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Low-level laser therapy for temporomandibular disorders (tmd) treatment: a systematic review of randomized trials

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Restorative*Dentistry*Department,*Federal*University*of*Paraíba,*João*Pessoa,*PB,*Brazil**

Correspondence:*andreulisses@yahoo.com.br*(BATISTA*AUD)*|*Received*09*Jul*2014*Received'in'revised'form*12*Jul*2014*Accepted*18*Jul*2014*

*

*

LEITE

,*Priscila*Kelly*Batista*da*Silva**

MELO

,*Nicole*Freitas*Pereira**

SILVA

,*Pâmela*Lopes*Pedro**

MONTENEGRO

,*Robinsom*Viégas**

BONAN

,*Paulo*Rogério*Ferreti**

BATISTA

,*André*Ulisses*Dantas**

*

*

*

*

*

*

*

*

*

*

*

LOW=LEVEL'LASER'THERAPY'FOR'

TEMPOROMANDIBULAR'DISORDERS'

(TMD)'TREATMENT:'A'SYSTEMATIC'

REVIEW'OF'RANDOMIZED'TRIALS'

*

*

*

ABSTRACT'

*

AIM:* Conducting* a* systematic* review* of* randomized* clinical* trials*

focusing* on* the* efficacy* of* LLLT* on* pain* control* in* patients* with*

TMD,* diagnosed* by* the* Research* Diagnostic* Criteria* for*

Temporomandibular* Disorders* (RDC/TMD).*

MATERIAL' AND'

METHODS:* Search* was* performed* at* PubMed/MEDLINE* database*

with* the* terms:* (1)* “Laser* AND* temporomandibular* disorders”;*(2)*

“Laser* AND* temporomandibular* disorders* AND* RDC/TMD”;* (3)*

“Lowalevel* laser* therapy* AND* temporomandibular* disorders”;* (4)*

“Lowalevel* laser* therapy* AND* temporomandibular* disorders* AND*

RDC/TMD”;* (5)* “Lowalevel* laser* therapy* AND* temporomandibular*

joint* dysfuntion* syndrome”;* (6)* “Lowalevel* laser* therapy* AND*

temporomandibular*joint*dysfuntion*syndrome*AND*RDC/TMD”;*(7)*

“Laser* AND* temporomandibular* joint* dysfuntion* syndrome”* (8)*

“Laser* AND* RDC/TMD”;* (9)* “Lowalevel* laser* therapy* AND*

RDC/TMD”.*Inclusion*criteria:*articles*need*to*be*randomized*clinical*

trial* performed* in* humans;* evaluate* the* effect* of* LLLT* in* the*

treatment* of* TMD* diagnosed* by* the* use* of* RDC/TMD;* published* in*

English*or*Portuguese*in*the*last*10*years.*Protocol*studies*and*pilot*

studies* were* excluded.' RESULTS:* Ten* studies* were* included.* The*

type*of*laser*used*was*Gallium*Aluminum*Arsenide*(GaAlAs)*diode,*

with*exception*of*1*paper,*which*used*super*pulsed*Gallium*Arsenide*

laser.*Eight*studies*reported*decreased*in*pain*levels,*in*two*articles*

there* was* no* statistically* significant* difference* between* test* and*

placebo*groups.*CONCLUSION:*In*most*studies,*LLLT*was*effective*in*

pain* remission,* but* there* is* no* standardization* in* parameters* like*

wavelength,* output* power* and* frequency.* Studies* with* more*

complex* experimental* designs,* standardized* diagnostic* criteria* for*

TMD* and* defined* protocols* for* the* use* of* LLLT* are* needed* to*

determine*its*efficacy*in*the*treatment*of*TMD.*

'

'

KEYWORDS'

*

(2)

INTRODUCTION

Temporomandibular. disorder.(TMD). is.

term.that. includes. several. disorders. involving.

masticatory.muscles,.temporomandibular.joint.

(TMJ). and.orofacial. structures

1

.. Besides,. TMD.

is. considered. as. a. musculoskeletal. disorders.

subclass

2

.. It. possesses. multifactorial. etiology.

and.a.multidisciplinary.approach.is. necessary.

in.its.therapy...

)

Nowadays. there. are.two. main. systems.

for. classiDication. and. diagnosis. of.TMD. which.

are. accepted. worldwide,. the. American.

