Temporomandibular Disorders Research Articles

Study of the Diagnostic Accuracy Between the Position of the Articular Disc According to Magnetic Resonance Imaging and Arthroscopy Findings for Temporomandibular Disorders.

The aim of this study was to prospectively evaluate the diagnostic accuracy between the position of the disc in the temporomandibular joint (TMJ) according to findings on magnetic resonance (MRI) imaging and the position of the disc depending on the "roofing" in arthroscopic evaluation in patients who underwent arthroscopy for a temporomandibular disorder (TMD). This relationship was analyzed in 298 patients diagnosed with internal derangements. The concordance between the 2 methods was evaluated using the κ coefficient. A significant agreement was observed between the findings in MRI and roofing in arthroscopy with an excellent concordance between the variables (κ=0.83, P<0.05). This indicates that both diagnostic methods are equally valid in the precise description and evaluation of the disc position for patients with a TMD undergoing arthroscopy.

Healing joints with precision: The role of prolotherapy in treating TMD’s

Temporomandibular disorders (TMD) affect the masticatory muscles and temporomandibular joints, causing pain and functional issues. This case report describes a 41-year-old female with chronic severe degenerative arthropathy of the left TMJ, who initially responded to conservative treatments but later received prolotherapy for persistent symptoms. Following prolotherapy, her pain score decreased from 7 to 3, and her mouth opening improved from 25 mm to 44 mm over three months. This case highlights prolotherapy's potential as an effective alternative for TMD treatment, complementing traditional conservative methods.

EFFECT OF INTERMAXILLARY FIXATION ON BIOCHEMICAL AND BLOOD MARKERS IN A SAMPLE OF YEMENI ADULTS

Background: Intermaxillary fixation is a technique that is used in the treatment of jaw fractures, orthognathic surgery, temporomandibular joint disorders, and occasionally morbid obesity. However, it disrupts normal nutrition, leading to weakened immunity, impaired healing, and higher complication risks, negatively impacting treatment outcomes and patient recovery. Thus, the aim of this study was to investigate the physiological changes in a sample of Yemeni patients following four weeks of IMF treatment. Materials and Methods: A study involving ten Yemeni adults underwent intermaxillary fixation for mandibular fractures. Parameters like body weight, lipid profile, liver function tests, kidney function tests, electrolytes, and hemoglobin levels were analyzed before and after treatment at a central blood bank. Results: The majority of patients were male (80.0%) and aged between 25 and 35 years, and the majority had a unilateral mandibular body fracture (50%). Clinical results after 4 weeks of intermaxillary fixation demonstrated significant reductions in body weight (4.2 kg) and BMI (1.0 kg/m2). post-IMF application, lipid profile analysis showed non-significant changes in total cholesterol, high-density lipoprotein levels, low-density lipoprotein, and triglycerides (p&gt;0.05), liver function tests exhibited significant decreases in AST (7.7 µ/l, p=0.044), kidney function tests and electrolyte analysis revealed non-significant changes, and there were significant reductions in T.WBC (2.48 x 10⁹/L) and neutrophils (19.5%) after IMF (p=0.007). Conclusions: Intermaxillary fixation in Yemeni adults leads to weight loss and changes in liver and blood parameters, indicating its systemic effects. These findings highlight the importance of nutritional support and close monitoring during IMF treatment to mitigate malnutrition risks and optimize healing outcomes. Peer Review History: Received 21 May 2024; Reviewed 15 July 2024; Accepted 25 August; Available online 15 September 2024 Academic Editor: Dr. Marwa A. A. Fayed, University of Sadat City, Egypt, maafayed@gmail.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Abdulwahab Ismail Al-kholani, Dean of Faculty of Dentistry at 21 September University, Yemen. prof_khholani@yahoo.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com

