Clinical Oral Investigations (2020) 24:61–70

https://doi.org/10.1007/s00784-019-03126-1

REVIEW

Treatment of temporomandibular joint luxation: a systematic

literature review
Helene Abrahamsson 1 & Lars Eriksson 2 & Peter Abrahamsson 3 & Birgitta Häggman-Henrikson 1,4

Received: 20 November 2018 / Accepted: 16 October 2019 / Published online: 15 November 2019
# The Author(s) 2019

Abstract
Objectives To evaluate the effectiveness of surgical and nonsurgical treatment of temporomandibular joint (TMJ) luxation.
Materials and methods This systematic literature review searched PubMed, the Cochrane Library, and Web of Science databases
to identify randomized controlled trials on TMJ luxation treatment published between the inception of each database and 26
March 2018.
Results Two authors assessed 113 unique abstracts according to the inclusion criteria and read nine articles in full text. Eight
articles comprising 338 patients met the inclusion criteria, but none of these evaluated surgical techniques. Three studies
including 185 patients concerned acute treatment with manual reduction of luxation while five studies including 153 patients
evaluated minimally invasive methods with injection of autologous blood or dextrose prolotherapy for recurrent TMJ luxation.
These studies reported that mouth opening after treatment was reduced and that independent of type of injection, recurrences of
TMJ luxation were rare in most patients.
Conclusions In the absence of randomized studies on surgical techniques, autologous blood injection in the superior joint space
and pericapsular tissues with intermaxillary fixation seems to be the treatment for recurrent TMJ luxation that at present has the
best scientific support. Well-designed studies on surgical techniques with sufficient numbers of patients, long-term follow-ups,
and patient experience assessment are needed for selection of the optimal surgical treatment methods.
Clinical relevance Autologous blood injection combined with intermaxillary fixation can be recommended for patients with
recurrence of TMJ luxation.

Keywords Hypermobility . Luxation . Prolotherapy . TMJ dislocation . TMJ reduction

Introduction and eat [1]. Furthermore, psychological and social impact are
high and TMJ luxation can therefore be regarded as one of the
Temporomandibular joint (TMJ) luxation (dislocation) is rare, most severe conditions in dentistry [2].
but when it occurs, it has a high impact on the individual and TMJ hypermobility can be classified as a subluxation or a
usually requires urgent medical attention. In the acute stage, luxation. TMJ subluxation is a condition where the condyle
TMJ luxation severely affects oral health due to the severity of translates anteriorly of the articular eminence during jaw
the pain or discomfort and the reduced ability to speak, chew, opening and briefly catches in an open position before
returning to the fossa spontaneously [3] or with manual self-
manipulation by the patient. The Research Diagnostic Criteria
* Birgitta Häggman-Henrikson for Temporomandibular Disorders (RDC/TMD) classification
Birgitta.haggman.henrikson@mau.se scheme [4] was expanded in 2014 to include less common, but
1
clinically important disorders. According to these, the
Department of Orofacial Pain and Jaw Function, Malmö University,
205 06 Malmö, Sweden
Diagnostic Criteria for Temporomandibular Disorders (DC/
2
TMD), subluxation should have a positive history that the
Department of Oral Surgery and Oral Medicine, Malmö University,
Malmö, Sweden
jaw has been caught in a wide open position and the patient
3
had to do a self-maneuver to be able to close the jaw [5].
The Maxillofacial Unit, Halmstad Hospital, Halmstad, Sweden
During TMJ luxation, the patient is unable to self return to
4
Department of Odontology/Clinical Oral Physiology, Umeå the fossa without the help of a clinician to maneuver the jaw
University, Umeå, Sweden
62 Clin Oral Invest (2020) 24:61–70

