Efficacy of manual therapy by different healthcare professionals on pain and function in temporomandibular disorders: a systematic review of randomized controlled trials

May combine two claims.

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.”

• cites [29] DeVocht JW, Goertz CM, Hondras MA, et al. A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder. J Am Dent Assoc. 2013; 144(10): 1154– 1163. doi: 10.14219/jada.archive.2013.0034 PMC4103021 24080932 sourcePartly supported

  The Results (Study outcomes; page not provided) report improvement in all groups, including the chiropractic intervention group. The Methods (Self-care; page not provided) describe care provided by a dentist or dental care coordinator, but the paper does not identify dental nurses or report a positive effect specifically attributable to nurse-delivered treatment. Thus, it supports the chiropractic portion of citation [34], not the dental-nurse portion. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [34] Kalamir A, Bonello R, Graham P, et al. Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial. J Manipulative Physiol Ther. 2012; 35: 26– 37. doi: 10.1016/j.jmpt.2011.09.004 22079052 sourceNot checked — no full text of the source
• cites [36] Nagata K, Hori S, Mizuhashi R, et al. Efficacy of mandibular manipulation technique for temporomandibular disorders patients with mouth opening limitation: a randomized controlled trial for comparison with improved multimodal therapy. J Prosthodont Res. 2019; 63: 202– 209. doi: 10.1016/j.jpor.2018.11.010 30563758 sourceDisputed

  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)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The systematic review was conducted in accordance with the PRISMA statement and structured using the PICOS guidelines.

“This systematic review was conducted in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-analyses (PRISMA) statement [19], and structured using the Population, Intervention, Comparison, Outcome, Study design (PICOS) guidelines [20].”

• cites [19] Shamseer L, Moher D, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015; 2(350): 7647. 25555855 sourcePartly supported

  The Discussion checklist and the eligibility-criteria explanation recommend structuring review questions around PICO elements and specifying study design. But this paper explains PRISMA-P for systematic review protocols, not the PRISMA statement for reporting a completed review, and it cannot establish that the citing authors followed either guideline. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [20] Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. Br Med J. 2011; 343: 889– 893. PMC3196245 22008217 sourceCould not verify

  Citation [20] is attached to the claim that the review was structured using PICOS guidelines. The passages from the paper’s Discussion and Additional information sections describe a tool for assessing risk of bias in randomised trials; a search of our copy found no passage addressing PICOS guidelines or whether the citing review used them. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Manual therapy may be administered by different professionals, including physiotherapists, osteopaths, chiropractors, dental specialists and medical doctors.

“Manual therapy may be administered by different professionals, including physiotherapists, osteopaths, chiropractors, dental specialists and medical doctors from various specializations [14].”

• cites [14] Degenhardt B, van Dun PLS, Jacobson E, et al. Profession-based manual therapy nomenclature: exploring history, limitations, and opportunities. J Man Manip Ther. 2024; 32: 96– 110. doi: 10.1080/10669817.2023.2288495 PMC10795627 38104312 sourcePartly supported

  The Results’ scope-of-practice table identifies physiotherapists, chiropractors and osteopathic practitioners as manual-therapy providers, and describes osteopathic physicians as licensed to practise medicine and use osteopathic manipulative medicine. It does not identify dental specialists or medical doctors from other specializations as providers. The available passages have section labels but no page numbers. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Treatment targets differed, with some studies focusing solely on masticatory muscles while others included cervical or upper-cervical spine structures.

“Treatment targets also differed, with some studies focusing solely on masticatory muscles [24,28] while others including cervical or upper-cervical spine structures [21].”

• cites [24] Cuccia AM, Caradonna C, Annunziata V, et al. Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2010; 14: 179– 184. doi: 10.1016/j.jbmt.2009.08.002 20226365 sourceNot checked — no full text of the source
• cites [28] Capellini VK, de Souza GS, de Faria CR. Massage therapy in the management of myogenic TMD: a pilot study. J Appl Oral Sci. 2006; 14: 21– 26. doi: 10.1590/s1678-77572006000100005 PMC4327166 19089025 sourceSupported
• cites [21] Corum M, Basoglu C, Topaloglu M, et al. Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders. Manuelle Medizin. 2018; 56: 230– 238. doi: 10.1007/s00337-018-0406-5 sourceSupported

Classified as probably not a substantial claim.

The INfORM/IADR recommends conservative, reversible approaches aimed at pain reduction and functional improvement.

“the International Network for Orofacial Pain and Related Disorders Methodology group of the International Association for Dental, Oral and Craniofacial Research (INfORM/IADR) recommends conservative, reversible approaches aimed at pain reduction and functional improvement [11].”

• cites [11] Manfredini D, Häggman-Henrikson B, Al Jaghsi A, et al. Temporomandibular disorders: inform/IADR key points for good clinical practice based on standard of care. Cranio. 2025; 43: 1– 5. doi: 10.1080/08869634.2024.2405298 39360749 sourceSupported

Classified as probably not a substantial claim.

The overall quality of evidence was graded using the GRADE approach, considering study limitations, inconsistency, indirectness, imprecision and publication bias.

“The overall quality of evidence was graded using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach, considering study limitations, inconsistency, indirectness, imprecision and publication bias [40–44].”

