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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 -
Journal of Dentistry May 2021Bruxism is a commonly reported oral parafunctional activity characterised by excessive tooth grinding or clenching outside normal functional activity. The present... (Review)
Review
OBJECTIVES
Bruxism is a commonly reported oral parafunctional activity characterised by excessive tooth grinding or clenching outside normal functional activity. The present systematic review aims to examine the available literature to determine the effectiveness of occlusal splints in the treatment of bruxism compared to no treatment and alternative treatment modalities.
DATA
Data extraction was undertaken in conjunction with quality of evidence assessment.
SOURCES
A literature search of the following databases was undertaken: MEDLINE via OVID, Pubmed (Medline), Cochrane Oral Health Group's Trials, The Cochrane Central Register of Controlled Trials and EMBASE.
STUDY SELECTION
Randomised Controlled Trials (RCT) and quasi-RCTs which met the inclusion criteria were selected for analysis. These included studies comparing occlusal splints to no treatment or other interventions.
RESULTS
Twenty-two studies were identified for review with fourteen meeting the inclusion criteria. Only a small number of studies were available in each comparison (one or two for some) all of which had a medium to high risk of bias.
CONCLUSIONS
There is insufficient evidence to determine whether occlusal splint therapy for the treatment of bruxism provides a benefit over no treatment, other oral appliances, TENS, behavioural or pharmacological therapy. Furthermore, there is a lack of studies in each comparison with many suffering from a high risk of bias. There is a need for further research in this area and improvement in trial quality.
CLINICAL SIGNIFICANCE STATEMENT
This systematic review aimed to determine the effectiveness of occlusal splints in the treatment of bruxism. It found there was insufficient evidence to recommend occlusal splint therapy over no treatment or other treatment modalities. This is relevant to dental clinicians who may provide such appliances and cautions them in treatment provision.
Topics: Bruxism; Humans; Occlusal Splints; Splints
PubMed: 33652054
DOI: 10.1016/j.jdent.2021.103621 -
Cranio : the Journal of... Nov 2023To evaluate current studies to establish and compare the efficacy of traditional and laser acupuncture in reducing the signs and symptoms of temporomandibular disorders...
OBJECTIVE
To evaluate current studies to establish and compare the efficacy of traditional and laser acupuncture in reducing the signs and symptoms of temporomandibular disorders (TMD).
METHODS
PubMed, Cochrane, Scopus, and Web of Science databases were searched. Clinical, controlled, and randomized trials written in English and having used traditional or laser acupuncture as therapy for TMD and RDC/TMD or DC/TMD as a diagnostic criterion for TMD were included.
RESULTS
Six studies that evaluated the intensity of pain and the level of mouth opening of the patients submitted to acupuncture were selected, and all showed improvement. However, similar results were also observed in the groups treated with occlusal splint and placebo acupuncture. Only one study evaluated laser acupuncture and showed a higher proportion of patients with remission of symptoms in the experimental group.
CONCLUSION
The traditional acupuncture seems to relieve the signs and symptoms of TMD, as well as laser acupuncture when associated with occlusal splint. However, more rigorous and high-quality clinical trials are needed.
Topics: Humans; Temporomandibular Joint Disorders; Acupuncture Therapy; Pain; Occlusal Splints; Lasers; Treatment Outcome
PubMed: 33433268
DOI: 10.1080/08869634.2021.1873605 -
Journal of Oral Rehabilitation Apr 2021Mandibular advancement devices (MADs) are used to treat patients with obstructive sleep apnoea (OSA). To date, there are no data that identify the most effective MAD... (Meta-Analysis)
Meta-Analysis Review
Effectiveness of different mandibular advancement device designs in obstructive sleep apnoea therapy: A systematic review of randomised controlled trials with meta-analysis.