back into a normal position. Thus, relocation of the condyle to with a weak capsule and ligament laxity [19]; these patients
its normal position occurs through self-manipulation in cases are at risk for recurrent TMJ luxation.
of subluxation, but not in luxation [1]. Clinically, the patient
will present with the jaw wide open, or protruded, or in lateral Acute therapy
position to the nonaffected side (in the case of a unilateral
luxation) [5]. Manual repositioning of the mandibular condyle into the
glenoid fossa is the first choice for acute treatment and con-
sidered to be the best approach [2]. In patients with recurrent
Incidence
conditions, this acute treatment can be regarded as a tempo-
rary solution, and additional preventative measures may be
Although a retrospective study by Agbara et al. at a uni-
required.
versity hospital in Nigeria reported that TMJ luxation was
associated with yawning, higher age, and male gender, in
Preventive therapy
general, the TMJ joints are more flexible in women and
therefore more likely to luxate [6]. However, the inci-
The preventive treatment of TMJ luxation can be either non-
dence of TMJ luxation is low; two medical emergency
surgical or surgical. Jaw exercises are one example of nonsur-
departments, with 100,000 annual visits combined, report-
gical treatment that aims to improve muscle strength and co-
ed an average of 5.3 cases annually of TMJ luxation over
ordination after TMJ luxation. Jaw exercises are considered to
a period of 7 years [7]. Bilateral luxation of the TMJ is
have a moderate effect on the ability to prevent repeated lux-
most common with the mandible in a straight open posi-
ation, but the scientific evidence is weak. Other nonsurgical
tion [8], whereas with a single-sided luxation, the mandi-
methods include intermaxillary fixation (IMF) [20];
ble is deviated to the opposite side, with a partially open
prolotherapy, which is injection of sclerosing or proliferant
mouth. Luxation of the TMJ represents 3% of all cases of
solutions [21] or autologous blood into the TMJ [22]; and
reported dislocated joints in the body [9].
botulinum toxin injection into the masseter and pterygoid
TMJ luxation can be acute or chronic [10]. Acute TMJ
muscles [23, 24].
luxation may occur as a result of external trauma, sudden wide
Several surgical procedures for creating an obstacle at the
mouth opening while yawning, taking a large bite, or
eminence have been suggested for limiting the anterior move-
laughing. In the clinical situation, TMJ luxation may occur
ment of the condylar head to hinder recurrent TMJ luxation.
after excessive mouth opening during dental treatment or oth-
Examples are down fracture of the zygomatic arch, also
er oro-pharyngeal procedures [11]. A patient with a history of
known as Dautrey’s procedure [25], miniplating, bone
a TMJ luxation is more likely to have a recurrence [12]. It has
grafting, and alloplastic materials attached to the articular em-
been proposed that abnormalities in the stabilizing structures
inence have also been described. Soft tissue surgery for
of the TMJ may be associated with luxation. The main factors
restricting condyle movement has been suggested, i.e.,
for joint stability are the ligaments and muscles together with
myotomy of the lateral pterygoids, lateral pterygoid muscle
the anatomy of the bony components of the joint [13], which
tendon scarification, scarification of the temporalis tendon
means that the pathophysiology is multifactorial [14].
[26], and capsule plication. Another surgical strategy,
Concerning the anatomy of the TMJ, a steep articular emi-
eminectomy, clears the path of the condylar head by removing
nence or an abnormal condylar shape [14] are risk factors
the eminence and is the recommended procedure for achiev-
for luxation.
ing total release of condylar translation [15].
In conclusion, several methods have been proposed for the
Pathogenesis treatment of TMJ luxation.
The aim of this systematic review was to evaluate clinical
When the TMJ condyle luxates into an anterior position of the randomized controlled trials (RCTs) on the effectiveness of
eminence, a reflex is generated that sets the masticatory mus- surgical and nonsurgical treatment of TMJ luxation that had
cles into a spasm; this hinders the condyle from moving back been published over the last 50 years.
to its normal position [15]. Systemic diseases associated with
muscular spasm and muscular dystonia have been reported to
increase the risk for TMJ luxation [14]. Some brands of anti- Materials and methods
psychotic medications could also contribute to the risk of TMJ
luxation due to their side effects of dystonia [16]. Benign Inclusion and exclusion criteria
hypermobility, which often is hereditary, is another predispos-
ing factor for TMJ luxation [17, 18]. In patients with Ehlers- Clinical RCT studies published in English, Swedish, or
Danlos syndrome, hypermobility is common and associated German on patients diagnosed with TMJ luxation were
Clin Oral Invest (2020) 24:61–70 63

