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Effect of Occlusal Interference on Habitual Activity of Human Masseter
A. Michelotti, M. Farella, L.M. Gallo, A. Veltri, S. Palla and R. Martina J DENT RES 2005 84: 644 DOI: 10.1177/154405910508400712 The online version of this article can be found at: http://jdr.sagepub.com/content/84/7/644

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2005. and active-interference conditions. 1961). michelot@unina. single-contact balancing side and protrusive occlusal interference. dental prostheses. previous orthodontic treatment. The effects of the interference on signs and symptoms of TMD were also investigated. Palla2. International and American Associations for Dental Research . 1995a. The proposed causal chain of events suggests that interference triggers masticatory muscle hyperactivity and bruxism. 1999).7 ± 1. occlusal interference. KEY WORDS: electromyography. Via Pansini. Farella1. *corresponding author.sagepub. Martina1 1Department of Dental and Maxillo-Facial Sciences. and habitual drug intake. the final sample included 11 females (mean age ± SD = 19. 2005 644 Downloaded from jdr. nail biting. and most of them adapted fairly well to the occlusal disturbance.. selfreport of clenching or bruxism. 1992. and temporomandibular joint clicking (Ramfjord. Clark et al. masseter muscle. 1998). Italy. 1981). inflammatory conditions. Dental and Maxillo-Facial Surgery. headaches and/or other neurological disorders. The EMG activity did not change significantly during the dummy-interference condition. temporomandibular disorders.e. Gallo2.it Effect of Occlusal Interference on Habitual Activity of Human Masseter J Dent Res 84(7):644-648. The study protocol had been approved by the local ethics committee (#139/00). with the exception of third molars. Last revision February 20. INTRODUCTION cclusal interference has been considered as a risk factor for O temporomandibular disorders (TMD) (Kirveskari et al. Switzerland. received = C 150 for participation. This was a major limitation. 2004. which in turn may result in overload of the masticatory muscle. School of Dentistry.com at UNIVERSIDAD DE CHILE on July 1. Strips of gold foil were glued either on a selected occlusal contact area (active interference) or on the vestibular surface of the same tooth (dummy interference) and left for 8 days each. habitual use of chewing-gum. This has been done in subjects during sleep (Rugh et al. M. these studies recorded the masticatory activity during a short time in an experimental setting. but not in awake subjects. S. To test this hypothesis. to investigate the effects of the application of an acute alteration of occlusion (i. 1982. MATERIALS & METHODS Subjects Female subjects were recruited from among medical first-year students. Received June 29. pain in other parts of the body. pain. 1984). therefore. Christensen and Rassouli. slide from retruded contact position to intercuspal position greater than 2 mm. None of the subjects developed signs and/or symptoms of TMD throughout the whole study. Exclusion criteria were: any TMD diagnosis. Katz et al. Center for Oral Medicine. it is necessary that one record long-term masticatory muscle activity in the habitual environment. Electromyographic (EMG) studies have shown that the application of occlusal interference may increase the activity of several jaw elevator muscles at rest (Riise and Sheikholeslam. Veltri1.. Accepted April 22. Michelotti1*. and 2Clinic for Masticatory Disorders and Complete Dentures. L. Nine subjects were excluded from the study. 1995b). previous investigators have studied the local and peripheral effects arising from the application of several kinds of experimental interference (Christensen and Rassouli. and were assured that they could leave the study at any time. depression and physical symptoms above the norm. Ash and Ramfjord. The subjects signed an informed consent. For a better understanding of an individual's response to occlusal interference. tenderness. 1995. smoking. Electromyographic masseter activity was recorded in the natural environment by portable recorders under interference-free. 5. Dawson. absence of one or more teeth.1 yrs). therefore.M. Furthermore. periodontal diseases. 2011 For personal use only. 2005 ABSTRACT It has been suggested that occlusal interference may increase habitual activity in the jaw muscles and may lead to temporomandibular disorders (TMD). We tested these hypotheses by means of a double-blind randomized crossover experiment carried out on 11 young healthy females. interference) on the habitual masseter activity assessed in the natural environment. The active occlusal interference caused a significant reduction in the number of activity periods per hour and in their mean amplitude. Of the 32 students who completed a questionnaire about their health conditions and common habits. University of Zürich. University of Naples "Federico II". dummy-interference. The aim of this study was..RESEARCH REPORTS Clinical A. No other uses without permission. 1989). 1992). 1969.. A.. and R. occlusal wear (> 2 as defined by Clark et al.I-80131. Section of Orthodontics and Clinical Gnathology. since laboratory conditions may influence the amount of muscle activity (Yemm. 20 subjects were selected and underwent a preliminary oral clinical examination (AM) according to the Axis I and Axis II RDC/TMD (Dworkin and LeResche..

