顎関節症に対する初期保存的治療の有効性： ランダム化比較試験のネットワークメタアナリシス ―二次出版論文―

西山 暁; 山口 賀大; 大井 一浩; 湯浅 秀道; 松香 芳三; 安部 貴大; 松田 慎平; 渡邊 友希; 鈴木 善貴; 柏木 美樹; 高才 東; 菅井 健一; 星 佳芳; 小野 康寛; 深澤 敏弘; 松村 英尚; 藤原 夕子; 石山 裕之

doi:10.2186/ajps.18.144

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

Akira Nishiyama, Yoshihiro Yamaguchi, Kazuhiro Ooi, Hidemichi Yuasa, 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

Author information

Akira Nishiyama
Department of General Dentistry, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo
Yoshihiro Yamaguchi
Department of Fixed Prosthodontics and Oral Implantology, School of Dentistry, Aichi-Gakuin University
Kazuhiro Ooi
Department of Oral and Maxillofacial Surgery, Graduate School of Medical Science, Kanazawa University
Hidemichi Yuasa
Department of Oral and Maxillofacial Surgery, National Hospital Organization Toyohashi Medical Center
Yoshizo Matsuka
Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University
Takahiro Abe
Oral and Maxillofacial Surgery, Jichi Medical University Saitama Medical Center
Shinpei Matsuda
Department of Dentistry and Oral Surgery, University of Fukui Hospital
Yuki Watanabe
Division of Temporomandibular Disorders and Orofacial Pain, Department of Prosthodontics, School of Dentistry, Showa Medical University
Yoshitaka Suzuki
Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences, Tokushima University
Miki Kashiwagi
Department of Oral and Maxillofacial Surgery, School and Graduate School of Dentistry, The University of Osaka
Azuma Kosai
Department of Oral-Maxillofacial Surgery and Orthodontics, The University of Tokyo Hospital
Kenichi Sugai
The Nippon Dental University School of Life Dentistry at Tokyo (Library Section)
Keika Hoshi
Center for Health Informatics Policy, National Institute of Public Health
Yasuhiro Ono
Hitachinaka Familiar Dental Clinic
Toshihiro Fukazawa
Fukazawa Dental Clinic
Hidehisa Matsumura
Matsumura Dental Clinic
Yuko Fujihara
Department of Dentistry and Oral Surgery, Tokyo Teishin Hospital
Hiroyuki Ishiyama
Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo

Keywords: TMD, Network meta-analysis, Initial conservative treatment option

JOURNAL RESTRICTED ACCESS

2026 Volume 18 Issue 2 Pages 144-155

DOI https://doi.org/10.2186/ajps.18.144

Details

Abstract

Purpose: This network meta-analysis (NMA) aimed to evaluate the comparative effectiveness of initial conservative treatments for temporomandibular disorders (TMD), focusing on pain-related Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD).

Study Selection: A systematic search of PubMed and Embase databases was conducted for randomized controlled trials (RCTs) published between January 2000 and July 2021. Eligible studies included adults diagnosed with myalgia or arthralgia based on DC/TMD or RDC/TMD and evaluated the efficacy of conservative treatments. Twelve interventions, including stabilization splints, low-level laser therapy (LLLT), self-exercise, and placebo, were compared. Risk of bias was evaluated using Risk of Bias 2.0. MetaInsight software generated forest plots for direct comparisons, and network meta-analysis was performed standardized mean differenceing the netmeta package in R.

Results: A total of 24 RCTs comprising 1,336 participants were included in the analysis of pain outcomes, while 12 RCTs involving 614 participants evaluated maximal mouth opening (MMO). LLLT (SMD: −2.12; 95% CI: −3.18, −1.06), self-exercise (SMD: −1.51; 95% CI: −2.82, −0.2), and stabilization appliance (St-A) (SMD: −1.16; 95% CI: −2.02, −0.29) demonstrated statistically significant improvements in pain. For MMO, self-exercise (SMD: 0.71; 95% CI: −0.58, 2.01), St-A (SMD: 0.65; 95% CI: −0.09, 1.39), and LLLT (SMD: 0.63; 95% CI: −0.34, 1.6) showed promising effects. However, the certainty of evidence across outcomes was rated as very low due to methodological limitations and heterogeneity among studies.

Conclusions: Self-exercise, St-A, and low-level laser therapy show potential as effective conservative treatments in the early management of TMD. Nonetheless, the low certainty of evidence highlights the need for high-quality RCTs with standardized outcomes to strengthen clinical guidelines.

Corresponding author

Register with J-STAGE for free!