Unilateral posterior CROXXBITE.pdf

25 EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY VOL. 13/1-2012 D. Ciavarella 1 , A. Monsurrò 2 , G. Padricelli 2 , G. Battista 1 , L. Laino 2 , L. Perillo 2 1 Department of Surgical Sciences University of Foggia, Foggia, Italy 2 Department of Dentistry, Orthodontics and Surgery Second University of Naples, Naples, Italy e-mail: Introduction Unilateral posterior crossbite (UPCB) is an asymmetric Keywords Adolescents; Surface electromyography; Unilateral posterior crossbite
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  25 E UROPEAN  J OURNAL   OF  P AEDIATRIC  D ENTISTRY   VOL . 13/1-2012 D. Ciavarella 1 , A. Monsurrò 2 , G. Padricelli 2 , G. Battista 1 , L. Laino 2 , L. Perillo 2 1 Department of Surgical SciencesUniversity of Foggia, Foggia, Italy  2 Department of Dentistry, Orthodontics and Surgery Second University of Naples, Naples, Italy e-mail:  Introduction Unilateral posterior crossbite (UPCB) is an asymmetric Keywords  Adolescents; Surface electromyography; Unilateral posterior crossbite.  ABSTRACT  Aim  Unilateral posterior crossbite (UPCB) is characterised by an inverse relationship of the upper and lower buccal dental cusps and may involve one or  several teeth. The aim of this study was to compare the electromyographic outcomes of patients with UPCB and those of healthy controls. Materials and methods  Fifteen patients (mean age 11.5 years) with UPCB and fifteen healthy controls (mean age 12 years) were examined at the Department of Orthodontics, Second University of Naples. Surface electromyography was performed on  patients and controls. Results and conclusion Patients with UPCB had less muscle activation than healthy subjects (p<0.0001) and an asymmetric muscle activation with 89.23% muscle balancing for temporals and 83.21% for masseters. The control group showed a 99.32% of muscle balancing for temporals and 97.77% for masseters. These findings suggest that asymmetric muscle activation may influence maxillary and mandibular growth in adolescents with UPCB. Unilateral posterior crossbite in adolescents: surface electromyographic evaluation malocclusion affecting 8-22% of children [Harrison and Ashby 2000; Perillo et al., 2010]. This condition is characterised by an inverse relationship of the upper and lower buccal dental cusps and may involve one or several teeth [Daskalogiannakis 2002]. According to Planas [Planas, 1997] the crossbite side presents a greater number of occlusal contacts, because it is the preferred chewing side. However, this has not been confirmed elsewhere (Salioni et al., 2005; Alarcon et al., 2009]. The pathogenesis of this malocclusion is still unknown. It may srcinate from altered skeletal and/or dental growth that can induce mandibular displacement frequently associated with lower midline deviation. Surface electromyography is often used to study the pathogenesis of UPCB. Some studies have shown that UPCB was commonly related to asymmetric elevator muscle function [Ingervall and Carlsson 1982; Ferrario et al., 1999]. Moreover, asymmetric muscle function induced poor occlusal contacts and temporomandibular stress [Ciavarella et al., 2010]. Changes in masticatory cycles and reverse chewing cycles were also reported [Piancino et al., 2009].The aim of this study was to compare the electromyographic outcomes of patients with UPCB and those of healthy controls. Materials and methods Fifteen patients between the ages of 9-14 (mean 11.5 years, 9 girls and 6 boys) with UPCB and fifteen healthy controls between the ages of 9-14 (mean age 12 years, 7 girls and 8 boys) were selected and examined at the Department of Orthodontics, Second University of Naples, Italy. The participants and parents provided written informed consent to be involved in the study. Exclusion criteria included Class II and III malocclusions, open and deep-bite, oral or systemic diseases, previous orthodontic treatment. Four of the eight channels of a surface electromyograph recorder (sEMG, Biopack) were employed to record sEMG activity of anterior temporal (TA) and masseter (MM) muscles. This diagnostic test provided information on the functional status of the craniomandibular neuromuscular system and was useful in determining the proper cranio-mandibular relationship. To position the electrodes, subjects were requested to close their mouths and clench. To reduce electrode impedance, the skin was carefully cleaned prior to electrode positioning, and recordings were performed 5–6 min later, allowing the conductive paste to adequately moisten the skin surface.The analogue sEMG signal was amplified, digitised, and digitally filtered.The instrument was directly interfaced with a computer, which presented the data graphically.  