Lydia Eberhard

Long-term training effects on masticatory muscles.

Neuromuscular adaptations during skill acquisition have been extensively investigated for skeletal muscles. Motor rehabilitation is the main target for application of motor training. Such measures are also relevant for the musculature of the jaw, but few data are available for motor adaptation of the masticatory system. The objective of this study was to evaluate and compare long-term training effects of different motor tasks on masseter and temporal muscles. In 20 healthy subjects, the electromyographic response to unilateral and bilateral maximum voluntary tooth clenching, balancing the mandible on a hydrostatic system under force-feedback-controlled conditions, and unilateral chewing was investigated in an initial session and then in two follow-up sessions separated by 2 and 10 weeks from baseline. Motor tasks were repeated three times for chewing, nine times for maximum biting (MB) and 24 times for the coordination tasks (CT). The sequences of the various motor tasks were applied once in the first session and twice in the second and third sessions. No effects of training were observed for MB tasks except for MB in intercuspation, for which significant yet transient avoidance behaviour occurred in the second session. No significant effects were found for chewing tests. For the CT, however, a robust significant long-term training effect was detected which reduced the electric muscle activity in session 2 by approximately 20% and in session 3 by approximately 40% compared with the initial measurements. The study showed that the masticatory muscles are remarkably prone to motor adaptation if demanding CT must be accomplished.

The effect of various jaw motor tasks on body sway.

Alterations of body sway caused by isometric contractions of the jaw muscles have been reported previously. The objective of this study was to test if motor tasks of the masticatory system with different control demands affect body posture differently during quiet stance. Position and sway displacements of the center of foot pressure (COP) were measured for 20 healthy subjects who either kept the mandible at rest or performed unilateral and bilateral maximum voluntary teeth clenching, feedback-controlled biting tasks at submaximum bite forces, or unilateral chewing. Two weeks later the measurements were repeated. Compared with quiet stance, the COP results revealed significant changes during the feedback-controlled biting tasks. Robust sway reduction and anterior displacement of the COP were observed under these conditions. Body oscillations were not significantly affected by maximum bites or by unilateral chewing. For most of the variables investigated there were no significant differences between unilateral and bilateral biting. Robust sway reduction during feedback-controlled biting tasks in healthy subjects involved a stiffening phenomenon that was attributed to the common physiological repertoire of posture control, and might optimize the stability of posture under these conditions.

Comparison of particle-size distributions determined by optical scanning and by sieving in the assessment of masticatory performance.

Aim of this study was to introduce a feasible and valid technique for the assessment of masticatory performance that is comparable to the standard sieving method. Twenty-one chewing samples (Optosil) comminuted by healthy dentate adults were analysed with a sieving and scanning method. Scanning was performed using a conventional flatbed scanner (1200dpi). All scanned images underwent image analysis (ImageJ), which yielded descriptive parameters such as area, best-fitting ellipse for each particle. Of the 2D-image, a volume was estimated for each particle, which was converted into a weight. To receive a discrete distribution of particle sizes comparable to sieving, five chewing samples were used to calculate a size-dependent area-volume-conversion factor. The sieving procedure was carried out with a stack of 10 sieves, and the retained particles per sieve were weighed. The cumulated weights yielded by either method were curve-fitted with the Rosin-Rammler distribution to determine the median particle size x(50) . The Rosin-Rammler distributions for sieving and scanning resemble each other. The distributions show a high correlation (0·919-1·0, n= 21, P<0·01, Pearsons correlation coefficient). The median particle sizes vary between 3·83 and 4·77mm (mean: 4·31) for scanning and 3·53 and 4·55mm (mean: 4·21) for sieving. On average, scanning overestimates the x(50) values by 2·4%. A modified Bland-Altman plot reveals that 95% of the x(50) values fall within 10% of the average x(50) . The scanning method is a valid, simple and feasible method to determine masticatory performance.

