Effect of low-level LASER therapy versus CAD/CAM Michigan splint on patients with Temporomandibular Muscle Disorders: a randomized clinical trial / Efeito da terapia LASER de baixa potência versus placa de Michigan CAD/CAM em pacientes com Distúrbios Temporomandibulares musculares: um ensaio clínico randomizado

Objective: This study aimed to evaluate the efficacy and sustainability of using low level LASER therapy and CAD/CAM Michigan splint on improving the range of mandibular movements, muscle activity and reducing the pain. Material and Methods: 56 female patients were randomly divided into two groups. Group A: Patients received applications of low-level LASER therapy using semiconductor InGaAsp diode LASER type 940 nm with continuous mode of operation, applied for 180 sec per session for 12 sessions. Group B: Patients received Michigan splint of 2 mm thickness constructed on their upper teeth, the splint was 3D digitally printed. Electromyography was used to evaluate muscle activity, visual analogue scale was used to evaluate the pain intensity, ARCUS digma facebow was used to evaluate range of mandibular movements, and maximum mouth opening was taken using a millimeter ruler. They were measured before the beginning of the treatment, and at three and six month follow-up periods. Results: The results revealed that both low-level LASER therapy and Michigan splint reduce the myofascial pain, improved the range of the mandibular movements, and the muscles activity, but the effect of the low-level LASER therapy was more profound and sustainable. After 6 months from the beginning of the treatment, changes in masseter muscle activity (P= 0.001; effect size= 1.757), pain intensity (P= 0.003; effect size= 3), and range of mandibular movement (P= 0.001, effect size= 1.729) differed significantly between the two groups. Conclusions: Low-level LASER therapy had a better and more sustainable effect on reducing the pain intensity and improving the muscle activity as well as the mandibular movement when compared to Michigan splint (AU)

Objetivo: Este estudo teve como objetivo avaliar a eficácia e a durabilidade do uso da terapia LASER de baixa potência e da placa de Michigan CAD/CAM na melhora da amplitude dos movimentos mandibulares, atividade muscular e redução da dor. Material e Métodos: 56 pacientes do sexo feminino foram divididos aleatoriamente em dois grupos. Grupo A: os pacientes receberam aplicações de terapia LASER de baixa potência utilizando diodo semicondutor InGaAsp LASER tipo 940 nm em modo contínuo de operação, aplicado por 180 segundos por sessão durante 12 sessões. Grupo B: os pacientes receberam a placa de Michigan com uma espessura de 2 mm confeccionada sobre a arcada superior, a placa foi impressa digitalmente em 3D. A eletromiografia foi utilizada para avaliar a atividade muscular, a escala visual analógica foi utilizada para avaliar a intensidade da dor, o arco facial ARCUS digma foi utilizado para determinar a amplitude dos movimentos mandibulares e a abertura máxima da boca foi medida com uma régua milimétrica. Todas as medidas foram realizadas antes do início do tratamento e nos períodos de acompanhamento de três e seis meses. Resultados: Os resultados revelaram que tanto a terapia LASER de baixa potência como a placa de Michigan reduziram a dor miofascial, aumentaram a amplitude dos movimentos mandibulares e melhoraram a atividade muscular, mas o efeito da terapia LASER de baixa potência foi mais profundo e duradouro. Após 6 meses do início do tratamento, as alterações na atividade do músculo masseter (P= 0. 001; tamanho do efeito= 1,757), intensidade da dor (P= 0,003; tamanho do efeito= 3), e amplitude de movimento mandibular (P= 0,001, tamanho do efeito= 1,729) diferiram significativamente entre os dois grupos. Conclusão: A terapia com LASER de baixa potência teve um efeito melhor e mais duradouro na redução da intensidade da dor e na melhora da atividade muscular, bem como do movimento mandibular, quando comparada à placa de Michigan(AU)

Short term histopathological effects of GaAlAs laser on experimentally induced TMJ osteoarthritis in rabbits

