Associação da estimulação elétrica nervosa transcutânea (TENS), terapia manual e placas oclusais nas disfunções temporomandibulares: estudo de caso / Association of transcutaneous electrical nerve stimulation (TENS), manual therapy and occlusal splints in temporomandibular dysfunction: Case study

As disfunções temporomandibulares (DTM) apresentam etiologia multifatorial. Os pacientes com DTM apresentam características clínicas como dores de cabeça crônica, ruídos na articulação temporomandibular (ATM) como crepitações e estalidos, limitação dos movimentos mandibulares, dor e tensão na musculatura mastigatória do pescoço e da cabeça. A redução desses sinais e sintomas pode ser obtida por terapia física, medicamentosa, oclusal e psicoterapia. O objetivo deste trabalho é verificar a eficácia do tratamento conjunto da aplicação da estimulação elétrica nervosa transcutânea (TENS), da terapia manual e da utilização de placa oclusal na DTM. A terapia foi realizada em três pacientes do sexo feminino com idade entre 20 a 40 anos. Os resultados deste estudo demonstram que a associação das técnicas de TENS, terapia manual e terapia oclusal, proporcionaram aos pacientes diminuição do quadro álgico e melhora da amplitude de movimento da ATM, de acordo com os meios de avaliação utilizados. Conclui-se que a associação das técnicas pode ser indicada como método eficaz, não invasivo e de baixo custo no tratamento destes pacientes, ressaltando que ainda é preciso muitos estudos nessa área para comprovação e esclarecimento de protocolos terapêuticos, envolvendo uma equipe multiprofissional.

The temporomandibular dysfunctions (DTM) have a multifactorial etiology. Patients with DTM present clinical features as chronic headache, noises in the temporomandibular joint (ATM) as crackles and click, limitation ofmandibular movements, pain and tension in the masticatory muscles of the neck and head. The reduction of signs and symptoms can be obtained by physical therapy, medication, psychotherapy and occlusal therapy. The objective of this work is to verify the effectiveness of joint processing of the application of transcutaneous electric nerve stimulation (TENS), manual therapy and use of occlusal splints. This treatment was held in three patients females aged between 20 and 40 years. The results of this study demonstrate that the combination of the techniques of TENS, manual therapy and occlusal therapy enabled patients to decrease the pain symptoms and to improve the range of motion of the ATM, according to the methods of evaluation that were used. It is concluded that the combination of these techniques can be suggested as an effective, non invasive and cost-effective method in the treatment of these patients,emphasizing that many studies are needed in this area for evidence and clarification of treatment protocols, involving a multidisciplinary group.

Assessment of cytoskeleton and endoplasmic reticulum of fibroblast cells subjected to low-level laser therapy and low-intensity pulsed ultrasound.

OBJECTIVE: The aim of the present study was to compare the effect of low-level laser therapy (LLLT) and low-intensity pulsed ultrasound (LIPUS) on the cytoskeleton and endoplasmic reticulum of L929 cells. Thermal and non-thermal physical mechanisms such as LLLT and LIPUS induce clinically significant responses in cells, tissues, and organs. MATERIALS AND METHODS: L929 fibroblast cell cultures were irradiated with LLLT and subjected to LIPUS. Cultures irradiated with the laser (904 nm) were divided into three groups: group I, control (no irradiation); group II, irradiated at 6 J/cm(2); and group III, irradiated at 50 mJ/cm(2). Cultures subjected to ultrasound were divided into five groups: group I, control (no LIPUS); group II, LIPUS at 0.2 W/cm(2) in pulsed mode at 10% (1:9 duty cycle); group III, LIPUS at 0.6 W/cm(2) in pulsed mode at 10% (1:9 duty cycle); group IV, LIPUS at 0.2 W/cm(2) in pulsed mode at 20% (2:8 duty cycle); and group V, LIPUS at 0.6 W/cm(2) in pulsed mode at 20% (2:8 duty cycle). Each group was irradiated at 24-h intervals, with the following post-treatment incubation times: 24, 48, and 72 h. The effects of LLLT and LIPUS on the cytoskeleton and endoplasmic reticulum was evaluated by the use of fluorescent probes and with fluorescence microscopy analysis. RESULTS: The results following LLLT and LIPUS demonstrate that ultrasound was more effective than laser on fibroblast cell cultures when the endoplasmic reticulum was assessed, whereas there was a better distribution of the filaments of the cytoskeleton in the cells subjected to laser irradiation. CONCLUSION: The study demonstrated that both LLLT and LIPUS promote changes on the cellular level. However, LIPUS was more effective than LLLT at the doses used here, as assessed by fluorescence microscopy, which revealed increased reticulum activity and increased protein synthesis. However, when the organization of actin filaments was assessed, LLLT achieved a better result.

Comparison between the effect of low-level laser therapy and low-intensity pulsed ultrasonic irradiation in vitro.

OBJECTIVE: The objective of this study was to compare the effect of low-level laser therapy (LLLT) and low-intensity pulsed ultrasound (LIPUS) on fibroblast cell culture. Several methods, including ultrasound treatment and LLLT, are being used to facilitate tissue repair and healing processes. MATERIALS AND METHODS: L929 fibroblast cell cultures were irradiated with low-level laser energy and LIPUS. Cultures irradiated with ultrasound were divided into five groups: group 1: control (did not receive irradiation); group 2: 0.2 W/cm(2) in pulsed mode at 10% (1:9 duty cycle); group 3: 0.6 W/cm(2) in pulsed mode at 10% (1:9 duty cycle); group 4: 0.2 W/cm(2) in pulsed mode at 20% (2:8 duty cycle); and group 5: 0.6 W/cm(2) in pulsed mode at 20% (2:8 duty cycle). Cultures irradiated with laser energy were divided into three groups: group 1: control (did not receive irradiation); group 2: 6 J/cm(2); and group 3: 50 mJ/cm(2). Each group was irradiated at 24-h intervals, with the following incubation periods post-irradiation: 24, 48, and 72 h; after each irradiation cycle the cultures were analyzed using MTT [3-(4.5-dimethylthiazol-2-yl)-2.5 diphenyltetrazolium bromide]. RESULTS: Analysis of results after LLLT and LIPUS demonstrated that the effect of laser therapy on fibroblast cell culture was greater than that of LIPUS (p < 0.05). CONCLUSION: Results demonstrated that LLLT significantly increased fibroblastic activity more than LIPUS. Therefore, in the first and second phases of tissue repair, laser treatment may be more effective than ultrasound treatment.