Objective To evaluate ultrasonography (US) guidance on the single-puncture temporomandibular joint (TMJ) arthrocentesis technique. Methods Twenty-four patients were randomly divided into two groups (n = 12 in each group), and single puncture arthrocentesis (SPA) was performed with and without US guidance in groups 1 and 2. During the one-year follow-up period, the groups were statistically evaluated by the visual analog scale for pain, maximum mouth opening, lateral excursion, and protrusion within each group and between the two groups. Results Both treatment groups showed significant improvement, compared to the baseline levels for almost all outcome variables. However, there were no statistically significant differences between groups 1 and 2 (p > 0.05). Conclusion US guidance can be used for cannula placement in SPA. However, the outcome results are the same with or without its use.