Bruxing patterns in children compared to intercuspal clenching and chewing as assessed with dental models, electromyography, and incisor jaw tracing: preliminary study

The purpose of the present study was to compare bruxing patterns in children with chewing and maximum intercuspal clenching as defined in a clinical and laboratory environment. Six non-bruxing controls and six children who actively bruxed according to parent reports were evaluated. Both control and experimental subjects were assessed by an initial questionnaire, intraoral examination, extraoral examination, dental study models, incisor mandibular tracking, and bilateral surface electromyographic recordings (e.g., EMG). Bruxing was defined as grinding, clenching, or both in combination. The clinical examination consisted of an intraoral examination of the dentition, number of occlusal contacts, and wear facets. Dental study models were used to substantiate the intraoral findings for occlusal contact and wear facets. The mandibular incisors position was tracked during opening, closing, laterotrusion, protrusion, and chewing and compared to the bruxing movements in the experimental subjects. Bilateral surface EMG signals from the temporalis and masseter muscles were recorded in three maximum intercuspal clenches, ten chewing cycles on sugarless gum, and during simulated bruxing. The dental contacts were equal in number bilaterally in both control and bruxing subjects. Both groups demonstrated wear facets, but the bruxing subjects had more facets. The wear facets indicated lateral excursions but not clenching. Only the incisor jaw tracking and bilateral EMG differentiated the bruxing patterns. In those subjects (n = 4) who clenched during bruxing, the EMG pattern was not similar to that of intercuspal clenching and demonstrated its own unique muscle recruitment for the temporalis and masseter muscles. In the subjects who exhibited lateral excursions for bruxing (n = 2), the pattern of muscle recruitment of the two-closing muscles in terms of amplitude was similar for both the bruxing and chewing gum. Our findings support a concept that bruxing may depend upon factors that modify coactivation of muscle recruitment and do not depend upon occlusal contacts.     

Condylar position recorded using leaf gauges and specific closure forces

Retruded interocclusal records were made for 40 subjects after deprogramming using leaf gauges and controlled incisal forces, which were exerted on a specially constructed occlusal force sensor. These records were used to assess the resulting displacements of the mandibular condyles from their positions in centric occlusion. The leaf gauges were found not to position the condyles inferiorly and posteriorly as has been previously reported.     

Effects of calcitriol on proliferation and differentiation of human fetal jejunum

This study was conducted in order to determine the influence of variation in the occlusal contacts on electromyographic (EMG) cervical activity in 20 patients with myogenic cranio-cervical-mandibular dysfunction. EMG recordings during maximal voluntary clenching were performed by placing surface electrodes on the left sternocleidomastoid and upper trapezius muscles in the following conditions: intercuspal position; edge to edge left laterotrusive contacts (ipsilateral); edge to edge right laterotrusive contacts (contralateral); edge to edge protrusive contacts; and retrusive occlusal contacts. A significant higher EMG activity was recorded in both muscles during maximal voluntary clenching in retrusive occlusal contact position, whereas no significant differences in EMG activity were observed between intercuspal position, ipsilateral, contralateral and protrusive contact positions. The EMG pattern observed suggests that a more frequent intensity and duration of tooth clenching in retrusive occlusal contact position could result in more clinical symptomatology in these cervical muscles in patients with myogenic cranio-cervical-mandibular dysfunction.     

Correlation between maximum bite force and facial morphology in children

The correlation between maximum bite force and facial morphology was studied in 54 boys, 8 to 16 years old, and 66 girls, 7 to 17 years old. Bite force was measured at the first molars with a miniature bite force recorder. Facial morphology was evaluated on profile cephalograms. In addition, the number of teeth in contact in the intercuspal position was recorded with occlusal foils. In the girls, maximum bite force was correlated with the inclination of the mandible, the size of the gonial angle, and the ratio between posterior and anterior face heights. The correlations implied a large bite force with a small mandibular inclination and gonial angle, a large posterior face height in relation to the anterior face height, and a small bite force with the opposite facial characteristics. These correlations were nonexistent or weaker in boys. In both sexes, bite force was correlated with the number of occlusal contacts. Elimination of the influence of age and occlusal contact in the group of girls by the use of partial correlations reduced the correlation between bite force and facial morphology. A significant correlation with the size of the gonial angle remained, however, and the correlation with mandibular inclination was close to significance. In addition to the correlations found with facial morphology, the study clearly demonstrated the need to take gender and occlusal contacts into consideration in future studies of masticatory muscle function and strength in relation to facial morphology.     

