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SUMMARY This study aimed to measure neuromus- effect on the per cent overlap, anterior–posterior
cular function for the masticatory muscles under a and torque coefficients (P = 0Æ0000–0Æ0024), which
range of occlusal conditions in healthy, dentate describe the degree of symmetry in these muscle
adults. Forty-one subjects conducted maximum activities. Bilateral posterior contact conditions had
voluntary clenches under nine different occlusal significantly greater symmetry in muscle activities
loading conditions encompassing bilateral posterior than anterior contact conditions. Activity in the
teeth contacts with the mandible in different posi- sternocleidomastoid, anterior digastric and trape-
tions, anterior teeth contacts and unilateral poster- zius was consistently low for all clench conditions,
ior teeth contacts. Surface electromyography was i.e. <20% of the maximum voluntary contraction
recorded bilaterally from the anterior temporalis, level. In conclusion, during maximum voluntary
superficial masseter, sternocleidomastoid, anterior clenches in a healthy population, maximum masti-
digastric and trapezius muscles. Clench condition catory muscle activity requires bilateral posterior
had a significant effect on muscle function contacts and the mandible to be in a stable centric
(P = 0Æ0000) with the maximum function obtained position, whilst with anterior teeth contacts, both
for occlusions with bilateral posterior contacts and the muscle activity and the degree of symmetry in
the mandible in a stable centric position. The muscle activity are significantly reduced.
remaining contact points and moving the mandible KEYWORDS: electromyography, masseter, temporalis,
to a protruded position, whilst keeping posterior maximum voluntary clench, jaw
contacts, resulted in significantly lower muscle
activities. Clench condition also had a significant Accepted for publication 28 March 2010
Teeth
contacts Code Summary Description
i.e. an activity of 0Æ9 indicates that the muscle was at Hz linear envelope of the signal. The values of the
90% of the global maximum value. For each maximum parameters described in 1–4 were compared between
voluntary clench, the following four sets of parameters the nine occlusal conditions using a repeated measures
were evaluated from the normalized EMG signals: ANOVA with Tukey’s HSD post hoc test and a significance
1 maximum and mean amplitude for each muscle over level of P £ 0Æ05.
the duration of the clench
2 per cent overlap coefficients (POC) for TA and MS,
Results
anterior–posterior coefficient (APC) and torque coef-
ficient (TC)
Muscle activity for different bite points and mandible positions
3 muscle onset times
4 mean EMG amplitude and the coefficients given in 2 There were no significant differences in any of the
for consecutive time windows immediately following muscle activity parameters between the initial and
onset repeated clenches onto natural dentition, indicating
The coefficients given by 2 are those described by good measurement reliability (Fig. 1).
Ferrario et al. (17–19) and were used to give a measure For clenches onto natural dentition, TA dominated
of muscle co-ordination. The coefficients are given as a over MS (0Æ83 0Æ12 versus 0Æ72 0Æ16, P = 0Æ001).
percentage, where 100% represents the right and left MS activity increased for clenches onto cotton rolls
muscles contracting with perfect symmetry and 0% (0Æ72 0Æ16 to 0Æ87 0Æ12; P < 0Æ001), leading to
perfect asymmetry for POC. Anterior–posterior coeffi- balanced TA and MS activities.
