Scoping review of systematic review abstracts about temporomandibular disorders: Comparison of search years 2004 and 2017

SYSTEMATIC REVIEW

Scoping review of systematic review abstracts about temporomandibular disorders: Comparison of search years 2004 and 2017 Donald J. Rinchusea and Charles S. Greeneb Greensburg, Pa, and Chicago, Ill

Introduction: The purposes of this study were to determine how many systematic reviews and meta-analyses relating to temporomandibular disorders (TMDs) had been published as of 2017 compared with those published as of 2004 and then to summarize the findings, based on an analysis of the abstracts from those studies. Methods: A PubMed search was initiated on May 1, 2017. There were 2 separate searches. The first search was for the topic, “temporomandibular disorders.” The second search was for “temporomandibular disorders and published in the Cochrane database.” The number and the topic category of reviews for 2017 were compared with those published as of 2004. Results: There were 120 relevant TMD systematic reviews found in search year 2017: 110 from the PubMed and 10 from the Cochrane searches. By comparison, there were only 8 TMD systematic reviews published in 2004. The abstracts for all 120 reviews indicated increased roles of genetics and psychosocial factors in the etiology of TMD. The future of TMD diagnoses appears to be toward various psychosocial and cellular tests, along with brain neuroimaging. The reviews on the topic of “treatment” supported conservative, noninvasive, reversible therapies, with a trend toward more targeted individual strategies. Conclusions: There were only 8 TMD systematic reviews published in 2004 compared with 110 in 2017. Overall, the trend has been in the direction of better diagnostic procedures, more scientific concepts of etiology, and more conservative treatments for TMD. (Am J Orthod Dentofacial Orthop 2018;154:35-46)

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nce considered a single disorder with a single cause, temporomandibular disorders (TMDs) are now considered a collection of musculoskeletal conditions involving the masticatory muscles, temporomandibular joints (TMJs), and associated structures.1,2 According to the American Dental Association's first TMD conference, held in June 1982, there are 6 subclasses of TMD: masticatory muscle disorders, derangements of the TMJs, traumatic arthritis, degenerative joint diseases, chronic mandibular hypomobility, and growth disorders.1 There is a multifactorial etiology for each subclass.1,2 Occlusion and specific locations of the condyles in the glenoid fossae a

Corporate practice, Greensburg, Pa. Department of Orthodontics, College of Dentistry, University of Illinois at Chicago. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and none were reported. Address correspondenct to: Donald J. Rinchuse, 7269 Mansfield Lane, Irwin, PA 15642; e-mail, [email protected]. Submitted, January 2017; revised and accepted, December 2017. 0889-5406/$36.00 Ó 2018 by the American Association of Orthodontists. All rights reserved. https://doi.org/10.1016/j.ajodo.2017.12.011 b

(eg, centric relation) are no longer considered to be the primary factors in the multifactorial etiology of TMD.2-7 For many years, orthodontists have had serious interests and concerns about TMDs. In 1988, Greene3 asked, “Does orthodontic treatment cause, cure, or prevent TMDs?” His answer to all 3 parts of the question was “no,” based on the limited research available at that time. Since then, there has been a tremendous increase in interest in this issue in the orthodontic specialty and the entire dental profession. The huge number of clinical and scientific studies reported in the past 30 years on TMJ topics has led to many systematic reviews and meta-analyses of that literature. In the end, the current literature has supported4-7 the 1988 conclusions of Greene; orthodontics does not generally cause, mitigate, or cure TMD, nor does it prevent the future development of TMD.7 Discussions about the etiology and treatment of TMDs have moved away from a historic, dental-based model to a biopsychosocial model that integrates the host of biologic, behavioral, and social factors that are related to the onset, maintenance, and management of 35

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TMD.8-10 Many studies have led to the conclusion that TMD treatments should be, at least initially, conservative (noninvasive), reversible, palliative, and when possible based on science and evidence.2,3,5,8,9 A medical orthopedic approach is recommended that focuses on the biomedical sciences and musculoskeletal therapies similar to those for most chronic pain.9 Cognitive-behavioral therapies and biofeedback are now prominent among contemporary TMD treatment modalities.8-10 Genetics (vulnerabilities related to pain), cell studies, endocrinology, behavioral risk-conferring factors, and brain neuroimaging are the exciting future of TMD studies.8-10 Systematic reviews (and meta-analyses) are at the highest level in the hierarchy of scientific evidence. Systematic reviews involve an exhaustive search of the literature on a topic, and then an expert panel selects a limited number of worthy studies, mostly randomized controlled trials (RCTs), to be included in the review.11 Depending on the nature of the review, RCTs may not be included. The relevant information from the chosen studies is then interpreted and summarized.11 The Cochrane database of systematic reviews takes a more discriminatory approach; authors submit proposals that are reviewed by its editorial team, with systematic reviews updated at least every 4 years. It would be of interest for dentists, including orthodontists, to know and understand the information in TMD systematic reviews to make objective, evidencebased decisions regarding patient diagnoses and treatments. In 2006, Rinchuse and McMinn12 published a report in which they listed, reviewed, and discussed the 8 TMD systematic reviews (1 was a meta-analysis) published in 2004. The purpose of this current investigation was to obtain the listings and abstracts of all the TMD systematic reviews published up to 2017 and then to present this information in 6 tables arranged by topic heading: prevalence, diagnosis, etiology, treatment, surgery, and miscellaneous (Appendix Tables I-VI). The numeric data from the 2017 search was compared with those from 2004. MATERIAL AND METHODS

Two PubMed searches were initiated on May 1, 2017, to look for systematic reviews and meta-analyses related to TMD. The first search was for the topic, “temporomandibular disorders.” The second search was for “temporomandibular disorders and published in the Cochrane database.” The number of reviews and categories of the topics covered in those reviews were compared with the 8 TMD systematic reviews published in 2004. For the purpose of this study, only the abstracts of the

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systematic reviews were obtained and analyzed to create the tables of results presented in this article. The inclusion criteria were all systematic reviews (meta-analyses) listed in the PubMed and Cochrane databases for a search on May 1, 2017, under the title of “temporomandibular disorders.” The exclusion criterion for the general PubMed search was articles that were not TMD systematic reviews or had missing information; for the Cochrane database, the exclusion criterion was any articles that were withdrawn because they were supplanted by an updated review on a certain TMD topic. The salient information from the systematic reviews for both searches was placed into 6 categories: prevalence, diagnosis, etiology, treatment, surgery, and miscellaneous. From the abstracts, tables were constructed for each category; the most notable information from each abstract, such as author and year, topic, number of articles meeting the selection criteria, quality of the review, and findings and conclusions are included in the 6 Appendix Tables. A table was also constructed comparing the numbers and categories of TMD systematic reviews from the 2004 search with those from the 2017 search (Table I). In addition, for the 2017 search, PubMed listings were compared with Cochrane listings (Table I). Results were summarized per numeric comparison, as well as per narrative, informational findings. The quality of the systematic reviews was evaluated and reported. The criteria and protocol for the assessment of the quality of the studies were based on what their authors stated, as well as the subjective opinions (when possible to ascertain from only reading an abstract) of the authors. RESULTS

For the first PubMed search, there were 115 listings for TMDs; 110 were relevant. For the second search in the Cochrane databse, there were 19 listings; 10 were relevant; the other 9 had been withdrawn because the listings were replaced by more current reviews. The 5 articles excluded from the general PubMed listing had various deficiencies: (1) older review with no author identification, (2) article dealing with pain that was not a systematic review, (3) article on exercise and TMD with not all information reported (ie, only reported title and author), (4) article that was a critique of a publication by a world-renowned TMD expert who summarized the American Association of Dental Research 2010 Policy Statement on TMD and was not a systematic review, and (5) review that did not explicitly deal with TMD. We divided the reviews into 6 categories: diagnosis, etiology, prevalence, treatment, surgery, and miscellaneous.

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Table I. Comparison of the numbers of TMD systematic reviews (and meta-analyses) published in 2004 and 2017 in

various categories Year 2004 2017 (PubMed) 2017 (Cochrane)

Prevalence 4

Diagnosis 1 13

Etiology 3 16

The quality of the studies analyzed in all reviews was low to low-medium, with no high-level quality of evidence reported in any publication. The 8 reviews from 2004 that had been analyzed by Rinchuse and McMinn12 in 2006 were compared with the 110 reviews found by searching in 2017 (Table I). The 10 Cochrane 2017 reviews were also compared. For 2004, half of the reviews (4 of 8) were related to treatment, and 4 were related to etiology. For 2017, most of the reviews (58 of 110) in the PubMed listing were for TMD treatments, whereas all 10 of the Cochrane reviews for 2017 were related to TMD treatment. The reviews for TMD treatment focused on conservative, reversible, low-tech, and noninvasive therapies vs aggressive, irreversible treatments (Appendix Table IV). For instance, there were only 3 reviews from the general PubMed search (Appendix Table IV) and 1 review from the Cochrane search (Table II) that dealt with occlusal adjustments (an irreversible form of treatment); all of those reviews reported a lack of support for this type of TMD treatment. The 2017 systematic review findings indicated increased roles of genetics and psychosocial factors in the etiology of TMD. There was little to no support for a causal relationship between occlusal factors and TMD, and occlusion-changing treatments were not supported by evidence. Data do not indicate that traditional orthodontic treatment increased the prevalence or risk of TMD. The future of TMD diagnosis appears to be toward various cellular and psychosocial tests, along with brain neuroimaging. The reviews on treatment supported conservative, noninvasive, reversible therapies, with a trend toward more targeted individual strategies. There were 4 TMD systematic reviews dealing with prevalence; 3 of those dealt with TMD prevalence in the general population,13-15 and 1 dealt with diagnostic findings in a TMD patient population.16 As in most reports on the prevalence of TMD, there was variability in the findings depending on age, sex, geographic region, assessment method, and so forth (Appendix Table I).13-16 Da Silva et al14 in 2016 reported that in the general population 1 in 6 children and adolescents has clinical signs of TMD, but their inclusion criteria for positive findings were questionable.