• cites [40] Guyatt G, Oxman AD, Akl EA, et al. Grade guidelines: 1. Introduction-grade evidence profiles and summary of findings tables. J Clin Epidemiol. 2011; 64: 383– 394. doi: 10.1016/j.jclinepi.2010.04.026 21195583 sourceNot checked — no full text of the source
• cites [41] Guyatt GH, Oxman AD, Kunz R, et al. Grade guidelines 6. Rating the quality of evidence-imprecision. J Clin Epidemiol. 2011; 64: 1283– 1293. doi: 10.1016/j.jclinepi.2011.01.012 21839614 sourceNot checked — no full text of the source
• cites [42] Guyatt GH, Oxman AD, Vist G, et al. Grade guidelines: 4. Rating the quality of evidence–study limitations (risk of bias). J Clin Epidemiol. 2011; 64: 407– 415. doi: 10.1016/j.jclinepi.2010.07.017 21247734 sourceNot checked — no full text of the source
• cites [43] Guyatt GH, Oxman AD, Montori V, et al. Grade guidelines: 5. Rating the quality of evidence–publication bias. J Clin Epidemiol. 2011; 64: 1277– 1282. doi: 10.1016/j.jclinepi.2011.01.011 21802904 sourceNot checked — no full text of the source
• cites [44] Guyatt GH, Oxman AD, Kunz R, et al. Grade guidelines: 8. Rating the quality of evidence-indirectness. J Clin Epidemiol. 2011; 64: 1303– 1310. doi: 10.1016/j.jclinepi.2011.04.014 21802903 sourcePartly supported

  The Introduction describes GRADE rating down evidence for bias, imprecision, inconsistency, and indirectness. The paper also discusses risk of bias from study limitations, but the passages found do not identify publication bias as a consideration; the Introduction’s general reference to “bias” does not establish that specific item. No page numbers are available in our copy. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Dunning et al. and Kalamir et al. observed improvements within six weeks, confirming the short-term efficacy of manual therapy.

“Similarly, Dunning et al. [25] and Kalamir et al. [35] observed improvements within six weeks, confirming the short-term efficacy of manual therapy.”

• cites [25] Dunning J, Butts R, Bliton P, et al. Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: a multi-center randomized clinical trial. Cranio. 2022; 12: 1– 14. doi: 10.1080/08869634.2022.2062137 35412448 sourceNot checked — no full text of the source
• cites [35] Kalamir A, Graham PL, Vitiello AL, et al. Intra-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomised, clinical trial. Chiropr Man Therap. 2013; 5(21): 17. doi: 10.1186/2045-709X-21-17 PMC3706243 23738586 sourcePartly supported

  The Results (Secondary outcome; page not provided) report significant pain reductions at six weeks, with clinically significant reductions in the intra-oral myofascial therapy group. But the Discussion says the difference from education and self-care was not clinically significant and that other factors might explain the added improvement. Thus the six-week improvement is supported, while “confirming” the short-term efficacy of manual therapy overstates this trial’s finding. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

In this systematic review, most studies applied Axis I criteria, while a subset incorporated both Axis I and II.

“In this systematic review, most studies applied Axis I criteria [22,25,27,30,35], while a subset incorporated both Axis I and II [21,33] to identify TMD subtypes most responsive to manual therapy.”

• cites [22] Tuncer AB, Ergun N, Tuncer AH, et al. Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2013; 17: 302– 308. doi: 10.1016/j.jbmt.2012.10.006 23768273 sourceNot checked — no full text of the source
• cites [25] Dunning J, Butts R, Bliton P, et al. Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: a multi-center randomized clinical trial. Cranio. 2022; 12: 1– 14. doi: 10.1080/08869634.2022.2062137 35412448 sourceNot checked — no full text of the source
• cites [27] Bortolazzo GL, Pires PF, Dibai-Filho AV, et al. Effects of upper cervical manipulation on the electromyographic activity of the masticatory muscles and the opening range of motion of the mouth in women with temporomandibular disorder: randomized and blind clinical trial. Fisioter Pesq. 2015; 22: 426– 434. doi: 10.590/1809-2950/15568322042015Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [30] Gębska M, Dalewski B, Pałka Ł, et al. Evaluation of the efficacy of manual soft tissue therapy and therapeutic exercises in patients with pain and limited mobility TMJ: a randomized control trial (RCT). Head Face Med. 2023; 19(1): 42. doi: 10.1186/s13005-023-00385-y PMC10486124 37684652 sourcePartly supported

  The Abstract’s Material and methods section (page unavailable) says the trial enrolled women diagnosed with DC/TMD Ib, supporting the claim that it identified a TMD subtype. It does not say that the trial applied both Axis I and Axis II criteria; searches for Axis II and psychosocial assessment found no such procedure in our copy. The trial also cannot establish how many studies in the citing systematic review used each set of criteria. (LLM, conf=0.82)

  Experimental — accuracy not yet measured
• cites [35] Kalamir A, Graham PL, Vitiello AL, et al. Intra-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomised, clinical trial. Chiropr Man Therap. 2013; 5(21): 17. doi: 10.1186/2045-709X-21-17 PMC3706243 23738586 sourcePartly supported

  Methods > Subjects says the trial used both the physical and psychosocial RDC axes to select participants with myogenous TMD and exclude those with severe depression or somatisation. This supports citing the trial as one that incorporated both axes, but it did not compare TMD subtypes to identify which were most responsive to manual therapy. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [21] Corum M, Basoglu C, Topaloglu M, et al. Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders. Manuelle Medizin. 2018; 56: 230– 238. doi: 10.1007/s00337-018-0406-5 sourcePartly supported

  The Participants section (page unavailable) says this trial classified TMD as category I and/or II under RDC/TMD criteria. It does not say that the trial applied both Axis I and Axis II criteria; the categories named in that passage are not identified as the two axes. The paper also does not report how many studies in the citing systematic review used either set of criteria. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [33] Guarda-Nardini L, Stecco A, Stecco C, et al. Myofascial pain of the jaw muscles: comparison of short-term effectiveness of botulinum toxin injections and fascial manipulation technique. Cranio. 2012; 30: 95– 102. doi: 10.1179/crn.2012.014 22606852 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Most studies employed the DC/TMD diagnostic criteria and the Wilkes TMJ staging system.

“Most studies employed the DC/TMD diagnostic criteria [3,45], and the Wilkes TMJ staging system [46].”

• cites [3] Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD consortium network* and orofacial pain special interest group. J Oral Facial Pain Headache. 2014 Winter; 28: 6– 27. doi: 10.11607/jop.1151 PMC4478082 24482784 sourceSupported
• cites [45] Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992 Fall; 6: 301– 355. 1298767Not checked — no full text of the source
• cites [46] Wilkes CH. Internal derangements of the temporomandibular joint. Pathological variations. Arch Otolaryngol Head Neck Surg. 1989; 115: 469– 477. doi: 10.1001/archotol.1989.01860280067019 2923691 sourceNot checked — no full text of the source

May combine two claims.

