Cochrane · intervention · CD012850
Occlusal interventions for managing temporomandibular disorders
Singh, BP, Singh, N, Jayaraman, S, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library
Oral HealthOral and maxillofacial surgeryTemporomandibular disorders and sleepAMSTAR 2: not assessed
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
60
current version
GRADE rated
17
No studies
30
Included studies
57 studies (81 records; 2846 participants); 35 studies in quantitative synthesis
as reported
No studies 30 · 50%Ungraded 13 · 21.7%Very low 17 · 28.3%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 | People with temporomandibular disorders (TMD); myogenous, arthrogenous, or mixed; diagnosed by RDC/TMD, DC/TMD (or later), or AAOFP criteria; no age restriction; >=80% TMD or separable TMD data | TMD subtypes across included studies (n=57 studies; 2846 participants): myofascial pain; arthrogenous; disc displacement with reduction (DDwR); disc displacement without reduction (DDwoR); mixed TMD; osteoarthritis |
| Intervention | Occlusal splint (stabilisation: full hard, full soft, liquid, UNIRA; reflex: anterior midline deprogrammer, NTI; repositioning: anterior repositioning, twin block, pivot, distraction); Occlusal adjustment (grinding of occlusal surfaces) | Occlusal splints only (no occlusal adjustment studies): full hard stabilisation splint (FHSS, most common); full soft stabilisation splint (FSSS); anterior repositioning splint; UNIRA; Lingual Ring Ri.P.A.Ra; pivot splint; anterior midline deprogrammer / NTI / Relax; twin block; Planas appliance; distraction splint |
| Comparison | No treatment or waiting-list control; Placebo (transparent-foil 0.5 mm or non-occluding splint); Another occlusal splint (within or between types); Other active treatments (physical therapy; behavioural therapy; acupuncture; pharmacological therapy) | No treatment (n=1); placebo / non-occlusal or transparent-foil splint (n=1); another occlusal splint (n=2); physical therapy (n=3); behavioural therapy (n=4); acupuncture (n=5); pharmacological therapy (n=6) |
| Outcomes | Joint pain at rest and mastication; Muscle pain at rest and mastication; Participant satisfaction; Quality of life; Any adverse effect or discomfort; Severity and frequency of joint noises; Range of mandibular motion; Duration of treatment; Recurrence rate; Depression; Somatisation | Reported: joint pain at rest; self-reported joint pain when chewing; muscle pain at rest; muscle pain when chewing; participant satisfaction / quality of life; severity of joint noise; frequency of joint noise; range of mandibular motion; depression; somatisation. Not reported by any study: discomfort; recurrence rate |
| Study designs | Randomised controlled trials (parallel; cross-over included using first-period data; follow-up >=1 week; any language; quasi-RCTs excluded) | Randomised controlled trials (n=57; 35 in quantitative synthesis) |
| Timing | Short term (<=3 months); Long term (>3 months) | Short term (<=3 months); Long term (>3 months) |
Search date: 2022-08. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; ClinicalTrials.gov; WHO ICTRP
Questions and results
Occlusal splint vs No treatment or placebo (non-occlusal or transparent-foil placebo splint)
Population: People with temporomandibular disorders (TMD)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Joint pain at rest Short term (10 weeks) · Mixed TMD | RR 0.13 [0.02, 0.94] | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Muscle pain when chewing Short term (3 months) · Disc displacement without reduction (DDwoR) | MD -1.97 [-2.37, -1.57] | 1 study · 84 participants | Very low Downgraded: risk of bias, imprecision |
Severity of joint noise Long term (4 months) · Mixed TMD | MD -0.58 [-7.09, 5.93] | 1 study · 20 participants | Very low Downgraded: risk of bias, imprecision |
Depression Short term · Mixed TMD | MD -2.58 [-4.62, -0.54] | 1 study · 32 participants | Ungraded |
Frequency of joint noise Short term (mean 10 weeks) · Myofascial pain TMD | RR 1.18 [0.63, 2.20] 367 per 1000 vs 433 per 1000 | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Discomfort | Listed in Summary of findings 1 as 'Not reported'; this outcome was not reported by any included study for this comparison. Discomfort was not reported in any included study across the whole review. | 0 studies | No studies |
Range of mandibular motion Short term · Disc displacement (with/without reduction) | MD -2.41 [-7.78, 2.96] | 1 study · 30 participants | Ungraded |
Recurrence rate | Listed in Summary of findings 1 as 'Not reported'; this outcome was not reported by any included study for this comparison. Recurrence rate was not reported in any included study across the whole review. | 0 studies | No studies |
Self-reported joint pain when chewing Short term (10 weeks) · Mixed TMD | RR 1.88 [0.94, 3.75] 267 per 1000 vs 501 per 1000 | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Muscle pain at rest Short term (mean 2 months) · Myofascial pain TMD | MD -11.63 [-29.37, 6.11] | 1 study · 37 participants | Very low Downgraded: risk of bias, imprecision |
Occlusal splint vs Another occlusal splint with a different mechanism of action
Population: People with temporomandibular disorders (TMD)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Joint pain at rest Long term (12 months) · Disc displacement with reduction (DDwR) | RR 7.00 [0.41, 120.16] | 1 study · 20 participants | Very low Downgraded: risk of bias, imprecision |
Severity of joint noise | Listed in Summary of findings 2 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Self-reported joint pain when chewing | Listed in Summary of findings 2 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Recurrence rate | Listed in Summary of findings 2 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Frequency of joint noise Short term (3 months) · Disc displacement with reduction (DDwR) | RR 0.80 [0.07, 9.18] 250 per 1000 vs 200 per 1000 | 1 study · 9 participants | Very low Downgraded: risk of bias, imprecision |
Muscle pain when chewing | Listed in Summary of findings 2 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Range of mandibular motion Short term (12 weeks) · Mixed TMD | MD 0.63 [-3.16, 4.42] | 1 study · 40 participants | Ungraded |
