Comparative Analysis of Evidence Based Practices of Biomechanical Modeling and Clinical Management of TMJ Disc Displacement: A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/098Keywords:
Disc Displacement, Disorder, PRISMA, Biomechanical, Joints, Temporomandibular JointsAbstract
Background: TMJ disc displacement without reduction (DDWoR) results in excruciating pain and functional issues. The management of TMJ disc displacement without reduction has improved thanks to biomechanical modelling and clinical interventions; however, more work is required to integrate biomechanical insights with patient outcomes. The goal of this review was to combine clinical and biomechanical data regarding treatment approaches for disc displacement without reduction in the temporomandibular joint (TMJ).
Methods: The review's systematic evaluation procedure was carried out under PRISMA 2020 guidelines. PubMed, Web of Science, and Scopus databases were used in the study conducted in April 2025. Finite element biomechanical models, clinical trials, or cohorts assessing treatment outcomes were included in the studies that were approved for analysis. The GRADE methodology was used to evaluate the evidence certainty, and a fixed-effect analysis of randomised controlled trials was conducted.
Results: Five biomechanical modelling studies and five clinical studies were included in the research analysis. Both mandibular springs and splints showed their capacity to redistribute stress in the joint area within models. The combination of arthrocentesis and splint treatments resulted in a pooled risk ratio of 1.46 (95% CI 1.17–1.82) with transparent result consistency (I² = 0%) and positive effects on maximum mouth opening and pain reduction. The levels of evidence that were obtained were moderate to high.
Discussion: The effectiveness of splint and arthrocentesis treatments for TMJ disc displacement was supported by a combined strategy that incorporated biomechanical research and clinical observations. Future studies must create customized patient models and run experiments in several medical facilities instead of one.
References
1. De Almeida AM, Botelho J, Machado V, Mendes JJ, Manso C, González-López S. Comparison of the Efficacy of Two Protocol Treatments in Patients with Symptomatic Disc Displacement without Reduction: A Randomized Controlled Trial. Journal of Clinical Medicine. 2023 Apr 30;12(9):3228. https://doi.org/10.3390/jcm12093228
2. Warburton G, Patel N, Anchlia S. Current Treatment Strategies for the Management of the Internal Derangements of the Temporomandibular Joint: A Global Perspective. Journal of Maxillofacial and Oral Surgery. 2022 Mar;21(1):1-13. https://doi.org/10.1007/s12663-021-01509-0
3. Dawoud BE, Tabbenor O, Crawford C, Bayoumi S. Arthrocentesis versus occlusal coverage splints in the management of disc displacement without reduction: a systematic review and meta-analysis. International Journal of Oral and Maxillofacial Surgery. 2024 Sep;53(9):779-786. https://doi.org/10.1016/j.ijom.2024.03.013
4. Lahoud P, Faghihian H, Richert R, Jacobs R, EzEldeen M. Finite element models: A road to in-silico modeling in the age of personalized dentistry. Journal of Dentistry. 2024 Nov;150:105348. https://doi.org/10.1016/j.jdent.2024.105348
5. Ferrillo M, Nucci L, Giudice A, Calafiore D, Marotta N, Minervini G, d'Apuzzo F, Ammendolia A, Perillo L, de Sire A. Efficacy of conservative approaches on pain relief in patients with temporomandibular joint disorders: a systematic review with network meta-analysis. Cranio. 2025 Mar;43(2):258-274. https://doi.org/10.1080/08869634.2022.2126079
6. Trindade D, Cordeiro R, José HC, Ângelo DF, Alves N, Moura C. Biological Treatments for Temporomandibular Joint Disc Disorders: Strategies in Tissue Engineering. Biomolecules. 2021 Jun 23;11(7):933. https://doi.org/10.3390/biom11070933
