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Objective: The purpose of this study was to verify the characteristics of surface electromyography (sEMG) of masticatory muscles in patients with temporomandibular disorders (TMDs) with differing pathology., Study Design: A total of 24 patients with TMDs were categorized according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD); magnetic resonance imaging (MRI) classified the patients as having disk displacement alone (DD) (mean age, 22 years; SD, 5; 3 men, 6 women) or having osteoarthrosis with or without disk displacement (OA) (mean age, 37 years; SD, 10; 4 men, 11 women); sEMG was performed according to a standardized protocol., Results: The MRI score was significantly correlated to the torque coefficient (r = 0.57) and the temporalis (r = 0.85) and masseter (r = 0.46) muscle standardized symmetry. The discriminating ability of participant age and sEMG scores in separating the 2 groups was assessed by receiver operating characteristic analysis. Each of the sEMG scores showed a significant ability in discriminating between osteoarthrosis and disk displacement., Conclusions: The recording of the masticatory muscle function through sEMG can be a first diagnostic approach to patients with TMDs, reserving MRI assessment to selected cases., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Mandibular kinematic and standardized surface electromyography (sEMG) characteristics of masticatory muscles of subjects with short lasting TMD of mild-moderate severity were examined. Volunteers were submitted to clinical examination and questionnaire of severity. Ten subjects with TMD (age 27.3years, SD 7.8) and 10 control subjects without TMD, matched by age, were selected. Mandibular movements were recorded during free maximum mouth opening and closing (O-C) and unilateral, left and right, gum chewing. sEMG of the masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position, and during gum chewing. sEMG indices were obtained. Subjects with TMD, relative to control subjects, had lower relative mandibular rotation at the end of mouth opening, larger mean number of intersection between interincisal O-C paths during mastication and smaller asymmetry between working and balancing side, with participation beyond the expected of the contralateral muscles (P<0.05, t-test). Overall, TMD subjects showed similarities with the control subjects in several kinematic parameters and the EMG indices of the static test, although some changes in the mastication were observed., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Aim: To compare the influence of occlusal versus craniofacial characteristics on the functionality of the stomatognathic apparatus., Materials and Methods: Two groups of subjects were selected: 27 patients (13 women and 14 men), 18 to 42 years old, all candidates for orthognathic surgery, 7 with prognathic syndrome and 20 with progenic syndrome; and 26 healthy young adults (13 women and 13 men) of corresponding age (control group). To verify the neuromuscular equilibrium induced by occlusion, the electromyographic activities of both right and left masseter and anterior temporal muscles were recorded and analyzed, calculating the percentage overlapping coefficient (an index of the symmetric distribution of the muscular activity determined by the occlusion) and TORS (index of the presence of mandibular torque). Data were compared with Student t-test for independent samples., Results: Between the 2 groups of patients, no statistically significant differences were found, whereas the statistical analysis showed differences between patients and control subjects (P < 0.05): overall, the control subjects had a better neuromuscular stability than the patients who were candidates for orthognathic surgery., Conclusions: The electromyographic evaluations revealed that there was a neuromuscular imbalance determined by an occlusal instability in the patients candidates for orthognathic surgery, thus indicating that occlusion plays a more important role than any possible mechanical disadvantages due to altered craniofacial morphology.

Aim: To evaluate left and right masseter and anterior temporalis muscle activity in patients before and after orthognathic surgery., Patients: Nineteen patients were enrolled, 9 males and 10 females, aged 17-34 years. Four patients were suffering from a prognathic syndrome (skeletal class II with mandibular retrusion) and were candidates for surgical correction involving a mandibular Bilateral Sagittal Split Osteotomy (BSSO), whereas the other 15 patients showed a progenic syndrome (skeletal class III with mandibular protrusion) and were selected for bimaxillary surgery with maxillary advancement and mandibular retrusion., Methods: Electromyographic examinations were carried out on all subjects presurgically and 6-8 months postoperatively. To verify the neuromuscular equilibrium, the electromyographic activities of both the right and left masseter and anterior temporalis muscles were registered and analysed calculating: percentage overlapping coefficient (POC, index of the symmetric distribution of the muscular activity determined by the occlusion) and torque coefficient (TC, index of presence of mandibular torque)., Results: After surgery, a trend in the improvement of POC and TC indices was found, with a reduced intragroup variability., Conclusion: The electromyographic evaluation allowed the impact of occlusion on neuromuscular equilibrium to be quantified, and showed that improvements gained by surgical intervention are primarily due to better occlusal stability and not to biomechanical advantages.