Academy. of. Orofacial. Pain. (AAOP). and. the.

Diagnostic. Criteria. for. Temporomandibular.

Disorders.Research.(RDC./.TMD)..According.to.

the. AAOP,. TMD. is. divided. into. two. large.

groups.of.disorders:.muscle.TMD.and.articular.

TMD

3

...

.

Dworkin. and. LeResche

4

. (1992),. when.

published.the. Research.Diagnostic. Criteria. for.

Temporomandibular. Disorders. (RDC/TMD),.

suggested. deDined. and. validated. criteria. to.

classify. TMD. patients. in. three. diagnostic.

groups:.Group.I.–.Muscle.disorders,. Group.II.–.

Disc. displacements.and. Group.III. R. Arthralgia,.

osteoarthritis. and. osteoarthrosis,. and. this.

classiDication. is. considered. the. Golden.

standard. in. TMD. diagnosis. research.. The.

diagnosis. is. given. through. two. axis. bringing.

information. on. clinical. evaluation. and. TMD.

classiDication. (Axis. I). and. psychosocial.

evaluation.(Axis.II).of.TMD

5

..Hence,.the.criteria.

e s t a b l i s h e d. b y. R D C / T M D. b r i n g. a.

standardization.for.diagnosis. on.TMD.and.it.is.

an.effective.tool.for.controlled.clinical.studies..

.

For. pain. treatment. of. TMD. patients,.

several. techniques. has. been. suggested,.

prioritizing. the. use. of. conservative. therapies.

such.as.physical.therapy,.acupuncture,.occlusal.

splints,. behavioral. cognitive. interventions,.

drug. therapy. and. lowRlevel. laser. therapy

1

..

Given.that,. invasive.or.irreversible.treatments,.

like. complex. occlusal. therapies,. occlusal.

adjustment.and.surgeries.should.be.avoided.as.

the.Dirst.choice.in.therapy.

.

Several. types. of. phototherapy. devices.

with. different. characteristics. are. available.

including. those. which.use.laser.light.. HeliumR

neon. laser. (HeNe). and. Gallium. Arsenide. and.

Aluminum. laser. (GaAlAs). are.highlighted.. The.

laser.often.applied.in.Dentistry.to.treat.TMD.is.

the.GaAlAs.laser.due. to. its.analgesic. and.antiR

inDlammatory.effects

6

.. Wavelength.of.choice.is.

infrared,..ranging.from.780R904.nm7,.due.to.its.

higher.penetration.power

7

.

.

The. use. of. LowRlevel. laser. therapy.

(LLLT). presents. bio. stimulant,. regenerative,.

analgesic. and. antiRinDlammatory. efDicacy,. also.

providing.the.possibility.to. act.on.the.immune.

system

8

.. Due. to. its. alegated. analgesic. effect,.

LLLT. has. been. suggested. for. TMD. clinical.

treatment..

.

The. low. power. pulse. of. GaAlAs. laser.

showed. signiDicant. stimulating. effects. on. the.

Dibroblasts. activity,. increasing. the. connective.

tissue. repair.. The. analgesia. was. explained.

377

(3)

suggesting.there.is.an.effect.on.the.stimulation.

of. peripheral. nerves. and. of. micro. circulation.

regulation,.interrupting.the.vicious.circle.in.the.

pain.origin.and.development

9

..

.

Regarding. to. the. laser. use. on. TMD.

treatment,. the.evidences. are. relatively. recent..

There. are. several. differences. on. regarding.

research. protocols,. studied. population,.

diagnostic. criteria. used,. laser. type. tested,.

intensity. of. energy,. number. and. places. of.

applications. and. use. or. not. of. placebo.. Many.

times. it. generates. controversial. results. and.

questioning.about.the.real.efDicacy.on.the.LLLT.

treatment. for.pain.control. in.TMD.patients.. In.

many.studies,.the.protocols.used.do.not.follow.

scientiDic. rules. accepted. for. clinical.

investigation. and. they. have. little. credibility.

d u e. t o. t h e. l a c k. o f. d e t a i l i n g. a b o u t.

methodology

8

.

.

Thus,. the. purpose. of.this. study. was. to.

assess,. through.a.systematic. literature.review.

of. randomized.clinical. trials,. the.effectiveness.

of. LLLT. in. the. treatment. of. TMD. pain,.

diagnosed.by.RDC./.TMD.criteria,.verifying.the.

