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Occlusal treatments in temporomandibular disorders: a qualitative systematic review of randomized controlled trials
Heli Forssell1, Eija Kalso, Pirkko Koskela
1Department of Oral Diseases, Turku University Central Hospital, Lemminkäisenkatu 2, FIN-20520 Turku, Finland Department of Anaesthesia, Helsinki University Central Hospital, Haartmaninkatu 4, FIN-00290 Helsinki, Finland Department for Oral Health, Centre of Health and Social Services, City of Jyväskylä, Hannikaisenkatu 11-13, FIN-40100 Jyväskylä, Finland Health Center of Tampere, Satamakatu 17 B, FIN-33200 Tampere, Finland Social Insurance Institution, Research and Development Center, Peltolantie 3, FIN-20720 Turku, Finland Institute of Dentistry, University of Turku, Lemminkäisenkatu 2, FIN-20520 Turku, Finland.
Abstract:
Occlusal treatments (occlusal splints and occlusal adjustment) are controversial but widely used treatment methods for temporomandibular disorders (TMD). To investigate whether studies are in agreement with current clinical practices, a systematic review of randomized controlled trials (RCTs) of occlusal treatment studies from the period 1966 to March 1999 was undertaken. Eighteen studies met the inclusion criteria, 14 on splint therapy, and 4 on occlusal adjustment. The trials were scored using the quality scale presented by Antczak et al., 1986a (A.A. Antczak, J. Tang, T.C. Chalmers, Quality assessment of randomized control trials in dental research. I. Methods, J. Periodontal Res. 1986a;21:305-314). The overall quality of the trials was fairly low, the mean quality score was 0.43/1.00 (range 0.12-0.78). The most obvious methodological shortcomings were inadequate blinding, small sample sizes, short follow-up times, great diversity of outcome measures and numerous control treatments, some of unknown effectiveness. Splint therapy was found superior to 3, and comparable to 12 control treatments, and superior or comparable to 4 passive controls, respectively. Occlusal adjustment was found comparable to 2 and inferior to one control treatment and comparable to passive control in one study. Because of the methodological problems, only suggestive conclusions can be drawn. The use of occlusal splints may be of some benefit in the treatment of TMD. Evidence for the use of occlusal adjustment is lacking. There is an obvious need for well designed controlled studies to analyse the current clinical practices.