n OCCLUSION
Occlusion Factors Influencing the Magnitude of Sleep
0886-9634/2902-
000$05.00/0, THE
JOURNAL OF
CRANIOMANDIBULAR
PRACTICE,
Copyright © 2011
by CHROMA, Inc.
Manuscript received
November 2, 2009; revised
manuscript received
July 28, 2010; accepted
October 10, 2010
Address for correspondence:
Dr. Sadao Sato
Dept. of Craniofacial Growth
and Development Dentistry
Div. of Orthodontics
Kanagawa Dental College
82 Inaokacho, Yokosuka
Kanagawa 238-8580
Japan
E-mail: satos@kdcnet.ac.jp
Bruxism Activity
Koichi Sugimoto, D.D.S.; Hidehiro Yoshimi, D.D.S., Ph.D.;
Kenichi Sasaguri, D.D.S., Ph.D.; Sadao Sato, D.D.S., Ph.D.
ABSTRACT: The biomechanical load during strong bruxism activity reportedly causes many dental/oral
problems. However, it is unknown whether the magnitude of muscle activity during sleep is controllable.
In this study, the relationship between the magnitude of muscle activity during sleep and types of tooth
contacts was examined, including anterior and posterior guidance, in order to clarify how occlusion fac-
tors contribute to sleep bruxism (SB). An EMG-2-axis accelerometer system was used for monitoring
patterns and activities of SB. Bruxchecker was used to evaluate tooth contacts during SB, and a condy-
lograph was used to measure posterior guidance (sagittal condylar inclination). Results show that grind-
ing rather than clenching or tapping was observed in the high SB group, and there was
Incisor-Canine-Premolar-Molar (ICPM) tooth contact during SB grinding movement. The canine
occlusal guidance (COG) was flatter in the low SB group than in the moderate SB group. Relative canine
occlusal guidance (rCOG), which is the difference between the sagittal condylar inclination (SCI) and
COG, was larger in the low SB group than that in the high SB group. These findings suggest that the
grinding pattern must be controlled to prevent strong bruxism, and that the muscle activity during brux-
ism can be reduced by controlling the tooth contact pattern during SB grinding.
S
leep bruxism (SB) is defined as a parafunctional
clenching and grinding action between the upper
and lower teeth during sleep. Under the current
sleep medicine diagnostic criteria, SB is classified as a
parasomnia related movement disorder.1 The etiology of
bruxism is controversial and includes both occlusal and
psychological factors being primary or idiopathic, or
secondary to other medical conditions, often neurological
(e.g., Parkinson’s disease, Tourette syndrome, etc.) or
Dr. Koichi Sugimoto received his D.D.S.
degree from the Tokyo Dental College in psychiatric (e.g., mental retardation, dementia, depres-
1999. He is a postgraduate student at sion). It can also be iatrogenic, associated with smoking,
Kanagawa Dental College. His major alcohol, medication, antipsychotic, and drugs (cocaine,
research interests include function and
dysfunction of the masticatory organ and amphetamine).2
the role of emotion in sleep bruxism At present, there is no single treatment regimen or
activity. strategy that results in the remission of SB, moreover, SB
treatment is based on a combination of behavioral, phar-
macological and dental treatments according to the car-
rier’s profile.3
However, regarding dynamic craniomandibular in-
teraction during bruxism, extremely strong forces are
applied for time periods exceeding those of functional
mastication. As a result, significant loads are distributed
to the dentition, alveolar process, periodontal supporting
1
OCCLUSION AND SLEEP BRUXISM ACTIVITY
structures, and temporomandibular joint (TMJ). Simul-
taneously, the masticatory muscles become hyperactive.
These biomechanical loads cause abfraction, hypersensi-
tivity, periodontal distraction, muscle fatigue, temporo-
mandibular dysfunction, and other dental/oral problems.4-8
Aside from these harmful effects, the strong grinding
and clenching activity of masticatory muscles mitigates
stress-induced psychosomatic disorders by down-regulat-
ing the limbic system, the hypothalamic-pituitary-adrenal
(HPA) axis and autonomic nervous system. 9-13 Many
investigators suggest that patho-psycho-physiological
factors are responsible for precipitating bruxism.
Lobbezoo14 reported that SB appears to be mainly regu-
lated centrally and is not a peripheral input. These find-
ings require dentists to have more knowledge about the
physiological characteristics of SB.
Although the mechanisms of bruxism can be associ-
