Annali di Stomatologia | 2026; 17(2): 301-385

ISSN 1971-1441 | DOI: 10.59987/ads/2026.2.301-385

Articles

Physical therapy for temporomandibular disorders: a scoping review

Martina Ferrillo,^1#* Vincenzo Federico Vetrano,^2# Matteo Chiorboli,³ Francesco Agostini,⁴ Umile Giuseppe Longo,^5,6 Mario Migliario,⁷ Eda Fani,⁸ Vincenzo Quinzi,⁹ Alfredo De Rosa,⁹ Alessandro de Sire^10,11

¹Dentistry Unit, Department of Health Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy

²Physiotherapist, Private practice, Milan, Italy

³Physiotherapist, Private practice, Biella, Italy

⁴Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy.

⁵Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.

⁶Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Roma, Italy.

⁷Translational Medicine Department, Università del Piemonte Orientale, Novara, Italy

⁸Department of Life, Health and Environmental Sciences, Postgraduate School of Orthodontics, University of L’Aquila, L’Aquila, Italy

⁹Department of Life Science, Health and Health Professions, Link Campus University, Rome, Italy

¹⁰Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy

¹¹Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, Catanzaro, Italy

^# = Equal contribution as first authors

^*Corresponding author: Martina Ferrillo - martina.ferrillo@unicz.it

Article History

Received: May 13, 2026

Accepted: June 23, 2026

Published: June 30, 2026

Abstract

Background

Temporomandibular disorders (TMDs) are heterogeneous and multifactorial musculoskeletal conditions. The current standard of care recommends conservative, patient-centered approaches consistent with the biopsychosocial model. However, the physical therapy literature remains heterogeneous in terms of intervention protocols, assessed outcomes, and follow-up duration.

Objective

To map the available evidence on conservative physical therapy interventions for TMDs, describe the main therapeutic strategies and most frequently investigated outcomes, and identify the main methodological gaps in the literature.

Methods

A Scoping Review was conducted in accordance with the JBI Manual for Evidence Synthesis and the PRISMA-ScR guidelines. Eligibility criteria were reorganized according to the PICO framework. The search was performed in MEDLINE/PubMed and included studies published from 2014 to 2026; the last search was conducted on April 1, 2026. Primary studies involving adults with TMDs diagnosed according to RDC/TMD or DC/TMD criteria and receiving conservative physical therapy interventions were included. Data synthesis was descriptive; no formal risk-of-bias or methodological quality assessment was conducted.

Results

A total of 119 studies, including 7015 participants, were included. Scientific production showed a growing trend, with 93 studies published from 2020 onward (78.2%) and a predominance of randomized controlled trials (n = 92; 77.3%). The diagnostic criteria used were RDC/TMD in 61 studies (51.3%), DC/TMD in 57 studies (47.9%), and mixed criteria in 1 study (0.8%). The most frequently investigated interventions were therapeutic exercise (n = 64; 53.8%), manual therapy (n = 63; 52.9%), and physical modalities (n = 39; 32.8%). Outcomes mainly focused on pain (n = 112; 94.1%), mandibular ROM/maximum mouth opening (n = 86; 72.3%), and function/disability (n = 51; 42.9%). Psychological outcomes (n = 18; 15.1%) and quality of life (n = 16; 13.4%) were less represented. Follow-up longer than 6 months was reported in 4 studies (3.4%). The most frequent limitations included small sample sizes, short follow-up periods, heterogeneity of protocols, and difficulties with blinding or control conditions.

Conclusions

The physical therapy literature on TMDs is broad and growing but remains heterogeneous. Therapeutic exercise, manual therapy, and physical modalities were the most frequently studied interventions, whereas pain and MMO/ROM were the most commonly reported outcomes. Biopsychosocial outcomes, quality of life, psychological aspects, and long-term follow-up were less represented. In the absence of a formal risk-of-bias assessment and due to the heterogeneity of the included studies, definitive conclusions on the comparative effectiveness of interventions cannot be drawn. Physical therapy should be interpreted within conservative, patient-centered, and multidisciplinary care pathways. Future studies should adopt more standardized protocols, multidimensional outcomes, and longer follow-up periods.

Keywords: Temporomandibular disorders; physical therapy; rehabilitation; manual therapy; therapeutic exercise; orofacial pain; scoping review.

1. Introduction

Temporomandibular disorders (TMDs) are a heterogeneous group of musculoskeletal conditions involving the temporomandibular joint, the masticatory muscles, and related structures. [1] Clinically, they frequently present with orofacial pain, limitation or alteration of mandibular movements, and joint noises. [2] Beyond local symptoms, TMDs may be associated with reduced quality of life, painful comorbidities, headache, neck pain, and psychological distress, representing a complex and multidimensional clinical condition. [3]

Historically, the etiology of TMDs has been interpreted through predominantly mechanistic or occlusal models, focused on malocclusion, condylar position, and biomechanical alterations as the main diagnostic and therapeutic targets. [1] However, more recent research has progressively challenged these unidimensional interpretations, favoring the adoption of a multifactorial and biopsychosocial model. [4–7] In this context, the introduction of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and, subsequently, the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) contributed to standardizing clinical and research assessment by integrating the physical examination of clinical conditions, represented by Axis I, with the psychosocial and pain-related disability assessment, represented by Axis II.

Consistently with this evolution, recent INfORM/IADR recommendations propose a patient-centered management of TMDs based on conservative, reversible approaches aligned with the biopsychosocial model. In particular, supported self-management, cognitive-behavioral recommendations, and physical therapy are indicated as key components of conservative treatment, whereas invasive or surgical interventions should be reserved for selected cases.

Conservative management is currently considered the first-line treatment for most patients with TMDs, with physical therapy playing a central role within multidisciplinary rehabilitation pathways. Physical therapy interventions encompass a broad range of approaches, including therapeutic exercise, manual therapy, patient education, and physical modalities aimed at reducing pain and improving mandibular function. Recent evidence has also explored adjunctive physical therapy interventions, such as extracorporeal shock wave therapy, which has been investigated for pain reduction among patients with TMDs [54,57,60]. The growing diversification of therapeutic strategies reflects the need for individualized treatment plans tailored to the specific clinical presentation of each patient.

Despite the broad body of available scientific literature, conservative management of TMDs remains characterized by substantial clinical and methodological heterogeneity. Healthcare professionals are faced with a wide range of therapeutic options and evidence that is not always easily translatable into clear decision-making pathways. In this context, evidence-based medicine requires the critical and conscious use of the best available evidence to guide clinical decisions toward appropriate and patient-centered interventions.

Therefore, the present scoping review aims to systematically map the literature on conservative physical therapy interventions for TMDs, describe the most frequently investigated therapeutic strategies and outcomes, and identify methodological limitations that may guide future research and clinical practice.

2. Materials and Methods

2.1. Study Design

This review was conducted as a Scoping Review, in accordance with the JBI Manual for Evidence Synthesis and the PRISMA Extension for Scoping Reviews (PRISMA-ScR). The review protocol was not formally registered, but it was developed before the study and is available from the author upon request.

2.2. Eligibility Criteria

Eligibility criteria were reorganized according to the PICO framework (Population, Intervention, Comparison, Outcome) to more explicitly define the population of interest, conservative physical therapy interventions, possible comparators, and clinical outcomes mapped in the review. This reorganization did not modify the methodological nature of the review, which maintained the descriptive and exploratory aims of a Scoping Review.

The population of interest included adult participants (≥18 years) of both sexes with a diagnosis of temporomandibular disorder, formulated according to the standardized RDC/TMD or DC/TMD diagnostic criteria. Studies involving pediatric populations, animal or in vitro models, or conditions in which orofacial pain was exclusively attributable to systemic diseases, neuralgias, isolated cervical disorders, or conditions not classifiable as TMDs according to standardized diagnostic criteria were excluded.

Interventions of interest included conservative physical therapy strategies used as the main treatment or as a central component of the rehabilitation pathway, including therapeutic exercise, manual therapy, myofascial therapy, physical modalities, patient education, self-management strategies, and dry needling.

Eligible comparators included sham/placebo treatment, no treatment, waiting list, usual care, intraoral devices such as occlusal splints or bite guards, pharmacological therapy, other conservative approaches, or invasive/surgical interventions, only when directly compared with physical therapy as the primary therapeutic alternative. Studies concerning post-surgical rehabilitation or physical therapy protocols administered exclusively after invasive procedures had already been performed were excluded, since the aim of the review was to map physical therapy as a conservative, standalone, or comparative strategy in the primary management of TMDs.

Pain intensity, mainly measured using the Visual Analog Scale (VAS) or Numeric Rating Scale/Numeric Pain Rating Scale (NRS/NPRS), was considered the primary outcome mapped in the review. Secondary outcomes included mandibular ROM/maximum mouth opening (MMO), mandibular function and disability, quality of life, psychological outcomes, pressure pain threshold, and instrumental outcomes.

Only quantitative primary studies were included, such as randomized controlled trials, non-randomized clinical trials, and analytical observational studies. Case reports, case series, systematic reviews, meta-analyses, narrative reviews, qualitative studies, editorials, letters, opinions, abstracts without full text, grey literature, and non-peer-reviewed contributions were excluded. Only full-text articles available in English or Italian and published from 2014 onward were considered eligible, in relation to the publication of the DC/TMD criteria.

2.3. Search Strategy and Study Selection

The literature search was conducted in the MEDLINE database through PubMed. The search strategy was developed by combining MeSH terms and free-text words related to temporomandibular disorders and conservative physical therapy interventions. The complete search string is the following:

((“Temporomandibular Joint Disorders”[MeSH Terms] OR “Temporomandibular Joint Disorders”[Title/Abstract] OR TMD[Title/Abstract] OR “TMJ Diseases”[Title/Abstract] OR “Temporomandibular Disorders”[Title/Abstract] OR “TMJ Disorders”[Title/Abstract] OR “orofacial pain”[Title/Abstract] OR “myofascial pain”[Title/Abstract]) AND (“Physical Therapy Modalities”[MeSH Terms] OR “Exercise Therapy”[MeSH Terms] OR “Muscle Stretching Exercises”[MeSH Terms] OR “Resistance Training”[MeSH Terms] OR “Musculoskeletal Manipulations”[MeSH Terms] OR “Therapy, Soft Tissue”[MeSH Terms] OR physiotherapy[Title/Abstract] OR rehabilitation[Title/Abstract] OR “manual therapy”[Title/Abstract] OR “dry needling”[Title/Abstract] OR “trigger point”[Title/Abstract] OR “myofascial release”[Title/Abstract] OR “myofunctional therapy”[Title/Abstract]) ) AND (“2014”[Date - Publication] : “3000”[Date - Publication]).

The search was limited to studies published between 2014 and 2026. The most recent literature search was performed on April 1, 2026. Grey literature was not searched, and no contact with the authors of the included studies was planned.

Search results were initially subjected to duplicate removal. Study selection was then conducted through title screening, abstract assessment, and full-text review of potentially eligible articles. The management and organization of the study selection process were facilitated by the online software Rayyan.

2.4. Data Extraction and Synthesis

Data extraction was performed using a predefined data charting form. For each included study, the main bibliographic and methodological characteristics were collected, including author, year of publication, country where the study was conducted, study design, and sample size. Data were also extracted on the diagnostic criteria used, characteristics of physical therapy interventions, comparators, clinical outcomes assessed, measurement tools, follow-up duration, main results reported by the authors, and methodological limitations described in the studies. The complete characteristics of the included studies are reported in Supplementary Table S1.

Data synthesis was conducted descriptively, consistent with the aims of the Scoping Review. No meta-analysis or advanced quantitative synthesis of intervention effectiveness was performed. Data were organized using frequency counts, percentages, and thematic categorizations related to study characteristics, diagnostic criteria, interventions, outcomes, follow-up duration, and the main reported methodological issues.

No formal risk-of-bias or methodological quality assessment was conducted for the included studies. However, the main methodological issues reported across the studies, such as small sample sizes, short follow-up periods, absence of a control group, difficulty of blinding, intervention heterogeneity, and drop-out, were summarized descriptively. These elements should be interpreted as a narrative mapping of reported limitations and not as a structured risk-of-bias assessment.

3. Results

3.1. Study Selection

The literature search identified 1602 potentially relevant records. After removing 21 duplicates, 1581 records were screened by title and abstract. Of these, 164 full texts were assessed for eligibility. At the end of the selection process, 119 primary studies [1–119] were included in the present Scoping Review, as reported in the PRISMA flow diagram (see Figure 1).

**Figure 1.** PRISMA-ScR flow diagram of the study selection process.

3.2. General Characteristics of Included Studies

A total of 119 studies [1–119] were included, comprising 7015 participants (Table 1). The temporal distribution showed a concentration of scientific production in recent years, with 93 studies published from 2020 onward, accounting for 78.2% of the total.

From a geographical perspective, Brazil was the most represented country (n = 29; 24.4%), followed by Turkey (n = 19; 16.0%), Poland (n = 15; 12.6%), Spain (n = 10; 8.4%), and Italy (n = 5; 4.2%). The analysis by macro-area showed a predominance of studies conducted in Europe (n = 43; 36.1%), followed by South America (n = 29; 24.4%), the Middle East (n = 26; 21.8%), Asia (n = 18; 15.1%), and North America (n = 3; 2.5%). No studies from Africa or Oceania were identified.

Regarding study design, most included publications were randomized controlled trials (RCTs) (n = 92; 77.3%). The remaining study designs included observational studies (n = 13; 10.9%), quasi-experimental studies (n = 7; 5.9%), retrospective studies (n = 6; 5.0%), and mixed-methods studies (n = 1; 0.8%).

Table 1. General characteristics of the included studies.

Characteristic	n	%
Included studies	119	100.0
Total participants	7015	—
Studies published from 2020 onward	93	78.2
Randomized controlled trials (RCTs)	92	77.3
Observational studies	13	10.9
Quasi-experimental studies	7	5.9
Retrospective studies	6	5.0
Mixed-methods studies	1	0.8
Italian studies	5	4.2

Note: Percentages were calculated based on the total number of studies included in the Scoping Review (n = 119) and rounded to one decimal place. The total number of participants represents the aggregate sample size reported across the included studies.

3.3. Diagnostic Criteria and Mapped Interventions

For TMD diagnostic classification, RDC/TMD criteria were used in 61 studies (51.3%), DC/TMD criteria in 57 studies (47.9%), and mixed criteria in 1 study (0.8%) (Table 2).

The mapping of interventions highlighted marked heterogeneity among the therapeutic strategies investigated. Therapeutic exercise was reported in 64 studies (53.8%), and manual therapy in 63 studies (52.9%). Physical modalities were reported in 39 studies (32.8%). Interventions based on patient education and self-management were documented in 26 studies (21.8%), while multimodal protocols were identified in 23 studies (19.3%). Needling or acupuncture was reported in 17 studies (14.3%). Occlusal splints or bite guards were present in 27 studies (22.7%), mainly as comparators or co-interventions, whereas pharmacological therapies were reported in 8 studies (6.7%), primarily as comparators.

Table 2. Diagnostic criteria and mapped therapeutic interventions.

Variable	n	%
RDC/TMD	61	51.3
DC/TMD	57	47.9
Mixed criteria	1	0.8
Therapeutic exercise	64	53.8
Manual therapy	63	52.9
Physical modalities	39	32.8
Education/self-management	26	21.8
Multimodal interventions	23	19.3
Needling/acupuncture	17	14.3
Splints/bite guards as comparators or co-interventions	27	22.7
Pharmacological therapies as comparators	8	6.7

Note: Diagnostic categories were reported as mutually exclusive. In contrast, intervention categories were not mutually exclusive, as some studies included multimodal protocols or multiple therapeutic components within the same study design.

3.4. Mapped Outcomes and Follow-up

Pain was the most frequently reported clinical outcome, present in 112 studies (94.1%) (Table 3). The most commonly used tools for pain measurement were the Visual Analog Scale (VAS), reported in 79 studies (66.4%), and the Numeric Rating Scale/Numeric Pain Rating Scale (NRS/NPRS), reported in 29 studies (24.4%). Owing to its high frequency, pain was considered the primary outcome mapped in the review.

Mandibular ROM/maximum mouth opening (MMO) was reported in 86 studies (72.3%). Outcomes related to function and disability were reported in 51 studies (42.9%). Instrumental outcomes were documented in 35 studies (29.4%), whereas psychological outcomes and quality of life were reported in 18 studies (15.1%) and 16 studies (13.4%), respectively.

Follow-up duration was predominantly short- or medium-term. Medium-term follow-up, defined as longer than 1 month and up to 6 months, was reported in 62 studies (52.1%), while short-term follow-up was reported in 39 studies (32.8%). Follow-up limited to the immediate post-treatment period was present in 11 studies (9.2%). Only 4 studies (3.4%) reported follow-up longer than 6 months, whereas in 3 studies (2.5%) the follow-up duration was not clearly reported.

Table 3. Mapped clinical outcomes and follow-up duration.

Outcome/follow-up	n	%
Pain	112	94.1
VAS	79	66.4
NRS/NPRS	29	24.4
Mandibular ROM/MMO	86	72.3
Function/disability	51	42.9
Instrumental outcomes	35	29.4
Psychological outcomes	18	15.1
Quality of life	16	13.4
Immediate follow-up	11	9.2
Short-term follow-up	39	32.8
Medium-term follow-up	62	52.1
Follow-up >6 months	4	3.4
Follow-up not reported	3	2.5

Note: VAS and NRS/NPRS represent specific pain measurement tools and are not additional categories separate from the “pain” outcome. Follow-up categories were aggregated as mutually exclusive categories based on the last timepoint explicitly reported in the included studies.

3.5. Reported Methodological Limitations of the Included Studies

No formal methodological quality or risk-of-bias assessment was conducted (Table 4). However, the main methodological issues reported in the included studies were descriptively mapped. The most frequent limitations included small sample size (n = 67; 56.3%) and short follow-up (n = 52; 43.7%). Other issues included the absence of a control group or sham intervention (n = 45; 37.8%), absence or difficulty of blinding (n = 40; 33.6%), gender imbalance (n = 31; 26.1%), absence of randomization (n = 20; 16.8%), and high or unbalanced drop-out rates (n = 15; 12.6%).

Table 4. Reported methodological limitations of the included studies.

Reported methodological limitation	n	%
Small sample size	67	56.3
Short follow-up	52	43.7
Absence of a control group or sham intervention	45	37.8
Absence or difficulty of blinding	40	33.6
Gender imbalance in the sample	31	26.1
Absence of randomization	20	16.8
High or unbalanced drop-out rates	15	12.6

Note: Categories were not mutually exclusive, as the same study could present more than one methodological limitation. This table summarizes methodological issues reported by the authors or descriptively mapped from the included studies and does not constitute a formal risk-of-bias or methodological quality assessment.

4. Discussion

4.1. Main Findings

The present scoping review mapped the evidence on conservative physical therapy interventions for the management of temporomandibular disorders, including 119 primary studies. The analysis showed a relevant growth in scientific production from 2020 onward, with a predominance of randomized controlled trials. Despite this expansion, the available literature appears to be characterized by considerable heterogeneity of interventions, with therapeutic exercise, manual therapy, and physical modalities being the most represented strategies. Regarding outcomes, pain and mandibular ROM/maximum mouth opening were the most frequently investigated domains, whereas long-term follow-up was poorly represented. In line with the Scoping Review design, no formal risk-of-bias or methodological quality assessment was conducted, and the results should therefore be interpreted as a descriptive mapping of the breadth and characteristics of the available literature.

4.2. Interpretation in Light of the Biopsychosocial Model and INfORM/IADR Recommendations

The findings of the present review appear to be consistent with the INfORM/IADR recommendations, which orient the standard of care for TMDs toward patient-centered, predominantly conservative, and reversible management. In this context, supported self-management, cognitive-behavioral recommendations, and physical therapy are indicated as key components of conservative treatment. This orientation is part of the progressive shift away from exclusively mechanistic or occlusal models and toward the adoption of a multifactorial and biopsychosocial perspective on TMDs.

However, the predominance of outcomes mainly focused on pain and mandibular function suggests that the operational translation of the biopsychosocial paradigm in physical therapy research is still developing. Although pain and function represent essential clinical domains, the lower presence of measures related to quality of life, perceived disability, and psychological aspects indicates the need for a more multidimensional and patient-centered assessment in future studies.

4.3. Heterogeneity of Interventions, Outcomes, and Follow-up

A relevant aspect emerging from the mapping concerns the heterogeneity of the rehabilitation interventions investigated, which included therapeutic exercise, manual therapy, physical modalities, education and self-management, multimodal protocols, dry needling, and acupuncture. This variability involved not only the type of intervention, but also modes of delivery, duration, dosage, comparators, and assessment tools, limiting direct comparability across studies.

Outcome selection also appeared heterogeneous. The predominance of measures related to pain and mandibular opening contrasted with the lower representation of psychological outcomes, quality of life, and long-term follow-up. This pattern limits the possibility of fully describing the impact of physical therapy interventions on the patient’s global functioning. Consequently, the heterogeneity of protocols, outcomes, and follow-up prevents definitive conclusions from being drawn regarding the comparative effectiveness or clinical superiority of one physical therapy intervention over another.

4.4. Clinical and Research Implications

The procedural heterogeneity emerging from the present mapping suggests the need to develop rehabilitation protocols that are more standardized and more easily comparable across studies. Consistently with the biopsychosocial model of TMDs, future clinical investigations should more systematically integrate multidimensional outcomes, including not only pain and mandibular functional parameters, but also quality of life, perceived disability, psychological factors, and longer follow-up periods.