Striatal dopaminergic D1 and D2 receptors after intracerebroventricular application of alloxan and streptozocin in rat

The purpose of this study was to evaluate the changes in condylar position following bilateral sagittal split ramus osteotomy with 5- and 10-mm setback in 1 symmetric human cadaver mandibles. A Plexiglas device was constructed to determine the mandibular morphology and the movements of the condyle and the proximal segments before and after surgery. There was no statistically significant relationship between mandibular morphology or the magnitude of setback and changes in condylar position postsurgery. All condyles and rami tipped in a highly variable fashion in the coronal plane. In the axial plane, the lateral pole of the condyles rotated predominantly anteriorly; the left side rotated significantly more than did the right. In the sample studied, the position of the condylar and proximal segments was altered in a highly variable and unpredictable manner, regardless of the magnitude of setback or the morphology of the mandible.     

Stability of the mandibular position in occlusion of mandibulectomy patients with lateral discontinuity defect

In mandibulectomy patients with lateral discontinuity defect, the mandible is severely deviated and the occlusion is considered to be unstable. A thorough understanding of the mandibular occlusal position of these patients is important to achieve desirable results in their occlusal rehabilitation. This study compared the stability of the mandibular positions in occlusion, when the opening distance or the biting force was changed during mandibular movements, by simultaneously measuring four points on the mandible three-dimensionally. This study indicated that the mandibular positions in occlusion of these patients were extremely unstable as compared with those of the normal subjects and were considerably different from each other when the opening distance or the biting force was changed during mandibular movements.     

Experimental occlusal interferences. Part IV. Mandibular rotations induced by a pliable interference

In 12 subjects, a pliable, yet unbreakable, intercuspal interference (aluminum shim onlay splint; uniform height of 0.25 mm) was placed between either the right or left maxillary and mandibular second premolars and first molars. During brief and forceful biting (dynamic chewing stroke of about 20 kg force) the interference emulated a semisoft food bolus, and at the end of biting (subsequent static clenching stroke of about 20 kg force) it emulated a rigid metal interference. During dynamic/static biting, rotational electrognathography measured maximum frontal and horizontal plane torque of the right and left mandibular condyles. Eleven subjects (92%) showed frontal plane upward rotation (mean of 1.0 degree) of the condyle contralateral to the interference, and one subject (8%) showed frontal plane upward rotation (0.4 degree) of the condyle ipsilateral to the interference. Two subjects (17%) showed no horizontal plane rotation; seven subjects (58%) showed backward rotation (mean of 0.4 degree) of the condyle contralateral to the interference; and three subjects (25%) showed backward rotation (mean of 0.3 degree) of the condyle ipsilateral to the interference. It is suggested that, in the presence of an occlusal interference, mastication may have both short- and long-term detrimental effects.     

Use of activator appliances in pediatric patients treated with costochondral grafts for temporomandibular joint ankylosis: analysis of 13 cases

