Efficacy of mandibular manipulation technique for temporomandibular disorders patients with mouth opening limitation: a randomized controlled trial for comparison with improved multimodal therapy
Open accessAbstract
PURPOSE: Manual therapy has been used for the treatment of patients with temporomandibular disorders (TMD) with mouth-opening limitations. However, the curative effect of manipulation differs among researchers, and its necessity remains controversial. The purpose of this study was to confirm the efficacy of manipulation using a randomized controlled trial (RCT). METHODS: A total of 61 TMD patients who had mouth-opening limitation (upper and lower middle incisor distance ≤35mm) were selected. They were divided into two treatment groups: conventional treatment (n=30) and conventional treatment plus manipulation (n=31). The conventional treatment included two types of self-exercise: cognitive behavioral therapy for bruxism and education. Mouth-opening limitation, orofacial pain, and temporomandibular joint (TMJ) sounds were recorded from baseline to 18 weeks after baseline. These parameters were statistically compared between the two treatment groups by using analysis of variance (ANOVA) and Scheffe's test to assess mouth opening distance and pain; TMJ sounds were compared using Mann-Whitney U test. RESULTS: No statistical difference was observed between the two treatment groups except for mouth-opening limitation after treatment at the first visit. Subgroup analyses, stratified according to the pathological type of TMD, indicated a similar trend. CONCLUSIONS: The efficacy of manipulation seems to be limited, in contrast to our expectations, and improved execution of therapeutic exercises has a similar effect to that of manipulation during long-term observation. The advantage of manipulation was observed only during the first treatment session. The RCT was registered in the University Hospital Medical Information Network in Japan (UMIN-CTR: 000010437).
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Chiropractic interventions and dental practice-based treatments, including those by dentists and dental nurses, also showed positive effects.
“Chiropractic interventions [29,34] and dental practice-based treatments, including those by dentists [36] and dental nurses [34], also showed positive effects.”
From Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials (2026) · cites this paper as [36]
The Methods (section 2.3) say that nine dentists were the study practitioners and that a dentist performed the jaw manipulation—not dental nurses or chiropractors. The Results (section 3) report an initial improvement in mouth opening, but no significant between-group difference over 10 weeks. Thus the paper does not support the intervention-provider claims for which citation [34] is used. (LLM, conf=0.84)
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Experimental — accuracy not yet measuredMedical doctors and oral health professionals achieved positive outcomes using HVLA, myofascial release, and intraoral manipulation techniques.
“Medical doctors and oral health professionals achieved positive outcomes using HVLA, myofascial release, and intraoral manipulation techniques [21,34,36].”
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Cites
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Randomized Controlled Trial on Physical Therapy for TMJ Closed Lock
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Chiaramonte, R., Ferrillo, M., de Sire, A., & Vecchio, M. (2026) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2026.2629282
“Studies highlighted the involvement of departments of dental, prosthetic, stomatology sciences [24,30,36] and oral and maxillofacial surgery [33,38].”
Influential
- Authors
- Nagata, K., Hori, S., Mizuhashi, R., Yokoe, T., Atsumi, Y., Nagai, W., & Goto, M.
- Affiliations
- Nippon Dental University (JP)
- Corresponding author
- Nagata, Kazuhiro
- Venue
- Journal of Prosthodontic Research
- Publisher
- Japan Prosthodontic Society
- Published
- 2019-04
- Volume
- 63
- Issue
- 2
- Pages
- 202-209
- ISSN
- 1883-1958 (ISSN-L)
- OpenAlex
- W2905144590
- Cited by
- 61
- References
- 2
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 13 · 2023: 11 · 2022: 8 · 2021: 5 · 2020: 5 · 2019: 1
- FWCI
- 4.45
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Prosthodontic Research (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Myofascial pain diagnosis and treatment
- Keywords
- temporomandibular disorders, limited mouth opening, manual therapy, multimodal therapy, orofacial pain, temporomandibular joint sounds, exercise therapy
- MeSH terms
- Adult, Aged, Bruxism, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Mouth, Temporomandibular Joint Disorders, Exercise, Cognitive Behavioral Therapy, Range of Motion, Articular, Treatment Outcome, Musculoskeletal Manipulations, Young Adult
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