JMedLife 14 148

JOURNAL of MEDICINE and LIFE
JML | REVIEW
Low-level laser therapy in temporomandibular joint

disorders: a systematic review
Syed Ansar Ahmad 1, Shamimul Hasan 2 *, Shazina Saeed 3, Ateeba Khan 4, Munna Khan 5
Author Affiliations: * Corresponding Author:

1. Department of Oral Surgery, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India Dr. Shamimul Hasan, Professor,
2. Department of Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, Department of Oral Medicine
New Delhi, India and Radiology, Faculty of
Dentistry, Jamia Millia Islamia,
3. Laboratory of Disease Dynamics and Molecular Epidemiology,
New Delhi, India.
Amity Institute of Public Health, Amity university, Noida, Uttar Pradesh, India
Phone: 9953290676
4. Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India E-mail: shasan1@jmi.ac.in
5. Department of Electrical Engineering, Jamia Millia Islamia, New Delhi, India
DOI
10.25122/jml-2020-0169
Dates
Received: 1 November 2020
Accepted: 29 March 2021
ABSTRACT
Temporomandibular joint disorders (TMDs) encompass a wide array of ailments affect-
ing the temporomandibular joint (TMJ), muscles of mastication, and the allied struc-
tural framework. Myofascial pain, internal derangement of the joint, and degenerative
joint diseases constitute the majority of TMDs. TMDs usually have a multifactorial
etiology, and treatment modalities range from conservative therapies to surgical inter-
ventions. Low-level laser therapy (LLLT) has evolved as an efficient non-invasive thera-
peutic modality in TMDs. Previously conducted systematic reviews and meta-analyses
have shown variable results regarding the efficiency of LLLT in TMJ disorder patients.
Hence, this systematic review was carried out as an attempt to evaluate the efficacy of
LLLT in the treatment of temporomandibular joint disorder patients.
KEYWORDS: low-level laser therapy (LLLT), pain intensity, randomized controlled

trials (RCTs), temporomandibular joint disorders (TMDs).
INTRODUCTION
TMJ disorders (TMDs) are categorized as degenerative musculoskeletal disorders causing structural and functional abnormalities [1].
Pain, diminished jaw functions and movements, midline deviation, malocclusion, joint noises, and locking constitutes the cardinal signs
and symptoms of TMDs [2, 3]. The overall incidence of TMDs ranges from 21.5% to 50.5%, with a female gender predilection [4].
TMDs are categorized into three forms. Myofascial pain is the most typical form, followed by internal derangement of the joint and
degenerative joint disease, respectively [5]. TMDs represent a primary cause of non-odontogenic pain in the orofacial region, with
40–75% of the individuals showing at least one TMD sign, such as TMJ noise, and 33% at least one symptom, TMJ or facial pain [6].
Many TMDs may be self-limiting, with periodic remission and exacerbation of symptoms [7].
TMD therapies primarily aim to eliminate pain, joint clicking, restoring TMJ functions and entails dietary and behavioral amendments,
pharmacotherapy, physical therapy, occlusal splint therapy, intra-articular injections, arthroscopy, arthrocentesis, Lasers, or open joint
surgery [8]. Lasers have gained wide applications in dentistry owing to their therapeutic attributes, such as tissue healing and enhanced
local microcirculation [9]. Low-level laser therapy (LLLT) refers to a light-based therapy that produces monochromatic and coherent
light of a single wavelength [3].
© 2021 JOURNAL of MEDICINE and LIFE. VOL: 14 ISSUE: 2 MARCH-APRIL 2021

148
LLLT may act via numerous mechanisms of action, including facilitating the release of endogenous opioids, augmenting tissue repair
and cellular respiration, increasing vasodilatation and pain threshold, and decreasing inflammation [10]. LLLT exerts a photochemical
effect, in contrast to the ablative or thermal effects related to medical laser procedures [11].
The current state of knowledge in LLLT as a therapeutic modality in TMDs is primarily based upon previously conducted prospective
clinical trials, which have yielded debatable outcomes [12–16]. Few studies have demonstrated higher efficacy of LLLT over placebo
[12, 15, 16], while others have shown similar efficiency of LLLT and placebo in the treatment of TMD [13, 14].
Many systematic reviews with or without meta-analyses have also demonstrated contentious results regarding the effectiveness of LLLT
in TMDs [17–19]. A systematic review by Melis et al. demonstrated better efficacy of LLLT in eliminating TMJ pain as compared
to the masticatory muscle diseases [20]. The meta-analyses by Gam et al. [21], Petrucci et al. [18], and McNeely et al. [22] could not
establish the efficacy of LLLT therapy in TMJ pain. However, a meta-analysis conducted by Chang et al. suggested that LLLT has
a reasonable analgesic effect on TMJ pain [19]. A meta-analysis by Chen et al. reported that LLLT might substantially enhance the
functional outcomes with limited pain amelioration in TMD patients [23]. A systematic review with meta-analyses demonstrated that
LLLT is not only effective in pain relief but also improves functional outcomes in TMD patients [4]. Few randomized controlled trials
(RCTs) documenting the efficacy of LLLT in TMDs have been conducted since the last published systematic review [5, 11, 24–27].
However, to date, there is still no conclusive validation to substantiate or contradict LLLT for TMDs. Hence, this systematic review was
conducted to substantiate and re-validate the eﬀicacy of LLLT as a therapeutic modality in TMDs and review the evidence from previ-
ously published literature. The study results are also expected to serve as useful insight and guidelines for clinical practitioners treating
patients with TMDs. This review will provide precise and obvious knowledge about the benefits and procedures of laser application,
which have already been successfully established in TMD management.
Our objectives were to:
• Ascertain the efficacy of LLLT in pain diminution as the primary outcome and secondary outcome on TMJ functions, masticatory
efficiency, psychological and emotional aspects;
• Compare LLLT with placebo and other interventions used in TMD management.
MATERIAL AND METHODS
A systematic literature review was carried out to assess the efficiency of low-level laser therapy in patients with temporomandibular
joint disorders.
Research questions
The search for the systematic review was initiated by defining the keywords concerning the population, intervention, control, and
outcomes (PICO) format: a) population – “temporomandibular joint disorders (TMDs)”; b) intervention/exposure – “low-level laser
therapy (LLLT)”; c) control – “placebo or other interventions like occlusal splints, analgesics, transcutaneous electrical nerve stimulation
(TENS) and botulinum toxins”; and d) outcome – “efficacy assessment”. The research question was designed for the above-mentioned
keywords: a) “Is low-level laser therapy (LLLT) efficacious in patients with temporomandibular joint disorders”?
Literature search and identification of studies
This search strategy followed the Cochrane guidelines for a systemic review. An extensive hand-searching and electronic searching were
made between January 2000 to June 2020 using the combination of controlled vocabulary and free text terms in PubMed and Science
direct search engines.
Inclusion criteria
a) RCTs involving LLLT therapy in human subjects with TMDs; b) articles published in the English language between January 2000 to
June 2020; c) at least a total of 10 study subjects (both LLLT and placebo categories).
Exclusion criteria
a) Nonrandomized or crossover studies (studies other than RCTs); b) studies conducted on animal models; c) articles published in
languages other than English and before January 2000; d) study subjects less than 10; e) studies that fail to provide information on the

