Ozone for the treatment of temporomandibular joint disorders: a systematic review and meta-analysis

Temporomandibular joint disorders (TMD) generate pain and difficulties for mouth opening affecting the patients' quality of life. Ozone is an emerging therapy that has been proposed as a potential treatment, due to that, the evidence about its efficacy should be reviewed. Therefore, this work aimed to conduct a comprehensive systematic review to address the efficacy of ozone therapy for the treatment of pain and limited mouth opening in patients with TMD. The design of the included studies was clinical trials and observational studies, whereas, a series of cases, in vivo, and in vitro studies were excluded. The search was performed in PubMed, ClinicalTrials, Web of Science, and Scopus. Gray literature was searched at Google Scholar. Relevant data of all included studies were recorded. The risk of bias (using RoB 2) and the quality (using Grading of Recommendations Assessment, Development, and Evaluation) assessments were carried out. Meta-analyses using random-effects models of pain and maximal mouth opening data were performed. This review included 8 studies with 404 participants suffering limited function and pain related to TMD. At the overall bias of the studies, 25% exhibited some concerns and 75% had high risk; and the quality of the studies was low. The analysis of the included studies suggests that ozone therapy can diminish pain and improve the maximal mouth opening in TMD patients. However, there is no conclusive evidence of ozone therapy as a superior treatment for TMD compared with occlusal splint and pharmacotherapy.