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Journal of Oral Rehabilitation 1995 22; 835-844

Experimental occlusal interferences. Part IV. Mandibular


rotations induced by a pliable interference
L . V . C H R I S T E N S E N & N . M . R AS S OVLl MarqueUe University, School of Dentistry, Milwaukee, Wisconsin,
U.S.A. • ' " : - ': \ . : ' • . .

SUMMARY In 12 subjects, a pliable, yet unbreakable, Eleven subjects (92%) showed frontal plane upward
intercuspal interference (aluminium shim onlay rotation (mean of l'0°) of the condyle contralateral
splint; uniform height of 0-25 mm) w^as placed to the interference, and one subject (8%) show^ed
between either the right or left maxillary and frontal plane upward rotation (0-4°) of the condyle
mandibular second premolars and first molars. During ipsilateral to the interference. Two subjects (17%)
brief and forceful biting (dynamic chew^ing stroke of show^ed no horizontal plane rotation; seven subjects
about 20 kg force) the interference emulated a (58%) showed backward rotation (mean of 0-4°) of
semisoft food bolus, and at the end of biting the condyle contralateral to the interference; and
(subsequent static clenching stroke of about 20 kg three subjects (25%) showed backw^ard rotation
force) it emulated a rigid metal interference. During (mean of 0-3°) of the condyle ipsilateral to the
dynamic/static biting, rotational electrognathography interference. It is suggested that, in the presence of
measured maximum frontal and horizontal plane an occlusal interference, mastication may have both
torque of the right and left mandibular condyles. short- and long-term detrimental effects.

efforts in the mandibular position of maximum


Introduction, intercuspation (Bakke & Moller, 1980; McCarroll 1988;
In our previous studies on experimental occlusal Christensen, 1989; Christensen & Rassouli, 1995a).
interferences (prematurities), we showed that brisk and Presumably, maximal bilateral occlusal stability is a
forceful clenching on a rigid unilateral intercuspal prerequisite for optimal neuromuscular generation of
interference altered the amplitude, but not the duration, well adjusted bilateral brief clenching forces (McCarroll,
of the electromyographic (EMG) clenching patterns of 1988). The minimum magnitude of the interference, and
the paired masseter muscles (Christensen & Rassouli, that of the interocclusal gap opposite the interference,
1995b). In addition, clenching on the interference gave did not linearly determine the amount of distorted
rise to rotatory motions of the mandible (Rassouli & masseteric clenching activity, so the mere presence of
Christensen, 1995). the unstable occlusion, and not its vertical magnitude,
The unstable occlusion, created by the interference, appeared to be sufficient to disrupt optimal
elicited a non-linear (complex) coordination pattern of neuromuscular function (Christensen & Rassouli, 1995b).
the EMG amplitude levels of the two masseter muscles; On brisk and forceful clenching on the rigid unilateral
frequently there was significant motor facilitation on the intercuspal interference, rotational electrognathography
side of the interference and significant motor inhibition (EGN) suggested that the mandible rotated about both a
on the side opposite the interference (Christensen £r frontal and a horizontal axis (Rassouli & Christensen,
Rassouli, 1995b). Normally, the paired masseter muscles 1995). In the frontal plane, the mandibular condyle
show symmetry or near symmetry of action at maximal opposite the interference always showed upward
(MVC) and submaximal (50% MVC) brief clenching rotation, joint compression = condylar 'seating', and on