cient and TC give similar measures for total TA and MS, There was a significant reduction (P < 0Æ001) in both
and opposing TA and MS, respectively. The onset times TA (55–60%) and MS (50%) activity for clenches onto
used in 3 were obtained using the algorithm of Hodges anterior contacts such that the MS activity was
and Bui (20), which is based on an amplitude threshold relatively higher than TA activity (P £ 0Æ010). For
of the mean plus three standard deviations of the quiet clenches onto unilateral posterior tooth contacts, there
time amplitude to be exceeded for 25 ms based on a 50- was a significant reduction in contralateral TA activity
(a) (b)
(15%, P < 0Æ001), whilst ipsilateral (blade-side) TA points (bilateral posterior versus anterior versus unilat-
activity and MS activity on both sides were similar to eral posterior) indicated that POC was significantly
the natural dentition condition. Consequently, ipsilat- higher for bilateral posterior contacts compared to
eral TA activity significantly dominated MS activity anterior contacts for both TA (88Æ7 7Æ4% versus
(P = 0Æ001–0Æ002), whilst contralateral TA and MS 83Æ9 8Æ3%) and MS (83Æ9 9Æ8% versus 75Æ4
activities were approximately balanced. The trends for 11Æ7%; Table 2). The APC (Fig. 3) showed a similar
the single and triple tongue blade were similar; how- dependency on contact points with APC significantly
ever, for the triple layer, activities in both TA and MS higher for bilateral posterior contacts compared to
were consistently lower (by 5–10%). anterior contacts (87Æ5 8Æ1% versus 79Æ1 10Æ2%;
For clenches onto cotton rolls with the mandible Table 2). The TC (Fig. 3) showed lower variability
protruded, there was a significant reduction in both TA between clench conditions but was still significantly
and MS activities, by approximately 35% for TA higher for bilateral posterior contacts compared to
(P < 0Æ001) and 30% for MS (P < 0Æ001) compared to anterior contacts (91Æ7 4Æ4% versus 89Æ7 4Æ0%;
clenches onto cotton rolls with the mandible in a stable Table 2).
centric position. This reduction was greater for the TA, Per cent overlap coefficients was consistently higher
such that MS activity became relatively higher than TA for TA compared to MS, particularly for clenches onto
activity (P = 0Æ001). natural dentition, cotton rolls with the mandible
protruded and anterior contacts. The difference was
less marked for the clenches onto cotton rolls with the
Muscle co-ordination: per cent overlap, anterior–posterior
mandible centric and the unilateral tongue blades.
and torque coefficients
The cotton rolls with the mandible centric provided the
The POC (Fig. 2) varied with clench condition for both most consistent co-ordination coefficient values, i.e.
TA and MS. Pooling clench conditions based on contact the lowest group variances (Figs 2–3).
(a) (b)
Table 2. Magnitude of the per cent overlap (POC), asymmetric (AS), anterior–posterior (APC) and torque (TC) coefficients for clenches
with [1] bilateral posterior contacts, [2] anterior contacts, [3] unilateral posterior contacts and averaged over all conditions (mean s.d.)
[1] Posterior bilateral [2] Anterior [3] Posterior unilateral All clench
Coefficient (ND, NDr, CR) (LJ, TF) (TL, T3L, TR, T3R) conditions P Post hoc
POC, TA 88Æ7 7Æ4 83Æ9 8Æ3 84Æ2 10Æ0 86Æ0 8Æ9 0Æ0000 [1] > [2]
[1] > [3]
POC, MS 83Æ9 9Æ8 75Æ4 11Æ7 83Æ8 8Æ7 82Æ0 10Æ5 0Æ0000 [1] > [2]
[3] > [2]
APC 87Æ5 8Æ1 79Æ1 10Æ2 89Æ5 5Æ0 86Æ5 8Æ4 0Æ0000 [1] > [2]
[3] > [2]
TC 91Æ7 4Æ4 89Æ7 4Æ0 89Æ9 5Æ5 90Æ5 5Æ0 0Æ0024 [1] > [2]
[1] > [3]
Significant differences between the different contact conditions are indicated. TA, anterior temporalis.
(a) (b)
Activities of sternocleidomastoid, anterior digastric and Table 3. Maximum and mean activities for the sternocleidomas-
toid, anterior digastric and trapezius averaged over all maximum
trapezius were generally low (Table 3), and there were
clench conditions and left and right sides (mean s.d.)
no significant differences between occlusal conditions.
Maximum Mean
Muscle activity ()) activity ())
Discussion
Sternocleidomastoid 0Æ36 0Æ23 0Æ17 0Æ11
Neuromuscular function of the masticatory muscles Anterior digastric 0Æ27 0Æ18 0Æ11 0Æ07
was measured for maximum voluntary clenches over a Trapezius 0Æ15 0Æ10 0Æ066 0Æ045
wide range of occlusal conditions in a healthy popula-
Note that the values are normalized based on the maximum
tion. As has been previously observed (8–13, 21, 22), voluntary electromyography (EMG) amplitudes obtained from
the highest muscle activities occurred for clenches with independent trials aimed specifically at eliciting a maximum effort
bilateral posterior teeth contacts (natural dentition and in each of the muscle groups.
