A Cochrane Systematic Review of Stabilisation Splint Therapy for Temporomandibular Pain Dysfunction Syndrome

Tags: Poster
Al-Ani Z, Worthington H, Gray R, Sloan P, Davies S

Background: Pain dysfunction syndrome (PDS) is the most common temporomandibular disorder (TMD). The aetiology of PDS is multifactorial. Consequently many different therapies, some conservative and reversible, others irreversible, have been advocated for patient with PDS. A number of successful treatment outcomes have been reported. There are various types of occlusal splints described in the literature and they have different indications and functions. The stabilization splint (SS) is one such type of occlusal splint and is also known as the Tanner appliance, the Fox appliance, the Michigan splint or centric relation appliance. The stabilization splint is a hard acrylic splint and provides a temporary and removable ideal occlusion. Providing an occlusion by the use of splint therapy reduces abnormal muscle activity and produces 'neuromuscular balance'.

When properly constructed and adjusted, the SS delivers a good method of providing centric relation occlusion, eliminating posterior interferences, provides anterior guidance on anterior teeth, reducing neuromuscular activity, and obtains stable occlusal relationships with uniform tooth contacts throughout the dental arch. However, no systematic review of these trials (examining stabilisation splint therapy as a treatment of PDS specifically) has been published, and the true effectiveness of this splint for PDS has yet to be established.

Objectives: To establish the effectiveness of stabilisation splint therapy in reducing symptoms in patients with pain dysfunction syndrome (compared with any control group) using a Cochrane systematic review procedure and to aggregate overall survival results.

Methods: Using a comprehensive search strategy, all relevant studies were identified irrespective of language of publication. Every attempt was made to have non-English language papers translated.

All relevant articles and reports were assessed using previously prepared inclusion criteria form, two reviewers have assessed the relevance of each article independently. Disagreements were handled by discussion and by consulting a third reviewer. Additional information was sought from the authors when necessary. To reduce pre-formed opinions of experts in the area that can bias the assessment of the relevance of articles, one reviewer was not an expert in the area.

Results: Five studies were included in the review and subjective and clinical outcomes were recorded. Data showed no statistically significant difference between the effectiveness of SS, acupuncture and biteplates in treating PDS. However, the comparisons were based on a small number of patients with no standardization of the outcomes measured.

Conclusion: There was no evidence of a difference in the effectiveness of stabilisation splint therapy in reducing symptoms in patients with pain dysfunction syndrome compared with other conventional treatments like acupuncture. A standardization of the outcomes of the treatment of PDS should be established in the randomized control trials.