149
outcomes of interest and f) subjects with systemic disorders (i.e., rheumatoid arthritis and fibromyalgia) or non-TMD related pain (i.e.,
odontogenic pain, neuralgia, and psychological dysfunctions).
Study selection
The titles and abstracts of the identified studies were thoroughly evaluated for potential eligibility. Studies that did not assess the efficacy
of LLLT on TMDs were excluded. However, if the abstract of the study was unclear, the full texts of the study were then procured for
evaluation. Manual cross-referencing of all the retrieved articles was carried out to identify any study missed previously.
Outcome parameters
The primary outcome parameter was a diminution in the pain intensity in TMDs after LLLT therapy, expressed by the visual analog
scale (VAS). The secondary outcome parameters were the effect on TMJ functions (expressed in terms of mouth opening, lateral and
protrusive mandibular excursive movements, and TMJ noises), masticatory efficiency, pressure pain threshold (PPT), electromyographic
(EMG) activity, quality of life (QoL), psychological and emotional aspects associated with TMDs.
Data extraction
Data extraction was made based on the first author, year of publication, journal name, sample size, treatment design, type and wave-
length of laser, dose and power of the used laser, study design, study outcome, and results. The included studies were reviewed by two
other authors.
Risk of bias assessment
The risk of publication bias was assessed by using the R-based Robvis software package introduced by the National Institute for Health
Research (NIHR) (https://www.riskofbias.info/welcome/robvis-visualization-tool).
RESULTS
Thirty-seven articles were considered eligible for this systematic review. The selection cycle is in accordance with the Preferred Report-
ing Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and is represented as a flowchart in Figure 1.
Based on visual inspection of the figure generated by the Robvis software package, there is no potential publication bias in this study
assessing the effectiveness of low-level laser treatment used in various RCTs for TMD patients (Figures 2 and 3). Out of 37 studies, 33
(89.18%) are high methodological studies, which have an overall low risk of bias or with some concerns, while only 4 studies have a high
risk of bias. A detailed description of the eligible studies is given in Tables 1 and 2.
Characteristics of the studies
Eighteen studies used the “Research Diagnostic Criteria” (RDC/TMD) for diagnosis of TMDs, followed by VAS in 6 conducted RCTs.
7 studies utilized a combination of these two diagnostic criteria. A wide variety of lasers were used in the included studies. Nineteen
studies used a Gallium-aluminum-arsenide laser (GaAlAs). Gallium-arsenide laser (GaAs) was used in 5 studies. Neodymium-doped
yttrium aluminum garnet (Nd: YAG), diode lasers, and red and infrared lasers were applied in 2 studies each, followed by Indium-gal-
lium-aluminum-phosphide laser (InGaAlP) and Helium-neon laser (HeNe), which were used in one study each as shown in Table 1. A
combination of two laser types was also used in 3 studies, namely that of Shirani et al. [28], Demirkol et al. [29], and Pereira et al. [30].
A single laser type at two different wavelengths (GaAlAs at 650 nm/830 nm) was used in an RCT by Wang et al. [16]. Single laser with
two or three laser dosages was employed in 4 studies (Table 1).
The shortest and longest laser wavelengths used among the included studies were 632.8 nm [13] and 1064 nm [29, 31], respectively,
except for Altindis et al. [25] and Rodriguez et al. [27], who did not mention the wavelength used in their lasers therapy. Laser dosage
ranged between 1.5 J/cm2 to 112.5 J/cm2 for the majority of the studies. Laser power ranged between 1.76Mw [32] to 500mW [33];
3 studies did not mention the power of the laser [25, 27, 30]. Temporomandibular joint and/or the affected muscles were the primary
site of laser application in 18 of the conducted RCTs. Laser therapy was applied specifically at the TMJ in 9 RCTs. In 8 RCTs, the site
of laser application was only in the muscles. In most of the conducted studies, laser application was made at pre-decided sites, irrespec-
tive of the fact that they were the points of maximum pain or not. However, in other RCTs, only the points of maximum pain intensity
were irradiated (Table 2).

150
Total 1047 studies identified from PubMed and Science Direct search engines
89 studies identified from PubMed
958 studies identified from Science Direct
Applying the inclusion and exclusion

criteria, 883 studies were excluded:
• Only Randomized Controlled Trials
(RCTs) with Minimum 10 participants
were included (nonrandomized/crossover
studies were excluded).
• Studies on human subjects were included
(systemic diseases, pain other than TMDS,
studies on animal models were excluded)
• Studies published in the English language
were included (literature in Spanish,
Portuguese, Chinese were excluded)
• Studies conducted between January 2000
to June 2020 were included
Total 164 studies included for further assessment

128 studies were excluded after reading

title and abstract of the identified studies
Total 36 studies identified

2 duplicate studies excluded

3 studies included after cross checking
the references of the identified studies
Total 37 studies included for detailed assessment
Figure 1. Selection of studies for the systematic review according to the PRISMA guidelines.

151
Bias arising from the randomization process

Bias due to deviations from intended interventions
Bias due to missing outcome data
Bias in measurement of the outcome
Bias in selection of the reported result
Overall risk of bias
0% 25% 50% 75% 100%
Low risk Some concerns High risk
Figure 2. Robvis output for risk bias assessment.
Most of the studies involved a comparison of LLLT and placebo groups. However, seven studies involved comparison of laser with
other interventions, namely, botulinum toxin A [9], TENS therapy [11], ibuprofen [15], needling [34], occlusal splints [33, 35], physio-
therapeutic and drug protocol (PDP) [36]. Two studies incorporated co-interventions equally to both LLLT and placebo groups. Piroxi-
cam was incorporated with LLLT in one study [37], and in the other study, oral motor (OM) exercises were combined with LLLT [38].
Most of the included studies provided data on the primary outcome of laser therapy, like pain intensity. Eighteen studies focused on
secondary outcomes like mouth opening (MO), followed by 13 studies on lateral excursive (LE) mandibular movements, 10 studies on
protrusive excursive (PE) mandibular movements, 7 studies on PPT, and 2 studies each on EMG, joint noises, TMD related psychologi-
cal and emotional aspects, masticatory efficiency (ME), respectively. One study each focused on subjective tinnitus and occlusal contacts
distribution (Table 1).
Eighteen studies showed that LLLT was efficacious in diminishing TMD pain, whereas 12 studies showed that LLLT had similar
efficacy as of placebo/controls/other intervention in TMD pain diminution. Four studies presented varied effects of LLLT on pain
intensity, mandibular motion, EMG activity, and masticatory efficiency. Two studies revealed that LLLT improved the psychological
and emotional aspects associated with TMDs, joint noises, masticatory efficiency, and EMG parameters, respectively. One study focused
on subjective tinnitus, whereas another study suggested laser acupuncture (LAT) therapy as a suitable alternative to LLLT. The results
demonstrate that LLLT appears to be efficient in diminishing TMD pain with variable effects on the outcome of secondary parameters
(Table 1).
DISCUSSION
Orofacial pain/pain in the stomatognathic system region has a varied pathophysiological basis, and its diagnosis and therapy cover
diverse aspects of medicine and dentistry. TMDs are one of the principal causes of orofacial pain. According to the International Asso-
ciation for the Study of Pain, TMDs are defined as an assembly of painful musculoskeletal disorders of the temporomandibular joints,
masticatory muscles, and adjacent architecture [39].
The exact etiology of TMDs is still not completely elucidated; however, stress-induced repetitive jaw clenching and grinding accounts
as the most important causative factor. Stress also plays a major role in sustaining and augmenting the TMD symptoms. TMDs pose
significant diagnostic and therapeutic challenges owing to their multifactorial etiology, lack of investigative guidelines and strategies, and
are widely considered as a physical, psychological, and functional disorder [40].
A vast majority of studies assessing TMD therapeutic protocols incorporate only pain scales (VAS) and MO analysis, thereby omitting
other imperative characteristics like chronic pain, stress, anxiety, and depression. Dworkin and Le Resche later adopted the Research
Diagnostic Criteria (RDC/TMD) in 1992 to overpower these discrepancies, and it also provided the academicians and practitioners
with an effective and systematic method of examination, diagnosis, and classification of TMDs [24].
In our systematic review, 18 studies used RDC/TMD to diagnose TMDs. Six RCTs utilized VAS, whereas 7 studies utilized a combi-
nation of these two diagnostic criteria. TMDs generally have a gender predisposition, the disease predominantly affecting females (F:M
= 2:1–8:1). Patients in the age group of 20 and 50 years are usually affected, an unusual age distribution for a degenerative disorder
[1]. In our systematic review, most of the studies revealed a higher prevalence of TMDs among women compared to men with an age
range between 20–55 years. Pain is the cardinal manifestation in TMDs. Pain in TMDs accounts for the most probable explanation
of these patients seeking treatment. This also serves as a justification for most of the studies focused on assessing the efficacy of a wide

152
Risk of bias domains

D1 D2 D3 D4 D5 Overall
Kulekcioglu et al. (2003)
Venancio et al. (2005)
Mazzetto et al. (2007)
Cunha et al. (2008)
Emshoff et al. (2008)
Frare et al. (2008)
Carrasco et al. (2008)
Shirani et al. (2009)

Study
Marini et al. (2010)
Mazzetto et al. (2010)
Venezian et al. (2010)
Oz S et al. (2010)
Wang et al. (2011)
Röhlig et al. (2011)
Carli et al. (2012)
Silva et al. (2012)
Figure 3. Weighted output for risk bias assessment.

