Assessment of Electromyographic Changes in Masseter and Temporalis Muscles for Patients Undergoing Lower Third Molar Surgery: A Prospective Study.

Introduction Lower third molar impaction surgery is one of the most common minor oral surgical procedures done. Trismus has been one of the most common and disturbing postoperative sequelae for patients. The study aimed to evaluate the electrical activity of the masseter and temporalis muscles after mandibular third molar surgery. Materials and methods The research was conducted at Saveetha Dental College and hospitals in the Department of Oral and Maxillofacial Surgery. The study consisted of 20 individuals. The EMG (electromyography) activities of both masseter muscles in each patient were measured before the tooth extraction surgery, postoperatively after 72 hours, and after seven days. The inter-incisal distance was also measured at similar follow-up intervals. Data were analyzed using IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp., with p-values less than 0.05 considered statistically significant. The Mann-Whitney U test was used for the comparison of electrical activity between masseter and temporalis on both the operated and non-operated sides during preoperative, postoperative, 72-hour, and postoperative seven-day periods. Results It has been found that the electrical activity of the temporalis is higher than that of the masseter muscle measured at all the intervals of the follow-up period, with statistically significant values (p=0.001). It was noted that all the patients have reduced mouth opening when compared with preoperative (mean mouth opening = 45.6 mm), postoperative 72 hours (mean mouth opening = 31.2 mm), and postoperative seven days (mean mouth opening =35.6 mm). When a comparison was done between temporalis and masseter, the masseter took longer to return to pre-operative electrical activity, which might also imply that for prolonged trismus seen in patients after lower third molar surgery, it is the masseter that is affected and needs recovery for trismus to be resolved.  Conclusion  Based on the results obtained, it can be concluded that there was a reduction in the electrical activity of both the masseter and temporalis post-third molar impaction surgery. It was also found that there was a reduction in mouth opening in patients who underwent lower third molar extraction surgery. Masseter muscle took longer to return to its preoperative electrical activity than temporalis muscle, implying that targeted therapies to accelerate the healing of masseter muscle may prevent prolonged trismus in patients who undergo lower third molar impaction surgery.

Electromyography Analysis of the Masseter Muscle's Activity in the Management of Oral Submucous Fibrosis.

Introduction Oral submucous fibrosis (OSMF) is a persistent, collagen metabolic disorder distinguished by the presence of fibrosis of the connective tissue stroma in the oral mucosa with a higher malignant potential rate for oral cancer. This study aimed to analyze the utility of electromyography (EMG) as the prognostic assessment tool in the management of OSMF with conventional intralesional corticosteroid therapy. Materials and methods This study included 20 OSMF cases of age range 20 to 80 years without systemic comorbidities to assess pre-treatment and post-treatment changes with intralesional corticosteroid therapy as an intervention and to determine if it could be assessed using electromyographic study. Clinical and histopathological grading of OSMF was done. The five clinical parameters were evaluated for measuring treatment prognosis. Among them, mouth opening, tongue protrusion, and burning sensation assessments were quantitative parameters, and palpable fibrotic bands and mucosa colour were qualitative parameters. As OSMF involves changes in muscle plane in moderately advanced and advanced cases, EMG was used as an assessment tool for measuring muscle activity. Among the muscles of mastication, the masseter and temporalis were selected for evaluation. Twenty age and gender-matched healthy controls were required for this study as there are no standardized normal values for amplitude and onset of activity in muscle analysis. The EMG activity of the right and left temporalis and masseter muscles were recorded using surface electrodes and were correlated with five clinical assessment parameters. Results In the right masseter, the rest amplitude of 1.6010 µV of the OSMF was statistically significant (p-value: 0.050) when compared with 4.1275 µV of the control. The clench amplitude of 133.370 µV of the OSMF was statistically significant (p-value: 0.062) when compared with 94.310 µV of the control. In the left masseter, the rest amplitude of 1.6695 µV of the OSMF was statistically significant (p-value 0.066) when compared with 2.5735 µV of the control. In the left masseter, the onset of muscle action of 62.670 ms of the OSMF was statistically significant (p-value: 0.017) when compared with 131.835 ms of the control. The clench amplitude differences in the right masseter of 133.370 µV pre-treatment, and 102.775 µV post-treatment were statistically significant (p-value: 0.007). The clench amplitude in the left masseter of 102.535 µV pre-treatment, and 92.090 µV post-treatment were statistically significant (p-value: 0.036). The correlation was seen between tongue protrusion and rest amplitude in the right masseter in OSMF (r = 0.376, p-value: 0.023). Conclusion There was a correlation between tongue protrusion and rest amplitude in the right masseter muscle in OSMF patients before treatment. In the right and left masseter, during rest, the amplitude of the OSMF group was lesser than that of the control group. During clench, in the right masseter, the amplitude of the OSMF group was higher than that of the control group. During clench in the left masseter, the onset of muscle action was lesser in the OSMF group than in the control group. After treatment, there was a reduction in clench amplitude in OSMF patients from their pretreatment values signifying muscle relaxation and a better onset of muscle action.