A notable finding was that bilateral posterior contacts voluntary clenches onto natural dentition of 0Æ14–
only resulted in the highest muscle activities when the 0Æ24; Clark et al. (23) reported values of 0Æ12–0Æ14 for
mandible was in a muscularly supported and stable the sternocleidomastoid under similar conditions; and
centric position. For clenches onto cotton rolls with the Ciuffolo et al. (24) measured sternocleidomastoid, ante-
mandible protruded, both TA and MS activities were rior digastric and trapezius for maximum voluntary
significantly reduced and, in contrast to all other clenches onto natural dentition and found significant
bilateral posterior teeth contact conditions, MS was co-activation in the sternocleidomastoid and anterior
more active than TA. This suggests geometrical feed- digastric only. It is likely that jaw depressor muscles are
back on the position of the mandible may also influence active during mastication and clenching to protect the
masticatory muscle activity. Given that masticatory teeth in the event of fracture of brittle foods (8). Their
muscles have previously been shown to have a sensi- activation is lower in clenches than mastication (25),
tive stretch reflex mechanism (5), this is unsurprising. probably because of the reduced likelihood of distur-
Values of the per cent overlap, anterior–posterior and bance if biting in intercuspation or onto robust occlusal
torque coefficients for clenches onto natural dentition appliances.
and cotton rolls were similar to those reported by The failure of the results to distinguish differences in
Ferrario et al. (18, 19) for healthy young adults under onset time between the individual muscles may not
similar conditions. Notably, the coefficients were sig- support no difference in onset time but rather the
nificantly higher for clenches on bilateral posterior limitation in the accuracy with which onset time could
contacts compared to anterior contacts, indicating that be estimated from the EMG signals. Because of this
subjects were not able to recruit muscles as symmetri- issue, muscle activity parameters and co-ordination
cally during clenches with anterior contacts. Similar coefficients immediately following onset were also
higher levels of asymmetry have been observed in evaluated and compared between occlusal conditions
individuals with temporomandibular disorders (17), in an attempt to gain a more reliable assessment of
and thus, it might be beneficial to consider changes in neuromuscular function around onset. This analysis
muscular symmetry with differing bite points when produced results very similar to those obtained by
designing occlusal devices. Interestingly, variances in considering the whole clench, which may support the
the co-ordination coefficients tended to be lowest for reliability of the data presented. However, it should be
the clenches onto cotton rolls, i.e. onto a softer occlusal noted that such an analysis includes the effects of both
surface than provided by natural dentition, indicating muscle onset time and rate of increase in muscle
that this clench condition produced the most consistent activity following onset, and thus, differences in muscle
muscle activity co-ordination patterns across the group. activity onset times cannot strictly be inferred.
To a lesser extent, this was also seen in the unilateral In summary, this study has supported the existence
tongue blade conditions. This may indicate that clench- of a number of common neuromuscular patterns for
ing onto a softer substance leads to activation patterns occlusion in a healthy population. Maximum mastica-
more representative of those employed by people in tory muscle function was obtained for occlusion with
more functional activities and support the use of bilateral posterior teeth contacts. However, maximum
clenching onto cotton rolls as the most effective masticatory muscle function also required the mandible
condition to investigate differences in neuromuscular to be in a muscularly supported and stable centric
function between different populations. position, indicating that geometrical factors, as well as
Low levels of co-activity were observed in the periodontal ligament feedback, may influence muscle
sternocleidomastoid, anterior digastric and trapezius activity. The co-ordination coefficients were signifi-
(0Æ17, 0Æ11 and 0Æ07, respectively) that were unaffected cantly higher for bilateral posterior contacts compared
by occlusal condition. Although it should be noted that to anterior contacts indicating clenches onto posterior
as these activities were low, the signal-to-noise ratios contacts resulted in more symmetric, or balanced,
may not have been sufficiently high to allow statistical muscle activity. Group variance in the co-ordination
differences between conditions to be identified. The coefficients were lowest for clenches onto cotton rolls,
co-activity values from this study are in good agree- indicating that this may be the most effective condition
ment with the literature: Ferrario et al. (18) reported to investigate differences in neuromuscular function
mean sternocleidomastoid activity for maximum between different populations.
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