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de Lima MC, Rizzatti Barbosa CM, Duarte Gavião MB, Ferreira Caria PH. Is low dose of botulinum toxin effective in controlling chronic pain in sleep bruxism, awake bruxism, and temporomandibular disorder? Cranio 2024; 42:421-428. [PMID: 34488556 DOI: 10.1080/08869634.2021.1973215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effects of low doses of botulinum toxin type A (BoNT-A) to control pain in patients with sleep bruxism (SB), awake bruxism (AB), and temporomandibular disorder (TMD) during 180 days. METHODS Overall sample of thirty-five patients with chronic pain related to TMD, SB, and AB received a single dose of 20 U of BoNT-A in masseter and temporalis muscles. The pain was assessed with a visual analog scale (VAS) before and after 15, 30, 60, 90, and 180 days of the application. RESULTS The three clinical conditions experienced decrease in pain after 15 days of treatment (p < 0.0001); the maximum pain relief persisted for up to 90 days after BoNT-A application in patients with SB and AB and 15 days for patients with TMD. CONCLUSION A low dose of BoNT-A may be effective for controlling chronic pain related to SB and AB, but TMD pain reduction was short-lived.
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Affiliation(s)
- Maristela Corrêa de Lima
- Department of Biosciencies - Human Anatomy Area, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | | | - Maria Beatriz Duarte Gavião
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
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Ferreira NR, Marto CM, de Sousa BM, Loureiro M, Oliveira AT, DosSantos MF, Rodrigues MJ. Synthesis of temporomandibular disorders management intervention outcomes for development of core outcome sets: A systematic review. J Oral Rehabil 2024; 51:1303-1319. [PMID: 38572886 DOI: 10.1111/joor.13692] [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: 11/05/2022] [Revised: 02/12/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION The selection of appropriate outcomes in clinical trials and systematic reviews is a crucial factor in determining the results that are useful, reliable, and relevant for both patients and healthcare professionals. Clinicians and researchers have been encouraged to develop and apply core outcome sets (COS) to minimise the discrepancy between studies. AIM This systematic review is the first phase of the COS development project for clinical trials in temporomandibular disorders (COS-TMD). It aims to identify and synthesise the outcomes used in the randomised controlled trials (RCT) that evaluated the effectiveness of interventions used in TMD management. MATERIALS AND METHODS An electronic search was performed in several databases: MEDLINE (via PubMed), Scopus, Web of Science, Cochrane Library and EMBASE. The eligibility criteria comprised RCT that applied any intervention to treat temporomandibular joint disorders or masticatory muscle disorders. The identified outcomes were categorised according to domains of the Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT). RESULTS The electronic search resulted in 1606 studies. After removing duplicates and applying the eligibility criteria, 106 RCT were included. A total of 43 studies evaluated masticatory muscle disorders, 27 evaluated temporomandibular joint disorders, and 36 analysed mixed TMD. CONCLUSIONS The evaluation showed significant variability in the types of outcomes and their measurement instruments. In addition, some domains such as physical and emotional functioning, participant ratings of global improvement and adverse events have been neglected when determining the effectiveness of treatments for TMD.
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Affiliation(s)
- N R Ferreira
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
| | - C M Marto
- Faculty of Medicine, Institute of Experimental Pathology, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, Institute of Integrated Clinical Practice, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), University of Coimbra, Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra, CACC, Coimbra, Portugal
| | - B M de Sousa
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
| | - M Loureiro
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
| | - A T Oliveira
- Postgraduate Program in Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - M F DosSantos
- Postgraduate Program in Radiology, Faculty of Medicine, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Laboratory of Mechanical Properties and Cell Biology (PropBio) School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - M J Rodrigues
- Faculty of Medicine, Institute of Occlusion and Orofacial Pain, University of Coimbra, Coimbra, Portugal
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de Souza Nobre BB, Rezende L, Barbosa Câmara-Souza M, Sanchez-Ayala A, Blass R, Carbone AC, Manso AC, Ernberg M, Christidis N, De la Torre Canales G. Exploring botulinum toxin's impact on masseter hypertrophy: a randomized, triple-blinded clinical trial. Sci Rep 2024; 14:14522. [PMID: 38914688 PMCID: PMC11196657 DOI: 10.1038/s41598-024-65395-5] [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: 01/30/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
The present study aimed to assess the effectiveness and functional adverse effects of a single and multiple injections of botulinum toxin A (BoNT-A) for masseter hypertrophy (MH). Twenty-six women complaining about lower third facial enlargement due to MH, received 75 U of BoNT-A (abobotulinum toxin) in each masseter muscles. After 3 months, patients were randomly assigned to receive a second treatment session of Saline Solution: (G1; n = 11) or BoNT-A: (G2; n = 12). Muscle thickness (ultrasound), electrical activity (electromyography; EMG), masticatory performance, and subjective perception of MH were evaluated. Follow-up was performed at 1, 3 and 6 months. Muscle thickness, EMG activity, and masticatory performance were analyzed using ANOVA two-way and Sidak test as post-hoc. Masticatory performance was analyzed by the Friedman's test and Mann-Whitney test. Regarding inter-groups comparisons, there was a significant decrease in the left masseter muscle thickness in the G2 group at the 6 month follow-up (p < 0.02). For EMG, significant differences were evident at the 6 month assessment, with higher masseter activity for G1 (p < 0.05). For masticatory performance, no significant differences were observed throughout the study (p > 0.05) and a higher improvement in subjective perception of MH was observed in the 1 month follow-up for G2 (p < 0.05). In conclusion, BoNT-A is effective for MH, however multiple injections cause functional adverse effects in masseter muscle.
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Affiliation(s)
| | - Luciana Rezende
- Department of Dentistry, Ingá University Center, Uningá, Paraná, Brazil
| | | | | | | | | | - Ana Cristina Manso
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal
| | - Malin Ernberg
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), 14104, Huddinge, Sweden
| | - Nikolaos Christidis
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), 14104, Huddinge, Sweden
| | - Giancarlo De la Torre Canales
- Department of Dentistry, Ingá University Center, Uningá, Paraná, Brazil.
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal.
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), 14104, Huddinge, Sweden.
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De la Torre Canales G, Câmara-Souza MB, Ernberg M, Al-Moraissi EA, Grigoriadis A, Poluha RL, Christidis M, Jasim H, Lövgren A, Christidis N. Botulinum Toxin-A for the Treatment of Myogenous Temporomandibular Disorders: An Umbrella Review of Systematic Reviews. Drugs 2024:10.1007/s40265-024-02048-x. [PMID: 38900335 DOI: 10.1007/s40265-024-02048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Temporomandibular disorders (TMDs) encompass several conditions that cause pain and impair function of the masticatory muscles (M-TMDs) and temporomandibular joints. There is a large interest among clinicians and researchers in the use of botulinum toxin-A (BoNT-A) as a treatment for M-TMD. However, due to the lack of consistent evidence regarding the efficacy as well as adverse events of BoNT-A, clinical decision making is challenging. Therefore, this umbrella review aimed to systematically assess systematic reviews (SRs) evaluating BoNT-A treatment effects on pain intensity, mandibular movements, and adverse events in patients with M-TMDs. METHOD An electronic search was undertaken in the databases MEDLINE, EMBASE, CINAHL, Cochrane Central Registry of Controlled Trials (CENTRAL), Web of Science, Epistemonikos, ClinicalTrials.gov, and ICTRP to identify SRs investigating BoNT-A effects on M-TMDs, published from the inception of each database until 6 December 2023. The quality of evidence was rated according to the critical appraisal checklist developed by the umbrella review methodology working group. Only high-quality SRs were included. RESULTS In total, 18 SRs were included. BoNT-A was shown to be more effective than placebo to reduce pain intensity, but not compared to standard treatments. Additionally, BoNT-A was not superior to placebo or standard treatments regarding improvement of mandibular movements. BoNT-A was considered to have a higher risk for adverse events on muscle and bony tissue compared with other treatments. CONCLUSION The synthesis in this umbrella review provides the highest level of evidence present. Taken together, there are indications of effectiveness of BoNT-A for treatment of M-TMDs, supported by moderate evidence. However, considering the risk of causing serious adverse events, treatment with BoNT-A is recommended to be the last treatment alternative.
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Affiliation(s)
- Giancarlo De la Torre Canales
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal
- Department of Dentistry, Ingá University Center, Uningá, Paraná, Brazil
| | | | - Malin Ernberg
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
| | - Essam Ahmed Al-Moraissi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen
| | - Anastasios Grigoriadis
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
| | | | - Maria Christidis
- The Institute of Health Sciences, The Swedish Red Cross University, SE-141 21, Huddinge, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, SE-14183, Huddinge, Sweden
| | - Hajer Jasim
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden
- Public Dental Services, Department of Orofacial Pain and Jaw Function, Folktandvården Stockholms län AB, Eastmaninstitutet, SE-102 31, Stockholm, Sweden
| | - Anna Lövgren
- Clinical Oral Physiology, Department of Odontology, Faculty of Medicine, University of Umeå, Umeå, Sweden
| | - Nikolaos Christidis
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Box 4064, SE-14104, Huddinge, Sweden.
