The Effect of Osteopathic Manipulative Treatment Adjunct on Stabilization Splint Treatment in Temporomandibular Joint Anterior Disc Displacement with Reduction Disorder: A Quantitative Analysis, Pilot Study

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

OMT may have a significant effect on headaches, migraines, and cranial pain.

“Emerging evidence suggests that OMT may have a significant effect on headaches, migraines, and cranial pain [15].”

• cites [15] Kowalski, 2019, The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis, Headache sourcePartly supported

  The Results section reports reductions in migraine days and migraine pain or intensity with spinal manipulation, and the Conclusion describes the evidence as preliminary. Two included studies used manipulation performed by osteopathic physicians, but the review does not establish an effect for OMT specifically or for headaches and cranial pain beyond migraine. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

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

TMD is commonly established with biopsychosocial factors.

“A recent study investigating the etiological factors of TMD showed that TMD is commonly established with biopsychosocial factors [10].”

• cites [10] Warzocha, J., Gadomska-Krasny, J., and Mrowiec, J. (2024). Etiologic factors of temporomandibular disorders: A systematic review of literature containing diagnostic criteria for temporomandibular disorders (DC/TMD) and research diagnostic criteria for temporomandibular disorders (RDC/TMD) from 2018 to 2022. Healthcare, 12. sourceSupported

May combine two claims.

OMT has been shown to be effective in reducing pain and increasing mandibular range of motion.

“the treatment has been shown to be effective in reducing pain and increasing the mandibular range of motion”

• cites [15] Kowalski, 2019, The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis, Headache sourcePartly supported

  The Results (Effect of spinal manipulation on migraine pain or intensity; page unavailable) report a small reduction in migraine pain, and Study Selection and Characteristics notes that osteopathic physicians performed manipulation in two included studies. The finding concerns spinal manipulation for migraine and is described as preliminary; the paper does not report increased mandibular range of motion. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [16] Steel, 2017, Osteopathic manipulative treatment: A systematic review and critical appraisal of comparative effectiveness and health economics research, Musculoskelet. Sci. Pract. sourceNot checked — no full text of the source
• cites [17] Martins, 2016, Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta-analysis, Man. Ther. sourceNot checked — no full text of the source
• cites [18] Kalamir, 2007, Manual therapy for temporomandibular disorders: A review of the literature, J. Bodyw. Mov. Ther. sourceNot checked — no full text of the source
• cites [19] Monaco, 2008, Osteopathic manipulative treatment (OMT) effects on mandibular kinetics: Kinesiographic study, Eur. J. Paediatr. Dent.Not checked yet

  Not checked in the free run.

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

Some evidence shows a relation between malocclusion and parafunctional habits.

“some evidence shows the relation between malocclusion and parafunctional habits [11].”

• cites [11] Kapos, 2020, Temporomandibular disorders: A review of current concepts in aetiology, diagnosis and management, Oral Surg. sourceCould not verify

  The Management section discusses oral parafunctions under self-care and occlusion under TMD treatment, but does not describe a relationship between malocclusion and parafunctional habits. Searches for those terms together and for bruxism with occlusion found no passage addressing the claimed relationship. The statement that occlusion lacks a supported causal role in TMD does not settle this separate claim. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

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

Further reductions in pain scores are achievable when additional relaxation therapies are delivered.

“However, further reductions in pain scores are achievable when additional relaxation therapies are delivered [39].”

• cites [39] Navrotchi, 2017, The influence of occlusal stabilization appliances on cervical dystonia symptoms, Clujul Med. sourcePartly supported

  The Results report that patients using relaxation techniques were more likely to report pain reduction while using an occlusal stabilization appliance (4 versus 0; p=0.2), and the Discussion describes this finding as close to statistical significance. The paper does not report further reductions in pain scores or establish that delivering additional relaxation therapy causes an incremental benefit. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

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

Our study used the hand-measuring method for the splint appliance, which may have decreased the therapeutic effect in all groups.

