***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The authors compared the efficacy of bilateral balanced and canine guidance ( occlusal ) splints in the treatment of temporom and ibular joint ( TMJ ) pain in subjects who experienced joint clicking with a nonoccluding splint in a double-blind , controlled r and omized clinical trial . METHODS The authors r and omly assigned 57 people with signs of disk displacement and TMJ pain into three groups according to the type of splint : bilateral balanced , canine guidance and nonoccluding . The authors followed the groups for six months using analysis of a visual analog scale ( VAS ) , palpation of the TMJ and masticatory muscles , m and ibular movements and joint sounds . They used repeated analysis of variance and a chi(2 ) test to test the hypothesis . RESULTS The type of guidance used did not influence the pain reduction , yet both occlusal splints were superior to the nonoccluding splint , on the basis of the VAS . Despite similar outcomes in relation to opening , left lateral and protrusive movements , TMJ and muscle pain on palpation , subjects who used the occlusal splints had improved clinical outcomes . The frequency of joint noises decreased over time , with no significant differences among groups . Subjects in the groups using the occlusal splints reported more comfort . CONCLUSION The type of lateral guidance did not influence the subjects ' improvement . All of the subjects had a general improvement on the VAS , though subjects in the occlusal splint groups had better results that did subjects in the nonoccluding splint group Thirty-two patients with disabling tinnitus  received stomatognathic treatment and biofeedback therapy according to a cross-over design . The evaluation of treatment outcomes showed some improvements at the group level : decrease of tinnitus intensity , mood improvement and reduction of clinical signs of dysfunction in the masticatory system . Qualitative observations indicated numerous positive changes in patients ' emotional and cognitive orientation vis à vis tinnitus . Some possible predictors of positive treatment outcome were observed : comparatively low severity of tinnitus , normal hearing or compensated hearing loss , occlusal interferences , jaw fatigue , diurnal bruxism and fluctuations in tinnitus intensity . Left-sided tinnitus seemed to be a negative predictor of stomatognathic and biofeedback treatment outcome . Consequently , stomatognathic and biofeedback treatment seem to have some positive effects on subgroups of tinnitus patients OBJECTIVE To measure the effect of occlusal splints as an additional treatment on psychological aspects in temporom and ibular disorder patients . DESIGN A r and omized controlled trial was performed comprising 60 adults diagnosed with masticatory myofascial pain according the Research Diagnostic Criteria for Temporom and ibular Disorders ( RDC/TMD ) . The participants were divided equally into 2 treatment groups , which received only counselling ( Group 1 ) or occlusal splints in addition to counselling ( Group 2 ) . The assessment s occurred at baseline and at 2 and 5 months after treatment . The outcomes were symptoms of anxiety and depression , as well as pain catastrophizing . Two-way ANOVA , Friedman and Mann-Whitney tests were used to perform the statistical analysis , considering a significance level of 5 % . RESULTS In relation to the baseline assessment , 60 % of the subjects had at least mild anxiety and 25 % had at least mild depression , and the mean and st and ard deviation ( SD ) of pain catastrophizing was 2.41 ( 1.33 ) for Group 1 and 2.06 ( 1.04 ) for Group 2 . Comparisons between baseline and the fifth-month evaluation showed an improvement in anxiety and depression symptoms only in Group 2 ( p<0.05 ) . Otherwise , there was a significant reduction in pain catastrophizing in both groups ( p<0.05 ) , with a mean ( SD ) of 1.14 ( 1.28 ) for Group 1 and 0.76 ( 0.82 ) for Group 2 . CONCLUSION Minimally invasive strategies could provide an improvement in the psychological aspects of temporom and ibular disorder patients , and the use of an occlusal splint seems to hasten the manifestation of these effects The aim of this research was to test the hypothesis that treatment with intra-oral appliances with different occlusal design s was beneficial in the management of pain of masticatory muscles compared with a control group . A