Cochrane · intervention · CD002778
Stabilisation splint therapy for temporomandibular pain dysfunction syndrome
Cochrane Database of Systematic Reviews · 2004 · Cochrane Library
Oral HealthOral and maxillofacial surgeryTemporomandibular disorders and sleep2 versionsAMSTAR 2: not assessed
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
21
current version
GRADE rated
0
No studies
0
Included studies
12
as reported
No studies 0 · 0%Ungraded 21 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | All patients with pain dysfunction syndrome (PDS) of all degrees of severity. A diagnosis of PDS can be made if the patient exhibits more than one of the following signs and/or symptoms in any combination: pain on palpation of the temporomandibular joint; pain on palpation of associated mandibular muscles; limitation or deviation of mandibular movement; joint sounds and headache may or may not be a symptom | Patients referred for treatment of PDS to a special clinic; number of participants per study ranged from 20 to 80 (20 or fewer per study group in four studies) |
| Intervention | Stabilisation splint (Tanner appliance, the Fox appliance, the Michigan splint or the centric relation appliance) | Stabilisation splint (n=12) |
| Comparison | Any control group: no treatment; physiotherapy; pharmacological intervention; any other occlusal appliances | Minimal/no treatment (n=4); Non-occluding splints (n=3); Acupuncture (n=2); Biofeedback/stress management (n=2); Relaxation/hypnorelaxation (n=2); Bite plates (n=1); Visual feedback (n=1); Jaw exercises (n=1) |
| Outcomes | Improvement in pain of the temporomandibular joint; improvement in pain of associated mandibular muscles; improvement of the range of movement (normal range of movement, disappearance of joint sounds). Response classified as cured/improved/same/worse. Depression, dysfunction scores, treatment credibility and quality of life were also examined although not specified in the protocol | Pain (n=10); Movement of the jaw (n=4); TMJ clicking (n=2); Depression (n=1); Helkimo dysfunction score (n=3); Treatment credibility (n=1); Quality of life (n=1); Overall improvement (n=2) |
| Study designs | Randomised or quasi-randomised controlled trials (RCTs); abstracts not considered | 12 RCTs/quasi-RCTs; none reported sequence generation or allocation concealment; blind outcome assessment stated in 2 (Dao 1994, Winocur 2002); drop-outs reported in 6, none with full intention-to-treat analysis |
| Timing | Studies grouped according to treatment type and duration of follow up | Period of treatment/follow up varied from 4 to 12 weeks; Magnusson 1999 assessed at 3 and 6 months with a 1 to 4 year follow-up questionnaire |
Search date: 2001-06. Databases: Cochrane Oral Health Group's Trials Register; The Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; Dissertations and Theses
Questions and results
Show all 2 versionsStabilisation splint (SS) vs Minimal/no treatment
Population: Patients with pain dysfunction syndrome (PDS) of all degrees of severity
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Depression (CES-D, POMS) 3 months or less | MD -3.90 [-6.29, -1.52] | 1 study | Ungraded |
Pain (severity/palpation; PSS, PPI, VAS) 3 months or less | MD -3.20 [-4.81, -1.59] | 4 studies | Ungraded |
Stabilisation splint (SS) vs Non-occluding splint
Population: Patients with pain dysfunction syndrome (PDS) of all degrees of severity
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (unpleasantness/intensity/palpation) 3 months or less | RR 1.44 [0.81, 2.58] | 3 studies | Ungraded |
Movement (increase in maximal mouth opening) 3 months or less | MD 1.45 [-1.47, 4.37] | 1 study | Ungraded |
Quality of life 3 months or less | RR 0.12 [0.02, 0.90] | 1 study | Ungraded |
Overall improvement of symptoms 3 months or less | RR 1.13 [0.79, 1.61] | 2 studies | Ungraded |
Stabilisation splint (SS) vs Acupuncture
Population: Patients with pain dysfunction syndrome (PDS) of all degrees of severity
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Movement (deviation and range of mouth opening) 3 months or less | RR 0.55 [0.35, 0.84] | 1 study | Ungraded |
Helkimo clinical dysfunction score 3 months or less | SS vs acupuncture (Johansson 1991): Helkimo clinical dysfunction score decreased significantly in both groups (P<0.01) with no significant between-group difference; data not available for a pooled estimate. | 1 study | Ungraded |
TMJ clicking 3 months or less | RR 1.00 [0.56, 1.78] | 1 study | Ungraded |
Pain (palpation and on movement) 3 months or less | RR 0.63 [0.24, 1.65] | 2 studies | Ungraded |
Stabilisation splint (SS) vs Bite plates
Population: Patients with pain dysfunction syndrome (PDS) of all degrees of severity
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Helkimo dysfunction score 3 months or less | RR 0.68 [0.20, 2.23] | 1 study | Ungraded |
Stabilisation splint (SS) vs Biofeedback/stress management
Population: Patients with pain dysfunction syndrome (PDS) of all degrees of severity
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Treatment credibility 3 months or less | MD -0.10 [-0.69, 0.49] | 1 study | Ungraded |
Helkimo clinical dysfunction index 3 months or less | RR 1.11 [0.64, 1.92] | 1 study | Ungraded |
Pain (severity/muscle palpation) 3 months or less | MD 0.30 [-0.48, 1.08] | 1 study | Ungraded |
Depression (CES-D, POMS) 3 months or less | MD 5.50 [1.49, 9.51] | 1 study | Ungraded |
Stabilisation splint (SS) vs Jaw exercises
Population: Patients with pain dysfunction syndrome (PDS) of all degrees of severity
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
TMJ clicking up to 6 months | SS vs jaw exercises (Magnusson 1999): TMJ clicking at 3 months and greater than 3 months; no statistically significant between-group difference. Forest-plot data presented, totals not pooled. | 1 study | Ungraded |
Pain (TMJ, muscle, on movement) up to 6 months | SS vs jaw exercises (Magnusson 1999): improvements in all pain outcomes (TMJ pain, muscle pain, pain on movement) for both groups at 3 and 6 months; no statistically significant between-group difference at any time… | 1 study | Ungraded |
Overall improvement up to 6 months | SS vs jaw exercises (Magnusson 1999): overall improvement at 3 months and greater than 3 months; no statistically significant between-group difference; a follow-up questionnaire 1 to 4 years later showed a lasting… | 1 study | Ungraded |
Stabilisation splint (SS) vs Relaxation
Population: Patients with pain dysfunction syndrome (PDS) of all degrees of severity
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Pain (reduction in pain on palpation) 3 months or less | SS vs relaxation (Okeson 1983; Winocur 2002): reduction in pain on palpation. Okeson 1983 showed a significant reduction favouring SS; Winocur 2002 did not. Significant heterogeneity (P<0.01, I2=98.3%) meant the data… | 2 studies | Ungraded |
Movement (maximal mouth opening) 3 months or less | SS vs relaxation (Okeson 1983; Winocur 2002): change in maximal mouth opening (active/comfortable and assisted/painful). Significant heterogeneity (active/comfortable P<0.01, I2=92.9%; assisted/painful P<0.01, I2=94%);… | 2 studies | Ungraded |
Stabilisation splint (SS) vs Visual feedback
Population: Patients with pain dysfunction syndrome (PDS) of all degrees of severity
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Movement (lateral mandibular movement) 3 months or less | SS vs visual feedback (Monteiro 1988): both SS and visual feedback groups showed a significant decrease in lateral mandibular movement scores (P<0.01); data were unavailable for analysis. | 1 study | Ungraded |