153
Uemoto et al. (2013)
Ferreira et al. (2013)
Ahrari et al. (2014)
Pereira et al. (2014)
Maia et al. (2014)
Demirkol et al. (2015)
Godoy et al. (2015)
Fornaini et al. (2016)

Study
Sancakli et al. (2016)
Machado et al. (2016)
Carli et al. (2016)
Cavalcanti et al. (2016)
Magri et al. (2017)
Costa et al. (2017)
Demirkol et al. (2017)
Shobha et al. (2017)
Brochado et al. (2018)
Figure 3. Continued.

154
Rodrigues et al. (2019)
Altindis et al. (2019)

Study
Madani et al. (2020)
Chellappa et al. (2020)
Domains: Judgement
D1: Bias arising from the randomization process High
D2: Bias due to deviations from intended interventions Some concerns
D3: Bias due to missing outcome data
D4: Bias in measurement of the outcome Low
D5: Bias in selection of the reported result
Figure 3. Continued.
array of therapeutic protocols with pain amelioration as the primary outcome [41]. Pain reduction also results in improved jaw motion,
chewing, and masticatory efficiency [4]. The results in this systematic review were in coherence with the published literature, as most of
the included studies in our review considered pain amelioration as the primary outcome of laser therapy.
Restriction or deflection in the range of mandibular movements (MO, LE and PE mandibular movements) and joint clicking are other
frequent manifestations of TMDs. TMD patients also frequently report loss of masticatory efficacy. The masticatory patterns should
be evaluated, and a definitive therapeutic protocol should be planned. Surface EMG, myofunctional procedure ratings, and assessment
of masticatory efficiency are some of the employed objective approaches [42]. This systematic review also focused on improving the
secondary outcomes like MO [5, 9, 10, 14–16, 26, 28, 30, 34, 37, 43–47], LE and PE mandibular movements [10, 14–16, 26, 28, 34,
37, 43–46, 48], PPT [14, 34, 35, 44, 46, 49, 50], EMG parameters [32, 34], joint noises [5, 28], TMD masticatory efficiency (ME) [49,
51], subjective tinnitus [29], and occlusal contacts distribution [48].
The importance of psychological factors (stress, anxiety, depression, and personality changes) has been thoroughly investigated in the
etiopathogenesis of TMDs over the years. Published literature has demonstrated that the interrelation between stress, anxiety, depres-
sion, and distinct physical manifestations of TMDs is universally in sync with manifestations that are similar to those seen in other
chronic musculoskeletal pain disorders [52]. Approximately 75% of TMD patients exhibit chronic features, with detrimental biopsy-
chosocial outcomes like depression and somatization [12]. In our systematic review, two studies emphasized the role of LLLT in improv-
ing TMD-related psychological and emotional aspects [24, 27]. The World Association of Laser Therapy came to a consensus in 2004
on the design of clinical trials with LLLT in TMDs. According to the established protocol, the placebo group should compulsorily be
a part of the study design [53]. Most of the included RCTs involved a comparison of LLLT and placebo groups. However, 7 RCTs in-
volved a comparison of laser with other interventions or compared co-interventions equally to both LLLT and placebo groups (Table 1).
Therapeutic lasers are generally close to the electromagnetic radiation spectrum and vary from visible (red) to invisible (infrared) light.
The most used wavelengths usually range between 600 and 1000 nm, permitting deeper penetration, relatively poor absorption, and
easier transmission through the skin and mucous membranes [30].
In this systematic review, most of the studies used lasers with wavelengths within the electromagnetic radiation spectrum. The wave-
lengths ranged between 632.8 nm and 1064 nm. Only five studies used lasers with wavelengths in the red range (shorter than 780 nm).
RCTs conducted by Altindis et al. [25] and Rodriguez et al. [27] did not mention the wavelength of the used lasers. Published literature
has ascertained that combining lasers of two wavelengths have furnished positive outcomes. Lasers exert distinct effects in various bio-
logical tissues, explaining the variable results of laser therapy with different wavelengths [30]. In our systematic review, a combination
of two laser types at different wavelengths was demonstrated by Shirani et al. [28], who used InGaAlP (660 nm) and GaAs (890 nm)
lasers, Demirkol et al. [29], who used Nd: YAG (1064 nm) and diode laser (810 nm), and Pereira et al. [30], who used red laser (660 nm)
and infrared laser (795 nm).
LLLT may show heterogeneity in the dose, power, and application time, with an irradiance of 5 mW/cm2 to 5 W/cm2, power range
between 1 mW up to 10 W, with pulsed or continuous beams, and the application span of 30–60 s/point [54]. The measure of the laser

155
Table 1. Characteristics of the included studies.
Type of laser,
Treatment dose (j/cm2) and
Author Sample size (n) Age/gender Outcome measures Results
design power (mw) of
laser used
n=40 Diode laser

PI at function and at • ↓pain observed in both
Shobha Group 1 (Laser Laser (20) (gallium
18–40 yrs rest (VAS), MO and active LLLT and placebo
et al. [5] group n=20) versus aluminum
Not mentioned temporomandibular groups
(2017) Group 2 (placebo placebo (20) arsenide, 810 nm,
clicking • improvement in clicking
group n=20) 0.1 W, 6 J/cm2).
Both Laser and Botulinum

toxin A treatments were
efficient in reducing
n=15
pain, but laser therapy
Group 1 (Laser Laser (8)
Carli Mean was much faster
group n=8) versus GaAlAs 890 nm,
et al. [9] age=28 yrs PI (VAS) and MO in pain diminution.
Group 2 Botulinum 100 mW, 80 J/cm2
(2016) M: F=2:13 (LLLT>Botulinum toxin A in
(Botulinum toxin toxin A (7)
pain resolution). However,
A n=7)
both treatments showed
no statistically significant
improvement in MO.
n=20
Ahrari Group 1 (laser Mean age Laser (10)
GaAIAs 810 nm, PI, mandibular
et al. [10] group n=10) 35.5 yrs, versus LLLT>placebo
50 mW, 3.4 J/cm2 movements
(2014) Group 2 (placebo 20 Females placebo (10)
group n=10)
n=60
Chellappa Group 1 (LLLT LLLT group (30) 672 nm diode
PI and range of
et al. [11] group n=30) Not mentioned TENS group laser 50 mW, LLLT>TENS
mandibular motion
(2020) Group 2 (TENS (30) n=60 3 J/cm2
group n=30)
n=40
Ferreira Group 1 (laser Laser (20) GaAIAs 780 nm,
20–40 yrs
et al. [12] group n=20) versus 112.5 J/cm2, PI LLLT>placebo
40 females
(2013) Group 2 (placebo placebo (20) 50 mW
group n=20)
n=52
Group 1 (Study
Emshoff Laser (26) HeNe 632.8 nm,
group n=26) 18–58 yrs
et al. [13] versus 1.5 J/cm2 and PI LLLT=placebo
Group 2 M: F=10:42
(2008) placebo (26) 30 mW
(control-placebo
n=26)
n=30
Group 1 (Study
Venancio Laser (15) GaAlAs 780 nm, PI, mandibular
group n=15) Not mentioned
et al. [14] versus 6.3 J/cm2 and function, pain LLLT=placebo
Group 2 M: F=5:25
(2005) placebo (15) 30 mW sensitivity
(control-placebo
n=15)
n=99
Group 1
(Study/laser Laser (39) PI, mandibular
Marini group n=39) versus function,
GaAIAs 910 nm,
et al. [15] Group 2 Not mentioned ibuprofen (30) morphologic LLLT>placebo
400 mW
(2010) (ibuprofen n=30) versus structural analysis
Group 3 placebo (30) of TMJ
(control-placebo
n=30)
n=42
PI, functional
Group 1 (Study
Wang Laser (21) GaAIAs examination
group n=21)
et al. [16] Not mentioned versus 650 nm/830 nm, (MO, lateral and LLLT > placebo
Group 2
(2011) placebo (21) 300 mW protrusive excursive
(control-placebo
movements)
n=21)