1995 Blackwell Science Ltd 835


836 L.V. CHRISTENSEN & N.M. RASSOULI

the side of the interference the mandibular condyle Materials and methods
always showed downward rotation, joint distraction =
Subjects '•- '' • • • t - .. • ..:::. ..;,. -. .:..••;
condylar 'unseating' (Rassouli & Christensen, 1995). In
the horizontal plane, the mandibular torque was The subject material was the same as that of our previous
somewhat unpredictable, but in 58% of subjects the studies (Christensen & Rassouli, 1995b; Rassouli &
mandibular condyle on the side of the interference Christensen, 1995), that is nine men and three women
showed backward rotation, retrusive torque, and that having a mean age of 26 years. The subjects were in good
opposite the interference showed forward rotation, general health, without clinical symptoms and signs from
protrusive torque (Rassouli & Christensen, 1995). the mandibular locomotor system, and with a mean of
We suggested that, under adverse circumstances, the 30 permanent teeth present.
observed EMG and EGN changes might have short- and
long-term detrimental effects (Christensen & Rassouli,
1995a,b; Rassouli & Christensen, 1995). On the side of Experimental occlusal interference
the interference, the masseter muscle appeared to In each subject, a pliable, yet unbreakable, aluminium
contract excentrically because of the downward motion shim onlay splint was placed unilaterally between the
of the ipsilateral mandibular ramus (Christensen & maxillary and mandibular second premolars and first
Rassouli, 1995b; Rassouli & Christensen, 1995). Excentric molars (Fig. 1). The shim had a prefabricated uniform
muscle contractions, entailing lengthening of the height of 0-25 mm, a width of 8 mm, and a length of 24
contracting muscle fibres, are known to cause mechanical mim, and it is referred to as prematurity B (Fig. 2). In the
muscle injuries (Christensen, 1986a,c; Christensen & previously described six subjects where prematurity A
Hutchins, 1992). Furthermore, on the side opposite the (rigid acrylic onlay splint) was made for the right side of
interference it is conceivable that the repeated imipact the mandible (Christensen & Rassouli, 1995b; Rassouli
forces of joint compression might give rise to excessive & Christensen, 1995), the shim was placed on the right
negative hydrostatic pressures, resulting in side of the mouth, and in the six subjects where
immobilization ('vacuum sticking') of the prematurity A was made for the left side of the mandible,
temporomandibular joint (TMJ) disc (Rassouli & the shim was placed on the left side of the mouth.
Christensen, 1995). Before biting on prematurity B the interocclusal
It is known that the normal act of mastication usually distance was 3-5 mm (Fig. 2), and after brisk and forceful
elicits frontal as well as horizontal plane rotations of the biting on the pliable prematurity B the bite was rigidly
mandible (Moller, 1973; Lewin, 1985; Rassouli &
Christensen, 1995). Conceivably, the rotations may
exceed those elicited by static biting on a rather thin
intercuspal interference, but because the dynamic act of
feeding involves alternating (right/left) miasticatory
patterns (Christensen & Radue, 1985a,b), it seems
probable that the mere act of chewing only occasionally
may have long-term detrimental effects; for example,
where chewing occurs in the presence of an occlusal
interference.
The objective of this study was to examine, through
rotational EGN in young and healthy subjects, the
mandibular rotational responses to the experimental
introduction of a pliable, yet unbreakable, unilateral
occlusal interference. The pliable interference
(aluminium shim onlay splint) emulated both a semisoft
Fig. 1. Occlusal view of prematurity B (aluminium shim onlay splint)
food bolus and a rigid, rather thin, unilateral interference placed on mandibular left second premolar and first molar.
distorting maximum intercuspation of the opposing Articulator mounted cast of mandibular dentition. Picture shows
dentitions. the condition before biting on prematurity B.

© 1995 Blackwell Science Ltd, Journal of Oral Rehabilitation 22; 835-844


OCCLUSAL INTERFERENCES.PART IV 837

Fig. 2. Lateral view of prematurity B (aluminium shim onlay splint) Fig. 3. Lateral view of prematurity B (aluminium shim onlay splint)
placed on mandibular left second premolar and first molar. placed on mandibular left second premolar and first molar.
Articulator mounted casts of maxillary and mandibular dentitions. Articulator mounted casts of maxillary and mandibular dentitions.
Before biting on prematurity B, note interocclusal gap of 3-4 mm. After biting on the pliable, yet unbreakable, prematurity B note
interocclusal gap of about 0-25 mm.

