IADR Abstract Archives
Manipulation of TMJ Closed-lock: a Systematic Review of ‘Unlocking’ Techniques
Objectives: Manual manipulation of the mandible is an accepted initial diagnostic/therapeutic approach used in patients suffering from a persistent, or intermittent, closed lock caused by temporomandibular joint disc displacement. Various manipulation techniques have been described in the literature, but there is no universally agreed technique. The aim of this qualitative systematic review is to describe and examine the advantages and disadvantages of different manipulation techniques used for persistent, or intermittent, closed lock in order to aid clinicians in selecting the most suitable technique to use in clinical practice.
Methods: Electronic search in Medline-database up to September-1st-2016 and additional searches in Google Scholar and other sources were conducted for English-language publications of any reported manual mandibular manipulation technique used in an attempt to ‘unlock’ the closed lock and/or ‘recapture’ the anteriorly displaced disc. Each novel technique reported was examined and two-independent reviewers assessed its advantages and disadvantages.
Results: Fourteen different manipulation techniques and various modifications were identified. The majority of the reported techniques have two-sequential steps in common: distraction the affected joint by a downward-upward movement; reduction the displaced disc by a forward-inward movement. The reported techniques differed in: person delivering manipulation (patient, clinician); force application (intra-oral, extra-oral); adjunctive use of anaesthetic modalities; assisted joint pumping or lavage. The oldest technique reported by Farrar was the most commonly used in the literature (15-studies).
Conclusions: Mandibular manipulation is a simple, safe, quick, inexpensive, and non-invasive first-line management of TMJ closed lock. The effectiveness of the reviewed techniques, however, is unclear because most of the techniques were examined in non-controlled studies. Future high-quality randomized controlled trials on large sample and long-term follow-up with pre- and post-manipulation imaging are needed to investigate the effects of these techniques in order to determine the most effective and appropriate technique to use for patients with closed lock.
Methods: Electronic search in Medline-database up to September-1st-2016 and additional searches in Google Scholar and other sources were conducted for English-language publications of any reported manual mandibular manipulation technique used in an attempt to ‘unlock’ the closed lock and/or ‘recapture’ the anteriorly displaced disc. Each novel technique reported was examined and two-independent reviewers assessed its advantages and disadvantages.
Results: Fourteen different manipulation techniques and various modifications were identified. The majority of the reported techniques have two-sequential steps in common: distraction the affected joint by a downward-upward movement; reduction the displaced disc by a forward-inward movement. The reported techniques differed in: person delivering manipulation (patient, clinician); force application (intra-oral, extra-oral); adjunctive use of anaesthetic modalities; assisted joint pumping or lavage. The oldest technique reported by Farrar was the most commonly used in the literature (15-studies).
Conclusions: Mandibular manipulation is a simple, safe, quick, inexpensive, and non-invasive first-line management of TMJ closed lock. The effectiveness of the reviewed techniques, however, is unclear because most of the techniques were examined in non-controlled studies. Future high-quality randomized controlled trials on large sample and long-term follow-up with pre- and post-manipulation imaging are needed to investigate the effects of these techniques in order to determine the most effective and appropriate technique to use for patients with closed lock.