Treatment 4 58 10

Surgery 16

Miscellaneous 3

Total 8 110 10

Manfredini et al16 in 2011 reported that the most common diagnostic TMD finding in TMD populations is myofascial pain, with and without mouth-opening limitations; disc displacement with reduction was the most common finding in community samples (Appendix Table I). Thirteen articles addressed TMD diagnosis (Appendix Table II).17-29 The listings covered a host of subtopics such as cellular, imaging, ultrasound, muscle palpation, joint vibration, and posturography. Obviously, TMD imaging had the most scientific support, followed by ultrasound. Joint vibration and posturography had no evidence-based support when subjected to critical assessments. Interestingly, muscle palpation of the lower head of the lateral pterygoid muscle lacked scientific support.25 Importantly, there is growing evidence for various cellular tests for TMD, and this may be the future of TMD diagnoses. The etiology or cause of TMD has arguably been the topic of most interest in the TMD field over the past century. There were 16 general PubMed listings under this topic (Appendix Table III).30-45 The subtopics for etiology included bruxism, orthodontics, facial types, posterior crossbites, occlusion, heredity/genes, “brain,” hypermobility, posture, trauma/psychological, and whiplash. In the 2 reports that dealt with bruxism, there was a positive relationship between bruxism and TMD30,31; 1 of the reports was published in 2017, with the quality of the evidence low-moderate.30 There were 3 listings for orthodontics.32-34 The metaanalysis by Kim et al32 in 2004 is known in the orthodontic community; they concluded that, “although no definitive conclusions could be made due to the heterogeneity of the studies, the data do not indicate that traditional orthodontic treatment increased the prevalence or risk of TMD.” The review by Iodice et al33 in 2013 indicated that no conclusions could be drawn related to posterior crossbites causing TMD. Also, no conclusions could be drawn by Manfredini et al34 in 2016 related to facial/skeletal types (ie, Class II profiles and hyperdivergent growth patterns) being associated with TMJ disc displacement and degenerative disorders. In addition, there were 2 reports dealing with occlusion and TMD.35,36 Both reviews concluded that there is little

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Table II. TMD systematic reviews published in Cochrane database

Author Aggarwal et al46 2015

Topic Treatment/psychosocial

Articles meeting criteria /17

Al-Ani et al47 2016

Stabilizing splints

20/12

Low

De Souza et al48 2012

Treatment/TMD osteoarthritis/many types

/3

Low

Guo et al49 2015

Treatment/arthrocentesis lavage

/2

Low

Koh and Robinson50 2016

Treatment/occlusal adjustments

660/6

Medium

Luther et al51 2016

Treatment/orthodontics

284/55

Low

Mujakperuo et al52 2010

Treatment/pharmacology

/11

Low

Rigon et al53 2015

Treatment/arthroscopy

/7

Low-medium

Shi et al54 2013

Treatment/hyaluronate

/7

Low

Agostino et al55 2014

Not TMD/posterior crossbite

/15

Low

Quality Low

Findings/conclusions There is weak evidence to support the use of psychosocial interventions for chronic orofacial pain. However, given the noninvasive nature of such interventions, they should be used in preference to other invasive and irreversible therapies. There is insufficient evidence either for or against the use of stabilizing splints for the treatment of TMD. Evaluated the most common forms of treatment for TMD osteoarthritis. The reports indicated a not dissimilar degree of effectiveness with intraarticular injections consisting of either sodium hyaluronate or corticosteroids, and an equivalent pain reduction with diclofenac sodium compared with occlusal splints. Glucosamine appeared to be just as effective as ibuprofen. There is insufficient, consistent evidence to either support or refute the use of arthrocentesis and lavage for TMD. There is no evidence from randomized controlled trials that occlusal adjustment treats or prevents TMD. Occlusal adjustments are not recommended for management or prevention of TMD. There is insufficient data to answer the question whether orthodontics is a viable TMD treatment modality. There is insufficient evidence to support or not support the effectiveness of reported drugs for the management of pain due to TMD. Both arthroscopy and nonsurgical treatments reduced pain after 6 months. In comparison with arthroscopy, open surgery was more effective at reducing pain after 12 months. Nevertheless, there were no differences in mandibular functionality or other outcomes. Arthoscopy led to greater improvement in maximum interincisal opening after 12 months than arthrocentesis; there was no difference in pain. There is insufficient evidence to either support or refute the use of hyaluronate for treating TMD. The quad-helix may be more successful than removable expansion plates at correcting posterior crossbites for children in the early mixed dentition (ages 8-10).

/, the number before the symbol is the total number of articles accessed and the number after the symbol is the number meeting the criteria. If there is no number before the symbol, the number could not be ascertained from the abstract.

to no support for a causal relationship between occlusal factors and TMD. Of interest is the relationship of heredity and genes in the etiology of TMD. It is common knowledge that genes play a significant role in the cause or development of

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most diseases and ailments, and this now includes TMD. Visscher and Lobbezoo37 in 2015 found evidence for the role of heritability in the development of TMD pain: genetic contributions from candidate genes that encode proteins involved in the processing of painful

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stimuli from serotonergic and cathecholaminergic systems. Equally important is the role of changes in the brain in the development of TMD. Further consideration of this topic ultimately leads to the question of what causes the brain changes; it is clear that these are not the primary etiology for TMD. Brain neuroimaging has demonstrated that TMD patients show consistent functional and structural changes in the thalamus and the primary somatosensory cortex, indicating the thalamocortical pathway as the major site of plasticity. There is also the suggestion that cognitive modulation and reward processing play roles in chronic orofacial pain.38 Brain neuroimaging will almost certainly become an important investigative tool for understanding chronic orofacial pain.38 There were several other additional findings from the etiology category. One review on generalized TMJ hypermobility concluded that it was not clear whether there was an association with TMD.39 The role of head and cervical posture (craniocervical posture) in TMD was not clearly demonstrated in any of the 3 articles that dealt with this topic.40-42 Also, 1 review concluded that traumatic events (including psychological, emotional, sexual, or physical, including combat exposure) are associated with TMD.43 Whiplash trauma was considered an initiating or aggravating factor, as well as a comorbid condition for TMD; the prevalence of such trauma ranged from 8.4% to 70% in the TMD population compared with 1.7% to 13% in the non-TMD groups.44,45 All 10 Cochrane reviews dealt with TMD treatment (Tables I and II).46-55 As previously mentioned, 58 of the 110 PubMed reviews were in the category of “treatment” (Table I; Appendix Table IV).56-111 Several types of treatment modalities were reviewed, including various conservative and noninvasive approaches such as hypnosis and relaxation, counseling, biofeedback, acupuncture, pharmacology, physical therapy, manual techniques, and various exercises. Other modalities studied included occlusal splints, occlusal adjustments, injections, lasers, luxation, and so on. Of course, various surgical procedures were among the TMD treatments, but they are discussed below under the category of “surgery” (Appendix Table V). Parenthetically, dentistry in general and orthodontics in particular have for decades had an interest in the possible relationship between occlusion and TMD, and many experts and practitioners have assumed a causeand-effect relationship between these 2 variables. This has changed in the last several decades; by 2017, it was clear that occlusal variables are not a significant etiologic factor for the vast majority of TMD patients.50,94,96 We can now say that occlusal

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adjustments are not considered a logical and evidencebased treatment modality for TMD; there is no scientific basis, and it is an irreversible form of TMD therapy.1,2 To explain, there were 3 reviews from the general PubMed listing94-96 and 1 from the Cochrane listing50 dealing with this topic, and all of them pointed in the same direction: occlusal adjustments are not recommended for the management or prevention of TMD. The most recent of these reviews, from the Cochrane database, was by Koh and Robinson50 in 2016, and they reported that there was no evidence from RCTs that occlusal adjustment should be used to treat or prevent TMD. There was support for the various noninvasive and conservative treatment modalities such as counseling,56 psychosocial therapies,64-67 biofeedback,66,67 hypnosis/ relaxation,63 accupuncture,68-73 pharmacology,52,74-98 physical therapy/exercise,79-86 physiotherapy,88 and stabilizing splints.89-93 The efficacy of lasers was equivocal.103-106 Naeije et al61 found, with medium to high quality of evidence, that TMJ disc displacement with reduction is mostly stable and a life-long, painfree condition. Therefore, because of the favorable natural course of disc displacement, active treatment is only indicated for symptomatic disc displacement without reduction.61 TMJ injections with sodium hyaluronate, or corticosteroids, or botulinum toxin are inconclusive.97-102 There was no listing of orthodontics as a treatment choice among the systematic reviews for the general PubMed listing. In the Cochrane database, there was 1 article by Agostino et al55 in 2014 about the quadhelix appliance as a successful treatment for posterior crossbites in the early mixed dentition. This report was not a systematic review dealing with TMD. We decided to keep it in the Cochrane “treatment” listing even though it dealt with orthodontic treatment per se and not specifically TMD, because there has been a long history about the possibilities of crossbites associated with TMD. Most of the 16 TMD systematic reviews in the “surgery” category (Appendix Table V) dealt with surgical treatments and could also have been placed in the “treatment” category,112-127 but we decided to place them in the separate category of “surgery” in order to highlight those findings. Surgeries for TMD are indicated only when conservative and reversible treatments fail, for chronic conditions, or for an acute, sudden traumatic event in need of immediate attention. In the “surgery” category, 16 reviews112-127 were found in the PubMed listings (Appendix Table V), and 2 were found in the Cochrane listings (Table II).49-53 The 2 Cochrane reviews specifically dealt with surgical treatment for TMD. For the 16 PubMed listings, there

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were reviews that dealt with both the treatment efficacy of various surgical procedures and the effects of certain maxillofacial surgical procedures on the TMJs. In 1 Cochrane review, the authors concluded that there was insufficient evidence to either support or refute the use of arthrocentesis and lavage for TMD.49 The other Cochrane review was more comprehensive, comparing nonsurgical treatments with arthrocentesis, arthroscopy, and open surgery.53 Although both arthroscopy and nonsurgical treatments reduced pain after 6 months, open surgery was more effective than arthroscopy for pain after 12 months. In addition, there was greater maximum interincisal opening after 12 months with arthroscopy vs arthrocentesis, but there was no difference in pain.53 The 16 PubMed articles that covered surgical topics dealt with a wide variety of issues; readers are encouraged to read the summaries in Appendix Table V. Two noteworthy studies are mentioned here: Al-Moraissi117 reported that no final conclusion could be drawn for arthroscopy vs arthrocentesis for management of TMJ internal derangements; this is similar to the conclusions from the Cochrane reviews. From the review by AlRiyami et al113 in 2009, it was concluded that, although orthognathic surgery should not be advocated solely to treat TMD, it may be likely to improve TMD signs and symptoms; the quality of evidence was, however, low, and the review was dated. There were 3 publications in the “miscellaneous” category (Appendix Table VI).128-130 The first one by Fricton et al128 alerted the reader about certain limitations of TMD systematic reviews. Foremost is the potential for systemic bias, particularly for older studies, and therefore some systematic reviews should be interpreted with caution. Of the other 2 listings, 1 dealt with an unusual TMJ case of pigmented villodular synovitis,129 and the other concluded that having symptomatic TMD negatively affects oral health-related quality of life, which would be an expected finding.130 DISCUSSION

The main finding from this extensive search of the TMD literature was that there has been a marked increase in the number of TMD systematic reviews between 2004 and 2017. There were 8 reviews published in 2004 and 110 general PubMed listings and 10 Cochrane reports as of 2017. Although this increase is impressive, with few exceptions the quality of evidence for current TMD systematic reviews (2017) is low (weak); in most cases, the reviews are based on small numbers of RCTs. As a result, the intellectual yield from those studies still leaves much to be desired, with many issues remaining unresolved at this time.

