Keiichi Ishigami

Functional near-infrared spectroscopy study on primary motor and sensory cortex response to clenching

The purpose of this study was to elucidate the influence of clenching and clenching intensity on oxygenated hemoglobin (OxyHb) levels in regional cerebral blood flow as an indicator of brain activity in the primary motor and sensory cortices. Functional near-infrared spectroscopy (fNIRS) was used to minimize the effect of clenching-associated muscle activity in eight healthy subjects. Subjects were required to clench at 20%, 50% and 80% of maximum clenching force. To minimize the effect of temporal muscle activity on the working side of the jaw, the fNIRS probes were positioned contralaterally, in the left temporal region. Activation of the primary motor and sensory cortices with clenching was noted in all subjects, irrespective of intensity of clenching. A significant increase was observed in OxyHb in the primary motor cortex between at 80% and both 20% and 50% clenching intensity. In the primary sensory cortex, OxyHb showed a significant increase between all levels of clenching intensity. The results suggest that clenching elicits activation of both the primary motor and sensory cortices, and that intensity of clenching influences activation levels in the brain.

Are all mouthguards the same and safe to use? Part 2. The influence of anterior occlusion against a direct impact on maxillary incisors.

The purpose of this study was to clarify the influence anterior occlusion, of mouthguards, has on protecting against a direct collision to the maxillary anterior teeth. In other words, the support mandibular dentition has when wearing a mouthguard. Two types of mouthguards were used for this study, one with an appropriate anterior occlusion or a mouthguard with positive anterior occlusion (MGAO+) and another which was a single-layer mouthguard lacking the same occlusion or a mouthguard with negative anterior occlusion (MGAO-) but with the same thickness on the buccal side. The instruments used for testing were a pendulum-type impact device with two interchangeable impact objects (a steel ball and a baseball), with a plastic jaw model having artificial teeth. Four testing conditions were observed: one with the jaw open without a mouthguard (Open NoMG), the second with the jaw clenching (loaded with 30 kg weight) without a mouthguard (Clench. NoMG), the third with the jaw clenching with MGAO- (Clench. MGAO-) and the last with the jaw clenching with MGAO+ (Clench. MGAO+). The results are as follows: both types of mouthguards showed the effects in reducing the distortion of the teeth. However, the effect was significantly obvious (steel ball = about 57% shock absorption ability, baseball = about 26%) in the mouthguard with anterior occlusion or support by lower dentition through mouthguard (Clench. MGAO+) than Clench. MGAO-. Thus, the influence of anterior occlusion of mouthguards or the support of mandibular dentition through wearing a mouthguard (MGAO+) is indispensable in reducing the impact force and tooth distortion. The results of this research should further contribute to the establishment of guidelines for safer mouthguards.

Effect of experimental horizontal mandibular deviation on dynamic balance

PURPOSE There are two aspects of human balance: static balance and dynamic balance. However, to the authors knowledge, no studies have investigated how changes in the stomatognathic system influence dynamic balance. This aim of this study was to determine the effect of horizontal mandibular deviation on stability of upright posture on an unstable platform in order to clarify the relationship between the stomatognathic system and the dynamic balance. METHODS Fifteen healthy adult participants were selected. To determine the effect of changes in the stomatognathic system on dynamic balance, three experimental conditions were established: a resting mandibular position, a position in which experimental horizontal mandibular deviation was maintained by a splint, and a mandibular rest position maintained by a splint. Each participant was instructed to stand in a natural upright posture on an unstable board, and resulting variation in angle of the board was then measured. Measurements were taken 15 times under each condition. RESULTS Variation in angle of inclination of the board as dynamic balance was the largest in the splint-maintained deviated mandibular position. CONCLUSION Horizontal deviation in mandibular position interfered with stability of upright posture on an unstable platform, suggesting that changes in the stomatognathic system affect dynamic balance.