Furthermore, the etiological and clinical complexity of TMDs supports the usefulness of conservative and multidisciplinary pathways in which physical therapy can be integrated with supported self-management strategies and cognitive-behavioral recommendations, in accordance with the INfORM/IADR recommendations. From this perspective, the limited presence of indexed Italian studies in the present review does not allow conclusions to be drawn regarding the actual organization of national clinical practice. However, this finding suggests a potential area for development in Italian scientific production through multicenter and interdisciplinary studies focused on the conservative management of TMDs.

4.5. Strengths and Limitations

The strengths of the present Scoping Review include the broad mapping of recent literature and the structured synthesis of conservative interventions, assessed outcomes, follow-up windows, and the main methodological issues reported in the included studies. An additional element of methodological rigor is represented by the decision to include only primary studies based on internationally standardized diagnostic criteria, such as RDC/TMD and DC/TMD, thereby promoting greater diagnostic homogeneity within the mapped body of evidence.

This review also has some limitations. First, the literature search was conducted in a single database and did not include grey literature; moreover, no contact with the authors of the primary studies was planned for the retrieval of unpublished data. Second, in line with the exploratory purpose of the Scoping Review, no formal risk-of-bias or methodological quality assessment of the included studies was performed. The absence of this assessment, together with the heterogeneity of rehabilitation protocols, outcomes, and follow-up durations, limits the possibility of drawing definitive conclusions on the comparative effectiveness of individual interventions. Therefore, the results should be interpreted as a descriptive mapping of the available evidence.

5. Conclusions

The present scoping review highlighted a broad and growing body of literature on conservative physical therapy interventions for temporomandibular disorders. Therapeutic exercise, manual therapy, and physical modalities were the most frequently investigated strategies, whereas pain and mandibular ROM/maximum mouth opening were the most commonly reported outcomes. However, the marked heterogeneity of protocols, the limited presence of long-term follow-up, and the lower representation of psychological and quality-of-life outcomes suggest that the integration of the biopsychosocial paradigm into physical therapy research on TMDs is still developing.

In accordance with the current conservative and patient-centered approach, physical therapy should be considered within multidisciplinary pathways integrating education, self-management, and cognitive-behavioral recommendations. In light of the absence of a formal risk-of-bias assessment and the heterogeneity of the included studies, the results do not allow definitive conclusions to be drawn regarding the comparative effectiveness of individual interventions. Nevertheless, they provide a useful mapping to guide future, more standardized clinical studies with multidimensional outcomes and longer follow-up periods.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interest

Authors declare no conflict of interest and that they did not receive support from any organization for the submitted work. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Acknowledgements

None.

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Supplementary Table S1. Characteristics of the included studies and summary of extracted data.

