The Physiology of Masticatory System

Masticatory system composes of the teeth, the skeletal, and the neuromuscular
components. The occlusion of the teeth is the key to oral function. They play the
integral part in maintain occlusal harmony, a concept which a skillful practitioner
must be trained to recognize them or appreciate their significance. The skeletal
components consist of the temporomandibular joints, the mandible, and the
maxilla. Finally the neuromuscular components consists of the muscle of
mastication and the somatosensory system. The three components worked
interactively with each other. Complex occlusal problem often begins with a weak
link in one of the three components and later manifests into different components.
As described by Henry L Beyron: masticatory system is a unitary system, each part
which the teeth, for instance- must be considered in relation to the while. The
masticatory system is a functional system, the prime object of which to promote
perfect condition functionally rather than morphologically.

To fully understand the concept of natural teeth occlusion, we must analyze the
mandibular movements. These series of movement can occur around three axes:
the horizontal, the vertical, and the sagittal axis. The movement about the
horizontal axis, which occurs in the sagittal plane, can be demonstrated when the
retruded mandible produces a purely rotational opening and closing movement
around the hinge axis, which extends through both condyles. The movement about
the vertical axis, which occurs in the horizontal plane, can be demonstrated when
the mandible moves into a lateral excursion. The center for this rotation is a
vertical axis extending through the working side condyle. The movement about the
sagittal axis, occurs when the mandible moves to one side and cause the condyle
on the contralateral side travels forward. As it does, the condyle crosses the
eminentia of the glenoid fossa and moves downward simultaneously. Movement of
the mandible can be a combination of two or more movements about one or more
of the axis. Centric occlusion, the up and down motion, demonstrated a
combination of the purely rotational about the hinge axis and also possible the
translational movement (gliding movement) in the upper compartment of the
joints. The centric relation, is the most duplicatable position, occurs when the
condyle is in its most retruded position at the posterior and superior of glenoid
fossa. The protrusive movement occurs when the mandible slides forward so that
the maxillary and the mandibular teeth are in end to end position. In this
movement, the anterior segment of the mandible will travel a path guided by
contacts between anterior teeth, thus gives rise to the term anterior guidance.
Mandibular working movement occurs when the mandible move to one side;
whereas the term nonworking demonstrated the same movement but on the
contralateral side. In this type of movement, the condyle on the nonworking side
will arc forward and medially, whereas the condyle on the working side will shift
laterally and usually slightly posteriorly. This bodily shift of the mandible in the
direction of the working side is termed Bennett movement, named after the man
first described it. Aull has been demonstrated that the presence of an immediate
side shift occured in 86% of the condyles studied. Lundeen and Wirth have shown
this median dimension to be approximating 1mm-3mm.

Movement areas of the mandible was measured by Ulf Posselt using the gnatho-
thesiometer, a tool to record the positions of the mandible in persons with natural
teeth. Earlier investigation have shown the figure of the movement of the anterior
part of mandible is rhomboidal in shape. Ulf Posselt sets out to investigate the
shape and dimension of the contact area of movement of the anterior measuring
point, and of the points on the condyles. Individual variations were studied also in
five subjects. He showed that the contact area of movement of the anterior
measuring point has the shape of a rhombus and the areas of movement of the
condylar points were all different in the five case studied. Furthermore, he found
that there are differences between the extreme position and habitual positions.
Overall, he found that the shape of the mandibular movement show wide variation
at both condyle points and the anterior measuring point.

The determinants of all the mandibular movements described above are the right
and left temporomandibular joints in the posterior, the teeth of the maxillary and
mandibular arches, and the neuromuscular system.