total of 51 patients were analysed according to the research diagnostic criteria for temporom and ibular disorders ( RDC/TMD ) to obtain the diagnosis of masticatory myofascial pain ( MMP ) . The sample was then r and omly divided into three groups : group I ( n = 21 ) wore a full coverage acrylic stabilisation occlusal splint ; group II ( n = 16 ) wore an anterior device nociceptive trigeminal inhibitory ( NTI ) system ; and group III ( n = 14 ) only received counselling for behavioural changes and self-care ( the control group ) . The first two groups also received counselling . Follow-ups were performed after 2 and 6 weeks and 3 months . In these sessions , patients were evaluated by means of a visual analogue scale ( VAS ) and pressure pain threshold ( PPT ) of the masticatory muscles . Possible adverse effects were also recorded , such as discomfort while using the appliance and occlusal changes . The results were analysed with Kruskal-Wallis , anova , Tukey 's and Friedman tests , with a significance level of 5 % . Group I showed improvement in the reported pain at the first follow-up ( 2 weeks ) , whereas for groups II and III , this progress was detected only after 6 weeks and 3 months , respectively . The PPT values did not change significantly . It was concluded that behavioural changes are effective in the management of pain in MMP patients . However , the simultaneous use of occlusal devices appears to produce an earlier improvement Objective . The aim of the study was to investigate the presence of symptoms and signs of temporom and ibular disorders ( TMD ) in patients with tinnitus  and to evaluate the effect of TMD treatment on tinnitus in a long-term perspective in comparison with a control group of patients on a waiting list . Material and Methods . One-hundred- and -twenty patients with tinnitus were subjected to a clinical examination of the masticatory system and whether they had co-existing TMD to TMD treatment .  Ninety-six patients had TMD , most frequently localized myalgia . Seventy-three of these completed the treatment and responded to a question naire 2 years later . Fifty patients with tinnitus who were on the waiting list served as a control group . Results . Eighty percent of the patients had signs of  TMD  , most commonly myofascial pain . Forty-three percent of the patients reported that their tinnitus was improved at the 2-year follow-up , 39 % that it was unchanged , and 17 % that it was impaired compared to before the treatment . Twelve percent of the subjects in the control group reported that their tinnitus was improved compared to 2 years previously , 32 % that it was unchanged , and 56 % that it was impaired . The difference between groups was significant ( χ2 : p<0.001 ) . Conclusion . The results of this study showed that TMD symptoms and signs are frequent in patients with tinnitus and that TMD treatment has a good effect on tinnitus in a long-term perspective , especially in patients with fluctuating tinnitus BACKGROUND Whether the co-occurrence of signs and symptoms of a craniom and ibular disorder ( CMD ) and chronic tinnitus are coincidental or causal is controversial . Therefore , the effects of splint therapy and self-therapy on perceived tinnitus were evaluated . PATIENTS AND METHODS Fifty-nine patients with chronic tinnitus  were divided into three groups . In a cross-over design , two groups received the two different treatments and were compared with a control group . All patients received the initial basic tinnitus therapy . RESULTS No significant correlation was established between the groups receiving treatment and the control group that would vali date a link between tinnitus and CMD . CONCLUSION The results of this study suggest a coincidental relationship between the two complexes of symptoms The aim of this study was to investigate the frequency of otologic symptoms and their relationship to orofacial signs and symptoms of temporom and ibular disorder ( TMD ) , and the effect of orofacial myofunctional therapy . The study was conducted on eight asymptomatic subjects ( Group C ) and 20 subjects with articular TMD , r and omly distributed over two groups :  one  treated using orofacial myofunctional therapy ( OMT Group ) and a control group with TMD ( Group CTMD ) . Patient selection was based upon the Research Diagnostic Criteria for TMD ( RDC/TMD ) . All subjects su bmi tted to a clinical examination with self-reporting