Study no.	Study (Author/Year/Country)	Study design	design Sample (n, mean age ± SD, sex, drop-out)	Clinical diagnosis	Diagnostic criteria (DC/TMD or RDC/TMD)	Intervention (experimental vs control; dose and frequency)	Primary outcomes (measurement scales)	Main results (quantitative data, p-value, effect size)	Notes and methodological limitations
1	Tavares et al. / 2026 / Brazil	Randomized controlled clinical trial (RCT)	n = 58 (Experimental = 28, Control = 30); age: Experimental 30.32 ± 8.37, Control 31.63 ± 8.61; sex: 58 F, 0 M; drop-out: 7	Chronic painful temporomandibular disorders (TMDs)	DC/TMD	Experimental: cervical exercises + aerobic training (treadmill, 30 min, moderate intensity 60–80% HRR). Control: cervical exercises only (30–40 min). Dose/frequency: supervised sessions twice weekly for 8 weeks + home exercises on alternate days.	Orofacial pain intensity (VAS 0–100 mm), neck disability (NDI)	No statistically significant between-group difference (p > 0.05). Statistically significant within-group change over time in both groups (p < 0.05). Within-group effect size for pain intensity (Hedges’ g): Experimental = 1.43; Control = 1.08.	Therapist blinding was not feasible; exclusively female sample, limiting generalizability to males; possible ceiling effect due to the active control intervention.
2	Korkmaz Üçüncü et al. / 2026 / Turkey	Prospective controlled non-randomized intervention study	n = 40 (Experimental = 20, Control = 20); age: Experimental 37.25 ± 13.84, Control 28.47 ± 8.26; sex: 38 F, 2 M; drop-out: NR	Temporomandibular joint disc displacement with reduction (DDWR)	DC/TMD (Axis I, Group II)	Experimental: home-based exercise program for the TMJ and cervical region + patient education. Control: patient education only. Dose/frequency: twice daily for 4 weeks.	Maximum mouth opening (MMO, caliper). Secondary outcomes included pain (NRS) and function (MFIQ).	Statistically significant between-group difference post-treatment for MMO (p < 0.001; effect size = 0.66) and pain during activity (p < 0.001; effect size = 0.73). No statistically significant between-group difference for pain at rest (p = 0.176).	Non-randomized design; very short follow-up (1 month); exercise adherence assessed only through patient telephone reports.
3	Gençosmanoğlu et al. / 2026 / Turkey	Multicenter randomized controlled pilot study	n = 30 randomized (analyzed: FDM = 9, CST = 10, CG = 10); age: FDM 31.7 ± 9.14, CST 37.6 ± 13.58, CG 27.5 ± 7.35; sex: 27 F, 3 M; dropout: 9 (30%)	Mixed TMD	DC/TMD	Experimental 1: Fascial Distortion Model (FDM) therapy + SHEP (home exercise program). Experimental 2: Pilates-based Core Stability Training (CST) + SHEP. Control (CG): waiting list. Dose/frequency: one 45-min session per week for 8 weeks (FDM/CST).	Feasibility (recruitment/adherence). Clinical outcomes assessed included pain (GCPS-R, VAS, NPRS), disability (MFIQ), and posture (photo-grammetry).	Statistically significant group × time interaction for GCPS-R (p < 0.001). Statistically significant between-group difference in eating ability between FDM and CG (p < 0.05). No statistically significant between-group difference for BETY-BQ (p > 0.05).	Small sample size; no long-term follow-up; blinding of therapists and patients was not feasible.
4	Ferrillo et al. / 2026 / Italy	Randomized controlled pilot study (RCT)	n = 27 analyzed (Experimental = 14, Control = 13); age: Experimental 34.71 ± 19.66, Control 37.00 ± 13.16; sex: 20 F, 7 M; drop-out: 3	Myogenous TMD (myofascial pain)	DC/TMD (Axis I, Group I)	Experimental (PT+OS): education + physical therapy + occlusal splint (night-time use for 6 months). Control (PT): education + physical therapy. Dose/frequency: 12 physical therapy sessions in total (40 min, 3 times/week for 4 weeks).	TMD pain intensity (NRS 0–10)	Repeated-measures ANOVA showed statistically significant between-group differences between T0 and T2 (6 months) in TMD pain, Neck Disability Index, and EQ-VAS values, with changes reported in the PT+OS group (p = 0.033; p = 0.025; p = 0.039).	Small sample size; lack of objective monitoring of adherence to occlusal splint use and exercises; psychosocial disability (Axis II) not investigated.
5	Abaci et al. / 2026 / Turkey	Randomized controlled study (RCT)	n = 40 analyzed (Experimental = 20, Control = 20); age: Experimental 29.95 ± 9.34, Control 25.85 ± 5.27; sex: 36 F, 4 M; drop-out: 10 (20%)	TMD associated with probable sleep bruxism (TMDs-SB)	DC/TMD (Axis I) and clinical assessment (bruxism)	Experimental (TR): real-time telerehabilitation (exercises supervised via WhatsApp video call) + home exercises. Control (HE): unsupervised home exercises. Dose/frequency: 30-min video sessions once weekly for 8 weeks.	Pain (VAS), maximum mouth opening (MMO), craniovertebral angle (CVA), anxiety (STAI), disability (NDI), oral behaviors (OBC), sleep (PSQI)	Statistically significant changes over time in both groups (p < 0.05). Statistically significant between-group differences for morning jaw pain (p = 0.012, r = 0.396), NDI (p = 0.032, r = 0.339), trait anxiety (p = 0.028, r = 0.347), and OBC (p = 0.001, r = 0.712). No statistically significant between-group difference for sleep quality (p = 0.154).	Conducted during the COVID-19 pandemic, limiting generalizability to normal periods; bruxism was reported through history taking, without polysomnography; dependence on internet infrastructure.
6	Patra et al. / 2026 / India	Randomized controlled clinical trial (RCT)	n = 87 (CMSE = 29, MT = 29, Control = 29); age: CMSE 34 ± 13.11, MT 36 ± 12.11, Control 35 ± 14.12; sex: 55 F, 32 M; dropout: 0	Myofascial or mixed TMD	RDC/TMD	Experimental 1 (CMSE): cranio-mandibular stabilization exercises (biofeedback + cervical flexion/extension). Experimental 2 (MT): manual therapy (dry needling and muscle inhibition). Control: home exercises for cervical mobility. Dose/frequency: interventions for 8 weeks (1 or 2 sessions/week).	Orofacial pain intensity (VAS 0–10 cm)	Statistically significant between-group difference at 8 weeks for pain between CMSE and Control (MD = −1.91, p < 0.05, Cohen’s d = 0.94). Statistically significant between-group differences for OHRQoL between CMSE and MT (effect size = 0.91) and between CMSE and Control (effect size = 1.03). No statistically significant between-group difference for mandibular ROM (p > 0.05).	Lack of objective neurophysiological evidence (e.g., fMRI, EMG) supporting the effect on the trigeminocervical nucleus; complete and unusual absence of drop-outs.
7	Lin et al. / 2026 / Japan	Prospective repeated-measures study (pre-post)	n = 37 TMD patients + 27 healthy controls; age (TMD): 46.9 ± 18.5; sex (TMD): 34 F, 3 M; drop-out: 20 at long-term follow-up (64%)	TMD with limited mouth opening (LMO < 40 mm) associated with DD, M, or DD+M	DC/TMD + MRI	Experimental: finger-assisted manual Passive Stretch Training (PST). Control: healthy subjects assessed only for baseline EMG. Dose/frequency: short-term protocol (15 repetitions × 5 s in clinical setting); long-term protocol (home exercises 1–3 times/day for 3 months).	Surface electromyographic activity (sEMG) of the masseter, mouth opening amplitude (mm), pain (VAS)	Short term: statistically significant changes over time for mouth opening (p < 0.001) and sEMG (p < 0.05). Long term (n = 11): statistically significant changes over time for MMO (DD+M p = 0.002; M p = 0.045) and VAS pain (DD+M p = 0.026; M p = 0.042).	Extremely high dropout rate at 3 months (20 of 31 patients lost); adherence to home-based PST only self-reported; absence of a true randomized clinical control group.
8	Sahin et al. / 2026 / Turkey	Randomized controlled clinical trial (RCT)	n = 62 analyzed (PNFE = 30, CEG = 32); age: PNFE 22.20 ± 3.74, CEG 23.21 ± 4.86; sex: 35 F, 27 M; drop-out: 4	Myogenous TMD	DC/TMD (Axis I)	Experimental (PNFE): conventional physical therapy + Proprioceptive Neuromuscular Facilitation (PNF) for the head-neck-jaw region. Control (CEG): conventional physical therapy (TENS, infrared therapy, Rocabado 6×6 exercises). Dose/frequency: 16 total sessions over 4 weeks.	Pain intensity (NPRS)	Statistically significant changes over time in pain values in both groups (p < 0.001), with a statistically significant group-time interaction (p = 0.008, η_p² = 0.110). Statistically significant between-group difference for MMO values (p = 0.005, η_p² = 0.002).	Between-group differences in ROM/MMO were statistically significant but below the Minimum Clinically Important Difference (MCID of 6 mm); sample mainly restricted to young adults.
9	Yu et al. / 2026 / China	Randomized controlled clinical trial (RCT)	n = 65 (A+M = 33, M = 32); age: A+M 29.69 ± 2.32, M 26.66 ± 1.73; sex: 54 F, 11 M; drop-out: 0	Myofascial TMD (myalgia)	DC/TMD + MRI	Experimental (A+M): electroacupuncture (30 min) + intraoral and extraoral manual therapy. Control (M): manual therapy only. Dose/frequency: 1 session/day, 5 days/week for 2 weeks (10 sessions total).	Pain (VAS), pressure pain threshold (PPT), maximum mouth opening (MMO), function (JFLS), magnetic resonance imaging of the lateral pterygoid muscle (LPM)	Statistically significant between-group differences were reported for VAS, JFLS, MMO, and PPT (p = 0.004; p = 0.010; p = 0.006; p = 0.041). MRI showed statistically significant changes in LPM muscle area and Signal Intensity Ratio (SIR) values (p < 0.05).	Single-center study; small sample size; difficulty standardizing the degree of teeth clenching during closed-mouth MRI scanning; no long-term follow-up.
10	Amro et al. / 2026 / Palestine	Self-controlled experimental study (single-group pre-post)	n = 32; age: 29 ± 5; sex: 20 F, 12 M; drop-out: 0	Myogenous TMD	RDC/TMD (Axis I, Group I)	Experimental: structured home-based program (Rocabado exercises, postural re-education, deep neck flexor training, self-stretching, and TMJ self-mobilization). Control: self-controlled comparison against baseline parameters (no external control group). Dose/frequency: six short daily sessions (10–15 min) for 2 weeks.	Mandibular ROM, pain (VAS), muscle tenderness (Tenderness VAS), deep neck flexor endurance (DNF)	Statistically significant changes over time for MMO (35.75 vs 41.41 mm, p < 0.001), static TMJ pain (1.88 vs 0.78, p = 0.002), masseter palpation tenderness (4 vs 2, p < 0.001), and DNF endurance (21.16 vs 32.16 s, p < 0.001).	Single-arm design without a control group, making it impossible to distinguish the intervention effect from placebo or natural clinical course; assessors not blinded; no follow-up beyond the two-week testing period.
11	Tang et al. / 2026 / China	Prospective controlled non-randomized study	n = 60 (TMD = 30, healthy = 30); age: TMD median 28.5 (IQR 12.5), healthy median 29.5 (IQR 13.0); sex: 53 F, 7 M; drop-out: 0	Temporomandibular disorders (TMDs) including different subtypes (myalgia, arthralgia, disc displacement with or without reduction)	DC/TMD	Experimental (TMD): physical rehabilitation protocol including education, laser, ultrasound, TENS, thermotherapy, and mandibular exercises. Control (healthy): no treatment, single assessment only. Dose/frequency: 3 sessions/week for 2 weeks.	Tongue-palate distance (cm), tongue thickness (cm) measured by ultrasound	Statistically significant difference in tongue thickness values in the TMD group after treatment (4.67 vs 5.08 cm, p < 0.05, Cohen’s d = 0.65). No statistically significant change in tongue-palate distance (p = 0.127, r = 0.27). No statistically significant difference compared with the healthy group for either parameter (p > 0.05).	Absence of a sham control group; very short follow-up (2 weeks); assessors not blinded to group allocation; diagnostic heterogeneity of the TMD group.
12	Czarnecka et al. / 2025 / Poland	Prospective single-arm pilot study	n = 25; age: NR (range 25–39 years); sex: NR (both males and females included); drop-out: 0	Myogenous TMD with coexisting orofacial myofunctional disorders	DC/TMD	Experimental: Orofacial Myofunctional Therapy (OMT), including awareness, myofascial massage, oromotor training, and functional re-education. Control: none (single-arm study). Dose/frequency: 3 sessions of approximately 30 min every 2 weeks, for a total of 4 weeks + home exercises.	Maximum mouth opening (MAX), tongue mobility (TRMR-TIP, TRMRLPS), pain intensity (VAS), quality of life (SF-36)	Statistically significant changes over time for all assessed indices (p < 0.001). VAS values changed from 7 to 4 (Cohen’s d = −2.62). Statistically significant changes over time in maximum opening during each session (Cohen’s d for the second session = 1.39). Statistically significant changes in SF-36 values (Cohen’s d = −3.71).	Single-arm design without a control group, making placebo effects impossible to exclude; same clinician delivered therapy and performed measurements, increasing risk of bias; no long-term follow-up.
13	Duran et al. / 2025 / Turkey	Multicenter randomized controlled clinical trial (RCT)	n = 90 (DN = 30, KT = 30, Control = 30); age: DN 37.6 ± 9.93, KT 35.6 ± 8.26, Control 35.6 ± 4.75; sex: 49 F, 41 M; dropout: 0	Myogenous TMD	RDC/TMD	Experimental 1 (DN): dry needling of the masseter and temporalis muscles. Experimental 2 (KT): Kinesio taping of the masseter. Control: conservative recommendations, including heat, analgesics, and diet. Dose/frequency: DN, 20 min, 3 times/week for 6 weeks; KT, tape maintained for 4 days and renewed weekly for 6 weeks.	Pain intensity (VAS), mouth opening, depression (BDI), sleep quality (PSQI)	Statistically significant between-group difference for pain values (p < 0.001). Effect size (Cohen’s d): DN = 2.844; KT = 1.326. Statistically significant change over time in mouth opening in the DN group (p < 0.001). No statistically significant between-group difference in depression levels (p = 0.464).	Short-term follow-up only (6 weeks); control based on recommendations without a sham intervention; potential type II error for secondary outcomes, as sample size calculation was based only on pain.
14	Law et al. / 2025 / China (Hong Kong)	Double-blind randomized controlled clinical trial (RCT)	n = 64 analyzed (ESWT = 33, Placebo = 31); age: ESWT 44.2 ± 19.0, Placebo 48.7 ± 17.6; sex: 51 F, 13 M; drop-out: 3	Myogenous TMD	DC/TMD	Experimental (ESWT): focused extracorporeal shock wave therapy applied to the masseter (500 pulses, 0.15 mJ/mm², 6 Hz). Control (Placebo): identical application with a stand-off device blocking energy transmission. Dose/frequency: 1 session/week for 3 sessions in total.	Pain (NRS 0–10), maximum mouth opening (MMO), lateral excursions, protrusion	Pain reduction was statistically significant over time in both groups. At 3 months, the ESWT group showed a mean reduction of 2.6 points (p < 0.001) compared with 1.8 points in the placebo group (p = 0.002). No statistically significant between-group differences for MMO or mandibular excursions (p > 0.05). No serious adverse events were reported.	Heterogeneous sample, with documented presence of patients with intra-articular conditions associated with myalgia; ESWT dose based only on manufacturer recommendations, without a dose-finding study.
15	Prott et al. / 2025 / Germany	Randomized controlled pilot study (RCT)	n = 20 randomized (analyzed: taVNS = 9, Sham = 9); mean age: 44.5 ± 17.2; sex: 19 F, 1 M; drop-out: 2 (10%)	Chronic pain associated with temporomandibular disorders (myogenous and/or arthrogenous TMD)	DC/TMD and GCPS (Graded Chronic Pain Scale)	Experimental: transcutaneous auricular vagus nerve stimulation (taVNS) for 4 h/day. Control: inactive and non-functional sham electrode. Dose/frequency: 25 Hz, 28 s on/32 s off, daily for 8 weeks.	Feasibility, compliance, pain intensity (GCPS), quality of life (OHIPG14), muscle activity (MVC), and kinematics	Intervention adherence was 83%. No statistically significant between-group difference for GCPS (p = 0.775, η_p² = 0.011) or OHIP-14 (p = 0.140, η_p² = 0.116).	Very small pilot sample; no long-term follow-up; assessors were not blinded.
16	Zieliński et al. / 2025 / Poland	Randomized controlled clinical trial (RCT)	n = 97 (PIR = 30, Compression = 32, healthy controls = 35); mean age: 33.37 ± 4.43 (patients); sex: 68 F, 29 M including healthy subjects; drop-out: 0	Masticatory muscle myalgia with active myofascial trigger points (MTrPs)	RDC/TMD and Travell & Simons criteria	Experimental 1: Post-Isometric Relaxation (PIR) of the masseter. Experimental 2: manual compression (90 s, 2 kg/cm²) on trigger points. Control: healthy asymptomatic subjects, no treatment. Dose/frequency: single intervention, assessed 5 min after therapy.	Bioelectrical activity (sEMG), pain intensity (VAS), range of motion (ROM)	Statistically significant reduction in sEMG activity and increase in pain-free mouth opening over time in both groups (p < 0.05). Maximum unassisted opening was significantly greater in the PIR group than in the Compression group (p = 0.01). Within-group changes in VAS values did not reach statistical significance (p > 0.05).	Assessment limited to a very short-term effect (5 min); use of RDC/TMD rather than the more recent DC/TMD due to lack of local validation.
17	Cakıcı & Sahin / 2025 / Turkey	Randomized controlled clinical trial (RCT)	n = 40 (Experimental CEG = 20, Control CG = 20); age: Experimental 42.00 ± 13.69, Control 43.00 ± 12.71; sex: 21 F, 19 M; drop-out: 0	Myogenous TMD associated with chronic non-specific low back pain (CLBP)	RDC/TMD for TMD and orthopedic clinical examination for CLBP	Experimental (CEG): Rocabado 6×6 exercises + therapeutic lumbar exercises. Control (CG): Rocabado exercises only. Dose/frequency: 24 remotely supervised sessions, 3 times/week for 6 weeks.	Chronic pain severity (GCPS-2.0), TMJ pain (SF-MPQ), low back pain (NPRS), function (JFLS-20), mandibular ROM, OHRQoL (OHIP-14)	Both groups showed statistically significant improvements in GCPS-2.0 (p < 0.001, effect size d = 0.876) and JFLS-20 (p < 0.001). Sensory TMJ pain reduction was significantly greater in the CEG group (p = 0.045). In the CEG group, low back pain NPRS was significantly reduced (p < 0.001, d = 3.756), whereas this was not observed in the CG group (p = 0.330).	Therapists and patients were not blinded; primary pain origin was not identified for individual patients; short duration (6 weeks).
18	Acıkgoz et al. / 2025 / Turkey	Prospective observational single-arm pre-post study	n = 20; age: F 29.3 ± 11.38, M 30.8 ± 10.42; sex: 10 F, 10 M; drop-out: 0	TMD with pain in the masseter region (spasm)	DC/TMD	Experimental: manual therapy with bidirectional deep friction massage on trigger points. No control group. Dose/frequency: single 30-min session, with immediate and 1-week assessments.	Muscle thickness, echogenicity, and elasticity (ultrasonography and elastography), pain (VAS), mouth opening (MMO)	Statistically significant reduction in muscle thickness (p < 0.001) and increase in elasticity (p < 0.01) at both follow-ups (immediate post-treatment and 1 week). Statistically significant pain reduction (p < 0.001). Statistically significant increase in MMO immediately post-treatment (p < 0.01), not maintained at 1-week follow-up. No statistically significant change in echogenicity (p > 0.05).	Single-arm design without a control group, indicating high risk of bias; extremely short follow-up (1 week); small sample size.
19	Ny et al. / 2025 / Vietnam	Prospective observational single-arm study	n = 36; mean age: 26.69 ± 5.66; sex: 24 F, 12 M; drop-out: 0	Internal derangement of the TMJ (disc displacement, with/without reduction)	DC/TMD (Axis I)	Experimental: home-based therapeutic exercises (lateral movements performed in a pain-free position without dental contact). No control group. Dose/frequency: gradual progression up to 50 movements/day for 8 weeks.	Pain and discomfort related to joint noises and movements (VAS), mandibular ROM, sagittal condylar path assessed by axiography	Statistically significant reductions in pain, discomfort related to joint sounds, and mandibular movements (p < 0.05). Statistically significant increase in right and left lateral excursions at 8 weeks (p < 0.05). No statistically significant changes for maximum opening, protrusion, or objective condylar path measurements (p > 0.05).	Lack of an independent control group, reducing causal interpretation of the intervention; no objective monitoring of adherence; joint sounds measured using a phonendoscope, which is not fully objective (no JVA).
20	Gu et al. / 2025 / China	Retrospective non-randomized observational study	n = 65 (Splint = 22, Combined = 22, Education = 21); age: Splint 34.5 ± 7.2, Combined 33.8 ± 6.9, Education 35.2 ± 7.5; sex: 37 F, 28 M; dropout: 0	Anterior disc displacement without reduction (ADDwoR)	DC/TMD + magnetic resonance imaging (MRI)	Experimental 1: digital occlusal splint (KDOS) via CAD/CAM, night-time use >12 h. Experimental 2 (Combined): KDOS + manual therapy (15–20 min/week for 3 months). Control: patient education only.	Maximum mouth opening (MMO), pain intensity (VAS), mandibular functional disability (MFIQ)	At 3 months, statistically significant differences favored the Combined group compared with the Splint group for MMO (38.20 vs 34.89 mm, p < 0.01), VAS (0.93 vs 1.88, p < 0.01), and MFIQ (9.30 vs 11.60, p < 0.01). No statistically significant improvements were observed in the Education group (p > 0.05).	Retrospective non-randomized design; allocation based on patient preference, with risk of expectation bias; short-term follow-up (3 months).
21	Yang et al. / 2025 / China	Single-center retrospective cohort study	n = 99; median age: 28 (IQR 25–34); sex: 87 F, 12 M; dropout: NR (follow-up completed by 99 participants)	Temporomandibular disorders (TMDs)	DC/TMD + magnetic resonance imaging (MRI)	Pre-post observation: patients treated with physical therapy (physical modalities, manual therapy, exercises, and education; 2–3 times/week for 2–4 weeks) were assessed at 6 months to evaluate risk factors for TMD recurrence compared with those without recurrence.	TMD recurrence, pain intensity (NRS), maximum mouth opening (MMO), jaw function (JFLS-8), oral behaviors (OBC)	Recurrence rate: 25%. Statistically significant association between sleep bruxism and recurrence (OR = 4.411, p = 0.023). Statistically significant changes were observed for MMO, NRS, and daytime oral behaviors (p < 0.05). No statistically significant changes were observed for nighttime oral behaviors (p > 0.05).	Absence of an untreated control group; sleep bruxism assessed by questionnaire without polysomnography/EMG, with possible underestimation; small sample size and short follow-up (6 months).
22	Yıldız et al. / 2025 / Turkey	Randomized controlled clinical trial (RCT)	n = 51 (EG = 17, TG = 17, MTG = 17); age: EG 37.7 ± 3.3, TG 38.2 ± 3.8, MTG 39.1 ± 3.6; sex: 33 F, 18 M; drop-out: 0	Unilateral myogenous TMD with symptoms lasting >6 months	DC/TMD	Experimental 1 (TG): TENS (30 min, 3 times/week) + exercises (5 times/day). Experimental 2 (MTG): manual therapy (30 min, 3 times/week) + exercises. Control (EG): home exercise program only. Duration: 6 weeks.	Pain intensity (VAS), maximum mouth opening (MMO), masticatory muscle activity during chewing (MMA-DC) of the masseter and temporalis using sEMG	Statistically significant changes over time in all groups (p < 0.001). Statistically significant differences favored the MTG group compared with TG and EG for pain and MMA-DC (p < 0.001). Effect size for MMO in the MTG group: η² = 0.84. No statistically significant difference between TG and EG for MMO.	No long-term follow-up to verify maintenance of results beyond 6 weeks; exclusive inclusion of unilateral cases, limiting generalizability to bilateral or mixed cases.
