From: Efficiency of occlusal splint therapy on orofacial muscle pain reduction: a systematic review
Reference | First author | Publication year | Study population | Mean age | Sex | Total sample size | Diagnostic criteria | TMD qualification | Groups | Types of intervention including types of occlusal appliance |
---|---|---|---|---|---|---|---|---|---|---|
14 | Ficnar T | 2013 | 63 | 34,66 | 79,4% women, 20,6% men | 63 | RDC/TMD | Ia/Ib myofascial pain | Group 1 (CO)—conservative therapy Group 2 (SS)—conservative therapy and a laboratory-made stabilization splint Group 3 (SB)—conservative therapy and the SOLUBrux splint | Stabilization splint, SOLUBrux splint |
8 | Costa D | 2021 | Â | 31,4 | 80% women, 20% men | 70 | RDC/TMD | Ia/ib Myofascial TMD | Group 1 (G1) only conventional therapy with OS; Group 2 (G2) treatment with OS and therapy with LED (device turned off) Group 3 (G3) LED therapy (infrared) Group 4 (G4) LED therapy (infrared) Group 5 (G5) OS associated with LED (infrared) therapy; Group 6 (G6) OS therapy plus infrared LED | Stabilizing plates, used during sleep for 4Â weeks |
15 | Conti P | 2012 | Â | I 38,09, 1135,25 III38,14 | I women 80,9%, II women 87,5%, III 100% women | 51 | RDC/TMD | Myofascial | Group I stabilization occlusal splint and counseling Group II anterior device nociceptive trigeminal inhibitory (NTI) system, counseling Group III only counseling (the control group) | Full coverage acrylic stabilization occlusal splint, anterior device nociceptive trigeminal inhibitory (NTI) |
16 | Grillo C | 2014 |  | 18–45 | Women using contraceptives | 40 | RDC/TMD | Myogenic dysfunction | Group 1—acupuncture group Group 2—splint group | Flat occlusal plane appliance (control 1 session per week, final evaluation after 4 weeks) |
17 | Oz. S | 2010 |  | 32,84 | 34 women, 6 men | 40 | RDC/TMD | Myofascial | Group 1—study group; low-level laser Group 2—control group; occlusal splints | Stabilization occlusal splint described by Okeson wearing 24 h/d for 3 months |
18 | Giannakopoulos | 2018 | 45 | 18–45 | Female | 45 | RDC/TMD | Myofascial | A. sensorimotor training B. occlusal splint | Conventional Michigan splint, use during sleep only |
19 | Manfredini D | 2017 | 30 patients | 35,3 + -9.4 | Female | 30 | DC/TMD | Myofascial pain | LST (laser therapy), OA (oral appliance therapy), CSL (counseling) | Flat occlusal appliance covering the maxillary teeth at night for 3 weeks and then intermittent use for the following two months |
20 | Keskinruzgar A | 2018 | 34 patients with sleep bruxism | Kinesio group 27.38 + -9.05. 26.11 +—8.71 | Mixed | 34 | Pressure pain threshold for masseter and temporal muscle, mouth opening, VAS | Tenderness on palpation, teeth abrasions, teeth grinding reported by bedtime friend hypertrophy of masseter muscle | Kinesio taping group—16 occlusal splint—18 | Occlusal appliance made according to Okeson models. 0,5 mm thick thermoplastic hard splint |
21 | HAsanoglu Erbasar | 2017 | 40 patients with myofascial pain |  | Mixed |  | RDC/TMD | RDC/TMD group I | Group 1—guidance, counseling, assurance, behavioral changes advice, Group 2—NTI-tss device | NTI-tss device |
22 | Vicente-Barrero M | 2012 | 20 patients | 18–58 | 17 females, 3 males | 20 | Sensitivity to pressure on area: preauricular, masseter muscle, temporal muscle, trapezius | Muscle pain during palpation | 1. acupuncture group 2. occlusal splint group | Decompression splints with canine guidance |
23 | Claudia Maria de Felicio | 2014 | 40 | 13–68 | Female | 22 | RDC/TMD, Helkimo index | Myofascial | T group—OMT OS group—occlusal splint, SC—symptomatic control group with TMDs AS—asymptomatic control group | Occlusal splint Michigan type |
24 | Robert van Grootel | 2017 | 72 patients | 1 group 31,4 2 group 29,0 | 1 group- 95% female; 2 group 91% female | 72 | RDC/TMD | Group Ia and Ib | 1 group—physiotherapy, 2 group—splint therapy | Michigan splint |
25 | Michelotti A | 2012 | 44 patients | 2 group 31,4 1 group- 31,1 | Mixed | 41 | RDC/TMD | Ia group or Ib group | 1. Occlusal splint group 2. Control—information about TMDs and self-care measures | Michigan splint (only during sleep) |
Reference | Types of comparator | Blinding | Allocation sequence | Follow-up | Losses to follow-up | Primary outcome | Secondary outcome | Results | Conclusion |
---|---|---|---|---|---|---|---|---|---|
14 | Conservative therapy | Not described | Via randomization | 3Â months | 2 Patients from CO, 3 patients from SS | Pressure-sensitive areas upon muscle palpation | Extent of vertical movement (incisal edge distance in mm) | Not established significant differences regarding pain reduction (muscular/joint pain) and mouth opening between the various therapeutic approaches; TMDs should initially be treated with conservative therapy consisting of self-exercises, as well as drug-based and manual treatment | In the SS and SB groups, a statistically significant improvement in mouth opening, especially in the case of the initial limitation of this range |
8 | LED therapy | Only the irradiation was hidden | Randomized | 4 weeks of treatment, last evaluation 30 days after finishing treatment | 11 | Pain intensity (VAS) | Muscle activity (electromyography) Blood lactate level | Pain intensity significantly decreased both post-therapy and 30 days post-treatment | The combination of LED therapy and occlusal splint achieves superior results compared to isolated treatments, and the protocol of two sessions per week proved to be better |
