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Al-Moraissi EA, Al-Otaibi K, Almaweri AA, Bastos RM, Haas Junior OL, Amran AG. Treatment of painful temporomandibular joint disc displacement without reduction: network meta-analysis of randomized clinical trials. Int J Oral Maxillofac Surg 2024; 53:584-595. [PMID: 38395688 DOI: 10.1016/j.ijom.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
There is currently no consensus on the best treatment for painful temporomandibular disc displacement without reduction (DDwoR), and no network meta-analysis (NMA) of randomized clinical trials (RCTs) comparing all types of treatments for this condition has been conducted. The objective of this study was to compare and rank all treatments for DDwoR, including conservative treatments, occlusal splints, low-level laser therapy (LLLT), arthrocentesis (Arthro) alone, Arthro plus intra-articular injection (IAI) of platelet-rich plasma (PRP), Arthro plus IAI of hyaluronic acid (HA), Arthro with exercises, Arthro plus occlusal splints, and manipulative therapy. Outcome variables were pain intensity on a visual analogue scale (VAS) and maximum mouth opening (MMO, mm). The mean difference with 95% confidence interval was estimated using Stata software. The GRADE system was used to assess the certainty of the evidence. A total of 742 patients from 16 RCTs were included in the NMA. Both direct meta-analysis and NMA showed that Arthro with IAI of co-adjuvants provided better pain reduction in the short term (≤3 months) than Arthro alone. However, the quality of the evidence was very low. In the intermediate term, Arthro alone or combined with co-adjuvants provided better pain reduction than conservative treatment, but with low-quality evidence. Conservative treatment significantly increased MMO in the short term compared to other treatments. In conclusion, the results of this NMA suggest that arthrocentesis with intra-articular injection of adjuvant medications may be superior to conservative treatments in reducing pain intensity at long-term follow-up, while no significant differences were found for the MMO outcome. However, the quality of evidence was generally low to very low, and further RCTs are needed to confirm these findings.
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Affiliation(s)
- E A Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Thamar University, Thamar, Yemen.
| | - K Al-Otaibi
- Department of Maxillofacial Surgery and Diagnostics Sciences, College of Dentistry, Qassim University, Qassim, Saudi Arabia
| | - A A Almaweri
- Department of Oral Medicine, Thamar University, Thamar, Yemen
| | - R M Bastos
- Department of Oral and Maxillofacial Surgery, Hospital São Lucas of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - O L Haas Junior
- Department of Oral and Maxillofacial Surgery, Hospital São Lucas of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - A G Amran
- Department of Periodontolgy, Thamar University, Thamar, Yemen
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Ulmner M, Bjørnland T, Rosén A, Berge TI, Olsen-Bergem H, Lund B. Evidence for minimally invasive treatment-A systematic review on surgical management of disc displacement. J Oral Rehabil 2024; 51:1061-1080. [PMID: 38400536 DOI: 10.1111/joor.13661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform minimal invasive interventions as first-line surgical treatment since there are no evidence on best surgical practice yet. OBJECTIVE The aim was to perform a complex systematic review (SR) on the topic-is there evidence for surgical treatment of TMJ DD? METHODS The PICO was defined as DD patients (population), treated with different surgical interventions including arthrocentesis (intervention), compared with other or no treatment (control) regarding the outcome variables mandibular function, mouth opening capacity, TMJ pain, etcetera (outcome). For identification of prospective controlled trials and SRs, a search strategy was developed for application in three databases. RESULTS The search yielded 4931 studies of which 56 fulfilled the stipulated PICO. Studies with low or moderate risk of bias were possible to include in meta-analyses. There were evidence suggesting arthrocentesis being more effective compared to conservative management (maximum interincisal opening (MIO): p < .0001, I2 = 22%; TMJ pain: p = .0003, I2 = 84%) and arthrocentesis being slightly more effective than arthrocentesis with an adjunctive hyaluronic acid injection (MIO: p = .04, I2 = 0%; TMJ pain: p = .28, I2 = 0%). Other treatment comparisons showed nonsignificant differences. The performed meta-analyses only included 2-4 studies each, which might indicate a low grade of evidence. CONCLUSION Although arthrocentesis performed better than conservative management the findings should be interpreted cautiously, and non-invasive management considered as primary measure. Still, several knowledge gaps concerning surgical methods of choice remains.
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Affiliation(s)
- Mattias Ulmner
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Tore Bjørnland
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Annika Rosén
- Department of Oral and Maxillofacial Surgery, Folktandvården Stockholm Eastmaninstitutet, Stockholm, Sweden
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Trond Inge Berge
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Heming Olsen-Bergem
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Bodil Lund
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
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Militi A, Bonanno M, Calabrò RS. It Is Time for a Multidisciplinary Rehabilitation Approach: A Scoping Review on Stomatognathic Diseases in Neurological Disorders. J Clin Med 2023; 12:jcm12103528. [PMID: 37240633 DOI: 10.3390/jcm12103528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
Patients affected by neurological disorders can develop stomatognathic diseases (SD) related to decreased bite force and quality of mastication, bruxism, severe clicking and other temporomandibular disorders (TMD), which deeply affect patients' swallowing, masticatory and phonation functions and, therefore, their quality of life. The diagnosis is commonly based on medical history and physical examination, paying attention to the temporomandibular joint (TMJ) range of movements, jaw sounds and mandibular lateral deviation. Diagnostic tools such as computed tomography and magnetic resonance imaging are used instead in case of equivocal findings in the anamnesis and physical evaluation. However, stomatognathic and temporomandibular functional training has not been commonly adopted in hospital settings as part of formal neurorehabilitation. This review is aimed at describing the most frequent pathophysiological patterns of SD and TMD in patients affected by neurological disorders and their rehabilitative approach, giving some clinical suggestions about their conservative treatment. We have searched and reviewed evidence published in PubMed, Google Scholar, Scopus and Cochrane Library between 2010 and 2023. After a thorough screening, we have selected ten studies referring to pathophysiological patterns of SD/TMD and the conservative rehabilitative approach in neurological disorders. Given this, the current literature is still poor and unclear about the administration of these kinds of complementary and rehabilitative approaches in neurological patients suffering from SD and/or TMD.
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Affiliation(s)
- Angela Militi
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, 98125 Messina, Italy
| | - Mirjam Bonanno
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. Da Casazza, 98123 Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. Da Casazza, 98123 Messina, Italy
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Emam ANM, Abdel-Gawwad EA, Baiomy AAA, Farhat MY, Atito E, Helal MA. Efficacy of Occlusal Splints and Low-Level Laser Therapy on the Mandibular Range of Motion in Subjects with Temporomandibular Joint Disc Displacement with Reduction. J Int Soc Prev Community Dent 2023; 13:229-236. [PMID: 37564171 PMCID: PMC10411297 DOI: 10.4103/jispcd.jispcd_159_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 08/12/2023] Open
Abstract
Aims and Objectives The study was carried out to evaluate the efficacy of four conservative therapeutic modalities on the mandibular range of motion (MRM) in subjects with anterior disc displacement with reduction (ADDwR) of the temporomandibular joint (TMJ). Materials and Methods One hundred patients (64 women and 36 men) were selected, and randomly distributed into four groups. Group I: Subjects receiving behavioral therapy (BT). Group II: Subjects receiving low-level laser therapy (LLLT). Group III: Subjects receiving maxillary anterior repositioning splint (MARS). Group IV: Subjects receiving stabilization splint (SS). The MRM was evaluated for each patient before treatment and after 6 months. Paired t test and one-way analysis of variance (ANOVA) tests were used for statistical analysis followed by a post hoc Tukey test (P ≤ 0.05). Results All groups showed significant improvement in MRM after 6 months of treatment (P ≤ 0.05) except for BT. There was a significant improvement for SS and MARS on the different movements of MRM, more than for LLLT and BT (P ≤ 0.05). Conclusion The MARS and the SS are effective in increasing the MRM for patients with ADDwR.
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Affiliation(s)
- Abdel-Naser M Emam
- Department of Prosthetic Dental Science, College of Dentistry, Najran University, Najran, Saudi Arabia
| | | | | | - Mostafa Yassin Farhat
- Department of Prosthodontics, Faculty of Dentistry, Al-Azhar University (Boys Branch), Cairo, Egypt
| | - Ehap Atito
- Department of Prosthodontics, Faculty of Dentistry, Al-Azhar University (Boys Branch), Cairo, Egypt
| | - Mohamed Ahmed Helal
- Department of Prosthodontics, Faculty of Dentistry, Al-Azhar University (Boys Branch), Cairo, Egypt
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Idáñez-Robles AM, Obrero-Gaitán E, Lomas-Vega R, Osuna-Pérez MC, Cortés-Pérez I, Zagalaz-Anula N. Exercise therapy improves pain and mouth opening in temporomandibular disorders: A systematic review with meta-analysis. Clin Rehabil 2023; 37:443-461. [PMID: 36263523 DOI: 10.1177/02692155221133523] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyse the effectiveness of exercise therapy in improving pain and active or passive maximum mouth opening in patients with temporomandibular disorders. DATA SOURCES PubMed Medline, Web of Science, Scopus, CINAHL Complete and Physiotherapy Evidence Database, until April 2022, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. REVIEW METHODS We included randomized controlled trials evaluating the effect of exercise therapy on pain and on active and passive maximum mouth opening in patients with temporomandibular disorders. Effect size was calculated using Cohen's standardized mean difference (SMD) and their 95% confidence interval (95% CI) in a random-effects model. RESULTS A total of 16 studies with 812 participants were included. Exercise therapy is effective in reducing pain (SMD: -0.58; 95% CI: -1.01 to -0.12) and increasing the pain pressure threshold (SMD: 0.45; 95% CI: 0.14-0.76), active and passive maximum mouth opening (SMD: 0.43; 95% CI: 0.14-0.71 and SMD: 0.4; 95% CI: 0.06-0.75, respectively). Subgroup analyses showed more effect of exercise therapy more splints versus splints on pain (SMD: -0.5; 95% CI: -0.73 to -0.26), active and passive maximum mouth opening (SMD: 1.14; 95% CI: 0.22-2.07 and SMD: 0.56; 95% CI: 0.06-1.06, respectively). On pain pressure threshold, exercise therapy was better than physiotherapy approach (manual therapy and electrotherapy) (SMD: 0.48; 95% CI: 0.09-0.87). CONCLUSIONS Therapeutic exercise is an effective therapy to reduce pain and increase pain pressure threshold and active and passive maximum mouth opening in patients with temporomandibular disorders.
