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EFFICIENCY OF LIGHT AMPLIFICATION BY STIMULATED EMISSION OF RADIATION (LASER) IN TMJ DISORDERS: AN ORIGINAL RESEARCH

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Abstract

Introduction: The aim of this paper was to evaluate the efficacy of a Laser therapy in patients with Temporomandibular Disorders (TMD) using a low level lasers. Material and methods: A sample of 20 patients with a chief complaint of pain was divided into myogenous and arthrogenous groups. The sample was also divided on the basis of the treatment rendered: real versus placebo treatment. An 830 nm Ga-AI-As Laser device with a energy power of 4 joules was used (OMNILASE, LASERDYNE PTY LTD.) in three treatment sessions. To evaluate the effectiveness of laser treatment, a Visual Analogue Scale (VAS) was used for pain and active range of motion (AROM) was used to measure changes in mandibular function. Results: We observed an improvement in pain only for the myogenous pain patients (p 0.02). For the arthrogenous pain patients, real laser treatment resulted in an improvement in Total Vertical Opening (TVO) (p<0.05), Protrusive excursion (PROT} (p<0.02) and Left lateral excursion (LATLEF} (p<0.02). The placebo control group showed improvement in TVO and PROT for those patients having myogenous pain and LATLEF for those patients having arthrogenous pain. Conclusion: LASER being non-invasive and harmless features of this modality, more research is suggested, using higher power and increased frequency of laser applications.
Turkish Journal of Physiotherapy and Rehabilitation; 32(3)
ISSN 2651-4451 | e-ISSN 2651-446X
www.turkjphysiotherrehabil.org 15233
EFFICIENCY OF LIGHT AMPLIFICATION BY STIMULATED EMISSION OF
RADIATION (LASER) IN TMJ DISORDERS: AN ORIGINAL RESEARCH
DR SHAIKH AFZALUDDIN HUSSAIN1, DR. VIJAY KUMAR YADAV2,
DR. TALWADE PRIYANKA3, DR. SAURABH SHEKHAR4,
DR. ABHISHEK GUPTA5, DR. SHIAD SALIM6, DR. RAHUL VC TIWARI7.
1Associate Professor, Dept. Of Anatomy, SSR Medical College, Belle Rive, Mauritius.
dr.afzaluddin@gmail.com
2Post graduate student, Dept. of Oral Medicine and radiology, Hazaribag college of dental sciences
and hospital, Hazaribag, Jharkhand. vijaydentist259@gmail.com
3Assistant prof. Dept of Pediatrics and Preventive Dentistry, JSS Dental college and Hospital.
JSSAHER, Mysore. talwadepriyanka@gmail.com
4Lecturer, Oral pathology, AIMST University, Bedong, Kedah, Malaysia.
saurabhshekhar2001@gmail.com
5Assistant Professor, Department of Oral Medicine and Radiology, Chitwan Medical college,
Bharatpur, Chitwan, Nepal, 44207. abhishek.gupta@cmc.edu.np
6Reader, Dept. of Oral & MaxilloFacial Surgery, PMS college of dental science and research,
Thiruvananthapuram, Kerala. shiadslm36@gmail.com
7OMFS, FOGS, (MHA), PhD Scholar, Dept of OMFS, Narsinhbhai Patel Dental College and
Hospital, Sankalchand Patel University, Visnagar, Gujarat, 384315. drrahulvctiwari@gmail.com
ABSTRACT
Introduction: The aim of this paper was to evaluate the efficacy of a Laser therapy in patients with
Temporomandibular Disorders (TMD) using a low level lasers.
Material and methods: A sample of 20 patients with a chief complaint of pain was divided into myogenous
and arthrogenous groups. The sample was also divided on the basis of the treatment rendered: real versus
placebo treatment. An 830 nm Ga-AI-As Laser device with a energy power of 4 joules was used (OMNILASE,
LASERDYNE PTY LTD.) in three treatment sessions. To evaluate the effectiveness of laser treatment, a Visual
Analogue Scale (VAS) was used for pain and active range of motion (AROM) was used to measure changes
in mandibular function.
