Differential activity patterns in the masseter muscle under simulated clenching and grinding forces

Occlusal overload with dental implants: a review

Controversy persists as to the role of occlusal overload in peri-implantitis. Animal studies have not revealed the biological threshold for fatigue failure in the peri-implant bone. On the other hand, clinical studies have demonstrated a link between parafunction and implant failure, although variables such as intensity and frequency of loads, as well as bone density, have led to different outcomes. The absence of specific engineering “building codes” for the clinician has relegated prosthetic design planning to intuitive guidelines for all patients. For example, higher crown to implant ratios (2–3:1), implant cantilever prostheses and non-splinted restorative designs have been avoided because of the concern for overload. However, evidence has not supported this general approach. A call for preclinical research to establish specific patient load thresholds is in order to establish a customized treatment plan.

Co-contraction behaviour of masticatory and neck muscles during tooth grinding

The objective of this study was to analyse the co-contraction behaviour of jaw and neck muscles during force-controlled experimental grinding in the supine position. Twelve symptom-free subjects were enrolled in the experimental study. Electromyographic (EMG) activity of semispinalis capitis, splenius capitis and levator scapulae muscles was recorded bilaterally with intramuscular fine-wire electrodes, whereas that of sternocleidomastoideus, infrahyoidal, suprahyoidal, masseter and anterior temporalis muscles were registered with surface electrodes. EMG and force measurements were performed during tasks simulating tooth grinding on custom-made intraoral metal splints. The mean EMG activity normalised by maximum voluntary contraction (% MVC) of each of the neck muscles studied during grinding was analysed and compared with previous data from jaw clenching at identical force (100 N) and (supine) position. The occurrence of low-level, long-lasting tonic activation (LLTA) of motor units was also documented. The mean three-dimensional force vector of the grinding forces was 106 ± 74 N. In the frontal plane, the incline to the midsagittal plane ranged between 10° and 15°. In the midsagittal plane, the incline to the frontal plane was negligibly small. Posterior neck muscle activity during grinding ranged between 4.5% and 12% MVC and during clenching with 100 N between 1.8% and 9.9% MVC. Masticatory muscle activity during grinding ranged between 17% and 21% MVC for contralateral masseter and ipsilateral temporalis and between 4% and 6.5% for ipsilateral masseter and contralateral temporalis. LLTA had an average duration of 195 ± 10 seconds. The findings from this study do not support pathophysiological muscle chain theories postulating simple biomechanical coupling of neck and jaw muscles. Co-contractions of neck and masticatory muscles may instead occur as a result of complex neurophysiological interactions.

Jaw Clenching: Muscle and Joint Forces, Optimization Strategies

Realistic masticatory muscle and temporomandibular joint forces generated during bilateral jaw clenching are largely unknown. To determine which clenching directions load masticatory muscles and temporomandibular joints most heavily, we investigated muscle and joint forces based on feedback-controlled electromyograms of all jaw muscles, lines of action, geometrical data from the skull, and physiological cross-sectional areas acquired from the same individuals. To identify possible motor control strategies, we applied objective functions. The medial pterygoid turned out to be the most heavily loaded muscle for all bite directions. Biting with accentuated horizontal force components provoked the highest loading within the medial and lateral pterygoids. The largest joint forces were also found for these bite directions. Conversely, the lowest joint forces were detected during vertical biting. Additionally, joint forces with a clear posterior orientation were found. Optimization strategies with the elastic energy as objective function revealed the best fit with the calculated results.

Small vertical changes in jaw relation affect motor unit recruitment in the masseter