“Our study used the hand-measuring method for the splint appliance, which may have decreased the therapeutic effect in all groups [45].”

• cites [45] Wieckiewicz, M., Zietek, M., Nowakowska, D., and Wieckiewicz, W. (2014). Comparison of selected kinematic facebows applied to mandibular tracing. Biomed. Res. Int., 2014. sourcePartly supported

  The Conclusions (page unavailable) state that mechanical facebow handling has a higher risk of hand-measuring errors during mandibular tracing. The paper does not study hand-measuring a splint appliance or report therapeutic effects in treatment groups, so it supports only the general concern about measurement error. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

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

Anterior repositioning splint treatment achieves better backward movements for the discs of the joints with anterior disc displacement with reduction.

“In contrast, the anterior repositioning splint treatment achieves better backward movements for the discs of the joints with anterior disc displacement with reduction [43].”

• cites [43] Liu, 2017, Metrical analysis of disc-condyle relation with different splint treatment positions in patients with TMJ disc displacement, J. Appl. Oral Sci. sourcePartly supported

  The Discussion reports greater posterior disc movement in joints with disc displacement with reduction at the anterior repositioning splint position (2.23 mm) than at the stabilization splint position (0.75 mm). However, the Discussion also states that actual oral splints were not fabricated, so these findings support an immediate positional effect rather than an effect demonstrated from splint treatment. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

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

The minimum clinically important differences in pain scores before and after treatment are reported to range from 1.50 to 3.20 points.

“The minimum clinically important differences in pain scores before and after treatment are reported to range from 1.50 to 3.20 points [37,38].”

• cites [37] Yoshida, 2011, Evaluation of mandibular condylar movement exercise for patients with internal derangement of the temporomandibular joint on initial presentation, Br. J. Oral Maxillofac. Surg. sourceNot checked — no full text of the source
• cites [38] Maughan, 2010, Outcome measures in chronic low back pain, Eur. Spine J. sourcePartly supported

  The Discussion reports clinically important changes in pain scores, but not the stated 1.50–3.20-point range. For the numerical pain rating scale, it gives 2.4 points using a distribution-based method and 4 points using an anchor-based method, and notes that the value depends on the method used. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Based on their results, Wieckiewicz et al. suggested the risks of hand measuring.

“Based on their results, they suggested the risks of hand measuring.”

• cites [45] Wieckiewicz, M., Zietek, M., Nowakowska, D., and Wieckiewicz, W. (2014). Comparison of selected kinematic facebows applied to mandibular tracing. Biomed. Res. Int., 2014. sourceSupported

Classified as probably not a substantial claim.

Wieckiewicz et al. noted the significance of virtual assessment methods such as Gerber Dynamic Facebow in their study.

“Wieckiewicz et al. noted the significance of virtual assessment methods such as Gerber Dynamic Facebow in their study.”

• cites [45] Wieckiewicz, M., Zietek, M., Nowakowska, D., and Wieckiewicz, W. (2014). Comparison of selected kinematic facebows applied to mandibular tracing. Biomed. Res. Int., 2014. sourcePartly supported

  The Discussion says virtual tools for mandibular tracing have high diagnostic potential. But the Discussion and Materials and Methods identify the Gerber Dynamic Facebow as mechanical, not virtual; the computerized device studied was ARCUSdigma II. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Quality can be assessed using subjective sleep quality, sleep latency, habitual sleep efficiency, and sleep disturbances.

“Quality can be assessed using subjective sleep quality, sleep latency, habitual sleep efficiency, and sleep disturbances [40,41].”

• cites [40] Guler, 2012, Self-reported data on sleep quality and psychologic characteristics in patients with myofascial pain and disc displacement versus asymptomatic controls, Int. J. Prosthodont.Not matched

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

• cites [41] John, 2014, Exploration of dimensionality and psychometric properties of the Pittsburgh Sleep Quality Index in cases with temporomandibular disorders, Health Qual. Life Outcomes sourceSupported

May combine two claims.

