Efficiency of Neuromuscular Bite vs Physiotherapy in TMD Patients

NCT ID: NCT02946645

Last Updated: 2021-04-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

63 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-10-31

Study Completion Date

2020-12-31

Brief Summary

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Temporomandibular joint dysfunction (TMD) therapy remains an open challenge for modern dentistry. Usually physiotherapy is considered a reliable approach to treatment of TMD patients. Moreover, neuromuscular bites (orthotic) are able to reduce signs and symptoms of TMD. To our knowledge, no specific trials have been designed for the evaluation of the efficiency of physiotherapy vs neuromuscular bites in TMD patients.

The aim of this trial is to evaluate the efficiency in term of cranial muscles electromyography (sEMG), mandibular kinetic (KNG) and subjective pain scores, of orthotic vs manual physiotherapy therapy compared to placebo.

Detailed Description

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Conditions

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TMD

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Testing Bite device "A"
Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Caregivers Investigators Outcome Assessors

Study Groups

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Manual Physiotherapy

TMD patients will treat with orofacial physiotherapy by one expert operator according to literature

Group Type ACTIVE_COMPARATOR

Mandibular Physiotherapy

Intervention Type PROCEDURE

Mandibular Stabilisation Exercises

1. Place knuckle of index finger between top and bottom teeth.
2. Remove it, keeping the teeth separated one-knuckle apart.
3. Apply gentle pressure to the to the jaw using your index finger/thumb as demonstrated in the pictures above.

Neuromuscular Bite

TMD patients will receive an intraoral neuromuscular bite according to literature

Group Type ACTIVE_COMPARATOR

Neuromuscular Bite (orthotic/sub-lingual)

Intervention Type DEVICE

Bite is a device which simulates a set of properly positioned teeth

Placebo

TMD placebo group.

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type OTHER

No interventions.

Interventions

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Neuromuscular Bite (orthotic/sub-lingual)

Bite is a device which simulates a set of properly positioned teeth

Intervention Type DEVICE

Mandibular Physiotherapy

Mandibular Stabilisation Exercises

1. Place knuckle of index finger between top and bottom teeth.
2. Remove it, keeping the teeth separated one-knuckle apart.
3. Apply gentle pressure to the to the jaw using your index finger/thumb as demonstrated in the pictures above.

Intervention Type PROCEDURE

Placebo

No interventions.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* myogenous TMD;
* pain duration longer than 3 months;
* presence of complete permanent dentition, with the possible exception of the third molars;
* normal occlusion.

Exclusion Criteria

Patients were excluded from the study if they met one or more of the following criteria:

* presence of systemic or metabolic diseases;
* eye diseases or visual defects;
* history of local or general trauma;
* neurological or psychiatric disorders;
* muscular diseases;
* cervical pain;
* bruxism, as diagnosed by the presence of parafunctional facets and/or anamnesis of parafunctional tooth clenching and/or grinding;
* pregnancy;
* assumed use of anti-inflammatory, analgesic, anti-depressant, opioid, or myorelaxant - - drugs;
* smoking;
* fixed or removable prostheses;
* fixed restorations that affected the occlusal surfaces;
* and either previous or concurrent orthodontic or orthognathic treatment. For comparison with previous literature, the diagnosis of myofascial-type TMD was provided after clinical examination by a trained clinician according to group 1a and 1b of the Research Diagnostic Criteria for TMD (RDC/TMD), in a blinded manner
Minimum Eligible Age

25 Years

Maximum Eligible Age

45 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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University of L'Aquila

OTHER

Sponsor Role lead

Responsible Party

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Davide Pietropaoli

PI

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Dental Clinic, University of L'Aquila, St. Salvatore Hospital,

L’Aquila, , Italy

Site Status

Countries

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Italy

References

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de Toledo EG Jr, Silva DP, de Toledo JA, Salgado IO. The interrelationship between dentistry and physiotherapy in the treatment of temporomandibular disorders. J Contemp Dent Pract. 2012 Sep 1;13(5):579-83.

Reference Type BACKGROUND
PMID: 23250156 (View on PubMed)

List T, Axelsson S. Management of TMD: evidence from systematic reviews and meta-analyses. J Oral Rehabil. 2010 May;37(6):430-51. doi: 10.1111/j.1365-2842.2010.02089.x. Epub 2010 Apr 20.

Reference Type BACKGROUND
PMID: 20438615 (View on PubMed)

Molin C. From bite to mind: TMD--a personal and literature review. Int J Prosthodont. 1999 May-Jun;12(3):279-88.

Reference Type BACKGROUND
PMID: 10635197 (View on PubMed)

Michelotti A, de Wijer A, Steenks M, Farella M. Home-exercise regimes for the management of non-specific temporomandibular disorders. J Oral Rehabil. 2005 Nov;32(11):779-85. doi: 10.1111/j.1365-2842.2005.01513.x.

Reference Type BACKGROUND
PMID: 16202040 (View on PubMed)

Capellini VK, de Souza GS, de Faria CR. Massage therapy in the management of myogenic TMD: a pilot study. J Appl Oral Sci. 2006 Jan;14(1):21-6. doi: 10.1590/s1678-77572006000100005.

Reference Type BACKGROUND
PMID: 19089025 (View on PubMed)

Ash MM Jr, Ramfjord SP. Reflections on the Michigan splint and other intraocclusal devices. J Mich Dent Assoc. 1998 Oct;80(8):32-5, 41-6.

Reference Type BACKGROUND
PMID: 9863432 (View on PubMed)

Yamashita A, Kondo Y, Yamashita J. Thirty-year follow-up of a TMD case treated based on the neuromuscular concept. Cranio. 2014 Jul;32(3):224-34. doi: 10.1179/0886963413Z.00000000020. Epub 2014 Jan 24.

Reference Type BACKGROUND
PMID: 25000166 (View on PubMed)

Di Fabio RP. Physical therapy for patients with TMD: a descriptive study of treatment, disability, and health status. J Orofac Pain. 1998 Spring;12(2):124-35.

Reference Type BACKGROUND
PMID: 9656890 (View on PubMed)

Starnes LO. A bite orthotic for the resting period between two phases of treatment. J Clin Orthod. 2002 Feb;36(2):92-4. No abstract available.

Reference Type BACKGROUND
PMID: 11902010 (View on PubMed)

Heit T. Neuromuscular orthotics in the treatment of craniomandibular dysfunction and the effects on patients with multiple sclerosis: a pilot study. Cranio. 2011 Jan;29(1):57-70. doi: 10.1179/crn.2011.009.

Reference Type BACKGROUND
PMID: 21370770 (View on PubMed)

Cooper BC, Kleinberg I. Establishment of a temporomandibular physiological state with neuromuscular orthosis treatment affects reduction of TMD symptoms in 313 patients. Cranio. 2008 Apr;26(2):104-17. doi: 10.1179/crn.2008.015.

Reference Type BACKGROUND
PMID: 18468270 (View on PubMed)

Pietropaoli D, Cooper BC, Ortu E, Monaco A; I.A.P.N.O.R.. A Device Improves Signs and Symptoms of TMD. Pain Res Manag. 2019 May 6;2019:5646143. doi: 10.1155/2019/5646143. eCollection 2019.

Reference Type RESULT
PMID: 31198477 (View on PubMed)

Other Identifiers

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16137/24.05.2016

Identifier Type: -

Identifier Source: org_study_id

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