Diagnosis-based pathways for conservative and minimally invasive management of temporomandibular disorders: a scoping review

Abstract

Temporomandibular disorders (TMDs) encompass a spectrum of musculoskeletal and joint conditions of the masticatory system that frequently lead to chronic pain, limited function, and reduced quality of life. Although conservative and minimally invasive approaches are recommended as first-line therapies, their comparative efficacy remains unclear.This scoping review mapped evidence from randomized controlled trials (RCTs) published between 2015 and 2025 to identify diagnosis-based effective management pathways for TMDs. A comprehensive literature search was conducted using the Scopus, Embase, Web of Science, and PubMed databases for RCTs published within the last 10 years. Eligible studies included adult patients diagnosed with Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) or Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) categories and compared conservative or minimally invasive treatments reporting pain, function, or psychosocial outcomes. Data were extracted and charted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, and findings were organized into diagnosis-based intervention pathways reflecting first-line, adjunctive, and escalation therapies. A total of 129 RCTs met the inclusion criteria, revealing a stepwise treatment pathway across the diagnostic subtypes. Education, behavioral therapy, and exercise are the first-line management options that improve pain intensity and mandibular function. Splint therapy and other physical modalities can enhance pain modulation. Minimally invasive interventions for refractory cases provide various long-term benefits. Visual Analog Scale (VAS) and Maximum Mouth Opening (MMO) improvements were the primary outcomes, indicating pain relief and functional recovery as therapeutic endpoints. Overall, the evidence from the past decade supports a diagnosis-driven, stepwise model that emphasizes conservative multimodal care as the cornerstone of TMD management. Minimally invasive procedures should be reserved for persistent pain after optimized non-surgical therapy. Future RCTs should standardize diagnostic and outcome measures to strengthen evidence-based clinical pathways.

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