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.     

Synthesis of inositol-containing glycophospholipids

Referring to the temporomandibular joint (TMJ) of the human mandibular locomotor system, it has been asserted that displacement of the TMJ disc and inflammation of TMJ tissues are the results of acute and indirect trauma to the TMJ; on occasion this is allegedly experienced in motor vehicle accidents and commonly known as a TMJ whiplash injury. It is postulated that the TMJ whiplash injury is released in the occupant or occupants of a target vehicle when its rear end is impacted by the front end of a bullet vehicle. On the basis of detailed analyses of TMJ trauma/pain histories and TMJ magnetic resonance images, presented as circumstantial evidence in favour of the postulated TMJ whiplash injury, and detailed analyses of the mathematical biophysics of the mandibular locomotor system as well as direct experimental evidence, it is concluded that the postulated TMJ whiplash injury does not exist as a single and independent disease entity caused by motor vehicle accidents. If TMJ disc displacement and inflammation are present, they are expressions of an insidious and progressive pre-existing (pre-accident) disease entity that is comprised of TMJ synovitis/osteoarthritis (phase of inflammation with presence of immune system cells), TMJ internal derangement (phase of disc displacement and deformation with presence of proteinases), and TMJ osteoarthrosis (phase of degeneration with absence of immune system cells). For the asserted TMJ whiplash manoeuvre and ensuing injury to occur as postulated, the laws of physics and biology would have to be suspended.     

An examination of the degrees of freedom of human jaw motion in speech and mastication

The kinematics of human jaw movements were assessed in terms of the three orientation angles and three positions that characterize the motion of the jaw as a rigid body. The analysis focused on the identification of the jaw's independent movement dimensions, and was based on an examination of jaw motion paths that were plotted in various combinations of linear and angular coordinate frames. Overall, both behaviors were characterized by independent motion in four degrees of freedom. In general, when jaw movements were plotted to show orientation in the sagittal plane as a function of horizontal position, relatively straight paths were observed. In speech, the slopes and intercepts of these paths varied depending on the phonetic material. The vertical position of the jaw was observed to shift up or down so as to displace the overall form of the sagittal plane motion path of the jaw. Yaw movements were small but independent of pitch, and vertical and horizontal position. In mastication, the slope and intercept of the relationship between pitch and horizontal position were affected by the type of food and its size. However, the range of variation was less than that observed in speech. When vertical jaw position was plotted as a function of horizontal position, the basic form of the path of the jaw was maintained but could be shifted vertically. In general, larger bolus diameters were associated with lower jaw positions throughout the movement. The timing of pitch and yaw motion differed. The most common pattern involved changes in pitch angle during jaw opening followed by a phase predominated by lateral motion (yaw). Thus, in both behaviors there was evidence of independent motion in pitch, yaw, horizontal position, and vertical position. This is consistent with the idea that motions in these degrees of freedom are independently controlled.     

Variability and stability in cognitive abilities are largely genetic later in life

Radiographic cephalometry has been used for the assessment of the effects of mandibular rotation and of posterior growth displacement of the temporomandibular joint on the development of the face and on overjet in 43 patients with complete unilateral cleft lip and palate between the ages of 10 and 15 years. Rotation acted mainly on vertical facial measurements and on the position of the lower jaw. The degree of posterior displacement of the temporomandibular joint exerted an influence on the position of the mandible, on the difference between the functional length of the upper and lower jaw, and on the occlusion of incisors. The direction of growth of the mandible as a whole represented the result of a combination of changes produced by the rotation of the jaw and by the degree of posterior displacement of the temporomandibular joint. The most favourable conditions for development were a combination of the neutral type of rotation with a more pronounced posterior displacement of the temporomandibular joint.     

