Course of Dentistry, University of Ribeirão Preto (UNAERP), Ribeirão Preto, São Paulo, Brazil.
Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
J Photochem Photobiol B. 2023 Jan;238:112612. doi: 10.1016/j.jphotobiol.2022.112612. Epub 2022 Nov 26.
Photobiomodulation therapy (PTB) is a therapeutic possibility for temporomandibular disorders (TMD), but its effectiveness and protocols for use remain controversial. This study is a RCT that compared the effectiveness of PTB on pain points of the masticatory muscles and TMJs, located through palpation versus application of pre-established points in women with painful TMD, diagnosis by DC/TMD (Diagnostic Criteria for Temporomandibular Disorders - Brazilian Portuguese version). Therefore, a total sample of 54 women, aged between 18 and 60 years, was investigated. Volunteers were randomly randomized and PTB was applied in four different groups with a dose of 4 J and 6 J divided into pre-established application points (PE - G1) and pain points (PD - G2) - Groups 4PE, 4PD, 6PE and 6PD. Four laser applications were performed with a wavelength of 780 nm, one session per week, totaling one month of therapy. The following assessments were performed: DC/TMD, Brief Pain Inventory (BPI), McGill Questionnaire - Short Version (SF-MPQ) and Pain Intensity, Visual Analogue Scale (VAS). Friedman's test was used for within-group comparisons, while the Mann-Whitney test was used for between-group comparisons (p < 0.05). According to the results, laser application on pain points (G2) was more effective. McGill's results showed that regardless of dose, the pain point application group had better outcomes (p = 0.004). Pain intensity evaluation (last days) also showed that application at the pain points was more effective regardless of dose (p = 0.0002). Medians and interquartile deviations showed overall that PTB was more effective at pain points, with a trend towards better outcomes at the 6 J dose. Therefore, it can be concluded that in women with chronic painful TMD, the application of PTB at pain points is more effective than the application at pre-established points. Therefore, individualized PTB protocols are proposed, based on examination palpation of the masticatory structures.
光生物调节疗法（PTB）是治疗颞下颌关节紊乱症（TMD）的一种可能性，但它的有效性和使用方案仍存在争议。本研究是一项 RCT，比较了通过触诊定位咀嚼肌和 TMJ 痛点与应用预先设定的点在患有疼痛性 TMD 的女性中的疗效，TMD 的诊断依据为 DC/TMD（颞下颌关节紊乱症诊断标准-巴西葡萄牙语版）。因此，对 54 名年龄在 18 至 60 岁之间的女性进行了总体样本研究。志愿者被随机分组，PTB 以 4 J 和 6 J 的剂量分为四个不同的组，分别应用于预先设定的应用点（PE-G1）和痛点（PD-G2）-4PE、4PD、6PE 和 6PD 组。应用波长为 780nm 的激光进行四次治疗，每周一次，共治疗一个月。进行了以下评估：DC/TMD、简明疼痛量表（BPI）、麦吉尔疼痛问卷-短版（SF-MPQ）和疼痛强度、视觉模拟量表（VAS）。采用 Friedman 检验进行组内比较，采用 Mann-Whitney 检验进行组间比较（p<0.05）。根据结果，在痛点上应用激光（G2）更有效。麦吉尔的结果表明，无论剂量如何，痛点应用组的结果都更好（p=0.004）。疼痛强度评估（最后几天）也表明，无论剂量如何，在痛点应用都更有效（p=0.0002）。中位数和四分位距总体显示，PTB 在痛点处更有效，6 J 剂量的疗效趋势更好。因此，可以得出结论，在患有慢性疼痛性 TMD 的女性中，在痛点处应用 PTB 比在预先设定的点处应用更有效。因此，提出了基于咀嚼结构触诊检查的个体化 PTB 方案。