Co-activation of jaw and neck muscles during submaximum clenching in the supine position

OBJECTIVE The purpose of this study was to test the hypothesis that jaw clenching induces co-contraction and low-level long-lasting tonic activation (LLTA) of neck muscles in the supine position. DESIGN Ten healthy subjects developed various feedback-controlled submaximum bite forces in different bite-force directions in supine position. The electromyographic (EMG) activity of the semispinalis capitis, semispinalis cervicis, multifidi, splenius capitis, levator scapulae, trapezius, sternocleidomastoideus, masseter and infra/supra-hyoidal muscles was recorded. For normalization of EMG data, maximum-effort tasks of the neck muscles were performed. RESULTS Co-contractions of the posterior neck muscles varied between 2% and 11% of their maximum voluntary contraction. Different bite forces and bite-force directions resulted in significant (p<.05) activity differences between the co-contraction levels of the neck muscles. In addition, LLTA of specific neck muscles, provoked by the jaw clenching tasks, was observed. CONCLUSIONS This study demonstrated for the first time moderate co-contractions of jaw and neck muscles in the supine position under controlled submaximum jaw clenching forces. LLTA of most neck muscles was observed, outlasting clenching episodes and indicating an additional neuromuscular interaction between the two muscle groups.

A new instrument for assessing the quality of studies on prevalence

There are numerous scientific articles of studies on the prevalence of disorders with non-standardised examination and diagnostic protocols. Because their quality is heterogeneous, a new instrument has been developed for the assessment of such studies. The new instrument is based mainly on statistical criteria. The points assigned for each of the main criteria according to the information gained from each paper are summed up to form a Total Quality Score (TQS). The interrater reliability of the instrument was tested by employing Kappa and Interrater Correlation Coefficient (ICC) statistics. The latter was assessed on the results of three independent investigators. The new quality instrument appeared to be easy to use, and the instructions were comprehensible. The ICC(2,1) for the TQS ranged between 0.94 and 1.00 indicating almost perfect agreement between the investigators. The reliability of the new instrument enables its use for scientific review purposes. In this way, its validity will also be tested. The instrument could be adopted for assessment of scientific articles of studies on the prevalence of disorders in many, similar, scientific areas.

Immediate Loading of Dental Implants in Edentulous Mandibles by Use of Locator® Attachments or Dolder® Bars: Two-Year Results from a Prospective Randomized Clinical Study.

PURPOSE The study aims to evaluate survival and incidence of complications for pairs of implants placed in the front region of edentulous mandibles and immediately loaded with either bar or Locator attachments. MATERIALS AND METHODS Forty-six patients with edentulous mandibles (mean age 69.4 years at inclusion in the study; 73.9% male) received two implants in the interforaminal area of the symphysis. Dolder bar or Locator attachments, allocated randomly, were then attached immediately, and both clips and a framework were fastened to the denture by the dental technician within 72 hours. RESULTS During the first 3 months of the 2-year period of observation, eight implants in five patients were lost, and were removed. Survival was 89.1% and 93.5% for the bar and Locator groups, respectively. During the entire period of observation, 38 prosthetic complications required aftercare. Five dentures had to be removed or reworked after implant failure, but no superstructure was lost or had to be remade for prosthetic reasons. Survival of the original dentures was 93.5% and 95.7% for the bar and Locator groups, respectively. CONCLUSION Within the limitations of this study, results from immediate loading of two implants in the edentulous mandible with either Locator or bar attachments hardly differed. Prosthetic complications and aftercare measures in the Locator group were frequent but easy to handle. Ease of repair and cleaning, in particular, might be reasons for choosing the single-attachment system.Purpose The study aims to evaluate survival and incidence of complications for pairs of implants placed in the front region of edentulous mandibles and immediately loaded with either bar or Locator attachments. Materials and Methods Forty-six patients with edentulous mandibles (mean age 69.4 years at inclusion in the study; 73.9% male) received two implants in the interforaminal area of the symphysis. Dolder bar or Locator attachments, allocated randomly, were then attached immediately, and both clips and a framework were fastened to the denture by the dental technician within 72 hours. Results During the first 3 months of the 2-year period of observation, eight implants in five patients were lost, and were removed. Survival was 89.1% and 93.5% for the bar and Locator groups, respectively. During the entire period of observation, 38 prosthetic complications required aftercare. Five dentures had to be removed or reworked after implant failure, but no superstructure was lost or had to be remade for prosthetic reasons. Survival of the original dentures was 93.5% and 95.7% for the bar and Locator groups, respectively. Conclusion Within the limitations of this study, results from immediate loading of two implants in the edentulous mandible with either Locator or bar attachments hardly differed. Prosthetic complications and aftercare measures in the Locator group were frequent but easy to handle. Ease of repair and cleaning, in particular, might be reasons for choosing the single-attachment system.

