J Korean Assoc Oral Maxillofac Surg 2020; 46(2): 87~98
No evidence on the effectiveness of oral splints for the management of temporomandibular joint dysfunction pain in both short and long-term follow-up systematic reviews and meta-analysis studies
Atef Abdel Hameed Fouda
Department of Maxillofacial Surgery, Kasr El Eyne Hospital, Cairo University, Cairo, Egypt
Atef Abdel Hameed Fouda
Department of Maxillofacial Surgery, Kasr El Eyne Hospital, Cairo University, Manial, Cairo 12111, Egypt
TEL: +20-1093440600 FAX: +20-23642938
E-mail: Atef.fouda@dentistry.cu.edu.eg
ORCID: https://orcid.org/0000-0001-6386-3696
Received September 20, 2019; Revised November 30, 2019; Accepted December 17, 2019.; Published online April 30, 2020.
© The Korean Association of Oral and Maxillofacial Surgeons.. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
The aim of this study was to determine the efficacy of oral splints in reducing the intensity of pain in patients with temporomandibular joint dysfunction in both short and long-term treatment durations. Electronic databases, Cochrane Library, MEDLINE via PubMed, Web of Science, Egyptian Knowledge Bank, and EMBASE were searched for randomized controlled trials comparing different types of splints to non-occluding splints, behavioral therapy, pharmacotherapy, counseling, and no treatment. The risk of bias was assessed by using Cochrane risk of bias recommendations. Fixed and random effects were used to summarize the outcomes. The effect estimates were expressed as standardized mean differences (SMD) or risk ratios with a 95% confidence interval (CI). Subgroup analyses were carried out according to the treatment duration. Twenty-two studies met the inclusion criteria. A meta-analysis of short-term studies up to three months revealed no significant difference between the study groups. However, long-term studies exhibited a significant difference in pain reduction in favor of the control group. Total analysis revealed that the control group resulted in significant pain reduction (SMD 0.14, 95% CI 0.05-0.23, P=0.002, I2=0%). Oral splints are not effective in reducing pain intensity or improving function in patients with temporomandibular joint dysfunction.
Keywords: Occlusal splints, Pain, Review, Meta-analysis
I. Introduction

Psychologic, social, and biologic factors are several causes of temporomandibular joint dysfunction (TMJD). The relief of pain and the ability to masticate are considered the principal concerns for patients. An understanding of the psychological conditions with proper treatments for chronic pain and dysfunction must be considered1. The ultimate success was achieved when the operator met the patients’ expectations by improving their quality of life2.

Successful treatment of TMJD depends on an accurate diagnosis followed by the selection of proper treatment. Treatment modalities applied to relieve pain and other symptoms of this disorder are classified into non-invasive physical therapy3, pharmacotherapy4, counseling assurance5, and occlusal splint therapy6. Minimally invasive arthrocentesis7, acupuncture8, and lasers9 are among the invasive surgical intervention methods10.

Occlusal splints are considered a simple, chair-side, and less invasive treatment. Occlusal splints are the favorable treatment of choice in our institute after medications. The clinical findings of occlusal splints for the treatment of both myofascial pain dysfunction (MPD) syndrome and disk displacement are controversial and they may act as a placebo rather than a specific therapeutic mechanism11.

Regardless of the splint mode of action, many old and several recent clinical trials and systematic reviews have documented its therapeutic effectiveness in reducing pain intensity and improving masticatory function in patients with painful temporomandibular disorder (TMD)12,13. However, most of the current literature did not demonstrate any beneficial effect in short-term14 and long-term follow-up15.

Among the causes of variability between the results, patients with TMJD cannot be considered a homogeneous group and will respond differently, with investigators relying on subjective symptoms reported by the patients. Moreover, studies can present with inadequate sample sizes, short follow-up periods, poor quality of the control group, and bias in data reporting. Proper evaluation of splint appliance therapy is achieved by applying long-term follow-ups, randomized controlled study designs, recruitment of a homogeneous population, and blinding in data extraction.