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Affiliation(s)
- Ana M Idáñez-Robles
- Servicio de Fisioterapia, Residencia de Mayores "Fuente de la Peña", Dean de la Fuente González, Jaén, Spain
| | - Esteban Obrero-Gaitán
- Physiotherapy Area, 536192Department of Health Sciences, 553090Faculty of Health Sciences, 16747University of Jaén, 16747Campus Las Lagunillas s/n, Jaén, Spain
| | - Rafael Lomas-Vega
- Physiotherapy Area, 536192Department of Health Sciences, 553090Faculty of Health Sciences, 16747University of Jaén, 16747Campus Las Lagunillas s/n, Jaén, Spain
| | - María C Osuna-Pérez
- Physiotherapy Area, 536192Department of Health Sciences, 553090Faculty of Health Sciences, 16747University of Jaén, 16747Campus Las Lagunillas s/n, Jaén, Spain
| | - Irene Cortés-Pérez
- Physiotherapy Area, 536192Department of Health Sciences, 553090Faculty of Health Sciences, 16747University of Jaén, 16747Campus Las Lagunillas s/n, Jaén, Spain
| | - Noelia Zagalaz-Anula
- Physiotherapy Area, 536192Department of Health Sciences, 553090Faculty of Health Sciences, 16747University of Jaén, 16747Campus Las Lagunillas s/n, Jaén, Spain
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El-Shaheed NH, Mostafa AZH, Aboelez MA. Efficacy of stabilisation splint and low-level laser therapy for patients with chronic closed lock from non-reducible displaced temporo-mandibular joint discs: A parallel randomised clinical trial. J Oral Rehabil 2023; 50:177-193. [PMID: 36564950 DOI: 10.1111/joor.13405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Stabilisation splint therapy (SST) and low-level laser therapy (LLLT) are effective-invasive treatment for temporo-mandibular disorder (TMD) patients. However, the specific efficacy of each therapy in patients with chronic closed lock (CCL) from temporo-mandibular joints (TMJ) disc displacement without reduction (DDwoR) remains unknown. OBJECTIVES The aim of this study was to assess and compare the efficacy of SST and LLLT alone or in combination in patients with CCL from TMJ DDwoR. METHODS This parallel randomised clinical trial included 42 patients who were diagnosed with CCL from TMJ DDwoR. Patients were allocated equally and randomly into three treatment groups: group I received combined SST and LLLT, group II received LLLT and group III received SST. Maximum mouth opening (MMO), visual analogue scale (VAS), muscle and joint palpation scores and time required to achieve normal state were evaluated at baseline, 1, 2, 4 weeks, 3 and 6 months after the intervention. Data were collected and analysed using SPSS software. RESULTS Regarding MMO and VAS, a statistically significant improvement was found between group I versus group II and versus group III at all evaluation times. Regarding muscle and joint palpation scores, a statistically significant difference was found between group I versus group III, while non-significant difference was found between group I and group II. A statistically significant faster improvement was found in group I versus group III and versus group II. CONCLUSION All treatment modalities can be effective in management of CCL from a TMJ DDwoR cases, but the combined SST and LLLT group seems to provide the best and quickest improvement. CLINICAL TRIAL REGISTRATION NUMBER NCT05548894.
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Yamaguchi Y, Sakuma S, Ogi N, Taguchi N, Kimoto S. Short-term efficacy of exercise therapy for temporomandibular disorders: a case control study. J Phys Ther Sci 2023; 35:139-145. [PMID: 36744198 PMCID: PMC9889212 DOI: 10.1589/jpts.35.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/16/2022] [Indexed: 02/04/2023] Open
Abstract
[Purpose] This study compared the short-term outcomes of manual therapy performed by a dentist and home exercises performed by patients as a single exercise therapy program for temporomandibular joint anterior disc displacement without reduction. [Participants and Methods] In this study we included seventeen patients with temporomandibular joint anterior disc displacement without reduction, moderate or greater temporomandibular joint functional impairment, and no treatment interventions. Patients receiving treatment underwent exercise therapy at the time of their first visit, whereas those in the non-treatment group received only an explanation of the condition. We evaluated the clinical symptoms (maximum painless opening distance, pain on motion and mastication, and degree of difficulty in daily life) at the first visit and at the two-week follow-up visit. [Results] For both groups, maximum painless opening distance and degree of difficulty in daily life improved significantly. For the treatment group, the pain on motion and mastication values significantly improved throughout the assessment period. [Conclusion] An exercise therapy program may be useful for the early treatment of temporomandibular joint anterior disc displacement without disc reduction.
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Affiliation(s)
- Yoshihiro Yamaguchi
- Department of Fixed Prosthodontics and Oral Implantology,
School of Dentistry, Aichi-Gakuin University: 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi
464-8651, Japan,Corresponding author. Yoshihiro Yamaguchi (E-mail: )
| | - Shigemitsu Sakuma
- Department of Fixed Prosthodontics and Oral Implantology,
School of Dentistry, Aichi-Gakuin University: 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi
464-8651, Japan
| | - Nobumi Ogi
- Department of Oral and Maxillofacial Surgery, School of
Dentistry, Aichi Gakuin University, Japan
| | | | - Suguru Kimoto
- Department of Gerodontology and Home Care Dentistry, School
of Dentistry, Aichi-Gakuin University, Japan
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Einfluss von aktiven Übungsprogrammen und Aufbissschienen auf die kraniomandibuläre Dysfunktion. MANUELLE MEDIZIN 2023. [DOI: 10.1007/s00337-022-00931-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Zusammenfassung
Hintergrund
Rund 40 % der Weltbevölkerung sind von einer kraniomandibulären Dysfunktion (CMD) betroffen. Diese äußert sich durch Schmerzen, Bewegungseinschränkungen und/oder Kiefergelenkgeräusche und wird durch die große Varianz an Symptomen meist erst spät diagnostiziert und behandelt. Nicht selten kommt es zu Einschränkungen der Lebensqualität der Betroffenen. In der Behandlung der CMD spielen Physiotherapie und Schienenversorgung eine wichtige Rolle.
Ziel
Ziel dieser Arbeit ist es, die Auswirkungen von Heimübungsprogrammen (HÜs) und Schienentherapie (ST) auf die Hauptsymptome der CMD zu klären. Es soll herausgefunden werden, ob eine Kombination der beiden Therapien einen therapeutischen Mehrwert darstellt.
Material und Methoden
Mittels Literaturrecherche in den Datenbanken PubMed, PEDro und Cochrane wurden Studien recherchiert und nach Durchsicht adäquater Abstracts die Volltexte zusammengefasst und kritisch diskutiert.
Ergebnisse
Sowohl HÜs als auch ST führen zu einer Verbesserung der beschriebenen Symptome und der Lebensqualität. Bei myogener CMD zeigen HÜs einen besseren Therapieeffekt auf die Kiefergelenkbeweglichkeit. Bei der Diagnose Diskusverlagerung mit Reposition waren im Gegensatz dazu keine deutlichen Therapieerfolge feststellbar. In keiner der analysierten Studien ergab eine Kombination der beiden Interventionen einen Mehrwert. Bei der Analyse der Lebensqualität war die Vergleichbarkeit aufgrund unterschiedlicher und nicht optimaler Fragebögen nur beschränkt möglich. Vergleicht man die Ergebnisse der durchgeführten Maßnahmen in Bezug auf die Interventionsdauer, ließ sich feststellen, dass zu Beginn der Therapien bessere Ergebnisse erzielt wurden als nach längerer Behandlungszeit. Auch die Dropout-Raten nahmen bei längeren Follow-up-Zeiten zu.
Schlussfolgerungen
Eine individuelle Anpassung der HÜs fördert die Compliance und Therapieadhärenz. Aufgrund der aktuellen Studienlage wird davon ausgegangen, dass sowohl HÜs als auch ST angemessene Methoden darstellen, um Schmerzen und Kiefergelenkgeräusche zu reduzieren und eine Verbesserung der Kiefergelenkbeweglichkeit und Lebensqualität zu erzielen. Bei myogener CMD stellen HÜs eine adäquate, kostengünstige Alternative zur ST dar. Weitere Forschung ist notwendig, um die genaue Therapiewirkung auf die verschiedenen Diagnosegruppen zu analysieren. Bezüglich der Lebensqualität sind weitere Analysen mit adäquaten Fragebögen notwendig.
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Li Z, Zhou J, Yu L, He S, Li F, Lin Y, Xu J, Chen S. Disc-condyle relationship alterations following stabilization splint therapy or arthrocentesis plus hyaluronic acid injection in patients with anterior disc displacement: a retrospective cohort study. Oral Radiol 2023; 39:198-206. [PMID: 35648303 DOI: 10.1007/s11282-022-00621-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/27/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The objective of this study was to quantitatively evaluate the efficacy of stabilization splint (SS) therapy or arthrocentesis plus hyaluronic acid (HA) injection in the treatment of anterior disc displacement (ADD) through magnetic resonance imaging (MRI). METHODS 99 subjects were collected in this study. 46 subjects received SS treatment (SS group), 53 subjects received arthrocentesis plus HA injection (HA group). Joints with anterior disc displacement with reduction (ADDwR) and anterior disc displacement without reduction (ADDwoR) were compared separately. MRI before the beginning of the treatment and after a set of treatment were used for measurement. Disc-condyle relationship and positions of condyles and discs were determined by disc-condyle angles and X-Y coordinates. RESULTS The disc-condyle angles decreased significantly in the SS group (P < .0001). Whereas no significant change was found in the HA group. Substantial anteroinferior condyle movement was detected in the SS group, slight anterior movement of condyles was discovered in the HA group. Anterior shift of discs position was observed in HA group and joints with ADDwoR in the SS group. CONCLUSIONS SS was effective in improving the disc-condyle relationship in ADD subjects, while significant improvement of disc-condyle relationship cannot be achieved through arthrocentesis plus HA injection.
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Affiliation(s)
- Ziyu Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics and Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Section 3, No. 14, Renmin South Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jialiang Zhou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics and Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Section 3, No. 14, Renmin South Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lixia Yu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Shushu He
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics and Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Section 3, No. 14, Renmin South Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Fei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yao Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics and Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Section 3, No. 14, Renmin South Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jingchen Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics and Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Section 3, No. 14, Renmin South Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Song Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Orthodontics and Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Section 3, No. 14, Renmin South Road, Chengdu, 610041, Sichuan, People's Republic of China.
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Tobe S, Ishiyama H, Nishiyama A, Miyazono K, Kimura H, Fueki K. Effects of Jaw-Opening Exercises with/without Pain for Temporomandibular Disorders: A Pilot Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16840. [PMID: 36554726 PMCID: PMC9779752 DOI: 10.3390/ijerph192416840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
This study aimed to evaluate the effects of jaw-opening exercises with and without pain on temporomandibular disorders (TMDs), specifically in relation to pain intensity and range-of-mouth opening in patients with TMDs. Participants were randomly assigned to either the jaw-opening exercise with pain (JE w/pain) or the jaw-opening exercise without pain (JE w/o pain) groups, and each exercise was performed for eight weeks. TMDs pain intensity was assessed using a 100-mm visual analog scale (VAS), and the range-of-mouth opening was evaluated at the baseline (T0), 2 weeks (T1), 4 weeks (T2), and 8 weeks (T3). Of the 61 participants, 57 (JE w/pain group, n = 30; JE w/o pain group, n = 27) were included in the analysis. The range-of-mouth opening and TMDs pain intensity improved from T1 to T3 in both groups. The JE w/pain group showed significant differences at T3 compared to T1 (pain-free unassisted mouth opening, p = 0.006; jaw-opening pain, p = 0.014; chewing pain, p = 0.018). In addition, the JE w/pain group showed significantly greater changes in the maximum unassisted mouth opening at T2 and T3 than the JE w/o pain group (T2, p < 0.001; T3, p = 0.003). Thus, jaw-opening exercises, until the occurrence of pain, may be effective in patients with TMDs.
