CLINICAL EFFICACY OF DIFFERENTIATED PROTOCOLS FOR COMPREHENSIVE ORTHOPAEDIC REHABILITATION OF PATIENTS WITH TEMPOROMANDIBULAR JOINT DYSFUNCTION

Relevance. Temporomandibular joint dysfunction is characterized by high prevalence, clinical polymorphism, and a substantial influence on the course of dental rehabilitation. A unified treatment sequence does not account for the differences between masticatory muscle myalgia, arthralgia, and intra-articular disorders without osteoarthrosis, which limits treatment effectiveness. Objective. To develop differentiated clinical protocols for comprehensive orthopaedic rehabilitation of patients with temporomandibular joint dysfunction depending on the subtype of pathology and to compare their clinical effectiveness with the standard treatment sequence. Materials and methods. A prospective controlled comparative clinical study included 90 patients randomized into 6 subgroups of 15 each: main and control subgroups for myalgia, arthralgia, and intra-articular disorders. In the main subgroups, treatment was performed according to differentiated protocols; in the control subgroups, a standard rehabilitation scheme was used. Pain intensity was assessed by the visual analogue scale, maximal mouth opening, frequency of painful episodes and forced treatment interruptions, treatment tolerance, adverse events, and surface electromyography parameters of the masticatory muscles. Results. Differentiated protocols provided greater pain reduction, faster restoration of mouth opening, lower frequency of painful episodes and forced interruptions, and more favorable electromyographic outcomes. Conclusion. The developed differentiated clinical protocols for comprehensive orthopaedic rehabilitation demonstrate statistically significant clinical superiority over the standard treatment sequence and provide more complete restoration of the functional state of the masticatory apparatus in patients with different subtypes of temporomandibular joint dysfunction.