n CLINICAL PRACTICE

Muscular Activity in Class III Dentofacial Deformity

Beatriz Ueti Lombardi de Farias, D.D.S.; Esther Mandelbaum Gonçalves
Bianchini, Ph.D.; João Batista de Paiva, D.D.S., Ph.D.; José Rino Neto, D.D.S., Ph.D.

ABSTRACT: Individuals with Class III dentofacial deformities exhibit morphological changes and
myofunctional adaptations, and an accurate diagnosis is essential for treatment planning. The purpose
of this study was to evaluate the electrical activity of the masseter, temporal, and suprahyoid muscles in
subjects with Class III dentofacial deformities, assessing electromyographic characteristics using func-
tional tests. The research group consisted of 20 subjects with Class III dentofacial deformities and indi-
cations for surgical-orthodontic treatment. The control group consisted of 10 individuals presenting a
0886-9634/3103-

good maxilla and mandible relationship. Electrical activities of the masseter and temporal were recorded
181$0.25/pp, THE
JOURNAL OF
during isometric contraction and maximal isometric contraction. The suprahyoid and masseter were
CRANIOMANDIBULAR

assessed during maximal mouth opening and swallowing of saliva. Isometric contraction and maximal
& SLEEP PRACTICE,
Copyright © 2013
isometric contraction analysis showed less potential in the research group, with a significant difference
by CHROMA, Inc.

regarding the masseter muscle in isometric contraction. In maximal isometric contraction, an increase in
electrical activity in both groups was observed; it remained lower for the research group, but with no sig-
Manuscript received

nificant difference. With regard to symmetry, significant differences among the groups were observed
August 6, 2012; revised
manuscript received
only for the left masseter in the research group, as well as during isometric contraction. There was no
March 19, 2013; accepted

significant difference found regarding maximal mouth opening. During swallowing of saliva, there was a
March 25, 2013

high percentage of abnormal electromyographic tracings for both groups. This finding was not expected
Address for correspondence:
Dr. Beatriz U. L. de Farias
for the control group. The study found some changes in muscular activity in Class III dentofacial defor-
Av. Paulista, 509 conj. 808 -

C
mities, characterized by lower potential in the masseter muscle during isometric contractions. No other
Bela Vista
CEP 01311-000
peculiarities were found that could contrast either group.
São Paulo, Brazil
Email:
beatrizlombardi@gmail.com

lass III dentofacial deformities result from man-

Dr. Beatriz Ueti Lombardi de Farias
received a D.D.S. degree in 2004 from the
Dentistry School at the University of São
Paulo, São Paulo, Brazil. She received
her specialty in orthodontics in 2012 from
the same university. Her foremost areas
of interest are orthodontic diagnosis with
regard to clinical and electromyographic
evaluation of the activity of masticatory
muscles in patients with dentofacial
deformity and muscular behavior after
orthognathic surgery.
dibular prognathism, maxillary deficiency, or a
combination of both conditions. In patients with
dentofacial deformity, myofunctional adaptations have
been observed that enable stomatognathic functions, such
as chewing, swallowing, speaking, and breathing. These
individuals have peculiar myofunctional characteristics
related to the kind of disparity they present, because the
need to perform functions promotes myofunctional adap-
tations.1
When seeking orthognathic surgery, the individuals’
complaints include, aside from the aesthetic factor, func-
tional problems, such as difficulty chewing resulting
from a lack of coordination, and occlusal and muscular
instability.2 Thus, a major reason for the correction of
Class III dentofacial deformity is an improvement of
masticatory function, highlighting the importance of
functional assessment both before and after surgical treat-
ment, to obtain quantitative data regarding the real limita-
tions of the patients and regarding their subsequent
modifications.

