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Acta Medica Croatica : Casopis... Mar 2015Stabilization splint is the treatment of choice for pain control in temporomandibular disorder (TMD) patients, even though its mechanism of action is still unknown. The... (Review)
Review
Stabilization splint is the treatment of choice for pain control in temporomandibular disorder (TMD) patients, even though its mechanism of action is still unknown. The aim of this systematic review is to provide a critical overview of the effectiveness of stabilization splint therapy on the basis of currently available literature data. The available Medline database was searched and 24 studies published since the 1995s have been consequently included in this review. The selection criteria were randomized controlled trials and clinical trials comparing splint therapy to either no treatment or another active treatment (physiotherapy, relaxation and drugs). Studies were grouped according to treatment type. Based on the currently best evidence available, it appears that stabilization splint has similar efficacy in controlling TMD symptoms as other active treatments (physiotherapy, relaxation and drugs). Stabilization splint therapy may be beneficial in reducing pain at rest and on palpation when compared with non-occluding splint. During a short period, education was slightly more effective than occlusal splint in treating spontaneous muscle pain. These two treatments did not have significantly different effects on pain-free mouth opening and pain during chewing. This review has shown evidence that most TMD patients are helped by incorporation of a stabilization splint. There is not enough data on the long-term efficacy and effectiveness of this widely used therapeutic tool. In the future, there is a need for well-conducted randomized controlled trials paying attention to adequate sample size, blind outcome assessment, duration of follow up, and using standardized methods for measuring treatment outcomes.
Topics: Facial Pain; Humans; Occlusal Splints; Pain Management; Physical Therapy Modalities; Splints; Temporomandibular Joint Dysfunction Syndrome; Treatment Outcome
PubMed: 26606783
DOI: No ID Found -
International Journal of Oral and... Feb 2015Idiopathic condylar resorption (ICR) is progressive resorption of the condyle of unknown aetiology. There is no consensus on the approaches for diagnostic imaging and... (Review)
Review
Idiopathic condylar resorption (ICR) is progressive resorption of the condyle of unknown aetiology. There is no consensus on the approaches for diagnostic imaging and management of this disease. The objective of this systematic review was to examine the best practices for imaging and to appraise the success of surgical and non-surgical therapy of ICR. Eleven search engines were queried via explicit literature searches for studies describing ICR, published until 2012. Two authors independently extracted data using predetermined characteristics. Studies that identified patients as having either ICR or progressive condylar resorption and that described the radiographic findings or treatment options were included. Seventeen studies contributing 178 cases met the eligibility criteria. The major radiographic findings, as assessed mostly by two-dimensional imaging, included decreased ramus height, decreased condylar height, altered volume of the condyle, decreased SNB angle and mandibular plane angle, and a retrognathic profile. Treatments included occlusal splints with orthodontic treatment, condylectomy with costochondral graft, and other surgical approaches. This systematic review was limited by the lack of meta-analysis. Nevertheless, we identified the need for future investigations: characterization of findings on three-dimensional imaging and its contribution to treatment planning, outcomes of non-surgical and pharmacological management of ICR, and randomized trials and comparative studies with longer follow-up periods.
Topics: Bone Resorption; Diagnostic Imaging; Humans; Mandibular Condyle
PubMed: 25270187
DOI: 10.1016/j.ijom.2014.09.005 -
Journal of Oral & Facial Pain and... 2014To carry out a systematic review and meta-analysis comparing the effects of occlusal splint therapy ("usual treatment") and psychosocial interventions for the treatment... (Meta-Analysis)
Meta-Analysis Review
AIMS
To carry out a systematic review and meta-analysis comparing the effects of occlusal splint therapy ("usual treatment") and psychosocial interventions for the treatment of myofascial temporomandibular disorder (TMD) pain in adult patients.
METHODS
Independent screening and evaluation of randomized clinical trials included comparisons between "usual treatment" based on splint therapy and psychosocial interventions for TMD treatment within electronic databases (PubMed/MEDLINE, CENTRAL, EMBASE), ongoing trials databases (Current Controlled Trials, ClinicalTrials.gov), and additional sources. The outcomes selected for the systematic review were self-reported pain, pain interference, unassisted jaw opening without pain, muscle pain upon palpation, depression, and somatization. The effect measures were analyzed using a random-effect model (Review Manager computer program).
