Quintessence international (Berlin, Germany : 1985) · 2026
Photobiomodulation therapy for the management of pain associated with temporomandibular disorders: a systematic review.
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Vargas-Neri Carlos, Benitez-Cárdenas Oscar, Garrocho-Rangel Arturo, Félix-Sicairos Brianda, Noyola-Frías Miguel, Martínez-Martínez Rita
Аннотация
PURPOSE: To determine whether photobiomodulation (PBM; formerly low-level laser therapy) reduces temporomandibular disorder (TMD) pain relative to a concurrent comparator, to report the evidence by diagnostic stratum, and to appraise its certainty and dosimetric reporting.
STUDY SELECTION: PubMed, Embase, the Cochrane Library, and Web of Science were searched from January 2016 to July 2026 for controlled clinical trials of PBM for TMD-related pain in participants diagnosed by RDC/TMD or DC/TMD criteria. The review followed PRISMA 2020 and was registered on the Open Science Framework (DOI 10.17605/OSF.IO/YP8GW); screening, extraction, and risk-of-bias assessment were duplicated independently.
RESULTS: Nine reports representing eight independent cohorts were included. Protocols were markedly heterogeneous in wavelength (635-940 nm), energy density (5-300 J/cm²), number of sessions, and follow-up, precluding quantitative synthesis. Pain decreased from baseline in most PBM groups, but placebo groups often improved comparably and between-group superiority was less consistent: three of five myogenous cohorts favored PBM and two did not. Only one trial prespecified myalgia and arthralgia as separate strata, favoring PBM for arthralgia but not myalgia. No trial reported the complete World Association for Laser Therapy (WALT) parameter set. Certainty was low for myogenous and very low for arthrogenous TMD.
CONCLUSIONS: Photobiomodulation demonstrates pain reduction superior to sham controls in several myogenous TMD trials. However, due to low GRADE certainty and evidence inconsistency, it should be considered a complementary treatment option rather than a standalone therapy.
CLINICAL RELEVANCE: TMD affects approximately 31% of adults and is a leading cause of chronic orofacial pain. PBM was safe, noninvasive, and free of reported adverse effects, and may be considered an adjunct within a conservative, multimodal plan for myogenous TMD. Clinicians should be aware that no preferred dosimetric protocol is established, that the joint-pain evidence rests on one small subgroup, and that placebo responses were substantial. PBM should not displace established conservative measures, and patients should be counseled that the expected benefit over placebo remains uncertain.
STUDY SELECTION: PubMed, Embase, the Cochrane Library, and Web of Science were searched from January 2016 to July 2026 for controlled clinical trials of PBM for TMD-related pain in participants diagnosed by RDC/TMD or DC/TMD criteria. The review followed PRISMA 2020 and was registered on the Open Science Framework (DOI 10.17605/OSF.IO/YP8GW); screening, extraction, and risk-of-bias assessment were duplicated independently.
RESULTS: Nine reports representing eight independent cohorts were included. Protocols were markedly heterogeneous in wavelength (635-940 nm), energy density (5-300 J/cm²), number of sessions, and follow-up, precluding quantitative synthesis. Pain decreased from baseline in most PBM groups, but placebo groups often improved comparably and between-group superiority was less consistent: three of five myogenous cohorts favored PBM and two did not. Only one trial prespecified myalgia and arthralgia as separate strata, favoring PBM for arthralgia but not myalgia. No trial reported the complete World Association for Laser Therapy (WALT) parameter set. Certainty was low for myogenous and very low for arthrogenous TMD.
CONCLUSIONS: Photobiomodulation demonstrates pain reduction superior to sham controls in several myogenous TMD trials. However, due to low GRADE certainty and evidence inconsistency, it should be considered a complementary treatment option rather than a standalone therapy.
CLINICAL RELEVANCE: TMD affects approximately 31% of adults and is a leading cause of chronic orofacial pain. PBM was safe, noninvasive, and free of reported adverse effects, and may be considered an adjunct within a conservative, multimodal plan for myogenous TMD. Clinicians should be aware that no preferred dosimetric protocol is established, that the joint-pain evidence rests on one small subgroup, and that placebo responses were substantial. PBM should not displace established conservative measures, and patients should be counseled that the expected benefit over placebo remains uncertain.