considered. Non-RCT studies as well as data already reported for full-text assessment. All potentially eligible articles were
in other studies (dual publication), studies on TMJ fractures, then retrieved as full-text articles to determine if they met the
and studies with fewer than 10 patients were excluded. inclusion criteria. Disagreement was resolved by discussion
among the investigators. Authors were not contacted for miss-
Literature search ing information. One of the reviewers was an experienced
orofacial pain researcher and the other, an orofacial pain reg-
The search strategy was designed to identify studies on treat- istrar. One author (HA) carried out the data extraction which
ment of TMJ luxation and encompassed all articles in was reviewed by another author (BHH).
PubMed, the Cochrane Library, and Web of Science. The These data were extracted from the RCTs:
initial search included studies published from the inception
of each database until 31 October 2015; an update search & Clinic setting
was carried out 26 March 2018. We used these search terms: & Inclusion and exclusion criteria
“Temporomandibular joint” (MeSH) OR “TMJ” (MeSH) & Number of patients
AND “Luxation” OR “Subluxation” OR “Dislocation “OR & Age and gender of patients
“Open lock “OR “Hypermobility “OR “JHS” OR “Joint & Number of drop outs
Hypermobility Syndrome” and limited the search to random- & Treatment method
ized controlled trials. Table 1 provides the full search strategy & Follow-ups
for PubMed. A hand search of the reference lists in the includ- & Results
ed articles was done to identify additional studies. Grey liter- & Authors’ conclusions
ature was not included, and authors were not contacted for
additional information.
Quality assessment
Procedures
Two authors (HA, BHH) independently evaluated the
Two of the authors (HA, BHH) independently read all titles quality of each identified article. The quality of each
and abstracts that were found in searches to identify potential- study was assessed using a tool for RCT studies from
ly eligible studies for inclusion. If one of the reviewers the Swedish Agency for Health Technology Assessment
deemed an article as potentially of interest, it was included and Assessment of Social Services (SBU), which SBU

Table 1 Full search strategy on

PubMed, 26 March 2018 Search Search string No. of articles

Temporomandibular joint
1 Temporomandibular joint [MeSH] 25,556
2 TMJ [MeSH] 26,047
3 #1 OR #2 26,047
Luxation or subluxation
4 Luxation 3,526
5 Subluxation 43,945
6 Dislocation 63,547
7 Open lock 397
8 Hypermobility 2,513
9 JHS 649
10 Joint hypermobility syndrome 2,220
11 #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 73,406
Study design
13 ((((randomized controlled trial[Publication Type] OR 718,112
(randomized[Title/Abstract] AND controlled[Title/Abstract]
AND trial[Title/Abstract]))))) OR randomi*[Title/Abstract]
Combined searches
12 #3 AND #11 3,203
14 #12 AND #13 93
64 Clin Oral Invest (2020) 24:61–70