LLLT. efDicacy. on. RDC/TMD. subgroups,. the.

laser. type,. number. of.irradiated. points,. study.

duration,. interval. between. applications,.

applied. energy,. power. and. application. time.

with. better. results.. Also,. it. will. try. to.

determine. if. there. is. a. well. deDined. LLLT.

protocol. for. TMD. treatment. in. the. current.

literature..

MATERIAL)AND)METHODS

A. systematic. literature. review. was.

performed. using. the. data. base. PubMed/

MEDLINE. (International. Literature. in. Health.

S c i e n c e s ). a v a i l a b l e. o n. h t t p : / /

www.ncbi.nlm.nih.gov/pubmed.. Search. terms.

were. selected. in. articles. about. the. theme,.

previously. chosen. and. on. MESH. (Medical.

Subject. Headings). keywords. available. on.

http://www.ncbi.nlm.nih.gov/mesh.. These.

describers. were. used. singly. and. grouped,.

resulting.on.the.following.search.strategy:. (1).

“Laser. AND. temporomandibular. disorders”;.

(2).“Laser.AND.temporomandibular. disorders.

AND.RDC/TMD”;. (3). “LowRlevel. laser. therapy.

AND.temporomandibular.disorders”;.(4).“LowR

level. laser. therapy. AND. temporomandibular.

disorders.AND.RDC/TMD”;.(5).“LowRlevel.laser.

therapy. AND. temporomandibular. joint.

dysfuntion. syndrome”;. (6). “LowRlevel. laser.

therapy. AND. temporomandibular. joint.

dysfuntion. syndrome. AND. RDC/TMD”;. (7).

“Laser. AND. temporomandibular. joint.

dysfuntion. syndrome”. (8). “Laser. AND. RDC/

TMD”;. (9).“LowRlevel. laser. therapy.AND.RDC/

TMD”.

.

Nine. searches. were. performed.. On. the.

Dirst,.Difth.and.seventh.ones,.the.Dilters.from.the.

website. Pubmed. were. included. to. reDine. the.

research,. such. as:. clinical. trial,. randomized.

clinical.trial.e.10.years..On.the.third.search,.the.

Dilters.clinical.trial

)

and.10.years.were.used..On.

the.others.(two,. four,. six,. eight. and.nine),. the.

(4)

Dilters. were. not. used,. since. only. few. matches.

were.found..Each.article.was.revised.and.singly.

selected. by. an. examiner,. based. on. the.

inclusion. criteria. described:. (A). randomized..

clinical.trial;.(B).research.in.humans;.(C).use.of.

LLLT. for. TMD. treatment;. (D). TMD. diagnosed.

by.RDC/TMD.(Research.Diagnostic.Criteria.for.

Temporomandibular. Disorders). Axis. I;. (E).

published. in. English. or. Portuguese;. (F).

published. . in. . the. . last. . 10. years.. NonR

concluded.randomized..clinical.trials.were.not.

included..

RESULTS

The. Dinal. electronic. search. resulted. in.

66.matchs,. as. listed.on. the. Table. 1.. After. the.

revision.of.all.the.articles.found,.the.duplicates.

were.removed.and.the.exclusion.based.on.the.

title. and. abstract. was. performed,. and. 11.

studies. were. selected.. Next,. they. were. suited.

to. the. inclusion. criteria. proposed. on. the.

methods,. and. 10. articles. were. selected,. and.

one.study.was. excluded. because.it. was. in.the.

conclusion. stage. yet. (Table. 2).. The. Figure. 1.

demonstrates.how.the.selection.of.articles.was.

carried.out.in.this.study..

.

Table. 3. presents. data. extracted. from.

the.selected. papers:. author,. year. and. country.

where.the.study.was.performed,.as.well.as.the.

TMD. classiDication. (according. to. RDC/TMD),.

study.type,. number.of.subjects.evaluated,. age,.

presence. or. absence. of. control,. . evaluation.

period,. laser. type,. laser. energy. and. dose. as.

well.as.the.most.signiDicant.results..

.

The. TMD. classiDication. by. RDC/TMD.

occurred. as. follows:. group. I. –. myofascial.

pain

7,10,15

;. group. II. –. disc. displacement

14,15,17

;.

group. III. –. arthralgia

1,14

.. The. study. by.

Rodrigues. et. al.

