Properties and plasticity of the primate somatosensory and motor cortex related to orofacial sensorimotor function

Cutaneous stimulation of the digits and lips evokes responses with different adaptation patterns in primary somatosensory cortex

Neuromagnetic evoked fields were recorded to compare the adaptation of the primary somatosensory cortex (SI) response to tactile stimuli delivered to the glabrous skin at the fingertips of the first three digits (condition 1) and between midline upper and lower lips (condition 2). The stimulation paradigm allowed to characterize the response adaptation in the presence of functional integration of tactile stimuli from adjacent skin areas in each condition. At each stimulation site, cutaneous stimuli (50 ms duration) were delivered in three runs, using trains of 6 pulses with regular stimulus onset asynchrony (SOA). The pulses were separated by SOAs of 500 ms, 250 ms or 125 ms in each run, respectively, while the inter-train interval was fixed (5s) across runs. The evoked activity in SI (contralateral to the stimulated hand, and bilaterally for lips stimulation) was characterized from the best-fit dipoles of the response component peaking around 70 ms for the hand stimulation, and 8 ms earlier (on average) for the lips stimulation. The SOA-dependent long-term adaptation effects were assessed from the change in the amplitude of the responses to the first stimulus in each train. The short-term adaptation was characterized by the lifetime of an exponentially saturating model function fitted to the set of suppression ratios of the second relative to the first SI response in each train. Our results indicate: 1) the presence of a rate-dependent long-term adaptation effect induced only by the tactile stimulation of the digits; and 2) shorter recovery lifetimes for the digits compared with the lips stimulation.

Perceptual changes in the peri-implant soft tissues assessed by directional cutaneous kinaesthesia and graphaesthesia: a prospective study

BACKGROUND

The innervation of skin and oral mucosa plays a major physiological role in exteroception. This innervation is also clinically relevant as sensory changes occur after neurosurgical procedures.

PURPOSE

The goal of this study was to compare the perception of mechanical stimuli applied to the buccal mucosa in the vicinity of osseointegrated oral implants with that in the controlateral dentate side. The role of the previously reported increased innervation in the peri-implant soft tissues in the oral sensorimotor function was thus examined.

MATERIALS AND METHODS

Seventeen subjects with 20 implants were tested. Directional cutaneous kinaesthesia (DCK) and graphesthesia (G) were performed on the buccal side of the alveolar mucosa before and at planned intervals after implant placement. The observation was pursued until 6 months after the prosthetic rehabilitation. In each subject, the contralateral mucosa served as a control to the implant sites. Average percentages of correct responses in a four-choice task for DCK and a three-choice task for G were calculated.

RESULTS

Despite an intersubject variation in both the DCK and G, high intraindividual correlations were found (p < .005). The implant sites showed a significant difference toward the control sites at the four interval test for both tests. For DCK and G, the average of correct responses decreased after abutment connection (i.e., after the implant uncovering surgery) to increase afterwards to reach a level close to, but still lower than, the control sites 3 to 6 months after the prosthetic rehabilitation.

CONCLUSION

The DCK and G are simple but reliable sensory tests that can be easily applied in the oral region. This prospective study indicates that tooth loss reduces tactile function compared with implant-supported prostheses. The peri-implant soft tissues could be partially involved in the osseoperception function.

Modulation, adaptation, and control of orofacial pathways in healthy adults

Although the healthy adult possesses a large repertoire of coordinative strategies for oromotor behaviors, a range of nonverbal, speech-like movements can be observed during speech. The extent of overlap among sensorimotor speech and nonspeech neural correlates and the role of neuromodulatory inputs generated during oromotor behaviors are unknown. The focus of this review is to consider the adaptive capacity of the orofacial substrate, and the neural correlates of kinematic parameter encoding at cortical and subcortical levels subserving oromotor behaviors. Special emphasis is directed toward distributed neural networks that are dynamically modulated by environment and task related demands.

LEARNING OUTCOMES

Readers will (1) gain a better understanding of healthy adult orofacial pathways, (2) be able to identify orofacial pathway components that contribute to sensorimotor integration, and (3) better understand the flexible connectivity among distributed neural networks subserving oromotor behavior.

The effects of intra-oral pain on motor cortex neuroplasticity associated with short-term novel tongue-protrusion training in humans

To determine if short-term (15 min) training in a novel tongue-task is associated with rapid neuroplasticity of the tongue primary motor area (MI) in the human cerebral cortex, and if intra-oral tonic pain affects the tongue MI neuroplasticity and tongue-task training performance. Nine healthy volunteers (7 men, 2 women, mean age 24+/-1.1 years) participated in two cross-over training sessions in which the application to the tongue of the algesic chemical capsaicin (1%) or vehicle cream was randomized. Prior to and again immediately after 15 min of training in a tongue-protrusion task, transcranial magnetic stimulation (TMS) was applied to the MI in each session and motor evoked potentials (MEPs) were recorded in the tongue musculature and the first dorsal interosseous (FDI) muscle (as control). Neuroplasticity of the tongue MI, as reflected in a significantly enhanced TMS-MEP stimulus-response curve and reduced MEP threshold, was observed after the vehicle session but not after the capsaicin session. Subjects' overall mean performance scores were significantly higher in the vehicle session than in the capsaicin session. MI neuroplasticity may rapidly occur in association with successful performance in novel tongue-task training, but intra-oral tonic pain interferes with these effects. These findings suggest that nociceptive input modulates MI neuroplasticity associated with novel motor training and may impair the ability to learn a new motor task.

