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Sleep Medicine Reviews Aug 2022Mandibular advancement device (MAD) therapy is the most commonly used second-line treatment for obstructive sleep apnea (OSA), but MAD may be ineffective in a subgroup... (Meta-Analysis)
Meta-Analysis Review
Comparison of the phenotypic characteristics between responders and non-responders to obstructive sleep apnea treatment using mandibular advancement devices in adult patients: Systematic review and meta-analysis.
Mandibular advancement device (MAD) therapy is the most commonly used second-line treatment for obstructive sleep apnea (OSA), but MAD may be ineffective in a subgroup of patients. The aim of this systematic review is to identify predictors of the efficacy of oral appliance (OA) therapy for OSA in adult patients. This review focuses on performing the quantitative analysis by subgroups based on the response criteria used in the literature and based on the type of device. PubMed, EMBASE, Scopus, Web of Science and Cochrane databases was conducted to identify potentially relevant studies published until Dec 2021. The search identified 1343 preliminary references. A total of 99 studies met the eligibility criteria and were included in the review, and 60 in the meta-analysis. The quality of studies was assessed using the Newcastle-Ottawa scale and the Cochrane scale. Based on meta-analysis, and considering a low to moderate evidence profile according to the GRADE scale, responders are younger patients, with smaller neck circumference, lower body mass index. Responders have shorter maxillary length, lower anterior and posterior facial height, a shorter distance from the hyoid bone to the third cervical vertebra, a shorter airway length, a smaller minimum airway cross-sectional area and a higher minimum oxygen saturation during sleep. Responders needed a lower optimal continuous positive airway pressure than non-responders. The type of device has not affected the results of the meta-analysis. The criterion "AHI <10 and reduction AHI >50%" is the one that provides the "weight" of significance for several variables. This criterion should be taken into consideration for future studies to predict OSA treatment by OA.
Topics: Adult; Continuous Positive Airway Pressure; Humans; Mandibular Advancement; Occlusal Splints; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 35653952
DOI: 10.1016/j.smrv.2022.101644 -
Healthcare (Basel, Switzerland) Apr 2022There is still a gap in the scientific knowledge on the linkage between craniofacial structure and spinal postural control in temporomandibular disorder (TMD) patients.... (Review)
Review
There is still a gap in the scientific knowledge on the linkage between craniofacial structure and spinal postural control in temporomandibular disorder (TMD) patients. This systematic review aimed to assess the role of occlusal splints on spinal posture of TMD patients. PubMed, Web of Science, and Scopus were systematically searched from inception until 5 January 2022 to identify observational studies with a longitudinal study design presenting: patients with diagnosis of TMD according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD); occlusal splint therapy as intervention; postural assessment as outcome. Out of 133 records identified, 104 were suitable for data screening, and only 7 articles were included satisfying the eligibility criteria. We found that occlusal splints might have a positive effect on posture in TMD patients, albeit there is little evidence of appropriate investigation for postural assessment. This systematic review suggested that the occlusal splint might be considered a non-invasive therapeutic approach for patients with TMD. However, the low number of studies with high-quality methodology in these patients showed an urgent need for further research using combined force platform stabilometry and kinematic evaluation of the spine to investigate the impact of occlusal splints on posture.
PubMed: 35455916
DOI: 10.3390/healthcare10040739 -
The Japanese Dental Science Review Nov 2022This systematic review aimed to update the management of sleep bruxism (SB) in adults, as diagnosed using polysomnography (PSG) and/or electromyography (EMG). Management... (Review)
Review
This systematic review aimed to update the management of sleep bruxism (SB) in adults, as diagnosed using polysomnography (PSG) and/or electromyography (EMG). Management methods covered were oral appliance therapy (OAT) with stabilization splints, cognitive-behavioral therapy (CBT), biofeedback therapy (BFT), and pharmacological therapy. A comprehensive search was conducted on MEDLINE, Cochrane Library, and Web of Science up to October 1st, 2021. Reference list searches and hand searches were also performed by an external organization. Two reviewers for each therapy independently performed article selection, data extraction, and risk of bias assessment. The reviewers resolved any disagreements concerning the assortment of the articles by discussion. Finally, 11, 3, 14, and 22 articles were selected for each therapy. The results suggested that OAT tended to reduce the number of SB events, although there was no significant difference compared to other types of splints, that the potential benefits of CBT were not well supported, and that BFT, rabeprazole, clonazepam, clonidine, and botulinum toxin type A injection showed significant reductions in specific SB parameters, although several side effects were reported. It can be concluded that more methodologically rigorous randomized large-sample long-term follow-up clinical trials are needed to clarify the efficacy and safety of management for SB.
