An interventional study of Stabilization occlusal splint and manual therapy in Temporomandibular Disorders, sponsored by Wroclaw Medical University. Status unknown. Open to participants aged 18 Years to 60 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2019-04-04.
Sponsored by Wroclaw Medical University · Not applicable, Interventional, and Diagnostic
Contemporary medicine lacks sensitive and objective diagnostic methods for the evaluation of patients with temporomandibular disorders (TMD). Shear wave sonoelastography allows for objective assessment of hardness, tone, and cohesiveness of tissues. Results are expressed in kilopascals (kPa) and can be compared at different time points in the same patient or between patients. The method is non-invasive and safe without any unpleasant experiences for patients.
The project aims to evaluate the usefulness of shear wave sonoelastography in the diagnosis and monitoring of the management of masseter muscles disorders in TMD.
The project will analyze shear wave sonoelastography to determine the pathological tone of masticatory muscles in TMD characterized by pain, abnormal jaw movements and frequent coexistence of headache, otolaryngological disorders, as well as increased tension and pain in the muscles of the neck and shoulder girdle. In the first stage, standardization of sonoelastography of masseter muscles on healthy subjects without TMD will be performed. Normal values of elasticity for various groups of patients as well as factors affecting the result of the study will be determined. Standardization will cover the methodology of the examination. The second stage will assess efficacy of this method in monitoring the treatment progress in patients with TMD diagnosed with the DC-TMD protocol. Standardized sonoelastography examinations and assessment of pain and oral health will be conducted in healthy subjects and in TMD patients at baseline and after 12 weeks of treatment with manual therapy and stabilization occlusal splint. As a result, it will be possible to compare sonoelastography changes in muscle structure in relation to regression of clinical symptoms in response to treatment and to compare sonoelastography results to currently used methods for assessment of TMD.
The need for reliable determining of the sonoelastography values for diagnosis of TMD exist. The hardness of muscles of the human body vary, but norms for masticatory muscles remain undetermined. Available reports are inconclusive. They do not provide a methodology and do not address factors such as age, sex, examination at rest and during jaw-clenching. The present project eliminates those limitations, and as a result, contemporary medicine will get the basis for introducing sonoelastography for the diagnosis and monitoring of masticatory muscles disorders in various groups of patients.
Research project objectives/Research hypothesis Masticatory muscles disorders constitute a serious and frequent diagnostic and therapeutic problem in dental practice. Its symptoms appear in 40-90% of the population. The most characteristic symptoms include acute and chronic pain in masticatory muscles and/or temporomandibular joints, sounds in temporomandibular joints (clicking, popping), and abnormal jaw movements. Those main symptoms may be associated with a headache and otolaryngological disorders, as well as increased tension and pain in the muscles of the neck and shoulder girdle. Physical examination shows that masseter muscles disorders are often associated with their hypertrophy and pain during palpation. The pathogenesis of this disorder is unclear and multifactorial. Diagnostic criteria are based on recommendations of INfORM (International Network for Orofacial Pain and Related Disorders Methodology). The main goal of treatment is the elimination of pain in the masticatory muscles.
The aim of the project is to evaluate the usefulness of shear wave sonoelastography in the diagnosis and monitoring of the progress of treatment of masticatory muscles disorders. To date, few reports attempting to establish normal values have been published, but the available reports have significant limitations.
Research project methodology The study is divided into two stages. The aim of the first stage is the development of the sonoelastography methodology with precise determination of the positioning of the sonography head and the patient's condyles in temporomandibular joints as well as the determination of the normal range of masticatory muscle structure in the population of healthy subjects. This stage includes people without the history of TMD and any deviations from normal values according to DC-TMD protocol. Patients treated with drugs affecting masticatory muscles function as well as those with systemic diseases which affect muscle function (e.g., neurological and hormonal disorders, neoplastic disease), above 60 years of age, patients with mental disorders and not agreeing to participate in the study will be excluded.
Measurement of the masticatory muscle structure will be performed based on the shear wave sonoelastography (SWE) used in the noninvasive assessment of soft tissue hardness. In this method, share waves generated by pressure are detected by longitudinal ultrasonography waves which propagate in the tissues much faster than shear waves. The measurement reflects the quantitative measurement of tissue hardness expressed in kilopascals. Among its advantages are low dependence on the operator, high repeatability and the possibility of quantitative evaluation of tested parameters. The main disadvantage of this method is the fact that every organ has its unique characteristics and hence, normative values must be determined separately for each of them. Examination of masticatory muscles will be conducted by one experienced operator in the same conditions using the same head and the same device. During the examination, the patients will lie on the bed in a supine position. Both masseter muscles will be examined in jaw bite and rest positions.
The second stage concerning the evaluation of the sonoelastography in the monitoring of the efficacy of treatment. Patients with temporomandibular disorders classified as group II - Masticatory Muscle Disorders (DC-TMD). Exclusion criteria will include previous treatment for masticatory muscles disorders and clinical criteria used in the first stage. Control group will include patients without temporomandibular disorders. The treated group will undergo treatment for masticatory muscles disorders with manual therapy and stabilization occlusal splint. The assessment of severity of pain with Numerical Rating Scale and quality of life associated with oral health using standardized international questionnaire - the Oral Health Impact Profile-14 (OHIP-14) will be conducted at baseline and after 12 weeks of treatment. Masticatory muscle structure as measured with sonoelastography and the results of DC-TMD protocols will be compared in order to evaluate treatment efficacy.
609 studies on the registry are indexed under Temporomandibular Joint Disorders; 160 are open to participants now.
This study's planned enrollment of 150 is above the median of 46 across 434 interventional studies indexed under Temporomandibular Joint Disorders.
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Exclusion Criteria:
Without intervention.
With providing stabilization occlusal splint and manual therapy.
Other: Stabilization occlusal splint and manual therapy
Providing stabilization occlusal splint and manual therapy
Determination of normal elasticity values of the masseter muscle
Elasticity values of the masseter muscle will be measured using shear wave elastography in patients without temporomandibular disorders.
Time frame: 12 months
Comparison of elasticity values of the masseter muscle between study groups.
Elasticity values of the masseter muscle will be measured using shear wave elastography in patients with temporomandibular disorders.
Time frame: 12 months
Comparison of the mean intensity of pain between study groups.
Pain will be measured with the Visual Analogue Scale (VAS) for pain and reordered before and after the treatment with stabilization occlusal splint and manual therapy. This is a self-reported single-item scale. Patients select a point between 0 score (no pain) and 10 scores (the worst pain ever) on a 10-point scale.
Time frame: 12 months
Comparison of oral health status between study groups.
Oral health status will be measured with the Oral Health Impact Profile-14 (OHIP-14) score will be reordered before and after the treatment with stabilization occlusal splint and manual therapy. OHIP-14 consists of 14 items testing 7 domains: functional limitations, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap. Response for each question is scored from 0 (the lowest score) to 4 (the highest score). The total scores are calculated by summing response codes. Higher scores indicate poorer oral health status.
Time frame: 12 months
Number of participants with treatment-related adverse events
The information about adverse events according to CTCAE v4.0 of the standardised shear wave sonoelastography will be collected.
Time frame: 12 months
No study locations are listed for this record.
Plan to share: Undecided — Undecided.
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Wroclaw Medical University