Cortical lateralization of bilateral symmetric chin movements and clinical relevance in tumor patients—A high field BOLD–FMRI study

Although unilateral lesion studies concerning the opercular part of primary motor cortex report clinically severe motor deficits (e.g. anarthria, masticatory paralysis), functional lateralization of this area has not yet been addressed in neuroimaging studies. Using BOLD-FMRI, this study provides the first quantitative evaluation of a possible cortical lateralization of symmetric chin movements (rhythmic contraction of masticatory muscles) in right-handed healthy subjects and presurgical patients suffering tumorous lesions in the opercular primary motor cortex. Data were analyzed according to "activation volume" and "activation intensity". At group level, results showed a strong left-hemispheric dominance for chin movements in the group of healthy subjects. In contrast, patients indicated dominance of the healthy hemisphere. Here, a clinically relevant dissociation was found between "activation volume" and "activation intensity": Although "activation volume" may be clearly lateralized to the healthy hemisphere, "activation intensity" may indicate residual functionally important tissue close to the pathological tissue. In these cases, consideration of BOLD-FMRI maps with the exclusive focus on "activation volume" may lead to erroneous presurgical conclusions. We conclude that comprehensive analyses of presurgical fMRI data may help to avoid sustained postoperative motor deficits and dysarthria in patients with lesions in the opercular part of primary motor cortex.

The bases for using a particular occlusal design in tooth and implant-borne reconstructions and complete dentures

OBJECTIVES

A systematic review identified randomised and other trials (1966-2006) of studies of occlusal design of crowns, complete (CRP) and partial (PRP) removable prostheses and implant-borne reconstructions, and whether occlusal design influenced diet, quality of life, bruxism and attrition.

METHODS

The search primarily included Cochrane Database of Systematic Reviews and Central Register of Controlled Trials, Database of Abstracts of Reviews of Effectiveness, Ovid Medline and PreMedline.

RESULTS

The search yielded 1315 studies: 20 on CRP--1 RCT, one systematic review, four clinical trials, 10 case series; 22 on PRP - one cohort study, two experimental studies, 15 case reports or case series, three clinical trials; 23 on implant superstructures, and 24 reports on implant failure, 37 on oral health related quality of life, eight on attrition; and four studies on masticatory function.

CONCLUSIONS

CRP--Studies of occlusal form and tooth arrangements, included balanced, lingualised and monoplane arrangements--lingualised posterior occlusion was preferred. Early studies on CRP design were observational as case reports, however data suggested that optimum function is achieved by modification of the maxillary occlusion, irrespective of the opposing mandibular occlusion. PRP--Edentulous ridge resorption is patient-specific, has a multifactorial aetiology and there is no objective data to confirm that mechanical factors cause bone loss; oral hygiene management is crucial for long-term health. Studies on distal extension PDs confirmed a link between bite force and masticatory function; preservation of two functioning posterior tooth units ipsilateral to the distal extension optimises function. Data indicate that patient-specific factors, rather than PD design-specific features, influence long-term PD outcomes. Implant superstructures--There is little scientific evidence specifying occlusal and superstructure design for fixed prostheses for teeth or implants. Occlusal scheme design and occlusal form have evolved through clinical experience, but there is no evidence to indicate that a particular design is superior. Complex neurophysiological mechanisms allow the jaw muscle system to accommodate to oral and dental changes.

Neuroplasticity of face primary motor cortex control of orofacial movements

We have carried out a series of studies to address the role of the face primary motor area (MI) in the cerebral cortex in trained or semi-automatic orofacial motor behaviours and in behavioural adaptations to an altered oral environment. These studies have utilized intracortical microstimulation (ICMS), reversible cold block or single neurone recordings in face MI. Our studies in monkeys have revealed that face MI plays a strategic role in elemental and learned motor behaviours and in certain aspects of chewing and swallowing. Furthermore, successful training of awake monkeys in a novel tongue-protrusion task is associated with significant neuroplastic changes in face MI. These findings in monkeys are supported by correlated findings in humans which have revealed significantly enhanced corticomotoneuronal excitability when humans learn the novel tongue-protrusion task. Our related ICMS studies in rats reveal that trimming or extraction of the rat's lower incisors or damage to the rat's lingual nerve can result in significant changes in the MI representations of the tongue or jaw muscles. These various findings suggest that the face MI is important in orofacial motor skill acquisition and adaptation to an altered occlusion or loss of teeth or lingual sensory function, and that it reflects dynamic and modifiable constructs that are modelled by behaviourally significant experiences and that are critical to learning and adaptive processes.