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Affiliation(s)
- Shoko Tobe
- Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Hiroyuki Ishiyama
- Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Akira Nishiyama
- Department of General Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Keisuke Miyazono
- Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Hiroko Kimura
- Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Kenji Fueki
- Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
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Zhang Q, Ye Z, Wu Y, Zhu Y, Liu J, Yang W, Ye C, Lau Rui Han S, Wang J, Xiong X. Nonlinear Relationship between Temporomandibular Joint Disc Displacement Distance and Disc Length: A Magnetic Resonance Imaging Analysis. J Clin Med 2022; 11:jcm11237160. [PMID: 36498733 PMCID: PMC9741082 DOI: 10.3390/jcm11237160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022] Open
Abstract
Objective: to explore the association between the distance of disc displacement and disc morphology in patients with temporomandibular disorders (TMDs). Methods: a total of 717 joints in 473 subjects were enrolled in this cross-sectional study. The magnetic resonance imaging (MRI) of each patient was evaluated for temporomandibular joint (TMJ) disc morphology classification and position. The distance of the disc displacement and disc length were measured for smoothing spline prediction. A stratified analysis was performed based on the types of disc positions. The disc width and length-width ratio (L/W) were also measured. Descriptive statistics, one-way analysis of variance, smoothing spline analysis, threshold analysis, and two piecewise linear regression were performed to investigate the association between the displacement distance and length of discs. Results: the differences in displacement distance among morphological categories and among different disc positions were statistically significant. Nonlinear relationships were found between distance and length in all subjects. Two turning points of distance (−1.8 mm and 1.7 mm) were found, dividing the curve into three segments. Disc width and L/W were significantly different among discs in the three segments of the curve. The correlation coefficient (β) for the three segments were as follows: −0.6 [95% confidence interval (CI) = −0.9 to −0.3, p < 0.001], 0.0 (95% CI = −0.1 to 0.0, p = 0.027), and −0.7 (95% CI = −0.8 to −0.7, p < 0.001). Nonlinear relationships were also found between the distance and length in cases with anterior disc displacement (ADD), anterior disc displacement with reduction (ADDWR), and without reduction (ADDWoR). Conclusion: the turning points of the disc displacement distance may be considered as a potential reference value for high-risk disc deformation and ADD. Disc length decreases sharply with anterior disc displacement when the disc displacement distance is over 1.7 mm. Prospective and long-term studies are required to clarify the natural course of the disc at different stages of the regression curve.
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Affiliation(s)
- Qinlanhui Zhang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Zheng Ye
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yange Wu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yufan Zhu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jiaqi Liu
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Wenke Yang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Chengxinyue Ye
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Sophie Lau Rui Han
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Jun Wang
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Correspondence: (J.W.); (X.X.); Tel.: +86-28-85501425 (J.W.); +86-28-85503898 (X.X.)
| | - Xin Xiong
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Oral Diseases and National Clinical Research Center for Oral Diseases, Department of Temporomandibular Joint, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
- Correspondence: (J.W.); (X.X.); Tel.: +86-28-85501425 (J.W.); +86-28-85503898 (X.X.)
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Di Giacomo P, Di Paolo C, Qorri E, Gatto R, Manes Gravina G, Falisi G. Conservative Therapies for TMJ Closed Lock: A Randomized Controlled Trial. J Clin Med 2022; 11:jcm11237037. [PMID: 36498611 PMCID: PMC9737370 DOI: 10.3390/jcm11237037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/09/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background. Acute anterior disc displacement without reduction (ADDWoR) is characterized by permanent TMJ disc displacement, pain and functional limitations. Occlusal appliances (OA) are among the therapies of choice. Methods. A single-blind randomized study was carried out to compare the therapeutic success of two different types of splints in patients with ADDWoR. A total of 30 subjects were eligible for the study out of the 330 screened. Group I (n = 15) received RA.DI.CA splint therapy and Group II (n = 15) received stabilization splint therapy. Temporomandibular pain, headache, neck pain and functional excursions were evaluated at baseline (T0), after 4 weeks (T1) and after 6 months (T2). Descriptive and inferential statistics were performed. Results. There was a significant increase in maximum jaw opening and a reduction in pain in both groups (p < 0.05), except for neck pain in Group II. Significant differences in between- and within-subject factors emerged in all of the parameters evaluated, especially between T1 and T2 scores, with a greater trend of improvement in Group I than Group II. Conclusion. RA.DI.CA splints were found to be more effective for the considered sample, especially in the treatment of comorbidities and functional movements, probably due to the greater orthopedic action and joint mobilization.
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Affiliation(s)
- Paola Di Giacomo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
| | - Carlo Di Paolo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Erda Qorri
- Department of Dentistry, Faculty of Medical Sciences, Albanian University, 1001 Tirana, Albania
| | - Roberto Gatto
- Department of Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Giovanni Manes Gravina
- Department of Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Giovanni Falisi
- Department of Life Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
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Temporomandibular Joint Disk Displacement: Etiology, Diagnosis, Imaging, and Therapeutic Approaches. J Craniofac Surg 2022; 34:1115-1121. [PMID: 36730822 DOI: 10.1097/scs.0000000000009103] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/05/2022] [Indexed: 02/04/2023] Open
Abstract
An estimated 8 to 15% of women, and 3 to 10% of men currently suffer from Temporomandibular disorders, and it has been reported that sounds are a common finding and have been observed in 28% to 50% of the adult population; sounds are almost always connected to "internal derangements" a condition in which the articular disk displaced from its position on the mandibular condyle. Due to the multifactorial etiology of temporomandibular joint dysfunction, any accurate diagnosis based on clinical examination alone often proves to be difficult, so a clinical examination should be utilized together with other imaging methods to determine the relationship between the disk and condyle before and after treatment. In general, management of temporomandibular joint-related conditions is necessary when pain or dysfunction is present, so many surgical or nonsurgical methods of treatment have been reported. The Occlusal splint is 1 of the most widespread treatment it induces a slight vertical condylar distraction and eliminates the occlusal factor, which can be responsible for Temporomandibular joint disturbances, removing the influence of the teeth on the joint position by the slight distraction of the joint which, in turn, enables damaged connective tissue to heal.
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14
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Decellularized small intestine submucosa device for temporomandibular joint meniscus repair: Acute timepoint safety study. PLoS One 2022; 17:e0273336. [PMID: 36006938 PMCID: PMC9409591 DOI: 10.1371/journal.pone.0273336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/06/2022] [Indexed: 12/02/2022] Open
Abstract
Temporomandibular joint (TMJ) Meniscus removal is an option for the patient to regain full range of motion if the disc is irreversibly damaged or unable to be reduced. However, this procedure leaves the joint vulnerable to condylar remodeling and degeneration. We have shown that extracellular matrix (ECM) scaffolds remodel into a tissue with near native TMJ meniscus in previous studies. The next step towards clinical translation is to manufacture the ECM scaffold as a device under good manufacturing practices (GMP) and test it in a pre-clinical animal study under good laboratory practices (GLP). The primary objective of this study was to evaluate the in-vivo histopathological response to a Prototype GMP manufactured device made of decellularized porcine small intestinal submucosa (SIS), by observing for signs of surrounding tissue reaction to the device that are indicative of an adverse host response in comparison to an empty control at 21 days post-surgical implantation in a canine TMJ meniscus removal and implant model in a GLP setting. The conclusive findings were that the ECM device is safe for placement in the TMJ. After 21 days post implantation, histology of tissue surrounding the device and draining lymph nodes showed that the Prototype GMP device had no negative effects compared to the empty site (as evaluated by the board-certified veterinary pathologist). Furthermore, there was a lack of negative findings for clinical pathology (hematology and clinical chemistry), mortality, and body weight/weight change. Future studies will go to one year after implantation to show that the remodel device remains as a viable tissue with near native mechanical properties.
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Diverse therapies for disc displacement of temporomandibular joint: A systematic review and network meta-analysis. Br J Oral Maxillofac Surg 2022; 60:1012-1022. [DOI: 10.1016/j.bjoms.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/18/2022] [Accepted: 04/13/2022] [Indexed: 11/20/2022]
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Argueta-Figueroa L, Flores-Mejía LA, Ávila-Curiel BX, Flores-Ferreyra BI, Torres-Rosas R. Nonpharmacological Interventions for Pain in Patients with Temporomandibular Joint Disorders: A Systematic Review. Eur J Dent 2022; 16:500-513. [PMID: 35259762 PMCID: PMC9507562 DOI: 10.1055/s-0041-1740220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This systematic review aimed to compare the efficacy of nonpharmacological therapies for painful temporomandibular joint disorders. The protocol was registered on International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020171364). The search was performed on the electronic databases PubMed, Google Scholar, Clinical Trials, and Web of Science. The eligibility criteria were randomized controlled trials in patients diagnosed with painful temporomandibular joint disorders comparing the pain relief between conventional treatment and nonpharmacological therapies such as acupuncture, physiotherapy, low-level laser, and massage. Fourteen articles were included in this review. At the overall bias of the studies included, 71.42% exhibited some concerns and 28.57% had high risk. The efficacy of nonpharmacological interventions was found to be moderate in the short term and variable in the long term for pain reduction in patients with temporomandibular joint disorders. The evidence pointed out that acupuncture, laser therapy, and physiotherapy are potentially useful interventions for pain relief in patients with temporomandibular joint disorders. However, there is a lack of consistency and short-term follow-up in the studies to determine the lasting of such effect.
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Affiliation(s)
- Liliana Argueta-Figueroa
- CONACyT - Facultad de Odontología, Universidad Autónoma "Benito Juárez" de Oaxaca, Oaxaca, México
| | | | - Beatriz Xóchitl Ávila-Curiel
- Laboratorio de Medicina Complementaria, Centro de Estudios en Ciencias de la Salud y la Enfermedad, Facultad de Odontología, Universidad Autónoma "Benito Juárez" de Oaxaca Oaxaca, México
| | | | - Rafael Torres-Rosas
- Laboratorio de Medicina Complementaria, Centro de Estudios en Ciencias de la Salud y la Enfermedad, Facultad de Odontología, Universidad Autónoma "Benito Juárez" de Oaxaca Oaxaca, México
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17
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Olivencia O, Kaplan K, Dreger M, Veloz M, Kais A, Marlowe K. Postrehabilitation Considerations for Individuals With Temporomandibular Disorders. Strength Cond J 2021. [DOI: 10.1519/ssc.0000000000000685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Zhou H, Xue Y, Liu P. Application of auriculotemporal nerve block and dextrose prolotherapy in exercise therapy of TMJ closed lock in adolescents and young adults. Head Face Med 2021; 17:11. [PMID: 33773589 PMCID: PMC8004452 DOI: 10.1186/s13005-021-00261-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/11/2021] [Indexed: 12/19/2022] Open
Abstract
Background Temporomandibular joint (TMJ) ‘closed lock’ is a clinical condition causing TMJ pain and limited mouth opening (painful locking). Recent studies suggest an increasing prevalence of degenerative joint disease associated with the onset of TMJ closed lock in adolescents and young adults. Early interventions are recommended, but the curative effect of standard therapies remains controversial. In this retrospective study, an alternative method of non-surgical treatment of TMJ closed lock is presented, and its long-term efficacy has been observed. Methods Forty adolescents and young adults, aged 16 to 30 years old, with distinct combination of symptoms of TMJ closed lock, were enrolled. Patients received anesthetic blockages of the auriculotemporal nerve, then performed mandibular condylar movement exercise for 10 min, and subsequently received hypertonic dextrose prolotherapy in retro-discal area of TMJ. Clinical assessments at baseline and at follow-up (2 weeks, 2 months, 6 months, and 5 years) included intensity and frequency of TMJ pain, mandibular range of motion, TMJ sounds, and impairment of chewing. Results Cone beam CT images of the TMJs revealed joint space changes in all patients and degenerative bone changes in 20% (8/40) of the patients. The patients were diagnosed as having disc displacement without reduction with limited opening. Successful reduction of displaced disc had been achieved in the treatment. And pain at rest and pain on mastication had substantially decreased in all patients and mandibular function and mouth opening had significantly improved since 2 weeks’ follow-up. The overall success rate kept at a high level of 97.5% (39/40) at 6 months and 5 years’ follow-up. Conclusions The technique combining mandibular condylar movement exercise with auriculotemporal nerve block and dextrose prolotherapy is straightforward to perform, inexpensive and satisfactory to young patients with TMJ closed lock.