Control of human jaw elevator muscle activity during simulated chewing with varying bolus size

During chewing, a small part of the observed muscle activity is needed for the basic open-close movements of the mandible, and additional muscle activity (AMA) is needed to overcome the resistance of the food. The AMA consists of two contributions: a large peripherally induced contribution, starting after food contact and a small anticipating contribution, starting before food contact. We investigated whether the latencies of these contributions depend on the expected or actual bolus size. Subjects made rhythmic open-close movements near their natural chewing frequency controlled by a metronome. This frequency was determined while the subjects were chewing gum. Food resistance was simulated by an external force, acting on the jaw in a downward direction during part of the closing movement. Bolus size was simulated by the jaw gape at which the force started. Jaw movement and surface EMG of the masseter and anterior temporal muscles on both sides and the suprahyoid muscles were recorded during experiments in which the jaw gape at which the force started was varied. The peripherally induced contribution to the AMA started about 20 ms after the onset of the force, irrespective of the jaw gape at which the force started. It is concluded that the onset of this contribution depends solely on food contact in the actual cycle. The function of the observed mechanism for jaw elevator muscle control may be to enable a highly automatic control of the muscle activity required to overcome the resistance of food of different hardness and different size. The onset of the anticipating contribution to the AMA showed neither a relationship with the actual jaw gape at which force onset occurred nor with the expected jaw gape of force onset. It is suggested that the onset of the anticipating AMA is related to the jaw gape at the onset of closing. The function of this contribution may be the regulation of the mechanical response of the jaw after an expected disturbance of the closing movement by food contact, by tuning the muscle stiffness to the expected hardness of the food.     

The effect of immediate dentures on maxillomandibular relations

Immediate mandibular and maxillary dentures were made for six patients to determine the relative changes in the vertical dimension of occlusion and rest position over a 3-month test period. The dentures were mounted on the articular in centric occlusion (habitual). Pilkington-Turner anatomic teeth were used on the maxillary denture, which was set against a flat, noninterfering acrylic resin occlusion rim instead of mandibular posterior teeth. Positional cephalometric measurements in centric occlusion and rest position were made before extraction and at 1-week, 1-month, 2-month, and 3-month intervals. The dentures were relined after 2 months. The results were as follows: 1. In the centric occlusion position the mandible moved forward after 1 week and remained forward for the 3-month test period. 2. The rest position showed no significant change in the anteroposterior position of the mandible with time. 3. The vertical dimension of occlusion and rest showed a gradual decrease over the entire test period. 4. The reline procedure did not affect the trend of the dimensional changes. 5. A noninterfering occlusal scheme is advantageous for immediate dentures.     

Combination drug therapy in hypertension: a rational approach for the pharmacist

Knowledge of precise head kinematics during whiplash trauma is important for identifying possible injury mechanisms and their prevention. This study reports a comprehensive data set describing head kinematic response to horizontal accelerations simulating whiplash. Seven isolated fresh human cervical spine specimens (C0 to T1 or C7), each carrying a surrogate head designed to represent a 50th percentile human head, were mounted on the sled and subjected to incremental trauma by horizontal sled accelerations of 2.5, 4.5, 6.5, 8.5, and 10.5 g. Sled and head kinematics were measured with potentiometers and accelerometers. The incremental sled accelerations resulted in average (standard deviations) sled velocity changes (delta V) ranging from 5.8 (0.2) to 15.8 (0.2) km/h. Generally, all the peak head kinematic parameters increased with increasing sled acceleration, except for the peak head angular displacement, which decreased. In the initial phase of a whiplash trauma, the head translated posteriorly with respect to T1, without rotation. In the later phase, the head rotated backwards, but much less than its physiological limit. Maximum head rotation of 31.5 (23.9) degrees occurred in a 2.5 g trauma class, and this was less than the maximum physiological head extension of 55.1 (13.3) degrees. Head kinematics expressed in the T1 or shoulder coordinate system is better suited to study potential neck injury in whiplash.     