CIAVARELLA D. ET AL. E UROPEAN  J OURNAL   OF  P AEDIATRIC  D ENTISTRY   VOL . 13/1-2012 26 The signals were averaged over 25 ms, with muscle activity of the four tested muscles espressed in microvolts (µV).Right and left muscle activity was monitored at rest and in maximum voluntary clench (MCV).The clench test was repeated three times to ascertain stability according to the protocol developed by Donaldson and Donaldson [1990].The percentage of muscle balancing, called percentage of torque (PT), was also calculated. Statistical analysis An intragroup comparison was made between the mean activation of left and right sides of temporals and masseters in the control group and cross and non cross side of the same muscles in the UPCB group. An intergroup comparison was performed by testing the mean activation of temporals and masseters of the UPCB group versus the control group at rest and during clenching (Tables 1 and 2).Data were evaluated on “graph pad program” TAB. 1   The sEMG evaluation of temporalis and masseters at rest and maximum volontary clench (MCV).TA: Temporal Anterior; MM: Masseter; UPCB: Unilateral Posterior CrossBite Group; HC: Healthy Control Group; SD: Standard Deviation; SE: Standard Error of the mean. ns: not significant - p < 0.05* FIG. 1   Mean activation of masticatory muscles and percentage of torque (PT) in Unilateral Posterior CrossBite (UPCB) patients and healthy controls (HC). GROUPS SIDEMEAN( µ V)SDSELOW. 95%UP. 95%P TA UPCB RESTCROSS2.92411.5310.44191.9513.897*NO CROSS1.9380.94470.27271.3382.539TA HC RESTR2.55551.5090.50311.3953.716nsL2.33331.4140.47141.2463.420MM UPCB RESTCROSS1.38750.51350.26841.0611.714nsNO CROSS1.8580.92980.26841.2682.449MM HC RESTR3.22222.2240.74121.5134.931nsL3.002.3450.78171.1974.803TA UPCB MCVCROSS104.542.2912.21177.624131.38nsNO CROSS93.2542.09312.15166.505119.99TA HC MCVR173.3438.89712.966143.45203.24nsL174.5143.77014.590140.80208.15MM UPCB MCVCROSS128.5883.80524.19375.336181.83nsNO CROSS107.0060.67017.51468.452145.55MM HC MCVR234.777741.24313.748203.08266.48nsL240.111150.31516.772201.44278.79  POSTERIOR CROSSBITE EVALUATION WITH SURFACE ELECTROMYOGRAPHY  E UROPEAN  J OURNAL   OF  P AEDIATRIC  D ENTISTRY   VOL . 13/1-2012 27 performing one-way ANOVA test. Statistical significance was set at 0.05. Results Results of the intragroup comparison (i.e., activation of temporals and masseters on both sides) in the UPCB and control group are shown in Table 1. The UPCB group showed statistically significant differences in anterior temporal rest test (p<0.05), whereas no statistically significant differences were observed in the control group. A different muscle activation between cross and non crossbite side was seen in the UPCB group. Temporals and masseters showed higher mean activation on the crossbite side. These findings were not statistically significant. No differences were seen in the control group. In the UPCB group, asymmetric activation in clench test generated 89.23% torque for temporals and 83.21% torque for masseters. The control group showed 99.32% torque for temporals and 97.77% torque for masseters (Fig. 1). Surface electromyography evaluation showed that the mean electric activity for masseter and temporal muscles at clench was lower in the UPCB group than in the control group (p<0.0001). Mean muscle activity at rest showed how the UPCB group presented lower activation of masseters than the control group (p<0.05). The temporal means for the UPCB and control at rest were not different (Table 2). Discussion The pathogenesis of UPCB is a matter of great interest for orthodontists and oral rehabilitators. It is well known that for an optimal muscle function, ideal occlusal contacts are necessary. Altered occlusal relationships have already been found to influence the coordination of the masticatory muscles during chewing in adolescents and young adult women [Deguchi et al., 1994; Deguchi et al., 1995]. Many authors have reported how patients with UPCB have an unbalanced masticatory muscle activation. Thus, it may influence mandibular position during clenching and at rest. Cooper and Rabuzzi suggested