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Kim YM, Son JY, Ahn DK. Botulinum toxin type A is a potential therapeutic drug for chronic orofacial pain. J Oral Biosci 2024:S1349-0079(24)00141-5. [PMID: 38908515 DOI: 10.1016/j.job.2024.06.004] [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: 04/16/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Botulinum toxin type A (BTX-A), produced by the gram-positive anaerobic bacterium Clostridium botulinum, acts by cleaving synaptosome-associated protein-25 (SNAP-25), an essential component of the presynaptic neuronal membrane that is necessary for fusion with the membrane proteins of neurotransmitter-containing vesicles. Recent studies have highlighted the efficacy of BTX-A in treating chronic pain conditions, including lower back pain, chronic neck pain, neuropathic pain, and trigeminal neuralgia, particularly when patients are unresponsive to traditional painkillers. This review focuses on the analgesic effects of BTX-A in various chronic pain conditions, with a particular emphasis on the orofacial region. HIGHLIGHT This review focuses on the mechanisms by which BTX-A induces analgesia in patients with inflammatory and temporomandibular joint pain. This review also highlights the fact that BTX-A can effectively manage neuropathic pain and trigeminal neuralgia, which are difficult-to-treat chronic pain conditions. Herein, we present a comprehensive assessment of the central analgesic effects of BTX-A and a discussion of its various applications in clinical dental practice. CONCLUSION BTX-A is an approved treatment option for various chronic pain conditions. Although there is evidence of axonal transport of BTX-A from peripheral to central endings in motor neurons, the precise mechanism underlying its pain-modulating effects remains unclear. This review discusses the evidence supporting the effectiveness of BTX-A in controlling chronic pain conditions in the orofacial region. BTX-A is a promising therapeutic agent for treating pain conditions that do not respond to conventional analgesics.
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Affiliation(s)
- Yu Mi Kim
- Department of Oral Physiology, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Jo Young Son
- Department of Oral Physiology, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Dong Kuk Ahn
- Department of Oral Physiology, School of Dentistry, Kyungpook National University, Daegu, Korea.
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Zieliński G, Gawda P. Analysis of the Use of Sample Size and Effect Size Calculations in a Temporomandibular Disorders Randomised Controlled Trial-Short Narrative Review. J Pers Med 2024; 14:655. [PMID: 38929876 PMCID: PMC11204826 DOI: 10.3390/jpm14060655] [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: 05/17/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Temporomandibular disorder (TMD) is the term used to describe a pathology (dysfunction and pain) in the masticatory muscles and temporomandibular joint (TMJ). There is an apparent upward trend in the publication of dental research and a need to continually improve the quality of research. Therefore, this study was conducted to analyse the use of sample size and effect size calculations in a TMD randomised controlled trial. METHODS The period was restricted to the full 5 years, i.e., papers published in 2019, 2020, 2021, 2022, and 2023. The filter article type-"Randomized Controlled Trial" was used. The studies were graded on a two-level scale: 0-1. In the case of 1, sample size (SS) and effect size (ES) were calculated. RESULTS In the entire study sample, SS was used in 58% of studies, while ES was used in 15% of studies. CONCLUSIONS Quality should improve as research increases. One factor that influences quality is the level of statistics. SS and ES calculations provide a basis for understanding the results obtained by the authors. Access to formulas, online calculators and software facilitates these analyses. High-quality trials provide a solid foundation for medical progress, fostering the development of personalized therapies that provide more precise and effective treatment and increase patients' chances of recovery. Improving the quality of TMD research, and medical research in general, helps to increase public confidence in medical advances and raises the standard of patient care.
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Affiliation(s)
- Grzegorz Zieliński
- Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | - Piotr Gawda
- Department of Sports Medicine, Medical University of Lublin, 20-093 Lublin, Poland
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de Souza Nobre BB, de Oliveira Resende Machado L, Poluha RL, Câmara-Souza MB, Carbone AC, de Almeida AM, Grigoriadis A, Kumar A, De la Torre Canales G. Temporalis Muscle Changes Following Botulinum Toxin A Injections in Masseter Hypertrophy Patients: A Randomized Triple-Blinded Trial. Aesthetic Plast Surg 2024:10.1007/s00266-024-04064-4. [PMID: 38740627 DOI: 10.1007/s00266-024-04064-4] [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: 02/23/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND This study aimed to elucidate the effects of botulinum toxin A (BoNT-A) treatment for patients diagnosed with masseter hypertrophy on the temporalis muscle, with a particular focus on assessing alterations in muscle thickness, electromyographic (EMG) activity, and the development of muscle pain. METHODS The present randomized triple-blinded clinical trial enrolled 26 female participants aged between 25 and 50 years complaining about masseter hypertrophy. Participants received 75U of BoNT-A (abobotulinumtoxinA) in both masseter muscles and after three months were randomized to receive a second treatment session of saline solution (S-BoNT-A) or BoNT-A (M-BoNT-A). Longitudinal assessments included temporalis muscle thickness through ultrasound, EMG activity, subjective pain, and masseter prominence severity after one, three, and six months of the first injection session. Muscle thickness, EMG, and subjective pain were analysed using two-way ANOVA with repeated measures and post hoc Sidak test, and for masseter prominence severity, Friedman and Mann-Whitney tests were used. RESULTS Regarding inter-group comparisons, a higher muscle thickness (p < 0.02) and a higher EMG activity (p < 0.01) were found in the M-BoNT-A group at the 6-month follow-up. For subjective pain assessments, inter-group comparisons showed a higher prevalence of painful regions in M-BoNT-A group at the 6-month follow-up (p < 0.02). No significant differences were found in masseter prominence severity at the 6 months assessment between groups. CONCLUSION BoNT-A treatment for masseter hypertrophy lead to structural and functional changes in the temporalis muscle, presenting higher changes after multiple injections of this treatment. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | | | | | | | | | - Andre Mariz de Almeida
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, Almada, Portugal
| | - Anastasios Grigoriadis
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, Stockholm, Sweden
| | - Abhishek Kumar
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, Stockholm, Sweden
- Academic Center for Geriatric Dentistry, Stockholm, Sweden
| | - Giancarlo De la Torre Canales
- Department of Dentistry, Ingá University Center, Uningá, Paraná, Brazil.
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Caparica, Almada, Portugal.
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Alfred Nobels Allé 8, Huddinge, Stockholm, Sweden.
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Li K, Tan K, Yacovelli A, Bi WG. Effect of botulinum toxin type A on muscular temporomandibular disorder: A systematic review and meta-analysis of randomized controlled trials. J Oral Rehabil 2024; 51:886-897. [PMID: 38151884 DOI: 10.1111/joor.13648] [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: 05/08/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Botulinum toxin type A (BTX-A) is increasingly used to manage painful temporomandibular disorders (TMD). However, the effect of BTX-A on muscular TMD remains unclear. OBJECTIVE To assess the efficacy, safety and optimal dose of BTX-A for treating TMD. METHODS We conducted systematic literature searches in MEDLINE, Embase, Web of Science, ClinicalTrials.gov and Cochrane Library until March 2023. We extracted data from randomized controlled trials (RCTs) that evaluated the efficacy and safety of BTX-A in treating muscular TMD. We performed a meta-analysis using a random-effects model. RESULTS Fifteen RCTs involving 504 participants met the inclusion criteria. BTX-A was significantly more effective than placebo in reducing pain intensity, as measured on a 0-10 scale, at 1 month (MD [95% CI] = -1.92 [-2.87, -0.98], p < .0001) and 6 months (MD [95% CI] -2.08, [-3.19 to -0.98]; p = .0002). A higher dosage of BTX-A (60-100 U bilaterally) was associated with a greater reduction in pain at 6 months (MD [95% CI] = -2.98 [-3.52, -2.44]; p < .001). BTX-A also resulted in decreased masseter muscle intensity (μV) (MD [95% CI] = -44.43 [-71.33, -17.53]; p = .001) at 1 month and occlusal force (kg) at 3 months (MD [95% CI] = -30.29 [-48.22 to -12.37]; p = .0009). There was no significant difference in adverse events between BTX-A and placebo. CONCLUSIONS BTX-A is a safe and effective treatment for reducing pain and improving temporomandibular muscle and joint function in muscular TMD patients. A bilateral dose of 60-100 U might be an optimal choice for treating muscular TMD pain.
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Affiliation(s)
- Kaiyang Li
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Kenneth Tan
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Alexandra Yacovelli
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Wei Guang Bi
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Lippi L, Ferrillo M, Losco L, Folli A, Marcasciano M, Curci C, Moalli S, Ammendolia A, de Sire A, Invernizzi M. Aesthetic Rehabilitation Medicine: Enhancing Wellbeing beyond Functional Recovery. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:603. [PMID: 38674249 PMCID: PMC11052208 DOI: 10.3390/medicina60040603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Although rehabilitation medicine emphasizes a holistic health approach, there is still a large gap of knowledge about potential interventions aimed at improving overall wellbeing through cosmetic interventions. Therefore, this narrative review investigates the role of different rehabilitative techniques in enhancing aesthetics, quality of life, and psychosocial wellbeing for patients with disabilities. The study follows the SANRA framework quality criteria for a narrative review. Literature searches across PubMed/Medline, Web of Science, and Scopus identified articles focusing on rehabilitation strategies within the aesthetic rehabilitation domain. The review identified evidence supporting injection procedures, such as Botulinum Toxin, Platelet-Rich Plasma, Hyaluronic Acid, Ozone, and Carboxytherapy, and assessing their applications in several disabling disorders. Additionally, physical therapies like Extracorporeal Shock Wave Therapy, Laser Therapy, Microcurrent Therapy, Tecar Therapy, and physical exercises were explored for their impact on cutaneous microcirculation, cellulite treatment, wound healing, and scar appearance improvement. Lastly, the manuscript underlines the role of manual therapy techniques in addressing both physical discomfort and aesthetic concerns, discussing their effectiveness in adipose tissue therapy, scar tissue mobilization, and regional fat thickness reduction. Taken together, this review emphasizes the role of a multidisciplinary approach, aiming to provide valuable insights into potential benefits for both functional and aesthetic outcomes.
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Affiliation(s)
- Lorenzo Lippi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (S.M.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Martina Ferrillo
- Department of Health Sciences, School of Dentistry, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Luigi Losco
- Plastic Surgery Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Via Salvador Allende, 43, 84081 Baronissi, Italy;
| | - Arianna Folli
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (S.M.); (M.I.)
| | - Marco Marcasciano
- Plastic Surgery, Experimental and Clinical Medicine Department, Division of Plastic and Reconstructive Surgery, “Magna Graecia” University of Catanzaro, 88100 Catanzaro, Italy;
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy
| | - Stefano Moalli
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (S.M.); (M.I.)
