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Anatomic location of the lateral pterygoid muscle for nee- dling. Fig. 3. The needle was inserted taking into account the relationship between the muscle and TPs with the surrounding anatomical structures . The presence of a local twitch response during DDN is important given its proven relationship with the desired therapeutic effect.
Source publication
Background:
To determine whether deep dry needling (DDN) of trigger points (TPs) in the lateral pterygoid muscle (LPM) would significantly reduce pain and improve function, compared with methocarbamol/paracetamol medication.
Material and methods:
Forty-eight patients with chronic myofascial pain located in the LPM were selected and randomly assi...
Citations
... Frequency of headache attributed to TMD 84,85 Protrusion 58,62,71,72,79,83,86,89,90 Eletromyographic analysis 29,57,[66][67][68]76,77 Intensity of headache attributed to TMD 80,84,85 Lateral movement 58,62,71,72,79,83,86,[88][89][90] Participants' expectancy 110,116 Tinnitus-related handicap 103 Pain intensity while chewing 123 Pain-related disability (Graded Chronic Pain Scale) 98-100, 103, 110, 115, 116 Nonspecific physical symptoms 99,109,110 Patients' satisfaction 118 ...
... Frequency of headache attributed to TMD 84,85 Protrusion 58,62,71,72,79,83,86,89,90 Eletromyographic analysis 29,57,[66][67][68]76,77 Intensity of headache attributed to TMD 80,84,85 Lateral movement 58,62,71,72,79,83,86,[88][89][90] Participants' expectancy 110,116 Tinnitus-related handicap 103 Pain intensity while chewing 123 Pain-related disability (Graded Chronic Pain Scale) 98-100, 103, 110, 115, 116 Nonspecific physical symptoms 99,109,110 Patients' satisfaction 118 ...
Introduction
The selection of appropriate outcomes in clinical trials and systematic reviews is a crucial factor in determining the results that are useful, reliable, and relevant for both patients and healthcare professionals. Clinicians and researchers have been encouraged to develop and apply core outcome sets (COS) to minimise the discrepancy between studies.
Aim
This systematic review is the first phase of the COS development project for clinical trials in temporomandibular disorders (COS‐TMD). It aims to identify and synthesise the outcomes used in the randomised controlled trials (RCT) that evaluated the effectiveness of interventions used in TMD management.
Materials and Methods
An electronic search was performed in several databases: MEDLINE (via PubMed), Scopus, Web of Science, Cochrane Library and EMBASE. The eligibility criteria comprised RCT that applied any intervention to treat temporomandibular joint disorders or masticatory muscle disorders. The identified outcomes were categorised according to domains of the Initiative on Methods, Measurement and Pain Assessment in Clinical Trials (IMMPACT).
Results
The electronic search resulted in 1606 studies. After removing duplicates and applying the eligibility criteria, 106 RCT were included. A total of 43 studies evaluated masticatory muscle disorders, 27 evaluated temporomandibular joint disorders, and 36 analysed mixed TMD.
Conclusions
The evaluation showed significant variability in the types of outcomes and their measurement instruments. In addition, some domains such as physical and emotional functioning, participant ratings of global improvement and adverse events have been neglected when determining the effectiveness of treatments for TMD.
... Only 4 out of 11 RCT trials were proven to have a low risk of bias, necessitating careful interpretation of the study's findings [44][45][46]51]. It is significant to note that the conclusions presented by other researchers in other systematic reviews correspond with the lack of quality seen in other included studies [57,58,68]. The remaining 7 papers that were a part of this systematic review are of Di Francesco et al. ...
... It is important to emphasize that in the past 10 years, more studies using acupuncture to treat TMD have been published [60][61][62][63][64].The application of AT, LAT, and placebo simultaneously in the management of TMDs is the study's strength, however the small sample size and brief follow-up time should be viewed as its weaknesses. To further clarify the best course of action for treating patients with TMD, double-blind, randomized controlled trials with a bigger patient sample and lengthy follow-up periods are necessary [65][66][67][68]. Future research should examine different laser parameters in LLLT and LAT modalities in order to establish the ideal setting and maximize the physiological benefits of laser therapy for the treatment of TMD, even though Madani et al. [43] found that these treatments were more effective than a placebo. ...
Objective
The aim of this study is to perform a qualitative and quantitative analysis of the scientific literature regarding the use of acupuncture and laser acupuncture in the treatment of pain associated with temporomandibular disorders (TMDs). The aim of this article was to assess the clinical evidence for acupuncture and laser acupuncture therapies as treatment for temporomandibular joint disorder (TMD).