PURPOSE: The long-term outcomes and clinical results of costochondral transplants used for the treatment of condylar ankylosis of the mandible in children with and without application of postoperative activator appliances are evaluated and compared. MATERIALS AND METHODS: A nonrandomized, retrospective clinical study of 13 cases of condylar ankylosis (16 joints) of the mandible surgically treated during a 9-year period from 1988 to 1997 was performed. All 13 patients were treated by condylectomy and immediate costochondral rib grafts. Nine of these patients underwent long-term postoperative therapy using removable activator appliances. Four patients did not undergo activator therapy postoperatively. Casts, radiographs, photographs, computed tomography (CT) scans, magnetic resonance imaging (MRI) and 99Tc bone scans were used postsurgically to evaluate graft take, condylar growth and function, occlusion, and facial and condylar symmetry. RESULTS:The postoperative and long-term clinical results in both groups showed costochondral growth center transplants to be effective in restoring mandibular growth of the affected side. However, symmetry, arch coordination, correction of occlusal canting, mandibular deviation, facial growth, and prevention of reankylosis were obtained and better controlled only in those cases that underwent long-term orthodontic activator therapy postoperatively and were followed closely. CONCLUSIONS: Children with long-standing condylar ankylosis of the mandible and its resultant facial asymmetry and occlusal canting (secondary to a nonfunctional joint and maxillary compensation) treated with condylectomy and immediate costochondral rib graft reconstruction of the affected joint were treated more favorably when activators were used postsurgically. The patients that failed to comply with or continue activator therapy postsurgically developed complications relating to mandibular deviation, occlusal dysharmony, asymmetry and, in one case, reankylosis of the temporomandibular joint (TMJ).     

Reflex jaw motions and jaw stiffness pertaining to whiplash injury of the neck

Because a so-called mandibular whiplash injury requires the absence of short-latency jaw-closing reflexes in order to explain the postulated mechanism of injury (excessive jaw opening); the authors studied the presence and absence and more importantly, the kinematics (duration, displacement, velocity, acceleration) of monosynaptic and possibly, polysynaptic myotatic (stretch) reflexes in the jaw elevator muscles. In six healthy adults jaw jerk maneuvers were elicited through a brisk tap on the chin, and surface electromyography identified elevator reflexes while translational electrognathography identified the kinematics of the reflexes. The maneuvers were done while maintaining the rest position (3% MVC) and moderate clenching of the teeth (30% MVC). Electromyography was also used to identify phasic elevator excitations during a passive brisk neck extension maneuver. A sudden and unexpected elongation of the jaw elevators released autogenic reflex responses that, in conjunction with augmented tissue elasticity (stiffness), elevated the mandible into centric occlusion within approximately 150 milliseconds. In 86% of trials, the responses occurred regardless of the prevailing resting and clenching contractile activities. There was no evidence of a depressor force that consistently would and could anchor the mandible in a position of extreme or moderate depression, the theoretical linchpin of the mandibular whiplash injury. It was concluded that the mandibular locomotor system is very efficient in maintaining the rest and intercuspal positions of the mandible. This study found no evidence corroborating the mechanism claimed to release a so-called mandibular whiplash injury.     

Prediction of mandibular autorotation

PURPOSE: The purpose of this investigation was to test the hypothesis that the mandible rotates around the same point during maxillary impaction surgery as during initial jaw opening. This point, called the center of mandibular autorotation (CAR), could then be used to predict mandibular position and to decide whether only maxillary impaction would be needed to correct the occlusion and the facial profile. PATIENTS AND METHODS: Preoperatively, two lateral cephalograms were obtained from a consecutive series of 20 patients who underwent maxillary impaction without concomitant mandibular ramus osteotomy. One cephalogram was taken with the mandible in centric relation using a wax bite wafer and another with a jaw opening of 10 mm using a fabricated acrylic bite block with the mandible manipulated to its most retruded position. The CAR was calculated before and after jaw opening using the Rouleaux method on the lower incisor and gonion point. A third lateral cephalogram was taken within 2 days postoperatively. The postoperative lower incisal point was then transferred to the first cephalogram using cranial base superimposition. RESULTS: When the preoperative and postoperative distances between CAR and incisal point were compared, there was no significant difference between these distances, proving the hypothesis. CONCLUSIONS: The method used is a practical and precise way to determine the center of mandibular autorotation on an individual basis. The center of rotation during initial jaw opening is the same as during impaction surgery.     