156
Table 1. Continued.
All protocols tested were

n=51
able to promote pain
Group 1 (photo
relief, improve mandibular
biomodulation
PBM group (18) PI, mandibular function, and reduce the
(PBM) group
Manual movements, negative psychosocial
Brochado n=18) PBM with 808 nm,
21–77 Yrs therapy group psychosocial aspects and levels of
et al. [24] Group 2 (Manual 100 mW,
M: F=3:48 (16) aspects, and anxiety anxiety in TMD patients.
(2018) therapy group 13.3 J/cm2
Combined symptoms in TMD However, the combination
n=16)
group (17) patients of PBM and MT did not
Group 3
promote an increase in
(Combined group
the effectiveness of both
n=17)
therapies alone.
Occlusal splint therapy

and LLLT were effective
PI, muscle
in the treatment of MPS,
Altindis Laser (10) sensitivity and
18–45 yrs and when thermographic
et al. [25] n=20 stabilization N/A the superficial
Not mentioned data were considered, LLLT
(2019) splint (10) skin temperature
treatments could provide
differences
more advantageous results
in these patients.
Both LLLT and LAT were

effective in reducing pain
The mandibular
n=45 and increasing excursive
range of motion
Group 1 (LLLT LLLT group (15) and protrusive mandibular
Madani A. GaAlAs laser (Lateral excursive
group n=15) LAT group (15) motion in TMD patients.
et al. [26] Not mentioned 810 nm, 200 mW, and protrusive
Group 2 (LAT n=15 Placebo group LAT could be suggested
(2020) 21 J/cm2 movements)
Group 3 Placebo (15) as a suitable alternative
PI and Mouth
group n=15) to LLLT, as it provided
opening
effective results while
taking less chair time.
Physical and LLLT improved the physical

Rodrigues
emotional and emotional symptoms
et al. 27 N/A Not mentioned N/A N/A
symptoms in TMD of TMD, with results like
(2019)
patients splint therapy.
n=16 Laser (the InGaAlP 660 nm

Group 1 (Study combination and GaAs 890 nm,
Shirani
group n=8) 16-37 yrs of two 6.2 J/cm2 and
et al. [28] PI LLLT>placebo
Group 2 M: F=4:12 wavelengths, 8) 1.0 J/cm2,
(2009)
(control-placebo versus 17.3 mW and
n=8) placebo (8) 1.76 mW
n=41
Nd: YAG laser
Group 1 (Nd: YAG
(15) Nd: YAG laser
Demirkol laser group n=15)
versus (1064 nm), diode The severity of the
et al. [29] Group 2 (diode Not mentioned LLLT>placebo
diode laser (16) laser (810 nm), tinnitus (VAS)
(2017) Laser group n=16)
versus placebo 250 mW, 8 J/cm2
Group 3 (placebo
(15)
n=15)
660 nm (red
laser) and Both lasers are effective
Pereira
21–55 yrs 795 nm (infrared) in the treatment and
et al. [30] n=19 N/A PI
M: F=4:15 laser remission of TMD
(2014)
8 J/cm2 in Muscles symptoms
4 J/cm2 in Joint
n=30
Laser (10)
Group 1 (laser
versus
Demirkol group n=10)
occlusal splint Nd: YAG 1064 nm,
et al. [31] Group 2 (occlusal Not mentioned PI LLLT>placebo
(10) 250 mW, 8 J/cm2
(2014) splint group n=10)
versus
Group 3 (placebo
placebo (10)
n=10)

157
Table 1. Continued.
n=48
Group 1 (Study GaAIAs 780 nm,
Venezian Laser (24) LLLT>placebo (PI)
group n=24) 18–60 yrs 25 J/cm2 or
et al. [32] versus PI and EMG Activity LLLT=placebo (EMG
Group 2 M: F=5:43 60 J/cm2, 50 mW
(2010) placebo (24) Activity)
(control-placebo or 60 mW
n=24)
n=40
Group 1 (Study
Cunha Laser (20) GaAlAs 830 nm,
group n=20) 20–68 yrs
et al. [33] versus 100 J/cm2 and PI and TMD status LLLT=placebo
Group 2 Not mentioned
(2008) placebo (20) 500 mW
(control-placebo
n=20)
n=21
Laser (7)
Group 1 (laser
versus PI, EMG activity,
Uemoto group n=7) Laser type N/A
20–50 yrs needling group pain sensitivity,
et al. [34] Group 2 (needling 795 nm, 4 J/cm2 or LLLT>placebo (only 4 J/cm2)
28 females (7) mandibular
(2013) group n=7) 8 J/cm2, 80 mW
versus movements
Group 3 (placebo
placebo (7)
n=7)
n=40
Group 1 (Study Laser (20) PI, mandibular
Oz S Mean age Laser type N/A
group n=20) versus movements and
et al. [35] 32.8 yrs 820 nm, 3 J/cm2 LLLT=occlusal splints
Group 2 occlusal splints pressure pain
(2010) M: F=6:34 and 300 mW
(control-occlusal (20) threshold
splints n=20)
n=60
Group 1 (laser Laser (20)
Cavalcanti group n=20) versus
20–50 Yrs GaAlAs 780 nm, Presence/absence
et al. [36] Group 2 (PDP PDP (20) LLLT>placebo
60 females 30 mW, 35 J/cm2 of Pain
(2016) group n=20) versus
Group 3 (placebo placebo (20
n=20)
n=32
Group 1 (Laser + Laser +
piroxicam group piroxicam (11)
PI, functional
n=11) versus
Carli GaAlAs 830 nm, examination
Group 2 (laser + 18–58 yrs laser + placebo
et al. [37] 100 J/cm2 and (MO, lateral and LLLT=placebo
placebo piroxicam M: F=3:29 piroxicam (11)
(2012) 100 mW protrusive excursive
n=11) versus
movements)
Group 3 (placebo placebo laser +
laser + piroxicam piroxicam (10)
n=10)
n=24
Fornaini Group 1 (laser Laser (10)
17–64 Yrs GaAs 904 nm,
et al. [38] group n=12) versus PI LLLT>placebo
M: F=5:19 15 mW, 6 J/cm2
(2015) Group 2 (placebo placebo (10)
group n=12)
n=40
Group 1 (Study
Mazzetto Laser (20) GaAlAs 830 nm,
group n=20) PI, mandibular
et al. [43] Not mentioned versus 5 J/cm2 and LLLT>placebo
Group 2 movements
(2010) placebo (20) 40 mW
(control-placebo
n=20)
n=40
Group 1 (laser
Röhlig Laser (20) PI, functional
group n=20) GaAs 820 nm,
et al. [44] Not mentioned versus examination, pain LLLT>placebo
Group 2 300 mW, 8J/cm2
(2011) placebo (20) sensitivity
(control-placebo
n=20)