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From an evaluation of the 110 currently available TMD systematic reviews (and 10 Cochrane reviews), it was apparent that most are on the topic of “treatment.” Not surprising is that most treatments considered in these reviews are in the category of conservative and reversible forms of therapy, including hypnosis and relaxation, counseling, biofeedback, acupuncture, pharmacology, physical therapy, and manual techniques as well as various head and neck related exercises. Other modalities studied included occlusal splints, occlusal adjustments, injections, lasers, luxation, and so on. Whereas the findings from those reviews were generally positive for all conservative therapies, the level of evidence was low. Aggressive and irreversible forms of TMD treatments, such as occlusal adjustments, were not supported by the evidence.50 The first organized attempts to deal scientifically with the issues related to TMD at a national level took place at the first TMD conference of the American Dental Association (ADA) in June 1982, with the findings published in the Journal of the American Dental Association in January 1983.1 A second ADA-sponsored conference took place in 1989.2 Current evidencebased reports and findings about TMD are often juxtaposed with the findings and recommendations from these 2 ADA conferences. The knowledge and understanding of TMD from an evidence-based perspective has certainly been bolstered by subsequent national TMD conferences including 1 sponsored by the National Institutes of Health in 1996131 and several educational conferences.132 The general guidelines and recommendations about diagnosis and treatment of TMDs from those conferences still hold true today, but there definitely is more evidence to support them. For example, the recommendations of the ADA conferences regarding treatment were that TMD management should be based on conservative and reversible (noninvasive) treatment modalities and, when possible, have a scientific basis for the recommended treatment.1,2 Evidence-based recommendations for TMD treatments that followed shortly after the ADA conferences were consistent with the conference recommendations.8,9 For instance, they emphasized that TMD treatments should generally be symptomatic and palliative; rarely do TMD treatments address causation or etiology.8,9 The more aggressive and irreversible types of TMD treatments were only necessary as a “when all else fails” option.8,9 As we learn more about chronic pain, it is clear that escalation to aggressive treatments is often inappropriate. In addition, the gold standard for TMD diagnosis in the early years was rather simplistic (but nonetheless true): (1) medical and dental histories, (2) TMJ clinical examination, and (3)

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when indicated, TMJ imaging.1,2,8,9 Parenthetically, orthodontics was considered TMJ neutral; it neither caused, prevented, nor cured TMD.7,133 Certainly, a consideration of these systematic reviews should be important to both the clinician and the academic with an interest in TMD. All general dental and orthodontic clinicians need to have current, evidence-based knowledge of the TMD literature to properly manage patients with signs and symptoms of TMD; this information also would be useful for patient referrals to other professionals. Furthermore, as stated by Mullmani134: “[It is] crucial for orthodontists to step up to the challenge and equip themselves with biologically sound scientific rationale and evidencebased facts to face the Google-equipped and informed patients and their interrogations.” By giving the reader succinct summaries of all 110 TMD reviews (and 10 Cochrane reviews), arranged in tables by topic categories, we hope that clinicians will find this updated information useful in dealing with TMD patients in their practices. After our data collection process in May 2017, another important TMD systematic review about TMD and occlusion was published in July 2017. Manfredini et al135 reviewed 822 citations and chose 25 studies that met their inclusion criteria (17 were case control studies of TMD vs non-TMD subjects). They believed that only 2 studies had high quality, whereas most fell into the moderate category. The general conclusion was that there was a lack of a clinically relevant association between TMD and dental occlusion; this means that occlusion should not be viewed as the critical host factor in the pathophysiology of TMD.135 This leads to the clinical implication that TMD treatments based on altering the dental occlusion should be viewed with caution, and patients should be advised of this current state of the evidence. As the past concepts of etiology and treatment fade away, there are important developments in the TMD field. Current evidence suggests that TMDs should be viewed as a group of orthopedic disorders, with strong genetic and psychosocial factors playing important roles.8-10 Of course, these developments were not expected by all previous TMD conferences. Experts now view TMD as a chronic musculoskeletal disorder, with all considerations of diagnosis and treatment based on those for orthopedics and physical therapy and physical medicine, as well as those related to chronic pain mangement.8-10 Regarding the genetic considerations for TMD, there are candidate genes that encode proteins involved in the processing of painful stimuli from serotonergic and cathecholinergic systems.37 Brain neuroimaging will increase to identify

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changes in brain areas related to chronic orofacial pain.38 No discussion of contemporary TMD research would be complete without noting the recent high level, evidence-based TMD study that was not a systematic review; it deals with one of the largest TMD research projects ever conducted. It was a 2016 report from 4 OPPERA studies that included the combined data from 4300 adults from sites in the United States: ie, 1 large cohort study and 3 case control studies.136 The findings from this report were that (1) there were higher rates of TMD in subjects with poor health and those who smoke and had deteriorating sleep quality, (2) participants' selfreports of jaw parafunction more strongly predicted TMD than did examiners' assessments such as tooth wear and TMJ derangement, and (3) among the 300 genes that were investigated, 6 loci were associated with chronic TMD, and 6 were associated with intermediate phenotype of TMD.136 This study was limited, since we evaluated only the abstracts from the systematic reviews in PubMed and the Cochrane database for 2017, and did not evaluate the full publications. Therefore, no assessment of the methodologic strengths and weaknesses of the these systematic reviews was undertaken. In addition, no conclusions could be drawn regarding the quality of the reporting of the systematic reviews in relation to PRISMA or the risk of bias at the review level. However, the analysis of only the abstracts was a deliberate choice, allowing us to present the complete panorama of what researchers have been reporting in their systematic reviews in this complex field. Also, it enabled us to edit those abstracts into readable summaries as presented in Appendix Tables I through VI. Furthermore, it was clear from reading these abstracts that all studies had not defined and classified TMD in the same manner. For instance, they did not always use the classic research diagnostic criteria/TMD criteria to describe their patient populations. The reader should therefore be cautious about interpreting the findings of each study, since it may include a mixed population of TMD subjects. At best, systematic reviews per se have limitations and shortcomings, so it is necessary to consider and evaluate all newly published literature.134 When the evidence-based paradigm was initially conceived, it was assumed that clinicians would merely need to wait and read published systematic reviews to be totally up to date on the literature in a field. Clearly, this is not the current belief regarding the utility of systematic reviews, including TMD systematic reviews. Therefore, clinicians should not abrogate their responsibility for acquiring the current best evidence in the TMD field by depending only on systematic reviews.134

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CONCLUSIONS

1.

2.

3.

There were over 110 TMD systematic review in the general PubMed listings as of 2017; in the Cochrane database, there were 10. In 2004, there were only 8 TMD systematic reviews. Most of the 2017 listings dealt with TMD treatments: 58 for the general PubMed listings and all 10 for the Cochrane listing. The recommendation in these TMD reviews was for conservative (noninvasive) and reversible therapies. Occlusal adjustments were not considered a logical and evidence-based treatment modality for TMD, because there is no scientific basis and also because it is an irreversible form of therapy. Much information could be gleaned from a study of the 2017 TMD systematic review abstracts.

ACKNOWLEDGMENT

We thank Jackie Hittner, librarian at the American Association of Orthodontists, for her help with the systematic review searches. REFERENCES 1. Griffiths RH. Report of the president's conference on the examination, diagnosis and management of temporomandibular disorders. J Am Dent Assoc 1983;106:75-7. 2. McNeill C, Mohl ND, Rugh JD, Tanaka TT. Termporomandibular disorders: diagnosis, management, education, and research. J Am Dent Assoc 1990;120:253-60. 3. Greene CS. Orthodontics and temporomandibular disorders. Dent Clin N Am 1988;32:529-38. 4. Rinchuse DJ, Kandasamy S. Centric relation: a historical and contemporary orthodontic perspective. J Am Dent Assoc 2006; 137:494-501. 5. Kandasamy S, Boeddinghaus R, Kruger E. Condylar position assessed by magnetic resonance imaging after various bite position registrations. Am J Orthod Dentofacial Ortho 2013;144:512-27. 6. Rinchuse DJ, Kandasamy S. A contemporary and evidence-based view of canine protected occlusion. Am J Orthod Dentofacial Orthop 2007;132:90-102. 7. Gianelly A. Orthodontics, condylar position and TMJ status. Am J Orthod Dentofacial Orthop 1989;95:521-3. 8. Turp JC, Greene CS, Strub JR. Dental occlusion: a critical reflection on past, present and future concepts. J Oral Rehabil 2008; 35:446-53. 9. Greene CS, Laskin DM. Temporomandibular disorders: moving from a dentally based to a medically based model. J Dent Res 2000;79:36-9. 10. Gardea MA, Gatchel RJ, Mishra KD. Long-term efficacy of biobehavioral treatment of temporomandibular disorders. J Behav Med 2001;24:341-59. 11. Ismail A, Bader J. Evidence-based dentistry in clinical practice. J Am Dent Assoc 2004;135:78-83. 12. Rinchuse DJ, McMinn JT. Summary of evidence-based systematic reviews of temporomandibular disroders. Am J Orthod Dentofacial Orthop 2006;130:715-20.