raised by about 0-25 mm on the side of the interference


(Figs 3 & 4), and supposedly by 0 mm on the side opposite
the interference as a result of mandibular torquing.
During biting (dynamic chewing stroke), prematurity B
emulated a semisoft food bolus, and at the end of biting
(static clenching stroke) it emulated the rigid prematurity
A described elsewhere (Christensen & Rassouli, 1995b;
Rassouli & Christensen 1995).
Using a manual force-meter on prematurity B, placed
on a cast of the mandibular second premolar and first
molar, the vertical force necessary to deform prematurity
B in 1 s(n = 6) was on average (+s.d.) 18-9 ±1-5 kg (185
± 14 N).
Fig. 4. Occlusal view of prematurity B (aluminium shim onlay
On brisk and forceful biting on prematurity B, it is splint) placed on mandibular left second premolar and first molar.
postulated that the mandibular elevator muscles on the Articulator mounted cast of mandibular dentition. Picture shows
side of the interference generated afterload contractions the condition after biting on the pliable, yet unbreakable,
followed by excentric contractions. An afterload prematurity B.
contraction is a combination of an isometric and a
concentric contraction (Christensen, 1986a,b,c). Before decelerated the rotatory 'unseating' of the TMJ condyle
biting on prematurity B, it must be assumed that to carry on the side of the prematurity (Christensen, 1986a,b,c;
and stabilize the weight of the mandible the elevator Christensen & Hutchins, 1992; Christensen & Rassouli
muscles generated isometric contractions (static activity 1995b; Rassouli & Christensen, 1995).
with no change in muscle length), followed by concentric On the side opposite prematurity B, it is postulated
contractions (power stroke = dynamic activity with that the mandibular elevator muscles generated
shortening of muscle length) when the accelerating concentric contractions in order to accelerate the rotatory
mandible bit into the pliable interference, and finally 'seating' of the TMJ condyle contralateral to the
followed by excentric contractions (dynamic activity with interference (Christensen, 1986a,b,c; Christensen &
elongation of muscle length) when the elevator muscles, Hutchins, 1992; Christensen &• Rassouli, 1995b; Rassouli
as induced by the now rigid intercuspal prematurity B, & Christensen, 1995). , .• • • ;. ;«

© 1995 Blackwell Science Ltd, Journal of Oral Rehabilitation 22;


838 L.V. CHRISTENSEN & N . M . RASSOULI

A concentric contraction (shortening of muscle fibre rotations about a superior-inferior z-axis (Fig. 5).
length) produces external work (force x distance) that is One of the inherent disadvantages of rotational EGN
known as positive work, and the physiological function is the fact that concurrent translations of the magnet will
of the contraction is that of acceleration (Christensen, introduce an error in the torque measurement (Rassouli
1986a,b,c; Christensen & Hutchins, 1992). An excentric & Christenen, 1995). In a frontal plane rotation, a
contraction (elongation of muscle fibre length) produces simultaneous translation/translations (vertical and/or
external work that is known as negative work, and the lateral) will distort the torque measurement; and in a
function of the contraction is that of deceleration horizontal plane rotation, a simultaneous translation/
(Christensen, 1986a,b,c; Christensen & Hutchins, 1992). translations (sagittal and/or lateral) will distort the torque
An isometric contraction (no change in muscle fibre measurement (Rassouli & Christensen, 1995). The error
length) produces no external work, only tension (force), is small and less than the resolution of the system
and the function of the contraction is that of fixation (0-0625°), when the concurrent translations are less than
(Christensen, 1986a,b,c; Christensen & Hutchins, 1992). 1 mui, as was the case using prematurity A (acrylic onlay
The above postulates are based mainly on observations splint) where all error terms ranged from 0-01 to 0-04°
pertaining to the right and left masseter muscles (Rassouli & Christensen, 1995). Although this study
(Christensen & Rassouli, 1995b; Rassouli & Chirstensen, measured rather small amounts of rotation, the
1995). The masseter muscle appears to be especially concurrent translations were rather large (> 1 mm). In
susceptible to the effects of occlusal interferences (Bakke frontal plane rotations, the error terms ranged from 0-2
& Moller, 1980; McCarroll, 1988). Note, however, that to 0-3°; in horizontal plane rotations, the error terms
in this and our previous study (Rassouli & Christensen, ranged from 0-1 to 0-2°. No corrections were made,
1995) the vectors (forces causing the mandibular however, because the computer program did not
rotations) are largely unknown, and so are the lever arms automatically calculate the appropriate corrections.
on which the vectors act to torque the mandible, namely Another disadvantage of the rotational EGN system is
the lever arms arising from the use of experimental the fact that the instantaneous locations of the axes of
prematurities A and B (Christensen & Rassouli, 1995b; rotation cannot be determined; they can only be
Rassouli Er Christensen, 1995). For example, consider a suggested on the basis of surmised vectors (lines of pull).
force F acting on a lever arm to rotate it, but which is
not perpendicular (normal) to the arm. In other words,
the vector (line of pull) forms an angle a from the normal
to the lever arm. In the case where a vector is acting at
an angle a from the normal to the lever arm, the torque
c= Raw data Risht Left
is the product of the component of the vector that is
normal to the lever arm (F x cos a) and the length I of
the vector arm. That is to say, torque - (Fx cos a) x(l),
and in this study both the term F x cos a and the term 1
were unknown.