158
Table 1. Continued.
n=45
Group 1 (low Low energy
energy level laser (15)
Silva group n=15) versus GaAIAs 780 nm,
25–53 yrs PI, mandibular
et al. [45] Group 2 (high high energy 52 J/cm2 and LLLT>placebo
M: F=15:30 movements
(2012) energy level laser (15) 105 J/cm2, 70 mW
group n=15) versus
Group 3 (placebo placebo (15)
n=15)
n=30
Group 1 (laser
Laser I (10)
group I n=10)
Sancakli versus PI, mandibular
Group 2 (laser 18–60 yrs GaAs 820 nm
et al. [46] laser II (10) mobility, pain LLLT>placebo
group II group M: F=9:21 30 mW, 3 J/cm2
(2016) versus sensitivity
n=10)
placebo (10)
Group 3 (placebo
n=10)
n=60 PBM PBMT (830 nm) reduces

infrared laser Referred pain
Costa Group 1 (photo group (30) pain in algic points, but
18–76 yrs (830 nm) elicited by palpation
et al. [47] biomodulation versus does not influence the
M: F=6:54 100 mW, and maximum
(2017) (PBM) group placebo extent of mouth opening
100 J/cm2 mouth opening
n=30) group (30) in patients with myalgia
No statistically significant
differences were found
PI, mandibular regarding pain, mandibular
Godoy Laser Laser type N/A
14–23 yrs range of motion range of motion, or the
et al. [48] N/A versus 780 nm, 50 mW,
Not mentioned and occlusal distribution of occlusal
(2015) Placebo 33.5 J/cm2
contacts contacts after treatment
with low-level laser
therapy.
n=21
Maia Group 1 (laser Mean age Laser (10) PI, masticatory
GaAlAs 808 nm,
et al. [49] group n=11) 27.7±1.44 yrs versus performance, pain LLLT>placebo
100 mW, 70 J/cm2
(2014) Group 2 (placebo M: F=2:19 placebo (9) sensitivity
group n=10)
n=91
Group 1 (laser Laser (31)
GaAlAs 780 nm, PI, pain sensitivity,
Magri group n=31) versus
18–60 Yrs TMJ, 20 mW, the sensory
et al. [50] Group 2 (placebo placebo (30) LLLT=placebo
91 females muscle, 30 mW, and affective
(2017) group n=30) versus
5 or 7.5 J/cm2 dimensions of pain
Group 3 (control control (30)
n=30)
n=14
Group 1 (Study
Carrasco Laser (7) GaAlAs 780 nm LLLT>placebo (PI on
group n=7)
et al. [51] Not mentioned versus 105 J/cm2 and PI and ME palpation) LLLT=placebo
Group 2
(2008) placebo (7) 70 mW (ME)
(control-placebo
n=7)
n=18
Group 1 (Study
Frare Laser (10)
group n=10) 18–45 yrs GaAs 904 nm
et al. [56] versus PI LLLT>placebo
Group 2 18 females 70 mW, 6 J/cm2
(2008) placebo (8)
(control-placebo
n=8)
n=48
Group 1 (Study
Mazzetto Laser (24) GaAIAs 780 nm
group n=24)
et al. [57] Not mentioned versus 89.7 J/cm2 PI LLLT>placebo
Group 2
(2007) placebo (24) and 70 mW
(control-placebo
n=24)

159
Table 1. Continued.
n=35
Group 1 (Study PI, mandibular
Kulekcioglu Laser (20) GaAs 904 nm LLLT>placebo (MO, LM)
group n=20) 20–59 yrs function (Mouth
et al. [58] versus 3 J/cm2 and LLLT=placebo (PI, TMJ
Group 2 M: F=7:28 opening: MO and
(2003) placebo (15) 17 mW sounds)
(control-placebo LM), TMJ sounds
n=15)
GI: laser + Oral

motor (OM)
exercises (21)
versus
GII: pain relief
PI, TMD severity,
Machado strategies + OM GaAlAs 780 nm,
and orofacial
et al. [59] n=82 Not mentioned exercises (22) 60 mW, LLLT=placebo
myofunctional
(2016) versus 60±1.0 J/cm2
status
GIII laser
placebo + OM
exercises (21)
versus
GIV: laser (18)
F – Female; GaAlAs – Gallium-aluminum-arsenide laser; GaAS – Gallium-arsenide laser; HeNe – Helium-neon laser; LAT – Laser acupuncture thera-
py; LLLT – Low-level laser therapy; LM – Lateral movements; ND: YAG – Neodymium-doped yttrium aluminum garnet; M – Male; ME – masticatory
efficiency; MPS – Myofascial pain syndrome; MO – mouth opening; MT – Manual therapy; N/A: Not Applicable; OM – Oral motor; PBM – Photobi-
omodulation; PI – Pain intensity; TENS – Transcutaneous electrical nerve stimulation; TMD – temporomandibular joint dysfunction; VAS – visual
analog scale.
Table 2. Details of the eligible studies.
Treatment
Country time/number of total Site of laser
Author Journal Evaluation/follow-up
of study sessions/number of application
sessions week
Shobha et al. [5] Indian Journal of

India 60 s/8/2–3 per week TMJ and muscles Follow-up after 30 days
(2017) Dental research
Journal of
-/7/48 hours interval
Photochemistry and
Carli et al. [9] (2016) Brazil between each Muscles N/A
Photobiology,
session
B: Biology
Before intervention, after six

Ahrari et al. [10] Lasers in Medical applications, at the end of
Iran 120 s/12/3 Muscles
(2014) Science treatment, and 1 month after
the last application
120 s/12/two
Chellappa et al. [11] Indian Journal of
India sessions/week for 6 TMJ and muscles N/A
(2020) Dental research
weeks
Ferreira et al. [12] Lasers in Medical Before intervention, monthly

Brazil 90 s/12/1 TMJ and Muscles
(2013) Science until intervention completed
Oral Surgery, Oral

Medicine, Oral Before treatment and 2, 4, and
Emshoff et al. [13]
Austria Pathology, Oral 120 s/20/2–3 TMJ 8 weeks after the first laser
(2008)
Radiology, and therapy
Endodontics
Immediately before the first,

third, and fifth treatment
Venancio et al. [14] Journal of Oral sessions, and at the follow-up
Brazil 10 s/6/2 TMJ
(2005) Rehabilitation appointments after 15, 30,
and 60 days of the end of
treatment

160
Table 2. Continued.
PI at baseline, 2, 5, 10, and

15 days after treatment.
Mandibular function at
Marini et al. [15] Clinical Journal of
Italy 20 min/10/5 TMJ baseline, 15 days and 1 month
(2010) Pain
after treatment. MRI at
baseline and at the end of the
treatment.
Before treatment, immediately,

Wang et al. [16] (2011) China West China Journal 15 min/6/6 TMJ 1 month and 2 months after
treatment
40 s (joint); 21min
Brochado et al. [24] Brazilian Oral (muscle)/12/3
Brazil TMJ and muscles Follow-up after 4 and 8 weeks
(2018) Research times a week for 4
consecutive weeks
Complementary
Altindis et al. [25]
Brazil Therapies in N/A Muscles N/A
(2019)
Medicine
Evaluated before
Madani A et al. [26] Lasers in Medical 30 s/10/two times a joint, muscles, and treatment/after 5 sitting/10
Iran
(2020) Science week for 5 weeks acupuncture points sitting and 30 days after
therapy
Complimentary
Rodrigues et al. 27
Brazil Therapies in N/A TMJ and muscles N/A
(2019)
Medicine
Before and immediately

Shirani et al. [28] Lasers in Medical after treatment, 1 week after
Iran 360 s/6/2 Muscles
(2009) Science treatment, and on the day of
feeling complete pain relief
Demirkol et al. [29] Photomedicine and External Auditory Before treatment, immediately
Turkey 20 s or 9 s/10/5
(2017) Laser Surgery Meatus and 1 month after treatment
Reassessed at 24 hours and 30

Cranio: The Journal
Pereira et al. [30] days (short-term assessment),
Brazil of Craniomandibular N/A TMJ and Muscles
(2014) 90 days (medium-term), and
and Sleep Practice
180 days (long-term)
Demirkol et al. [31] Lasers in Medical Before treatment, immediately

Turkey 20 s/10/5 Muscles
(2014) Science and 3 weeks after treatment
PI: before treatment,

Cranio: The Journal immediately and 30 days after
Venezian et al. [32]
of Craniomandibular 20 or 40 s/8/2 Muscles treatment
(2010)
and Sleep Practice EMG: before and immediately
after treatment
Cunha et al. [33] International Dental Before treatment and after the
Brazil 20 s/4/1 TMJ and/or muscles
(2008) Journal last treatment
Before treatment, after four

Uemoto et al. [34] Journal of Oral
Brazil –/4/– Muscles sessions with intervals ranging
(2013) Science
between 48 and 72 h
Journal of
Oz S et al. [35] (2010) Turkey N/A -/10/2 times per week N/A
Craniofacial Surgery
Before treatment, at each

Cavalcanti et al. [36] Photomedicine and
Brazil 20 s/12/3 TMJ and Muscles week till the fourth week after
(2016) Laser Surgery
treatment
Before treatment, after the

Journal of Oral first, second, third, and fourth
Carli et al. [37] (2012) Brazil 28 s/4/2 TMJ and Muscles
Rehabilitation treatment sessions, and 30
days after last treatment.

