Temporomandibular disorders (TMD) constitute a spectrum of painful and dysfunctional conditions that affect the temporomandibular joint, the masticatory muscles, and associated structures. With prevalence estimated at 5–12% of the general population, TMD represents the second most frequent cause of orofacial pain after toothache. Management is complex, involves multiple specialties, and lacked direct comparisons across the different modalities of traditional East Asian medicine. A network meta-analysis published in Integrative Medicine Research in March 2025, conducted by Há, Kang, and Lee of Kyung Hee University — WHO Collaborating Center for Traditional Medicine — filled this gap.
The study systematized 45 randomized clinical trials with 2,211 patients and 13 distinct interventions, including acupotomy (acupuncture with needle-knife), electroacupuncture, conventional acupuncture, laser acupuncture, scalp acupuncture, moxibustion, and manipulation. Using the SUCRA (Surface Under the Cumulative Ranking Curve) ranking model from Bayesian network analysis, the authors identified the hierarchy of interventions for the pain reduction outcome — the principal measure of clinical efficacy in TMD.
STUDY DATA
Ranking of interventions: acupotomy in the lead
The most striking result of the NMA was the performance of acupotomy — a technique that uses a needle with a scalpel-shaped tip (instead of the conventional solid needle) for dissection and release of adhesions in the deep fascial planes. Acupotomy reached 1st place in SUCRA for pain reduction, with mean difference of −5.07 compared with sham. This effect is superior to that of conventional acupuncture (−1.18) and electroacupuncture, suggesting that the mechanical action of fascial release of acupotomy adds significant benefit beyond peripheral neural stimulation.
Electroacupuncture took 2nd place in the SUCRA ranking, with substantial effect on myofascial pain in the masticatory muscles — especially masseter and temporalis — through inhibition of ectopic firing at trigger points and descending pain modulation. Conventional acupuncture occupied 3rd place, with a clinically relevant effect (MD −1.18 vs. sham) and excellent safety profile. Laser acupuncture and manipulation showed more modest results in the rankings.
Clinical context: why TMD is difficult to treat
TMD has multifactorial etiology — it involves malocclusion, bruxism, joint overload, myofascial dysfunction, psychosocial factors (stress, anxiety), and central sensitization. Conventional management includes occlusal splint, orofacial physical therapy, NSAIDs, cyclobenzaprine, and, in refractory cases, intra-articular botulinum toxin. Frequent refractoriness to conventional treatment, combined with the impact on chewing, speech, sleep, and quality of life, makes this population particularly receptive to evidence-based complementary interventions. The NMA from Kyung Hee University — conducted under the methodological standards of the WHO Collaborating Center — provides the most complete map of evidence available through 2025 to guide the choice between modalities.
Frequently Asked Questions
Yes. Bruxism — a frequent etiologic factor in TMD — is modulated by acupuncture through two main mechanisms: reduction of excessive masseter muscle tone via inhibition of trigger points, and reduction of the stress/anxiety component that frequently triggers or aggravates bruxism. Points such as GV-20, HT-7, and PC-6 have a documented anxiolytic effect, complementing the local action. The nighttime occlusal splint remains indicated for dental protection.
Acupotomy uses a different instrument from the conventional solid needle — it is a needle with a cutting tip (microscalpel) that performs percutaneous fascial releases. It requires specific additional training beyond conventional acupuncture and is indicated for cases with a mechanical component (movement restriction, adhesions). Conventional acupuncture and electroacupuncture — 3rd and 2nd place in the ranking of this NMA — already have clinically relevant efficacy and are more widely available. Talk to your medical acupuncturist about which modality is most indicated for your case.
Acupuncture and the occlusal splint act through complementary mechanisms: acupuncture reduces pain, muscular spasm, and the inflammatory component; the splint protects dental structures from mechanical wear and redistributes joint loads. For most patients with TMD associated with bruxism, the combined approach — acupuncture for rapid pain relief and splint for long-term protection — is superior to any modality in isolation. The medical acupuncturist and the dentist should work in coordination.
Fonte Original
Integrative Medicine Research(em inglês)Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).