RESULTS
The outcomes "longterm self-reported pain" and "long-term depression" were significantly different for the comparisons of "usual treatment" and psychosocial interventions, and they favored the latter (P < .005 and P < .05, respectively). These results must be viewed with caution due to the limited number of studies available. A tendency toward greater improvements of psychological outcomes was observed for psychosocial interventions, while physical functioning was slightly more responsive to "usual treatment."
CONCLUSION
No evidence was found to distinguish the clinical effectiveness between "usual treatment" and psychosocial interventions for myofascial TMD pain. Future studies of TMD and related subdiagnoses should be reported according to core standardized outcomes to facilitate comparisons.
Topics: Depression; Humans; Occlusal Splints; Pain Measurement; Psychotherapy; Randomized Controlled Trials as Topic; Range of Motion, Articular; Somatoform Disorders; Temporomandibular Joint Dysfunction Syndrome; Treatment Outcome
PubMed: 25068215
DOI: 10.11607/ofph.1241 -
The International Journal of... 2014Despite the documented excellent clinical performance of dental implants, concerns linger regarding the best way to protect the restored dentition in patients with... (Review)
Review
Despite the documented excellent clinical performance of dental implants, concerns linger regarding the best way to protect the restored dentition in patients with bruxism. This is because of the risk of occlusal overload that is reported to cause biological and biomechanical failures in the implant-prosthesis system. To better distribute occlusal loads to the rigid components of the prosthesis and to the interface between bone and implant during parafunctional movements, several dentists prescribe acrylic resin occlusal splints for nocturnal use by patients considered at risk. However, it is unclear whether this recommendation is based on scientific evidence or expert clinical opinion. This report reflects our effort to employ the systematic review protocol to assess whether there is scientific evidence to recommend an occlusal splint in bruxers after implant therapy.
Topics: Bruxism; Dental Implants; Dental Prosthesis, Implant-Supported; Evidence-Based Dentistry; Humans; Occlusal Splints; Prescriptions
PubMed: 24905259
DOI: 10.11607/ijp.3883 -
Cranio : the Journal of... Jul 2013The aim of this study was to evaluate the efficacy of self-care combined with anti-inflammatory medications in the treatment of temporomandibular joint (TMJ) pain... (Review)
Review
The aim of this study was to evaluate the efficacy of self-care combined with anti-inflammatory medications in the treatment of temporomandibular joint (TMJ) pain associated with disc displacement without reduction (DDWOR). A systematic review of randomized clinical trials was done by the authors. The databases searched were Medline (1966 to July 2012); EMBASE (1980 to July 2012); and LILACS (from 1982 to July 2012). The review authors independently assessed trials for eligibility and methodological quality and also extracted all data. The data was double-checked for accuracy. There was no language restriction in the searches of EMBASE, PubMed, and LILACS databases, or in the manual search. The risk of bias and the heterogeneity of the studies taken into consideration were assessed. Two studies, randomizing 175 patients, were included in this review. The first study (n = 106) compared the following interventions: medical treatment, rehabilitation, arthroscopic surgery with postoperative rehabilitation, or arthroplastic surgery with post-operative rehabilitation. The second study (n = 69) compared the use of nonsteroidal anti-inflammatory medications and self-care instructions, nonsteroidal anti-inflammatory medications, occlusal splint, and mobilization therapy. The third group received no treatment; patients were only informed of their prognosis. There is no sufficient evidence regarding efficacy and safety of the palliative treatments associated with anti-inflammatory versus other treatments, or absence of treatment on pain reduction in patients with TMJ DDWOR.
Topics: Anti-Inflammatory Agents; Humans; Joint Dislocations; Palliative Care; Randomized Controlled Trials as Topic; Self Care; Temporomandibular Joint Disc; Temporomandibular Joint Disorders
PubMed: 23971162
DOI: 10.1179/crn.2013.032 -
Journal of Orofacial Pain 2013To assess, by systematic review of the literature, (1) the prevalence and incidence of temporomandibular disorder (TMD) pain after whiplash trauma, and (2) whether... (Review)
Review
AIMS
To assess, by systematic review of the literature, (1) the prevalence and incidence of temporomandibular disorder (TMD) pain after whiplash trauma, and (2) whether treatment modalities commonly used for TMD are equally effective in patients with solely TMD pain and those with TMD/whiplash-associated disorders (WAD) pain.
