Electromyography: Processing, Muscles' Electric Signal Analysis, and Use in Myofunctional Orthodontics

Electromyography, commonly known as EMG, utilizes superficial or needle electrodes to record and analyze the fundamental electrical characteristics of skeletal muscles, determining whether the muscles are contracting. The motor unit, which consists of a collection of group muscle fibers and the motor neurons that govern them, is the structural basis of EMG. Three types of electrode are used in EMG which are needle electrode, fine wire electrode, and surface electrode. A significant amount of literature indicates that the correction of muscle function affects the relationships between teeth within the same jaw and between the jaws on opposing sides. The mechanism of action in myofunctional appliance therapy is linked to neuromuscular and skeletal adaptations resulting from altered function in the orofacial region. Both myofunctional therapy and orthodontics aim to address abnormal muscular behavior, restore abnormal muscle activity, and maintain proper alignment in various areas, including the lips, lower jaw, and tongue. This knowledge is essential for functions such as swallowing, speaking, chewing, and respiration as well as for minimizing incorrect movements and positioning. This article aims to describe the application of surface EMG as a diagnosis tool for assessing muscle activities in various orthodontic disorders, such as class II malocclusion open bite, crossbite, maxillary constriction, cleft lip and palate (CLP), and temporomandibular dysfunction, in patients. The electrodes used in EMG can be utilized to detect bioelectric activity in the muscles of the jaws and abnormalities in jaw movement. Analyzing EMG data is vital for obtaining a comprehensive understanding of the masticatory muscle system.

Electromyographic Assessment of Masseter Muscle Activity: A Proposal for a 24 h Recording Device with Preliminary Data

OBJECTIVE

The instrumental measurement of electromyographic (EMG) activity in the natural environment is the best strategy available to collect information on bruxism. The twofold aim of this study was to (1) introduce and discuss a novel EMG device for the assessment of awake (AB) and sleep bruxism (SB) in the home environment over 24 h and (2) present some preliminary data.

METHODS

Fifteen healthy volunteers (eight males and seven females; mean age: 48.2 ± 4.1 years) underwent 24 h EMG recording trials of their masseter muscle activity (MMA) with a miniaturized wireless device. This device allowed us to measure the durations of the different phases of the recordings (total duration, awake time, sleep time, and electrode dislodgement time) as well as the bruxism time index (BTI) and bruxism work index (BWI) for both the waking and sleeping hours.

RESULTS

For the healthy volunteers, on average, the bruxism work index (BWI) values were 0.4 ± 0.2 and 0.1 ± 0.1 for awake and sleep, respectively, while the mean bruxism time index (BTI) values were 0.9 ± 0.5 for awake and 0.3 ± 0.1 for sleep.

CONCLUSIONS

This investigation describes the technical features of a novel EMG recording device that permits the evaluation of masseter muscle activity in the home environment over 24 h. For the first time, a dedicated elaboration of the EMG signal allowed an assessment of muscle work and not just a count of purported SB/EMG events.

CLINICAL SIGNIFICANCE

Based on the multidisciplinary approach in the study of bruxism, such a methodology, thanks to its peculiar features, will allow researchers and clinicians to monitor the epidemiology of MMA and delve deeper into the awake and sleep bruxism correlates for tailored management in clinical settings.

Integrity of a Single Superior Border Plate Repair in Mandibular Angle Fracture: A Novel Cadaveric Human Mandible Model

PURPOSE

The purpose of this study was to compare the integrity of human mandibular angle fracture after fixation with a single titanium plate along the upper lateral border with that of the native human mandible.

