Koh H, Robinson P G
Department of Dental Public Health & Community Dental Education, Guy's, King's and St. Thomas' School of Dentistry, King's College London, London, UK, SE5 8AN.
Cochrane Database Syst Rev. 2003(1):CD003812. doi: 10.1002/14651858.CD003812.
There has been a long history of using occlusal adjustment in the management of temporomandibular disorders (TMD). It is not clear if occlusal adjustment is effective in treating TMD.
To assess the effectiveness of occlusal adjustment for treating TMD in adults and preventing TMD.
We searched the Cochrane Oral Health Group's Trials Register (April 2002); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2002); MEDLINE (1966 to 8th April 2002); EMBASE (1980 to 8th April 2002) and handsearched journals of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from review articles of treating TMD. There were no language restrictions. Unpublished reports or abstracts were considered from the SIGLE database.
All randomised or quasi-randomised controlled trials (RCTs) comparing occlusal adjustment to placebo, reassurance or no treatment in adults with TMD. The outcomes were global measures of symptoms, pain, headache and limitation of movement.
Data were independently extracted, in duplicate, by two reviewers, Holy Koh (HK) and Peter G Robinson (PR). Authors were contacted for details of randomisation and withdrawals and a quality assessment was carried out. The Cochrane Oral Health Group's statistical guidelines were followed and relative risk values calculated using random effects models where significant heterogeneity was detected (P<0.1).
Over 660 trials were identified by the initial search. Six of these trials, which reported results from a total of 392 patients, were suitable for inclusion in the review. From the data provided in the published reports, symptom-based outcomes were extracted from trials on treatment. Data on incidence of symptoms were extracted from trials on prevention. Neither showed any difference between occlusal adjustment and control group.
REVIEWER'S CONCLUSIONS: There is an absence of evidence, from RCTs, that occlusal adjustment treats or prevents TMD. Occlusal adjustment cannot be recommended for the management or prevention of TMD. Future trials should use standardised diagnostic criteria and outcome measures when evaluating TMD.
在颞下颌关节紊乱病（TMD）的治疗中，使用咬合调整已有很长的历史。目前尚不清楚咬合调整对治疗TMD是否有效。
评估咬合调整治疗成人TMD及预防TMD的有效性。
我们检索了Cochrane口腔健康组试验注册库（2002年4月）；Cochrane对照试验中央注册库（CENTRAL）（Cochrane图书馆2002年第2期）；MEDLINE（1966年至2002年4月8日）；EMBASE（1980年至2002年4月8日），并手工检索了对本综述特别重要的期刊。从检索到的报告的参考文献列表和治疗TMD的综述文章中识别出其他报告。没有语言限制。未发表的报告或摘要来自SIGLE数据库。
所有比较咬合调整与安慰剂、安慰治疗或不治疗成人TMD的随机或半随机对照试验（RCT）。结局指标为症状、疼痛、头痛和运动受限的综合测量。
数据由两位评价者Holy Koh（HK）和Peter G Robinson（PR）独立提取，一式两份。联系作者获取随机分组和撤组的详细信息，并进行质量评估。遵循Cochrane口腔健康组的统计指南，在检测到显著异质性（P<0.1）时，使用随机效应模型计算相对风险值。
初步检索识别出660多项试验。其中6项试验报告了总共392例患者的结果，适合纳入本综述。从已发表报告中提供的数据来看，基于症状的结局指标从治疗试验中提取。症状发生率的数据从预防试验中提取。两者均未显示咬合调整组与对照组之间有任何差异。
随机对照试验中缺乏证据表明咬合调整能治疗或预防TMD。不推荐使用咬合调整来管理或预防TMD。未来的试验在评估TMD时应使用标准化的诊断标准和结局指标。