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Affiliation(s)
- Hongzhi Zhou
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, 145# Western Changle Road, Xi'an, 710032, P.R. China. .,Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University (FMMU), Xi'an, 710032, China.
| | - Yang Xue
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, 145# Western Changle Road, Xi'an, 710032, P.R. China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University (FMMU), Xi'an, 710032, China
| | - Ping Liu
- State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, 145# Western Changle Road, Xi'an, 710032, P.R. China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University (FMMU), Xi'an, 710032, China
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Di Paolo C, Falisi G, Panti F, Di Giacomo P, Rampello A. "RA.DI.CA." Splint for the Management of the Mandibular Functional Limitation: A Retrospective Study on Patients with Anterior Disc Displacement without Reduction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9057. [PMID: 33291679 PMCID: PMC7730108 DOI: 10.3390/ijerph17239057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
The study aimed at assessing the effectiveness of the RA.DI.CA. splint in the management of temporomandibular joint disc displacement without reduction (ADDwoR) and jaw functional limitation. The authors developed a retrospective clinical study. A total of 2739 medical records were screened. One hundred and forty-one patients with chronic unilateral disc displacement without reduction and jaw limitation, treated with a multifunctional RA.DI.CA. splint, were enrolled. Temporomandibular pain, headache, familiar pain, neck pain, and emotional strain, maximum spontaneous mouth opening, and lateral excursions were evaluated at baseline (T0), after therapy (T1), and during the follow-up (T2). Descriptive statistical analysis was performed. Wilcoxon test assessed changes in symptomatology and functional aspects before and after treatment and between T1 and T2, with p < 0.05. Ninety-nine patients (70%) declared themselves "healed" from jaw functional limitation with no residual painful symptoms, 31 (22%) improved their symptoms and jaw function, 11 (8%) reported no changes compared to T0 and no one worsened. As for all parameters analyzed, the comparison between the ones before and after treatment was statistically significant (p < 0.05). The RA.DI.CA. splint proved to be highly performing and promoting functional and symptomatologic recovery, also in the medium and long term, through the restoration of the functional disc-condyle relationship and the healing of joint tissues.
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Affiliation(s)
| | | | | | - Paola Di Giacomo
- Gnathologic Division, Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00161 Rome, Italy; (C.D.P.); (G.F.); (F.P.); (A.R.)
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Rodrigues-de-Souza DP, Paz-Vega J, Fernández-de-las-Peñas C, Cleland JA, Alburquerque-Sendín F. Is Irritable Bowel Syndrome Considered in Clinical Trials on Physical Therapy Applied to Patients with Temporo-Mandibular Disorders? A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228533. [PMID: 33213056 PMCID: PMC7698821 DOI: 10.3390/ijerph17228533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
The aim of the current scoping review was to identify if the presence of irritable bowel syndrome was included as eligibility criteria of participants included in clinical trials investigating the effects of physical therapy in individuals with temporomandibular pain disorders (TMDs). A systematic electronic literature search in the Web of Science database was conducted. Scientifically relevant, randomized clinical trials (those cited in other studies at least 5 times, or clinical trials published in high-impact journals, i.e., first and second quartiles (Q1-Q2) of any category of the Journal Citation Report (JCR)) evaluating the effects of any physical therapy intervention in patients with TMDs were included. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of the selected trials. Authors affiliated to a clinical or non-clinical institution, total number of citations, objective, sex/gender, age, and eligibility criteria in each article were extracted and analyzed independently by two authors. From a total of 98 identified articles, 12 and 19 clinical trials were included according to the journal citation criterion or JCR criterion, respectively. After removing duplicates, a total of 23 trials were included. The PEDro score ranged from 4 to 8 (mean: 6.26, SD: 1.48). Based on the eligibility criteria of the trials systematically reviewed, none considered the presence of comorbid irritable bowel syndrome in patients with TMDs. The comorbidity between TMDs and irritable bowel syndrome is not considered within the eligibility criteria of participants in highly cited clinical trials, or published in a high-impact journal, investigating the effects of physical therapy in TMDs.
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Affiliation(s)
- Daiana P. Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (D.P.R.-d.-S.); (J.P.-V.); (F.A.-S.)
| | - Javier Paz-Vega
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (D.P.R.-d.-S.); (J.P.-V.); (F.A.-S.)
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain
- Cátedra Institucional en Docencia, Clínica e Investigación en Fisioterapia: Terapia Manual, Punción Seca y Ejercicio Terapéutico, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Correspondence: ; Tel.: +34-914-888-884
| | - Joshua A. Cleland
- Doctor of Physical Therapy Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02155, USA;
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (D.P.R.-d.-S.); (J.P.-V.); (F.A.-S.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain
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Yamaguchi Y, Sakuma S, Takagi S, Ogi N, Kurita K, Ariji Y, Taguchi N. Efficacy of therapeutic exercise for temporomandibular disorders as assessed by magnetic resonance imaging: a case report. J Phys Ther Sci 2020; 32:477-482. [PMID: 32753791 PMCID: PMC7344288 DOI: 10.1589/jpts.32.477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/14/2020] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The efficacy of exercise therapy in temporomandibular disorders has been
recognized. Here, we present our experience with exercise therapy. [Participant and
Methods] A 25-year-old female with a sudden onset of mouth opening limitation in October
2018 was admitted to our hospital in November 2018. Based on our initial findings, the
patient was diagnosed with left disc derangement of the temporomandibular joint without
reduction. A definitive diagnosis was established following magnetic resonance imaging in
December 2018. Subsequently, range-of-motion exercises for the temporomandibular joint as
passive movements and self-traction therapy as active movements were conducted. Magnetic
resonance imaging was repeated 4 months after the first treatment. [Results] The
temporomandibular joint disc remained in anterior dislocation during mouth opening and
closing. The mouth opening joint motion was significantly improved compared to the
pre-therapy range. The pain-related visual analog scale score also significantly improved.
[Conclusion] The range of motion of the temporomandibular joint was improved by
range-of-motion exercises for the temporomandibular joint, and was maintained and managed
using self-traction therapy. Improvement of the range of motion was confirmed by magnetic
resonance imaging.
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Affiliation(s)
- Yoshihiro Yamaguchi
- The Third Department of Fixed Prosthodontics, School of Dentistry, Aichi-Gakuin University: 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi 464-8651, Japan
| | - Shigemitsu Sakuma
- The Third Department of Fixed Prosthodontics, School of Dentistry, Aichi-Gakuin University: 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi 464-8651, Japan
| | - Shinya Takagi
- The Third Department of Fixed Prosthodontics, School of Dentistry, Aichi-Gakuin University: 2-11 Suemori-dori, Chikusa-ku, Nagoya, Aichi 464-8651, Japan
| | - Nobumi Ogi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Japan
| | - Kenichi Kurita
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Japan
| | - Yoshiko Ariji
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Aichi-Gakuin University, Japan
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22
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Al-Moraissi E, Farea R, Qasem K, Al-Wadeai M, Al-Sabahi M, Al-Iryani G. Effectiveness of occlusal splint therapy in the management of temporomandibular disorders: network meta-analysis of randomized controlled trials. Int J Oral Maxillofac Surg 2020; 49:1042-1056. [DOI: 10.1016/j.ijom.2020.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 12/27/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
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Abstract
Objectives To evaluate the clinical-effectiveness of oral splints for patients with TMD or bruxism for the primary outcomes: pain (TMD) and tooth wear (bruxism). Data sources Four databases including MEDLINE and EMBASE were searched from inception until 1 October 2018. Data selection and extraction Randomised controlled trials comparing all types of splints versus no/minimal treatment for patients with TMD or bruxism were eligible. Standard Cochrane review methods were used. Standardised mean differences (SMD) were pooled for the primary outcome of pain, using random effects models in TMD patients. Data synthesis Thirty-seven trials were included and the evidence identified was of very low certainty using GRADE assessments. When all subtypes of TMD were pooled into one global TMD group, there was no evidence that splints reduced pain: SMD (up to 3 months) -0.18 (95% CI -0.42 to 0.06); 13 trials, 1,076 participants. There was no evidence that any other outcomes improved when using splints. There was no evidence of adverse events associated with splints, but reporting was poor regarding this outcome. No trials measured tooth wear in patients with bruxism. There was a large variation in diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these factors did not indicate a reduction in pain. Conclusions The very low-certainty evidence identified did not demonstrate that splints reduced pain in TMD as a group of conditions. There is insufficient evidence to determine whether splints reduce tooth wear in patients with bruxism.
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La Touche R, Boo-Mallo T, Zarzosa-Rodríguez J, Paris-Alemany A, Cuenca-Martínez F, Suso-Martí L. Manual therapy and exercise in temporomandibular joint disc displacement without reduction. A systematic review. Cranio 2020; 40:440-450. [PMID: 32589520 DOI: 10.1080/08869634.2020.1776529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this systematic review was to analyze the effectiveness of exercise and manual therapy interventions in patients with disc displacement without reduction. METHOD The authors performed a systematic review of Medline, EMBASE, PEDro, CINAHL, and Google Scholar databases. Two independent reviewers conducted the eligibility and quality assessment of studies. Interventions based on exercise and manual therapy regarding pain intensity and maximum mouth opening as primary outcomes were examined. RESULTS Ten articles were included, according to the inclusion criteria. Most of the interventions showed statistically significant improvements in the primary outcomes. CONCLUSION Results show that interventions based on therapeutic exercise or manual therapy may be beneficial and play a role in the treatment of disc displacement without reduction. Limited evidence suggests that exercise significantly improves mouth opening in comparison to splints. Due to the heterogeneity of the included studies, these results should be interpreted with caution.
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Affiliation(s)
- Roy La Touche
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain.,Neuroscience and Craniofacial Pain Institute, (INDCRAN), Madrid, Spain
| | - Tania Boo-Mallo
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain
| | - Joseba Zarzosa-Rodríguez
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain
| | - Alba Paris-Alemany
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain.,Neuroscience and Craniofacial Pain Institute, (INDCRAN), Madrid, Spain
| | - Ferran Cuenca-Martínez
- Department of Physiotherapy, Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain.,Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain
| | - Luis Suso-Martí
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Autonomous University of Madrid, Madrid, Spain.,Department of Physiotherapy, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
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Fouda AAH. No evidence on the effectiveness of oral splints for the management of temporomandibular joint dysfunction pain in both short and long-term follow-up systematic reviews and meta-analysis studies. J Korean Assoc Oral Maxillofac Surg 2020; 46:87-98. [PMID: 32364348 PMCID: PMC7222619 DOI: 10.5125/jkaoms.2020.46.2.87] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/30/2019] [Accepted: 12/17/2019] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to determine the efficacy of oral splints in reducing the intensity of pain in patients with temporomandibular joint dysfunction in both short and long-term treatment durations. Electronic databases, Cochrane Library, MEDLINE via PubMed, Web of Science, Egyptian Knowledge Bank, and EMBASE were searched for randomized controlled trials comparing different types of splints to non-occluding splints, behavioral therapy, pharmacotherapy, counseling, and no treatment. The risk of bias was assessed by using Cochrane risk of bias recommendations. Fixed and random effects were used to summarize the outcomes. The effect estimates were expressed as standardized mean differences (SMD) or risk ratios with a 95% confidence interval (CI). Subgroup analyses were carried out according to the treatment duration. Twenty-two studies met the inclusion criteria. A meta-analysis of short-term studies up to three months revealed no significant difference between the study groups. However, long-term studies exhibited a significant difference in pain reduction in favor of the control group. Total analysis revealed that the control group resulted in significant pain reduction (SMD 0.14, 95% CI 0.05-0.23, P=0.002, I2=0%). Oral splints are not effective in reducing pain intensity or improving function in patients with temporomandibular joint dysfunction.