After a one-week washout period. Description of the study design. always by the same examiner who was blind to the interference condition (AV). Farmingdale. day-1. 2000). AICday-8. Skovlunde.. and recorded it in the data file. We used analysis of variance (ANOVA) for repeated measurements with post hoc multiple comparisons to test whether the EMG variables varied under the different occlusal contact conditions. the interference was applied in reverse order. Figure 1. Clinical Protocol After 3 consecutive days of baseline EMG recordings (IFCbefore). Bioggio. the active or dummy interference was applied. electrodes) was 7. and electromagnetic fields. Each subject went through 4 different conditions during a six-week period: interference-free condition before the interference application (IFC before ). Based on this threshold. all subjects serving as their own control (Fig. and IFCafter. 6 mm diameter) were attached. NY. and then reproduced on the casts by means of a pencil. Parkell. Tooth contact was defined as the subject's ability. physical exercise.J Dent Res 84(7) 2005 Study Design Occlusal Interference and Masseter Activity 645 The study was carried out in a double-blind crossover design. CA. and at AICday-1 immediately after the application of the interference. Occlusal Discomfort. Contact points between first molars were marked on the subject in the intercuspal position by means of marking paper (Accufilm II. while we used the Friedman's test to analyze whether Downloaded from jdr. They were aligned along the muscle fibers with 20 mm between them (Gallo et al.. USA). CA. Grand Terrace. Hawe Neos Dental. USA). to the AIC (n = 5) or DIC (n = 6). but did not create interference during lateral or protrusive mandibular excursions. to maintain the strip between opposing teeth against a strong pull (Bakke et al. AIC = active interference condition. Statistics Normality of data was checked by the Kolmogorov-Smirnov test (K-S). using composite (Revolution. USA). Italia). dummy interference condition (DIC). 1). 3 swallows. DICday-8. International and American Associations for Dental Research . 1990). active interference condition (AIC).2 ± 3. Orange. .m. Two surface EMG electrodes (model 13L20. during firm biting. Recording time was set between 10 a. USA) were poured with stone (Vel-Mix Stone type IV. day-1. To create the dummy interference. A total of 16 recording days was obtained from each subject (Fig. The numbers and distributions of occlusal contacts were assessed by means of plastic strips 0.05 g) was placed on the lower first molar of the preferred chewing side (nine right-sided and two left-sided subjects) on the occlusal contact and carefully adapted to the tooth anatomy on the dental cast.com at UNIVERSIDAD DE CHILE on July 1. 1999). EMG Recordings The activity of the masseter muscle ipsilateral to the interference side was recorded by means of a portable EMG recorder (Gallo and Palla. After the second washout period. To define the threshold for activity periods. the active and the dummy.. EMG activity was monitored for 3 additional consecutive days. Panadent Co. Kerr. One of the authors (RM). and Occlusal Contacts Muscle pain. 2011 For personal use only. by means of a balanced block randomization. This active interference disturbed the intercuspal position. 1995). Mean value (± SD) for simulated artifacts ( i. DIC = dummy interference condition. then glued both kinds of interference. TMD examinations were performed independently by two blind examiners (AM. The masseter activity was recorded during days 1-2-3-5-8. at DICday-8 and AICday-8 before the removal of the interference. and net duration (Dur) and mean amplitude (Amean) of activity periods (APs) (Gallo et al. Electrode repositioning was achieved by means of a plastic template (Farella et al. IFC = interference-free condition. 