181
DENTOFACIAL DEFORMITY AND MUSCLE ACTIVITY ON EMG
Surface electromyography (EMG) of the masticatory
muscles is used by health professionals to evaluate
muscle behavior during the functioning of the stomatog-
nathic system in normal or abnormal patterns, in the diag-
nosis and monitoring of treatments, to establish the rest
positions and occlusion, and to detect hyper- or hypoac-
tivity, spasms, fatigue, and imbalance.3-5 EMG testing
allows for muscle monitoring,6 producing results that do
not differ significantly from those obtained using intra-
muscular assessments, and is notably reproducible when
performed using standard protocols.7-12
The purpose of the electromyographic exam in patients
with Class III dentofacial deformity is to verify changes
or compensation in muscular activity caused by occlusal
and skeletal interferences. Knowledge of muscular behav-
ior in these individuals enables a therapeutic approach to
find out how the individual is compensating for the defor-
mity, preventing development of disorders, such as pain
and movement limitation.
The purpose of this study was to evaluate the EMG
activity of the masseter, temporal, and suprahyoid mus-
cles in subjects with Class III dentofacial deformities in
functional tests, thereby assessing the characteristics of
EMG at maximum isometric muscle contraction, during
mouth opening and during saliva swallowing. Then,
based on this comparison, check for possible changes or
compensation in muscular activity that can result in
favorable or unfavorable responses to orthodontic-surgi-
cal treatment.
Materials and Methods
This research was approved by the Research Ethics
Commitee from University of São Paulo (n° 124/11,
CAAE 0138.0.017.000-11), and informed consent was
obtained from all subjects, who voluntarily agreed to
undergo the proposed procedures.
The current study evaluated 30 adult subjects, includ-
ing both genders and ages between 18 and 35 years old,
who were divided into two groups. The research group
(RG) consisted of 20 individuals with Angle Class III
relationships of the molars and canines, concave facial
profiles caused by dentofacial deformities, and an indica-
tion for surgical-orthodontic treatment. The control group
(CG) consisted of 10 subjects with Angle Class I rela-
tionships of the molars and canines, complete permanent
dentition, good dental and periodontal status, good rela-
tionships between the maxilla and mandible, the presence
of facial symmetry, passive lip closure, and balanced soft
tissue profiles.
The examinations were completed using the following
surface electromyography equipment and settings:
182 THE JOURNAL OF CRANIOMANDIBULAR & SLEEP PRACTICE
DE FARIAS ET AL.
Miotool 200/400 USB; 4 channels; 14-bit resolution;
acquisition rate of 2000 samples per channel per second;
noise <2 LSB; common mode rejection of 110 dB; and
Data Acquisition System SDC500, MIOGRAPH soft-
ware and USB 2.0, (Miotec Biomedical Equipment
Ltda., Porto Alegre-Brazil). Bipolar SDS 500 electrodes
were positioned at a fixed distance of 1.5 cm, and a
mono-polar electrode was used as a reference, using a 20
Hz - 500 Hz filter.
During the examination, patients were seated comfort-
ably in a chair with their backs supported, feet on the
floor with rubber insulation, hands resting on thighs,
heads positioned properly, and eyes opened and looking
at a predetermined point. After cleaning the subject’s skin
with 70% alcohol and mildly abrading with sandpaper,
the electrodes were placed bilaterally on the temporalis
muscles (predominantly anterior) and the masseter and
submental regions in a position above the neck (suprahy-
oid muscles), and in a position parallel to the muscle
fibers. These muscles were identified by palpation during
rest and during maximal contraction. To identify the mas-
seter and temporal, the patient was asked to clench their
teeth. For the submental region, pressure of the tongue
against the palate was required. A monopolar reference
electrode was positioned at the elbow, which is not
affected by the activity of the muscles evaluated, to mea-
sure the potential difference between the two points.
Electrical potentials were recorded in the usual posture
for 15 seconds, thereby defining minimum individual
potential. The activity of the masseter and temporal mus-
cles was recorded using the following tests:
1. Isometric contraction (IC) was obtained during a
maximum intercuspal contraction for five seconds in
a series of three, with rest periods of five seconds.
The temporal and masseter muscles were evaluated.
2. Maximal isometric contraction (MIC): Using a
cotton roll positioned between the posterior teeth,
maximum intercuspal contraction was held for five
seconds in a series of three, with rest periods of five
seconds. The temporal and masseter muscles were
evaluated.
3. Maximal mouth opening was held for five seconds in
a series of three, with rest periods of five seconds.
The masseter and suprahyoid muscles were evalu-
ated.
4. Swallowing of saliva: this required movement of the
tongue on the floor of the mouth, until there was a
perception of saliva accumulation, and swallowing
was performed at the command of the person evalu-
ating. The masseter and suprahyoid muscles were
evaluated.
The muscle groups were assessed for electrical poten-
JULY 2013, VOL. 31, NO. 3
DE FARIAS ET AL.
tial in microvolts (µV), as well as symmetry between
pairs of muscles and functional particularities in the
research and control groups. For evaluation, and to stan-
dardize the EMG data, the results were calculated in per-
centages, from the values of isometric contraction and
maximal isometric contraction, with regard to the poten-
tial habitual posture at rest, which is considered the
normal electrical activity. On the EMG graphics, raw
signal windowing (RAW) was performed during the iso-
metric contraction and maximal isometric contraction, by
selecting a series and discarding the first and last seconds,
and the median value was obtained across the three inter-
mediate seconds of the rectified signal (RMS), shown in
Figure 1. From this average, the percentage was calcu-
lated, relating the averages obtained in isometric contrac-
tion and maximal isometric contraction to the potential of
the muscle at rest. For the suprahyoid muscle, the same
procedures were performed with maximal mouth opening
potential. Standardization of 1-2% was expected. 5 In
order to assess the muscle symmetry, the activity of the
right and left sides was compared for each muscle group.
Up to a 20% discrepancy between the sides was consid-
ered symmetrical.
For evaluation of swallowing, the RMS graphics of the
suprahyoid and masseter muscles’ activity were superim-
posed and classified as normal or abnormal, based on the
number of peaks, the duration, and the characteristics of
Figure 1
Raw signal window (RAW) during isometric contraction.
JULY 2013, VOL. 31, NO. 3
DENTOFACIAL DEFORMITY AND MUSCLE ACTIVITY ON EMG
the onset and offset. The RMS graphics were considered
normal when represented by a wave, with deflections in
the upward section, a single peak and a longer downward
section in the direction of rest position (Figure 2). An
abnormal wave was characterized by the presence of sev-
eral peaks, the absence of a peak, or changes in the onset
and offset9-11 (Figure 3).
Statistical analysis consisted of descriptive data and
nonparametric tests: equality of two proportions, a Mann-
Whitney test, and confidence intervals for means. A level
of p<0.05 was considered significant. The conditions for
the use of techniques and parametric tests, such as nor-
mality (Anderson-Darling test) and homogeneity of vari-
ances (Levene test) were not found in this data set.
Results
1. Isometric contraction (IC) and maximal isometric
contraction (MIC): When comparing the electrical poten-
tials of the masseter and temporal muscles between the
groups, lower potentials were obtained for the research
group in both isometric contraction and maximal isomet-
ric contraction, with a significant difference observed
only for isometric contraction in the masseter (p=0.038).
The p-value obtained for the temporal muscle in isomet-
ric contraction was p=0.154 (Table 1). In maximal iso-
metric contraction, an increase in electrical activity in
both groups was observed, which remained lower for the
research group, but with no significant difference. For
maximal isometric contraction in the masseter muscle,
Figure 2
Normal swallowing graphic.
THE JOURNAL OF CRANIOMANDIBULAR & SLEEP PRACTICE 183
DENTOFACIAL DEFORMITY AND MUSCLE ACTIVITY ON EMG DE FARIAS ET AL.