MATERIALS AND METHODS

This cross-sectional anatomic study involved the left hemimandibles of 16 human cadavers. They were selected and divided in 2 groups by remaining dental status. Additional predictor variables, such as height of the left mandibular body and gender, were noted. Left hemisected native mandibles were mounted at the condyle and loaded on an Instron 5565 mechanical unit (Instron Corp, Norwood, MA) until fracture. Fractured left hemimandibles were fixated with a titanium miniplate and screws. After plate fixation, each hemimandible was reloaded on an Instron 5565 until fracture. Data pertaining to primary outcomes of load application were recorded in newtons at displacement values of 3.0, 5.0, and 7.0 mm and at displacement at fixation failure. Primary outcomes of maximum load and displacement at maximum load were recorded in newtons and millimeters, respectively. Descriptive statistics were used to summarize sample characteristics. Statistical comparisons were performed using t test, χ² (or Fisher exact) test, and linear regression. Pearson correlation was used to examine relations between select biomechanical measurements.

RESULTS

The study sample was composed of 12 female and 4 male cadaveric hemimandibles. Donors' age at time of death ranged from 54 to 95 years (mean age, 78.94 yr). The mean maximum load in native and plated hemimandibles was 943.56 and 292.57 N, respectively (P < .0001).

CONCLUSION

Key clinical findings of this study include the inability of single plate mandible fixation to restore the mandible to preinjury levels and verification that gender, dental status, and height of the mandible do not alter the stability of a single plate fixated mandible.

Duty Time of Rabbit Jaw Muscles Varies with the Number of Activity Bursts

The relative duration of muscle activity during a specified period (duty time) varies depending on activity level and time of the day. Since both the number and the length of activity bursts contribute to the duty time, it was hypothesized that these variables would show intra-day variations similar to those of the duty time. To test this, we determined duty times, burst numbers, and burst lengths per hour, in relation to multiple activity levels, in a 24-hour period of concurrent radio-telemetric long-term electromyograms of various rabbit jaw muscles. The marked intra-day variation of the burst number resembled that of the duty time in all muscles, and was in contrast to the relatively invariable mean burst length. Furthermore, the duty times were more highly correlated with the number than with the length of bursts at all activity levels. Thus, the variation of the duty time in rabbit jaw muscles is caused mainly by changes in burst numbers.

Masticatory efficiency and muscular activity in removable partial dental prostheses with different cusp angles

STATEMENT OF PROBLEM

The loss of posterior teeth has a negative effect on the masticatory efficiency and activity of mastication muscles. How these muscles are affected by partial removable dental prostheses (PRDPs) with different cusp angles is unknown.

PURPOSE

The purpose of this clinical study was to evaluate the influence of different cusp angles, with anatomic (33 degrees), semianatomic (20 degrees), and nonanatomic teeth (0 degree), on the masticatory efficiency and muscular activity of participants receiving mandibular bilateral distal PRDPs.

MATERIAL AND METHODS

Fifteen participants consented to the evaluation of masticatory efficiency and electromyographic (EMG) activity with a PRDP with a unified bilateral design. The cusp angles of the artificial teeth were randomly changed from anatomic (33 degrees), semianatomic (20 degrees), and nonanatomic teeth (0 degree). Masticatory efficiency was evaluated by recording 5 parameters, including number of strokes, and time of mastication while the EMG activities of the masseter and temporalis muscles, measured using surface electromyography. The data were analyzed with 1-way ANOVA and the Tukey multiple post hoc test with statistical software (α=.05).

RESULTS

With regard to masticatory efficiency, PRDPs with anatomic and semianatomic teeth exhibited higher masticatory efficiency than those with nonanatomic teeth, whereas no significant differences were found between PRDPs with anatomic and semianatomic teeth. With respect to EMG activity, the least EMG activity was observed in PRDPs with anatomic teeth, whereas the highest activity was observed with nonanatomic teeth. No significant differences were found between the effect of PRDPs with anatomic and semianatomic teeth on masseter activity.

CONCLUSIONS

Changing the cusp angle from 33 to 20 degrees in PRDPs did not influence the masticatory efficiency or the EMG activity of the masseters. However, it did lead to increased EMG activities of the temporalis muscle. PRDPs with nonanatomic teeth were associated with a significant decrease in masticatory efficiency accompanied by a significant increase in EMG activity.