Rotational electrognathography (EGN)

As in our previous study, horizontal and frontal plane


rotational EGN Was performed by measuring the
maximum torque of a magnetic incisor point; for details
see Rassouli & Christensen (1995). As a baseline for the
rotations of the mandible relative to the maxilla, the zero
position (0°) was that of first and light contact between Fig. 5. Electrognathographic recording of frontal and horizontal
plane rotation of the mandible while subject bites on prematurity
the maxillary teeth and prematurity B (Fig. 2). Only
B (aluminium shim onlay splint) placed on the right mandibular
maximum torques (maximum rotation in degrees) were second premolar and first molar. In the frontal plane, the left
used, and they represented frontal plane rotations about mandibular condyle rotates 0-7° upward. In the horizontal plane,
an anterior-posterior x-axis and horizontal plane the left mandibular condyle rotates 0-7° backward. '

© 1995 Blackwell Science Ltd, Journal of Oral Rehabilitation 22; 835-844


OCCLUSAL INTERFERENCES.PART IV 839

Prematurities A and B o •: : ;v ' ^ ;; ' • ^ ' > Table 1. Frontal plane upward rotation (°) of temporomandibular
joint condyle contralateral and ipsilateral to prematurity B
Because the subject material and rotational EGN system (aluminium shim onlay splint) ' ; .
were the same as in our previous studies, using a rigid
unilateral intercuspal prematurity A (acrylic onlay splint; Subject Rotation
minimum mean height of 0-24 mm), certain comparisons Contralateral
will be made between the mandibular rotations caused
by prematurities A and B (Rassouli & Christensen, 1995). 1 1-2
2 • 1-0
3 • 1-0
Statistical tests . 4 0-9
5 1-3
As described previously (Christensen & Rassouli, 1993b), 6 0-5
the one-sample r-test was used to detect a statistically 7 0-9
significant difference between two paired arithmetic 8 0-9
10 M
means. In all cases, alpha = 0-05 (two-tailed test). To
11 1-4
determine linear associations between two sets of 0-9
12
measurements, a simple linear correlation test was used.
In all cases, alpha = 0-05 (two-tailed test). In the analysis, X 1-0
the coefficient of linear correlation was expressed by r, ±s.d. 02
and the coefficient of linear determination by r^. To obtain
Ipsilateral
Gaussian frequency distributions of all observations, the
arcsine transformation was applied (Christensen & 9 0-4
Rassouli, 1995b).

