The Effect of Low Level Laser with Repositioning Appliance in the Management of Temporomandibular Joint Disc Displacement with Reduction

Statement of problem Management of temporomandibular joint (TMJ) Disc Displacement with Reduction (DDwR) is controversial and always presented a therapeutic challenge. The literature suggested the use of a variety of physical therapies in conjunction with occlusal appliances. The majority of the studies were evaluating low Level Laser Therapy (LLLT) effect in treatment of patients with Temporomandibular Disorders (TMDs) of myogenic origin. Few studies had investigated its efficacy in TMDs of arthrogenic origin and degenerative disorders. Purpose Evaluate of the effectiveness of LLLT as an adjunctive treatment modality for DDwR with Anterior Repositioning Appliance (ARA) in comparison to ARA alone. Materials and Methods Thirty two female patients complaining of symptomatic clicking of TMJ were selected. They were diagnosed clinically using Research Diagnostic Criteria of Temporomandibular Disorders (RCD/TMD) as Axis I group II. a (DDwR) and confirmed by magnetic resonance imaging (MRI). They were randomly divided into 2 groups, the first group received maxillary ARA, while the second group received a combination of maxillary ARA and LLLT. Both groups were evaluated after three months for recapturing of articular disc by MRI and for subjective DDwR improvement in terms of Temporomandibular Index (TMI). Results Clinical results revealed a significant reduction in the total TMI index in both groups (P= 0.001 for both groups). Greater improvement from DDwR symptoms was noticed in group II (Who received LLLT and ARA), 87.5 % of patients showed a complete relief of symptoms. However, in group I (who received ARA alone) 62.5 % of patients only showed a complete relief of their symptoms. Magnetic Resonance Imaging results displayed 62.5 % of group I patients and 87.5 % of group II patients showed recapturing of TMJ disc (p= 0.001 for both groups), concentric condylar position, and a mean decrease in anterior joint space values and a mean increase in posterior space values (p= 0.012, 0.001 for group I and II respectively). Conclusions The combined treatment modalities used in this study resulted in recapturing of the articular disc and significant relief of the symptoms. In view of the noninvasive action of LLLT, it can be considered as an effective physical modality in the management of DDwR through its analgesic, anti inflammatory, and biostimulating effect.