The investment in evidence-based medicine and its role in improving the acceptance of studies for publication, besides the natural progress of the disease, recent diagnostic measures, and improvement of communication between clinicians and patients means it is likely these account for changes in the old concepts that previously guided temporomandibular joint (TMJ) treatment.

This review was conducted to shed light on doubts about the therapeutic value of oral splints through a meta-analysis of data from different relevant randomized controlled trials (RCTs) and studies of different types of occlusal splints. Our purpose was to evaluate the effectiveness of splint therapy in ameliorating pain issues in patients with TMJD.

II. Materials and Methods

The recommendations from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement were followed16.

1. Eligibility criteria

1) Inclusion criteria

RCT studies that were conducted in humans over the past twenty years. Patients with TMJD that included myofascial pain with the source of pain being either muscular or from the joint, and patients with disk displacements with or without reduction. Studies that compared splints to non-invasive treatment (medications-biofeedback, counseling, and non-occluding splints). Patient diagnosis was either based on Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) or clinical examination.

2) Excluded from the study

Published studies older than twenty years, studies on animals, uncontrolled studies comparing different types of splints with each other, or studies with minimally invasive treatment modalities (low-level laser, arthrocentesis, acupuncture, and physiotherapy). If there were multiple comparisons within the same study, each comparison was included separately. Moreover, various intervals within the related research were recorded in each relevant subgroup.

2. Population

Patients with myofascial pain and/or disk displacement with or without reduction were included. Patients with arthritis or neuralgias were excluded.

3. Intervention

The study included all types of splints (stabilizing splint, Michigan splint, centric relation appliance, flat occlusal appliance, soft or hard splints, vinyl appliances, and positioning splints).

4. Control group

The patients in the control group underwent medical treatment, biofeedback, non-occluding splints, massages, behavioral therapy, cognitive, counseling, or no treatment.

5. Outcome

1) Primary outcome

Pain intensity was estimated with any recognized, validated pain scale: visual analogue scale, numeric rating scale, characteristic pain intensity, and symptom severity index. Subgroup analyses were carried out for the outcomes based on the follow-up duration classified into one, two, three, six, and twelve months.

2) Secondary outcome

Maximum mouth opening (MMO) was evaluated by inter-incisal opening measured in millimeters.

6. Search methods for studies identification

The search for studies in the English language was conducted up to August 2018. The following databases were searched individually from 1998 to the present: MEDLINE, Web of Science, EMBASE, and Egyptian Knowledge Bank. Manual searches, references from primary studies, and systematic reviews for relevant data were obtained. The search used a combination of controlled vocabulary: ‘temporomandibular joint disorders’[MeSH Terms] OR ‘temporomandibular’[All Fields], AND ‘joint’[All Fields], AND ‘disorders’[All Fields], OR ‘temporomandibular joint disorders’[All Fields], OR (‘temporomandibular’[All Fields] AND ‘disorders’[All Fields]) OR ‘temporomandibular disorders’[All Fields], OR ‘mouth’[MeSH Terms] OR ‘mouth’[All Fields] OR ‘oral’[All Fields]) AND (‘splints’[MeSH Terms] OR ‘splints’[All Fields] OR ‘splint’[All Fields]). ‘temporomandibular joint’[MeSH Terms] OR (‘temporomandibular’[All Fields] AND ‘joint’[All Fields]) OR ‘temporomandibular joint’[All Fields] OR ‘TMJ’[All Fields], AND ‘pain’[MeSH Terms] OR ‘pain’[All Fields].

7. Data extraction and management

Both continuous (mean, standard deviation) and dichotomous (event, control) studies were included in the analysis.

8. Assessment of study risk of bias

All included studies were evaluated with consent from the Cochrane Handbook for Systematic Reviews of Interventions version 5.1.017. The risk of bias was assessed using Cochrane Collaboration’s tool with response options of ‘low risk’, ‘unclear risk’, and ‘high risk’ for the following criteria: sequence generation, allocation concealment, blinding, incomplete outcome data, reporting bias, and other biases.