Figure 3
Abnormal swallowing graphics. A: presence of several peaks; B: absence of a peak; C: changes in the onset; D: changes in the offset.

the p-value was p=0.323, and for the temporal muscle,
the p-value was p=0.331 (Table 1). The comparison
between the average potential obtained on the sides and
the percentage of asymmetry in isometric contraction are
shown in Table 2, while comparisons of maximal iso-
metric contractions are shown in Table 3. Results of the
comparison between the groups regarding the normaliza-
tion of the isometric contraction are shown in Table 4,
and results regarding the maximal isometric contraction
are presented in Table 5.
2. Maximal mouth opening: Comparing the potentials
of the masseter and suprahyoid muscles between the con-
trol group and research group, there were no significant
differences found regarding the suprahyoid muscle
(p=0.307) and masseter muscle (p=0.100), as shown in
Table 6. The comparison between the means of electrical
potentials obtained on the sides and the percentage of
asymmetry are found in Table 7. Results comparing the
normalization of maximal mouth opening between the
groups are shown in Table 8.
3. Swallowing of saliva: An abnormal swallowing
curve was seen in 64.3% of the control group and 80% of
the research group. Although the research group had the
highest percentage of subjects with changes, when com-
paring the relative frequency distribution between the
groups, there were no statistically significant differences
(p=0.307).
Discussion
In the interdisciplinary morphological and myofunc-
tional assessment of dentofacial deformity, quantitative
data, including EMGs, have been essential in the plan-
ning of orthodontic-surgical treatment and speech ther-
apy.13-15
Considering that dentofacial deformity is associated
with skeletal, occlusal, and muscular imbalance, evident
on clinical examination, peculiar EMG characteristics
were expected in this sample,14,15 as reflected by the quan-
titative data expressed by the EMGs.3,7,8,10,11,16,17