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Riley P, Glenny AM, Worthington HV, Jacobsen E, Robertson C, Durham J, Davies S, Petersen H, Boyers D. Oral splints for patients with temporomandibular disorders or bruxism: a systematic review and economic evaluation. Health Technol Assess 2020; 24:1-224. [PMID: 32065109 PMCID: PMC7049908 DOI: 10.3310/hta24070] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Splints are a non-invasive, reversible management option for temporomandibular disorders or bruxism. The clinical effectiveness and cost-effectiveness of splints remain uncertain. OBJECTIVES The objectives were to evaluate the clinical effectiveness and cost-effectiveness of splints for patients with temporomandibular disorders or bruxism. This evidence synthesis compared (1) all types of splint versus no/minimal treatment/control splints and (2) prefabricated versus custom-made splints, for the primary outcomes, which were pain (temporomandibular disorders) and tooth wear (bruxism). REVIEW METHODS Four databases, including MEDLINE and EMBASE, were searched from inception until 1 October 2018 for randomised clinical trials. The searches were conducted on 1 October 2018. Cochrane review methods (including risk of bias) were used for the systematic review. Standardised mean differences were pooled for the primary outcome of pain, using random-effects models in temporomandibular disorder patients. A Markov cohort, state-transition model, populated using current pain and Characteristic Pain Intensity data, was used to estimate the incremental cost-effectiveness ratio for splints compared with no splint, from an NHS perspective over a lifetime horizon. A value-of-information analysis identified future research priorities. RESULTS Fifty-two trials were included in the systematic review. The evidence identified was of very low quality with unclear reporting by temporomandibular disorder subtype. When all subtypes were pooled into one global temporomandibular disorder group, there was no evidence that splints reduced pain [standardised mean difference (at up to 3 months) -0.18, 95% confidence interval -0.42 to 0.06; substantial heterogeneity] when compared with no splints or a minimal intervention. There was no evidence that other outcomes, including temporomandibular joint noises, decreased mouth-opening, and quality of life, improved when using splints. Adverse events were generally not reported, but seemed infrequent when reported. The most plausible base-case incremental cost-effectiveness ratio was uncertain and driven by the lack of clinical effectiveness evidence. The cost-effectiveness acceptability curve showed splints becoming more cost-effective at a willingness-to-pay threshold of ≈£6000, but the probability never exceeded 60% at higher levels of willingness to pay. Results were sensitive to longer-term extrapolation assumptions. A value-of-information analysis indicated that further research is required. There were no studies measuring tooth wear in patients with bruxism. One small study looked at pain and found a reduction in the splint group [mean difference (0-10 scale) -2.01, 95% CI -1.40 to -2.62; very low-quality evidence]. As there was no evidence of a difference between splints and no splints, the second objective became irrelevant. LIMITATIONS There was a large variation in the diagnostic criteria, splint types and outcome measures used and reported. Sensitivity analyses based on these limitations did not indicate a reduction in pain. CONCLUSIONS The very low-quality evidence identified did not demonstrate that splints reduced pain in temporomandibular disorders as a group of conditions. There is insufficient evidence to determine whether or not splints reduce tooth wear in patients with bruxism. There remains substantial uncertainty surrounding the most plausible incremental cost-effectiveness ratio. FUTURE WORK There is a need for well-conducted trials to determine the clinical effectiveness and cost-effectiveness of splints in patients with carefully diagnosed and subtyped temporomandibular disorders, and patients with bruxism, using agreed measures of pain and tooth wear. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068512. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Philip Riley
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Anne-Marie Glenny
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Justin Durham
- Centre for Oral Health Research and School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Davies
- TMD Unit, University Dental Hospital of Manchester, Manchester, UK
| | - Helen Petersen
- University Dental Hospital of Manchester, Manchester, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Al-Moraissi EA, Wolford LM, Ellis E, Neff A. The hierarchy of different treatments for arthrogenous temporomandibular disorders: A network meta-analysis of randomized clinical trials. J Craniomaxillofac Surg 2019; 48:9-23. [PMID: 31870713 DOI: 10.1016/j.jcms.2019.10.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/07/2019] [Accepted: 10/15/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Different treatment options for patients with arthrogenous Temporomandibular Disorders (TMDs) have been reported. However, evidence regarding the most effective intervention using network meta-analysis (NMA) has not been performed. Thus, we conducted a NMA of randomized clinical trials (RCTs) to identify the most effective treatment of arthrogenous TMDs with respect to pain reduction and improved mouth opening, and to generate a ranking according to their effectiveness. MATERIAL AND METHODS An electronic search on three major databases was undertaken to identify RCTs published before August 2019, comparing up to fourteen different treatments against control/placebo patients for arthrogenous TMDs with respect to pain reduction and improved mouth opening. The treatment variables were controls/placebo, conservative treatment (muscle exercises and occlusal splint therapy), occlusal splint therapy alone, intraarticular injection (IAI) of hyaluronic acid (HA) or corticosteroid (CS), arthrocentesis with or without HA, CS and platelet-rich plasma (PRP), arthroscopy with or without HA and PRP, open joint surgery, and physiotherapy. Frequentist NMA was performed using STATA software. Studies meeting the inclusion criteria were divided according to the length of follow-up (short-term (≤5 months) and intermediate-term (≥6 months to 4 years) and type of TMJ arthrogenous disorders; internal derangement (ID) and TMJ osteoarthritis (OA). The standardized mean differences (SMD) in post-treatment pain reduction and maximum mouth opening (MMO) were analysed. RESULTS Thirty-six RCTs were identified that performed comparative outcome assessments for pain and 33 RCTs for MMO. At the short term (≤5 months), IAI-HA (SMD = -2.8, CI: -3.7 to -1.8) and IAI-CS (SMD = -2.11, CI: -2.9 to -1.2) (all very low quality evidence) achieved a substantially greater pain reduction than control/placebo. At intermediate term (≥6 months), a statistically significant decrease in posttreatment pain intensity was observed following Arthroscopy-PRP (SMD = -3.5, CI: -6.2 to -0.82), Arthrocentesis-PRP (SMD = -3.08, CI: -5.44 to -0.71), Arthroscopy-HA (SMD = -3.01, CI: -5.8 to -0.12), TMJ surgery (SMD = -3, CI: -5.7 to -0.28), IAI-HA (SMD = -2.9, CI: -4.9 to -1.09) (all very low quality evidence), Arthroscopy-alone (SMD = -2.6, CI: -5.1 to -0.07, low quality evidence) and Arthrocentesis-HA (SMD = -2.3, CI: -4.5 to -018, moderate-quality evidence) when compared to the control/placebo groups. Relative to MMO, the most effective treatments for short- and intermediate-term improvement were the arthroscopy procedures (PRP > HA > alone, all very low-quality evidence) followed by Arthrocentesis-PRP (very low-quality evidence) and Arthrocentesis-HA (moderate-quality evidence). The non-invasive procedures of occlusal splint therapy, physical therapy, conservative therapy, placebo/control provided significantly lower quality outcomes relative to pain and MMO. CONCLUSION The results of the present meta-analysis support a paradigm shift in arthrogenous TMJ disorder treatment. There is a new evidence (though on a very low to moderate quality level) that minimally invasive procedures, particularly in combination with IAI of adjuvant pharmacological agents (PRP, HA or CS), are significantly more effective than conservative treatments for both pain reduction and improvement of MMO in both short (≤5 months) and intermediate term (6 months-4 years) periods. In contrast to traditional concepts mandating exhaustion of conservative treatment options, minimally invasive procedures, therefore, deserve to be implemented as efficient first-line treatments (e.g. IAIs and/or arthrocentesis) or should be considered rather early, i.e. as soon as patients do not show a clear benefit from an initial conservative treatment.
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Affiliation(s)
- Essam Ahmed Al-Moraissi
- Dept. of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
| | - Larry M Wolford
- Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University College of Dentistry, Baylor University Medical Center, Dallas, TX, USA
| | - Edward Ellis
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Andreas Neff
- Dept. of Oral and Maxillofacial Surgery, University Hospital Marburg UKGM GmbH, Marburg, Germany
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Shimada A, Ishigaki S, Matsuka Y, Komiyama O, Torisu T, Oono Y, Sato H, Naganawa T, Mine A, Yamazaki Y, Okura K, Sakuma Y, Sasaki K. Effects of exercise therapy on painful temporomandibular disorders. J Oral Rehabil 2019; 46:475-481. [DOI: 10.1111/joor.12770] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 12/30/2018] [Accepted: 01/13/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Akiko Shimada
- Department of Oral Rehabilitation Osaka Dental University Hospital Osaka Japan
- Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Faculty of Health Aarhus University Aarhus Denmark
- Scandinavian Center for Orofacial Neurosciences Aarhus Denmark
| | - Shoichi Ishigaki
- Department of Fixed Prosthodontics Osaka University Graduate School of Dentistry Suita Japan
| | - Yoshizo Matsuka
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences Tokushima University Tokushima Japan
| | - Osamu Komiyama
- Department of Oral Function and Rehabilitation Nihon University School of Dentistry at Matsudo Chiba Japan
| | - Tetsurou Torisu
- Department of Prosthetic Dentistry, Graduate School of Biomedical Sciences Nagasaki University Nagasaki Japan
| | - Yuka Oono
- Division of Dental Anesthesiology, Department of Diagnostic and Therapeutic Sciences Meikai University School of Dentistry Saitama Japan
| | - Hitoshi Sato
- Department of Oral and Maxillofacial Surgery, School of Dentistry Showa University Tokyo Japan
| | - Takuya Naganawa
- Department of Oral and Maxillofacial Surgery, School of Medicine Tokyo Women's Medical University Tokyo Japan
| | - Atsushi Mine
- Department of Fixed Prosthodontics Osaka University Graduate School of Dentistry Suita Japan
| | - Yoko Yamazaki
- Orofacial Pain Clinic, Tokyo Medical and Dental University Hospital of Dentistry Tokyo Japan
| | - Kazuo Okura
- Department of Stomatognathic Function and Occlusal Reconstruction, Graduate School of Biomedical Sciences Tokushima University Tokushima Japan
| | - Yasushi Sakuma
- Department of Anesthesiology Osaka Dental University Graduate School Osaka Japan
| | - Keiichi Sasaki
- Division of Advanced Prosthetic Dentistry Tohoku University Graduate School of Dentistry Sendai Japan
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Efficacy of mandibular manipulation technique for temporomandibular disorders patients with mouth opening limitation: a randomized controlled trial for comparison with improved multimodal therapy. J Prosthodont Res 2018; 63:202-209. [PMID: 30563758 DOI: 10.1016/j.jpor.2018.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Manual therapy has been used for the treatment of patients with temporomandibular disorders (TMD) with mouth-opening limitations. However, the curative effect of manipulation differs among researchers, and its necessity remains controversial. The purpose of this study was to confirm the efficacy of manipulation using a randomized controlled trial (RCT). METHODS A total of 61 TMD patients who had mouth-opening limitation (upper and lower middle incisor distance ≤35mm) were selected. They were divided into two treatment groups: conventional treatment (n=30) and conventional treatment plus manipulation (n=31). The conventional treatment included two types of self-exercise: cognitive behavioral therapy for bruxism and education. Mouth-opening limitation, orofacial pain, and temporomandibular joint (TMJ) sounds were recorded from baseline to 18 weeks after baseline. These parameters were statistically compared between the two treatment groups by using analysis of variance (ANOVA) and Scheffe's test to assess mouth opening distance and pain; TMJ sounds were compared using Mann-Whitney U test. RESULTS No statistical difference was observed between the two treatment groups except for mouth-opening limitation after treatment at the first visit. Subgroup analyses, stratified according to the pathological type of TMD, indicated a similar trend. CONCLUSIONS The efficacy of manipulation seems to be limited, in contrast to our expectations, and improved execution of therapeutic exercises has a similar effect to that of manipulation during long-term observation. The advantage of manipulation was observed only during the first treatment session. The RCT was registered in the University Hospital Medical Information Network in Japan (UMIN-CTR: 000010437).