ated with the physiological and patho-psycho-physio-
logical system, the occlusion factor is still considered
to affect SB activity, based on experimental results from
grinding muscle activity in different types of tooth
contacts.15-20 The current results showed that the mus-
cle activity was increased by experimentally provid-
ing teeth contact in posterior teeth, indicating a possibil-
ity of an increase in muscle activity during SB. A certain
type of occlusion may play an important role in deter-
mining the activity of the masticatory muscles during
SB, even if bruxism itself is regulated by the central
nervous system.
Sleep bruxism can occur in otherwise normal subjects
or can be associated with dental, mandibular, or maxil-
lary malfunction, such as malocclusion.2 Local anatomic
factors definitely play a role in some cases (e.g., malfor-
mations of the jaw or poor occlusion).21
This raises the question of whether it is possible to con-
trol bruxism activity with a dental approach. However,
there is not currently enough evidence to answer this
question. Therefore, an understanding of the relationship
between bruxism activity and individual occlusion pat-
terns is important in clinical dental practice. The authors
have developed a simple device, a 2D accelerometer
system,22 for categorizing individual types of SB, includ-
ing grinding, clenching, and tapping. They also devel-
oped Bruxchecker23 for categorizing teeth contact patterns
during SB.
The relationship between the magnitude of muscle
activity during sleep and types of tooth contact, including
anterior and posterior guidance, was examined. The cur-
rent study was designed to examine the relationship
between bruxing activity and individual occlusion pat-
terns. The null hypothesis was that occlusion factors are
not related to SB.
2 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
SUGIMOTO ET AL.
Materials and Methods
Subjects
Twenty volunteers (17 males and 3 females, aged
27.5±5.7 years) consented to have their SB activity ana-
lyzed. The experimental design, procedures, and tasks
were carefully explained to the volunteers prior to the
experiment. Each volunteer slept for the entire night with
a bruxism-monitoring system in the sleep laboratory of
Kanagawa Dental College. The Human Ethics Committee
of Kanagawa Dental College approved the experimental
procedures.
Monitoring Sleep Bruxism
Monitoring and categorizing of SB was carried out as
described previously.22 The monitoring system of SB
consisted of a 2-axis accelerometer (ACC, ADXL202E,
Analog Devices Co. Ltd, Norwood, MA), an electroen-
cephalogram to measure the sleep stage (EEG, Poly Mate
AP1124, TEAC Co. Ltd., Tokyo, Japan), and an EMG
(EMG, SN 700, Techno Science Co. Ltd., Tokyo, Japan)
to analyze the activities and patterns of SB. The maxi-
mum voluntary contraction (MVC), which indicates the
muscle activity, was measured 30 minutes before the vol-
unteers went to sleep in order to compare it with bruxism
activity during sleep. To establish a relative level of
contraction before SB recording, each subject performed
intercuspal position clenches at least three times for less
than five seconds in duration at a 100% MVC effort. The
initial MVC data for each subject was used to normalize
all subsequent data so that all EMG signals could be re-
ported as a percentage of the maximum signal (%MVC).
In order to categorize different patterns of bruxism,
first, tapping activity was eliminated from the raw data
since tapping was most recognizable and distinctive from
other activities. Tapping movement was characterized by
rhythmic, sharp and short integral EMG activity, as well
as Y-axis movements, which could be detected by the
EMG-ACC system. Clenching activity was characterized
by long continuous muscle bursts in the EMG data with
little or no deviation in the XY-axis. The remaining EMG
activity, with long continuous muscle bursts and mandibu-
lar movement in the XY-axis, was recorded as a grinding
pattern.
Tooth Contact Pattern During Sleep Bruxism
A simple device, called a Bruxchecker, proved to be a
useful tool in examining the grinding pattern during sleep
bruxism.23 It was used to detect tooth contact patterns
associated with bruxism, which correspond to the places
where the disclosing dye was abraded. Tooth contact
could be recognized as two distinct areas, laterotrusive
APRIL 2011, VOL. 29, NO. 2
SUGIMOTO ET AL. OCCLUSION AND SLEEP BRUXISM ACTIVITY