that unbalanced masticatory muscle EMG activity was not physiologic [Cooper and Rabuzzi, 1984]. Ferrario et al. showed that in healthy patients there was no difference between right and left side activation, whereas in unilateral posterior crossbites patients, the muscles appeared to contract with altered and asymmetric patterns [Ferrario et al., 1999]. UPCB is usually present at a young age suggesting that primary teeth occlusion starts the timing of oral development control (TMJ/muscle/occlusion). Normally young patients use both sides to chew on. Using just half of the oral system may trigger growth imbalance. With uneven chewing the masticatory muscles receive asymmetrical activation. Masticatory muscles on the working side become larger and stronger than those on the balanced side. All these alterations may cause change in primary and secondary occlusion, generating UPCB [Ciavarella et al., 2009]. Neurologic impulses are generated by the periodontal ligament (PDL), considered a periphereal oral receptor and may modulate muscle contraction. PDL is directly connected to the mesencephalic trigeminal nucleus [Lund, 1999; Yokomizo, 2005] and to the trigeminal motor neurons and interneurons [Yokomizo, 2005]. In this way all impulses starting from PDL may influence muscle contraction generating asymmetric activation and modification of the masticatory cycle.Piancino et al. showed how patients affected by UPCB often have reverse chewing cycles [Piancino et al., 2011]. Reverse chewing cycles are substantially TAB. 2   Mean activation of masticatory muscles (µV) at rest and maximum volontary clench (MCV).SE: Standard Error of the mean - CI: Confidence Interval p < 0.05* - p<0.0001** GROUPS SIDEMEAN( µ V)SEMEDIANMINMAX95% CIP Rest TA activationUPCB (Cross/Non Cross)2.4310. ns HC (R/L)2.4440.332. activationUPCB (Cross/Non Cross)1.6220. * HC (R/L)3.1110.522. MCV TA activationUPCB (Cross/Non Cross)98.8758.5963116981.27-116.47 ** HC (R/L)173.9259.46166.05135.8286.00153.95-193.91MM activationUPCB (Cross/Non Cross)117.7914.77102.0013.00242.0087.21-148.37 ** HC (R/L)237.4410.53236.50178322215.21-259.68  CIAVARELLA D. ET AL. E UROPEAN  J OURNAL   OF  P AEDIATRIC  D ENTISTRY   VOL . 13/1-2012 28 different from normal ones; reverse cycles are narrow, the closing trajectory is near the vertical line or it may be displaced on the opposite side of the bolus, and the opening and closing trajectories may cross each other [Throckmorton et al., 2001]. The outcomes of this paper showed that the unilateral posterior crossbites patients compared to the healthy controls had asymmetric activation of muscles with a lower percentage of torque at rest and a lower muscle activation at clench.These data were consistent with those found by other authors [Ingervall and Thilander 1975; Egermark-Eriksson et al., 1990] supporting the functional association between muscle activation and occlusal contact modifications. Many investigations compared the bite force in children with UPCB and control groups showing that the maximum bite forces and number of teeth in contact were significantly lower in children with UPCB when [Sonnesen et al., 2001; Rentes et al., 2002; Castelo et al., 2007; Sonnesen and Bakke 2007]. In patients with UPCB a greater but not significant (p < 0.05) TA and MM activation on the crossbite side was found but this finding was not in agreement with the literature. Many authors showed that, during maximum clenching, on the crossbite side, the masseter was less active whereas the anterior temporal showed a significantly higher EMG value than the same muscles on the non-cross bite side [Kecik et al., 2007; Andrade Ada et al., 2009]. Conclusion This study showed that patients with UPCB presented muscle weakness and an asymmetric activation at rest and clench with higher sEMG activity on the crossbite side. The findings suggested that asymmetric muscle activation may influence mandibular growth and tooth position in adolescents. However, more investigations to draw conclusions are needed. References › Alarcon JA, Martin C, Palma JC, Menendez-Nunez M. Activity of jaw muscles in unilateral cross-bite without mandibular shift. Arch Oral Biol 2009; 542: 108-14.› Andrade Ada, S., G. H. Gameiro, M. Derossi and M. B. Gaviao. Posterior crossbite and functional changes. A systematic review. Angle Orthod 2009; 792: 380-6.