The efficacy of anterior repositioning splints in the management of temporomandibular disc displacement: a systematic review and meta-analysis.

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the effectiveness of anterior repositioning splint (ARS) compared with other conservative treatments for temporomandibular joint (TMJ) disc displacement.

METHODS

This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Four databases (PubMed, Web of Science, Embase, and Cochrane) were searched up to January 8, 2024, so as to identify eligible randomized controlled trials (RCTs) of ARS for the treatment of TMJ disc displacement.

RESULTS

This analysis finally included 14 studies. The research findings showed that after 3 months of treatment, ARS significantly improved VAS score compared to the physical therapy [MD: -1.90, 95%CI (-2.69, -1.11), P < 0.00001] and behavioral therapy [MD=-3.00, 95%CI (-4.30, -1.71), P < 0.05]. However, it was less effective than other occlusal splint treatments [MD: 0.71, 95%CI (0.30, 1.11), P = 0.0007]. In terms of pain free mouth opening, ARS significantly outperformed the physical therapy [MD = 2.83, 95%CI (1.04, 4.62), P = 0.002] and behavioral therapy [MD: 1.79, 95%CI (1.33, 2.26), P < 0.00001] after 3 months of treatment. No significant difference was observed between ARS and other occlusal splint treatments [MD=-0.97, 95%CI (-2.65, 0.71), P = 0.26]. Regarding maximal active mouth opening, after 3 months of treatment, ARS was significantly superior to the physical therapy [MD = 3.10, 95%CI (1.05, 5.15), P = 0.03] and behavioral therapy [MD: 3.19, 95%CI (2.71, 3.66), P < 0.00001]. There was no significant difference between ARS and other occlusal splint treatments [MD: - 1.92, 95%CI (-4.05, 0.21), P = 0.08]. In terms of maximal passive mouth opening, ARS was significantly more effective than physical therapy [MD: 1.91, 95%CI (0.13, 3.68), P = 0.04]. There was no significant difference between ARS and other occlusal splint treatments [MD: -2.25, 95%CI (-5.02, 0.53), P = 0.11]. For relieving jaw popping symptoms, ARS was significantly more effective than the physical therapy [RR:0.45, 95%CI (0.34, 0.58), P < 0.00001] and behavioral therapy [RR: 0.48, 95%CI (0.36, 0.64), P < 0.00001]. However, no significant difference was found between ARS and other occlusal splint treatments [RR: 1.29, 95%CI (0.83, 2.02), P = 0.26].

CONCLUSION

A total of 14 studies were included in this systematic review and meta-analysis, which compared the efficacy of ARS with other conservative treatments for disc displacement. While ARS did not demonstrate a significant difference compared to physical therapy in improving TMJ pain, popping, and mandibular motor function in the initial treatment phase, it exhibited more pronounced effects than physical therapy and behavioral therapy with continued use. Splints have demonstrated significant efficacy in alleviating TMJ popping and improving mandibular movement. However, ARS has not shown superior effectiveness compared to other types of occlusal splints in alleviating pain.