Avaliação de imagem por ressonância magnética do posicionamento do disco articular em indivíduos com DTM após mobilização mandibular: estudo de viabilidade

Abstract

Background: Among the instrumental devices that have been proposed over the years to integrate the clinical evaluation of temporomandibular joint disorders (TMD), imaging techniques are the most studied, showing that magnetic resonance imaging (MR) is the technique most need to describe the anatomy of the TMJ and to evaluate the correlation of imaging findings with the clinical diagnosis. Despite the amount available studies on the use of MR for evaluation of TMJ disorders and treatments, there is a lack of studies that evaluate the imaging findings after physical therapy. Purpose: To evaluate the influence of nonspecific mandibular mobilization on the positioning of the articular disc by MR in individuals with TMD diagnosis of anterior disc displacement with and without reduction. And also to analyze the behavior of pain through the numerical scale of pain assessment (END), the quality of life and the behavior of functionality by the Patient´s Functional Scale baseline, immediately, 3 and 6 months after treatment. Metodology: This is a randomized, placebo controlled, blind study designed to study the effects of the nonspecific mandibular mobilization technique x placebo. Individuals will be randomized and divided into two groups: Group A (intervention) and Group B (placebo, and also assessed according to: Diagnostic Criteria for Temporomandibular Disorders (DC / TMD), MR, END, WHOQOL - BREF, the patient's specific functional scale. The positioning of the articular disc, extracted through the use of MR, will be considered the primary outcome and, as a secondary outcome will be assessed the pain, quality of life and functionality after treatment. The adherence of the data to a Gaussian curve will be verified by the Shapiro-Wilk and the data are expressed as mean values and standard deviation. Two-way repeated measures analysis of variance with Bonferroni post hoc test will be used for inter-and intra-group comparisons. The significance level is adjusted p ≤ 0.05. Results: Total of 14 participants were eligible for the study through MRI, diagnosed with anterior disc displacement with or bilateral reduction, totaling 28 temporomandibular joints. The 14 participants were randomized and allocated into 2 groups, 8 participants in the intervention group (GA) and 6 participants in the control group (GB). It was possible to observe that there was a difference in the positioning of the disc assessed by MRI when comparing the moments before and after treatment, as well as a difference in the intensity of pain. There were no differences in secondary outcomes patient-specific functional scale and quality of life. Conclusion: We can conclude that mandibular mobilization influences the positioning of the articular disc and reduces pain intensity in patients with anterior displacement of the disc with and without reduction.