9. Measurements of the treatment effect

1) Pain intensity

Standardized mean difference (SMD) with 95% confidence interval (CI) and fixed effects were used for continuous outcomes. For dichotomous outcomes, the estimate of the effect was expressed as a risk ratio (RR) together with 95% CIs and random effects.

2) Maximum mouth opening

The mean difference (MD) with 95% CI and fixed effects was used for the assessment of the outcomes.

3) Assessment of heterogeneity

Chi-square testing for heterogeneity was performed, and the extent of the inconsistency of the treatment effects (I2) across the trials was measured. We considered heterogeneity substantial if I2 was greater than 30%, or if there was a low P-value (less than 0.10) in the chi-square test for heterogeneity. We used a fixed-effect meta-analysis for combining the data, but clinical heterogeneity random-effect was used in the subgroup analyses.

4) Assessment of reporting biases

Publication bias was appraised using the symmetry of the funnel plots. We visually assessed funnel plot asymmetry. When asymmetry was detected, investigations were performed using exploratory analyses.

5) Methodological quality assessment

Data synthesis and meta-analyses were performed according to the rules adopted by the Cochrane Collaboration reviewer’s handbook17. All statistical analyses were conducted using Review Manager software (RevMan 5.3).

III. Results

The initial search yielded a total of 2,418 titles: 1,763 from PubMed, 51 from EMBASE, 385 from the Cochrane Central library, 182 from the Web of Science, 5 from Egyptian Knowledge Bank (ClinicalKey), and 32 through manual searches.

After reviewing the abstracts, 1,377 studies were excluded from the analysis, and 1,041 were considered for further full-text screening. Finally, a total of 22 studies14,15,18-37 were included in this systematic review38.(Fig. 1)

1. Results and study characteristics

1) Primary outcome (pain intensity) (Fig. 2)

(1) Short follow-up period: up to one month

Table 1 reviews the summary of the included subgroup studies. Studies starting from the one week follow-up period up to one month included a total of eight studies with ten comparisons14,18-24, two of them comparing occlusal splints with medications18,23, and two comparisons of soft and hard occlusal splints with a non-occluding palatal splint19. Two studies compared occlusal splints versus exercise14,20, two studies compared them with counseling22,24, and the last two compared them with no treatment18,21.

Control groups in four comparisons reported better pain reduction compared to splint therapy14,19,20; however, the other six comparisons favored splint therapy18,21-24.

Total subgroup analysis of the eight identified studies with a total of 396 participants revealed non-significant overall effects on pain reduction (SMD –0.11, 95% CI –0.31 to 0.08, P=0.67, I2=0%).

(2) Short term evaluation: up to two months

Studies with a follow-up period greater than one month and up to two months were included. Subgroups included eight studies with nine comparisons18-22,25-27. Three comparisons involved non-occluding palatal splints19,25,26, three comparisons involved exercise20,21,25, and one study compared occlusal splints versus counselling22 with a single comparison for every medical treatment18 and cognition27.

In five comparisons, the control group exhibited better results than splints18-20,25,26, with four comparisons in favor of splints18,19,22,27. The total subgroup analysis of the identified studies with a total of 385 participants revealed non-significant overall effects on pain reduction (SMD 0.18, 95% CI –0.02 to 0.38, P=0.08, I2=16%).

(3) Intermediate follow-up period: three months

Nine studies with thirteen comparisons at the three months’ follow-up period were included14,15,19,23,28-32. One study compared occlusal splints with medications23, two studies involved occlusal splints with a non-occluding palatal splint19, and three studies compared occlusal splints with counselling15,31. Two studies by Wahlund et al.29,32 compared splints with relaxation, and two comparisons with self-care30.

In twelve studies, the control group exhibited better results than the splints14,15,19,23,28-31, with one study in favor of splints32.