Patterns of jaw reflexes induced by incisal and molar pressure stimulation in relation to background levels of jaw-clenching force in humans

Patterns of jaw reflexes induced by periodontal stimulation were examined in ten adults. Surface electromyograms (EMGs) from the masseter and anterior temporal muscles were recorded when pressure stimulation was applied to either an incisor or a molar. Reflex responses to periodontal pressure stimulation varied, depending on the background levels of jaw-clenching force that preceded stimulation (background clenching force, BCF). At low BCF, excitatory reflexes were elicited from the jaw-closing muscles and jaw-clenching force. However, the magnitude of excitatory reflexes varied with the location of the stimulated tooth along the dentition. While excitatory reflexes were induced equally in the masseter and temporal muscles during incisal stimulation, stronger excitatory reflexes were induced in the temporal muscle than in the masseter muscle during molar stimulation. At high BCF, inhibitory reflexes in the jaw-closing muscles and jaw-clenching force were elicited in eight subjects (group A) during periodontal stimulation. However, excitatory reflexes in the muscles and force were elicited in the remaining two subjects (group B). In the subjects of group A, stronger inhibitory reflexes were elicited in the temporal muscle than in the masseter muscle, and jaw-clenching force also decreased during both incisal and molar stimulation. In the subjects of group B, the magnitude of excitatory reflexes decreased with increases in BCF.     

Position of the mental foramen in adult black Zimbabwean mandibles: a clinical anatomical study

OBJECTIVE: To provide some anatomical information on the shape, size, and position of the mental foramen among Black Zimbabweans that could be used as reference material by dental and other health practitioners during clinical practice in Zimbabwe. DESIGN: Cross sectional anatomical study. SETTING: Department of Anatomy, Faculty of Medicine, University of Zimbabwe, Mount Pleasant, Harare, Zimbabwe. SUBJECTS: 32 mandibles derived from adult Black Zimbabweans. MAIN OUTCOME MEASURES: The shape of the mental foramen, its relation to the lower teeth and its position in relation to the mandibular symphysis, the posterior border of the ramus of the mandible, the lower border of the mandible, and the alveolar margin. RESULTS: The shape of the mental foramen was round in 14 out of 32 mandibles (43.8%) and was oval in the remaining 18 (56.3%). The percentage of occurrence of the mental foramen was highest below the lower second premolar tooth on the right side (position 4) and posterior to it on the left side (position 5). In the vertical plane, the mental foramen lay slightly below the midpoint of the distance between the lower border of the mandible and the alveolar margin (44.1% and 45.5% for the right and left sides respectively). In the horizontal plane, it lay approximately one quarter (27.3% for the right and 27.4% for the left sides) of the distance from the mandibular symphysis to the posterior border of the ramus of the mandible. CONCLUSION: The percentage distribution of the mental foremen in relation to the lower teeth in the adult Black Zimbabwean mandible was at variance with that of other population groups. However, the quantitative position of the mental foremen was bilaterally symmetrical in the adult Black Zimbabwean mandible. The latter observation is of clinical significance to dental and other health practitioners in Zimbabwe with regards to the achievement of effective mental nerve block anaesthesia and the prevention of damage to the mental nerve during surgical procedures on the lower jaw.     

Quantitative and somatotopic mapping of neurones in the trigeminal mesencephalic nucleus and ganglion innervating teeth in monkey and baboon

Neurones of the trigeminal mesencephalic nucleus (Mes V) and ganglion innervating the periodontium of incisor, canine and molar teeth in 10 monkeys and 10 baboons were counted and mapped using the horseradish peroxidase (Hrp), retrograde axonal transport method. Periodontal afferent neurones of all these teeth were well represented in the Mes V, although the incisors had a significantly higher number of labelled neurones than the canines or molars. The primary cell bodies of the periodontal afferents were located mainly in the caudal part of the ipsilateral Mes V from the level of the inferior colliculus to the floor of the fourth ventricle in the pons. The caudal periodontal Mes V neurones may be favourably located to make collateral connections with the trigeminal motor nucleus for jaw reflexes. Incisors and canines had a large and predominantly ipsilateral representation of Hrp-labelled neurones in the ganglion. In contrast, molar representation in the ganglion was sparse and all labelled neurones supplied ipsilateral teeth. The maxillary and mandibular teeth had a somatotopic distribution within the respective maxillary (middle) and mandibular (posterolateral) compartments of the trigeminal ganglion. It is suggested that the anterior teeth with greater connections to the Mes V and the ganglion may impart greater sensory perception and be involved in jaw reflexes to ensure a good occlusal relation during mastication, while the afferent connections of the molars may initiate complex jaw reflexes during the occlusal phase of mastication.     