Mandibular advancement devices (MADs) are used to treat patients with obstructive sleep apnoea (OSA). To date, there are no data that identify the most effective MAD design for apnoea-hypopnea index (AHI) reduction. The purpose of this systematic review is to investigate the effectiveness of different MAD designs in AHI reduction and oxygen saturation improvement in OSA patients. An electronic search was performed in MEDLINE, Cochrane Database, Scopus, Web of Knowledge and LILACS. Randomised controlled trials (RCTs) investigating the reduction of AHI on adult patients wearing MAD for OSA were included. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by the Cochrane Collaboration's tool for assessing risk of bias in randomised controlled trial. The success rate of each study was computed: [(mean baseline AHI - mean AHI after treatment)/mean baseline AHI]. Fifty RCTs were included. The risk of bias resulted with some concerns in most of the studies. The GRADE scores indicated that the quality of evidence was very low. The meta-analysis showed a success rate with mono-bloc and duo-bloc MADs respectively of 0.821 [0.722-0.887] and 0.547 [0.443-0.637]. The mono-bloc compared with duo-bloc better improved the minimum oxygen saturation (10.048 [7.733-12.363] and 3.357 [2.290-4.423], respectively). There is a very low quality body of evidence that mono-bloc MADs are more effective in reducing AHI and improving minimum oxygen saturation compared with duo-bloc MADs. The study protocol was registered on PROSPERO (n. CRD42019118084).
Topics: Adult; Humans; Mandibular Advancement; Occlusal Splints; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 32805753
DOI: 10.1111/joor.13077 -
Sleep Medicine Aug 2020The goal of this study was to review relevant randomized controlled trials in order to determine the efficacy of continuous positive airway pressure (CPAP) versus... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The goal of this study was to review relevant randomized controlled trials in order to determine the efficacy of continuous positive airway pressure (CPAP) versus mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA).
METHODS
Using appropriate keywords, we identified relevant studies using PubMed, the Cochrane Library, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through October 2019 were considered for inclusion. For each study, we used odds ratios (ORs), mean difference (MD), and 95% confidence interval (95% CI) to assess and synthesize outcomes.
RESULTS
We included 14 RCTs, for a total of 249 patients in the CPAP group and 247 in the MAD group. Compared with MAD, CPAP significantly decreased apnea hypopnea index (AHI) (WMD: -7.08, 95%CI: -9.06∼-5.10) and the percentage of stage 1 and 2 after therapy (WMD: -3.728, 95%CI: -6.912∼-0.543). However, compared with MAD, CPAP significantly decreased the SF-36-social function score (WMD: -3.381, 95%CI: -6.607∼-0.154).There was no significant difference in Epworth sleepiness scale score after therapy between the two groups.
CONCLUSION
CPAP has better therapeutic efficacy in OSA patients than MAD.
Topics: Continuous Positive Airway Pressure; Humans; Mandibular Advancement; Occlusal Splints; Randomized Controlled Trials as Topic; Sleep Apnea, Obstructive
PubMed: 32534403
DOI: 10.1016/j.sleep.2020.03.015 -
European Journal of Orthodontics Aug 2021Obstructive sleep apnoea (OSA) is a common sleep-related breathing disorder, attributed to the collapse of the pharyngeal walls and the subsequent complete or partial... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Obstructive sleep apnoea (OSA) is a common sleep-related breathing disorder, attributed to the collapse of the pharyngeal walls and the subsequent complete or partial upper airway obstruction. Among different treatment options for OSA, Continuous Positive Airway Pressure, and oral appliances (OAs) have been used, with various outcomes and side effects.
OBJECTIVE
The aim of this study was to summarize current knowledge in an evidence-based manner regarding the upper airway volume increase of OSA patients while treated with OAs.
SEARCH METHODS
Electronic search was conducted in Pubmed, Cochrane Library, and Scopus, up to May 2020.
SELECTION CRITERIA
Studies were selected after the application of predetermined eligibility criteria.
DATA COLLECTION AND ANALYSIS
Mean airway volume differences and the corresponding 95% confidence intervals were calculated, using the random effects model. Sensitivity, exploratory, and meta-regression analyses were also implemented.