Abstract The aim of this study was to evaluate the biostimulation (BS) effect of the gallium-aluminum-arsenide (GaAlAs) diode laser by histopathology with an experimental osteoarthritis (OA) model in the temporomandibular joints (TMJ) of rabbits, in the early period. GaAlAs diode laser is used for pain reduction in TMJ disorders. Twenty-four adult male New Zealand white rabbits were randomly divided into three equal groups: Control Group (CG), Study Group 1 (SG-1), and Study Group 2 (SG-2). Mono-iodoacetate (MIA) was administered to the right TMJs of all rabbits. The rabbits did not undergo any treatment for four weeks to allow the development of osteoarthritis. In SG-1, laser BS was applied to the rabbits at 940 nm, 5 W, and 15 J/cm2 in continuous wave mode at 48-hour intervals for 14 sessions; and in SG-2, laser BS was applied with the same parameters at 24-hour intervals for 28 sessions. Laser BS was not applied to the rabbits in CG. All rabbits were sacrificed simultaneously. The TMJ cartilage, osteochondral junction, chondrocyte appearance, and subchondral ossification were evaluated histopathologically. There was no statistically significant difference between the groups in terms of cartilage, osteochondral junction, chondrocyte appearance, and subchondral ossification values (p > 0.05). The laser BS protocol used in the study had no positive histopathological effects on TMJ OA in the early period.

The analgesic effect of photobiomodulation therapy (830 nm) on the masticatory muscles: a randomized, double-blind study

Abstract: This study assesses the efficacy of photobiomodulation therapy (830 nm) for myalgia treatment of masticatory muscles. Sixty patients with muscular myalgia were selected and randomly allocated into 2 groups (n=30): Group A comprised patients given a placebo (control), and Group B consisted of those undergoing photobiomodulation therapy (PBMT). PBMT and placebo were applied bilaterally to specific points on the masseter and temporal muscles. Referred pain elicited by palpation and maximum mouth opening were measured before (EV1) and after (EV2) the treatments. The data were analyzed using statistical tests, considering a significance level of 5%. No significant differences in range were observed for active or passive mouth opening (p ≥ 0.05). Comparing the final outcomes (EV1-EV2) of both treatments, statistical significance was verified for total pain in the right masseter muscle (p = 0.001) and total pain (p = 0.005). In EV2, significant differences in pain reported with palpation were found between Groups A and B for the following: left posterior temporal muscle (p = 0.025), left superior masseter muscle (p = 0.036), inferior masseter muscle (p = 0.021), total pain (left side) (p = 0.009), total masseter muscle (left side) (p = 0.014), total temporal (left side) (p = 0.024), and total pain (p = 0.035). We concluded that PBMT (830 nm) reduces pain in algic points, but does not influence the extent of mouth opening in patients with myalgia.

Effectiveness of Electrophysical Modalities in the Management of Temporomandibular Joint Disorders: A Review.

This review was conducted by three investigators to assess the scientific evidence and eff ectiveness of various electro physical modalities in the treatment of temporomandibular joint (TMJ) disorders. This review was conducted by three investigators. The databases of PubMed, Science direct, Cochrane clinical trials register (June 1994-Jan 2013) were electronically searched for the key terms TMJ disorders with low-level laser therapy (LLLT), iontophoresis, phonophoresis, therapeutic ultrasound, transcutaneous electric nerve stimulation, microcurrent electrical nerve stimulation. The retrieved titles were thoroughly evaluated, and full text was obtained. Based on the inclusion and exclusion criteria the selected studies were assessed for the quality evidence of the trails using the Grade Pro 3.6 version software and summary of finding table was generated. Of 1544 titles, 28 full text publications, which were eligible for this review were included, and 15 randomized placebo controlled trials that were fulfilling the set criteria. Out of 15 studies 10 are performed on LLLT, 2 on iontophoresis, 1 on pulsed radiofrequency energy, 1 on cathodal high voltage electric stimulation and 1 on laser acupuncture. LLLT is the extensively practiced electrophysical treatment modality with the moderate quality of evidence. Electrophysical modalities are helpful as adjuvant in the treatment of TMJ symptoms. However, there are no evidences to conclude that a single electrophysical modality is beneficial over the other in the temporomandibular disorders management.