When changes in quality-of-life measures were evaluated, significant differences between groups were observed in physical functionality (p = 0.048) and reported health transition (p = 0.044).

“When the changes calculated by subtracting the post-treatment values from the pre-treatment values for the quality-of-life measures were evaluated, significant differences were observed in physical functionality (p = 0.048) and reported health transition (p = 0.044).”

The quote only partly states this claim.

An average of 2.30 points was observed for patients receiving SS + OMT on sleep quality.

“whereas an average of 2.30 points was observed for patients receiving SS + OMT.”

May combine two claims.

Effect size analysis between the control and study groups revealed a large effect for the disc position difference on the X-axis in the study group (Cohen's d = 1.09) and a small effect for the disc position difference on the Y-axis and vice versa (Cohen's d = 0.49).

“In addition, effect size analysis between the control and study groups revealed a large effect for the disc position difference on the X-axis in the study group (Cohen’s d = 1.09) and a small effect for the disc position difference on the Y-axis and vice versa (Cohen’s d = 0.49) (Table 10).”

May combine two claims.

In the study group, increases in maximum mouth opening, mandibular retrusion, lateral excursions, cervical rotation, and lateral flexion were significant (p = 0.027-0.008).

“in the study group, there were increases in the movement ranges and angles, and the increases in maximum mouth opening, mandibular retrusion and lateral excursions, cervical rotation, and lateral flexion were significant (p = 0.027–0.008).”

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

There was a significant difference in sleep quality between the control and study groups before treatment (p = 0.047).

“while there was a significant difference in sleep quality between the control and study groups before treatment (p = 0.047)”

May combine two claims.

The largest distinction was in the role limitation due to emotional problems score, which was 50.0, and the smallest distinction was in the energy and vitality score, which was 13.9.

“However, the largest distinction was in the role limitation due to emotional problems score, which was 50.0, and the smallest distinction was in the energy and vitality score, which was 13.9.”

The quote only partly states this claim.

In the current study, no significant changes were observed in lateral excursions and protrusion after treatment.

“no significant changes were observed after treatment.”

May combine two claims.

In the control group, some improvements in sleep quality were observed, but the differences were not significant.

“Some improvements in sleep quality were observed in the control group, although the differences were not significant.”

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

In the current study, lower scores were obtained for patients within the same age group, as they all had TMDs.

“In the current study, lower scores were obtained for patients within the same age group, as they all had TMDs.”

May combine two claims.

In the study group, significant pain reductions after treatment were detected in the temporomandibular joint, neck, back, lower back, and head regions (p = 0.007-0.033).

“Significant pain reduction in all body regions was seen in the study groups (p = 0.007–0.033)”

• Also stated in: § 3. Results · plain

  “significant reductions were detected not only in the temporomandibular joint but also in the neck, back, lower back, and head regions (p = 0.007–0.033)”

The quote only partly states this claim.

In the current study, an average of 0.11 points was noted for patients receiving SST on sleep quality.

“In the current study, an average of 0.11 points was noted for patients receiving SST”

May combine two claims.

There was no statistically significant difference between the groups regarding post-treatment disc position changes on the Y-axis and condyle position changes on the X-Y-axis (p > 0.05).

“There was no statistically significant difference between the groups regarding post-treatment disc position changes on the Y-axis and condyle position changes on the X–Y-axis (p > 0.05) (Table 9).”

May combine two claims.

In the current study, before treatment, the right and left rotations of the cervical spine were restricted, and the right and left lateral flexions of the cervical spine were constrained when compared to the normal ranges defined by the American Medical Association.

“In the current study, before treatment, the right and left rotations of the cervical spine were restricted, and the right and left lateral flexions of the cervical spine were constrained when compared to the normal ranges defined by the American Medical Association.”

Classified as probably not a substantial claim.

Patients were randomly assigned to the control and study groups using the sealed envelope method.

“Thereafter, 21 patients (28 joints) were randomly assigned to a “control group” and a “study group” using the sealed envelope method.”