Single ventricle (cor trilocular biatriatum). A case report]

This study investigates the cusp angle and movement variables related to balancing-side disclusion and compares the characteristics between the 1st and 2nd molar regions. Fifty-six normal young adults were divided into two groups according to balancing-side contact: a disclusion group consisting of 40 subjects (80 excursions), and a non-disclusion group consisting of 16 subjects (20 excursions). Lateral excursions were measured in six-degrees of freedom, and the inclinations of the frontal paths were calculated on the working-side canine, balancing-side 1st and 2nd molars and balancing-side condylar point. The cusp angle was measured using a three-dimensional digitizer. While there were no differences between disclusion and non-disclusion groups in the inclination of the balancing-side condylar path, significant differences were found in the cusp angle and the inclination of the working-side canine path. In the non-disclusion group, the cusp angle of the 2nd molar was markedly greater than that of the 1st molar. It was concluded that the inclination of the anterior guidance and the cusp angle of related teeth have a great effect on the occurrence of balancing-side disclusion and that the mechanism of high frequent balancing-side contacts at the 2nd molar was characterized by its greater cusp angle compared to the 1st molar.     

Evoked potentials as predictors of outcome in neonatal intensive care unit survivors: review of the literature

The twin blocks technique was developed by Dr. William Clark of Scotland during the early 1980s. Twin Blocks are an uncomplicated system that incorporates the use of upper and lower bite blocks. These bite blocks reposition the mandible and redirect occlusal forces to achieve rapid correction of malocclusions. They are also comfortable and the patients wear them full-time--including eating time. Occlusal forces transmitted through the dentition provide a constant proprioceptive stimulus to influence the rate of growth and the trabecular structure of the supporting bone. This feature of Twin Blocks means easier and quicker treatment. The occlusal inclined plane is the fundamental functional mechanism of the natural dentition. Twin Blocks are bite blocks that effectively modify the occlusal inclined plane to induce favorably directed occlusal forces by causing a functional mandibular displacement. Upper and lower bite blocks interlock at a 45 degree angle and are designed for full-time wear to take advantage of all functional forces applied to the dentition including the forces of mastication. The patients who were treated with Modified Twin Blocks received the following benefits: 1) large overjets and deep overbites were corrected. 2) Class II molar relationships were changed into Class I, and 3) the profiles of the patients were improved by anterior displacement of mandible.     

The health of our children continues to improve--but... (a litany of change--Part III)

Interarch occlusal relationships are defined by temporomandibular joint (TMJ) position. Determination of the most physiologic joint position is a logical prerequisite for occlusal analysis. Existing classification systems for occlusion do not consider TMJ position or condition when relating the mandibular arch to the maxillary arch or the range of adaptive changes that can affect the position of the condyles or influence long-term occlusal stability. If the relationship between occlusion and TMJ position is as important as many clinicians believe, condylar position must be defined precisely as an essential control in any clinical study that purports to evaluate the relationship between occlusion and any masticatory system disorder to include temporomandibular disorders. This article presents a new classification system that defines the relationship between maximal intercuspation and the position and condition of the TMJs. The classification uses guidelines that are specific enough to be consistent and verifiably reproducible. A recently introduced term, "adapted centric posture," is used in this classification to distinguish deformed TMJs that have remodeled or adapted to a conformation that can comfortably accept maximal loading. This classification is necessary because deformed but adapted joints may within certain conditions function with the same degree of comfort as intact, properly aligned condyle disk assemblies in centric relation.     

Occlusal forces and mandibular bone strain: is the primate jaw "overdesigned"?

