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

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

doi:10.2186/jpr.JPR_D_23_00273

This article has now been updated. Please use the final version.

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

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

Author information

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

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

JOURNAL OPEN ACCESS Advance online publication
Supplementary material

Article ID: JPR_D_23_00273

DOI https://doi.org/10.2186/jpr.JPR_D_23_00273

The final version of this article is now available: Vol. 69 (2024), No. 2 pp. 173-180

Details

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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