For patients with temporomandibular disorders stablisation splint did not provide additional pain relief over counselling and muscle exercises alone in short term

splint

The 2003 Cochrane review by Al-Ani et al found no evidence for or against the use of stablisation splints for the treatment of temporomandibular disorders (TMD). While a subsequent review by Fricton et al in 2010 found modest evidence for effectiveness of hard stabilization splints.  The implications from both reviews are that more robust randomised controlled trial evidence is needed to provide definitive answers for this common clinical problem. The aim of this trial was to examine the short-term efficacy of the stablisation splint treatment on TMD-related facial pain and mandibular mobility.

Patients age 20 and above with clinically diagnosed TMD as defined by research diagnostic criteria for TMD (RDC ⁄ TMD) with no systemic diseases that could affect the masticatory muscles (e.g. rheumatoid arthritis) were randomised to splint  (n=39) or control (n=41)groups. The splint group received stablisation splint, counselling and masticatory muscle exercises while the control only received counseling and exercises.  Outcomes were facial pain intensity measured on visual analogue scale (VAS) and clinical findings for TMD which were measured at baseline and after 1-month follow-up.

  • Four patients in the control group were lost to follow up
  • Facial pain decreased and most of the clinical TMD findings resolved in both of the groups.
  • The differences in changes in VAS or clinical TMD findings between the groups were not statistically significant.

The authors concluded

The findings of this study did not show that stablisation splint treatment in combination with counselling and masticatory muscle exercises has additional benefit in relieving facial pain and increasing the mobility of the mandible than counselling and masticatory muscle exercises alone in a short time-interval.

Links

Niemelä K, Korpela M, Raustia A, Ylöstalo P, Sipilä K. Efficacy of stabilisation splint treatment on temporomandibular disorders. J Oral Rehabil.2012 Jul 19. doi: 10.1111/j.1365-2842.2012.02335.x. [Epub ahead of print] PubMed PMID: 22809314.

Al-Ani MZ, Davies SJ, Gray RJM, Sloan P, Glenny AM. Stabilisation splint therapy for temporomandibular pain dysfunction syndrome. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD002778. DOI: 10.1002/14651858.CD002778.pub2.

Fricton J, Look JO, Wright E, Alencar FG Jr, Chen H, Lang M, Ouyang W, Velly AM. Systematic review and meta-analysis of randomized controlled trials evaluating intraoral orthopedic appliances for temporomandibular disorders. JOrofac Pain. 2010 Summer;24(3):237-54. Review. PubMed PMID: 20664825.

ADA-EBD Critical summary of  Fricton et al

 

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