10 pullings of the wire. 691. and at IFCafter. Scafati. Each active and dummy interference was left in place for 8 days. to the tooth at AIC day-1 and DIC day-1. we adapted a second strip to the vestibular surface of the same tooth without interfering with the intercuspal position. MI. which also measured (every 5 min) the impedance between the electrodes to detect a possible disconnection.5% MVC. and 7 p. Kerr. The first 3 min of each recording included standard tasks: 3 maximal voluntary contractions (MVC) with 10-second intervals.1% MVC) was not cut off. and the casts were mounted in the intercuspal position in a semi-adjustable articulator (Panadent 1210.e. and 10 self-touchings of the electrodes. Switzerland).m. Off-line analysis included calculation of the number per hour (N/hr). day-1.. Occlusal contacts were assessed by one of the authors (RM) at IFCbefore. each with a duration of 8 days.250 mm. IFCafter). No other uses without permission..2 ± 7. day-1. the swallowing activity (22. A strip of gold foil (length x width x height = 2 x 8 x 0. MF) calibrated in TMD diagnosis at the following days: IFCbefore. Subjects were asked to eat between 1 and 2 p..sagepub. at DICday-1. The null hypothesis was that the insertion of experimental interference does not influence masseter EMG activity and does not induce TMDs. Occlusal Interference Dental impressions (Extrude XP and Wash. with each subject being assigned. Based on this result. touching and pulling of the Pain. headache. and interference-free condition after interference removal (IFC after ). current stress level.m. and occlusal discomfort were assessed by means of 100-mm visual analog scales (VAS) (Michelotti et al.05 mm thick (Model No. respectively. over the skin of the masseter muscle on the preferred chewing side. we analyzed the first 3 min of each EMG recording. the threshold was set at 10% MVC. again with the teeth free of any foil strips (IFCafter). Dantec. Romulus. 1999). TMD. sleeping. Denmark. Kerr. The allocation sequence was prepared and sealed before enrollment and assignment (LMG). as well as to avoid chewing gum. 1). The individual maximal voluntary contraction (MVC) was determined as the mean of 6 measurements obtained during the interference-free conditions (IFCbefore. VAS ratings were collected at the beginning of each recording day. 1999). at DICday-8 and AICday-8 immediately after the removal of the interference. weight = 0..

0 1.05) from baseline (mean ± SD.3 39.7 93. Level of significance: days of the active* = p < 0. the design achieved 76 to 88% power to test the factor 'dental condition'. Dur. the beta error at 0. Student's t test.1 44.. The significance VAS scores for headache and orofacial pain (K-S.646 Michelotti et al.5 1.2 10. International and American Associations for Dental Research 48.5 7.6 ± 19. 0. MVC = maximal voluntary contraction. 0.05) level was set at p < 0. p > 0. IFC = interference-free the corresponding days of the condition. and IFCafter.01. all the remaining VAS scores were zero.4. IL. The amount of dental discomfort was almost negligible (mean ± SD.8 32.05.9 31.8 10.3 ± 1.8 10. Three subjects reported a single-day mild error set at 0.9 30.001) and increased gradually during AIC up to 4.7 ± 2.1 ± 0. Amean.2 (i.5 8. Before statistical interference condition were tests were computed.8 8.7 13.05) did not vary signifDIC 16.05 n. The reduction in N/hr during AIC this was the