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Comparison of two physiotherapy programmes for rehabilitation after temporomandibular joint arthroscopy. Int J Oral Maxillofac Surg 2018; 47:755-761. [DOI: 10.1016/j.ijom.2017.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 09/01/2017] [Accepted: 10/23/2017] [Indexed: 11/17/2022]
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The Efficiency of Anterior Repositioning Splints in the Management of Pain Related to Temporomandibular Joint Disc Displacement with Reduction. Pain Res Manag 2018; 2018:9089286. [PMID: 29682131 PMCID: PMC5841089 DOI: 10.1155/2018/9089286] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/29/2018] [Indexed: 11/29/2022]
Abstract
Background and Objective Intra-articular temporomandibular disorders are often related to pain in the area of the temporomandibular joint, ear, and temple. The aim of the study was to investigate the efficiency of anterior repositioning splints in decreasing pain related to temporomandibular joint disc displacement with reduction. Methods The research material consisted of 112 patients, aged 24 to 45 years, of both genders, who reported for treatment at the Consulting Room of Temporomandibular Joint Dysfunctions at the Jagiellonian University in Cracow between 2014 and 2016 due to pain in the area of the temporomandibular joint(s) and noise(s) of temporomandibular joint(s) present during jaw movements with comorbid contracture of masticatory muscles. Subjects were examined according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol and, after diagnosis of painful disc displacement with reduction and masticatory muscle contracture, they were assigned randomly to either the study or control groups (56 patients in each). In the study group, we used an anterior repositioning splint on the full lower arch for about 20 hours usage over a 4-month period. In the control group, a noninvasive therapy was applied using a biostimulation laser over 12 sessions performed every second day on the area of both temporomandibular joints with mouth open and while performing muscle self-exercises with a dominant protrusive position of the mandible. Pain intensity was evaluated using the Verbal Numerical Rating Scale (VNRS) immediately before the treatment and then after 4 and 16 weeks. The obtained data were analyzed using the Mann–Whitney U test (p ≤ 0.005). Results The VNRS values reported during the final examination for the study group were significantly lower than for the control group (p=0.0004). Conclusions The anterior repositioning splint is an efficient tool in decreasing pain related to disc displacement with reduction. This trial is registered with Clinicaltrials.gov NCT03057262.
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Bas B, Kazan D, Kutuk N, Gurbanov V. The Effect of Exercise on Range of Movement and Pain After Temporomandibular Joint Arthrocentesis. J Oral Maxillofac Surg 2018; 76:1181-1186. [PMID: 29406255 DOI: 10.1016/j.joms.2018.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/16/2017] [Accepted: 01/02/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Arthrocentesis is an effective treatment modality for temporomandibular disorders, especially in patients who have pain and limited mouth opening. Surgeons generally suggest physical exercises after arthrocentesis and arthroscopy procedures; however, there has been no study in the literature evaluating the effects of exercise on clinical outcomes. This study investigated whether physical exercises after arthrocentesis would result in early improvements in clinical symptoms in patients with temporomandibular joint disc displacement without reduction (TMJ DDw/oR). MATERIALS AND METHODS The study group was composed of 27 patients with TMJ DDw/oR. Patients who needed arthrocentesis after failed conservative nonsurgical treatment were enrolled in the study. Group 1 was composed of 14 patients who were not started on a physiotherapy program after the arthrocentesis procedure. Group 2 was composed of 13 patients who were started on a self-administered physiotherapy program immediately after the arthrocentesis procedure. Physiotherapy included a 6-week exercise program. Patients were followed for 3 months. Range of maximal mouth opening (MMO) and joint pain as measured by the visual analog scale (VAS) were examined to determine clinical efficacy before and after treatment. RESULTS In groups 1 and 2, mouth opening increased and pain scores decreased at 1-week and 1- and 3-month follow-ups (P < .05). No relevant relation was found between the 2 groups according to MMO for all time points and VAS scores at 1 week. A relevant relation was found between the 2 groups according to VAS scores at 1 and 3 months. CONCLUSION Physical exercise after arthrocentesis has no effect on range of mouth opening but does decrease pain.
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Affiliation(s)
- Burcu Bas
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Dilara Kazan
- Research Assistant, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey.
| | - Nukhet Kutuk
- Associate Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bezmialem University, Istanbul, Turkey
| | - Vugar Gurbanov
- Research Assistant, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
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Shaffer SM, Stuhr SH, Sizer PS, Courtney CA, Brismée JM. The status of temporomandibular and cervical spine education in post-professional physical therapy training programs recognized by Member Organizations of IFOMPT: an investigation of didactic and clinical education. J Man Manip Ther 2018; 26:102-108. [PMID: 29686484 DOI: 10.1080/10669817.2017.1422614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objectives The purpose of this investigation was to establish an international baseline of the quantity of physical therapist education on temporomandibular disorders (TMD) during post-professional Orthopedic Manual Physical Therapy (OMPT) education. Methods An electronically distributed survey was sent to programs and data analyzed for trends, including a comparison of TMD and cervical spine disorders education. Current data were compared to pre-existing data from the United States. Results For the current data-set, the Mann-Whitney U test demonstrated statistical significance when comparing TMD and cervical spine disorders education for both the hours of didactic training provided (p < 0.0001) and the number of patients seen during clinical training (p < 0.006). When comparing the United States and international data, statistically significant greater exposure was reported for both didactic (p < 0.0001) and clinical education (p < 0.006) of TMD topics in the United States but not for didactic (p = 0.23) or clinical education (p = 0.15) of cervical spine topics. Discussion These data again indicate a lack of uniformity between post-professional training programs in OMPT with respect to TMD education. There is, however, consistency in that most programs provided more training on cervical spine disorders than TMD. Based on these findings, further investigations are appropriate to determine if TMD education is adequate during post-professional OMPT education.
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Affiliation(s)
- Stephen M Shaffer
- Program in Physical Therapy, Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Sarah H Stuhr
- School of Physical Therapy, College of Health Professions, Pacific University, Hillsboro, OR, USA
| | - Phillip S Sizer
- Program in Physical Therapy, Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Carol A Courtney
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Jean-Michel Brismée
- Program in Physical Therapy, Department of Rehabilitation Sciences, School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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MRI-based determination of occlusal splint thickness for temporomandibular joint disk derangement: a randomized controlled clinical trial. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:74-87. [DOI: 10.1016/j.oooo.2017.09.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 09/24/2017] [Accepted: 09/30/2017] [Indexed: 11/20/2022]
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Lin SL, Wu SL, Ko SY, Yen CY, Yang JW. Effect of Flat-Plane Splint Vertical Thickness on Disc Displacement Without Reduction: A Retrospective Matched-Cohort Study. J Oral Maxillofac Surg 2017; 75:1627-1636. [PMID: 28157490 DOI: 10.1016/j.joms.2016.12.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The efficacy of occlusal splints for treating temporomandibular disorders (TMDs) remains controversial. This study aimed to evaluate and compare the effectiveness of flat-plane splints (FPSs) with a vertical thickness of 3 mm (VT3) and 5 mm (VT5) in treating disc displacement without reduction (DDWOR). MATERIALS AND METHODS This retrospective matched-cohort study selected the study participants from 400 TMD patients treated in the Department of Oral and Maxillofacial Surgery of Tainan Sin-Lau Hospital, Tainan, Taiwan, between August 2013 and July 2015. The thickness of occlusal splints was the predictor variable. The outcome variables included joint crepitus sound, deviation of the mandible during opening, TMD-associated headache, myofascial pain with referral, temporomandibular joint (TMJ) arthralgia, and maximum assisted opening. The case and control groups were matched 1:1 by propensity scoring to ensure that there were no statistical differences in the categorical variables and continuous variables. The analysis used χ2 tests, t tests, and multiple regression analyses. RESULTS We allocated 162 patients into 2 groups, with 81 patients each: VT3 group and VT5 group. Both VT3 FPSs and VT5 FPSs effectively improved the DDWOR. At 12 months after treatment, the VT5 group showed remarkable improvement in joint crepitus sound and TMJ arthralgia compared with the VT3 group. No statistical differences in other TMJ-associated symptoms such as deviation of the mandible during opening, TMD-associated headache, and myofascial pain with referral were observed between the 2 groups. CONCLUSIONS Both VT3 and VT5 FPSs can effectively improve various clinical symptoms of DDWOR. We suggest that VT5 FPS treatment for at least 1 year is a suitable option for DDWOR patients with joint crepitus sound and TMJ arthralgia. For DDWOR patients without joint crepitus sound and TMJ arthralgia, there are no differences between the VT3 and VT5 FPSs.
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Affiliation(s)
- Shang-Lun Lin
- Attending Physician, Department of Psychiatry, Kaohsiung Armed Forces General Hospital Pingtung Branch, Pingtung, Taiwan; and Graduate Student, Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan, Taiwan
| | - Shang-Liang Wu
- Associate Professor, School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Shun-Yao Ko
- Associate Professor, Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan, Taiwan
| | - Ching-Yu Yen
- Associate Professor, School of Dentistry, Taipei Medical University, Taipei, Taiwan, and Director, Department of Oral and Maxillofacial Surgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jung-Wu Yang
- Director, Department of Oral and Maxillofacial Surgery, Tainan Sin-Lau Hospital (The Presbyterian Church in Taiwan), Tainan, Taiwan; Assistant Professor, Graduate Institute of Medical Science, College of Health Science, Chang Jung Christian University, Tainan, Taiwan; and Chief Executive Officer, Yuan Yuan Dental Federation, Tainan, Taiwan.
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Effect of jaw-opening exercise on prevention of temporomandibular disorders pain associated with oral appliance therapy in obstructive sleep apnea patients: A randomized, double-blind, placebo-controlled trial. J Prosthodont Res 2017; 61:259-267. [PMID: 28063976 DOI: 10.1016/j.jpor.2016.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/11/2016] [Accepted: 12/02/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE There are no studies on the prevention of temporomandibular joint and/or masticatory muscle pain (TMD pain) associated with oral appliance (OA) therapy in patients with obstructive sleep apnea (OSA). The aim of this study was to determine the effect of jaw-opening exercise on TMD pain associated with OA therapy in OSA patients. METHODS Twenty-five OSA patients without pain-related TMD were consecutively enrolled into a two-arm, randomized, double-blind, placebo-controlled trial. One group performed jaw-opening exercise (JE, n=13), and the other group performed placebo exercise (PE, n=12) for 1-month, and had started 2-weeks prior to insertion of an adjustable OA. TMD sign using the Research Diagnostic Criteria for Temporomandibular Disorders and TMD pain intensity using a visual analog scale (VAS) in the morning and daytime were evaluated at baseline (pre-exercise) and at 2-weeks, 1-month, and 3-months after OA insertion. RESULTS Pain-related TMD was not observed in the JE-group at all evaluation periods, although one subject in the PE-group was diagnosed with arthralgia at the 1-month evaluation. The JE-group showed lower morning and daytime VAS scores than the those of the PE-group at all evaluation periods, and significant group differences were found in terms of chewing pain and jaw-opening pain in the morning at the 1-month evaluation, and of jaw-opening pain during daytime at the 3-month evaluation (P<0.05). CONCLUSIONS Within the limitations of the study, jaw-opening exercise prior to OA therapy reduced the risk of TMD pain associated with OA use. Therefore, jaw-opening exercise may contribute to the prevention of TMD pain.