side and mediotrusive side.

The tooth-grinding scheme was classified into three
patterns on the laterotrusive side (Figure 1):
1. Incisor-Canine (IC) type; the grinding area included
canines with or without incisors.
2. Incisor-Canine-Premolar (ICP) type; the grinding
area included premolars with or without canines and
incisors.
3. Incisor-Canine-Premolar-Molar (ICPM) type; the
grinding area included molars with or without pre-
molars, canines and incisors.
The mediotrusive side was marked on the internal
inclined plane to the lingual cusp tip or the ridge of the
lingual cusp of premolars or molars on the mediotrusive
side; whether mediotrusive grinding (MG) was present
was then evaluated.

Measurement of Sagittal Condylar Inclination

Protrusion/retrusion, open/close and mediotrusive
movements of the condyle were recorded using the
Condylograph (Cadiax III, Gamma GmbH, Kroster-
neuburg, Austria), which is a computer-aided device
developed to evaluate the functional status of the TMJ.24
Sagittal condylar inclination (SCI) was measured in each
individual using protrusion/retrusion movement of the
condyle with respect to the axis-orbital reference plane
(AOP).

Occlusal Guidance and Bruxism Facet Measurement

Each maxillary and mandibular plaster cast was
mounted on either a SAM 2P articulator (SAM prazision-
stechnik, Munich, Germany) or a Girrbach SL articulator
(Girrbach, Germany) using a face bow transfer and bite
registration. Canine lingual inclination referred to as
AOP was measured as COG (F1-F2; where only maxil-
lary and mandibular canines made contact during mandibu-
lar lateral grinding movements) utilizing a 3-D digitizer.25
Canine bruxism facet inclination (BFI) was also mea-
sured on the articulator after being examined as an active
facet using the Bruxchecker. After measuring these para-
meters, relative canine occlusal guidance (rCOG) and rel-
ative bruxism facet inclination (rBFI) were calculated as
SCI minus COG inclination and SCI minus BFI, respec-
tively.

Statistical Analysis
A standard statistical software package SPSS version
15 for Windows (SPSS Inc., USA) was used for data
analysis. Statistical significance of paired samples was
evaluated by Student’s t-test. The statistically significant
level was determined when the confidence level
was p<0.05.
Figure 1
BruxChecker presented different grinding patterns during sleep brux-
ism on the laterotrusive side. Incisor-canine grinding (IC, top photo);
incisor-canine-premolar grinding (ICP, middle photo); and incisor-
canine-premolar-molar grinding (ICPM, bottom photo) with or without
mediotrusive grinding (MG) were identified.

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OCCLUSION AND SLEEP BRUXISM ACTIVITY
Results
Total muscle activity (%MVC) during sleep measured
in the 20 volunteers showed that individual muscle activ-
ity ranged widely from low sleep bruxism muscle activity
(low SB) to high sleep bruxism muscle activity (high
SB), which indicates that the bruxism muscle activity
depends on the individual (Figure 2). The purpose of the
current study was to examine the relationship between
SB activity and occlusion factors. Therefore, for further
investigation, we divided the volunteers into three groups
(high SB, moderate SB, and low SB), based on bruxism
muscle activity (total %MVC).
Bruxism Activity and Types of Bruxism
With the bruxism monitoring system, including EMG
and ACC, bruxism was divided into three types; grinding,
clenching and tapping (Tables 1, 2). The distribution of
different patterns of bruxism activity showed that clench-
ing and grinding were predominant, whereas tapping was
not highly prevalent during sleep.
Occurrence and length of bruxism in different groups
also indicated that clenching and grinding were the pre-
4 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
SUGIMOTO ET AL.
dominant bruxism activities in any group. The muscle
activity in the high SB group was 117.6±25.9 (%MVC),
whereas the values in the moderate SB and low SB
groups were 37.9±11.8 and 11.1±4.5 (%MVC), respec-
tively (Table 1). Especially in the high SB group, grind-
ing was the predominant activity (82.7±26.9, 70.3% of
muscle activity) compared with clenching (24.4%) and
tapping (5.3%). The length of sleep bruxism (sec/hr) was
also predominant in the high SB group, with 54.9% of
grinding, 39.4% of clenching, and 5.7% of tapping
(Table 2), while the length of bruxism in the low SB
group was constituted by 35.0% of grinding, 53.3% of
clenching, and 11.7% of tapping.
Bruxism Activity and Tooth Contact Pattern
The Bruxchecker showed the tooth contact pattern
during sleep of each volunteer, and the patterns were cat-
egorized into IC, ICP and ICPM. The low SB group
showed 27.8% of IC, 50.0% of ICP, and 22.2% of ICPM,
while the high SB group showed 12.5% of IC, 25.0% of
ICP, and 62.5% of ICPM, indicating that tooth contact
pattern influences bruxism activity, and molar tooth con-
tact, like ICPM, causes high SB activity (Table 3). The
Figure 2
Distribution of total muscle activity (%MVC)
in volunteers. A wide variation of muscle
activity was observed. In the current study, SB
activity was divided into three groups (high
SB, moderate SB, and low SB) based on
bruxism muscle activity (%MVC).
APRIL 2011, VOL. 29, NO. 2
SUGIMOTO ET AL. OCCLUSION AND SLEEP BRUXISM ACTIVITY