Objective: To assess rotation and translation movements of the mandible at maximum mouth opening in a group of patients successfully rehabilitated after condylar fractures., Materials and Methods: Using a three-dimensional motion analyser, free movements of mouth opening were recorded in nine patients, and divided into their rotation and gliding components. Surface electromyography (EMG) of the masticatory and sternocleidomastoid (SCM) muscles was performed during maximum voluntary teeth clenching (MVC). Data were compared with those collected in healthy adults., Results: At maximum mouth opening, the total displacement of the mandibular interincisor point was 86% of reference value (p>0.05, Student's t test), with a reduced vertical displacement (84% of reference value, p=0.012). Percentage mandibular rotation was significantly larger in patients (82%) than in reference subjects (77%, p=0.005). During MVC, patients had more asymmetric EMG potentials (p=0.018), with greater mandibular torque (p<0.001), and reduced co-contraction of SCM (p=0.003). EMG indices were used to formulate an overall performance score that was related to the characteristics of mouth opening (r=0.557)., Conclusion: Notwithstanding a good recovery in the total mandibular movement, the rotation/translation components of mouth opening were modified. The overall EMG performance score could be used to predict the characteristics of mandibular motion.

This study evaluated the electromyographic characteristics of masticatory and neck muscles in subjects with vestibular lesions. Surface electromyography of the masseter, temporalis and sternocleidomastoid muscles was performed in 19 patients with Ménière's disease, 12 patients with an acute peripheral vestibular lesion, and 19 control subjects matched for sex and age. During maximum voluntary clenching, patients with peripheral vestibular lesions had the highest co-contraction of the sternocleidomastoid muscle (analysis of covariance, p=0.02), the control subjects had the smallest values, and the patients with Ménière's disease had intermediate values. The control subjects had larger standardized muscle activities than the other patient groups (p=0.001). In conclusion, during maximum voluntary tooth clenching, patients with vestibular alterations have both more active neck muscles, and less active masticatory muscles than normal controls. Results underline the importance of a more inclusive craniocervical assessment of patients with vestibular lesions.

Objectives: To compare the electromyographic (EMG) characteristics of masticatory and neck muscles in patients with natural dentition, teeth-supported prostheses and implant-supported prostheses., Materials and Methods: Twenty-five subjects aged 40-80 years were examined. Five patients had maxillary and mandibular implant-supported fixed prostheses; five patients had mandibular implant-supported fixed prosthesis and maxillary removable complete denture; seven patients had implant-supported fixed prosthesis (one arch) and natural dentition or full-arch tooth-fixed prosthesis (one arch); and eight control subjects had natural dentition or single tooth-fixed prostheses. Surface EMG of masseter, temporal and sternocleidomastoid muscles was performed during maximum teeth clenching and unilateral gum chewing. Interarch dental contacts were assessed with shim stocks., Results: All groups had similar interarch dental contacts (P>0.05). During clenching, patients with maxillary and mandibular implant-supported fixed prostheses had unbalanced standardized masseter and temporalis anterior activities (74%), with significantly larger values found in the other patients and control subjects (all mean values larger than 86%, P=0.017). All patients chewed with significantly larger muscular potentials than control subjects (on average, 1434-2100 microV s vs. 980 microV s, P=0.04), and had altered muscular patterns (left side, P=0.021). The patients with one arch with natural dentition/tooth fixed prostheses had chewing muscular patterns similar to the control subjects., Conclusions: Clenching with the analyzed prostheses was performed with a relative increment of temporalis activity. Neuromuscular coordination during chewing was larger in patients who maintained their teeth or dental roots, independently from the number of dental contacts.