Assessment of Oral Masticatory Muscle Activity With Different Chewing Gums: A Cross-Sectional Study Based on Electromyogram Analysis.

BACKGROUND: Facial muscles, particularly those involved in mastication, play a pivotal role in the chewing process. Despite their influence on chewing, these muscles undergo alterations during mastication. Examining the relationship between chewed substances and muscle activity can provide insights into various pathological processes and aid in the development of therapeutic chewing techniques. AIM: This study aimed to evaluate the impact of different commercially available chewing gums on the activity of key masticatory muscles. METHOD: Twenty-two participants were recruited for the study. They were instructed to chew four commercially available gums: group 1 comprised sugar gum with a strong flavor; group 2 included gum containing sorbitol; group 3 consisted of gum containing xylitol; and group 4 provided sugar gum with a mild flavor. Electromyogram (EMG) recordings were utilized to assess muscle activity. Various aspects of muscle activity, including chewing time, maximum muscle potential, and coordination between different muscles, were evaluated. Data tabulation and analysis were performed using IBM SPSS software version 23.0 (IBM Corp., Armonk, NY). RESULT: Analysis revealed that in terms of temporalis symmetry, group 2 exhibited the highest mean deviation, while for masseter symmetry, group 3 demonstrated the highest mean deviation. The total deviation for the temporalis and masseter muscles was 72.16% and 65.55%, respectively, indicating greater symmetry in the temporalis muscle. Additionally, group 3 displayed the highest mean deviation in both left and right-sided synergic activity of the muscles. The total deviation for the right and left sides was 64.34% and 65.67%, respectively. CONCLUSION: The findings suggest that sugar-free chewing gums elicit increased muscle activity compared to sugar-containing chewing gums. Furthermore, the utilization of calorie-free chewing gums with a firm texture was associated with better-coordinated muscle activity. These results provide valuable insights into the effects of different chewing gums on masticatory muscle function and coordination, which may have implications for therapeutic interventions and oral health management.

A novel technique to detect cover screw location at stage two uncovery surgery over conventional technique - A randomized controlled trial.

AIM: The conventional technique of implant uncovery using a blade and scalpel is associated with various drawbacks, including profuse bleeding, soft-tissue trauma, delayed healing, and patient noncompliance. Therefore, there is a need to explore the alternative approaches that offer improved accuracy and time efficiency during the cover screw location at the second stage of recovery. This study aims to assess the accuracy and time efficiency of a novel technique that utilizes an apex locator in comparison to conventional locating techniques for implant uncovery. SETTINGS AND DESIGN: The study employed a simple randomized controlled trial with a sample size of 161. MATERIALS AND METHODS: The study employed apex locator (Woodpecker Woodpex III Gold 5th generation) in conjunction with a K-file (Mani k-file #10, 21 mm) for detecting the implant location. The accuracy of the novel technique was determined based on the values measured on the apex locator, with positive values indicating soft-tissue response and negative values indicating the cover screw (metal). The accuracy was cross-verified using radiovisiography (RVG). The clinician-based scoring was also done, considering RVG evaluation, amount of incision given, and ease of the procedure. The time required to locate the cover screw was recorded using a timer for both the novel technique and the conventional method. STATISTICAL ANALYSIS USED: All the recorded values were statistically analyzed using the independent t-test (P < 0.005) with the SPSS software (version 23). RESULTS: The results revealed a significant difference in terms of incision given, ease of treatment, and time taken for the procedure (P < 0.05), while the accuracy of the novel technique was not disturbed (P > 0.05). CONCLUSION: Based on the findings of this in vivo study, the use of an apex locator as an alternative to conventional methods for detecting cover screw location at the second stage of recovery is recommended. The novel technique demonstrated faster uncovering of implants without posing any risks to the surrounding tissues or implants.