14

. (2013). was. the. only. one.

which. allowed. patients. with. any. RDC/TMD.

classiDication,.in.the.Group.I,.II.or.III.

.

The. number. of. patients. in. the.

researches. varied. from. 10. (Rodrigues. et. al.,.

2010). to. 99. (Marini,. Gatto. e. Bonetti;. 2010),.

and. the. female. gender. were. prevalent,. what.

corroborates. with. several. studies. that. show.

the.high.prevalence.of.TMD.in. female.gender..

All.the.studies.presented.control.group,.except.

for.Melchior. et. al.. (2013).and.Rodrigues.et.al..

(2013)..The.period.of.study.and.the.quantity.of.

sessions. applied. on. the. patients. varied.

signiDicantly. among. the. studies,. as. can. be.

observed.on.the.Table.3..

.

The. standard. laser. type. used. was.

Gallium. Arsenide. and. Aluminum. laser.

(GaAlAs). diode. in. all. the. studies,. except. for.

Marini,. Gatto. e. Bonetti

16

(2010),. who. used.the.

super.pulsed.Gallium.Arsenide.laser.with.wave.

length. γ. =. 910. nm.. The. wave. length. in. the.

other.studies.varied.from.780.to.830.nm..

379

(5)

Table21.2Number2of2articles2found2for2each2term2researched.2

Term)used)for)search

Number)of)results)

laser.AND..temporomandibular.disorders

24

laser.AND..temporomandibular.disorders.AND.RDC/TMD

02

low.laser.therapy.AND.temporomandibular.disorders

19

low.laser.therapy.AND.temporomandibular.disorders..AND.RDC/TMD

01

low.laser.therapy.AND.temporomandibular.joint.dysfunction.syndrome

06

low.laser.therapy.AND.temporomandibular.joint.dysfunction.syndrome..AND.RDC/TMD

01

laser.AND..temporomandibular.joint.dysfunction.syndrome

08

Laser.AND.RDC/TMD

03

Low.laser.therapy.AND.RDC/TMD

02

Table22.2Article2excluded2after2complete2evaluation.

Author)and)year

Exclusion)criteria

Godoy.et.al.(2013)

10

Study.in.recruiting.stage

Figure21.2Experimental2draw2for2this2study.

.

About.energy.(J/cm²).and.power.(mW),.

a.great.variety.of.parameters.used.can.be.seen..

The.energy.used.varied.from.3.J/cm².to.105.J/

cm²,.and.the.power.from.10.mW.to.400.mW..

(6)

Ta

bl

e&3.&Descript

ion&of&sel

ect

ed&a

rt

icl

es&a

ccording&t

o&t

he&eva

lua

tion&crit

eria

&proposed.&

Author

TMD*classif

Type*of*study

Sample

Con

trol*group

Quan

t*of*session

s/

period*of*study

Laser*type

En

ergy,*power*an

d*

applic

ation

*time

Results

1.&

Çet

iner,&

Kahraman,&Yucetas,&

(2006)

7

Mus

cle

&T

MD

&G

ro

up&

I:&myofascial&pain

Randomized&

cont

rol

led&Cl

inical

&

tr

ial&

39&(4&men&and&35&

women)

Test

&group:&24&

patients

Con

trol

&g

rou

p:&

15&

(l

aser&t

urned&off)

16&

to&

62&

yea

rs&

ol

d

Yes&(15)&–placebo&

las

er

&(

tur

ne

d&o

ff

)

10&

sessions&

divided&

int

o&&2&w

eek

s,&ex

cept

&

we

eke

nd

s

GaAlAs&(830&

nm&–&infra&

red)

7&J/cm²

No&information

by

&1

62

s

Improvement&on&maximum&

mouth&opening,&pain&and&

masticatory&difYicult&

redu

ct

ion

&w

ere&

st

at

ist

ica

lly&

signiYica

nt

&in&

the&

test

&grou

p&

when&compared&to&the&

control&one.&C

onclusion&Z&

LLLT&

w

as&

effect

ive.

