ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Mandibular Advancement Surgery Cannot Be Said to Worsen or Improve TMD Symptoms
Clinical Question In patients with mandibular deficiency seeking TMD symptom relief, would mandibular advancement surgery result in TMD symptom improvement, as compared to no surgery?
Clinical Bottom Line In patients with mandibular deficiency seeking TMD symptom relief, mandibular advancement surgery does not necessarily improve TMD symptoms.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26644217Bermell-Baviera/201612 trials/580 subjects and 1 systematic review of 56 articlesSystematic review of nonrandomized trials
Key resultsOf the 22 articles composing the systematic review, 13 were related to TMD and mandibular advancement surgery. Twelve trials consisting of 580 patients and one systematic review of 56 articles compared the effects of mandibular advancement surgery and the effects on the TMJ. Two studies showed that condylar resorption was accelerated as a result of the surgery. Another four articles showed that TMD symptoms worsened following mandibular advancement surgery. The authors found that if this surgery is performed in conjunction with disc repositioning, there tended to be some TMD symptom improvement. Some studies found TMD symptom improvement and others did not, so this surgery can not be definitively said to improve nor to worsen TMD symptoms.
Evidence Search Mandibular advancement surgery AND TMD
Comments on
The Evidence
The authors searched for studies that were systematic reviews and meta-analyses, randomized controlled trials (RCTs), cohort studies, or case-control studies, both prospective and retrospective. The authors' search was not limited only to English articles and used an extensive search strategy through multiple electronic databases of all studies published from 2002-2014 (PubMed, Scopus, Embase, and Cochrane Library). It used nine different terms for mandibular advancement surgery queries and six terms for TMJ-related queries. This initially yielded 544 articles of interest. Two independent reviewers assessed the articles, and if a disagreement arose, a third reviewer would assess the article. Additionally, the authors gave the reasons that articles were excluded: not meeting inclusion criteria, not answering the research question, and/or being of low scientific quality. This left 22 articles for the systematic review. The authors evaluated articles based on CONSORT criteria (Consolidated Standards of Reporting Trials). The authors then eliminated those articles of low value and only kept articles with a quality rating of moderate or high. Additionally, a review of systematic review articles was completed via PRISMA (Preferred Reporting Items for Systematic Reviews). One problem with the study was the lack of homogeneity between the various articles. The authors were aware of this problem and identified the need for more stringent and homogenous methods. The heterogeneity arose from various radiographic techniques used to assess patient outcomes (CBCT, lateral teleradiology, 3D photography, MRI). Additionally, sources of heterogeneity were identified to include lack of information on the sample, follow-up time, and type of TMJ disorder present before surgery. Furthermore, the authors acknowledged that their rigorous screening methodology significantly limited the number of articles that could be used, and hence there was a lack of information available to draw more solid conclusions. These factors made it difficult to assess the outcomes of the surgical procedures presented.
Applicability Mandibular advancement surgery is an well-established procedure for the correction of a retrognathic mandible. These patients may also suffer from TMD symptoms. It would not be desirable to recommend orthognathic surgery as a method to improve TMD symptoms. Less invasive options such as an occlusal appliance, self-management therapies, and physical medicine would yield better results in managing TMD symptoms. Likewise, if a patient presents with condylar resorption the patient should be warned that the surgery may accelerate the resorption.
Specialty/Discipline (General Dentistry) (Oral Surgery)
Keywords Mandibular advancement surgery, TMD
ID# 3181
Date of submission: 03/27/2017spacer
E-mail villajl@livemail.uthscsa.edu
Author Jose Villa
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward F. Wright, DDS, MS
Faculty mentor/Co-author e-mail WrightE2@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
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Comments on the CAT
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