Quantitative evaluation of osteopathic treatment in temporomandibular joint disorders using magnetic resonance imaging

We aimed this study to quantitatively assess the outcome of osteopathic manual treatment (OMT) and investigate the effectiveness of OMT in the treatment of anterior disc displacement (ADDwR) of the temporomandibular joint (TMJ). A total of 19 patients were involved in the study and they were divided into two groups randomly. The study group received a six-week OMT with the occlusal splint during sleeping and the control group only used an occlusal splint for 6 weeks during sleeping. Quantitative MR image analysis was performed to estimate the displacement of the disc and condyle at the intercuspal position of the jaw before and after the treatments. Also, TMJ pain levels, TMJ range of motion, SF-36 Health Quality Scores, Pittsburgh Sleep Quality Index, cervical range of motion, fascial restrictions and muscle shortness were assessed before and after the treatments. To compare inter-group and intragroup differences, Mann Whitney-u Test and Wilcoxon test were performed. There was a significant decrease in TMJ pain in both groups (p<0.05). In the study group, maximum mouth opening (p:0.027; p<0.05), mandibular retrusion (p:0.011; p<0.05) and left lateral excursion (p:0.011; p<0.05) degrees after the treatment compared to pre-treatment values were improved. After OMT+Splint treatment articular disc significantly moved backward (0.74 mm) within the ADD joints and downward (-0.20 mm) within the normal joints. Although there was not any superiority between the disc and condyle position changes of two groups, the effect size analysis revealed that OMT+splint treatment has a strong effect on disc position changes in x axis (d=1.09). Also, in the study group there was a significant increase in the Physical Function (p: 0.018; p <0.05), General Health (p:0.027; p<0.05), Reported Health Transition (p:0.019; p<0.05) SF-36 sub-parameter scores after treatment compared to the scores before treatment. Previous MRI studies revealed the improvement in the disc-condyle disarrangements when the stabilization splint is worn. However, the effect of the splint vanished when it is taken. Therefore, adding OMT to the treatment program may be beneficial in terms of reducing TMJ pain, increasing mandibular movements and disc-condyle stability.