Conservative and Minimally Invasive Interventions for Temporomandibular Disorders: Protocol for a Systematic Review of Randomized Controlled Trials

TL;DR

This study aims to evaluate the effectiveness of conservative and minimally invasive treatments for temporomandibular disorders in reducing pain and improving quality of life.

Contribution

The study introduces a systematic review protocol to consolidate fragmented evidence on TMD treatments using standardized methods and modern diagnostic criteria.

Findings

The review will assess the effectiveness of various interventions like splints and physical therapies for TMD pain.

It will explore differences in treatment outcomes based on TMD subtypes and diagnostic criteria.

The study will provide a methodologically rigorous synthesis to guide clinical decisions and future research.

Abstract

Background: Temporomandibular disorders (TMDs) are common musculoskeletal conditions associated with pain, functional limitation, and reduced quality of life (QoL). Despite the widespread use of conservative and minimally invasive treatments, the available evidence remains fragmented across heterogeneous interventions, diagnostic criteria, and outcome measures, limiting comparative interpretation and clinical applicability. Objectives: The primary objective of this systematic review is to evaluate the effectiveness of conservative and minimally invasive interventions for pain reduction in adult patients with temporomandibular disorders. Secondary objectives include assessing effects on mandibular function and QoL and exploring differences across intervention categories, TMD subtypes, diagnostic criteria, and follow-up durations. Methods: This protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251250251) and adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. A systematic search will be conducted in PubMed/MEDLINE, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) published from 1 January 2015, up to the date of study initiation, using controlled vocabulary terms and free-text keywords combined with Boolean operators. Eligible studies will include adult patients (≥18 years) diagnosed with temporomandibular disorders using validated diagnostic criteria and treated with conservative or minimally invasive interventions, compared with placebo/sham, no treatment or usual care, or active comparators, in accordance with the PICOS framework. Two reviewers will independently screen studies and extract data, with disagreements resolved by consensus or consultation with a third reviewer; the study selection process will be documented using a PRISMA 2020 flow diagram. Interventions will be synthesized within predefined clusters (e.g., physical and manual therapies, occlusal splint therapy, physical agent modalities, and minimally invasive joint procedures). Risk of bias will be assessed using the revised Cochrane Risk of Bias tool (RoB 2). The primary outcome will be pain intensity, while secondary outcomes will include mandibular function and QoL. Where appropriate, meta-analysis using a random-effects model will be performed; otherwise, a structured narrative synthesis will be provided. Expected Impact: The systematic review is expected to deliver an updated and methodologically rigorous synthesis of evidence on conservative and minimally invasive interventions for TMDs. By addressing existing research gaps such as the fragmentation of evidence across intervention types, heterogeneity in diagnostic criteria, and variability in outcome measures, this review will support evidence-based clinical decision-making and identify priorities for future research.