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Is Hyaluronic Acid Injection Effective for the Treatment of Temporomandibular Joint Disc Displacement With Reduction? J Oral Maxillofac Surg 2016; 74:1728-40. [DOI: 10.1016/j.joms.2016.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 11/21/2022]
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He D, Yang X, Wang F, Yang C, Dong M. Acute trauma induced disc displacement without reduction and its sequelae. Sci Rep 2016; 6:32684. [PMID: 27582054 PMCID: PMC5007667 DOI: 10.1038/srep32684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022] Open
Abstract
Acute traumatic temporomandibular joint disc displacement (ATDD) and its sequelae are not familiar for most surgeons. This study is to discuss its sequelae in cases without disc reduction after failed conservative treatment. From 2010 to 2015, 26 patients with 34 joints were included in the study. All patients had at least 3 months conservative treatment. Their maximal incisor opening (MIO) was measured during follow-ups and MRI examination was used to check the condylar bone degeneration. The mean follow-up for conservative treatment after admission was 8.69 months, the patients reached an average of 25.7 mm MIO. MRI showed condylar bone intact in 8 joints (23.5%), condylar surface bone destruction (Wilks IV, V stages) in 14 joints (41.2%), and severe bone resorption in 12 joints (35.3%). 15 patients with 23 joints were asked for surgical treatment after a mean conservative treatment of 5.4 months (3–12 months) to improve mouth opening and relieve chronic pain. 12 joints had total joint replacement (TJR). 11 joints had disc repositioning. Their mean MIO before operation was 19.8 mm and significantly improved to 33.9 mm after operation (p = 0.0000). ATDD may cause severe osteoarthritis or ankylosis. Disc repositioning and TJR could significantly improve MIO.
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Affiliation(s)
- DongMei He
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, Shanghai, 200011, China
| | - XiuJuan Yang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, Shanghai, 200011, China
| | - FeiYu Wang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, Shanghai, 200011, China
| | - Chi Yang
- Department of Oral Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Key Laboratory of Stomatology, Shanghai, 200011, China
| | - MinJun Dong
- Department of Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
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Machado BCZ, Mazzetto MO, Da Silva MAMR, de Felício CM. Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up. Lasers Med Sci 2016; 31:945-54. [PMID: 27085322 DOI: 10.1007/s10103-016-1935-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/28/2016] [Indexed: 01/05/2023]
Abstract
This study investigated the efficacy of combining low-level laser therapy (LLLT) with oral motor exercises (OM-exercises) for rehabilitation of patients with chronic temporomandibular disorders (TMDs). Eighty-two patients with chronic TMD and 20 healthy subjects (control group) participated in the study. Patients were randomly assigned to treatment groups: GI (LLLT + OM exercises), GII (orofacial myofunctional therapy-OMT-which contains pain relief strategies and OM-exercises), and GIII (LLLT placebo + OM-exercises) and GIV (LLLT). LLLT (AsGaAl; 780-nm wavelength; average power of 60 mW, 40 s, and 60 ± 1.0 J/cm²) was used to promote analgesia, while OM-exercises were used to reestablish the orofacial functions. Evaluations at baseline (T1), after treatment immediate (T2), and at follow-up (T3) were muscle and joint tenderness to palpation, TMD severity, and orofacial myofunctional status. There was a significant improvement in outcome measures in all treated groups with stability at follow-up (Friedman test, P < 0.05), but GIV did not show difference in orofacial functions after LLLT (P > 0.05). Intergroup comparisons showed that all treated groups had no difference in tenderness to palpation of temporal muscle compared to GC at follow-up (Kruskal-Wallis test, P < 0.01). Moreover, GI, GII, and GIII showed no difference from GC in orofacial functional condition (T2 and T3) while they differed significantly from GIV (P < 0.01). In conclusion, LLLT combined with OM-exercises was more effective in promoting TMD rehabilitation than LLLT alone was. Similar treatment results were verified with the OMT protocol.
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Affiliation(s)
- Barbara Cristina Zanandréa Machado
- Department of Ophtalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine, University of São Paulo, Av. dos Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil.,Craniofacial Research Support Centre, University of São Paulo, São Paulo, Brazil
| | - Marcelo Oliveira Mazzetto
- Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Marco Antonio M Rodrigues Da Silva
- Craniofacial Research Support Centre, University of São Paulo, São Paulo, Brazil.,Department of Restorative Dentistry, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Cláudia Maria de Felício
- Department of Ophtalmology, Otorhinolaryngology, and Head and Neck Surgery, School of Medicine, University of São Paulo, Av. dos Bandeirantes 3900, Ribeirão Preto, São Paulo, 14049-900, Brazil. .,Craniofacial Research Support Centre, University of São Paulo, São Paulo, Brazil.
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Armijo-Olivo S, Pitance L, Singh V, Neto F, Thie N, Michelotti A. Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis. Phys Ther 2016; 96:9-25. [PMID: 26294683 PMCID: PMC4706597 DOI: 10.2522/ptj.20140548] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 08/01/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Manual therapy (MT) and exercise have been extensively used to treat people with musculoskeletal conditions such as temporomandibular disorders (TMD). The evidence regarding their effectiveness provided by early systematic reviews is outdated. PURPOSE The aim of this study was to summarize evidence from and evaluate the methodological quality of randomized controlled trials that examined the effectiveness of MT and therapeutic exercise interventions compared with other active interventions or standard care for treatment of TMD. DATA SOURCES Electronic data searches of 6 databases were performed, in addition to a manual search. STUDY SELECTION Randomized controlled trials involving adults with TMD that compared any type of MT intervention (eg, mobilization, manipulation) or exercise therapy with a placebo intervention, controlled comparison intervention, or standard care were included. The main outcomes of this systematic review were pain, range of motion, and oral function. Forty-eight studies met the inclusion criteria and were analyzed. DATA EXTRACTION Data were extracted in duplicate on specific study characteristics. DATA SYNTHESIS The overall evidence for this systematic review was considered low. The trials included in this review had unclear or high risk of bias. Thus, the evidence was generally downgraded based on assessments of risk of bias. Most of the effect sizes were low to moderate, with no clear indication of superiority of exercises versus other conservative treatments for TMD. However, MT alone or in combination with exercises at the jaw or cervical level showed promising effects. LIMITATIONS Quality of the evidence and heterogeneity of the studies were limitations of the study. CONCLUSIONS No high-quality evidence was found, indicating that there is great uncertainty about the effectiveness of exercise and MT for treatment of TMD.
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Affiliation(s)
- Susan Armijo-Olivo
- S. Armijo-Olivo, PT, BScPT, MScPT, PhD, Department of Physical Therapy, Faculty of Rehabilitation Medicine, 3-48 Corbett Hall, University of Alberta, Edmonton, Alberta, Canada T6G 2G4.
| | - Laurent Pitance
- L. Pitance, PT, MT, PhD, Université Catholique de Louvain-Institute of Neuroscience, Brussels, Belgium, and Stomatology and Maxillofacial Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Vandana Singh
- V. Singh, DDS, MS, MSc, Department of Dentistry, Faculty of Medicine, TMD/Orofacial Pain Clinic, Kaye Edmonton Clinic, Edmonton, Alberta, Canada
| | - Francisco Neto
- F. Neto, PT, FisioNeto-Terapia Manual Ortopédica and Pilates Clínico, Póvoa de Varzim, Portugal
| | - Norman Thie
- N. Thie, BSc, MSc, MMSc, DDS, School of Dentistry, Faculty of Medicine and Dentistry, TMD/Orofacial Pain Graduate Program, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Ambra Michelotti
- A. Michelotti, BSc, DDS, Orthodontic Post-Graduate Program and TMD/Orofacial Pain Master Program, School of Medicine Federico II-Dental School, Naples, Italy
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Kang YH, Bok JS, Park BW, Choi MJ, Kim JE, Byun JH. Assessment of functional improvement with temporalis myofascial flap after condylectomy in elderly patients with anterior disc displacement without reduction and an erosive condylar surface. Maxillofac Plast Reconstr Surg 2015; 37:23. [PMID: 26280009 PMCID: PMC4531137 DOI: 10.1186/s40902-015-0025-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 08/03/2015] [Indexed: 11/30/2022] Open
Abstract
Background The purpose of this study was to investigate the functional effects of temporalis myofascial flap after condylectomy, with or without disc removal, in elderly patients with anterior disc displacement (ADD) without reduction and an erosive condylar surface of the temporomandibular joint (TMJ). Methods A total of 15 joints from 11 elderly patients (71–78 years old) were included. The patients had pain, mandibular dysfunction symptoms, and unilateral or bilateral ADD as well as an erosive condylar surface of the TMJ. All patients underwent temporalis myofascial flap reconstruction after condylectomy, with or without disc removal. If the maximal mouth opening (MMO) remained <35 mm after condylectomy, coronoidotomy was also performed. Self-assessed pain and mandibular function, including MMO and protrusive and lateral movements, were evaluated. Results No patient experienced serious complications. Most measurements improved significantly after surgery compared to preoperatively. Most patients achieved nearly-normal mouth opening at 4 weeks after surgery. Although most patients felt discomfort during active postoperative physiotherapy, no patient reported serious pain during the follow-up period. Conclusion Although nonsurgical therapy is often the first treatment choice for ADD without reduction of the TMJ, surgical intervention involving condylectomy and temporalis myofascial flap reconstruction may be a reasonable first option for elderly patients with an erosive condylar surface of the TMJ.
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Affiliation(s)
- Young-Hoon Kang
- Department of Oral and Maxillofacial Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Chilam-dong, Jinju 660-702 South Korea
| | - Jung-Suk Bok
- Department of Oral and Maxillofacial Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Chilam-dong, Jinju 660-702 South Korea
| | - Bong-Wook Park
- Department of Oral and Maxillofacial Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Chilam-dong, Jinju 660-702 South Korea
| | - Mun-Jeoung Choi
- Department of Oral and Maxillofacial Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Chilam-dong, Jinju 660-702 South Korea
| | - Ji-Eun Kim
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - June-Ho Byun
- Department of Oral and Maxillofacial Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Chilam-dong, Jinju 660-702 South Korea
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Nagata K, Maruyama H, Mizuhashi R, Morita S, Hori S, Yokoe T, Sugawara Y. Efficacy of stabilisation splint therapy combined with non-splint multimodal therapy for treating RDC/TMD axis I patients: a randomised controlled trial. J Oral Rehabil 2015; 42:890-9. [PMID: 26174571 DOI: 10.1111/joor.12332] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2015] [Indexed: 11/29/2022]
Abstract
Stabilisation splint therapy has long been thought to be effective for the management of temporomandibular disorders (TMD). However, the superiority of stabilisation splint therapy compared to other TMD treatments remains controversial. The aim of this study was to determine the efficacy of stabilisation splint therapy combined with non-splint multimodal therapy for TMD. A total of 181 TMD participants were randomly allocated to a non-splint multimodal therapy (NS) group (n = 85) or a non-splint multimodal therapy plus stabilisation splint (NS+S) group (n = 96). Non-splint multimodal therapy included self-exercise of the jaw, cognitive-behavioural therapy, self-management education and additional jaw manipulation. Three outcome measurements were used to assess treatment efficacy: mouth-opening limitation, oro-facial pain and temporomandibular joint sounds. A two-factor repeated-measures analysis of variance (anova) was used to evaluate the efficacy of the two treatment modalities (NS vs. NS+S), and Scheffe's multiple comparison test was used to compare the treatment periods. Subgroup analyses were performed to disclose the splint effects for each TMD diagnostic group. All three parameters significantly decreased over time in both groups. However, there were no significant differences between the two treatment groups in the total comparison or subgroup analyses; an exception was the group with degenerative joint disease. No significant difference between the NS and NS+S treatment approaches was revealed in this study. Therefore, we conclude that the additional effects of stabilisation splint are not supported for patients with TMD during the application of multimodal therapy.
