A novel vibratory stimulation-based splint for chronic and untreatable masticatory myofascial pain: a case-series.

AIM: This clinical report aimed to introduce a novel vibratory stimulation-based occlusal splint (VibS) for management of chronic and untreatable masticatory myofascial pain (MMFP). METHODS: This study was conducted on four chronic MMFP patients (mean age: 27.5±5.56 years, females) who were diagnosed according to the research diagnostic criteria for temporomandibular disorders (RDC/TMD), and who were using stabilization splints for more than 6 months and still complained of pain above 40 mm in a 100-mm VAS scale. The included subjects utilized the active VibS and subsequently the inactive VibS during 30 days in each trial, separated by a wash-out period of at least 8 months. VAS pain levels were the only measured dependent variable, and were recorded before and after the use of active VibS and inactive VibS. RESULTS: At baseline, mean VAS pain levels before using the active or inactive splint were 54.5±19.8 mm and 44.0±13.6 mm, respectively. After using the active VibS, mean pain level decreased by 77% (VASpos-pre=-42.0±30.3 mm). On the other hand, after using the inactive VibS, severe pain aggravation of 67% in magnitude was observed (VASpos-pre=+29.5±21.5 mm). CONCLUSION: This case-series study demonstrated a good tendency of this novel VibS in chronic MMFP alleviation after a 4-week management period compared to a control inactive VibS.

Estudo do efeito da vibração no tratamento da disfunção temporomandibular através de um protótipo de placa vibratória oclusal / Study of the effectiveness of vibratory plate in the treatment of dysfunction temporomandibular

Este estudo teve como objetivo estudar uma placa oclusalcom estimulação vibratória (POV) de base, para o tratamento da dor crônica miofascial. Foram selecionados 18 pacientes com mialgia crônica facial, de acordo com os Critérios para Diagnóstico em Pesquisa RDC . Os pacientes tinham entre 18 e 65 anos de idade, pertenciam ao sexo feminino e haviam usado placa estebilizadora acrílica por mais de 6 meses, e permaneciam com dor muscular. Foram excluídos pacientes com Disfunção Temporomandibular, que haviam feito uso de analgésicos ou de moduladores de sono, e pacientes desdentados parciais ou totais. A variável analisada foi a dor reportada pelos pacientes, usando a Escala Visual Analógica (EVA) de 100mm, medindo-se antes da instalação da POV, e um mes após o seu uso. Das 18 POV instaladas, 10 apresentaram falhas no mecanismo vibratório. As médias da EVA para os 8 pacientes que utilizaram a POV durante 1 mês foram de 56,62±22.82mm na aferição inicial e média de EVA final de 24,75±20,52mm, com p=0,011. Dos 8 pacientes apenas 4 concordaram com o uso da placa oclusal inativa (POI) por 30 dias, separadas por um período de wash-out de pelo menos 8 meses. Os níveis de dor da escala VAS foram a única variável analisada, e foram registrados antes e após o uso das placas. Foram utilizadas os testes t-teste pareado e ANOVA para medidas repetidas, para se obter os resultados estatísticos. No início do estudo, os níveis médios da VAS de dor antes de se utilizar a placa vibratória de maneira ativa e inativa foram 54,5±19,8 milímetros, e 44,0±13,6 milímetros, respectivamente

A comparação entre esses valores de referência não apresentaram diferença estatística (p> 0,05, teste t pareado). A variação média nos níveis de dor (VAS póspré) ao usar o mesmo tipo de placa, de maneira ativa e inativa foi de -42,0±-30,3 milímetros e 29,5±21,5 milímetros, e o t-teste revelou uma diferença significativa entre os dois grupos (p = 0,07). Foi feitauma nova análise, utilizando-se as mesmas medidas, através da Análise de Variância ANOVA, onde encontrou-se diferença estatisticamente significante (f(3,9)=7.543, p=0.008) antes do uso das placas ativas e das inativas. Entretanto, após o uso da correção com o teste de Bonferroni, foram encontrados resultados condizentes com aqueles obtidos na análise feita pelo programa do teste t. (p>0.05). Pode-se concluir que do uso da vibração como mecanismo de controle da DTM foi eficaz, mas a POV falhou na maioria dos casos devido a problemas mecânicos.

This study aimed to study an occlusal splint with vibratory stimulation (VibsS) as standard, for the treatment of chronic myofascial pain. Were selected 18 patients with chronic facial myalgia, according to the Research Diagnostic Criteria for Temporomandibular Disorders, RDC-TMD.The patients were between 18 and 65years old, female, using stabilization splints for more than six months, and that remained with muscle pain. Were excluded patients with Temporomandibular Disorders, which had made use of analgesics or sleeps modulators and those who were partially or totally edentulous. The analyzed variable was pain reported by patients using visual analog scale (VAS) of 100mm, measuring before the installation of VibsS, and one month after its use. Were installed 18 VibsS; 10 failures in the vibrating mechanism.The mean VAS for the 8 patients who used the VibsS for 1 month were 56.62 ± 22.82mm to measure initial and final mean VAS of 24.75 ± 20.52 mm, p = 0.011. From these 8 patients, only four agreed to the use of an occlusal splints inactive for 30 days, separated by a wash-out period of at least 8 months. The levels of pain-VAS score was the only variable analyzed, and were recorded before and after use of the splints. Were used paired t-tests and ANOVA for repeated measures to obtain the statistics. At baseline, mean levels of VAS pain before using the vibrating splint active and inactive were 54.5±19.8 mm, and 44.0±13.6 mm, respectively

The comparison of these reference values showed no statistical difference (p> 0.05, paired t-test). The average change in pain levels (VAS post-pre) when using the same type of analysis, with active and inactive splints was -42.0±- 30.3 and 29.5 mm±21.5 mm, and the t-test showed a significant difference between the two groups (p = 0.07). After that, was made, a new analysis, using the same measures through the analysis of variance ANOVA, where were found a statistically significant difference (f (3,9) = 7543, p = 0.008) before the use of active boards and inactive. However, after using the correction with the Bonferroni test, we found results consistent with those obtained in the analysis performed by the test program t. (p>0.05). Conclusion: This study showed that is an effective use of vibration as a control mechanism of TMD, but this VibsS failed in most cases due to mechanical problems