Treatment Outcomes for Temporomandibular Disorders (TMD) Via the Clayton Intra-aural Device (CID) Clinical Trial

This study has been completed.
Sponsor:
Information provided by:
Ascentia Health, Inc.
ClinicalTrials.gov Identifier:
NCT00815776
First received: December 29, 2008
Last updated: August 16, 2010
Last verified: August 2010
  Purpose

The purpose of this study is to characterize the safety profile and assess the effectiveness of the CID in treating subjects with temporomandibular disorders (TMDs). This study is an open-label, three arm, randomized, unblinded clinical trial with a pre-treatment screening phase, a baseline visit and a 3 month treatment or exercise phase.


Condition Intervention Phase
Temporomandibular Disorders
Device: Clayton Intra-aural Device (CID)
Device: Mouth Splint
Other: Exercise Group
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Treatment Outcome of Temporomandibular Disorders Via the Clayton Intra-aural Device (CID): A Randomized Clinical Trial

Resource links provided by NLM:


Further study details as provided by Ascentia Health, Inc.:

Primary Outcome Measures:
  • Change From Baseline In Craniomandibular Index (CMI) Scores At 3 Months (In A Scale) [ Time Frame: Change from Baseline in Craniomandibular Index (CMI) Scores at 3 months (in a scale) ] [ Designated as safety issue: No ]
    The Craniomandibular Index (CMI) is designed to provide a basis for evaluating the severity of Temporomandibular Disorder (TMD) signs and symptoms. The assessment involves asking questions related to the condition of Mandibular Movement, TMJ noise, and palpations of the extraoral muscle, neck muscle, TMJ capsule and intraoral muscle. The answers to all of the questions are combined to calculate a score from 0 to 1 in which 0 represents no TMD signs and symptoms and 1 represents the most severe TMD signs and symptoms.

  • Number of Subjects With Adverse Events [ Time Frame: From Baseline through 3 months post-baseline visit. ] [ Designated as safety issue: Yes ]
    Subjects were assessed for adverse events from the baseline visit through study completion (3 months post-baseline). Adverse events were categorized by the investigator for severity and relationship to treatment.


Secondary Outcome Measures:
  • Change From Baseline In Craniomandibular Index (CMI) Scores At 3 Months (In A Scale) [ Time Frame: Change from Baseline in Craniomandibular Index (CMI) Score at Three Months Post-Baseline (in a scale) ] [ Designated as safety issue: No ]
    The Craniomandibular Index (CMI) is designed to provide a basis for evaluating the severity of Temporomandibular Disorder (TMD) signs and symptoms. The assessment involves asking questions related to the condition of Mandibular Movement, TMJ noise, and palpations of the extraoral muscle, neck muscle, TMJ capsule and intraoral muscle. The answers to all of the questions are combined to calculate a score from 0 to 1 in which 0 represents no TMD signs and symptoms and 1 represents the most severe TMD signs and symptoms.


Enrollment: 152
Study Start Date: April 2008
Study Completion Date: January 2009
Primary Completion Date: January 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
Treatment group receiving the CID
Device: Clayton Intra-aural Device (CID)
The CID is a patented small, hollow, ear insert made of medical grade polymers that is custom-fit to each subject's ear. Each subject that is randomized to the CID study group will wear a pair of inserts, one in each ear. (For the purpose of this protocol, the pair of inserts will be referred to as the "CID").
Active Comparator: 2
Group assigned a mouth splint
Device: Mouth Splint
Group 2 subjects will be assigned to the active control device, which is current standard of care therapy. The device is an intraoral flat-planed splint full coverage plastic (hard) orthotic that fits over the occlusal one-third surfaces of the dentition. The appliance is made by taking a standard wax bite registration and is made using the standard technique of taking alginate impressions of the subject's teeth, pouring dental laboratory stone into the impression and processing the acrylic appliance on the stone model. This appliance raises the plane of occlusion and provides complete contact with the opposing dentition.
Active Comparator: Exercise Control Group
Group who received no device but were instead assigned a study-specified jaw exercise program
Other: Exercise Group
Subjects assigned to Group 3 will be asked to track daily compliance with the protocol-specific exercise plan in their 4 week diaries. The exercise plan will consist of the following instructions: subjects will be instructed to open their jaw as far as possible, without pain and hold the jaw in that position for 5 seconds. Subjects will then close their jaw and rest 10 seconds. The exercise should be repeated exactly ten times in a row, with a 10 second rest in between each stretch. Subjects will be advised to apply a warm compress to the jaw area after completing their exercises for 10 minutes.

