Table 2 Characteristics of the included studies

14

Ficnar T

2013

63

34,66

79,4% women, 20,6% men

63

RDC/TMD

Ia/Ib myofascial pain

Group 1 (CO)—conservative therapy

Group 2 (SS)—conservative therapy and a laboratory-made

stabilization splint

Group 3 (SB)—conservative therapy and the SOLUBrux splint

Stabilization splint, SOLUBrux splint

8

Costa D

2021

31,4

80% women, 20% men

70

RDC/TMD

Ia/ib Myofascial TMD

Group 1 (G1) only conventional therapy with OS;

Group 2 (G2) treatment with OS and therapy with LED (device turned off)

Group 3 (G3) LED therapy (infrared) Group 4 (G4) LED therapy (infrared) Group 5 (G5) OS associated with LED (infrared) therapy;

Group 6 (G6) OS therapy plus infrared LED

Stabilizing plates, used during sleep for 4 weeks

15

Conti P

2012

I 38,09, 1135,25 III38,14

I women 80,9%, II women 87,5%, III 100% women

51

RDC/TMD

Myofascial

Group I

stabilization occlusal splint and counseling

Group II

anterior device nociceptive trigeminal inhibitory (NTI) system, counseling

Group III only counseling (the control group)

Full coverage acrylic stabilization occlusal splint, anterior device nociceptive trigeminal inhibitory (NTI)

16

Grillo C

2014

18–45

Women using contraceptives

40

RDC/TMD

Myogenic dysfunction

Group 1—acupuncture group

Group 2—splint group

Flat occlusal plane appliance (control 1 session per week, final evaluation after 4 weeks)

17

Oz. S

2010

32,84

34 women, 6 men

40

RDC/TMD

Myofascial

Group 1—study group; low-level laser

Group 2—control group; occlusal splints

Stabilization occlusal splint described by Okeson wearing 24 h/d for 3 months

18

Giannakopoulos

2018

45

18–45

Female

45

RDC/TMD

Myofascial

A. sensorimotor training

B. occlusal splint

Conventional Michigan splint, use during sleep only

19

Manfredini D

2017

30 patients

35,3 + -9.4

Female

30

DC/TMD

Myofascial pain

LST (laser therapy),

OA (oral appliance therapy),

CSL (counseling)

Flat occlusal appliance covering the maxillary teeth at night for 3 weeks and then intermittent use for the following two months

20

Keskinruzgar A

2018

34 patients with sleep bruxism

Kinesio group 27.38 + -9.05. 26.11 +—8.71

Mixed

34

Pressure pain threshold for masseter and temporal muscle, mouth opening, VAS

Tenderness on palpation, teeth abrasions, teeth grinding reported by bedtime friend hypertrophy of masseter muscle

Kinesio taping group—16

occlusal splint—18

Occlusal appliance made according to Okeson models. 0,5 mm thick thermoplastic hard splint

21

HAsanoglu Erbasar

2017

40 patients with myofascial pain

Mixed

RDC/TMD

RDC/TMD group I

Group 1—guidance, counseling, assurance, behavioral changes advice,

Group 2—NTI-tss device

NTI-tss device

22

Vicente-Barrero M

2012

20 patients

18–58

17 females, 3 males

20

Sensitivity to pressure on area: preauricular, masseter muscle, temporal muscle, trapezius

Muscle pain during palpation

1. acupuncture group

2. occlusal splint group

Decompression splints with canine guidance

23

Claudia Maria de Felicio

2014

40

13–68

Female

22

RDC/TMD, Helkimo index

Myofascial

T group—OMT

OS group—occlusal splint,

SC—symptomatic control group with TMDs

AS—asymptomatic control group

Occlusal splint Michigan type

24

Robert van Grootel

2017

72 patients

1 group 31,4 2 group 29,0

1 group- 95% female; 2 group 91% female

72

RDC/TMD

Group Ia and Ib

1 group—physiotherapy,

2 group—splint therapy

Michigan splint

25

Michelotti A

2012

44 patients

2 group 31,4 1 group- 31,1

Mixed

41

RDC/TMD

Ia group or Ib group

1. Occlusal splint group

2. Control—information about TMDs and self-care measures

Michigan splint (only during sleep)

14

Conservative therapy

Not described

Via randomization

3 months

2 Patients from CO, 3 patients from SS

Pressure-sensitive areas upon muscle palpation

Extent of vertical movement (incisal edge distance in mm)

Not established significant differences regarding pain reduction (muscular/joint pain) and mouth opening between the various therapeutic approaches; TMDs should initially be treated with conservative therapy consisting of self-exercises, as well as drug-based and manual treatment

In the SS and SB groups, a statistically significant improvement in mouth opening, especially in the case of the initial limitation of this range

8

LED therapy

Only the irradiation was hidden

Randomized

4 weeks of treatment, last evaluation 30 days after finishing treatment

11

Pain intensity (VAS)

Muscle activity (electromyography)

Blood lactate level

Pain intensity significantly decreased both post-therapy and 30 days post-treatment

The combination of LED therapy and occlusal splint achieves superior results compared to isolated treatments, and the protocol of two sessions per week proved to be better

