Comparison of occlusal splint with other treatment modalities in management of internal derangement of temporomandibular joint: A systematic review

Internal derangement is a disruption within the internal aspects of the temporomandibular joint (TMJ). Treatment modalities consist of conservative management (medication, modification of habits, physical therapy, splint therapy, laser therapy and ultrasound), minimally invasive (arthrocentesis with lavage, hyaluronic acid injection, and prolotherapy) and surgical management. Thus, evaluation of efficacy of occlusal splint as compared to other treatment modalities is done in this systematic review. The focused question was formulated based on the PRISMA guidelines. Articles published in English between 1 January 2000 and 31 December 2021 involving randomised controlled clinical trials performed on human subjects diagnosed with either unilateral or bilateral internal derangement of TMJ; and treatment provided with occlusal splints comparing other treatment modalities for the same were searched through databases, PubMed and Google scholar. A total of eight studies were included. Three studies evaluated occlusal splint in comparison to arthrocentesis and hyaluronic acid injection, three studies evaluated occlusal splint in comparison with control group (no active treatment), two studies evaluated occlusal splint in comparison with arthrocentesis and hyaluronic acid injection, and, one study compared occlusal splint with only arthrocentesis. One study each evaluated occlusal splint in comparison with medical therapy; prolotherapy; fixed orthodontic appliance; ultrasound, and high-intensity laser therapy (HILT); low-level laser therapy (LLLT); and, single and double hyaluronic acid injection respectively. Hyaluronic acid injection and stabilisation (occlusal) splint therapy benefits patients with painful TMJ disc displacement with reduction. However, in patients with disc displacement without reduction, arthrocentesis is a better treatment modality as compared to occlusal splints. Generalised comment on other treatment modalities namely HILT, LLLT, ultrasound and prolotherapy cannot be made due to limited study as per the inclusion criteria for this systematic review. CRD42021285027.