Results: We observed an improvement in pain only for the myogenous pain patients (p 0.02). For the
arthrogenous pain patients, real laser treatment resulted in an improvement in Total Vertical Opening (TVO)
(p<0.05), Protrusive excursion (PROT} (p<0.02) and Left lateral excursion (LATLEF} (p<0.02). The placebo
control group showed improvement in TVO and PROT for those patients having myogenous pain and LATLEF
for those patients having arthrogenous pain.
Conclusion: LASER being non-invasive and harmless features of this modality, more research is suggested,
using higher power and increased frequency of laser applications.
Key words: LASER, TMJ Disorders, Original Study.
Turkish Journal of Physiotherapy and Rehabilitation; 32(3)
ISSN 2651-4451 | e-ISSN 2651-446X
www.turkjphysiotherrehabil.org 15234
I. INTRODUCTION
Low Level Laser Therapy (LLLT) is used for a variety of conditions, including wound healing, management of
some neuropathic disorders, pain relief and therapy for some musculoskeletal disorders. The most common LLLT
currently used includes the helium-neon laser and infrared lasers or gallium-aluminum- arsenide.1-5 Previous studies
demonstrated that a rapid decrease of intra- articular inflammation in the TMJs after infrared laser application.
Parameters of clinical evaluation were maximum mouth opening and subjective pain. However, the author also
stressed the importance of using occlusal appliance therapy concomitantly to stabilize the mandible during the
treatment to achieve optimal results.6-10 When meta-analyses were performed, a study showed that positive
outcomes of LLLT to manage pain are more frequently reported by better designed (double-blind) studies.5,11 On
the other hand, Gam, et al.12 analyzed twenty three LLLT studies and concluded that LLLT is not effective in
musculoskeletal syndromes. As shown in the above studies, double-blind studies are more appropriate when a new
therapeutic modality is being tested. The best advantage of continuing the testing of laser devices for TMD
management is the non-invasive and harmless characteristics. In this study, we evaluate a low laser device featuring
a reliable energy output assessment has been tested in a double-blind placebo trial.13-15
II. MATERIAL AND METHODS
We conducted a prospective clinical trial with 20 subjects diagnosed with TMD. Patients presenting with any other
health conditions were excluded. We selected the subjects based on a standardized and complete clinical
examination, including masticatory and cervical muscle palpation, palpation of lateral and posterior aspects of the
TMJ, measurements of the active range of motion (AROM), and joint noises. In accordance with their diagnoses,
subjects were divided into arthrogenous (10 patients) and myogenous pain patients (10 patients). The response to
palpation was classified as follows: “0” (no pain); “1” (mild pain); “2” (moderate pain); and “3”(severe pain).
Myogenous pain patients constituted a group of ten patients diagnosed with masticatory muscle myalgia without
TMJ pain.
The groups are divided as:
Group I - myogenous pain patients receiving real treatment;
Group II - arthrogenous pain patients receiving real treatment;
Group III - myogenous pain patients receiving placebo treatment
Group IV - arthrogenous pain patients receiving placebo treatment.
Laser treatment was performed once a week for three consecutive weeks with a Ga-Al-As Low Level Laser with a
830 nm wavelength. For the arthrogenous group, the probe was placed over the lateral joint surface close at a 22
degree angle to allow optimum joint penetration. For the myogenous group, the probe was applied over the most
painful muscle spot, detected during muscle palpation. For the control group, the laser device was adjusted with
the same time (40 seconds), but without power. Neither the patient nor the examiner was able to differentiate
between real or placebo treatment. Each patient was evaluated immediately before and five minutes after the laser
treatments. Visual Analogue Scale (VAS) was used to assess the individual level of pain. The objective - the total
vertical opening (TVO), right lateral excursion (LATRIG), left lateral excursion (LATLEF), and protrusive
excursion (PROT) were measured using a plastic millimeter ruler. Comparison was done keeping the p<0.05 as
significant.