Cryoablation in Chronic Pain Management: A Narrative Review

Abstract Cryoneurolysis is a technique of applying extreme cold temperatures to specific sensory nerves, causing a prolonged period of loss of conduction through that nerve. This technique has found widespread application in the field of interventional pain medicine in a variety of conditions including chronic postsurgical pain, phantom limb pain (PLP), and cancer pain. Its use in chronic pain states has been aided further by the advent of handheld cryoneurolysis devices and the widespread use of ultrasonographic imaging to guide and target nerves accurately. Chronic pain states – chronic knee pain from osteoarthritis, refractory PLP, temporomandibular disorders, cervicogenic headaches, low back pain, different peripheral neuropathies, and metastatic bone tumor pain – are some of the conditions where cryoneurolysis has been proven to benefit patients in cases where the symptoms were refractory to other conventionally used modalities. Chronic pain is a complex and multifaceted condition and hence requires a variety of individualized treatment approaches. Current research on this treatment method for chronic pain indicates that it carries low risk and, when used correctly, offers extended pain relief without causing motor function loss. This narrative review includes all types of scientific studies, published between 2010 and 2023, which were selected using a specific set of keywords through two different literature search engines. In conclusion, it explains how cryoneurolysis works to provide long-term pain relief and summarizes the latest evidence supporting its use in chronic pain management.

The preliminary study of the effects of individual musculoskeletally stable position in the treatment of temporomandibular disorders

BackgroundTemporomandibular Disorders (TMD) is the dysfunction of group of muscles and bones in the joint area, the main symptoms of TMD are the pain of the chewing muscles and (or) the temporomandibular joints, mandibular movement disorders and joint noise. This study was designed to explore the therapeutic effects following Individual Musculoskeletally Stable (IMS) position stabilization splint therapy for TMD patients using Fricton index, cone beam computed tomography (CBCT) and surface-Electromyogram (sEMG).MethodsIn this study, we enrolled 31 TMD patients (ranging from 18 to 26 years old, including 7 males and 24 females), first Fricton index was used to evaluate the clinical curative effect of TMD with the treatment of IMS stabilization splint; then CBCT was used to observe the TMJ condylar position changes of TMD before and after the treatment of IMS stabilization splint; finally sEMG was used to observe the changes of electromyography of anterior temporalis (AT) and masseter muscles (MM) of TMD before and after the treatment of IMS stabilization splint.ResultsThe course of treatment was 6–8 months, with an average of 7.6 months. After the IMS stabilization splint treatment, TMD symptoms relieved, especially in pain, mandibular movement disorder, but still slightly inferior in the treatment of joint noise. And there was a statistically significant difference in the anterior and inner joint space, the condyle had the tendency of moving forward and outward. AT presented reduction significantly of EMG value at rest position after treatment.ConclusionsIMS stabilization splint is a therapeutic reversible treatment for TMD, especially for pain and mandibular movement disorder; it produces effects of forward and outward condylar movement and elimination of the masticatory muscles antagonism.

Impact of manual therapy on body posture-3-D analysis with rasterstereography – pilotstudy

IntroductionThe relationship between posture and temporomandibular disease (TMD) is unclear. The aim of our study was to determine the influence of manual therapy (MT) on posture in TMD patients compared with healthy subjects.Material/methodAfter consideration of inclusion and exclusion criteria, 30 subjects were included. These were divided into two groups: group A comprised 15 healthy subjects and group B 15 patients with present proven TMD disease. Rasterstereographic images were taken at different times. Group A subjects were scanned twice within half a year and group B before initiation as well as after the first MT and after completion of the prescribed MT. The different posture variables were calculated using DIERS Formetric software.ResultsTo illustrate the differences between the two groups, 10 different postural variables were examined. Significant differences between the two groups were observed in pelvic tilt, surface rotation, and kyphotic apex. Pelvic tilt: mean = 7.581, p-value = 0.029; surface rotation: mean = 3.098, p = 0.049; and mean kyphotic apex = 11.538 and 11.946, respectively, with p-values of 0.037 and 0.029, respectively.ConclusionMT leads to a change in posture in TMD patients. This could influence the course of TMD treatment.

Achieving excellence with interdisciplinary approaches in complex orthodontic adult patients

Over the last decades the percentage of adult orthodontic patients has substantially increased. Undeniably, an important motif for seeking orthodontic care at an older age is smile improvement, but this is not all. Frequently, impaired dentofacial aesthetics are combined with several other issues: severe dentoskeletal malocclusions; multiple tooth loss due to caries or endodontic failure; dental agenesis or trauma; periodontal breakdown; or functional problems, such as temporomandibular disorders or obstructive sleep apnoea. Therefore, comprehensive adult treatment mostly requires close collaboration of a team of equally well-trained dental specialists to select and execute the most suitable treatment option for the individual patient from day one. With joint planning, intensive communication with the patient and the involved specialists, and continuous monitoring of the treatment process, true patient-centred care can be delivered. In order to serve the individual patient best, the treating orthodontist does not only need thorough speciality training and continuing education, but furthermore, should be well-equipped with sufficient knowledge of the other dental fields of expertise. In combination with digital technology as an important tool for enhancing communication and efficient exchange of information between all involved team members, excellent joint clinical skills will take comprehensive interdisciplinary treatment to the next level.