Table 1
Comparison of Isometric Contraction (IC) and Maximal Isometric Contraction (MIC) in the Temporal (T)
and Masseter (M) Muscles for the Control Group (CG) and Research Group (RG)
IC T IC M MIC T MIC M
CG RG CG RG CG RG CG RG
Medium 156.9 139.8 177.0 152.7 154.4 152.7 133.1 121.4
Median 140.8 109.8 149.4 138.5 135.1 128.1 129.2 104.4
Std Dev 69.2 84.9 100.5 94.2 56.6 105.8 39.3 90.9
No. 20 40 20 40 20 40 20 40
IC 30.3 26.3 44.0 29.2 24.8 32.8 17.2 28.2
p-value 0.154 0.038* 0.331 0.323
Mann-Whitney
Std Dev: standard deviation; No.: number
*Statistically significant difference

184 THE JOURNAL OF CRANIOMANDIBULAR & SLEEP PRACTICE JULY 2013, VOL. 31, NO. 3
DE FARIAS ET AL. DENTOFACIAL DEFORMITY AND MUSCLE ACTIVITY ON EMG

Table 2
Comparison of Isometric Contraction (IC) in the Right Temporal (RT), Left Temporal (LT),
Right Masseter (RM), and Left Masseter (LM) Muscles and the Difference Between Sides
for the Control Group (CG) and the Research Group (RG)
Difference Difference
IC RT IC LT LTxRT IC RM IC LM LMxRM
CG RG CG RG CG RG CG RG CG RG CG RG
Medium 153.1 135.7 160.6 143.9 28.1% 20.6% 130.3 126.2 135.9 116.7 26.0% 22.1%
Median 140.8 105.8 139.9 111.6 32.1% 14.3% 126.2 110.6 132.2 99.4 22.0% 14.5%
Std Dev 59.5 80.8 80.9 90.7 16.3% 17.9% 43.3 94.4 37.1 89.6 19.7% 20.9%
Q1 113.6 81.8 108.9 87.6 15.6% 7.1% 100.1 83.3 113.7 78.2 12.2% 6.6%
Q3 159.2 174.1 220.0 168.0 33.8% 27.7% 144.8 138.3 161.5 120.3 42.0% 30.8%
IC 36.9 35.4 50.1 39.7 10.1% 7.9% 26.8 41.4 23.0 39.3 12.2% 9.1%

p-value 0.253 0.403 0.159 0.355 0.048* 0.598

Mann-Whitney
*Statistically significant difference
Std Dev: Standard deviation

Table 3
Comparison of Maximal Isometric Contraction (MIC) in the Right Temporal (RT), Left Temporal (LT),
Right Masseter (RM), and Left Masseter (LM) Muscles and the Difference Between Sides
for the Control Group (CG) and the Research Group (RG)
Difference Difference
MIC RT MIC LT LTxRT MIC RM MIC LM LMxRM
CG RG CG RG CG RG CG RG CG RG CG RG
Medium 165.9 145.1 188.2 160.2 23.6% 20.7% 149.2 159.7 159.6 145.8 25.7% 19.6%
Median 136.5 127.8 157.2 148.6 24.0% 18.2% 141.7 135.1 135.1 121.9 23.5% 19.5%
Std Dev 100.6 91.1 104.5 99.1 13.3% 18.9% 57.1 108.2 58.6 105.7 20.1% 11.6%
Q1 106.2 86.1 101.5 87.6 16.0% 7.9% 116.3 99.5 117.3 94.1 9.5% 10.8%
Q3 175.1 189.1 235.0 181.8 29.4% 30.4% 162.6 197.2 215.1 161.8 38.2% 27.3%
IC 62.4 39.9 64.8 43.4 8.2% 8.3% 35.4 47.4 36.3 46.3 12.5% 5.1%