Materials and methods
This systematic review includes randomized clinical trials (RCTs) of acupuncture and laser acupuncture as a treatment for TMD compared to other treatments. Systematic searches were conducted in 3 electronic databases up to July 2023; PubMed, EMBASE, and SCOPUS databases. All RCTs of acupuncture for TMD were searched without language restrictions. Studies in which no clinical data and complex interventions were excluded. The Cochrane risk of bias tool (RoB 2) tool was employed to analyze randomized controlled trials. A Meta-analysis was performed in order to investigate a quantitative analysis comparing acupuncture and laser acupuncture to placebo.
Results
A total of 11 RCTs met our inclusion criteria. The findings show that acupuncture is short-term helpful for reducing the severity of TMD pain with muscle origin. Meta-analysis revealed that the Acupuncture group and Laser Acupuncture group had a higher efficacy rate than the Placebo control group, showing a high efficacy of Acupuncture and Laser Acupuncture group in the treatment of temporomandibular.
Conclusions
In conclusion, our systematic review demonstrate that the evidence for acupuncture as a symptomatic treatment of TMD is limited. Further rigorous studies are, however, required to establish beyond doubt whether acupuncture has therapeutic value for this indication. However high efficacy of Laser Acupuncture in the treatment of temporomandibular disorders was reported.
... The only outcome measure that was consistently evaluated in at least three studies of dry needling and three studies of manual therapy over the same timescale (short term: between 1 and 3 months) was pain intensity. Therefore, a total of eight RCTs were included in the NMA; five evaluated the effects of manual therapy [21,22,[36][37][38] and three the effects of dry needling [20,23,39] on pain intensity between 1 and 3 months after the end of the treatment. The flow of studies through the selection process of the review is presented in Fig. 1. ...
... The contribution table shows that the studies with the greatest influence on the mixed comparisons are the studies by Gonzalez-Perez et al. [39] and Lopez-Martos et al. [20] that compared dry needling versus placebo (0.841%), and the studies by Corum [22], De Laat [36] and Kalamir [38] that compare cognitive therapy vs. manual therapy (0.897%). However, no direct comparison influenced more than 1% in the total of mixed comparisons, so it is unlikely that the methodological quality of the individual articles did not bias the consistency of the analysis (Additional file 7: Appendix S7). ...
Background
Temporomandibular disorders (TMDs) are the most common cause of orofacial pain of non-dental origin, with approximately 42% of diagnoses corresponding to myofascial pain. Manual therapy and dry needling are commonly used interventions for the treatment of myofascial temporomandibular disorders. However, it is unclear whether one of them could be superior to the other.
Objectives
The aim of the present systematic review and network meta-analysis was to compare the effectiveness of manual therapy and dry needling in patients with myofascial TMD.
Methods
This is a systematic review and network meta-analysis. Randomized clinical trials were searched in the databases of Pubmed, PEDro, CINAHL, Web of Science, Scopus, Cochrane, Google Academic and EMBASE. The methodological quality of studies included in this review was judged using the Physiotherapy Evidence Database (PEDro) scale. A frequentist network meta-analysis was carried out, assuming random effects, to estimate the effects of interventions for temporomandibular joint pain measured on a 10-point visual analogue scale.
Results
Out of 3190 records identified, 17 met the inclusion criteria for qualitative analysis and eight were included in the network meta-analysis. Indirect comparisons between dry needling and manual therapy showed no significant differences in their effects on pain reduction (Odds Ratio [95%CI]; − 0.263 [− 1.517, 0.992]). The ranking of treatments shows that manual therapy (SUCRA = 0.932) followed by deep dry needling (SUCRA = 0.775) present the highest values of estimation and can be considered the most likely to reduce pain.
Conclusions
The results of the network meta-analysis should be considered with caution due to the low quality of the evidence available and the high variability of the study protocols in terms of the method of application of dry needling and manual therapy interventions.
PROSPERO under identifier: (CRD42020186470).
... A breakdown by country of the 32 articles ultimately selected revealed that there were 9 from China, [58][59][60][61][62]64,68,71,72] 3 from Turkey, [41,66,67] 1 from Japan, [43] 5 from Brazil, [49,55,56,63,69] 3 from the US, [42,46,47] 2 from the UK, [45,53] 4 from Spain, [50,51,57,70] 2 from Sweden, [52,54] 1 from Poland, [65] and 2 from Austria. [44,48] Participants with TMD included in the studies presented with various TMJ-related clinical features, and various diagnostic criteria were included. ...
