Occlusal splints may be of benefit in TMD, but there is little evidence for the use of occlusal adjustment

Abstract

Objective A systematic review of occlusal splints and occlusal adjustments in the treatment of temporomandibular disorders (TMD).Data sources Medline (1966–1999), Embase, Index Medicus (1966–1980), Cochrane Controlled Trial Register, DARE and reference lists of retrieved papers. There were no language exclusions.Study selection Studies were included if they were randomised comparisons of occlusal splint therapy or occlusal adjustments to treat TMD and placebo, no-treatment or other interventions. Studies were scored for quality.Results Eighteen studies met the inclusion criteria, 14 of splint therapy and four of occlusal adjustment. The overall quality of the trials was fairly low: the mean quality score was 0.43 (range, 0.12–0.78) out of a maximum score of 1.00. 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 to be superior to three and comparable to 12 control treatments, and superior or comparable to four passive controls. Occlusal adjustment was found to be comparable to two and inferior to one control treatment, and comparable to the passive control in one study.Conclusion Occlusal splints may be of some benefit in the treatment of TMD but evidence for the use of occlusal adjustment is lacking. There is obviously a need for well-designed controlled studies to analyse current clinical practices.