title: Meta-analysis of surgical treatments for temporomandibular articular disorders.
abstract: OBJECTIVE
  Temporomandibular joint articular disorders may cause severe pain and dysfunction. We addressed the following questions. Can any surgical procedures effectively treat these disorders? If so, which procedures are most effective?
  
  
  METHODS
  We performed meta-analyses of surgical trial results to determine whether certain surgical procedures are effective in specific patient groups. To compensate for the lack of parallel control groups in published studies and for the improvement that has been observed in untreated patients, we used historical data from nonsurgical trials to derive 3 estimates of historical control group improvement (0%, 37.5%, and 75%). To our knowledge, this is the first meta-analytic evaluation of surgical treatments for temporomandibular joint disorders.
  
  
  RESULTS
  Among patients refractory to nonsurgical therapies, surgical arthrocentesis and arthroscopy were effective for patients with disc displacement without reduction at all assumed control group improvement rates. Disc repair/repositioning had a statistically significant effect at all but the highest improvement rate. In patients with disc displacement with reduction, arthroscopy and disc repair/repositioning had statistically significant effects at all but the highest assumed rate of control group improvement. There were no statistically significant differences between the effects of any treatments.
  
  
  CONCLUSIONS
  Surgical treatments appear to provide some benefit to patients refractory to nonsurgical therapies. The most reliable evidence supports the effectiveness of arthrocentesis and arthroscopy for patients with disc displacement without reduction. Better designed trials are needed before one can accurately determine the magnitude of the benefits of surgery.
authors.affiliation: Department of Health Technology Assessment, ECRI, Plymouth Meeting, PA 19462-1298, USA.
authors.forename: James T
authors.initials: JT
authors.lastname: Reston
authors.forename: Charles M
authors.initials: CM
authors.lastname: Turkelson
mesh_terms: D001182:Arthroscopy; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery; D010003:Osteoarthritis / Q000601:surgery; D019152:Paracentesis; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D019224:Temporomandibular Joint Disc / Q000601:surgery; D013705:Temporomandibular Joint Disorders / Q000601:surgery*; D016896:Treatment Outcome