Table 1
Comparison of Bruxism Activity in Low, Moderate, and High Muscle Activity Groups
Muscle Low SB group Moderate SB group High SB group
activity (n=9) (n=7) (n=4)
(%MVC) Mean SD (%) Mean SD (%) Mean SD (%)
Grinding 5.4 ± 2.2* (48.5) 19.4 ± 6.4§ (51.2) 82.7 ± 26.9*§ (70.3)
Clenching 4.7 ± 3.2*§ (42.5) 16.4 ± 8.6*† (43.3) 28.7 ± 5.4†§ (24.4)
Tapping 1.0 ± 0.7* ( 9.0) 2.1 ± 1.7 ( 5.5) 6.3 ± 6.2* ( 5.3)

Total 11.1 ± 4.5*§ (100) 37.9 ± 11.8*† (100) 117.6 ± 25.9†§ (100)
*§†Statistically significant differences among the groups, at p<0.05

Table 2
Comparison of Bruxism Length in Low, Moderate, and High Muscle Activity Groups
Bruxism Low SB group Moderate SB group High SB group
length (n=9) (Sec.) (n=7) (Sec.) (n=4) (Sec.)
(sec./hr) Mean SD (%) Mean SD (%) Mean SD (%)
Grinding 117 ± 72* (35.0) 260 ± 130§ (47.0) 381 ± 123*§ (54.9)
Clenching 178 ± 140 (53.3) 269 ± 144 (48.5) 273 ± 201 (39.4)
Tapping 39 ± 39 (11.7) 25 ± 36 ( 4.5) 40 ± 23 ( 5.7)

Total 334 ± 144* (100) 555 ± 265 (100) 695 ± 274* (100)
*§Statistically significant differences among the groups, at p<0.05

mediotrusive contact (MG) did not show any influence
on bruxism muscle activity.
Canine Occlusal Guidance, Wear Facet and Sagittal
Condylar Inclination (SCI)
The COG in low SB group was significantly shallower
than the moderate SB group, while there was no signifi-
cant difference between low SB and high SB groups
(Table 4). There were no significant differences in the
SCI among the groups; however, the differences between
SCI and COG (rCOG) in moderate SB and high SB
groups showed significantly lower values than the low
SB group. This illustrates that COG must be taken into
consideration in relation to SCI.
A frequency distribution of rCOG was made in order to
examine the relationships between rCOG and bruxism
activity (Figure 3). High SB subjects were distributed
into small value areas of rCOG, while the low SB sub-
jects were distributed into large value areas of rCOG.
This indicates that a large difference between COG and
SCI and a flatter COG than the SCI, provides less muscu-
lar activity. Figure 4 shows muscular activity with a dif-
ferent rCOG value. Larger rCOG tended to correlate with
lower muscle activity and smaller rCOG with higher
muscular activity, although there was a dispersed area,
which showed a large standard deviation, suggesting
muscle activity of this area was related not only to
occlusal guidance, but also to different factors.
Steep and Flat Facet Inclination
When the tooth-contact patterns during sleep were ana-
lyzed using the Bruxchecker, there were two distinct
bruxism facet patterns: flat and steep facets (Figure 5).
Therefore, we categorized different bruxism facet incli-
nation (BFI) groups and analyzed the relationship between
the BFI and bruxism behaviors.
The flat-facet group had higher muscular activity
(%MVC) than those of the steep-facet group, and there
were significant differences in the grinding and clenching
activities, that is, the flat-facet group showed higher

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OCCLUSION AND SLEEP BRUXISM ACTIVITY SUGIMOTO ET AL.

