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Reviewing Published Opinions

An Assessment of theUsefulness of Kinesiograph as an Aid in the Diagnosis of TMD: a Review of Manfredini et al.’s Studies

Barry C. Cooper1 , Fray Adib2 1 Clinical Professor, Division of Translational Oral Biology, School of Dental Medicine, State University of New York, Stony Brook, NY, USA, 2 Myotronics-Noromed, Inc., Kent, WA, USA

Aim: Performing a literature review of publications by Dr. Manfredini et al. related to their temporomandibular joint (TMJ) injection therapy outcome with conclusions on the clinical utility of computerized measurement devices used in the management of temporomandibular disorders (TMDs). In addition, reviewing their published opinion on an occlusion: TMD versus a biopsychosocial paradigm for TMD. Manfredini et al. authored an article published in the Journal of the American Dental Association (JADA) 2013, ‘‘An Assessment of the usefulness of jaw kinesiography in monitoring temporomandibular disorders,’’ the most recent of 12 articles. In all studies, subjects received TMJ injections with an objective measurement outcome criterion; increased maximum mouth opening (MMO) and subjective symptom improvement of pain and chewing function. In the 2013 JADA article, the Mandibular Kinesiograph, referred to as KG, measured MMO before and after therapy. In 11 prior articles, all subject groups with limited mouth opening exhibited very significant increased MMO post-treatment, documenting treatment success using the same 2013 protocol. The 2013 study showed a 1.1 mm improved MMO, described as insignificant. The authors did not critique or explain the aberrant, skewed 2013 outcome data contrasted with their prior studies, which showed overwhelmingly significant increased MMO. Instead, they concluded that the MMO recording device was clinically useless. This motivated a literature review of the authors’ TMD publications.

The publications by Manfredini et al. recognized proponents of the psychosocial model of TMD, including the 2013 article, appear to be part of a campaign denying an occlusion: TMD relationship and disparaging the specific computerized measurement devices and the dentists using them in the management of their TMD patients using neuromuscular occlusion dental treatment.

In their most recent study, their results regarding a positive therapeutic effect of
injection therapy into the TMJs on increasing MMO was minimal. This is in sharp contrast with the significantly larger increases in MMO reported in all their previous studies and those of others. Rather than scrutinizing and critiquing their 2013 data, they
instead concluded that the device used to measure MMO had no clinical utility.
These reviews of the scientific literature substantiate that the publications of Manfredini et al. are part of a long campaign by the authors to discredit an occlusion: TMD etiological and therapeutic connection and to disparage the specific computerized
measurement devices and denigrate the dentists who use them in the management of their patients with TMDs. As recognized proponents of the biopsychosocial (psychosocial) model of TMD, it is evident that the authors did not perform an objective study on the use of diagnostic aid devices in their 2013 article or the positive association between dental occlusion and TMD in all of their publications for over a decade,
nor did they perform a comprehensive review of the scientific literature which includes articles demonstrating the efficacy of diagnostic aid devices.

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