HVLA techniques applied to the jaw and cervical spine demonstrated efficacy in reducing pain and improving maximum mouth opening.

“HVLA techniques applied to the jaw [24,29,31] and cervical spine [21,23,25–27] demonstrated efficacy in reducing pain and improving MMO.”

• cites [24] Cuccia AM, Caradonna C, Annunziata V, et al. Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2010; 14: 179– 184. doi: 10.1016/j.jbmt.2009.08.002 20226365 sourceNot checked — no full text of the source
• cites [29] DeVocht JW, Goertz CM, Hondras MA, et al. A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder. J Am Dent Assoc. 2013; 144(10): 1154– 1163. doi: 10.14219/jada.archive.2013.0034 PMC4103021 24080932 sourcePartly supported

  The Methods (AMCT; page not provided) describe instrument-assisted, quick, shallow thrusts that can involve the temporomandibular joint and spine. The Results (Study outcomes; page not provided) report reduced pain in the AMCT group, but no statistically significant improvement over the comparison groups. The paper does not report an improvement in maximum mouth opening or establish the efficacy of HVLA techniques applied specifically to the jaw and cervical spine. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [31] Gesslbauer C, Vavti N, Keilani M, et al. Effectiveness of osteopathic manipulative treatment versus osteopathy in the cranial field in temporomandibular disorders - a pilot study. Disabil Rehabil. 2018; 40: 631– 636. doi: 10.1080/09638288.2016.1269368 28029069 sourceNot checked — no full text of the source
• cites [21] Corum M, Basoglu C, Topaloglu M, et al. Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders. Manuelle Medizin. 2018; 56: 230– 238. doi: 10.1007/s00337-018-0406-5 sourceSupported
• cites [23] Reynolds B, Puentedura EJ, Kolber MJ, et al. Effectiveness of cervical spine high-velocity, low-amplitude thrust added to behavioral education, soft tissue mobilization, and exercise for people with temporomandibular disorder with myalgia: a randomized clinical trial. J Orthop Sports Phys Ther. 2020; 50: 455– 465. doi: 10.2519/jospt.2020.9175 31905097 sourceNot checked — no full text of the source
• cites [25] Dunning J, Butts R, Bliton P, et al. Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: a multi-center randomized clinical trial. Cranio. 2022; 12: 1– 14. doi: 10.1080/08869634.2022.2062137 35412448 sourceNot checked — no full text of the source
• cites [26] Oliveira-Campelo NM, Rubens-Rebelatto J, N-Vallejo M, et al. The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles. J Orthop Sports Phys Ther. 2010; 40: 310– 317. doi: 10.2519/jospt.2010.3257 20436241 sourceNot checked — no full text of the source
• cites [27] Bortolazzo GL, Pires PF, Dibai-Filho AV, et al. Effects of upper cervical manipulation on the electromyographic activity of the masticatory muscles and the opening range of motion of the mouth in women with temporomandibular disorder: randomized and blind clinical trial. Fisioter Pesq. 2015; 22: 426– 434. doi: 10.590/1809-2950/15568322042015Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Cuccia et al. and DeVocht et al. demonstrated significant improvements at six months, while Kalamir et al. reported sustained efficacy up to one year, particularly in chronic myogenous temporomandibular disorder.

“Cuccia et al. [24] and DeVocht et al. [29] demonstrated significant improvements at six months, while Kalamir et al. [34] reported sustained efficacy up to one year, particularly in chronic myogenous TMD.”

• cites [24] Cuccia AM, Caradonna C, Annunziata V, et al. Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2010; 14: 179– 184. doi: 10.1016/j.jbmt.2009.08.002 20226365 sourceNot checked — no full text of the source
• cites [29] DeVocht JW, Goertz CM, Hondras MA, et al. A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder. J Am Dent Assoc. 2013; 144(10): 1154– 1163. doi: 10.14219/jada.archive.2013.0034 PMC4103021 24080932 sourceSupported
• cites [34] Kalamir A, Bonello R, Graham P, et al. Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial. J Manipulative Physiol Ther. 2012; 35: 26– 37. doi: 10.1016/j.jmpt.2011.09.004 22079052 sourceNot checked — no full text of the source

May combine two claims.

Osteopathic interventions and physician-led treatments were effective when compared to education- or sham-controls.

“Osteopathic interventions [24] and physician-led treatments [21] were effective when compared to education- or sham- controls.”

• cites [24] Cuccia AM, Caradonna C, Annunziata V, et al. Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2010; 14: 179– 184. doi: 10.1016/j.jbmt.2009.08.002 20226365 sourceNot checked — no full text of the source
• cites [21] Corum M, Basoglu C, Topaloglu M, et al. Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders. Manuelle Medizin. 2018; 56: 230– 238. doi: 10.1007/s00337-018-0406-5 sourceSupported

May combine two claims.

Physiotherapists consistently achieved significant outcomes in pain reductions and maximum mouth opening improvement.

“Physiotherapists consistently achieved significant outcomes in pain reductions [21–23] and MMO improvement [21,22,26].”

• cites [21] Corum M, Basoglu C, Topaloglu M, et al. Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders. Manuelle Medizin. 2018; 56: 230– 238. doi: 10.1007/s00337-018-0406-5 sourceSupported
• cites [22] Tuncer AB, Ergun N, Tuncer AH, et al. Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2013; 17: 302– 308. doi: 10.1016/j.jbmt.2012.10.006 23768273 sourceNot checked — no full text of the source
• cites [23] Reynolds B, Puentedura EJ, Kolber MJ, et al. Effectiveness of cervical spine high-velocity, low-amplitude thrust added to behavioral education, soft tissue mobilization, and exercise for people with temporomandibular disorder with myalgia: a randomized clinical trial. J Orthop Sports Phys Ther. 2020; 50: 455– 465. doi: 10.2519/jospt.2020.9175 31905097 sourceNot checked — no full text of the source
• cites [26] Oliveira-Campelo NM, Rubens-Rebelatto J, N-Vallejo M, et al. The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles. J Orthop Sports Phys Ther. 2010; 40: 310– 317. doi: 10.2519/jospt.2010.3257 20436241 sourceNot checked — no full text of the source

May combine two claims.

