Randomized Effectiveness Study of Four Therapeutic Strategies for TMJ Closed Lock
Open accessAbstract
For individuals with temporomandibular joint (TMJ) disc displacement without reduction with limited mouth opening (closed lock), interventions vary from minimal treatment to surgery. In a single-blind trial, 106 individuals with TMJ closed lock were randomized among medical management, rehabilitation, arthroscopic surgery with post-operative rehabilitation, or arthroplasty with post-operative rehabilitation. Evaluations at baseline, 3, 6, 12, 18, 24, and 60 months used the Craniomandibular Index (CMI) and Symptom Severity Index (SSI) for jaw function and TMJ pain respectively. Using an intention-to-treat analysis, we observed no between-group difference at any follow-up for CMI (p > or = 0.33) or SSI (p > or = 0.08). Both outcomes showed within-group improvement (p < 0.0001) for all groups. The findings of this study suggest that primary treatment for individuals with TMJ closed lock should consist of medical management or rehabilitation. The use of this approach will avoid unnecessary surgical procedures.
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Only 6 studies accomplished more than 60% of the items listed in eTable 2.
“Only 6 studies accomplished more than 60% of the items listed in eTable 2. 57,66,67, 76 -78”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [78]
Five of these studies favored the use of MT in conjunction with exercises compared with splints or with medications or other nonconservative treatments for arthrogenous TMD, such as arthroscopy and arthroplasty.
“Five of these studies 69,78,87,88,91 favored the use of MT in conjunction with exercises compared with splints 69,87,88 or with medications 91 or other nonconservative treatments for arthrogenous TMD, such as arthroscopy and arthroplasty.78”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [78]
In general, MT plus exercises reduced symptoms and increased ROM for patients with arthrogenous TMD, particularly for those with reduced ROM due to disk displacements without reduction (closed lock).
“In general, we found that MT plus exercises reduced symptoms and increased ROM for patients with arthrogenous TMD, particularly for those with reduced ROM due to disk displacements without reduction (”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [78]
When pooling results from studies with homogeneous interventions and similar outcomes, diagnoses, and available data, pain was significantly reduced in patients receiving MT combined with exercises compared with splint therapy, self-care, or medications.
“When pooling the results from the studies with homogeneous interventions and similar outcomes, diagnoses, and available data, 69,78,87,88,90 we found that pain was significantly reduced in patients receiving MT combined with exercises compared with splint therapy, self-care, or medications.”
From Effectiveness of Manual Therapy and Therapeutic Exercise for Temporomandibular Disorders: Systematic Review and Meta-Analysis (2016) · cites this paper as [78]
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References 40 · Cited by 124
- Authors
- Schiffman, E. L., Look, J. O., Hodges, J. S., Swift, J. Q., Decker, K. L., Hathaway, K. M., Templeton, R. B., & Fricton, J. R.
- Affiliations
- University of Minnesota (US)
- Venue
- Journal of Dental Research
- Publisher
- SAGE Publications
- Published
- 2007-01
- Volume
- 86
- Issue
- 1
- Pages
- 58-63
- ISSN
- 0022-0345 (ISSN-L)
- 1544-0591
- PMC
- PMC2278036
- OpenAlex
- W2159292488
- Cited by
- 124
- References
- 40
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 9 · 2023: 10 · 2022: 7 · 2021: 8 · 2020: 3 · 2019: 9 · 2018: 7 · 2017: 10 · 2016: 5 · 2015: 8 · 2014: 9 · 2013: 9 · 2012: 10
- FWCI
- 9.12
- Type
- journal article
- Language
- en
- Update notices
- correction (2012-11-09)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Dental Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5r29de008668-05, 5p30de009737-10, n01de22635-14-0-0)
- National Heart, Lung, and Blood Institute (N01 DE022635)
- National Eye Institute (R01EY013421)
- National Institute of Dental and Craniofacial Research (P30DE09737, R29DE08668, R01DE013421, N01-DE13421-01)
- Topics
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- temporomandibular joint, closed lock, disc displacement without reduction, limited mouth opening, arthroscopic surgery, arthroplasty, postoperative rehabilitation, medical management, jaw function, temporomandibular joint pain, craniomandibular index
- MeSH terms
- Adolescent, Adult, Aged, Anti-Inflammatory Agents, Anti-Inflammatory Agents, Non-Steroidal, Arthroplasty, Arthroscopy, Counseling, Joint Dislocations, Follow-Up Studies, Humans, Methylprednisolone, Middle Aged, Severity of Illness Index, Temporomandibular Joint Disorders, Single-Blind Method, Treatment Outcome, Occlusal Splints, Temporomandibular Joint Disc, Physical Therapy Modalities
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