case for the VAS ratings.05. n.05) at baseline was 13.s Not significantly different.2 *** ** icantly (p > 0.7 ± 1. fading during AIC up to 9. Descriptive Statisticsc of the Long-term EMG Variables N/hr. p < 0. - ** ** - n.4 mm.1 ** 3 different occlusal IFCafter 16.01.com at UNIVERSIDAD DE CHILE on July 1. No other uses without permission. ** * RESULTS . Number of events/hr (mean and standard error of the mean. p > 0.8 0. *** n. With ten subjects per group. the tenderness scores. p N = 11) for conditions IFCbefore. mean amplitude (K-S. p < 0.2 9. 3).2 0.0 0.001.7 42. Table. but it increased significantly after the Figure 2.01 n.7 ± 2. AIC. 2). 0.05) did not change (p > 0.05). EMG variables were logarithmically transformed.5 5.4 3. 8. occlusal contacts (SPSS 10. p < 0. < 0. reduced (0.9 10.s. but the score did not change significantly from baseline levels (mean ± SD. The number of occlusal contacts (K-S.6 18.9 14.5 ± 1.9 0.s. n. USA).s. and no subject withdrew at any stage.2.05. It decreased significantly immediately after the application of the active interference (2. application of the active interference (55. The mean values of N/hr a Degrees of freedom = [ 3.0 1.sagepub.05).001).4 ± 0.2 ± 23.2. n. ** = p < 0.8 ± 4. * = p < 0.6 < 0.2 ± 1.5 9.0 n.s. than those obtained during Abbreviations: DIC = dummy interference condition. obtained during the first two b Post hoc multiple comparisons were performed by the Student-Newman-Keuls test. never during the active-interference condition.5 8.s. significantly lower (p < 0.0 n.05 (two-tailed).3 ± 0.s. and with a headache.6 ± 0. 80% power).e.4 71. DIC.7 ± 10.0 under the active-interference condition. The number of activity Dur (sec) periods per hour and their IFCbefore 2.001 n.6 22.0 ± 1. Subjects reported mild to moderate stress levels throughout the study. still being lower (p < 0. Dur = net duration of activity periods.0. 2011 For personal use only. Downloaded from jdr. and mean scores for temporomandibular joints (TMJs) and muscle tenderness (K-S. At the end of the study.1 87. None of the subjects developed TMD across the study. whereas their Amean (%MVC) mean duration (K-S. A power analysis for did not change significantly throughout the study.30 ].s. p > IFCbefore 16. dummy-interference condition (Fig.05) n.0 ± 2.8. 0.4 ± 2. and was more pronounced for the high-level APs (Fig. AIC = active interference condition.s.1 27.6 mm VAS. ** = p < 0. Amean = mean duration of activity periods.1 for TMJs and 0.s.05) among the AIC 14.3 37.4 > 0.5 ± 0. p < 0.001 < p < 0.1 mm VAS) after the application of the dummy interference.1 85. the latter repeated-measurements ANOVA was carried out with the alpha always being zero.4 for muscle tenderness). *** = p < 0. the number of occlusal contacts did not differ from baseline (13. Chicago.0 14.0 ± 27. Preliminarily Averaged Over Each Recording and Each Condition 5th Percentile 95th Percentile Median Variables N/hr IFCbefore DIC AIC IFCafter Mean ± SD F-ratioa p DIC Post hocb AIC IFCafter The whole study was carried out over a six-month period (February to July).2 conditions (Table).8 mm VAS.2 ± 1.4 8.0 < 0.s.0 1. J Dent Res 84(7) 2005 15% change in EMG variables being considered clinically relevant. N/hr = number of contraction episodes per hour. Obtained from 11 Subjects for Each Experimental Condition Resulting from the Analysis of Contraction Episodes Over All Recordings.5 14.1 ± 18.01) than the baseline value and remaining unchanged throughout DIC.0 10. c Data were analyzed by a one-factor (dental condition) repeated-measurements ANOVA.4 ± 23.9 34. p > DIC 2.05) were significantly AIC 3.5 1.01) IFCafter 2.

