Relationships between facial morphology and activity of orofacial muscles in patients with a complete upper and a partial lower denture.

In a sample of 30 partially edentulous subjects, provided with an immediate complete upper denture and a partial lower denture and followed for 2 years, a correlation analysis was performed between facial morphology, as measured by lateral head films, and EMG peak mean voltages of the anterior temporal and masseter muscles when clenched and during swallowing and chewing, and of the lip muscles during swallowing. At the pre-treatment stage, when the patients occluded on a residual anterior dentition, correlations between facial morphologic characteristics and peak mean voltages of the jaw closing muscles indicated stronger muscle activity in individuals with a square facial type. No significant associations were observed between muscle activity and the age of the subjects, which ranged from 36 to 71 years. After placement and use of the dentures a significant forward-upward rotation of the mandible with a decrease in overbite occurred, as a result of resorption of the edentulous maxillary ridge. At the 1 year stage of denture use, the elevator activity showed no significant correlations with facial morphology. On the other hand, negative correlations were observed especially between the anterior temporal activity and anterior overbite. Similar negative correlations were observed for the lip activity during swallowing, especially of the upper lip. These findings suggest occlusal contact between the incisors during the various functions in subjects with a small overbite. The findings further suggest that the anterior temporal and the upper lip muscles are sensitive to changes in anterior occlusal relations of the dentures.

Swallowing activity of lip muscles in patients with a complete upper and a partial lower denture.

In 30 partially edentulous subjects provided with an immediate complete upper and a partial lower free-end denture the lip activity in swallowing was studied before and after denture treatment and during a 2-year period of denture wearing. Electromyographic recordings of the right side upper and lower orbicularis oris, mentalis and anterior temporal muscles were obtained during swallowing saliva and during swallowing of water with and without the dentures in the mouth. In the different types of swallows recorded, the lower lip and mentalis muscles showed much stronger activity than the upper lip and anterior temporal muscles and also initiated the swallowing activity. No significant changes in mean voltages of the swallowing activity were observed during the 2-year observation period. On the other hand, the durations of the swallows showed marked increases after 1 year of denture use, when no further rebasings of the complete upper denture had been made.

Chewing and swallowing activity of masticatory muscles in patients with a complete upper and a partial lower denture.

The chewing and swallowing activity of jaw-closing muscles was studied longitudinally in 30 partially edentulous subjects who were provided with an immediate complete upper and a partial lower denture. Electromyographic recordings of the anterior temporal and masseter muscles were obtained during habitual chewing of apple and during swallowing of saliva and water, before final extractions and 7 weeks, 6 months, 1 year and 2 years after denture insertion. At the pre-treatment stage, when the patients were chewing with a residual anterior dentition, the mean voltages showed low values compared to findings reported in subjects with a complete natural dentition. After 6 months of denture use, the chewing forces showed significant increases in amplitude, and the increased force of contraction persisted to the 2-year stage. The recordings of swallowing revealed no significant changes in maximal mean voltage during the observation period. However, there was a significant increase in the duration of the swallows after 1 year of denture wearing, which might be related to stabilization of the complete upper denture due to continuing resorption of the maxillary ridge.

A two-year kinesiographic study of mandibular movement patterns in denture wearers.

Changes in functional jaw movements during a 2-year period of denture wear were investigated. The sample consisted of 27 partially edentulous subjects who were provided with an immediate complete maxillary denture and a removable partial mandibular denture. Recordings of habitual chewing of apple and empty open-close cycles were made with a mandibular kinesiograph. At the pretreatment stage, when the patients occluded on a residual anterior dentition, irregular patterns of movement were observed. After placement of the dentures, which restored posterior occlusion, the chewing and open-close patterns showed marked improvement and were characterized by significant mean decreases in sagittal and transversal range of movement. Relining of the maxillary dentures further stabilized the functional patterns. During the second year, significant reductions in vertical range of movement and lateral chewing excursions were observed, and were probably related to impaired retention of the complete upper denture.

A 2-year electromyographic study of patients with an immediate complete upper and a partial lower denture.