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy;
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy; (L.L.); (A.F.); (S.M.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Hosseindoost S, Inanloo SH, Pestehei SK, Rahimi M, Yekta RA, Khajehnasiri A, Rad MA, Majedi H, Dehpour AR. Cellular and molecular mechanisms involved in the analgesic effects of botulinum neurotoxin: A literature review. Drug Dev Res 2024; 85:e22177. [PMID: 38528637 DOI: 10.1002/ddr.22177] [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: 01/19/2024] [Revised: 03/02/2024] [Accepted: 03/11/2024] [Indexed: 03/27/2024]
Abstract
Botulinum neurotoxins (BoNTs), derived from Clostridium botulinum, have been employed to treat a range of central and peripheral neurological disease. Some studies indicate that BoNT may be beneficial for pain conditions as well. It has been hypothesized that BoNTs may exert their analgesic effects by preventing the release of pain-related neurotransmitters and neuroinflammatory agents from sensory nerve endings, suppressing glial activation, and inhibiting the transmission of pain-related receptors to the neuronal cell membrane. In addition, there is evidence to suggest that the central analgesic effects of BoNTs are mediated through their retrograde axonal transport. The purpose of this review is to summarize the experimental evidence of the analgesic functions of BoNTs and discuss the cellular and molecular mechanisms by which they can act on pain conditions. Most of the studies reviewed in this article were conducted using BoNT/A. The PubMed database was searched from 1995 to December 2022 to identify relevant literature.
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Affiliation(s)
- Saereh Hosseindoost
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Hassan Inanloo
- Department of Urology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Khalil Pestehei
- Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Rahimi
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Atef Yekta
- Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Department of Anesthesiology, Critical Care, and Pain, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khajehnasiri
- Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Department of Anesthesiology, Critical Care, and Pain, Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hossein Majedi
- Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Ramos DM, de Brito Silva R, De la Torre Canales G, Resende L, Esquisatto MAM, Moreira NCF, Ernberg M, Rizzatti-Barbosa CM. Histomorphometric Changes of the Masseter Muscle of Rats After a Single Injection of Botulinum Toxin Type A. Aesthetic Plast Surg 2024; 48:1037-1044. [PMID: 37620565 DOI: 10.1007/s00266-023-03572-z] [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: 06/08/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND It has been reported that botulinum toxin type A (BoNT-A) produces structural changes in masticatory muscles. However, not all histomorphometric parameters affected by BoNT-A parameters have been assessed. This study investigated the histomorphometric changes in the masseter muscle of rats after a single injection of BoNT-A. METHODS Forty-four adult animals were randomly divided into control group (n = 22) and BoNT-A group (n = 22). Controls received a single dose of 0.14 mL/kg of saline in masseter muscles, and the BoNT-A group received a 7 U/Kg of BoNT-A. The groups received the same volume of injected substances. Animals were sacrificed on 7th (n = 5), 14th (n = 5), 21st (n = 5), 28th (n = 4) and 90th (n = 3) days post-treatment. Histological masseter tissue slides were obtained from hematoxylin-eosin treatment and analyzed in optical microscopy regarding muscle cross-sectional area, amount of connective tissue and quantity and diameter of myocytes. For statistical analysis, generalized linear models were used to compare the data (ANOVA). In all test, the significance level of 5% was set. RESULTS BoNT-A values of cross-sectional area of the masseter muscle were significantly lower than controls (p < 0.01) throughout the study. Regarding myocytes quantity, BoNT-A subgroups presented higher values than controls (p < 0.0001) since the 14th day until the end of the study; however, the diameter of myocytes was smaller in all BoNT-A subgroups (p < 0.0001) in all assessment points. The amount of connective tissue was higher in BoNT-A subgroups (p < 0.0001) throughout the study. CONCLUSION A single injection of BoNT-A altered the structure of masseter muscle of rats, regarding its histomorphometric parameters. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Douglas Massoni Ramos
- Department of Oral Biology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Raira de Brito Silva
- Department of Oral Biology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Giancarlo De la Torre Canales
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal.
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Network for Orofacial Neurosciences (SCON), Huddinge, Sweden.
- Ingá University Center Uningá, Department of Dentistry, Maringá, PR, Brazil.
| | - Luciana Resende
- Ingá University Center Uningá, Department of Dentistry, Maringá, PR, Brazil
| | | | | | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Network for Orofacial Neurosciences (SCON), Huddinge, Sweden
| | - Célia Marisa Rizzatti-Barbosa
- Department of Oral Biology, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
- Ingá University Center Uningá, Department of Dentistry, Maringá, PR, Brazil
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12
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Ayala JC, Rizzatti-Barbosa CM, Custodio W. Influence of botulinum toxin A in pain perception and condyle-fossa relationship after the management of temporomandibular dysfunction: a randomized controlled clinical trial. Oral Maxillofac Surg 2024; 28:269-277. [PMID: 36729315 DOI: 10.1007/s10006-023-01141-x] [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: 12/01/2022] [Accepted: 01/29/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To investigate the pain perception (PP) and condyle-fossa relationship (CFR) after botulinum toxin A (BoNTA) injection in the masseter muscles of painful muscular temporomandibular dysfunction (TMD) patients. MATERIALS AND METHODS Fourteen women (aged 29.7 ± 5.4 years) diagnosed with myogenic TMD were randomized in the BoNTA-treated group (TG) and control group (CG). TG masseter muscles (n = 7) were bilaterally injected with 30 U. The CG (n = 7) were injected with saline injections. Condyle-fossa relationship (CFR) spaces were measured in sagittal (SP) and frontal planes (FP) of images of cone-beam computed tomography (CBCT) done before (T0) and after 30 days' interventions (T1). Visual analogue scale (VAS) measured the patients' TMD pain perception (PP). Data were compared by generalized linear models considering the results over time (α = .05). RESULTS There were no statistical differences in CFR in the SP or FP for TG and CG over time (p ˃ .05), except for frontal lateral space CFR (p < .05). In both groups, the condyle was positioned medially after interventions. Frontal lateral space increased in TG for both, left and right sides, over time (p < .05), as well as PP decreased over time (p < .05) for TG and CG. CONCLUSIONS The results depicted that there was no significant association with BoNTA injection in TMD masseter muscles in PP and CFR, except considering the frontal lateral space of CFR. CLINICAL RELEVANCE BoNTA injection in the masseter muscles may not promote clinically significant shifts in the condyle-fossa relationships of muscular TMD patients.
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Affiliation(s)
- Julian Calegari Ayala
- University Center of the Hermínio Ometto Foundation -FHO, Avenida Dr Maximiliano Baruto, Araras, SP, 50013607-339, Brazil
| | | | - William Custodio
- University Center of the Hermínio Ometto Foundation -FHO, Avenida Dr Maximiliano Baruto, Araras, SP, 50013607-339, Brazil.
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Ferreira EF, Camões-Barbosa A. IncobotulinumtoxinA in refractory temporomandibular disorder due to disk dislocation: A prospective study. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101804. [PMID: 38412921 DOI: 10.1016/j.jormas.2024.101804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Temporomandibular disorders (TMD) may include conditions involving the temporomandibular joint and/or masticatory muscles. Approximately 20 % of patients are refractory to first-line therapies. This study aims to evaluate the effects and safety of incobotulinumtoxinA in the treatment of refractory TMD due to disk dislocation. MATERIAL AND METHODS A quasi-experimental one-arm prospective study was conducted. Target population included individuals with a diagnosis of TMD due to disk dislocation. Patients were treated with electromyography or ultrasound guided injection of incobotulinumtoxinA in the masticatory muscles (20 U into each masseter and pterygoideus lateralis). Pain was assessed using the pain numerical rating scale, maximum unassisted mouth opening was measured in mm, and adverse events were registered at baseline, week 4, week 12 and week 24 post-treatment. Statistical analysis used the Wilcoxon test for the comparison of paired samples and the Mann-Whitney U test for independent samples, considering a p-value ≤ 0.05 as significant. RESULTS 51 patients with 75 painful temporomandibular joints due to disk dislocation (38 with reduction and 37 without) were included. A significant reduction in pain from a pre-treatment mean of 6.08/10 to a post-treatment mean of 2.04/10 (week 4), 3.18/10 (week 12), and 3.65/10 (week 24) was observed (p < 0.001). A significant decrease in maximum unassisted mouth opening from a pre-treatment mean of 36.45 mm to a post-treatment mean of 32.29 mm at week 4 was observed (p < 0.001). DISCUSSION Botulinum toxin injection of the masticatory muscles is safe and seems equally effective in reducing pain in patients with refractory TMD due to disk dislocation.