Manual therapy was effective across all professional categories, with significant reductions in pain and improvements in maximum mouth opening.

“Manual therapy was effective across all professional categories, with significant reductions in pain [21–25] and improvements in MMO [21–26].”

• Also stated in: § Conclusions · boosted

  “1) Efficacy in reducing pain and improving functional outcomes, consistently observed across studies and independent of the professional performing the intervention;”

• cites [21] Corum M, Basoglu C, Topaloglu M, et al. Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders. Manuelle Medizin. 2018; 56: 230– 238. doi: 10.1007/s00337-018-0406-5 sourcePartly supported

  The Discussion reports that upper-cervical manipulation combined with neck exercises reduced jaw pain for a limited period and increased pain-free maximum mouth opening in women with TMD. The paper does not evaluate effectiveness across professional categories, and its pain reduction was not maintained at one month. Page numbers are not available in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [22] Tuncer AB, Ergun N, Tuncer AH, et al. Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2013; 17: 302– 308. doi: 10.1016/j.jbmt.2012.10.006 23768273 sourceNot checked — no full text of the source
• cites [23] Reynolds B, Puentedura EJ, Kolber MJ, et al. Effectiveness of cervical spine high-velocity, low-amplitude thrust added to behavioral education, soft tissue mobilization, and exercise for people with temporomandibular disorder with myalgia: a randomized clinical trial. J Orthop Sports Phys Ther. 2020; 50: 455– 465. doi: 10.2519/jospt.2020.9175 31905097 sourceNot checked — no full text of the source
• cites [24] Cuccia AM, Caradonna C, Annunziata V, et al. Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2010; 14: 179– 184. doi: 10.1016/j.jbmt.2009.08.002 20226365 sourceNot checked — no full text of the source
• cites [25] Dunning J, Butts R, Bliton P, et al. Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: a multi-center randomized clinical trial. Cranio. 2022; 12: 1– 14. doi: 10.1080/08869634.2022.2062137 35412448 sourceNot checked — no full text of the source
• cites [26] Oliveira-Campelo NM, Rubens-Rebelatto J, N-Vallejo M, et al. The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles. J Orthop Sports Phys Ther. 2010; 40: 310– 317. doi: 10.2519/jospt.2010.3257 20436241 sourceNot checked — no full text of the source

May combine two claims.

Several studies emphasized that manual therapy was performed by professionals with specialized training, reinforcing the notion that clinical expertise is critical to achieving effective results.

“Several studies [21,22,25,26,29,31,34] emphasized that manual therapy was performed by professionals with specialized training, reinforcing the notion that clinical expertise is critical to achieving effective results.”

• cites [21] Corum M, Basoglu C, Topaloglu M, et al. Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders. Manuelle Medizin. 2018; 56: 230– 238. doi: 10.1007/s00337-018-0406-5 sourceSupported
• cites [22] Tuncer AB, Ergun N, Tuncer AH, et al. Effectiveness of manual therapy and home physical therapy in patients with temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2013; 17: 302– 308. doi: 10.1016/j.jbmt.2012.10.006 23768273 sourceNot checked — no full text of the source
• cites [25] Dunning J, Butts R, Bliton P, et al. Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: a multi-center randomized clinical trial. Cranio. 2022; 12: 1– 14. doi: 10.1080/08869634.2022.2062137 35412448 sourceNot checked — no full text of the source
• cites [26] Oliveira-Campelo NM, Rubens-Rebelatto J, N-Vallejo M, et al. The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles. J Orthop Sports Phys Ther. 2010; 40: 310– 317. doi: 10.2519/jospt.2010.3257 20436241 sourceNot checked — no full text of the source
• cites [29] DeVocht JW, Goertz CM, Hondras MA, et al. A pilot study of a chiropractic intervention for management of chronic myofascial temporomandibular disorder. J Am Dent Assoc. 2013; 144(10): 1154– 1163. doi: 10.14219/jada.archive.2013.0034 PMC4103021 24080932 sourcePartly supported

  The Methods (AMCT; page not provided) say that one chiropractor performed all chiropractic treatment. The Discussion says the trial was expertise-based, but its statement about training and technique calibration refers to clinicians who performed diagnostic assessments, not the chiropractor. The paper does not establish that specialized training was critical to effective treatment results. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [31] Gesslbauer C, Vavti N, Keilani M, et al. Effectiveness of osteopathic manipulative treatment versus osteopathy in the cranial field in temporomandibular disorders - a pilot study. Disabil Rehabil. 2018; 40: 631– 636. doi: 10.1080/09638288.2016.1269368 28029069 sourceNot checked — no full text of the source
• cites [34] Kalamir A, Bonello R, Graham P, et al. Intraoral myofascial therapy for chronic myogenous temporomandibular disorder: a randomized controlled trial. J Manipulative Physiol Ther. 2012; 35: 26– 37. doi: 10.1016/j.jmpt.2011.09.004 22079052 sourceNot checked — no full text of the source

May combine two claims.

Intra-oral myofascial therapy demonstrated pain relief and significant myorelaxant effects.

“Intra-oral myofascial therapy also demonstrated pain relief and significant myorelaxant effects [30,35].”

