SynthesisBMC oral health2026
Comparative effectiveness of nonpharmacological therapies for adult myogenic temporomandibular disorders: a network meta-analysis of randomized trials.
Synthesis in BMC oral health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
4 authors.
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Abstract
backgroundNonpharmacological therapies are widely used for adult myogenic temporomandibular disorders (TMD), but their comparative effectiveness for pain and mandibular function remains uncertain. This study compared multiple interventions using a frequentist random-effects network meta-analysis.
methodsMEDLINE (via PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar were searched from inception through October 31, 2025, without language restrictions. Randomized controlled trials enrolling adults (≥ 18 years) with myogenic TMD were included if they compared at least one predefined nonpharmacological modality (including photobiomodulation therapy [PBMT], manual therapy [MT], exercise therapy [EX], occlusal splint therapy [OST], acupuncture [ACU], electrotherapy [ELEC], combined therapy [COMB], cognitive behavioral therapy [CBT], central neuromodulation, or extracorporeal shock wave therapy) with sham or placebo control, usual care or no-treatment control, or another predefined active nonpharmacological modality. Primary outcomes were pain and maximum mouth opening, and outcome data were extracted at the short-term assessment closest to completion of the intervention. Effects were summarized as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using a frequentist random-effects model implemented in Stata. Treatments were ranked using the surface under the cumulative ranking curve (SUCRA), which provides a probabilistic ranking rather than a direct measure of treatment superiority. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool (RoB 2.0).
resultsForty-one trials (2021 participants) were included. For pain, PBMT ranked highest (SUCRA, 88.9%) and was superior to CBT (SMD, - 2.00; 95% CI, - 2.99 to - 1.00), ELEC (SMD, - 1.64; 95% CI, - 2.55 to - 0.73), conventional care (SMD, - 1.49; 95% CI, - 2.07 to - 0.91), OST (SMD, - 1.43; 95% CI, - 2.29 to - 0.56), and ACU (SMD, - 1.07; 95% CI, - 1.93 to - 0.21). MT (SUCRA, 79.9%) and COMB (SUCRA, 72.5%) also showed significant analgesic advantages versus several comparators. For maximum mouth opening (31 trials; 1463 participants), MT ranked highest (SUCRA, 92.9%) and improved opening more than conventional care (SMD, 2.79; 95% CI, 1.33 to 4.26), PBMT (SMD, 2.23; 95% CI, 0.19 to 4.28), ACU (SMD, 2.01; 95% CI, 0.12 to 3.90), and EX (SMD, 1.85; 95% CI, 0.05 to 3.64). Inconsistency was detected for pain in the ELEC versus MT comparison; no significant inconsistency was observed for maximum mouth opening.
conclusionAmong adults with myogenic TMD, PBMT showed the most favorable short-term comparative profile for pain relief, whereas MT ranked highest for improving maximum mouth opening. These findings support targeted selection of specific nonpharmacological modalities, prioritizing PBMT when pain reduction predominates and MT when restoration of mandibular mobility is the primary goal.
trial registrationPROSPERO (CRD420261278458).
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.