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13. De Kanter RJ, Truin GJ, Burgersdijk RC, Van't Hof MA, Battistuzzi PG, Kalsbeek H, et al. Prevalence in the Dutch adult population and a meta-analysis of signs and symptoms of temporomandibular disorder. J Dent Res 1993;72:1509-18. 14. da Silva CG, Pacheco-Pereira C, Porporattii AL, Savi MG, Peres MA, Flores-Mir C, et al. Prevalence of clinical signs of intra-articular temporomandibular disorders in children and adolescents: a systematic review and meta-analysis. J Am Dent Assoc 2016;147:10-8. 15. Al-Jundi MA, John MT, Setz JM, Szentpetery A, Kuss O. Metaanalysis of treatment need for temporomandibular disorders in adult nonpatients. J Orofac Pain 2008;22:97-107. 16. Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F. Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112: 453-62. 17. Kellesarian SV, Al-Kheraif AA, Vohra F, Ghanem A, Malmstrom H, Romanos GE. Cytokine profile in the synovial fluid of patients with temporomandibular joint disorders: a systematic review. Cytokine 2016;77:98-106. 18. Reneker J, Paz J, Petrosino C, Cook C. Diagnostic accuracy of clinical tests and signs of temporomandibular joint disorders: a systematic review of the literature. J Orthop Sports Phys Ther 2011;41:408-16. 19. Hussain AM, Packota G, Major PW, Flores-Mir C. Role of different imaging modalities in assessment of temporomandibular joint erosions and osteophytes: a systematic review. Dentomaxillofac Radiol 2008;37:63-71. 20. Ribeiro-Roffa RF, Marques KD, Pacheco MJ, Leies CR. Do computed tomography and magnetic resonance imaging add to temporomandibular joint disorder treatment? A systematic review of diagnostic efficacy. J Oral Rehabil 2011;38:120-35. 21. Koh KJ, List T, Peterson A, Rohlin M. Relationship between clinical and magnetic resonance imaging diagnoses and findings in degenerative and inflammatory temporomandibular joint diseases: a systematic literature review. J Orofac Pain 2009;23:123-39. 22. Limchaichana N, Peterson A, Rohlin M. The efficacy of magnetic resonance imaging in the diagnosis of degenerative and inflammatory temporomandibular joint disorders: a systematic literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:521-36. 23. Dong XY, He S, Zhu L, Dong TY, Pan SS, Tang LJ, et al. The diagnostic value of high-resolution ultrasonography for the detection of anterior disc displacement of the temporamandibular joint: a meta-analysis employing the HSROC statistical model. Int J Oral Maxillofac Surg 2015;44:852-8. 24. Li C, Su N, Yang X, Yang X, Shi Z, Li L. Ultrasonography for detection of disc displacement of temporomandibular joint: a systematic review and meta-analysis. J Oral Maxillofac Surg 2012;70: 1300-9. 25. Turp JC, Minagi S. Palpation of the lateral pterygoid region in TMD—where is the evidence? J Dent 2001;29:475-83. 26. Sharma S, Crow HC, McCall WD Jr, Gonzales YM. Systematic review of reliability and diagnostic validity of joint vibration analysis for diagnosis of temporomandibular disorders. Oraofac Pain 2013;27:51-60. 27. Perinetti G, Contardo L. Posturography as a diagnostic aid in dentistry: a systematic review. J Oral Rehabil 2009;36:922-36. 28. Perinetti G, Primozic J, Manfredini D, Di Lenarda R, Contardo L. The diagnostic potential of static body-sway recording in orthodontics: a systematic review. Eur J Orthod 2013;35:696-705.

American Journal of Orthodontics and Dentofacial Orthopedics

Rinchuse and Greene

29. Naeije M, Kalaykova S, Visscher CM, Lobbezoo F. Evaluation of the research diagnostic criteria for temporomandibular disorders for the recognition of an anterior disc displacement with reduction. J Orofac Pain 2009;23:303-11. 30. Jimenez-Silva A, Pena-Duran C, Tobar-Reyes J, FrugoneZambra R. Sleep and awake buxism in adults and its relationship with temporomandibular disorders: a systematic review from 2003 to 2014. Acta Odontol Scand 2017;75:36-58. 31. Manfredini D, Lobbezzoo F. Relationship between bruxism and temporomandibular disorders: a systematic review of literature from 1998 to 2008. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e26-50. 32. Kim MR, Graber TM, Viana MA. Orthodontics and temporomandibular disorder: a meta-analysis. Am J Orthod Dentofacial Orthop 2002;121:438-46. 33. Iodice G, Danzi G, Cimino R, Paduano S, Michelotti A. Association between posterioir crossbite, masticatory muscle pain, and disc displacement: a systematic review. Eur J Orthod 2013;35: 737-44. 34. Manfredini D, Segu M, Arveda N, Lombardo L, Siciliani G. Temporomandibular joint disorders in patient with different facial morphology. A systematic review of the literature. J Oral Maxillofac Surg 2016;74:29-46. 35. Marzooq AA, Yatabe M, Ai M. What type of occlusal factors play a role in termporomandibular disorders? A literature review. J Med Dent Sci 1999;46:111-6. 36. Gesch D, Bernhardt O, Kirbschus A. Association of malocclusion and functional occlusion with temporomandibular disorders (TMD) in adults: a systematic review of population-based studies. Quintessence Int 2004;35:211-21. 37. Visscher CM, Lobbezzoo F. TMD pain is partly heritable. A systematic review of family studies and genetic association studies. J Oral Rehabil 2015;42:386-99. 38. Lin CS. Brain signature of chronic orofacial pain: a systematic review and meta-analysis on neuroimaging research of trigeminal neuropathic pain and temporomandibular joint disorders. PLoS One 2014;9:e94300. 39. Dijkstra PU, Kropmans TJ, Stegenga B. The association between generalized joint hypermobility and temporomandibular joint disorders: a systematic review. J Dent Res 2002;81:158-63. 40. Olivo SA, Bravo J, Magee DJ, Thie NM, Major PW, Flores-Mir C. The association between head and cervical posture and temporomandibular disorders: a systematic review. J Orofac Pain 2006; 20:9-23. 41. Rocha CP, Croci CS, Caria PH. Is there relationship between temporomandibular disorders and head and cervical posture? A systematic review. J Oral Rehabil 2013;40:875-81. 42. Chaves TC, Turci AM, Pinheiro CF, Sousa LM, Grossi DB. Static body postural misalignment in individuals with temporomandibular disorders: a systematic review. Braz J Phys Ther 2014;18: 481-501. 43. Afari N, Ahurmada SM, Wright LJ, Mostoufi S, Golnari G, Reis V, et al. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosom Med 2014;76: 2-11. 44. Haggman-Hennikson B, List T, Westergren HT, Axelsson SH. Temporomandibular disorder pain after whiplash trauma: a systematic review. J Orofac Pain 2013;27:217-26. 45. Haggman-Henrikson B, Rezvani M, List T. Prevalence of whiplash trauma in TMD patients: a systematic review. J Oral Rehabil 2014; 41:59-68. 46. Aggarwal VR, Lovell D, Peters S, Javidi H, Joughin A, Goldthorpe J. Psychosocial interventions for the management

43

47.

48.

49.

50.

51.

52.

53.

54. 55.

56.

57.

58.

59.

60.

61.

62.

63.

American Journal of Orthodontics and Dentofacial Orthopedics

of chronic orofacial pain. Cochrane Database Syst Rev 2011; (11):CD008456: update, 2015 Dec 17;(12):CD008456. Al-Ani MZ, Davies SJ, Gray RJ, Sloan P, Glenny AM. Stabilisation splint therapy for temporomandibular pain dysfunction. Cochran Database Syst Rev 2016;(1):CD002778. De Souza RF, Lovato da Silva CH, Nasser M, Fedorowicz Z, AlMuharraqi MA. Interventions for the management of temporomandibular joint osteoarthritis. Cochrane Database Syst Rev 2012;(4):CD007261. Guo C, Shi Z, Revington P. Arthrocentesis and lavage for treating temporomandibular joint disorders. Cochrane Database Syst Rev 2015;(12):CD004973. Koh H, Robinson PG. Occlusal adjustment for treating and preventing temporomandibular joint disorders. Cochrane Database Syst Rev 2016;(1):CD003812. Luther F, Layton S, McDonald F. Orthodontics for treating temporomandibular (TMJ) disorders. Cochrane Database Syst Rev 2016;(1):CD006541. Mujakpenruo HR, Watson M, Morrison R, Macfarlane TV. Pharmacological intervention for pain in patientrs with temporomandibular disorders. Cochrane Database Syst Rev 2010;(10): CD004715. Rigon M, Perelra LM, Bortoluzzi MC, Loguercio AD, Ramos AL, Cardoso JR. Arthroscopy for temporomandibular disorders. Cochrane Database Syst Rev 2015;(12):CD006385. Shi Z, Guo C, Awad M. Hyaluronate for temporomandibular disorders. Cochrane Database Syst Rev 2013;(10):CD002970. Agostino P, Ugolini A, Signori A, Silvestrini-Biavati A, Harrison JE, Riley P. Orthodontic treatment for posterior crossbites. Cochrane Database Syst Rev 2014;(8):CD000979. de Freitas RF, Ferreira MA, Barbosa GA, Calderon PS. Counseling and self-management therapies for termporomandibular disorders: a systematic review. J Oral Rehabil 2013;40:864-74. Randhawa K, Bohay R, Cote R, van der Veide G, Sutton D, Wong JJ, et al. The effectiveness of noninvasive interventions for temporomandibular disorders: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTMa) Collaboration. Clin J Pain 2016;32:260-78. Liu HX, Liang QJ, Xiao P, Jiao HX, Gao Y, Ahmetjiang A. The effectiveness of cognitive-behavioral therapy for temporomandibular disorders: a systematic review. J Oral Rahabil 2012;39: 55-62. Turp JC, Jokstad A, Motschall E, Schindler H, Windeck-Getaz I, Ettlin DA. Is there a superiority of multimodal as opposed to simple therapy in patients with temporomandibular disorders? A qualitative systematic review of the literature. Clin Oral Implants Res 2007;18(Suppl 3):138-50. Akinbami BO. Evaluation of the mechanism and principles of management of temporomandibular joint dislocation. Systematic review of literature and a proposed new classification of temporomandibular joint dislocation. Head Face Med 2011; 15:7-10. Naeije M, Te Veldhuis AH, Te Veldhuis EC, Visscher CM, Lobbezoo F. Disc displacement within the human temporomandibular joint: a systematic review of a 'noisy annoyance'. Oral Rehabil 2013;40:139-58. Al-Baghdadi M, Durhan J, Araujo-Soares V, Robalino S, Errington L, Steele J. TMJ disc displacement without reduction management: a systematic review. J Dent Res 2014;93(7 Suppl):37S-51S. Zhang Y, Montoya L, Ebrahim S, Busse JW, Couban R, McCabe RE, et al. Hypnosis/relaxation therapy for temporomandibular disorders: a systematice review and meta-analysis of

July 2018  Vol 154  Issue 1

Rinchuse and Greene

44

64.