23	Cho et al. / 2025 / South Korea	Multicenter randomized controlled clinical trial (RCT)	n = 80 randomized (analyzed: CMT = 40, Control = 40); age: CMT 35.5 ± 10.2, Control 36.0 ± 10.4; sex: 59 F, 21 M; drop-out: 5 (2 CMT, 3 Control at 26 weeks)	Chronic myofascial TMD (TMJ pain >3 months)	RDC/TMD (Axis I, Group 1)	Experimental: Chuna Manual Therapy (CMT), including traction, manipulation, and trigger point stimulation. Control (usual care): standard physical therapy, including interferential current therapy, TENS, and thermotherapy. Dose/frequency: both interventions, 2 sessions/week for 4 weeks.	TMJ pain intensity (VAS 0–100) measured at 5 weeks. Secondary outcomes included NRS, MMO, JFLS, and quality of life (EQ-5D, SF-12).	No statistically significant between-group difference for VAS at 5 weeks (p = 0.115). Statistically significant differences favored the CMT group for JFLS, EQ-VAS, and SF-12 PCS (p < 0.05). Kaplan-Meier analysis showed a hazard ratio of 1.75 for pain recovery in the CMT group (p = 0.047).	Blinding of patients and therapists was impossible; pain outcomes (pre-declared primary outcome) were not significant between groups at 5 weeks; JFLS assessment was discontinued after 5 weeks, with no prolonged functional follow-up.
24	Simma-Kletschka et al. / 2025 / Austria	Three independent prospective clinical pilot studies	n = 28 overall (Aqualizer = 9, Physical therapy = 9, Acupuncture = 10); overall mean age: 33.41 ± 11.26; sex: 19 F, 9 M; drop-out: 2 (1 in Aqualizer, 1 in physical therapy)	Myogenous orofacial pain (myalgia)	RDC/TMD	1 (Aqualizer): soft bite appliance for postural balancing, nighttime use >8 h/day. 2 (Physical therapy): active and passive exercises and stretching every evening. 3 (Acupuncture): dry needling of intraoral/extraoral “very points” (3 sessions every 2 weeks). Overall duration: 4 weeks.	Pain (VAS and muscle palpation), maximum mouth opening (MMO), cervical mobility	Statistically significant changes in muscle pain and cervical mobility were observed in the Aqualizer and physical therapy groups (p < 0.05). No statistically significant change in MMO was observed in any group. The acupuncture group showed statistically significant changes only for muscle pain and cervical mobility (p < 0.01). The physical therapy group reported the highest number of statistically significant outcomes.	Extremely small groups (n = 9 or 10); absence of an untreated control group; therapeutic arms assessed independently and grouped post hoc; acupuncture performed for only 5 s per dry point without injectable solutions, suggesting underdosing.
25	Arikan et al. / 2025 / Turkey	Randomized controlled clinical trial (RCT)	n = 34 analyzed (HG = 17, EG = 17); age: HG 27.77 ± 7.23, EG 33.59 ± 8.13; sex: 22 F, 12 M; drop-out: 7	Temporomandibular disorders (TMDs): myofascial pain, disc displacement with reduction, and mixed disorders	DC/TMD	Experimental (HG): High-Voltage Electrical Stimulation (HVES) + therapeutic exercise. Control (EG): therapeutic exercise only (Laskin protocol). Dose/frequency: 12 sessions (30 min HVES) over 4 weeks; exercises 3 times/week for 4 weeks.	Pain intensity (VAS). Secondary outcomes included MMO, cervical mobility (CROM), head posture, pressure pain threshold (algometer), bite force, TMJ sounds, and muscle strength.	Statistically significant changes in VAS values were observed in both groups (p < 0.001), with no between-group difference (p = 0.679). No statistically significant between-group difference for MMO (p > 0.05). Statistically significant reduction of joint sounds was observed only in the experimental group (p = 0.008).	Significant baseline age difference between groups (p = 0.035); absence of an untreated or sham control group; joint sounds measured using a stethoscope, potentially less objective.
26	Justribó-Manion et al. / 2025 / Spain	Double-blind randomized controlled clinical trial (RCT)	n = 34 analyzed (IG = 17, CG = 17); age: IG 49.8 ± 18.15, CG 46.15 ± 16.5; sex: 28 F, 6 M; dropout: 5 (intention-to-treat analysis)	TMD associated with chronic pain (arthralgia, myalgia, headache attributed to TMD)	DC/TMD	Experimental (IG): pain neuroscience education (PNE) + manual therapy (MT) + therapeutic exercise (TE). Control (CG): manual therapy only. Dose/frequency: MT, 5 sessions of 20 min over 5 weeks; PNE, two 30-min workshops; TE, 3 times/day.	Craniofacial pain and disability (CFPDI). Secondary outcomes included MMO, forward head posture (FHP), kinesiophobia (TSK-11), and catastrophizing (PCS).	Within-group improvement was observed for CFPDI, with no statistically significant between-group interaction (p = 0.4). The IG group showed statistically significant improvements compared with the CG group for kinesiophobia at long-term follow-up (SMD = −8.6, p = 0.019). For catastrophizing, a non-statistically significant difference was observed (p = 0.15). No statistically significant differences were observed for MMO or FHP (p > 0.05).	Lack of placebo group; open-protocol design with subjective adaptation of interventions; small sample size for detecting marked statistical differences in the primary outcome.
27	Márquez-Vera et al. / 2024 / Spain	Double-blind randomized controlled clinical trial (RCT)	n = 61 (EG = 31, CG = 30); age: EG 40.13 ± 10.28, CG 38.47 ± 11.39; sex: 50 F, 11 M; drop-out: 0	Chronic TMD	DC/TMD	Experimental (EG): mandibular muscle energy technique (MMET). Control (CG): sham suboccipital muscle inhibition technique (placebo). Dose/frequency: single therapeutic session, immediate effects assessed.	Pain intensity (VAS), pressure pain threshold (PPT, algometer), mandibular mobility (MMO), kinesiophobia (TAMPA)	Statistically significant reduction in VAS pain in the EG compared with the CG (p < 0.001 between groups, effect size d = 0.427). MMO increased by 8.58 mm (22%) in the EG, with no changes in the CG (p < 0.001, d = 0.742). Statistically significant improvement in PPT values was observed in the EG (p < 0.05).	Only short-term/immediate effects were assessed, with no prolonged follow-up; control based on a sham manual technique rather than a validated alternative therapeutic technique; gender bias (82% females).
28	Narin Aral et al. / 2024 / Turkey	Controlled quasi-experimental study (non-randomized)	n = 26 analyzed (DG = 13, PEG = 13); age: DG 36.46 ± 14.03, PEG 41.00 ± 14.27; sex: 23 F, 3 M; drop-out: 3	Myofascial TMD, differentiated between dentate group (DG) and partially edentulous group (PEG)	DC/TMD	Experimental: no absolute control group. Both clinical groups (DG and PEG) received the same treatment: manual therapy, postural exercises, Kinesio taping, and stabilization exercises. Dose/frequency: 12 sessions, 2 times/week for 6 weeks.	Balance (Tetrax Fall Index), pain intensity (NPRS), mandibular movements (MMO, protrusion), posture (NYPRC)	Statistically significant post-treatment changes were observed in both groups (p < 0.05). Statistically significant between-group differences for neck pain under effort and Tetrax FI favored the PEG group (p < 0.05). No statistically significant differences were observed for MMO and NYPRC (p > 0.05).	Non-randomized study; absence of an untreated control group or a group avoiding physical therapy; monitoring and compliance with complex home exercises were difficult to verify.
29	Dunning et al. / 2024 / USA	Multicenter single-blind randomized controlled clinical trial (RCT)	n = 120 (Experimental = 62, Control = 58); age: Experimental 40.2 ± 12.4, Control 43.0 ± 13.1; sex: 90 F, 30 M; drop-out: 0	Chronic muscular TMD	RDC/TMD (Group 1, muscle disorders)	Experimental: dry needling (7 perioral points) + spinal thrust manipulation (C0–C3). Control: nighttime occlusal splint + NSAIDs (diclofenac) + non-thrust TMJ mobilization. Dose/frequency: 1–2 times/week for 4 weeks (maximum 8 sessions).	Average pain intensity over the previous 7 days (VAS 0–100), pain over the previous 24 h, pain-free maximum mouth opening (MMO, mm), Global Rating of Change (GROC)	At 3 months, statistically significant differences favored the experimental group compared with the control group for 7-day pain (Δ −21.9, p < 0.001, SMD = 1.10) and MMO (Δ +9.1 mm, p < 0.001, SMD = 1.61). A total of 71% of participants in the experimental group achieved GROC ≥ +5 compared with 28% in the control group (p < 0.001).	Absence of a sham needling control group (placebo); treatment bias because therapists were enrolled in the same orthopedic training program (AAMT); technical variability not standardized for occlusal splints prepared by multiple dentists.
30	Keskin Tunç et al. / 2024 / Turkey	Single-blind randomized controlled clinical trial (cross-sectional)	n = 61 analyzed (ESWT = 25, Control = 36); age: ESWT 25.18 ± 8.96, Control 27.00 ± 11.01; sex: 48 F, 13 M; drop-out: 19 (15 from ESWT, 4 from Control)	Disc displacement with reduction and arthralgia	DC/TMD	Experimental (ESWT): extracorporeal shock wave therapy (ESWT) + medical therapy (etodolac/thiocolchicoside) + night-time stabilization splint. Control: medical therapy + stabilization splint. Dose/frequency: ESWT twice weekly for 4 weeks (1.2 bar, 8 Hz).	Pain intensity (VAS), pain-free active maximum mouth opening (MMO), passive forced opening	Statistically significant short-term pain reduction was observed in the ESWT group (p = 0.030). Statistically significant increase in active MMO (p = 0.009) and passive forced opening (p = 0.004) was observed at the second week in the experimental group compared with the control group.	No long-term follow-up; lack of a placebo/sham group for ESWT, reportedly excluded for ethical reasons; limited algorithmic classification of TMD diagnostic subgroups.
31	Mahmoud et al. / 2024 / Egypt	Randomized controlled clinical trial with non-stratified block randomization	n = 90 (Group I = 30, Group II = 30, Group III = 30); overall mean age: 35.9 ± 12.6; sex: 75 F, 15 M; drop-out: 0	Myofascial pain dysfunction syndrome with trigger points in the masseter muscle for >6 months	DC/TMD	Experimental I: low-level laser therapy (LLLT, 940 nm), 1 session/week. Experimental II: LLLT, 2 sessions/week. Experimental III: LLLT, 3 sessions/week. Dose/frequency: 4 J/cm² per point for 4 weeks overall. No “no-treatment” control group was included.	Pain intensity (0–10 scale), unassisted maximum mouth opening (MMO), quality of life (OHIP-14)	Statistically significant between-group difference in pain reduction at 8 weeks (p < 0.001), with a dose-dependent pattern; each additional session/week was associated with a 0.09 reduction in pain. MMO and quality of life (OHIP-14) showed dose-dependent between-group changes, with more favorable values in Group III.	No pure control group was included; other laser wavelengths were not compared; measurements depended on clinical feedback without electromyography (EMG).
32	Tăut et al. / 2024 / Romania	Retrospective cohort study	n = 24; age: 23.88 ± 4.66; sex: 22 F, 2 M; drop-out: 0	TMD associated with degenerative joint disease, including arthralgia, myalgia, and intra-articular signs	RDC/TMD	Experimental: custom stabilization occlusal splint in centric relation + craniomandibular manual therapy + Rocabado 6×6 exercises. Control: self-controlled pre-post comparison. Dose/frequency: splint use 24 h/day, manual therapy twice weekly, with a mean overall duration of 7.42 ± 3.27 months.	Condylar bone remodeling assessed by CBCT; skeletal and occlusal changes assessed using cephalometric measures (SNA, SNB, ANB, AFH/PFH facial heights)	Complete and significant condylar remodeling for erosions and subchondral cysts was observed in 21 of 33 pathological TMJs (63.6%, p < 0.05). SNB angle decreased from 75.61° to 74.82° (p = 0.02, d = 0.73). Anterior facial height (AFH) increased (p < 0.001), and ANB angle increased (p < 0.001), suggesting therapeutic mandibular retrusion.	Retrospective design does not ensure certainty about home compliance with exercises and splint use; absence of an untreated control group; very small sample size.
33	Espejo-Antúnez et al. / 2024 / Spain	Single-blind parallel-arm randomized controlled clinical trial (RCT)	n = 46 (ES- +MT = 25, MT = 21); age: ES- +MT 23.92 ± 7.14, MT 26.24 ± 9.42; sex: 37 F, 9 M; drop-out: 0	Bilateral temporomandibular myofascial pain lasting >3 months	DC/TMD (Axis I) and ICOP	Experimental (ES+MT): manual therapy + dynamic cervical electrical stimulation using interferential electro-massage. Control (MT): manual therapy only, including soft tissue release of the neck and TMJ. Dose/frequency: 1 session/week for 2 weeks.	Pain intensity (VAS), pressure pain threshold (PPT, algometer) over masseter and trapezius, pain-free maximum mouth opening (VMO)	Statistically significant differences favored the ES+MT group for pain intensity (p < 0.001), VMO (p < 0.001), and PPT (p < 0.001), with large effect sizes (η² > 0.14). Total cervical ROM increased significantly (p < 0.001, η² = 0.246), whereas no statistically significant differences were observed for cervical rotation (p ≥ 0.05).	Lack of a sham intervention, preventing measurement of placebo effect; patients could not be blinded to treatment; short-term follow-up only (4 weeks).
34	Gębska et al. / 2024 / Poland	Single-blind randomized controlled clinical trial (RCT)	n = 64 (KTG = 32, CG = 32); age: KTG 30.00 ± 9.34, CG 29.00 ± 8.20; sex: 64 F, 0 M; drop-out: 0	Myofascial pain with mandibular opening limitation lasting >3 months	DC/TMD (Group Ib)	Experimental (KTG): masseter Kinesio Taping (KT) with 10–15% tension + education + therapeutic exercises (TE). Control (CG): education + therapeutic exercises only. Dose/frequency: intervention assessed at 6 and 12 days.	Bioelectrical activity (sEMG) of the masseter, pain (NRS), joint mobility (MMO, laterality), perceived stress (PSS-10)	NRS values were significantly reduced in the KTG compared with the control group (p < 0.001). MMO increased significantly more in the KTG (p < 0.001). PSS-10 values were significantly reduced compared with the control group (p < 0.001). sEMG activity showed changes over time (p = 0.05) in both groups, without statistically significant between-group differences (p > 0.05).	Exclusively female sample; very short clinical observation period (12 days); absence of placebo/sham taping in the control group, with risk of bias related to tape perception.
35	Salloum et al. / 2024 / Syria	Single-blind parallel-group randomized controlled clinical trial	n = 80 (20 per group); age: ultrasound 31.00 ± 9.04, splint 28.20 ± 6.16, TheraBite 31.20 ± 8.34, exercises 29.90 ± 7.46; sex: 48 F, 32 M; drop-out: 0 after randomization	Myofascial pain syndrome (MPS) / TMD	DC/TMD	Experimental interventions: 1) ultrasound therapy, 3 sessions/week for 4 weeks; 2) TheraBite device, 10 bites/session, daily use; 3) masticatory muscle exercises, 1 min, twice/day. Control: stabilization splint, 8 h/night. Total duration: 4 weeks.	Pain intensity (VAS), maximum interincisal opening (MIO), right and left lateral movements (RLM, LLM)	Ultrasound and splint were superior to exercises in reducing pain at 4 weeks (p = 0.012 and p = 0.013). At 5-month follow-up, all treatments showed comparable effectiveness. Ultrasound and splint appeared to favor faster clinical improvement. Effect size: NR.	Strong dependence on patient compliance for exercises and devices; pain measurement based on a subjective method (VAS); longer follow-up needed.
36	Romeo et al. / 2024 / Italy	Double-blind randomized controlled clinical trial (RCT)	n = 62 randomized (Experimental = 29, Control = 33); age: Experimental 38.48 ± 17.75, Control 31.88 ± 9.10; sex: 49 F, 13 M; drop-out: 8 (1 Experimental, 7 Control)	Myogenous TMD (M-TMD)	DC/TMD	Experimental: musculoskeletal physical therapy, including manual therapy and exercises, 10 sessions of 45 min over 3 months + night-time occlusal splint + education. Control: night-time occlusal splint + education. Dose/frequency: treatments assessed over 3 months with 6-month follow-up.	Pain intensity at rest (VAS rest), pain during opening (VAS open), pain during chewing (VAS chew), range of motion (ROM)	The experimental group showed significantly greater improvements than the control group for pain at rest VAS (−1.50 cm, p = 0.04), pain during opening VAS (−2.00 cm, p < 0.01), pain during chewing VAS (−1.71 cm, p = 0.01), and mandibular ROM (+4.61 mm, p = 0.04). Odds of improvement in pain during opening were higher among responders (OR = 3.06). Effect size: NR.	Follow-up interruptions and unbalanced drop-out in the control group due to the COVID-19 pandemic; absence of sham physical therapy; adherence to education and self-treatment was not assessed.
37	Song et al. / 2024 / China	Single-blind prospective randomized controlled study	n = 26 (Group B [ESWT] = 13, Group A = 13); age: B 39.15 ± 11.16, A 38.85 ± 11.03; sex: 17 F, 9 M; drop-out: 0	TMD (Axis I, including myalgia or arthralgia)	DC/TMD (Axis I)	Experimental (B): low-intensity high-frequency extracorporeal shock wave therapy (ESWT), 3 total sessions, 1 every 5 days + routine therapy, including massage, TENS, and ultrasound. Control (A): sham ESWT + routine therapy. Overall duration: 2 weeks.	Pain intensity (VAS), temporomandibular opening index (TOI)	Both groups showed significant post-treatment improvements in VAS and TOI (p < 0.05). The ESWT group showed significantly greater VAS pain reduction and functional TOI improvement than the control group (p < 0.001 for both). Effect size: NR.	Very small sample size (preliminary study); absence of TMD Axis II assessment for non-muscular joint disorders; follow-up limited to 4 weeks post-intervention, not assessing long-term effects.
38	Tariq et al. / 2024 / Pakistan	Randomized controlled clinical trial with blinded assessor	n = 46 (Group B = 23, Group A = 23); age: B 35.22 ± 2.44, A 36.39 ± 3.57; sex: 32 F, 14 M; drop-out: 0 after randomization	Myogenous TMD	RDC/TMD (Group I)	Experimental (B): Post-Isometric Relaxation (PIR) + conventional therapy, including massage and exercises. Control (A): conventional therapy only, including massage and exercises. Dose/frequency: daily sessions for 2 consecutive weeks, 5 days/week.	Pain (VAS), maximum mouth opening (MMO assessed using the TheraBite Scale)	Both groups showed improvements. Group B (PIR + massage) was superior to Group A for pain reduction (p < 0.001, Cohen’s d = 1.53) and MMO increase (p < 0.001, Cohen’s d = 4.14).	Lack of long-term follow-up to understand stability of results; confounding variables such as psychological stress or diet were not considered.
39	Shah et al. / 2024 / Pakistan	Randomized controlled clinical trial	n = 40 (MT+PT = 20, PT only = 20); age: MT+PT 37.90 ± 7.40, PT only 37.25 ± 8.31; sex: 24 F, 16 M; drop-out: 0	TMD including myalgia and disc displacement with reduction	RDC/TMD (Categories Ia, Ib, IIa)	Experimental (MT+PT): in-clinic manual therapy + patient education + home physical therapy (HPT). Control (PT): education + home physical therapy only. Dose/frequency: manual therapy 3 times/week for 6 weeks; HPT maintained for 6 weeks.	Pain at rest (VAS), pain during function/stress (VAS), pain-free maximum mouth opening (MMO)	No statistically significant between-group difference was observed for MMO (p = 0.067) or pain at rest (p = 0.062). The experimental MT+PT group showed a significantly greater reduction in pain during effort/function (p = 0.001) compared with the control group. Effect size: NR.	Short evaluation period; lack of objective verification of compliance with recommended home treatments (HPT); heterogeneous inclusion of both articular and muscular cases.
40	Nemani et al. / 2024 / India	Randomized controlled clinical trial (RCT)	n = 48 (12 per group); age: NR (range 18–60); sex: NR (both sexes reported); drop-out: 0	Temporomandibular pain and chronic cervical pain	RDC/TMD (Criteria 3 and 15g)	Experimental groups: all included cervical physical therapy (PT) and occlusal equilibration + 1) night-time soft splint, 2) TENS (30 min, 500 W), or 3) LLLT laser (1 min/point). Control: monthly cervical physical therapy only. Dose/frequency: therapies assessed at 3, 6, 9, and 12 months of follow-up.	TMJ and cervical pain intensity (VAS 0–10), thermography	TENS and laser achieved superior and comparable reductions in TMJ pain at 12 months compared with splint and control (p = 0.001 between groups). No significant between-group difference was observed for cervical pain (p = 0.124).	Very small sample size (12 patients per arm); subjective pain measurement tool; variables such as stress, habits, and posture were not fully controlled.
41	Oliveira-Souza et al. / 2024 / Brazil	Randomized controlled clinical trial (RCT)	n = 54 (NTG = 18, MTG = 18, PG = 18); age: NTG 26.0 ± 6.7, MTG 31.8 ± 9.8, PG 28.8 ± 10.4; sex: 54 F, 0 M; drop-out: 15 overall at 3-month follow-up	Myofascial or mixed TMD	RDC/TMD	Experimental 1 (NTG): cervical motor training + home exercises. Experimental 2 (MTG): cervical manual therapy, including myofascial release + self-stretching. Control (PG): placebo ultrasound, switched off. Dose/frequency: one 30–40 min session/week for 8 weeks.	Orofacial pain intensity (VAS 0–10 cm). Secondary outcomes included function (MFIQ), oral health-related quality of life (OHRQoL, OHIP-14), and ROM.	NTG was superior to placebo in reducing pain at the end of treatment (effect size = 0.9), at 1 month (ES = 0.8), and at 3 months (ES = 0.7). NTG also showed better quality of life (OHIP-14) than MTG and PG at 3 months (ES = 0.9 vs MTG). No clinically relevant difference in ROM was observed between groups. No significant pain differences emerged between NTG and MTG.	Inclusion of women only, reducing generalizability; therapist not blinded, which was not feasible due to the type of interventions; strict exclusion criteria, excluding patients with chronic comorbidities.
42	van der Meer et al. / 2024 / Netherlands	Mixed-methods study (qualitative and quantitative)	n = 20 (10 orofacial physical therapists [OPT], 10 patients); age: patients 52.3, OPT 34.3; sex: patients 10 F, 0 M; OPT 2 F, 8 M; drop-out: 0	TMD, including myalgia, anterior disc displacement, and other conditions	DC/TMD, supported by the ICF framework	Observation and intervention: addition of the e-health application “Physitrack” to the usual orofacial physical therapy pathway, including exercise videos and online consultations. No external control group. Dose/frequency: mean of 4.9 total sessions, both in-clinic and online.	Experience and added value, assessed through qualitative thematic interviews; Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ); TMD pain (NPRS 0–10)	Clinically relevant reduction in TMD pain was observed in all patients (mean NPRS from 5.5 to 1.1). Home exercise videos improved adherence and self-efficacy; however, physical contact was still considered essential.	Study design not intended to demonstrate comparative effectiveness (no RCT); very small and entirely female patient sample; risk of bias because therapists were already using the Physitrack platform; no participant used all app functions.
43	Gębska et al. / 2023a / Poland	Single-blind randomized controlled clinical trial (RCT)	n = 208 (G1 experimental TMD = 104, G2 healthy controls = 104); G1 subgroups of 26 patients; age: median 29.5 (IQR 24.5–38.5) in TMD patients; sex: 208 F, 0 M; drop-out: 0	Chronic myofascial pain with restricted mouth opening lasting >3 months	DC/TMD (Group Ib)	Experimental interventions: 1) magnetostimulation (MS); 2) magnetoledtherapy (MLE); 3) magnetolasertherapy (MLA); 4) manual therapy (MT), including post-isometric relaxation and trigger point techniques. Control: healthy subjects without TMD for baseline assessments only. Dose/frequency: 10 consecutive treatment days, excluding weekends.	Bioelectrical activity (sEMG) of the masseter, range of motion (MMO and lateral movements), pain intensity (NRS)	Manual therapy (MT) achieved the greatest reduction in sEMG activity (MVC%) compared with physical modalities (p < 0.001). Significant increase in MMO was observed only in the MT group, from approximately 36 to approximately 43 mm. Pain decreased markedly in the MT group by about 6 NRS points as early as day 6, compared with more modest improvements with electromedical modalities (MS, MLE, MLA).	Exclusively female sample; treatment and observation period limited to 10 days; no long-term follow-up to determine maintenance of clinical effects.
