Quais métodos de tratamento para luxação recidivante da ATM com maior evidência científica?

Abstract

OBJECTIVE: This study aims to identify which methods are most effective in treating recurrent TMJ dislocations and their scientific evidence. METHODOLOGY: A systematic review was developed following the PRISMA recommendations, having as search strategy in five different databases (Pubmed, Scopus, Medline, The Cochrane Library, Web of science). As inclusion criteria, we selected articles in English, Portuguese and Spanish; studies carried out in humans, and the reports / case series that should have a minimum sample of 10 patients, with a minimum follow-up time for each patient of 1 year for all types of studies. Articles that did not answer the research question were excluded, as well as those that did not score more than 10 in the STROBE (observational studies) and CONSORT (clinical trials) and that did not present all the necessary elements when the publication of the case series ( Guidelines to the writing of case studies). The articles were initially selected by two independent researchers, by title and later, were submitted to the inclusion and exclusion criteria, and after this selection, the "Check lists" STROBE, CONSORT and GUIDELINESS were applied, according to the type of article. In this way, each selected article received a score that defined its permanence in the research. The results of this selection and evaluation were organized in a table and the test was also applied to analyze possible biases, only in clinical trials, validated by The Cochrane Library. RESULTS: Twenty articles were included in the review, of which only 4 were clinical trials. Of the 20 articles, 4 were level II, 3 evidence level III and 13 level IV, 10 articles for noninvasive treatments, with the majority concentrating on the use of autologous blood injection in the TMJ and 10 articles for surgical treatment, highlighting mainly eminectomy as the main procedure. CONCLUSION: Of the minimally invasive procedures, the injection of autologous blood is the one with the greatest evidence and favorable results, which is better documented. As for invasive treatment, by means of surgery, the Dautrey procedure showed a resolving potential similar to the eminectomy procedure and proved to be a promising procedure. Based on the analysis of the scientific evidence to date, it can be seen that there is a need to propose studies with a higher level of evidence on the subject, as so far, there are few clinical trials available and still have a high rate of uncertain bias, undermining more definitive conclusions.