OBJECTIVE: To compare the efficacy of dry needling therapy (DNT), traditional acupuncture (TAT), acupuncture-based combined therapy (ACT), and other interventions for temporomandibular disorders (TMD), focusing on pain relief, functional improvement, and treatment efficacy.
METHODS: Following the PICOS framework, we systematically searched PubMed, Embase, Cochrane Library, Web of Science, and CNKI up to July 2025 for randomized controlled trials (RCTs) enrolling adults with TMD. Interventions included seven conservative treatments-TAT, DNT, ACT, cognitive behavioral therapy (CBT), comprehensive physiotherapy (CPT), pharmacologic injection therapy (PIT), and control interventions (CTRL). Primary outcomes were pain intensity (VAS) and functional indices, and secondary outcomes included maximal mouth opening (MMO) and effective rate. Bayesian network meta-analysis was used to estimate comparative efficacy, and risk of bias was assessed using RoB 2.0.
RESULTS: This network meta-analysis included 37 randomized controlled trials with a total of 2581 participants. DNT exhibited the strongest analgesic effect (MD vs control: -1.61, 95% CI: -2.81 to -0.4), outperforming TAT (MD: -1.56) and pharmacological injection (MD: -1.41). ACT showed superior multimodal efficacy: significant reductions in PI (MD vs TAT: -0.13) and CMI, plus the highest treatment efficacy rate (RR: 1.8 vs control). For DI, ACT demonstrated marginal improvement over TAT (MD: -0.065, CI near zero). No intervention significantly improved MMO. Importantly, the pain reduction achieved by DNT and ACT met the minimal clinically important difference (MCID) threshold for TMD (VAS 0-1.9), indicating clinically meaningful benefit. Cumulative ranking (SUCRA) confirmed DNT and ACT as top-tier for pain and function, respectively.
CONCLUSION: DNT and ACT appear to be the most effective interventions for TMD, offering complementary benefits in pain relief and functional recovery. These findings support their potential inclusion in multimodal management strategies, though interpretation should remain cautious given the predominance of Chinese studies and limited long-term and safety data.
| Discipline Area | Score |
|---|---|
| Rehab Clinician (OT/PT) |  |
| Physician |  |
Rehab Clinician (OT/PT) rater
This article is highly useful to my physiotherapy practice as it provides high-level comparative evidence supporting dry needling and acupuncture-based combined therapy as clinically meaningful options for managing TMD-related pain and dysfunction. The network meta-analysis confirms that the pain reductions achieved with DNT and ACT meet MCID thresholds, strengthening the rationale for integrating acupuncture techniques within multimodal physiotherapy care. It also helps guide clinical decision-making by clarifying where acupuncture and dry needling outperform or complement other conservative interventions.When supported by research evidence, the therapist can clearly rationalize the chosen therapy to the patient and reasonably expect positive clinical outcomes. Evidence-based justification also improves patient confidence, adherence to treatment, and shared decision-making.
Rehab Clinician (OT/PT) rater
The results should be interpreted cautiously as the mean difference in pain level between dry needling and control or between acupuncture-based combined therapy and control had wide credible intervals, with the lower limits having the values of 0.4 and 0.21, respectively. These were only trivial differences.
, McMaster University