Efficacy Of Different Types Of Physiotherapy Approaches In Temporomandibular Disorders

NCT04294602 | Completed

• 1 other identifier: BitlisErenU1
• Study Type: interventional
• Target: 59
• Locations: 1 country
• Sites: 1

Brief Summary

The aim of this study is to investigate the efficacy of different types of physiotherapy approaches in cases with cervical myofascial painful TMD.

Conditions

Temporomandibular Disorder

Keywords

Temporomandibular disorders; Exercise; Low-level laser therapy

Outcome Measures

Primary Outcomes (6)

• Pressure Pain Threshold Assessment

  Pressure Pain Threshold (PPT) of an individual's mastication and cervical muscle was measured with an algometer (JTECH Medical Industries, CommanderTMAlgometer), and the applied pressure was increased to 1 cm2/ kg per second. PPT measurements were repeated three times and the average was used for analysis in every participant.

  Change from baseline pressure pain threshold score in neck and mastication muscles at week 4.

• Pain Severity Assessment

  To evaluate the general pain severity of the patients, the Visual Analog Scale (VAS), which is the Visual Pain Scale of Turkish, was used. Patients were asked to mark their general pain separately on a 10 cm scale. According to this, "0" indicates that there is no pain, and "10" indicates the most severe pain. The distance between the marked point and the beginning of the line was recorded in centimeters

  Change from baseline TMJ pain and intensity of head pain, TMJ noise and jaw locking score at week 4.

• Jaw Movements Assessment

  Maximum mouth opening (MMO) and lateral deviation were measured with a caliper.

  Change from baseline MMO and lateral deviation score at week 4.

• Neck Movements Assessment

  Cervical rotations and the craniovertebral angle between C7 and tragus were measured by a goniometer.

  Change from baseline cervical rotations and craniovertebral angle score at week 4.

• Temporomandibular Disorder Severity

  The TMD severity in participation is defined by the Craniomandibular Index (CMI) which was developed to provide a standardized measure to the severity of problems in mandibular movement, muscle, and joint tenderness and TMJ noise for use in epidemiological and clinical outcome studies. The instrument was designed to have clearly defined objective criteria, simple clinical methods, and ease in scoring; it is divided into the Palpation Index (PI) and the Dysfunction Index (DI). The means of the subscales were averaged to produce a CMI score ranging from 0 (best) to 1 (worst)

  Change from baseline temporomandibular disorder severity score at week 4

• Quality of Life Assesment

  Short Form-36 questionnaire contains the physical and mental component, which is evaluated, is close to 100, indicating an increase in health-related quality of life. The means SF-36 score ranging from 0 (worst) to 100 (best).

  Change from baseline quality of life score at week 4

Secondary Outcomes (2)

• Neck Disability Assesment

  Change from baseline neck disability score at week 4.

• Psychological Status Assesment

  Change from baseline psychological status score at week 4.

Study Arms (3)

Exercise Program

EXPERIMENTAL

This group received therapeutic exercises and patient education. For patients to encounter fewer problems and to reduce their problems, some recommendations were made that should be taken into consideration in daily life. These suggestions were given in writing. The exercise program included muscle stretching, massage of painful muscles, guided opening and closing movements, gentle isometric tension exercises against resistance, correction of body posture and relaxation techniques. All exercises were done in 6 repetitions a set, 3 sets a day, 3 days a week, treatment program lasted 4 weeks.

Other: Exercise; Other: Patient Education

Low Level Laser Therapy Program

EXPERIMENTAL

This group received LLLT, therapeutic exercises and patient education in the therapy programs. LLLT (max output power: 1200mW, wavelength: 808 nm, dosage: 10j/ cm2 Electronica Pagani Laser Tower Light, Italy) 2.5-4j/TrP dosage was applied to MTrP or sensitive points. The application was applied to MTrP or sensitive points in the mastication and cervical muscles.LLLT program was done in 3 days a week, the treatment program lasted 4 weeks.

Other: Exercise; Other: Low Level Laser Therapy; Other: Patient Education

Manual Pressure Release Program

EXPERIMENTAL

ThisThis group received manual pressure release (MPR), therapeutic exercises and patient education in the therapy programs. MPR technique is a noninvasive method based on pressure on the trigger point in accordance with the patient's tolerance and technique applies supine position relax as much as possible, MTrPs in the mastication and neck muscle. Applied pressure gradually with finger over the MTrPs until the subject reported a 'moderate but easily tolerable' pain value of 7 out of 10. When the pain value decreased to at least 3 or 4 therapist increased pressure again until discomfort and/or pain appeared again. This process was repeated until there was no MTrP tension/tenderness or 60 s had elapsed. MPR program was done in 3 days a week, the treatment program lasted 4 weeks.

Other: Exercise; Other: Manuel Pressure Release; Other: Patient Education

Interventions

Exercise OTHER

Exercise therapy intended in reducing muscle spasm, improving coordination of the mastication muscles and alter the jaw closure pattern.

Exercise Program; Low Level Laser Therapy Program; Manual Pressure Release Program

Low Level Laser Therapy OTHER

LLLT (max output power: 1200mW, wavelength: 808 nm, dosage: 10j/ cm2 Electronica Pagani Laser Tower Light, Italy) 2.5-4j/TrP dosage was applied to MTrP or sensitive points.

Low Level Laser Therapy Program

Manuel Pressure Release OTHER

MPR technique is a noninvasive method based on pressure on the trigger point in accordance with the patient's tolerance and technique applies supine position relax as much as possible, manuel pressure applied trigger point in neck and mactication muscles

Manual Pressure Release Program

Patient Education OTHER

Some suggestions were made to TMD people who should pay attention to in daily life. These suggestions were given in writing.

Exercise Program; Low Level Laser Therapy Program; Manual Pressure Release Program

Eligibility Criteria

• Age: 18 Years - 30 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Cases who have 3 or more symptoms related to TMJ problems
• cases who have trigger points in cervical and masticatory muscles
• cases who TMD detected by the dentist,
• being between the ages of 18-30,
• volunteer to participate in the study

You may not qualify if:

• Patients with a positive history of trauma in the face and neck area and neurological disorders
• patients undergoing TMJ or cervical region surgery in the last 3 months,
• patients who used dental orthotics within 1 month,
• patients who have TMJ instability,
• patients who have cervical and upper thoracic region,
• patients who have active infection and chronic pain, such as trigeminal neuralgia

Sponsors & Collaborators

• Bitlis Eren University: lead
• Marmara University: collaborator

Study Sites (1)

Marmara University

Istanbul, Maltepe, 34000, Turkey (Türkiye)

Location

MeSH Terms

Conditions

Temporomandibular Joint Disorders; Motor Activity

Interventions

Exercise; Low-Level Light Therapy; Patient Education as Topic

Condition Hierarchy (Ancestors)

Craniomandibular Disorders; Mandibular Diseases; Jaw Diseases; Musculoskeletal Diseases; Joint Diseases; Muscular Diseases; Stomatognathic Diseases; Behavior

Intervention Hierarchy (Ancestors)

Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena; Laser Therapy; Therapeutics; Phototherapy; Health Education; Preventive Health Services; Health Services; Health Care Facilities Workforce and Services

Study Officials

• Abdurrahman TANHAN, MSc

  Bitlis Eren University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: research assistant

Model Details: Randomized Controlled Study

Study Record Dates

• First Submitted: February 29, 2020
• First Posted: March 4, 2020
• Study Start: May 15, 2017
• Primary Completion: March 13, 2018
• Study Completion: May 10, 2018
• Last Updated: March 4, 2020

Record last verified: 2020-03

Locations

TU (1)