Manrriquez Salvador L, Robles Kenny, Pareek Kam, Besharati Alireza, Enciso Reyes
Orofacial Pain and Oral Medicine Clinic, Division of Diagnostic Sciences, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, California, USA.
Master of Science Program in Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, California, USA.
J Dent Anesth Pain Med. 2021 Jun;21(3):183-205. doi: 10.17245/jdapm.2021.21.3.183. Epub 2021 Jun 1.
This systematic review and meta-analysis aimed to analyze the effectiveness of maxillary stabilization splint (SS) therapy to reduce headache (HA) intensity and HA frequency in patients with temporomandibular disorders (TMD)-HA comorbidity. Randomized controlled trials (RCTs) using full-arch coverage, hard resin, and maxillary SS therapy were included. Electronic databases, including Cochrane Library, MEDLINE through PubMed, Web of Science, and EMBASE, were searched. The risk of bias was analyzed based on Cochrane's handbook. The search yielded 247 references up to January 28, 2020. Nine RCTs were included at a high risk of bias. The comparison groups included other splints, counseling, jaw exercises, medications, neurologic treatment, and occlusal equilibration. Four studies reported a statistically significant reduction in HA intensity, and five studies reported significant improvement in HA frequency from baseline at 2-12 months in patients with TMD-HA comorbidity treated with a full-arch hard maxillary SS. HA frequency in tension-type HA (TTH) comorbid with TMD diagnoses of myofascial pain (MFP) or capsulitis/synovitis improved significantly with SS than that with full-arch maxillary non-occluding splint (NOS) in two studies. Comparison groups receiving hard partial-arch maxillary splint nociceptive trigeminal inhibition (NTI) showed statistically significant improvements in HA intensity in patients with mixed TMD phenotypes of MFP and disc displacement comorbid with "general HA." Comparison groups receiving partial-arch maxillary resilient/soft splint (Relax) showed significant improvements in both HA intensity and frequency in patients with HA concomitant with MFP. The meta-analysis showed no statistically significant difference in the improvement of pain intensity at 2-3 months with comparison of the splints (partial-arch soft [Relax], hard [NTI], and full-arch NOS) or splint use compliance at 6-12 months with comparison of the splints (partial-arch Relax and full-arch NOS) versus the SS groups in patients with various TMD-HA comorbidities. In conclusion, although SS therapy showed a statistically significant decrease in HA intensity and HA frequency when reported, the evidence quality was low due to the high bias risk and small sample size. Therefore, further studies are required.
本系统评价和荟萃分析旨在分析上颌稳定咬合板（SS）疗法对降低颞下颌关节紊乱病（TMD）合并头痛（HA）患者头痛强度和头痛频率的有效性。纳入使用全牙弓覆盖、硬质树脂和上颌SS疗法的随机对照试验（RCT）。检索了包括Cochrane图书馆、通过PubMed检索的MEDLINE、科学网和EMBASE在内的电子数据库。根据Cochrane手册分析偏倚风险。截至2020年1月28日，检索共得到247篇参考文献。纳入9项偏倚风险较高的RCT。比较组包括其他咬合板、咨询、颌部锻炼、药物、神经治疗和咬合平衡。四项研究报告称，接受全牙弓硬质上颌SS治疗的TMD-HA合并症患者在2至12个月时，头痛强度有统计学意义的降低，五项研究报告头痛频率较基线有显著改善。在两项研究中，与TMD诊断为肌筋膜疼痛（MFP）或囊炎/滑膜炎合并的紧张型头痛（TTH）患者相比，使用SS治疗的头痛频率较使用全牙弓上颌非咬合板（NOS）有显著改善。接受硬质部分牙弓上颌咬合板伤害性三叉神经抑制（NTI）的比较组中，MFP和盘移位混合TMD表型合并“一般性HA”的患者头痛强度有统计学意义的改善。接受部分牙弓上颌弹性/软质咬合板（Relax）的比较组中，HA合并MFP的患者头痛强度和频率均有显著改善。荟萃分析显示，在不同TMD-HA合并症患者中，比较不同咬合板（部分牙弓软质[Relax]、硬质[NTI]和全牙弓NOS）在2至3个月时疼痛强度的改善情况，或比较不同咬合板（部分牙弓Relax和全牙弓NOS）在6至12个月时的咬合板使用依从性与SS组相比，均无统计学意义上的显著差异。总之，尽管SS疗法在报告时有统计学意义上的头痛强度和头痛频率降低，但由于偏倚风险高和样本量小，证据质量较低。因此，需要进一步研究。
