Intercontinentaljournalofmedicineandmedicalscience Vol. 1(1), pp.

01-08, 20 October, 2012

Available online at http://www.intercontinentalresearchjournals.org/IJMMS.htm

Full Length Research Paper

EMG ACTIVITY OF THE MASSETER AND TEMPORAL

MUSCLES IN CHILDREN WITH MALOCCLUSION CLASS II
AND III
Marcio Guimarães dos Santos1. Diego Galace de Freitas2, Adilson Apolinário3, Fabio Navarro
Cyrillo3, Paulo Garcia Roberto Lucareli4, Thiago Yukio Fukuda2.
1
Irmandade da Santa Casa de Misericórdia de Diadema – Quarteirão da Saúde (ISCMD-QS), Diadema, São
Paulo, Brazil.
2
Irmandade da Santa Casa de Misericórdia de São Paulo (ISCMSP), Department of Physical Therapy, São
Paulo, São Paulo, Brazil.
3
Centro Universitário São Camilo, Physical Therapy Sector (CUSC), São Paulo, Brazil.
4
Universidade Nove de Julho – (UNINOVE), Department of Physical Therapy, São Paulo (SP), Brasil.

ACCEPTED 20 August 2012

Introduction: Changes in facial muscle activity are very common findings in subjects with
temporomandibular disorders, especially when associated with malocclusions classes II and III. The
purpose of this study was to determine the root mean square (RMS) value of the EMG signal of the
masseter and temporal muscles in children with normal occlusion, malocclusion classes II and III, as
well as a possible clinical application for this parameter. Methods: We selected 44 children between 7
and 11 years of age, of both genders, with a diagnosis of normal occlusion and malocclusion classes II
and III. Analyses were performed by quantitative EMG of the masseter and temporal at rest, during
maximum bite (MB) conditions, and including the relationship between the RMS at rest and MB.
Results: Our results demonstrated that children with class III malocclusion have abnormal masticatory
muscle function when compared to normal occlusion. We found a hyperactivity of the masseter muscle
in malocclusion class III at rest (increase RMS mean values, p<0.05) and decreased activity in MB
(decreased RMS mean values, p<0.05) when compared to normal occlusion. These findings were
corroborated by the relationship of MB/rest. There was no difference between the normal occlusion and
class II malocclusion for the masseter, as well as the temporal muscle. Conclusion: We conclude that
the masseter has hyperactivity at rest and decreased strength in MB, which would imply a functional
deficit.