... [44,48] Participants with TMD included in the studies presented with various TMJ-related clinical features, and various diagnostic criteria were included. Study populations varied between 12 and 240, while the number of participants included in acupuncture or control group varied between 6 and 80 (Supplementary Tables 2-4 Study designs for RCTs included in the analysis were as follows: comparisons of acupuncture with an inactive control (n = 16), [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] comparison of acupuncture with a conventionally used active control (n = 19), [50,[52][53][54][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70] and comparison of effects of an active control with the same treatment plus acupuncture use as an add-on treatment (n = 4). [65,66,71,72] Among these, 5 articles contained both inactive and active controls, [50,[52][53][54]56] and 2 articles used both active controls and add-on treatments with active controls [65,66] (Supplementary Tables 2-4 Inactive controls used included the following: sham acupuncture, [41][42][43][45][46][47]49,50,55] sham laser acupuncture, [44,48,56] sham DN, [51,53] and no treatment (wait-list) [52,54] (Supplementary Table 2, http://links.lww.com/MD/J688). ...
... [65,66,71,72] Among these, 5 articles contained both inactive and active controls, [50,[52][53][54]56] and 2 articles used both active controls and add-on treatments with active controls [65,66] (Supplementary Tables 2-4 Inactive controls used included the following: sham acupuncture, [41][42][43][45][46][47]49,50,55] sham laser acupuncture, [44,48,56] sham DN, [51,53] and no treatment (wait-list) [52,54] (Supplementary Table 2, http://links.lww.com/MD/J688). Traditional active controls identified were as follows: physical therapy including ultrasound and ultrashort-wave therapy, [50,[58][59][60][61][62] laser therapy, [56] drug therapy, [57,64,65,67] injection therapy, [53,63,[66][67][68] and the use of a splint [52,54,69,70] (Supplementary Table 3, http://links.lww. com/MD/J689). ...
Background
Acupuncture is used for treating various disorders, but its effects on temporomandibular disorder (TMD) remain unclear. This study aimed to assess the effectiveness and safety of acupuncture for TMD via a systematic review of randomized clinical trials.
Methods
A total of 11 Korean and worldwide databases were searched to identify acupuncture studies in adults with TMD. A Cochrane risk of bias assessment was performed on all articles; a meta-analysis, which involved the categorization according to the type of control used (inactive control, active control, or add-on), was subsequently performed. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation methodology.
Results
The qualitative analysis of randomized clinical trials with acupuncture as the intervention included 32 articles, 22 of which were included in the quantitative analysis (471 participants). Acupuncture significantly improved outcomes (effect rate, relative risk [RR]: 7.00, 95% confidence interval [CI]: 1.91, 25, 62; visual analog scale, standardized mean difference: 0.49, 95% CI: 0.24, 0.73) versus active controls (effect rate, RR: 1.19; 95% CI: 1.12, 1.27). In the analysis of add-ons, acupuncture significantly improved the effect rate and pain intensity (effect rate, RR: 1.36; 95% CI: 1.04, 1.77; visual analog scale, mean difference: −1.23; 95% CI −1.79, −0.67). However, the quality of evidence was determined to range from low to very low.
Conclusion
Acupuncture in TMD significantly improved outcomes versus active controls and when add-on treatments were applied. However, as the quality of evidence was determined to be low, well-designed clinical trials should be conducted in the future.
... Myofascial pain disorder must be suspected in patients with pain in the masticatory muscles, along with the existence of painful trigger points on palpation, and limited mouth opening [13]. One of the masticatory muscles most frequently affected is the lateral pterygoid muscle [14,15]. Patients with TMDs often present with a reduced range of motion, deviations in mouth opening, and joint noise. ...
... When performing this technique, an analgesic effect is produced as a consequence of its somatosensory involvement, producing relief from local and referred pain [23]. In recent studies, dry needling has shown positive effects in the treatment of pain in some myofascial structures that are difficult to access through manual palpation [15]. ...