A longitudinal electromyographic (EMG) investigation was performed on thirty subjects provided with an immediate complete upper and a partial lower denture. Electromyographic recordings in maximal clench, light tapping and postural position were obtained from the anterior temporal and masseter muscles before final extractions and 7 weeks, 6 months, 1 year and 2 years after denture insertion. The maximal clench activity of the jaw closing muscles showed an average tendency to decrease upon insertion of the dentures, but thereafter significant increases in mean voltages were observed during the first year of denture wear. During the second year no significant changes in EMG clenching force were noted. At the 2-year stage most of the muscles showed significantly greater clench activity than at the post-insertion stage, but did not exceed the pre-extraction level. The jaw muscle activity in light tapping showed no significant mean changes during the observation period. The postural activity tended to decrease during the period of denture wear, the decrease being significant for some of the muscles at the 2-year stage.

Changes in jaw relations and activity of masticatory muscles in patients with immediate complete upper dentures.

A longitudinal radiographic cephalometric and electromyographic investigation was performed on eighteen subjects provided with an immediate complete upper and a partial lower denture. The observation stages were: before final extractions and 7 weeks, 6 months and 1 year after denture insertion. The cephalometric analysis was based on measurements from lateral head films taken in centric occlusion. The EMG activity of the anterior temporal and masseter muscles was studied in postural position, light tapping and in maximal clench. The changes in jaw and occlusal relationships due to resorption of the edentulous maxillary ridge were slight, the mean decrease in occlusal vertical dimension during one year being 0.7 mm. The EMG clench activity at the pre-extraction stage, when the patients occluded on a residual anterior dentition, showed low mean values round 100 microV, and a further decrease was observed at the post-insertion stage. At the 1-year stage all muscles displayed significant increases to above the post-insertion level. The jaw muscle activity in light tapping and in postural position generally showed no significant mean changes during the observation period. The results indicate that preservation of a residual dentition in the lower jaw prevents marked changes in jaw and occlusal relationships and resulting changes in muscle activity.

Age changes in the perception of comfortable mandibular occlusal positions.

It has been shown that a zone of comfort in maxillo-mandibular relationships in edentulous subjects can be identified with some precision. Whilst the neurophysiological mechanism involved has not been explained fully, the phenomenon is influenced by starting position and by fatigue. This experiment was set up to test the hypothesis that age is another significant factor in perception of the comfortable zone. A group of seventeen subjects with a mean age of 62 years and an equivalent younger group, the mean age of which was 28 years, were tested with Timmer screw jacks applied using the central approach to record the upper and lower limits of the zone fifteen times in succession for each subject. A linear statistical model was used to analyse the data from upper and lower borders separately. The results showed that the effect of making successive adjustments, whilst not significant statistically in the young group, was significant in the more elderly. Regression lines from the young group data were horizontal signifying the high degree of accuracy with which their perceptual mechanisms worked: the upwards inclination of those from the more elderly was interpreted as showing that initial appreciations were subjected to constant correction.

Dynamic and static recordings of the comfortable zone.

A dynamic and a static method of assessing the comfortable zone by means of a screw jack were compared in 12 subjects. Recorded under dynamic conditions the average width of the comfortable zone was approximately 3.0 mm, and under static conditions approximately 5.0 mm (P less than 0.0001). It is suggested that in the dynamic experiments the larger output from receptors in the chewing system was responsible for the narrower zone, i.e. the more precise assessments of the comfortable zone.

Horizontal stabilization of upper and lower borders of the comfortable zone.

Using a screw jack device the upper and lower borders of the comfortable zone were recorded in a two step procedure designed to counteract bias inherent in previous measurements. In these measurements, successively increasing and decreasing values of zonal borders were recorded corresponding to a fully closed or fully opened starting position of the screw. Both of these positions are outside the comfortable zone. The two step procedure used a starting position which was supposed to lie inside the comfortable zone. However, the procedure did not achieve its aim fully. It succeeded only in stabilizing the lower border values. In the discussion hypothetical considerations are made concerning the neurophysiological mechanism underlying recordings of the borders of the comfortable zone, which might explain the differential behaviour of the zonal borders.