Temporomandibular Joint Pain Measurement by Bite Force and Von Frey Filament Assays in Mice.

Temporomandibular joint (TMJ) pain and osteoarthritis (OA) are common and debilitating disorders that impair patients' quality of life. The mechanisms driving diseases-related pain are poorly understood, and current treatments fail to provide effective and long-term therapeutic effects. Additionally, pain assessment in research, particularly orofacial pain, poses several challenges that complicate studies in both clinical and basic science settings. Therefore, we have established an inflammatory TMJ pain mouse model via intra-articular injection of CFA (Complete Freund's Adjuvant) and evaluated pain behaviors by bite force measurement and the von Frey filament test. Mice with CFA injection exhibited orofacial pain behaviors compared to PBS injection, including reduced bite force and head withdrawal threshold in the von Frey filament test. These methods are relatively easy to execute to have reproducible results and can be potentially extended to pain studies for other disease models related to TMJ disorders. Together, bite force, and the von Frey filament tests are reliable in measuring orofacial pain, as demonstrated in CFA injection-induced painful TMJOA mouse models.

Association between Estrogen Levels and Temporomandibular Disorders: An Updated Systematic Review.

The aim of this systematic review is to evaluate the impact of estrogen levels on the occurrence of temporomandibular disorders (TMDs) in humans. Searches were conducted in the same databases as follows: PubMed, the Cochrane Collaboration database, and the Scopus database. In accordance with the MeSH database and previous work, the following keywords were used: 'estrogens' and 'temporomandibular joint disorders'. Twelve studies were included in the review and were assessed for the quality of evidence. Estrogen levels are associated with pain modulation in the temporomandibular joint and the entire orofacial region. There is insufficient evidence to either confirm or refute the influence of estrogen on the occurrence of TMDs. The study was registered under the identifier: 10.17605/OSF.IO/BC7QF.

Efficacy of Intra-articular Platelet-rich Plasma versus Hydrocortisone with Local Anaesthetic Injection in Temporomandibular Joint Disorders - A Prospective Study

Abstract Introduction: Temporomandibular joint (TMJ) is subjected to many disorders commonly termed temporomandibular disorders (TMDs) which include TMJ hypermobility, ankylosis and internal derangement. In the past, many non-invasive conservative treatment modalities were tried out for their treatment which include joint unloading, the use of anti-inflammatory agents and physiotherapy. In recent times, injections of corticosteroids and platelet-rich plasma (PRP) into the TMJ have been proposed as alternative therapeutic methods. The main objective of the prospective study was to compare the efficacy of intra-articular injection of PRP and hydrocortisone with local anaesthetic agents in reducing the symptoms in patients with TMDs. Materials and Methods: This prospective study included 30 patients with TMDs, out of which 15 patients (Group I) received PRP injections and 15 patients (Group II) received hydrocortisone with local anaesthetics for arthrocentesis in their affected joints. The patients were assessed for pain, maximum interincisal mouth opening, TMJ sound and disc displacement. Results: The pain was markedly reduced in patients who received PRP injections (Group I) as compared to those who received hydrocortisone injection (Group II). An increase in mouth opening was similar in both the groups, and TMJ sounds were reduced in patients who received PRP. Magnetic resonance imaging also showed that PRP-treated patients showed better articular disc repair than patients treated with hydrocortisone. Discussion: PRP increases chondrocyte proliferation and production of matrix molecules and helps maintain the integrity of the chondral surface, thereby facilitating joint movement, whereas corticosteroids are more potent anti-inflammatory agents and they act by inhibiting prostaglandin synthesis which is the mediator of inflammation. Thus, the use of PRP has been proven to show better results in reducing the symptoms of TMDs and also helped in articular disc repair.

Effect of Extracorporeal Shock Wave on IGF-1, TNF-α, and IL-1in Joint Fluid of Patients with Temporomandibular Joint Disorder Syndrome.