161
Table 2. Continued.
Fornaini et al. [38] Before treatment, 1 and 2

Italy Laser Therapy 15 min/14/7 TMJ
(2015) weeks after treatment
Before treatment, immediately,

Mazzetto et al. [43] Brazilian Dental
Brazil 10 s/8/2 TMJ 7 and 30 days after
(2010) Journal
applications
Turkish Journal of
Röhlig et al. [44] Before treatment and after the
Turkey Physical Medicine 10 s/10/3–4 Muscles
(2011) last applications
and Rehabilitation
Before treatment, immediately

Cranio: The Journal
after the first, fifth, tenth
Silva et al. [45] (2012) Brazil of Craniomandibular 30 s or 60 s/10/2 TMJ and/or Muscles
treatments, and 5 weeks after
and Sleep Practice
completing the applications
Sancakli et al. [46] Before treatment and after the

Turkey BMC Oral Health 10 s/12/3 Muscles
(2016) completion of therapy
Costa et al. [47] Brazilian Oral Long-term evaluation (6

Brazil 28 s/-/- Muscles
(2017) Research months)
Godoy et al. [48] Journal of Oral and

Brazil 20 s/-/- Muscles N/A
(2015) Maxillofacial Surgery
MP and PPT, before treatment,

at the end of treatment and 30
Lasers in Medical
Maia et al. [49] (2014) Brazil 19 s/8/2 Muscles days after treatment VAS, at
Science
the same time as above; it was
also measured weekly
Before treatment, after each

Magri et al. [50] Lasers in Medical
Brazil 10 s/8/2 TMJ and muscles treatment and 30 days after
(2017) Science
last treatment
Cranio: The Journal Before treatment, after the 8th

Carrasco et al. [51]
Brazil of Craniomandibular 60 s/8/2 TMJ application, 30 days after the
(2008)
and Sleep Practice last application
Before and immediately

Frare et al. [56] Revista Brasileira de TMJ and external
Brazil 16 s/8/2 after all sessions of laser
(2008) Fisioterapia auditory meatus
applications
Cranio: The Journal Before treatment, after the

Mazzetto et al. [57] TMJ (external
Brazil of Craniomandibular 10 s/8/2 4th and 8th applications, and 30
(2007) auditory meatus)
and Sleep Practice days after the last application.
Kulekcioglu et al. [58] Scandinavian Journal Before, after, and 1 month after
Turkey 180 s/15/– TMJ and/or muscles
(2003) of Rheumatology treatment
Machado et al. [59] Lasers in Medical Before treatment, immediately

Brazil 45 min/12/1–0.5 TMJ and Muscles
(2016) Science and 1 month after treatment
EMG – electromyography; MRI – magnetic resonance imaging; PI – Pain intensity; PPT – Pressure pain threshold; TMJ – temporomandibular joint;
VAS – visual analog scale.
effect is also determined by the laser dose. According to Bjordal et al. [55], the debate on the efficacy of LLLT in TMDs is primarily
because of the variability in the laser dose. In our systematic review, laser dosage ranged between 1.5 J/cm2 to 112.5 J/cm2, except for
5 studies where data was not available (Table 1). Laser power ranged between 1.76 Mw [28] to 500 mW [35].
The included RCTs also showed a wide disparity in the frequency of laser application, the number of sessions/weeks, and the total
number of laser sessions. The studies showed that the number of sessions per week ranged from 1–7. Most of the studies argued for 2
sessions per week [5, 11, 13, 14, 26, 28, 32, 35, 37, 43, 45, 49–51, 56, 57]. However, there was no mention of the number of sessions/
weeks in a few studies [25–28, 30, 34, 47]. The total number of laser applications also showed great variance, ranging from 4 to 20
sessions. Eight studies argued for a total of 8 sessions [5, 32, 43, 49–51, 56, 57], followed by 12 sessions in by 7 studies [10–12, 24, 36,
38, 46], and 10 sessions in 6 studies [15, 26, 29, 31, 44, 45]. However, few studies provided no information on the total number of laser
sessions [25, 27, 30, 35, 47, 48]. The time of laser application also varied widely in the included studies.

162
Kulekcioglu et al. recommended using LLLT as an alternative to other conventional treatment modalities in TMD of myogenic and ar-
throgenic origin [58]. However, Machado et al. suggested that combination therapy of LLLT and oral motor exercises are more efficient
for the rehabilitation of TMD patients [59]. Studies using supplementary diagnostic aids – panoramic radiography (OPG), computed
tomography (CT), and magnetic resonance imaging (MRI) – should be vigilantly evaluated, as the interpretations of these investigations
may not always correspond with the signs and symptoms of TMDs [53].
Few studies in our review used auxiliary diagnostic methods for TMD diagnosis. TMJ imaging using CT and MRI was done in a study
by Shirani et al. [28], and OPG was used in studies conducted by Shobha et al. [5], Venancio et al. [14], Venezian et al. [32], and Carrasco
et al. [51]. Over the last few years, LLLT has evolved as an excellent intervention for TMDs, owing to its analgesic, anti-inflammatory,
and regenerative effects with no documented unfavorable outcomes and exceptional patient compliance. However, there is still no con-
clusive validation to substantiate or contradict LLLT for TMDs. Here, we have attempted to upgrade the clinical validation for LLLT
effects on TMDs [4]. The strengths of our systematic review were the large number of included RCTs, hence a larger sample size that
was analyzed. Regarding the limitations of the review, published literature on the use of LLLT in TMDs has revealed contradictory
outcomes, primarily due to the variation in laser dosage [19].
The primary limitation of this systematic review was that only two specific databases were searched (PubMed and Science Direct) due
to limited access to databases. This study advocated performing another systematic review with meta-analyses by incorporating some
more databases to strengthen the findings. The disparity in the treatment parameters (dosage, power, wavelength, number, and frequen-
cy of laser application) and within the patient sample are the other limiting factor of this review. Generally, LLLT yields better efficacy
when used within the electromagnetic radiation spectrum, incorporating higher irradiation parameters (higher dose and power), a
greater number of sessions, and frequency of applications [53].
CONCLUSION
This systematic review aimed to re-validate the eﬀiciency of LLLT in TMDs by thoroughly evaluating the previously conducted re-
searches and further compare with placebo and other interventions. The study outcomes are expected to provide useful guidelines for
practitioners treating patients with TMDs. The results demonstrate that LLLT appears to be efficient in diminishing TMD pain with
variable effects on the outcome of secondary parameters. Also, LLLT provides advantages as the therapeutic regimen is non-invasive,
reversible, with fewer adverse effects, and may also improve the psychological and emotional aspects associated with TMDs. Therefore,
this systematic review highlights the role of LLLT as a promising therapeutic regimen for TMDs.
ACKNOWLEDGMENTS
Conflict of interest
The authors declare that there is no conflict of interest.
REFERENCES 7. Romero-Reyes M, Uyanik JM. Orofacial pain management:

current perspectives. J Pain Res. 2014; 7:99–115.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod.
2008;105[4]:452–456.
8. Abouelhuda AM, Khalifa AK, Kim YK, Hegazy 14. Venancio A., Camparis C. M., Lizarelli F. Low intensity
SA. Non-invasive different modalities of treatment for laser therapy in the treatment of temporomandibular
1. Murphy MK, MacBarb RF, Wong ME, Athanasiou KA. temporomandibular disorders: review of literature. J Korean disorders: a double-blind study. J Oral Rehabil.
Temporomandibular disorders: a review of etiology, clinical Assoc Oral Maxillofac Surg. 2018;244[2]:43–51. 2010;32[11]:800–807.
management, and tissue engineering strategies. Int J Oral
Maxillofac Implants. 2013;28[6]:393–414. 9. Carli BM, Magro AK, Souza-Silva BN, Matoo FD, Carli 15. Marini I, Gatto MR, Bonetti GA. Effects of super pulsed
JP, Paranhos LR, et al. The effect of Laser and Botulinum low-level laser therapy on temporomandibular joint pain. Clin
2. Ouanounou A, Goldberg M, Haas DA. Pharmacotherapy toxin in the treatment of Myofascial pain and Mouth J Pain. 2010;26[7]:611–616.
in Temporomandibular Disorders: A Review. J Can Dent Opening. Journal of Photochemistry & Photobiology,
Assoc. 2017; 83:1–8. B: Biology 2016;159:120–123. 16. Wang X, Yang Z, Zhang W, Yi X, Liang C, Li X. Efficacy
evaluation of low-level laser therapy on temporomandibular
3. Khairnar S, Bhate K, S N SK, Kshirsagar K, Jagtap 10. Ahrari F, Madani AS, Ghafouri ZS, Tunér J. The disorder. Cranio. 2011;29[4]:393–395.
B, Kakodkar P. Comparative evaluation of low-level Efficacy of Low-Level Laser Therapy for the Treatment of
laser therapy and ultrasound heat therapy in reducing Myogenous Temporomandibular Joint Disorder. Lasers Med 17. Chang WD, Lee CL, Lin HY, Hsu YC, Wang CJ, Lai
temporomandibular joint disorder pain. J Dent Anesth Pain Sci 2014;29[2]:551–557. PT. A meta-analysis of clinical effects of low-level laser
Med. 2017;19[5]:289–294. therapy on temporomandibular joint pain. J Phys Ther Sci.
11. Chellappa D, Thirupathy M. Comparative efficacy 2014;26[8]:1297–1300.
4. Xu GZ, Jia J, Jin L, Li JH, Wang ZY, Cao DY. Low-Level of low-level laser and TENS in the symptomatic relief of
Laser Therapy for Temporomandibular Disorders: A temporomandibular joint disorders: A randomized clinical 18. Petrucci A, Sgolastra F, Gatto R, Mattei A, Monaco A.
Systematic Review with Meta-Analysis. Pain Res Manag. trial. Indian J Dent Res 2020; 31:42–47. Effectiveness of low-level laser therapy in temporomandibular
2018:4230583. disorders: a systematic review and meta-analysis. J Orofac
12. Ferreira LA, de Oliveira RG, Guimarães JP, Carvalho Pain. 2011; 25:298–307.
5. Shobha R, Narayanan VS, Jagadish Pai B S, Jaishankar AC, De Paula MV. Laser acupuncture in patients with
H P, Jijin M J. Low-level laser therapy: A novel therapeutic temporomandibular dysfunction: a randomized controlled 19. Shukla D, Muthusekhar MR. Efficacy of low-level laser
approach to temporomandibular disorder – A randomized, trial. Lasers Med Sci. 2013;28[6]:1549–1558. therapy in temporomandibular disorders: a systematic review.
double-blinded, placebo-controlled trial. Indian J Dent Res. Natl J Maxillofac Surg. 2016;7[1]:62–66.
2017; 28:380–387. 13. Emshoff R., Bosch R., Pumpel E., Schoning H., Strobl H.
Low-level laser therapy for treatment of temporomandibular
6. Alzarea BK. Temporomandibular Disorders [TMD] in joint pain: a double-blind and placebo-controlled trial.
Edentulous Patients: A Review and Proposed Classification
[Dr. Bader's Classification]. J Clin Diagn Res. 2015;9[4]:6–9.