had modified by combining both parts from the Reports on surgical techniques and acute therapy
Cochrane Risk of Bias Tool and adding a specific item
on possible conflict of interest to the domain “Other No RCT studies that evaluated surgical techniques were iden-
risks of bias” [27]. tified. Three of the included articles described acute manage-
ment of TMJ luxation and evaluated methods for manual re-
positioning. In an external approach proposed by Ardehali
et al., the physician places both hands externally, one hand
Results on each of the patient’s cheeks. The mandibular angle is pulled
anteriorly; at the same time, pressure is applied to the coronoid
Altogether, 113 unique articles were identified after re- process on the opposite side, with a gentle movement the
moval of duplicates (Fig. 1). Following the initial condylar head is then pushed back into the glenoid fossa on
screening of all abstracts, nine articles were reviewed one side. This approach, termed the external approach for
in full text by applying the inclusion and exclusion reduction of TMJ luxation, was less successful (55%) com-
criteria. One article, Sato et al. [1] did not meet the pared to the conventional method (86%) [28]. A later study by
inclusion criteria and was excluded. The eight remaining the same author compared conventional repositioning, the ex-
articles (Tables 2 and 3) met the inclusion criteria. Six ternal approach, and a wrist pivot method, and reported no
articles were considered to be at moderate risk of bias significant differences between the techniques concerning
and the remaining two articles low risk (Table 4). successful reduction [29]. Xu et al. evaluated a supine position

Fig. 1 Flowchart of articles included and excluded in the study

Table 2 Studies on methods for reducing TMJ luxation (n = 3) in the present systematic review

Article First Study sample Setting Number of subjects (% Treatment Outcome measures Results Authors’ conclusions Comments
author Year females) mean age

Ardehali 2016 Acute TMJ dislocation Total: 90 (53%) 47 years Conventional First try successful reduction Successful reduction The wrist pivot method Only acute short-term
Tertiary referral center Conventional: 30 (47%) method (intraoral) Method: should be considered outcome
Clin Oral Invest (2020) 24:61–70

otorhino-laryngology 47 years compared with Conventional: 87% as the first line of

Extraoral: 30 (60%) 48 extraoral and Extraoral: 67% treatment in the
years wrist pivot meth- Wrist pivot: 97% treatment of acute TMJ
Wrist pivot: 30 (53%) 47 od More successful luxation
years reductions for wrist
pivot method
compared to
extraoral method
(p<0.01)
Jiantao 2016 Acute nontraumatic TMJ Total: 40 (48%) 34 years Conventional First try successful reduction Conventional intraoral Reduced operation time Only acute short-term
dislocation Conventional: 20 (45%) method (intraoral) Reduction time method: Reduction: and reduced pain outcome
Hospital clinic 34 years compared with Pain during reduction (VAS) 100% perception indicated
Supine technique: 20 Supine position Operation time: 269 s that the supine position
(62%) 32 years technique (SD 70) technique method
Pain: 8.1(0.7) might be a more viable
Supine position alternative to the
technique: conventional method
Reduction: 100% of reduction of acute
Operation time: 173s nontraumatic TMJ
(SD17) dislocation
Pain: 6.3 (0.8)
Reduced operation
time (p < 0.05) and
pain (p < 0.01) with
supine position
Ardehali 2009 Acute dislocation 58 attempts in 55 patients Intraoral compared First try successful reduction Successful reduction External method for TMJ Only acute short-term
of TMJ Conventional method: to extraoral Conventional method: reduction could be a outcome
Tertiary referral center 29 (41%) 26 years reposition 86.2% (95% CI good method to avoid Authors’ conclusion not
otorhino-laryngology Extraoral method: 73–100) bites, and if it is in line with the results.
29 (62%) 32 years Extraoral method: unsuccessful the Unclear benefits with
55.2% (95% CI conventional method the new proposed
39–79) still is the gold standard method compared to
p = 0.009 the conventional
intraoral method.