As a new therapeutic method, extracorporeal shock wave (ESW) has shown remarkable efficacy in the treatment of temporomandibular joint disorder syndrome. Numerous studies have shown that it has the advantages of noninvasiveness, short treatment time, etc. It can effectively relieve pain and improve symptoms such as joint mobility and opening degree. In clinical practice, through accurate diagnosis and positioning of different patients, appropriate treatment parameters such as therapeutic transducer, frequency and pressure can be selected to significantly improve the efficacy. At the same time, follow-up evaluation after treatment, including temporomandibular joint disorder index and visual analogue score, is also helpful to fully understand the rehabilitation of patients. Extracorporeal shock wave therapy (ESWT) brings new hope to patients with temporomandibular joint disorder syndrome and has a broad application prospect.

Assessment of cone beam computed tomography use in pediatric and adolescent patients: a cross-sectional study

BackgroundThe use of cone beam computed tomography (CBCT) for dentomaxillofacial diagnostics in pediatric dentistry is expanding and concerns have been raised about the radiation risks associated with this imaging modality, especially for children. Dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks (DIMITRA) is a multidisciplinary project focused on optimizing CBCT exposure for children and adolescents. This study aims to clarify the indications behind CBCT scans in children aligned with DIMITRA’s recommendations.MethodsFor each CBCT examination, data were collected on patient age at the time of the CBCT examination, gender, reason for request, referring department, CBCT-requested region, and the field of view (FOV) dimension of imaging. The CBCT indications were categorized under six headings according to an adaptation of the DIMITRA project recommendations: impacted teeth, dentoalveolar trauma, orofacial clefts, dental anomalies, bone pathology, syndromes. Indications not categorized in DIMITRA were recorded below the heading “other”.ResultsThe most common indication was the “other” category (34.8%), which included implant, temporomandibular joint dysfunction, orofacial anomalies, foreign object and root canal morphology. The least common indication was “orofacial cleft” (1.9%) and no requests were made for cases related to syndromes. Detection of supernumerary tooth in dental anomalies (68.6%) was the most common CBCT indication, while dentigerous cysts (37.6%) were among the most common CBCT indication in bone pathologies and orofacial anomalies (68.1%) in the other category. The most common size was External Center (15 × 15 cm) (27%) and the least common size was Both Arches/small (8 × 8 cm) (0.4%) when the CBCT FOV was analysed.ConclusionsAlthough the option of a smaller FOV size was available, the larger FOV size that included the both jaws were most frequently used. When justifying CBCT requests, patient-specific radiation dose risks should be considered and specific guidelines should be followed.

The Potential of Percent Agreement as an Adjunctive Diagnostic Tool for Acute Temporomandibular Disorder.

Background/Objectives: It is well established that individuals with chronic temporomandibular disorder (TMD) exhibit differences in their physical and psychosocial characteristics from those with acute TMD. However, few studies have analyzed the physical and psychosocial characteristics of patients with acute TMD. The objective of this cross-sectional study is twofold: first, to ascertain whether there are differences in physical and psychosocial factors among patients with acute TMD based on the percent agreement between patient-reported pain sites and pain sites identified through standardized palpation and, second, to determine the potential of percent agreement as a diagnostic and prognostic factor. Methods: We analyzed physical and psychosocial factors in 309 patients diagnosed with acute TMD. Of these, 171 patients were selected for an analysis of their response to treatment. These patients were divided into three groups based on their percent agreement: Group A (agreement under 80%), Group B (agreement 80-89%), and Group C (agreement 90% or over) in the initial analysis and Group a (agreement under 80%), Group b (agreement 80-89%), and Group c (agreement 90% or over) in the subsequent analysis. This study was approved by the Ethics Committee of Pusan National University Dental Hospital (IRB No. 2023-05-011, 25 May 2023). Results: The lower the percent agreement, the greater the parafunctional oral habits, stress, chronicity, somatization, depression, anxiety, and number of painful sites. A lower percent agreement was associated with poorer treatment outcomes. The percent agreement demonstrated a 41.2% capacity to predict residual pain after treatment. Conclusions: Clinicians can utilize percentage agreement as an adjunctive diagnostic tool to provide more suitable treatments to patients.

Effectiveness of Laser Therapy in Treatment of Temporomandibular Joint and Muscle Pain.

