n LITERATURE REVIEW

The Use of Electrognathography in Jaw Movement

Research: A Literature Review
Paulo Fernandes Pinheiro, Júnior, D.D.S., M.S.; Daniele Andrade da Cunha, Ph.D.;
Mário Genuíno Dourado Filho, M.D., M.S.; Ada Salvetti Cavalcanti Caldas, M.S.;
Thais Myriam Aragão Melo, M.S.; Hilton Justino da Silva, Ph.D.

0886-9634/3004-
ABSTRACT: The measurement of mandibular movements is a complex task that can be simplified
293$0.25/pp, THE through the use of electrognathography (EGN), an examination that can be applied as an auxiliary
JOURNAL OF
CRANIOMANDIBULAR
method for the diagnosis or follow-up of the evolution of specific therapeutics applied to the stomatog-
PRACTICE, nathic system. The aim of the present study was to review the literature pertaining to the use of EGN as
Copyright © 2012
by CHROMA, Inc.
a method for monitoring jaw movements in the research and treatments related to the stomathognathic
system. A literature review was made by searching for articles in PubMED, MEDLINE (1997-2010),
Manuscript received MEDLINE (1966-1996), LILACS, Ovid, BBO and SciELO databases. In this systematic review, 373 arti-
September 6, 2011; revised cles were found, of these, 23 articles were selected. The study concluded that EGN can be used with
manuscript received
December 6, 2011; accepted advantages in varied clinical situations, although it is a technique still not widely applied.
December 6, 2011
Address for correspondence:
Dr. Paulo F. Pinheiro, Júnior
Av. Antônio Lira – 458
Ed. Luxor Tambaú – SL 03
CEP 58.039-050 João
Pessoa
PB – Brazil
Email: pgmap@ufpe.br

Dr. Paulo Fernandes Pinheiro, Júnior
received his D.D.S. from the Federal
University of Paraíba (UFPB) in 1999
and a specialty degree in prosthetic
dentistry from the Brazilian Association
of Dentistry in 2002. He completed his
postgraduate studies in prosthetics and
implants from the Centro Odontológico
de Estudos e Pesquisas (COESP) in 2007.
Currently, Dr. Pinheiro is pursuing a
Master’s degree in pathology at the
Federal University of Pernambuco
(UFPE). From 2003-2005, he taught in
the Prosthetic Clinic at the UFPB
Department of Restorative Dentistry.
Currently, he is a dentist at the Brazilian
Army’s “Hospital de Guarnição” in João
Pessoa. He has professional experience in
oral rehabilitation and temporomandibu-
lar dysfunction.
J
aw movements incorporate shifts in three dimensions
that may be better analyzed when projected and
recorded against the orthogonal spacial planes. 1
These projections and markings represent the border
movements of the jaw, beyond which no movement is
possible and border movements can be reproduced.
Functional movements occur in the opposite manner;
they are not reproducible.1-3 Markings of these move-
ments generally allow a specific interpretation of their
influences on the diagnosis, in the analysis of the occlusal
equilibrium, and in the development of occlusal patterns
on the masticatory surfaces.1,4
The identification of jaw movements is not a simple
task, although it may be confirmed in the literature;
however, it can be simplified with technological develop-
ment in the area of magnetoresistive sensors.2 One such
process is electrognathography (EGN), which is a com-
puterized three-dimensional analysis of jaw movement.
This analysis is possible through the reception of these
movements in the three orthogonal spacial planes by a
magnetic field placed in the median line to the lower
incisors.5 There-fore, electrognathography can display
jaw movement amplitude and accelerate the measure-
ment of variables, which can be altered in pathological
situations.6,7