2.&

De&

Ca

rl

i&et

&a

l.,&

(2013)

1

Mus

cle

&and

&o

r&jo

int&

TM

D

Pat

ient

s&coul

d&have&

ot

her&TM

D&

subtypes,&inasmuch&

as

&d

iagno

se

d&wi

th

&

changes&of&Group

IIIa&Z&Arthralgia

Randomized&doubleZ

bli

nd

&c

ontr

olle

d&

Cl

in

ica

l&t

ria

l&

32&(29&women&and&3

&

men)

G1:laser+20&mg&de&

piroxicam&(11)

G2:l

(7)

Ta

bl

e&3.&Descript

ion&of&sel

ect

ed&a

rt

icl

es&a

ccording&t

o&t

he&eva

lua

tion&crit

eria

&proposed.&

Author

TMD*classif

Type*of*study

Sample

Con

trol*group

Quan

t*of*session

s/

period*of*study

Laser*type

En

ergy,*power*an

d*

applic

ation

*time

Results

4.&Gokçen<Rohlig&et&

al.,&(

20

12

)

13

Mus

cle

&T

MD

Group&I:&&myofascial&

pain

Randomized&

cont

rol

led&Cl

inical

&

tr

ial

40&(28&women&and&

12&men)

Group&t

est

:&l

aser&

(20)

Group&cont

rol

:&

hea

lt

hy&individua

ls

Average&33&years&

ol

d

Ye

s&(

20

)&G

ro

up&

cont

rol

:&heal

thy&

individua

ls

3&times&a&week&–&10&

sessions

GaAlAs&(820&

nm&–&infra&

red)

3&J/cm²

300&mW&by&10s

No&information&on&

the&number&of&

appli

cati

on&po

ints

&

There&w

as&pa

in&decrea

se&on

&

th

e&gr

oup&i

rr

ad

iate

d,&but&no

&

changes&on&t

he&b

it

e&force.&

Conclusion&<&LLLT&was&

effect

ive&on&pa

in&rel

ief,&b

ut

&

it

&does&not

&provide&

improvement&on&the&bite&

force.&

5.&

M

arini,&

Ga

tt

o,&

Bo

ne

tti

,&(

20

10

)

14

Join

t&TM

D

Cha

ng

es&

of&

Grou

p&

II

&

–&disc&displacement&

wi

th

out&r

ed

uc

ti

on&

and&Group&III&–&

ost

eoa

rt

hrit

is

Randomized&double<

bli

nd

&c

ontr

olle

d&

Cl

in

ica

l&t

ria

l

99&(74&women&and&

25&men)

GL:&l

aser&(39)

GD:&Ib

uprofen&800&

mg&(30)

GC:&pl

aceb

o&l

aser&

(30)

15&

a&

50&

yea

rs&

ol

d

Ye

s&

(G3:30)&pl

aceb

o&

las

er

10&

sessions&

al

ong&

2&

we

eks

SLLLT&–&

Arsenide&

diode&

gallium,&

su

per&

pu

lsed&

laser&–&910&

nm

No&information

400&mW

Appliction&of&20kH

z&

por&10&min,&18&kH

z&

by&5&min&and&16kH

z&

by&5&min

The&pain&decreased&more&

wi

th

&SL

LL

T

&th

an&o

n&th

e&

medicine&groups&and&

control&from&5th&day&until&

th

e&e

nd

&o

f&th

e&pe

ri

od

.&&On&

the&mouth&opening&and&side

&

movements,&the&superiority&

of&SLLLT&w

as&evident

&one&

month&after&the&treatment.&

Conclusion&–the&laser&was&

effect

ive&on&t

he&pa

in&

treatment.

6.&

M

el

chior&

et

&a

l.,&

(2013)

15

My

of

as

ci

al&pai

n&wi

th

&

or&w

it

hout

&joint

&

TM

D

Group&I&–myofascial&

pain&can&pr

es

ent&

ot

her&cha

nges&of&

gr

oups&II&and&III

Randomized&

cont

rol

led&Cl

inical

&

tr

ial

12&(all&women)

All&of&the&group&test&

–&laser

18&

to&

60&

yea

rs&

ol

d

No

2&

sessions&

a&

w

eek

&

du

ring&

4&

w

eek

s

(8&sessions)

GaAlAs&(780&

nm&–&infra&

red)

60&J/cm²

60&mW

by

&4

0&s

&in&e

ac

h&

point&(total&4

&

points

)

There&w

as&signi_ica

nt

&

decrea

se&

on&

the&

va

lu

es&

of&

pain&s

ubjective&to&palpation&

(p&<0.05).&Initial&pain&(A1)&

was

&s

igni

_ic

ant&d

iff

er

ent&o

f&

A2&(30&days&after&

treatment),&but&it&was&no&

signi_icantly&different&of&A3&

(30&days&after&treatment).&

Pain&improvement&did&not&

(8)