7. Alowaimer HA, Al Shutwi SS, Alsaegh MK, Alruwaili OM, Alrashed AR, AlQahtani SH, Batais MS. Comparative Efficacy of Non-Invasive Therapies in Temporomandibular Joint Dysfunction: A Systematic Review. Cureus. 2024 Mar 22;16(3):e56713. https://doi.org/10.7759/cureus.56713
8. Pinheiro M, Willaert R, Khan A, Krairi A, Van Paepegem W. Biomechanical evaluation of the human mandible after temporomandibular joint replacement under different biting conditions. Scientific Reports. 2021 Jul 7;11(1):14034. https://doi.org/10.1038/s41598-021-93564-3
9. Della Posta D, Paternostro F, Costa N, Branca JJV, Guarnieri G, Morelli A, Pacini A, Campi G. Evaluating Biomechanical and Viscoelastic Properties of Masticatory Muscles in Temporomandibular Disorders: A Patient-Centric Approach Using MyotonPRO Measurements. Bioengineering. 2025 Jan 22;12(2):97. https://doi.org/10.3390/bioengineering12020097
10. Lai L, Huang C, Zhou F, Xia F, Xiong G. Finite elements analysis of the temporomandibular joint disc in patients with intra-articular disorders. BMC Oral Health. 2020 Mar 30;20(1):93. https://doi.org/10.1186/s12903-020-01074-x
11. He J, Ran J, Zheng B, Algahefi A, Liu Y. Finite element analysis of various thickness occlusal stabilization splint therapy on unilateral temporomandibular joint anterior disc displacement without reduction. American Journal of Orthodontics and Dentofacial Orthopedics. 2022 Mar;161(3):e277-e286. https://doi.org/10.1016/j.ajodo.2021.09.011
12. Gao W, Lu J, Gao X, Zhou J, Dai H, Sun M, Xu J. Biomechanical effects of joint disc perforation on the temporomandibular joint: a 3D finite element study. BMC Oral Health. 2023 Nov 29;23(1):943. https://doi.org/10.1186/s12903-023-03521-x
13. Mude AH, Ikbal M, Hatta MP, Sugianto I, Machmud E, Rahman FUA, Irsal I, Fibrianti E, Bachtiar MM, Attamimi TRAS. Finite element analysis of stabilization splint pressure distribution in a patient with disc displacement without reduction: A preliminary study. Imaging Science in Dentistry. 2024 Sep;54(3):251-256. https://doi.org/10.5624/isd.20240017
14. Zhu C, Li R, Yuan L, Zheng Y, Jin Y, Li H, Liu C, Xia L, Fang B. Effects of the advanced mandibular spring on mandibular retrognathia treatment: a three-dimensional finite element study. BMC Oral Health. 2022 Jul 5;22(1):271. https://doi.org/10.1186/s12903-022-02308-w
15. Grossmann E, Poluha RL. The benefits of performing temporomandibular joint arthrocentesis with catheters and a vacuum pump: A randomized control trial. Journal of Cranio-Maxillofacial Surgery. 2024 Mar;52(3):369-373. https://doi.org/10.1016/j.jcms.2024.01.020
16. Erdil A, Demirsoy MS, Tümer MK. Evaluation of the effects of arthrocentesis combined with occlusal stabilization splint on disc displacement without reduction-induced acute and closed lock: A prospective cohort study. Journal of Stomatology Oral and Maxillofacial Surgery. 2023 Oct;124(5):101438. https://doi.org/10.1016/j.jormas.2023.101438
17. Manafikhi M, Ataya J, Heshmeh O. Evaluation of the efficacy of platelet rich fibrin (I-PRF) intra-articular injections in the management of internal derangements of temporomandibular joints: a controlled preliminary prospective clinical study. BMC Musculoskeletal Disorders. 2022 May 14;23(1):454. https://doi.org/10.1186/s12891-022-05421-7
18. El-Shaheed NH, Mostafa AZH, Aboelez MA. Efficacy of stabilisation splint and low-level laser therapy for patients with chronic closed lock from non-reducible displaced temporo-mandibular joint discs: A parallel randomised clinical trial. Journal of Oral Rehabilitation. 2023 Mar;50(3):177-193. https://doi.org/10.1111/joor.13405