Data presented in the charts (dots = mean values..e. The disadvantage of this approach. our findings cannot be directly compared with those of previous studies. we were able to decrease the number of these artifacts.001). 20-30. AIC = active interference condition. N = 11) were averaged across subjects. the coping strategy with a stressor is highly variable and depends on both environmental and individual factors (Ando. and IFCafter. it has been reported that subjects without a TMD history adapted fairly well to experimental occlusal interference. DIC. artifacts. The reduction in the number of activity periods was more pronounced at higher contraction levels (between 20 and 40% of MVC). 2001). up to the levels recorded during the non-interference conditions. for the conditions IFCbefore. It must be stressed that the EMG changes observed could not be related to an impairment of chewing function.com at UNIVERSIDAD DE CHILE on July 1. The increase in the numbers of activity periods after the third recording day paralleled the gradual decrease in the perception of occlusal discomfort. By setting the threshold at 10% MVC. In general. No other uses without permission. 1982). either through an intrusion of the tooth pair with the interference. and 30-40% MVC vs. during the active-interference condition. 2011 For personal use only. p < 0. . DISCUSSION The application of active occlusal interference in healthy females influenced the daily pattern of habitual activity of the masseter muscles. Plots of N/hr for events with amplitudes 10-20. International and American Associations for Dental Research . This might be due to the subjects' adaptation to the occlusal disturbance and/or to the decrease of the height of the interference. DIC = dummy interference condition. whereas subjects with a TMD history showed a significant increase in clinical signs (Le Bell et al.001). Indeed. showing a decrease in EMG activity (Rugh et al. therefore. however. is that changes in very low-level EMG activity (below 10% MVC) could not be detected. At higher amplitude levels. because the subjects were asked not to chew outside a definite time lapse (i. However. the number of activity periods dropped in the first two days following the application of the interference.5- Downloaded from jdr. however. and increased gradually thereafter. 2002). 1984). a significant negative trend of AUC was found for the activity periods recorded during AIC (test for linear trend. conditions.sagepub. or through wear of the gold foil. that the opposite has also been reported (Kobayashi. which were supposed to be randomly distributed across the different conditions of the study. The observation that the high-level AP decreased more than the low-level ones may further corroborate this hypothesis. p < 0. A limitation of EMG recordings obtained by means of portable recorders is the occurrence of electrical movement Figure 3. AIC. It must be mentioned. 1 hr) that was discarded from the EMG analysis. without adding systematic variations. an increase in masseter and temporalis postural activity has been reported after the insertion of a 0. The females investigated in the present study had normal Axis II RDC/TMD profiles. Nevertheless.J Dent Res 84(7) 2005 Occlusal Interference and Masseter Activity 647 The subjects did not report any adverse events. The absence of shiny facets on the gold foil points toward the first hypothesis. this is the first long-term study investigating the effect of occlusal interference on the EMG activity of the masseter during awake subjects. 2002). Twofactor (dental condition. and recording days. amplitude level) repeated-measurements analysis of variance was computed on the log values of areas under the curves (AUC) of each individual data point (Kolmogorov-Smirnov test. N/hr = number of activity periods per hour.1. Indeed. 1961). Long-term EMG recordings in TMD patients might help to clarify this point. To our knowledge. The most likely explanation for the reduction in the number and amplitude of activity periods. p > 0. analysis of our data is consistent with that obtained in bruxists during sleep. p < 0. or who have or have had a TMD history. with lower values during AIC (Student-NewmanKeuls test. MVC = maximal voluntary contraction. contrary to the 'hyperactivity' hypothesis (Ramfjord. Indeed. IFC = interference-free condition. . Psychologically distressed women might react differently to the introduction of an occlusal disturbance.001). The significant increase in the number of occlusal contacts from the application of the active interference to the time immediately before its removal seems to indicate a reduction in the height of the interference.05): The conditions differed with statistical significance (F = 12. APs with higher EMG levels should produce higher occlusal contact forces and. This activity might play some role in the responses to experimental interference. therefore. event duration. greater discomfort. is an avoidance behavior developed in response to occlusal discomfort. It may be that the reaction to an occlusal disturbance is different in subjects who are occlusally hypervigilant (Palla.

