Occlusal treatments in temporomandibular disorders: a qualitative systematic review of randomized controlled trials

Occlusal treatments (occlusal splints and occlusal adjustment) are controve rsial but widely used treatment methods for temporomandibular disorders (TM D). To investigate whether studies are in agreement with current clinical p ractices, a systematic review of randomized controlled trials (RCTs) of occ lusal treatment studies from the period 1966 to March 1999 was undertaken. Eighteen studies met the inclusion criteria, 14 on splint therapy, and 4 on occlusal adjustment. The trials were scored using the quality scale presen ted by Antczak et al., 1996a (A.A. Antczak, J. Tang, T.C. Chalmers, Quality assessment of randomized control trials in dental research. I. Methods, J. Periodontal Res. 1986a;21:305-314). The overall quality of the trials was fairly low, the mean quality score was 0.43/1.00 (range 0.12-0.78). The mos t obvious methodological shortcomings were inadequate blinding, small sampl e sizes, short follow-up times, great diversity of outcome measures and num erous control treatments, some of unknown effectiveness. Splint therapy was found superior to 3, and comparable to 12 control treatments, and superior or comparable to 4 passive controls, respectively. Occlusal adjustment was found comparable to 2 and inferior to one control treatment and comparable to passive control in one study. Because of the methodological problems, o nly suggestive conclusions can be drawn. The use of occlusal splints may be of some benefit in the treatment of TMD. Evidence for the use of occlusal adjustment is lacking. There is an obvious need for well designed controlle d studies to analyse the current clinical practices. (C) 1999 International Association for the Study of Pain. Published by Elsevier Science B.V.