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Mandibular Manipulation for the Treatment of Temporomandibular Disorder

Alves, Betania Mara Franco MD*; Macedo, Cristiane Rufino MD*; Januzzi, Eduardo MD*; Grossmann, Eduardo MD; Atallah, Álvaro Nagib MD*; Peccin, Stella MD*

Journal of Craniofacial Surgery: March 2013 - Volume 24 - Issue 2 - p 488–493
doi: 10.1097/SCS.0b013e31827c81b3
Clinical Studies

The aim of this study was to conduct a systematic review to identify the randomized clinical studies that had investigated the following research question: Is the mandibular manipulation technique an effective and safe technique for the treatment of the temporomandibular joint disk displacement without reduction? The systematic search was conducted in the electronic databases: PubMed (Medical Publications), LILACS (Latin American and Caribbean Literature in Health Sciences), EMBASE (Excerpta Medica Database), PEDro (Physiotherapy Evidence Database), BBO (Brazilian Library of Odontology), CENTRAL (Library Cochrane), and SciELO (Scientific Electronic Library Online). The abstracts of presentations in physical therapy meetings were manually selected, and the articles of the ones that meet the requirements were investigated. No language restrictions were considered. Only randomized and controlled clinical studies were included. Two studies of medium quality fulfilled all the inclusion criteria. There is no sufficient evidence to support the effectiveness of the mandibular manipulation therapy, and therefore its use remains questionable. Being minimally invasive, this therapy is attractive as an initial approach, especially considering the cost of the alternative approaches. The analysis of the results suggests that additional high-quality randomized clinical trials are necessary on the topic, and they should focus on methods for data randomization and allocation, on clearly defined outcomes, on a priori calculated sample size, and on an adequate follow-up strategy.

From the *Department of Internal Medicine, Federal University of São Paulo, São Paulo; and †Department of Morphological Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

Received August 29, 2012.

Accepted for publication November 4, 2012.

Address correspondence and reprint requests to Betania Mara Franco Alves, Federal University of São Paulo, The Brazilian Cochrane Centre, Rua Pedro de Toledo, 598-Vl. Clementino, São Paulo, SP CEP 04039-001, Brazil; E-mail:

The authors report no conflicts of interest.

© 2013 Mutaz B. Habal, MD