p-value 0.572 0.288 0.483 0.946 0.141 0.839

Mann-Whitney
Std Dev: Standard deviation

Isometric contraction and maximal isometric contrac-
tion analysis showed less potential for the research group,
in agreement with previous studies,15,18 and with a signif-
icant difference regarding the masseter muscle in isomet-
ric contraction. As this difference may reflect the real
muscle electric potential or show any type of dental inter-
ference, another test was performed, with cotton rolls
between the posterior teeth. In maximal isometric con-
traction, an increase in electrical activity in both groups
was observed, remaining lower for the research group,
but without significant difference. This test, conducted
with cotton rolls between the posterior teeth, removed
possible occlusal interferences, thereby reflecting the real
electrical potential of the evaluated muscles.5,16 The sig-
nificant result obtained only in isometric contraction may
indicate that occlusal interferences are changing or mod-
ifying the electrical potential. This difference was not
found in maximal isometric contraction, once the inclu-
sion of the cotton roll between the posterior teeth removed
interference from the occlusal characteristics of the
research group.
With regards to symmetry, which was considered as
the difference between left and right sides, significant
differences among the groups were observed only for

JULY 2013, VOL. 31, NO. 3 THE JOURNAL OF CRANIOMANDIBULAR & SLEEP PRACTICE 185
DENTOFACIAL DEFORMITY AND MUSCLE ACTIVITY ON EMG DE FARIAS ET AL.

Table 4
Comparison of Isometric Contraction (IC) Normalization in the Right Temporal (RT), Left
Temporal (LT), Right Masseter (RM) and Left Masseter (LM) Muscles for the
Control Group (CG) and Research Group (RG)

Normalized IC RT Normalized IC LT Normalized IC RM Normalized IC LM

CG RG CG RG CG RG CG RG
Medium 2.7% 3.3% 2.6% 2.8% 2.1% 3.2% 2.2% 3.2%
Median 2.9% 2.8% 2.2% 2.3% 2.0% 2.1% 2.1% 2.4%
Std Dev 1.3% 2.1% 1.5% 1.5% 0.6% 2.9% 1.0% 2.1%
Q1 1.7% 1.8% 1.7% 1.9% 1.7% 1.5% 1.4% 1.9%
Q3 3.3% 4.3% 2.8% 3.8% 2.4% 3.6% 2.6% 3.6%
IC 0.8% 0.9% 1.0% 0.7% 0.4% 1.3% 0.6% 0.9%

p-value 0.567 0.553 0.809 0.235

Mann-Whitney
Std Dev: standard deviation

Table 5
Comparison of Maximal Isometric Contraction (MIC) Normalization in the Right Temporal (RT), Left
Temporal (LT), Right Masseter (RM) and Left Masseter (LM) Muscles for the
Control Group (CG) and Research Group (RG)

Normalized MIC RT Normalized MIC LT Normalized MIC RM Normalized MIC LM

CG RG CG RG CG RG CG RG
Medium 2.8% 3.4% 2.2% 2.7% 1.9% 2.3% 2.0% 2.5%
Median 2.7% 2.9% 1.9% 2.5% 2.1% 1.9% 1.7% 2.2%
Std Dev 1.4% 2.6% 1.1% 1.9% 0.6% 1.9% 1.3% 1.8%
Q1 1.7% 1.2% 1.5% 1.5% 1.5% 1.1% 1.3% 1.4%
Q3 3.9% 4.0% 2.8% 3.0% 2.3% 2.4% 2.1% 2.7%
IC 0.9% 1.1% 0.7% 0.8% 0.4% 0.8% 0.8% 0.8%