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Affiliation(s)
- Eduardo Freitas Ferreira
- Physical and Rehabilitation Medicine Specialist, Physical and Rehabilitation Medicine Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.
| | - Alexandre Camões-Barbosa
- Physical and Rehabilitation Medicine Specialist, Neurotoxin Clinic - Neurophysiology Unit of Centro Hospitalar Universitário de Lisboa Central, Portugal
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De la Torre Canales G, Poluha RL, Bonjardim LR, Ernberg M, Conti PCR. Botulinum toxin-A effects on pain, somatosensory and psychosocial features of patients with refractory masticatory myofascial pain: a randomized double-blind clinical trial. Sci Rep 2024; 14:4201. [PMID: 38378855 PMCID: PMC10879180 DOI: 10.1038/s41598-024-54906-z] [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: 05/30/2023] [Accepted: 02/18/2024] [Indexed: 02/22/2024] Open
Abstract
The antinociceptive effect of BoNT-A have been well documented in animal studies; however, results of few but well-designed randomized placebo-controlled clinical trials about BoNT-A efficacy in masticatory myofascial pain (MFP) are inconsistent. Therefore, the present randomized, double-blind, placebo-controlled clinical trial evaluated the efficacy of BoNT-A in patients with refractory MFP. Twenty-eight patients with pain reduction of less than 30% despite conservative treatment and with an average pain intensity of > 50 mm on the visual analogue scale (VAS) participated. Patients were randomly assigned to receive a total of 80 U of BoNT-A or saline solution (SS) injected into the masseter and anterior temporalis muscles. Pain intensity (VAS), quantitative sensory testing (QST), conditioned pain modulation (CPM), and psychosocial status were examined. Follow-up was performed at 1 and 6 months. For repeated-measure comparisons between evaluation times, Friedman test with Bonferroni correction was used for pain and somatosensory variables and the Wilcoxon test for the psychosocial variables. The Mann-Whitney test was used for all comparisons between groups. The BoNT-A group had a significant decrease in pain intensity at follow-ups compared with the SS group (p < 0.001). QST assessment revealed higher pressure pain threshold values in the masseter muscle for BoNT-A group compared to SS (p < 0.03) at all follow-ups. No differences were found for mechanical pain threshold and wind-up ratio values (p > 0.05) in the entire study. The BoNT-A group presented the most efficient CPM effect (p < 0.03) only at the 1 month follow-up in the masseter muscle. There was a significant time effect for BoNT-A in all psychosocial variables (p < 0.05) and a drug effect in the Central Sensitization Inventory (p < 0.01), Pittsburgh Sleep Quality Index (p < 0.004), and Healthy Survey 36 (p < 0.05) at 6 months follow-up. The study demonstrates that a single injection-session of BoNT-A has positive effects on the hall pain spectrum of patients with refractory masticatory myofascial pain.
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Affiliation(s)
- Giancarlo De la Torre Canales
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and The Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden.
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health & Science, Caparica, Almada, Portugal.
- Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
| | - Rodrigo Lorenzi Poluha
- Department of Dentistry, State University of Maringá, Paraná, Brazil
- Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Leonardo Rigoldi Bonjardim
- Bauru Orofacial Pain Group, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
- Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Malin Ernberg
- Division of Oral Rehabilitation, Department of Dental Medicine, Karolinska Institutet, and The Scandinavian Center for Orofacial Neurosciences (SCON), Huddinge, Sweden
| | - Paulo César Rodrigues Conti
- Bauru Orofacial Pain Group, Department of Prosthodontics, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
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Griswold D, Learman K, Ickert E, Clewley D, Donaldson MB, Wilhelm M, Cleland J. Comparing dry needling or local acupuncture to various wet needling injection types for musculoskeletal pain and disability. A systematic review of randomized clinical trials. Disabil Rehabil 2024; 46:414-428. [PMID: 36633385 DOI: 10.1080/09638288.2023.2165731] [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: 01/12/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE Systematically evaluate the comparative effectiveness of dry needling (DN) or local acupuncture to various types of wet needling (WN) for musculoskeletal pain disorders (MPD). METHODS Seven databases (PubMed, PEDro, SPORTDiscus, CINAHL, Scopus, Embase, and Cochrane Central Register of Controlled Trials) were searched following PROSPERO registration. Randomized clinical trials were included if they compared DN or local acupuncture with WN for MPD. Primary outcomes were pain and/or disability. The Revised Cochrane Collaboration tool (RoB 2.0) assessed the risk of bias. RESULTS Twenty-six studies were selected. Wet Needling types included cortisone (CSI) (N = 5), platelet-rich plasma (PRP) (N = 6), Botox (BoT) (N = 3), and local anesthetic injection (LAI) (N = 12). Evidence was rated as low to moderate quality. Results indicate DN produces similar effects to CSI in the short-medium term and superior outcomes in the long term. In addition, DN produces similar outcomes compared to PRP in the short and long term and similar outcomes as BoT in the short and medium term; however, LAI produces better pain outcomes in the short term. CONCLUSION Evidence suggests the effectiveness of DN to WN injections is variable depending on the injection type, outcome time frame, and diagnosis. In addition, adverse event data were similar but inconsistently reported. PROSPERO Registration: 2019 CRD42019131826Implications for rehabilitationDry needling produces similar effects for pain and disability in the short and medium term compared to cortisone, Botox, and platelet-rich plasma injections. Local anesthetic injection may be more effective at reducing short-term pain.Long-term effects on pain and disability are similar between dry needling and platelet-rich plasma injections, but dry needling may produce better long-term outcomes than cortisone injections.The available adverse event data is similar between dry and wet needling.The conclusions from this study may be beneficial for patients and clinicians for considering risk and cost benefit analyses.
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Affiliation(s)
- David Griswold
- Department of Graduate Studies in Health and Rehabilitation Sciences, Associated Universities: Youngstown State University, Youngstown, OH, USA
| | - Ken Learman
- Department of Graduate Studies in Health and Rehabilitation Sciences, Associated Universities: Youngstown State University, Youngstown, OH, USA
| | - Edmund Ickert
- Department of Graduate Studies in Health and Rehabilitation Sciences, Associated Universities: Youngstown State University, Youngstown, OH, USA
| | - Derek Clewley
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | | | - Mark Wilhelm
- School of Medicine, Tufts University, Boston, MA, USA
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16
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Barjandi G, Svedenlöf J, Jasim H, Collin M, Hedenberg-Magnusson B, Christidis N, Ernberg M. Clinical aspects of mastication myalgia-an overview. FRONTIERS IN PAIN RESEARCH 2024; 4:1306475. [PMID: 38264542 PMCID: PMC10803665 DOI: 10.3389/fpain.2023.1306475] [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: 10/03/2023] [Accepted: 12/26/2023] [Indexed: 01/25/2024] Open
Abstract
Mastication myalgia is the most common cause of non-odontogenic pain in the orofacial region and is often associated with a reduced quality of life. The purpose of this review is to provide an overview of the clinical aspects of myalgia based on available research. The review includes epidemiological, diagnostic, and etiological aspects. In addition, the potential risk factors related to the transition from acute to chronic myalgia are explored and treatment strategies are presented for its management. As a result, this review may increase clinical knowledge about mastication myalgia and clarify strategies regarding prevention, diagnostics, and management to improve prognosis and reduce patient suffering.
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Affiliation(s)
- Golnaz Barjandi
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Johanna Svedenlöf
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Hajer Jasim
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
- Department of Orofacial Pain and Jaw Function, Eastman Institute, Stockholm, Sweden
| | - Malin Collin
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Britt Hedenberg-Magnusson
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
- Department of Orofacial Pain and Jaw Function, Eastman Institute, Stockholm, Sweden
| | - Nikolaos Christidis
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
| | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neuroscience (SCON), Huddinge, Sweden
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Kim SR, Chang M, Kim AH, Kim ST. Effect of Botulinum Toxin on Masticatory Muscle Pain in Patients with Temporomandibular Disorders: A Randomized, Double-Blind, Placebo-Controlled Pilot Study. Toxins (Basel) 2023; 15:597. [PMID: 37888628 PMCID: PMC10610636 DOI: 10.3390/toxins15100597] [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: 08/29/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/28/2023] Open
Abstract
This study aimed to evaluate the efficacy of botulinum toxin type A (BoNT/A) in patients with temporomandibular disorders (TMDs) associated with masticatory muscle pain (MMP) and headaches. This randomized, double-blind, placebo-controlled pilot study is the first clinical trial to evaluate both disorders simultaneously. Twenty-one patients with myogenous TMD were randomly assigned to two groups. The experimental and control groups received injections of either BoNT/A or saline into the sites showing tenderness after palpation of a total of 16 muscle areas, including each masseter, a temporalis, splenius capitis, sternocleidomastoid, and trapezius muscle. During each visit, the clinical effects, based on the intensity of orofacial pain (OVAS), headache (HVAS), number of tender points (TPs), maximum mouth opening (MMO), and headache frequency (HF), were evaluated at four time points, namely, pre-injection and 4, 8, and 12 weeks after the injection, in both groups. Friedman and Mann-Whitney tests were used for the analyses. In the experimental group, the reductions in OVAS, TP, HVAS, and HF showed significant differences over time, excluding MMO, whereas there was no significant difference in any of the variables in the control group. In addition, the decline in TPs was significantly different between the experimental and control groups at all time points, especially after 4 and 12 weeks, compared to that during pre-injection. In conclusion, treatment with BoNT/A was relatively effective for masticatory muscle pain caused by TMDs and headache compared to the saline placebo.
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Affiliation(s)
- So Ra Kim
- Department of Orofacial Pain and Oral Medicine, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea; (S.R.K.); (M.C.)
| | - Min Chang
- Department of Orofacial Pain and Oral Medicine, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea; (S.R.K.); (M.C.)
| | - Alec Hyung Kim
- TMJ & Orofacial Pain Center, Los Angeles, CA 90006, USA;
| | - Seong Taek Kim
- Department of Orofacial Pain and Oral Medicine, Yonsei University College of Dentistry, Seoul 03722, Republic of Korea; (S.R.K.); (M.C.)