Electrical study of jaw and orbicularis oculi reflexes after trigeminal nerve surgery

Trigeminal nerve ophthalmic and motor division function was assessed clinically and electrically in 32 patients who had undergone various surgical procedures for trigeminal neuralgia. Using known electrophysiological techniques, the orbicularis oculi and jaw reflexes were tested in all subjects. Abnormalities of the orbicularis oculi reflex were anticipated on the basis of ophthalmic division anaesthesia. However, jaw reflex abnormalities appeared in operated cases with no clinical or electromyographic evidence of masseter denervation. These results were unexpected, and imply that the proprioceptive fibres of the jaw reflex are mediated by a sensory and not a motor root as previously believed.     

Reconstruction of the jaw and oral cavity with free vascularized grafts

59 microvascular graft transfers performed in 50 patients in our department since 1985 have been studied retrospectively. The indications for microvascular reconstruction were sequelae after tumour surgery in 38 patients, gunshot injury in seven, chronic osteomyelitis of the mandible in three, complication after jaw fracture in one patient, and atrophy of the alveolar ridge also in one patient. Transplants from the iliac crest, fibula, radius, radial forearm skin and jejunum were used. Three transplants were lost because of arterial thrombosis, giving a success rate of 94.9%. Complications were registered in 19 cases, the largest group being wound infections. 21 of the 50 patients have been treated with dental implants for total rehabilitation of masticatory function. Transfer of free vascularized bone and soft tissue grafts has greatly improved the functional and cosmetic results obtained in reconstructive surgery of the orofacial region.     

Mandibular forces during simulated tooth clenching

Differential, functional loading of the mandibular condyles has been suggested by several human morphologic studies and by animal strain experiments. To describe articular loading and the simultaneous forces on the dental arch, static bites on a three-dimensional finite element model of the human mandible were simulated. Five clenching tasks were modeled: in the intercuspal position; during left lateral group effort; during left lateral group effort with balancing contact; during incisal clenching; and during right molar clenching. The model's predictions confirmed that the human mandibular condyles are load-bearing, with greater force magnitudes being transmitted bilaterally during intercuspal and incisal clenching, as well as through the balancing-side articulation during unilateral biting. Differential condylar loading depended on the clenching task. Whereas higher forces were found on the lateral and lateroposterior regions of the condyles during intercuspal clenching, the model predicted higher loads on the medial condylar regions during incisal clenching. The inclusion of a balancing-side occlusal contact seemed to decrease the forces on the balancing-side condyle. Whereas the predicted occlusal reaction forces confirmed the lever action of the mandible, the simulated force gradients along the tooth row suggest a complex bending behavior of the jaw.     

Relationship between autoregressive model coefficients of EMG and its potentials of jaw closing muscles at rest position and clenching

At rest position and varied clenching levels at intercuspal position, autoregressive (AR) models of myoelectrical activities of both masseter and anterior temporal muscles of 11 healthy subjects with intact natural dentitions were established. The relationship between the AR model coefficients of surface EMGs and their potentials was analyzed by multiple linear regression. It was found that the fourth order coefficient of AR had the greatest effect on the EMG potential levels and their relationship was positive in all recorded muscles. The results indicate the AR coefficients may become a characteristic parameter to describe myoelectrical activity of jaw closing muscles.     

