Effects Of Different Energy Density LLLT For TMD Patients: A Systematic Review And Network Meta-analysis Of Parallel RCTs

Objectives:To compare the effects of different energy density LLLT for TMD patients'pain reduction.Methods:Reviewers searched RCTs published in Embase,PubMed and Cochrane Library databases before 27 August 2019.Reviewers included RCTs which compared the effects of LLLT with placebo or different energy density LLLT for TMD patients'pain reduction.After assessing the internal study validity via Cochrane risk of bias tool,RCTs with high risk of bias in any domain were excluded.Reviewers did network meta-analysis and evaluated the quality of evidence using the GRADE process.Results:From 344 studies,reviewers included 9 RCTs.Immediately after treatment,d1 laser therapy(energy density ranging from 0 to 10 J/cm~2)ranked the first.D1 laser therapy showed more pain reduction than placebo(MD=2.51,95%CI ranging from 1.40 to 3.61).Compared with d4 laser therapy(energy density more than 100J/cm~2),d1 laser therapy reduced more pain intensity(MD=2.14,95%CI ranging from0.67 to 3.60).Above two comparisons were rated as“high”and“moderate”quality respectively.1 month after treatment,d1 laser therapy also performed best but the difference between d1 laser therapy and placebo didn't reach the point of statistical significance.The quality of secondary outcome was assessed as“moderate”.Conclusions and Clinical Relevance:For TMD patients,d1 laser therapy is recommended.It performed best and significantly reduced pain intensity immediately after treatment.However,whether it could reduce pain intensity in longtime follow-up is unclear.