• Also stated in: § 2.1. Study Population · plain

  “As the sample size was small, an equal number of written papers were put in envelopes, and patients were asked to choose one to determine the groups.”

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

G-power software determined the sample size as 30 participants.

“G-power software, which is used to calculate the power analysis, determined the sample size as 30 participants.”

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

The control group consisted of nine patients (2 men and 7 women), and the study group consisted of ten patients (1 man and 9 women).

“The control group consisted of nine patients (2 men and 7 women), and the remaining ten were the study group (1 man and 9 women)”

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

Advances in maximum mouth opening and lateral excursions were possible because during osteopathic manipulative treatments, mandibular movements in all axes were evaluated with utmost care, and Grade I or II mobilizations were applied to the identified restricted movements of the mandible.

“Advances in maximum mouth opening and lateral excursions were possible because during osteopathic manipulative treatments, mandibular movements in all axes were evaluated with utmost care, and Grade I or II mobilizations were applied to the identified restricted movements of the mandible.”

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

Disc-condyle angles from −15° to +15° were considered normal, while angles larger than +15° were treated for a disc with anterior displacement.

“Disc–condyle angles from −15° to +15° were considered normal, while angles larger than +15° were treated for a disc with anterior displacement [27].”

• cites [27] Chen, 2017, Physiological effects of anterior repositioning splint on temporomandibular joint disc displacement: A quantitative analysis, J. Oral Rehabil. sourceNot checked — no full text of the source

May combine two claims.

The control and study groups included patients with similar age, height, weight, and social habits.

“The control and study groups included patients with similar age, height, weight, and social habits.”

May combine two claims.

Splint treatment complemented with osteopathic manipulative treatment facilitated lateral excursions, so that patients put less effort into performing these movements.

“However, splint treatment complemented with osteopathic manipulative treatment facilitated lateral excursions, so that patients put less effort into performing these movements.”

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

The radiological findings of the temporomandibular joints were assessed using MR imaging by a radiologist who had specialized in musculoskeletal radiology for 20 years.

“The radiological findings of the temporomandibular joints of the patients were assessed using MR imaging by a radiologist who had specialized in musculoskeletal radiology for 20 years.”

May combine two claims.

The results showed that applying SS + OMT may increase sleep quality, physical function, and general health while reducing pain related to TMD.

“The results showed that applying SS + OMT may increase sleep quality, physical function, and general health while reducing pain related to TMD.”

May combine two claims.

The treatments led to a 3 mm increase on average, showing a remarkable improvement according to the definitions of Kropmans T. et. al.

“The treatments led to a 3 mm increase on average, showing a remarkable improvement according to the definitions of Kropmans T. et. al.”

• cites Kropmans T. et. al.Not matched

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

May combine two claims.

This application may improve cervical and mandibular motion and facilitate a cure for TMD.

“Moreover, this application may improve cervical and mandibular motion and facilitate a cure for TMD.”

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

The study was conducted with approval of the Yeditepe University Clinical Research Ethics Committee and the Ministry of Health of Turkey, according to the Declaration of Helsinki.

“This study was conducted with the approval of the Yeditepe University Clinical Research Ethics Committee (16.05.2018/No:846) and the Ministry of Health of Turkey (18.07.2018/No: E.201129), according to the declaration of Helsinki.”

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

The study was completed with 19 patients (age range 20-38 years; mean age 26.95 ± 6.87 years).

“Consequently, the study was completed with 19 patients (age range—20–38 years; mean age—26.95 ± 6.87 years).”

May combine two claims.

The results of the current study are in accordance with these studies, indicating that SST leads to decreased cervical pain.

“The results of the current study are in accordance with these studies, indicating that SST leads to decreased cervical pain.”

May combine two claims.

Between the groups, no systematic difference was observed in collected demographic attributes (p = 0.211-0.850) except for disease history (p = 0.020).