Finite element modelling of the function of the periodontium and surrounding alveolar bone suggests these tissues are subjected to unusually large strains in comparison with the bone of the basal mandibular corpus. These studies, in addition to certain experimental investigations, have led to the suggestion that the strains experienced in the basal mandibular corpus are not functionally important. Under this view, size and shape of the basal corpus are not functionally linked to masticatory forces. Since previous comparative investigations have been premised on the assumption that masticatory strains in the basal corpus are functionally important, the assertion that masticatory stresses are concentrated primarily in the alveolar process undermines the credibility of this body of work. The hypothesis that the biomechanical effects of masticatory forces are localized in the alveolar process can be evaluated by reference to a number of bone strain investigations, as well as through consideration of current understanding of bone biology and behavior. Experimental studies indicate that the effects of occlusal forces during mastication are quite apparent in alveolar bone, although relatively large strains are also observed in regions well-removed from a loaded alveolus. It is also apparent that both alveolar and basal mandibular bone are subject to bending and twisting strains associated not only with occlusal forces, but also with muscular and condylar reaction forces. The result is that strain levels in alveolar vs. basal bone may be roughly similar, in contradiction to some published theoretical models. Based on empirical evidence and theoretical considerations, it is premature to conclude that mandibular corpus size and shape are not functionally linked to the biomechanics of chewing and biting.     

Occlusal rehabilitation under conditions of the simulation of averages

The Fag articulator is an anatomical and semi-adaptable one, light and with a supple, stable and rigid mechanism of manipulation and an easy access to the models. These characteristics make it more sensitive in all situations of occlusal rehabilitation. The articular system permits the exactness mechanical reproduction of the fundamental movements of the mandible, with the possibility to reproduce the characteristics of the lateral movements (angle Benett adjustable), protrusion and variable inclinations of the condylar slope. The employment of this articulator in the dentistry practice allowed us to obtain a functional occlusal rehabilitation in all types of edentulous and we avoided the premature occlusal contacts.     

Ground reaction forces and EMG activity with ankle bracing during inversion stress

PURPOSE: The purpose of this investigation was to evaluate the effects of external ankle support on ground reaction forces and myoelectrical activity of selected lower extremity muscles during dynamic inversion stress. METHODS: Twenty-four healthy males performed five trials of a lateral dynamic movement at a rate between 80-90% of their maximal speed under three ankle brace conditions (no brace--control, Aircast Sport-Stirrup, Active Ankle). Ground reaction forces along the mediolateral axis and EMG activity of the peroneus longus, tibialis anterior, and medial gastrocnemius were simultaneously recorded during force plate contact. RESULTS: Ankle bracing did not affect peak impact force (P > 0.05), maximum loading force (P > 0.05), or peak propulsion force (P > 0.05) in the lateral direction compared with the control condition. Ankle bracing reduced the EMG activity of the peroneus longus during peak impact force compared with the control condition (P < 0.05), although no differences were noted between the two braces. Furthermore, peroneous longus activity during maximum loading force and peak propulsion remained unaffected (P < 0.05). Ankle bracing did not affect the EMG activity of the tibialis anterior and medial gastrocnemius at the point of peak impact force, maximum loading force (P > 0.05), and peak propulsion force (P > 0.05). CONCLUSIONS: These data suggest that ankle bracing may not affect the forces experienced at the foot and ankle, but helps reduce the strain placed on the peroneus longus during peak impact force. Furthermore, ankle bracing does not alter the function of the tibialis anterior and medial gastrocnemius during dynamic inversion stress.     

British and West African facial form in ideal occlusion

True lateral cephalometric radiographs of 20 adult male British subjects and 20 Nigerian adult males were collected. All subjects showed an ideal occlusion of the teeth. These radiographs were analysed using a facial polygon joining the points Nasion, Sella, Articulare, Gonion and Menton. Additionally, measurements were made of the axial inclination of the incisor teeth and the distances from the incisal edges and apices of the teeth to the facial plane. Statistical examination of the results using "t" tests revealed that the average British mandible had a longer ramus but shorter body joined at a wider angle than the Negro, that the nasal part of the face was longer on average in the British group and that the incisor teeth, on average, projected further and were inclined further forward in the Nigerian group. A linear discriminant function in only three variables predicted with 100 per cent accuracy membership of the two groups. The three variables were the mandibular body length, the height of the nasal part of the face, and the amount by which the incisal edges of the lower incisor teeth projected beyond the facial plane.     

