Manual Therapy Techniques Versus Occlusal Splint Therapy for Temporomandibular Disorders: A Systematic Review with Meta-Analysis

Abstract

Background: Manual therapy (MT) and occlusal splint therapy (OST) are the most conservative therapies applied on patients with temporomandibular disorders (TMDs). The aim was to compare the efficacy of MT vs. OST in improving pain, maximal mouth opening (MMO), disability, and health related-quality of life (hr-QoL) in these patients. Methods: According to PRISMA guidelines, a meta-analysis (CRD42022343915) was conducted including randomized controlled trials comparing the effectiveness of MT vs. OST in TMD patients, after searching in PubMed, PEDro, SCOPUS, and WOS up to March 2024. Methodological quality and risk of bias were assessed using the PEDro Scale. Cohen's standardized mean difference (SMD) and its 95% confidence interval (95% CI) were the pooled effect measures calculated. Results: Nine studies, providing data from 426 patients, were included. Meta-analyses revealed that MT is more effective than OST in reducing disability (SMD = -0.81; 95% CI -1.1 to -0.54) and increasing MMO (SMD = 0.52; 95% CI 0.27 to 0.76) without differences for improving pain intensity and hr-QoL. Subgroup analyses revealed the major efficacy of OST in reducing pain in myogenic patients (SMD = 0.65; 95% CI 0.02 to 1.28). Conclusions: With caution, due to the low number of studies included, MT may be more effective than OST for improving disability and MMO in patients with TMDs.

Keywords: disability; manual therapy; occlusal splints; pain; temporomandibular disorders.

Figure 1

PRISMA flow chart.

Figure 2

Forest plot for pain intensity (A) [44,47,48,50,51], disability (B) [44,45,46,50], maximal mouth opening (C) [20,44,45,49,50], and health related-quality of life (D) [47,48].