“Between the groups, no systematic difference was observed in the collected demographic attributes (p = 0.211–0.850) except for disease history (p = 0.020).”

Classified as probably not a substantial claim.

Except for the osteopath who gave the treatments, all evaluators were blind to the groups.

“Except for the osteopath who gave the patients treatments, all the evaluators were blind to the groups.”

Classified as probably not a substantial claim.

This may be because osteopathic manipulative treatment in the current study consisted of interventions to treat the craniocervical system and its structural connections.

“This may be because osteopathic manipulative treatment in the current study consisted of interventions to treat the craniocervical system and its structural connections.”

Classified as probably not a substantial claim.

Drace-Enazmann's methodology was followed using OsiriX Lite tools for the condyle and disc measurements.

“Drace–Enazmann’s methodology was followed using OsiriX Lite tools”

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

A threshold value of 30 mm for maximum mouth opening was reported for patients experiencing sudden or chronic closed locked symptoms due to TMDs, in whom conservative treatments are preferred.

“A threshold value of 30 mm for maximum mouth opening was reported for patients experiencing sudden or chronic closed locked symptoms due to TMDs, in whom conservative treatments, such as manual therapy, physiotherapy, and home exercise, are preferred [33,34].”

• cites [33] Segami, 1990, Arthrographic evaluation of disk position following mandibular manipulation technique for internal derangement with closed lock of the temporomandibular joint, J. Craniomandib. Disord.Not checked — no full text of the source
• cites [34] Komatsu, 2002, A new training device for rehabilitation of lateral mandibular movements: A pilot study, Cranio sourceNot checked — no full text of the source

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

The use of occlusal splints may trigger the inhibition of harmful and sensory stimuli around the cervical tissues and decrease cervical pain in patients with cervical dystonia.

“The use of occlusal splints may trigger the inhibition of harmful and sensory stimuli around the cervical tissues and decrease cervical pain in patients with cervical dystonia [28].”

• cites [28] Kashima, 2005, Effect of short-term use of a centric occlusion stabilization oral appliance on sensory and pain perception thresholds in the cervically innervated area: A pilot study, Cranio sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

An increase >3 mm is recognized as a remarkable improvement for maximum mouth opening ranging from 40 mm to 50 mm.

“However, an increase >3 mm is recognized as a remarkable improvement for maximum mouth opening ranging from 40 mm to 50 mm [35].”

• cites [35] Yoshida, 2005, Simple manipulation therapy for temporomandibular joint internal derangement with closed lock, Asian J. Oral Maxillofac. Surg. sourceNot checked — no full text of the source

May combine two claims.

Joints diagnosed with anterior disc displacement with reduction may gain normal disc-condyle positions when the splint is worn, but most discs and condyles return to their initial positions after the occlusal splint is removed.

“The joints diagnosed with anterior disc displacement with reduction may gain normal disc–condyle positions when the splint is worn. Still, most discs and condyles return to their initial positions after the occlusal splint is removed [28].”

• cites [28] Kashima, 2005, Effect of short-term use of a centric occlusion stabilization oral appliance on sensory and pain perception thresholds in the cervically innervated area: A pilot study, Cranio sourceNot checked — no full text of the source

May combine two claims.

Preferring SS + OMT to SST may increase sleep quality, physical function, and general health while reducing pain related to TMD.

“Preferring SS + OMT to SST may increase sleep quality, physical function, and general health while reducing pain related to TMD.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

The application of osteopathic manipulative treatments may also lead to improvements in cervical and mandibular motions, which are beneficial in curing TMDs.

“Moreover, the application of osteopathic manipulative treatments may also lead to improvements in cervical and mandibular motions, which are beneficial in curing TMDs.”

Classified as probably not a substantial claim.

Another limitation of this study was the small sample size.

“Another limitation of this study was the small sample size.”

Classified as probably not a substantial claim.

In the study of Kropmans et al., improvement in the pain status was deemed significant when the pain was reduced by at least 1.90 points.

“In that study improvement in the pain status was deemed significant when the pain was reduced by at least 1.90 points [36].”