Dry needling (DN) is an invasive physiotherapy technique employed for reducing myofascial pain. To compare the effectiveness of dry needling (DN) versus manual therapy (MT) in improving pain, active maximal mouth opening (AMMO) and cervical disability in patients with myofascial pain from temporomandibular disorders (TMDs) were investigated against these treatments. A single-blind, randomized controlled trial was carried out. Individuals (n = 50) with TMDs were randomly allocated in a 1:1 ratio to the DN (n = 25) or MT group (n = 25). Each group received three sessions, separated by 4 days, of either DN or MT. Outcomes were assessed according to pain intensity (Numeric Pain Rating Scale), AMMO (cm), disability (Neck Disability Index), and pressure–pain threshold (PPT) (digital algometry) from the active myofascial trigger points. In both groups, pain and neck disability were significantly lower at the end of treatment compared with those measured at baseline (pain: −2.52 with 95% CI: −3.43 to −1.60 for DN group; pain: −2.92 with 95% CI: −3.77 to −2.07 for MT group; disability: −3.2 with 95% CI: −4.31 to −2.09 for DN group; disability: −2.68 with 95% CI: −3.56 to −1.79 for MT group), but not were not lower after the first session, without differences between the groups. AMMO was significantly higher after the first session (0.16 with 95% CI: 0.03 to 0.29 for DN group; 0.30 with 95% CI: 0.20 to 0.41 for MT group) and at the end of treatment in both groups (0.27 with 95% CI: 0.14 to 0.41 for DN group; 0.37 with 95% CI: 0.22 to 0.52 for MT group) compared with the baseline measurements. Finally, PPT results for the masseter and pterygoid muscles were significantly higher at the end of treatment in both groups (without statistically significant differences between groups), but not after the first session. The assessed therapies, DN and MT, are equally effective in improving pain, AMMO, cervical disability, and PPT in the muscles directly involved in the temporomandibular joint biomechanics of patients with myofascial TMDs.
... Although in a large number of patients a satisfactory reduction in pain can be achieved after one or more conservative treatment methods, there remains a significant group of refractory cases that should be directed towards minimally invasive procedures, with dry needling being one such technique used to inactivate TrPs without the injection of any substance [8]. Several studies have shown that dry needling provides effective pain relief and short-term muscle functional recovery, and have reported its safety, efficacy, and low cost [9,10]. Dry needling can be combined with an electrical current to provide other management modalities. ...
... We designed a randomized controlled study comparing two minimally invasive emergent interventions. As in previous studies, an adequate sample size of 26 subjects per group was calculated [2,8,10]. We established this estimate by taking into account the required change in VAS pain scores and the existing standard deviation of the results. ...
... The best site to inject the toxin and the optimal dose must be determined, and BTA cost-effectiveness studies must be conducted to estimate whether the cost-benefit ratio is clinically acceptable. Epidemiological studies on the prevalence of patients with localized MM are scarce, and more valid data are needed in the context of a public health system such as ours [2,8,10]. Therefore, its cost should be considered in comparison with other less costly conservative measures, such as PNE [14]. ...
Botulinum toxin type A (BTA) is applied in muscle hyperactivity disorders and injected into affected muscles, producing deep and persistent muscle relaxation. Several multidisciplinary groups investigated the treatment of temporomandibular disorders for several years, and there is currently some data on the beneficial effects of BTA in specific cases of chronic masticatory myalgia. Percutaneous needle electrolysis (PNE), which applies a low-intensity galvanic current to promote tissue regeneration, has been shown to be effective in reducing pain and improving masticatory function. The purpose of this study was to investigate the efficacy and safety of BTA and to assess whether its application in patients with localized masticatory myalgia can significantly reduce pain and improve function compared to a group treated with PNE. Fifty-two patients with long-term refractory masticatory myalgia were randomly assigned to two groups. The BTA group (n = 26) received a bilateral botulinum toxin injection and the PNE group (n = 26) received percutaneous electrolysis. The dose of BTA injected was 100 units distributed among the main primary masticatory muscles, and PNE was administered at 0.5 mA/3 s/3 consecutive times in a single session. Patient assessments were performed prior to treatment and one, two, and three months after treatment. The results revealed good therapeutic response in both groups. In the long term, both BTA and PNE showed high efficacy and safety in reducing pain and improving muscle function for the treatment of chronic masticatory myalgia. This improvement was sustained over a three-month period in both groups. Therefore, the use of BTA and PNE could be considered a valid and safe therapeutic alternative among the available options to treat refractory and localized masticatory myalgia when a better therapeutic response is expected as it demonstrated high efficacy.