Detailed Description:

After providing consent, subjects will be assessed as to whether they meet inclusion criteria for the study. Subjects will complete a 4 week diary to measure TMD symptoms by recording pain levels on a Visual Analog Scale (VAS) twice daily. Standardized Research Diagnostic Criteria (RDC) are used to classify types of TMDs. The formal assessment tool is known as the RDC/TMD. It is an empirically-based and operationalized system for diagnosing and classifying RDC/TMD using a biopsychosocial model of disease as a framework. The CMI/TMD(hereafter referred to as the CMI) is designed to provide a basis for evaluating the severity of TMD signs and symptoms. The CMI score is calculated from a dysfunction index (DI) and palpation index (PI). The majority of questions found in the CMI are also included in the RDC/TMD, with the exception of five questions. As part of the baseline medical history, all subjects will be asked the five questions that are included in the RDC/TMD but not included in the CMI. Data from the CMI and the five RDC/TMD questions will be combined in the database and scored according to scoring guidelines for the RDC/TMD in order to diagnose and classify TMDs for all study subjects. Subjects may be categorized in one or more of the three diagnostic groups, including muscle disorders (myofascial pain), arthralgia, and disc displacements with reduction. Subjects will have an examination using the CMI at their screening visit. Subjects who meet inclusion criteria will be randomized to one of three groups: The study device (Clayton Intra-aural Device (CID)) group, the mouth splint group, or the exercise group. Subjects in all groups will return to the clinic for a baseline visit, followed by visits at one month, two months and three months post-baseline to return their completed 4 week VAS diary and to complete follow-up testing. At the baseline visit, subjects will have a targeted physical examination, with results documented by the investigator on the CMI questionnaire. Subjects will complete an in-office VAS score, a Modified SSI questionnaire, and will also complete the TMJ Scale, a questionnaire designed to measure possible improvement using a 10 point scale. At each follow-up visit, each subject will complete questionnaires (including the Modified SSI questionnaire and an in-office VAS score)and will have a targeted physical examination, with results documented by the investigator on the CMI questionnaire. At each follow-up visit, subjects will be issued a new monthly diary to complete for the VAS scores twice daily, (once in the morning before 10:00 a.m. and once before bed) as well as to track their device wearing time or exercise compliance, as applicable. At the three month follow-up visit, subjects will also complete the TMJ Scale. Adverse events will be assessed at each visit.

  Eligibility

Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

A subject must meet all of the following criteria to be eligible for study participation:

  • Subjects who present to IMIC for jaw pain or dysfunction
  • Subjects who sign and date an IRB/EC approved informed consent form
  • Subjects must have an RDC/TMD diagnoses that include at least one of the following:

    • Myofascial Pain
    • Arthralgia
    • Disc displacement with reduction; AND

The subject has the presence of one or more of the following findings associated with pain as demonstrated with a VAS score of >4:

  • Increased (>60mm) or decreased (<40mm) range of interincisal jaw opening;
  • Pain upon any jaw movement;
  • Pain on digital palpation (about 0.45 kg of pressure) of the periauricular area or external auditory meatal areas;
  • Pain on digital palpation (about 0.45 kg of pressure) in 2 or more muscles of mastication; or
  • Joint sound with pain

Exclusion Criteria:

  • Subjects diagnosed with rheumatoid arthritis, osteoarthritis, osteoarthrosis or another connective tissue disorder
  • Subjects who have had direct trauma to the jaw
  • Subjects who have used an occlusal appliance to treat a TMD within the previous six months
  • Subjects who have had prior TMJ or ear surgery
  • Subjects with any physical or behavioral disorder, which, in the opinion of the Principal Investigator, may interfere with the use of the device or compliance with the study protocol
  • Subjects who have a narrow ear canal or impression of the ear canal, which is prolapsed due to an anatomical shift or failure of the ear canal wall structure, or a canal that does not allow for the ear canal second turn to be identified
  • Subjects with visible or congenital ear deformity as observed on targeted physical exam
  • Subjects whose ear canal anatomy does not allow for fit of the study device
  • Subjects who have taken a narcotic pain medication in the last seven days or who have taken aspirin or a non-steroidal anti-inflammatory agent in the last 24 hours
  • Subjects who have a history of ear pain unrelated to TMJ
  • Subjects who have a history of ear drainage in the past 2 years
  • Subjects who have active ear drainage, swelling, or redness as observed on targeted physical exam
  • Subjects whom the investigator believes may not be a appropriate candidates for an intra-oral splint due to missing or poor quality dentition or untreated pain of dental origin (pulpal pain, pericoronitis of wisdom teeth, or similar conditions)
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00815776

Locations
Mexico
Instituto Mexicano de Investigacion Clinica
Mexico City, D.f., Mexico, 06700
Sponsors and Collaborators
Ascentia Health, Inc.
Investigators
Principal Investigator: Alejandro Tsuchiya, DDS Insitituto Mexicano de Investigacion Clinica
Study Director: Lawrence G. Clayton, M.A. Ascentia Health, Inc.
  More Information

No publications provided by Ascentia Health, Inc.

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Lawrence G. Clayton, Ascentia Health, Inc.
ClinicalTrials.gov Identifier: NCT00815776     History of Changes
Other Study ID Numbers: CID2007
Study First Received: December 29, 2008
Results First Received: March 23, 2010
Last Updated: August 16, 2010
Health Authority: Mexico: Ministry of Health

Keywords provided by Ascentia Health, Inc.:
Temporomandibular disorders

Additional relevant MeSH terms:
Temporomandibular Joint Disorders
Temporomandibular Joint Dysfunction Syndrome
Craniomandibular Disorders
Mandibular Diseases
Jaw Diseases
Musculoskeletal Diseases
Joint Diseases
Muscular Diseases
Stomatognathic Diseases
Myofascial Pain Syndromes

ClinicalTrials.gov processed this record on April 17, 2014