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

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  • Jovana Kuzmanovic Pficer
  • Slobodan Dodic
  • Vojkan Lazic
  • Goran Trajkovic
  • Natasa Milic
  • Biljana Milicic

Abstract

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. Conclusion: 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.

Suggested Citation

  • Jovana Kuzmanovic Pficer & Slobodan Dodic & Vojkan Lazic & Goran Trajkovic & Natasa Milic & Biljana Milicic, 2017. "Occlusal stabilization splint for patients with temporomandibular disorders: Meta-analysis of short and long term effects," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-21, February.
    • Handle: RePEc:plo:pone00:0171296
    DOI: 10.1371/journal.pone.0171296
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    2. Kenneth F Schulz & Douglas G Altman & David Moher & for the CONSORT Group, 2010. "CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomised Trials," PLOS Medicine, Public Library of Science, vol. 7(3), pages 1-7, March.
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    1. Edoardo Staderini & Romeo Patini & Michele Tepedino & Giulio Gasparini & Maria Antonietta Zimbalatti & Francesca Marradi & Patrizia Gallenzi, 2020. "Radiographic Assessment of Pediatric Condylar Fractures after Conservative Treatment with Functional Appliances—A Systematic Review," IJERPH, MDPI, vol. 17(24), pages 1-13, December.

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