... The research of Luis-Miguel Gonzalez-Perez et al. [16] resulted in a significant reduction in spontaneous pain, pain in chewing, increased opening and movement, functionality of TMJ in patients treated with muscle relaxant and dry injection, but better results for the latter, with side effects to pharmacotherapy in patients treated with muscle relaxants. ...
The wide variety of disorders and abnormalities affecting the manducatory apparatus has led to a multitude of therapies of various kinds including orthopedic, kinesiological as well as pharmacological treatments. Several studies have highlighted the effectiveness of orthopedic therapies using occlusal splints as well as kinesiological treatments. However, pharmacological treatments, by their multitude and their diversity remain little documented regarding clinical efficiency, with the absence of a global conclusive study. The aim of this work is to conduct a systematic review evaluating the clinical efficacy of the drugs used in the treatment of temporomandibular dysfunction. Materials and Methods: This is a systematic review questioning the Pubmed database. The research was conducted using the following key words: "Craniomandibular disorders"; "Drug therapy"; "Relaxing Muscle, Central". Articles published between January 2012 and end of August 2017 and meeting the eligibility criteria were identified after reading their titles then summarized by 2 readers. The critical analysis of the methodology was conducted based on the PICO criteria and the JADAD scoring analysis (strengths and weaknesses of each study). The effectiveness of drugs was evaluated based on their action on the following three parameters: Dyskinesia, pain and noise. Results: Of the 420 references originally found on Pubmed, 23 articles were selected. After full reading of the 24 articles selected and application of the JADAD score: • 3 articles treated botulinum toxin including 1 high rank and 2 low ranks for a conclusion in favor of the toxin. • 7 articles discussed hyaluronic acid, 5 of which ranked high and 2 of low rank all agreeing on the efficacy of this therapy. 5 articles on corticosteroids, including 1 high and 4 low, however, no consensus has been reached on its effectiveness. Only 1 item of high rank proved the beneficial effect of anesthetics on muscle pain. 1 high-ranked study and 1 low-ranked trial for nonsteroidal anti- inflammatory drugs that have not been conclusive about its effectiveness. • 3 low-grade items treating PRP were able to demonstrate efficacy as an adjunct to arthrocentesis. 1 low ranking article on painkillers has proven its value as an adjunct to arthrocentesis.
... An interesting meta-analysis found evidence suggesting that acupuncture applied by physical therapists was superior to no treatment or sham treatment, but was as equally effective as other physical therapy treatments for short-and mid-term follow-ups for functional outcomes in patients with musculoskeletal pain [54]. Several studies have demonstrated that real acupuncture of the masticatory muscles was more effective than medication or sham needling in patients with pain syndrome caused by TMDs [55][56][57] or bruxismrelated pain [58]. Moreover, the orofacial region is the area where more studies are comparing the effectiveness of acupuncture versus other injection therapies. ...
Background: Pain management is one of the main parts of treatments for Temporomandibular Disorders (TMDs). However, there is still a lack of high-quality evidence that compare the overall effects of these non-surgical treatments. The objective of this systematic review is to identify the most potential treatment protocol in dealing with pain caused by TMDs through a mixed comparison of interventions based on network meta-analysis. Methods: A systematic review and network meta-analysis of studies identified by searching PubMed, Embase, Medline, Ovid, and CINAHL. All the included studies should have characteristics that: (1) participants with TMDs of any age; (2) non-surgical treatments; (3) score of Visual Analog Scale (VAS) as the outcome measure; (4) randomized controlled trials. The Cochrane Bias Assessment Toll was used to assess the bias, the CINeMA website was applied to rate the confidence of evidence, and ADDIS software was used to conduct the network meta-analysis. Results: 46 studies were included in this review. The agreement between authors reached a kappa value of 0.78. The results of the network meta-analysis showed that wearable therapy devices are more likely to be the best choice for reducing the pain of patients with myogenic TMDs, whereas a combination of platelet-rich plasma injection and wearable therapy devices is more likely to be the best choice for reducing the pain in a long term after treatment for patients with mix-type TMDs. Moreover, the application of therapy equipment has the most potential in reducing pain in a long term after treatment for patients with articular TMDs. Discussion: Wearable devices have a great potential for pain syndrome caused by TMDs, the mechanism might come from a biomechanical perspective. However, the overall confidence rating of evidence is low. Studies with high quality are still needed in the future. Other: The PROSPERO Registration Number of this systematic review is CRD42021253442.