p-value 0.700 0.319 0.769 0.786

Mann-Whitney
Std Dev: standard deviation

the left masseter muscles in the research group, for
isometric contraction. In both groups and in both tests,
symmetrical and asymmetrical categorization was
observed, according to the frequency classification.
Previous studies have reported the presence of these
asymmetries for these muscles.14,17 This situation may be
reflected or associated with the large standard deviation
that was found in electromyographic evaluations, once
the sides of lower and higher electrical potential are dif-
ferent among individuals.
As regards normalization, percentages greater than 2%
were observed in most subjects, in the research and con-
trol groups, both during isometric contraction and maxi-
mal isometric contraction. Considering the criteria
adopted for this study,5 which are suitable for percentages
between 1 and 2%, and that the greater this percentage is,
the greater the electrical activity of muscle exercises from
rest to contraction,5 it could be deduced that there was a
probability of hyper-function, especially in the research
group, which had percentages that were higher in the
masseter and temporal muscles. Although not statistically
significant, higher percentages in the research group for
isometric contractions could be observed by analyzing
the statistical data from the third quartile (Q3), showing

186 THE JOURNAL OF CRANIOMANDIBULAR & SLEEP PRACTICE JULY 2013, VOL. 31, NO. 3
DE FARIAS ET AL. DENTOFACIAL DEFORMITY AND MUSCLE ACTIVITY ON EMG

uals with dentofacial deformities seem to require more

effort to achieve lower potential during opening. By ana-
lyzing the masseter muscles in this test, greater potential
Table 6 was found in the research group, with higher percentages
Comparison of Maximal Mouth Opening in the of asymmetry and significant differences being observed
Suprahyoid (S) and Masseter (M) Muscles between the groups. These characterizations were not
for the Control (CG) and Research Group (RG) found in previous studies, making a comparison with the
Opening S Opening M existing literature impossible.
CG RG CG RG A wide variation in electrical potential was observed
between the participants, preventing the use of paramet-
Medium 115.25 111.74 27.03 63.95

ric statistical techniques in the evaluated functional tests.

Median 126.05 79.90 20.40 38.40
Std Dev 42.18 89.73 22.47 90.17
IC (95%) (89.1:141.4) (72.41:151.06) (13.1:40.96) (24.43:103.46) This fact underscores the individual results achieved with
No. 10 20 10 20 EMGs, making this measurement an important feature to
be considered when analyzing EMGs.3,4,14,17,18
Electromyographic tracings of the swallowing of
p-value 0.307 0.100

saliva have been classified as normal or abnormal, accord-

Mann-Whitney
Std Dev: Standard deviation; No.: Number
that as much as 75% of the sample had no influence on
the median.
In maximal mouth opening, there was no significant
difference found regarding the suprahyoid and masseter
muscles, when comparing the research group and control
group. With regard to normalization, a greater electrical
activity from rest to contraction was observed in the
research group. As both groups’ percentages were greater
than 2%, but with no significant differences, these data
may reflect a situation to be researched in which individ-
ing to the literature.5,9-12 It was expected that the research
group would present significant alterations compared to
the control group, since patients with dentofacial defor-
mities present larger and deeper lower arches and wider
and lower tongue bases and plane positions. However,
there was a large percentage of abnormal tracings for
both groups, which was a result that was in disagreement
with the clinical evaluation of swallowing in these groups
and in the data from the literature, particularly studies on
normal swallowing.10,11
The small number of subjects, mainly in the control
group, is considered a limitation of the current study, as
many interfering variables were controlled and excluded,

Table 7
Comparison of Maximal Mouth Opening in the Right Suprahyoid (RS), Left Suprahyoid (LS),
Right Masseter (RM), and Left Masseter (LM) Muscles for the Control Group (CG) and the Research Group
(RG) and the Difference Between Sides for the Control Group (CG) and the Research Group (RG)
Difference Difference
Opening RS Opening LS LSxRS Opening RM Opening LM LMxRM
CG RG CG RG CG RG CG RG CG RG CG RG
Medium 108.0 107.1 101.3 84.0 19.8% 20.5% 21.6 40.0 23.8 52.4 26.7% 40.8%
Median 115.2 74.8 107.4 71.3 23.6% 18.6% 20.0 25.6 16.4 28.7 23.5% 43.7%
Std Dev 46.7 91.6 38.7 45.8 10.3% 18.4% 13.0 42.8 22.7 87.4 15.0% 20.9%
Q1 67.2 53.4 87.8 52.7 11.4% 7.4% 12.0 15.7 14.5 14.1 15.6% 22.4%
Q3 142.9 125.9 116.6 106.1 27.5% 25.8% 24.2 40.1 20.1 48.2 42.2% 55.1%
IC 29.0 40.1 24.0 20.1 6.4% 8.1% 8.1 18.8 14.1 38.3 9.3% 9.2%

p-value 0.379 0.187 0.692 0.173 0.301 0.048*

Mann-Whitney
*Statistically significant difference
Std Dev: Standard deviation

JULY 2013, VOL. 31, NO. 3 THE JOURNAL OF CRANIOMANDIBULAR & SLEEP PRACTICE 187
DENTOFACIAL DEFORMITY AND MUSCLE ACTIVITY ON EMG DE FARIAS ET AL.

