J CranioMand Func 11 (2019), No. 1 6. Mar. 2019
J CranioMand Func 11 (2019), No. 1 (06.03.2019)
Digital Offprint Page 17-29, Language: German/English
Physiotherapy home exercises and occlusal splint therapy for myofascial TMD pain
A comparative clinical pilot study
Rauer, Ann-Kristin / Giannakopoulos, Nikolaos-Nikitas / Hellmann, Daniel / Hugger, Sybille / Schmitter, Marc / Schindler, Hans-Jürgen / Hugger, Alfons
The objective of this randomized clinical trial (RCT) was to compare conventional occlusal splint therapy with the RehaBite (Dentrade International, Cologne, Germany) device-supported sensorimotor training program of physiotherapy home exercises for the treatment of temporomandibular joint (TMJ) pain and tempormandibular disorders (TMD). A total of 45 women (aged 18 to 45 years) with acute or acute-persistent Graded Chronic Pain Scale (GCPS) grade I or II myofascial TMD pain were included in the study. Twenty-three subjects received RehaBite therapy and the other 22 received occlusal splint therapy. Masticatory muscle activity at a submaximal clenching force of 100 Newtons (N) and at maximum voluntary clenching (MVC) in the intercuspal position (ICP) was measured by force-controlled electromyography (EMG) before the start of a 3-month treatment period (T0) and repeated after 2 weeks (T1), 6 weeks (T2), and 3 months (T3) of treatment. In addition to jaw opening measurements and muscle palpation, patient-reported data on the following variables were collected on each sampling date: characteristic pain intensity (CPI) as measured on the GCPS form, pain location, ease of handling, and therapeutic efficacy.
Significant pain reduction was observed in both groups, but the degree of reduction was significantly larger in the RehaBite group. Likewise, jaw opening increased in both groups but to a greater degree in the RehaBite group. Conversely, the occlusal splint group performed better in the ease of handling and therapeutic efficacy assessments by the patients (subjective measures). A statistically significant difference between normalized EMG activity during submaximal clenching (100 N) from T0 to T3 was only observed in the RehaBite group. Analysis of the change in normalized EMG activity during MVC in the ICP from T0 to T3 showed a significant increase in activity in both the masseter and anterior temporal muscles in the RehaBite group, but only in the masseter muscles in the occlusal splint group.
Since the therapeutic effects of the two methods are comparable, the home exercise program can be recommended as an alternative or supplement to occlusal splint therapy for the treatment of myofascial TMD.
Keywords: Elektromyographie, Funktionstherapie, Craniomandibuläre Dysfunktion, RehaBite, Okklusionsschiene, Physiotherapeutische Heimübungen