Table 3
Comparison of Tooth Contact Pattern Evaluated by BruxChecker
in Low, Moderate, and High Muscle Activity Groups
Tooth Low SB group Moderate SB group High SB group
contact (n=18) (n=14) (n=8)
patterns Number (%) Number (%) Number (%)
IC 5/18 (27.8) 3/14 (21.4) 1/8 (12.5)
ICP 9/18 (50.0) 7/14 (50.0) 2/8 (25.0)
ICPM 4/18 (22.2) 4/14 (28.6) 5/8 (62.5)

MG 7/18 (38.9) 8/14 (57.1) 4/8 (50.0)

IC: incisor-canine contact; ICP: incisor-canine-premolar contact; ICPM: incisor-canine-premolar-molar contact;
MG: mediotrusive grinding

Table 4
Relationship Between Bruxism Activity and Canine Occlusal Guidance
Low SB group Moderate SB group High SB group
(n=18 sides) (n=14 sides) (n=8 sides)
Mean SD Mean SD Mean SD
Canine guidance
inclination (COG) (°) 37.2 ± 9.0* 45.2 ± 9.1* 44.8 ± 7.5
SCI1 (°) 53.7 ± 7.6 51.0 ± 7.5 47.1 ± 12.2
rCOG2 (°0) 16.5 ± 11.2*§ 5.8 ± 11.9* 2.3 ± 12.9§
1Sagittal condylar inclination
2Relative canine occlusal guidance (calculated as SCI-COG)
*§Statistically significant differences among groups, at p<0.05

activities than those of the steep-facet group (Table 5).
Regarding bruxism duration, there were no significant
differences between the flat-facet group and the steep-
facet group (Table 6).
The SCI, COG, and rCOG in the flat- and steep-facet
groups showed no significant differences. The BFI of the
flat-facet group was significantly smaller than that of the
steep-facet group. The BFI of the steep-facet group was
similar to COG, indicating that the steep-facet group was
grinding on the lingual surface of the canines. In contrast,
the flat-facet group had a greater difference between the
BFI and the COG, indicating that the flat-facet group did
not grind on the lingual surfaces of the canines, but on
another part of the dentition. The difference between the
SCI and the BFI (rBFI) was also significantly different
between the groups. (Table 7)
Evaluation of tooth-contact pattern by the Bruxchecker
in the groups showed that 50% of the flat-facet group was
ICPM type, while 60% of the steep-facet group was ICP
type (Table 8), suggesting that the high SB activity in the
flat-facet group was due to more molar contact than that
in the steep-facet group.
Discussion
The current study showed that in the high SB group,
grinding behavior was more predominant, based on both
muscle activity (%MVC) and length of activity (sec/hr).
As an occlusal factor, the high SB group was related with
the ICPM type of tooth contact during SB grinding move-
ment, because 62.5% of the high SB group showed ICPM
tooth contact, while the low SB group showed approxi-
mately 77.8% IC and ICP tooth contact. These findings
indicate that in order to prevent strong bruxism activity,
grinding pattern control is necessary, and controlling the
tooth contact pattern during grinding can reduce the

6 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE APRIL 2011, VOL. 29, NO. 2

SUGIMOTO ET AL. OCCLUSION AND SLEEP BRUXISM ACTIVITY

Figure 3
Frequency distribution of rCOG.
The different range of rCOG
values showed a tendency to
high SB subjects being distrib-
uted into the small rCOG range
and low SB subjects were
distributed into the high rCOG
range, while the middle range of
the rCOG (from 1 to 20 rCOG)
was a mixture of the subjects
(dispersed area).

Figure 4
Relationship between muscular
activity (%MVC) and rCOG. A
high %MVC ws observed in
small rCOG and low %MVC
in large rCOG, while the dis-
persed area had a large standard
deviation.

muscle activity of bruxism. In other words, it is possible contact pattern. Belser and Hannam15 showed that canine
to control bruxism activity by occlusal factors. protected guidance does not significantly alter muscle
Extensive experimental research has been conducted activity during mastication but significantly reduces
on muscular activities and occlusal guidance or tooth muscle activity during parafunctional clenching. Shupe,16

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OCCLUSION AND SLEEP BRUXISM ACTIVITY SUGIMOTO ET AL.

Figure 5
Inclinations of canine lingual surface and active facets due to sleep bruxism. The inclination of the lingual surface of the canine was measured from
F1 to F2 as occlusal guidance (COG). The bruxism facet had two different inclinations: steep facet on the lingual surface of the canine and flat facet
on the cusp tip of the canine.