Total subgroup analysis of the identified studies with a total of 704 participants revealed a significant overall effect on pain reduction in favor of the control (SMD 0.18, 95% CI 0.03-0.33, P=0.02, I2=0%).

(4) Long term evaluation

(i) Six months

Five studies at the six months’ follow-up period15,23,27,32,37 were included with one study comparing occlusal splints with medications23. Two comparisons between splint and counselling15,37 One study compared splints with relaxation32, while the remaining study compared occlusal splints versus cognition27.

All five studies in the control group showed better results than splints regarding pain reduction.

Total subgroup analysis of the identified studies with total of 213 participants revealed a significant overall effect on pain reduction in favor of the control (SMD 0.31, 95% CI 0.03-0.58, P=0.03, I2=0%).

(ii) One-year follow-up

Four studies with five comparisons at the one-year follow-up period15,28,30,33 were included. One study compared occlusal splints with no treatment28, two studies compared splints and counselling15,33, and two comparisons of Truelove et al.30 compared soft and hard splints with self-care.

In all five comparisons, the control group exhibited better results than splints regarding pain reduction.

Total subgroup analysis of the identified studies with total of 344 participants revealed a significant overall effect on pain reduction in favor of the control (SMD 0.23, 95% CI 0.01-0.44, P=0.04, I2=0%).

(5) Total analysis

The five included subgroups reveal moderate heterogeneity between them (I2=53.9%). However, no heterogeneity between the individual studies (I2=0%) was observed. The overall effect of the meta-analysis with a total of 2,042 participants revealed a significant difference between the control and splint therapy in favor of the control group (SMD 0.14, 95% CI 0.05-0.23, P=0.002, I2=0%).

(6) Dichotomous studies (Fig. 3)

Five studies were included25,26,28,33,34. Two studies compared manual mobilization and active exercises25,33, two studies compared splints with a palatal non-occluded splint26,34, and one study compared splints with no treatment28.

Total analysis of the identified studies with a total of 164 participants revealed no significant overall effects of splint therapy on pain reduction (RR 1.12, 95% CI 0.84-1.50, P=0.45, I2=0%).

2) Secondary outcome

(1) Maximum mouth opening

(i) Short-term evaluation

Table 2 presents a summary of the included subgroup studies. Included studies involved a follow-up period up to three months. Subgroups included five studies with nine comparisons18,24,25,35,36. In five comparisons, the splint group exhibited better results than the non-splint group18,25,36 and four comparisons were in favor of the control18,24,35.

Total subgroup analysis of the identified studies with a total of 386 participants revealed non-significant overall effects on the improvement in mouth opening (MD –0.87, 95% CI –2.29 to 0.55, P=0.23, I2=0%).

(ii) Long-term evaluation

Included studies involved a follow-up period up to one year. Subgroups included four studies with eight comparisons28,29,31,32. In two comparisons, the splint group exhibited better results than then control30, and six comparisons were in favor of the control group28,29,32.

Total subgroup analysis of the identified studies with a total of 398 participants revealed non-significant overall effects on the improvement of mouth opening (MD –0.62, 95% CI –1.96 to 0.72, P=0.37; I2=0%).

Total analysis of the identified studies with a total of 784 participants revealed no significant overall effects of splint therapy on MMO (MD –0.74, 95% CI –1.71 to 0.24, P=0.14, I2=0%).(Fig. 4)

3) Methodological quality assessment

(1) Risk of bias across all the included studies

Nine studies had a high risk for selection bias (random sequence generation) (41%), eleven studies were at high risk of selection bias (allocation concealment) (50%), five studies had performance bias (23%), eight studies exhibited detection bias (36%), three studies had attrition bias (14%), and finally two studies exhibited reporting bias (1%).

The funnel plots declared no publication bias for the two primary outcomes, continuous and dichotomous, in both short and long-term follow-up periods (Fig. 5) and also no publication bias for the secondary outcome (MMO).