PubMed: 35356038
DOI: 10.1016/j.jdsr.2022.02.004 -
European Respiratory Review : An... Dec 2021Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have... (Review)
Review
Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have been refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-continuous positive airway pressure (CPAP) therapies for OSA, we present recommendations determined by a systematic review of the literature. It is an update of the 2011 ERS statement on non-CPAP therapies, advanced into a clinical guideline. A multidisciplinary group of experts, including pulmonary, surgical, dentistry and ear-nose-throat specialists, methodologists and patient representatives considered the most relevant clinical questions (for both clinicians and patients) relating to the management of OSA. Eight key clinical questions were generated and a systematic review was conducted to identify published randomised clinical trials that answered these questions. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the quality of the evidence and the strength of recommendations. The resulting guideline addresses gastric bypass surgery, custom-made dual-block mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillo-mandibular osteotomy, carbonic anhydrase inhibitors and positional therapy. These recommendations can be used to benchmark quality of care for people with OSA across Europe and to improve outcomes.
Topics: Adult; Continuous Positive Airway Pressure; Humans; Mandibular Advancement; Occlusal Splints; Respiratory System; Sleep Apnea, Obstructive
PubMed: 34853097
DOI: 10.1183/16000617.0200-2021 -
Sleep Medicine Reviews Dec 2021Obstructive Sleep Apnea (OSA) is often treated with Mandibular Advancement Devices (MADs). It is unclear whether particular design features are superior to others in... (Meta-Analysis)
Meta-Analysis Review
Obstructive Sleep Apnea (OSA) is often treated with Mandibular Advancement Devices (MADs). It is unclear whether particular design features are superior to others in terms of OSA alleviation. In order to facilitate clinical decision-making, this systematic review summarizes the objective and subjective outcomes of different available MAD designs. Studies comparing different MAD designs in OSA treatment were searched. After screening 1887 titles and abstracts, 20 original RCTs and six cohort studies were included. 14 articles were systematically reviewed in a meta-analysis. The decrease in AHI was significantly different between some of the MAD designs. The clinical relevance of the observed differences was however limited. Monoblock appliances performed more favorable, compared to bilateral thrust (effect size:-0.37; CI:-1.81 to 0.07). Midline traction appliances performed more favorable, compared to other designs. Custom appliances performed more favorable, compared to thermoplastic appliances (effect size:0.86; CI:-0.62 to 2.35). Furthermore, there were no clinically relevant differences between MAD designs in reduction of ESS, compliance, preference, side effects, and cost effectiveness. With respect to the included trials, presently there is not one superior custom MAD design in OSA treatment regarding the effect on AHI reduction, ESS improvement, compliance, preference, side effects, cost effectiveness, and other disease-related outcomes. We confirm custom MAD designs perform superior to thermoplastic MAD designs.