44	García-de la-Banda-García et al. / 2023 / Spain	Single-blind randomized controlled clinical trial (RCT)	n = 50 (DN = 25, MT = 25); age: DN 34.56 ± 8.43, MT 38.08 ± 9.75; sex: 29 F, 21 M; drop-out: 0	Myofascial TMD	RDC/TMD (Axis I)	Experimental 1 (DN): deep dry needling of trigger points in the masseter, lateral pterygoid, and sternocleidomastoid muscles. Experimental 2 (MT): manual therapy, including neuromuscular technique and ischemic compression for 90 s per point. Dose/frequency: 3 sessions spaced 4 days apart for both groups.	Pain intensity (NPRS), active maximum mouth opening (AMMO), neck disability (NDI), pressure pain threshold (PPT)	Significant post-treatment reductions, but not after the first session, were observed for pain (DN −2.52; MT −2.92) and NDI (DN −3.2; MT −2.68). AMMO increased significantly (DN +0.27 cm; MT +0.37 cm). PPT increased significantly in the assessed orofacial muscles. No statistically significant between-group differences were observed (p > 0.05).	Lack of an untreated or sham needling control group; study was not double-blind; effects reported only in the short term, 2 weeks after treatment.
45	Gębska et al. / 2023b / Poland	Randomized controlled clinical trial (RCT)	n = 186 (G1 TMD = 82, G2 healthy = 104); G1 analyzed: MTM_TE = 26, MTPIR_TE = 26, TE = 28; median age: G1 28.1, G2 29; sex: 186 F, 0 M; drop-out: 4 from G1	Myofascial pain with limited mandibular mobility (TMD Ib)	DC/TMD	Experimental 1 (MTM_TE): massage + therapeutic exercises (TE). Experimental 2 (MTPIR_TE): post-isometric relaxation (PIR) + TE. Control 1 (TE): therapeutic exercises only. Control 2 (G2): healthy subjects without treatment. Dose/frequency: 1 session/day for 10 working days.	Bioelectrical activity of the masseter (sEMG), mandibular mobility (MMO and lateral movements), pain intensity (NRS)	Reduction in sEMG values was observed in all treatment groups; by day 6, a statistically significant between-group difference emerged (p < 0.001). For NRS, significant between-group differences were observed from the 4th session (p < 0.001), with lower mean values in the MTM_TE group. For MMO, statistically significant differences emerged between TE and the manual therapy groups (p < 0.001). Effect size: NR.	Exclusively female sample; observation period limited to 10 days, with no long-term follow-up.
46	Sirikaku et al. / 2022 / Brazil	Double-blind randomized controlled clinical trial	n = 25 (SG = 13, CG = 12); age: NR (range 18–60); sex: NR; drop-out: 1 from SG	Tinnitus associated with myofascial pain of the masseter muscle	RDC/TMD	Experimental (SG): dry needling (DN) of the masseter muscle + counseling. Control (CG): sham needling + counseling. Dose/frequency: 3 sessions spaced 7–14 days apart. Follow-up at 30, 60, and 90 days.	Pain intensity (VAS), tinnitus intensity and discomfort (VAS), Tinnitus Handicap Inventory (THI)	At 90 days, the SG showed a statistically significant reduction in total THI score compared with the CG (p = 0.041). No statistically significant between-group differences were found for pain (p = 0.645), tinnitus intensity (p = 0.073), or tinnitus-related discomfort (p = 0.165). Effect size: NR.	Limited sample size; variable interval between sessions (7–14 days); intervention applied only to the masseter muscle, excluding other masticatory muscles.
47	Serrano-Hernanz et al. / 2023 / Spain	Single-blind parallel-arm randomized controlled clinical trial	n = 72 analyzed (PRT = 37, Sham = 35); age: PRT 46.9 ± 14.0, Sham 36.6 ± 13.2; sex: 60 F, 12 M; dropout: 2 from Sham	Chronic myofascial or mixed TMD lasting >6 months	DC/TMD	All patients had used an occlusal splint and received education for >6 months. Experimental (PRT): Pressure Release Technique (PRT) on masticatory and cervical trigger points. Control (Sham): sham pressure <2 N/cm². Dose/frequency: 45 min, once/week for 5 weeks.	Pain intensity (VAS). Secondary outcomes included PPT, ROM, NDI, PCS, TSK-11, STAI, and ST-DEP.	Statistically significant time × group interaction was observed for VAS pain (F = 21.92, p < 0.001), with lower mean values in the PRT group. Significant time × group interactions were also found for ROM, NDI, PCS, TSK-11, STAI, and ST-DEP (all p < 0.002). No statistically significant between-group difference was observed for PPT values. Effect size for VAS in the PRT group: Cohen’s d = 1.25 (T1) and 1.36 (T2).	Single-blind study, with therapist aware of allocation; heterogeneous mean age between groups at baseline; no follow-up beyond 3 months.
48	Macedo et al. / 2023 / Brazil	Randomized controlled double-blind crossover clinical trial	n = 32, of whom n = 24 were analyzed for the primary outcome; age: TMD 21.53 ± 3.79; sex for primary outcome: 24 F, 0 M; drop-out: 2	Myogenous TMD	DC/TMD (Axis I)	Experimental (DN): single session of dry needling applied to a masseter trigger point. Control (Sham): single session of sham needle. Dose/frequency: crossover design with a 7-day washout between interventions.	Tissue oxygen saturation (TSI%, measured by NIRS), pain (VAS)	DN showed a significantly greater change in tissue saturation (ΔTSI%) than sham (2.108% vs 0.142%, p = 0.014) and a significant immediate post-treatment change in pain (ΔVAS, p = 0.0015). Effect size: NR.	Males were excluded from NIRS analysis due to instrumental reading limitations; assessment was limited to immediate effects without medium-or long-term monitoring.
49	Tanhan et al. / 2023 / Turkey	Randomized controlled clinical trial	n = 59 analyzed (E = 17, LLLT = 20, MPR = 22); age: E 20.45 ± 1.50, LLLT 21.41 ± 4.30, MPR 20.95 ± 1.83; sex: 46 F, 13 M; drop-out: 16	TMD with masticatory myofascial pain (Groups Ia and Ib) and cervical pain	RDC/TMD (Axis I)	Group 1 (E): masticatory/cervical exercises + education. Group 2 (LLLT): low-level laser therapy + exercises + education. Group 3 (MPR): manual pressure release + exercises + education. Dose/frequency: 3 sessions/week for 4 weeks.	Pressure pain threshold (PPT, algometer), TMJ symptoms, MMO, Craniomandibular Index (CMI), disability, quality of life, and depression	Statistically significant PPT increase was observed in all groups (p < 0.01 within groups). In post-treatment between-group comparisons, PPT changes in the left temporalis and right upper trapezius were greater in the LLLT and MPR groups than in the E group (p < 0.05). No statistically significant between-group difference was observed for CMI values. Effect size: NR.	Uneven gender distribution at baseline; lack of a pure or placebo control group; manual pressure in the MPR group applied without objective instrumentation.
50	Prado Junior et al. / 2023 / Brazil	Longitudinal observational clinical study (prepost)	n = 30 (GDN = 15, GIMR = 15); age: GDN 43.2 ± 13.0, GIMR 39.4 ± 16.1; sex: NR; dropout: NR	Temporomandibular disorders (TMDs) of muscular origin	RDC/TMD (Axis I)	Experimental 1 (GDN): dry needling (DN) of myofascial trigger points. Experimental 2 (GIMR): instrument-assisted myofascial release (IMR) applied parallel and perpendicular to muscle fibers for approximately 40 s. Dose/frequency: 2 sessions separated by a 1-month interval.	Pain intensity (VAS), maximum molar bite force (digital dynamometer), occlusal force distribution (Occlusense), pressure pain threshold (PPT, algometer)	Statistically significant time × group interaction for VAS pain in the head-neck area (F = 5.523, p = 0.006, η² = 0.165). Statistically significant differences between interventions were found for PPT in several facial muscles (e.g., RSO p = 0.020; RIO p = 0.004). Bite force increased with a significant time effect in both groups (p = 0.003 right; p = 0.012 left).	Sample size and participant sex were not described in detail in the text; number of intervention sessions limited to only 2.
51	Lee et al. / 2023 / South Korea	Randomized controlled clinical trial	n = 34 (EG = 17, CG = 17); age: EG 34.47 ± 10.51, CG 37.59 ± 15.16; sex: 27 F, 7 M; drop-out: 0	Myofascial TMD associated with headache	DC/TMD (Axis I, Group I)	Experimental (EG): cervical manual therapy + cervical stretching exercises (40 min) + conservative physical therapy (60 min). Control (CG): conservative physical therapy only (60 min). Dose/ frequency: 1 session/week for 10 weeks.	Headache impact (KHIT-6), TMJ and cervical pain (NPRS and VAS), neck disability (NDI), cervical kyphotic angle (Ishihara index), jaw function (JFLS-8), pressure pain threshold (PPT)	Statistically significant time × group interaction for KHIT-6 (F = 12.015, p < 0.01), cervical pain (F = 29.219, p < 0.01), masseter PPT (p < 0.01), cervical kyphotic angle (F = 8.205, p < 0.01), NDI (F = 22.092, p < 0.01), and JFLS-8 (F = 15.232, p < 0.01). At 10 weeks, the EG showed lower mean values than the CG for all clinical variables considered. Effect size: NR.	Absence of blinding for therapists and patients; difference in total treatment time between groups, as the EG received an additional 40 min per session.
52	Taşkesen & Cezairli / 2023 / Turkey	Randomized controlled clinical trial	n = 45 (MNB = 15, DN = 15, LA = 15); age: MNB 26.20 ± 7.48, DN 24.60 ± 8.75, LA 26.26 ± 6.65; sex: 39 F, 6 M; drop-out: 0	Masticatory myofascial pain with trigger points	DC/TMD	Experimental 1 (MNB): masseteric nerve block, 1.0 mL local anesthetic in a single injection. Experimental 2 (DN): dry needling of trigger points, 2 sessions 7 days apart. Control (LA): local anesthetic injection into trigger points, 2 sessions 7 days apart. Follow-up up to 12 weeks.	Pain on palpation (PoP, Likert scale 0–4), pain during function (PoF, VAS), pain-free maximum mouth opening (MMO)	No statistically significant differences were found between groups for MMO (p = 0.904) or PoP (p > 0.48). A statistically significant between-group difference was observed for PoF post-intervention (p = 0.042). At 4-week follow-up, the MNB group showed significantly higher mean PoF values than the DN (p = 0.006) and LA (p = 0.003) groups. At 12 weeks, percentage reduction in PoF was lower in the MNB group than in the other two groups, suggesting lower effectiveness for functional pain improvement. Effect size: NR.	Asymmetrical number of injections, with a single injection in the MNB group and two injections in the LA and DN groups; follow-up limited to 12 weeks; small sample size.
53	Aguiar et al. / 2022 / Brazil	Double-blind randomized controlled clinical trial	n = 148 (Education = 74, Control = 74); age: Education 37.9 ± 10.5, Control 38.2 ± 11.2; sex: 119 F, 29 M; dropout: 9	TMD, including myalgia or myofascial pain	RDC/TMD (Axis I, Group I)	Experimental (Education): Pain Science Education (PSE), 2 sessions of 40 min + craniocervical manual therapy and exercises. Control: craniocervical manual therapy and exercises only. Dose/ frequency: 12 sessions over 6 weeks. Follow-up at 6, 10, and 18 weeks.	Pain intensity (NPRS), disability (CF-PDI). Secondary outcomes included GPE, PSEQ, TSK/TMD, rNPQ, and EARS.	No statistically significant between-group difference for NPRS post-treatment (p = 0.36), but statistically significant differences were observed at 10-week (p < 0.01) and 18-week follow-up (p < 0.01), with lower mean values in the PSE group. Statistically significant difference for CF-PDI post-treatment (MD = 6.1, p < 0.01, Cohen’s f = 0.77), with lower mean values in the PSE group, maintained at 18 weeks (p < 0.01).	Therapists and patients were not blinded; difference in total operator-patient interaction time between groups, as the experimental group received 90 additional minutes of attention.
54	Sarfraz et al. / 2023 / Pakistan	Quasi-experimental clinical study with randomization by draw	n = 24 recruited (20 analyzed, 10 per group); age: NR (range 18–55); sex: NR; drop-out: 4	Myogenous TMD	RDC/TMD (Categories Ia and Ib)	Experimental (MPT): manual physical therapy, including mobilization, myofascial release, and muscle energy techniques (MET). Control (ET): therapeutic exercise, including Rocabado exercises, isometrics, strengthening, and stretching. Dose/frequency: 3 sessions/week for 6 weeks.	Pain (NPRS), function (PSFS), severity (Fonseca Anamnestic Index, FAI), mouth opening (MMO)	Post-treatment, a statistically significant between-group difference was observed for all assessed parameters in favor of the MPT group compared with the ET group: NPRS pain (means: 2.60 vs 4.70; p = 0.0001), PSFS function (means: 8.29 vs 4.40; p = 0.0001), FAI (means: 1.60 vs 2.60; p = 0.0001), and MMO (means: 32.10 mm vs 23.20 mm; p = 0.0001). Effect size: NR.	Quasi-experimental study design; baseline demographic data, including exact age and sex distribution, not reported in detail; very small sample size.
55	Benli et al. / 2023 / Turkey	Single-blind randomized controlled clinical trial	n = 91 recruited (L = 30, P = 30, C = 30), 90 analyzed; age: L 39.1 ± 3.4, P 39.2 ± 3.3, C 39.1 ± 4.0; sex: 74 F, 16 M; drop-out: 1 from C	Myogenous TMD (myofascial pain)	DC/TMD (Axis I)	Experimental 1 (L): aromatherapy massage with lavender oil and coconut oil as carrier. Experimental 2 (P): massage with almond oil as placebo. Control (C): no treatment. Dose/ frequency: 2 sessions/week for 8 weeks. Follow-up at 2 months.	Pain intensity (VAS), pain-free maximum mouth opening (MMO)	A statistically significant time × group interaction was observed for MMO values at T1 and T2 (p < 0.001). Similarly, statistically significant between-group differences were observed for VAS pain values at T1 and T2 (p < 0.001). Cohen’s d effect sizes at T1 for the comparison between L and C were very large: 12.798 for MMO and 7.967 for VAS.	Single-blind study, as double blinding was impossible due to the smell of the essential oil; predominance of female participants; short-term follow-up.
56	Tobe et al. / 2022 / Japan	Parallelarm randomized controlled clinical trial	n = 61 recruited, n = 57 analyzed (JE with pain = 30, JE without pain = 27); age: JE with pain 48.7 ± 19.8, JE without pain 51.6 ± 19.1; sex: 46 F, 11 M; drop-out: 4	Pain-related TMD, including myalgia, arthralgia, or both	DC/TMD	Experimental 1 (JE with pain): manual jaw-opening exercise pushed to the point of pain onset. Experimental 2 (JE without pain): jaw-opening exercise without manual assistance and without provoking pain. Dose/ frequency: hold for 10 s, 5 repetitions, 4 sets/day for 8 weeks.	TMD pain intensity (VAS for jaw-opening and chewing pain), range of mouth opening (pain-free unassisted and maximum unassisted)	Statistically significant changes over time (T1–T3) were observed for mouth-opening range and VAS (p < 0.05). Statistically significant between-group difference was found for maximum unassisted mouth opening at T2 (p < 0.001) and T3 (p = 0.003). No statistically significant between-group difference was observed for VAS values (p > 0.05). Effect size (Cohen’s d) at T3 for maximum unassisted opening = 1.0.	Force applied during exercises was not objectively standardized; statistically significant difference in TMD subtypes at baseline between groups; diagnosis of absence of disc displacement was based on clinical assessment without MRI.
57	Asquini et al. / 2022 / Italy	Prospective observational cohort study	n = 102 recruited, 90 analyzed; mean age: 36.9 ± 14.5; sex: 74 F, 16 M; dropout: 12	TMD	DC/TMD	Observed intervention: manual therapy (MT) program applied to craniomandibular structures according to clinical reasoning. This was a predictive model development study with no control group. Dose/frequency: 4 sessions, 1/week for 4 weeks.	Predictive model for ≥30% pain reduction, measured by VAS, and functional improvement using the Patient Specific Functional Scale (PSFS)	LASSO regression predictors selected for pain reduction (AUC = 0.89, R² = 58% after internal validation) were: pain during mouth opening >2/10, positive treatment expectations, pain locations ≤2, and low Central Sensitization Inventory (CSI) score. Predictors for functional improvement were maximum mouth opening (MMO) and previous pain duration (R² = 26%). Effect size: NR.	No external validation of the developed predictive nomogram; lack of untreated control group; short-term follow-up; drop-out mostly attributable to COVID-19 restrictions.
58	Sakaguchi et al. / 2022 / Japan	Single-arm retrospective study	n = 59 analyzed; mean age: 46.6 ± 17.0; sex: 46 F, 13 M; drop-out: 0	Masticatory muscle myalgia, isolated cases without joint impairment	DC/TMD	Intervention: exercise therapy consisting of static stretching in the direction of contraction of painful muscles, involving masseter and/or cervical muscles. Dose/frequency: single clinical session, immediate effects assessed, with 10 rounds of 10 s for masseter and 3 rounds of 30 s for cervical muscles.	Maximum pain-free mouth opening distance (mm), pain level (VAS)	Statistically significant immediate pre-post changes were observed for both mouth opening values (p < 0.001) and VAS values (p < 0.001). In subgroup comparisons, statistically significant difference in VAS change was observed according to pain side (unilateral vs bilateral, p = 0.019). No statistically significant difference was observed according to sex, involved muscle, or therapist (p > 0.05). Effect size: NR.	Single-arm retrospective design, with placebo effect not quantifiable in the absence of a control group; assessment limited exclusively to immediate post-stretching effects.
59	Derwich & Pawlowska / 2022 / Poland	Non-randomized controlled clinical study	n = 55 (Study group = 40, Control group = 15); age: Study 26.1 ± 11.6, Control 31.3 ± 12.9; sex: 44 F, 11 M; dropout: 4 from the study group	TMD, with myalgia identified in 72.5% of cases	DC/TMD	Experimental (Study): initial physical therapy for 5 weeks + occlusal splint therapy associated with physical therapy. Control: patients waiting for orthodontic treatment without active TMD intervention. Dose/frequency: 6 months overall treatment in the Study group.	Hyoid bone position and airway dimensions, including nasopharynx and oropharynx, measured on lateral cephalograms before and after treatment	In the Study group, statistically significant post-treatment changes were observed for hyoid triangle height (H-H’, p < 0.0001) and hyoid-to-cranial plane distance (H-MGP, p < 0.0001). Statistically significant change in lower oropharyngeal width was observed, with volumetric reduction (p = 0.0104). No statistically significant changes were observed in the Control group during observation (p > 0.05). Effect size: NR.	Non-randomized group allocation; two-dimensional cephalometric analysis; absence of blood chemistry tests to exclude autoimmune or myopathic diseases.
60	Sekito et al. / 2022 / Brazil	Randomized controlled clinical trial (RCT)	n = 28 (G1 = 14, G2 = 14); age: G1 46.25 ± 13.12, G2 49.33 ± 13.64; sex: 28 M, 0 F; drop-out: 1 from G2 at 6-month follow-up	Myofascial pain with or without opening limitation	RDC/TMD (Axis I)	Experimental (G1): Fascial Manipulation (FM) on coordination and fusion centers. Control (G2): Michigan occlusal appliance, night-time use + 3 h/day, anesthetic injection + dry needling. Dose/ frequency: G1, 1 h/session, 5 weekly sessions; G2, 3 weekly dry needling sessions.	Pain intensity (VRS), mandibular range of motion (RDC/ TMD), resting and isometric electromyographic activity (EMG), pressure pain threshold (algometer)	Statistically significant changes over time were observed for VRS values (p < 0.0001) and pain-free opening (p < 0.001) in both groups. No statistically significant between-group difference was found for these parameters (p > 0.05). Statistically significant within-group difference was observed in G1 for maximum unassisted opening (T0 vs T1 p = 0.001). Statistically significant between-group difference during isometric contraction was found for masseter EMG (p = 0.0064). Effect size: NR.	Use of non-parametric tests due to small sample size; participants were exclusively male; heterogeneous education levels were associated with communication barriers during follow-up.
61	Rezaie et al. / 2022 / Iran	Single-blind parallel-arm randomized controlled clinical trial	n = 45 randomized, 30 analyzed (Intervention = 15, Control = 15); age: Intervention 27.65 ± 4.04, Control 28.33 ± 5.43; sex: 15 F, 15 M at baseline; drop-out: 15 (8 Intervention, 7 Control)	Myogenous, arthrogenous, or mixed TMD	DC/TMD	Experimental: manual therapy of the TMJ and upper cervical spine + routine conservative treatment. Control: routine conservative treatment, including TENS, ultrasound, and massage. Dose/frequency: 10 sessions over 8 weeks. Follow-up at 4 weeks.	Jaw pain intensity (VAS), maximum mouth opening (MMO), cervical flexion and extension ROM (goniometer)	Statistically significant group × time interaction was observed for jaw pain intensity (p < 0.001), MMO (p < 0.001), and cervical flexion ROM (p < 0.001). No statistically significant group × time interaction was observed for cervical extension ROM (p = 0.970). Effect size (Cohen’s d) at T3: jaw pain = −2.08, MMO = 4.37, cervical flexion = 2.86.	High post-randomization drop-out rate, mainly associated with the COVID-19 pandemic; per-protocol analysis without intention-to-treat application; follow-up limited to 4 weeks.
62	Brandão et al. / 2022 / Brazil	Parallelarm randomized controlled clinical trial	n = 23 randomized, 19 analyzed (EG = 11, CG = 8); age: EG 35.4 ± 10.4, CG 36.7 ± 11.2; sex: 16 F, 3 M; drop-out: 4 (1 EG, 3 CG)	Myogenous or mixed TMD, including myalgia with/without limitation and disc displacement with reduction	RDC/TMD (Axes I and II)	Experimental (EG): isotonic pain-relief exercises and relaxation techniques + self-care education. Control (CG): self-care education only. Dose/frequency: 2 in-clinic sessions/week + home performance for 4 weeks overall.	Pain severity (NRS 0–10), Myofunctional Orofacial Evaluation Protocol (AMIOFE), daily limitations, and depression grade (RDC)	No statistically significant between-group differences were observed in daily activity limitations after intervention (ε² = 0.07). For depression grade, a within-group change was observed in the EG, with increased effect size from baseline to post-treatment (baseline ε² = 0.027; post-treatment ε² = 0.126). No intervention-attributable changes were observed for pain grade in either group (ε² = 0).	Small and unbalanced sample size; intervention and observation duration limited to 30 days; identical exercise protocol for all subjects without individualized adaptations; lack of objective verification of home adherence.
63	Dias et al. / 2022 / Brazil	Single-blind randomized controlled clinical trial	n = 34 (G1 = 19, G2 = 15); age: G1 32.16 ± 8.60, G2 34.67 ± 13.05; sex: 27 F, 7 M; drop-out: 0	Muscular TMD	RDC/TMD (Axis I)	Experimental (G1): orofacial myofunctional therapy (OMT) + active photobiomodulation using low-level 830-nm laser with scaled dosage (6 J–4 J). Control (G2): OMT + inactive photobiomodulation (placebo laser). Dose/ frequency: 10 clinical sessions of 45 min, once weekly.	Oral health-related quality of life (OHIP-14), orofacial pain intensity (VAS)	Both groups showed statistically significant pre-post improvement in total OHIP-14 scores (G1: p = 0.001; G2: p = 0.002) and VAS pain values (G1: p = 0.001; G2: p = 0.002). In post-treatment between-group comparison, a statistically significant difference was found only for the “functional limitation” domain of OHIP-14 (p = 0.036). A strong positive correlation emerged between VAS values and total OHIP-14 score after treatment in both G1 (ρ = 0.767) and G2 (ρ = 0.704). Effect size: NR.	Limited sample size; unbalanced participant distribution between experimental and control groups.
