Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Reduction of headache intensity and frequency with maxillary stabilization splint therapy in patients with temporomandibular disorders-headache comorbidity: a systematic review and meta-analysis

  • Manrriquez, Salvador L. (Orofacial Pain and Oral Medicine Clinic, Division of Diagnostic Sciences, Herman Ostrow School of Dentistry of University of Southern California) ;
  • Robles, Kenny (Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of University of Southern California) ;
  • Pareek, Kam (Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of University of Southern California) ;
  • Besharati, Alireza (Orofacial Pain and Oral Medicine, Herman Ostrow School of Dentistry of University of Southern California) ;
  • Enciso, Reyes (Division of Dental Public Health and Pediatric Dentistry, Herman Ostrow School of Dentistry of University of Southern California)
  • Received : 2021.01.16
  • Accepted : 2021.04.24
  • Published : 2021.06.01
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Abstract

This systematic review and meta-analysis aimed to analyze the effectiveness of maxillary stabilization splint (SS) therapy to reduce headache (HA) intensity and HA frequency in patients with temporomandibular disorders (TMD)-HA comorbidity. Randomized controlled trials (RCTs) using full-arch coverage, hard resin, and maxillary SS therapy were included. Electronic databases, including Cochrane Library, MEDLINE through PubMed, Web of Science, and EMBASE, were searched. The risk of bias was analyzed based on Cochrane's handbook. The search yielded 247 references up to January 28, 2020. Nine RCTs were included at a high risk of bias. The comparison groups included other splints, counseling, jaw exercises, medications, neurologic treatment, and occlusal equilibration. Four studies reported a statistically significant reduction in HA intensity, and five studies reported significant improvement in HA frequency from baseline at 2-12 months in patients with TMD-HA comorbidity treated with a full-arch hard maxillary SS. HA frequency in tension-type HA (TTH) comorbid with TMD diagnoses of myofascial pain (MFP) or capsulitis/synovitis improved significantly with SS than that with full-arch maxillary non-occluding splint (NOS) in two studies. Comparison groups receiving hard partial-arch maxillary splint nociceptive trigeminal inhibition (NTI) showed statistically significant improvements in HA intensity in patients with mixed TMD phenotypes of MFP and disc displacement comorbid with "general HA." Comparison groups receiving partial-arch maxillary resilient/soft splint (Relax) showed significant improvements in both HA intensity and frequency in patients with HA concomitant with MFP. The meta-analysis showed no statistically significant difference in the improvement of pain intensity at 2-3 months with comparison of the splints (partial-arch soft [Relax], hard [NTI], and full-arch NOS) or splint use compliance at 6-12 months with comparison of the splints (partial-arch Relax and full-arch NOS) versus the SS groups in patients with various TMD-HA comorbidities. In conclusion, although SS therapy showed a statistically significant decrease in HA intensity and HA frequency when reported, the evidence quality was low due to the high bias risk and small sample size. Therefore, further studies are required.

Keywords

Acknowledgement

The protocol of this systematic review was registered with PROSPERO #CRD42020160714. Drs. Manrriquez, Robles, Pareek, Besharati, and Enciso contributed to the conceptualization and methodology. Drs. Robles, Pareek, and Besharati conducted data extraction, while Dr. Manrriquez and Dr. Enciso performed data validation. Dr. Enciso conducted the electronic search and formal analysis. Drs. Manrriquez, Robles, Pareek, Besharati, and Enciso wrote the original draft and participated in the writing (review and editing) of the final manuscript. The protocol of this systematic review was registered with PROSPERO (number removed for blinded copy).

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