Results
Table 2. Horizontal plane backward rotation (°) of tempo-
Eleven subjects (11/12 = 92%) showed frontal plane
romandibular joint condyle contralateral and ipsilateral to
upward rotation (x= 1-0°) of the mandibular condyle prematurity B (aluminium shim onlay splint)
contralateral to prematurity B and, because of the
symmetry of the measuring system, the same amount of Subject Rotation (°)
frontal plane downward rotation of the condyle ipsilateral
Contralateral
to the interference (Table 1). The remaining subject (1/
12 = 8%) showed frontal plane upward rotation (0-4°) 1 0-7
of the condyle ipsilateral to prematurity B and, of course, 5 0-4
the same amount of frontal plane downward rotation of 6 0-1
8 0-1
the condyle contralateral to the interference (Table 1).
9 0-2
Among 12 subjects, two (2/12= 17%) showed no 11 0-8
horizontal plane rotation when biting on prematurity B 12 0-5
(Table 2). In the horizontal plane, seven subjects (7/
12 = 58%) showed backward rotation ( x= 0-4°) of the X 0-4
mandibular condyle contralateral to prematurity B and, ±s.d 03

of course, the same amount of forward rotation of the


Ipsilateral
condyle ipsilateral to the interference (Table 2). Three
subjects (3/12 = 25%) showed backward rotation 3 0-2
( X = 0-3°) of the condyle ipsilateral to prematurity B and, 7 0-3
of course, the same amount of forward rotation of the 10 0-4
condyle contralateral to the interference (Table 2).
X 0-3
To make reasonably valid intra-individual comparisons + s.d. 0-1
between frontal and horizontal plane rotations.
Among 12 subjects, two subjects showed no rotation.

© 1995 Blackwell Science Ltd, Journal of Oral Rehabilitation 22; 835-844


840 L.V. C H R I S T E N S E N & N . M . R A S S O U L I

contralateral to prematurity B, only six subjects (nos. 1, Discussion . . •••^ , -; .-..,,.;•C',^>•-.:•^vn.;;;,^•;;;


5, 6, 8, 11, 12) remained for statistical analyses. There
Experimental prematurity '- • • ;' • •; - <; '•'•:• •- • ' - •
was a significant difference (?= 7-0036; ^/= 5; P< 0-001)
between a mean frontal plane rotation of 1-03° and a In contrast to our previous studies (Christensen &
mean horizontal plane rotation of 0.43° (Tables 1 & 2). Rassouli, 1995b; Rassouli & Christensen, 1995), where
The linear association between frontal and horizontal we used a rigid unilateral intercuspal prematurity A
plane rotations (contralateral to prematurity B) was r = (acrylic onlay splint), this study employed a pliable
+ 0-7829, and r2= 0-6129 (rf/= 4; 0-05 < ? < 0-10). In other intercuspal prematurity B (aluminium shim onlay splint)
words, 61 % of the variation in one variable (frontal plane that covered unilaterally the occlusal surfaces of the
rotation) was insignificantly explained by the variation mandibular second premolar and first molar (Fig. 1). A
in the other variable (horizontal plane rotation), and vice priori, it was thought that prematurity B would closely
versa. emulate a semisoft food bolus as well as a rigid metal
To make reasonably valid intra-individual comparisons interference at all sagittal physiological equilibrium
between frontal plane rotations caused by and points of the hemimandibular dental arch (Figs