III. RESULTS
For the myogenous pain patients (Groups I and III), the most painful spot was found in the superficial masseter in
seven patients, in the temporalis in two patients and in the deep masseter in one patient. Among those considered
arthogenous pain patients (Groups II and IV), three were believed to have an anteriorly displaced disk with
reduction, accompanied by capsulitis and synovitis. When performing the analysis within groups, from time I to
time 6, significant differences were found (p<0.05), as seen in Table 1. For Group I, significant differences were
detected for the VAS between time 1 (mean 56 mm) and times 4 and time 6 (p<0.02). Table 2. For Group II,
significant differences were detected for TVO between time 1 and time 6 (p<0.05), PROT between time l and times
2 and 6 and LATLEF between time 1 and times 5 and 6. For the Group III, for TVO, time l was significantly
different from times 4 and 6. When analyzing PROT for this group, significant differences were found between
time 1 and times 2, 3, 4 and 6 (p<0.05). For Group IV, differences were found in LATLEF between time l and
time 6. The analysis between groups showed no statistical differences for the variables studied.
Turkish Journal of Physiotherapy and Rehabilitation; 32(3)
ISSN 2651-4451 | e-ISSN 2651-446X
www.turkjphysiotherrehabil.org 15235
Table 1: One-way within Groups ANOVA at Different Times
Group Variable
I “p” sig.
II “p” sig.
III “p” sig.
IV“p” sig.
TVO
PROT
LATRIG
LATLEF
VAS
0.561
0.137
0.397
0.251
0.014 “
0.035 *
0.020 * 0.013 “
0.095
0.159
0.159
0.024 “
0.003 “
0.410
0.869
0.803
0.098
0.282
0.109
0.043 *
0.076
Table 2: VAS Mean Values at Different Times (mm)
TIME
2
3
4
5
6
GROUP I
30
34
24
38
20
GROUP II
38
44
36
42
34
GROUP III
46
48
36
42
46
GROUP IV
40
40
32
42
30
IV. DISCUSSION
In our study the differences found for VAS in Group I, were is an agreement with previous studies,10,16,17 where a
cumulative effect of laser therapy was believed to be responsible for pain lowering.18,19 Although not performing a
long-term follow-up study, the benefits obtained from the laser therapy reducing pain in this group seemed to occur
after second and third sessions, which suggest a gradual improvement. An interesting finding was the difference in
VAS between even and odd times, which reflects an immediate response to the laser application, regardless the
type of treatment (real or placebo). 20 In this study, TMJ patients showed no improvement using the VAS analysis
(p = 0.095). This result are similar to the studies of Gam.12 Heussler, et al. reported no differences between real and
placebo groups.14 It could possibly have occurred as a consequence of the anti- inflammatory effect of the laser
therapy as suggested in previous papers. 5,18,19 But why this supposed reduction in inflammation was not reflected
in a statistically significant reduction in pain reported for this group has not been explained. Some authors found
an improvement in range of motion for arthralgic degenerative joint diseases and improvements in maximum mouth
opening for arthrogenous patients. For the placebo groups, when statistical differences were found for TMJ patients,
no differences were found in the pain reported. The power of placebo effect has been extensively demonstrated in
the treatment of TMD. A good relationship between the patient and the professional, along with the “high tech”
appearance of the laser appliance, could possibly explain the improvement in the range of motion.5,14,19 Although
no significant differences were found in the analysis between groups, the VAS value for Group I at time 6 (mean
20.0 mm) represented more than two times that found for Group III (mean 46.0 mm), which could be considered a
meaningful clinical finding. We suggest that a larger sample size and long-term follow-up are needed to evaluate
the exact effect of the LASER.
V. CONCLUSION
Based on the results reported above and the non-invasive aspect of this modality, treatment with laser therapy
should be invigorated.
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