19. Abdel-Gawwad EA, Atito E, Osman M, Emam AM, Baraka Y, Abdullah AAB, Helal MA. Evaluating the Impact of Various Treatment Modalities on the Chewing Efficiency of Anterior Disc Displacements of Temporomandibular Joint Disorder Cases: A Comparative Study. Journal of International Society of Preventive and Community Dentistry. 2024 Apr 29;14(2):136-143. https://doi.org/10.4103/jispcd.jispcd_151_23
20. Silva CAGD, Grossi ML, Araldi JC, Corso LL. Can hard and/or soft occlusal splints reduce the bite force transmitted to the teeth and temporomandibular joint discs? A finite element method analysis. Cranio. 2023 Jul;41(4):298-305. https://doi.org/10.1080/08869634.2020.1853464
21. Musa M, Zhang Q, Awad R, Wang W, Ahmed MMS, Zhao Y, Almashraqi AA, Chen X, Alhammadi MS. Quantitative and qualitative condylar changes following stabilization splint therapy in patients with temporomandibular joint disorders. Clinical Oral Investigations. 2023 May;27(5):2299-2310. https://doi.org/10.1007/s00784-023-04963-x
22. Tang YH, Vos LM, Tuin AJ, Huddleston Slater JJR, Gareb B, van Bakelen NB, Spijkervet FKL. Arthrocentesis versus non-surgical intervention as initial treatment for temporomandibular joint arthralgia: a randomized controlled trial with long-term follow-up. International Journal of Oral and Maxillofacial Surgery. 2023 May;52(5):595-603. https://doi.org/10.1016/j.ijom.2022.08.018
23. Thorpe ARDS, Haddad Y, Hsu J. A systematic review and meta-analysis of randomized controlled trials comparing arthrocentesis with conservative management for painful temporomandibular joint disorder. International Journal of Oral and Maxillofacial Surgery. 2023 Aug;52(8):889-896. https://doi.org/10.1016/j.ijom.2022.12.005
24. Sagl B, Schmid-Schwap M, Piehslinger E, Kundi M, Stavness I. Effect of facet inclination and location on TMJ loading during bruxism: An in-silico study. Journal of Advanced Research. 2021 Apr 29;35:25-32. https://doi.org/10.1016/j.jare.2021.04.009
25. Schoenen S, Heussen N, Verbeeck J, Hilgers RD. The impact of allocation bias on test decisions in clinical trials with multiple endpoints using multiple testing strategies. BMC Medical Research Methodology. 2024 Sep 30;24(1):223. https://doi.org/10.1186/s12874-024-02335-x
26. Kirnaz S, Capadona C, Lintz M, Kim B, Yerden R, Goldberg JL, Medary B, Sommer F, McGrath LB Jr, Bonassar LJ, Härtl R. Pathomechanism and Biomechanics of Degenerative Disc Disease: Features of Healthy and Degenerated Discs. International Journal of Spine Surgery. 2021 Apr;15(s1):10-25. https://doi.org/10.14444/8052
27. Altaweel AA, Ismail HA, Fayad MI. Effect of simultaneous application of arthrocentesis and occlusal splint versus splint in management of non-reducing TMJ disc displacement. Journal of Dental Sciences. 2021 Mar;16(2):732-737. https://doi.org/10.1016/j.jds.2020.08.008
28. Bhattacharjee B, Bera RN, Verma A, Soni R, Bhatnagar A. Efficacy of Arthrocentesis and Stabilization Splints in Treatment of Temporomandibular Joint Disc Displacement Disorder Without Reduction: A Systematic Review and Meta-analysis. Journal of Maxillofacial and Oral Surgery. 2023 Mar;22(1):83-93. https://doi.org/10.1007/s12663-021-01675-1
29. Augat P, Hast MW, Schemitsch G, Heyland M, Trepczynski A, Borgiani E, Russow G, Märdian S, Duda GN, Hollensteiner M, Bottlang M, Schemitsch EH. Biomechanical models: key considerations in study design. OTA International. 2021 Apr 15;4(2 Suppl):e099(1-6). https://doi.org/10.1097/OI9.0000000000000099
30. Roberts A, Harris K, Outen B, Bukvic A, Smith B, Schultz A, Bergman S, Mondal D. Osteopathic Manipulative Medicine: A Brief Review of the Hands-On Treatment Approaches and Their Therapeutic Uses. Medicines. 2022 Apr 27;9(5):33. https://doi.org/10.3390/medicines9050033
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Medicine and Dentistry

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access article distributed under the terms of the CreativeCommons Attribution License (CC BY) 4.0 https://creativecommons.org/licenses/by/4.0/