Strategies for recruitment of masseter muscle motor units (MUs), provoked by constant bite force, for different vertical jaw relations have not previously been investigated. The objective of this study was to analyse the effect of small changes in vertical jaw relation on MU recruitment behaviour in different regions of the masseter during feedback-controlled submaximum biting tasks. Twenty healthy subjects (mean age: 24·6 ± 2·4 years) were involved in the investigation. Intra-muscular electromyographic (EMG) activity of the right masseter was recorded in different regions of the muscle. MUs were identified by the use of decomposition software, and root-mean-square (RMS) values were calculated for each experimental condition. Six hundred and eleven decomposed MUs with significantly (P < 0·001) different jaw relation-specific recruitment behaviour were organised into localised MU task groups. MUs with different task specificity in seven examined tasks were observed. The RMS EMG values obtained from the different recording sites were also significantly (P < 0·01) different between tasks. Overall MU recruitment was significantly (P < 0·05) greater in the deep masseter than in the superficial muscle. The number of recruited MUs and the RMS EMG values decreased significantly (P < 0·01) with increasing jaw separation. This investigation revealed differential MU recruitment behaviour in discrete subvolumes of the masseter in response to small changes in vertical jaw relations. These fine-motor skills might be responsible for its excellent functional adaptability and might also explain the successful management of temporomandibular disorder patients by somatic intervention, in particular by the use of oral splints.

Co-activation of jaw and neck muscles during submaximum clenching in the supine position

OBJECTIVE

The purpose of this study was to test the hypothesis that jaw clenching induces co-contraction and low-level long-lasting tonic activation (LLTA) of neck muscles in the supine position.

DESIGN

Ten healthy subjects developed various feedback-controlled submaximum bite forces in different bite-force directions in supine position. The electromyographic (EMG) activity of the semispinalis capitis, semispinalis cervicis, multifidi, splenius capitis, levator scapulae, trapezius, sternocleidomastoideus, masseter and infra/supra-hyoidal muscles was recorded. For normalization of EMG data, maximum-effort tasks of the neck muscles were performed.

RESULTS

Co-contractions of the posterior neck muscles varied between 2% and 11% of their maximum voluntary contraction. Different bite forces and bite-force directions resulted in significant (p<.05) activity differences between the co-contraction levels of the neck muscles. In addition, LLTA of specific neck muscles, provoked by the jaw clenching tasks, was observed.

CONCLUSIONS

This study demonstrated for the first time moderate co-contractions of jaw and neck muscles in the supine position under controlled submaximum jaw clenching forces. LLTA of most neck muscles was observed, outlasting clenching episodes and indicating an additional neuromuscular interaction between the two muscle groups.

[The therapy of masticatory muscle pain with oral splints]

Myofascial masticatory muscle pain is the second most frequent pain-related complaint in the orofacial region. Like unspecific musculoskeletal pain in other body segments, masticatory muscle pain is characterised by a multifactorial aetiology. The aim of this article is to document the current knowledge about the therapy with oral splints. It is shown that in both the short and long term, oral appliances can achieve sufficient pain relief in the majority of patients. In chronic myofascial jaw pain associated with psychosocial impairment in patients, effectiveness of splint therapy is limited, though. Within an interdisciplinary pain management programme, additional involvement of a psychotherapist is essential.

The dental occlusion as a suspected cause for TMDs: epidemiological and etiological considerations

The relationship between the dental occlusion and temporomandibular disorders (TMDs) has been one of the most controversial topics in the dental community. In a large epidemiological cross-sectional survey - the Study of Health in Pomerania (Germany) - associations between 15 occlusion-related variables and TMD signs or symptoms were found. In other investigations, additional occlusal variables were identified. However, statistical associations do not prove causality. By using Hill's nine criteria of causation, it becomes apparent that the evidence of a causal relationship is weak. Only bruxism, loss of posterior support and unilateral posterior crossbite show some consistency across studies. On the other hand, several reported occlusal features appear to be the consequence of TMDs, not their cause. Above all, however, biological plausibility for an occlusal aetiology is often difficult to establish, because TMDs are much more common among women than men. Symptom improvement after insertion of an oral splint or after occlusal adjustment does not prove an occlusal aetiology either, because the amelioration may be due to the change of the appliance-induced intermaxillary relationship. In addition, symptoms often abate even in the absence of therapy. Although patients with a TMD history might have a specific risk for developing TMD signs, it appears more rewarding to focus on non-occlusal features that are known to have a potential for the predisposition, initiation or perpetuation of TMDs.

Evaluation of T2 values and apparent diffusion coefficient of the masseter muscle by clenching

OBJECTIVE

The aim of this study was to evaluate the changes in T2 values and apparent diffusion coefficient (ADC) in the masseter muscle by clenching in healthy volunteers.