64	van der Wal et al. / 2022 / Belgium and Netherlands	Secondary analysis of a randomized controlled trial (mediation analysis)	n = 80 randomized, 78 analyzed (orofacial treatment = 40, control = 38); age: orofacial treatment 46 ± 13, control 45 ± 15; sex: 38 F, 42 M; drop-out: 2 from control group	Moderate-to-severe somatic tinnitus attributed to the temporomandibular region	DC-TMD	Experimental: multidisciplinary orofacial treatment, including counseling, massage, stretching, relaxation, and occlusal splint if clinically indicated. Control: usual care, including information and advice. Dose/ frequency: up to 18 total sessions over 9 weeks of treatment.	Tinnitus severity (Tinnitus Functional Index, TFI), change in TMD pain (TMD Pain Screener)	Total effect (path c) of orofacial treatment compared with control on TFI change was statistically significant (B = 0.253, p = 0.025). The relationship between intervention and change in TMD pain (path a) was statistically significant (Exp(B) = 2.800, p = 0.034). Change in TMD pain was statistically associated with change in TFI (path b) (B = −0.273, p = 0.016). The calculated mediated effect proportion was 35%. Effect size: NR.	Use of the TMD Pain Screener as an outcome measure despite its diagnostic nature, preventing pain-free subjects at baseline from recording changes; analysis limited to a single potential mediator.
65	Dib-Zakkour et al. / 2022 / Spain	Double-blind randomized controlled clinical trial	n = 36 (Group E = 18, Group C = 18 estimated); age: range 18–40; sex: NR; dropout: NR	Myogenous TMD (myofascial pain)	RDC/TMD	Experimental (Group E): bilateral deep dry needling (DDN) of the masseter muscle. Control (Group C): sham needling (PN). Dose/frequency: single session, with assessments at 10 min and 15-day follow-up.	Pain (VAS and PPT using algometer), mouth opening and symmetry (caliper), muscle activity (sEMG), occlusion and disclusion times (T-Scan)	Statistically significant change was reported for sEMG values in centric relation (CR) and for maximum mouth opening between pre-and post-needling. The authors reported the statistical significance of these differences using the atypical wording “p > 0.05”. Statistically significant change over time was observed for posterior disclusion time (DT). Effect size: NR.	Baseline demographic data, including sex, exact mean age, and drop-out, were not reported or were missing; statistical significance wording (“p > 0.05”) was reported anomalously in the PDF and likely represents an author typographical error.
66	Detoni et al. / 2022 / Brazil	Double-blind randomized controlled clinical trial	n = 20 (TG = 10, PG = 10); age: TG 34.5 ± 10.4, PG 32.6 ± 7.2; sex: 15 F, 5 M; dropout: 0	Mixed TMD, involving muscular and articular components	DC/TMD	Experimental (TG): bilateral 6-mm molar shim (MS) + Joint Mobilization of the Mandibular Condyle (JMMC) for 1 min. Control (PG): bilateral MS + placebo technique, with hands still for 1 min.	Pain pressure threshold (algometry), plantar pressures in standing position (baropodometry: mean pressure, peak pressure, % area)	No statistically significant post-intervention between-group difference was observed for algometric pain values. Post-intervention between-group effect size was moderate for the left trapezius (0.51) and right/left TMJ (0.41/0.54). Statistically significant within-group difference was observed in TG for mean plantar pressure during MS positioning and after the JMMC technique (p < 0.05).	Dysfunctional side of the TMJ was not analyzed as a subgroup; TMD severity was not assessed; no specific podiatric assessment was included as a postural covariate; small sample size.
67	Ekici et al. / 2022 / Turkey	Single-blind prospective controlled clinical study	n = 102 randomized, 100 analyzed (HILT = 34, TENS = 32, Control = 34); age: HILT 33.2 ± 11.6, TENS 32.2 ± 10.6, Control 31.1 ± 11.2; sex: 91 F, 9 M; drop-out: 2 from TENS group	Symptomatic disc displacement with reduction (DDWR)	DC/TMD (Axes I and II)	Experimental 1 (HILT): high-intensity laser therapy + exercises. Experimental 2 (TENS): TENS + exercises. Control: exercises only, 10 min/ day for 3 weeks. Dose/frequency: HILT and TENS 5 times/week for 3 weeks, 15 total sessions. Follow-up at 4 and 12 weeks.	Maximum mouth opening (MMO), pain (VAS), function (VAS), disability (JFLS-20), quality of life (OHIP-14)	Statistically significant between-group differences favored the HILT and TENS groups compared with control for VAS pain, MMO, JFLS-20, and OHIP-14 values at 4 and 12 weeks (p < 0.05). Statistically significant differences between HILT and TENS at 4 weeks were observed for VAS pain (HILT 48% vs TENS 25%) and MMO (HILT 24% vs TENS 10%). No statistically significant difference was observed between HILT and TENS for pain values at 12 weeks. Effect size: NR.	Home exercises were not objectively supervised, with adherence based on instruction; predominant use of subjective questionnaires; no gold-standard clinical dose for HILT has been defined in the literature; recommended exercise duration was relatively short.
68	Jo et al. / 2021 / South Korea	Double-blind randomized controlled clinical trial	n = 160 randomized, 86 analyzed (Intervention = 45, Control = 41); age: Intervention 36.7 ± 13.9, Control 38.4 ± 13.8; sex: 86 F, 0 M; dropout: 74 (35 Intervention, 39 Control)	Mixed TMD, including myalgia, arthralgia, and headache	DC/TMD (Axes I and II)	Experimental (Intervention): pulsed radiofrequency (PRF), 1.5 W, 1 MHz, 10 min + conventional treatments, including splint, physical therapy, and drugs. Control: sham PRF + conventional treatments. Dose/frequency: once weekly for 12 weeks. Follow-up at 24 weeks (12 weeks post-treatment).	Pain intensity (NRS), comfortable mouth opening and maximum unassisted mouth opening (mm), palpation pain, joint sounds	Statistically significant time × group interaction was observed for NRS pain intensity values (p = 0.026). Statistically significant change over time (T0–T24) was observed for mouth opening values in both groups (p < 0.001), with no statistically significant between-group difference at follow-ups. A statistically significant difference in burning sensation was reported in the PRF group (p = 0.001). Effect size: NR.	Very high drop-out rate, with 74 of 160 randomized patients lost; ethnic and gender limitation, as only Korean women were included; PRF was assessed as an add-on therapy, preventing isolated evaluation.
69	Urbański et al. / 2021 / Poland	Randomized controlled clinical trial with alternate allocation	n = 60 (PIR = 30, MR = 30); age: PIR 28.37 ± 5.31, MR 27.77 ± 5.10; sex: 47 F, 13 M; drop-out: 0	Pain-related TMD with increased masticatory muscle tension (Group Ia)	RDC/TMD (Axis I)	Experimental 1 (PIR): post-isometric muscle relaxation treatments. Experimental 2 (MR): myofascial release treatments. Dose/ frequency: 10 sessions over 10 consecutive days. Follow-up on the 4th day after the end of therapy.	Electrical activity of the anterior temporalis and masseter muscles (sEMG), spontaneous muscle pain intensity (VAS)	Statistically significant changes over time (M1 vs M2/M3) were observed for sEMG values (p < 0.001) and VAS pain (p < 0.001) in both groups. No statistically significant between-group difference was found for sEMG values of the masseter muscle (right p = 0.10, left p = 0.11) or for VAS pain changes (p > 0.05). Effect size: NR.	Randomization procedure not based on a generated sequence, using simple alternate allocation; follow-up limited to only 4 days post-treatment, with no long-term assessment; possible millimetric variability in electrode repositioning across sEMG sessions.
70	Gałczyńska-Rusin et al. / 2021 / Poland	Observational clinical study (pre-post)	n = 110 analyzed; age: 26.8 ± 5.4; sex: 98 F, 12 M; dropout: 27	Myofascial pain	RDC/TMD (Axis I)	Global intervention: stretching exercises, 3 sessions/ day of 10 min + relaxation exercises + sublingual relaxation splint (SRS), night-time use. Comparison: outcomes assessed between patients reporting possible sleep bruxism (n = 67) and no bruxism (n = 43). Dose/frequency: 3 months of treatment.	Painful muscle sites (PMS), maximum mouth opening (MMO)	Statistically significant changes over time were observed for MMO and PMS values in both groups (p < 0.05). Statistically significant between-group difference at 3-month follow-up was found for PMS (p = 0.01) and MMO (p = 0.03). Effect size: NR.	Absence of an untreated or sham splint control group; diagnosis of bruxism based on a self-report questionnaire without polysomnographic assessment; use of RDC/TMD version.
71	Moleirinho-Alves et al. / 2021a / Portugal (Pain & Neuromuscular)	Randomized controlled clinical trial (RCT)	n = 45 analyzed (G1 = 15, G2 = 15, G3 = 15); age: G1 26.9 ± 5.5, G2 26.0 ± 4.4, G3 24.9 ± 3.4; sex: 39 F, 6 M; dropout: 7	Local myalgia and myofascial pain	DC/TMD	Experimental 1 (G1): therapeutic exercise, including massage and stretching. Experimental 2 (G2): therapeutic exercise + aerobic exercise using a cycle ergometer. Experimental 3 (G3): aerobic exercise. Dose/ frequency: 8 weeks overall. Follow-up: 8–12 weeks.	Pain intensity (NPRS), resting neuromuscular sEMG activity (RP), maximum voluntary contraction (MVC), bite force (BF, dynamometer)	Statistically significant post-intervention between-group difference in NPRS values was observed between G1/G2 and G3. Statistically significant time × group interaction was observed for BF values in G1 and G2. No statistically significant within-group or between-group changes were observed for sEMG values (MVC and RP) in any group. BF effect size (Cohen’s d) post-intervention: 1.5 and 1.7 (G1), 0.7 and 0.8 (G2).	Allocation was not purely randomized for G1, which included patients who refused aerobic activity; statistically heterogeneous baseline diagnosis distribution, with higher prevalence of myalgia in G3; double blinding was not feasible.
72	Moleirinho-Alves et al. / 2021b / Portugal (Anxiety & OHIP)	Randomized controlled clinical trial (RCT)	n = 45 analyzed; age: G1 26.9 ± 5.5, G2 26.0 ± 4.4, G3 24.9 ± 3.4; sex: 39 F, 6 M; dropout: 7	Myalgia	DC/TMD	Experimental 1 (G1): therapeutic exercise. Experimental 2 (G2): therapeutic exercise + aerobic exercise. Experimental 3 (G3): aerobic exercise. Same protocol as the previous study, focused on different outcomes.	Pain intensity (NRS), anxiety level (GAD-7), oral health-related quality of life (OHIP-14)	Statistically significant change over time from baseline to post-intervention was observed for NRS in G1 (p < 0.001), G2 (p < 0.001), and G3 (p = 0.001). Statistically significant change over time for OHIP-14 was observed in G1 and G2 (p < 0.001). No statistically significant change over time for OHIP-14 was observed in G3 (p = 0.55). No statistically significant between-group difference was observed for GAD-7. No statistical correlation was found between NRS and GAD-7. Effect size: NR.	Absence of a passive/ educational control group; sample did not include patients older than 35 years; patient stratification was based only on Axis I, without psychosocial Axis II subgroups.
73	Fetai et al. / 2021 / Croatia	Randomized controlled clinical trial (RCT)	n = 42 analyzed (Laser = 21, Self-massage = 21); age: median 33 (range 16–67); sex: 26 F, 16 M; dropout: 10	Chronic masseter myalgia lasting >3 months	DC/TMD	Experimental 1 (Laser): low-level laser therapy (940 nm, 6 W) on alternate days for 4 weeks in the clinic. Experimental 2 (Self-massage): home-based’ self-treatment for 4 weeks.	Pain intensity (VAS at rest, during chewing, and for headache), Jaw Function Limitation Scale, Chronic Pain Grading Scale	Both groups showed a statistically significant reduction in pain intensity (VAS) over time (p < 0.001). At 3-month follow-up, statistically significant between-group differences emerged for VAS at rest, VAS during chewing, and headache (p < 0.05), indicating more favorable results in one of the two groups. For characteristic pain change, an effect size expressed as η² was reported, with a statistically significant between-group difference (p = 0.004).	Self-massage protocol execution was not objectively monitored; no sham laser group was included to assess placebo effect; potential concomitant use of analgesic drugs was discouraged but not formally controlled.
74	Melchior et al. / 2021 / Brazil	Cross-sectional observational study	n = 24 analyzed; age: range 18–52; sex: 10 F, 14 M; drop-out: 6	Chronic painful TMD lasting >6 months	DC/TMD	No clinical treatment was assigned. The analysis was based on sample stratification using the 50th percentile (P50) of Orofacial Myofunctional Evaluation (OMES) scores related to tongue function.	sEMG activity of the masseter and anterior temporalis muscles during MVC and tongue exercise, symptom perception (ProT-MDMulti), OMES scores	No statistically significant between-group differences (≤P50 vs >P50) were observed for ProTMDMulti pain scores (p > 0.05) or for sEMG activity recorded during tongue exercise (p > 0.05). Conversely, statistically significant between-group differences were observed only for OMES variables related to tongue mobility and swallowing (p < 0.05). Effect size: NR.	Cross-sectional design does not allow causal longitudinal inference between myofunctional condition and electromyographic outcomes; small sample size.
75	Resende et al. / 2021 / Brazil	Single-blind randomized controlled clinical trial	n = 89 analyzed (OS = 24, MT = 21, C = 19, OSC = 25); age: 28.0 ± 9.34; sex: 72 F, 17 M; dropout: 23 (22 withdrawals, 1 death)	Mixed TMD, including muscular and articular disorders	RDC/TMD (Axis I)	Experimental 1 (MT): manual therapy + home exercises. Experimental 2 (C): counseling. Experimental 3 (OSC): occlusal splint + counseling. Control (OS): occlusal splint, night-time use. Dose/frequency: follow-up at 30 days.	Pain (VAS), sleep quality (PSQI), quality of life (WHO-QOL-BREF), oral health-related quality of life (OHIP-14)	Statistically significant changes over time were observed in all groups for VAS pain intensity (p < 0.001), sleep quality PSQI (p = 0.001), oral quality of life OHIP-14 (p < 0.001), and WHO-QOL general score (p = 0.006). However, no statistically significant between-group differences emerged for VAS (p = 0.260), PSQI (p = 0.097), or OHIP-14 (p = 0.961). Time effect sizes (η_p²) were 0.277 for VAS, 0.119 for PSQI, and 0.489 for OHIP-14; between-group effect sizes were small: 0.048 for VAS, 0.075 for PSQI, and 0.003 for OHIP-14.	Absence of a negative untreated control group due to ethical restrictions; short-term follow-up (1 month); predominance of female participants (80.9%).
76	Sant’Anna et al. / 2021 / Brazil	Randomized controlled clinical trial	n = 29 analyzed (G1 = 17, G2 = 12); age: range 20–65; sex: 25 F, 4 M; drop-out: 11	Masticatory muscle pain + probable sleep bruxism	DC/TMD	Experimental (G2): acupuncture using local and distal points + occlusal splint, night-time use. Control (G1): acupuncture only. Dose/frequency: 1 session/week for 4 weeks.	Reported pain (RP, VAS), pressure pain threshold (PPT, algometry over masseter and anterior temporalis)	In G1, statistically significant within-group changes in RP values were observed after each session, except at P4; in G2, this change was significant only after P1 (p = 0.002). However, no statistically significant between-group differences were found for RP values (ANOVA: p = 0.630). Regarding PPT values, no statistically significant within-group or between-group changes were detected (p > 0.05), except for the right masseter at P3 in G2 (p = 0.042). Effect size: NR.	Absence of blinding for operators and patients; absence of sham splint or sham acupuncture control group; small sample size.
77	De La Torre Canales et al. / 2021 / Brazil	Single-blind randomized controlled clinical trial	n = 54 analyzed (Acupuncture = 18, BoNT-A = 18, SS = 18); age: Acupuncture 30.3 ± 6.9, BoNT-A 34.6 ± 6.5, SS 30.8 ± 6.9; sex: 54 F, 0 M; drop-out: 6	Masticatory myofascial pain (MMFP)	RDC/TMD (Axis I)	Experimental 1 (BoNT-A): bilateral botulinum toxin type A injection (30 U masseter, 10 U anterior temporalis). Experimental 2 (Acupuncture): 4 sessions of traditional acupuncture. Control (SS): saline solution injection. Dose/frequency: BoNT-A and SS in a single session. Follow-up at 1 month.	Self-perceived pain (VAS), pressure pain threshold (PPT, algometry), electromyographic activity (EMG) of masseter and anterior temporalis	Statistically significant change over time for VAS was observed in all groups (p < 0.001). No statistically significant between-group difference for VAS was observed between Acupuncture and BoNT-A (p > 0.05). Statistically significant between-group difference for VAS was observed between experimental groups and SS (p < 0.001). Statistically significant between-group difference for PPT values and reduction in EMG values was found only in the BoNT-A group compared with SS (p < 0.016). Effect size: NR.	Exclusively female sample; assessment limited to immediate/ short-term effects (1 month); EMG activity reduction was reported by the authors as a potential adverse effect of infiltration.
78	Alves et al. / 2021 / Brazil	Single-blind randomized controlled clinical trial	n = 11 analyzed (EG = 5, CG = 6); age: range 25–55; sex: 11 F, 0 M; drop-out: 5	Mild to moderate muscular TMD	RDC/TMD	Experimental (EG): orofacial myofunctional therapy (OMT) + photobiomodulation, 830 nm laser, 3 J, 48 J/ cm². Control (CG): OMT + inactive photobiomodulation, placebo laser. Dose/frequency: 10 clinical sessions, 1/week, 50 min.	Pain perception (VAS), palpation sensitivity (RDC/ TMD), quality of life (OHIP-14), mandibular movements (opening and protrusion)	Statistically significant within-group change over time was observed for VAS in EG (p = 0.002) and CG (p = 0.007). Statistically significant within-group changes for opening (p = 0.042) and protrusion movements (p = 0.048) were recorded only in EG. Statistically significant change over time for total OHIP-14 score was observed in EG (p = 0.002) and CG (p = 0.015). Effect size: NR.	Extremely small final sample size (n = 11 overall); no long-term follow-up after intervention.
79	Brandão et al. / 2021 / Brazil	Parallelarm randomized controlled clinical trial	n = 9 analyzed, belonging exclusively to the experimental group; age: 34.36 ± 10.4; sex: 8 F, 1 M in the analyzed group; drop-out: 5 withdrawals + 4 excluded due to EEG artifacts	Muscular TMD with/ without opening limitation and chronic pain	RDC/TMD (Axis I)	Experimental: isotonic exercises for pain reduction + self-care guidelines, 2 sessions/week for 4 weeks. Control: self-care guidelines only, excluded from statistical analysis due to imbalance.	Electroencephalography (EEG) for calculation of absolute alpha power density	No statistically significant change over time (pre-post intervention) was observed for alpha power density values in any analyzed brain region (p > 0.05). Within-group effect sizes (Cohen’s d) reported: left temporal = 0.39, left occipital = 0.22, right frontal = 0.17, left parietal = 0.15.	Severe baseline imbalance between groups for age and pain intensity forced the authors to exclude the control group entirely from statistical analysis; high data loss due to EEG artifacts; very small final analyzed sample size (n = 9).
80	Xu et al. / 2021 / China	Longitudinal single-arm observational clinical study	n = 54 recruited, 48 analyzed; age: 31.94 ± 12.27; sex: 46 F, 8 M; dropout: 6	TMD, including 12 masticatory muscle pain and 42 disc displacement cases	DC/TMD	Intervention: physical therapy, including ultrasound, laser, manual therapy, and posture training for 3–10 sessions + patient education, involving single 10–20 min recommendations to modify oral behaviors. No control group. Dose/frequency: follow-up performed between 3 and 9 months after treatment.	Oral Behaviour Checklist (OBC), maximum painless mouth opening (mm), pain intensity (VAS), Jaw Functional Limitation Scale (JFLS)	Statistically significant change over time from baseline to follow-up was observed for maximum painless mouth opening (p ≤ 0.001), JFLS score (p ≤ 0.001), and VAS values (p ≤ 0.001). Conversely, no statistically significant change over time was observed for total OBC score (p = 0.960). However, specific OBC items, such as “chewing food on one side”, showed statistically significant changes over time (p ≤ 0.001). Effect size: NR.	Absence of an independent or untreated control group; temporal bias related to highly heterogeneous follow-up intervals among participants (3–9 months).
81	Kuć et al. / 2020 / Poland	Single-arm experimental clinical study	n = 50; age: 23.36 ± 2.14; sex: 37 F, 13 M; drop-out: 0	Myofascial pain with referral	DC/TMD (Axes I and II)	Intervention: soft tissue mobilization, including trigger point pressure release and myofascial relaxation of the masseter and temporalis muscles. No control group. Dose/frequency: 3 sessions of 30 min, spaced 1 week apart.	Bioelectrical activity (sEMG), symmetry and synergy of the anterior temporalis, masseter, sternocleidomastoid (SCM), and anterior digastric muscles	Statistically significant change (Friedman test) in sEMG activity before and after treatment was observed for the right and left masseter (p = 0.00000), right temporalis (p = 0.00010), right SCM (p = 0.00251), left SCM (p = 0.00033), right digastric (p = 0.00045), and left digastric (p = 0.00000). A statistically significant change over time was observed for the SCM symmetry parameter (p = 0.00729). No statistically significant change was found for synergy metrics. Effect size (Kendall’s W): right masseter = 0.302, left masseter = 0.147.	Disegno di studio privo di gruppo di controllo placebo/ sham; valutazioni cliniche limitate all’effetto immediato prima e dopo le sessioni senza indagine a lungo termine.
82	Leite et al. / 2020 / Brazil	Randomized controlled clinical trial (RCT)	n = 40 randomized (IG = 20, SG = 20), n = 34 completed, with intention-to-treat analysis on 40 participants; age: IG 23.4 ± 5.62, SG 27.1 ± 7.25; sex: 40 F, 0 M; dropout: 6 (3 IG, 3 SG)	Muscular TMD, including myalgia with/without disc displacement or joint pain	RDC/TMD (Axis I)	Experimental (IG): diacutaneous fibrolysis (DF) using a specific metallic hook on the temporal and masseter fasciae. Control (SG): sham DF, consisting of superficial traction without mechanical engagement of deep tissues. Dose/frequency: 2 sessions/week for 4 weeks.	Orofacial pain (VAS), pressure pain threshold (PPT, algometry over TMJ, masseter, and temporalis), maximum unassisted mouth opening, Mandibular Function Impairment Questionnaire (MFIQ)	Statistically significant time × group interaction at 4 weeks was observed for VAS (p = 0.001) and PPT over the left temporalis (p = 0.003) and right temporalis (p = 0.001). Statistically significant time × group interaction was observed for maximum mouth opening in IG (F = 6.37, p = 0.017). Statistically significant between-group difference at 4 weeks was found for MFIQ severity levels (p = 0.01). No statistically significant difference was observed for PPT over masseter and TMJ. Between-group effect size (Cohen’s d) at 4 weeks: VAS = 1.06, right temporalis PPT = 1.51.	Campione composto esclusivamente da donne; le variabili biopsicosociali non sono state incluse nell’analisi; assenza di follow-up oltre la fine delle 4 settimane di protocollo.
83	Piech et al. / 2020 / Poland	Single-arm observational clinical study	n = 20 analyzed, extracted from n = 44 total patients in therapy; age: 38.9 ± 10.9; sex: 20 F, 0 M; drop-out: 0	TMD with TMJ hypomobility and myofascial pain	DC/TMD and palpatory examination (Festa)	Intervention: physical therapy including intraoral and extraoral manual therapy, traction, suboccipital techniques, soft tissue mobilization, and active/stretching exercises. Dose/ frequency: 3 sessions/week for 3 weeks, 45 min/session + home self-care.	Maximum mouth opening (mm), pain intensity (NRS) over temporalis, masseter, trapezius, and SCM muscles	Statistically significant change over time was observed for maximum mouth opening values (p = 0.00054), with mean baseline value of 38.9 mm increasing to a final mean value of 45.5 mm. Statistically significant change over time was also observed for NRS scores calculated across all muscles (p = 0.00002). Effect size: NR.	Modesta numerosità del campione, peraltro confinato al solo sesso femminile; assenza di un gruppo di controllo non esposto alla terapia manuale; mancanza di misurazioni differite (follow-up).