METHODS
A systematic literature search of the PubMed, Cochrane Library, and Bandolier databases was conducted from January 1966 through October 2012. The systematic search identified 125 articles. After an initial screening of abstracts, 45 articles were reviewed in full text. Two investigators evaluated the methodological quality of each identified study.
RESULTS
Eight studies on prevalence/incidence of TMD pain in WAD and four studies on interventions in TMD pain and WAD met the inclusion criteria. The reported median prevalence of TMD pain after whiplash trauma was 23% (range 2.4% to 52%) and the incidence ranged from 4% to 34%. For healthy controls, the reported median prevalence was 3% (range 2.5% to 8%) and the incidence ranged from 4.7% to 7%. For patients with a combination of TMD pain and WAD, treatment modalities conventionally used for TMD, such as jaw exercises and occlusal splints, had less of an effect (median improvement rate of 48%, range 13% to 68%) compared to TMD patients without a whiplash injury (75%, range 51% to 91%).
CONCLUSION
There is some evidence that prevalence and incidence of TMD pain is increased after whiplash trauma. The poorer treatment outcome suggests that TMD pain after whiplash trauma has a different pathophysiology compared to TMD pain localized to the facial region.
Topics: Adult; Arthralgia; Exercise Therapy; Facial Pain; Humans; Incidence; Occlusal Splints; Prevalence; Temporomandibular Joint Disorders; Treatment Outcome; Whiplash Injuries; Young Adult
PubMed: 23882454
DOI: 10.11607/jop.1027 -
Journal of Oral Rehabilitation Sep 2013An extensive search for randomised controlled clinical trials was accomplished to compare dental prostheses and occlusal splints constructed with or without face-bow... (Review)
Review
An extensive search for randomised controlled clinical trials was accomplished to compare dental prostheses and occlusal splints constructed with or without face-bow transfer, and question whether face-bow transfer may present better clinical results than simpler approaches. Studies were identified by searching electronic databases (PubMed/MEDLINE, Latin American and Caribbean Literature on the Health Science, and Brazilian Bibliography of Dentistry). The keywords 'dental articulator', 'semi-adjustable articulator', 'face-bow', 'jaw relation record' and 'occlusal splint therapy' were used. The minimum inclusion requirements were (i) randomised controlled trials with patients of any age, (ii) comparison between dental prostheses or occlusal splints constructed with or without face-bow transfer and (iii) assessment of clinician's time, number of occlusal contacts, patient satisfaction or masticatory function. The search resulted in the identification of 8779 articles. Subsequently, 8763 articles were excluded on the basis of title and abstract. By the end of the search phase, eight randomised controlled trials were considered eligible. Current scientific evidence suggests that face-bow transfer is not imperative to achieve better clinical results in prosthodontics. Randomised clinical trials suggest that simpler approaches for the construction of complete dentures and occlusal splints may present acceptable results, while no clinical study has investigated its use in fixed and removable partial dentures.
Topics: Aged; Aged, 80 and over; Dental Prosthesis; Humans; Middle Aged; Occlusal Splints; Prosthodontics; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 23829310
DOI: 10.1111/joor.12081 -
Sleep & Breathing = Schlaf & Atmung May 2014The aim of this systematic review was to evaluate the efficacy of any biofeedback treatment on sleep bruxism. (Review)
Review
PURPOSE
The aim of this systematic review was to evaluate the efficacy of any biofeedback treatment on sleep bruxism.
METHODS
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, ISI Web of Science, System for Information on Grey Literature in Europe, Chinese Biomedical Literature Database, and PsycINFO up to October 2012 for randomized controlled trials and controlled clinical trials involving biofeedback treatment for sleep bruxism. Reference lists of relevant studies were hand searched. Quality assessment and data extraction were performed by two reviewers independently.
RESULTS
Seven eligible studies involving 240 participants were finally included. Three of them had moderate risk of bias, and four had high risk of bias. In an electromyographic-measured sleep bruxism episode, meta-analysis showed no significant difference between contingent electrical stimulation and blank control (95% confidence interval = -12.33, 3.38, P = 0.26). Moreover, five studies reported electromyographic activity index. Due to the diversity of biofeedback modalities (auditory, electrical, and visual stimulus) and controls (splint, occlusal adjustment, etc.), these data were unable to be pooled, so only qualitative description was provided.