Effect of low-level laser therapy on pain levels in patients with temporomandibular disorders: a systematic review

Temporomandibular disorders (TMD) are characterized by the presence of temporomandibular joint (TMJ) and/or masticatory muscle pain and dysfunction. Low-level laser is presented as an adjuvant therapeutic modality for the treatment of TMD, especially when the presence of inflammatory pain is suspected. Objective: To systematically review studies that investigated the effect of low level laser therapy (LLLT) on the pain levels in individuals with TMD. Material and Methods: The databases Scopus, embase, ebsco and PubMed were reviewed from January/2003 to October/2010 with the following keywords: laser therapy, low-level laser therapy, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome, temporomandibular joint, temporomandibular, facial pain and arthralgia, with the inclusion criteria for intervention studies in humans. exclusion criteria adopted were intervention studies in animals, studies that were not written in english, Spanish or Portuguese, theses, monographs, and abstracts presented in scientific events. Results: After a careful review, 14 studies fit the criteria for inclusion, of which, 12 used a placebo group. As for the protocol for laser application, the energy density used ranged from 0.9 to 105 J/cm², while the power density ranged from 9.8 to 500 mW. The number of sessions varied from 1 to 20 and the frequency of applications ranged from daily for 10 days to 1 time per week for 4 weeks. A reduction in pain levels was reported in 13 studies, with 9 of these occurring only in the experimental group, and 4 studies reporting pain relief for both the experimental group and for the placebo. Conclusion: Most papers showed that LLLT seemed to be effective in reducing pain from TMD. However, the heterogeneity of the standardization regarding the parameters of laser calls for caution in interpretation of these results. Thus, it is necessary to conduct further research in order to obtain a consensus regarding the best application protocol for pain relief in patients with TMD.

Prevalence of vertical condilar asymmetry of the temporomandibular joint in patients with signs and symptoms of temporomandibular disorders / Prevalencia de asimetría condilar vertical de la articulación temporomandibular en pacientes con signos y síntomas de trastornos temporomandibulares

Vertical condylar asymmetry (VCA) is considered a risk factor for the development of a temporomandibular disorder (TMD). VCA is determined by comparing the vertical condylar height between the left and right condyle. Several techniques have been developed to evaluate this asymmetry, and the most common among them are developed by Kjellberg et al. (1994) and Habets et al. (1988). The objective of this study was to evaluate the similarity of the Habets' and Kjellberg's methods with regard to these results and analyze the VCA results of the temporomandibular joint in patients with signs and symptoms of TMD. We analyzed 48 patients between 12 and 65 years of age. In each patient, the percentage of condylar symmetry according to the Kjellberg's and Habets' indexes was established and related to sex, age, and signs and symptoms of TMD at admission compared with patients who are symmetrical and asymmetrical. Finally, we compared the results of two indexes. According to Habets' index, 70.8 percent of patients were classified as asymmetric, compared with Kjellberg index where it was only 54.2 percent. No statistically significant difference was found between the severity of signs and symptoms of TMD and sex, age, Habets' index, and Kjellberg's index. We also found no statistically significant difference between patient age and Kjellberg index, but between age and Habets' index, younger patients were symmetrical. We conclude that it is conceivable that the presence of VCA is not a risk factor for TMD development.

La asimetría condilar vertical (ACV) es considerada un factor de riesgo para el desarrollo de un Trastorno Temporomandibular (TTM). ACV se determina al comparar la altura condilar vertical entre el cóndilo derecho e izquierdo. Se han desarrollado diversas técnicas para evaluar esta asimetría, las más conocidas son las desarrolladas por Kjellberg et al. (1994) y Habets et al. (1988). El Objetivo de éste estudio fue evaluar la similitud de la técnica de Habets con la técnica de Kjellberg en cuanto a los resultados y analizar éstos resultados de ACV de la articulación temporomandibular en pacientes con signos y síntomas de un trastorno temporomandibular. Se analizaron 48 pacientes entre 12 y 65 años. En cada paciente se estableció el porcentaje de simetría condilar según el índice de Kjellberg y el índice de Habets y se relacionó con las variables sexo, edad, y signos y síntomas de TTM al momento del ingreso con respecto a los pacientes simétricos y asimétricos. Por último se compararon los resultados de ambos índices. Según el índice de Habets el 70,8 por ciento de los pacientes fue clasificado como asimétrico, en comparación con kjellberg donde fue solo el 54,2 por ciento. No se encontró diferencia estadísticamente significativa entre la severidad de los signos y síntomas de un trastorno temporomandibular y las variables sexo, edad, índice de Habets e índice de Kjellberg. Tampoco se encontró diferencia estadísticamente significativa entre la edad de los pacientes y el índice de Kjellberg, pero si se encontró diferencia entre la edad y el índice de Habets donde los pacientes simétricos tenían menor edad. Se concluye que es posible pensar que la presencia de ACV no representa un factor de riesgo para el desarrollo de un TTM.

