Myogymnastics in the treatment of the temporomandibular joint disorders: Randomized controlled clinical trial

BACKGROUND: Myogymnastics, as a way of relaxing the muscular and articular components of the TMJ, is an important element in the implementation of complex therapy. During prosthetic, therapeutic, and orthodontic treatment of patients, including those suffering from cranio–mandibular disorders, the first stage of rehabilitation is the restoration of physiological occlusion – the creation of a horizontal occlusal plane, which includes the use of splint therapy. At the second stage, when restoring the functional position of the lower jaw, myohymnastics is used to normalize the position of the state of the muscular structures of the maxillofacial region. Then the parameters and functional characteristics of the upper jaw are normalized and the structures of the lower jaw are modeled. At the same time, at the stage of treatment and rehabilitation, myohymnastics can be used in combination with other therapies (laser therapy, physiotherapy, etc.).

In this study, for the first time, we applied a method for recording the jaw central relation (CR) by using the deprogramming device in combination with the complex of M. Rocobado’s myohymnastic exercises in patients with occlusive disorders complicated by the presence of TMJ dysfunction. In the course of our work, in order to assess the relaxation of muscle structures, we applied the method of electromyography. We used the Lucia jig as a deprogramming device. The activity of muscle structures, (temporal and masticatory muscles) was recorded at three stages of the study to assess the correctness of prosthetic treatment after obtaining a new jaw position, as well as 3 months after the installation of permanent prosthetic structures in order to assess the long-term results of therapy.

AIM: To evaluate the effectiveness of the using of a complex technique of relaxation of the masticatory and temporal muscles by the deprogramming devices and M. Rokobado’s myohymnastics in patients with occlusive disorders and TMG musculoskeletal dysfunction.

METHODS: For registration the new position of the mandible in the main study group, the Lucia jig was used in combination with the M. Rokobado myogymnastics complex. In the control group, deprogramming devices and subsequent splint therapy were not used in the new position of the lower jaw, and no preliminary relaxation of the masticatory and temporal muscles was performed. In this work, the muscular activity of the temporal and masticatory muscles on the right and left was recorded, and the symmetry of their work on each side and synergy during the period of no load ("physiological rest") and during the "maximum compression" exercise test were compared. In each group of patients, data was obtained at three stages: before the start of treatment (diagnostic stage), after registering the new position of the lower jaw, and 3 months after the end of orthopedic treatment. To assess the intergroup differences at each stage, we use the Kruskal-Wallis H-test.

RESULTS: We determined statistically significant differences in the relaxed state ("physiological rest") of the biopotentials of the muscles of the maxillofacial region (p<0.001): the temporal muscles on the right (Iu=33.51 Mv) and on the left (Iu=32.74 MV) are less than when conducting the corresponding test in the control group of the study – the temporal muscle on the right (Me =37.34 Mv), on the left – (Me=39.35 MV). The results of masticatory muscle activity during electromyography have the same tendency: in patients of the main group (Iu =25.65 Mv), it is statistically significantly less than in patients of the control group (Iu=39 MV). After conducting the "maximum compression" stress test, we recorded statistically significant differences in the bioelectric activity of the masticatory muscle on the right (in patients of the main group (Iu=386.22 Mv, in patients of the control group (Iu=470.05 MV) and in the main group for the masticatory muscle on the left (Iu=388.15), which is statistically significantly less compared to the control patients (Iu=538.78). Electromyography of the temporal muscle in the main group of the study under stress showed the following results (p<0.001): on the right - (Iu=365.43 Mv), on the left - (Iu=367.73 MV). In the control group, the parameters of the temporal muscle (p<0.001) under load were as follows: on the right - (Iu=452.84 Mv), on the left - (Iu=482 MV). A similar trend is observed in the values of muscle symmetry – in the main group, this indicator exceeds that in the control group by 14%. When assessing the synergy, this indicator is higher in the main study group by 5.5%.

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CONCLUSION: According to the results, we have proven the effectiveness of using deprogramming devices (jig Luica) in combination with M. Rocobado's myohymnastics in order to relax the muscles and register a new position of the lower jaw. This fact is confirmed by positive long-term treatment results after permanent orthopedic restorations. Consequently, the performance of complexes of myohymnastic exercises by patients with dysfunctional disorders of the TMJ contributes to the development of a stable myostatic reflex, which reduces the load on the ligamentous–capsular apparatus of the TMJ, reduces pain symptoms, and also has a beneficial effect on the psycho–emotional state of the patient.