Díaz Leonardo, Restelli Lukas, Valencia Emilia, Atalay Damla Ilhan, Abarca José Manuel, Gil Alain Chalple, Fernández Eduardo
Department of Prosthodontics, Faculty of Dentistry, University of Chile, Santiago, Chile; Department of Stomatology, Faculty of Dentistry, Universidad de Sevilla, Sevilla, Spain; Perioplastic Institute, Santiago, Chile.
Postgraduate School, Faculty of Dentistry, University of Chile, Chile.
Photodiagnosis Photodyn Ther. 2025 Jun;53:104558. doi: 10.1016/j.pdpdt.2025.104558. Epub 2025 Mar 15.
This study aimed to systematically evaluate the efficacy of LLLT in the management of TMD, focusing on its impact on pain reduction and functional improvement. Additionally, this review sought to identify the most effective laser parameters (wavelength, energy density, and duration of therapy) and compare LLLT outcomes with conventional treatment modalities.
A comprehensive search was conducted across PubMed, Scopus, Web of Science, and EBSCO databases until December 2024. Randomized controlled trials (RCTs) that evaluated LLLT's effects on pain (via Visual Analog Scale) and vertical aperture (VA) were included. The risk of bias was assessed using Cochrane's RoB 2 tool.
This systematic review analyzed 44 randomized clinical trials (RCTs) with 1,816 participants, confirming that low-level laser therapy (LLLT) significantly reduces pain intensity (60-70 % decrease on the Visual Analog Scale) and improves mandibular function (10-20 % increase in maximum mouth opening). The most effective laser wavelengths ranged from 810 to 940 nm, with energy densities of 3-12 J/cm². Longer treatment durations (>4 weeks) provided more sustained benefits. Compared to occlusal splints, NSAIDs, and TENS, LLLT showed superior or comparable pain relief with fewer side effects. However, variability in laser parameters and protocols remains a limitation.
LLLT is a safe and effective non-invasive treatment for TMD, offering substantial benefits in pain management and functional recovery. Standardized protocols based on optimized dosimetry are needed to enhance clinical outcomes further.
本研究旨在系统评估低强度激光疗法（LLLT）在颞下颌关节紊乱病（TMD）治疗中的疗效，重点关注其对减轻疼痛和改善功能的影响。此外，本综述试图确定最有效的激光参数（波长、能量密度和治疗持续时间），并将LLLT的治疗结果与传统治疗方式进行比较。
截至2024年12月，在PubMed、Scopus、Web of Science和EBSCO数据库中进行了全面检索。纳入评估LLLT对疼痛（通过视觉模拟量表）和垂直开口度（VA）影响的随机对照试验（RCT）。使用Cochrane的RoB 2工具评估偏倚风险。
本系统综述分析了44项随机临床试验（RCT），涉及1816名参与者，证实低强度激光疗法（LLLT）可显著降低疼痛强度（视觉模拟量表上降低60 - 70%）并改善下颌功能（最大开口度增加10 - 20%）。最有效的激光波长范围为810至940纳米，能量密度为3 - 12焦/平方厘米。较长的治疗持续时间（>4周）可带来更持久的益处。与咬合板、非甾体抗炎药和经皮电刺激神经疗法（TENS）相比，LLLT显示出更好或相当的疼痛缓解效果，且副作用更少。然而，激光参数和方案的变异性仍然是一个限制因素。
LLLT是一种安全有效的TMD非侵入性治疗方法，在疼痛管理和功能恢复方面具有显著益处。需要基于优化剂量测定的标准化方案来进一步提高临床疗效。
