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Objectives: (i) To evaluate the effect of three different interventions on treatment outcomes and (ii) to determine how the frequency of oral parafunction influences the effectiveness of the different therapeutic modalities., Methods: Forty-five participants were randomly assigned into three treatment groups [physical therapy (PT), stabilisation splint (SS) and control therapy (CT)]. According to Oral Behavior Checklist score, participants were divided into "high-frequency parafunction" (HFP) and low-frequency parafunction" (LFP) group. Primary (spontaneous pain and characteristic pain intensity) and secondary outcomes (range of mouth opening, anxiety symptoms, quality of life, perceived stress and global functional limitation) were evaluated during six-month treatment period., Results: Participants in PT group showed a significant reduction in characteristic pain intensity (p = .047, η 2  = 0.243) when compared to SS and CT group, but significant improvement in spontaneous pain was found in all treatment groups. Patients treated with PT and SS exhibited significantly stronger improvement in pain-free mouth opening than patients in CT group (3rd month: p=.037, η2=0.258; 6th month: p = .005, η 2  = 0.383). Within-group analyses showed significant decrease of perceived stress, anxiety symptoms and global functional limitation only in PT group over a six-month treatment period. Participants with HFP presented significantly greater levels of anxiety (3rd month: p = .009, η 2  = 0.275; 6th month: p = .041, η 2  = 0.176) than participants with LFP. Within-group analyses, however, showed significant improvement of anxiety, but also the decrease of perceived stress and improvement of global limitation for the HFP group but not for the LFP group., Conclusion: Although no treatment can be marked as superior in terms of spontaneous pain relief, PT was more effective when observing relief of characteristic pain intensity. In HFP group the reduction of anxiety, stress and functional limitation was present regardless of the applied therapy., Trial Registration: ClinicalTrials.gov NCT04694274. Registered on 01/04/2021., (© 2021 John Wiley & Sons Ltd.)

Objective: Temporomandibular disorders (TMD) are the most common source of orofacial pain of a non-dental origin. The study was performed to investigate the therapeutic effect of the conventional occlusal splint therapy and the physical therapy. The hypothesis tested was that the simultaneous use of occlusal splint and physical therapy is an effective method for treatment of anterior disc displacement without reduction., Materials and Methods: Twelve patients (mean age =30.5 y) with anterior disc displacement without reduction (according to RDC/TMD and confirmed by magnetic resonance imaging) were randomly allocated into 2 groups: 6 received stabilization splint (SS) and 6 received both physical therapy and stabilization splint (SS&PT). Treatment outcomes included pain-free opening (MCO), maximum assisted opening (MAO), path of mouth opening and pain as reported on visual analogue scale (VAS)., Results: At baseline of treatment there were no significant differences among the groups for VAS scores, as well as for the range of mandibular movement. VAS scores improved significantly over time for the SS&PT group (F=28.964, p=0.0001, effect size =0.853) and SS group (F=8.794, p=0.001, effect size =0.638). The range of mouth opening improved significantly only in the SS&PT group (MCO: F=20.971, p=0.006; MAO: F=24.014, p=0.004) (Figure 2). Changes in path of mouth opening differ significantly between the groups (p=0.040). Only 1 patient in SS&PT group still presented deviations in mouth opening after completed therapy while in the SS group deviations were present in 5 patients after completed therapy., Conclusion: This limited study gave evidence that during the treatment period lasting for 6 months, the simultaneous use of stabilization splint and physical therapy was more efficient in reducing deviations and improving range of mouth opening than the stabilization splint used alone. Both treatment options were efficient in reducing pain in patients with anterior disc displacement without reduction. Despite of objectively diagnosed disruption of temporomandibular joint anatomy, physiological function was regained., Competing Interests: None to declare.

Stabilization splint is the treatment of choice for pain control in temporomandibular disorder (TMD) patients, even though its mechanism of action is still unknown. The aim of this systematic review is to provide a critical overview of the effectiveness of stabilization splint therapy on the basis of currently available literature data. The available Medline database was searched and 24 studies published since the 1995s have been consequently included in this review. The selection criteria were randomized controlled trials and clinical trials comparing splint therapy to either no treatment or another active treatment (physiotherapy, relaxation and drugs). Studies were grouped according to treatment type. Based on the currently best evidence available, it appears that stabilization splint has similar efficacy in controlling TMD symptoms as other active treatments (physiotherapy, relaxation and drugs). Stabilization splint therapy may be beneficial in reducing pain at rest and on palpation when compared with non-occluding splint. During a short period, education was slightly more effective than occlusal splint in treating spontaneous muscle pain. These two treatments did not have significantly different effects on pain-free mouth opening and pain during chewing. This review has shown evidence that most TMD patients are helped by incorporation of a stabilization splint. There is not enough data on the long-term efficacy and effectiveness of this widely used therapeutic tool. In the future, there is a need for well-conducted randomized controlled trials paying attention to adequate sample size, blind outcome assessment, duration of follow up, and using standardized methods for measuring treatment outcomes.

The aim of the study was to evaluate changes in pain intensity and self-perceived quality of life in patients with temporomandibular disorders (TMD) during stabilization splint therapy. The hypothesis was that the clinical subtype of TMD, depending on whether pain is of muscular or temporomandibular joint origin, and pain chronicity (acute vs. chronic pain) differently affect treatment response. Thirty patients were included and treated with a stabilization splint in a 6-month clinical trial. Treatment outcomes included pain-free maximal mouth opening (MO), assisted maximal MO, path of MO, asymmetry in lateral excursions, spontaneous pain intensity (visual analog scale, VAS), and self-perceived quality of life (Oral Health Impact Profile, OHIP-14). Overall, VAS and OHIP-14 scores changed significantly over time (VAS: F = 80.85, p < 0.001; OHIP-14: F = 34.78, p < 0.001). After 6 months, changes in pain intensity did not differ significantly between myofascial pain (MP) and disc displacement (DD) groups (F = 0.497, p = 0.685, effect size = 0.018), or between acute pain (AP) and chronic pain (CP) patients (F = 1.856, p = 0.144, effect size = 0.064). Changes in self-perceived quality of life did not differ significantly between MP and DD groups (F = 0.213, p = 0.847, effect size = 0.008), or between AP and CP patients (F = 0.816, p = 0.489, effect size = 0.029). Linear regression analysis was used to assess the contribution of each predictor variable to the explanation of the OHIP summary score variance. Results showed pain reduction (coefficient = 0.303; 95% CI: 0.120 to 0.485) and MO increase (coefficient = 0.149; 95% CI: 0.037 to 0.260) to be independent predictors of the OHIP-14 summary score changes (R2 = 0.453), whereas other variables did not affect treatment outcome as assessed by OHIP-14. In conclusion, during 6-month stabilization splint therapy, significant changes in VAS and OHIP-14 summary scores were found. However, there were no significant differences in improvement rates between subjects with acute and chronic pain. Furthermore, no significant differences in improvement rates were found depending on whether pain was of muscular or temporomandibular joint origin.