Temporomandibular Disorders and Bruxism Clinic, Niigata Hospital, The Nippon Dental University, Niigata, Japan.
Temporomandibular Disorders and Bruxism Clinic, Niigata Hospital, The Nippon Dental University, Niigata, Japan.
J Prosthodont Res. 2019 Apr;63(2):202-209. doi: 10.1016/j.jpor.2018.11.010. Epub 2018 Dec 15.
Manual therapy has been used for the treatment of patients with temporomandibular disorders (TMD) with mouth-opening limitations. However, the curative effect of manipulation differs among researchers, and its necessity remains controversial. The purpose of this study was to confirm the efficacy of manipulation using a randomized controlled trial (RCT).
A total of 61 TMD patients who had mouth-opening limitation (upper and lower middle incisor distance ≤35mm) were selected. They were divided into two treatment groups: conventional treatment (n=30) and conventional treatment plus manipulation (n=31). The conventional treatment included two types of self-exercise: cognitive behavioral therapy for bruxism and education. Mouth-opening limitation, orofacial pain, and temporomandibular joint (TMJ) sounds were recorded from baseline to 18 weeks after baseline. These parameters were statistically compared between the two treatment groups by using analysis of variance (ANOVA) and Scheffe's test to assess mouth opening distance and pain; TMJ sounds were compared using Mann-Whitney U test.
No statistical difference was observed between the two treatment groups except for mouth-opening limitation after treatment at the first visit. Subgroup analyses, stratified according to the pathological type of TMD, indicated a similar trend.
The efficacy of manipulation seems to be limited, in contrast to our expectations, and improved execution of therapeutic exercises has a similar effect to that of manipulation during long-term observation. The advantage of manipulation was observed only during the first treatment session. The RCT was registered in the University Hospital Medical Information Network in Japan (UMIN-CTR: 000010437).
手动疗法已被用于治疗张口受限的颞下颌关节紊乱病（TMD）患者。然而，不同研究人员对手法治疗的疗效存在差异，其必要性仍存在争议。本研究旨在通过随机对照试验（RCT）证实手法治疗的疗效。
共选择 61 例张口受限（上下中切牙距离≤35mm）的 TMD 患者，将其分为两组：常规治疗组（n=30）和常规治疗加手法组（n=31）。常规治疗包括两种自我锻炼：磨牙症认知行为疗法和教育。从基线到基线后 18 周，记录张口受限、口颌面疼痛和颞下颌关节（TMJ）声音。采用方差分析（ANOVA）和 Scheffe 检验对两组治疗后的张口距离和疼痛进行统计学比较；采用 Mann-Whitney U 检验比较 TMJ 声音。
除首次就诊时治疗后的张口受限外，两组间无统计学差异。根据 TMD 的病理类型进行亚组分析，结果也有类似趋势。
与我们的预期相反，手法治疗的疗效似乎有限，而治疗性锻炼的执行得到改善与手法治疗的效果相似，在长期观察中。手法治疗的优势仅在第一次治疗时观察到。该 RCT 已在日本大学医院医疗信息网络（UMIN-CTR：000010437）注册。
