Highlights We examined reorganization of masticatory muscle activity in chronic TMD patients. A functional index of EMG for maximal clenching and gum chewing was introduced. TMD patients have reduced cooperation and coordination between masticatory muscles. TMD patients recruited the balancing side more than the control group. Worse functional index was associated with more severe symptomatology. AbstractObjective To investigate whether reorganization of muscle activity occurs in patients with chronic temporomandibular disorders (TMD) and, if so, how it is affected by symptomatology severity.Methods Surface electromyography (sEMG) of masticatory muscles was made in 30 chronic TMD patients, diagnosed with disc displacement with reduction (DDR) and pain. Two 15-patient subgroups, with moderate (TMDmo) and severe (TMDse) signs and symptoms, were compared with a control group of 15 healthy subjects matched by age. The experimental tasks were: a 5s inter-arch maximum voluntary clench (MVC); right and left 15s unilateral gum chewing tests. Standardized sEMG indices characterizing masseter and temporalis muscles activity were calculated, and a comprehensive functional index (FI) was introduced to quantitatively summarize subjects' overall performance. Mastication was also clinically evaluated.Results During MVC, TMDse patients had a significantly larger asymmetry of temporalis muscles contraction. Both TMD groups showed reduced coordination 3 between masseter and temporalis muscles' maximal contraction, and their muscular activity distribution shifted significantly from masseter to temporalis muscles. During chewing, TMDse patients recruited the balancing side muscles proportionally more than controls, specifically the masseter muscle. When comparing right and left side chewing, the muscles' recruitment pattern resulted less symmetric in TMD patients, especially in TMDse. Overall, the functional index of both TMDmo and TMDse patients was significantly lower than that obtained by controls.Conclusions Chronic TMD patients, specifically those with severe symptomatology, showed a reorganized activity, mainly resulting in worse functional performances.

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BackgroundThe objectives of this study were to develop and validate a novel analysis protocol to measure linear and angular measurements of tip and torque of each tooth in the dental arches of virtual study models.MethodsMaxillary and mandibular dental casts of 25 subjects with a full permanent dentition were scanned using a three-dimensional model scanner. Sixty points per arch were digitized on each model, five points on each tooth. A custom analysis to measure linear distances and angles of tip and torque was developed using a new reference plane passing as a best-fit among all of the lingual gingival points, with the intermolar lingual distance set as the reference X-axis. The linear distances measured included buccal, lingual, and centroid transverse widths at the level of canines, premolars, and molars as well as arch depth and arch perimeter.ResultsThere was no systematic error associated with the methodology used. Intraclass correlation coefficient values were higher than 0.70 on every measure. The average random error in the maxilla was 1.5° ± 0.4° for torque, 1.8° ± 0.5° for tip, and 0.4 ± 0.2 mm for linear measurements. The average random error in the mandible was 1.2° ± 0.3° for torque, 2.0° ± 0.8° for tip, and 0.1 ± 0.1 mm for the linear measurements.ConclusionsA custom digital analysis protocol to measure traditional linear measurements as well as tip and torque angulation on virtual dental casts was presented. This validation study demonstrated that the digital analysis used in this study has adequate reproducibility, providing additional information and more accurate intra-arch measurements for clinical diagnosis and dentofacial research.

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Maxillary segments have the potential for growth during presurgical orthopedic treatment in the early neonatal period. The cleft segment delimitation on digital dental casts and area measurements by the 3D stereophotogrammetric system revealed an accurate (true and precise) method for evaluating the stone casts of newborn patients with UCLP.

The choice of the motor donor nerve is a crucial point in free flap transfer algorithms. In the case of unilateral facial paralysis, the contralateral healthy facial nerve can provide coordinated smile animation and spontaneous emotional expression, but with unpredictable axonal ingrowth into the recipient muscle. Otherwise, the masseteric nerve ipsilateral to the paralysis can provide a powerful neural input, without a spontaneous trigger of the smile. Harvesting a bulky muscular free flap may enhance the quantity of contraction but esthetic results are unpleasant. Therefore, the logical solution for obtaining high amplitude of smiling combined with spontaneity of movement is to couple the neural input: the contralateral facial nerve plus the ipsilateral masseteric nerve. Thirteen patients with unilateral dense facial paralysis underwent a one-stage facial reanimation with a gracilis flap powered by a double donor neural input, provided by both the ipsilateral masseteric nerve (coaptation by an end-to-end neurorrhaphy with the obturator nerve) and the contralateral facial nerve (coaptation through a cross-face nerve graft: end-to-end neurorrhaphy on the healthy side and end-to-side neurorrhaphy on the obturator nerve, distal to the masseteric/obturator neurorrhaphy). Their facial movements were evaluated with an optoelectronic motion analyzer. Before surgery, on average, the paretic side exhibited a smaller total three-dimensional mobility than the healthy side, with a 52% activation ratio and >30% of asymmetry. After surgery, the differences significantly decreased (analysis of variance (ANOVA), p < 0.05), with an activation ratio between 75% (maximum smile) and 91% (maximum smile with teeth clenching), and <20% of asymmetry. Similar modifications were seen for the performance of spontaneous smiles. The significant presurgical asymmetry of labial movements reduced after surgery. The use of a double donor neural input permitted both movements that were similar in force to that of the healthy side, and spontaneous movements elicited by emotional triggering.

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To assess the relative contribution of rotation and translation of the temporomandibular condyle-disc assembly during opening and closing movements, free movements of maximum mouth opening and closing were recorded in healthy subjects (12 men, 14 women) using an optoelectronic three-dimensional motion analyzer. For each subject, the displacement of the lower interincisal point, the path of the condylar reference point, the degree of rotation around the three orthogonal rotational axes, and the relative contribution of translation and rotation were calculated during all movement of mouth opening and closing. The distance covered by the interincisor point and the rotational angle about the transverse axis at maximum mouth opening were larger in men than in women, but the difference cancelled after correcting for mandibular radius in the sagittal plane; mandibular rotation was always larger than translation, but never approaching 100%; opening and closing translations were similar within sex, but their paths were longer in men than in women (P < 0.05); rotational angles around vertical and sagittal axes were negligible; the linear correlation between maximum mandibular opening and condylar translation was minor and not significant. In normal subjects, mouth opening and closing as modeled at the interincisor point was determined more by mandibular rotation than by translation, but in no occasion a pure rotation was found. The percentage rotation was not identical during mouth opening and closing; female and male paths were not totally coincident; no correlation between maximum mandibular opening and condylar translation was found.