Williamson and Lundquist, 17 Shinogaya, et al. 18 and
Akoren19 demonstrated more EMG activity in the jaw
muscles when the posterior teeth made contact on the
working side than when only the canines made contact.
Tamaki, et al., 20 showed clear EMG activities using arti-
ficial tooth contact from canine through 2nd molar, and
posterior molar contacts increased the temporal and mas-
seter muscle activity. All these approaches measured
EMG activity using an experimentally designed model,
not the real muscle activity during SB. A significant
aspect of the current study was that this is the first report
of an association between muscle activity and tooth con-
tact pattern during true SB. Our results regarding muscle
activity and tooth contact pattern coincide with the results
of previous experimental research.
The canine occlusal guidance (COG) was flatter in the

Table 5
Comparison of the Muscle Activity of Bruxism in Flat or Steep Facet Groups
Flat facet Steep facet
Bruxism activity (n=10) (n=10)
(%MVC) Mean SD Mean SD
Grinding 35.8 ± 41.2* 15.7 ± 15.4*
Clenching 17.0 ± 11.6* 10.1 ± 9.6*
Tapping 2.8 ± 4.6 2.0 ± 1.6

Total 55.7 ± 52.5* 27.8 ± 25.6*

*Statistically significant differences among the groups, at p<0.05

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SUGIMOTO ET AL. OCCLUSION AND SLEEP BRUXISM ACTIVITY

Table 6
Comparison of the Length of Bruxism in Flat or Steep Facet Groups
Flat facet Steep facet
Bruxism length (n=10) (n=10)
(Sec) Mean SD Mean SD
Grinding 231.7 ± 141.1 208.3 ± 155.9
Clenching 243.3 ± 150.8 214.6 ± 161.8
Tapping 32.0 ± 31.7 37.0 ± 38.5

Total 507.0 ± 234.1 459.9 ± 283.6

Table 7
Relationship Between the Flat or Steep Bruxism Facets and the Guidance Elements of Occlusion
Flat facet Steep facet
(n=20) (n=20)
Mean SD Mean SD
SCI1 (°) 52.6 ± 6.8 50.3 ± 10.4
COG2 (°) 43.1 ± 8.2 39.3 ± 11.4
BFI3 (°) 23.7 ± 12.1* 40.0 ± 12.3*
rCOG4 (°) 9.5 ± 11.6 11.0 ± 15.0
COG-BFI (°) 19.4 ± 14.4* -0.7 ± 6.5*
SCI-BFI (°) 28.9 ± 13.8* 10.3 ± 13.8*
1Sagittal condylar inclination
2Canine occlusal guidance (measurement of F1-F2)
3Bruxism facet inclination
4Relative canine occlusal guidance (calculated as SCI-COG)

*Statistically significant differences among the groups

low SB group than in the moderate SB group, and relative
canine occlusal guidance (rCOG) was larger in the low
SB group than in the high SB group. These findings show
that the negative or small value of rCOG provided
stronger SB activity and the larger value of rCOG pro-
vided low SB activity (Figure 3). Low values of rCOG
tended to provide strong %MVC (Figure 4), and in the
range -10 to 20, rCOG showed a wide range of %MVC
(large standard deviation), because the rCOG is not the
only limiting factor for bruxism muscle activity. As
already mentioned, the tooth contact pattern may influ-
ence muscle activity more than rCOG. However, it is still
an interesting phenomenon that negative rCOG (>-10)
showed very strong %MVC, while a rCOG of more than
20 showed low SB activity.
In this study, mediotrusive grinding (MG) demon-
strated no significant relation to bruxism activity, while
there was a tendency for less MG in the low SB group.
The hypothesis that there is a connection between brux-
ism activity and mediotrusive side interference has
caught the attention of some researchers. Ramfjord 26
reported that balancing interferences are more apt to be
responsible for bruxism than working-side or protrusion
interferences. Consequently, he recommended occlusal
adjustment in order to eliminate bruxism. However,
Egermark-Eriksson, et al.,27 found no significant correla-
tion with any type of occlusal interferences. Egermark-
Eriksson, et al.,28 and Ingervall, et al.,29 reported in a
longitudinal study that occlusal interferences had no sig-
nificant influence on bruxism activity. However, some
clinical studies suggest that all the bruxers had posterior
working-side interferences and 78% had posterior non-
working-side interferences.30 Since this area of research
is still controversial, the subject regarding the relation-