293
EGN IN JAW MOVEMENT RESEARCH
The use of EGN as an auxiliary method to clinical
examination 2,5 may provide a new perspective to the
treatments related to the adaptive or compensatory alter-
ations of the stomatognathic system caused by diverse
pathological situations.4 It is an easily completed exami-
nation for quantifying jaw movements using numeric
values,5 thus making the functional diagnosis and the
evolution of the applied therapeutics more precise.2,4
The useful application of EGN on the diagnostic and
therapeutic problems that affect jaw biomechanics is still
rare. In this context, the present study aimed to review the
literature regarding the use of EGN as a method for
monitoring jaw movement in research and treatment
related to the stomatognathic system. As well as observ-
ing in which clinical situations its use is appropriate,
accessing the applicability of the statistical treatment,
and observing the level of reliability, the authors con-
sider the EGN equipment utilized, and verify if there
are studies in which EGN has been associated with other
examination methods.
Materials and Methods
In order to identify published articles about the use of
electrognathography as a method for monitoring jaw bio-
mechanics in the treatment and research related to the
stomatognathic system, a literature review was conducted
during the period of September through November of
2010 in the following health electronic databases:
PubMED, MEDLINE 1966-1996, MEDLINE 1997-
2010, LILACS, OVID, BBO and SciELO. There was no
limitation as to publication period, and the articles were
then selected using criteria of inclusion and exclusion.
The keywords used in the search were: jaw, move-
ments, mastication, jaw biomechanics, articular range of
motion and three-dimensional image, and all terms were
included in Medical Subject Headings (MeSH). Also, the
free terms “electrognathography,” “EGN,” “computer
tracking,” “magneto sensors,” and “3-D analysis” were
included, based on their relevance and correlation within
the studied subject. The search was made using all key-
words and the free terms, both in the Portuguese language
and their corresponding terms in the English language.
The following cross-checking with the keywords and
the free terms were compiled, using the English word
“AND” among them: jaw movements and EGN, com-
puter tracking, electrognathography, magneto sensors,
3-D analysis, articular range of motion and three-dimen-
sional image; mastication and electrognathography; mas-
tication and EGN; electrognathography and articular
range of motion; electrognathography and jaw biome-
chanics; EGN and jaw biomechanics; jaw movements
294 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
PINHEIRO ET AL.
computer and electrognathography. The free term elec-
trognathography without cross-checking was also used.
Original articles in the Portuguese, English, and
Spanish languages that present the use of electrognathog-
raphy made through magnetoresistive sensors as a method
for monitoring and tracking jaw movements in several
functional and/or pathological situations were included.
Articles that consider jaw tracking done through opto-
electronic systems or other computerized or analogous
methods not utilizing a tracking mechanism of magne-
toresistive sensors were excluded. Besides this, the fol-
lowing were also excluded: review articles, clinical case
analysis, theses, dissertations, and articles that do not fea-
ture their abstracts in the electronic databases.
Results
For the studies related to the use of electrognathogra-
phy as a method for monitoring jaw biomechanics in
treatments and research related to the stomatognathic
system, 164 articles were found in the database PubMED,
124 in the database MEDLINE (1997-2010), 52 articles
in the database MEDLINE (1966-1996), 18 in LILACS,
0 in OVID, 10 in BBO, and 5 in SciELO, totaling 373
articles.
Removing the redundant cross references, present in
one and sequentially in all the searched databases and
following the criteria for exclusion and inclusion previ-
ously described, a total of 23 articles were selected.
Details of the number of articles found and selected by
cross-checking of the features can be found in Figure 1.
The 23 articles that study the use of electrognathogra-
phy as a method for monitoring jaw biomechanics in
treatments and research related to the stomatognathic
system were organized according to author/year, country,
sample, aim of the study, method used, instrument and
results found, and can be observed in Table 1.
Discussion
The great diversity of articles did not allow the appli-
cation of statistical treatment (meta-analysis). Among the
several differences in the studies, attention is called to the
number of individuals used in the 23 selected articles. It
was identified in the studies that a small number of sub-
jects is generally perceived convenient, as the pathologi-
cal situations involved possibly make it difficult to find a
more expressive number of individuals or cases with a
more complex methodology for casuistic pursuit.
In the studies with a more expressive sampling, the
number is possibly due to a relatively prolonged period
for the data collection, as in the case of the work of
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PINHEIRO ET AL. EGN IN JAW MOVEMENT RESEARCH

DIAGRAM

Articles saved by the search

strategy in the databases
N=373

Articles excluded by
reading the title
and abstract
N=242
Articles selected
after reading title
and abstract
N=131
Articles excluded for
being redundant in the
same databases
N=42

Articles selected after exclusion of redundant

articles in the same databases
N=89

Articles excluded for

being redundant in
the different
Articles excluded for not databases
approaching the use of N=350
electrognathographic resources
in the analysis of jaw
movements after its reading
N=34

Articles
selected for
review
N=23

Figure 1
Diagram of the number of articles found and selected after applying the criteria of inclusion and exclusion, according to descriptors and databases.