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Balanta-Melo J, Eyquem-Reyes A, Blanco N, Vásquez W, Kupczik K, Toro-Ibacache V, Buvinic S. Unilateral Hypofunction of the Masseter Leads to Molecular and 3D Morphometric Signs of Atrophy in Ipsilateral Agonist Masticatory Muscles in Adult Mice. Int J Mol Sci 2023; 24:14740. [PMID: 37834190 PMCID: PMC10572689 DOI: 10.3390/ijms241914740] [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: 08/15/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
Mice are commonly used to study mandibular dynamics due to their similarity in chewing cycle patterns with humans. Adult mice treated unilaterally with botulinum toxin type A (BoNTA) in the masseter exhibit atrophy of this muscle characterized by an increase in the gene expression of atrophy-related molecular markers, and a reduction in both muscle fiber diameter and muscle mass at 14d. However, the impact of this muscle imbalance on the non-treated masticatory muscles remains unexplored. Here, we hypothesize that the unilateral masseter hypofunction leads to molecular and 3D morphometric signs of atrophy of the masseter and its agonist masticatory muscles in adult mice. Twenty-three 8-week-old male BALB/c mice received a single injection of BoNTA in the right masseter, whereas the left masseter received the same volume of saline solution (control side). Animals were euthanized at 2d, 7d, and 14d, and the masticatory muscles were analyzed for mRNA expression. Five heads were harvested at 14d, fixed, stained with a contrast-enhanced agent, and scanned using X-ray microtomography. The three-dimensional morphometric parameters (the volume and thickness) from muscles in situ were obtained. Atrogin-1/MAFbx, MuRF-1, and Myogenin mRNA gene expression were significantly increased at 2 and 7d for both the masseter and temporalis from the BoNTA side. For medial pterygoid, increased mRNA gene expression was found at 7d for Atrogin-1/MAFbx and at 2d-7d for Myogenin. Both the volume and thickness of the masseter, temporalis, and medial pterygoid muscles from the BoNTA side were significantly reduced at 14d. In contrast, the lateral pterygoid from the BoNTA side showed a significant increase in volume at 14d. Therefore, the unilateral hypofunction of the masseter leads to molecular and morphological signs of atrophy in both the BoNTA-injected muscle and its agonistic non-injected masticatory muscles. The generalized effect on the mouse masticatory apparatus when one of its components is intervened suggests the need for more clinical studies to determine the safety of BoNTA usage in clinical dentistry.
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Affiliation(s)
- Julián Balanta-Melo
- School of Dentistry, Faculty of Health, Universidad del Valle, Cali 760043, Colombia;
- Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Indiana Center for Musculoskeletal Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Andrea Eyquem-Reyes
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (A.E.-R.); (N.B.); (W.V.); (V.T.-I.)
| | - Noelia Blanco
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (A.E.-R.); (N.B.); (W.V.); (V.T.-I.)
| | - Walter Vásquez
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (A.E.-R.); (N.B.); (W.V.); (V.T.-I.)
| | - Kornelius Kupczik
- Department of Anthropology, Faculty of Social Sciences, Universidad de Chile, Santiago 7750000, Chile
- Max Planck Institute for Evolutionary Anthropology, 04103 Leipzig, Germany
| | - Viviana Toro-Ibacache
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (A.E.-R.); (N.B.); (W.V.); (V.T.-I.)
| | - Sonja Buvinic
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago 8380544, Chile; (A.E.-R.); (N.B.); (W.V.); (V.T.-I.)
- Center for Exercise, Metabolism and Cancer Studies CEMC2016, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile
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Val M, Delcanho R, Ferrari M, Guarda Nardini L, Manfredini D. Is Botulinum Toxin Effective in Treating Orofacial Neuropathic Pain Disorders? A Systematic Review. Toxins (Basel) 2023; 15:541. [PMID: 37755967 PMCID: PMC10535201 DOI: 10.3390/toxins15090541] [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: 08/11/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The aim of this paper is to provide a systematic review of the literature regarding the clinical use of botulinum toxin (BTX) to treat various orofacial neuropathic pain disorders (NP). METHODS A comprehensive literature search was conducted using Medline, Web of Science, and the Cochrane Library databases. Only randomized clinical trials (RCT) published between 2003 and the end of June 2023, investigating the use of BTX to treat NP, were selected. PICO guidelines were used to select and tabulate the articles. RESULTS A total of 6 RCTs were selected. Five articles used BTX injections to treat classical trigeminal neuralgia, and one to treat post-herpetic neuralgia. A total of 795 patients received BTX injections. The selected studies utilised different doses and methods of injections and doses. All the selected studies concluded superiority of BTX injections over placebo for reducing pain levels, and 5 out 6 of them highlighted an improvement in the patient's quality of life. Most of the studies reported transient and mild side effects. CONCLUSION There is evidence of the efficacy of BTX injections in orofacial pain management. However, improved study protocols are required to provide direction for the clinical use of BTX to treat various orofacial neuropathic pain disorders.
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Affiliation(s)
- Matteo Val
- Department of Biomedical Technologies, School of Dental Medicine, University of Siena, 53100 Siena, Italy
| | - Robert Delcanho
- School of Dentistry, University of Western Australia, Perth 6009, Australia
| | - Marco Ferrari
- Department of Biomedical Technologies, School of Dental Medicine, University of Siena, 53100 Siena, Italy
| | - Luca Guarda Nardini
- Unit of Oral and Maxillofacial Surgery, Ca’Foncello Hospital, 31100 Treviso, Italy
| | - Daniele Manfredini
- Department of Biomedical Technologies, School of Dental Medicine, University of Siena, 53100 Siena, Italy
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Gonzalez-Perez LM, Vera-Martin R, Montes-Latorre E, Torres-Carranza E, Infante-Cossio P. Botulinum Toxin and Percutaneous Needle Electrolysis for the Treatment of Chronic Masticatory Myalgia. Toxins (Basel) 2023; 15:toxins15040278. [PMID: 37104216 PMCID: PMC10144780 DOI: 10.3390/toxins15040278] [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: 02/06/2023] [Revised: 03/08/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023] Open
Abstract
Botulinum toxin type A (BTA) is applied in muscle hyperactivity disorders and injected into affected muscles, producing deep and persistent muscle relaxation. Several multidisciplinary groups investigated the treatment of temporomandibular disorders for several years, and there is currently some data on the beneficial effects of BTA in specific cases of chronic masticatory myalgia. Percutaneous needle electrolysis (PNE), which applies a low-intensity galvanic current to promote tissue regeneration, has been shown to be effective in reducing pain and improving masticatory function. The purpose of this study was to investigate the efficacy and safety of BTA and to assess whether its application in patients with localized masticatory myalgia can significantly reduce pain and improve function compared to a group treated with PNE. Fifty-two patients with long-term refractory masticatory myalgia were randomly assigned to two groups. The BTA group (n = 26) received a bilateral botulinum toxin injection and the PNE group (n = 26) received percutaneous electrolysis. The dose of BTA injected was 100 units distributed among the main primary masticatory muscles, and PNE was administered at 0.5 mA/3 s/3 consecutive times in a single session. Patient assessments were performed prior to treatment and one, two, and three months after treatment. The results revealed good therapeutic response in both groups. In the long term, both BTA and PNE showed high efficacy and safety in reducing pain and improving muscle function for the treatment of chronic masticatory myalgia. This improvement was sustained over a three-month period in both groups. Therefore, the use of BTA and PNE could be considered a valid and safe therapeutic alternative among the available options to treat refractory and localized masticatory myalgia when a better therapeutic response is expected as it demonstrated high efficacy.
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Affiliation(s)
- Luis-Miguel Gonzalez-Perez
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain
- Department of Surgery, School of Medicine, University of Seville, 41009 Seville, Spain
| | - Ramon Vera-Martin
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain
| | - Enrique Montes-Latorre
- Department of Clinical Neurophysiology, Virgen del Rocio University Hospital, 41013 Seville, Spain
| | - Eusebio Torres-Carranza
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain
| | - Pedro Infante-Cossio
- Department of Oral and Maxillofacial Surgery, Virgen del Rocio University Hospital, 41013 Seville, Spain
- Department of Surgery, School of Medicine, University of Seville, 41009 Seville, Spain
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21
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Botulinum toxin in the management of myalgia in temporomandibular disorders: are all injections equal? Br J Oral Maxillofac Surg 2023; 61:89-93. [PMID: 36522255 DOI: 10.1016/j.bjoms.2022.11.279] [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: 09/22/2022] [Revised: 11/01/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022]
Abstract
Botulinum toxin (BTX) is becoming widely used as an adjunct to conservative management of myalgia-predominant temporomandibular disorders (TMDs) with reports of improved quality of life. There is, however, no consensus on the optimal dosage. Based on previous studies, dose regimens vary between clinicians, and we know of no standard dose protocol for the administration of BTX for the purpose of TMD management. A survey was sent to members of the British Association of Oral and Maxillofacial Surgeons (BAOMS) Temporomandibular Joint Sub-Specialty Interest Group (TMJ SSIG) and an international mailing list of high-volume TMJ surgeons (the TMJ Internetwork) to ascertain variations in dose regimens between different clinicians. The survey found that 41 respondents offered BTX to patients. The masseter muscle group was the most commonly injected site, and the majority of respondents (34/41) used Botox® (Allergan). Brands less commonly used included Dysport® (Ipsen), and Xeomin® (Merz Pharma). Botox® doses varied between 30 and 100 units, whilst Dysport® doses ranged from 50 - 300 units/muscle. The number of injection sites/muscle also varied. This survey demonstrates the wide variation in practice amongst clinicians with respect to BTX administration. To ensure optimal dose and response titration, further studies and evidence-based research are needed to standardise its use for the treatment of TMDs.
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22
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Long-Term Effects of a Single Application of Botulinum Toxin Type A in Temporomandibular Myofascial Pain Patients: A Controlled Clinical Trial. Toxins (Basel) 2022; 14:toxins14110741. [PMID: 36355991 PMCID: PMC9721314 DOI: 10.3390/toxins14110741] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 01/26/2023] Open
Abstract
This study assessed the long-term effects of botulinum toxin type A (BoNT-A) in subjective pain, pain sensibility, and muscle thickness in persistent myofascial temporomandibular-disorder pain (MFP-TMD) patients. Fourteen female subjects with persistent MFP received BoNT-A treatment with different doses (10U-25U for temporalis muscle and 30U-75U for masseter muscle). The treatment was injected bilaterally in the masseter and anterior temporalis muscles in a single session. Clinical measurements included: self-perceived pain (VAS), pain sensibility (PPT), and muscles thickness (ultrasonography). Follow-up occurred 1, 3, 6, and 72 months after treatment for VAS and PPT and 1, 3, and 72 months for ultrasonography. For statistical analysis, the Friedman test with the Bonferroni test for multiple comparisons as a post hoc test was used for non-parametric repeated measures comparisons among the evaluation times. A 5% probability level was considered significant in all tests. VAS values presented a significant decrease throughout the study (p < 0.05). Regarding PPT values, a significant increase was found when comparing baseline data with post-treatment follow-ups (p < 0.05), and even though a significant decrease was found in muscle thickness when baseline values were compared with the 1- and 3-months assessments, no differences were found when compared with the 72 months follow-up (p > 0.05). A single injection of BoNT-A presents long-term effects in reducing pain in persistent MFP-TMD patients, and a reversibility of adverse effects on masticatory-muscle thickness.