65.

66.

67.

68.

69.

70.

71. 72.

73.

74.

75.

76.

77.

78.

randomized controlled trials. J Oral Facial Pain Headache 2015; 29:115-25. Kotiranta U, Suvinen T, Forssell H. Tailored treatments in temporomandibular disorders: where are we now? A systematic qualitative literature review. J Oral Facial Pain Headache 2014;28: 28-37. Roldan-Barraza C, Janko S, Villanueva J, Araya I, Lauer HC. A systematic review and meta-analysis of usual treatment versus psychosocial interventions in the treatment of myofascial temporomandibular disorder pain. J Oral Facial Pain Headache 2014;28:205-22. Crider AB, Glaros AG. A meta-analysis of EMG biofeedback treatment of temporomandibular disorders. J Orofac Pain 1999;13: 29-37. Crider A, Glaros AG, Gevirtz RN. Efficacy of biofeedback-based treatments for temporomandibular disorders. Appl Psycholphysiol Biofeedback 2005;30:333-45. Ernst E, White AR. Acupuncture as a treatment for temporomandibular joint dysfunction: a systematic review of randomized trials. Arch Otolarygol Head Neck Surg 1999;125:269-72. La Touche R, Angulo-Diaz-Parreno S, de-la-Hoz JL, FernandezCarnero J, Ge HY, Linares MT, et al. Effectiveness of acupuncture in the treatment of temporomandibular disorders of muscular origin: a systematic review of the last decade. J Altern Complement Med 2010;16:107-12. La Touche R, Goddard G, De-la-Hoz JL, Wang K, ParisAlemany A, Angulo-Diaz-Parreno S, et al. Acupuncture in the treatment of pain in temporomandibular disorders: a systematic review and meta-analysis of randomized controlled trials. Clin J Pain 2010;26:541-50. Cho SH, Whang WW. Acupuncture for temporomandibular disorders: a systematic review. J Orofac Pain 2010;24:152-62. Jung A, Shin BC, Lee MS, Sim H, Ernst E. Acupuncture for treating temporomandibular joint disorders: a systematic review and meta-analysis of randomized, sham-controlled trials. J Dent 2011;39:341-50. Wu JY, Zhang C, Xu YP, Yu YY, Peng L, Leng WD, et al. Acupuncture therapy in the management of the clinical outcome for temporomandibular disorders: a PRISMA-compliant meta-analysis. Medicine (Baltimore) 2017;96:e6064. Turp JC, Motschall E, Schindler HJ, Heydecke G. In patients with temporomandibular disorders, do particular interventions influence oral health-related quality of life? A qualitative systematic review of the literature. Clin Oral Implants Res 2007;(Suppl 3): 127-37. Januzzi E, Nasri-Heir C, Grossman E, Leite FM, Heir GM, Melnik T. Combined palliative and anti-inflammatory medications as treatment of temporomandibular joint disc displacement without reduction: a systematic review. Cranio 2013;31:211-25. Senye M, Mir CF, Morton S, Thie NM. Topical nonsteroidal anti-inflammatory medications of temporomandibular joint degenerative pain: a systematic review. J Orofac Pain 2012; 26:26-32. List T, Axelsson S, Leijon G. Pharmacologic interventions in the treatment of temporomandibular disorders, atypical facial pain and burning mouth syndrome. A qualitative systematic review. J Orofac Pain 2003;17:301-10. Cascos-Romero J, Vazquez-Delgado E, Vazquez-Rodriguez E, Gay-Escoda C. The use of tricyclic antidepressants in the treatment of temporomandibular joint disorders: systematic review of the literature of the last 20 years. Med Oral Patol Oral Cir Bucal 2009;14:E3-7.

July 2018  Vol 154  Issue 1

79. Craane B, Dijkstra PU, Stappaerts K, De Laat A. Methodological quality of a systematic review on physical therapy for temporomandibular disorders: influence of hand search and quality scales. Clin Oral Investig 2012;16:295-303. 80. Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A. Effectiveness of manual therapy and therapeutic exercise for temporomandibular disorders: systematic review and meta-analysis. Phys Ther 2016;96:9-25. 81. McNeely ML, Armijo Olivo S, Magee DJ. A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders. Phys Ther 2006;86:710-25. 82. Medicott MS, Harris SR. A systematic review of the effectiveness of exercise, manual therapy, electrotherapy, relaxation training, and biofeedback in the management of temporomandibular disorder. Phys Ther 2006;86:955-73. 83. Calixtre LB, Moreira RF, Franchini GH, Aburquerque-Sendin F, Oliveira AB. Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials. J Oral Rehabil 2015;42:847-61. 84. Martins WR, Blasczyk JC, Aparecida Furlan de Oliveira M, Lagoa Goncalves KF, Bonini-Rocha AC, Dugailly PM, de Oliveira RJ. Efficacy of musculoskeletal manual approach in the treatment of temporomandibular disorder: a systematic review with metaanalysis. Man Ther 2016;21:10-7. 85. Brantingham JW, Cassa TK, Bonnefin D, Pribicevic M, Robb A, Pollard H, et al. Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: a systematic review. J Manipulative Phsiol Ther 2013;36:143-201. 86. Fricton J, Veilly A, Ouyang W, Look JO. Does exercise therapy improve headache? A systematic review with meta-analysis. Curr Pain Headache Rep 2009;13:413-9. 87. Al-Baghdadi M, Durham J, Steele J. Timing interventions in relation to temporomandibular joint closed lock duration: a systematic review of 'locking duration'. J Oral Rehabil 2014;41:24-58. 88. Paco M, Peleteiro B, Duarte J, Pinho T. The effectiveness of physiotherapy in the management of temporomandibular disorders: a systematic review and meta-analysis. J Oral Facial Pain Headache 2016;30:210-20. 89. Kreiner M, Betancor E, Clark GT. Occlusal stabilization appliances. Evidence of their efficacy. J Am Dent Assoc 2001;132: 770-7. 90. Turp JC, Komine F, Hugger A. Efficacy of stabilization splints for the management of patients with masticatory muscle pain: a qualitative systematic review. Clin Oral Investig 2004;8:179-95. 91. Ebrahim S, Montoya L, Busse JW, Carrasco-Labra A, Guyatt GH. The effectiveness of splint therapy in patients with temporomandibular disorders: a systematic review and meta-analysis. J Am Dent Assoc 2012;143:847-57. 92. Al-Ani Z, Gray RJ, Davies SJ, Sloan P, Glenny AM. Stabilization splint therapy for the treatment of temporomandibular myofascial pain: a systematic review. J Dent Educ 2005;69:1242-50. 93. Fricton J, Look JO, Wright E, Alencar FG, Chen H, Lang M, et al. Systematic review and meta-analysis of randomized controlled trials evaluating intraoral orthopedic appliances for temporomandibular disorders. J Orofac Pain 2010;24:237-54. 94. Forssell H, Kalso E, Koskela P, Vehmanen R, Puukka P, Alanen P. Occlusal treatments in temporomandibular disorders: a qualitative systematic review of randomized controlled trials. Pain 1999;83:549-60. 95. Fricton J. Current evidence providing clarity in management of temporomandibular disorders: summary of a systematic review

American Journal of Orthodontics and Dentofacial Orthopedics

Rinchuse and Greene

96.

97.

98.

99.

100.

101.

102.

103.

104.

105.

106.

107.

108.

109.

110.

111.

112.

of randomized clinical trials for intra-oral appliances and occlusal therapies. J Evid Based Dent Pract 2006;6:48-52. Tsukiyama Y, Baba K, Clark GT. An evidence-based assessment of occlusal adjustment as a treatment for temporomandibular disorders. Prosthet Dent 2001;86:57-66. de Souza RF, Lovato da Siva CH, Nasser M. Fedorowicz. AlMuharraqi MA. Interventions for the management of temporomandibular joint osteoarthritis. Cochrane Database Syst Rev 2012;(4):CD007261. Manfredini D, Piccotti F, Guarda-Nardini L. Hyaluronic acid in the treatment of TMJ disorders: a systematic review of the literature. Cranio 2010;28:166-76. Machado E, Bonotto D, Cunali PA. Intra-articular injections with corticosteroids and sodium hyaluronte for treating temporomandibular joint disorders: a systematic review. Dental Press J Orthod 2013;18:128-33. Li C, Zhang Y, Lv J, Shi Z. Inferior or double joint spaces injection versus superior joint space injection for temporomandibular disorders: a systematic review and meta-analysis. J Oral Maxillofac Surg 2012;70:37-44. Chen YW, Chiu YW, Chen CY, Chuang SK. Botulinum toxin therapy for temporomandibular joint disorders: a systematic review of randomized controlled trials. Int J Oral Maxillofac Surg 2015;44:1018-26. Stoustrup P, Kristensen KD, Verna C, Kuseler A, Pedersen TK, Herlin T. Intra-articular steroid injection for temporomandibular joint arthritis in juvenile idiopathic arthritis: a systematic review on efficacy and safety. Semin Arthritis Rheum 2013; 43:63-70. Melis M, Di Glosia M, Zawawi KH. Low level laser therapy for the treatment of temporomandibular disorderss: a systematic review of the literature. Cranio 2012;30:304-12. Maia ML, Bonjardim LR, Quintans Jde S, Ribeiro MA, Maia LG, Conti PC. Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review. J Appl Oral Sci 2012;20:594-602. Chen J, Huang Z, Ge M, Gao M. Efficacy of low-level laser therapy in the treatment of TMDs: a meta-analysis of 14 randomised controlled trials. J Oral Rehabil 2015;42:291-9. Petrucci A, Sgolastra F, Gatto R, Mattei A, Monaco A. Effectiveness of low-level laser therapy in temporomandibular disorders: a systematic review and meta-analysis. J Orofac Pain 2011;25: 298-307. de Almeida VL, Vitorino Nde S, Nascimento AL, da Silva Junior DC, de Freitas PH. Stability of treatments for recurrent temporomandibular joint luxation: a systematic review. Int J Oral Maxillofac Surg 2016;45:304-7. List T, Axelsson S. Management of TMD: evidence from systematic reviews and meta-analyses. J Oral Rehabil 2010;37: 430-51. Stepan L, Shaw CL, Oue S. Temporomandibular disorder in otolaryngology: systematic review. J Laryngol Otol 2017; 131(Suppl 1):S50-6. Te Veldhuis EC, Te Veldhuis AH, Koudstaal M. Treatment management of children with juvenile idiopathic arthritis with temporomandibular joint involvement: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2014;117:581-9. von Bremen J, Ruf S. Juvenile idiopathic arthritis-and now? A systematic literature review of changes in craniofacial morphology. J Orofac Orthop 2012;73:265-76. Al-Riyami S, Moles DR, Cunningham SJ. Orthognathic treatment and temporomandibular disorders: a systematic review. Part 1. A new quality-assessment technique and analysis of study charac-

45

113.

