الفهرس 
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Abstract
The temporomandibular joint is one of the most complex joints in the body. It is the area where in which the mandible articulates with the cranium.
Temporomandibular joint disorder is multicausal and includes traumatic, pathologic, and physiologic factors. Psychological problems which considered as an important etiological factor in the development and maintenance of bruxing behavior. TMD manifests with facial pain, joint sounds, and/or headache. Treatment of those symptoms includes pharmacological therapy, occlusal splints, and rarely surgical intervention.
The aim of this study was to evaluate the efficacy of botulinum toxin type-A injection Therapy either as a solitary treatment or in combination with stabilization-type occlusal splint in reducing painful symptoms of TMD.
To carry out this study, twenty-four female patients with detectable signs and symptoms of TMD in form of muscle pain, tenderness or impaired range of jaw movements were selected from those attended to the Prosthodontic Department, Faculty of Dentistry, Alexandria University.
Patients with a history of conservative treatment for TMD and those who were suffering from systemic diseases that possibly affect masticatory system e.g. rheumatoid arthritis, epilepsy, neurological disorders and heart diseases were excluded from the study. Also pregnant, lactating females were excluded.
According to the treatment regimen, selected patients were randomly divided into 3 groups, each comprising eight patients.
Group I: Patients who received botulinum toxin type A injection
Group II: Patients who received occlusal splint therapy.
Group III: Patients who received botulinum toxin type A injection and occlusal splint therapy.
Botulinum toxin type A injection therapy was performed once under electromyographic guidance. The patients who received occlusal splint therapy were instructed to wear the splint during sleeping hours for the entire treatment period of 28 days.
The patients were evaluated subjectively using The Anamnestic Dysfunction Index (Ai), and objectively using measurement of maximum mouth opening (MMO) in millimeters, and surface EMG. Theses evaluations were carried out for three studied groups at the diagnosis and patient selection stage, 14 days and 28 days after treatment sessions.
The collected data was tabulated and statistically analyzed. Results obtained had showed that the treatment modalities caused general improvement in patient’s clinical condition.