Efficacy of Botulinum Toxin Type-A I in the Improvement of Mandibular Motion and Muscle Sensibility in Myofascial Pain TMD Subjects: A Randomized Controlled Trial

Abstract

This study assessed the effects of botulinum toxin type A (BoNT-A) in mandibular range of motion and muscle tenderness to palpation in persistent myofascial pain (MFP) patients (ReBEC RBR-2d4vvv). Eighty consecutive female subjects with persistent MFP, were randomly divided into four groups (n = 20): three BoNT-A groups with different doses and a saline solution group (placebo control group). Treatments were injected bilaterally in the masseter and anterior temporalis muscle in a single session. Clinical measurements of mandibular movements included: pain-free opening, maximum unassisted and assisted opening, and right and left lateral excursions. Palpation tests were performed bilaterally in the masseter and temporalis muscle. Follow-up occurred 28 and 180 days after treatment. For the statistical analysis the Mann–Whitney U-test with Bonferroni correction was used for groups comparisons. Regardless of dose, all parameters of mandibular range of motion significantly improved after 180 days in all BoNT-A groups, compared with the control group. Palpation pain over the masseter and temporalis muscles were significantly reduced in all BoNT-A groups regardless of dose, compared with the control group, after 28 and 180 days of treatment. Independent of doses, BoNT-A improved mandibular range of motion and muscle tenderness to palpation in persistent MFP patients.

Diagnosis and Treatment of Myogenous Temporomandibular Disorders: A Clinical Update

“…Although limited information is available in the literature to compare the efficacies of different injectates, it has been observed that BTXs are increasingly popular in recent years [ 126 ], despite a lack of consensus on its clinical value [ 127 , 128 , 129 , 130 ]. For selected patients, especially those refractory to conventional conservative treatment measures, BTX injection might be a useful tool in modulating pain threshold and restoring motion [ 46 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 ]. It has been noted that the administration of BTX can also improve sleep bruxism [ 139 ], which has long been closely associated with the signs and symptoms of myogenous TMD.…”

Long-Term Effects of a Single Application of Botulinum Toxin Type A in Temporomandibular Myofascial Pain Patients: A Controlled Clinical Trial

“…Additionally, our study found that PPT values significantly increased after 3 months of assessment and that this effect was maintained until the 6-year follow-up. Likewise, previous studies [ 23 , 26 , 29 ] have shown that BoNT-A was able to diminish muscle tenderness to palpation when compared to the placebo over 3 to 6 months. On the other hand, a doble-blind crossover study [ 24 ] including the same population characteristics as ours showed that while BoNT-A achieved a clinically significant reduction in subjective pain (i.e., 30% less pain), no differences were found when compared with the placebo group after three months of evaluation of subjective pain intensity and PPT assessment.…”

Effects of Botulinum Toxin Therapy on Health-Related Quality of Life Evaluated by the Oromandibular Dystonia Rating Scale

“…However, most other studies on BoNT therapy for OMD were based on retrospective chart reviews. Meanwhile, randomized controlled trials have already been reported for bruxism or temporomandibular disorders, which have symptoms similar to jaw closing dystonia and involuntary jaw closing [ 66 , 67 , 68 ]. This is likely because bruxism and temporal disorders have a higher prevalence than OMD and there are many more clinicians and researchers.…”