84	Özden et al. / 2020 / Turkey	Randomized controlled clinical trial (RCT)	n = 60 (SDN = 20, DDN = 20, Control = 20); age: range 18–65; sex: 31 F, 29 M; drop-out: 0	Myofascial temporomandibular disorder (MTMD) associated with the masseter muscle	RDC/TMD	Experimental group 1 (SDN): superficial dry needling of masseter trigger points, depth ≤5 mm. Experimental group 2 (DDN): deep dry needling of masseter trigger points, depth ≥10 mm. Control group: healthy subjects receiving no treatment. Treatment protocol: 1 session/week for 3 weeks, with follow-up at 3 and 6 weeks post-treatment.	Pressure pain threshold (PPT, algometry), pain intensity (VAS), maximum mouth opening (mm)	Statistically significant changes over time from baseline to 3- and 6-week follow-up were observed for PPT (p < 0.05) and VAS values in both SDN and DDN groups. A statistically significant between-group difference for VAS favored the SDN technique. No statistically significant change over time or between groups (SDN vs DDN) was observed for maximum mouth opening. Effect size: NR.	Lo studio è privo di un braccio di controllo sham per i pazienti patologici, poiché il gruppo di controllo era formato solo da individui asintomatici non trattati; assenza di mascheramento per i clinici.
85	Melo et al. / 2020 / Brazil	Single-blind randomized controlled clinical trial	n = 89 analyzed (OSCS = 25, OS = 24, MT = 21, CS = 19); age: 28.0 ± 9.34; sex: 72 F, 17 M; drop-out: 23 pre-randomization	TMD, predominantly mixed TMD	RDC/TMD (Axis I)	Experimental 1 (OSCS): occlusal splint + counseling. Experimental 2 (OS): occlusal splint. Experimental 3 (MT): manual therapy + home exercises/ thermotherapy. Experimental 4 (CS): counseling. Dose/frequency: follow-up at 1 month post-treatment.	Pain intensity (VAS), anxiety level (HADS, BAI, STAI-T, STAI-S)	Statistically significant changes over time from baseline to 1 month were observed in all groups for VAS pain intensity (p < 0.001), HADS (p < 0.001), BAI (p < 0.001), and STAI-T (p = 0.006). However, no statistically significant between-group differences were found for VAS (p = 0.260), HADS (p = 0.260), BAI (p = 0.532), STAI-T (p = 0.546), or STAI-S (p = 0.760). Time effect sizes (η_p²) were 0.277 for VAS, 0.240 for HADS, 0.211 for BAI, and 0.086 for STAI-T.	Assenza di un gruppo di controllo non trattato o trattato con sham; follow-up limitato al breve termine (1 mese); campione prevalentemente femminile (82.1%).
86	Reynolds et al. / 2020 / USA	Randomized controlled clinical trial	n = 50 (HVLAT = 25, Sham = 25); age: HVLAT 32.2 ± 11.3, Sham 38.8 ± 14.8; sex: 43 F, 7 M; dropout: 0	TMD associated with myalgia	DC/TMD	Experimental (HVLAT): cervical spine high-velocity, low-amplitude thrust manipulation (C0–1 and C2–3) + behavioral education + soft tissue mobilization + home exercise program (HEP). Control (Sham): sham cervical manipulation + education + soft tissue mobilization + HEP. Dose/ frequency: 4 sessions over 4 weeks.	Maximum mouth opening (MMO), pain intensity (NPRS), Jaw Functional Limitation Scale (JFLS), Tampa Scale of Kinesiophobia for TMD (TSK-TMD), Global Rating of Change (GROC)	Statistically significant time × group interaction was observed for JFLS scores at 1 week (p = 0.026) and TSK-TMD at 4 weeks (p = 0.008). Conversely, no statistically significant time × group interaction was found for maximum mouth opening (MMO; p = 0.28) or pain NPRS (p = 0.059). Statistically significant between-group differences were also observed in success rates defined as GROC ≥ +5, both immediately post-treatment (p = 0.022) and at 4-week follow-up (p = 0.047). Effect sizes (Cohen’s d) were 0.60 for JFLS and 0.80 for TSK-TMD.	Operatori clinici non in cieco (impossibile per la natura del thrust); livelli basali di dolore del campione relativamente bassi; mancata misurazione dell’aspettativa di beneficio del paziente.
87	Li & Wu / 2020 / China	Parallel-arm randomized controlled clinical trial	n = 80 analyzed (ESW = 40, UW = 40); age: ESW 25.8 ± 7.7, UW 35.0 ± 8.0; sex: 27 F, 13 M, see notes; drop-out: 0	TMD, including myofascial pain with/without opening limitation	RDC/TMD	Experimental (ESW): extracorporeal shock wave therapy, 1000–1500 shocks, 8 Hz, once weekly for 4 weeks. Control (UW): ultrashort wave therapy, 45 W, 5 days/week for 4 weeks.	Pain intensity (VAS), pain-free MMO, Fricton indexes: mandibular movement (MM), joint noise (JN), joint pressure (JP), disability index (DI)	Statistically significant changes over time were observed for VAS and MMO in both groups (p < 0.05). Statistically significant between-group differences at 4 weeks were found for VAS (p = 0.007), MMO (p = 0.011), and MM, JN, JP, and DI metrics (all p < 0.05). Effect size: NR.	Discrepanza matematica riportata nella Tabella 1 degli autori originali (la somma del rapporto M/F per ciascun gruppo riporta 20 anziché 40, probabile errore di battitura degli autori); assenza di gruppo sham.
88	Kang / 2020 / South Korea	Retrospective observational cohort study	n = 187 (Control = 45, pTMD = 52, TMD1ST = 47, MIG1ST = 43); age: 35.3 ± 15.4; sex: 153 F, 34 M; dropout: NR, retrospective design	TMD associated with pain, headache, and neck pain	RDC/ TMD and ICHD-3	Global intervention: night-time stabilization splint therapy + physical therapy, including hot pack and Rocabado 6×6 exercises, applied to all pathological and control groups. Dose/frequency: treatment and follow-up assessed at 6 months.	Cephalometric analysis of head-neck posture (OPT-CVT, Ba-C3ia, C0–1), trigger points, orofacial pain (VAS, GCPS), migraine symptoms, neck pain (NDI)	Statistically significant time × group interaction was observed for orofacial pain intensity (p < 0.001), number of active masticatory trigger points (p < 0.001), and cervical trigger points (p = 0.002). Statistically significant time × group interaction was also found for NDI scores (p = 0.048) and OPT-CVT angle (p = 0.049). Statistically significant time × group interaction between TMD1ST and MIG1ST groups was found for headache intensity, duration, and frequency (all p < 0.005). Effect size: NR.	Studio retrospettivo (potenziali bias di selezione e compliance); assenza di un gruppo di controllo che non ha ricevuto alcuno splint; potenziale alterazione della natural head position dovuta all’uso del cefalostato.
89	Pihut et al. / 2020 / Poland	Randomized controlled clinical trial	n = 40 (SG = 20, CG = 20); age: SG mean 26, CG mean 28; sex: 26 F, 14 M; dropout: 0	TMD, predominantly muscular pain	RDC/ TMD, with DC/TMD criteria also mentioned	Experimental (SG): radiofrequency waves, 20 J, 3 MHz, bipolar technique for 10 min. Control (CG): sonophoresis, 0.9 W/cm², 25% Voltaren gel for 10 min. Dose/ frequency: 10 procedures, performed daily except Sundays, as supportive treatment before splint therapy.	Muscular pain intensity (VAS), clinical symptoms (Axis I)	Both groups showed statistically significant changes over time from Examination 1 to Examination 2 in VAS scores (p ≤ 0.001). Post-treatment (Examination 2), a statistically significant between-group difference was observed for VAS values (p ≤ 0.001), with lower mean values in the SG compared with the CG (1.85 vs 3.20). Effect size: NR.	Procedura di randomizzazione non esplicitata nella metodologia; assenza di valutazione tramite doppio cieco; follow-up non esteso oltre il termine della decima procedura clinica; assenza di gruppo di controllo con placebo fittizio (sham).
90	Zhang et al. / 2020 / China	Parallelarm randomized controlled clinical trial	n = 40 (TMJ TENS = 10, TMJ sTENS = 10, Control TENS = 10, Control sTENS = 10); age: range 25–38; sex: 20 F, 20 M; drop-out: 0	TMJ pain associated with disc displacement without reduction (DDwoR)	DC/TMD (Axis I) and MRI	Experimental (TENS): transcutaneous electrical nerve stimulation, 500 μs, 1.5 s interval, 45 min. Control (sTENS): sham TENS, visually active device but without electrical output, 45 min. Dose/ frequency: single application assessed before and after 20 repeated mandibular movements, including open-close, fast open-close, and horizontal movements.	Pain intensity (NRS 0–10), jaw functional assessment, including total opening distance (TOD), average opening/ closing velocity (AOV/ ACV), and horizontal movement range	Statistically significant time × group × intervention interaction was observed for NRS values during openclose (p = 0.007) and fast open-close movements (p = 0.016). Statistically significant change over time in NRS scores was observed in the TMJ TENS group (p < 0.05). No statistically significant change over time in NRS was observed in the TMJ sTENS group or in healthy controls (p > 0.05). Statistically significant time × intervention interaction was observed for TOD values (p = 0.019). Effect size: NR.	Valutazioni effettuate dal medesimo operatore clinico pre e post intervento (rischio di bias); oltre il 50% dei pazienti nel gruppo TENS ha indovinato correttamente l’assegnazione del trattamento; campione di piccole dimensioni.
91	Delgado de la Serna et al. / 2020 / Spain	Multicenter parallelarm randomized controlled clinical trial	n = 61 analyzed at baseline (EX-+EDUC+MT = 31, EX+EDUC = 30); age: MT 42.5 ± 12.0, EX+EDUC 44.0 ± 10.5; sex: 36 F, 25 M; drop-out: 5 at 6-month follow-up	Somatic tinnitus attributed to TMD	RDC/TMD	Experimental (EX+EDUC+MT): cervico-mandibular manual therapies, including TMJ mobilization, pressure release, and soft tissue mobilization + exercises + education. Control (EX+EDUC): exercises + education. Dose/frequency: 6 sessions over 4 weeks. Follow-up at 3 and 6 months.	TMD pain intensity (NPRS), tinnitus severity (VAS), Tinnitus Handicap Inventory (THI), CF-PDI, SF-12, BDI-II, pressure pain thresholds (PPT, algometry), mandibular range of motion	Statistically significant group × time interaction was observed for TMD pain (p < 0.001), tinnitus severity (p < 0.001), THI (p < 0.001), CF-PDI (p < 0.001), BDI-II (p < 0.001), PPTs (p < 0.001), and mandibular range of motion (p < 0.001). Conversely, no statistically significant group × time interaction was observed for SF-12 values (p = 0.622). Effect sizes (η_p²) were 0.153 for TMD pain, 0.233 for tinnitus severity, 0.501 for THI, 0.395 for CF-PDI, 0.194 for BDI-II, 0.415 for masseter PPT, 0.395 for temporalis PPT, 0.363 for TMJ PPT, 0.367 for maximum oral opening, and 0.395 for mandibular lateral excursion.	Absence of a sham manual therapy control group, so the placebo effect related to manual contact and greater therapist time could not be isolated; tinnitus diagnosis based exclusively on self-report.
92	Lindfors et al. / 2020 / Sweden	Randomized controlled clinical trial	n = 97 randomized (Jaw exercises = 35, Stabilization appliance = 33, No treatment = 29); age: 35 ± 18; sex: 77 F, 20 M; drop-out: 9	Masticatory myofascial pain	RDC/TMD (Axis I)	Experimental 1 (Jaw exercises): jaw exercises, including relaxation, free and resisted movements, and stretching. Experimental 2 (Stabilization appliance): hard acrylic resin stabilization appliance, night-time use. Control (No treatment): waiting-list patients. Dose/frequency: assessment at 3 months post-randomization.	Pain intensity (VAS), global improvement (PGIC), depression and anxiety (HADS), jaw function (JFLS-20), analgesic consumption, frequency of tension-type headache	Statistically significant between-group differences between Jaw exercises and No treatment were observed for VAS during mandibular movement (p < 0.001), headache frequency (p = 0.028), analgesic consumption (p = 0.007), and JFLS scores (p = 0.008). No statistically significant between-group difference was observed between Jaw exercises and Stabilization appliance for VAS during movement. PGIC values showed statistically significant differences in treatment groups compared with No treatment (p < 0.001). Effect size: NR.	Patients were not blinded to treatment; adherence was extremely low in the jaw exercises group, with only 4 of 28 patients following the instructions exactly; the No treatment group received fewer clinical appointments than active groups; baseline age and education level were heterogeneous between the control and experimental groups.
93	Chellappa et al. / 2020 / India	Randomized controlled clinical trial	n = 60 (LLLT = 30, TENS = 30); age: NR; sex: NR; drop-out: 0	TMD, including chronic pain >3 months, opening limitation, and joint clicking	RDC/TMD	Experimental 1 (LLLT): Zolar photon diode laser, 672 nm, 50 mW, 3 J/site, 120 s/site. Experimental 2 (TENS): TENS, Digi Dual, 20 W, max 60 Hz, 15 min. Dose/frequency: 2 sessions/week for 3 weeks, 6 total sessions.	Numeric Pain Distress scale (VAS), active mandibular range of motion, including maximal pain-free mouth opening	Statistically significant changes over time from baseline to follow-up were observed for VAS values in the LLLT group (p < 0.01) and TENS group (p < 0.06). Statistically significant changes over time were observed for mouth opening values in the LLLT group (p = 0.00) and TENS group (p = 0.03). Statistically significant between-group differences were observed for post-treatment VAS and mouth opening values between LLLT and TENS (p < 0.01). Effect size: NR.	Baseline demographic data, including mean age and sex, were not reported in the text; absence of a sham or untreated control group; inconsistencies in p-value reporting within the original manuscript, such as “p < 0.06” in the text versus “p = 0.00” in other sections.
94	Aksu et al. / 2019 / Turkey	Randomized controlled clinical trial	n = 63 (Group 1 = 21, Group 2 = 20, Group 3 = 22); age: 39.4 ± 14.9; sex: 53 F, 10 M; drop-out: 0	Temporomandibular myofascial pain	RDC/TMD	Experimental 1 (Group 2): dry needling + exercises and protection. Experimental 2 (Group 3): trigger point injection with 1 mL prilocaine + exercises and protection. Control (Group 1): exercises and protection. Dose/frequency: injections performed once weekly for 3 weeks. Follow-up at 10 days and 1 month.	Pain intensity (VAS), maximum mouth opening, functional limitations (RDC/TMD), algometry (PPT)	Statistically significant changes over time in VAS values were observed in all groups (p < 0.001). No statistically significant between-group difference was observed for post-treatment VAS scores (p = 0.557). Statistically significant between-group differences were found for algometric PPT values at the left temporalis (p = 0.040), right masseter (p < 0.001), left masseter (p < 0.001), right lateral pterygoid (p < 0.001), and left lateral pterygoid (p = 0.002). Effect size: NR.	Baseline VAS scores were statistically and significantly lower in Group 1 than in Groups 2 and 3; absence of a sham injection control group, preventing determination of placebo effects related to needling; group allocation based on patient arrival order rather than computer-generated randomization.
95	Monaco et al. / 2019 / Italy	Randomized controlled clinical trial	n = 50 (Study = 25, Control = 25); age: Study 36.41 ± 6.41, Control 37.02 ± 9.15; sex: 50 F, 0 M; drop-out: 0	Myogenous TMD (myofascial)	RDC/TMD (Groups 1a, 1b)	Experimental (Study): ELIBA device (lingual elevator by Balercia), constructed under ULF-TENS. Control: no intraoral device. Dose/frequency: home use ≥ 16 h/day. Follow-up at 6 months.	Resting electromyographic activity (sEMG), freeway space (FWS), jaw tracking (KNG: MO, MVO, MVC), pain intensity (VAS)	At follow-up, statistically significant between-group differences were observed for VAS pain (p ≤ 0.001), mouth opening (MO; p = 0.003), maximum voluntary opening (MVO; p = 0.003), maximum voluntary contraction (MVC; p ≤ 0.001), and the vertical component of freeway space (FWS; p = 0.001). A statistically significant between-group difference was also observed for mean resting sEMG values (p ≤ 0.001). Effect size: NR.	Absence of a control group treated with a sham or alternative intraoral device; sample limited to female participants.
96	Oliveira et al. / 2019 / Brazil	Single-blind randomized controlled clinical trial	n = 49 analyzed (Test = 36, Control = 13); age: 39.8 ± 16.3; sex: 39 F, 10 M; drop-out: 21 excluded from analysis due to instrumental artifacts	TMD	RDC/TMD (Axis I) and MRI	Experimental (Test): occlusal splint + therapeutic exercises. Control: therapeutic exercises only. Dose/frequency: night-time splint use + 4 h/daytime use, 15 exercise repetitions 3 times/day for 12 weeks.	Postural balance, including AP velocity of the center of pressure (COP), assessed on a force platform with eyes open (eo) and closed (ec)	Statistically significant within-group change over time was observed for AP velocity with eyes closed in both Test (p < 0.001) and Control (p = 0.046). Statistically significant within-group change over time for AP velocity with eyes open was observed only in the Test group (p = 0.023). No statistically significant post-treatment between-group difference was observed for any postural balance variable (p > 0.05). Effect size: NR.	Randomization discrepancy with numerically unbalanced group allocation (36 vs 13); blinding applied only to the clinical outcome assessor.
97	Nagata et al. / 2019 / Japan	Single-blind randomized controlled clinical trial	n = 61 analyzed (TE+MN = 31, TE = 30); age: TE+MN 48.2 ± 21.1, TE 50.7 ± 18.3; sex: 50 F, 11 M; drop-out: 5	TMD with opening limitation (≤35 mm)	DC/TMD (Axis I) and MRI	Experimental (TE+MN): therapeutic exercise (S-MFT) + CBT + education + jog-manipulation. Control (TE): therapeutic exercise (S-MFT) + CBT + education. Dose/frequency: manipulation performed in clinic until partial resolution; daily self-exercise. Follow-up up to 18 weeks.	Mouth-opening distance (mm), orofacial pain (NRS), TMJ sounds (NRS)	Statistically significant changes over time were observed for all clinical measurements in both groups. Statistically significant between-group difference in mouth-opening values was observed only after the first treatment session. No statistically significant time × group interaction was observed for mouth-opening, pain, or sound parameters over the full 18-week period (p > 0.05). Effect size: NR.	The control group received an advanced form of therapeutic exercise (S-MFT), capable of producing clinical improvements overlapping with the experimental intervention over the long term.
98	Calixtre et al. / 2019 / Brazil	Single-blind randomized controlled clinical trial	n = 61 (CG = 31, IG = 30); age: CG 26.3 ± 4.6, IG 26.1 ± 5.7; sex: 61 F, 0 M; drop-out: 5, analyzed by intention-to-treat	Myogenous TMD (orofacial myalgia) or mixed TMD	RDC/TMD	Experimental (IG): upper cervical mobilizations + craniocervical flexor training. Control (CG): no treatment. Dose/frequency: 2 sessions/week for 5 weeks.	Orofacial pain intensity (VAS). Secondary outcomes included PPT algometry, HIT-6, and MFIQ.	Statistically significant time × group interactions were observed for VAS current pain (p < 0.01), maximum pain (p < 0.01), minimum pain (p = 0.03), HIT-6 (p = 0.02), and MFIQ (p = 0.02). No statistically significant time × group interaction was observed for temporalis PPT (p = 0.58) or masseter PPT (p = 0.34). Between-group effect size (Cohen’s d) at 5 weeks: current pain = −0.81, maximum pain = −0.75, minimum pain = −0.58, HIT-6 = 0.86, MFIQ = 0.62.	Absence of a sham intervention in the control group; patients were not blinded to allocation; recruitment exclusively included young women.
99	Herpich et al. / 2018 / Brazil	Double-blind randomized controlled clinical trial	n = 60 (G1 = 15, G2 = 15, G3 = 15, Placebo = 15); age: range 18–40; sex: 60 F, 0 M; drop-out: 0	Myofascial pain with/without opening limitation (Groups Ia, Ib)	RDC/TMD	Experimental interventions: phototherapy with super-pulsed laser (905 nm) + red and infrared LED. G1: 2.62 J/point; G2: 5.24 J/point; G3: 7.86 J/point. Control: placebo phototherapy (0 J). Dose/frequency: single application on 10 points. Follow-up at 24 h and 48 h.	Pain intensity (VAS), PPT (algometer), maximum vertical mandibular movement (mm), sEMG muscle activity of masseter and temporalis	All active groups (G1, G2, G3) showed statistically significant changes over time from baseline in VAS pain values across all assessment windows (p < 0.0001). Conversely, no statistically significant group × treatment interaction was observed for PPT (p = 0.39), resting sEMG activity (p = 0.63), sEMG activity during MHI contraction (p = 0.48), or maximum vertical mandibular movement (p = 0.44). Effect sizes (η_p²) were very small: 0.01 for PPT, 0.003 for resting sEMG, 0.002 for MHI sEMG, and 0.05 for maximum vertical mandibular movement.	Absence of an independent control group not exposed to any device; limited observation duration, ending 48 h after the single application.
100	Brochado et al. / 2018 / Brazil	Single-blind randomized controlled clinical trial	n = 51 randomized, n = 41 analyzed (PBM = 14, MT = 13, CT = 14); age: 44.5 ± 17.1; sex: 39 F, 2 M; drop-out: 10	Myogenous and arthrogenous TMD, including TMJ pain and opening limitation	RDC/TMD (Axes I and II)	Experimental 1 (PBM): photo-biomodulation, 808 nm, 100 mW, 4 J/point. Experimental 2 (MT): manual therapy applied to masticatory muscles and TMJ for 21 min. Experimental 3 (CT): PBM + MT. Dose/frequency: 3 sessions/week for 4 weeks. Follow-up at 4 and 8 weeks.	Pain intensity (VAS), RDC/TMD Axes I and II, anxiety symptoms (BAI)	All groups showed statistically significant changes over time from baseline to follow-up for VAS pain values (p < 0.001), mandibular movements (p < 0.001), and BAI scores (p ≤ 0.05). However, no statistically significant between-group differences were observed for VAS values during the assessment period (p > 0.05). No statistically significant change was observed for chronic pain intensity D1 (p > 0.05). Effect size: NR.	Absence of a placebo/sham control group; most changes detected on Axis II were based on assessment periods shorter than the 6 months required by the D1 questionnaire.
101	Lietz-Kijak et al. / 2018 / Poland	Randomized clinical study	n = 60 (KT = 30, TrP = 30); age: KT 25.87 ± 4.86, TrP 27.37 ± 5.08; sex: 31 F, 29 M; drop-out: 0	Painful functional disorders of the masticatory muscles of myofascial origin	RDC/TMD (Axis I)	Experimental 1 (KT): Kinesio taping application over the masseter area for 5 days. Experimental 2 (TrP): trigger point release using ischemic compression on days 1, 3, and 5. Dose/frequency: assessments performed before and at the end of therapy after 5 days.	Pain intensity (VAS)	Both therapeutic methods produced a statistically significant reduction in VAS pain values in the pre-post comparison (p < 0.001). Statistically significant between-group differences were also observed for both absolute change in pain intensity (AbsCh; p < 0.001) and relative change (RelCh; p < 0.001). Linear regression models did not show statistically significant interactions related to sex or age. Effect size: NR.	Study focused exclusively on very short-term effects (5 days); absence of an untreated control group or sham taping group.
102	Rampello et al. / 2018 / Italy	Randomized controlled clinical trial	n = 80 (PG = 40, CG = 40); age: PG mean 34 (range 20–58), CG mean 38 (range 25–51); sex: 69 F, 11 M; drop-out: 0	Reducible disc displacement, myalgia, arthralgia, and comorbidity with headache or neck pain	DC/TMD	Experimental (PG): universal “Lingual Ring Ri.P.A.Ra.” device, used 6–12 h/day. Control (CG): no treatment. Dose/frequency: assessments at baseline and at the end of the therapeutic cycle, up to 3 months.	Articular noises, painful symptomatology (NVS), parafunctional habits, healing/improvement frequency	Statistically significant between-group difference was observed at follow-up (p < 0.05). In the PG group, recorded frequencies were 33% “cured”, 68% “improved”, 0% “stationary”, and 0% “worsened”. In the CG group, recorded frequencies were 0% “cured”, 10% “improved”, 45% “stationary”, and 45% “worsened”. Effect size: NR.	Sample size limited in relation to heterogeneous clinical presentations; observation period limited to a maximum of 3 months; absence of a placebo device or traditional splint as an active control group.