METHODS

37 volunteers were enrolled in the study. We measured bite force using pressure-sensitive paper and a T2 map. The ADC map was obtained at rest, during clenching, immediately after and 5 min after clenching. The spin-echo sequence was used to calculate T2, and single-shot spin-echo echo planar imaging was used to calculate the ADC. The motion-probing gradients (MPGs) were applied separately along the posterior-to-anterior (PA), right-to-left (RL) and superior-to-inferior (SI) directions, with b values of 0, 300 and 600 s mm(-2) in each direction. ADC-PA, ADC-RL, and ADC-SI values were obtained, and we calculated the ADC-iso for the mean diffusivity.

RESULTS

There were no significant differences between the stronger and weaker sides of bite force before, during or 5 min after clenching for T2 and ADC. The bite force had little effect on these parameters; thus, we used the average of the two sides for the following analyses. Time course analysis of ADC-iso, ADC-PA, ADC-RL and ADC-SI demonstrated a marked increase after clenching and a rapid decrease immediately after clenching, although they did not completely return to the initial values; however, the change in ADC-RL was significantly greater than those in ADC-PA or ADC-SI (P<0.001 each). The changes in T2 were similar to those of ADC, although not as marked.

CONCLUSIONS

ADC (especially ADC-RL) was altered by contraction of the masseter muscle.

Clenching and grinding: effect on masseter and sternocleidomastoid electromyographic activity in healthy subjects

This study compares the effect of clenching and grinding on masseter and sternocleidomastoid electromyographic (EMG) activity during different jaw posture tasks in the sagittal plane. The study included 34 healthy subjects with natural dentition, Class I bilateral molar Angle relationship, and absence of posterior occlusal contacts during mandibular protrusion. An inclusion criterion was that subjects had to be free of signs and symptoms of any dysfunction of the masticatory system. Bipolar surface electrodes were located on the right masseter and sternocleidomastoid muscles. EMG activity was recorded while the subjects were in standing position, during the following jaw posture tasks: A. maximal clenching in the intercuspal position; B. grinding from intercuspal position to edge-to-edge protrusive contact position; C. maximal clenching in the edge-to-edge protrusive contact position; D. grinding from edge-to-edge protrusive contact position to intercuspal position; E. grinding from retrusive contact position to intercuspal position. EMG activities in tasks B, C, D, and E were significantly lower than in task A in both muscles (mixed model with unstructured covariance matrix). EMG activity among tasks B, C, D, and E did not show significant differences in both muscles, except between tasks D and E in the masseter muscle. A higher effect was observed on the masseter than on the sternocleidomastoid muscle to avoid excessive muscular activity during clenching and grinding. The EMG patterns observed could be of clinical importance in the presence of parafunctional habits, i.e., clenching and/or grinding.

The NTI-tss device for the therapy of bruxism, temporomandibular disorders, and headache - where do we stand? A qualitative systematic review of the literature

BACKGROUND

The NTI-tss device is an anterior bite stop, which, according to the manufacturer, is indicated for the prevention and treatment of bruxism, temporomandibular disorders (TMDs), tension-type headaches, and migraine. The aim of this systematic review was to appraise the currently available evidence regarding the efficacy and safety of the NTI-tss splint.

METHODS

We performed a systematic search in nine electronic databases and in NTI-tss-associated websites (last update: December 31, 2007). The reference lists of all relevant articles were perused. Five levels of scientific quality were distinguished. Reporting quality of articles about randomized controlled trials (RCTs) was evaluated using the Jadad score. To identify adverse events, we searched in the identified publications and in the MAUDE database.

RESULTS

Nine of 68 relevant publications reported about the results of five different RCTs. Two RCTs concentrated on electromyographic (EMG) investigations in patients with TMDs and concomitant bruxism (Baad-Hansen et al 2007, Jadad score: 4) or with bruxism alone (Kavakli 2006, Jadad score: 2); in both studies, compared to an occlusal stabilization splint the NTI-tss device showed significant reduction of EMG activity. Two RCTs focused exclusively on TMD patients; in one trial (Magnusson et al 2004, Jadad score: 3), a stabilization appliance led to greater improvement than an NTI-tss device, while in the other study (Jokstad et al 2005, Jadad score: 5) no difference was found. In one RCT (Shankland 2002, Jadad score: 1), patients with tension-type headache or migraine responded more favorably to the NTI-tss splint than to a bleaching tray. NTI-tss-induced complications related predominantly to single teeth or to the occlusion.