Table 8
Comparison of Maximal Mouth Opening Normalization in the Right Suprahyoid (RS),
Left Suprahyoid (LS), Right Masseter (RM) and Left Masseter (LM) Muscles
for the Control Group (CG) and Research Group (RG)
Normalized Normalized Normalized Normalized
opening RS opening LS opening RM opening LM
CG RG CG RG CG RG CG RG
Medium 2.6% 3.9% 2.9% 4.1% 16.0% 10.9% 14.4% 11.8%
Median 2.2% 3.2% 2.8% 3.4% 14.2% 8.4% 14.9% 8.3%
Std Dev 1.2% 2.4% 1.5% 2.1% 9.8% 7.5% 4.5% 10.2%
Q1 2.0% 2.1% 1.6% 2.5% 8.3% 5.0% 11.6% 5.3%
Q3 3.4% 5.1% 3.5% 6.4% 19.6% 16.4% 17.3% 15.4%
IC 0.8% 1.1% 0.9% 0.9% 6.1% 3.3% 2.8% 4.5%

p-value 0.202 0.108 0.078# 0.113

Mann-Whitney
#Difference with a tendency toward statistical significance

Std Dev: standard deviation

thereby resulting in a reduced number in this group. As and Neuromuscular Solutions (AANMS), 2006.

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188 THE JOURNAL OF CRANIOMANDIBULAR & SLEEP PRACTICE JULY 2013, VOL. 31, NO. 3
DE FARIAS ET AL.
Dr. Esther Mandelbaum Gonçalves Bianchini graduated with a
degree in speech, language and hearing science from Pontifica
Universidade Católica de São Paulo, Brazil in 1981. She received her
Masters degree in education from the same university in 1998 and a
Ph.D. degree in 2005 from the Faculty of Medicine, University of São
Paulo, São Paulo, Brazil. Dr. Bianchini is a professor in the post gradu-
ate program at the University Veiga de Almeida, Rio de Janeiro, Brazil.
Her major research interest is diagnosis and rehabilitation procedures
with regard to electromyographic evaluation of the masticatory muscles,
dentofacial deformities, orthognathic surgery, and temporomandibular
disorders. She has authored many scientific articles, books, and book
chapters.
JULY 2013, VOL. 31, NO. 3
DENTOFACIAL DEFORMITY AND MUSCLE ACTIVITY ON EMG
Dr. João Batista de Paiva received a D.D.S. degree in 1979 from the
School of Dentistry, University of São Paulo, Ribeirão Preto, Brazil, a
Masters degree in dental science and orthodontics in 1990, and a Ph.D.
degree in dental science and orthodontics in 1999 from the same univer-
sity. Dr. Paiva is an associate professor and chairman of the Department
of Orthodontics, Dentistry School, University of São Paulo, Brazil. His
major research interest is orthodontic diagnosis with regard to maxillo-
facial development, acoustic rhinometry, and respiratory patterns, and he
has authored many scientific articles, as well as chapters in books.
Dr. José Rino Neto graduated with a D.D.S. degree in 1984 from the
Dentistry School, University of São Paulo, Bauru, Brazil. He received a
Masters degree in dental science and orthodontics in 1988 from the
Dentistry School, University of São Paulo, São Paulo, Brazil and a Ph.D.
degree in 1999 from the same university. He is an associate professor in
the Department of Orthodontics, Dentistry School, University of São
Paulo, Brazil. His major research interest is orthodontic diagnosis with
regard to orthognathic surgery, electromyography, and computed tomog-
raphy. Dr. Neto has authored many scientific articles, as well as chapters
in books.
THE JOURNAL OF CRANIOMANDIBULAR & SLEEP PRACTICE 189