Efficacy of initial conservative treatment options for temporomandibular disorders: A network meta-analysis of randomized clinical trials

IF 3.2 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE Journal of prosthodontic research Pub Date : 2024-09-13 DOI:10.2186/jpr.jpr_d_23_00273

Yoshihiro Yamaguchi, Kazuhiro Ooi, Hidemichi Yuasa, Akira Nishiyama, Yoshizo Matsuka, Takahiro Abe, Shinpei Matsuda, Yuki Watanabe, Yoshitaka Suzuki, Miki Kashiwagi, Azuma Kosai, Kenichi Sugai, Keika Hoshi, Yasuhiro Ono, Toshihiro Fukazawa, Hidehisa Matsumura, Yuko Fujihara, Hiroyuki Ishiyama

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Abstract

Purpose: This network meta-analysis (NMA) of randomized controlled trials (RCTs) aimed to identify effective initial conservative treatment strategies for patients with temporomandibular joint disorders (TMD).

Study selection: RCTs comparing treatment options for TMD published between January 2000 and July 2021 were retrieved from the databases of PubMed and Embase via a comprehensive electronic search. Patients diagnosed with myalgia (muscle pain) or arthralgia (joint pain) according to pain-related Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were eligible for inclusion. Twelve treatment options and a placebo were included in the mutual comparisons. The risk of bias was assessed using Risk of Bias 2.0. Forest plots of direct comparisons between individual studies were created using MetaInsight. NMA was performed using R statistical software (netmeta).

Results: Twenty-four RCTs involving 1336 patients assessing pain and 12 RCTs involving 614 patients assessing maximal mouth opening were identified. Low-level laser therapy (standard mean difference [SMD]: -2.12, 95% confidence interval [CI]: -3.18, -1.06), self-exercise (SMD: -1.51, 95% CI: -2.82, -0.2), and stabilization splints (SMD: -1.16, 95% CI: -2.02, -0.29) were effective in improving pain; however, the certainty of evidence was very low. Self-exercise (SMD: 0.71, 95% CI: -0.58, 2.01), stabilization splints (SMD: 0.65, 95% CI: -0.09, 1.39), and low-level laser therapy (SMD: 0.63, 95% CI: -0.34, 1.6) were effective in improving maximal mouth opening; however, the certainty of evidence was very low.

Conclusions: Stabilization splints, self-exercise, and low-level laser therapy may be effective in the initial treatment of TMD.

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颞下颌关节紊乱症初期保守治疗方案的疗效：随机临床试验网络荟萃分析

目的：这项随机对照试验（RCT）网络荟萃分析（NMA）旨在确定颞下颌关节紊乱症（TMD）患者有效的初始保守治疗策略：通过全面的电子检索，从 PubMed 和 Embase 数据库中检索了 2000 年 1 月至 2021 年 7 月间发表的比较 TMD 治疗方案的 RCT。根据疼痛相关的颞下颌关节紊乱诊断标准（DC/TMD）和颞下颌关节紊乱研究诊断标准（RDC/TMD）诊断为肌痛（肌肉痛）或关节痛（关节痛）的患者均符合纳入条件。相互比较中包括 12 种治疗方案和一种安慰剂。偏倚风险采用 Risk of Bias 2.0 进行评估。使用 MetaInsight 绘制了单项研究间直接比较的森林图。使用 R 统计软件（netmeta）进行 NMA：结果：共确定了 24 项研究，涉及 1336 名患者的疼痛评估，以及 12 项研究，涉及 614 名患者的最大张口度评估。低强度激光疗法（标准平均差 [SMD]：-2.12，95% 置信区间 [CI]：-3.18，-1.06）、自我锻炼（SMD：-1.51，95% 置信区间 [CI]：-2.82，-0.2）和稳定夹板（SMD：-1.16，95% 置信区间 [CI]：-2.02，-0.29）可有效改善疼痛；但证据的确定性很低。自我锻炼（SMD：0.71，95% CI：-0.58，2.01）、稳定夹板（SMD：0.65，95% CI：-0.09，1.39）和低水平激光疗法（SMD：0.63，95% CI：-0.34，1.6）对改善最大张口有效，但证据的确定性非常低：结论：稳定夹板、自我锻炼和低强度激光疗法可能对 TMD 的初期治疗有效。

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来源期刊

Journal of prosthodontic research DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

6.90

自引率

11.10%

发文量

161

期刊介绍： Journal of Prosthodontic Research is published 4 times annually, in January, April, July, and October, under supervision by the Editorial Board of Japan Prosthodontic Society, which selects all materials submitted for publication. Journal of Prosthodontic Research originated as an official journal of Japan Prosthodontic Society. It has recently developed a long-range plan to become the most prestigious Asian journal of dental research regarding all aspects of oral and occlusal rehabilitation, fixed/removable prosthodontics, oral implantology and applied oral biology and physiology. The Journal will cover all diagnostic and clinical management aspects necessary to reestablish subjective and objective harmonious oral aesthetics and function. The most-targeted topics: 1) Clinical Epidemiology and Prosthodontics 2) Fixed/Removable Prosthodontics 3) Oral Implantology 4) Prosthodontics-Related Biosciences (Regenerative Medicine, Bone Biology, Mechanobiology, Microbiology/Immunology) 5) Oral Physiology and Biomechanics (Masticating and Swallowing Function, Parafunction, e.g., bruxism) 6) Orofacial Pain and Temporomandibular Disorders (TMDs) 7) Adhesive Dentistry / Dental Materials / Aesthetic Dentistry 8) Maxillofacial Prosthodontics and Dysphagia Rehabilitation 9) Digital Dentistry Prosthodontic treatment may become necessary as a result of developmental or acquired disturbances in the orofacial region, of orofacial trauma, or of a variety of dental and oral diseases and orofacial pain conditions. Reviews, Original articles, technical procedure and case reports can be submitted. Letters to the Editor commenting on papers or any aspect of Journal of Prosthodontic Research are welcomed.