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Meta-Analysis
. 2017 Feb 6;12(2):e0171296.
doi: 10.1371/journal.pone.0171296. eCollection 2017.

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

Jovana Kuzmanovic Pficer  1 , Slobodan Dodic  2 , Vojkan Lazic  2 , Goran Trajkovic  3 , Natasa Milic  3 , Biljana Milicic  1
Affiliations
Meta-Analysis

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

Jovana Kuzmanovic Pficer et al. PLoS One. .

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart diagram.
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi: 10.1371/journal.pmed1000097. For more information, visit www.prisma-statement.org.
Fig 2
Fig 2. Risk of bias graph: Review authors' judgments about each risk of bias item presented as percentages across all included studies.
Fig 3
Fig 3. Forest plot comparison: Stabilization splint vs. Control group.
Pain reduction according to RDC/TMD at short term.
Fig 4
Fig 4. Forest plot comparison: Stabilization splint vs. Control group.
Pain reduction according to TMDs origin at short term.
Fig 5
Fig 5. Forest plot comparison: Stabilization splint vs. Control group.
Pain reduction according to individual treatments at short term.
Fig 6
Fig 6. Forest plot comparison: Stabilization splint vs. Control group.
Pain intensity according to numeric scales at short term.
Fig 7
Fig 7. Forest plot comparison: Stabilization splint vs. Control group.
Pain intensity according to RDC/TMD at short term.
Fig 8
Fig 8. Forest plot comparison: Stabilization splint vs. Control group.
Pain intensity according to TMDs origin at short term.
Fig 9
Fig 9. Forest plot comparison: Stabilization splint vs. Control group.
Pain reduction at long term.
Fig 10
Fig 10. Forest plot comparison: Stabilization splint vs. Control group.
Pain intensity on according to numeric scales at long term.
Fig 11
Fig 11. Forest plot comparison: Stabilization splint vs. Control group.
Pain intensity according to RDC/TMD at long term.
See this image and copyright information in PMC

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