VAS visual analog scale

65
 66

Table 3 Studies on injection of autologous blood or dextrose prolotherapy (n = 5) in the present systematic review

Article First author Study sample Number of subjects (% Treatment Outcome Results Authors’ conclusions Comments
Year Setting females) mean age measures

Mustafa 2018 Painful TMJ Total: 37 (70%) 33 years Placebo injection (saline) MMO Reduction MMO mm (SD) There was no significant No recurrence of
subluxa- Placebo: 9 (55%) 25 years compared with 10%, Pain intensity after 4 months difference between the luxations
tion or 10% dextrose:10 (70%) 20%, and 30% dex- Placebo: 52.3 (6.6)–43.4 (4.2) placebo group and the Relatively short
dislocation 24 years trose injections 10% dextrose: 54.3 (5.9)–39.4 dextrose groups and there is follow-up time (4
20% dextrose: 9 (89%) 27 (4.2) no superiority of any months)
years 20% dextrose: 52.1 (6.9)–41.2 concentration of dextrose
30% dextrose: 9 (67%) 24 (5.4) over the others in TMJ
years 30% dextrose: 54.0 (7.4)–39.4 prolotherapy.
(4.5)
Reduction in all groups
NS between groups
Cömert Kiliç 2016 Bilateral TMJ Total: 26 (73%) 31 years Placebo injection (saline) MMO Reduction MMO mm (SD) These findings suggest that No evaluation of
hypermo- Placebo: 12 (75%) 29 compared with 30% TMJ pain after 1 year dextrose prolotherapy is no recurrence of luxation
bility years dextrose injections (VAS) Placebo: 46.3 (3.5)–43.7 (5.6) more effective than placebo during follow-up peri-
University Dextrose: 14 (71%) 32 30% dextrose: 46.1 (6.9)–43.3 treatment for any of the od
clinic years (5.9) outcome variables of TMJ
Reduction MMO in dextrose hypermobility assessed
group
Pain reduced both groups
NS between groups
Hegab 2013 Bilateral Total: 48 (77%) 33 years ABI compared to: IMF MMO Reduction MMO (mm) after 1 ABI is a simple and safe Sex and age distribution
recurrent ABI 16 ABI+IMF (measured year (number of recur- technique for treatment of not provided for the
TMJ IMF 16 as rences) TMJ dislocation in the subgroups
dislocation ABI+IMF 16 interincisal ABI: 8.5 (8) outpatient clinic.
Outpatient distance) IMF: 9.13 (3) Recurrence can be
Oral and Number of ABI+IMF: 11.0 (0) overcome by multiple
Maxillofa- recurrences MMO reduction all groups (p injections. However, the
cial clinic of < 0.0001) best clinical results are
dislocation Greatest MMO reduction given by a combination of
ABI+IMF group and no ABI and IMF.
recurrences
NS between ABI and IMG
groups
Refai 2011 Bilateral TMJ Total: 12 (83%) Placebo injection (saline) MMO Reduction MMO (cm) after 3 Prolotherapy with 10% Small groups; relatively
subluxation Placebo: 6 (66%) 30 years compared with 10% Frequency of months dextrose looks promising short follow-up time (3
or Dextrose: 6 (100%) 23 dextrose injections disloca- Placebo: 0 for the treatment of months)
dislocation years tions Dextrose: 0.7 symptomatic TMJ
Outpatient TMJ pain on Greater reduction in the hypermobility, as
Oral and palpation dextrose group (p = 0.039) evidenced by the
Maxillofa- Reduced frequency of therapeutic benefits,
cial clinic luxation and pain in both simplicity, safety, patient
groups acceptance of the injection
NS between groups technique and lack of
significant side effects
Clin Oral Invest (2020) 24:61–70
Clin Oral Invest (2020) 24:61–70 67

Injection of autologous blood Sex and age distribution

technique compared to the conventional technique and report-

not provided for the

ed reduced operation time and pain with the supine position
technique [30].
Comments

groups
Reports on preventive therapy

dislocation is a simple, safe Five studies [3, 11, 31–33] evaluated nonsurgical methods for
treating recurrent TMJ luxation with injection. Three of these
into the TMJ in patients

and cost-effective tech-

studies evaluated the effect of dextrose prolotherapy and re-
with chronic recurrent

MMO maximal mouth opening, VAS visual analog scale, ABI autologous blood injection, IMF intermaxillary fixation, SJS superior joint space, PT pericapsular tissues
ported that maximal mouth opening was significantly reduced
Authors’ conclusions

with dextrose treatment, but only one study showed a signif-

icant difference compared to placebo [3]. There were no sig-
nificant differences between the dextrose and placebo groups
nique

concerning the frequency of luxation or pain.