The influence of occlusal morphology on occlusion time

OBJECTIVES

The aim of the study was to assess how the morphology of the occlusal surfaces of premolars and molars influenced the occlusion time in a mixed gender group of young adults with full natural dentition.

METHODS

Fifty healthy volunteers with Angle's Class I occlusion were included in the study. After clinical examination, the alginate impressions of both arches were taken, and plaster casts were prepared. To assess the morphology of lateral teeth, the digital models were measured. Occlusal analysis was performed with the T-Scan^® III to assess occlusion time.

RESULTS

A direct correlation was found between the cusp distance for the first upper premolar and occlusion time (r = -0.29, p<0.05) and the distance between distal buccal and distal lingual cusps of the first lower premolar and occlusion time (r = 0.33, p<0.05). The parameters that had their impact on occlusion time were the opening angle of lingual cusps for the lower molars and the furrow angle of aperture between cusps for first upper premolar.

DISCUSSION

Occlusal surface morphologies of premolars may have direct impact on occlusion time. However, anterior guidance parameters and morphologies of molars could also influence the time teeth are in contact coming to maximal intercuspation.

Surface electromyography in orthodontics - a literature review

Electromyography is the most objective and reliable technique for evaluating muscle function and efficiency by detecting their electrical potentials. It makes it possible to assess the extent and duration of muscle activity. The main aim of surface electromyography is to detect signals from many muscle fibers in the area of the detecting surface electrodes. These signals consist of a weighted summation of the spatial and temporal activity of many motor units. Hence, the analysis of the recordings is restricted to an assessment of general muscle activity, the cooperation of different muscles, and the variability of their activity over time.

This study presents the main assumptions in the assessment of electrical muscle activity through the use of surface electromyography, along with its limitations and possibilities for further use in many areas of orthodontics. The main clinical uses of sEMG include the diagnostics and therapy of temporomandibular joint disorders, an assessment of the extent of stomatognathic system dysfunctions in subjects with malocclusion, and the monitoring of orthodontic therapies.

Morphological and Functional Parameters in Patients with Tooth Wear before and after Treatment

Advanced tooth wear often results in lost vertical dimension and impacts facial aesthetics. Complex restorative treatment can replace the lost tooth structure and improve functional occlusal and facial skeleton parameters.

PURPOSE

The aim of the study is to assess changes in the morphological and functional occlusal parameters of the facial skeleton after prosthetic rehabilitation that increased lost occlusal vertical dimension.

MATERIAL AND METHODOLOGY

50 patients with advanced tooth wear were clinically examined, to assess the degree of wear. Each subject underwent cephalometric analysis, digital occlusal analysis, and electromyographic analysis, of the anterior temporalis, superficial masetter, anterior digastric, and the sternocleidomastoid muscles. Prosthodontic treatment was performed to restore the occlusal vertical dimension of each subject's occlusion, which was followed by repeating the pretreatment analyses. Pre and post treatment parameters were statistically compared.

RESULTS

Pre-treatment cephalometric analysis showed that lost vertical dimension reduced anterior facial height and resulted in small angular skeletal parameters. Post treatment anterior facial height increased from the increased occlusal vertical dimension. The mean value of functional electrical activity during clenching post treatment, increased compared to pretreatment.

CONCLUSION

Increasing the vertical dimension of occlusion improved facial aesthetics by positively affecting facial skeletal angles. The restored occlusal surface morphology changed the pre treatment flat broad occlusal contacts into more point contacts. The increased vertical dimension of occlusion after treatment also increased muscle activity levels over the pretreatment levels after three months period of adaptation.