114.

115.

116.

117.

118.

119.

120.

121.

122.

123.

124.

125.

126.

127.

128.

American Journal of Orthodontics and Dentofacial Orthopedics

teristics and classification. Am J Orthod Dentofacial Orthop 2009; 136:624.e1-15: discussion, 624-5. Al-Riyami S, Cunningham SJ, Moles DR. Orthognathic treatment and temporomandibular disorders: a systematic review. Part 2. Signs and symptoms and meta-analyses. Am J Orthod Dentofacial Orthop 2009;136:626.e1-16: discussion, 626-7. Abrahamsson C, Ekberg E, Hennikson T, Bondemark L. Alterations of temporomandibular disorders before and after orthognathic surgery. Angle Orthod 2001;77:729-34. Bermell-Baviera A, Bellot-Arcis C, Montiel-Company JM, Almerich-Silla JM. Effects of manibular advancement surgery on the temporomanibular joint and muscular and articular adaptive changes- a systematic review. Int J Oral Maxillofac Surg 2016; 45:545-52. Al-Moraissi EA. Open versus arthroscopic surgery for the management of internal derangement of the temporomandibular joint: a meta-analysis of the literature. Int J Oral Maxillofac Surg 2015;44:763-70. Al-Moraissi EA. Arthroscopy versus arthrocentesis in the management of internal derangement of the temporomandibular joint: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2015;44:104-12. Al-Moraissi EA, El-Sharkawy TM, Mounair RM, El-Ghareeb TI. A systematic review and meta-analysis of the clinical outcomes for various surgical modalities in the management of temporomandibular joint ankylosis. Int J Oral Maxillofac Surg 2015;44: 470-82. Ma J, Jiang H, Liang L. Interpositional arthroplasty versus reconstruction arthroplasty for temporomandibular joint ankylosis: a systematic review and meta-analysis. J Craniomaxillofac Surg 2015;43:1202-7. Al-Moraissi EA, Wolford LM. Does temporomandibular joint pathology with or without surgical management affect the stability of counterclockwise rotation of the maxillomandibular complex in orthognathic surgery? A systematic review and meta-analysis. J Oral Maxillofac Surg 2017;75:805-21. Katsnelson A, Markiewicz MR, Keith DA, Dodson TB. Operative management of temporomandibular joint ankylosis: a systematic review and meta-analysis. J Oral Maxillofac Surg 2012;70:531-6. Lindenmeyer A, Sutcliffe P, Eghltessad M, Goulden R, Speculand B, Harris M. Oral and maxillofacial surgery and chronic painful temporomandibular disorders- a systematic review. J Oral Maxillofac Surg 2010;66:2755-64. Reston JT, Turkelson CM. Meta-analysis of surgical treatments for temporomandibular articular disorders. J Oral Maxillofac Surg 2003;61:3-10: discussion, 10-2. Vos LM, Huddleston Slater JJ, Stegenga B. Lavage therapy versus nonsurgical therapy for the treatment of arthralgia of the temporomandibular joint: a systematic review of randomized controlled trials. J Orofac Pain 2013;27:171-9. Ma J, Liang L, Jiang H, Gu B. Gap arthroplasty versus interpositional arthroplasty for temporomandibular joint ankylosis: a meta-analysis. PLoS One 2015;10(5):e0127652. Catherine Z, Breton P, Bouletreau P. Condylar resorption after orthognathic surgery: a systematic review. Rev Stomatol Chir Maxillofac Chir Orale 2016;117:3-10. Al-Saleh MA, Armijo-Olivo S, Thie N, Seikaly H, Boulanger P, Wolfaardt J, et al. Morphologic and functional changes in the temporomandibular joint and stomatognathic system after transmandibular surgery in oral and oropharyngeal cancers: a systematic review. J Otolaryngol Head Neck Surg 2012;41:345-60. Fricton JR, Quyang W, Nixdort DR, Schiffman EL, Velly AM, Look JO. Critical appraisal of methods used in randomized

July 2018  Vol 154  Issue 1

Rinchuse and Greene

46

129.

130.

131.

132.

controlled trials of treatment for temporomandibular disorders. J Orofac Pain 2010;24:139-51. Safaee M, Oh T, Sun MZ, Parsa AT, McDermott MW, El-Sayed, et al. Pigmented villonodular synovitis of the temporomandibular joint with intracranial extension: a case series and systematic review. Head Neck 2015;37:1213-24. Dahlstrom L, Carlsson GE. Temporomandibular disorders and oral health-related quality of life. A systematic review. Acta Odontol Scand 2010;68:80-5. National Institutes of Health Technology Assessment Conference Statement. Management of temporomandibular disorders. J Am Dent Assoc 1996;127:1595-606. Mohl ND, Attanasio R. The third educational conference to develop the curriculum in temporomandibular disorders

July 2018  Vol 154  Issue 1

133. 134.

135.

136.

and orofacial pain: introduction. J Orofac Pain 2002;16: 173-5. Michelotti A, Iodice G. The role of orthodontics in temporomandibular disorders. J Oral Rehabil 2010;37:411-29. Mullmani PS. Evidence-based practice and the evidence pyramid: a 21st century orthodontic odyssey. Am J Orthod Dentofacial Orthop 2017;152:1-8. Manfredini D, Lombardo L, Siciliani G. Temporomandibular disorders and dental occlusion. A systematic review of association studies: end of an era? J Oral Rehabil 2017;44:908-23. Slade GD, Ohrbach R, Greenspan JD, Fillingim RB, Bair E, Sanders AE, et al. Painful temporomandibular disorder: a decade of discovery from OPPERA studies. J Dent Res 2016; 95:1084-92.

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Rinchuse and Greene

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Appendix Table I. Prevalence of TMD Author De Kanter et al13 1993

Topic Prevalence in population

Articles meeting criteria 6577 persons

da Silva et al14 2016

Prevalence in population

/11

Al-Jundi et al15 2008

Prevalence in population

676/17

Manfredini et al16 2011

Prevalence in population and in TMD clinic

/21

Quality Medium

-

Findings/conclusions Dutch-perceived dysfunction rate of 30%; clinically assessed dysfunction rate of 44%. One in 6 children and adolescents has clinical signs of TMD. The treatment need of TMD in the general adult population is substantial and varies according to definition, criteria, and age. RDC/TMD prevalence reports were highly variable across studies. Myofascial pain with and without mouthopening limitation was the most common diagnosis in TMD populations, and disc displacement with reduction was the most common diagnosis in community samples.

/, the number before the symbol is the total number of articles accessed and the number after the symbol is the number meeting the criteria. If there is no number before the symbol, the number could not be ascertained from the abstract. RDC, Research Diagnostic Criteria.

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46.e2

Appendix Table II. Diagnosis of TMD

Author Kellesarian et al17 2016

Topic Cellular DX

Articles meeting criteria /15

Reneker et al18 2011

Signs/tests

/7

Low

Hussain et al18 2008

Imaging

-

Dated

Ribeiro-Rotta et al20 2011

Imaging

257/1

Low

Koh et al21 2009

Imaging

219/23

Medium

Limchaichana et al22 2006

Imaging

494/22

Low-medium

Dong et al23 2015

Ultrasound

/11

Low

Li et al24 2012

Ultrasound

/15

Medium

Turp and Minagi25 2001

Muscle palpation

/5

Medium

Sharma et al26 2013

Joint vibration

/15

Low

Perinetti and Contardo27 2009

Posturography

/21

Low

Perinetti et al28 2013

“Body sway”

/12

-

Naeije et al29 2009

RDC/TMD

-

-

Quality Medium

Findings/conclusions Cytokines IL-10, osteoclastogenesis inhibitory factor/ osteoprotegerin (OCIF/OPG), and VEGF were found In the synovial fluid of patients with TMD, which could have an anti-inflammatory effect. No clear evidence to conclude whether current signs and tests are valid to diagnose TMD and distinguish among the subclasses. Axially corrected sagittal tomography is currently the imaging of choice for diagnosing erosion and osteophytes in the TMJ. CT does not seem to add any significant information to what Is obtained from axially corrected sagittal tomography. CBCT should be considered in the future. No conclusions could be made on the benefit of MRI and CT for TMD. No clear evidence was found for a relationship between clinical TMD signs and MRI. The evidence is insufficient for the diagnostic efficacy of MRI. Diagnostic value of high-resolution ultrasonography for detection of anterior disc displacement of the TMJ has advantages of simplicity and cost, but questionable diagnostic efficacy. The diagnostic efficacy of ultrasonography is acceptable and can be used as a rapid preliminary diagnostic method to exclude some clinical suspicions. Palpation of the lower head of the lateral pterygoid muscle lacks scientific support, and procedure should be discarded. Little to no evidence to support joint vibration analysis for diagnosis of TMD. Body posture monitoring: current evidence does not support the usefulness of posturography as a diagnostic aid in dentistry, including TMD. More related to orthodontics and only a minor impact for TMD. Body sway as a diagnostic aid in orthodontics may not be indicated. RDC/TMD have no great diagnostic value in the recognition of anterior TMJ disc displacement.

/, the number before the symbol is the total number of articles accessed and the number after the symbol is the number meeting the criteria. If there is no number before the symbol, the number could not be ascertained from the abstract. DX, disease; RDC, Research Diagnostic Criteria.