IV. Discussion

Systematic reviews are a critical assessment tool in evidence-based decision-making. This study was assigned to PRISMA16 statements for systematic reviews. Well-structured PICO (Problem Intervention-Comparison-Outcome) questions with clearly outlined inclusion and exclusion criteria were also included. A publication bias analysis was performed for every outcome using funnel plots.

Pain is considered the most common reason for medical consultation. Therefore, it was selected as the primary outcome of this review. However, restoring the normal range of mouth opening, and subsequently, normal masticatory and jaw function was the secondary outcome examined.

We investigated the effects of splint therapy as a conservative TMD treatment modality in reducing pain intensity and improving mouth opening through the analysis of twenty-two included studies.

There is no gold standard control to compare the different types of splints. Therefore, all the splints included in the current review were compared with no treatment or behavioral therapy.

Over-estimation of the effect of treatment resulted from an improper means of randomization, neglecting concealment of treatment allocation, not adequately blinded assessments, short follow-ups, or lacking of study power due to small sample sizes being the most serious problems.

Although several studies investigated splint therapy, the results remain controversial. Methodological differences among the studies are evident, and a comparison of the results is often difficult due to heterogeneity. The clinical relevance of these findings shows a need for more well-designed RCTs.

Studies that were older than twenty years were excluded due to the introduction of RDC/TMD classification which decreases diagnostic pitfalls and improves population selection. The use of recent materials and continuous changes in splint design all may confound the results associated with the classification’s effectiveness.

In this systematic review, we tried to minimize bias across the studies and obtain maximal homogeneity among the subgroups by using appropriate eligibility criteria and selecting only studies with the control group receiving no treatment or palliative treatment. Subsequently, meta-regression analysis was not required.

In the current review, subgroups were selected according to the recommendation of Pficer et al.39 who studied confounding factors with meta-regression analysis and found that that duration of treatment is one of the parameters that could affect the outcome of using oral splints. He reported that investigators should pay attention not only to the short-term but also long-term therapeutic effects in their studies.

Continuous outcome data was obtained using SMD, 95% CI, and applying inverse variance with a fixed effect for accurate analysis. For dichotomous pain intensity data, we used relative risk and random effects because of the low number of included studies and heterogeneity.

For secondary outcomes based on continuous data, we used MD because of using the same scale in measurements and 95% CI. Inverse variance and fixed effects were applied to achieve sensitive analysis.

In short-term follow-ups, oral splints exhibited no significant effect on pain reduction. However, in long-term follow-ups, behavioral therapy was associated with significant pain reduction.

These findings do not mean that behavioral therapy is better than oral splints, but that the effect of splint therapy was abolished or equal to no treatment after an extended period of time.

The findings of the conducted review follow the individual studies18-20,24,26-28,30,33,40 that did not observe any difference between splint therapy and placebos.

Most of the reviews that compared splints with lasers, arthrocentesis, acupuncture, or physiotherapy resulted in fake estimations because such comparisons depend on the power of the comparator and do not provide a clue about the actual estimation.

There are several articles that included studies comparing splints with behavioral treatment, pharmacologic treatment, arthroscopy, surgical intervention, or no treatment41.

This review showed that there is no evidence to suggest that splint therapy is beneficial for pain reduction measured with different scales or even effective in reducing symptoms in patients with myofascial pain when compared with placebo or no treatment. These findings are in agreement with the systematic review by Al-Ani et al.42.

There was no evaluation of each splint type separately, and the populations were mixed including disk displacement with myofascial pain participants. Non-occluding splints were considered as controls which may have some effects through the repositioning of the tongue and patient awareness issues.

We recommend an evaluation of each type of splint separately and subgroup analysis separating cases of myofascial pain from cases of disk displacement.

V. Conclusion

Based on the limitations of the included studies in this systematic review due to considerable bias in selection, concealment, and blinding, the present outcome suggests that oral splints are not effective for either the reduction of pain intensity or improvement in MMO compared to control groups in patients with TMJD.

