{"title":"颞下颌关节紊乱症初期保守治疗方案的疗效：随机临床试验网络荟萃分析","authors":"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","DOIUrl":null,"url":null,"abstract":"</p><p><b>Purpose:</b> 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).</p><p><b>Study selection:</b> 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).</p><p><b>Results:</b> 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.</p><p><b>Conclusions:</b> Stabilization splints, self-exercise, and low-level laser therapy may be effective in the initial treatment of TMD.</p>\n<p></p>","PeriodicalId":16887,"journal":{"name":"Journal of prosthodontic research","volume":"34 1","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy of initial conservative treatment options for temporomandibular disorders: A network meta-analysis of randomized clinical trials\",\"authors\":\"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\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"</p><p><b>Purpose:</b> 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).</p><p><b>Study selection:</b> 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).</p><p><b>Results:</b> 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.</p><p><b>Conclusions:</b> Stabilization splints, self-exercise, and low-level laser therapy may be effective in the initial treatment of TMD.</p>\\n<p></p>\",\"PeriodicalId\":16887,\"journal\":{\"name\":\"Journal of prosthodontic research\",\"volume\":\"34 1\",\"pages\":\"\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-09-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of prosthodontic research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2186/jpr.jpr_d_23_00273\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"DENTISTRY, ORAL SURGERY & MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of prosthodontic research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2186/jpr.jpr_d_23_00273","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
Efficacy of initial conservative treatment options for temporomandibular disorders: A network meta-analysis of randomized clinical trials
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.
期刊介绍：
Journal of Prosthodontic Research is published 4 times annually, in January, April, July, and October, under supervision by the Editorial Board of Japan Prosthodontic Society, which selects all materials submitted for publication.
Journal of Prosthodontic Research originated as an official journal of Japan Prosthodontic Society. It has recently developed a long-range plan to become the most prestigious Asian journal of dental research regarding all aspects of oral and occlusal rehabilitation, fixed/removable prosthodontics, oral implantology and applied oral biology and physiology. The Journal will cover all diagnostic and clinical management aspects necessary to reestablish subjective and objective harmonious oral aesthetics and function.
The most-targeted topics:
1) Clinical Epidemiology and Prosthodontics
2) Fixed/Removable Prosthodontics
3) Oral Implantology
4) Prosthodontics-Related Biosciences (Regenerative Medicine, Bone Biology, Mechanobiology, Microbiology/Immunology)
5) Oral Physiology and Biomechanics (Masticating and Swallowing Function, Parafunction, e.g., bruxism)
6) Orofacial Pain and Temporomandibular Disorders (TMDs)
7) Adhesive Dentistry / Dental Materials / Aesthetic Dentistry
8) Maxillofacial Prosthodontics and Dysphagia Rehabilitation
9) Digital Dentistry
Prosthodontic treatment may become necessary as a result of developmental or acquired disturbances in the orofacial region, of orofacial trauma, or of a variety of dental and oral diseases and orofacial pain conditions.
Reviews, Original articles, technical procedure and case reports can be submitted. Letters to the Editor commenting on papers or any aspect of Journal of Prosthodontic Research are welcomed.
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