In the Daif et al. study, autologous blood was injected in the
superior joint space in one group and compared with a group
Reduction in both groups (p <

X-ray showed no destruction

SJS+PT group (p < 0.05)

of patients injected in both the superior joint space and the

Reduction MMO mm (SD)

0.05) and greater in the

SJS Group: 3.6 (1.5) no

of bony components.

pericapsular tissues. The group injected in both areas had a

SJS+PT: 5.3 (2.1) no

more favorable outcome after 1 year with an 80% success rate

recurrence 60%

recurrence 80%

compared to 60% in the superior joint space only group. The

after 1 year

group that had been injected in the superior joint space and
pericapsular tissue also had a significantly larger reduction in
Results

maximal mouth opening. In both groups, digital radiographic

imaging of the TMJ showed absence of any destructive chang-
Digital lateral

es of the bony components. However, only in the group

radiograph

injected in both areas did the condylar head not exceed the
double
measures
Outcome

TMJ
MMO

articular eminence in the open position [11].

Injections of autologous blood into the superior joint space
and pericapsular tissue were also done in the Hegab et al.
Injection of blood in SJS

study. Patients treated with autologous blood injection in com-

bination with 4 weeks of IMF had significantly better outcome
and SJS+PT

(p < 0.0001) concerning reduced interincisal distance (average

reduction 11 mm) and no recurrence of TMJ luxation, com-
Treatment

pared to autologous blood injection alone (8 mm reduction)

and the intermaxillary fixation group (9 mm reduction) after 1
year. The autologous blood injection alone group had the
Total: 30 (60%) 34 years

highest recurrence of luxation during the study period (8 of

Study sample Number of subjects (%

16 patients) [32].
females) mean age

ABI SJS+PT : 15
ABI SJS: 15

Discussion

The main finding of this systematic review was that there are
dislocation

Maxillofa-

few RCTs on treatment of TMJ luxation and a lack of RCT’s

cial clinic
recurrent

on surgical techniques. Only eight RCTs matching the inclu-

Oral and
Bilateral

TMJ
Setting

sion and exclusion criteria were available, all dealing with

nonsurgical treatment. These findings are in line with
Prechel et al. [34] suggesting that the possibilities for
Table 3 (continued)

Article First author

evidence-based conclusions are limited. As the number of

patients seeking treatment for recurrent TMJ luxation is lim-
Daif 2010

ited, it seems necessary to do multicenter studies in order to

recruit enough patients for the RCTs, especially concerning
Year

surgical treatment of TMJ luxation. However, in a surgical

68 Clin Oral Invest (2020) 24:61–70

Table 4 Risk-of-bias assessment of included studies (n = 8). Quality graded as low, moderate, or high

First author Year Selection Treatment Assessment Drop-out rate Reporting Conflict of interest Summary

Mustafa 2018 Moderate Moderate Low Moderate Moderate Moderate Moderate

Cömert Kiliç 2016 Moderate Low Moderate Moderate Moderate Moderate Moderate
Ardehali 2016 Low Low Moderate Moderate Moderate Moderate Moderate
Jiantao 2016 Low Low Moderate Low Moderate Moderate Low
Hegab 2013 Moderate Moderate Moderate Low Moderate Moderate Moderate
Refai 2011 Moderate Low Moderate Low High Moderate Moderate
Daif 2010 Moderate Moderate Moderate Moderate Moderate Moderate Moderate
Ardehali 2009 Low Low Moderate Low Moderate Moderate Low