Biomechanics of the weakened mandible: use of image correlation analysis

Uninterrupted resection of mandibular bone is often necessary during maxillofacial operations for cancer. This weakens the mandible, and increases the risk of fracture. To our knowledge no biomechanical analysis has been made of deformations and strains that occur during chewing if this happens, so we have made such an analysis of the weakened mandible using a new technique: image correlation. Five fresh explanted human mandibles were prepared with black and white lacquer, and placed in a loading device that allowed replication of a physiological biting exercise. Calibrated pieces of bone were resected from the right body of each mandible. Images of the mandibular surface were recorded by 2 cameras and analysed with an algorithm to correlate them, which allowed us to confirm the distribution of strain on the body of the mandible, and to focus on the weak points. Before the bone was resected, we noted tensile strains on the alveolar border of the body, and compressive strains on the basilar border. The intensity of the strains in the posterior angle of the resected bony area then increased, with reduction in the height of the bone until fracture. The orientation of the fracture line started at the lower posterior angle of the resection area and spread in a lower posterior direction until it reached the basilar border of the mandible. Image correlation is a new technique for the study of mandibular biomechanics that provides accurate measurements on a wide bony surface with high definition images and without modification of the structure. Its application to weakened mandible provided reliable images of modifications to strains during simulated biting exercises.

Comparison of immediate complete denture, tooth and implant-supported overdenture on vertical dimension and muscle activity

PURPOSE

To compare the changes in the occlusal vertical dimension, activity of masseter muscles and biting force after insertion of immediate denture constructed with conventional, tooth-supported and Implant-supported immediate mandibular complete denture.

MATERIALS AND METHODS

Patients were selected and treatment was carried out with all the three different concepts i.e, immediate denture constructed with conventional (Group A), tooth-supported (Group B) and Implant-supported (Group C) immediate mandibular complete dentures. Parameters of evaluation and comparison were occlusal vertical dimension measured by radiograph (at three different time intervals), Masseter muscle electromyographic (EMG) measurement by EMG analysis (at three different positions of jaws) and bite force measured by force transducer (at two different time intervals). The obtained data were statistically analyzed by using ANOVA-F test at 5% level of significance. If the F test was significant, Least Significant Difference test was performed to test further significant differences between variables.

RESULTS

Comparison between mean differences in occlusal vertical dimension for tested groups showed that it was only statistically significant at 1 year after immediate dentures insertion. Comparison between mean differences in wavelet packet coefficients of the electromyographic signals of masseter muscles for tested groups was not significant at rest position, but significant at initial contact position and maximum voluntary clench position. Comparison between mean differences in maximum biting force for tested groups was not statistically significant at 5% level of significance.

CONCLUSION

Immediate complete overdentures whether tooth or implant supported prosthesis is recommended than totally mucosal supported prosthesis.

Surface electromyography in the assessment of jaw elevator muscles

Surface electromyography (EMG) allows the non-invasive investigation of the bioelectrical phenomena of muscular contraction. The clinical application of surface EMG recordings has been long debated. This paper reviews the main limitations and the current applications of the surface EMG in the investigation of jaw elevator muscles. Methodological factors associated with the recording of the surface EMG may reduce the reliability and sensitivity of this technique and may have been the cause of controversial results reported in different studies. Despite these problems, several clinical applications of surface EMG in jaw muscles are promising. Moreover, technological advances in signal detection and processing have improved the quality of the information extracted from the surface EMG and furthered our understanding of the anatomy and physiology of the stomatognathic apparatus.

Muscle activities are differently modulated between masseter and neck muscle during sleep-wake cycles in guinea pigs

Sleep bruxism is a sleep-related movement disorder characterized by an exaggerated jaw motor activity during sleep. Currently, the magnitude of jaw motor activation in normal sleep remains poorly understood. In this study, we aim to assess the state-dependent changes in the magnitude of electromyographic activities of the jaw-closing masseter muscle in comparison with those of a neck muscle (specifically, the obliquus capitis) during sleep-wake cycles in guinea pigs. These electromyographic activities were integrated for 10-s epochs during wakefulness, non-rapid eye movement (NREM) and rapid eye movement (REM) sleep. The masseter activity per epoch was found to be five times lower in both sleep stages while the neck muscle activity also decreased to 30% in NREM sleep and was lowest (16%) in REM sleep. In the periods without motor activity, masseter tone did not differ between the three states, whereas neck muscle tone decreased from wakefulness to NREM sleep and further to REM sleep. Moreover, in the epochs with masseter activation, the neck muscle activity did not increase during sleep. These results suggest that masseter activity decreases but is occasionally activated during sleep, and that state-dependent changes in electromyographic activity can be differently modulated in time and intensity between the masseter and the obliquus capitis.

