Department of Rehabilitation Musculoskeletal System, Pomeranian Medical University, Szczecin, 70-204, Poland.
Department of Dental Prosthetics, Pomeranian Medical University, Szczecin, 70-204, Poland.
BMC Oral Health. 2023 Nov 25;23(1):927. doi: 10.1186/s12903-023-03601-y.
Physical therapy (PT) methods applied in dentistry are increasingly discussed nowadays. Taking into account a rapidly growing number of temporomandibular disorders (TMDs) and orofacial pain patients, it is reasonable to determine which of the available physiotherapeutic (PT) methods are more effective than others, especially in terms of their possible analgesic and myorelaxant effects.
To assess manual and physical factors influencing pain reduction or elimination and increased muscle tension in patients with TMD; yet the influence of the applied forms of PT on the range of motion (ROM) of temporomandibular joints (TMJ).
A randomized, parallel-group, RCT, single-blind, equi-randomized (1:1) study was conducted in DC/TMD Group Ib patients (20-45 years of age). An experimental group (G1, n = 104) and a control group without TMD (G2, n = 104) were created according to CONSORT guidelines. Diagnostic measurements were performed in both groups (mass sEMG, temporomandibular joint range of motion-ROM, pain intensity - NRS). Group G1 was randomly divided (envelope method) into 4 therapeutic groups, in which therapy was carried out for 10 days: magnetostimulation (MS), magnetoledotherapy (MLE), magnetolaserotherapy (MLA), manual therapy (MT). Each time after the therapy, ROM and NRS measurements were performed, and after the 5th and 10th day sEMG.
Statistically significant differences were found in the sEMG values of the masseter muscles, TMJ ROM and the pain intensity in G1 and G2 (p < 0.00). The largest decrease in sEMG (% MVC) of the masseter muscle occurred in the subgroup in which the manual therapy (MT) procedures were applied, p < 0.000. There was no clinically significant difference in and between other subgroups. There was a distinct mandible ROM increase noted in the MT group, with minimal changes in the MLA and MLE groups and no changes in the MS group. There was a clear increase in the lateral mobility of both right and left TMJ in the MT group. There were no differences in the course of the study in the MS group, and slight increases in the MLA and MLE groups. In the case of pain measurements, the greatest decrease in pain intensity was observed in the MT subgroup.
According to our results manual therapy is an effective form of treatment in patients with pain, increased masticatory muscle tension and limitation in mandible ROM. Dental physiotherapy should become an integral part of multimodal TMD patients' treatment.
如今，牙科中应用的物理疗法（PT）方法越来越受到关注。考虑到颞下颌紊乱（TMD）和口面疼痛患者数量的快速增长，确定哪些可用的物理治疗（PT）方法比其他方法更有效是合理的，特别是在其可能的镇痛和肌肉松弛作用方面。
评估影响 TMD 患者疼痛减轻或消除以及肌肉张力增加的手动和物理因素；然而，应用 PT 形式对颞下颌关节（TMJ）运动范围（ROM）的影响。
对 DC/TMD Group Ib 患者（20-45 岁）进行了一项随机、平行组、RCT、单盲、等随机（1:1）研究。根据 CONSORT 指南创建了实验组（G1，n = 104）和无 TMD 对照组（G2，n = 104）。在两组中均进行了诊断测量（表面肌电图，TMJ 运动范围-ROM，疼痛强度-NRS）。实验组（G1）随机分为 4 个治疗组，每组 10 天：磁刺激（MS）、磁光疗法（MLE）、磁激光疗法（MLA）、手动疗法（MT）。每次治疗后进行 ROM 和 NRS 测量，第 5 天和第 10 天进行 sEMG。
G1 和 G2 的咀嚼肌肌电图（sEMG）值、TMJ ROM 和疼痛强度均有统计学差异（p < 0.00）。在应用手动治疗（MT）程序的亚组中，咀嚼肌的 sEMG（%MVC）下降幅度最大，p < 0.000。其他亚组之间没有明显差异。MT 组下颌骨 ROM 明显增加，MLA 和 MLE 组变化不大，MS 组无变化。MT 组双侧 TMJ 侧向活动明显增加，MS 组无差异，MLA 和 MLE 组略有增加。在疼痛测量方面，MT 亚组疼痛强度下降幅度最大。
根据我们的结果，手动治疗是疼痛、咀嚼肌张力增加和下颌骨 ROM 受限患者的有效治疗方法。牙科物理疗法应成为多模式 TMD 患者治疗的一个组成部分。