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Bakke M. Botulinum Toxin, a Drug with Potential Interest for Dentists—An Introduction. Toxins (Basel) 2022; 14:toxins14100667. [PMID: 36287936 PMCID: PMC9607019 DOI: 10.3390/toxins14100667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
The review is an introduction to medical, non-cosmetic treatments with botulinum neurotoxin (BoNT) in the orofacial region. It focuses on the current most common, best-documented and safest indications of interest for dentists in terms of dystonia and sialorrhea. These conditions are recommended to start with and suitable to gain better skill and experience with BoNT. The introduction also stresses the importance of correct diagnostics based on interdisciplinary cooperation, precise targeting of the injections, measurements of treatment effect, and control of the oral health with regard to side effects.
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Affiliation(s)
- Merete Bakke
- Clinical Oral Physiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
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24
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Cairns BE. The contribution of autonomic mechanisms to pain in temporomandibular disorders: A narrative review. J Oral Rehabil 2022; 49:1115-1126. [PMID: 36098708 DOI: 10.1111/joor.13370] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/22/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Temporomandibular disorders (TMD) are diagnosed based on symptom presentation and, like other functional pain disorders, often lack definitive pathology. There is a strong association between elevated stress levels and the severity of TMD-related pain, which suggests that alterations in autonomic tone may contribute to this pain condition. OBJECTIVES This narrative review examines the association between altered autonomic function and pain in TMD. METHODS Relevant articles were identified by searching PubMed and through the reference list of those studies. RESULTS TMD sufferers report an increased incidence of orthostatic hypotension. As in other chronic musculoskeletal pain conditions, TMD is associated with increased sympathetic tone, diminished baroreceptor reflex sensitivity and decreased parasympathetic tone. It remains to be determined whether ongoing pain drives these autonomic changes and/or is exacerbated by them. To examine whether increased sympathetic tone contributes to TMD-related pain through β2 adrenergic receptor activation, clinical trials with the beta blocker propranolol have been undertaken. Although evidence from small studies suggested propranolol reduced TMD-related pain, a larger clinical trial did not find a significant effect of propranolol treatment. This is consistent with human experimental pain studies that were unable to demonstrate an effect of β2 adrenergic receptor activation or inhibition on masticatory muscle pain. In preclinical models of temporomandibular joint arthritis, β2 adrenergic receptor activation appears to contribute to inflammation and nociception, whereas in masticatory muscle, α1 adrenergic receptor activation has been found to induce mechanical sensitization. Some agents used to treat TMD, such as botulinum neurotoxin A, antidepressants and α2 adrenergic receptor agonists, may interact with the autonomic nervous system as part of their analgesic mechanism. CONCLUSION Even if dysautonomia turns out to be a consequence rather than a causative factor of painful TMD, the study of its role has opened up a greater understanding of the pathogenesis of this condition.
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Affiliation(s)
- Brian E Cairns
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
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Sitnikova V, Kämppi A, Teronen O, Kemppainen P. Effect of Botulinum Toxin Injection on EMG Activity and Bite Force in Masticatory Muscle Disorder: A Randomized Clinical Trial. Toxins (Basel) 2022; 14:toxins14080545. [PMID: 36006207 PMCID: PMC9416064 DOI: 10.3390/toxins14080545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Botulinum toxin type A (BoNT-A) is increasingly used in treating masticatory muscle pain disorder; however, safe doses and reinjection intervals still need to be established. The purpose of this randomized clinical trial was to evaluate the degree and duration of the impairment of masticatory muscle performance. Fifty-seven subjects were randomly divided into two groups: one of which received BoNT-A first (n = 28) while the other received saline first (n = 29), with the cross-over being in week 16, and a total follow-up period of 32 weeks. A total dose of 50 U of BoNT-A was injected in the masseter and temporal muscles bilaterally. Electromyographic (EMG) activity and bite forces were assessed. A significant reduction in EMG activity was observed up to week 18 (p ≤ 001), with total recovery at week 33. A significant reduction in maximum bite force was observed up to week 11 (p ≤ 005), with total recovery at week 25. In conclusion, when treating masticatory muscle pain disorder with 50 U of BoNT-A, a reinjection interval of 33 weeks can be considered safe since the recovery of muscle function occurs by that time.
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Affiliation(s)
- Victoria Sitnikova
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, 00280 Helsinki, Finland
| | - Antti Kämppi
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, 00280 Helsinki, Finland
- Correspondence: ; Tel.: +358-2941911
| | - Olli Teronen
- Dental Clinic, Private Practice Mehiläinen, 00100 Helsinki, Finland
| | - Pentti Kemppainen
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, 00280 Helsinki, Finland
- Oral and Dental Centre, Helsinki University Central Hospital (HUCH), 00290 Helsinki, Finland
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De la Torre Canales G, Poluha RL, Pinzón NA, Da Silva BR, Almeida AM, Ernberg M, Manso AC, Bonjardim LR, Rizzatti-Barbosa CM. Efficacy of Botulinum Toxin Type-A I in the Improvement of Mandibular Motion and Muscle Sensibility in Myofascial Pain TMD Subjects: A Randomized Controlled Trial. Toxins (Basel) 2022; 14:toxins14070441. [PMID: 35878179 PMCID: PMC9323061 DOI: 10.3390/toxins14070441] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 12/20/2022] Open
Abstract
This study assessed the effects of botulinum toxin type A (BoNT-A) in mandibular range of motion and muscle tenderness to palpation in persistent myofascial pain (MFP) patients (ReBEC RBR-2d4vvv). Eighty consecutive female subjects with persistent MFP, were randomly divided into four groups (n = 20): three BoNT-A groups with different doses and a saline solution group (placebo control group). Treatments were injected bilaterally in the masseter and anterior temporalis muscle in a single session. Clinical measurements of mandibular movements included: pain-free opening, maximum unassisted and assisted opening, and right and left lateral excursions. Palpation tests were performed bilaterally in the masseter and temporalis muscle. Follow-up occurred 28 and 180 days after treatment. For the statistical analysis the Mann–Whitney U-test with Bonferroni correction was used for groups comparisons. Regardless of dose, all parameters of mandibular range of motion significantly improved after 180 days in all BoNT-A groups, compared with the control group. Palpation pain over the masseter and temporalis muscles were significantly reduced in all BoNT-A groups regardless of dose, compared with the control group, after 28 and 180 days of treatment. Independent of doses, BoNT-A improved mandibular range of motion and muscle tenderness to palpation in persistent MFP patients.
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Affiliation(s)
- Giancarlo De la Torre Canales
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, CRL, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal; (A.M.A.); (A.C.M.)
- Ingá University Center, Uningá, Maringa 87020-900, Brazil;
- Correspondence:
| | | | - Natalia Alvarez Pinzón
- Institución Universitaria Colegios de Colombia-Centro de Investigación del Colegio Odontológico (CICO) 20, Bogotá 111611, Colombia;
| | | | - Andre Mariz Almeida
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, CRL, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal; (A.M.A.); (A.C.M.)
| | - Malin Ernberg
- Department of Dental Medicine, Karolinska Institutet, and the Scandinavian Center for Orofacial Neurosciences (SCON), 141 52 Huddinge, Sweden;
| | - Ana Cristina Manso
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, CRL, Quinta da Granja, Monte de Caparica, 2829-511 Caparica, Portugal; (A.M.A.); (A.C.M.)
| | - Leonardo Rigoldi Bonjardim
- Bauru Orofacial Pain Group, Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Sao Paulo 17012-900, Brazil;
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Yoshida K. Botulinum Toxin Therapy for Oromandibular Dystonia and Other Movement Disorders in the Stomatognathic System. Toxins (Basel) 2022; 14:282. [PMID: 35448891 PMCID: PMC9026473 DOI: 10.3390/toxins14040282] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/01/2022] [Accepted: 04/11/2022] [Indexed: 01/02/2023] Open
Abstract
Various movement disorders, such as oromandibular dystonia, oral dyskinesia, bruxism, functional (psychogenic) movement disorder, and tremors, exist in the stomatognathic system. Most patients experiencing involuntary movements due to these disorders visit dentists or oral surgeons, who may be the first healthcare providers. However, differential diagnoses require neurological and dental knowledge. This study aimed to review scientific advances in botulinum toxin therapy for these conditions. The results indicated that botulinum toxin injection is effective and safe, with few side effects in most cases when properly administered by an experienced clinician. The diagnosis and treatment of movement disorders in the stomatognathic system require both neurological and dental or oral surgical knowledge and skills, and well-designed multicenter trials with a multidisciplinary team approach must be necessary to ensure accurate diagnosis and proper treatment.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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28
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Dadjoo S, Michelogiannakis D, Rossouw PE, Javed F. Potential adjunct therapies for the management of temporomandibular disorders: An evidence-based review. Cranio 2022:1-11. [PMID: 35156534 DOI: 10.1080/08869634.2022.2036437] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The aim was to review the role of adjuvant therapies that may potentially contribute toward the management of temporomandibular disorders (TMD). METHODS The addressed focused question was, "Are there any adjuvant therapies that may contribute toward the management of TMD?". Indexed databases were searched up to June 2021. The eligibility criteria were the following: (a) original clinical studies and (b) randomized controlled clinical trials (RCTs). RESULTS Adjuvant therapies were comprised of acupuncture, manual therapy, jaw exercises, dietary modifications, botulinum toxin therapy, and photobiomodulation. Short-term follow-up results from each of these RCTs showed beneficial effects in terms of pain reduction and improvements in jaw movement among patients with TMD. There are no long-term follow-up results in this regard. CONCLUSION The most effective adjunct treatment for managing TMD remains unknown, primarily due to a lack of sufficient scientific evidence.