Eficácia da laserterapia nas disfunções têmporo-mandibulares: estudo controle / Lasertherapy efficacy in temporomandibular disorders: control study

Temporomandibular dysfunction is characterized by the presence of painful joint/muscular symptoms muscle in the face. The main justification for the use of lasers in laser therapy dysfunction is its analgesic effect, which was observed in most studies in the literature. AIM: We evaluated the effectiveness of laser therapy in the treatment of temporomandibular disorders. METHODS: 50 volunteers with temporomandibular disorders were divided into two groups (control and experimental) had amplitudes of movements of mouth opening, right and left laterality recorded before and after laser application. Was also recorded, the score the individual gave to pain by visual analog scale and, through physical examination, the pain points. We used the AsGaAl laser with a 40mW power, with 80J/cm² for 16 seconds at four selected points for just one session with reassessment after a week. Study design: Clinical. RESULTS: It was noted that laser therapy increased the mean amplitude of mandibular movements (p = 0.0317) and decreased significantly (43.6 percent) the pain intensity measured by the visual analog scale. CONCLUSIONS: The laser decreases the painful symptoms of the patient after application through its analgesic and/or a placebo effect.

A disfunção têmporo-mandibular é caracterizada pela presença de sintomatologia dolorosa articular/muscular na região da face. A principal justificativa do uso do laser da laserterapia na disfunção é seu efeito analgésico, fato observado na maioria dos estudos encontrados na literatura. OBJETIVO: Foi avaliar a eficácia da laserterapia no tratamento das disfunções têmporo-mandibulares. MATERIAL E MÉTODO: 50 voluntários com disfunção têmporo-mandibular foram divididos em dois grupos (controle e experimental) tiveram as amplitudes dos movimentos de abertura bucal, lateralidade direita e esquerda registrados, antes e após aplicação do laser. Foi registrada, também, a nota de dor do indivíduo através da escala analógica visual de dor e, através do exame físico, os pontos álgicos. Utilizou-se o laser de AsGaAl com potência de 40mW, com 80J/cm², por 16 segundos, em quatro pontos selecionados por apenas uma sessão com reavaliação após uma semana. Desenho Científico Utilizado: Clínico. RESULTADOS: Notou-se que a laserterapia promoveu aumento da média de amplitude dos movimentos mandibulares (p=0,0317) e houve redução significativa (43,6 por cento) da intensidade de dor dos pacientes medida através da escala analógica visual de dor...

Measurements of jaw movements and TMJ pain intensity in patients treated with GaAlAs laser

The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) on the improvement of the mandibular movements and painful symptoms in individuals with temporomandibular disorders (TMD). Forty patients were randomly divided into two groups (n=20): Group 1 received the effective dose (GaAlAs laser ? 830 nm, 40 mW, 5J/cm2) and Group 2 received the placebo application (0 J/cm2), in continuous mode on the affected condyle lateral pole: superior, anterior, posterior, and posterior-inferior, twice a week during 4 weeks. Four evaluations were performed: E1 (before laser application), E2 (right after the last application), E3 (one week after the last application) and E4 (30 days after the last application). The Kruskal-Wallis test showed significant more improvements (p<0.01) in painful symptoms in the treated group than in the placebo group. A significant improvement in the range of mandibular movements was observed when the results were compared between the groups at E4. Laser application can be a supportive therapy in the treatment of TMD, since it resulted in the immediate decrease of painful symptoms and increased range of mandibular movements in the treated group. The same results were not observed in the placebo group.