Mechanisms of oral somatosensory and motor functions and their clinical correlates

This article provides a review of somatosensory and motor pathways and processes involved in oral sensorimotor function and dysfunction. It reviews somatosensory processes in peripheral tissues, brainstem and higher brain centres such as thalamus and cerebral cortex, with a particular emphasis on nociceptive mechanisms. It also outlines some of the circuits and processes involved in reflexes and motor control. In addition, it emphasizes the concept of neuroplasticity and its applicability to oro-facial pain, to motor control and motor learning, and to adaptation to changes in the oral sensory environment such as may occur with the placement of dental implants.

Validation of a musculo-skeletal model of the mandible and its application to mandibular distraction osteogenesis

Mandibular distraction osteogenesis will lead to a change in muscle coordination and load transfer to the temporomandibular joints (TMJ). The objective of this work is to present and validate a rigid-body musculo-skeletal model of the mandible based on inverse dynamics for calculation of the muscle activations, muscle forces and TMJ reaction forces for different types of clenching tasks and dynamic tasks. This approach is validated on a symmetric mandible model and an application will be presented where the TMJ reaction forces during unilateral clenching are estimated for a virtual distraction patient with a shortened left ramus. The mandible model consists of 2 rigid segments and has 4 degrees-of-freedom. The model was equipped with 24 hill-type musculotendon actuators. During the validation experiment one subject was asked to do several tasks while measuring EMG activity, bite force and kinematics. The bite force and kinematics were used as input for the simulations of the same tasks after which the estimated muscle activities were compared with the measured muscle activities. This resulted in an average correlation coefficient of 0.580 and an average of the Mean Absolute Error of 0.109. The virtual distraction model showed a large difference in the TMJ reaction forces between left and right compared with the symmetric model for the same loading case. The present work is a step in the direction of building patient-specific mandible models, which can assess the mechanical effects on the TMJ before mandibular distraction osteogenesis surgery.

Generation of the Central Masticatory Pattern and Its Modification by Sensory Feedback

Mammalian mastication results from the interaction of an intrinsic rhythmical neural pattern and sensory feedback generated by the interaction of the effecter system (muscles, bones, joints, teeth, soft tissues) with food. The main variables that explain variation in the pattern of human mastication are the subjects themselves, their age, the type of food being eaten, and time during a sequence of movements. The intrinsic pattern of mastication is generated by a central pattern generator (CPG) located in the pons and medulla. The output of the CPG is modified by inputs that descend from higher centers of the brain and by feedback from sensory receptors. Intraoral touch receptors, muscle spindles in the jaw-closing muscles, and specialized mechanoreceptors in the periodontal ligament have especially powerful effects on movement parameters.

The neurophysiology of osseointegrated oral implants. A clinically underestimated aspect

Amputation of a limb or a tooth leads to the loss of a large number of exteroceptors. These play an important role in sensory perception and feedback, which tune the motor control. Even after rehabilitation with a prosthetic device, tactile function remains impaired. This can present a subsequent risk of overloading the prosthesis. The peri-implant interface of oral osseointegrated implants is characterized by the absence of a periodontal ligament, a crucial difference towards the natural dentition, from a biomechanical but also from a neurophysiologic point of view. Patients rehabilitated with osseointegrated implants seem subjectively not much impaired in their masticatory and other oral functions. This observation might be linked to the presence of some peripheral feedback pathway to the sensory cortex. It may be attributed to the activation of receptors in the peri-implant environment (either bone or periosteum). This phenomenon called osseoperception, when it relates to the consciousness of the applied stimuli, has been described for both oral and skeletal implants. In the present review, besides osseoperecption other neurophysiological aspects of oral implants, such their reflex function, will be outlined and their clinical meaning pointed out.

One hour of tongue-task training is associated with plasticity in corticomotor control of the human tongue musculature

Corticomotor control of the human tongue has been reported to undergo neuroplastic changes following several days of training in a tongue-protrusion task. The aims of the present study were to determine if a 1 h tongue-task training is sufficient to induce signs of neuroplastic changes in the corticomotor pathways, and to obtain preliminary information on the time course of such changes. Corticomotor excitability was assessed by changes in electromyographic activity evoked by transcortical magnetic stimulation (TMS) in 11 healthy subjects. Motor evoked potentials (MEPs) recorded in the tongue musculature and the first dorsal interosseous (FDI) muscle were assessed at four sessions: at baseline before training, 30 min after training, and 1 and 7 days after training. All subjects performed successfully the task (success rate: 38+/-4%). Thresholds for evoking MEPs by TMS in the tongue were decreased at 30 min, 1 and 7 days after training compared with baseline (ANOVA: P<0.001). Tongue MEP amplitudes were significantly increased at 1 day follow-up and had returned to baseline values at 7 days follow-up (ANOVA: P<0.001). No significant effect of tongue-task training on FDI MEPs was observed (ANOVA: P=0.160). Corticomotor topographic maps revealed increases (ANOVA: P<0.001) in area at the 1 day follow-up. The success rate was significantly correlated to the net increases in tongue MEPs at 1 day follow-up (Spearman: 0.615; P=0.0039). The present findings confirm that tongue task training is associated with plasticity of corticomotor excitability specifically related to the tongue musculature and further document that plasticity is evident within 30 min post-training and may last up to at least 7 days.