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Affiliation(s)
- Shaahin Dadjoo
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Dimitrios Michelogiannakis
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - P Emile Rossouw
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Fawad Javed
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
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Delcanho R, Val M, Guarda Nardini L, Manfredini D. Botulinum Toxin for Treating Temporomandibular Disorders: What is the Evidence? J Oral Facial Pain Headache 2022; 36:6-20. [PMID: 35298571 PMCID: PMC10586579 DOI: 10.11607/ofph.3023] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/31/2021] [Indexed: 11/12/2022]
Abstract
AIMS To systematically review the scientific literature for evidence concerning the clinical use of botulinum toxin (BTX) for the management of various temporomandibular disorders (TMDs). METHODS A comprehensive literature search was conducted in the Medline, Web of Science, and Cochrane Library databases to find randomized clinical trials (RCT) published between 2000 and the end of April 2021 investigating the use of BTX to treat TMDs. The selected articles were reviewed and tabulated according to the PICO (patients/problem/population, intervention, comparison, outcome) format. RESULTS A total of 24 RCTs were selected. Nine articles used BTX injections to treat myofascial pain, 4 to treat temporomandibular joint (TMJ) articular TMDs, 8 for the management of bruxism, and 3 to treat masseter hypertrophy. A total of 411 patients were treated by injection of BTX. Wide variability was found in the methods of injection and in the doses injected. Many trials concluded superiority of BTX injections over placebo for reducing TMD pain levels and improving maximum mouth opening; however, this was not universal. CONCLUSION There is good scientific evidence to support the use of BTX injections for treatment of masseter hypertrophy and equivocal evidence for myogenous TMDs, but very little for TMJ articular disorders. Studies with improved methodologic design are needed to gain better insight into the utility and effectiveness of BTX injections for treating both myogenous and TMJ articular TMDs and to establish suitable protocols for treating different TMDs.
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30
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de-la-Hoz JL, de-Pedro M, Martín-Fontelles I, Mesa-Jimenez J, Chivato T, Bagües A. Efficacy of botulinum toxin type A in the management of masticatory myofascial pain: A retrospective clinical study. J Am Dent Assoc 2021; 153:683-691. [PMID: 34763815 DOI: 10.1016/j.adaj.2021.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/15/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Muscular pain is the main cause of disability worldwide. Myofascial pain of orofacial origin is a frequent condition, the treatment of which is not always accomplished with traditional treatment. Botulinum toxin type A (BTA) is being studied for the treatment of this type of pain with contradicting results. Thus, the objective of this study was to assess the efficacy of BTA in the therapeutic management of masticatory myofascial pain (MFP). CASE DESCRIPTION A retrospective study of 100 patients with a diagnosis of MFP was conducted. The control group (50 patients) received conventional treatment (prescription of a muscle relaxant and craniocervical physical therapy). The BTA group (50 patients) received this same treatment and the infiltration of 100 units of BTA in the masticatory musculature. Subjective and objective pain ratings and range of mandibular movements were recorded before and after the treatment. No differences were found between groups in the baseline values. Statistically significant improvements were found in both groups compared with baseline values in all studied parameters. Moreover, BTA improved the subjective pain ratings compared with the control group. The administration of BTA added to the conventional treatment does not seem to improve objective pain ratings and functional measurements, but it improves the subjective pain ratings. PRACTICAL IMPLICATIONS The addition of BTA could be beneficial in the treatment of MFP in addition to conventional treatment, but further studies are needed to elucidate the mechanisms underlying this positive effect.
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31
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Nowak Z, Chęciński M, Nitecka-Buchta A, Bulanda S, Ilczuk-Rypuła D, Postek-Stefańska L, Baron S. Intramuscular Injections and Dry Needling within Masticatory Muscles in Management of Myofascial Pain. Systematic Review of Clinical Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189552. [PMID: 34574476 PMCID: PMC8465617 DOI: 10.3390/ijerph18189552] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/21/2022]
Abstract
Background: Myofascial pain is an important cause of disability among the whole population, and it is a common symptom of temporomandibular joint disorders (TMDs). Its management techniques vary widely; however, in recent years, there has been a growing interest especially in needling therapies within masticatory muscles, due to their simplicity and effectiveness in pain reduction. Methods: The construction of the following study is based on PICOS and PRISMA protocols. A systematic literature search was conducted based on the PubMed and BASE search engines. Searching the abovementioned databases yielded a total of 367 articles. The screening procedure and analysis of full texts resulted in the inclusion of 28 articles for detailed analysis. Results: According to analyzed data, clinicians manage myofascial pain either with wet or dry needling therapies. The most thoroughly studied approach that prevails significantly within the clinical trials is injecting the botulinum toxin into the masseter and temporalis. Other common methods are the application of local anesthetics or dry needling; however, we notice the introduction of entirely new substances, such as platelet-rich plasma or collagen. In the analyzed articles, the target muscles for the needling therapies are most commonly localized by manual palpation although there are a variety of navigational support systems described: EMG, MRI or EIP electrotherapy equipment, which often aid the access to located deeper lateral and medial pterygoid muscle. Conclusions: Needling therapies within masticatory muscles provide satisfactory effects while being simple, safe and accessible procedures although there still is a need for high quality clinical trials investigating especially injections of non-Botox substances and needling within lateral and medial pterygoid muscles.
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Affiliation(s)
- Zuzanna Nowak
- Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland; (A.N.-B.); (S.B.)
- Correspondence:
| | - Maciej Chęciński
- Preventive Medicine Center, Komorowskiego 12, 30-106 Kraków, Poland;
| | - Aleksandra Nitecka-Buchta
- Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland; (A.N.-B.); (S.B.)
| | - Sylwia Bulanda
- Department of Pediatric Dentistry, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland; (S.B.); (D.I.-R.); (L.P.-S.)
| | - Danuta Ilczuk-Rypuła
- Department of Pediatric Dentistry, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland; (S.B.); (D.I.-R.); (L.P.-S.)
| | - Lidia Postek-Stefańska
- Department of Pediatric Dentistry, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland; (S.B.); (D.I.-R.); (L.P.-S.)
| | - Stefan Baron
- Department of Temporomandibular Disorders, Medical University of Silesia in Katowice, Traugutta sq. 2, 41-800 Zabrze, Poland; (A.N.-B.); (S.B.)
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Sitnikova V, Kämppi A, Teronen O, Kemppainen P. Comprehensive evaluation of botulinum toxin treatment outcomes of a patient with persistent myofascial orofacial pain. Clin Case Rep 2021; 9:e04731. [PMID: 34484765 PMCID: PMC8405429 DOI: 10.1002/ccr3.4731] [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: 01/29/2021] [Revised: 06/28/2021] [Accepted: 08/09/2021] [Indexed: 01/09/2023] Open
Abstract
The outcome evaluation method presented in this case study, including Axes I and II findings combined with the results of quantitative bite force and EMG measurements, provides a good tool for proper evaluation of the effect of BoNT-A on patients with myofascial orofacial pain and changes in jaw muscle function.
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Affiliation(s)
- Victoria Sitnikova
- Department of Oral and Maxillofacial DiseasesFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Antti Kämppi
- Department of Oral and Maxillofacial DiseasesFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | - Olli Teronen
- Department of Oral and Maxillofacial DiseasesFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Private Practice MehiläinenHelsinkiFinland
| | - Pentti Kemppainen
- Department of Oral and Maxillofacial DiseasesFaculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Helsinki University Central Hospital (HUCH)HelsinkiFinland
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Yoshida K. Effects of Botulinum Toxin Type A on Pain among Trigeminal Neuralgia, Myofascial Temporomandibular Disorders, and Oromandibular Dystonia. Toxins (Basel) 2021; 13:toxins13090605. [PMID: 34564609 PMCID: PMC8471742 DOI: 10.3390/toxins13090605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 12/17/2022] Open
Abstract
The differences in analgesic effects of botulinum toxin type A were compared in 28 patients with trigeminal neuralgia, 53 patients with myofascial temporomandibular disorders, and 89 patients with the jaw closing oromandibular dystonia. The patients were treated by injection of botulinum toxin type A into the masseter, temporalis, medial pterygoid, and other muscles based on the symptoms of each patient. The pain severity was evaluated using the visual analog scale, pain frequency, and pain scale of the oromandibular dystonia rating scale. Botulinum toxin injection was performed 1068 times in all patients without significant adverse effects. The visual analog, pain frequency, and pain scales at baseline were reduced (p < 0.001) after two, four, eight, and 12 weeks after the first botulinum toxin therapy and at the endpoint. The effects differed significantly (p < 0.001) among the groups (repeated-measures analysis of variance). The mean improvement (0%, no effect; 100%, complete recovery) at the endpoint was 86.8% for trigeminal neuralgia, 80.8% for myofascial pain, and 75.4% for oromandibular dystonia. Injection of the botulinum toxin can be a highly effective and safe method to treat trigeminal neuralgia, myofascial pain, and oromandibular dystonia.
