Usefulness of Biofeedback as an Educational Treatment of Temporomandibular Disorders: A Systematic Review and Network Meta-analysis

Objective: To evaluate the effectiveness of biofeedback (BF) as an educational treatment for temporomandibular disorders (TMD) through a systematic review and a network meta-analysis. Methods: A systematic search was conducted across five electronic databases (PubMed, WOS, PEDro, Scopus, and Cochrane), select clinical trials using BF as a therapeutic intervention in patients diagnosed with TMD based on RDC/TMD or DC-TMD criteria. A frequentist fixed-effects network meta-analysis was conducted with robust variance estimation to adjust for within-study correlations in repeated measures. Sensitivity analyses were performed using an autoregressive lag-1 (AR1) model at varying correlation levels (0–0.8). Model fit was assessed via likelihood ratio tests (LRT) and Akaike Information Criterion corrected for small samples (AICc). Results: Ten studies (n = 758) were included. No statistically significant differences in pain intensity were found between the interventions at post-treatment or follow-up. The model without autocorrelation showed a superior fit (AICc = 54.293) compared to models adjusted for covariates or random effects. Ranking analyses revealed higher P-scores for occlusal splints and parafunctional clenching. The Egger’s test and funnel plot suggested no publication bias. Conclusions: BF demonstrated effectiveness comparable to that of established TMD treatments, with no significant differences in pain outcomes. However, its educational role may offer added value by improving psychological factors, such as anxiety and stress. These findings support BF as a valuable component of a biopsychosocial approach to TMD rehabilitation.