前移位夹板与其他咬合夹板治疗伴复位的颞下颌关节盘前移位的疗效比较：一项荟萃分析。

BACKGROUND: Disc displacement with reduction (DDwR) is among the common disc disorders of temporomandibular joint (TMJ), which can be managed conservatively by splint therapy. Anterior repositioning splint (ARS) is the most commonly prescribed splint by dental practitioners, but not getting a normal disc-condyle relationship always and other side effects lead to need of comparing with other occlusal splints. This review will help in informed decision-making by clinicians in choosing an appropriate splint type for patients. AIM: The aim is to compare the effectiveness of ARS in the management of DDwR with other occlusal splints for TMJ and muscle pain, TMJ noise, any adverse effects, regaining normal disc-condyle relationship. MATERIALS AND METHODS: We followed published protocol in the International prospective register of systematic reviews. Databases were searched till May 2023 using different search strategies as per the database. Title and abstract screening, followed by full-text screening and data extraction with risk of bias, was done by two independent reviewers in Covidence. Outcomes were reported as risk ratio (RR) or mean difference (MD) for dichotomous or continuous outcomes, respectively, using RevMan 5.4 (Review Manager 5.4) software. We used a random effect model for statistical analysis. Certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation Guideline Development Tool (GRADEpro GDT) software. RESULTS: A total of 1145 reports were found from a database search. After screening, four studies were included for systematic reviews. Other occlusal splints reported were sagittal vertical extrusion device and mandibular ARS, full hard stabilization splint of canine or centric stabilization type. Data of only two studies could be used for meta-analysis having 30 participants received ARS and 40 received other occlusal splints. We did not find evidence of any difference between ARS and other occlusal splints for TMJ clicking in short term (RR 1.25, 95% confidence interval [CI] 0.91-1.72) but a small difference in favor of other occlusal splint in long term (RR 2.40, 95% CI 1.04-5.55). No evidence of any difference was found between both treatments for TMJ pain in short term (MD-5.68, 95% CI-17.31-5.95) and long term (MD 0.00, 95% CI-2.86-2.86) and muscle pain in short term. The certainty of evidence for comparison of two treatments for different outcomes was of low or very low level. CONCLUSION: Evidence is uncertain that other occlusal splints reduced TMJ clicking slightly in comparison to ARS. For the remaining outcomes, no evidence of any difference was found between the two splints and it may be biased due to selection bias, inadequate blinding of participants, and outcome assessor.

背景：盘移位伴复位（DDwR）是颞下颌关节（TMJ）常见的盘紊乱之一，可通过夹板治疗进行保守治疗。前定位夹板（ARS）是牙科医生最常开的夹板，但并非总能获得正常的盘-髁关系，并且存在其他副作用，这导致需要将其与其他咬合夹板进行比较。本综述将帮助临床医生在为患者选择合适的夹板类型时做出明智的决策。

目的：旨在比较 ARS 与其他咬合夹板治疗 TMJ 和肌肉疼痛、TMJ 噪音、任何不良反应、恢复正常盘-髁关系的有效性。

材料和方法：我们遵循国际系统评价前瞻性注册中的已发表方案。根据数据库的不同搜索策略，在 2023 年 5 月之前在数据库中进行了搜索。由两名独立审查员在 Covidence 中进行标题和摘要筛选，然后进行全文筛选和数据提取，并进行偏倚风险评估。使用 RevMan 5.4（Review Manager 5.4）软件报告二分类或连续性结局的风险比（RR）或均数差（MD）。我们使用随机效应模型进行统计分析。使用推荐评估、制定与评价分级工具（GRADEpro GDT）软件评估证据的确定性。

结果：从数据库搜索中发现了 1145 份报告。经过筛选，纳入了四项系统评价研究。其他咬合夹板报告包括矢状垂直挤压装置和下颌 ARS、犬齿或中央稳定型全硬稳定夹板。只有两项研究的数据可用于荟萃分析，其中 30 名参与者接受 ARS 治疗，40 名参与者接受其他咬合夹板治疗。我们没有发现 ARS 和其他咬合夹板在短期治疗 TMJ 咔哒声方面有任何差异的证据（RR 1.25，95%置信区间 [CI] 0.91-1.72），但长期治疗时其他咬合夹板的效果稍好（RR 2.40，95% CI 1.04-5.55）。在短期和长期治疗中，两种治疗方法在 TMJ 疼痛（MD-5.68，95% CI-17.31-5.95）和肌肉疼痛方面均未发现任何差异（MD 0.00，95% CI-2.86-2.86）。对于两种治疗方法不同结局的比较，证据的确定性水平为低或极低。

结论：证据不确定 ARS 是否能稍微减少 TMJ 咔哒声。对于其他结局，两种夹板之间没有发现任何差异，这可能是由于选择偏倚、参与者和结果评估者的盲法不足所致。