Precision of jaw-closing movements for different jaw gaps

Comparison of the accuracy of different types of bite recordings - an in vitro study

OBJECTIVES

Reconstruction of a three-dimensional jaw position determined by a bite recording is an important aspect of prosthetic therapy. Different materials are used for this purpose. In the dental technical workflow, recordings are used to mount a lower jaw cast in a patient-like spatial position relative to the upper jaw cast. We evaluated the accuracy of positioning under the influence of different jaw positions and materials.

MATERIALS AND METHODS

In an experimental setup, comprising an articulator, a pair of metal casts, and an optoelectronic measurement system, the spatial position of the incisal point and two condylar points were measured. To evaluate the accuracy of repeated repositioning of casts in the technical workflow, 324 measurements were taken from 108 recordings, consisting of silicone bite-stops made of addition curing silicone with 95 shore hardness, acrylic wafers, and wax recordings. The recordings were obtained in four jaw relations differing in vertical and protrusive components.

RESULTS

Of the three materials/material combinations examined, silicone showed the most consistent results across all measurements, followed by the acrylic wafer system, and then wax recordings. Generally, recordings with smaller gaps between the jaws and no protrusive components showed greater deviations compared to jaw positions with greater protrusion and higher vertical dimensions.

CONCLUSIONS AND CLINICAL RELEVANCE

To achieve reliable model mounting with high accuracy, recordings should include the use of a frontal jig and four small recording platelets made of silicone, especially if only a slight elevation of the vertical dimension is needed.

Fully digital workflow of an occlusal device including digital facebow record: A clinical report

In many current digital workflows for the production of occlusal devices and dentures, the traditional facebow record for the individual determination of the hinge axis has been omitted. A novel digital facebow record procedure including a scannable occlusal fork is described as a straightforward to use, cost-effective, and less time-consuming alternative to close this gap in fully digital prosthetic workflows.

Effects of preventing intercuspation on the precision of jaw movements

BACKGROUND

Closing movements are among the jaw's basic physiological motor actions. During functional movements, the jaw changes position continually, which requires appropriate proprioception. However, the significance of the various proprioceptive receptors involved and how they interact is not yet fully clear.

OBJECTIVES

This study's main objective was to test whether preventing intercuspation (IC) for 1 week would affect the precision of jaw-closing movements into IC and the functional space of habitual chewing movements (HCM). A secondary objective was to compare precision of jaw-closing movements into IC with the precision of movements into a target position (TP) far from IC.

METHODS

Fourteen participants' HCM and jaw-closing movements into IC were recorded on two sessions (T1 and T2) 1 week apart. Between sessions, participants wore posterior bite plates to prevent IC. They also received a 10-minute training session at T1 to guide their jaw-closing movements into TP. The precision of the closing movements into IC and TP was analysed. For HCM, the vertical amplitude, lateral width and area of chewing cycles were evaluated.

RESULTS

The precision of jaw movements into IC increased as the jaw gap decreased, but precision did not differ significantly between T1 and T2. For HCM, the vertical amplitude and area of chewing cycles increased significantly between T1 and T2. The precision of the closing trajectory into TP increased significantly during the training session.

CONCLUSION

Our results confirm the excellent adaptability of the craniomandibular system, controlled by stringent motor programmes that are supported by continuous peripheral sensory input.

Proprioceptive ability at the lips and jaw measured using the same psychophysical discrimination task

In the human face, the muscles and joints that generate movement have different properties. Whereas the jaw is a conventional condyle joint, the facial musculature has neither distinct origin nor insertion points, and the muscles do not contain muscle spindle proprioceptors. This current study aims to compare the proprioceptive ability at the orofacial muscles with that of the temporomandibular joint (TMJ) in 21 neuro-typical people aged between 18 and 65 years. A novel psychophysical task was devised for use with both structures that involved a fixed 30.5 mm start separation followed by closure onto stimuli of 5, 6, 7, 8 mm diameter. The mean proprioceptive score when using the lips was 0.84 compared to 0.79 at the jaw (p < 0.001), and response error was lower by 0.1 mm. The greater accuracy in discrimination of lip movement is significant because, unlike the muscles controlling the TMJ, the orbicularis oris muscle controlling the lips inserts on to connective tissue and other muscle, and contains no muscle spindles, implying a different more effective, proprioceptive mechanism. Additionally, unlike the lack of correlation previously observed between joints in the upper and lower limbs, at the face the scores from performing the task with the two different structures were significantly correlated (r = 0.5, p = 0.018). These data extend the understanding of proprioception being correlated for the same left and right joints and correlated within the same structure (e.g. ankle dorsiflexion and inversion), to include use-dependant proprioception, with performance in different structures being correlated through extended coordinated use. At the lips and jaw, it is likely that this arises from extensive coordinated use. This informs clinical assessment and suggests a potential for coordinated post-injury training of the lips and jaw, as well as having the potential to predict premorbid function via measurement of the uninjured structure, when monitoring progress and setting clinical rehabilitation goals.

Electronic central bearing point as registration method in individuals with and without temporomandibular disorders

OBJECTIVES

The aim of this study was to examine different central bearing point methods in patients with and without temporomandibular disorders (TMD) by an experienced and unexperienced examiner.

MATERIAL AND METHODS

The 20 fully dentulous subjects were screened for TMD based on the Research Diagnostic Criteria for TMD and distinguished into functional impaired and functional healthy groups. The mandibular relationship was recorded by an electronic central bearing tracing device (IPR-System, IPR GmbH, Oldenburg, Germany) with an integrated pressure sensor. Three bite registration methods were performed using this device: initial neuromuscular position, final neuromuscular position after dynamic sequences with the intraoral pin (=neuromuscular deprogramming), and centric relation guided manually by an experienced and an unexperienced examiner.

RESULTS

The neuromuscular positions before and after neuromuscular deprogramming were not significantly different (paired t test as a group comparison test: transverse: p = 0.369; sagittal: p = 0.486). Both positions were significantly anterior in comparison to the manually guided centric relation (paired t test as a group comparison test: p < 0.0001). The neuromuscular positions before and after deprogramming tend to have high scattering values.

CONCLUSION

By means of the central bearing point method, the manually guided centric relation is the one which is sufficiently reproducible. It seems doubtful to take the significant anterior neuromuscular position for a definite reconstruction.

CLINICAL RELEVANCE

Using the central bearing point method, the manually guided centric relation should be preferred, whereas the neuromuscular position should not be used for definite reconstructions.

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.