study, allocation of patients with recurrent TMJ luxation to a included only RCTs, which provide a higher level of evidence
placebo surgical treatment group might be questionable from compared to observational studies. In the Daif et al. study, 6 of
an ethical point of view. On the other hand, it is equally im- the 15 patients in the superior joint space injection group had
portant to ensure that unnecessary surgical procedures are not recurrences during the follow-up period and 3 of the 15 pa-
done, as exemplified by a double-blind RCT on arthroscopic tients in the superior joint space and pericapsular tissues in-
surgery for osteoarthritis of the knee, where the outcome after jection group had recurrences. These failures were later treated
arthroscopic lavage or arthroscopic debridement were no bet- surgically as the patients refused further injections. Further
ter than those after a placebo procedure [35]. follow-ups of these surgical patients have not yet been report-
The three main weaknesses observed in many of the studies ed [11]. Hegab et al. performed repeated injections of autolo-
in the present review were lack of placebo groups in the inter- gous blood in the superior joint space and pericapsular tissues
vention studies, small patient numbers, generally short follow- in patients with recurrent dislocations; this resulted in 6 recur-
up periods, and being operator dependent comparative studies rences of luxation in 16 patients after the first injection. After a
rather than true RCTs. Only three of the five studies on injec- second injection, there were still 2 recurrences, which were
tion methods included a placebo treatment group [3]. The then finally successfully treated with a third injection. This
number of patients varied from a relatively large study on 90 indicates that repeated injections might be successful in recur-
patients [29] to one with 12 patients [3]. The latter had only six rent TMJ luxation. However, the relatively short follow-up
patients in each group, which raises concerns regarding the time of 12 months should be considered [32].
statistical power of this study. This highlights the problem of For open surgery to limit the forward movement of the
recruiting large numbers of patients with TMJ luxation or condylar head by creating an obstacle [37] at the articular
subluxation to RCT studies. In addition, the follow-up periods eminence, from a viewpoint of prognosis and risk for compli-
in the included studies varied from acute treatment with no cations, treatment cost has been considered high in compari-
follow-up [28] to a 1-year follow-up [11, 32]. The systematic son to treatment effect [2]. For recurrent TMJ luxation,
review on treatment of recurrent TMJ luxation by de Almeida eminectomy is a recommended surgical procedure; however,
et al. only included studies with follow-ups of 3 years or more; significant evidence or RCTs that support best practice are
none were RCTs. Thus, they concluded that, based on the data lacking. Thus, this systematic review found no RCT studies
available at the time of their review, it was not possible to of surgical techniques, even though surgery is a commonly
determine the treatment option that could guarantee a long- used treatment option for recurring TMJ luxation. The rare-
term elimination of recurrent TMJ luxation [15]. Another non- ness of this condition may explain this, together with the dif-
systematic review combined with case reports concluded that ficulties in comparing surgery to a sham surgical procedure.
accurate comparisons of the reported surgical interventions The highest success rate based on the primary studies in our
are difficult because of varying follow-up times and defini- systematic review was reported for treatment with autologous
tions of success [8]. blood injection in the superior joint space and pericapsular
The main goal in surgical treatment of TMJ luxation has tissues in combination with intermaxillary fixation during 4
been to restore joint function by surgically modifying the bone weeks [32]. According to Hasson et al., blood injected into the
morphology and/or modifying the supporting muscles and superior joint space and pericapsular tissues causes scarring
ligaments [36]. According to de Almeida et al., the TMJ sys- when fibrous tissue forms, restricting the mobility of the con-
tem requires time to recover and adapt postoperatively; they dyle and preventing TMJ luxation [22]. Postoperative scarring
suggest a 36-month recurrence-free period as a benchmark for may also be responsible for a substantial portion of the surgi-
a stable result [15]. Their systematic review included only cal benefit as evidence suggests that immobilization of a joint
prospective or retrospective cohort studies, while our review after an intra-articular surgical procedure results in fibrosis
Clin Oral Invest (2020) 24:61–70 69

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