A Randomized controlled trial of therapeutic exercise for clicking due to disk anterior displacement with reduction in the temporomandibular joint

Therapeutic exercise is a new concept of treatment for patients with clicking due to anterior disk displacement with reduction (ADDWR). In order to investigate the efficacy of the exercise, we designed a randomized controlled clinical trial to compare with no-treatment controls. The subjects were patients who complained of painless unilateral reciprocal clicking and were diagnosed as having ADDWR by Magnetic Resonance Imaging (MRI). Forty-two patients were randomly assigned. Three months after the randomization, the success rate was 61.9% (13/21 joints) in the exercise group and 0% (0/21 joints) in the control group, with a significant difference between the two groups (p=0.0001). However, captured disks in the successful cases were seen in only 23.1% on MRI examination. In conclusion, the therapeutic exercise for clicking due to ADDWR is significantly effective in reducing the clicking, and thought to be much more conservative and cost-effective than splint therapy or surgery.