RESULTS
Eleven studies filled the inclusion criteria and were included in the systematic review, while 10 of them were suitable for meta-analysis. In total, 291 patients were included, with mean upper airway volume increase of 1.95 cm3 (95% CI, 1.37-2.53; P < 0.001) with Mandibular Advancement Devices in place. In all studies, post-treatment Apnea Hypopnea Index (AHI) was either <10 events/hour or was reduced by more than 50% from baseline levels. A greater increase of the velopharynx volume was observed, regarding airway compartments.
CONCLUSIONS
Treatment with OAs in OSA may lead to a significant increase of the upper airway volume with a subsequent decrease of AHI. The velopharynx seems to be affected the most from OA therapy.
Topics: Continuous Positive Airway Pressure; Humans; Mandibular Advancement; Occlusal Splints; Pharynx; Sleep Apnea, Obstructive
PubMed: 32524148
DOI: 10.1093/ejo/cjaa035 -
Acta Odontologica Scandinavica Nov 2020This systematic review aimed to assess the efficacy of occlusal splints in the treatment of temporomandibular disorders (TMDs). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review aimed to assess the efficacy of occlusal splints in the treatment of temporomandibular disorders (TMDs).
MATERIAL AND METHODS
This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Four databases (Medline Pubmed, Web of Science, Embase and Scopus) were searched, the last search was conducted on April 2020. Randomised controlled trials (RCTs) employing the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) or Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) as diagnostic criteria and including occlusal splint as one of the experimental groups were included in the present study. The data from the included studies were extracted and assessed for risk of bias.
RESULTS
Eleven studies were included. The sample size ranged from 12 to 96 subjects. The male to female ratio was 0 to 25%. The mean length of follow-up was 4 months. Occlusal splint had a positive effect on mandibular movements in all included studies. Seven studies showed a positive effect of occlusal splint on chronic pain reduction and pain intensity, while two others showed improvement of temporomandibular joint clicking sounds and locking of the jaws. Moreover, improvements in mouth opening, depression, and anxiety symptoms, were reported in four studies.
CONCLUSIONS
An occlusal splint can be considered as a non-invasive treatment approach for patients with TMD, especially those with signs and symptoms of restriction of mandibular movement and pain. Moreover, the present findings highlighted an urgent need of a standardised consensus regarding the prognostic evaluation of TMD.
Topics: Female; Humans; Male; Mandible; Occlusal Splints; Randomized Controlled Trials as Topic; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 32421379
DOI: 10.1080/00016357.2020.1759818 -
European Journal of Pediatrics Feb 2020The aim of the present study was to perform a critical reflection about intervention options for bruxism reduction in children and adolescents. Search was conducted... (Meta-Analysis)
Meta-Analysis
The aim of the present study was to perform a critical reflection about intervention options for bruxism reduction in children and adolescents. Search was conducted based on the PICO-structured question: "What are the intervention options to reduce bruxism in children/adolescents?". No language, year, or study design restrictions were imposed. Studies reporting interventions to reduce bruxism in children (< 10) and adolescents (10 to 19 years old) were included. Reviews and letters to editors were not included. From 2723 records, 17 papers were included. Included studies were primarily randomized clinical trials performed in Brazil (35.3%) and using different criteria for the diagnosis of bruxism. Reduction in self-reported bruxism and headaches associated with bruxism were observed in studies that used medications (hydroxyzine/trazodone/flurazepam), occlusal splints, orthodontic interventions, and psychological and physical therapy interventions. Reduction in Rhythmic Masticatory Muscle Activity was observed with the use of the occlusal splint and in orthodontic interventions. Alternative treatments (medicinal extracts such as Melissa officinalis-L) have shown inconclusive results.Conclusions: Several intervention options are available to inhibit or reduce bruxism activity. The respective indication, contraindications, and side effects of each treatment option must be assessed individually and carefully, taking into account that bruxism is not considered a disorder in otherwise healthy individuals.What is known• Biological and psychological factors have been strongly correlated to the development of bruxism• Bruxism prevalence ranging from 6 to 50% in childrenWhat is new• Reduction in self-reported bruxism and headaches associated with bruxism were observed in studies that used medication (Hydroxyzine/ Trazodone/ Flurazepam), occlusal splints, orthodontic interventions, psychological, and physical therapy interventions• A reduction in Rhythmic Masticatory Muscle Activity was observed with the use of the occlusal splint and orthodontic interventions. Alternative treatments (medicinal extracts such as Melissa officinalis L) show inconclusive results in respect of the reduction in bruxism.