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Bodin, et al.8 or possibly due to a more simplified method-
ology for obtaining results. The work with the smallest
sampling had six subjects,9 and the one with the largest
had 135.6,7
The variability of goals to be studied reinforced this
diversity, thus only some correlations between the arti-
cles were found. This is perceived in the case of the arti-
cles discussing the possibility of standardizing the
masticatory cycle, despite the diversity of clinical situa-
tions involved,8,10-14 and the articles analyzing jaw move-
ments from the use of different moveable15-17 or fixed18-20
interocclusal interferences.
In the works relating the masticatory system to cervical
posture, the veracity of hypotheses, such as the TMJ
whiplash injury when the neck is distended,9 and the rela-
tionship between occlusal support with neck posture21 are
reviewed. Both articles use EGN in association with elec-
tromyographic data, and this association was also applied
in seven other articles10-12,18,19,22,23 that were differentiated
by clinical situations.
The two studies discussing jaw biomechanics after sur-
gical interventions to the stomatognathic system diverge
in their characteristics, one for approaching orthognathic
corrections24 and the other for approaching mandibulec-
300 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
PINHEIRO ET AL.
tomies with and without prosthetic reparation provided
from surgical therapeutics for neoplastic processes25; this
diversion denotes the ample possibility of EGN clinical
applications. Another aspect in this latter study is its
unique character among the 23 selected studies for this
review.
The articles analyzing muscle activity together with
the performance of determined movements 22,23 were
joined by the EGN with electromyography (EMG), a fact
that gives more technical support in the analysis of the
results, as well as denotes the confidence of the researchers
in the equipment used, since the resulting measurements
did not have enough expressivity to support the initial
hypothesis.
The approaches on TMJ disorders are also expressed in
a particular manner, since one study seeks electrognatho-
graphics alterations in the speech of the surveyed individ-
uals,26 while the other seeks alterations through directed
anamnesis, specific physical examination and electrog-
nathographic and sonographic alterations in bruxers.27
Here, one can emphasize the heterogeneous character of
these two studies, the researchers’ confidence in the
equipment used, and, in the case of the second study, the
association of methods for the collection of data.
OCTOBER 2012, VOL. 30, NO. 4
PINHEIRO ET AL.
As to the articles that particularly discuss speech,6,7,26,28
all of them applied exclusively electrognathographic data
to compile the results to be discussed. Such characteris-
tics also demonstrate the reliability and ease of execution
of the methodology.
One differentiated study employed seven trained adju-
dicators for the description of meats as sampling for com-
paring electromyographic, electrognathographic, and
subjective data of masticatory perception.11 Here, once
more, they used various techniques to obtain and analyze
the results.
Regarding gender as a sampling parameter, the possi-
bility of variability in the results was not observed. Three
works did not describe the samples as male and fe-
male,11,24,28 three used only males,13,21,22 one worked with
female subjects only,14 and the other three divided the
genders equally.9,10,23 The remaining studies did not dis-
play an even division. Regarding age groups, only one
study sought to relate age with the characteristics of the
masticatory cycle,8 such situation allows that this para-
meter may need to be better investigated in further
research. The youngest age group found was five years
and one month old,8 and the oldest was 57 years old.6,7
With regard to the country where the study was done,
it can be stated that Brazil was the country with the most
frequent publication of EGN application research, with
seven publications, four of them led by Bianchini, et
al.6,7,26,28 Next in number of studies was Japan, where six
publications were found.13,14,20-22,24 Three originated in
research led by Yashiro, et al.13,14,20 In the United States,
four studies were found.9,15,18,19 China provided two stud-
ies,25,27 and Australia,10 South Africa,23 Italy,8 and South
Korea11 published one study each. These findings suggest
that there is a concentration of works involving just a few
groups of researchers in the countries where the largest
number of publications was found. This explains and
confirms the small number of studies collected in the
databases investigated.
The articles the current authors selected present results
that demonstrate the diversity of clinical situations inves-
tigated, showing EGN as a unique tool for the measure-
ment and tracking of jaw movements. They also imply, in
the reliability of the examination method as perceived by
the authors, the ease in obtaining data related to the speed
and amplitude of jaw movements, the possibility of gath-
ering clinical data or other devices in the perspective of
better supporting the results obtained, as well as stressing
the heterogeneity of the studies discussed here.
In this sense, based on the works whose approach was
the use of movable interocclusal devices related to possi-
ble jaw biomechanical alterations, as in the case of the
study analyzing the use of the leaf gauge, it can be
