technique resulted in a pain reduction of -56.07 (VAS), the semi-rigid technique reduced pain by -41.17 (VAS) and the non-rigid technique by -51.47 (VAS). Regarding MIO improvement, the semi-rigid technique showed the greatest increase, with a mean gain of 9.84 mm (7.06 ± 2.78 mm), followed by the non-rigid technique with 8.41 mm (7.06 ± 1.35 mm), and the rigid technique with 7.06 mm. All techniques demonstrated improvements in both pain reduction and mouth opening. However, the rigid technique achieved the best pain reduction, while the semi-rigid technique resulted in the most significant improvement in MIO.