Myogymnastics in the management of temporomandibular joint dysfunction: a randomized controlled clinical trial

BACKGROUND: Temporomandibular joint (TMJ) dysfunction, involving both the joint and the muscles, develops as a result of unbalanced loading of the joint produced by an incorrect orientation of the occlusal plane, even with optimal position of the articular structures. Favorable therapeutic outcomes can be achieved by establishing proper alignment of the vertical, orbital, occlusal, and auricular planes. Myogymnastics—synchronous, well-coordinated anterior and lateral mandibular excursions—plays a critical role in the comprehensive management of TMJ dysfunction.

AIM: This work aimed to evaluate the effectiveness of a combined protocol of masseter and temporalis muscle relaxation using a deprogramming device together with Mariano Rocabado’s myogymnastic regimen in patients with occlusal disturbances and TMJ dysfunction.

METHODS: Muscle relaxation was assessed using electromyography. In the intervention group, mandibular deprogramming and registration of a new mandibular position were performed using a Lucia Jig device in combination with Rocabado’s myogymnastic protocol. The control group did not use deprogramming devices, subsequent splint therapy in the new mandibular position, or preliminary relaxation of the masseter and temporalis muscles. Electromyographic activity of the temporalis and masseter muscles on the right and left sides was recorded, and symmetry and synergy were compared at physiologic rest (absence of load) and during maximal voluntary clenching (maximum load).

Data in each group were obtained at three time points: baseline (diagnostic stage), after registration of the new mandibular position, and 3 months after completion of prosthodontic treatment.

RESULTS: Outcomes in the intervention group, where the Lucia Jig and Rocabado’s myogymnastics were used to register a new mandibular position, were more favorable than in the control group. The difference in bioelectrical activity of the temporalis muscle at rest between groups was 3.83 μV on the right and 6.6 μV on the left. For the masseter muscle, the difference was 13.3 μV. Electromyography assessment of the masseter muscle during the maximum load test demonstrated between-group differences of 83.8 μV (right) and 150.6 μV (left). Additionally, the temporalis muscle values differed by 87.4 μV (right) and 114.3 μV (left) between the groups.

CONCLUSION: This study is the first to employ a method for registering centric relation using a deprogramming device combined with Rocabado’s myogymnastic exercises in patients with occlusal disorders complicated by TMJ dysfunction. The effectiveness of this approach has been demonstrated and is supported by favorable long-term outcomes after placement of definitive prosthodontic restorations. Performing myogymnastic exercises in patients with TMJ dysfunction promotes a stable myostatic reflex, reduces the load on the TMJ capsuloligamentous apparatus, alleviates pain, and positively influences the patient’s psychoemotional state.