Electromyographic Assessment of the Masseter and Temporalis Muscles in Skeletal II Malocclusion Subjects With Varying Overjets: A Pilot Study.

Introduction Class II malocclusions are commonly associated with some muscle disharmony and imbalance. Diagnosis of muscle imbalance helps in treating the malocclusion as well as preventing relapse of the treatment. The aim of this study is to compare the muscle activity of masseter and temporalis in patients with skeletal Class II division 1 malocclusion with varying overjet using surface electromyography (sEMG). Materials and methods Ten subjects in the age range 18-35 years with skeletal Class II malocclusion and varying overjets who required orthodontic treatment were included in this study. Out of these 10 patients, five of them had a 2-4mm overjet and the other five had an overjet >4mm. A four-channel sEMG system was used to conduct the sEMG of muscles. Muscle activity, synergy, and symmetry of masseter and temporalis muscles were assessed and compared between the two groups with an Independent t-test. Results There were no significant differences in the muscle activities of the temporalis and masseter muscles in both groups. Symmetry and synergy of these muscles in the two groups also showed no significant difference (p>0.05) at rest and clenching. However, during chewing, the masseter muscle showed poor balance and activity. Conclusion The overjet in Class II division 1 malocclusions did not seem to affect the muscle activity at rest and during clenching. In patients with increased overjet, during chewing, masseter activity in terms of intensity and balance was poor.

T-scans in implant procedures.

T scans are a breakthrough in technology which allows the user to accurately analyze the occlusion of a patient with minimal to zero errors. They are used during prosthodontic rehabilitation to map out the patient's occlusion to plan for replacements. Such a high advancement in technology has a backdraw. The cost of the equipment is a concern for simple dental practitioners. There are no large scale studies using T scans in determining the occlusion. Therefore, it is of interest to analyze the use of T scans in determining the percentage of contact in patients with dental implants. This retrospective analysis was done at the Saveetha University hospital set up where patients undergoing prosthesis fabrication for implants were included. Details like their age, gender and the percentage of contact of the implant and percentage of contact on the adjacent tooth were recorded. These details were tabulated and imported to IBM SPSS version 23 for statistical analysis. Chi square test was used to analyze comparable variables. 22 patients were analyzed, the mean percentage of contact of implants was found to be 7.45±;9.01 and the mean percentage of contact of adjacent teeth was found to be 10.14±6.7. Thus, T scan is an efficient method in recording the dynamic occlusal contacts of a patient. The use of T scan reveals data pertaining to individual tooth but in the present study there is no statistical significance in terms of exact values comparing implant contact to adjacent tooth contact. Further studies are needed with relation to timing and contact surface of implant prosthesis.

An Analysis of Implant Prosthesis and Its Dynamic Occlusal Contacts.

The prosthetic replacement is achieved for the functional aspect of the stomatognathic system. Achieving prosthetic occlusion is challenging and has an occlusal concept of its own when the type of prosthesis varies. The implant occlusion differs for its load transfer concept and longevity. The study was employed to assess the dynamic occlusal contact in implant occlusion through digital means. The study was carried out on implant prosthesis and its dynamic parameters were evaluated using T-Scan Novus (BioResearch, Inc., Brown Deer, WI, USA) in a university hospital setting after collecting 35 patients. Mandibular arch prosthesis tends to swing from high intensity to low or no contacts frequently and when the percentage of implant crown contact at 10% is present there is more of implant protected occlusion achieved. Use of T-Scan Novus can reveal more occlusal details in functional form which can help in achieving new treatment goals.