Key words: Facial muscles, Dental occlusion, Electromyography,

INTRODUCTION

There have been a high incidence of

temporomandibular disorders (TMD) and they are

characterized by intrinsic and extrinsic changes in the
Corresponding e-mail: mguimaraes7@yahoo.com.br temporomandibular joint which can lead to functional
disorders in the facial muscles. The masseter and
temporal muscles are the most affected (Ali et al, 2003).
The temporal muscle performs the elevation of the
jaw and participates in the closing phase of the
masticatory cycle, acting as a mandibular stabilizer
(Ringqvist, 1974). The masseter muscle provides the
force necessary for proper mastication and is important
for the occlusion movement at rest and during function
(Dupont et al, 2009). Significant decrease in their
activities can be observed in previous studies with TMD
subjects (Vecchione et al, 2007; Santana-Mora et al,
2008).
Edward Angle, in 1907 described different types of
occlusion, taking into account the sagittal plane. This
classification is based on the antero-posterior
displacement of the dental arches of the jaw in relation to
the maxilla, allowing the characterization of different
occlusions. The normal sagittal relationship is shown
between both dental arches, i.e., the normal occlusion is
indicated with the term class I. A dorsal position of the
mandibular dental arch in relationship to the maxilla is
specified as a class II malocclusion. An opposite situation
with the inferior dental arch positioned ventrally to the
superior, is characterized by a previous position of the
mandibular arch in relationship to the maxillary arch,
known as class III malocclusion (Angle, 1907).
Different methodologies have been used for the
diagnosis and measurement of the TMD including:
strength sensors in order to measure the isometric
contraction of facial muscles, pressure applied to the lips
(Lapatki et al, 2002; Castroflorio et al, 2006), studies
using computorized tomography (Chan et al, 2008),
three-dimensional analysis (Tardieu et al, 2009), and
even electrical stimulation to assess the reflex response
(Andersen et al, 2008). However, the most employed
device in scientific studies is the surface
electromyography (EMG) (Bergamini et al, 2008;
Piancino et al, 2008). It consists of the graphic recording
of the myoelectric signal and represents an important tool
for quantifying muscle activity, both at rest and during
contraction (Fridlund et al, 1986).
After receiving the EMG signal, the RMS (root mean
square) value has often been chosen for measurement
because it provides a better analysis of the levels of
physiological activity of the motor unit during contraction.
With respect to muscle activity, the RMS is an intrinsic
parameter of the EMG signal which shows a linear
relationship with the contraction force of the masseter
and anterior temporal muscles (Buxbaum et al, 1996;
Wang et al, 2000).
Thus, the purpose of this study was to determine the
RMS value of the EMG signal of the masseter and
temporal muscles in children with normal occlusion,
malocclusion classes II and III, while seeking a possible
clinical application for this parameter.
METHODOLOGY
According to the Human Research Ethics Committee
regulations of UMC (003/2003), the subjects and their
parents were fully informed regarding the procedures to
be conducted. Thus, the parents signed the consent
agreement before the beginning of tests.
Forty-four children between 7 and 11 years of age of
both genders were included with diagnoses of normal
occlusion (n=17, 6 males and 11 females, mean age of
10±1,2 years), malocclusion class II (n=14, 6 males and 8
females, 10±1,6 years) and malocclusion class III (n=13,
6 males and 7 females, 8±1,3 years), taking into account
their availability to participate in this study.
The diagnoses and types of occlusions were
provided by a single specialized dentist with sixteen
years of experience in orthodontics. The specific
procedures were intra-oral clinical evaluation, dental
models, and X-rays to visualize the relationship between
the teeth, maxillaries and temporomandibular joints. We
excluded patients who had used any medication or
orthodontic devices that could influence normal muscle
activity and patients with crossbite. Normal occlusion was
considered the normal antero-posterior relationship
between the two dental arches; class II malocclusion was
considered a dorsal position of the mandibular dental
arch in relationship to the maxilla, whereas a ventral
position was considered class III malocclusion (Angle,
1907).
INSTRUMENTATION
The acquisition and processing of the masseter and
temporal muscles myoelectric signal were performed with
a six-channel EMG system, a 3-way shielded cable,
Ag/AgCl surface electrodes, and an isolator transformer
specific for medical purposes (Isobox 600, Toroid-Brazil),
which isolates the device from the power line (Fukuda et
al, 2008).
Each channel of the amplifier displayed certain
characteristics such as: an on/off switch, off-set
adjustment, adjustable gains varying from 1.000 and
50.000-fold, a differential input, and a BNC type output.
The amplifying circuit had a high common rejection rate
(CMRR) of 106 dB at 60Hz and high input impedance of
10
10 MΩ. The amplifier input impedance, CMRR and
maximum peak-to-peak noise were, respectively 10MΩ,
48 dB (at 150 Hz) and 1µV. The bandwidth was adjusted
through a high pass filter of 8 Hz, a 60 Hz notch filter, and
a low pass filter of 10 kHz to minimize interference of low
frequency noise that originates from unwanted movement
of the cables and electrodes, and high frequency noise
that originates from several sources (bandwidth ranging
 Table 1: Mean (±SD) of the RMS value to the masseter and temporal muscles in the rest condition (RMSR) for the normal occlusion (class
I), malocclusion class II and class III

Masseter (µV) Temporal (µV)

Right Left Right Left

Class I 2.2 (±0.8) 2.1 (±0.8) 2.5 (±1.0) 2.5 (±1.0)

Class II 2.6 (±0.9) 2.6 (±0.8) 2.8 (±1.2) 3.0 (±1.1)
Class III 2.8 (±0.9) 2.9 (±0.8) 2.8 (±1.1) 2.8 (±1.1)

