School of Physical Education and Sports Science, Soochow University, Suzhou, China; Sport Rehabilitation Center of Soochow University, Suzhou, China.
Department of Stomatology, First Affiliated Hospital of Soochow University, Suzhou, China.
Complement Ther Med. 2023 Jun;74:102945. doi: 10.1016/j.ctim.2023.102945. Epub 2023 Mar 28.
The aim of this systematic review was to evaluate the efficacy of laser therapy in temporomandibular disorders (TMD).
Randomized controlled trials (RCTs) in regard to this issue were searched in electronic databases. Three investigators independently screened the eligible studies, and the quality of the included studies was assessed according to the risk of bias tool recommended by the Cochrane handbook. The primary outcome measure was the degree of pain, reported on a visual analog scale (VAS), and the secondary outcome measures were TMJ function, including maximum active vertical opening (MAVO), maximum passive vertical opening (MPVO), left and right lateral movement (LLE, RLE). Pooled effect sizes were calculated using random effects models and 95% confidence interval (95% CI).
A total of 28 randomized controlled trials were included. Laser therapy had a more significant effect in terms of VAS (SMD=﹣1.88; 95% CI=﹣2.46 to﹣1.30; P < 0.00001; I =93%), MAVO (MD = 4.90; 95% CI= 3.29-6.50; P < 0.00001; I =72%), MPVO (MD=5.8; 95% CI= 4.62-7.01; P < 0.00001; I =40%) and RLE (MD = 0.73; 95% CI= 0.23-1.22; P = 0.004; I = 0%) as compared to placebo group. However, there was no significant difference in LLE between two groups (MD= 0.35; 95% CI=﹣0.31-1.01; P = 0.30; I =0%).
Laser therapy can effectively reduce pain but have small effect on improving mandibular movement of TMD patients. More well-designed RCTs with large sample sizes are needed for further validation. And these studies should report detailed laser parameters and provide complete outcome measure data.
本系统评价旨在评估激光治疗颞下颌关节紊乱（TMD）的疗效。
检索了关于这一问题的随机对照试验（RCT）。三名研究者独立筛选合格研究，并根据 Cochrane 手册推荐的偏倚风险工具评估纳入研究的质量。主要结局测量指标为视觉模拟评分（VAS）报告的疼痛程度，次要结局测量指标为 TMJ 功能，包括最大主动垂直开口（MAVO）、最大被动垂直开口（MPVO）、左右侧方运动（LLE、RLE）。使用随机效应模型和 95%置信区间（95%CI）计算汇总效应大小。
共纳入 28 项随机对照试验。激光治疗在 VAS（SMD=﹣1.88；95%CI=﹣2.46 至﹣1.30；P<0.00001；I=93%）、MAVO（MD=4.90；95%CI=3.29-6.50；P<0.00001；I=72%）、MPVO（MD=5.8；95%CI=4.62-7.01；P<0.00001；I=40%）和 RLE（MD=0.73；95%CI=0.23-1.22；P=0.004；I=0%）方面的效果优于安慰剂组。然而，两组间 LLE 无显著差异（MD=0.35；95%CI=﹣0.31-1.01；P=0.30；I=0%）。
激光治疗能有效减轻疼痛，但对改善 TMD 患者下颌运动的效果较小。需要更多设计良好、样本量大的 RCT 进一步验证，且这些研究应报告详细的激光参数并提供完整的结局测量数据。