› Castelo, P. M., M. B. Gaviao, L. J. Pereira and L. R. Bonjardim. Masticatory muscle thickness, bite force, and occlusal contacts in young children with unilateral posterior crossbite. Eur J Orthod 2007; 292: 149-56.› Ciavarella D, Mastrovincenzo M, Sabatucci A, Campisi G, Di Cosola M, Suriano M, Lo Muzio L. [Primary and secondary prevention procedures of temporo-mandibular joint disease in the evolutive age]. Minerva Pediatr 2009; 611: 93-7.› Ciavarella D, Mastrovincenzo M, Sabatucci A, Parziale V, Granatelli F, Violante F, Bossu M, Lo Muzio L, Chimenti C. Clinical and computerized evaluation in study of temporo-mandibular joint intracapsular disease. Minerva Stomatol 2010; 593: 89-101.› Cooper BC, Rabuzzi DD. Myofascial pain dysfunction syndrome: a clinical study of asymptomatic subjects. Laryngoscope 1984; 94: 68-75.› Daskalogiannakis, J. Glossary of orthodontic terms. . Quintessence publishing group. 2002.› Deguchi T, Garetto LP, Sato Y, Potter RH, Roberts WE. Statistical analysis of differential lissajous EMG from normal occlusion and Class III malocclusion. Angle Orthod 1995; 652: 151-60.› Deguchi T, Kumai T, Garetto L. Statistics of differential Lissajous EMG for normal occlusion and Class II malocclusion. Am J Orthod Dentofacial Orthop 1994; 1051: 42-8.› Donaldson S, Donaldson M. Multi-channel EMG assesment and treatment techniques. In: Cram JR (ed). Clinical EMG for surface recordings. 2nd edn. Clinical Resources; Nevada City: 1990. 143-174.› Egermark-Eriksson I, Carlsson GE, Magnusson T, Thilander B. A longitudinal study on malocclusion in relation to signs and symptoms of cranio-mandibular disorders in children and adolescents. Eur J Orthod 1990; 124: 399-407.› Ferrario VF, Sforza C, Serrao G. The influence of crossbite on the coordinated electromyographic activity of human masticatory muscles during mastication. J Oral Rehabil 1999; 267: 575-81.› Harrison JE, Ashby D. Orthodontic treatment for posterior crossbites. Cochrane Database Syst Rev 2000; 2: CD000979.› Ingervall B, Carlsson GE. Masticatory muscle activity before and after elimination of balancing side occlusal interference. J Oral Rehabil 1982; 93: 183-92.› Ingervall B, Thilander B. Activity of temporalis and masseter muscles in children with a lateral forced bite. Angle Orthod 1975; 454: 249-58.› Kecik, D., I. Kocadereli and I. Saatci. Evaluation of the treatment changes of functional posterior crossbite in the mixed dentition. Am J Orthod Dentofacial Orthop 2007; 1312: 202-15.› Lund JP, Scott G, Kolta A, Westberg GR. Role of cortical inputs and brainstem interneuron populations in patterning mastication. In: Nakamura Y, Sessle GJ eds.: Neurobiology of mastication. From molecular to system approach. Tokyo: Elsevier Science; 1999. 504-514.› Perillo, L., C. Masucci, F. Ferro, D. Apicella and T. Baccetti. Prevalence of orthodontic treatment need in southern Italian schoolchildren. Eur J Orthod 2010; 321: 49-53.› Piancino MG, Comino E, Talpone F, Vallelonga T, Frongia G, Bracco P. Reverse-sequencing chewing patterns evaluation in anterior versus posterior unilateral crossbite patients. Eur J Orthod 2011 Sep 15. [Epub ahead of print].› Piancino MG, Farina D, Talpone F, Merlo A, Bracco P. Muscular activation during reverse and non-reverse chewing cycles in unilateral posterior crossbite. Eur J Oral Sci 2009; 1172: 122-8.› Planas P. Reabilitação Neuroclusal. 2nd Ed. Rio de Janeiro: Medsi; 1997. p.355.› Rentes, A. M., M. B. Gaviao and J. R. Amaral. Bite force determination in children with primary dentition. J Oral Rehabil 2002; 2912: 1174-80.› Salioni MA, Pellizoni SE, Guimaraes AS, Juliano Y, Alonso LG. Functional unilateral posterior crossbite effects on mastication movements using axiography. Angle Orthod 2005; 753: 362-7.› Sonnesen, L. and M. Bakke. Bite force in children with unilateral crossbite before and after orthodontic treatment. A prospective longitudinal study. Eur J Orthod 2007; 293: 310-3.› Sonnesen, L., M. Bakke and B. Solow. Bite force in pre-orthodontic children with unilateral crossbite. Eur J Orthod 2001; 236: 741-9.› Throckmorton GS, Buschang PH, Hayasaki H, Pinto AS. Changes in the masticatory cycle following treatment of posterior unilateral crossbite in children. Am J Orthod Dentofacial Orthop 2001; 1205: 521-9.› Yokomizo Y, Murai Y, Tanaka E, Inokichi H, Kusukawa J, Higashi H. Excitatory GABAergic synaptic potentials in the mesencephalic trigeminal nucleus of adult rat in vitro. Neurosci Res 2005; 51: 463-474.
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