Table 2: Mean (±SD) of the RMS value to the masseter and temporal muscles in the maximal bite condition (RMSMB) for the normal occlusion
(class I), malocclusion class II and class III

Masseter (µV) Temporal (µV)

Right Left Right Left

Class I 200.2 (±127.0) 156.4 (±102.5) 142.0 (±196.8) 113.0 (±73.1)

Class II 165.7 (±69.0) 160.0 (±65.0) 147.0 (±67.0) 127.6 (±43.0)
Class III 114.0 (±49.0) 110.2 (±61.0) 97.0 (±38.0) 109.0 (±57.3)

from 8 to 10.000 Hz). The notch filter was used to
decrease the incoming signal from the electric net.
Once the EMG signal was received, we obtained the
RMS value during a period of 15 seconds. This capture
and processing of the EMG device were applied and
validated in a previous study (Fukuda et al, 2008).
PROCEDURES
The exams were performed in the masseter and
temporal muscles of subjects with different occlusions.
The subjects were seated in a dental chair with their
heads supported and with a Frankfurt plane parallel to
the ground. The proceeding was performed in an isolated
and quiet room to provide total relaxation.
The positioning of the temporal muscle occurred with
the palpation of the anterior portion while the patient
voluntarily contracted these muscles. Soon afterwards, a
point measuring 50 mm of the tragus was marked on his
face. The first electrode was positioned 20 mm vertically
above this point and the second electrode was positioned
20 mm from the first electrode, and toward the muscle
fibers. The reference electrode was positioned in the
superior and central area of the frontal bone of the
subjects (Castroflorio et al, 2005)
The measurements of the RMS at rest (RMSR) and
maximum bite (RMSMB) were performed bilaterally on the
masseter and temporal muscles.

