Nd: Yag lllt in the treatment of temporomandibular disorders: A treatment protocol and preliminary report

Temporomandibular disorders (TMD) are a series of diseases which affect the masticatory system including temporomandibular joint (TMJ). Low reactive-level laser therapy (LLLT) has beenr eported as having good effects in various joint related pains and conditions. In this study, a suitable LLLT treatment protocol was proposed and the preliminary outcome was demonstrated in a short-term period of follow-up. Thirty (2 men and 28 women) patients with TMD who did not respond to initial conservative therapy were enrolled. The patients were divided into three groups according to their clinical signs, symptoms, and imaging modalities: disk derangement with clicking (DDC), disk derangement with locking (DDL), and osteoarthritis (OA). Low level laser therapy (LLLT) was administrated using a pulsed Nd:YAG laser at an output of 2.8 Watts and 20 pps. The treatment was started by bilaterally irradiating the C1/C2 zone, followed by irradiation of the TMJ area on the affected side. Subsequent treatment was given at intervals of 1 or 2 weeks for a total of two to five sessions. Although LLLT with the pulsed Nd:YAG laser significantly decreased pain in general, some patients, especially those in the DDL group, experienced little decrease in pain. Mean vertical maximal mouth opening increased from 36.8 to 40 mm. However, LLLT did not substantially improve maximal mouth opening in patients with severe impairment of mouth opening (i.e. closed lock). In total, LLLT was effective in 21 of 30 (70 %) of the subjects. The results suggest that LLLT at the wavelength and parameters used in the present study is somewhat effective for reducing pain in the TMJ area, but produces little improvement in mouth opening in patients with closed lock. The degree of efficacy, however, warrants the investigation of other wavelengths and parameters for LLLT for TMD.