Further assessment with a higher level of evidence including studies with proper selection randomization, concealment, calculated sample size, and blinding for better estimation of the effectiveness of splint therapy in patients with TMJD are needed.

Apparent improvements observed in most of the studies on oral splints are due to the placebo effect or the natural remission of symptoms.

Oral splints can be used only as an adjunct to other non or minimally invasive treatments for TMJD management. Furthermore, oral splints could be helpful in blocking bad habits and bruxism in order to inhibit dental damage potentially induced by that disorder.

Our results confirmed that the effect of splint therapy for pain reduction in short-term durations is better than that seen in control groups, but that results becomes insignificant with fading effects in long-term studies.

Note

Author’s Contributions

The author designed the study, collect the data, and did the statistical analysis.

Conflict of Interest

No potential conflict of interest relevant to this article was reported.

How to cite this article: Fouda AAH. No evidence on the effectiveness of oral splints for the management of temporomandibular joint dysfunction pain in both short and long-term follow-up systematic reviews and meta-analysis studies. J Korean Assoc Oral Maxillofac Surg 2020;46:87-98. https://doi.org/10.5125/jkaoms.2020.46.2.87

Tables

Summary of the included studies

Study (first author) Publication year Diagnostic mean Diagnosis Pain measurement tool Study splint type Control No. of participants Follow-up period
Minakuchi18 2001 Clinical DD VAS OS NSAID 48 4 wk
Minakuchi18 2001 Clinical DD VAS OS No treatment 46 4 wk
Alencar Jr19 2009 Clinical MPD SSI Soft splint NOS 28 1 mo
Alencar Jr19 2009 Clinical MPD SSI Hard splint NOS 28 1 mo
Haketa20 2010 Clinical DD VAS OS Exercise 44 4 wk
Niemelä24 2012 RDC/TMD MPD VAS SS Counseling 76 1 mo
Giannakopoulos21 2016 RDC/TMD MPD NRS Soft splint No treatment 24 2 wk
Hasanoglu Erbasar22 2017 RDC/TMD MPD VAS NTI-tss Counseling 40 3 wk
Hosgor23 2017 RDC/TMD DD VAS SS NSAID 20 1 mo
Giannakopoulos14 2018 RDC/TMD MPD NRS Michigan splint Exercise 42 2 wk
Raphael26 2001 RDC/TMD MPD PI Hard splint NOS 63 6 wk
Carmeli25 2001 Clinical DD PI Soft splint Exercise 36 5 wk
Minakuchi18 2001 Clinical DD VAS OS NSAID 48 2 mo
Alencar Jr19 2009 Clinical MPD SSI Soft splint NOS 28 2 mo
Alencar Jr19 2009 Clinical MPD SSI Hard splint NOS 28 2 mo
Shedden Mora27 2013 RDC/TMD DD VAS OS Cognition 56 2 mo
Giannakopoulos21 2016 RDC/TMD MPD NRS Soft splint No treatment 24 6 wk
Hasanoglu Erbasar22 2017 RDC/TMD MPD VAS NTI-tss Counseling 40 6 wk
Haketa20 2010 Clinical DD VAS OS Exercise 44 8 wk
Wahlund29 2003 RDC/TMD MPD PI SS BI 81 3 mo
Wahlund29 2003 RDC/TMD MPD PI SS Relaxation 81 3 mo
Truelove30 2006 RDC/TMD MPD PI Hard splint Self-care 108 3 mo
Truelove30 2006 RDC/TMD MPD PI Soft splint Self-care 110 3 mo
Wassell28 2006 Clinical MPD VAS SS NOS 72 3 mo
Alencar Jr19 2009 Clinical MPD SSI Soft splint NOS 28 3 mo
Alencar Jr19 2009 Clinical MPD SSI Hard splint NOS 28 3 mo
Wahlund32 2015 RDC/TMD MPD NRS SS Relaxation 57 3 mo
Conti31 2015 RDC/TMD DD PI ARS Counseling 21 3 mo
Conti31 2015 RDC/TMD DD PI NTI-tss Counseling 21 3 mo
Hosgor23 2017 RDC/TMD DD VAS SS NSAID 20 3 mo
Giannakopoulos14 2018 RDC/TMD MPD NRS SS Exercise 42 3 mo
Kokkola15 2018 RDC/TMD MPD OHIP SS Counseling 39 3 mo
Shedden Mora27 2013 RDC/TMD DD VAS SS Cognition 56 6 mo
Katyayan37 2014 RDC/TMD MPD VAS SS Counseling 80 6 mo
Wahlund32 2015 RDC/TMD MPD NRS SS Relaxation 22 6 mo
Hosgor23 2017 RDC/TMD DD VAS SS NSAID 20 6 mo
Kokkola15 2018 RDC/TMD MPD OHIP SS Counseling 35 6 mo
Truelove30 2006 RDC/TMD MPD PI Hard splint Self-care 113 1 yr
Truelove30 2006 RDC/TMD MPD PI Soft splint Self-care 103 1 yr
Qvintus33 2015 RDC/TMD MPD VAS SS Counseling 46 1 yr
Wassell28 2006 Clinical MPD VAS SS No treatment 39 1 yr
Kokkola15 2018 RDC/TMD MPD OHIP SS Counseling 43 1 yr
Ekberg34 2004 Clinical MPD VAS SS NOS 40 1 yr