Initially, each subject’s facial skin was cleaned with
cotton soaked with hydrated ethyl alcohol to remove
excess oil and died skin cells. Afterwards, the electrodes
were positioned and fixed with non-allergic adhesive
tape.
The positioning of the electrodes in the masseter
muscle was determined by palpation of the zygomatic
bone and inferior angle of the jaw, with the purpose to
determine the origin of muscular insertion, as well as the
direction of the fibers. Soon afterwards, a palpation of the
muscle while in contraction was performed, identifying
the area or larger mass of the stomach muscle
(Castroflorio et al, 2005).
STATISTICAL ANALYSIS
We used the unpaired t-test for side-to-side intra-group
comparison of the RMS mean value (GraphPad statistical
program) as well as the difference between genders. The
data were submitted to a normality test (Kolmogorov-
Smirnov), since the intergroup comparisons (occlusion
class I and malocclusion class II and III) were performed
by analysis of variance (ANOVA) - Kruskal-Wallis test for
the temporal and Tukey test for the masseter muscle. For
all analyses, we considered a significance level of 95%.
RESULTS
First, we made an intra-group analysis to compare
the gender influence in the three classes for the masseter
and temporal muscles. There were no significant
differences (p>0.95). The same analysis was performed
by comparing the right and left sides at rest and the MB
condition, which also showed no difference (p>0.92).
Thus, the data were taken together for each specific
group (Table 1 and 2).
Next, comparisons were performed between groups
for the masseter and temporal muscles at rest (RMSR).
We observed a statistical difference only when comparing
class III to class I for the masseter (p<0.001), i.e.,
subjects with malocclusion class III had a higher muscle
tension at rest (Figure 1). In the MB condition, we found
a significant weakness in the masseter in class III
malocclusion in relationship to class I (p<0.05; Figure 2).
Finally, the relationship between RMSMB and RMSR
(RMSMB/RMSR) was calculated for each subject and the
same analysis was performed comparing the masseter
and temporal muscles. It was observed that the masseter
muscle showed a significant decrease for subjects with
malocclusion class III compared to class I (p<0.001;
Figure 3).
DISCUSSION
The aim of this transversal study was to show the EMG
activity of the masseter and temporal muscles
during rest, the maximum bite, and also the ratio of the
MB/rest for children 7 to 11 years old who were
diagnosed with normal occlusion (Class I) or
malocclusion (Class II and III). The results showed that
children with malocclusion class III had a hyperactivity of
the masseter muscle at rest and decreased force during
maximum bite.
The masseter and temporal muscles have been
widely investigated for their important functions, such as
during rest as well as during activity, exhibiting a strong
relationship with occlusion changes. These findings were
observed in other studies showing the importance of
these muscles to the occlusion as well as the
convenience of their superficial anatomic locations that
facilitate the capture of EMG signals using surface
electrodes (Ringqvist, 1974; Pancherz, 1980; Biasotto et
al, 2005).
In the present study, we used the RMS value for
processing the EMG signal in order to reproduce muscle
activity levels at rest and during contraction. For this
reason, it has been the most used parameter in other
scientific studies (Buxbaum et al, 1996; Wang et al, 2000;
Garcia et al, 2003).
Some authors have demonstrated increased muscle
activity by EMG in both muscles at rest and MB in
subjects with occlusion disorders compared to normal
occlusion (Nuno-Licona et al, 1993; Thilander et al,
2002). However, in the present investigation, there were
only changes to the masseter, and the RMSMB/RMSR
ratio was different in children with class III malocclusion.
The increased RMSR and decreased RMSMB in class
III children can be explained by the anatomical
positioning of the masseter muscle, which is anteriorly
directed due to its insertion in the inferior edge of the
mandibular arch. Nevertheless, we can suggest that
children with class III malocclusion present a diminished
muscle-arm lever of the masseter muscle, thus leading to
an overload in the at rest condition, thus reducing the
occlusion, and decreasing muscular activity during
maximum bite (L. Vecchione et al, 2007).
Gavião et al, in 2001 evaluated children with normal
occlusion, posterior cross bite and open bite, showing
that the normal occlusion group had a better capacity of
tablets fragmentation in relation to the other two groups.
The authors could conclude that normal occlusion is
a preponderant factor to the mastication process (Gavião
et al, 2001).
Based on our findings, it can be observed that
children with class II malocclusion did not show changes
in the mastication process when compared to normal
occlusion. However, the class III children showed
weakness of the masseter muscle during maximum bite
and this can lead to changes in the normal mastication
process.
Other authors have shown that children with the
same demographic characteristics and diagnosis of cross
bite present muscular asymmetry during MB of the
masseter and temporal (Andrade et al, 2009). However,
another study showed that children with normal occlusion
have symmetry between right and left sides (Kecik et al,
2007), justifying our choice to consider both sides as the
same group; however, the patients did not show cross-
bite.
This side-to-side relationship was also demonstrated
in a study by Piancino et al, in 2008, which evaluated
masseter and temporal muscle activity during
mastication. They observed increased activity on the
mastication side. Nevertheless, the contra-lateral side
also showed a significant increase in activity in
accordance with increased mastication (Piancino et al,
2008).
Further, we suggest that increased activity in the
contralateral side occurs in order to improve the stability
and balance of the temporomandibular joint. Thus, this
hyperactivity seems more linked with side-to-side
joint stabilization than with the malocclusion.
Another important finding in the present study is
that there was no difference with respect to gender in the
intra-group analysis. These findings can be observed in

FIGURES

Figure 1: Mean (±SD) of RMS value (µV) obtained in the rest condition (RMSR) of the masseter and temporal muscles. Asterisks (*) denote significant

difference between the two circumstances.

Figure 2: Mean (±SD) of RMS value (µV) obtained in the maximum bite condition (RMSMB) of the masseter and temporal muscles. Asterisks (*)

denote significant difference between the two circumstances.

Figure 3: Relation among RMS means (±SD) in the condition of maximum bite and rest (RMSMB/RMSR) obtained of the masseter and

temporal muscles. Asterisks (*) denote significant difference between the two circumstances.

another study that evaluated mandibular asymmetry the muscle-arm lever of the masseter and temporal
during skeletal maturation (Duthie et al, 2007). muscles (Pancherz, 1980).