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EGN IN JAW MOVEMENT RESEARCH
concluded that no alteration in jaw displacement was
perceived.15 In the same way, the data obtained attests to
the efficacy of the evaluation of the therapeutic effect of
stabilizing occlusal appliances,17 and the results assume
the authors trust in the equipments applied.
In verifying the degree of reproducibility of jaw move-
ments during mastication, all the subjects exhibited sig-
nificant differences among them; however, with a good
individual reproducibility for the record, the type of food
offered was the largest variable, and the timing of the
number of strikes had a better consistency of data than the
measurement of the masticatory envelope dimensions.10
Furthermore, Oncins, et al. 12 added that the temporal
muscle presents more electrical activity in repose, and
with regard to the masseter, on the side of masticatory
preference, 65.4% chewed more to the right and 34.6%
more to the left. In other words, 100% of the individuals
presented preferred mastication on one side. In those
studies, the use of electrognathographics and electromyo-
graphic resources supported the results.
The influence of the localization of mastication on
facial and jaw muscle activity was also applied, as well as
electrognathographic resource data from EMG, and no
significant difference was found in the unilateral unspe-
cific localization.22
Measuring the rotational answer due to the introduc-
tion of a rigid unilateral occlusal interference altering the
maximal intercuspation between the antagonist teeth, the
result was that 100% of the cases experienced advance-
ment in the mandibular condyle contralaterally to the
interference in the frontal plane.19 In other words, when
the interference introduced was flexible, the result was an
advance of 92% in this rotation.18 Here one may point to
the variability of clinical situations for the use of EGN.
Wilding, et al.23 in an investigation of the normal phys-
iological tremor in jaw movements as a factor influencing
the masticatory performance more directly than muscle
activity or jaw displacement, demonstrated through EMG
and EGN results that the frequency of these tremors
during the movements of opening and closing of the mas-
ticatory cycle presents itself as a strong predictor for
good masticatory performance.
Attesting to the veracity of the TMJ whiplash lesion
theory when the neck is distended, McKay, et al.9 did not
display any voluntary or involuntary depressing force
that could anchor the jaw in a traumatic mouth opening
position. Additionally, in a method for examining the
relationship between occlusal support and neck posture,
Kibana, et al. 21 observed that there is a relationship
between occlusal support and neck posture. Such research,
beyond demonstrating the heterogeneity of themes, opens
up several possibilities for clinical application of EGN.
THE JOURNAL OF CRANIOMANDIBULAR PRACTICE 301
EGN IN JAW MOVEMENT RESEARCH
Takahashi, et al. 24 presented a study where four
mandibulectomy subjects without continuity and three
with continuity were evaluated based on their jaw biome-
chanics. The results showed that the first of the border
movements display an irregular and asymmetric enve-
lope deviating to the dry side, while for the second the
movements are presented smoothly symmetrical. In its
turn, for the jaw rotation angle, the movements were sig-
nificantly greater in the first group than in the second.
Yashiro, et al.13 affirmed that in order to characterize
the masticatory cycle of foods of varied consistencies in a
predictable way, the results suggested a predictability of
the jaw kinematic that may vary according to the consis-
tency of each food. According to Lee, et al.,11 no relation-
ship between the electrognathographic parameters and
the sensorial attributes was observed; however, this rela-
tionship could be perceived by comparing the elec-
tromyographic data.
In a study of the masticatory cycle of 52 children, the
results showed that their masticatory cycles can coexist
normally with occlusal discrepancies, with cranium/facial
growth and with TMJ alterations.8
Concerning speech, Bianchini, et al.28 verified that
mouth opening speed is directly related to the closing
one. The opening amplitude shows a direct correlation of
opening and closing velocity, and in all cases, one could
observe lateral translations during excursions in the jaw
trajectory.
It was observed that, in the studies discussing the pos-
sibility of speech interferences in individuals with and
without TMJ disorders, regarding speed and amplitude
alterations in jaw movements, no differentiated results
with clinical significance were found.26 However, the
presence of these dysfunctions caused reduction of the
maximum opening amplitudes and speed reduction of the
opening and closing jaw movements,6,7 as well as preva-
lence of unilateral deviations during speech.7
For individuals bearing mandibular prognathism,
Yashiro, et al. 14 characterized the variability of the
best tracing plane and the masticatory cycle trajectory
in women with this characteristic and observed a great-
er variability in the study group than the control group.
In the study on the effects of jaw kinematic prognathism
surgical correction, Wang, et al.25 observed an improve-
ment not only of the inter-jaw relationship, but also of
the jaw kinematic. Once more, based on this research, the
variability of clinical situations can employ electrog-