• cites [36] Kropmans, 2000, Smallest detectable difference of maximal mouth opening in patients with painfully restricted temporomandibular joint function, Eur. J. Oral Sci. sourceNot checked — no full text of the source

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

Immediate use of an occlusal splint may also lead to 0.75 mm replacements for the disc in the backward direction.

“Immediate use of an occlusal splint may also lead to 0.75 mm replacements for the disc in the backward direction [44].”

• cites [44] Kurita, 1998, Change of position of the temporomandibular joint disk with insertion of a disk-repositioning appliance, Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endodontol. sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

In the study of Kropmans et al., a minimum increase of 5 mm in the opening after treatment was reported to be clinically important, especially for maximum mouth openings <35 mm before treatment.

“In the study of Kropmans et al., a minimum increase of 5 mm in the opening after treatment was reported to be clinically important, especially for maximum mouth openings <35 mm before treatment [35].”

• cites [35] Yoshida, 2005, Simple manipulation therapy for temporomandibular joint internal derangement with closed lock, Asian J. Oral Maxillofac. Surg. sourceNot checked — no full text of the source

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

The use of different imaging protocols and jaw-fixing devices may result in different locations of the condyle and disc of the temporomandibular joint.

“The use of different imaging protocols and jaw-fixing devices may result in different locations of the condyle and disc of the temporomandibular joint.”

May combine two claims.

SST and SS + OMT increase the role limitation due to the emotional problems score, but the latter leads to a higher increase that can be clinically meaningful.

“SST and SS + OMT increase the role limitation due to the emotional problems score, but the latter leads to a higher increase that can be clinically meaningful.”

• AssumptionRests on an assumption: A five-point change in the 0–100 scale (5%) with a moderate effect size (0.50–0.79) is a minimal clinically important change in SF-36 sub-domains among patients with orthopedic problems.

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

Reduced maximum mouth opening, lateral excursions, and protrusion are well-acknowledged signs of temporomandibular disorders.

“Consequently, reduced maximum mouth opening, lateral excursions, and protrusion are well-acknowledged signs of this disorder [28,29,30,31,32].”

• cites [28] Kashima, 2005, Effect of short-term use of a centric occlusion stabilization oral appliance on sensory and pain perception thresholds in the cervically innervated area: A pilot study, Cranio sourceNot checked — no full text of the source
• cites [29] Yamaguchi, 2006, The advantageous direction of jaw movement for releasing TMJ intermittent lock, Cranio sourceNot checked — no full text of the source
• cites [30] Iglarsh, Z.A., and Oatis, C.A. (2017). Structure and function of the articular structures of the TMJ. Kinesiology: The Mechanics and Pathomechanics of Human Movement, Wolters Kluwer. [3rd ed.].Not checked yet

  Not checked in the free run.

• cites [31] Leader, 2003, Relation of jaw sounds and kinematics visualized and quantified using 3-D computer animation, Med. Eng. Phys. sourceNot checked — no full text of the source
• cites [32] Chen, 1998, The instantaneous center of rotation during human jaw opening and its significance in interpreting the functional meaning of condylar translation, Am. J. Phys. Anthropol. Off. Publ. Am. Assoc. Phys. Anthropol. sourceNot checked — no full text of the source

May combine two claims.

The current study also revealed that SS + OMT may decrease cervical pain even more, while also significantly decreasing other types of pain.

“Meanwhile, the current study also revealed that SS + OMT may decrease cervical pain even more, while also significantly decreasing other types of pain.”

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

Both anterior repositioning splint treatment and stabilization splint treatment may enhance the forward and downward movements of the condyle.

“On the contrary, both anterior repositioning splint treatment and stabilization splint treatment may enhance the forward and downward movements of the condyle.”

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

Different methodologies may lead to different measurements of condyle and disc positions.

“The condyle and disc positions were measured from MR images using Drace–Enazmann’s methodology, and different methodologies may lead to different measurements.”