Jagger Robert
Division of Restorative Dentistry, Department of Oral and Dental Sciences, University of Bristol, Bristol, UK.
Evid Based Dent. 2008;9(1):23. doi: 10.1038/sj.ebd.6400569.
Searches were made using the Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, LILACS (Latin American & Caribbean Health Sciences Literature), Biblioteca Brasileira de Odontologia, and Dissertations, Theses and Abstracts. Hand searches were made of abstracts of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from article reviews about treating sleep bruxism. There were no language restrictions.
Randomised controlled trials (RCT) or quasi-RCT were chosen that compared splint therapy concurrently with no treatment, other occlusal appliances, or any other intervention in participants who had sleep bruxism.
Data extraction was carried out independently and in duplicate. Validity assessment of the included trials was carried out at the same time as data extraction. Discrepancies were discussed and a third review author consulted. The author of the primary study was contacted when necessary.
Thirty-two potentially relevant RCT were identified of which five were eventually included. In these, use of an occlusal splint was compared with palatal splint, mandibular advancement device, transcutaneous electric nerve stimulation, and no treatment. There was just one common outcome (arousal index) which was combined in a meta-analysis. No statistically significant difference between the occlusal splint and control groups were found in meta-analysis.
There is not enough evidence to state that the occlusal splint is effective for treating sleep bruxism. Indication of its use is questionable with regard to sleep outcomes, but there may be some benefit with regard to tooth wear. This systematic review suggests the need for further investigation in more controlled RCT that pay attention to method of allocation, outcome assessment, large sample size, and sufficient duration of followup. The study design must be parallel in order to eliminate the bias provided by studies of crossover type. A standardisation of the outcomes of the treatment of sleep bruxism should be established in the RCT.
通过使用Cochrane口腔健康小组试验注册库、Cochrane对照试验中央注册库（CENTRAL）、医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）、拉丁美洲及加勒比健康科学文献数据库（LILACS）、巴西牙科学图书馆以及学位论文、论文及摘要进行检索。对本综述特别重要的摘要进行了手工检索。从检索到的报告的参考文献列表以及关于治疗睡眠磨牙症的文章综述中识别出其他报告。没有语言限制。
选择随机对照试验（RCT）或半随机对照试验，比较夹板疗法与不治疗、其他咬合器具或对患有睡眠磨牙症的参与者的任何其他干预措施。
数据提取由两人独立进行。在数据提取的同时对纳入试验的有效性进行评估。讨论差异并咨询第三位综述作者。必要时与主要研究的作者联系。
确定了32项可能相关的随机对照试验，最终纳入5项。在这些试验中，将咬合夹板的使用与腭夹板、下颌前移装置、经皮电神经刺激以及不治疗进行了比较。只有一个共同结局（觉醒指数），在荟萃分析中进行了合并。荟萃分析中未发现咬合夹板组与对照组之间存在统计学显著差异。
没有足够的证据表明咬合夹板对治疗睡眠磨牙症有效。就睡眠结局而言，其使用指征存在疑问，但在牙齿磨损方面可能有一些益处。本系统综述表明，需要在更严格控制的随机对照试验中进行进一步研究，这些试验应关注分配方法、结局评估、大样本量和足够的随访时间。研究设计必须是平行的，以消除交叉类型研究带来的偏差。应在随机对照试验中建立睡眠磨牙症治疗结局的标准化。