Habitual daily masseter activity of subjects with different vertical craniofacial morphology

Little is known about the habitual daily masticatory activity of subjects with different vertical craniofacial morphology. The purpose of the present study was to compare the daily long-term muscle activity of short-face subjects with that of long-face subjects as assessed in their natural environment. Digital photographs of the facial profile were obtained from a sample of 300 subjects and the ratio between anterior total and anterior lower facial height was assessed (Vertical Facial Index: VFI). Fourteen long-face and 16 short-face subjects were selected from the opposite tails of the frequency distribution of VFI. Long-term masseter activity was monitored for 8 h d(-1) in the natural environment by means of portable one-channel electromyograph recorders over three working days. Assessments included calculation of the number of activity periods (APs) per h (N/h), their mean amplitude (Amean), and their mean duration (Dur). The maximal electromyogram activity did not differ significantly between the short-face and the long-face subjects. There was no significant difference between the two groups investigated in N/h, in Amean and Dur. The findings suggest that habitual activity of masseter muscle in the natural environment was not influenced by the vertical craniofacial morphology as assessed in the present study.

Effects of activator on masticatory muscle activity during daytime and sleep

The purpose of this study was to investigate masticatory muscle activity with and without the use of an activator during daytime and sleep, and further to focus on the changes in muscle activity produced by the daytime use. The subjects in this study were 10 healthy males (mean age: 27.6 years). A portable electromyogram (EMG) recording device was used to record the activity from the right temporal, masseter and digastric muscles. After recording, the integrated EMG values (microV s) were measured. The muscle activity was lower during sleep than during daytime, irrespective of the use of the activator. In sleep-time, temporal and digastric muscle activity was significantly decreased, although masseter muscle activity presented no significant differences. With the activator in use, the digastric muscle activity tended to increase in comparison with the elevator muscles during daytime and sleep. Although the activity of both elevator muscles was diminished by use of the activator during sleep in all subjects, some subjects showed an increase during daytime. These results suggested that the activator should be used, if possible, not only during sleep, but also during daytime and clenched on consciously to obtain the adaptation and development of the masticatory muscles for the 're-training of the muscles' at a new favourable mandibular position.

An electromyographic evaluation of the bilateral symmetry and nature of masticatory muscle activity in jaw deformity patients during normal daily activities

This study was designed to investigate the nature of masticatory muscle activity and the balance in the bilateral symmetry of the masticatory muscle activity in jaw deformity patients. Fifteen patients (19.9 +/- 5.3 years) with lateral shift of the mandible caused by transverse craniofacial deformity and 15 controls (28.6 +/- 1.9 years) were used as the subjects in this study. Surface electromyographic (EMG) activities were recorded from the bilateral masseter and anterior temporal muscles during daytime (142 min, including mealtime) and sleep (142 min). The averaged rectified EMG values were normalized with reference to the EMG amplitude induced by a 98-N bite force. Bilateral symmetry of masseter and anterior temporal muscle activities was examined using an asymmetry index (AI) for both the controls and the patients. The normalized activities of the masseter and anterior temporal muscles during normal daily activities were lower in patients than in the controls. Asymmetry indices in patients were significantly greater during usual daytime activities and sleep for the anterior temporal muscle and significantly smaller during sleep for the masseter muscle as compared with the controls. The results show that masticatory muscle activity is lower in these jaw deformity patients in association with more prominent asymmetry of anterior temporal muscle activity than in the controls. It is suggested that these findings are highly relevant to occlusal interference and instability because of malocclusion and lateral mandibular deviation.