• cites [30] Gębska M, Dalewski B, Pałka Ł, et al. Evaluation of the efficacy of manual soft tissue therapy and therapeutic exercises in patients with pain and limited mobility TMJ: a randomized control trial (RCT). Head Face Med. 2023; 19(1): 42. doi: 10.1186/s13005-023-00385-y PMC10486124 37684652 sourcePartly supported

  The Discussion reports that manual therapy reduced pain and that massage and other treatments decreased masseter-muscle bioelectrical activity, with significant differences between treatment groups after five sessions. The Conclusions also report a significant analgesic effect for massage combined with self-therapy. The paper does not establish that the treatment producing these effects was intra-oral myofascial therapy; its mention of an intra-oral procedure in Materials and methods concerns a dental examination. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [35] Kalamir A, Graham PL, Vitiello AL, et al. Intra-oral myofascial therapy versus education and self-care in the treatment of chronic, myogenous temporomandibular disorder: a randomised, clinical trial. Chiropr Man Therap. 2013; 5(21): 17. doi: 10.1186/2045-709X-21-17 PMC3706243 23738586 sourcePartly supported

  The Results (Primary outcomes and Secondary outcome; page unavailable) report significant pain reductions with intra-oral myofascial therapy. The Methods (Outcome measures; page unavailable) list pain and jaw-opening measures, but no measure of muscle relaxation; the paper does not demonstrate a significant myorelaxant effect of the therapy. (LLM, conf=0.89)

  Experimental — accuracy not yet measured

May combine two claims.

For Axis I temporomandibular disorders, positive outcomes were reported with upper cervical HVLA techniques, likely due to interruption of nociceptive signaling via trigemino-cervical convergence mechanisms.

“For Axis I TMD, positive outcomes were reported with upper cervical HVLA techniques, likely due to interruption of the nociceptive signaling via trigemino-cervical convergence mechanisms [21,25,27].”

• cites [21] Corum M, Basoglu C, Topaloglu M, et al. Spinal high-velocity low-amplitude manipulation with exercise in women with chronic temporomandibular disorders. Manuelle Medizin. 2018; 56: 230– 238. doi: 10.1007/s00337-018-0406-5 sourcePartly supported

  The Participants section describes women with chronic TMD classified under RDC/TMD categories I and/or II. The Discussion reports improved pain and jaw function after upper-cervical HVLA manipulation combined with neck exercise, and the Conclusion attributes a role to interruption of nociceptive effects of trigemino-cervical convergence. The claim omits the exercise component and presents the findings more broadly than the studied population and short follow-up support. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [25] Dunning J, Butts R, Bliton P, et al. Dry needling and upper cervical spinal manipulation in patients with temporomandibular disorder: a multi-center randomized clinical trial. Cranio. 2022; 12: 1– 14. doi: 10.1080/08869634.2022.2062137 35412448 sourceNot checked — no full text of the source
• cites [27] Bortolazzo GL, Pires PF, Dibai-Filho AV, et al. Effects of upper cervical manipulation on the electromyographic activity of the masticatory muscles and the opening range of motion of the mouth in women with temporomandibular disorder: randomized and blind clinical trial. Fisioter Pesq. 2015; 22: 426– 434. doi: 10.590/1809-2950/15568322042015Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Across the selected RCTs, manual therapy consistently reduced pain intensity and improved maximum mouth opening in patients with temporomandibular disorders.

“Across the selected RCTs, manual therapy consistently reduced pain intensity and improved MMO in patients with TMD.”

• Also stated in: § Comparative analysis of secondary outcomes · plain

  “Across the included randomized controlled trials, manual therapy was consistently associated with reductions in pain intensity and improvements in maximum mouth opening (MMO) in patients with TMD.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Italy, Spain, Greece and Turkey stand out for their interdisciplinary approach independently by chiropractors, physiotherapists, or osteopaths in TMD management.

“Italy, Spain, Greece and Turkey stand out for their interdisciplinary approach independently by chiropractors, physiotherapists, or osteopaths in TMD management.”

• AssumptionRests on an assumption: Author affiliations and nationality accurately indicate the country and professional setting in which the manual therapy was delivered.

May combine two claims.

Downgrading of evidence certainty was primarily driven by methodological limitations, including unclear or high risk of bias in blinding, incomplete outcome data, and selective reporting; additional factors included clinical heterogeneity and imprecision due to small sample sizes and short follow-up.

“Downgrading of evidence certainty was primarily driven by methodological limitations, including unclear or high risk of bias in blinding of participants and personnel, incomplete outcome data, and selective reporting in several trials. Additional downgrading factors included clinical heterogeneity in intervention protocols and comparators, as well as imprecision due to small sample sizes and short”

May combine two claims.

Physiotherapists in rehabilitation settings showed the most consistent outcomes, particularly documented in Brazil.

“Physiotherapists in rehabilitation settings showed the most consistent outcomes, particularly documented in Brazil.”

• AssumptionRests on an assumption: Author affiliations and nationality accurately indicate the country and professional setting in which the manual therapy was delivered.
• AssumptionRests on an assumption: The clinical diagnosis of TMD in the included studies is valid and comparable across studies.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A total of 561 articles were identified, and after screening 169 titles and abstracts, 18 articles met the inclusion criteria and were selected for this systematic review.

“A total of 561 articles (85 from PubMed, 365 from Scopus, 44 from Web of Science, 67 from Cochrane Library) were identified. After screening 169 title and abstract, 18 articles met the inclusion criteria and were selected for this systematic review”

May combine two claims.

From 561 initial records, 18 randomized controlled trials met the inclusion criteria and were included in the analysis.

“From 561 initial records, 18 RCTs met the inclusion criteria and were included in the analysis.”

May combine two claims.

A meta-analysis was planned a priori but was not conducted because predefined methodological criteria were not met due to substantial heterogeneity across included studies in intervention type, treatment dosage, comparator interventions, outcome reporting, and follow-up timing.

“A meta-analysis was planned a priori and would have been conducted if a sufficient number of studies met predefined methodological criteria.”

• Also stated in: § Data analysis and outcome measures · plain

  “Due to substantial heterogeneity across included studies in terms of intervention type, treatment dosage, comparator interventions, outcome reporting, and follow-up timing, these criteria were not met.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Physiotherapy manipulation emerged as the most used technique.

“Physiotherapy manipulation emerged as the most used technique.”

May combine two claims.

Overall, manual therapy was associated with reductions in pain and improvements in maximum mouth opening (MMO) across different professional backgrounds and techniques.

