Dextrose Prolotherapy versus Low Level Laser Therapy (LLLT) for Management of Temporomandibular Joint Disorders (TMD): Clinical Randomized controlled Study

Abstract

Objective: To compare the effects of dextrose prolotherapy and low level laser therapy in terms of the pain (VAS) and maximum interincisal opening (MIO) in treatment of temporomandibular disorders. Patients and Methods:Twenty patients (10 males & 10 females) with temporomandibular disorders TMD participated in this clinical trial. All patients were randomly divided into two equal groups. In dextrose group; 12.5% Dextrose was injected into 3 targeted areas, the posterior joint space, the anterior disc attachment and superior attachment of masseter muscle. Dextrose prolotherapy was performed at 2 weeks, and 4 weeks intervals. In laser group; semi conductive (diode) gallium arsenide (Ga As) laser was utilized in this study. The therapeutic LLLT application was performed 3 times per week for four consecutive weeks. The primary outcome measure was the severity of the pain at rest assessed with visual analogue scale (0-10 cm). The secondary outcome measure was Maximum interincisal opening (MIO). All the evaluations in both groups were done at baseline, 2 weeks, and 4 weeks subsequent to the treatment.Results :The results demonstrated insignificant difference between the means of dextrose prolotherapy and laser groups in terms of VAS (at rest), MIO degree values before treatment (base line) (p>0.05). When the changes in the groups after treatment were compared, there was no significant difference between the means of dextrose and laser groups regarding VAS (at rest) after 2 weeks and 4 weeks (p-value>0.05). However, there was a statistical significant difference (P-value = 0.001) between the means of both groups regarding MIO after 2 weeks and 4 weeks (P-value <0.001). The improvement in maximum interincisal opening was greater in the group that submit to dextrose prolotherapy in comparison to the laser group (p<0.05). Conclusions:In temporomandibular disorders dextrose prolotherapy is more efficient in improving maximum interincisal opening in comparison to low level laser therapy. However, both treatments have the same effect in reducing pain at rest. KEY WORDS:Temporomandibular disorders, Low level laser therapy, Dextrose prolotherapy (96) Nermeen Hassanien, et al.

Efficacy of hypertonic dextrose injection (prolotherapy) in temporomandibular joint dysfunction: a systematic review and meta-analysis

“…In the domain of “bias arising from randomization process”, 2 studies had low bias 22 , 27 , and 8 had some bias 21 , 25 , 26 , 28 – 32 . In the domain of “bias due to deviations from intended interventions, 3 studies had high bias 26 , 28 , 29 , 2 had some bias 31 , 32 and 5 had low bias 21 , 22 , 25 , 27 , 30 . In the domain of “bias due to missing outcome data”, 3 had some bias 26 , 28 , 29 , and 7 had low bias 21 , 22 , 25 , 27 , 30 – 32 .…”

“…In the domain of “bias due to deviations from intended interventions, 3 studies had high bias 26 , 28 , 29 , 2 had some bias 31 , 32 and 5 had low bias 21 , 22 , 25 , 27 , 30 . In the domain of “bias due to missing outcome data”, 3 had some bias 26 , 28 , 29 , and 7 had low bias 21 , 22 , 25 , 27 , 30 – 32 . In the domain of “bias in measurement of outcome”, 7 had some bias 26 – 32 , and 3 with had low bias 21 , 22 , 25 .…”

“…In the domain of “bias due to missing outcome data”, 3 had some bias 26 , 28 , 29 , and 7 had low bias 21 , 22 , 25 , 27 , 30 – 32 . In the domain of “bias in measurement of outcome”, 7 had some bias 26 – 32 , and 3 with had low bias 21 , 22 , 25 . In the domain “bias in selection of reported outcome”, 1 had high bias 27 , 8 had some bias 22 , 25 , 26 , 28 – 32 and 1 had low bias 21 .…”

“…In the domain of “bias in measurement of outcome”, 7 had some bias 26 – 32 , and 3 with had low bias 21 , 22 , 25 . In the domain “bias in selection of reported outcome”, 1 had high bias 27 , 8 had some bias 22 , 25 , 26 , 28 – 32 and 1 had low bias 21 . Overall, the risk of bias assessment amongst included studies was “some” to “high” (Table 2 ).…”

Pain Management in Temporomandibular Disorders: A Review of the Literature

“…Prolotherapy involving the injection of 25% dextrose into the joint has given promising results in terms of pain reduction and improvement of other TMD symptoms when used in patients with TMJ internal derangement [58]. Prolotherapy has also been used with success in case of joint hypermobility where pericapsular injection of dextrose helped to strengthen the capsule and ligaments leading to efficient management of recurrent joint dislocation [59].…”