Does clenching reduce indirect head acceleration during rugby contact

BACKGROUND Concussions are common among athletes, with the potential to cause memory-related, physical, cognitive, emotional, and behavioral damage. A concussion is an acceleration/deceleration injury resulting from direct and indirect biomechanical forces transmitted to the cerebral tissues. From a sports dentistry viewpoint, increased mastication muscle activity or clenching due to the presence of a mouthguard may enhance cervical muscle activity, thereby reducing damage following impact. This relationship has not been previously investigated in the context of rugby. The purpose of this study was to investigate the effect of voluntary clenching on indirect head acceleration during attack- and defense-related drills. MATERIALS AND METHODS A total of 12 high school rugby players participated in the study. Linear acceleration of the head was measured using an accelerometer that took measurements in three axes. Masseter and sternocleidomastoid muscle activities were measured using wireless electromyography. These data were synchronized using digital video imaging software for analysis. The study protocol was approved by the Tokyo Dental College Ethics Committee. RESULTS AND CONCLUSIONS Within the limitations of this study, the following results were obtained: the activities performed during rugby practice involved relatively small indirect head acceleration and masseter and sternocleidomastoid muscle activities. After the young male rugby players were instructed to clench their masseter muscles, a marked decrease in head acceleration was observed.

Instrumented indentation characterisation of mouth-guard materials

OBJECTIVES The aim of the study was to investigate the mechanical properties and energy absorption behavior of mouth-guard materials. Interpretation of indentation force-displacement data has been used to determine these properties. METHODS An ultra micro-indentation system (UMIS) was used to determine near surface properties of mouth-guard materials with nanometer and micro-Newton displacement and force resolution. The measurement procedure was conducted with a small spherical steel indenter (R=500 microm), with impressions that were equally spaced (250 microm). Measurements of force-displacement response of surfaces at maximum forces of 10, 40 or 50 mN, 10 indentations were made at each of these forces. Tests were undertaken in two different modes to determine the mechanical properties, namely: (a) continuous load to the maximum force and then unload, (b) multiple loading and partially unloading sequence to the maximum load. RESULTS The force-displacement results were analysed to determine the elastic modulus and contact pressure versus depth of penetration as well as the energy loss. Energy absorption for each material was determined from the ratio of the hysteresis energy loss to the total energy at maximum load and ranged from 10 to 24% among different mouth-guard materials. Energy absorption ratio, elastic modulus and contact pressure were significantly different between different materials with same thickness (FC, GC and C3) (p<0.01) and significantly different between materials with different thickness (C1 and C3) (p<0.01). SIGNIFICANCE The present approach provides a simple and efficient method to readily measure the elastic-plastic (hysteretic) response of mouth-guard materials. The indentation technique lends itself to investigate the influence of ageing, heat treatment, sterilisation, moisture etc in a simple systematic manner.

Easy fabrication of a new type of mouthguard incorporating a hard insert and space and offering improved shock absorption ability

The positive effects of wearing a mouthguard have been indicated in various epidemiological surveys and experiments, and their usage appears to be increasing in many sports. However, many preventable sports-related dental injuries still occur even with the use of a conventional mouthguard. We have developed a mouthguard (the Hard & Space mouthguard) with sufficient injury prevention ability (more than 95% shock absorption ability against impact with a steel ball carrying 15.2 kg m(2) S(-2) potential energy) and ease of clinical application. This mouthguard consists of an outer and an inner EVA layer and a middle layer of acrylic resin (hard insert), with a space to prevent contact between the inner surface of the mouthguard and the buccal surfaces of the maxillary front teeth or teeth already weakened through prior damage or treatment. The purpose of this article is to describe the method by which the Hard & Space mouthguard may easily be fabricated. We believe that this new type of mouthguard has the potential to reduce sports-related dental injuries.