Ta

bl

e&3.&Descript

ion&of&sel

ect

ed&a

rt

icl

es&a

ccording&t

o&t

he&eva

lua

tion&crit

eria

&proposed.&

Author

TMD*classif

Type*of*study

Sample

Con

trol*group

Quan

t*of*session

s/

period*of*study

Laser*type

En

ergy,*power*an

d*

applic

ation

*time

Results

7.& O z& et &a l.,& (2010) 16 Mus cle &T MD Group&I&–&myofascial& pain Randomized&controlled & Cl in ica l&t ria l 40&(34&women&and&6& men) Group&t est :&l aser&(20) Group&cont rol :&occl usa l& splint&by&3&months Average&32&years&old Ye s (Cont rol &w it h&occl usa l& sp lint &u sed& 24h& hou rs& a& day&during&3&months) Twice&a&week&P&10& sessions

GaAlAs&diode& laser

,&8

20

&nm

3&J/cm² 300mW by

&1 0s No&information&on&the& number&of&application& points Bo th &o f&th e&gr oups &pr es ente d& decrea sed& sensit ivit y& to& palpation&of&muscles& signiXicantly.&C onclusion&P&LLLT& is&a s&effect ive&a s&t he&occl usa l& sp lint &on& the& pa in& decrea se& and& mandibular&movement& improvement.& 8.& Rodrigu es& et &a l.,& (2013) 17 Mus cle &T MD &and /o r& joint Allowed&patients&with& any&clas si Xicati on&o f& RD C:&Gr oup&I:& myofascial&pain,&Group& II:&disc&displacement&or &

Group&III:&Arthralgia,& arth

ri ti s&e &ar tr ho si s Randomized&controlled & Cl in ica l&t ria l

10&(9&women&and&1& man)&all&elderly 63&

to& 82& yea rs& ol d No 2& sessions& a& w eek & du ring& 4& w eek s (8&sessions)

GaAlAs&diode& laser

,&7 80 &nm My of as ci al&pai n: 5&J/cm² 10&mW&by&20s Join t&TM D: 105&J/cm² 70&mW&by&60s The&resul ts&show ed&signiXica nt & pain&r ed uction&in&all&the& patients.&C onclusion&P&LLLT&was& effect ive&on&t he&pa in&reduct ion& ando&n&the&movement&in&TMD& el derl y&pa tient s. 9.& Sil va &et &a l.,& (2012) 18 Mus cle &T MD &and /o r& joint Repor ts&that&all&the& patients &s hould &have& int ra &joint &TM D.&Resul ts & ar e&no t&d etai le d&by&RD C& dia gnosis& Randomized&doubleP bli nd &c ontr olle d& Cl in ica l&t ria l 45&(30&women&and&15& men) 3& grou ps

G1:&Laser&(52.5&J/cm2) G2:&Laser&105&J/cm2 G3:&pl

aceb o&l aser 25& to& 53& yea rs& ol d Ye s (G3:&pl aceb o&l aser) 2& sessions& a& w eek & du ring& 5& w eek s (10&sessions) GaAlAs&(780& nm&–&infra&red) G1:&52.5&J/cm²&(30s) G2:&105&J/cm² (60s) G3:&0&J/cm² (30s) 70&mW 5& joint &p oint s& and& 4& muscle The&resul ts&show ed&signiXica nt &

statistically&difference&among& the&gr

oups .&T he &pati ents &o f&G 2& ha d&fa st er&response.&Concl usion&

P&LLLT&was&effective&on&the& mandibular&movement& improvement&and&pain&

redu ct ion .& 10.& Venezia n& et &a l.,& (2010) 19 Mus cle &T MD & Group&I&–myofascial& pain&(Ia&e&Ib) Randomized&controlled & Cl in ica l&t ria l 48&(43&women&and&5& men)& G1:&Laser&(25&J/cm2) G2:&pl aceb o&l aser G3:&Laser&(60&J/cm2) G3:&pl aceb o&l aser 18& to& 60& yea rs& ol d Ye s (G2&a nd&G4&w ere& placebo) Tw ice&a &w eek &during&4& we eks (8&sessions)

GaAlAs&diode& laser

(9)

.