nathography.
In the EGN evaluation of the jaw movement patterns
and the freeway space of 16 rehabilitated patients with
complete sets of teeth, free of functional alterations in the
stomatognathic system, it was concluded that a signifi-
302 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
PINHEIRO ET AL.
cant decrease of this space was found; however, no dif-
ferences between opening and closing were found.16
When comparing the TMJ joint vibration difference
between bruxers and asymptomatic individuals, it was
found that such upheaval may induce abnormal vibra-
tions and that the energy of these vibrations can increase
along with the degree of bruxism.27
In the study where experimental occlusal interferences
were inserted, a rapidity in the adaptation of jaw mastica-
tion was perceived.18,19
Conclusion
The ease in obtaining data related to amplitude and
speed of jaw movements makes EGN a unique tool in the
rehabilitation and research involving the stomatognathic
system.
The ample gamut of possibilities for the clinical appli-
cation of this measurement method supports the hetero-
geneity of the studies discussed.
As a result, it can be observed that there are a consid-
erable variety of objectives in the studies presented, a fact
that makes it impossible to apply a meta-analysis.
The degree of precision and accuracy of the electrog-
nathograph equipment used in the research was not ques-
tioned at any time; this finding confirms the trust that the
authors have in this equipment.
The association of techniques, such as electromyogra-
phy, the manual functional analysis or a specific anamne-
sis for the collection of data, can provide better technical
support for the results of the studies.
Despite these facts, a reduced number of publications
that apply electrognathographic data in their methodol-
ogy is still found, mainly in situations where jaw biome-
chanics is discussed in individuals with handicaps in the
stomatognathic system.
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EGN IN JAW MOVEMENT RESEARCH
Dr. Daniele Andrade da Cunha received an undergraduate degree in
Speech Therapy from the Catholic University of Pernambuco in 2000, a
Specialist degree in Orofacial Motricity in 2002 from the Conselho
Federal de Fonoaudiologia, a Master’s degree in 2005, and a Ph.D.
degree in 2009 in nutrition from the Federal University of Pernambuco-
UFPE. Dr. da Cunha coordinated the undergraduate program in Speech
Therapy from 2006-2009 and the Specialist degree programs in
Orofacial and Oral Motricity from 2007-2008 at the Faculdade
Integrada do Recife. Currently, he is active in the following subjects:
orofacial motricity, speech therapy, stomatognathic system, and oral
respiration.
Dr. Mário Genuíno Dourado Filho received an M.D. degree from the
Federal University of Pernambuco – UFPE in 2004 and a Specialist
degree in Radiology and Image Diagnostics from the UFPE’s “Hospital
das Clínicas” in 2008. Currently, he is pursuing a Master’s degree in
Pathology at UFPE, as a member of the research group on
Stomatognathic System Pathophysiology. Dr. Filho is a member of the
Colégio Brazileiro de Radiologia – CBR (São Paulo). He is active in the
following subjects: computerized tomography, magnectic nuclear reso-
nance and ultrasonography. He has served on the staffs of the following
Brazilian institutions: Hospital Esperança - HESP, Diagno-Hospital São
Marcos - HSM, and the General Hospital of Mirueira - HGM.
Dr. Ada Salvetti Cavalcanti Caldas received an undergraduate degree
in Occupational Therapy from the Federal University of Pernambuco -
UFPE in 2006 and a Specialist degree in Collective Health, Systems
Management and Health Actions from the University of Pernambuco –
UPE in 2009. She is currently pursuing a Master’s degree in Pathology
at the Federal University of Pernambuco, as a member of the research
group on Stomatognathic System Pathophysiology. Her professional
experience is in the areas of physical therapy and occupational therapy,
with an emphasis in neurology and gerontology. She is a staff member of
the Centro de Atenção Psicossocial - CAPSAD.
Dr. Thais Myriam Aragão Melo received an undergraduate degree in
Physical Therapy from the Faculdade Integrada do Recife – FIR in 2008
and a Specialist degree in Physical Therapy in the Neonatal and
Pediatric ICU at Faculdade Redentor in Rio de Janeiro in 2010. Dr.
Melo is currently pursuing a Master’s degree in Pathology at the Federal
University of Pernambuco – UFPE, as a member of the research group
on Stomatognathic System Pathophysiology. Her professional experience
is in the areas of physical therapy and occupational therapy, with an
emphasis on neonatal and pediatric ICU.
Dr. Hilton Justino da Silva received an undergraduate degree in
Speech Therapy from the Catholic University of Pernambuco – UNICAP
in 1992, a Specialist degree in Orofacial Motricity from CEFAC/CFF in
1998, a Master’s degree in Morphology in 2001, and a Ph.D. degree in
Nutrition from the Federal University of Pernambuco – UFPE in 2006.
Currently, Dr. da Silva is an associate professor in the Speech Therapy
program at UFPE, in the area of Orofacial Motricity and a member of
the Master’s degree program in Pathology committee at UFPE. Her
professional experience is in the area of Speech Pathology where she is
especially active in the following subjects: orofacial motricity, voice,
stomatognathic system and nutrition, and surface electromyography and
biofeedback.
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