Participant satisfaction or quality of life Short term (3 months) · Mixed TMD | MD -2.29 [-3.13, -1.45] | 1 study · 40 participants | Ungraded |
Discomfort | Listed in Summary of findings 2 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Muscle pain at rest | Listed in Summary of findings 2 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Occlusal splint vs Physical therapy (ultrasound, exercise, sensorimotor training, laser, TENS, manual therapy)
Population: People with temporomandibular disorders (TMD)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recurrence rate | Listed in Summary of findings 3 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Depression Short term · Disc displacement with reduction (DDwR) | MD -0.25 [-0.52, 0.02] | 1 study · 60 participants | Ungraded |
Participant satisfaction or quality of life Short term (1 month) · Mixed TMD | MD -7.56 [-14.50, -0.63] | 2 studies · 75 participants | Ungraded |
Self-reported joint pain when chewing | Listed in Summary of findings 3 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Severity of joint noise Long term (4 months) · Mixed TMD | MD 5.92 [0.18, 11.66] | 1 study · 20 participants | Very low Downgraded: risk of bias, imprecision |
Joint pain at rest Short term (6 weeks) · Disc displacement without reduction (DDwoR) | RR 0.85 [0.47, 1.57] | 1 study · 31 participants | Very low Downgraded: risk of bias, imprecision |
Muscle pain when chewing Short term (mean 3 months) · Myofascial pain TMD | RR 0.17 [0.02, 1.26] 300 per 1000 vs 51 per 1000 | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Frequency of joint noise Short term (3 months) · Myofascial pain TMD | RR 1.50 [0.32, 6.94] 222 per 1000 vs 333 per 1000 | 1 study · 18 participants | Very low Downgraded: risk of bias, imprecision |
Muscle pain at rest Short term (mean 4.4 weeks) · Myofascial pain TMD | MD -0.19 [-1.25, 0.87] | 1 study · 72 participants | Very low Downgraded: risk of bias, imprecision |
Discomfort | Listed in Summary of findings 3 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Somatisation Short term · Disc displacement with reduction (DDwR) | MD -0.18 [-0.45, 0.09] | 1 study · 60 participants | Ungraded |
Range of mandibular motion Short term (3 months) · Disc displacement with reduction (DDwR) | MD -0.33 [-3.31, 2.65] | 1 study · 40 participants | Ungraded |
Occlusal splint vs Behavioural therapy (counselling, CBT, relaxation, self-care management)
Population: People with temporomandibular disorders (TMD)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Muscle pain at rest | Listed in Summary of findings 4 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Frequency of joint noise | Listed in Summary of findings 4 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Recurrence rate | Listed in Summary of findings 4 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Joint pain at rest Short term (1 month) · Mixed TMD | MD -2.59 [-4.21, -0.97] | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision |
Self-reported joint pain when chewing | Listed in Summary of findings 4 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Muscle pain when chewing | Listed in Summary of findings 4 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Range of mandibular motion Short term (6 weeks) · Myofascial pain TMD | MD 1.40 [-7.19, 9.99] | 1 study · 20 participants | Ungraded |
Severity of joint noise | Listed in Summary of findings 4 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Discomfort | Listed in Summary of findings 4 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Participant satisfaction or quality of life Short term (1 month) · Mixed TMD | MD -1.42 [-15.78, 12.94] | 2 studies · 73 participants | Ungraded |
Occlusal splint vs Acupuncture
Population: People with temporomandibular disorders (TMD)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Range of mandibular motion Short term · Myofascial pain TMD | MD 5.54 [-8.06, 19.13] | 2 studies · 67 participants | Ungraded |
Muscle pain when chewing Short term (1 month) · Myofascial pain TMD | MD 0.10 [-0.80, 1.00] | 1 study · 40 participants | Very low Downgraded: risk of bias, imprecision |
Discomfort | Listed in Summary of findings 5 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Self-reported joint pain when chewing | Listed in Summary of findings 5 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Recurrence rate | Listed in Summary of findings 5 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Participant satisfaction or quality of life Short term (1 month) · Mixed TMD | MD 0.80 [-7.36, 8.96] | 1 study · 30 participants | Ungraded |
Muscle pain at rest | Listed in Summary of findings 5 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Severity of joint noise | Listed in Summary of findings 5 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Frequency of joint noise | Listed in Summary of findings 5 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Occlusal splint vs Pharmacological therapy
Population: People with temporomandibular disorders (TMD)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Recurrence rate | Listed in Summary of findings 6 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Discomfort | Listed in Summary of findings 6 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Severity of joint noise | Listed in Summary of findings 6 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Muscle pain at mastication | Listed in Summary of findings 6 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Muscle pain at rest | Listed in Summary of findings 6 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Self-reported joint pain when chewing Short term (3 months) · Osteoarthritis | RR 2.10 [0.83, 5.30] 286 per 1000 vs 600 per 1000 | 1 study · 29 participants | Very low Downgraded: risk of bias, imprecision |
Range of mandibular motion Short term · Mixed TMD | MD -2.95 [-6.87, 0.97] | 1 study · 40 participants | Ungraded |
Frequency of joint noise | Listed in Summary of findings 6 as 'Not reported'; this outcome was not reported by any included study for this comparison. | 0 studies | No studies |
Joint pain at rest Short term · Osteoarthritis / mixed TMD | RR 1.87 [0.57, 6.07] | 1 study · 29 participants | Very low Downgraded: risk of bias, imprecision |