Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
Department of Restorative Dentistry, Edinburgh University, Edinburgh, UK.
Int J Oral Maxillofac Surg. 2020 Aug;49(8):1042-1056. doi: 10.1016/j.ijom.2020.01.004. Epub 2020 Jan 22.
A network meta-analysis (NMA) of randomized controlled trials (RCTs) was performed to assess the effectiveness of various types of occlusal splint in the management of temporomandibular disorders (TMDs) and to rank them according to their effectiveness. An electronic search was undertaken to identify RCTs published until August 2019. Predictor variables were control, non-occluding splint, hard stabilization splint (HSS), soft stabilization splint (SSS), prefabricated splint, mini-anterior splint, anterior repositioning splint (ARS), and counselling therapy (CT) with or without HSS. Outcome variables were pain improvement, post-treatment pain intensity, improvement in mouth opening, and disappearance of temporomandibular joint (TMJ) sounds. Forty-eight RCTs were included. There was a significant decrease in post-treatment pain intensity in arthrogenous TMDs after ARS (low quality evidence), CT+HSS (moderate quality evidence), mini-anterior splints (very low quality evidence), and HSS alone (low quality evidence), when compared to the control. There was a significant decrease in post-treatment pain intensity in myogenous TMDs with mini-anterior splints (very low quality evidence), SSS (very low quality evidence), CT alone (moderate quality evidence), CT+HSS (moderate quality evidence), and HSS alone (moderate quality evidence), when compared to control. ARS and CT were superior in decreasing TMJ clicking than control and HSS alone. The three highest-ranked treatments for post-treatment pain reduction in arthrogenous TMDs were ARS (92%, very low quality evidence), CT+HSS (67.3%, low quality evidence), and HSS alone (52.9%, moderate quality evidence). For myogenous TMDs, they were mini-anterior splints (86.8%, low quality evidence), CT+HSS (61.2%, very low quality evidence), and HSS alone (59.7%, moderate quality evidence). Based on this NMA of 48 RCTs, there is moderate to very low quality evidence confirming the effectiveness of occlusal splint therapy in the treatment of TMDs. Multimodal therapy consisting of CT+HSS may produce the maximum improvement for TMD patients.
对随机对照试验（RCT）进行网络荟萃分析（NMA），以评估各种类型的咬合夹板治疗颞下颌关节紊乱（TMD）的效果，并根据效果对其进行排序。进行电子检索以确定截至 2019 年 8 月发表的 RCT。预测变量为对照组、非咬合夹板、硬稳定夹板（HSS）、软稳定夹板（SSS）、预制夹板、迷你前夹板、前复位夹板（ARS）和伴有或不伴有 HSS 的咨询治疗（CT）。结局变量为疼痛改善、治疗后疼痛强度、张口度改善和颞下颌关节（TMJ）声音消失。共纳入 48 项 RCT。与对照组相比，在 ARS（低质量证据）、CT+HSS（中质量证据）、迷你前夹板（极低质量证据）和 HSS 单独治疗（低质量证据）后，关节源性 TMD 的治疗后疼痛强度显著降低。在肌源性 TMD 中，与对照组相比，迷你前夹板（极低质量证据）、SSS（极低质量证据）、单独 CT（中质量证据）、CT+HSS（中质量证据）和 HSS 单独（中质量证据）治疗后疼痛强度显著降低。与对照组相比，ARS 和 CT 更能减少 TMJ 咔哒声。关节源性 TMD 治疗后疼痛减轻的三种最高排名的治疗方法是 ARS（92%，极低质量证据）、CT+HSS（67.3%，低质量证据）和 HSS 单独（52.9%，中质量证据）。对于肌源性 TMD，它们是迷你前夹板（86.8%，低质量证据）、CT+HSS（61.2%，极低质量证据）和 HSS 单独（59.7%，中质量证据）。基于这 48 项 RCT 的 NMA，有中等至极低质量的证据证实了咬合夹板治疗 TMD 的有效性。由 CT+HSS 组成的多模式治疗可能会为 TMD 患者带来最大的改善。
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