Evaluation of the Effectiveness of Dry Needling in the Treatment of Myogenous Temporomandibular Joint Disorders

Juan Dib-Zakkour, Javier Flores-Fraile, Javier Montero-Martin, Sara Dib-Zakkour, Ibrahim Dib-Zaitun, Juan Dib-Zakkour, Javier Flores-Fraile, Javier Montero-Martin, Sara Dib-Zakkour, Ibrahim Dib-Zaitun

Abstract

Background and Objectives: The objective of our clinical trial was to determine the effectiveness of the deep dry needling technique (DDN) (neuromuscular deprogramming) as a first step in the treatment of temporomandibular disorders. Methods and Materials: The double-blind randomized clinical trial comprised 36 patients meeting the inclusion criteria who had signed the corresponding informed consent form. The participants were randomly distributed into two groups, the Experimental group (Group E) and the Control group (Group C). Group E received bilateral DDN on the masseter muscle, while Group C received a simulation of the technique (PN). All the participants were evaluated three times: pre-needling, 10 min post-needling, and through a follow-up evaluation after 15 days. These evaluations included, among other tests: pain evaluation using the Visual Analog Scale (VAS) and bilateral muscle palpation with a pressure algometer; evaluation of the opening pattern and range of the mouth, articular sounds and dental occlusion using T-scans; and electromyography, which was used to evaluate the muscle tone of the masseter muscles, in order to control changes in mandibular position. Results: Digital control of occlusion using Tec-Scan (digital occlusion analysis) showed a significant reduction both in the time of posterior disclusion and in the time needed to reach maximum force in an MI position after needling the muscle, which demonstrated that there were variations in the static position and the trajectory of the jaw. The symmetry of the arch while opening and closing the mouth was recovered in a centric relation, with an increase in the opening range of the mouth after the procedure. Conclusions: facial pain is significantly reduced and is accompanied by a notable reduction in muscle activity after needling its trigger points.

Keywords: deep dry needling trigger points; myofacial pain; randomized clinical trial; temporomandibular dysfunction.

Conflict of interest statement

The authors declare not to have any conflict of interest.

Figures

Figure 1
Figure 1
Patient lying in the required position for needling.
Figure 2
Figure 2
Electromyography surface electrode positioning.
Figure 3
Figure 3
Pre-needling registry of the activity in MI position.
Figure 4
Figure 4
Digital occlusal analysis determining the characteristics of the jaw position.
Figure 5
Figure 5
Graph of EMG activity in CR position compared with other techniques (CR-P, CR-L), Table 1.
Figure 6
Figure 6
Graph EMG activity comparison of the right masseter using different CR measuring methods. Regarding the opening of the mouth and its symmetry, we found a significant change, of >0.05, in the opening, with a mean value of 44.92 mm pre-needling, measured between the incisal borders of the superior and inferior centrals.
Figure 7
Figure 7
Graph mean mouth opening value measured in mm.
Figure 8
Figure 8
Graph T-Mi, time needed to achieve maximum force measured in seconds.
Figure 9
Figure 9
Graph DT posterior disclusion time measured in seconds.
Figure 10
Figure 10
Graph articular sound presence percentage.

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