Topics: Continuous Positive Airway Pressure; Humans; Mandibular Advancement; Occlusal Splints; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 34662769
DOI: 10.1016/j.smrv.2021.101557 -
International Journal of Environmental... Sep 2021The role of the dento-mandibular apparatus and, in particular, occlusion and jaw position, received increased attention during last years. In the present study, we aimed... (Review)
Review
The role of the dento-mandibular apparatus and, in particular, occlusion and jaw position, received increased attention during last years. In the present study, we aimed to systematically review, on the light of the new potential insights, the published literature covering the occlusal splint (OS) applications, and its impact on exercise performance. A structured search was carried out including MEDLINE/PubMed and Scopus databases with additional integration from external sources, between March and June 2021. To meet the inclusion criteria, studies published in the English language, involving humans in vivo, published from 2000 to 2021 and that investigated the role of occlusal splints on athletes' performance were selected. Starting from the 587 identified records, 17 items were finally included for the review. Four main aspects were considered and analyzed: (1) occlusal splint characteristics and occlusion experimental conditions, (2) jump performance, (3) maximal and explosive strength, and (4) exercise technique and biomechanics. The results of the systematic literature analysis depicted a wide heterogenicity in the experimental conditions and suggested the application of the OS as a way to improve athletes' or individuals' oral health, and as a potential tool to optimize marginal aspects of exercise performance.
Topics: Athletes; Exercise; Humans; Mandible; Occlusal Splints
PubMed: 34639640
DOI: 10.3390/ijerph181910338 -
Journal of Dental Anesthesia and Pain... Jun 2021This systematic review and meta-analysis aimed to analyze the effectiveness of maxillary stabilization splint (SS) therapy to reduce headache (HA) intensity and HA... (Review)
Review
Reduction of headache intensity and frequency with maxillary stabilization splint therapy in patients with temporomandibular disorders-headache comorbidity: a systematic review and meta-analysis.
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.
PubMed: 34136641
DOI: 10.17245/jdapm.2021.21.3.183 -
Annals of Palliative Medicine Jun 2021This systematic review of the literature was to compare the effects of exercise therapy and occlusal splint therapy on pain and mobility in individuals with painful... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systematic review of the literature was to compare the effects of exercise therapy and occlusal splint therapy on pain and mobility in individuals with painful temporomandibular disorders (TMD).
METHODS
PubMed, Embase and the Cochrane Central Register of Controlled Trials were searched for English publications from database root to March 1, 2020. Search terms were [("temporomandibular joint disorders" or "temporomandibular disorders" or "craniomandibular disorders" or "orofacial pain" or "myofascial pain" or "myofascial pain" or "facial pain") AND (exercise or "physical therapy modalities" or physiotherapy or "exercise therapy") AND ("splints" or "occlusal splints" or "stabilization splint" or "occlusal appliance" or "occlusal splint therapy")]. We included randomized controlled trials that evaluated the effects of therapeutic exercise therapy and occlusal splint therapy, and were published in English. Trial quality was assessed with the Physiotherapy Evidence Database scale.
RESULTS
Six studies were included (498 patients: 251 occlusal splint therapy, 247 therapeutic exercise). The results revealed that exercise therapy was not superior to occlusal splint therapy for pain reduction in patients with painful TMD (P=0.08; weighted standardized mean difference -0.29; 95% CI, -0.62 to 0.04). The effectiveness of occlusal splint therapy and exercise therapy was found to be equivalent in the maximum mouth-opening range (P=0.51; weighted standardized mean difference 0.12; 95% CI, -0.24 to 0.48), right laterotrusion (P=0.99; weighted standardized mean difference -0.00; 95% CI, -0.31 to 0.31), left laterotrusion (P=0.32; weighted standardized mean difference 0.16; 95% CI, -0.16 to 0.48), and protrusion (P=0.77; weighted standardized mean difference 0.06; 95% CI, -0.32 to 0.43) for painful TMD patients.
CONCLUSIONS
Given the limitations of the study, the small number of studies included in the sub-analysis for pain relief and the maximum mouth-opening range, and the small overall standardized mean difference for pain relief and mandibular movement observed, no high-quality evidence was found to distinguish the clinical effectiveness between occlusal splint therapy and exercise therapy for painful TMD patients. It appears that more randomized controlled trials comparing the effects of exercise therapy and occlusal splint therapy need to be implemented.
Topics: Exercise Therapy; Humans; Occlusal Splints; Pain; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 33977737
DOI: 10.21037/apm-21-451