The research diagnostic criteria for temporomandibular disorders (RDC/TMD) are used for the classification of patients with temporomandibular disorders (TMD). Surface electromyography of the right and left masseter and temporalis muscles was performed during maximum teeth clenching in 103 TMD patients subdivided according to the RDC/TMD into 3 non-overlapping groups: (a) 25 myogenous; (b) 61 arthrogenous; and (c) 17 psycogenous patients. Thirty-two control subjects matched for sex and age were also measured. During clenching, standardized total muscle activities (electromyographic potentials over time) significantly differed: 131.7 microV/muVs % in the normal subjects, 117.6 microV/microVs % in the myogenous patients, 105.3 microV/microVs % in the arthrogenous patients, 88.7 microV/microVs % in the psycogenous patients (p<0.001, analysis of covariance). Symmetry in the temporalis muscles was larger in normal subjects (86.3%) and in myogenous patients (84.9%) than in arthrogenous (82.7%), and psycogenous patients (80.5%) (p=0.041). No differences were found for masseter muscle symmetry and torque coefficient (p>0.05). Surface electromyography of the masticatory muscles allowed an objective discrimination among different RDC/TMD subgroups. This evaluation could assist conventional clinical assessments.

Objectives: To compare the electromyographic (EMG) characteristics of masticatory muscles in patients with fixed implant-supported prostheses and implant overdentures., Material and Methods: Nineteen subjects aged 45-79 years were examined. Fourteen were edentulous and had been successfully rehabilitated with (a) maxillary and mandibular implant-supported fixed prostheses (seven patients); (b) mandibular implant overdentures and maxillary complete dentures (seven patients). Five control subjects had natural dentition or single/partial (no more than two teeth) tooth or implant fixed dentures. Surface EMG of the masseter and temporal muscles was performed during unilateral gum chewing and during maximum teeth clenching. To reduce biological and instrumental noise, all values were standardized as percentage of a maximum clenching on cotton rolls., Results: During clenching, temporal muscle symmetry was larger in control subjects and fixed implant-supported prosthesis patients than in overdenture patients (analysis of variance, P=0.005). No differences were found in masseter muscle symmetry or in muscular torque. Muscle activities (integrated areas of the EMG potentials over time) were significantly larger in control subjects than in implant-supported prosthesis patients (P=0.014). In both patient groups, a poor neuromuscular coordination during chewing, with altered muscular patterns, and a smaller left-right symmetry than in control subjects were found (P=0.05). No differences in masticatory frequency were found., Conclusion: Surface EMG analysis of clenching and chewing showed that fixed implant-supported prostheses and implant overdentures were functionally equivalent. Neuromuscular coordination during chewing was inferior to that found in subjects with natural dentition.

To prevent relapse after orthodontic treatment, retention is often considered indispensable. Soft tissues are thought to have a significant influence on dental movements. To quantify the influence of masticatory muscles on post-treatment relapse, and in an attempt to avoid unnecessary procedures, 2 male orthodontic patients (13 and 30 years old at debonding) were followed up. The patients completed 2 years of fixed orthodontic treatment and received no post-orthodontic retention. After 1 week and again after 6 months, alginate impressions of dental arches and a surface electromyographic (EMG) assessment of the masseter and temporalis muscles during maximum voluntary clenching were performed. The younger patient received surface EMG monitoring once a month for the first 6 months and at the 1-year follow-up appointment. Arch dimensions and the 3-dimensional inclination of the facial axis of the clinical crown (FACC) were measured using a computerized digitizer. Symmetry in muscular contraction was measured by the percentage overlapping coefficient (POC), and potential lateral displacing components were assessed by the torque coefficient (TC). At the 6-month follow-up, no clinical modifications were observed. Quantitative evaluation assessed that arch dimensions had changed slightly (up to 1 mm). While the adolescent patient had no modifications in FACC inclinations, the 30-year-old patient showed significant alterations (up to 18 degrees). In all examinations of the adolescent patient, POC was higher than 86% and TC was lower than 10%. In the adult, POC was inside the normal range, while all TCs were higher than 10.5%. The larger TC measured in the adult may explain the larger modifications in the 3-dimensional position of his dental crowns. In conclusion, a surface EMG assessment may help in the detection of patients who might need post-orthodontic retention.

