Maitland Mobilization Versus Therapeutic Ultrasound on Trismus Following Third Molar Surgery

Effect of Maitland Mobilization Versus Therapeutic Ultrasound on Trismus Following Third Molar Surgery

This study aims to compare the effect of Maitland mobilization and therapeutic ultrasound on trismus (limited mouth opening) following third molar (wisdom tooth) surgery.

Participants who experience limited mouth opening after third molar surgery will receive one of two treatment methods: Maitland joint mobilization or therapeutic ultrasound. These treatments are commonly used in physical therapy to improve jaw movement and reduce stiffness.

The purpose of this study is to determine which treatment is more effective in improving mouth opening and reducing symptoms after surgery.

Participation is voluntary, and all collected information will be kept confidential and used only for research purposes.

Study Overview

• Status: Completed
• Conditions: Postoperative Trismus
• Intervention / Treatment: Procedure: Maitland Joint Mobilization; Device: Therapeutic Ultrasound group; Other: Control group

Detailed Description

This randomized clinical study will investigate the effect of Maitland mobilization compared to therapeutic ultrasound on trismus following third molar (wisdom tooth) surgery.

Trismus, characterized by limited mouth opening, is a common postoperative complication after third molar extraction and can affect oral function and quality of life All patients of both groups received Standard Postoperative Care designed to promote natural recovery after third molar surgery. The standard care protocol includes the use of Cold Compresses/Ice Packs, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), basic jaw exercises at home to prevent further restriction of jaw movement.

Group A Maitland Mobilization group: Participants received Maitland mobilization therapy. The manual therapy involved graded oscillatory movements targeting the temporomandibular joint (TMJ), aimed at improving jaw mobility and reducing pain following third molar surgery. Each therapy session lasted approximately 15-20 minutes and was conducted three times a week over a period of four weeks. During each session, the physiotherapist applied different grades of mobilization depending on the patient's progress. Grade I and II movements-small, rhythmic oscillations-were used initially to reduce pain and relax the muscles. As the treatment progressed, Grade III and IV mobilizations were applied to stretch the joint capsule and further improve range of motion. Additionally, patients were instructed to perform home exercises to maintain the therapeutic gains between sessions, such as gentle jaw stretching and mouth-opening exercises .

Group B (Therapeutic Ultrasound group): The procedure involved using an ultrasound device , such as the Chattanooga Intelect Mobile 2, which operates at a 1 MHz frequency to target deep tissues like the temporomandibular joint (TMJ) and surrounding muscles. The therapy was conducted three times a week for four weeks, with each session lasting 10-15 minutes. A water-based conductive gel was applied to the skin to facilitate effective transmission of sound waves, and the intensity of the ultrasound was adjusted between 0.8 to 1.5 W/cm² based on patient tolerance. The transducer was moved in slow, circular motions over the TMJ and affected muscles, focusing on areas of pain or stiffness. Group C (Control group ): received traditional physical therapy program only. The outcomes measured included Maximum Interincisal Opening (MIO) via a Vernier Caliper. MIO was measured as the primary indicator of jaw mobility in patients experiencing postoperative trismus. MIO is the distance between the upper and lower central incisors when the patient opens their mouth fully, with the patient seated comfortably and properly supported. The MIO was recorded at baseline (before the intervention) and again at the end of the 4-week intervention period. Each measurement was repeated three times to ensure accuracy, with the average of the three readings used as the final recorded value. This process allows for consistent and precise tracking of improvements in jaw mobility over time.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Egypt
  • El-Sharqia Governorate
    • Abū Ḩammād, El-Sharqia Governorate, Egypt
      • Abu Hammad General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Patients were included in this study have the following criteria

  • Sixty patients had done third molar extraction surgery
  • Patients suffering from postoperative trismus within 2 to 14 days post-surgery.
  • Their age between 20 and 30 years old
  • All patients are medically and clinically stable when attending the study 2.1.2. Exclusion criteria:

The study excluded the following patients:

• Pre-existing TMJ Disorders: Patients with a history of temporomandibular joint (TMJ) disorders or jaw-related conditions (e.g., TMJ dislocation, arthritis, or previous TMJ surgery).
• Neurological or Muscular Disorders: (e.g., facial palsy, stroke, muscular dystrophy).
• Previous Jaw Surgery or Trauma.
• Use of Muscle Relaxants or other form of Physical Therapy treatment.
• Chronic Pain Syndromes: such as fibromyalgia or chronic migraines
• Infections or abscesses post-Surgery.
• Patients have auditory and visual problems