Topics: Adolescent; Age Factors; Child; Female; Flurazepam; Humans; Male; Occlusal Splints; Patient Satisfaction; Randomized Controlled Trials as Topic; Risk Assessment; Severity of Illness Index; Sex Factors; Sleep Bruxism; Trazodone; Treatment Outcome; United States
PubMed: 31858254
DOI: 10.1007/s00431-019-03549-8 -
Medicina Oral, Patologia Oral Y Cirugia... Jul 2019Currently it has been shown that botulinum toxin is effective for a wide variety of medical conditions, and can be applied for therapeutic purposes as cosmetic. In...
BACKGROUND
Currently it has been shown that botulinum toxin is effective for a wide variety of medical conditions, and can be applied for therapeutic purposes as cosmetic. In recent years, there has been a growing trend in the use of this drug substance to control the muscular overactivity of bruxism. The objective of this study was the use of botulinum toxin type A (BTX-A) than traditional methods, by conducting a systematic review of randomized clinical trials (RCTs) published in the health sciences literature.
MATERIAL AND METHODS
An electronic search was made in the databases of the PubMed, Cochrane Library and Scopus data between March and October 2017, ECA, which will analyze the effect of botulinum toxin in the treatment of bruxism. We included studies of bruxist patients older than 18 years where BTX-A tests were performed on the masseter and / or temporal muscles and the control systems were injections of placebo (saline) or the use of traditional methods for the treatment of bruxism. such as occlusal splints, other medications or cognitive-behavioral therapy.
RESULTS
Of the 68 studies identified, 4 RCTs that fit our inclusion criteria were selected. These studies show that BTX-A injections can reduce the frequency of bruxism episodes, decrease pain levels and maximum occlusal force generated by this pathology, offer superior efficacy in the treatment of bruxism compared to control groups who were treated with placebo or with traditional methods for the treatment of bruxism.
CONCLUSION
Infiltrations with BTX-A are a safe and effective treatment for patients with bruxism, so its use is justified in daily clinical practice, especially in patients diagnosed with severe bruxism.
Topics: Botulinum Toxins, Type A; Bruxism; Humans; Injections, Intramuscular; Masseter Muscle; Neuromuscular Agents
PubMed: 31246937
DOI: 10.4317/medoral.22923 -
International Orthodontics Mar 2019This systematic review aimed to clarify whether there are any significant long-term sequelae to wearing mandibular advancement devices focusing on dental and skeletal... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This systematic review aimed to clarify whether there are any significant long-term sequelae to wearing mandibular advancement devices focusing on dental and skeletal effects in adults with OSA.
MATERIALS AND METHODS
Databases, including PubMed, Medline, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and SAGE Journals. Hand searches and grey literature were also used. A piloted data collection form was used to extract the appropriate data.
RESULTS
Twenty-three reports of 19 studies were included. Five had serious risk of bias while 18 had moderate risk of bias. Meta-analysis revealed a significant change in overbite and overjet. I-squared analysis showed a high level of statistical heterogeneity. A moderate correlation was found between wear time and amount of change.
CONCLUSION
Mandibular advancement devices will cause a small but statistically significant change in the dentition of long-term wearers. Skeletal changes are generally secondary to dental changes.
Topics: Adult; Databases, Factual; Humans; Mandibular Advancement; Occlusal Splints; Overbite; Sleep Apnea, Obstructive
PubMed: 30770329
DOI: 10.1016/j.ortho.2019.01.004