Immediate Loading of Two Dental Implants, in Edentulous Mandibles, with Locator® Attachments or Dolder® Bars: First Results from a Prospective Randomized Clinical Study

Objective The study aims to evaluate survival and the incidence of complications for pairs of implants placed in the frontal area of edentulous mandibles and immediately loaded with either bar or Locator® (Zest Anchors LLC, Escondido, CA, USA) attachments. Material and Methods Forty-six patients (mean age 69.4 years; 73.9% male) with edentulous mandibles each received two immediately loaded implants in the interforaminal area of the symphysis. Immediately after implant placement, Dolder® bar (Sub-Tec Wirobond; BEGO Implant Systems GmbH & Co. KG, Bremen, Germany) or Locator® attachments, allocated randomly, were attached, and both clips and a framework were incorporated into the denture by the dental technician. The implants were loaded within 72 hours. Results During a mean observation period of 6 months (maximum 24 months, SD 0.43) eight implants in five patients were lost. Survival was 93.5% for the Locator® group and 89.1% for the bar group. Estimated cumulative survival after 1 year of function was 93.4% for the Locator® group and 87.1% for the bar group. During the observation period, 12 prosthetic complications required aftercare. No superstructure was lost or had to be remade for prosthetic reasons, but five dentures had to be removed or reworked after implant failure. Survival of the original dentures was, therefore, 95.7% for the Locator® group and 93.5% for the bar group. Conclusion Within the limitations of this study, immediate loading of two implants in the edentulous mandible with either Locator® or bar attachments did hardly differ. Ease of repair and cleaning, in particular, might be arguments for choosing the single attachment system.OBJECTIVE The study aims to evaluate survival and the incidence of complications for pairs of implants placed in the frontal area of edentulous mandibles and immediately loaded with either bar or Locator® (Zest Anchors LLC, Escondido, CA, USA) attachments. MATERIAL AND METHODS Forty-six patients (mean age 69.4 years; 73.9% male) with edentulous mandibles each received two immediately loaded implants in the interforaminal area of the symphysis. Immediately after implant placement, Dolder® bar (Sub-Tec Wirobond; BEGO Implant Systems GmbH & Co. KG, Bremen, Germany) or Locator® attachments, allocated randomly, were attached, and both clips and a framework were incorporated into the denture by the dental technician. The implants were loaded within 72 hours. RESULTS During a mean observation period of 6 months (maximum 24 months, SD 0.43) eight implants in five patients were lost. Survival was 93.5% for the Locator® group and 89.1% for the bar group. Estimated cumulative survival after 1 year of function was 93.4% for the Locator® group and 87.1% for the bar group. During the observation period, 12 prosthetic complications required aftercare. No superstructure was lost or had to be remade for prosthetic reasons, but five dentures had to be removed or reworked after implant failure. Survival of the original dentures was, therefore, 95.7% for the Locator® group and 93.5% for the bar group. CONCLUSION Within the limitations of this study, immediate loading of two implants in the edentulous mandible with either Locator® or bar attachments did hardly differ. Ease of repair and cleaning, in particular, might be arguments for choosing the single attachment system.