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American Journal of Orthodontics and Dentofacial Orthopedics

Bruxism Bruxism

Kim et al32 2004

Orthodontics

950/31

Low

Iodice et al33 2013

Crossbites/TMD

2929/43

Low-medium

Manfredini et al34 2016

Facial types

/34

Low

Marzooq et al35 1999

Occlusion

275 articles

-

Gesch et al36 2004

Occlusion

22/4

Low

Visscher and Lobbezzoo37 2015

Heredity/genes

/21

-

Lin38 2014 Dijkstra et al39 2002 Olivo et al40 2006

“Brain” Hypermobility Posture

/14 /14 /12

Low Low

Rocha et al41 2013 Chaves et al42 2014 Afari et al43 2014

Posture Posture Trauma/psychological

22/17 /20 /71

Low -

Haggman-Hennikson et al44 2013

Whiplash

125/8

-

Haggman-Henrikson et al45 2014

Whiplash

129/32

-

Topic

Quality Low-medium low

Findings/conclusions Positive relationship of bruxism and TMD. Positive association with TMD pain for self-report or clinical bruxism, lower association for more quantitative and specific methods to diagnose bruxism. Anterior tooth wear not found to be a major risk for TMD. No definitive conclusions due to heterogeneity. Nonetheless, data do not indicate that traditional orthodontic treatment increased the prevalence of TMD. Posterior crossbite associated with the development of disc displacement, muscular pain, and tenderness, linked to skeletal and muscular adaptation and TMD? It was impossible to draw definite conclusions; long-term controlled studies are needed. No definitive conclusions, but the authors' conjecture was based on the review that it would seem reasonable to suggest that skeletal Class II profiles and hyperdivergent growth patterns are likely to be associated with increased frequency of TMJ disc displacement and degenerative disorders. Studies and literature do not support occlusal etiological factors in the etiology of TMD. Few associations were established between malocclusion or functional occlusion and signs and symptoms of TMD. Evidence for the role of heritability in the development of TMD pain is cumulating: genetic contributions from candidate genes that encode proteins involved in the processing of painful stimuli from serotonergic and catecholaminergic system. Thalamocortical pathway plasticity: prefrontal cortex and basal ganglia changes. It is not clear whether generalized joint hypermobility is associated with TMD. The association between intra-articular and muscular TMD and head and cervical posture is unclear. The relationship between TMD and head and neck posture is unclear. There is strong evidence of craniocervical postural changes in myogenous TMD. Traumatic events (of psychological, emotional, sexual, or physical nature) and combat exposure (PTSD) are associated with increased prevalence of functional somatic syndromes, including TMD. PTSD was significantly higher than sexual or physical abuse. Some evidence that prevalence and incidence of TMD pain is increased after whiplash trauma. The poorer treatment outcome suggests that TMD pain after whiplash trauma has a different pathophysiology compared with TMD pain localized to the facial region. Whiplash trauma might be an initiating or aggravating factor as well as a comorbid condition for TMD. The prevalence of whiplash trauma ranged from 8.4% to 70% in TMD populations, compared with 1.7% to 13% in non-TMD group.

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Author Jimenez-Silva et al30 2017 Manfredini and Lobbezzoo31 2010

Articles meeting criteria /39 /46

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American Journal of Orthodontics and Dentofacial Orthopedics

Appendix Table III. Etiology of TMD

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Appendix Table IV. Treatment of TMD

Author de Freitas et al56 2013

Randhawa et al57 2016

Topic Counseling

Articles meeting criteria 581/7

/31

Quality Low

Turp et al59 2007

Noninvasive/conservative

/11

Akinbami60 2011

Conservative/noninvasive

128/79

Naeije et al61 2013

Conservative/disc displacement

167

Medium-high

Al-Baghdadi et al62 2014

Conservative/disc displacement

/20

Low/medium

Zhang et al63 2015

Hypnosis/relaxation

/3

Low

Kotiranta et al64 2014

Psychosocial

/7

Low

Roldan-Barraza et al65 2014

Psychosocial

-

Low

Crider and Glaros66 1999

Biofeedback

/13

Low

Crider et al67 2005

Biofeedback

/14

Medium

Ernst and White68 1999 La Touche et al69 2010

Acupuncture Acupuncture

/6 /4

Low -

323/5

Low -

Medium

Rinchuse and Greene

American Journal of Orthodontics and Dentofacial Orthopedics

Liu et al58 2012

Cognitive-behavioral therapy/ self care/splints (noninvasive) Cognitive-behavioral therapy

Findings/conclusions Counseling- and self-management-based therapies could be considered conservative low-cost and beneficial treatment alternatives for treating TMD, with similar results to those of splints. Cognitive behavioral therapy, intraoral myofascial therapy, and self-care are therapeutic options for persistent TMD. Insufficient evidence to make a firm recommendation for the use of cognitive behavioral therapy over other interventions for treatment of TMD. Patients without major psychological symptoms do not require more than simple therapy. In contrast, patients with major psychological involvement need multimodal, interdisciplinary therapies; the importance of psychological factors In TMD pain. More complex and invasive methods of TMD treatments may not offer the best option and outcome, Recommend conservative approaches be used and exhausted before more invasive surgical treatments. A disc displacement with reduction is mostly a stable, pain-free, and lifelong condition of the TMJ. In only a few patients, the disc loses its capacity to reduce on opening. The favorable natural course of disc displacements only warrants active treatment for symptomatic disc displacements without reduction. The primary option is conservative, nonsurgical treatment focused at speeding up the natural process of alleviation of pain and improvement in mouth opening. For most patients, it is just a pain-free, lifelong, “noisy annoyance” from the TMJ. TMJ disc displacement without reduction.Patients with symptomatic disc displacement without reduction should be initially treated by the simplest and least invasive intervention. Hypnosis/relaxation therapy may have a beneficial effect on maximal pain and active maximal mouth opening but not on pain and pressure pain threshold. Evaluate RDC/TMD axis 2: cautious support for the notion that treatment targeted to different psychosocial subgroups of TMD paint patients may be beneficial. No evidence was found to distinguish the clinical effectiveness between “usual treatment” and psychosocial interventions for myofascial TMD pain. There was a tendency for greater improvements of psychological outcomes for psychosocial interventions, and physical functioning was slightly more responsive than “usual treatment.” Although limited, the available data support the efficacy of EMG biofeedback treatment for TMD. Surface electromyography training (SEMG) (biofeedback) with adjunctive cognitivebehavioral therapy is an efficacious treatment for TMD. Also, SEMG and biofeedback-assisted relaxation training (BART) are probably efficacious treatments. Low-level evidence that acupuncture is effective for TMD treatment. Short-term improvement; more studies needed.

Appendix Table IV. Continued

Topic

Quality

Acupuncture

/8

Medium

Cho and Whang71 2010

Acupuncture

/19

Medium

Jung et al72 2011 Wu et al73 2017

Acupuncture Acupuncture

/7 /9

Low

2001

Acupuncture

74/14

Turp et al74 2007

Pharmacology

/7

*Mujakperuo et al52 2010

Pharmacology

/11 496 subjects

Januzzi et al75 2013

Pharmacology

/2

Low

Senye et al76 2012

Pharmacology

/1

Low

List et al77 2003

Pharmacology

Cascos-Romero et al78 2009

Pharmacology

/11 368 subjects -

Craane et al79 2012

Physical therapy

/86

Armijo-Ovivo et al80 2016

Physical therapy

-

Low

McNeely et al81 2006

Physical therapy

36/12

Low

Medicott and Harris82 2006

Physical therapy

/30

Low

Low

-

Low-medium

Findings/conclusions Acupuncture is a reasonable adjunctive treatment for a short-term analgesic effect in patients with TMD pain Moderate evidence that acupuncture is an effective intervention to reduce symptoms associated with TMD. The evidence for acupuncture as a symptomatic treatment for TMD is limited. Conventional acupuncture is effective in reducing pain in patients with TMD, especially those with myofascial pain. In 3 of 3 RCTs, acupuncture proved effective for the treatment of TMD. Treatment should be given weekly for a total of 6 treatments. Pharmacologic meds led to at least some improvement of OHRQofL in patients with TMD. The only exception was patients with multiple TMJ surgeries. For the only RCT, a 6-week course of nonselective cyclooxygenase (COX) inhibitor naproxen may lead to slightly better OHQofL in patients with TMJ arthralgia than the selective COX-2 inhibitor celecoxib. Insufficient evidence to make a conclusion about effectiveness of a wide range of drugs (and combined with nondrug therapies) for the management of pain due to TMD. There was insufficient evidence regarding the efficacy and safety of palliative treatments (self-care) associated with anti-inflammatory vs other treatments, or absence of treatment on pain reduction in patients with TMD. Presently, there is insufficient evidence to support the use of topically applied NSAID meds to palliate TMJ degenerative joint disease. The common use of analgesics in TMD, including rheumatoid arthritis, atypical facial pain, and burning mouth syndrome is not supported by scientific evidence. Modest evidence to support the use of tricyclic antidepressants or the treatment of TMD. No conclusions drawn related to effectiveness of physical therapy for TMD treatment. Authors were most interested in quality of search methods. No high-quality evidenced was found, indicating great uncertainty about the effectiveness of exercise and mobilization and manipulation (MT) for treatment of TMD. No clear indication of superiority of exercise vs other conservative treatments for TMD. MT alone or combined with exercise at the jaw or cervical level showed promising effects. Poor quality studies on effectiveness of physical therapy interventions in TMD management. Look at acupuncture, active exercise, muscular awareness relaxation therapy, biofeedback, and low-level laser therapy. Recommendations viewed with caution. Active exercises and manual mobilizations may be effective. Postural training may be used combined with other interventions. Midlaser therapy may be more effective than other electromyography training. Programs involving relaxation techniques and biofeedback, electromyography training, and proprioceptive reeducation may be more effective than placebo or occlusal splints. Combinations of active exercise, manual therapy, postural correction, and relaxation techniques may be effective.