The temporomandibular joints, as described by Harry Sicher, is a bilateral

articulation, right and left joints, though anatomically separted, forming
functionally one articulation. There is only one position of the mandible in the
dead that imitates the position of the mandible in the living, that is, the position of
full occlusion. This centric occlusion is established by intercuspation of the
maxillary and mandibular teeth. When the teeth in is CO, there is no bony contact
exists at the mandibular articulation of the skull. There is always a space between
mandibular condyles and the cranial base at the articular tubercles. Normal
physiologic CR position of the jaws may be defined as the stable, comfortable,
functional craniomandibular relationship in which the condyles are in their most
superior position in intimate contact with the thinnest central bearing area of their
respective discs against the distal surface of the articular eminences at any vertical
rotational postion of the mandible. CR is a comfortable physiologic work position
during mastication and swallowing, provided there are no deflective interferences
from the teeth. It is not a rest postion; therefore when the mandible is in CR,
considerable electromyographic activity may be observed. When CO = CR, CR is
used during mastication and swallowing about 5000 times a day. This position has
been found clinically to be the best location for the maximum intercuspation of
teeth. Clinically, CR may be defined as the completely retruded position of the
mandible with the condyles in their most superior anterior postion at any vertical
rotational position of the mandible. As the jaw open, the condyle brace themselves
against the postglenoid process as the mandible travels upward and backward.
Studies have shown that physiological bone remodelling observed in the condyle
has no orientation that could be related to the changed occlusion. However,
occlusal forces brought about rebuilding of the bone in the neck of the condyle.
Longitudinal studies have shown that changes associated with orthodontic
treatment of class II malocclusion are related mainly to altered growth patterns of
the alveolar processes rather than to joint changes. It appears that the changes in
temporomandibular joint morphology may be the result of pathological rather than
physiological processes. Furthermore, there has been striking evidence of
periodontal trauma from occlusion and subsequent movement of teeth in all studies
of occlusal disharmony and TMJ morphology. The clinical significance of these
research findings to the practice of dentistry should be the adaptation of the
occlusion to be in harmony with the TMJ rather than hoping for the TMJ to adapt
to the occlusion.

The teeth of the maxillary and mandibular arches made up the second determinants
of mandibular movement. Tooth morphology is totally genetic and is not specific
to race or gender. Teeth occluded together and form “occlusion”. Occlusion refers
to the act of closure or the state of being closed. When teeth is in maximum
intercuspation, this position is referred to as centric occlusion (CO). As described
above, when CR = CO, this is the best clinical situation. In a normal class I
relationship, the buccal cusps of the mandibular premolars contact the marginal
ridge of the maxillary premolars. The mesiobuccal cusp of the first mandibular
molar occludes on the adjacent marginal ridges between the maxillary first molar
and second premolars while the distobuccal cusp of the mandibular first molar
occludes in the central fossa of the maxillary first molar. In the maxilla, the lingual
cusp of maxillary premolars occlude on the marginal ridges or in the distal fossae
of the mandibular premolars. There is usually no occlusal contact with the
rudimentary lingual cusp of the mandibular first premolar. The mesiolingual cusp
of the maxillary first molar occludes in the central fossa of its mandibular mate
while the distolingual cusp occludes on the adjacent marginal ridges between the
mandibular first and second molars. In good occlusion, all the teeth in the mouth
make simultaneous contacts in CR including the anterior teeth. However, the
anterior teeth should never contact harder than the posteriors or fremitus may be
produced with possible endodontics and periodontal trauma and/or interproximal
separation of the teeth. Normally, occlusal contacts on the anterior teeth are not
broad, but rather two or three spots per tooth on the incisors and one on each
canine. The total tooth contact area has been estimated to be about 4mm2 for the
entire mouth. Complete occlusion of the teeth (intercuspal position) approximately
5000 times per day helps to realign and stabilize the craniomandibular relationship
into a state of biological equilibrium. Stabilization of the craniomandibular relation
in CR is important to comfort, function, and longevity of the dental restoration.
The use of properly constructed, adjusted, and maintained maxillary, anterior
guided occlusal splint is probably the best way to align and stabilized the
craniomandibular relationship prior to treating the occlusion and articulation of the
teeth.

Samuel Adam and Helmut Zander described functional tooth contacts in lateral and
centric occlusion using miniature radio transmitters which were incorporated in
dental bridge work to record the functional tooth contacts on magnetic tape. Three
test food were used: bread, lettuce, and peanut, in analyzing the functional tooth
contacts in four adults. They found that contact was recorded more often in the
intercuspal position than lateral to it. The frequency of contact was least in the
early phase of mastication, increased in the middle third of mastication, and was
greatest during the last part for both the intercuspal postion and the lateral position.
The intercuspal contacts increased in duration as the act of eating progressed and
were longest during swallowing: however, the duration of lateral contacts did not
increase. Finally, by relating the onset of tooth contact to the envelope of
electromyographic activity, it became apparent that lateral contacts occurred before
as well as after the intercuspal position was reached. The ratio of these two types of
lateral contact was characteristic for each subject and was not altered by the nature
of the food being masticated.

