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Journal: Unpublished MSc thesis Wiener Schule für Osteopathie, Date: 2011/07, Pages: 141, type of study: randomized controlled trial

Free full text   (https://www.osteopathicresearch.org/s/orw/item/2886)

Keywords:

active mouth opening [3]
cranial base release [2]
release maximum [1]
TMD [14]
temporomandibular disorder [16]
cranio-sacral osteopathy [158]
randomized controlled trial [710]
WSO [433]

Abstract:

Study Design Randomised controlled trial Outline/Problem Definition As temporomandibular disorders (TMD) refers to musculoskeletal disorders in the jaw and facial area and adjacent regions of the body, which both can affect the TMJ and the masticatory muscles and adjacent tissues and tissue structures (Society for dental health, function and aesthetics, 2010). In the western industrialized countries about 10% of adults are affected with painful TMD - forms (Carlson and Leresche 1995). Further epidemiological data show clinical signs of TMD in 44 to 75% of the population. The treatment needs of the population is around three percent (De Kanter et al, 1992; John and Wefer, 1999a, b) and can affect all age groups (Helkimo 1974). Most frequently TMD - symptoms are in the age group between 18 and 45, in the elderly, the rate falls again (Locker and Slade 1988). The clinical symptoms of TMD are pain and tenderness on palpation in the TMJ and / or the masticatory muscles, reduced mandibular mobility and temporomandibular joint sounds with deviation of the mandible (society for dental health, function and aesthetics, 2010). The TMD is now classified as neither clear nor is there a generally accepted definition. The TMD at present is either not clear or there is no generally accepted definition. Unlike other diseases of the masticatory system the pathogenesis of TMD is poorly understood. This fact complicates the possibilities for prevention and treatment of TMD. The key taxonomies for TMD are from the anglo - american and scandinavian region. The most commonly used for scientific studies of the taxonomy Helkimo Index (Helkimo 1974) and in 1992 published LeResche of Dworkin the Research Diagnostic Criteria for Temporomandibular Disorders (RDC / TMD) (Dworkin et al. 1992). In both classifications patient history and clinical findings in taxonomies are summarized under symptom and / or diagnostic groups. Research Question & Objective Will a cranial base release have an effect by TMD - Patients on the maximum active mouth opening and the subjective perception of pain? Hypothesis A cranial base release (CBR) has an effect in the maximum active mouth opening and the subjective perception of pain. A cranial base release (CBR) has no effect in the maximum active mouth opening and the subjective perception of pain. Methodology Selection and classification of patients: For the selection of patients for the study dentists and orthodontists with additional qualifications in functional dentistry in the district of Hohenlohe, Heilbronn and Ludwigsburg were contacted. The dentists and orthodontists were given a detailed explanation about the background and purpose of the study and were asked to look for people who wish to voluntarily participate in this study. In a first interview potential participants were informed about the purpose and background of the study. Addition was checked by dentists and orthodontists using RDC / TMD, or ensures the potential participants and exclusion criteria. With a lack of clarity in the context of testing using RDC / TMD additional specialist examinations were ordered by dentists and orthodontists. The project is carried out in the premises of Natura Fit practice. The classification of participants in the two study groups was carried out immediately before the start of the study. Inclusion criteria: The patients who ultimately participated in the study were 19 to 40 years old and all had existing TMD - symptoms. The TMD - symptoms were determined by dentists and orthodontists using RDC / TMD. The age group was selected because TMD - symptoms are often found at the age between 18 and 45. Later the rate falls again (Locker and Slade 1988). Exclusion criteria: Potential patients for this study were excluded if one or more of the following diagnoses were present: ? An acute trauma in the cervical spine, skull ? Instability in the upper cervical region ? Cancer ? Acute respiratory infections ? In oro ? facial treatment ? Neurological disorders ? Blood circulation disorders in the area of the skull ? Taking blood-thinning medicaments Randomized allocation of patients into two groups After checking the inclusion and exclusion criteria the selected patients were randomly divided into two groups: ? CBR - group = with Cranial base release (CBR)-treated group, the CBR was carried out by an osteopath and ? UB - group = untreated control group To ensure the necessary randomization, a coin was thrown, with heads or tails as a possible result. (Kool, 2001). Patients with the outcome Results Active maximum mouth opening (AMMO) Comparison of both groups Looking at the statistic evaluation (comparison of median) the treated group shows a continuous increase in AMMO in contrast to the non-treated group. The conclusion of this is that the Cranial Base Release (CBR) leads to a change in AMMO, which confirms the alternative hypothesis. Thus the null hypothesis is not confirmed. It has to be noticed however that these changes have no significance. Gradient/Change (groups separated) Considering the result data the treated group shows significant changes in the parameter AMMO (p=0.000). The alteration of the median shows a continuous increase in AMMO from test to test. This alteration shows in all three percentiles (25, 50 and 75). As a conclusion the alternative hypothesis can be confirmed by that, whereas the null hypothesis was not confirmed. Comparison of RDC/ TMD (groups separated). The statistic evaluation of the data in this area shows an extreme weakness of the study. Within the single diagnostic groups (based on RDC /TMD) there are too few participants to provide relevant conclusions in the statistic evaluation. In none of the statistic tests there is a significant change visible, which is most likely due to the small number of participants in each group. Pain (GCPS) Comparison of both groups Looking at the statistic evaluation (comparison of median) the treated group shows no change in terms of pain. Within the non-treated group there is a slight decrease in pain.The conclusion of this changes is that the Cranial base release (CBR) has no effect on the AMMO which is a confirmation of the null hypothesis. Thus the alternative hypothesis is not confirmed. It has to be noticed however that this changes too have no significance. Gradient/ Change (groups separated) Looking at the result data the treated group shows a significant change in the parameter pain (p=0.004). The change of the median shows no decrease of pain through CBR as a conclusion of this the null hypothesis can be confirmed, the alterative hypothesis is not confirmed. Comparison RDC/ TMD (groups separated) The statistic evaluation of the result data in this area show an extreme weakness of the study. Within the single diagnostic groups (based on RDC /TMD) there are too few participants to provide relevant conclusions in the statistic evaluation. In none of the statistic tests there is a significant change visible, which is most likely due to the small number of participants in each group. Critical Reflection/Perspectives/Conclusions Discussion and Perspectives The intention of this clinical study was to elaborate the effect of cranial base release on the active maximum mouth opening (AMMO) and the current subjective sensation of pain (GCPS) on TMD patients, by using a visual analog scale (VAS). The following chapters contain a critical reflection and summary of the studies details and results. Methodology Looking at material and methods the following points of critique must be considered: - Regarding the inclusion criteria the group of participants was chosen too generally and non-specifically. The reduction based on the parameter age is possible according to Locker and Slade?s study (1988) but only shows one aspect of the clinical picture TMD. - For the inclusion criteria no parameters of RDC/TMD where included (e.g. diagnostic group reduced to group I) - A limitation of participant to diagnostic group I would also have led to a better illustration and evaluation of Cranial Base Release as a myofascial method. This missing limitation becomes obvious espatialy, where a clean statistic evaluation becomes impossible due to a lack of attendance. - The value established in the preliminary inquiry, which marks the occurrence of a CBR, was completely ignored in the following study. It would have been necessary to include this value in the CBR to have a reference value for upcoming studies. It would also be possible to compare different osteopaths to see if there are difference in the period of time until a release is achieved (maybe the influence of professional experience, specialization, etc.). - Within the study the 10 minute verticalization before the third measuring must be seen critically because of its huge postural influence (Ahlers, 2007). - The measuring parameters of the active maximum mouth opening have a high rate of reliability according to Cleland (2010). It has to be noticed however, that this test is only one of many test in the diagnostic of TMD. To cover more of the clinical picture of TMD and better show the effect of Cranial Base Release more measuring parameters of RDC/TMD would be useful (laterotrusion, deviation movements, etc.)