O objetivo deste estudo foi avaliar a eficácia da terapia com laser de baixa intensidade na melhora dos movimentos mandibulares e dos sintomas dolorosos em pacientes com disfunção temporomandibular (DTM). Quarenta pacientes foram aleatoriamente divididos em dois grupos (n=20): Grupo 1 recebeu a dose efetiva (laser de AsGaAl 830 nm, 40 mW, 5 J/cm2) e Grupo 2 recebeu a aplicação placebo (0 J/cm2), no modo contínuo no pólo lateral do côndilo afetado: superior, anterior, e posterior-posterior e inferior, 2 vezes por semana, por 2 meses. Quatro avaliações foram feitas: A1 (antes da aplicação), A2 (imediatamente após a última aplicação), A3 (uma semana após a última aplicação) e A4 (um mes após a última aplicação). O teste estatístico de Kruskal-Wallis mostrou melhoras significativas (p<0,01) nos sintomas dolorosos no grupo 1, diferentemente do grupo 2. Uma melhora significativa na extensão dos movimentos mandibulares foi observada quando os resultados foram comparados entre os dois grupos na A4. A aplicação do laser é uma terapia de suporte no tratamento da DTM, uma vez que resultou em imediata redução dos sintomas dolorosos e aumento na extensão dos movimentos mandibulares no grupo experimental. Os mesmos resultados não foram observados no grupo placebo.

Laserterapia de baixa intensidade no tratamento de desordens temporomandibulares / Low level lasertherapy in treatment of temporomandibular disorders

As disfunções temporomandibulares (DTMs) compreendem alterações músculo-esqueléticas causadas por diversos fatores relacionados a aspectos físicos, psicológicos e sociais. Dentre os tratamentos existentes, o uso do laser de baixa intensidade tem sido promissor, proporcionando alívio imediato dos sintomas e possibilitando que o paciente retome suas atividades em um menor período de tempo. Neste contexto, em função de seus efeitos terapêuticos, a laserterapia tem se tornado uma modalidade bastante discutida. Portanto, a revisão literária deste estudo tem como objetivo apresentar o laser de baixa intensidade como uma alternativa física para o tratamento das DTMs, e também estimular a continuidade de pesquisas com esta terapia, para que a mesma possa ser bem empregada com resultados satisfatórios.

Temporomandibular disorders (TMDs) are musculoskeletal alterations caused by different factors related to physical, psychological and social aspects. Among the many methods of treatment, the use of Low Level Laser Therapy (LILT) is a very promising one, allowing an immediate pain relief, so that the patient can be able to return faster to a social contact. In this context, because of it’s therapeutic effects, the lasertherapy is becoming a widely dicussed way of treatment. The purpose of this literature review is to indicate the LILT as an important tool to treat temporomandibular disorders and also to stimulate other studies with this therapy, so that it can be properly used and achieve satisfactory results. At the end of this study, was suggested a protocol for those pacients that had been suffering of TMDs and who are seeking less aggressive a treatment that can allow an improvement of quality of life.

Avaliação eletromiográfica de pacientes com DTM após a laserterapia / The electromyography evaluation in Temporomandibular joint disease patients after laser therapy

Este estudo avaliou a eficiência imediata da laserterapia de baixa potência em 13 pacientes portadores de dor e disfunção da articulação temporomandibular. Foram realizados exames clínicos para definir o lado de maior sintomatologia dolorosa e comprometimento da disfunção temporomandibular que foi tratado com aplicação do laser de diodo (Al-Ga-As), de comprimento de onda de 790 nm (infravermelho), irradiado em quatro pontos na disfunção da articulação temporomandibular com 1,5 J/cm²; um ponto na região do ouvido externo, com 2,5 J/cm²; em três pontos no músculo masseter, com 3 J/cm²; e três pontos no músculo temporal, com 3 J/cm². Os pacientes foram submetidos a uma avaliação subjetiva de dor. Os músculos masséter e temporal, de ambos os lados, foram avaliados eletromiográficamente antes da laserterapia, imediatamente a aplicação do laser, cinco minutos e vinte minutos após. Foram observadas reduções das atividades eletromiográficas medidas para todos os tempos, em ambos os músculos masseter e temporal, após a aplicação do laser. Conclusão: A laserterapia promoveu o relaxamento imediato dos músculos masseteres e temporais avaliados e conseqüente alívio na sintomatologia dolorosa.