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Occlusal stabilization splint for patients with temporomandibular disorders: Meta-analysis of short and long term effects. 2017

Jovana Kuzmanovic Pficer, and Slobodan Dodic, and Vojkan Lazic, and Goran Trajkovic, and Natasa Milic, and Biljana Milicic
Department for Medical Statistics and Informatics, School of Dental Medicine University of Belgrade, Belgrade, Serbia.

BACKGROUND Psychological discomfort, physical disability and functional limitations of the orofacial system have a major impact on everyday life of patients with temporomandibular disorders (TMDs). In this study we sought to determine short and long term effects of stabilization splint (SS) in treatment of TMDs, and to identify factors influencing its efficacy. METHODS MEDLINE, Web of Science and EMBASE were searched for randomized controlled trials (RCTs) comparing SS to: non-occluding splint, occlusal oral appliances, physiotherapy, behavioral therapy, counseling and no treatment. Random effects method was used to summarize outcomes. The effect estimates were expressed as odds ratio (OR) or standardized mean difference (SMD) with 95% confidence interval. Subgroup analyses were carried out according to the use of Research Diagnostic Criteria (RDC/TMD) and TMDs origin. Strength of evidence was assessed by GRADE. Meta-regression was applied. RESULTS Thirty three eligible RCTs were included in meta-analysis. In short term, SS presented positive overall effect on pain reduction (OR 2.08; p = 0.01) and pain intensity (SMD -0.33; p = 0.02). Subgroup analyses confirmed SS effect in studies used RDC/TMD and revealed its effect in patients with TMDs of muscular origin. Important decrease of muscle tenderness (OR 1.97; p = 0.03) and improvement of mouth opening (SMD -0.30; p = 0.04) were found. SS in comparison to oral appliances showed no difference (OR 0.74; p = 0.24). Meta-regression identified continuous use of SS during the day as a factor influencing efficacy (p = 0.01). Long term results showed no difference in observed outcomes between groups. Low quality of evidence was found for primary outcomes. CONCLUSIONS SS presented short term benefit for patients with TMDs. In long term follow up, the effect is equalized with other therapeutic modalities. Further studies based on appropriate use of standardized criteria for patient recruitment and outcomes under assessment are needed to better define SS effect persistence in long term.

UI MeSH Term Description Entries
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013705 Temporomandibular Joint Disorders A variety of conditions affecting the anatomic and functional characteristics of the temporomandibular joint. Factors contributing to the complexity of temporomandibular diseases are its relation to dentition and mastication and the symptomatic effects in other areas which account for referred pain to the joint and the difficulties in applying traditional diagnostic procedures to temporomandibular joint pathology where tissue is rarely obtained and x-rays are often inadequate or nonspecific. Common diseases are developmental abnormalities, trauma, subluxation, luxation, arthritis, and neoplasia. (From Thoma's Oral Pathology, 6th ed, pp577-600) TMJ Disorders,TMJ Diseases,Temporomandibular Disorders,Temporomandibular Joint Diseases,Disease, TMJ,Disease, Temporomandibular Joint,Diseases, TMJ,Diseases, Temporomandibular Joint,Disorder, TMJ,Disorder, Temporomandibular,Disorder, Temporomandibular Joint,Disorders, TMJ,Disorders, Temporomandibular,Disorders, Temporomandibular Joint,Joint Disease, Temporomandibular,Joint Diseases, Temporomandibular,Joint Disorder, Temporomandibular,Joint Disorders, Temporomandibular,TMJ Disease,TMJ Disorder,Temporomandibular Disorder,Temporomandibular Joint Disease,Temporomandibular Joint Disorder
D013997 Time Factors Elements of limited time intervals, contributing to particular results or situations. Time Series,Factor, Time,Time Factor
D016017 Odds Ratio The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. Cross-Product Ratio,Risk Ratio,Relative Odds,Cross Product Ratio,Cross-Product Ratios,Odds Ratios,Odds, Relative,Ratio, Cross-Product,Ratio, Risk,Ratios, Cross-Product,Ratios, Risk,Risk Ratios
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D017090 Occlusal Splints Rigid or flexible appliances that overlay the occlusal surfaces of the teeth. They are used to treat OBSTRUCTIVE SLEEP APNEA, clenching, BRUXISM, and their sequelae, and to provide temporary relief from muscle or temporomandibular joint pain. Dental Night Guard,Mandibular Advancement Devices,Mandibular Advancement Splints,Splints, Occlusal,Advancement Device, Mandibular,Advancement Devices, Mandibular,Advancement Splint, Mandibular,Advancement Splints, Mandibular,Dental Night Guards,Device, Mandibular Advancement,Devices, Mandibular Advancement,Guard, Dental Night,Guards, Dental Night,Mandibular Advancement Device,Mandibular Advancement Splint,Night Guard, Dental,Night Guards, Dental,Occlusal Splint,Splint, Mandibular Advancement,Splint, Occlusal,Splints, Mandibular Advancement

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