Abstract original language:
Das Ziel der Studie war die Überprüfung des Effektes eines Cranial base release (CBR) bei Patienten mit einer Temporomandibular disorder (TMD) auf die maximale aktive Mundöffnung und die aktuelle subjektive Schmerzwahrnehmung. 49 Patienten, 34 Frauen und 15 Männer, nahmen an dieser Studie teil. Die mit einem CBR behandelte und die unbehandelte Gruppe wurden bezüglich einer Veränderung der aktiven maximalen Mundöffnung und der subjektiven Schmerzwahrnehmung verglichen. Die Ergebnisse zeigen, dass es signifikantere Veränderungen in den Bereichen der aktuellen subjektiven Schmerzwahrnehmung (p=0,004) und der maximale aktive Mundöffnung (p=0,000) bei der mit einem CBR behandelten Gruppe gibt. Die unbehandelte Gruppe zeigt ebenfalls bei der subjektiven Schmerzwahrnehmung (p=0,002) und der maximalen aktiven Mundöffnung (p=0,000) ebenfalls signifikante Veränderungen. Unmittelbar nach der Durchführung des CBR trat in beiden Gruppen eine signifikante Vergrößerung der aktiven maximalen Mundöffnung ein. Die subjektive Schmerzwahrnehmung veränderte sich ebenfalls bei beiden Gruppen unmittelbar nach dem CBR. Nach  einer Pause von 10 Minuten, die die Patienten in der Vertikalisation verbrachten vergrößerte sich die aktive maximale Mundöffnung nochmals, das aktuelle subjektive Schmerzempfinden bliebt weitgehend unverändert.

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