CONCLUSION

Evidence from RCTs suggests that the NTI-tss device may be successfully used for the management of bruxism and TMDs. However, to avoid potential unwanted effects, it should be chosen only if certain a patient will be compliant with follow-up appointments. The NTI-tss bite splint may be justified when a reduction of jaw closer muscle activity (e.g., jaw clenching or tooth grinding) is desired, or as an emergency device in patients with acute temporomandibular pain and, possibly, restricted jaw opening.

The lateral pterygoid muscle, a heterogeneous unit implicated in temporomandibular disorder: a literature review

Based on its anatomical relationships, the lateral pterygoid muscle is strongly linked with the temporomandibular joint (TMJ). It plays a major role in mastication. Embryological, histological, and anatomical knowledge define the lateral pterygoid muscle as a single muscle with a penniform structure. The various results of electromyographic (EMG) studies describe a complex physiology with a chronological contraction of the layers during the masticatory cycle. The sequential contraction of the layers of the lateral pterygoid muscle is the result of a selective neuronal activation induced by the masticatory Central Pattern Generator (mCPG). This neurophysiological theory highlights the essential role of the reticular formation in oral motor control. The sensitivity of those neurological structures to chronic emotional stress is one of the possible explanations for the appearance of oral parafunctions accompanied by a modification of pain perception and a disorganized muscular activation, determining factors in temporomandibular disorders.

Therapie bei Schmerzen der Kaumuskulatur

Myalgias of the masticatory muscles are the most frequent noninfectious complaints in the orofacial region. After summarizing the current knowledge on the physiology, etiology, pathophysiology, diagnosis, and differential diagnosis of masticatory muscle pain, we specifically focus on management recommendations. Results of an extensive literature search show that for the majority of patients pain reduction or pain relief can be achieved with noninvasive reversible methods. Longitudinal short- and long-term studies have revealed that different therapeutic measures are similarly effective. In patients with chronic masticatory myalgias associated with psychosocial impairment, however, additional involvement of a psychotherapist is crucial.

Heterogeneous activation of the medial pterygoid muscle during simulated clenching

The aim of this study was to investigate whether the medial pterygoid muscle shows differential activation under experimental conditions simulating force generation during jaw clenching. To answer this question, the electromyographic activity of the right medial pterygoid was recorded with two intramuscular electrodes placed in an anterior and posterior muscle region, respectively. Intraoral force transfer and force measurement were achieved by a central bearing pin device equipped with strain gauges. The activity distribution in the muscle was recorded in a central mandibular position during generation of eight different force vectors at a constant amount of force (F=150 N). The investigated muscle regions showed different amounts of EMG activity. The relative intensity of the activation in the two regions changed depending on the task. In other words, the muscle regions demonstrated heterogeneous changes of the EMG pattern for various motor tasks. The results indicate a heterogeneous activation of the medial pterygoid muscle under test conditions simulating force generation during clenching. This muscle behaviour might offer an explanatory model for the therapeutic effects of oral splints.

Activity patterns of the masticatory muscles during feedback-controlled simulated clenching activities

In 10 normal subjects, the electromyographic (EMG) activities of the masseter, anterior and posterior temporalis, medial pterygoid, inferior lateral pterygoid, as well as the anterior digastric, were bilaterally recorded during clenching with various resulting force vectors. The intraoral force transfer was achieved with a three-component force transducer. The direction and magnitude of the force vectors were controlled by visual feedback. The goal of the study was to investigate how various clenching directions at constant magnitude of force influence the EMG activity in the masticatory muscles during gradual increase of the horizontal force component. Depending on the force direction and the individual muscle, an increase or decrease of activity was observed during clenching with increasing horizontal force components at constant magnitude of force. The inferior lateral pterygoid exhibited the highest activation (about 80% of maximal voluntary clenching) of all masticatory muscles. The medial pterygoid showed the greatest range of variation in activation behavior, and it was the most active muscle in relation to all clenching directions. In conclusion, the results show that with growing horizontal force components at constant magnitude of force, all muscles demonstrated an increase or decrease of activity in several clenching directions.