Additional splint therapy has no superiority in myogenic temporomandibular disorders: A systematic review and meta-analysis of randomized controlled trials (original) (raw)
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Journal of Oral & Facial Pain and Headache, 2014
Aims: To carry out a systematic review and meta-analysis comparing the effects of occlusal splint therapy ("usual treatment") and psychosocial interventions for the treatment of myofascial temporomandibular disorder (TMD) pain in adult patients. Methods: Independent screening and evaluation of randomized clinical trials included comparisons between "usual treatment" based on splint therapy and psychosocial interventions for TMD treatment within electronic databases (PubMed/MEDLINE, CENTRAL, EMBASE), ongoing trials databases (Current Controlled Trials, ClinicalTrials.gov), and additional sources. The outcomes selected for the systematic review were self-reported pain, pain interference, unassisted jaw opening without pain, muscle pain upon palpation, depression, and somatization. The effect measures were analyzed using a random-effect model (Review Manager computer program). Results: The outcomes "longterm self-reported pain" and "long-term depression" were significantly different for the comparisons of "usual treatment" and psychosocial interventions, and they favored the latter (P < .005 and P < .05, respectively). These results must be viewed with caution due to the limited number of studies available. A tendency toward greater improvements of psychological outcomes was observed for psychosocial interventions, while physical functioning was slightly more responsive to "usual treatment." Conclusion: No evidence was found to distinguish the clinical effectiveness between "usual treatment" and psychosocial interventions for myofascial TMD pain. Future studies of TMD and related subdiagnoses should be reported according to core standardized outcomes to facilitate comparisons.
Journal of Manipulative and Physiological Therapeutics, 2012
Objective: Studies investigating the efficacy of intraoral myofascial therapies (IMTs) for chronic temporomandibular disorder (TMD) are rare. The present study was an expansion of a previously published pilot study that investigated whether chiropractic IMT and the addition of education and self-care were superior to no-treatment or IMT alone for 5 outcome measures-interincisal opening range, jaw pain at rest, jaw pain upon opening, jaw pain upon clenching, and global reporting of change-over the course of 1 year. Methods: Ninety-three participants with myogenous TMD between the ages of 18 and 50 years experiencing chronic jaw pain of longer than 3 months in duration were recruited for the study. Successful applicants were randomized into 1 of 3 groups: (1) IMT consisting of 2 treatment interventions per week for 5 weeks, (2) IMT plus education and "selfcare" exercises (IMTESC), and (3) wait-list control. The main outcome measures were used. Range of motion findings were measured by vernier callipers in millimeters, and pain scores were quantified using an 11-point self-reported graded chronic pain scale. Global reporting of change was a 7-point self-reported scale, balanced positively and negatively around a zero midpoint. Results: There were statistically significant differences in resting, opening and clenching pain, opening scores, and global reporting of change (P b .05) in both treatment groups compared with the controls at 6 months and 1 year. There were also significant differences between the 2 treatment groups at 1 year. Conclusions: The study suggests that both chiropractic IMT and IMTESC were superior to no-treatment of chronic myogenous TMD over the course of 1 year, with IMTESC also being superior to IMT at 1 year. (J Manipulative Physiol Ther 2012;35:26-37) • Both treatment groups showed significant improvement in pain scores at 6 weeks, 6 months, and 1 year compared with the control group (notreatment group), with the combination group only showing general clinical superiority over the treatment-only group at 1 year.
Journal of Oral Rehabilitation, 2003
Limitation of mandibular movement is one of the cardinal signs of temporomandibular disorders (TMD), usually assessed by measurement of maximum voluntary mouth opening. A new measure of assessing mandibular mobility, the temporomandibular opening index (TOI), is less dependent on variables such as age, gender and ramus length. It has also been found to be useful to categorize patients. This study examined changes in TOI as treatment progressed in a group of myogenous TMD patients. Seven patients with myogenous TMD were included in the study and the TOI determined at 0 and 2 weeks, 1 and 6 months after initiation of treatment. Treatment outcome was assessed on a 4 point scale, 0 ¼ none, 1 ¼ mild, 2 ¼ moderate, and 3 ¼ severe. Headache, neckache, pain (joints and muscles) and joint sounds were assessed. Nine patients with no signs or symptoms of TMD were included to obtain a normal TOI. The mean TOI of the patient group was 16AE4% (s.d. ¼ 11AE2%) initially and 3AE95% (s.d. ¼ 1AE0%) at 6 months, while mean treatment scores changed from 12AE57 (s.d. ¼ 3AE05) to 1AE43 (s.d. ¼ 1AE90). The mean TOI of the control group was 3AE63 (s.d. ¼ 0AE74). A paired t-test showed that the TOI decreased significantly with time (P ¼ 0AE02) while there was a concomitant decrease in treatment score (P ¼ 0AE0003) over the same period. The TOI may be a useful method of following treatment of this group of myogenous TMD patients. KEYWORDS
BMC musculoskeletal disorders, 2017
Temporomandibular Disorders (TMD) may be characterized by pain and restricted jaw movements. In the absence of somatic factors in the temporomandibular joint, mainly myogenous, psychobiological, and psychosocial factors may be involved in the aetiology of myogenous TMD. An occlusal appliance (splint) is commonly used as a basic therapy of the dental practice. Alternatively, a type of physiotherapy which includes, apart from massage of sore muscles, aspects of cognitive-behavioural therapy might be a basic therapy for myogenous TMD. Treatment outcome of physiotherapy (Ph-Tx) was evaluated in comparison to that of splint therapy (Sp-Tx), using the index Treatment Duration Control (TDC) that enabled a randomized controlled trial with, comparable to clinical care, therapy-and-patient-specific treatment durations. Seventy-two patients were randomly assigned to either Ph-Tx or Sp-Tx, with an intended treatment duration between 10 and 21 or 12 and 30 weeks respectively. Using TDC, the clin...