Acta Odontol Scand 42:129-135. Kobayashi Y (1982). Michelotti A. Bruxism. Baba K.sagepub. Gallo LM. Part I. Christensen LV. or the inclusion criteria. None of the subjects developed any sign or symptom of TMD. Arch Oral Biol 34:393-398. J Oral Rehabil 22:455-462. In: Mioartropatie del sistema masticatorio e dolori orofacciali. Beemsterboer PL. and mood. Tsukiyama Y. J Oral Rehabil 22:515-520. Cardiovascular responses in humans to experimental chewing of gums of different consistencies. critique. pp. Jämsä T (1992). Acta Odontol Scand 60:219-222. Unilateral. Michler L. Downloaded from jdr. Experimental occlusal interferences. diagnosis and treatment of occlusal problems. Martina R (2000). ACKNOWLEDGMENTS This study was supported by the fund MM06181419-PRIN 2000 from the Italian Ministry for University and Research. Holm B. J Craniomandib Disord 6:301-355. Positive VAS ratings for headache occurred in only three subjects. Rassouli NM (1995a). Activity recognition in long-term electromyograms. Alanen P (2002). Occlusion. Palla S (1999). Relationships among mental health. St. Experimental occlusal discrepancies and nocturnal bruxism. Signs and symptoms of mandibular dysfunction after introduction of experimental balancing-side interferences. Odontol Revy 27:245-256. Bakke M. Edlund J. Sheikholeslam A (1982). No other uses without permission. and in no case was an RDC/TMD diagnosis made throughout the study. In conclusion. Martina R (1999). J Oral Rehabil 8:279-286. Palla S (2001). Marotta G. Clark GT. Jämsä T. Scand J Dent Res 98:149-158. Cimino R. Association between craniomandibular disorders and occlusal interferences in children. Sixty-eight years of experimental occlusal interference studies. Italy: RC libri srl. Tedesco A. J Dent Res 84(7) 2005 mm-thick interference in centric occlusion (Riise and Sheikholeslam. 4th ed. Clark GT. Terezhalmy GT. 18-20. J Oral Rehabil 11:325-333. Riise C. 2011 For personal use only. Rugh JD. Korri S. coping styles. J Oral Rehabil 22:521-531. Niemi PM. International and American Associations for Dental Research . Dawson PE (1998). none of the subjects investigated reported TMD symptoms. Møller E (1990). and not during the AIC period. Nocturnal masseter muscle activity and the symptoms of masticatory dysfunction. Dworkin SF. Mauro Morino for providing some of the materials used in this research. Katz JO. Ramfjord SP (1961). 1984). Variations in the electrical activity of the human masseter muscle occurring in association with emotional stress. Arch Oral Biol 14:873-878. Methodological differences concerning the collection of TMD data. Christensen LV. can account for these conflicting findings. Farella M. Ash MM. The effect of an occlusal interference on the masticatory system. Psychol Rep 90:606-612. editors (1992). Louis: Mosby. Milan. An experimental investigation. Masseteric EMG responses to an intercuspal interference. Palla S (1995). 1982. Ramfjord SP (1995). criteria. Italy) and Mr. Rugh JD (1981). Farella M. Alanen P. Influences of occlusal interference on human body. Yemm R (1969). Gallo LM. Bakke M. Magnusson and Enbom. Philadelphia: Saunders. J Prosthet Dent 67:692-696. Randow K. J Int Coll Dent 13:56-64. Nocturnal masseter EMG activity of healthy subjects in a natural environment. Riise and Sheikholeslam. Changes in pressure-pain thresholds of the jaw muscles during a natural stressful condition in a group of symptom-free subjects. J Orofac Pain 14:279-285. Michelotti A. Influence of experimental interfering occlusal contacts on the postural activity of the anterior temporal and masseter muscles in young adults. Research diagnostic criteria for temporomandibular disorders: review. a clinical and electromyographic study. Hatch JP. J Prosthet Dent 51:548-553. A special thanks to the Kerr Co. Part II. Mioartropatie del sistema masticatorio. J Am Dent Assoc 62:21-44. 1976. 2nd ed. Drago C (1984). Enbom L (1984). Watanabe T (1999). pp.com at UNIVERSIDAD DE CHILE on July 1. J Dent Res 78:1436-1444. Experimental occlusal interferences. REFERENCES Ando M (2002). Le Bell Y. Influence of experimental interfering occlusal contacts on the activity of the anterior temporal and masseter muscles during mastication. Riise C. Rugh JD. isometric bite force in 8-68-year-old women and men related to occlusal factors.648 Michelotti et al. Gross SS. Barghi N. Evaluation. editor. Effect of artificial occlusal interferences depends on previous experience of temporomandibular disorders. the introduction of experimental interference in the sample investigated reduced their masseter EMG habitual activity in the natural environment. Kirveskari P. Magnusson T. Oberg T (1976). Effect of experimental stress on masseter and temporalis muscle activity in human subjects with temporomandibular disorders. 434-456. Sheikholeslam A (1984). Carlsson K. (Scafati. Unlike other studies (Randow et al. Borcherding SH (1989). . Arch Oral Biol 44:835-842. Langlais RP. Palla S. A review. examinations and specifications. LeResche L. Jensen BL. Rassouli NM (1995b). What have we learned? J Prosthet Dent 82:704-713. 1984. 1982). J Oral Rehabil 9:419-425.