Ecologic changes in the oral cavity caused by removable partial dentures.

1. The introduction of a removable partial denture into the oral cavity adversely affects the prevailing ecologic situation in terms of plaque formation. 2. The rehabilitative effect of a removable partial denture may be safeguarded by controlling plaque formation by strict personal hygienic measures on the part of the patient. In particular, proximal surfaces adjacent to denture bases should be pointed out to patients as surfaces to which they must give special attention. 3. Simplification of the design of removable partial dentures can reduce their damaging potentialities. 4. Further prophylactic measures, such as topical application of fluorides and perhaps other chemicals, should also be taken.

A new intra-oral screw jack.

A new pattern of screwjack for assessing the vertical dimension for occlusion utilizing an edentulous patient's proprioceptive sensation is described. It provides a greater range of movement than other, giving infinitely variable heights between 9 and 21 mm. The elements being captive, it cannot come to pieces in use. Laboratory experiments were contrived to define the magnitude of reading errors and the play in the screw threads. It was found that, only in instances where a graduation related closely to the datum mark, did errors of interpretation arise. These were found to exceed the height set for test purposes by 0-1 mm consistently. An error of this order is of no practical significance clinically and is no impediment to such an application of the device. Mean play in the new pattern jacks was 0-01 mm compared to 0-05 mm in the Timmer versions. In a clinical experiment the performance of the screw was compared to that of Timmer. Statistical evidence was found which suggested a functional difference between the two, the new pattern being significantly more accurate.

A comparative study of three different approaches to the comfortable zone.

By means of a screw jack device, applied to thirteen edentulous subjects, the comfortable zone was approached in three different ways, by the central, the internal and the external approaches. Correspondingly, the zonal borders behaved differently. Applying the central approach it was found that the initial height of the screw jack had a lingering effect upon subsequent adjustments of the screw. Moreover, lower border data collected by the external approach distinguished themselves from other zonal border data by showing a significantly lower susceptibility to successive adjustments. The study suggests that muscle activity is a factor on which the perceptual mechanism relies, when a zonal border is assessed subjectively by a patient.

Short-term changes in the perception of comfortable mandibular occlusal positions.

In search of a new clinical method for determining the occlusal height of full dentures, the perception of the comfortable zone was studied in fifteen edentulous patients. In each experimental session perceptual changes were recorded from forty-four consecutive applications of a screw jack per subject. Two stages in perceptual acuity were found. An initial stage, in which only minor variations occurred among the final screw adjustments which the subjects made when they assessed the borders of the comfortable zone. In the ensuing stage greater variations emerged, indicating a deterioration in the ability of the subjects to discriminate.

Long-term changes in the perception of comfortable mandibular occlusal positions.

The aim of this study was to disclose, whether use of a screw jack device to set the distance between the jaws, would contribute towards a stabilization of the magnitude and position of a comfortable zone of mandibular positions or even eliminate it. Thirteen subjects participated in each of fifteen experimental sessions distributed over a 3-week period. Throughout the investigation the zone prevailed at an average width of 1-3 mm. The gap shrank 0-08 mm on average per experimental session. Although this latter value was found to be significant statistically, it can hardly be of clinical importance, considering the time needed for a total contraction of 0-8 mm to develop.

The linear model: a statistical tool applied to psychophysical research in dental prosthetics.

The construction of a linear model is described, and its function in analysing variations in the perception of comfortable mandibular occlusal positions is explained. In principle, the model combines analyses of variance and regression in a number of simple computer operations. Data from a clinical study were used to demonstrate the analytical capacity of a specific model, designed to estimate the effect of factors, which were supposed to influence the perception of comfortable mandibular positions.

The fallacy of facial measurements of occlusal height in edentulous subjects.

A controlled trial was made using fifteen subjects and making 120 measurements with a caliper gauge between marks disposed on the upper lip and the point of the chin when maxillo-mandibular relationships were altered vertically by known amounts within a range of 6 mm. It was found that mean facial measurements could account for only half of the skeletal movement involved. The variability of soft tissue translation in relation to skeletal movement led to the conclusion that such facial measurements are inappropriate to clinical practice.