The. study. by. Marini,. Gatto. e. Bonetti

16

.

(2010). did. not. inform. the. energy. used. and.

Çetiner,. Kahraman. e. Yucetas

7

. (2006). did. not.

speciDied.the.power.of.application..The.time.in.

which.the.laser.is.applied.is.not.informed.in.all.

the. articles.. Most. articles. demonstrated.

favorable. results. for. LLLT. as. a. treatment.

protocol.for.TMD.pain..According.to.Table.3,.it.

was. possible. to. observe. that. eight. studies.

reported. decrease. of. pain,. even. though. low.

pain. levels. were. not. maintained. after. LLLT.

was. discontinued

7,10,14,16,17

.. Carli. et. al

12

(2013).

and.Venezian.et.al

152

(2010).reported.there.was.

no.statistically.signiDicant.difference.among.the.

test.groups.and.the.placebo..

DISCUSSION

It. is. increasingly. frequent. Dind. in.

scientiDic.studies. high.epidemiological. data.for.

TMD.. 75%. of. population. presents. some. TMD.

signal. and. 33%. presents. at. least. one.

symptom

15

..It.is.suggested.that.near.from.20.to.

70%.of.population.present. any.TMD.signal.or.

symptom

18

.. Part. of. professional. attribution.

about.patient. treatment.is.the.prudence.in.the.

signals. and.symptoms. identiDication,. detailing.

their. causes. to. perform. an. adequate. plan. of.

treatment

19

..

.

SpeciDically. on. TMD. treatment,. LLLT.

shows,. most. of.studies,. as. efDicient. on. muscle.

pain.and.tension.reduction,.further.to.be.a.safe.

and.nonRinvasive.technique..

.

To.establish.the.clinical.efDicacy.of.LLLT,.

study.protocol.should.be.well.delineated..TMD.

classiDication. should. be. adequate,. studies.

should. be. randomized. . and. controlled,. and.

parameters. like. number. of. sessions,. study.

period,. as. well. as. the. type. of. laser. and. its.

parameters. (wavelength,. energy. density,.

power. and. exposure. time). should. be. well.

established.

...

Regarding. to. TMD,. the. most. prevalent.

was. the. Group. I. RDC/TMD. –myofascial. pain.

(seven.studies),. two.studies.classiDied.patients.

in. the. Group. II. –. Disc. displacements. and. for.

only. one. study.the.classiDication.in. the. Group.

III. –. Arthalgia. was. necessary.. Group. I.

prevalence. corroborates. the. study. by.

Manfredini.et.al.

20

.(2011).that.presents.muscle.

disturbances.as.most.frequent.among.patients.

population..

.

There. was. female. gender. prevalence,.

wich. agrees. with. the. current. literature..

Donnarumma. et. al.

21

. (2010). found,. the.

prevalence.of.female.gender.in.their.study.was.

85,6%. of. sample.. TMD. patients. populations.

composed.majority.by.women.was.also.Dind.by.

Manfredini.et.al.

20

.(2011)..

.

Regarding. to. the. age,. there. was. a.

variation.from.16.to. 82.years,. comprehending.

adolescent. and. elderly. with. most. prevalence.

from. 30. to. 40. years. old.. These. data.

corroborates. with. studies. reviewed. by.

Manfredini. et. al.. (2011)

20

,. where. the. average.

found. was. from. 20.2. to. 39.4. anos.. Carrara,.

(10)

Conti.and.Barbosa

3

.(2010).found.a.prevalence.

of. need. of. TMD. treatment. in. 15.6%. adult,.

observing.that.estimates.for.young.population,.

from. 19. to. 45. years,. was. higher. than. oldest.

adults.(up.to.46.years.old).

.

World. Association. for. Laser. Therapy.

presented. a. consesus. about. the. format. of.

clinical. trials.performed.on.LLLT.for.joint.and.

muscle. pain,. establishing. a. placebo. group. as.

part. of. the. trial. to. be.carried. out

7

.. Therefore,.

an.experimental.group.and.a.control.group.are.

of. fundamental. importance. in. any. kind. of.

research.involving. human.beings,. for.that. will.

determine. whether. resource. being. tested. is.

effective.or.not,.beyond.any.doubt.and.without.

interfering.in.the.Dinal.results

21

..

.