CONCLUSIONS
In the current stage, there is no powerful evidence to support the use of biofeedback technology on sleep bruxism treatment. Contingent electrical stimulation which is defined as a kind of biofeedback modality shows no effect on reducing sleep bruxism episode compared with the no-treatment group. Although many studies support the efficacy of biofeedback treatment, more large sample-sized randomized controlled trials which adopt uniform outcome index are necessitated to verify its application.
Topics: Controlled Clinical Trials as Topic; Humans; Neurofeedback; Sleep Bruxism; Treatment Outcome
PubMed: 23756884
DOI: 10.1007/s11325-013-0871-y -
Sleep & Breathing = Schlaf & Atmung Sep 2013The aim of this study was to review studies using cone beam computed tomography (CBCT) to assess dimensional changes in the upper airway after appliance or surgical... (Review)
Review
PURPOSE
The aim of this study was to review studies using cone beam computed tomography (CBCT) to assess dimensional changes in the upper airway after appliance or surgical therapy in subjects with obstructive sleep apnoea and to correlate CBCT findings with treatment outcome.
METHOD
Several electronic databases were searched. Studies that met selection criteria were evaluated using a customized evaluation tool.
RESULTS
Study parameters were met in seven articles. Fifty adults were assessed using CBCT 1.6-10 months after appliance therapy or maxillary mandibular advancement surgery with or without genial tubercle advancement. Airway parameters measured were linear, cross-sectional (CS) area, volume or airway function. In only two validated surgical case reports, airway volume increased by 6.5-9.7 cm(3) (>80 %) and minimum CS area by 0.1-1.2 cm(2) (21 and 269 %).
CONCLUSION
The available published studies show evidence of CBCT measured anatomic airway changes with surgery and dental appliance treatment for OSA. There is insufficient literature pertaining to the use of CBCT to assess treatment outcomes to reach a conclusion. High-quality evidence level studies, with statistically appropriate sample sizes and cross validated clinically, are needed to determine if CBCT airway dimensional changes are suitable for assessment of treatment outcome.
Topics: Adult; Airway Resistance; Cone-Beam Computed Tomography; Follow-Up Studies; Humans; Mandibular Advancement; Maxilla; Occlusal Splints; Radiographic Image Interpretation, Computer-Assisted; Sleep Apnea, Obstructive; Statistics as Topic; Treatment Outcome
PubMed: 23344828
DOI: 10.1007/s11325-012-0799-7 -
Journal of Oral Rehabilitation Feb 2013To describe the scientific literature about the diagnosis, prevalence, aetiology, natural course and possible treatment modalities of disc displacements within the... (Review)
Review
To describe the scientific literature about the diagnosis, prevalence, aetiology, natural course and possible treatment modalities of disc displacements within the temporomandibular (TM) joint. PubMed was searched for specific indexing terms. The search yielded 1211 papers. After screening according to title and abstract, 695 papers were excluded, and after full-text reading, 107 papers remained. Hand-searching of the reference lists resulted in an extra 47 papers. Thirteen studies, published since the literature search was carried out, were also included, resulting in 167 papers for this review. A disc displacement is a highly prevalent derangement within the TM joint, with reported prevalence ranging from 18% to 35% in the general population. A disc displacement with reduction is mostly a stable, pain-free and lifelong condition of the joint. In only a small minority of patients, the disc loses its capacity to reduce on opening. Surprisingly, only in rare cases, the loss of disc reduction is accompanied by signs and symptoms of a closed lock (viz. a painful and limited mouth opening). These signs and symptoms have a tendency to reduce and in many cases to resolve within months. The favourable natural course of disc displacements only warrants active treatment for symptomatic disc displacements without reduction. The primary treatment option is a conservative, non-surgical treatment focusing at speeding up the natural process of alleviation of pain and of improvement in mouth opening. For most patients, a disc displacement is just a pain-free, lifelong lasting, 'noisy annoyance' from their TM joint.
Topics: Facial Pain; Humans; Joint Dislocations; Magnetic Resonance Imaging; Occlusal Splints; Palliative Care; Range of Motion, Articular; Sound; Temporomandibular Joint Disc; Temporomandibular Joint Disorders
PubMed: 23199296
DOI: 10.1111/joor.12016