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OCCLUSION AND SLEEP BRUXISM ACTIVITY
ship of mediotrusive grinding and bruxism activity
remains to be clarified in the future.
The results of the current study show that there are two
different grinding patterns in the canine lingual surfaces
(COG): grinding with flat facets and grinding with steep
facets. We divided these into two groups, the flat-facet
group and the steep-facet group, and they were evaluated
for bruxism activity. The flat-facet group had more
muscle activity (%MVC) than the steep-facet group
(Table 5). There were more tendencies for steep canine
guidance inclination (COG) in the flat-facet group than in
the steep-facet group and a greater difference in the BFI,
between the BFI and the COG and between SCI and BFI
in the flat-facet group than in the steep-facet group
(Table 7). By contrast, the indication was that the flat-
facet group did not grind on the lingual surfaces of the
canines, but on another part of the dentition. These results
indicate that steep inclination of canine lingual surface
(COG) causes flat facets in the cusp-tip area, because
steep lingual inclination invites opening rotation of the
mandible during grinding movement. Since grinding is
basically promoted by the lateral pterygoid muscles on
the contra-lateral side, accompanied by strong closing
muscle activity, such as the masseter, temporal, and
medial pterygoid muscles on the working-side, steep
inclination of the lingual surface of the canine inhibits
smooth grinding. In this case, the patient may look for
other places to grind more comfortably, and the first
suitable location for smooth grinding would be the
canine cusp-tip.
The results in the current study indicate that there are
two factors which influence SB activity. First, posterior
molar contact during sleep bruxism grinding increases
muscular activity. Second, the position of grinding on the
lingual surface of the canines during excursive grinding
relates to SB activity; flat-facet grinding provides more
SB activity than steep-facet grinding. The latter depends
upon the inclination of the lingual surface of the canines.
Shinogaya, et al.,18 reported that when working-side
occlusal contact was restricted by the anterior teeth,
including the canines, the total actual EMG activity of the
jaw muscles had a significantly stronger correlation with
the frontal angle of the lateral incisal path and the occlusal
contact area at the lateral occlusion. He reported that
canine guidance possibly controls muscle activity during
lateral tooth clenching.
The question of whether it is possible to control brux-
ism in daily dental practice should be answered in the
future, because strong SB causes many dental and oral
problems. Based on our current results, we can say that it
is possible to control bruxism, although more research is
still needed on this subject. A good dental examination is
10 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
SUGIMOTO ET AL.
essential for determining whether there are possible cor-
rectible or occlusal factors responsible for the bruxism in
some way. We hope that future sleep laboratory studies
will be able to provide more information about the phys-
iological characteristics of bruxism and its relationship to
occlusion.
Acknowledgements
This work was performed at the Research Institute of
Occlusion Medicine and Research Center of Brain and
Oral Science, Kanagawa Dental College and supported
by a grant-in-aid for Open Research from the Ministry of
Education, Culture, Sports, Science and Technology,
Japan.
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OCCLUSION AND SLEEP BRUXISM ACTIVITY
Dr. Hidehiro Yoshimi is a lecturer in the Department of Craniofacial
Growth and Development Dentistry, Kanagawa Dental College. He
received his D.D.S. degree from Nihon University School of Dentistry at
Matsudo in 1987 and his Ph.D. in 2009 from Kanagawa Dental College.
His major research interests include function and dysfunction of the
masticatory organ and the role of emotion in sleep bruxism activity.
Dr. Kenichi Sasaguri is an assistant professor in the Department of
Craniofacial Growth and Development Dentistry, Kanagawa Dental
College. He received his D.D.S. from Kanagawa Dental College in 1985
and his Ph.D. in 1989 from the same school. His major research interests
include function and dysfunction of the craniomandibular system and
molecular mechanisms in stress and masticatory organ functions.
Dr. Sadao Sato is a professor and head of the Department of Craniofacial
Growth and Development Dentistry, Kanagawa Dental College. He
received his D.D.S. from Kanagawa Dental College in 1971 and his Ph.D.
in 1978 from the same school. Since 1992, he has been a member of the EH
Angle Society of Orthodontists. His major research interests include func-
tion and dysfunction of the masticatory organ, the emotional role of brux-
ism activity, and craniofacial growth and malocclusions.
THE JOURNAL OF CRANIOMANDIBULAR PRACTICE 11