Henry L. Beyron investigated the characteristics of functionally optimal occlusion

and principles of occlusal rehabilitation. He also described the reaction of the
supporting tissues to the load on a single tooth. A tooth should be subjected to a
certain occlusal load and should not be permanently without one; that is, it should
always have an antagonist. With longitudinal stress, the tooth and the periodontium
act as one unit to resist the load; whereas in lateral stress, the forced is taken up
regionally and result in bone resorption. In the article it also emphasized that it is
not the magnitude but the direction of the force that is decisive. In a functionally
optimal occlusion, the teeth should receive the stress consistent with the
physiologic requirements for stimulation of the supporting tissues; and, in
particular, the direction of stress should coincide as closely as possible with the
long axis of the tooth. This is referred to as the principle of axial stress. In viewing
of the entire dentition, the total load should be distributed by interproximal tooth
contact and by simultaneous occlusal contact in centric position among all teeth
and in eccentric postions primarily among the teeth in the engaged tooth segment.
Another characteristic of a functionally optimal occlusion is its closure without
interference in the centric maxillomandibular relation. The mandible on closing in
CR should close into the position of maximal intercuspation (CR=IP). The article
also described the need to determined a proper occlusal dimension in a functionally
optimal occlusion. There must be a proper interocclusal clearance between the rest
postion and the intercuspal position. This space also is referred to by Ramjford as
the physiologic resting range which the interocclusal distance average 1.7mm in
the clinically determined rest position, and 3.29mm when determined
electromyographically on the basis of minimal muscle activity. A functional
optimal occlusion also demonstrated free gliding movements in excursion without
any interference. The attainment of this objective is faciliated by a flat gliding
paths and simultaneous contact in eccentric positions among several teeth in the
engaged tooth segment.

The most thorough study on the occlusal relations and mastication was done by
Henry Beyron on the australian aborigines who lived under settlement conditions
in central Australia. The purpose of the investigatio is to obtain information on
occlusion and mandibular function concerning the anatomic size and shape of
dental arch, the intercuspal postion and its relation to CR, the occlusal contacts,
and the mandibular movements and its shape and size during mastication (envelope
movement). The subjects were arranged in age group: the youngest, middle aged,
and the oldest group. Prior to the study, the anatomic examination of the teeth, the
dental arch, and also the gingival condition were carried out. Number of teeth, the
mesiodistal width of mandibular and maxillary central incisors and lateral incisors
were measured. The tooth spacing, width and length of dental arch, the skeletal and
dental relationship in overbite and overjet was recorded, also the attrition of the
dentition using the location of wear in the tooth to classified (Broca classification)
was documented. The subjects also were examined for the intercuspal position and
its relation to the CR position. IP were found to achieved without deviation. The
result show the mean difference between the intercuspal and the retruded contact
positions was nearly the same for all age group: 1.15, 1.11, and 1.19 for the
youngest, middle aged, and oldest groups, respectively. The mean is 1.25 +-
1.0mm. The distance between the intercuspal and the lateral positions was from 2-
3mm. The presence of occlusal contacts was tested using strip of thin .03mm
cellophane placed between opposing teeth. 75% of young age group contact in the
IP for molars and premolars only. 50% of the middle aged group contact in IP for
molars and premolars only, whereas in old age group, contact spread to canines but
incisors still was separated by a small space. The only time incisors were contact is
when overbite and overjet was zero, i.e. edge to edge occlusion. He also investigae
the masticatory movement using cinematographic recording. The lower incisor was
chosen as the reference point, as it was possible to follow directly the movement of
an incisal angle of lower incisor. A camera was used to recored the movement of
masticatory system in the frontal plane at 32 frames per second. No extraoral
indicators were used and thus recording in the sagittal plane could not be obtained.
The film analysis showed that an opening an closing movement together form a
masticatory cycle. He found that the duration of masticatory cycle varied within
and between subjects. The enveloped movement of mastication was registered
during chewing, began on one side with 2, 3, and 4 cycles, then move to the other
side after an opening movement. This pattern was repeated regularly until the bolus
was swallowed. The time for one chewing cycle was less than 1 second. The shape
and size of the masticatory cycle also was determined and graphically
demonstrated. The means for the vertical dimension of the masticatory cycle were
18mm for young, 17mm for middle age, and 15mm for the oldest. Thus there is
loss of vertical dimension as one ages. The cranial part of the most of the
masticatory cycles coincided for some distance with the path of contact glide
obtained from empty movement. Results have shown that the cranial part of the
masticatory cycle is performed under cuspal guidance.

The neuromuscular system consists of the masticatory muscles and the

somatosensory nervous system. The masticatory muscles consist of the temporalis,
the masseter, the medial pterygoid, the lateral pterygoid, the anterior portion of
digastric, and the geniohyoid muscle. The temporalis muscle originates from the
lateral surface of the skull, extends as far forward as the lateral boder of the
supraorbital ridges, and inserts on the coronoid process and along the anterior
border of the ascending ramus of the mandible. The temporal muscle is innervated
by the three branches of temporal nerve of V3 of trigeminal nerve. It acts as the
principal positioner of the mandible during elevation. It is more sensitive to
occlusal interference than any other masticatory muscle.