Relationship between mandibular position and the coordination of masseter muscle activity during sleep in humans

Although bruxism has been regarded as having a possibly important role in the aetiology of craniomandibular disorders, the activity of masticatory muscles relative to mandibular position during sleep grinding as recorded by electromyography (EMG) has not yet been clarified. Surface EMGs of the bilateral superficial masseter muscles were recorded simultaneously with mandibular position during sleep from 12 volunteers for three consecutive nights. The incidence of two mandibular positions were recorded with magnetic sensors for both left- and right-sided mandibular grinding. One of the mandibular positions was the canine edge-to-edge position, and the other was the midpoint between the intercuspal position and the canine edge-to-edge position. The mode of the working/ balancing activity ratio ranged from 1/10 to 2/10, showing the marked predominance of balancing side masseter muscle activity during sleep grinding. During sleep grinding, EMG bursts of masseter muscle were observed mainly with mediotrusive mandibular movement from the canine edge-to-edge position. From the results of the present study, it is suggested that muscular dynamics during sleep are unique compared to that during voluntary clenching, and exert a greater mechanical load to the balancing side temporomandibular joint.     

A computer-controlled experimental set-up enabling the quantification of motor performance in man, applied to mastication

This paper describes a computer-controlled experimental set-up, which enables the simulation and manipulation of the resistance of food, the bolus size and reflex evoking events during chewing in man. Food resistance was simulated by an external downward directed force on the mandible during the closing phase. The force was supplied by a magnet-coil system. A coil, rigidly attached to the subject's mandible, was located in a permanent magnetic field. By varying the current through the coil, the force on the coil and thus on the mandible could be adjusted. The current was on line computed as a function of the jaw gape. Food resistance and bolus size could be simulated and manipulated by varying the amplitude of the force and the jaw gape at which the force started, respectively. The possibility of varying these parameters could be used simultaneously and independently. Reflex evoking events were simulated by an additional loading or unloading force pulse, superimposed on the food-simulating force. The set-up has been tested during experiments in which food resistance, bolus size and reflex evoking events were simulated. Examples of these experiments are presented in this paper.     

Occlusal stability in Class II, Division 1, deep bite cases followed up for many years after orthodontic treatment

This case report analyzes long-term occlusal stability that can be achieved in Class II, Division 1, deep bite cases with active treatment finished during the period of maxillomandibular growth. The analysis was designed to identify occlusal features common to two cases at the end of active treatment and to study how the occlusion changed with growth and jaw movement to achieve stability. The following occlusal features were shared by the two cases at the end of active treatment: (1) AB plane and axes of the maxillary and mandibular posterior teeth were perpendicular to functional occlusal plane; (2) the axis of the lower incisor was almost perpendicular to DC-L1i line; (3) the anterior occlusion was overcorrected to or near an edge-to-edge relationship. Items 1 and 2 remained unchanged throughout the follow-up periods, regardless of growth status, and the overjet and overbite increased during maxillomandibular growth after treatment. During the period of mandibular growth alone, after the end of retention, the axes of maxillary incisors tipped labially; as a result, F line became parallel to CDM line by the end of growth. The labial tipping of maxillary incisors brought the lower incisal edge into contact with or extremely near the inflection point (Bp).1 By the end of growth, the tangent of Bp became parallel to or coincident with DC-L1i line and perpendicular to the axis of the lower incisor, and the DC-L1i lines at various times posttreatment were almost parallel to each other in the two cases. Overjet increased as the maxillary incisors tipped labially, providing proper protrusive and retrusive paths for mandibular guidance. The angle between the functional occlusal plane and CDM line stayed almost the same as at the end of active treatment in the two cases, suggesting a possible change in the angle of eminence in harmony with the functional occlusal plane. These factors apparently contributed to the long-term occlusal stability in the two cases.