Chen Yun, Tsai Chia-Hsuan, Bae Tae Hui, Huang Ching-Ya, Chen Chiehfeng, Kang Yi-No, Chiu Wen-Kuan
Department of Primary Care Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Aesthetic Plast Surg. 2023 Apr;47(2):775-790. doi: 10.1007/s00266-023-03256-8. Epub 2023 Jan 24.
The present study compiled evidence on the efficacy of botulinum toxin A (BTX) for management of bruxism.
A literature review that included randomized control, cohort, as well as observational studies published between January 2000 and November 2022 was conducted. All studies related to BTX injections administered into the masseters of patients with bruxism were included. Primary outcomes were measured by performing a meta-analysis of changes in maximal biting forces and pain severity and meta-regression of the effects of the BTX dose.
Ten studies were included for quantitative analysis. The analysis of the maximal biting force after BTX injections demonstrated a significant reduction at 1 month or less compared with both oral splints (P < 0.000001) and saline injections (P = 0.01). BTX continued to outperform oral splinting (P = 0.001) and saline placebos (P = 0.03) at 3 months. Between 3 and 6 months, a significantly higher maximal biting strength was observed in the BTX group than the oral splinting group (P < 0.00001). No significant differences in the maximal biting force were observed between the BTX and saline placebo groups (P = 0.50). A similar trend was observed in the analysis of pain reduction after botulinum treatment. Additionally, for every unit increase in the BTX dose, pain severity decreased by 0.0831 points (P = 0.0011).
BTX is effective in reducing biting strength and pain severity. BTX effects are evident at less than 4 weeks, peak between 5 and 8 weeks, and last for up to 24 weeks. Higher BTX doses result in greater improvement in pain. Although BTX benefits manifest earlier, they gradually diminish, and oral splinting exerts a more enduring effect, especially after 9-12 weeks. BTX injections into masseters are recommended as management options for bruxers, especially for those having difficulties complying with wearing oral splints or those seeking earlier symptom relief. However, future studies should determine BTX effects beyond 24 weeks and after repetitive injections and how bruxers of different ages or genders respond to treatment.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
本研究汇总了关于A型肉毒毒素（BTX）治疗磨牙症疗效的证据。
进行了一项文献综述，纳入了2000年1月至2022年11月发表的随机对照、队列以及观察性研究。纳入所有与向磨牙症患者咬肌注射BTX相关的研究。主要结局通过对最大咬合力变化和疼痛严重程度进行荟萃分析以及对BTX剂量效应进行荟萃回归来衡量。
纳入10项研究进行定量分析。与口腔矫治器（P < 0.000001）和生理盐水注射（P = 0.01）相比，BTX注射后1个月或更短时间时最大咬合力显著降低。在3个月时，BTX仍优于口腔矫治器（P = 0.001）和生理盐水安慰剂（P = 0.03）。在3至6个月之间，BTX组的最大咬力显著高于口腔矫治器组（P < 0.00001）。BTX组与生理盐水安慰剂组之间的最大咬合力未观察到显著差异（P = 0.50）。在肉毒毒素治疗后疼痛减轻的分析中观察到类似趋势。此外，BTX剂量每增加一个单位，疼痛严重程度降低0.0831分（P = 0.0011）。
BTX在降低咬力和疼痛严重程度方面有效。BTX的效果在4周内明显，在5至8周达到峰值，并持续长达24周。更高的BTX剂量可使疼痛改善更明显。尽管BTX的益处出现较早，但会逐渐减弱，而口腔矫治器具有更持久的效果，尤其是在9至12周后。建议将BTX注射咬肌作为磨牙症患者的治疗选择，特别是对于那些难以坚持佩戴口腔矫治器或寻求早期症状缓解的患者。然而，未来的研究应确定BTX在24周后以及重复注射后的效果，以及不同年龄或性别的磨牙症患者对治疗的反应。
证据级别III：本刊要求作者为每篇文章指定证据级别。有关这些循证医学评级的完整描述，请参阅目录或在线作者指南www.springer.com/00266 。