contralateral to prematurities A and B, 11 subjects 1-4) (Tradowsky & Dworkin, 1982). On brief biting
remained for statistical analyses (Table 1). During (about 1 s) on prematurity B, the vertical forces of both
clenching on prematurity A, the upward rotation of the the mobile (chewing stroke) and the immobile phase
contralateral mandibular condyle was on average 0-7° (clenching stroke) were estimated to be in the order of
(Rassouli & Christensen, 1995), and during biting on 20 kg, as determined by bench testing. Normally, the
prematurity B the upward rotation of the contralateral highest masticatory forces are generated on the side of
condyle was on average 1-0° (Table 1). A difference of the food bolus, chewing vs. non-chewing side (Moller,
0-3° was significant (;'= 3-7930; df =10; 0-001 < P < 1973; Gibbs & Lundeen, 1982; Christensen & Radue,
0-005). The coefficient of linear correlation for the frontal 1985b; McCarroll, 1988).
plane rotations, caused by prematurities A and B, was r In addition, during the mobile phase of chewing
= +0-3205, and r^=Q-\On {df = 9; ?>0-20). In other modern food (dynamic activity of jaw closing) the
words, the frontal plane rotations caused by prematurity masticatory forces are about 10 kg, 10-15% MVC, and
A were not linearly associated with the frontal plane during the immobile phase of chewing (static activity of
rotations caused by prematurity B, and vice versa. intercuspation) the masticatory forces are about 25 kg,
To make reasonably valid intra-individual comparisons 35-40% MVC (Gibbs & Lundeen, 1982). In the presence
between the horizontal plane rotations caused by and of a unilateral intercuspal prematurity A, both the rather
ipsilateral to prematurity A and the horizontal plane high ipsilateral and the rather low contralateral clenching
rotations caused by and contralateral to prematurity B, forces are, in theory and practice, more than sufficient
only four subjects (nos. 1, 6, 8, 12) remained for statistical to cause frontal plane rotations of the mandible
analyses. During clenching on prematurity A, the (Christensen & Rassouli, 1995b; Rassouli Er Christensen,
condylar backward rotation ipsilateral to the prematurity 1995). The same appears to apply to the dynamic/static
was on average 0-45° (Rassouli Er Christensen, 1995). biting forces of this study.
On biting on prematurity B, the condylar backward A priori, it was thought that static biting on prematurity
rotation contralateral to the interference was on average A might give rise to mandibular rotations that differed
0-35° (Table 2). A difference of 0-1° was not significant {t from those arising from dynamic/static biting on
= 0-3871; rf/= 3; 0-70 < ? < 0-80). The coefficient of linear prematurity B. The frontal plane rotations caused by
correlation for the horizontal plane rotations, caused by prematurities A and B were, except for one instance,
prematurities A and B, was r =-0-7504, and r^= 0-5631 always of the same type: upward rotation of the TMJ
(df= 2; P> 0-20). That is, the horizontal plane rotations, condyle contralateral to the two prematurities and,
caused by prematurities A and B, were not associated in because of the symmetry of the measuring system,
a linear manner. downward rotation of the TMJ condyle ipsilateral to the