Effect of the Occlusal Profile on the Masticatory Performance of Healthy Dentate Subjects

PURPOSE The purpose of this study was to examine, on the basis of masticatory performance (MP), total muscle work (TMW), and range of movement (RoM), whether reduction of the profile of the cusps results in loss of the biomechanical effectiveness of chewing by healthy dentate patients. METHODS Twenty healthy patients (10 female, mean age: 24.1 ± 1.2 years) chewed standardized silicone particles, performing 15 masticatory cycles. Three experimental conditions were investigated: chewing on (1) the natural dentition (ND), (2) splints with structured occlusal profiles simulating the patients natural dentition (SS), and (3) splints with a plane surface (PS). The expectorated particles were analyzed by a validated scanning procedure. The size distribution of the particles was calculated with the Rosin-Rammler function and the mean particle sizes (X50) were determined for each experimental condition. The target variables of the experimental conditions were compared by repeated measures analysis of variance. RESULTS X50 values calculated for MP differed significantly (P < .002) between PS and SS, and between ND and SS. Conversely, no significant differences (P > .05) were observed between SS and ND. Regarding muscle work the EMG activity of the masseter differed significantly (P < .001) between the left and right sides, with higher values for the right (chewing) side. No significant differences (P > .05) were observed for TMW and RoM under the three test conditions. CONCLUSIONS The results confirm the biomechanical significance of structured occlusal surfaces during chewing of brittle test food by young dentate subjects.

Comparison of three different options for immediate treatment of painful temporomandibular disorders: a randomized, controlled pilot trial.

Abstract Objective: The purpose of this study was to compare the short-term effectiveness of three different types of immediate, non-pharmacological intervention for alleviation of the painful symptoms of temporomandibular disorders (TMD). Material and methods: Thirty-six patients (mean age 41.6 ± 16.7 years, 25 females) diagnosed with non-dysfunctional painful TMD received counselling and subsequently were randomly allocated to three treatment groups: patients in Group A received prefabricated oral splints with water-filled elastic pads (Aqualizer®), those in Group B were provided with vacuum-formed co-polyester oral splints and those in Group C were given appointments to receive Michigan-type hard splints. Clinical examination was conducted, at baseline and after 2 weeks, by use of the RDC/TMD. Current pain intensity was determined by evaluation of graded chronic pain status (GCPS) on a numerical rating scale (NRS). Active maximum mouth opening without pain (AMMOP) was also measured. Paired sample t-tests and one-way analysis of variance with a significance level of p ≤ 0.05 were conducted. Results: After 2 weeks, overall mean current pain was reduced by 41.95% (p < 0.001). Current pain reduction was significant for Group B (66.6%, p < 0.001) but not for Groups A (37.88%, p = 0.56) and C (22.29%, p = 0.26). After 2 weeks, current pain level for Group B was significantly lower than that for Group C (p = 0.041). Overall, there was a statistically significant increase of AMMOP (p = 0.01). Conclusion: All therapeutic options were pain-reducing. The results from this study suggest that cost-effective and time-effective intervention of counselling combined with use of a vacuum-formed splint is a favourable option for initial, short-term treatment of painful TMD.

Static balancing behaviour of the mandible

The objective of this study was to investigate the mechanisms of physiological control of the craniomandibular system during force-controlled biting: in intercuspation, restricted by predetermined anatomic-geometrical conditions [i.e. biting in intercuspation (BIC)]; and on a hydrostatic system [i.e. auto-balanced static equilibrium of the mandible (BAL)], in which the mandible is balanced under unrestricted occlusal conditions. For 20 healthy subjects, the spatial positions of the condyles, the lower molars, and the incisal point were measured, and the electromyographic (EMG) activity of the musculus masseter and musculus temporalis anterior were recorded bilaterally, during force-controlled biting (50, 75, 100 N) on a hydrostatic device. The results were compared with those obtained during BIC. During BAL, the neuromuscular system stabilizes one condyle, so it behaves as a virtual fulcrum, and all available biomechanical degrees of freedom of the opposite side are used to achieve a bilaterally equal vertical distance between the upper and lower dental arches. The variability of the positions of the molars was significantly smaller than for the condyles. The EMG co-contraction ratios calculated for homonymous muscle regions revealed significant differences between BIC and BAL, specifically, greater symmetry during BAL with substantial asymmetry of approximately 25% remaining. In conclusion, the results revealed precise neuromuscular control of the position of the lower dental arch; this information might form the basis for interference-free tracking of the mandible in intercuspation under different conditions.