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Affiliation(s)
- Kazuya Yoshida
- Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
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DE LA Torre Canales G, Câmara-Souza MB, Poluha RL, Grillo CM, Conti PCR, Sousa MDLRD, Rodrigues Garcia RCM, Rizzatti-Barbosa CM. Botulinum toxin type A and acupuncture for masticatory myofascial pain: a randomized clinical trial. J Appl Oral Sci 2021; 29:e20201035. [PMID: 34105695 PMCID: PMC8232932 DOI: 10.1590/1678-7757-2020-1035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/25/2021] [Indexed: 11/24/2022] Open
Abstract
BoNT-A has been widely used for TMD therapy. However, the potential benefits compared to dry needling techniques are not clear.
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Affiliation(s)
| | - Mariana Barbosa Câmara-Souza
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Prótese e Periodontia, Piracicaba, SP, Brasil
| | - Rodrigo Lorenzi Poluha
- Universidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Prótese, Bauru, SP, Brasil
| | - Cassia Maria Grillo
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Saúde Coletiva, Piracicaba, SP, Brasil
| | | | - Maria da Luz Rosário de Sousa
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Saúde Coletiva, Piracicaba, SP, Brasil
| | | | - Célia Marisa Rizzatti-Barbosa
- Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba, Departamento de Prótese e Periodontia, Piracicaba, SP, Brasil.,UNINGA, Departmento de Odontologia, Maringá, PR, Brasil
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Raphael KG, Janal MN, Tadinada A, Santiago V, Sirois DA, Lurie AG. Effect of multiple injections of botulinum toxin into painful masticatory muscles on bone density in the temporomandibular complex. J Oral Rehabil 2020; 47:1319-1329. [PMID: 32885475 PMCID: PMC7693250 DOI: 10.1111/joor.13087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 01/02/2023]
Abstract
Background Adverse effects of masticatory muscle injections of Botulinum Toxin (Btx) have been noted in animal and, less dramatically, human studies. Objective Among women treated in multiple community‐based private practices, to compare TMJ bone density and mandibular condylar volume between patients with myofascial TMJD receiving multiple masticatory muscle Btx treatments and similarly diagnosed women not receiving such treatment. Methods Cohorts consisted of women whose treatment charts indicated a diagnosis of myofascial TMJD: 35 received at least 2 Btx treatment cycles; 44 received none. Bone density at pre‐specified regions of interest (ROI) was defined by grey scale values from Cone Beam CT, adjusting for a fixed density phantom included in each scan. Mean bone density and mandibular condyle volume were compared between groups. Dose‐response effects were tested within the Btx‐exposed group. Results The mean density of primary and secondary ROIs was similar between exposure groups, as was condylar volume. Among Btx‐exposed women, increasing dose of Btx to the temporalis muscle was inversely proportional to the density of the trabecular area of the mandible body. Many Btx‐exposed women received smaller doses of Btx to the masseter muscles than in most TMJD Btx clinical trials. Conclusion Masticatory muscle injections of Btx failed to produce clinically significant TMJ bone‐related changes. Should Btx receive regulatory approval for treatment of myofascial TMJD, a phase IV study is recommended to evaluate potential adverse effects of Btx on bone and muscle when administered at higher doses and/or for more treatment cycles.
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Affiliation(s)
| | - Malvin N Janal
- New York University College of Dentistry, New York, NY, USA
| | - Aditya Tadinada
- University of Connecticut School of Dental Medicine, Farmington, CT, USA
| | | | - David A Sirois
- New York University College of Dentistry, New York, NY, USA
| | - Alan G Lurie
- University of Connecticut School of Dental Medicine, Farmington, CT, USA
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Manuel Muñoz-Lora VR, Abdalla HB, Del Bel Cury AA, Clemente-Napimoga JT. Modulatory effect of botulinum toxin type A on the microglial P2X7/CatS/FKN activated-pathway in antigen-induced arthritis of the temporomandibular joint of rats. Toxicon 2020; 187:116-121. [PMID: 32882256 DOI: 10.1016/j.toxicon.2020.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/11/2020] [Accepted: 08/30/2020] [Indexed: 12/23/2022]
Abstract
Analgesic mechanism of Botulinum toxin type A (BoNT/A) involves retrograde axonal transport to central nervous system, where it may interact with sensory neurons. Though, some authors suggested that BoNT/A antinociceptive action may also be associated with the inhibition intracellular factors and neuromodulators expressed by immune cells, especially by microglia. Antigen-induced arthritis in the temporomandibular joint (TMJ) of rats is signal by P2X7 receptor/Cathepsin S (CatS)/Fractalkine (FKN) microglia-activated pathway. Thus, we aimed to evaluate the possible modulatory effect of an intra-TMJ injection of BoNT/A on the P2X7/CatS/FKN microglia-activated pathway in the trigeminal subnucleus caudalis of rats with antigen-induced arthritis of the TMJ. A model of antigen-induced arthritis was used on Wistar rats (n = 40) by systemic injections of an emulsion containing complete Freund's adjuvant and methylated bovine serum albumin (mBSA) diluted in PBS. The arthritic condition was stablished by an intra-TMJ injection of mBSA (10 μg/TMJ/week) for 3 weeks. Then, animals were treated with an intra-TMJ injection of BoNT/A (onabotulinumtoxinA, Allergan®; 7U/kg) or vehicle saline. Animals were euthanized 24 h, 7 or 14 days after BoNT/A treatment and their trigeminal nucleus caudalis was harvested to evaluate the protein level of microglial purinergic P2X7 receptor and CX3 chemokine receptor 1 (CX3CR1) by Western blot, and to measure the protein level of microglial modulators CatS, FKN, and the pro-inflammatory cytokines tumor necrosis alfa (TNF-α) and interleukin 1β (IL-1β) by enzyme-linked immunosorbent assay (ELISA). The antigen-induced arthritis in the TMJ significantly increased the protein levels of P2X7, CatS, FKN, TNF-α and IL-1β in the trigeminal subnucleus caudalis (P < 0.05). The intra-TMJ injection of BoNT/A reduced the protein levels of P2X7 in all time points tested. Additionally, BoNT/A significantly reduced the protein levels of CatS, FKN, and TNF-α 14 days after treatment. However, IL-1β was significantly reduced just 24 h after the BoNT/A intra-TMJ treatment. Based on our results, we can suggest that the intra-TMJ injection of BoNT/A may promote a central effect by reducing the P2X7/CatS/FKN microglia-activated pathway in the trigeminal subnucleus caudalis.
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Affiliation(s)
- Victor Ricardo Manuel Muñoz-Lora
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil; Dental Research Division, School of Dentistry, Ibirapuera University, SP, Brazil
| | - Henrique Ballassini Abdalla
- Laboratory of Neuroimmune Interface of Pain Research, Faculdade São Leopoldo Mandic, Instituto e Centro de Pesquisas São Leopoldo Mandic, Campinas, SP, Brazil
| | - Altair Antoninha Del Bel Cury
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas - UNICAMP, Piracicaba, SP, Brazil.
| | - Juliana Trindade Clemente-Napimoga
- Laboratory of Neuroimmune Interface of Pain Research, Faculdade São Leopoldo Mandic, Instituto e Centro de Pesquisas São Leopoldo Mandic, Campinas, SP, Brazil.
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Buvinic S, Balanta-Melo J, Kupczik K, Vásquez W, Beato C, Toro-Ibacache V. Muscle-Bone Crosstalk in the Masticatory System: From Biomechanical to Molecular Interactions. Front Endocrinol (Lausanne) 2020; 11:606947. [PMID: 33732211 PMCID: PMC7959242 DOI: 10.3389/fendo.2020.606947] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/31/2020] [Indexed: 12/12/2022] Open
Abstract
The masticatory system is a complex and highly organized group of structures, including craniofacial bones (maxillae and mandible), muscles, teeth, joints, and neurovascular elements. While the musculoskeletal structures of the head and neck are known to have a different embryonic origin, morphology, biomechanical demands, and biochemical characteristics than the trunk and limbs, their particular molecular basis and cell biology have been much less explored. In the last decade, the concept of muscle-bone crosstalk has emerged, comprising both the loads generated during muscle contraction and a biochemical component through soluble molecules. Bone cells embedded in the mineralized tissue respond to the biomechanical input by releasing molecular factors that impact the homeostasis of the attaching skeletal muscle. In the same way, muscle-derived factors act as soluble signals that modulate the remodeling process of the underlying bones. This concept of muscle-bone crosstalk at a molecular level is particularly interesting in the mandible, due to its tight anatomical relationship with one of the biggest and strongest masticatory muscles, the masseter. However, despite the close physical and physiological interaction of both tissues for proper functioning, this topic has been poorly addressed. Here we present one of the most detailed reviews of the literature to date regarding the biomechanical and biochemical interaction between muscles and bones of the masticatory system, both during development and in physiological or pathological remodeling processes. Evidence related to how masticatory function shapes the craniofacial bones is discussed, and a proposal presented that the masticatory muscles and craniofacial bones serve as secretory tissues. We furthermore discuss our current findings of myokines-release from masseter muscle in physiological conditions, during functional adaptation or pathology, and their putative role as bone-modulators in the craniofacial system. Finally, we address the physiological implications of the crosstalk between muscles and bones in the masticatory system, analyzing pathologies or clinical procedures in which the alteration of one of them affects the homeostasis of the other. Unveiling the mechanisms of muscle-bone crosstalk in the masticatory system opens broad possibilities for understanding and treating temporomandibular disorders, which severely impair the quality of life, with a high cost for diagnosis and management.
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Affiliation(s)
- Sonja Buvinic
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
- Center for Exercise, Metabolism and Cancer Studies CEMC2016, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- *Correspondence: Sonja Buvinic,
| | - Julián Balanta-Melo
- School of Dentistry, Faculty of Health, Universidad del Valle, Cali, Colombia
- Evidence-Based Practice Unit Univalle, Hospital Universitario del Valle, Cali, Colombia
- Max Planck Weizmann Center for Integrative Archaeology and Anthropology, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Kornelius Kupczik
- Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Walter Vásquez
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Carolina Beato
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Viviana Toro-Ibacache
- Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
- Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
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