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Affiliation(s)
- K Nagata
- Temporomandibular Disorders and Bruxism Clinic, Niigata Hospital, The Nippon Dental University, Niigata, Japan
| | - H Maruyama
- Temporomandibular Disorders and Bruxism Clinic, Niigata Hospital, The Nippon Dental University, Niigata, Japan
| | - R Mizuhashi
- Temporomandibular Disorders and Bruxism Clinic, Niigata Hospital, The Nippon Dental University, Niigata, Japan
| | - S Morita
- Temporomandibular Disorders and Bruxism Clinic, Niigata Hospital, The Nippon Dental University, Niigata, Japan
| | - S Hori
- Temporomandibular Disorders and Bruxism Clinic, Niigata Hospital, The Nippon Dental University, Niigata, Japan
| | - T Yokoe
- Temporomandibular Disorders and Bruxism Clinic, Niigata Hospital, The Nippon Dental University, Niigata, Japan
| | - Y Sugawara
- Temporomandibular Disorders and Bruxism Clinic, Niigata Hospital, The Nippon Dental University, Niigata, Japan
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Baker Z, Eriksson L, Englesson Sahlström L, Ekberg EC. Questionable effect of lavage for treatment of painful jaw movements at disc displacement without reduction: a 3-year randomised controlled follow-up. J Oral Rehabil 2015; 42:742-50. [DOI: 10.1111/joor.12311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Z. Baker
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Malmö Sweden
| | - L. Eriksson
- Department of Oral Surgery and Oral Medicine; Faculty of Odontology; Malmö University; Malmö Sweden
| | | | - EC. Ekberg
- Department of Orofacial Pain and Jaw Function; Faculty of Odontology; Malmö University; Malmö Sweden
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Mandibular function after Myorelaxation Therapy in temporomandibular disorders. Adv Med Sci 2015; 60:6-12. [PMID: 25062086 DOI: 10.1016/j.advms.2014.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/07/2014] [Accepted: 05/30/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of this study was to analyze the efficacy of Myorelaxation Therapy in temporomandibular disorders on the basis of mandibular movement measurements, reported functional impairment and clinical findings. MATERIAL/METHODS To ascertain the mandibular movements 78 women were investigated. The first group consisted of 32 consecutive patients (23.3±4.8 years) suffering from muscle disorder and disk displacement with a reduction serving as a treated group. The second group was formed from 46 volunteers, as a healthy group (20.1±1.3 years). Jaw-tracking records (K7, Myotronics-Noromed Inc.) were performed including the measurements of opening, lateral and protrusive movement range, maximal and average velocity of opening/closing. Reported impairment and clinical data were collected. The treatment involved nocturnally applied a non-occluding sublingual relaxation splint combined with daily performed stretching exercises. Measurements were taken before treatment, after 4 weeks with no interventions (control period) and after 3 weeks, 3 and 6 months. RESULTS After the treatment mandibular opening range increased by 8mm (19%, p<0.05), lateral movement by 2.1mm (36%, p<0.05) while protrusive movement decreased by 0.5mm (p>0.05). Maximal and average velocity parameters significantly increased (p>0.05). These results were supported by the decrease in reported impairment and clinical pain occurrence (p<0.05). Only joint clicking change was non-significant (p>0.05). CONCLUSIONS Myorelaxation Therapy was effective in the treatment of our group of patients. A significant improvement in the opening and lateral movement range, as well as opening/closing velocity was obtained after 6 months of treatment. This method can be easily managed by general practitioner, especially in muscles-related TMD types.
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Muhtarogullari M, Avci M, Yuzugullu B. Efficiency of pivot splints as jaw exercise apparatus in combination with stabilization splints in anterior disc displacement without reduction: a retrospective study. Head Face Med 2014; 10:42. [PMID: 25300939 PMCID: PMC4197281 DOI: 10.1186/1746-160x-10-42] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 10/01/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate efficiency of pivot splints in jaw exercises, in combination with stabilization splints, in cases of anterior disc displacement without reduction of temporomandibular joint. SUBJECTS AND METHODS Twenty-three patients who referred to the prosthodontics clinic in 1995-1997 were included in the study, where anterior disc displacement without reduction of temporomandibular joint was diagnosed using magnetic resonance imaging and clinical examination. Pivot splints were used for jaw exercises for five minutes long; five times/day and stabilization splints were used at all other times. The patients were followed for 24 weeks. Lateral and protrusive excursions along with maximum mouth opening and were evaluated at each control. Bilateral palpation of temporal, masseter, sternocleidomastoid muscles and TMJ was assessed for pain perception before and after treatment. Data were statistically analyzed using Paired sample t-test and Independent Samples t-test (p < .05). RESULTS Mean mandibular range of motion measurements increased from 28.74 mm prior to 49.17 mm on maximum opening; right/left lateral excursion from 7.61 mm to 12.04 mm and 4.09 mm to 7.3 mm on protrusion after treatment. All changes observed before and after treatment were found to be statistically significant. (p < .001) Pain symptoms were eliminated at the end of 24 weeks of treatment in all patients. CONCLUSION Using pivot splints as an exercise regimen along with a stabilization splint may be a viable treatment option for patients with anterior disc displacement without reduction; as normal mandibular range of motion was established and pain was eliminated.
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Affiliation(s)
- Mehmet Muhtarogullari
- />Department of Prosthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey
| | | | - Bulem Yuzugullu
- />Department of Prosthodontics, Faculty of Dentistry, Baskent University, Ankara, Turkey
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Ishida T, Ono T. Asymmetric severe skeletal Class II division 1 patient with temporomandibular joint disorder treated with zygomatic anchorage devices and Ni-Ti alloy wires. Angle Orthod 2014; 84:919-30. [DOI: 10.2319/010414-13.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Takayoshi Ishida
- Assistant Professor, Orthodontic Sciences, Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical Dental University (TMDU), Tokyo, Japan
| | - Takashi Ono
- Professor, Orthodontic Sciences, Department of Orofacial Development and Function, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical Dental University (TMDU), Tokyo, Japan
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Ferreira CLP, Machado BCZ, Borges CGP, Rodrigues Da Silva MAM, Sforza C, De Felício CM. Impaired orofacial motor functions on chronic temporomandibular disorders. J Electromyogr Kinesiol 2014; 24:565-71. [DOI: 10.1016/j.jelekin.2014.04.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/06/2014] [Accepted: 04/07/2014] [Indexed: 01/07/2023] Open
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Evaluating the additional effects of arthrocentesis on the condylar pathways of temporomandibular joint in patients with internal derangement treated with stabilizing splint. J Craniomaxillofac Surg 2014; 42:e86-90. [DOI: 10.1016/j.jcms.2013.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 01/23/2013] [Accepted: 07/02/2013] [Indexed: 11/18/2022] Open
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Al-Baghdadi M, Durham J, Araujo-Soares V, Robalino S, Errington L, Steele J. TMJ Disc Displacement without Reduction Management: A Systematic Review. J Dent Res 2014; 93:37S-51S. [PMID: 24659775 PMCID: PMC4293719 DOI: 10.1177/0022034514528333] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Various interventions have been used for the management of patients with temporomandibular joint (TMJ) disc displacement without reduction (DDwoR), but their clinical effectiveness remains unclear. This systematic review investigated the effects of these interventions and is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic and manual searches up to November 1, 2013, were conducted for English-language, peer-reviewed, publications of randomized clinical trials comparing any form of conservative or surgical interventions for patients with clinical and/or radiologic diagnosis of acute or chronic DDwoR. Two primary outcomes (TMJ pain intensity and maximum mouth opening) and a number of secondary outcomes were examined. Two reviewers performed data extraction and risk of bias assessment. Data collection and analysis were performed according to Cochrane recommendations. Twenty studies involving 1,305 patients were included. Data analysis involved 21 comparisons between a variety of interventions, either between interventions, or between intervention and placebo or no intervention. Meta-analysis on homogenous groups was conducted in 4 comparisons. In most comparisons made, there were no statistically significant differences between interventions relative to primary outcomes at short- or long-term follow-up (p > .05). In a separate analysis, however, the majority of reviewed interventions reported significantly improved primary outcome measures from their baseline levels over time (p < .05). Evidence levels, however, are currently insufficient for definitive conclusions, because the included studies were too heterogeneous and at an unclear to high risk of bias. In view of the comparable therapeutic effects, paucity of high-quality evidence, and the greater risks and costs associated with more complex interventions, patients with symptomatic DDwoR should be initially treated by the simplest and least invasive intervention.
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Affiliation(s)
- M Al-Baghdadi
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, UK Institute of Health and Society, Newcastle University, UK
| | - J Durham
- Department of Oral and Maxillofacial Surgery, School of Dental Sciences, Newcastle University, UK Institute of Health and Society, Newcastle University, UK
| | | | - S Robalino
- Institute of Health and Society, Newcastle University, UK
| | | | - J Steele
- Institute of Health and Society, Newcastle University, UK Department of Restorative Dentistry, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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50
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Shaffer SM, Brismée JM, Sizer PS, Courtney CA. Temporomandibular disorders. Part 2: conservative management. J Man Manip Ther 2014; 22:13-23. [PMID: 24976744 DOI: 10.1179/2042618613y.0000000061] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Appropriate management of temporomandibular disorders (TMD) requires an understanding of the underlying dysfunction associated with the temporomandibular joint (TMJ) and surrounding structures. A comprehensive examination process, as described in part 1 of this series, can reveal underlying clinical findings that assist in the delivery of comprehensive physical therapy services for patients with TMD. Part 2 of this series focuses on management strategies for TMD. Physical therapy is the preferred conservative management approach for TMD. Physical therapists are professionally well-positioned to step into the void and provide clinical services for patients with TMD. Clinicians should utilize examination findings to design rehabilitation programs that focus on addressing patient-specific impairments. Potentially appropriate plan of care components include joint and soft tissue mobilization, trigger point dry needling, friction massage, therapeutic exercise, patient education, modalities, and outside referral. Management options should address both symptom reduction and oral function. Satisfactory results can often be achieved when management focuses on patient-specific clinical variables.
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Affiliation(s)
- Stephen M Shaffer
- Department of Rehabilitation Sciences, School of Allied Health Sciences, Texas Tech University Health Sciences Center, USA
| | - Jean-Michel Brismée
- Department of Rehabilitation Sciences, School of Allied Health Sciences, Texas Tech University Health Sciences Center, USA
| | - Phillip S Sizer
- Department of Rehabilitation Sciences, School of Allied Health Sciences, Texas Tech University Health Sciences Center, USA
| | - Carol A Courtney
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, USA
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