Influence of botulinum toxin A in pain perception and condyle-fossa relationship after the management of temporomandibular dysfunction: a randomized controlled clinical trial

Effects of botulinum toxin type A in patients with painful temporomandibular joint disorders: A systematic review and meta-analysis

“…Thirteen of the 20 studies employed the research diagnostic criteria for TMD or diagnostic criteria for TMD 17 – 21 , 23 – 26 , 30 – 33 , while the remaining seven studies failed to specify a standardized and validated diagnostic method 22 , 27 – 29 , 34 – 36 . In 11 out of the 20 studies, BTX-A was injected into the masseter and temporal muscles 21 – 23 , 25 , 26 , 29 , 30 , 32 , 33 , 35 , 36 ; in four studies, BTX-A was injected into the masseter, temporal, and pterygoid muscles 17 , 24 , 28 , 34 ; in two studies, BTX-A was injected into the masseter muscle 18 , 31 ; and in three studies, BTX-A was injected into the lateral pterygoid muscles 19 , 20 , 27 . The total dose of BTX-A ranged from 15 to 150 U for each side, and most studies used a low dose of BTX-A (30–50 U for each side).…”

“…The follow-up times range from 4 to 24 weeks. Thirteen studies used saline solution as a placebo 18 , 19 , 21 , 23 – 25 , 28 , 31 – 36 , four studies used oral appliances or occlusal splints 20 , 22 , 25 , 26 , two studies used laser treatment 20 , 29 , and one study used fascial manipulation 30 , dry needling 27 , lidocaine injection 24 , acupuncture 23 , or percutaneous needle electrolysis 17 as the control. Information on the diagnostic criteria of TMD, study design, number of participants, mean age or age range, follow-up period, intervention and control methods, outcome variables, and adverse effects are specified in Table 1 .…”

“…Thirteen studies compared BTX-A with saline injection 18 , 19 , 21 , 23 – 25 , 28 , 31 – 36 . Nine of these studies showed that BTX-A injections were more effective at reducing subjective pain than saline injections 21 , 23 – 25 , 28 , 33 – 36 , while in the other four studies 18 , 19 , 31 , 32 , there were no significant differences in pain reduction between the two treatments. One of the studies also assessed the effect of lidocaine injection, but the results were not significantly different from those of saline injection 24 .…”

“…Another study, which used three different doses of BTX-A, also reported a reduction in muscle contraction and a decrease in muscle thickness and bone volume in the condyloid and coronoid processes as dose-related adverse effects of BoNT-A (which appears more frequently in patients receiving higher doses) 25 . The remaining nine studies lacked information concerning adverse events 18 , 19 , 21 , 22 , 27 , 29 , 30 , 33 , 35 .…”

“…The risk of bias assessment of the included RCTs was carried out using the Cochrane RoB 2.0 tool. Six studies had a low risk of bias 18 – 21 , 23 , 25 , one had a high risk of bias 26 , and 13 studies were classified as having some concerns regarding the reported results 17 , 22 , 24 , 27 – 36 . The details are presented in Figure 4 .…”