“Overall, manual therapy was associated with reductions in pain and improvements in MMO across different professional background and techniques.”

• AssumptionRests on an assumption: The clinical diagnosis of TMD in the included studies is valid and comparable across studies.

Probably not a substantial claim: may not pass S3 (load-bearing).

Japan focused on intra-oral manipulations by dental and maxillofacial specialists.

“Japan focused on intra-oral manipulations by dental and maxillofacial specialists.”

• AssumptionRests on an assumption: Author affiliations and nationality accurately indicate the country and professional setting in which the manual therapy was delivered.

Probably not a substantial claim: may not pass S3 (load-bearing).

Chiropractic approaches were common in Australia, USA, and England.

“Chiropractic approaches were common in Australia, USA, and England”

• AssumptionRests on an assumption: Author affiliations and nationality accurately indicate the country and professional setting in which the manual therapy was delivered.

May combine two claims.

The certainty of evidence for pain reduction was judged as low to moderate, while the certainty for improvements in maximum mouth opening was low.

“Overall, the certainty of evidence for pain reduction was judged as low to moderate, while the certainty for improvements in maximum mouth opening (MMO) was low.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

HVLA are performed across Turkey, Spain, and Greece at the upper cervical spine, in Italy and Austria at the jaw, and in Brazil at the cervical and dorsal spine, with researchers affiliated with physical therapy, osteopathic, and dental science departments.

“HVLA are performed across Turkey, Spain, Greece at the upper cervical spine, in Italy and Austria at the jaw, in Brazil at the cervical and dorsal spine, with researchers affiliated with physical therapy, osteopathic, and dental science departments.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

HVLA of the cervical spine and of the jaw combined with myofascial release have been studied in Brazil.

“Additionally, HVLA of cervical spine [27] and of the jaw combined with myofascial release [24] have been studied in Brazil (Table 3).”

• cites [27] Bortolazzo GL, Pires PF, Dibai-Filho AV, et al. Effects of upper cervical manipulation on the electromyographic activity of the masticatory muscles and the opening range of motion of the mouth in women with temporomandibular disorder: randomized and blind clinical trial. Fisioter Pesq. 2015; 22: 426– 434. doi: 10.590/1809-2950/15568322042015Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [24] Cuccia AM, Caradonna C, Annunziata V, et al. Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2010; 14: 179– 184. doi: 10.1016/j.jbmt.2009.08.002 20226365 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Approximately 40% of studies employed manipulative physiotherapy, while only 13% involved chiropractors and osteopaths.

“Approximately 40% of studies employed manipulative physiotherapy, while only 13% involved chiropractors and osteopaths (Table 3).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Dentists and dental specialists are involved in intra-oral manipulations and jaw-related interventions, with studies from Japan, Australia and England.

“Dentists and dental specialists are involved in intra-oral manipulations and jaw-related interventions, with studies from Japan, Australia and England.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Chiropractic-based manipulation and myofascial interventions are mostly conducted in Australia and England, affiliated with chiropractic departments.

“Chiropractic-based manipulation and myofascial interventions are mostly conducted in Australia and England, affiliated with chiropractic departments (Table 3).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Physiotherapists are frequently involved in manual therapy for temporomandibular disorders, with contributions from Brazil, Turkey, and Europe (Poland, Italy, Spain, Greece and Austria).

“Physiotherapists are frequently involved in manual therapy for TMD, with contributions from Brazil, Turkey, Europe (Poland, Italy, Spain, Greece and Austria).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Dental and maxillofacial interventions are prevalent in Japan, conducted within oral and maxillofacial surgery clinics.

“Dental and maxillofacial interventions are prevalent in Japan, conducted within oral and maxillofacial surgery clinics (Table 3).”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Osteopaths play a crucial role in Brazil, Spain and Italy.

“Osteopaths play a crucial role in Brazil, Spain and Italy.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Chiropractors are more represented in Australia, England, and the USA.

“Chiropractors are more represented in Australia, England, and the USA.”

May combine two claims.

Most trials assessed outcomes over short follow-up periods, with limited data on long-term effectiveness.

“Most trials assessed outcomes over short follow-up periods, ranging from immediate post-treatment to a few months, with limited data available on long-term effectiveness.”

May combine two claims.

Most studies focused on physiotherapy interventions, often conducted in rehabilitation settings, outnumbering those involving osteopaths, chiropractors, or dental specialists and medical doctors.

“However, most studies focused on physiotherapy interventions, often conducted in rehabilitation settings, outnumbering those involving osteopaths, chiropractors, or dental specialists and medical doctors.”

May combine two claims.

Oliveira-Campelo et al. and Gesslbauer et al. reported immediate symptom relief and increased mandibular range of motion immediately after treatment.

“The studies by Oliveira-Campelo et al. [26] and Gesslbauer et al. [31] reported immediate symptom relief and increased mandibular range of motion immediately after treatment.”

• cites [26] Oliveira-Campelo NM, Rubens-Rebelatto J, N-Vallejo M, et al. The immediate effects of atlanto-occipital joint manipulation and suboccipital muscle inhibition technique on active mouth opening and pressure pain sensitivity over latent myofascial trigger points in the masticatory muscles. J Orthop Sports Phys Ther. 2010; 40: 310– 317. doi: 10.2519/jospt.2010.3257 20436241 sourceNot checked — no full text of the source
• cites [31] Gesslbauer C, Vavti N, Keilani M, et al. Effectiveness of osteopathic manipulative treatment versus osteopathy in the cranial field in temporomandibular disorders - a pilot study. Disabil Rehabil. 2018; 40: 631– 636. doi: 10.1080/09638288.2016.1269368 28029069 sourceNot checked — no full text of the source

May combine two claims.

All strategies demonstrated consistent improvements, particularly those involving physiotherapy-based manipulations, which supported both pain reduction and functional recovery.

“All strategies demonstrated consistent improvements, particularly those involving physiotherapy-based manipulations, which supported both pain reduction and functional recovery.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Medical doctors conducting manual therapy interventions are noted in Turkey.