Shock absorption ability of mouthguard against forceful, traumatic mandibular closure

BACKGROUND The positive effects of wearing a mouthguard on shock absorption have been indicated in various papers. The ability of a mouthguard to protect against indirect injury, however, is not clear, and the thickness that a mouthguard would require to provide such protection remains to be determined. The primary aim of this study was to clarify the shock absorption potential of a mouthguard against forced, traumatic occlusion. The secondary objective was to compare the shock absorption ability of different thicknesses of mouthguard against this type of trauma. MATERIALS AND METHODS An artificial skull (ZA20; 3B Scientific International, Co. Ltd, Niigata, Japan) with two-axis strain gages applied to the right buccal aspect of the mandible and the mandibular and maxillary teeth was used to measure shock absorption ability. Three different thicknesses of EVA mouthguard (1, 2, and 3 mm at the first molar) were tested. RESULTS AND CONCLUSIONS Within the limitations of this laboratory study, the following results were obtained: the results showed that increasing the thickness of the mouthguard improved its shock absorption ability.

A vacuum technique to increase anterior thickness of athletic mouthguards to achieve a full-balanced occlusion.

A full-balanced occlusion is essential for mouthguards. It has been reported that a balanced occlusion for upper and lower anterior teeth is essential for prevention of injuries occurring to the maxillary anterior teeth and alveolar bone caused by horizontal direct impact. The support of the mandibular teeth through the mouthguard is critical to prevent maxillary front tooth injury from a direct impact force. However, some vacuum mouthguard designs may not achieve a full-balanced occlusion. For example, when a player has a malocclusion, an elongated molar or premolar tooth, an open bite, a large over jet or a maxillary protrusion. An improved vacuum fabrication method is necessary to obtain full balanced occlusion in these cases as opposed to conventional vacuum type single-layer mouthguard technique.

Activity in the Premotor Area Related to Bite Force Control - A Functional Near-Infrared Spectroscopy Study

The purpose of this study was to elucidate the influence of bite force control on oxygenated hemoglobin (OxyHb) levels in regional cerebral blood flow as an indicator of brain activity in the premotor area. Healthy right-handed volunteers with no subjective or objective symptoms of problems of the stomatognathic system or cervicofacial region were included. Functional near-infrared spectroscopy (fNIRS) was used to determine OxyHb levels in the premotor area during bite force control. A bite block equipped with an occlusal force sensor was prepared to measure clenching at the position where the right upper and lower canine cusps come into contact. Intensity of clenching was shown on a display and feedback was provided to the subjects. Intensity was set at 20, 50 and 80% of maximum voluntary teeth clenching force. To minimize the effect of the temporal muscle on the working side of the jaw, the fNIRS probes were positioned contralaterally, in the left region. The findings of this study are: activation of the premotor area with bite force control was noted in all subjects, and in the group analysis OxyHb in the premotor cortex was significantly increased as the clenching strengthened at 20, 50 and 80% of maximum voluntary clenching force. These results suggest there is a possibility that the premotor area is involved in bite force control.

Functional Near-Infrared Spectroscopy Study on Primary Motor and Somatosensory Cortex Response to Biting and Finger Clenching

The purpose of this study was to compare the influence of biting and finger clenching intensity on the concentration of oxygenated hemoglobin (OxyHb) in regional cerebral blood flow (rCBF) as an indicator of brain activity in the primary motor (MI) and somatosensory (SI) cortices. Functional near-infrared spectroscopy (fNIRS) was used in 8 healthy subjects. Subjects were required to do biting (bite) and finger clenching (fclench) at 20, 50 and 80% of maximum force. To minimize the effect of temporal muscle activity on the working side of the jaw, the fNIRS probes were positioned contralaterally, in the left temporal region. Activation of MI and SI cortices with bite and fclench was noted in all subjects, irrespective of the intensity of bite and fclench. A significant increase was observed in OxyHb in MI and SI between 20% and both 50 and 80% intensity. In MI cortex, OxyHb showed a significant increase between 80% and both 20 and 50% fclench intensity. The results suggest that intensity of bite and fclench influences activation levels in MI and SI. Further, an activation was more obvious with bite than fclench.