15 | Counseling | No information | Via randomization | 2Â weeks, 6Â weeks, 3Â months | 12 | Pain intensity, pressure pain threshold (PPT) of the masticatory muscles | Patients who halved their VAS (visual analog scale) | All of the management strategies used in the present study provided a significant improvement in the pain levels of myofascial pain when judged by the VAS | The simultaneous use of occlusal devices appears to produce an earlier improvement high percentage of patients responsive to the treatment in groups I and II, which include those who had decreased their VAS Values by at least 50% (28), highlighting the importance of the occlusal splint in the management of myogenic pain |
16 | Acupuncture (traditional Chinese medicine) 4 sessions (one per week, 20 min duration) | No information | Via randomization | 4 weeks | 4 | Pain intensity—VAS, pain pressure threshold (PPT) | Range of mouth opening (RMO), electromyographic activity | Reduction in pain in each group. Increase in RMO in both groups | Both strategies can be used equally for control of chronic pain related to TMDs |
17 | Low-level laser therapy (applied 2 times per week- 10 sessions) | Double blind | Randomly divided | 90 days | No information | Self-report pain—VAS. Pressure pain threshold | Mandibular movement | Both groups—statistically significant improvement in vertical movements after treatment In both groups, tenderness to muscle palpation and PPT evaluations decreased significantly | Low-level laser therapy is effective like occlusal splining pain release and mandibular improvement in myofascial pain |
18 | Device-supported sensorimotor training (a prefabricated device with liquid-filled elastic pads) | No information | Via randomization | 6 weeks, 12 weeks | 3 patients from group A | Pain intensity (current, average, worst pain) NRS, characteristic pain intensity (CPI) | EMG activity, bite—force (bite force device) | Significant pain reduction in both groups EMG activity was not significantly different in both groups after treatment | Device-supported training could be a cost-effective alternative (or additional) treatment for myofascial functional pain TMD patients |
19 | Laser therapy, counseling | TMD practitioner who assessed outcome variables was blinded to patient groups assignment | Randomized | 6Â months | 1 | Visual analog scale (VAS) pain levels | Muscular index (MI) of the Craniomandibular Index | After 3Â weeks VAS values decreased significantly only in the LST group After six months for VAS values, positive changes were still shown for LST and were also shown for the appliance therapy and CSL groups | All three treatment groups improved at six months. The difference in the short-term effectiveness of LST and OA, with respect to CSL alone, may suggest that active treatments should be directed to maximize the positive changes in the short-term period |
20 | Occlusal appliance, Kinesio taping | Not described | Â | 5Â weeks | Â | Significantly lower VAS scores in both splint group and Kinesio taping group | Significantly increased mouth opening in both groups | Significant decrease in VAS values, increase in muscle pain threshold in masseter and temporal muscles in both groups | Kinesio taping is easy and reliable treatment, which can be applied to patients with bruxism |
21 | Guidance, counseling, assurance, behavioral changes | Evaluation and data collection were performed by another clinician who was unaware of patient group | Randomized |  |  | Pain reduction VAS | Jaw function | Reduction in pain with time was observed; no significant difference regarding pain reduction was noted between the groups. Jaw function gradually improved in both groups, no significant difference between the groups (P = 0,927) | Integration of NTI-tss device into protocol of counseling, guidance, and assurance did not provide any additional benefit for patients |
22 | Acupuncture therapy | Â | Â | 5Â weeks | 0 | VAS, pain upon palpation of masticatory muscles | Measurements of mouth opening and jaw lateral deviation | Both groups of patients showed reduction in myofascial pain in the short term | Acupuncture is an effective complement and/or an acceptable alternative to decompression splints in the treatment of myofascial pain and temporomandibular joint pain dysfunction syndrome |
23 | Orofacial Myofunctional Therapy | No blinding | GraphPad software | 120Â days | Â | Helkimo index | Questionnaire about the severity of their signs and symptoms | Group treated with OMT had significantly lower pain after treatment in comparison with SC (symptomatic control group), splint therapy group also revealed significant improvement, with some advantages for orofacial myofunctional therapy group | OMT has positive effects on patients with TMDs such as reduction in pain sensitivity on palpation of all muscles of the stomatognathic system |
24 | Physiotherapy | Blinded assessor after treatment |  | After 6 months and again after 6 more months |  | Clinical examination—pain intensity during jaw movements, palpation of jaw muscles and during clenching | Anamnestic questionnaire | Success rate for physiotherapy was similar to that of splint therapy in short term and long term. The duration of physiotherapy is on average 10.4 weeks shorter than that of splint therapy, so it might be the first step for patients without severe active sleep bruxism or psychological problems | Physiotherapy and splint therapy have similar success rates and effectiveness |
25 | Group with only information about TMD |  | Randomized | 3 months | 3 | VAS scores for spontaneous muscle pain | Pain-free maximal mouth opening, headache, pain during chewing | Changes in spontaneous muscle pain differed significantly between the groups. Changes did not differ significantly between groups pain-free maximal mouth opening (P = .528; effect size = 0.20); headache and pain on chewing (P ≥ .550, effect size ≤ 0.10) | During short period of time, education was slightly more effective than an occlusal splint in treating spontaneous muscle pain |