Background/Objectives: Temporomandibular joint disorders (TMDs) express a condition derived from a broad spectrum of etiological factors and clinical manifestations. Many treatment options have been developed for TMDs; nevertheless, conservative and non-invasive approaches ought to be prioritized. Laser therapy is an effective treatment for pain management due to its non-invasive nature and capacity for tissue regeneration. This review aimed at bringing an overview of the present evidence regarding the efficiency of laser therapy on myofascial or temporomandibular joint disorders pain. Methods: The search was conducted in four electronic databases: PubMed, Web of Science, Embase, and Scopus, of studies published between January 1997 and January 2023. The following terms have been extensively searched: "laser treatment", pain management", "temporomandibular joint disorders", "masseter muscle pain", "pterygoid muscle pain", and "temporal muscle pain". The inclusion criteria were original papers, available in full text, and written in English. Cohen's Kappa coefficient was used to assess the inter-rater reliability for article selection. The methodological quality was assessed with the Cochrane Risk of Bias tool for randomized controlled trials and the National Heart, Lung, and Blood Institute's quality assessment tool for before-after studies with no control group. Results: Out of 846 identified records, 7 studies were included, of which 5 were randomized controlled trials. The inter-rater reliability for article selection showed an almost perfect agreement (Cohen's Kappa = 0.832, p < 0.001). The protocol of laser application was not standardized; the laser wavelength ranged from 633 to 940 nm, with a power output range from 25 to 1600 mW. The number of sessions varied from 3 to 12, with a frequency of application from 1 time per week to 3 times per week. All studies reported pain reduction after laser therapy. Conclusions: Laser therapy is an efficient method to treat TMDs related to muscle pain. To accomplish the desired results, a standard procedure must be followed; however, the protocol is still not fully designed.

Tobacco smoking and its impact on pain intensity of temporomandibular disorders: A systematic review and metanalysis.

Temporomandibular disorders (TMDs) encompass a spectrum of orofacial conditions characterised by pain and dysfunction in the temporomandibular joint and surrounding structures. Tobacco smoking has been posited as a potential factor influencing the prevalence and intensity of TMD. However, the nature and extent of this relationship remain unclear due to variations in study outcomes. This systematic review aimed to consolidate existing research findings to elucidate the association between tobacco smoking and TMD pain intensity. A comprehensive search of electronic databases was conducted to identify relevant studies published up to June 2023. Studies investigating the relationship between tobacco smoking and TMD pain were included. Data extraction was conducted by two reviewers. Quality assessment was performed using the New Castle-Ottawa scale. Review Manager 5.4 was used to quantitatively analyse the results. The review included four studies employing similar TMD assessment techniques. All studies reported elevated TMD pain intensity among tobacco users, with non-smokers exhibiting lower pain intensity. The quality of the included studies was good. Meta-analytic results showed that TMD pain intensity was higher in the smokers group compared to the non-smokers group, with a weighted mean difference (WMD) of 0.65 (BPM) (95% CI: [0.10, 1.19], p = .02). This systematic review provides a comprehensive synthesis of the existing literature on tobacco smoking and TMD symptoms. The findings underscore the multifaceted nature of the relationship between smoking and TMD pain, highlighting its clinical relevance and the need for tailored interventions. Further research is warranted to elucidate underlying mechanisms and potential moderating factors, contributing to a more nuanced understanding of this complex association.

Nasopharyngeal Carcinoma Masquerading as Temporomandibular Disorder

Trismus, commonly associated with temporomandibular disorders (TMD), trauma, or infection, can occasionally manifest as a rare symptom of malignancy. The author present a case of misdiagnosed carcinoma initially presenting with features resembling TMD. A 72-year-old presented with left facial pain, earache, and progressive difficulty in mouth opening. Initial assessments suggested TMD, but further investigation revealed a nasopharyngeal mass indicating squamous cell carcinoma. This case underscores the need for a comprehensive approach in evaluating trismus to rule out malignancy. Early recognition and appropriate referral for further investigation, including imaging and biopsy, are essential for timely diagnosis and management of malignancy masquerading as TMD.