163
20. Melis M., Di Giosia M., Zawawi K. H. Low level laser 34. Uemoto L, Garcia MA, Gouvêa CV, Vilella OV, Alfaya muscles: a randomized, double-blind study. Braz. Oral Res
therapy for the treatment of temporomandibular disorders: a TA. Laser therapy and needling in myofascial trigger point 2017; 31:107.
systematic review of the literature. Cranio. deactivation. J Oral Sci. 2013;55[2]:175–181.
2012;30[4]:304–312. 48. De Godoy CHL. Effect of Low-Level Laser Therapy
35. Öz S, Gökçen-Röhlig B, Saruhanoglu A, Tuncer EB. on Adolescents with Temporomandibular Disorder: A
21. Gam AN, Thorsen H, Lonnberg F. The effect of low-level Management of myofascial pain: Low-level laser therapy Blind Randomized Controlled Pilot Study. Journ of Oral &
laser therapy on musculoskeletal pain: a meta-analysis. Pain versus occlusal splints. J Craniofac Surg. 2010; 21:1722–1728. maxillofac surg 2015;73[4]:622–629.
1993;52[1]:63–66.
36. Cavalcanti MF, Silva UH, Leal-Junior EC, Lopes-Martins 49. Maia ML, Ribeiro MG, Maia LG, Martins Maia LG,
22. McNeely ML, Armijo Olivo S, Magee DJ. A systematic RA, Marcos LR, Pallotta RC, et al. Comparative study Stuginski-Barbosa J, Costa YM, et al. Evaluation of low-level
review of the effectiveness of physical therapy interventions of the physiotherapeutic and drug protocol and low-level laser therapy effectiveness on the pain and masticatory
for temporomandibular disorders. laser irradiation in the treatment of pain associated with performance of patients with myofascial pain. Lasers Med
Phys Ther 2006;86[5]:710–725. temporomandibular dysfunction. Photomed Laser Surg Sci. 014;29[1]:29–35.
2016;34[12]:652–666.
23. Chen J, Huang Z, Ge M, Gao M. Efficacy of low-level 50. Magri LV, Carvalho VA, Rodrigues FC, Bataglion C.
laser therapy in the treatment of TMDs: a meta-analysis 37. Carli ML, Guerra MB, Nunes TB, di Matteo RC, Effectiveness of low-level laser therapy on pain intensity,
of 14 randomised controlled trials. J Oral Rehabil. de Luca CEP, Aranha AC, et al. Piroxicam and laser pressure pain threshold, and SF-MPQ indexes of women
2015;42[4]:291–299. phototherapy in the treatment of TMJ arthralgia: a with myofascial pain. Lasers Med Sci 2017;32[2]:419–428.
double-blind randomized controlled trial. J Oral Rehabil.
24. Brochado FT, Jesus LH, Carrard VC, Freddo AL, Chaves 2013;40[3]:171–178. 51. Carrasco TG, Mazzetto MO, Mazzetto RG, Mestriner
KD, Martins MD. Comparative effectiveness of photo WJ. Low intensity laser therapy in temporomandibular
biomodulation and manual therapy alone or combined in 38. Fornaini C, Pelosi A, Queirolo V, Vescovi P, Merigo E. disorder: a phase II double-blind study. Cranio
TMD patients: a randomized clinical trial. Braz Oral Res. The “at-home LLLT” in temporo-mandibular disorders pain 2008;26[4]:274–281.
2018; 32:50. control: a pilot study. Laser Ther. 2015;24[1]:47–52.
52. Chisnoiu AM, Picos AM, Popa S, Daniel-Chisnoiu P,
25. Altindiş T, Güngörmüş M. Thermographic evaluation of 39. Badel T, Pavičin IS, Čimić S, Zadravec D. Diagnostics Lascu L, Picos A, et al. Factors involved in the etiology of
occlusal splint and low-level laser therapy in myofascial pain and Management of Temporomandibular Joint Disorder – A temporomandibular disorders - a literature review. Clujul
syndrome. Complement Ther Med. 2019; 44:277–281. Reported Case with a Review of Literature. J Dent Probl Med. 2015;88[4]:473–478.
Solut 2016;3[1]:18–23.
26. Madani AS, Ahrari F, Fallahrastegar A, Daghestani N. 53. Maia ML, Bonjardim LR, Quintans S, Ribeiro MA, Maia
A Randomized Clinical Trial Comparing the Efficacy of 40. Reneker J, Paz J, Petrosino C, Cook C. Diagnostic LG, Conti PC. Effect of low-level laser therapy on pain levels
Low-Level Laser Therapy [LLLT] and Laser Acupuncture accuracy of clinical tests and signs of temporomandibular in patients with temporomandibular
Therapy [LAT] in Patients with Temporomandibular joint disorders: a systematic review of the literature. J Orthop disorders: a systematic review. Journal of applied oral
Disorders. Lasers Med Sci 2020;35[1]:181–192. Sports Phys Ther. 2011;41[6]:408–416. science: revista FOB 2012;20[6]:594–602.
27. Rodrigues MF, Rodrigues ML, Bueno KS, Aroca JP, 41. Gil-Martínez A, Paris-Alemany A, López-de-Uralde- 54. Zokaee H, Akbari Zahmati AH, Mojrian N, Boostani A,
Camilotti V, Busato MC, et al. Effects of Low-Power Laser Villanueva I, La Touche R. Management of pain in patients Vaghari M. Efficacy of low-level laser therapy on orofacial
Auriculotherapy on the Physical and Emotional Aspects with temporomandibular disorder (TMD): challenges and pain: A literature review. Adv Hum Biol 2008; 8:70–73.
in Patients with Temporomandibular Disorders: A Blind, solutions. J Pain Res. 2018; 11:571–587.
Randomized, Controlled Clinical Trial. Complement Ther 55. Bjordal JM., Couppé C, Chow RT, Tunér J, Ljunggren
Med. 2019; 42:340–346. 42. Rodrigues CA, Melchior MO, Magri LV, Mestriner EA. A systematic review of low-level laser therapy with
WR, Mazzetto MO. Is the Masticatory Function Changed location-specific doses for pain from chronic joint disorders.
28. Shirani AM, Gutknecht N, Taghizadeh M, Mir M. in Patients with Temporomandibular Disorders? Brazilian Aust J Physiotherapy 2003;49[2]:107–16.
Low-level laser therapy and myofacial pain dysfunction Dental Journal 2015;26[2]:181–185.
syndrome: a randomized controlled clinical trial. Lasers Med 56. Frare J, Nicolau R. Clinical analysis of the effect of laser
Sci. 2009;24[5]:715–720. 43. Mazzetto MO, Hotta TH, Pizzo RC. Measurements of photo biomodulation [GaAs-904 nm] on temporomandibular
jaw movements and TMJ pain intensity in patients treated joint dysfunction. Rev Bras Fisioter. 2008;12[1]:37–42.
29. Demirkol N, Usumez A, Demirkol M, Sari F, Akcaboy with GaAlAs laser. Braz Dent J. 2010;21[4]:356–360.
C. Efficacy of low-level laser therapy in subjective tinnitus 57. Mazzetto M. O., Carrasco T. G., Bidinelo E. F., Andrade
patients with temporomandibular disorders. Photomed Laser 44. Röhlig BG, Kipirdi S, Meriç U, Çapan N, Keskin H. Pizzo R. C., Mazzetto R. G. Low intensity laser application in
Surg 2017;35[8]:427–431. Masticatory muscle pain and low-level laser therapy: a temporomandibular disorders: a phase I double-blind study.
double-blind and placebo-controlled study. Turkiye Fiziksel Cranio. 2007;25[3]:186–192.
30. Silva-Pereira TL, Flecha OD, Guimara RC, Douglas de Tip ve Rehabilitasyon Dergisi 2011; 57:31–37.
Oliveira D, Adriana Maria Botelho AM, 58. Kulekcioglu S., Sivrioglu K., Ozcan O., Parlak M.
Ramos-Gloria JC et al. Efficacy of red and infrared lasers in 45.Silva MA, Botelho AL, Turim CV, Silva AM. Low level Effectiveness of low-level laser therapy in temporomandibular
treatment of temporomandibular disorders-A double blind, laser therapy as an adjunctive technique in the management disorder. Scand J Rheumatol. 2003;32[2]:114–118.
randomized, parallel clinical trial. Cranio: The Journal of of temporomandibular disorders. Cranio.
2013;30[4]:264–271. 59. Machado BCZ, Mazzetto MO, Silva M, Felicio CM.
Craniomandibular & Sleep Practice 2014;32[1]:51–56.
Effects of oral motor exercises and laser therapy on chronic
31. Demirkol N, Sari F, Bulbul M, Demirkol M, Simsek I, 46. Sancakli E, Gokcen-Rohlig B, Balik A, Ongul D, Kipirdi temporomandibular disorders: a randomized study with
Usumez A. Effectiveness of occlusal splints and S, Keskin H. Early results of low-level laser application for follow-up. Lasers Med Sci. 2016;31[5]:945–954.
low-level laser therapy on myofascial pain. Lasers Med Sci. masticatory muscle pain: a double-blind randomized clinical
2014;30[3]:1007–1012. study. BMC Oral Health 2015;15[1]:131.
32. Venezian GC, da Silva MA, Mazzetto RG, Mazzetto 47. Pinho-Costa SA, Florezi GP, Artes GE, da Costa JR,
MO. Low level laser effects on pain to palpation and Gallo RT, de Freista PM, et al. The analgesic effect of
electromyographic activity in TMD patients: a double-blind, photobiomodulation therapy [830 nm] on the masticatory
randomized, placebo-controlled study. Cranio:The Journal of
Craniomandibular & Sleep Practice 2010;28[2]:84–91.
33. Cunha L. A, Firoozmand LM, Silva AP, Camargo SE,

Esteves SA, Oliveira W. Efficacy of low-level laser therapy
in the treatment of temporomandibular disorder. Int Dent J.
2008;58[4]:213–217.

164

JMedLife 14 148

Uploaded by

Copyright:

Available Formats

JMedLife 14 148

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

JMedLife 14 148

Uploaded by

Copyright:

Available Formats

JOURNAL of MEDICINE and LIFE

Low-level laser therapy in temporomandibular joint

Author Affiliations: * Corresponding Author:

KEYWORDS: low-level laser therapy (LLLT), pain intensity, randomized controlled

© 2021 JOURNAL of MEDICINE and LIFE. VOL: 14 ISSUE: 2 MARCH-APRIL 2021

Our objectives were to:

MATERIAL AND METHODS

Literature search and identification of studies

© 2021 JOURNAL of MEDICINE and LIFE. VOL: 14 ISSUE: 2 MARCH-APRIL 2021

Risk of bias assessment

Characteristics of the studies

© 2021 JOURNAL of MEDICINE and LIFE. VOL: 14 ISSUE: 2 MARCH-APRIL 2021

Applying the inclusion and exclusion

Total 164 studies included for further assessment

128 studies were excluded after reading

Total 36 studies identified

2 duplicate studies excluded

Total 37 studies included for detailed assessment

© 2021 JOURNAL of MEDICINE and LIFE. VOL: 14 ISSUE: 2 MARCH-APRIL 2021

Bias arising from the randomization process

Low risk Some concerns High risk

Figure 2. Robvis output for risk bias assessment.

© 2021 JOURNAL of MEDICINE and LIFE. VOL: 14 ISSUE: 2 MARCH-APRIL 2021

Risk of bias domains

Kulekcioglu et al. (2003)

Venancio et al. (2005)

Mazzetto et al. (2007)

Cunha et al. (2008)

Emshoff et al. (2008)

Frare et al. (2008)

Carrasco et al. (2008)

Shirani et al. (2009)

Marini et al. (2010)

Mazzetto et al. (2010)

Venezian et al. (2010)

Wang et al. (2011)

Röhlig et al. (2011)

Carli et al. (2012)

Silva et al. (2012)

Figure 3. Weighted output for risk bias assessment.

© 2021 JOURNAL of MEDICINE and LIFE. VOL: 14 ISSUE: 2 MARCH-APRIL 2021

Uemoto et al. (2013)

Ferreira et al. (2013)

Ahrari et al. (2014)

Pereira et al. (2014)

Maia et al. (2014)

Demirkol et al. (2015)

Godoy et al. (2015)

Fornaini et al. (2016)

Sancakli et al. (2016)

Machado et al. (2016)

Carli et al. (2016)

Cavalcanti et al. (2016)

Magri et al. (2017)

Costa et al. (2017)

Demirkol et al. (2017)

Shobha et al. (2017)

Brochado et al. (2018)

© 2021 JOURNAL of MEDICINE and LIFE. VOL: 14 ISSUE: 2 MARCH-APRIL 2021