Anterior Repositioning Splints in the Management of Temporomandibular Disc Displacement: A Network Meta-Analysis

Anterior repositioning splints (ARS) are widely used for disc displacement with reduction, but their comparative effectiveness against other conservative and minimally invasive treatments remains unquantified within a network meta-analytic framework.

The objective of this study is to compare ARS with other treatment modalities for improving maximum mouth opening (MMO) and reducing pain in disc displacement with reduction using network meta-analysis.

Twelve randomized controlled trials met inclusion criteria: seven reported MMO, eight reported pain. Mean difference (MD) was the effect measure for both outcomes. Bayesian network meta-analysis ranked treatments using the surface under the cumulative ranking curve (SUCRA). A sensitivity analysis excluding a study with an implausibly narrow standard deviation tested the robustness of the pain ranking.

For MMO (10 treatments), arthrocentesis ranked highest (SUCRA 76.2%) and ARS ranked eighth (38.3%); no comparison against ARS reached statistical significance (arthrocentesis vs. ARS: MD 6.78, 95% CrI 17.57 to 4.01). For pain (12 treatments), stabilization splint ranked highest (SUCRA 77.7%), followed by ARS (65.9%); untreated control ranked lowest (11.1%). ARS did not differ from stabilization splint (MD 0.69, 95% CrI 0.64 to 2.02) but exceeded untreated control (MD 4.60, 95% CrI 2.01 to 7.19). Sensitivity analysis did not alter rankings; certainty of evidence ranged from very low to moderate, with no comparison reaching high certainty.

ARS was not the most effective treatment for MMO, and for pain it outperformed untreated control but not stabilization splint, which held the highest SUCRA ranking. ARS is therefore not the preferred first-line treatment over stabilization splint.