Giannakopoulos N N, Rauer A-K, Hellmann D, Hugger S, Schmitter M, Hugger A
Department of Prosthodontics, University of Würzburg, Würzburg, Germany.
Department of Prosthodontics, University of Düsseldorf, Düsseldorf, Germany.
J Oral Rehabil. 2018 Sep;45(9):669-676. doi: 10.1111/joor.12662. Epub 2018 Jun 19.
This study was to compare the short-term therapeutic efficacy of device-supported sensorimotor training with that of standard splint therapy for patients with myofascial temporomandibular disorder (TMD) pain over a treatment period of 3 months. We tested the hypothesis that both types of intervention are equally effective for pain reduction. In addition, the electromyographic (EMG) activity of the temporal and masseter muscles was recorded under conditions of force-controlled submaximum and maximum biting in intercuspation. Of consecutive patients seeking treatment for non-odontogenic oro-facial pain, 45 patients with myofascial TMD pain (graded chronic pain status, GCPS, I and II) were randomly assigned to 2 treatment groups (sensorimotor training and conventional splint treatment). Patients were evaluated 4 times (initial examination, 2, 6 and 12 weeks later) by use of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Electromyographic activity was recorded at the initial session and after 3 months. Ease-of-use of the treatment options was also evaluated. Significant (P < .0001) pain reduction (sensorimotor training 53%, splint therapy 40%) was achieved for both groups, with no significant differences (P > .05) between the groups. Force-controlled sub-maximum normalized electromyographic activity was significantly different between T0 and T3 for group A (sensorimotor training, P < .05) but was not significantly different for group B (splint, P > .05). For normalized maximum-biting EMG activity in intercuspation, however, a significant increase in EMG activity was observed for group A for the masseter and temporal muscles (P < .001) and for group B for the masseter muscle only (P < .001). Moreover, sensorimotor training was significantly (P < .05) less easy to use than the splint. The results of this study confirm the pain-reducing effect of sensorimotor training for patients with myofascial TMD pain (GCPS I and II). This innovative active treatment might be a promising option for TMD pain patients.
本研究旨在比较器械辅助感觉运动训练与标准夹板疗法对肌筋膜性颞下颌关节紊乱病（TMD）疼痛患者在3个月治疗期内的短期治疗效果。我们检验了两种干预方式在减轻疼痛方面同样有效的假设。此外，在牙尖交错位力控次最大和最大咬合力条件下记录颞肌和咬肌的肌电图（EMG）活动。在连续寻求非牙源性口面部疼痛治疗的患者中，45例肌筋膜性TMD疼痛患者（慢性疼痛状态分级，GCPS，I级和II级）被随机分配到2个治疗组（感觉运动训练组和传统夹板治疗组）。使用颞下颌关节紊乱病研究诊断标准（RDC/TMD）对患者进行4次评估（初诊、2周、6周和12周后）。在初诊时和3个月后记录肌电图活动。还评估了治疗方法的易用性。两组均实现了显著（P <.0001）的疼痛减轻（感觉运动训练组53%，夹板治疗组40%），组间无显著差异（P >.05）。A组（感觉运动训练组）在T0和T3之间力控次最大标准化肌电图活动有显著差异（P <.05），而B组（夹板组）无显著差异（P >.05）。然而，对于牙尖交错位标准化最大咬合力EMG活动，A组咬肌和颞肌的EMG活动显著增加（P <.001），B组仅咬肌的EMG活动显著增加（P <.001）。此外，感觉运动训练的易用性显著低于夹板（P <.05）。本研究结果证实了感觉运动训练对肌筋膜性TMD疼痛患者（GCPS I级和II级）的止痛效果。这种创新的主动治疗方法可能是TMD疼痛患者的一个有前景的选择。
