EMG-Based Evaluation of Occlusal Splint and Masseter Botox Effects on Head and Neck Muscles

Condition(s) studied

Investigational drug(s) / intervention(s)

Botulinum toxin injection: Patients will receive a total of 20 units of botulinum toxin type A (Botox) injected into each masseter muscle. The injections will be administered at three standardized sites on each side using a fine needle to ensure accurate delivery. Muscle activity will be recorded using electromyography (EMG) before the injection, and follow-up EMG measurements will be taken at one month and four months post-treatment to evaluate changes in muscle activity and treatment efficacy.

Occlusal splint: Patients with myofascial pain syndrome will receive custom-made occlusal splints to wear during sleep. These splints help reduce abnormal muscle activity and relieve pain by redistributing bite forces. EMG measurements will be taken before and during treatment to monitor changes in muscle activity.

Botulinum toxin + Occlusal splint combined: Patients will receive both botulinum toxin injections (20 units per masseter muscle, injected at three standardized points per side) and will use occlusal splints during sleep. EMG measurements will be conducted before treatment, and at follow-up visits to assess the combined effect of pharmacological and mechanical therapy on muscle activity.

Study summary

This randomized controlled clinical trial aims to evaluate the individual and combined effects of occlusal splint therapy and botulinum toxin type A (BTX-A) injections into the masseter muscle on the activity of head and neck muscles in patients diagnosed with myofascial pain syndrome (MPS). MPS is a common subtype of temporomandibular disorders (TMD), frequently involving the masticatory and cervical muscles. Despite various treatment modalities, there is still no universally accepted protocol. In this study, 56 adult participants of both sexes, without missing teeth and within a normal body mass index (BMI) range, will be randomly assigned to four groups: BTX-A injection only, occlusal splint only, combined BTX-A and splint therapy, and an untreated control group. Surface electromyography (EMG) will be used to assess muscle activity in the masseter, temporalis, sternocleidomastoid, splenius capitis, and trapezius muscles. EMG recordings will be performed at baseline, 4 weeks, and 12 weeks after the intervention. Pain levels and symptom severity will be assessed using the DC/TMD symptom questionnaire and the Visual Analog Scale (VAS). BTX-A injections will be administered by a neurology specialist (20 IU per masseter muscle), and occlusal splints will be custom-fabricated and fitted for each participant. This study seeks to determine the neuromuscular effects of these treatments-both alone and in combination-on masticatory and cervical muscles and to provide insight into the development of more comprehensive and effective treatment strategies for MPS.

Eligibility

Primary outcome measure(s)

• Electromyography results — 12 week
  Electromyographic (EMG) recordings will be used to assess changes in electrical activity in the masseter, temporalis, sternocleidomastoid (SCM), trapezius, and splenius capitis muscles. These muscles are often overactive in individuals with bruxism, parafunctional habits, and postural issues. Baseline EMG recordings will be taken at week 0, with follow-up measurements at the 1st and 12th weeks to observe short- and mid-term effects. EMG activity in the masseter and temporalis muscles will be evaluated to assess changes following botulinum toxin injections, focusing on potential reductions in muscle hyperactivity. Occlusal splint therapy will be analyzed in terms of its effect on normalizing muscle activity over time. The combined treatment group will be examined for additive or prolonged effects. The control group will serve as a reference to monitor natural variations in EMG activity.

Trial sites (1)

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