Abstract: The normalized electromyographic characteristics of masticatory muscles in patients with temporomandibular joint disorders (TMD) and healthy controls were compared. Thirty TMD patients (15 men, 15 women, mean age 23years) with long lasting pain (more than 6months), and 20 control subjects matched for sex and age were examined. All patients had arthrogenous TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). Surface electromyography of masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position. Standardized EMG indices and the median power frequency were obtained, and compared between the two groups and sexes using ANOVAs. During clenching, the TMD patients had larger asymmetry in their temporalis muscles, larger temporalis activity relative to masseter, and reduced mean power frequencies than the control subjects (p <0.05, ANOVA). In both groups, the mean power frequencies of the temporalis muscles were larger than those of the masseter muscles (p <0.001). No sex related differences, and no sex×group interactions were found. In conclusion, young adult patients with long lasting TMD have an increased and more asymmetric standardized activity of their temporalis anterior muscle, and reduced mean power frequencies, relative to healthy controls. [Copyright &y& Elsevier]

The modifications induced by microgravity on the coordinated patterns of movement of the head, trunk, and limbs are reported on extensively. However, apparently there is little data on the masticatory muscles. In normal gravitational conditions, information from the neck and stomatognathic apparatus play a role in maintaining the body's balance and equilibrium. The current pilot study used normal gravity conditions to investigate the hypothesis of a functional coupling between occlusion and neck muscles and body postural oscillations. The immediate effect of modified occlusal surfaces on the contraction pattern of the stemocleidomastoid muscles during maximum voluntary clenching and on the oscillation of the center of foot pressure was analyzed in 11 male astronauts (aged 31-54 yrs). All subjects were healthy and free from pathologies of the neck and stomatognathic apparatus. Occlusal splints were prepared using impressions of their dental arches. The splints were modeled on the mandibular arch, had only posterior contacts, and were modified to obtain a more symmetric, standardized contraction of the masseter and temporalis muscles during teeth clenching. Surface EMG activity of the sternocleidomastoid muscles was recorded during a maximal voluntary clench with and without the splint. Sternocleidomastoid potentials were standardized as percent of the mean potentials recorded during a maximum contralateral rotation of the head, and the symmetry of the EMG waves of left- and right-side muscles was measured. Body sway was assessed with and without the splint, either with eyes open or closed. The variations of the center of foot pressure were analyzed through bivariate analysis, and the area of the 90% standard ellipse was computed. Within each visual condition (eyes open or closed), the difference between the areas of oscillation measured with and without the splint was computed. Muscular activity was more symmetric with the splint. The area of oscillation of the center of foot pressure was larger without the splint than with the splint, both with eyes open and eyes closed. The modifications, induced by the occlusal splint in the sternocleidomastoid muscles' symmetry, and center of foot pressure differential area with closed eyes, were significantly related (p<0.05): the larger the increment in muscular symmetry, the smaller the area of oscillation with the splint as compared to without the splint. A functionally more symmetric maxillo-mandibular position resulted in a more symmetric sternocleidomastoid muscle contraction pattern and less body sway. Modifications in the contraction of the masticatory muscles may therefore affect the whole body. [ABSTRACT FROM AUTHOR]

Abstract: This study examined whether there is an association between surface electromyography (EMG) of masticatory muscles, orofacial myofunction status and temporomandibular disorder (TMD) severity scores. Forty-two women with TMD (mean 30years, SD 8) and 18 healthy women (mean 26years, SD 6) were examined. According to the Research Diagnostic Criteria for TMD (RDC/TMD), all patients had myogenous disorders plus disk displacements with reduction. Surface EMG of masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position. Standardized EMG indices were obtained. Validated protocols were used to determine the perception severity of TMD and to assess orofacial myofunctional status. TMD patients showed more asymmetry between right and left muscle pairs, and more unbalanced contractile activities of contralateral masseter and temporal muscles (p <0.05, t-test), worse orofacial myofunction status and higher TMD severity scores (p <0.05, Mann–Whitney test) than healthy subjects. Spearman coefficient revealed significant correlations between EMG indices, orofacial myofunctional status and TMD severity (p <0.05). In conclusion, these methods will provide useful information for TMD diagnosis and future therapeutic planning. [Copyright &y& Elsevier]