... However, only one trial [73] in the Jung et al. [72] review utilized manual needle manipulation, and 60 of the 91 needle locations were inserted into distal points (i.e., primarily in the hands and feet) far removed from the region of pain and dysfunction instead of the local muscles of mastication and/or peri-articular tissue associated with the TMJ capsule. Notably, acupuncture [74][75][76] and DN [69,77] trials that have directed needling to the local muscles of mastication (i.e., the lateral pterygoids, masseter, and temporalis) with manual and/ or electric stimulation have reported statistically significant improvements in pain and function, which is consistent with the findings of the present study. While a number of studies further recommend acupuncture [78] and DN [79] for joint osteoarthritis, the present study is one of the first to additionally insert needles in structures anatomically related to the posterior capsule of the TMJ itself, a primary anatomical structure that is seemingly associated with the pathophysiology of TMD [40,42,80]. ...
Objective:
To compare the effects of dry needling and upper cervical spinal manipulation with interocclusal splint therapy, diclofenac, and temporomandibular joint (TMJ) mobilization in patients with temporomandibular disorder (TMD).
Methods:
One hundred-twenty patients with TMD were randomized to receive six treatment sessions of dry needling plus upper cervical spinal manipulation (n = 62) or interocclusal splint therapy, diclofenac, and joint mobilization to the TMJ (n = 58).
Results:
Patients receiving dry needling and upper cervical spinal manipulation experienced significantly greater reductions in jaw pain intensity over the last 7 days (VAS: F = 23.696; p < 0.001) and active pain-free mouth opening (F = 29.902; p < 0.001) than those receiving interocclusal splint therapy, diclofenac, and TMJ mobilization at the 3-month follow-up.
Conclusion:
Dry needling and upper cervical spinal manipulation was more effective than interocclusal splint therapy, diclofenac, and TMJ mobilization in patients with TMD.
... In the orofacial area, several authors have studied the effectiveness of dry needling on the muscles of mastication in order to increase the pain threshold to pressure and to maximize the free-of-pain opening of the mouth [17,18]. The study conducted by Luis-Miguel Gonzalez-Perezse et al., focusing on the application of DDN in the lateral pterygoid muscle, which should always be treated under strict ultrasound control due to its complex accessibility and management, reported a reduction in pain and an improvement in maximum mouth opening mobility, jaw protrusion and laterality [18]. ...
... In the orofacial area, several authors have studied the effectiveness of dry needling on the muscles of mastication in order to increase the pain threshold to pressure and to maximize the free-of-pain opening of the mouth [17,18]. The study conducted by Luis-Miguel Gonzalez-Perezse et al., focusing on the application of DDN in the lateral pterygoid muscle, which should always be treated under strict ultrasound control due to its complex accessibility and management, reported a reduction in pain and an improvement in maximum mouth opening mobility, jaw protrusion and laterality [18]. This was in agreement with the results obtained in a different DDN study on the temporal and masseter muscles, where the effects measured immediately after and a week after the procedure were evaluated [19]. ...
Background and Objectives: The objective of our clinical trial was to determine the effectiveness of the deep dry needling technique (DDN) (neuromuscular deprogramming) as a first step in the treatment of temporomandibular disorders. Methods and Materials: The double-blind randomized clinical trial comprised 36 patients meeting the inclusion criteria who had signed the corresponding informed consent form. The participants were randomly distributed into two groups, the Experimental group (Group E) and the Control group (Group C). Group E received bilateral DDN on the masseter muscle, while Group C received a simulation of the technique (PN). All the participants were evaluated three times: pre-needling, 10 min post-needling, and through a follow-up evaluation after 15 days. These evaluations included, among other tests: pain evaluation using the Visual Analog Scale (VAS) and bilateral muscle palpation with a pressure algometer; evaluation of the opening pattern and range of the mouth, articular sounds and dental occlusion using T-scans; and electromyography, which was used to evaluate the muscle tone of the masseter muscles, in order to control changes in mandibular position. Results: Digital control of occlusion using Tec-Scan (digital occlusion analysis) showed a significant reduction both in the time of posterior disclusion and in the time needed to reach maximum force in an MI position after needling the muscle, which demonstrated that there were variations in the static position and the trajectory of the jaw. The symmetry of the arch while opening and closing the mouth was recovered in a centric relation, with an increase in the opening range of the mouth after the procedure. Conclusions: facial pain is significantly reduced and is accompanied by a notable reduction in muscle activity after needling its trigger points.
