Qual a melhor dose de toxina botulínica tipo a para o controle da dor orofacial em pacientes com disfunção temporomandibular muscular? revisão sistemática com meta-análise

Abstract

Temporomandibular Dysfunction (TMD) affects a considerable portion of the population and comprises a group of chronic pain conditions that affect the temporomandibular joint (TMJ), masticatory muscles and associated structures, and the most common symptom is pain in the masticatory muscles. Of complex pathogenesis and multifactorial etiology, presents fluctuating and self-limited symptoms that require the use of symptomatic therapies to reduce biopsychosocial impacts. The injections of botulinun toxin type A (BTX A) in the masticatory muscles has widespread use in dentistry to control orofacial pain, however, there is no consensus on the doses, as well as on the sites and also on effectiveness in pain control after applications . In view of these observations, the question of this review is whether there is an ideal dose, as well as the best application site for the control of myofascial pain in individuals with temporomandibular disorder (TMD)? A systematic review was performed following the Preferred Items guidelines of Systematic Reviews and Meta-Analysis Reports (PRISMA), using randomized clinical trials that compared pain after BTX A applications, sites and doses used that were compared with diverse active interventions, including saline placebo. Clinical trials were produced until 2019, presented in English, Portuguese or Spanish and were collected in the MEDLINE, VHL, EMBASE, PEDro, SciELO databases, LILACS AND CENTRAL, evaluated according to the JADAD and Cochrane. The results of this systematic review indicate that, with regard to the pain outcome, patients treated with BTX A show a progressive reduction in the values of the Visual Analog Scale (VAS). As for the dose outcome, 50 units (U) were the most used for the masseter muscle within the results found, and 25 U for the temporal muscle. For the outcome range of mandibular movement, there were controversies in the results about the alteration. The places considered to have the best application were the most painful regions on palpation and the largest muscle volume during contraction.