Influence of Manual Therapy in Temporomandibular Joint on the Mandibular Movement: Clinical Trial, Randomised, Placebo-controlled and Blind

Contextualization:Temporomandibular joint dysfunction (TMD) is defined as a group of heterogeneous changes affect a temporomandibular joint (TMJ), affecting anatomical and functional elements, is characterized as a complex and multifactorial disease. The most common signs are joint noises and limitations on the extent of the mandibular movements, associated or not to the articular disc displacement during a mandibular function and predominant symptoms are pain pre-Auricular, on ATM and/or masticatory muscles. A study of an urban brazilian population shows that 39.2% of evaluated feature at least one sign or symptom of TMD.

Its development can be related to the traumatic acometimentos of the jaw or occlusal interference or TMJ, malocclusion, changes in masticatory muscles, microtrauma caused by parafunctional habits, rheumatic diseases, emotional stress, anxiety and postural abnormalities, thus creating a major impact on quality of life and sleep of patients with this disease.

When there is a breakdown between anatomical condyle and articular eminence, disk, drift to occur for the most part, are characterized as previous joint disc displacement, with or without reduction. In both cases, the disk is presented prior to the mandibular condyle with mouth closed, and can resume his position, featuring a disc displacement with reduction (DDCR), having as main feature the snap during an opening. The disc may get introduced before the condyle during the entire opening movement, made a previous offset oral disc without reduction (DDSR), characterized by the presence of clicks, including, in the most serious cases, cause a limitation of motion and functional changes of the mandible, the adaptation of the retrodiscais tissue.

In the light of the whole complexity of the DTM it is necessary the involvement of a multidisciplinary team, including physiotherapy, with the use of manual features, have been highlighting. Manual therapy has been shown to be an important method for pain reduction, disabled and local ischemia, promoting the breakup of fibrous adhesions, improving extensibility of contractile structures, increasing range of motion. Notes that the use of Manual therapy favours the transmission of afferent information for the mecanoceptores stimulating a proprioception and a production of synovial fluid. Studies that have applied manual therapy, electing as mandibular mobilization technique in subjects with TMD, pain reduction and improvement of mandibular range. FELÍCIO et al. (2008), observed increase in WMD and pain reduction in patients treated with Orofacial Miofuncional Therapy in association with techniques such as massage therapy and a joint mobilization.

Knowledge of the movement of the jaw is important for a better understanding of the normal function of the temporomandibular joint (TMJ) and for the study of etiology, diagnosis and subsequent treatment of temporomandibular disorders. The mandibular movement also exerts influence on the joint development of the masticatory system. Therefore, knowing the three-dimensional movement of the jaw (3D) in relation to jaw is essential for clinical applications. A literature provides information on a range of motion measured by the distance between incisal edges of teeth like upper and lower incisors through digital central pachymetry and the average value of opening mouth of UM adult is approximately 50 mm. In patients with TMD buccal opening average is 32 mm and 44 mm to maximum opening without pain. In this way, pick up tools can exploit better a movement evaluation, will contribute without therapeutic success. The kinematics has been increasingly diffused in different areas of knowledge, as in gait analysis of adolescents, children, biomechanical related changes of the feet and Musculoskeletal changes related to patellofemoral syndrome, being useful also in the qualitative evaluation of the ATM graduates movements.