(DD: disk displacement, VAS: visual analogue scale, OS: occlusal splint, NSAID: nonsteroidal antiinflammatory drugs, MPD: myofascial pain dysfunction, SSI: symptom severity index, NOS: non-occluding splint, RDC/TMD: research diagnostic criteria of temporomandibular dysfunction, SS: stabilizing splint, NRS: numeric rating scale, NTI-tss: nociceptive trigeminal inhibition-tension suppression system, PI: pain intensity, BI: brief information, ARS: anterior reposition splint, OHIP: oral health impact profile)


Summary of the included studies of short- and long-term maximum mouth opening (MMO) subgroup analysis

Study (first author) Publication year Diagnostic mean Diagnosis Pain measurement tool Study splint type Control No. of participants
Carmeli25 2001 Clinical DD MM Soft splint Exercise 36
Minakuchi18 2001 Clinical DD MM Flat OS NSAID 50
Minakuchi18 2001 Clinical DD MM Flat OS No treatment 46
Niemelä24 2012 RDC/TMD MPD MM SS Counseling 76
Gomes35 2014 Clinical MPD MM OS No treatment 28
Gomes35 2014 Clinical MPD MM OS Massage 28
Wassell28 2006 AAOFP MPD MM SS NOS 39
Wassell28 2006 AAOFP MPD MM SS NOS 72
Wahlund29 2003 RDC/TMD MPD MM OS BI+relaxation 83
Wahlund29 2003 RDC/TMD MPD MM SS BI+relaxation 83
Wahlund32 2015 RDC/TMD MPD MM SS Relaxation 57
Conti31 2015 Clinical DD MM SS Relaxation 22
Conti31 2015 Clinical DD MM ARS Counseling 21
Conti31 2015 Clinical DD MM NTI-tss Counseling 21

(DD: disk displacement, MM: inter-incisal opening in millimeters, OS: occlusal splint, NSAID: nonsteroidal antiinflammatory drugs, RDC/TMD: research diagnostic criteria of temporomandibular dysfunction, MPD: myofascial pain dysfunction, SS: stabilizing splint, BI: brief information, NTI-tss: nociceptive trigeminal inhibition-tension suppression system, AAOFP: American Academy of Orofacial Pain, ARS: anterior reposition splint, NOS: non-occluding splint)


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Current Issue

30 April 2020
Vol. 46
No. 2 pp. 85~159

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