103	Garrigós-Pedrón et al. / 2018 / Spain	Single-blind randomized controlled clinical trial	n = 52 randomized, n = 45 analyzed (CG = 22, COG = 23); age: CG 48.2 ± 11.3, COG 46.0 ± 9.1; sex: 39 F, 6 M; drop-out: 7	Chronic migraine and myofascial TMD	ICHD-III and RDC/TMD	Experimental (COG): cervical and orofacial treatment, including manual therapy and therapeutic exercise. Control (CG): cervical treatment, including manual therapy and therapeutic exercise. Dose/frequency: 6 sessions over 3–6 weeks. Follow-up at 6 and 12 weeks post-treatment. Both groups continued baseline pharmacological therapy.	CF-PDI, HIT-6, TSK-11, pain intensity (VAS), trigeminal PPTs over temporalis and masseter, extra-trigeminal PPT over wrist, pain-free MMO	Statistically significant time × group interaction was observed for CF-PDI (p = 0.027), HIT-6 (p < 0.001), VAS (p < 0.001), temporalis PPT (p < 0.001), masseter PPT M1 and M2 (p = 0.001 and p < 0.001, respectively), and MMO (p < 0.001). No statistically significant time × group interactions were found for TSK-11 (p = 0.37) or extra-trigeminal PPT (p = 0.55). Effect sizes (η_p²): CF-PDI = 0.075, HIT-6 = 0.19, TSK-11 = 0.023, VAS = 0.33, temporalis PPT T1 = 0.26, masseter PPT M1 = 0.14, masseter PPT M2 = 0.20, wrist PPT = 0.061, MMO = 0.22.	Patients did not discontinue ongoing pharmacological therapies, and changes in medication intake were not analyzed; absence of an independent untreated control group to assess natural clinical course.
104	Ferreira et al. / 2017 / Brazil	Parallelarm randomized controlled clinical trial	n = 75 allocated, n = 40 analyzed (Active = 20, Placebo = 20); age: Active 25.10 ± 3.87, Placebo 24.15 ± 3.01; sex: 30 F, 10 M; drop-out: 35 pre-analysis, including withdrawals or losses to follow-up	Myofascial TMD (Categories Ia, Ib)	RDC/TMD	Experimental (Active): TENS, 50-min application alternating high and low frequency. Control (Placebo): placebo TENS, with the device covertly interrupted after 40 s. Dose/frequency: single application. Assessments immediately post-treatment (T1) and at 48 h (T2).	Pain intensity (VAS), PPT of masticatory and cervical structures, EMG activity during mandibular rest (MR), maximal voluntary contraction (MVC), and habitual chewing (HC)	In the Active group, a statistically significant change over time (T0 vs T1 and T2) was observed for VAS pain values (p < 0.050). Statistically significant between-group differences at T1 and T2 were also found for PPT values of the masseter and anterior temporalis muscles (p < 0.050). In the Active group, resting EMG activity was significantly reduced at T1 compared with T0 (p < 0.050). Between-group effect sizes (Cohen’s d) at T1 were −0.79 for VAS, 1.13 for temporalis PPT, 1.38 for sternocleidomastoid PPT, 3.11 for masseter EMG during HC, and 3.32 for temporalis EMG during HC.	No long-term follow-up; absence of an asymptomatic control group; risk of performance bias, as the clinician applying the intervention was aware of group allocation.
105	van Grootel et al. / 2017 / Netherlands	Randomized controlled clinical trial (RCT)	n = 72 analyzed (Ph-Tx = 37, Sp-Tx = 35); age: Ph-Tx 31.4 ± 9.6, Sp-Tx 29.0 ± 9.6; sex: 68 F, 4 M; drop-out: 18 before and during treatment	Myogenous TMD, exclusively muscular disorders	RDC/TMD (Groups Ia and Ib)	Experimental (Ph-Tx): physical therapy, including counselling, posture, relaxation, self-massage, stretching, and habit reversal. Control (Sp-Tx): occlusal splint therapy, Michigan type, night-time use. Dose/frequency: variable duration, 10–21 weeks for Ph-Tx and 12–30 weeks for Sp-Tx, controlled using the Treatment Duration Control (TDC) index. Follow-up at 6 and 12 months.	Number of visits / treatment duration, success rate (SR, TDC cut-off ≤ -0.379), effectiveness (post-treatment TDC), predominant pain intensity (VAS)	No statistically significant between-group difference was observed for SR in the short term (p = 0.339) or long term (p = 0.487). No statistically significant between-group difference was observed for mean TDC values (p = 0.446). Statistically significant between-group differences were found for treatment duration and number of visits (p < 0.0001). Pain intensity values changed significantly over time (p < 0.0001). Effect size (Cohen’s d) for post-treatment pain intensity: Ph-Tx = 0.86, Sp-Tx = 1.39.	Absence of an untreated or sham control group; strict selection criteria excluded marked psychosocial factors, restricting generalizability.
106	Machado et al. / 2016 / Brazil	Randomized controlled clinical trial	n = 104 allocated, n = 102 analyzed (GI = 21, GII = 22, GIII = 21, GIV = 18, GC = 20); age: 30–36 years, group means; sex: 94 F, 8 M; drop-out: 17	Chronic TMD	RDC/TMD (Axis I)	Experimental 1 (GI): LLLT, 780 nm, 60 mW, 60 J/cm² + orofacial myofunctional exercises. Experimental 2 (GII): orofacial myofunctional therapy (OMT), including pain relief + orofacial myofunctional exercises. Experimental 3 (GIII): placebo LLLT + orofacial myofunctional exercises. Experimental 4 (GIV): LLLT only. Control (GC): healthy controls, no intervention. Dose/frequency: 12 sessions over 120 days. Follow-up at 3 months.	Self-judgment of TMD severity (ProTMD-multi), tenderness to palpation, orofacial myofunctional status (OMES protocol)	Statistically significant changes over time (T1 vs T2/T3) were observed for outcomes in all treated groups (p < 0.01). No statistically significant change over time was observed for OMES in GIV. Statistically significant between-group differences at T2 and T3 for OMES score were found between GI/GII/GIII and GIV (p < 0.001). Effect size (Cohen’s d) T1 × T3 for ProTMD-multi: GI = -1.8, GII = −1.8, GIII = −1.1, GIV = −1.6.	Heterogeneity of TMD diagnoses across subgroups; absence of psychological factor assessment (Axis II).
107	Calixtre et al. / 2015 / Brazil	Single-arm pre-post clinical study	n = 12; age: 22.08 ± 2.23; sex: 12 F, 0 M; drop-out: 0	Myofascial pain with/without joint impairment or disc displacement	RDC/TMD (Axis I)	Experimental: cervical spine treatment, including upper cervical mobilizations, central posterior-anterior mobilization at C5, cranio-cervical flexor stabilization, and stretching. No independent control group. Dose/frequency: 10 sessions of 35 min over 5 weeks. Two baseline measurements (E1, E2) spaced 3 weeks apart, and one post-treatment measurement (E3).	Mandibular function (MFIQ), pain-free maximum mouth opening (MMO), self-reported pain (RDC/TMD), PPT of masseter and temporalis	Statistically significant change over time (E2 vs E3) was observed for MFIQ (p = 0.020), MMO (p = 0.009), self-reported pain (p = 0.017), left masseter PPT (p = 0.033), and left temporalis PPT (p = 0.047). No statistically significant change over time was observed during the baseline phase (E1 vs E2) for all parameters. Effect sizes (ES) E2–E3: MMO = 0.64, left masseter PPT = 0.71, left temporalis PPT = 0.67, right temporalis PPT = 0.91.	Single-arm design without an independent control group; low baseline clinical pain and disability values within the sample, suggesting a ceiling effect; follow-up assessed only a few days after therapy completion (3–5 days).
108	Benlidayi et al. / 2016 / Turkey	Single-blind randomized controlled clinical trial	n = 28 analyzed (Experimental = 14, Control = 14); age: Experimental 31.6 ± 11.5, Control 31.1 ± 10.1; sex: 24 F, 4 M; drop-out: 5	Myofascial pain, arthralgia, and disc displacement with reduction	RDC/TMD	Experimental: Kinesio taping (KT), Y-shaped technique + counseling + jaw exercises. Control: counseling + jaw exercises. Dose/frequency: KT for 2 applications of 3 days each. Exercises for 6 weeks. Follow-up at 1 and 6 weeks.	Active maximal mouth opening, laterotrusion, TMJ/muscle pain (VAS), masticatory efficiency, functional limitation, RDC/TMD Biobehavioral Questionnaire	Statistically significant between-group differences at week 6 were observed for active mouth opening (p = 0.003), TMJ VAS (p = 0.046), masticatory efficiency (p = 0.000), functional limitation (p = 0.000), pain score (p = 0.000), depression score (p = 0.046), and disability score (p = 0.026). Statistically significant change over time from baseline to week 6 was observed in the Experimental group for all outcomes (p < 0.05). Effect size: NR.	Statistically significant baseline heterogeneity between groups for “functional limitation” (p = 0.024); absence of sham taping in the control group.
109	Nagata et al. / 2015 / Japan	Randomized controlled clinical trial (RCT)	n = 181 analyzed (NS = 85, NS+S = 96); age: NS 43.1 ± 17.6, NS+S 41.1 ± 18.9; sex: 118 F, 63 M; drop-out: 20 pre-treatment	TMD	RDC/TMD (Axes I and II) and MRI	Experimental (NS+S): non-splint multi-modal therapy + stabilization splint, night-time use. Control (NS): non-splint multimodal therapy, including self-exercise, CBT, education, and possible jaw manipulation. Dose/frequency: measurements before and after treatment and follow-up at 2, 4, 6, 8, and 10 weeks.	Mouth-opening distance (mm), orofacial pain (NRS), TMJ sounds (NRS)	Statistically significant changes over time were observed in both groups for mouth-opening, pain score, and sound score (p < 0.05). No statistically significant time × group interaction was observed between NS and NS+S for mouth-opening (p = 0.4715), pain (p = 0.2699), or TMJ sounds (p = 0.2915). In subgroup analysis using MRI, no statistically significant between-group difference was found for clinical parameters (p > 0.05), except for pain in the DJD group (p = 0.0404). Effect size: NR.	Absence of an independent untreated control group; potential selection bias related to referral of patients who had already failed previous splint-based occlusal therapies.
110	Ariji et al. / 2015 / Japan	Single-arm clinical study	n = 41 recruited, 37 analyzed for effective-ness; age: median 46 (range 19–83); sex: 33 F, 8 M; drop-out: 4	TMD with myofascial pain	RDC/TMD	Intervention: bilateral massage of the masseter and temporalis muscles using an oral rehabilitation robot, including petrissage and effleurage. Outcome analysis compared “therapy-effective” vs “therapy-ineffective” subgroups. Dose/frequency: standard 16-min protocol, 10 N pressure. Median of 5 sessions, spaced 2 weeks apart.	Degree of TMJ dysfunction, including maximum mouth opening (MMO) and VAS pain; masseter muscle thickness measured by sonography	Statistically significant pre-post change was observed for MMO in the effective (p = 0.0001) and ineffective (p = 0.0167) groups. Statistically significant change over time was observed for VAS scores in the effective (p = 0.000008) and ineffective (p = 0.0076) groups. Statistically significant change over time in masseter thickness was observed only in the effective group (p = 0.000003), with no significant change in the ineffective group (p = 0.1467). Effect size: NR.	Absence of a control arm treated with alternative, placebo, or sham modalities; follow-up limited to the end of the treatment cycle; sonographic measurements may be affected by minor probe positioning errors.
111	Costa et al. / 2015 / Brazil	Randomized controlled clinical trial	n = 60 randomized, n = 41 analyzed (Group 1 = 17, Group 2 = 24); age: Group 1 36.0 ± 6.7, Group 2 27.5 ± 6.7; sex: 54 F, 6 M; drop-out: 19 (13 from G1, 6 from G2)	Masticatory myofascial pain concomitant with headache	RDC/TMD and ICHD-2	Experimental 1 (Group 2): counseling for behavioral changes + stabilization appliance, night-time use. Experimental 2 (Group 1): counseling only. Dose/frequency: assessments at baseline, 2 months, and 5 months.	Headache characteristics (ICHD-2 questionnaire), pain intensity (VAS), headache frequency	Statistically significant changes over time were observed for VAS scores at 2 months (p < 0.001) and 5 months (p < 0.001) in both groups. No statistically significant between-group difference was observed for VAS values at any follow-up (p > 0.05). Statistically significant changes over time were observed for headache frequency in both groups (Group 1 p = 0.01; Group 2 p = 0.001). No statistically significant between-group difference was observed for headache frequency reduction (p > 0.05). Temporal effect size (Cohen’s d): range 1.3–1.9.	High drop-out rate in Group 1 (13 withdrawals vs 6 in Group 2); absence of an independent control group with headache only and without TMD management; analgesic intake was not rigorously recorded.
112	Oliveira et al. / 2015 / Brazil	Double-blind randomized controlled clinical trial	n = 32 (Active = 16, Sham = 16); age: Active 23.8 ± 7.3, Sham 25.5 ± 6.3; sex: 29 F, 3 M; drop-out: 0	Myofascial TMD (Axis I)	RDC/TMD (Groups Ia, Ib)	Experimental (Active): Rocabado exercises + active tDCS, 2 mA for 20 min. Control (Sham): exercises + sham tDCS. Dose/frequency: active stimulation for the first 5 days, exercises for 4 weeks. Follow-up at 5 months.	Pain intensity (VAS), PPT by algometry over TMJ and cervical muscles, quality of life (WHO-QOL-BREF)	Statistically significant change over time was observed for VAS scores (F = 28.7, p < 0.001). No statistically significant time × group interaction was observed for VAS scores (F = 1.5, p = 0.137) or at 5-month follow-up (p = 0.76). No statistically significant between-group difference was observed for PPT values over trapezius, levator scapulae, suboccipital muscles, or condylar regions (p > 0.05). Absolute effect size: NR; Absolute Benefit Increase = 37.5%.	tDCS was administered during a resting phase after, rather than during, the exercise session; absence of a third clinical control arm not exposed to therapeutic exercises.
113	Rodriguez-Blanco et al. / 2015 / Spain	Double-blind randomized controlled clinical trial	n = 60 (EG = 30, CG = 30); age: CG 33.36 ± 9.43, EG 36.60 ± 12.63; sex: 40 F, 20 M; drop-out: 0	Myofascial TMD and reduced mobility of the first cervical vertebra	RDC/TMD	Experimental (EG): neuromuscular technique on the masseter + passive hamstring stretching + suboccipital muscle inhibition (SMI) technique. Control (CG): neuromuscular technique on the masseter + passive hamstring stretching. Dose/frequency: single session, with measurements before and 5 min after intervention.	Vertical mouth opening (VMO), PPT over masseter and trigeminal nerve, suboccipital ROM using digital inclinometer, lumbar spine mobility (SAR test)	No statistically significant between-group difference was observed for any assessed variable (p > 0.05). Statistically significant within-group changes were observed in EG for suboccipital flexion (p < 0.001) and SAR test (p = 0.009). Statistically significant within-group change in CG was limited to the SAR test (p = 0.003). No statistically significant within-group change was observed for VMO values (p = 0.057 for EG) or PPT values. Effect size (R²): suboccipital flexion EG = 0.33, SAR EG = 0.21, SAR CG = 0.27.	Study focused only on immediate effects, without short-, medium-, or long-term follow-up; subjects were not previously tested for suboccipital trigger points and were included exclusively based on C1 movement restriction.
114	Packer et al. / 2015 / Brazil	Blinded randomized controlled clinical trial	n = 32 (EG = 16, PG = 16); age: EG 23.50 ± 2.14, PG 26.06 ± 3.41; sex: 32 F, 0 M; drop-out: 0	Myofascial TMD with/without limitation	RDC/TMD	Experimental (EG): upper thoracic manipulation at T1, high-velocity, low-amplitude thrust. Control (PG): sham manipulation at T1, simulated manipulation without thrust. Dose/frequency: single session, with pre-treatment (PM), immediate post-treatment (IPM), and short-term follow-up (STPM, 2–4 days) assessments.	Vertical mouth opening (VMO) with and without pain, sEMG activity of masticatory muscles, including masseter, temporalis, and suprahyoid muscles, at rest and during isometric contraction	No statistically significant between-group difference was observed for VMO or sEMG activity values (p > 0.05). Statistically significant within-group changes over time were observed in EG for suprahyoid activity at STPM compared with PM (p = 0.014) and for left masseter activity at IPM compared with PM (p = 0.001). No statistically significant within-group change was observed for sEMG activity in the remaining muscles assessed at rest or during mandibular elevation contraction. Between-group effect size (Cohen’s d) for pain-free VMO (PM × IPM): −0.02 EG vs 0.05 PG. Effect size (Cohen’s d) for resting sEMG: RM PG (PM × STPM) = −0.56, LM PG (PM × STPM) = −0.59.	Heterogeneous timing of short-term follow-up assessment, varying from 2 to 4 days post-manipulation; absence of prior clinical diagnosis of thoracic vertebral hypomobility before inclusion; most of the sample did not show baseline opening limitation.
115	Gonzalez-Perez et al. / 2015 / Spain	Open-label randomized controlled clinical trial	n = 48 (DDN = 24, Control = 24); age: DDN 34.3 ± 13.8, Control 35.5 ± 11.2; sex: 38 F, 10 M; drop-out: 8, exclusively from the Control group	Chronic myofascial pain syndrome (MPS) lasting >6 months involving the lateral pterygoid muscle (LPM)	RDC/TMD (Group I)	Experimental (DDN): deep dry needling (DDN) of the lateral pterygoid muscle. Control: pharmacological therapy with methocarbamol 380 mg + paracetamol 300 mg. Dose/frequency: DDN, 1 session/week for 3 weeks; drug therapy, 2 tablets every 6 h for 3 weeks. Follow-up assessed on days 28 and 70.	Pain intensity at rest and during chewing (VAS), range of motion using TheraBite, including jaw opening, laterality, and protrusion, TMJ functionality on a 0–100 scale	Statistically significant changes over time from day 0 to days 28 and 70 were observed for VAS at rest in both DDN and Control groups. Statistically significant between-group differences were observed for VAS at rest (p = 0.005 at day 28; p = 0.016 at day 70) and during chewing (p < 0.001 at day 28; p = 0.011 at day 70). Statistically significant between-group differences were found for laterality (p < 0.01) and protrusion (p < 0.05). No statistically significant between-group difference was observed for jaw opening (p > 0.05). Effect size: NR.	Single-blind assessor evaluation was precluded by the open-label design; high drop-out rate confined to the control group; short-/medium-term follow-up (70 days).
116	Gawriołek et al. / 2015 / Poland	Observational/quasi-experimental clinical study	n = 78 (MT = 32, Healthy Control = 46); age: MT 23.3 ± 4.8, Healthy 20.1 ± 1.3; sex: 78 F, 0 M; drop-out: 0	TMD, including muscle disorder and TMJ disc displacement with reduction	RDC/TMD	Experimental (MT): myorelaxation therapy, including night-time sublingual relaxation splint + stretching exercises. Control (Healthy Control): healthy volunteers receiving no intervention. Dose/frequency: night-time splint use and 30 repetitions of exercises after meals for 6 months.	Jaw tracking (K7: opening, lateral and protrusive range, opening/closing velocity), functional perception, pain distribution (VAS)	Statistically significant changes over time (pre-post) were observed in the MT group for opening range (p < 0.05), lateral movement (p < 0.05), and velocity parameters (p < 0.01). No statistically significant change over time was observed for protrusive movement (p > 0.05). Statistically significant changes over time were observed for VAS scores and clinical pain (p < 0.05). No statistically significant change over time was observed for joint clicking. Effect size: NR.	Absence of a clinical control group with untreated TMD patients or patients receiving another splint/sham intervention; the sample included etiologically different conditions, muscular and articular, treated together without statistical distinction in outcomes; exclusively female sample.
117	Packer et al. / 2014 / Brazil	Double-blind randomized controlled clinical trial	n = 32 (Experimental = 16, Placebo = 16); age: Experimental 23.50 (range 21–25), Placebo 26.06 (range 22–29); sex: 32 F, 0 M; drop-out: 0	TMD, including myofascial pain with/without opening limitation, and presence of neck pain	RDC/TMD (Groups Ia and Ib)	Experimental: upper thoracic spinal manipulation, high-velocity, low-amplitude thrust at T1. Control (Placebo): sham manipulation at T1, with no thrust applied. Dose/frequency: single application. Follow-up immediately post-treatment (IP) and at 48–72 h (STP).	Pressure pain threshold (PPT, algometry) over masticatory muscles and TMJ, facial pain intensity (VAS)	No statistically significant time × group interaction was observed for PPT values in all assessed structures, including right/left TMJ, right/left masseter, and right/left temporalis (p > 0.05). No statistically significant time × group interaction was observed for VAS pain intensity (F = 2.681, p = 0.077). Effect size (Cohen’s d) for VAS in the Experimental group: Pre vs IP = 0.2, Pre vs STP = 0.3. Cohen’s d for PPT ranged from -0.2 to 0.2.	Sample composed exclusively of women; absence of specific pre-clinical assessment of dysfunction in the treated vertebral segment; low baseline VAS pain levels may have induced a floor effect.
118	Nitecka-Buchta et al. / 2014 / Poland	Double-blind randomized controlled clinical trial	n = 79 randomized, 68 analyzed (BV = 34, Placebo = 34); age: mean 23 (range 22–34); sex: 58 F, 10 M; drop-out: 11, including allergy exclusions and losses to follow-up	TMD, including myalgia and myofascial pain	RDC/TMD (Groups Ia and Ib)	Experimental (BV): 0.0005% bee venom ointment applied topically to the skin over the masseter. Control (Placebo): Vaseline ointment as neutral vehicle. Dose/frequency: 3-min massage, 3 times/day, for 14 days.	Rest muscle tonus (RMT) and maximal muscle contraction (MMC), measured by bilateral sEMG, pain intensity (VAS)	Statistically significant changes over time from baseline to 14 days were observed for VAS in the BV group (p = 0.000002) and Placebo group (p = 0.000024). Statistically significant changes over time for bilateral sEMG values in RMT and MMC were observed in the BV group (p < 0.05). No statistically significant change over time was observed in the Placebo group for right RMT and MMC measurements (p > 0.05). Effect size: NR.	Original statistical analysis was limited to detecting within-group changes using the Wilcoxon test, without examining between-group interaction between BV and placebo, meaning the direct statistical superiority of BV over placebo was not tested; follow-up limited to 14 days.
119	Conti et al. / 2014 / Brazil	Single-blind randomized controlled clinical pilot study	n = 23 eligible, 15 analyzed (Active = 7, Control = 8); age: Active 37.3 ± 8.9, Control 31.8 ± 12.3; sex: 12 F, 3 M; drop-out: 8, withdrawn before Phase 2	Probable sleep bruxism associated with masticatory myofascial pain	RDC/TMD	Experimental (Active): contingent electrical stimulation (CES) using GrindCare device. Control: inactive device, sham CES, used only in recording mode. Treatment protocol: Phase 1 = 5-night baseline; Phase 2 = device use for at least 10 nights; Phase 3 = follow-up without feedback for more than 5 nights.	Electromyographic events per hour of sleep (EMG/h), pain intensity (PI, VAS), pressure pain threshold (PPT, algometry over masseter and temporalis)	Statistically significant group × phase interaction was observed for EMG/h values (F = 5.96, p = 0.003). Statistically significant between-group difference in Phase 2 was observed for EMG/h (p = 0.004). Statistically significant within-group change over time for EMG/h was recorded only in the Active group between Phase 1 and subsequent phases (F = 6.56, p = 0.002). No statistically significant group × phase interaction was observed for temporalis PPT (F = 0.26, p = 0.776), masseter PPT (F = 0.22, p = 0.801), or PI (F = 0.20, p = 0.823). Effect size: NR.	Small sample size, resulting in limited statistical power for pain outcomes; high initial drop-out rate of approximately 35%, attributed to difficulty using the device during sleep; sleep bruxism diagnosis based on self-report and single-channel EMG, without polysomnography (PSG).