Analyzing the myoelectric activity between adults and
children with normal occlusion or class II malocclusion,
Pancherz, in 1980 found differences between the groups.
The results presented in this study do not agree with our
findings, because there were not found significant
differences for children with class II malocclusion when
compared with the control group. This leads us to
conclude that a retracted jaw does not significantly alter
Another author demonstrate that changes in patients
with class II malocclusion are related initially to a high lip
line and not to a stiffness of the perioral musculature.
This may be related to findings in the present study,
where no significant difference was found during the
evaluations of patients with class II malocclusion (Lapatki
et al, 2002). Gadotti et al, in 2005 have already
demonstrated that subjects with normal occlusion (class
I) tend to have hyperactivity in the masseter muscle when
 compared to the temporal muscle. Similar findings
were also found in the present study. However, the
results demonstrate that subjects with class II
malocclusion presented a more active temporal muscle
than class I occlusion (Gadotti et al, 2005).
One limitation of this study was the lack of bite
strength measurement by load cell device to correlate
with the EMG findings. However, based on previous
studies, there is a linear relationship between the
contraction force and RMS value of the EMG signals in
the specified muscles (Wang et al, 2000; Fukuda et al
2010).
These results indicate that quantitative EMG of
masseter and temporal muscles in children of both
genders can be a diagnostic support tool to clinical
practice, especially if we consider the RMS value of these
muscles.
CONCLUSION
Based on the obtained data, we conclude that
children with Class III malocclusion showed hyperactivity
of the masseter muscle during the rest condition and a
decrease of force during maximum bite when compared
to children with normal occlusion and Class II
malocclusion. On the other hand, was not observed
difference between groups in the temporal muscle. These
findings could be confirmed by analysis of the RMS value
of the EMG signal, and for the maximum bite/rest
relationship, which enables clinical applicability of this
diagnostic tool.
ACKNOWLEDGEMENTS
The authors would like to thank the Nucleus of
Technology Research (NPT) of the Mogi das Cruzes
University (UMC).
REFERENCES
Ali M,Yamada K,Alkhamrah B,Vergara R,Hanada K.(2003).
Relationship between occlusal curvatures and mandibular
deviation in orthodontic patients with TMD. J Oral
Rehabil.30:1095-103.
Andersen OK, Svensson P, Ellrich J, Arendt-Nielsen L (1998).
Conditioning of the masseter inhibitory reflex by
homotopically applied painful heat in humans.
Electroencephalogr clin Neurophysiol. 109:508–514.
Andrade AS, Gavião MBD,Derossi M,Gameiro GH (2009).
Electromyographic activity and thickness of masticatory
muscles in children with unilateral posterior crossbite. Clin
Anat. 22:200–206.
Angle E. Treatment of malocclusion of the teeth. 7th ed.
Philadelphia: S. S. White(1907).
Bergamini M, Pierleoni F, Gizduiich A, Bergamini C (2008).
Dental Occlusion and Body Posture: A Surface EMG
Study. J Craniomandib Pract 26:25-32.
Biasotto DC, Biasotto-Gonzalez DA, Panhoca I (2005).
Correlation between the clinical phonoaudiological
assessment and electromyographic activity of the masseter
muscle. J Appl Oral Sci. 13(4):424-30.
Buxbaum J, Mylinski N, Parente FR (1996). Surface EMG
reliability using spectral analysis. J Oral Rehabil. 23:771-
75.
Castroflorio T, Farina D, Bottin A, Debernardi C, Bracco P,
Merletti R, Anastasi G, Bramanti P (2005). Non-invasive
assessment of motor unit anatomy in jaw-elevator muscles.
J Oral Rehabil. 32:708–13.
Castroflorio T, Icardi K, Becchino B, Merlo E, Debernardi C,