1995 Blackwell Science Ltd, Journal of Oral Rehabilitation 22; 835-844


O C C L U S A L I N T E R F E R E N C E S . PART IV 841

two interferences. In consequence, it seems reasonably conceivably lead to discal immobilization ('vacuum
safe to infer that the elevator muscles on the side of sticking'), followed by discal displacements and
prematurities A and B contracted excentrically, and that degenerative processes, known as internal derangement
the resulting negative work (force x distance) decelerated and osteoarthrosis (Carlsson etal, 1967, 1974; Kopp,
the 'unseating' of the condyle ipsilateral to the two 1977; Rasmussen, 1983; Scapino, 1983; Westesson &
prematurities (Christensen, 1986a,b,c; Christensen Er Rohlin, 1984; De Bont et al, 1985a, b; Akerman et al,
Hutchins, 1992; Christensen & Rassouli, 1995b; Rassouli 1986; Isberg & Isacsson, 1986; Stegenga, 1991; Nitzan et
& Christensen, 1995). It is also inferred that the elevator al, 1992; Rajayogeswaran, 1992). Rotatory 'seatings' of
muscles on the side opposite prematurities A and B a TMJ condyle, elicited by prematurities A and B, are
contracted concentrically, and the resulting positive work thus likely to have detrimental effects that reach their
(force X distance) accelerated the 'seating' of the condyle full expression in 4 - 6 years (Kopp, 1977; Rasmussen,
contralateral to the two interferences (Christensen, 1983; Stegenga, 1991). :
1986a,b,c; Christensen & Hutchins, 1992; Christensen &
Rassouli, 1995b; Rassouli Er Christensen, 1995). The
Rotational electrognathography
horizontal plane rotations caused by prematurities A and
B were not of the same type; predominantly backward Using prematurity B, the frontal plane rotations (x = 1 -0°;
rotation (retrusive torque) of the TMJ condyle ipsilateral n = 6) were significantly larger than the horizontal plane
to prematurity A, and predominantly backward rotation rotations ( x = 0-4°; « = 6). Note, however, that the frontal
(retrusive torque) of the condyle contralateral to plane rotations might have been overestimated by 0-2 -
prematurity B. The possible vector mechanisms will be 0-3° because of concurrent excessive translations (>1
discussed later. mm) of the magnetic incisor point. The amount of frontal
Despite contentions to the contrary (Seligman & plane rotation did not appear to linearly determine the
Pullinger, 1991a,b,), there is experimental and clinical amount of horizontal plane rotation, and vice versa (r =
support for the tenet that occlusal interferences are + 0-78; P > 0-05). As discussed below, this could be a
associated with discomfort, dysfunction, and diseases of result of different axes of rotation and different vectors
the temporomandibular joints and jaw muscles (Carlsson (lines of pull). It is known that both the masseter and
&Droukas, 1984; McCarroll, 1988; Molle& Bakke, 1988; temporalis muscles, and probably also other elevator
Kirveskarirffl/., 1989, 1992; Seligman & Pullinger, 1989; muscles, show functional heterogeneity (compart-
Wanman & Agerberg, 1991; Ai &• Yamashita, 1992; mentalization); different regions of the muscles are
Christensen & Rassouli, 1995a). From the standpoint of recruited selectively for variably directed biting tasks
pathology and pathophysiology, there are two plausible (Christensen, 1989; Blanksma etal, 1990, 1992).
scenarios for interplays between occlusal interferences In 100% of subjects using prematurity A and in 92%
and discomfort, dysfunction, and diseases of the of subjects using prematurity B, the interferences caused
mandibular locomotor system. frontal plane upward rotation of the condyle contraiateral
Only two classes of skeletal muscle contractions are to the interferences and, because of the symmetry of the
known experimentally and clinically to give rise to EGN system, frontal plane downward rotation of the
exercise-induced pains: isometric contractions which condyle ipsilateral to the interferences (Rassouli &
elicit acute onset (seconds to minutes) of short-lasting Christensen, 1995). As discussed elsewhere, in these cases
muscle pains, and excentric contractions which cause it is suggested that prematurities A and B were the
delayed onset (hours to days) of long-lasting muscle pains rotational pivots of the x-axis (Rassouli & Christensen,
(Christensen, 1986a,b,c, 1989; Christensen Er Hutchins, 1995). If so, the condyles contralateral to the interferences
1992). Unaccustomed excentric contractions give rise to had the longer lever arms and those ipsilateral to the
mechanical muscle injuries, known as myofibrositis or interferences had the shorter lever a r m s - a distinct
fibromyalgia (Christensen, 1986a,c; Christensen & anatomical possibility. In the single case where the
Hutchins, 1992). The postulated excentric contractions, condyle ipsilateral to prematurity B showed frontal plane
associated with prematurities A and B, are thus likely to upward rotation (Table 1), it is suggested that the
have detrimental effects that reach their full expression rotational pivot was located somewhere on the molar
in hours or days (Christensen, 1986a,c; Christensen & arch contralateral to prematurity B. It is in agreement
Hutchins, 1992). Excessive loading of the TMJ disc may with the speculations of Moller (1973) regarding the

