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

Abstract

BackgroundPsychological 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.MethodsMEDLINE, 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.ResultsThirty 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.ConclusionSS 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.

Long-term effects of splint therapy in patients with posttraumatic stress disease (PTSD)

“…In the case of the latter, it would be expected that relief would be given in the short term, but that it would abate significantly after 3 months. This is supported by the results of a meta-analysis by Kuzmanovoc Pficer et al [3]. The authors show that the positive short-term effects (up to 3 months) of splints are significant, whereas these effects did not persist on the long-term when compared to presently accessible data about control groups.…”

Bilateral anterior elevation prosthesis boosts chondrocytes proliferation in mice mandibular condyle

“…Our present results demonstrate that proper distraction and stretch loading exhibit proliferation‐promoting effects on chondrocytes. These observations provide a good explanation for the effectiveness of the bite plate for TMJ OA (Kuzmanovic Pficer et al, ) and distraction treatment for knee OA (Intema, Roermund, et al, ; Intema, Thomas, et al, ; Wiegant et al, ). On the basis of the gradual growth of rodent incisors, an interruption in incisor eruption leads to an increase in occlusion.…”

“…Furthermore, some clinical studies have shown that distraction improved functional abilities and decreased pain in the knee and ankle joints with OA diagnosis and improved the structure of the cartilage as well as the subchondral bone, which was presented as an increased cartilage thickness and a decreased area of denuded bone (Intema, Roermund, et al, ; Intema, Thomas, et al, ; Wiegant et al, ). Occlusal splints have been widely used in the treatment of temporomandibular disorder syndrome (TMD) (Kuzmanovic Pficer et al, ), of which OA is the end‐stage outcome. Animal experiments have indicated that raising the occlusion height in the molar region by installing dental appliances increased cartilage thickness and promoted chondrocyte proliferation in TMJs (Akagawa, Nikai, & Tsuru, ; Li, Zhang, Wu, & Qiao, ).…”

The use of occlusal splints in temporomandibular disorders - an overview.

“…The most common complications refer to intrusion of the teeth covered by the splint or in contact with it, and the extrusion of the teeth not touching the appliance. For preventing those complications, the practitioner should consider indicating the patient either a full arch permissive splint, or dual splint covering both arches, during nighttime [25,26]. There is also some evidence suggesting that anterior midpoint contact permissive splints might increase the risk of further disk displacement [10].…”