Low-level laser therapy parameters in the treatment of Orofacial pain in temporomandibular disorder

Temporomandibular disorder (TMD) comprises a group of dysfunctions of the masticatory system involving joint, myofascial, and even sensory alterations. The main symptom of TMD is orofacial pain, which has a negative impact on the quality of life of TMD sufferers, affecting their productivity at work and school, the quality of their sleep, their appetite, and their satisfaction with life. An alternative for the treatment of TMD is the low-level laser therapy (LLLT), which stimulates cellular functions and promotes therapeutic effects. However, there is no consensus in the literature. Objective: This review aimed to elucidate the parameters of low-level laser therapy in the treatment of orofacial pain in patients with temporomandibular disorder. Methods: A search was carried out for scientific articles published between 2013 and 2023 in the MEDLINE, PEDro, LILACS and SciELO databases. Results: A total of 21 studies were previously selected and after the eligibility criteria, 10 studies were included. Can be suggest a protocol for treating patients with temporomandibular disorder by low-level laser therapy with the following parameters: infrared wavelength, energy density less than 10 J/cm2, output power from 100 to 250 mW and at least 8 sessions of treatment. Conclusion: The low-level laser therapy improves orofacial pain in patients with temporomandibular disorder.

Effects of Low-Level LASER Therapy on Temporomandibular Joint Dysfunction-Related Pain: A Systematic Literature Review

Purpose Low-Level LASER therapy (LLLT) is a non-pharmacologic medical device that purports to take advantage of photo biomodulation to induce cellular level biomechanical adaptations. Such mechanisms are sought by clinicians and patients to take advantage of reduced symptoms via faster healing times in cases like temporomandibular joint dysfunction (TMJD), where the joint affected is not easily accessible to traditional care. Systematic literature searches for randomized controlled trials between 2014 and 2024 were performed in PubMed, EBSCO, and Science Direct. A total of six randomized controlled trials (full text available, PEDro score 6, and conducted in the past ten years) met search criteria with a total of 363 subjects. Half the trials, with 36% of the total subjects, showed no difference between LLLT and the control or placebo. This review of current randomized controlled trials presented limited evidence for utilizing LLLT on patients with TMJD-related pain.

A nomogram for predicting the risk of temporomandibular disorders in university students

ObjectivesTemporomandibular disorders (TMDs) have a relatively high prevalence among university students. This study aimed to identify independent risk factors for TMD in university students and develop an effective risk prediction model.MethodsThis study included 1,122 university students from four universities in Changchun City, Jilin Province, as subjects. Predictive factors were screened by using the least absolute shrinkage and selection operator (LASSO) regression and the machine learning Boruta algorithm in the training cohort. A multifactorial logistic regression analysis was used to construct a TMD risk prediction model. Internal validation of the model was conducted via bootstrap resampling, and an external validation cohort comprised 205 university students undergoing oral examinations at the Stomatological Hospital of Jilin University.ResultsThe prevalence of TMD among university students was 44.30%. Ten predictive factors were included in the model, comprising gender, facial cold stimulation, unilateral chewing, biting hard or resilient foods, clenching teeth, grinding teeth, excessive mouth opening, malocclusion, stress, and anxiety. The model demonstrated good predictive ability with area under the receiver operating characteristic curve (AUC) values of 0.853, 0.838, and 0.821 in the training cohort, internal validation cohort, and external validation cohort, respectively. The calibration curves demonstrated that the predicted results were consistent with the actual results, and the decision curve analysis (DCA) indicated the model's high clinical utility.ConclusionsAn online nomogram of TMD in university students with good predictive performance was constructed, which can effectively predict the risk of TMD in university students. The model provides a useful tool for the early identification and treatment of TMDs in university students, helping clinicians to predict the probability of TMDs in each patient, thus providing more personalized and accurate treatment decisions for patients.

Evaluating the Impact of Posterior Edentulism on Temporomandibular Disorder-Related Bruxism, Tinnitus, and Depression

Purpose: The impact of posterior edentulism on the management of temporomandibular disorders (TMD) remains unclear, with a paucity of studies examining the influence of posterior edentulism on TMD symptoms. The objective of this study is to investigate the relationship between posterior edentulism and bruxism, tinnitus, and depression in TMD patients and to compare treatment outcomes in two groups with and without posterior edentulism. Material and methods: In a quasi-experimental controlled trial, 26 patients with TMD participated in a six-week intervention, including manual therapy, massage, postural exercises and kinesio taping. The patients were divided into 13 in the posterior edentulous group and 13 in the full dentate group. The participants attended 12 physiotherapy sessions, twice a week, over six weeks. Outcome measures, including bruxism, tinnitus, joint clicking, Beck Depression Inventory, and cervical range of motion, were evaluated at baseline and the end of the six weeks. Results: The six-week physiotherapy program significantly improved bruxism, tinnitus, cervical range of motion, and depression (p