Bracco P, Farina D (2006). Reproducibility of surface EMG
variables in isometric sub-maximal contractions of jaw
elevator muscles. J Electromyogr Kinesiol.16:498–505.
Chan HJ, Woods M, Stella D (2008). Mandibular muscle
morphology in children with different vertical facial patterns:
A 3-dimensional computed tomography study. Am J Orthod
Dentofacial Orthop. 133:10.e1-10.e13.
DuPont JS,Brown CE.(2009). Masseter Tenomyositis. J
Craniomandib Pract.27:180-4.
Duthie J,Bharwani D,Tallents RH,Bellohusen R,Fishmand
L.(2007). A longitudinal study of normal asymmetric
mandibular growth and its relationship to skeletal
maturation. Am J Orthod Dentofacial Orthoped. 132:179-
84.
Fridlund AJ, Cacioppo JJ (1986). Guidelines for human EMG
research. Psychophysiol. 23:567-89.
Fukuda TY, Alvarez AS, Nassri LFG, Godoy CMG (2008).
Electromyography of facial muscles in cross-bite female
children. Braz J Biomed Eng. 24:121-129.
Fukuda TY, Echeimberg JO, Pompeu JE, Lucareli PRG,
Garbelotti S, Gimenes RO, Apolinário A (2010). Root Mean
Square Value of the Electromyographic Signal in the
Isometric Torque of the Quadriceps, Hamstrings and
Brachial Biceps uscles in Female Subjects. J Appl Res.
12:32-39.
Gadotti IC, Bérzin F, Biasotto-Gonzalez D (2005). Preliminary
rapport on head posture and muscle activity in subjects
with class I and II. J Oral Rehabil. 32:794–799.
Garcia-morales P, Buschang PH, Throckmorton GS (2003).
Maximum bite force, muscle efficiency and mechanical
advantage in children with vertical growth patterns. Eur J
Orthod. 25:265-72.
Gavião MB, Raymundo VG, Sobrinho LC (2001). Masticatory
efficiency in children with primrya dentition. Pediatr Dent.
23:449-505.
Kecik D, Kocadereli I, Saatci I (2007). Evaluation of the
treatment changes of functional posterior crossbite in the
mixed dentition. Am J Orthod Dentofacial Orthop. 131:202–
215.
Lapatki BG, Mager AS, Schulte-Moenting J, Jonas IE (2002).
The Importance of the Level of the Lip Line and Resting Lip
Pressure in Class II, Division 2 Malocclusion. J Dent Res.
81:323-328.
Nuno-Licona A, Cavazos E, Angeles-Medina F (1993).
Electromyographic changes resulting from orthodontic
correction of classe III malocclusion. Int J Pediatr Dent.
3:71-6.
Panchers H (1980). Activity of the temporal and masseter
muscles in classe II, division 1 malocclusion: An
electromyographic investigation. Am J Orthod. 77:679-88.
Pancherz H (1980). Temporal and masseter muscle activity in
children and adults with normal occlusion: An
electromyographic investigation. Acta Odontol Scand.
38:343-48.
Piancino MG, Bracco P, Vallelonga T, Merlo A, Farina D (2008).
Effect of bolus hardness on the chewing pattern and
activation of masticatory muscles in subjects with normal dental
occlusion. J Electromyogr Kinesiol. 18:931–937.
Ringqvist M (1974). Fiber types in human masticatory muscles:
Relation to function. Scand J Dent Res. 82(4):333-355.
Santana-Mora U, CudeiroJ, Mora-Bermúdez MJ, Rilo-Pousa B,
Ferreira-Pinho JC, Otero-Cepeda JL, Santana-Penín U
(2008). Changes in EMG activity during clenching in
chronic pain patients with unilateral temporomandibular
disorders. J Electromyogr Kinesiol. 19:543-549
Tardieu C, Dumitrescu M, Giraudeau A, Blanc JL, Cheynet F,
Borel L (2009). Dental occlusion and postural control in
adults. Neurosci Lett. 450:221–224.
Thilander B, Rubio G, Pena L, Mayorga C (2002). Prevalence of
TMD and its association with malocclusion in children and
adolescents: an epidemiologic study related to specified
stages of dental development. Angle Orthodontist. 72:146-
154.
Vecchione L, Byron c, Cooper GM, Barbano T, Hamrick MW,
Sciote JJ,Mooney MP (2007). Craniofacial Morphology in
Myostatin-deficient Mice. J Dent Res. 86:1068-1072.
Wang K, Arima T, Arendt-Nielsen L, Svenson P (2000). EMG –
Force Relationships are Influenced by Experimental Jaw –
Muscle Pain. J Oral Rehabil. 27:394-402.