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Maitland Mobilization Group; Participants in this group received Maitland mobilization techniques applied to the temporomandibular joint. The intervention was performed by a trained therapist using graded passive mobilization techniques aimed at improving joint mobility and reducing trismus. Treatment sessions were conducted over the study period with standardized frequency and duration	Procedure: Maitland Joint Mobilization; Maitland mobilization was applied to the temporomandibular joint using graded passive accessory and physiological joint mobilization techniques (Grade I-IV depending on patient tolerance). The technique was performed by a trained physical therapist to improve joint mobility and reduce trismus following third molar surgery. Treatment sessions were conducted three times per week for four weeks
Experimental: Therapeutic Ultrasound group; Participants received therapeutic ultrasound applied to the temporomandibular joint and surrounding muscles. The ultrasound was delivered at a frequency of 1 MHz to target deep tissues. Treatment sessions were conducted three times per week for four weeks, with each session lasting 10-15 minutes. A water-based conductive gel was applied to enhance transmission of sound waves. The intensity ranged from 0.8 to 1.5 W/cm² based on patient tolerance, and the transducer was moved in slow circular motions over the affected area to reduce pain and stiffness	Device: Therapeutic Ultrasound group; using an ultrasound device , such as the Chattanooga Intelect Mobile 2, which operates at a 1 MHz frequency to target deep tissues like the temporomandibular joint (TMJ) and surrounding muscles. The therapy was conducted three times a week for four weeks, with each session lasting 10-15 minutes. A water-based conductive gel was applied to the skin to facilitate effective transmission of sound waves, and the intensity of the ultrasound was adjusted between 0.8 to 1.5 W/cm² based on patient tolerance. The transducer was moved in slow, circular motions over the TMJ and affected muscles, focusing on areas of pain or stiffness (Bhushan et al., 2025).
Active Comparator: Control group; traditional physical therapy program (Standard Postoperative Care, Cold Compresses/Ice Packs, NSAIDs);	Other: Control group; the traditional physical therapy program (Standard Postoperative Care, Cold Compresses/Ice acks, NSAIDs);

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain intensity level	Pain intensity level via The Visual Analog Scale (VAS): The VAS is self-completed by the participant. The participant is asked to place a line perpendicular to the VAS 100 mm line at the point that represents their pain intensity. The examiner reported the VAS score by measuring the distance (mm) from the marked point to the "no pain" anchor using a ruler, providing a range of scores from 0 -100 (Boonstra et al., 2008)	Baseline, immediately post-intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Maximum Interincisal Opening	Maximum Interincisal Opening (MIO) via a digital caliper: The maximum interincisal opening (MIO) measured as the primary indicator of jaw mobility in patients experiencing postoperative trismus. MIO is the distance between the upper and lower central incisors when the patient opens their mouth fully. The measurement taken using a digital caliper, with the patient seated comfortably and properly supported. The MIO will be recorded at baseline (before the intervention) and again at the end of the 4-week intervention period. Each measurement repeated three times to ensure accuracy, with the average of the three readings used as the final recorded value. This process allow for consistent and precise tracking of improvements in jaw mobility over time (Buesa-Bárez et al., 2018).	Baseline, immediately post-intervention

Collaborators and Investigators

• Sponsor: Cairo University

Study record dates

Study Major Dates

• Study Start (Actual): October 10, 2025
• Primary Completion (Actual): February 20, 2026
• Study Completion (Actual): March 10, 2026

Study Registration Dates

• First Submitted: May 3, 2026
• First Submitted That Met QC Criteria: May 3, 2026
• First Posted (Actual): May 8, 2026

Study Record Updates

• Last Update Posted (Actual): May 12, 2026
• Last Update Submitted That Met QC Criteria: May 8, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Maitland technique, Ultrasound, trismus.
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Neuromuscular Manifestations; Spasm; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Trismus; Investigative Techniques; Epidemiologic Research Design; Epidemiologic Methods; Research Design; Methods; Control Groups
• Other Study ID Numbers: 000000 (MRDC)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No