The masseter originates from the zygomatic archs and inserts into the ramus and
the body of mandible. Its insertion extends from the region of second molar on the
lateral surface of the mandible to the lower one-third of the posterior lateral surface
of the ramus. The masseter acts mainly in power comminution (chewing) and its
principal function is mandibular elevation.

Medial pterygoid muscle originates from the pterygoid fossa and inserts on the
medial surface of the angle of the mandible. Its principal functions are elevation
and lateral positioning of the mandible. It is very active in simple protraction. In
combined protrusive and lateral movements, the activity of the medial pterygoid
dominates that of the temporal muscle.

The lateral pterygoid has two origins: one originates from the outer surface of the
lateral pterygoid plate while a smaller, upper head originates from the greater
sphenoid wing. Both joins together and inserts on the anterior surface of the neck
of the condyle and some at the capsule of the TMJ joint and the anterior aspect of
the articular disk. The principle of the lateral pterygoid muscle is protracting the
condyle while drawing the disk forward.

The anterior digastric is found near the lower border of the mandible and near the
midline. It is innervated by the branch of mylohyoid nerve (V3 of trigeminal). It is
assoicated with the depression of the mandible, especially most prominent toward
the end of the mandibular depression (end of the opening of mandible).

Finally, two geniohyoid muscles run down and back from the mylohyoid ridges on
the lingual side of the mandible and are inserted on the hyoid bone. It functions in
depression and retraction of the mandible. It also lift the hyoid bone during
swallowing.

In summary, during opening of mandible, the lateral pterygoid acts first and
sustained activity. The activity of the anterior digastric follows that of the lateral
pterygoid muscles when the opening movements nears completion. During
combined protraction and opening, the medial and lateral pterygoid, the masseter,
and the temporalis all participated. The temporal and masseter limit the opening of
the mandible; thus they become active at the final stage of opening of the
mandible. During mandibular closure, the medial, temporal, and masseter are all
actived. In forced heavy closure, all the masticatory muscle contracted, along with
many of the facial and neck muscle contraction. During lateral mandibular
movement, there are the ipsilateral contraction of the posterior and middle fiber of
temporalis and the contralateral contraction of the lateral and medial pterygoid
muscles and the anterior fibers of the temporal muscle. During horizontal
movement, masseter or the temporal act as antagonists. Lateral movement are
initiated by the lateral and medial pterygoid muscle. During protraction, the lateral
and medial pterygoid acts simultaneously. Retraction of the mandible is
accomplished by contraction of the middle and posterior parts of the temporalis
and the suprahyoid muscle.

As we can see, in order to achieve the most optimal occlusion, we must determine
all the components of the masticatory system and ensure they are in balance. There
must not be any interference, with CR as close to CO or with freedom in centric if
possible. Only slight 10% of the population achieved the complete harmony
between the teeth and the TMJ. Only small group achieve maximum intercuspation
in CR. Therefore, in a normal occlusion, there will be a reflex function of
neuromuscular system producing the mandibular movement which avoids
premature contacts. This guides the mandible into IP with condyle in a less than
optimal occlusion. The result is the hypertonicity of nearby muscle, but well within
physiologic adaptive limits. If stress and emotional tension increased, the threshold
to this adaptability may be lowered and thus this adaptive normal occlusion may
manifested into pathologic occlusion. Dawson described the normal occlusion as:
firm contacts on all teeth in CR, anterior guidance which harmonizes with patient
customary envelope movement, disclusion of posterior teeth when the mandible
protrudes, disclusion of posterior teeth on the nonworking side in lateral
excursions, and finally absence of interference on the posterior teeth on the
working side in lateral excursions. Mastering occlusion is the primary objective
that must be achieved in order to restore the function of the dentition to last a
lifetime.

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Reference

1. Adams, S. Functional tooth contacts in lateral and centric occlusion. JADA,

465;1964.

2. Posselt, U. Movement areas of the mandibles.J. of Prosthetic Dentistry, 375,

1957

3. Sicher, H. Temporomandibular articulation: concepts and misconceptions. J.

Oral Surg, Anesth, and Hosp, D.Serv.; 20: 1962.

4. Beyron H,. Occlusal relations and mastications in Australian aborigines. Acta.

Odont Scand. 1964: 22: 597.

5. Beyron, H. Characteristics of functionally optimal occlusions and principles of

occlusal rehabilitation. JADA, 1954: 48: 648.

6. Rufenacht. Fundamental of Esthetics. Quintescence 1990.

7. Shillingburg, Hobo, Whitsett. Fundamentals of Fixed Prosthodontics.

Quintessence 1981.

8. Ramfjord, Ash. Occlusion. W.B. Saunders 1983.

9. Dawson, PE. Evaluation, Diagnosis, and treatment of occlusal problems. Mosby,

1989.