Treatment of Class II, Division 2 in the late growth period

The "Deckbiss" with skeletal Class II jaw relationship sometimes presents a considerable therapeutic problem, particularly in the late growth period (DP3U), as regards the coordination of dental and skeletal treatment objectives. An effective treatment approach was demonstrated: a modified Herbst appliance used simultaneously with fixed appliances in the maxilla. The sample comprised 12 male (14.0 +/- 0.9 years old) and 10 female (12.3 +/- 0.4 years old) patients. Correction of the distal occlusion was achieved in all patients by means of the Herbst appliance, which was removed after an average time period of 6.4 +/- 0.2 months. In the mandible the multibracket appliances were then immediately inserted, and Class II elastics were used for retention. Maximum anchorage was required in the maxilla as well as in the mandible. Complete diagnostic records were made at the beginning of the treatment as well as 6 and 12 months later, in order to document skeletal and dental changes. A dental and skeletal Class I relationship was achieved in all cases. A significant improvement was recorded in the vertical jaw base relationship; this was still stable after a period of 12 months. In the dental area in particular, a so-called high-pull headgear effect (intrusion and distalization 16, 26) and intrusion of teeth 34, 44 were registered. Only a minor protrusion of the mandibular incisors was observed. Reinforcement of the bands reduced the failure rate significantly. The Herbst appliance does not represent a standard treatment for Class II. Its indication range is limited.     

A method of studying adaptive changes of the oropharynx to variation in mandibular position in patients with obstructive sleep apnoea

The aim of this study was to develop a method of studying the effects of mandibular advancement on oropharyngeal airway dimensions in the sagittal plane in conscious, supine patients. Six white, dentate, male patients with proven obstructive sleep apnoea had sagittal fluoroscopic recordings taken in the resting supine position. Images were recorded at four frames per second as the mandible was advanced with the teeth in contact to maximum protrusion and then opened. Software in the fluoroscopic imaging system permitted measurement of the change in mandibular position together with oropharyngeal airway dimensions expressed as the narrowest dimension observable in the post-palatal and post-lingual sites. Plotting of airway dimensions during mandibular advancement enabled estimation of the degree of protrusion associated with maximal airway benefits. Progressive mandibular advancement produced variable adaptive changes in the post-palatal and post-lingual regions of the oropharynx. The amount of airway opening appeared to be related to the horizontal and vertical relationships of the face and to the dimensions of the soft palate. The changes in post-palatal and post-lingual airway dimensions were not always identical, despite the observation that both tongue and soft palate were seen to move in unison, with close contact being maintained between the two structures. Jaw opening resulted in synchronous posterior movement of both tongue and soft palate, with consequent narrowing of oropharyngeal airspace. Fluoroscopy is a simple method of assessing upper airway changes with mandibular advancement in the conscious patient. The technique should facilitate the selection of subjects for whom mandibular advancement would seem advantageous. The nature of the adaptive response is dependent on individual structural variation. It is suggested that, where artificial mandibular advancement with dental devices is considered beneficial, jaw opening should be kept to a minimum.     

Longitudinal evaluation of growth changes in Class II division 1 subjects

Longitudinal records from the Ohio State University Growth Study were used to compare the skeletal growth changes between Class II division 1 and Class I female subjects between ages 7 and 14. Tensor analysis was used to determine the yearly growth rate and direction. No significant difference was found in cranial base dimension between the Class I and Class II subjects. In Class II subjects, the maxilla (S-N-A) was found to be normally related to the cranial base. However, mandibular position (S-N-B and S-N-Pog) was found to be significantly more retrusive in Class II when compared with Class I subjects. Mandibular length (Ar-Gn) and corpus length (Go-Gn) were found to be shorter in Class II subjects. The ratio of PFH to AFH was found to be smaller in Class II subjects. This is particularly apparent during the pubertal growth period. The y-axis and mandibular plane angle were more open in Class II subjects which also contributed to the retrusive position of the mandible. Maxillo-mandibular difference (A-N-B) between Class I and II subjects was present at age 7 and persisted through puberty, maintaining a greater angle of convexity (A-N-Pg) in Class II subjects. These results suggest that Class II malocclusion can be detected early. The majority of the Class II cases showed mandibular skeletal retrusion or a combination of horizontal and vertical abnormalities of the mandible rather than maxillary protrusion. These skeletal differences remain through puberty without orthodontic intervention. Individual variations were found within each type of malocclusion.     