of symptom severity , and to orofacial myofunctional and electromyographic evaluation at diagnosis and again , at the end of the study . Correlations were calculated using the Pearson test and inter- and intragroup comparisons were made ( p < 0.05 ) . In the diagnosis phase , subjects with TMD reported earache ( 65 % ) , tinnitus ( 60 % ) , ear fullness ( 90 % ) , and 25 % of the asymptomatic subjects reported tinnitus . The otologic symptoms were correlated with tenderness to palpation of the temporom and ibular muscles and joints and with orofacial symptoms . Only the OMT group showed a reduction of otologic and orofacial symptoms , of tenderness to palpation and of the asymmetric index between muscles .  OMT may help with muscle coordination and a remission of TMD symptoms In clinical practice , it is commonly assumed that occlusal splints have therapeutic value in the treatment of temporom and ibular disorders ( TMD ) , but the evidence based on r and omized controlled trials is scarce . This study evaluated the short-term ( 10-week ) efficacy of a stabilization splint in subjects with recurrent secondary otalgia and active TMD treatment need using a r and omized , controlled , double-blind design . Thirty-six subjects were r and omly allocated to the two treatment groups : the stabilization splint and the control splint group . After 10 weeks ' treatment , the intensity of secondary otalgia , measured on a VAS scale ( from 0 to 100 mm ) , decreased statistically significantly in the stabilization splint group ( t 2.12 ; P 0.006 ) , but not in the control group . Improvement in active TMD treatment need in subjects showing moderate or severe signs and symptoms of TMD  was reported significantly more often in the stabilization splint group than in the control splint group ( χ2 5.71 ; P .017 ) . A statistically significant decrease in the Helkimo clinical dysfunction index was seen in the subjects with stabilization splint ( Z -2.63 ; P .009 ) , but not in the subjects with control splint . The results indicate that the use of a stabilization splint  is beneficial with regard to secondary otalgia and active TMD treatment need STATEMENT OF PROBLEM The frequent concurrence of tinnitus and temporom and ibular joint and masticatory muscle disorders ( TMD ) has led to the assumption that a possible relationship exists between these 2 conditions . PURPOSE The present prospect i ve clinical study was conducted to assess the possible association between tinnitus and TMD and to investigate the effect of stomatognathic therapy on tinnitus distress . MATERIAL AND METHODS The prevalence of TMD and tinnitus was investigated in a consecutive series of 951 patients at the Department of Prosthetic Dentistry at the University Medical Center Regensburg , Germany . Patients with TMD and simultaneous tinnitus were included in the prospect i ve clinical trial ( n=25 ) . Baseline examination comprised a detailed functional analysis , diagnosis of temporom and ibular joint and masticatory muscle disorder , and a tinnitus question naire . All the participants received individual dental functional therapy ( oral splints , physiotherapy ) . The effects of functional therapy on TMD and tinnitus symptoms were examined 3 to 5 months after the initiation of dental functional therapy . Means ( st and ard deviations ) were calculated , and 1-way ANOVA was used to investigate statistical differences ( α=.05 ) . The differences of the 2 binary outcomes were compared with the Pearson χ(2 ) test , and the relative risk was calculated . RESULTS Prevalence of tinnitus was found to be 8 times higher in participants with TMD ( 30 of 82 [ 36.6 % ] ) than in participants without TMD ( 38 of 869 [ 4.4 % ] ) . All the participants with unilateral TMD and unilateral tinnitus showed these conditions on the same side . Stomatognathic therapy improved tinnitus symptoms in 11 of 25 participants ( 44 % ) . CONCLUSIONS The results of this study and the prospect i ve clinical trial showed a significant correlation between tinnitus and TMD . The observed treatment outcome suggests that dental functional therapy may have a positive effect on TMD-related tinnitus 
    Output:
    
Upon the limitations of the studies included in this systematic review , the present outcomes suggested that there is insufficient evidence in favour or against the conservative therapies for TMD on changes in otologic signs and symptoms .