The. quantity. of. sessions. was. quite.

varied. and. there. is. no. standard. among. the.

research.. Hence,. more. studies. shall. be.

performed. to. determine. what. is. the. better.

standard. used. regarding. to. the. quantity. of.

sessions. on. TMD. treatment.. However,. it. was.

possible. noticed. that. researches. which. used.

higher.quantity.of.sessions. and.greater.period.

of. treatment. as. protocol. obtained. better.

results. both. regarding. to. the. pain. remission.

and. on. improvement. on. mandibular.

movements.. It. is. clear. that. post. treatment. is.

crucial. to. see. the. efDicacy. of. longRterm. laser.

therapy. on. TMD. treatment

1

,. but. this. conduct.

was. presented.in.few. works. evaluated.in. this.

study

1,12,15,17.

. The. most. used. laser. was. the.

Gallium. Arsenide. and. Aluminum. laser.

(GaAlAs)Dinding. that. there. is. standardization.

evidence,.because.only.one.study.used.another.

laser.type,.the.super.pulsed.GaAs.laser..

.

The. parameters. (doses,. power,.

application.time.and.number.of.point).used.in.

the. studies. varied. widely,. because. each.

researcher. elaborates. his/her. own. protocol.

based.on.previous. studies.. Most.cases. showed.

improvement.on.the.experimental.group.when.

compared. to. the. placebo. one,. proving. LLLT.

efDicacy.. However,. it. is. noticeable. that.

protocols. that. used. higher. energy. and. power.

density.of.irradiation.and.a.greater.number.of.

sessions. and. frequency. of. use. were. more.

effective. in. the. treatment. of. pain,. although.

these.parameters.still.need.to.be.established....

.

The. difDiculty. in. establish. speciDic.

parameters. on. irradiation. is. observed.also. in.

another. health. sciences,. such. as. Physical.

Therapy. and. Medicine

7

.. Even. though. laser.

therapy. seemed. to. be. effective. for. the.

treatment. of.TMD.pain,. it. is.noticeable.that.is.

also. additional. studies. are. necessary. to.

establish. parameters. and. conDirm. or. not. its.

effectiveness..

CONCLUSION

According. to. studies. used. in. this.

research,. the.protocols. of.LLLT.using.seem.to.

show. efDicacy. on. pain. remission. of. TMD.

patients. through. RDC/TMD.. The. diagnose.

subgroup. most. studied. was. myofascial. pain.

(group. I),. showing. good. results.. . The. most.

385

(11)

used. laser. type. was. Gallium. Arsenide. and.

Aluminum.laser.(GaAlAs).

.

There. is. no. standardization. on. the.

clinical. practice. for. LLLT. use,. and. it. was.

observed. great. variation. in. the. therapy.

employed,.mainly.regarding.to.the.parameters.

like.wave.length,.energy.frequency.and.output,.

what. shows. the. imperative. need. to.

standardize.a.protocol.to.achieve.effective.and.

trustful.results.

.

Performing. more. studies. with. most.

complexes. experimental. draws,. standardized.

diagnoses. for. TMD,. greater. samples,. well.

deDined. control. groups. and. deDined. protocols.

for.LLLT.use.with.standardized.parameters.are.

necessary. to. achieve. the. right. evaluation. of.

LLLT.effectivity.for.TMD.treatment..

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Luca. CEP,. Aranha. ACC,. et. al.. Piroxicam. and. laser.

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Maia,.LGM,.Conti. PCR.. Effect.of.lowRlevel.laser.therapy.

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Oral.Rehabil.2005;32(11):800R807.

10.. Fikácková. H.. Dostálová. T,. Navrátil. L,. Klaschka. J..

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Evaluation. of. orofacial. function.in.temporomandibular.

disorder. patients. after. lowRlevel. laser. therapy.. Acta.

Odontol.Scand.2013;71(5):1112R1117.

12..Melchior.MO,.Venezian.GC,.Machado.BCG,.Borges.RF,.

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pain. and. change. orofacial. myofunctional.conditions?. J.

Craniomandib.Pract.2013;31(2):133R139.

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Management. of. Myofascial. Pain:. LowRLevel. Laser.

Therapy. Versus. Occlusal. Splints.. J. Craniofac. Surg.

2010;21(6):1722R1728.

14.. Rodrigues. JH,. Marques. MM,. BiasottoRGonzalez. DA,.

Moreira.MS,.Bussadori.SK,.MesquitaRFerrari.RA,.Martins.

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