Effect of jaw opening on the direction and magnitude of human incisal bite forces

The maximum bite force (MBF) appears to be different when measured at different jaw openings (e.g., Manns et al., 1979; Mackenna and Turker, 1983; Lindauer et al., 1993). However, the change could be related to a change in the bite direction. We have measured the MBF on incisors and its direction in three dimensions for different jaw openings in ten subjects. Surface electromyography (EMG) of anterior temporalis and masseter muscles on both sides was recorded simultaneously. The results showed that: (1) the average %MBF increased as the jaw was opened, reached a plateau between 14 and 28 mm of incisal separation, and then decreased at wider jaw openings; (2) the initial forward bite direction with respect to the mandibular occlusal plane shifted backwards during jaw opening; and (3) the activity of the masseter muscles declined and that of the temporalis muscles was largely unchanged, resulting in an increase of the ratio between the activity in temporalis and masseter muscles (T/M). There was a significant correlation between bite direction and jaw opening (r = 0.51, p < 0.001) and between T/M ratio and jaw opening (r = 0.56, p < 0.001). Based on comparative data, we have calculated sarcomere lengths while the jaw is opened and hypothesize that the average %MBF reaches its maximum when the sarcomeres in the masseter muscle achieve their optimum length. A plateau continues during further jaw opening, until those of temporalis reach their optimum length while those of masseter lengthen beyond their optimum length. The change in bite direction was attributed to either a change in the relation between upper and lower bite points as the jaw was opened or the gradual decline of masseter activity at larger openings.     

A novel stretch receptor in the jaw of the rat

We report here an unusual type of stretch receptor found on each side of the rat jaw. This receptor has unique morphological features: it is quite long (24-28 mm), lies in connective tissue in between masticatory muscles, and extends between the medial pterygoid muscle-tendon on the maxilla and the masseter-tendon on the mandible through a zigzag course, forming a Greek capital letter sigma when viewed from the side. The receptor is neither in parallel nor in series with any masticatory muscles and receives multiple innervation. The receptor increases its length when the jaw closes and shortens when the jaw opens. Electron microscopy revealed axial structures composed of a central cellular core surrounded by tightly packed collagen bundles which are separated from the capsule by a wide capsular space. Most of the sensory endings are found among axial collagen bundles, some in between core cells. The core cells have many finger-like processes on their surface, being coupled by desmosomes. The origin and nature of these cells are unclear. The wide capsular space is filled with Alcian blue positive substrate, probably acid glycosaminoglycans. The structures of outer and inner capsules are similar to those of muscle spindles, the former being composed of three to ten layers of thin flattened cells. The response of the receptor was examined with in vivo as well as in vitro preparations. In in vivo experiments, impulse discharges from this receptor increased with the increase in jaw closing. When the jaw was fully opened the impulse discharge from this receptor disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cholesterol 7 alpha-hydroxylase activity in hypothyroidism and hyperthyroidism in humans

The effects of three root-end filling materials on healing following endodontic surgery were assessed radiologically and correlated with histological findings reported elsewhere. The materials compared were a light-cured glass ionomer cement (Vitrebond), a reinforced zinc oxide-eugenol cement (Kalzinol) and amalgam. The root canals of 27 two-rooted mandibular premolar teeth of six beagle dogs were inoculated with endodontic pathogenic bacteria to induce periradicular lesions. The roots were apicected and root-end cavities filled with the tested filling materials. The teeth and surrounding jaw were removed after 4 weeks (30 roots) or 8 weeks (24 roots). Radiographs were taken of each jaw section and subjected to image analysis. Healing was evaluated based on measurements of the size of the periradicular radiolucent areas. ANOVA disclosed no statistically significant differences in the size of the periradicular areas either between time periods or between materials. These results did not correlate with the tissue responses in the same material as assessed histologically and previously reported. The use of radiographs alone to assess healing after endodontic surgery in the dog mandible is unsatisfactory, and should not be regarded as a substitute for histological examination for the determination of healing.