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La Touche et al70 2010

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Author

Articles meeting criteria

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Appendix Table IV. Continued

Topic Physical therapy/manual techniques

Martins et al84 2016

Physical therapy/manual technique

308/8

Low-medium

Brantingham et al85 2013

Physical therapy/manual technique

764/35

Medium

Fricton et al86 2009 Al-Baghdah et al87 2014

Physical therapy/exercise Manipulation/timing

626/113

Low

Paco et al88 2016 Kreiner et al89 2001

Physiotherapy Splints

/7 -

Low -

Turp et al90 2004

Splints

/13

Low

Ebrahim et al91 2012

Splints

1,567/11

Al-Ani et al92 2005

Splints

20/12

Low

Fricton et al93 2010

Splints

/47

High

Forssell et al94 1999

Occlusal adjustment/splints

/18

Dated

Fricton95 2006 Tsukiyama et al96 2001

Occlusal therapy/splints Occlusal adjustment

/11

Low (dated)

de Souza et al97 2012

Injections

/3

Low

Quality Medium-high

Low-medium

Findings/conclusions There is moderate to high evidence that manual techniques are effective. Upper cervical spine thrust manipulation or mobilization techniques are more effective than controls, while thoracic manipulations are not. Musculoskeletal manual approaches are effective for TMD. In the short term, there is larger effect regarding manual approaches when compared with other conservative treatments. There is a fair level evidence for manipulative and multimodal therapy (MMT) to specific joints and the full kinetic chain combined generally with exercise and multimodal therapy for lateral epicondylopathy, carpal tunnel, and TMDs, in the short term. No abstract in PubMed listing. At present, early intervention by “unlock” mandibular manipulation seems to be the most practical and realistic approach that can be attempted first in every closed locked patient as an initial diagnostic/therapeutic approach. Physiotherapy seems to lead to decreased pain and improve active range of motion. The use of occlusal appliances in managing localized masticatory myalgia, arthralgia, or both is supported by the available evidence. Most patients with masticatory muscle pain are helped by a stabilizing splint. Nevertheless, a stabilization splint does not appear to yield better clinical outcome than a soft splint, a nonoccluding palatal splint, physical therapy, or body acupuncture. Overall results were promising for reduction of TMD pain with splints. Low to very low quality evidence showed no significant difference between splints and control groups in regard to quality of life or depression. Stabilizing splints may be beneficial for reducing pain severity at rest and on palpation and depression. Hard stabilizing splints, when adjusted properly, have good evidence of modest efficacy in the treatment of TMD pain compared with nonoccluding splints and no treatment. Other types of splints, including soft stabilization splints, anterior positioning splints, and anterior bite splints, have some RCT evidence of efficacy in reducing TMD pain. However, the potential for adverse events with these appliances is higher and suggests the need for close monitoring. The evidence for the use of occlusal adjustments for TMD is lacking. The use of occlusal splints may be of some benefit. The experimental evidence was neither convincing nor powerful enough to support occlusal therapy as a general method of treating a nonacute TMD, bruxism, or headache. Management of TMJ osteoarthritis is not dissimilar to effectiveness with intraarticular injections consisiting of either sodium hyaluronate or corticosteroid preparations. An equivalent pain reduction with diclofenac sodium compared with occlusal splints. Glucosamine appeared to be just as effective as ibuprofen.

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American Journal of Orthodontics and Dentofacial Orthopedics

Author Calixtre et al83 2015

Articles meeting criteria /8

Author

Topic 98

Articles meeting criteria

Quality

Injections Injections

/19 /9

Medium Low

Li et al100 2012

Injections

Chen et al101 2015 Stoustrup et al102 2013

Injections Injections

/4 349 subjects /5 94/7

Low Low

Melis et al103 2012

Lasers

/14

Low

Maia et al104 2012 Chen et al105 2015

Lasers Lasers

/14 /14

Low Low

Petrucci et al106 2011

Lasers

323/6

Low

de Almeida et al107 2016

Luxation treatments

List and Axelsson108 2010

Many treatments

Stepan et al109 2017

Otolaryngology/primary care

te Veldhuis et al110 2014

JIA treatments

/40

Medium

von Bremen and Ruf111 2012

JIA treatments

/19

Low

Low

-

/30

4155/12

Medium

-

Inconclusive as to the effectiveness of hyaluronic acid in treating TMD. Intra-articular injections with corticosteroids and sodium hyaluronate seem to be effective for treating internal derangements of the TMJ. Inferior or double TMJ spaces drug injection technique show better effect than superior space injection technique, and their safety is affirmed. No consensus on the therapeutic benefits of botulinum toxin therapy for TMD. Limited level of evidence suggests potential benefits of intra-articular corticosteroid injections (IACI) for TMJ arthritis in juvenile idiopathic arthritis patients. No knowledge is available on the long-term impact of IACI on mandibular growth. No definitive conclusion could be drawn on the efficacy of low-level laser therapy for the treatment of TMD. With caution, low-level laser therapy seemed to be effective in reducing TMD pain. Low-level laser therapy has limited efficacy in reducing pain In patients with TMD. However, it can significantly improve the functional outcomes of patients with TMD. Currently, no evidence supports the effectiveness of low-level laser therapy in treatment of TMD. There are several surgical and conservative treatment options. There is no goodquality evidence on which treatment options guarantee the long-term elimination of recurrent TMJ luxation. Eminectomy has often been used as a rescue procedure for postsurgical relapse. There is some evidence that the following can be effective In alleviating TMD pain: occlusal appliances, acupuncture, behavioral therapy, jaw exercises, postural training, and some pharmacologic treatments. Evidence for the effect of electrophysical modalities and surgery is insufficient, and occlusal adjustment seems to have no effect. Simple treatments can be initiated by the otolaryngologist; then referral to dentist, oral surgeon, physiotherapist if simple pharmacological treatment or TMD exercises fail. TMJ involvement in patients with juvenile idiopathic arthritis (JIA) has a high incidence. There is no consensus on the treatment of TMJ pathology and dentofacial deformities in JIA, and treatment varies from counseling to surgery. Due to the heterogeneous patient samples, it is currently impossible to draw conclusions on the influence of various types of JIA on craniofacial morphology.

/, the number before the symbol is the total number of articles accessed and the number after the symbol is the number meeting the criteria. If there is no number before the symbol, the number could not be ascertained from the abstract. RDC, Research Diagnostic Criteria.

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Manfredini et al 2010 Machado et al99 2013

Findings/conclusions

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Appendix Table IV. Continued

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Appendix Table V. Surgical treatments for TMD

Topic Surgery

Al-Riyami et al113 2009

Surgery

480/53

Low

Abrahamsson et al114 2007 Bermell-Baviera et al115 2016

Surgery Surgery

467/3 544/22

Low Medium

Al-Moraissi116 2015

Surgery

/7

Low

Al-Moraissi117 2015

Surgery

/6

Low

Al-Moraissi et al118 2015

Surgery

/16

Low

Ma et al119 2015

Surgery

/8

Low

Al-Moraissi and Wolford120 2017

Surgery

/12

Low-medium

Katsnelson et al121 2012

Surgery

/4

Low

Lindenmeyer et al122 2010 Reston and Turkelson123 2003

Surgery Surgery

/32 -

-

Vos et al124 2013

Surgery

/3

Low

Ma et al125 2015

Surgery

/8

Low

Catherine et al126 2016

Surgery

32/17

-

Al-Saleh et al127 2012

Surgery

271/12

Low

Quality -

Findings/conclusions Interstudy comparisons are difficult with the diversity of diagnostic criteria and classification methods. Although orthognathic surgery should not be advocated solely to treat TMD, subjects who have orthognathic surgery for correction of dentofacial deformities appear more likely to see improvement in their signs and symptoms of TMD. Scientific evidence was insufficient to evaluate the effects of orthognathic surgery on TMD. Mandibular advancement surgery can neither improve or worsen TMJ health. Condylar resorption is accelerated after mandibular advancement surgery. Open surgery for management of TMJ internal derangements is superior to arthroscopic surgery pain reduction, with comparable results for maximal incisal opening, jaw function, and clinical findings. Arthroscopic lysis and lavage provide greater improvements in maximal opening and comparable pain reduction compared with arthroscopic surgery. No final conclusion could be drawn about arthroscopy vs arthrocentesis for management of TMJ internal derangement. Both have comparable postoperative complication rates. TMJ ankylosis: which surgery? Various surgeries were best for some symptoms vs others: gap arthroscopy, interpositional gap, reconstruction using alloplastic and nonplastic grafts. TMJ ankylosis: interpositional arthroplasty and reconstructive arthroplasty produce similar outcomes. Counterclockwise rotation of the maxillomandibular complex Is a stable procedure for patients with healthy TMJs undergoing concomitant TMJ disc repositioning. TMJ ankylosis: gap arthroplasty had better postoperative maximal incisal opening than ankyloses resection and ramus-condyle reconstruction with a costochondral graft. No evidence of orthognathic surgery cause or therapeutic benefit for chronic painful TMD. Surgical treatments for appear to provide some benefit to TMD patients refractory to nonsurgical therapies. Most reliable evidence supports the effectiveness of arthrocentesis and arthroscopy for patients with disc displacements without reduction. Arthralgia of the TMJ; lavage might be slightly more effective than nonsurgical treatment for pain reduction. TMJ ankylosis: interpositional arthroplasty better than gap arthroplasty, with larger maximal incisal opening and similar incidence of reankylosis. Condylar resorption after orthognathic surgery: mainly occurred in 14- to 50-year-old women with preexisting TMJ dysfunction, estrogen deficiency, Class II malocclusion with high mandibular plane angle, diminished posterior facial height, and posteriorly inclined condylar neck, mandibular advancements greater than 10 mm, counterclockwise rotation of the mandible, and posterior condylar repositioning. Transmandibular surgery in oral and oropharyngeal cancers and morphologic and functional changes in the TMJ and stomatognathic system? No firm conclusions.

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American Journal of Orthodontics and Dentofacial Orthopedics

Author Al-Riyami et al112 2009

Articles meeting criteria 480/53

Author Friction et al128 2010

Topic Limitations/RCTs

Articles meeting criteria 210

Quality Medium

Safaee et al129 2015

Unusual case

Literature review

-

Dahlstrom and Carlsson130 2010

Oral health related quality of life

12

High

Findings/conclusions Review to evaluate the quality of methods used in RCT of treatments for management of pain and dysfunction associated with TMD and discuss implications for future studies. Much of the evidence base for TMD treatments may be susceptible to systemic bias, and most past studies should be interpreted with caution. However, improvement in RCT quality over time suggests that future studies may continue to improve methods to minimize bias. Pigmented villodular synovitis of the TMJ is rare, and surgical treatment outcome is excellent. TMD negatively affects OHRQoL

Rinchuse and Greene

American Journal of Orthodontics and Dentofacial Orthopedics

Appendix Table VI. Miscellaneous topics for TMD systematic reviews

/, the number before the symbol is the total number of articles accessed and the number after the symbol is the number meeting the criteria. If there is no number before the symbol, the number could not be ascertained from the abstract.

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