1995 Blackwell Science Ltd, Journal of Oral Rehabilitation 22; 835-844


542 L.V. C H R I S T E N S E N & N . M . R A S S O U L I

frontal plane mandibular rotations of mastication. • Whenever the condyle ipsilateral to prematurity B
Again, it should be noted that the significant difference showed backward rotation (retrusive torque), it is
between frontal plane rotations caused by prematurity B assumed that activity in the ipsilateral posterior
( x= 1-0°; w = 11) and those caused by prematurity A ( x temporalis muscle pulled the condyle backward, and that
= 0-7°; n=ll) may not be real. Using prematurity B, the the centre of rotation (z-axis) was located within
rotations might have been overestimated by 0-2 - 0-3° as prematurity B. It is in agreement with the findings of
a result of excessive translations of the magnetic incisor Moller (1973) and Bakke & Moller (1980). In addition,
point. Furthermore, the amounts of frontal plane rotation it is conceivable that activity in the opposite lateral
caused by prematurity A did not linearly determine the pterygoid muscle contributed to the rotation (Moller,
amounts of frontal plane rotation caused by prematurity 1973). Whenever the condyle contralateral to
B, and vice versa (r = +0-32; P> 0-20). In other words, a prematurity B showed retrusive torque, it is assumed that
rigid and a pliable interference seems to elicit the same activity in the posterior temporalis muscle (contralateral
type of frontal plane rotation, namely condylar 'seating' to prematurity B) pulled the condyle backwards, and that
contralateral to the interference and condylar 'unseating' the centre of rotation (z-axis) was located outside
ipsilateral to the interference, but possibly not the same prematurity B, possibly in the middle of an imaginary
amount of rotation. Again, the latter suggestion should transversal line between the mandibular first molars
be interpreted cautiously because of concurrent (Moller, 1973). In addition, it is conceivable that activity
translations of the magnet. in the lateral pyterygoid muscle (ipsilateral to prematurity
Using prematurities A and B, 33% and 17% of subjects, B) contributed to the rotation (Moller, 1973). It is not in
respectively, showed no horizontal plane rotation, full agreement with the findings of Bakke & Moller
possibly because the interferences caused horizontal (1980), but there appears to be no other reasonably
'locking' of the mandible, similar to that of a rigid acceptable explanation when we consider that the pliable
intercuspation (Christensen & Rassouli, 1995a; Rassouli prematurity B might have created rather unpredictable
& Christensen 1995). Whenever the two interferences vectors (Blanksma eZ^ a/., 1990, 1992).
elicited horizontal rotations, prematurity A caused It should be noted that the backward rotation of a TMJ
predominantly backward rotation (x = 0-5°; 58% of condyle ( x = 0-37°, K = 10; Table 2) was always less than
subjects) of the TMJ condyle ipsilateral to prematurity A the upward rotation of a condyle ( x =0-95°, « = 12; Table
and, of course, the same amount of forward rotation 1). Presumably, retrusive inclined planes prevented
(protrusive torque) of the opposite condyle (Rassouli & excessive backward rotations.
Christensen, 1995). Furthermore, prematurity B caused With regard to the health of the temporomandibular
predominantly backward rotation {x = 0-4°; 58% of joints, it seems reasonable to presume that an occlusal
subjects) of the condyle contralateral to prematurity B interference that causes upward and forward rotation of
and, of course, the same amount of forward rotation a mandibular condyle is the most hazardous (Nitzan et
(protrusive torque) of the opposite condyle. There was al, 1992). With regard to the therapeutic use of occlusal
no significant difference between the horizontal rotations splints (appliances) provided with a single occlusal pivot
elicited by prematurities A and B (intra-individual (unilateral centre of rotation), it would appear that the
comparison in four subjects). pivot should be placed on the side of TMJ disease
With regard to the horizontal plane rotations caused (Rasmussen, 1983). However, pivot splints may create
by prematurity B, it should be noted that they might rather unpredictable patterns of mandibular rotation and
have been overestimated by 0-1 - 0-2°. For example, in not consistently induce putative joint 'decompression'.
Fig. 5 the backward irotation of the left condyle was 0-7°,
and the concurrent lateral/sagittal translations of the
magnet were 1-6 mm (left) and 1-3 mm (anterior). In Conclusions
consequence, the error term was 0-0375 x 1-6 x 1-3 = Brisk and forceful biting on a pliable, yet unbreakable,
0-08, and the true rotation was 0-7-0-08 = 0-6° (Rassouli intercuspal interference, placed on either the right or left
& Christensen, 1995). mandibular second premolar and first molar, always leads
With regard to prematurity A, the possible vectors (lines to frontal, and in 83% of cases, to horizontal plane
of muscle pull) and the centres of rotation (z-axis) have rotations of the mandibular condyles. In 92% of cases
been discussed elsewhere (Rassouli Er Christensen, 1995). there is a frontal plane upward rotation of the condyle

1995 Blackwell Science Ltd, Journal of Oral Rehabilitation 22; 835-844


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© 1995 Blackwell Science Ltd, Journal of Oral Rehabilitation 22; 835-844