“Medical doctors conducting manual therapy interventions are noted in Turkey.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Studies on fascial manipulation and myofascial release often originate from physiotherapy and rehabilitation departments in universities across Brazil, Poland, Turkey, and the USA.

“Studies on fascial manipulation and myofascial release often originate from physiotherapy and rehabilitation departments in Universities across Brazil, Poland, Turkey, and the USA.”

May combine two claims.

Jaw HVLA combined with myofascial release yielded significant pain relief and increased maximum mouth opening, both immediately after treatment and at 2 months follow-up.

“Jaw HVLA combined with myofascial release [24,31], yielded significant pain relief and increased MMO, both immediately after treatment and at 2 months follow-up [24].”

• cites [24] Cuccia AM, Caradonna C, Annunziata V, et al. Osteopathic manual therapy versus conventional conservative therapy in the treatment of temporomandibular disorders: a randomized controlled trial. J Bodyw Mov Ther. 2010; 14: 179– 184. doi: 10.1016/j.jbmt.2009.08.002 20226365 sourceNot checked — no full text of the source
• cites [31] Gesslbauer C, Vavti N, Keilani M, et al. Effectiveness of osteopathic manipulative treatment versus osteopathy in the cranial field in temporomandibular disorders - a pilot study. Disabil Rehabil. 2018; 40: 631– 636. doi: 10.1080/09638288.2016.1269368 28029069 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Brazil showed strong representation in physiotherapy-based manual therapy, while Australia, USA, and England contributed significantly to chiropractic approaches.

“Brazil showed strong representation in physiotherapy-based manual therapy, while Australia, USA, and England contributed significantly to chiropractic approaches.”

May combine two claims.

The most commonly used techniques were HVLA manipulations, accounting for 56% of interventions, and fascial manipulations combined with myofascial release, representing 37.5% of approaches.

“The most commonly used techniques were HVLA manipulations, accounting for 56% of interventions of the examined literature, and fascial manipulations combined with myofascial release, representing 37.5% of the approaches.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Italy, Spain, Greece, Turkey and the USA demonstrated a mixed profile, with both osteopathic and physiotherapy-led interventions across multiple institutions.

“Italy, Spain, Greece, Turkey and the USA demonstrated a mixed profile, with both osteopathic and physiotherapy-led interventions across multiple institutions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

In the USA, HVLA are executed in physical therapy and chiropractic departments at the upper cervical spine and jaw.

“In USA, HVLA are executed in physical therapy and chiropractic departments at the upper cervical spine and jaw.”

May combine two claims.

Several studies lacked adequate blinding, used small samples, or reported outcomes over short follow-up periods, which limits confidence in the stability and generalizability of observed effects.

“Several studies lacked adequate blinding, used small samples, or reported outcomes over short follow-up periods, which limits confidence in the stability and generalizability of the observed effects.”

May combine two claims.

The available evidence is predominantly short-term and heterogeneous, with several studies being underpowered.

“However, the available evidence is predominantly short-term and heterogeneous, with several studies being underpowered.”

May combine two claims.

Predominant focus on Axis I of the DC/TMD diagnostic criteria, encompassing muscle disorders and disc displacements, with positive results reported for techniques such as upper cervical spine HVLA and myofascial release.

“2) Predominant focus on Axis I of the DC/TMD diagnostic criteria, encompassing muscle disorders and disc displacements, with positive results reported for techniques such as upper cervical spine HVLA and myofascial release;”

May combine two claims.

The included studies exhibited significant heterogeneity in temporomandibular disorder diagnosis, severity and chronicity, types of manual therapy applied, professional background of the therapist, and intervention timing and duration.

“The included studies exhibited significant heterogeneity in terms of TMD diagnosis (e.g. myogenic, myofascial, disc displacement), severity and chronicity, types of manual therapy applied (e.g. HVLA, myofascial release), professionals background of the therapist, and intervention timing and duration.”

May combine two claims.

According to GRADE, the overall certainty of evidence ranged from low to moderate, primarily due to study heterogeneity, risk of bias, imprecision related to small sample sizes, and short follow-up durations.

“According to the GRADE framework, the overall certainty of evidence ranged from low to moderate, primarily due to study heterogeneity, risk of bias, imprecision related to small sample sizes, and short follow-up durations.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Wilkes classification system was applied in studies addressing disc displacement cases.

“The Wilkes classification system, which categorizes TMJ disorders, from mild disc displacement to advanced degenerative stages, was applied in studies addressing disc displacement cases [46].”

• cites [46] Wilkes CH. Internal derangements of the temporomandibular joint. Pathological variations. Arch Otolaryngol Head Neck Surg. 1989; 115: 469– 477. doi: 10.1001/archotol.1989.01860280067019 2923691 sourceNot checked — no full text of the source

May combine two claims.

According to GRADE criteria, evidence for pain reduction was downgraded mainly due to risk of bias and imprecision, while evidence for maximum mouth opening improvement was further downgraded for inconsistency across studies and indirectness related to heterogeneous intervention protocols.

“According to GRADE criteria, evidence for pain reduction was downgraded mainly due to risk of bias and imprecision, while evidence for MMO improvement was further downgraded for inconsistency across studies and indirectness related to heterogeneous intervention protocols.”

May combine two claims.

Most studies assessed outcomes immediately post-treatment, with limited data on long-term efficacy, hindering conclusions about the durability of manual therapy effects.

“Moreover, most studies assessed outcomes immediately post-treatment, with limited data on long-term efficacy, hindering conclusions about the durability of manual therapy effects.”

Classified as probably not a substantial claim.

Most RCTs emphasized the importance of accurate diagnosis, specialized training, and clinical expertise.

“Moreover, most RCTs emphasized the importance of accurate diagnosis, specialized training, and clinical expertise.”

Classified as probably not a substantial claim.

Risk of bias was independently assessed by two authors using the Cochrane Risk of Bias tool.

“Risk of bias was independently assessed by two authors using the Cochrane Risk of Bias tool [39].”