BMJ Open
IntroductionTemporomandibular disorders (TMDs) are considered a collection of musculoskeletal conditions involving the masticatory muscles, the temporomandibular joint and associated structures. The myogenous group appears to represent the most frequently diagnosed category. In the context of a multimodal approach, splint therapy and musculoskeletal physiotherapy are often considered as a preferred therapy. The purpose of this study will be to investigate the effects of musculoskeletal physiotherapy combined with occlusal splint and education versus occlusal splint and education alone in the treatment of chronic myogenous TMD on pain and mandibular range of motion.Methods and analysisAll consecutive adults complaining of TMDs presented to the Department of Biomedical and Neuromotor Sciences of the University of Bologna will be considered eligible. Inclusion criteria shall be based on the presence of myogenous TMDs, as diagnosed through clinical examination in reference to the intern...
Chiropractic and Manual Therapies, 2013
Background: Myogenous temporomandibular disorders (TMD) are considered to be a common musculoskeletal condition. No studies exist comparing intra-oral myofascial therapies to education, self-care and exercise (ESC) for TMD. This study evaluated short-term differences in pain and mouth opening range between intra-oral myofascial therapy (IMT) and an ESC program. Methods: Forty-six participants with chronic myogenous TMD (as assessed according to the Research Diagnostic Criteria Axis 1 procedure) were consecutively block randomised into either an IMT group or an ESC group. Each group received two sessions per week (for five weeks) of either IMT or short talks on the anatomy, physiology and biomechanics of the jaw plus instruction and supervision of self-care exercises. The sessions were conducted at the first author's jaw pain and chiropractic clinic in Sydney, Australia. Primary outcome measures included pain at rest, upon opening and clenching, using an eleven point ordinal self reported pain scale. A secondary outcome measure consisted of maximum voluntary opening range in millimetres. Data were analysed using linear models for means and logistic regression for responder analysis.
Journal of Applied Oral Science
Are exercises with or without occlusal splints more effective in the reduction of pain in patients with temporomandibular disorders of myogenic origin? A systematic review Temporomandibular disorders (TMD) is a term used to describe a set of clinical conditions that may compromise the temporomandibular joint (TMJ) and masticatory muscles and/or associated structures, considered the most frequent cause of orofacial pain of non-dental origin. In recent years, many forms of physical therapy have been used in the treatment of TMD to reduce pain and improve the range of mandibular movement present in this impairment. Among these resources are kinesiotherapy (exercise), electrothermal and manual therapy, acupuncture, training posture, mobilizations, and biofeedback. Objectives: To determine if exercises with or without occlusal splints are effective in reducing pain in patients with temporomandibular disorders (TMD) of myogenic origin. Methodology: This systematic review was registered in the International Prospective Register of Systematic Reviews (CRD 42019134244). Controlled trials published in PubMed, Scopus, and Cochrane Library following PRISMA guidelines up to April 2022 were randomized and included. The population above 18 years, which evaluated the effectiveness of exercise with or without occlusal splints in reducing pain in patients with TMD of myogenic origin, diagnosed through the Research Diagnostic Criteria for Temporomandibular Disorders, was also included. There was no restriction on the period of publication. Cochrane risk of bias analysis was performed. Results: Of the five included articles, all showed a reduction of pain, but without significant differences between the interventions performed. Additionally, studies that evaluated the quality of life and mandibular movements showed a reduction in pain, but no significant differences between therapies. Conclusion: The analyzed studies showed no difference in the improvement of pain, quality of life, and mandibular movements between the groups that performed only exercises or the associated treatments.
Turkish Journal of Physical Medicine and Rehabilitation, 2021
Objectives: This study aims to evaluate the effectiveness of upper Michigan occlusal splint (OS) compared to mandibular OS in terms of pain, range of motion (ROM), and muscle activity as assessed by surface electromyography (sEMG) in patients affected by muscle-related temporomandibular disorders (TMD). Patients and methods: In this randomized-controlled trial, a total of 40 adult patients (13 males, 27 females; mean age: 47.2±12.8 years; range, 22 to 56 years) with a diagnosis of myofascial pain, lasting from at least three months on at least one masseter muscle. The patients were randomly allocated into two groups: Group 1 (n=20) using upper Michigan OS and Group 2 (n=20) using mandibular OS. At baseline (T0), at one (T1), three (T2), and six months (T3), the following outcomes were assessed: myofascial pain by Visual Analog Scale (VAS) and ROM of mandible movements, activity of the main masticatory muscles through sEMG. Results: There were no significant intra-group differences in the outcome measures assessed in both groups. However, Group 2 had a significantly higher right lateral mandibular ROM at T2 (7.1±3.1 vs. 9.8±2.3, respectively; p<0.05) and a significantly higher left lateral mandibular ROM at T3 (7.6±3.5 vs. 10.5±2.1, respectively; p<0.05). We found no significant difference in none of the sEMG parameters. Conclusion: Our study results suggest that OS, independently from being built on the upper or lower arch, seems to not have significant effects in reducing pain over a six-month period in TMD patients.