ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Prosthodontic Treatment Versus Occlusal Splints in Reducing Chronic TMD Symptoms for Patients with Disk Displacement without Reduction
Clinical Question For a patient with chronic disk displacement without reduction, would prosthodontic treatment be more effective than an occlusal splint in reducing their symptoms?
Clinical Bottom Line No study comparing the two specific treatment options in the PICO question was available. The closest match only compared repositioning onlays to occlusal splints (in patients with disk displacement WITH reduction) and found that repositioning onlays might offer an improvement over occlusal splints. (See Comments on the CAT below)
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) 3174047Lundh/199263 patients (54 females, 9 males) ranging in age from 13 to 74 years, with a median age of 24 yearsRandomized Controlled Trial
Key resultsPatients with repositioning onlays showed a statistically significant difference in pain reduction for their chief complaint (p <.01, d=6), pain during protrusion (p<.05, d=2.5) and reduction of disturbed joint dysfunction (p<.05, d=4.5) and no statistically significant difference in pain during protrusion. Those with occlusal splints showed no statistically significant difference between the control group for any category and repositioning onlays showed a statistically significant difference compared to occlusal splints in terms of reduction of pain for their chief complaint (p<.01).
Evidence Search Pubmed (keywords): "occlusal splint" AND "posthodontic treatment" AND "disk displacement without reduction"Pubmed (mesh): #87Search ((#62) AND #85) AND #86 09:10:5049#86Search "Occlusal Splints"[Mesh]01:33:441220#85Search "Dental Prosthesis"[Mesh]01:32:3578853#62Search "Temporomandibular Joint Disorders"[Mesh]
Comments on
The Evidence
The best evidence was only moderately valid and did not specifically address the PICO question. The patient pool was of modest size (n=63) and randomized (though with a female gender bias). Patient completion rate was 100% and there was a 6-month recall conducted as well. However, the study was not double-blinded (half of the patients were examined by the same dentist who performed the treatment.)
Applicability TMD symptoms with disk displacement (with and without reduction) are common and would be applicable to a general dentistry practice setting.
Specialty/Discipline (General Dentistry) (Orthodontics) (Prosthodontics) (Restorative Dentistry)
Keywords TMD, temperomandibular disorders, disk displacement without reduction, occlusal splint, dental prosthesis, prosthodontic treatment
ID# 796
Date of submission: 04/14/2011spacer
E-mail jonesc6@livemail.uthscsa.edu
Author Corey Jones
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?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Baker Drew (San Antonio, TX) on 10/03/2014
PubMed and TRIP database search was conducted September 2014, to address the previous PICO question. No new research was found. The Lundh H., et al., 1992 (PubMed ID: 3174047) study is still the closest match to address the PICO question, but the evidence is only moderately relevant.
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