• cites [39] Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. Chapter 5. Oxford, (UK): Cochrane Collaboration; 2008. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

A comprehensive literature search was performed across PubMed, Scopus, Cochrane Library, and Web of Science, covering database inception to March 2025.

“A comprehensive literature search was performed across the following databases: PubMed, Scopus, Cochrane Library, and Web of Science (WOS), covering the period from database inception to March 2025, (Figure 1).”

Classified as probably not a substantial claim. May combine two claims.

Two authors independently screened titles and abstracts, and full texts, resolving discrepancies by discussion or a third author.

“Two authors independently screened titles and abstracts, followed by full texts assessment of potentially eligible articles. Discrepancies were resolved through discussion or, if necessary, by consulting a third authors.”

May combine two claims.

Quantitative pooling was deemed inappropriate, and a systematic narrative synthesis was conducted in accordance with PRISMA guidelines.

“Therefore, quantitative pooling was deemed inappropriate, and a systematic narrative synthesis was conducted in accordance with PRISMA guidelines.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study selection and data extraction process were repeated independently by one author during the final update phase to ensure consistency.

“To ensure consistency, the study selection and data extraction process were repeated independently by one author during the final update phase.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The review protocol was registered in PROSPERO (CRD42024579074).

“The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024579074).”

May combine two claims.

Although most studies reported short-term improvements in pain and maximum mouth opening following manual therapy, overall confidence in these effects remains limited, particularly for long-term outcomes.

“Consequently, although most studies reported short-term improvements in pain and MMO following manual therapy, the overall confidence in these effects remains limited, particularly for long-term outcomes.”

May combine two claims.

The strongest evidence base emerged from physiotherapy-led or rehabilitation-based practices, likely reflecting their greater representation in the current literature.

“The strongest evidence base emerged from physiotherapy-led or rehabilitation-based practices, likely reflecting their greater representation in the current literature.”

May combine two claims.

While a consistent pattern of short-term positive effects emerged across different manual therapy approaches and professional settings, the certainty of evidence supporting sustained or long-term effectiveness remains limited.

“Therefore, while a consistent pattern of short-term positive effects emerged across different manual therapy approaches and professional settings, the certainty of evidence supporting sustained or long-term effectiveness remains limited.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

The evidence indicates a growing trend toward manual therapy as the primary intervention across temporomandibular disorder subtypes, with treatment increasingly tailored to the underlying pathology.

“The evidence indicates a growing trend toward manual therapy as the primary intervention across TMD subtypes, with treatment increasingly tailored to the underlying pathology.”

Probably not a substantial claim: may not pass S4 (based).

This is the first systematic review to evaluate the efficacy of manual therapy for temporomandibular disorders across multiple professional categories.

“To the best of our knowledge, this is the first systematic review to evaluate the efficacy of manual therapy for TMD across multiple professional categories, offering a comparative perspective on clinical outcomes based on practitioner background.”

May combine two claims.

Manual therapy represents a valuable option in the management of temporomandibular disorders, demonstrating clinical effectiveness regardless of the specific technique or professional category involved.

“Manual therapy represents a valuable option in the management of TMD, highlighting the interdisciplinary nature of treatment and demonstrating clinical effectiveness regardless of the specific technique or professional category involved.”

May combine two claims.

Broad effectiveness of manual therapy across countries and professional practices was observed, with physiotherapists leading the majority of interventions, likely due to the greater volume of published evidence.

“3) Broad effectiveness of manual therapy across countries and professional practices, with physiotherapists leading the majority of interventions, likely due to the greater volume of published evidence.”

May combine two claims.

As a result, the current evidence supports short-term symptomatic improvements, but provides limited certainty regarding sustained or long-term effectiveness of manual therapy for temporomandibular disorders.

“As a result, the current evidence supports short-term symptomatic improvements, but provides limited certainty regarding sustained or long-term effectiveness of manual therapy for TMD.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The terminology used to describe professional categories was derived directly from the cited articles, based on the qualifications and roles assigned by the original authors.

“Additionally, the terminology used to describe professional categories was derived directly from the cited articles, based on the qualifications and roles assigned by the original authors.”

May combine two claims.

While the findings indicate a consistent trend toward short-term benefit, the strength and certainty of evidence supporting long-term effectiveness and equivalence across professional categories remain limited.

“Therefore, while the findings indicate a consistent trend toward short-term benefit, the strength and certainty of evidence supporting long-term effectiveness and equivalence across professional categories remain limited.”

May combine two claims.

While manual therapy appeared broadly effective, its success varied depending on the professional practice.

“While manual therapy appeared broadly effective, its success varied depending on the professional practice.”

May combine two claims.

The analysis revealed differences in outcomes across professional categories, likely reflecting variations in technique, training, and therapeutic methodology.

“The analysis revealed differences in outcomes across professional categories, likely reflecting variations in technique, training, and therapeutic methodology.”

May combine two claims.

Although the majority of included RCTs reported positive effects of manual therapy on pain and function, these findings must be interpreted in light of identified risk-of-bias concerns and GRADE assessments.

“Although the majority of included RCTs reported positive effects of manual therapy on pain and function, these findings must be interpreted in light of the identified risk-of-bias concerns and GRADE assessments.”

May combine two claims.

In conclusion, consistent positive outcomes across techniques suggest that manual therapy is broadly effective for temporomandibular disorders, with variations in success linked to temporomandibular disorder subtype and therapeutic modality.

“In conclusion, the consistent positive outcomes across techniques suggest that manual therapy is broadly effective for TMD, with variations in success linked to TMD subtype and therapeutic modality.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The possibility that some non-English evidence exists cannot be entirely excluded.

“Nevertheless, the possibility that some non-English evidence exists cannot be entirely excluded, and this should be considered when interpreting the international scope of the findings.”

Classified as probably not a substantial claim.

High variability in temporomandibular disorder subtypes, treatment settings, professional background, and manual techniques highlights the need for more standardized and methodologically robust studies.

“Moreover, the high variability in TMD subtypes, treatment settings, professional background, and manual techniques highlights the need for more standardized and methodologically robust studies.”