Effect of Dietary Amino Acids L-Arginine and Lysine on Implant Osseointegration.

Background: Low protein diets have been linked to decreased bone strength in humans. Arginine and lysine can help improve the healing process and stimulate growth factors. Aim: To evaluate if dietary arginine and lysine combination aids in reducing the time frame for osseo-integration process and bone formation in animal models. Materials and Methods: Controls (Group I) and Experimental (Group II) consisted of twelve New Zealand rabbits. Animals in the experimental group were fed a conventional pellet food, water, and the amino acids L-Lysine and L-Arginine (Biovea, USA), whereas those in the control group were offered a standard diet. In both groups of animals, titanium implants measuring 2.5mm* 6mm were implanted in each tibial osteotomy. At the end of two weeks, four weeks, and eight weeks, the animals were euthanized. The tibial bone was removed and preserved in 1% formalin. The samples were analysed histologically for presence or absence of Necrosis, presence or absence of clot formation, Vascularization, Fibroblast, Osteoblasts and Osteoid Bone growth. Results: Histological outcomes on vascularization, fibroblasts, osteoblasts, osteoid bone growth inferred no significant variation between the control and experimental groups after 8 weeks (P>.05). Conclusion: Vascularity, clot organisation, osteoblasts, fibroblasts, and osteoid bone production in the protein fed experimental group animals were better in initial stages of healing when compared to control groups.

Retrospective Analysis of Immediate Implants: A Prism with a Different Dimension.

Any tooth loss can be addressed for rehabilitation by different types of prosthesis. But, for certain conditions patients and dentists expect immediate results. An immediate implant falls into such a category: The implant is placed immediately into the extracted socket with the expectation of a quick fix. The present study was designed to retrospectively analyze the factors or choices that lead to immediate implant placement, prevailing conditions during the implant surgical phase, and conditions in the implant prosthetic phase. The study indicates fractured teeth as the most chosen case for immediate implant placement, with more than 1 mm of jump space present between implant and bone socket invariably requiring bone grafting. The study also indicates a survival rate during stage 2 recovery as 16% less than what is reported in the literature.

Comparing Closed Tray Implant Impression Techniques Using Snap-On and Impression Analogues on a Clinical Radiographic Scale.

Several impression techniques have been proposed to achieve passive fitness between the prosthesis and the osseointegrated implant. The aim of this study was to compare closed tray implant impression techniques using snap-on and impression analogues on a clinical radiographic scale. The current study was comparative, descriptive, and retrospective, performed in a university setting in 2020. The data of patients reporting to the Department of Implantology between June 2019 to March 2020 were collected from patient records, and the data of 1000 plus patients were analyzed for snap-on impressions and impression analogue accuracy in seating and associated jig trial seating. A comparison of closed tray implant impression techniques using snap-on and impression analogues on a clinical radiographic scale found both to be perfect. The impression recorded with snappy with abutment and the impression recorded using impression coping exhibited no differences during jig trial seating verification. This study showed that both impression procedures are accurate and can be used for implant impressions.

An Analysis of Mean Bone Availability on the Choice of Implant Width and Length.

Success of dental implants depends on the quality and quantity of local bone, implant designs, and surgical technique. The amount and density of available bone in the patient's edentulous site are primary determining factors in predicting individual patient success. Our present study aims to analyze the mean bone availability to the choice of implant width and length and bone width and length compared with the adjacent teeth and condensing osteitis. This descriptive study was done at the Saveetha Dental College and Hospitals, Chennai. Retrospective data of bone width, bone height, implant width, implant height, adjacent teeth presence, and condensing osteitis presence were evaluated from the digital data to assess operators' implant dimensional choice. Residual bone height availability is in the range of 0-2 mm (about 52.1%). Residual bone width availability is in the range of 0-2 mm (about 56.9%). Presence of adjacent teeth is 79.8% and presence of condensing osteitis is 12%; these results were subjected to chi-square test. Presence of adjacent teeth tends to dictate the choice of width of implant whereas the length of implant is not much changed from planned length and width.