15

Counseling

No information

Via randomization

2 weeks, 6 weeks, 3 months

12

Pain intensity, pressure pain threshold (PPT) of the masticatory muscles

Patients who halved their VAS (visual analog scale)

All of the management strategies used in the present study provided a significant improvement in the pain levels of myofascial pain when judged by the VAS

The simultaneous use of occlusal devices appears to produce an earlier improvement high percentage of patients responsive to the treatment in groups I and II, which include those who had decreased their VAS

Values by at least 50% (28), highlighting the importance of the occlusal splint in the management of myogenic pain

16

Acupuncture (traditional Chinese medicine) 4 sessions (one per week, 20 min duration)

No information

Via randomization

4 weeks

4

Pain intensity—VAS, pain pressure threshold (PPT)

Range of mouth opening (RMO), electromyographic activity

Reduction in pain in each group. Increase in RMO in both groups

Both strategies can be used equally for control of chronic pain related to TMDs

17

Low-level laser therapy (applied 2 times per week- 10 sessions)

Double blind

Randomly divided

90 days

No information

Self-report pain—VAS. Pressure pain threshold

Mandibular movement

Both groups—statistically significant improvement in vertical movements after treatment

In both groups, tenderness to muscle palpation and PPT evaluations decreased significantly

Low-level laser therapy is effective like occlusal splining pain release and mandibular improvement in myofascial pain

18

Device-supported sensorimotor training (a prefabricated device with liquid-filled elastic pads)

No information

Via randomization

6 weeks, 12 weeks

3 patients from group A

Pain intensity (current, average, worst pain) NRS, characteristic pain intensity (CPI)

EMG activity, bite—force (bite force device)

Significant pain reduction in both groups

EMG activity was not significantly different in both groups after treatment

Device-supported training could be a cost-effective alternative (or additional) treatment for myofascial functional pain TMD patients

19

Laser therapy, counseling

TMD practitioner who assessed outcome variables was blinded to patient groups assignment

Randomized

6 months

1

Visual analog scale

(VAS) pain levels

Muscular index (MI) of the Craniomandibular Index

After 3 weeks VAS values decreased significantly only in the LST group

After six months for VAS values, positive changes were still shown for LST and were also shown for the appliance therapy and CSL groups

All three treatment groups improved at six months. The difference in the short-term effectiveness of LST and OA, with respect to CSL alone, may suggest that active treatments should be directed to maximize the positive changes in the short-term period

20

Occlusal appliance, Kinesio taping

Not described

5 weeks

Significantly lower VAS scores in both splint group and Kinesio taping group

Significantly increased mouth opening in both groups

Significant decrease in VAS values, increase in muscle pain threshold in masseter and temporal muscles in both groups

Kinesio taping is easy and reliable treatment, which can be applied to patients with bruxism

21

Guidance, counseling, assurance, behavioral changes

Evaluation and data collection were performed by another clinician who was unaware of patient group

Randomized

Pain reduction VAS

Jaw function

Reduction in pain with time was observed; no significant difference regarding pain reduction was noted between the groups. Jaw function gradually improved in both groups, no significant difference between the groups (P = 0,927)

Integration of NTI-tss device into protocol of counseling, guidance, and assurance did not provide any additional benefit for patients

22

Acupuncture therapy

5 weeks

0

VAS, pain upon palpation of masticatory muscles

Measurements of mouth opening and jaw lateral deviation

Both groups of patients showed reduction in myofascial pain in the short term

Acupuncture is an effective complement and/or an acceptable alternative to decompression splints in the treatment of myofascial pain and temporomandibular joint pain dysfunction syndrome

23

Orofacial Myofunctional Therapy

No blinding

GraphPad software

120 days

Helkimo index

Questionnaire about the severity of their signs and symptoms

Group treated with OMT had significantly lower pain after treatment in comparison with SC (symptomatic control group), splint therapy group also revealed significant improvement, with some advantages for orofacial myofunctional therapy group

OMT has positive effects on patients with TMDs such as reduction in pain sensitivity on palpation of all muscles of the stomatognathic system

24

Physiotherapy

Blinded assessor after treatment

After 6 months and again after 6 more months

Clinical examination—pain intensity during jaw movements, palpation of jaw muscles and during clenching

Anamnestic questionnaire

Success rate for physiotherapy was similar to that of splint therapy in short term and long term. The duration of physiotherapy is on average 10.4 weeks shorter than that of splint therapy, so it might be the first step for patients without severe active sleep bruxism or psychological problems

Physiotherapy and splint therapy have similar success rates and effectiveness

25

Group with only information about TMD

Randomized

3 months

3

VAS scores for spontaneous muscle pain

Pain-free maximal mouth opening, headache, pain during chewing

Changes in spontaneous muscle pain differed significantly between the groups. Changes did not differ significantly between groups pain-free maximal mouth opening (P = .528; effect size = 0.20); headache and pain on chewing (P ≥ .550, effect size ≤ 0.10)

During short period of time, education was slightly more effective than an occlusal splint in treating spontaneous muscle pain