Evolution of Chewing Force in Geriatric Edentulous Patients

Abstract

Objective The aim of this study was to assess the evolution of chewing force in edentulous geriatric patients rehabilitated with complete dentures. Chewing function is compromised in individuals who lose all their teeth, as well as in those with complete dentures. The maintenance and recovery of the chewing function in these patients require replacement of the lost natural teeth.

Materials and Methods In this study, the chewing force was evaluated by electromyographic analysis of the temporalis and masseter muscle endings in 120 patients with old and new bimaxillary complete dentures.

Results Replacement of complete dentures was shown to improve stability, retention, occlusion, and support of the prosthesis. All jaw movements were evaluated using electromyography to assess the evolution of chewing force with and without occlusal adjustment, identify premature contact points, identify occlusal interference, respect the balanced occlusal scheme, and assess the increase in muscle strength. This study found that muscle strength in patients with prosthesis without occlusal adjustment was 527.1 N but was higher for prostheses with occlusal adjustment at 614.7 N, and this strength of 614.7 N was maintained after 1 month of control.

Conclusion The chewing force evolved in patients with complete dentures, and an increase was observed when occlusal adjustment was performed.

Keywords

bite force - occlusal adjustment - electromyography - complete denture (MESH)

Introduction

Edentulous patients with complete dentures present functional limitations in the stomatognathic system, reduced masticatory performance, tooth loss, alveolar bone resorption, oral mucosa dystrophy, and atrophy of the muscle fibers causing neurotransmitter reduction compared with patients with natural teeth.[1] [2]

Chewing movements demonstrate decreased vertical development in geriatric patients wearing complete dentures compared with young patients. A factor causing mandibular crest resorption during function is ridge atrophy that could arise from compressive forces generated by dentures that exceed the physiological tolerance of the underlying bone.[3] [4]

This indicates that the replacement of complete dentures accompanied by occlusal adjustment can effectively correct the function of the stomatognathic apparatus, as well as of respiration, phonation, chewing, and swallowing. Appropriate occlusal guidance exhibits an optimal contact relationship between the upper and lower teeth and generates a force that is transmitted appropriately to the supporting tissues.[5] [6]

The optimal occlusal guidance in complete dentures is bilateral balanced occlusion. Unbalanced occlusal forces can lead to prosthetic instability, causing undesired movement of the prosthetic base and traumatizing the supporting structures.[7] [8]

Electromyography (EMG) gives us the possibility of exploring the neuromuscular system to evaluate the normal muscle function. Additionally, it can analyze any pathological conditions arising from said normality.[9]

EMG observation has indicated that in patients wearing conventional complete dentures, there is significant reduction in the power of the anterior temporalis and masseter muscles, which alters the masticatory functional capacity, compared with patients with complete natural dentition.[10] [11]

Thus, chewing efficiency is a parameter for quantifying the quality of mastication. It is defined as the number of chewing blows required to achieve a crushing level for a given aliment.[12]

Occlusal adjustment entails the evaluation of the relative bite forces by assessing relative occlusal forces, data recording, determining premature contacts, study and management of the occlusal balance in patients with natural teeth, and complete coronary or implant restorations in patients with complete dentures.

Therefore, this study aimed to assess the evolution of the masticatory force in rehabilitated geriatric patients with complete dentures.

Materials and Methods

This was an experimental, descriptive, observational, and quantitative study. The sample universe (n = 120) included completely edentulous patients with preexisting bimaxillary complete dentures, completely edentulous patients without dentures, and patients comfortable with their old dentures. The following four study groups were formed: control group (GC, n = 30), edentulous patients with old complete dentures; Group 1 (G1, n = 30), patients with immediate installation of complete dentures without occlusal adjustment; Group 2 (G2, n = 30), patients with immediate installation of complete dentures with occlusal adjustment; and Group 3 (G3, n = 30), patients with complete dentures with occlusal adjustment after 1 month of installation ([Fig. 1]).

Fig. 1 Flow diagram of the study.

Methods

This study was conducted at the Dental Care Center of the Universidad de las Americas (UDLA) and approved by the Bioethics Committee (CEISHSOLCAQ.OBS.19.124). The medical history was recorded for all patients. If patients expressed interest in being a part of the study, they were requested to read, accept, and sign the informed consent form.

The enrolled patients were asked to sit in front of the table where the EMG was placed at a 90-degree angle with the gaze straight ahead. New complete dentures were installed without occlusal adjustment, and we waited for 10 minutes. A gel was used for the echo with the electrodes, as a means of conduction of the muscular electrical signals to the EMG. The electrodes were placed on the anterior temporalis and superficial masseter muscles. We placed a piece of chewing gum without sucrose bilaterally at the level of the first molars, and the patient was asked to bite four times with pauses of 4 seconds. A software with a green light indicator indicated if the bite was unilateral or bilateral for each contraction. The values sent by the electrodes to the EMG were evaluated by software via Bluetooth. The electrodes were removed, and the data were stored in the EMG program. Data were evaluated and expressed in histograms in the EMG software installed on the computer. For the new complete dentures, the occlusal adjustment was performed using Accufilm II 80 µm articulating paper positioned bilaterally in the patient's mouth, to ensure that the patient performed opening, closing, lateral, protrusive, and retrusive movements, and the same procedure indicated previously was repeated.

Results

The results obtained in relation to muscle strength and chewing action, with and without occlusal adjustment, were analyzed descriptively as a prevalence variable. The concordance between total fit and nonocclusal fit prosthetics was analyzed using EMG electrodes ([Table 1]).

Table 1 Comparison between the muscle contraction forces in the four groups

Old complete denture				New complete denture without occlusal adjustment
Contraction[a]	N[b]	Media (N)[c]	Of (N)[d]	Contraction[a]	N[b]	Media (N)[c]	Of (N)[d]
Contraction 1	30	372.4	59.5	Contraction 1	30	533.8	89.3
Contraction 2	30	372.4	59.6	Contraction 2	30	533.8	89.1
Contraction 3	30	372.3	59.4	Contraction 3	30	527.1	88
Contraction 4	30	372.4	59.6	Contraction 4	30	527.7	88
New complete denture installed with occlusal adjustment				Complete dentures with occlusal adjustment after 1 month of installation
Contraction[a]	N[b]	Media (N)[c]	Of (N)[d]	Contraction[a]	N[b]	Media (N)[c]	Of (N)[d]
Contraction 1	30	614.1	42.2	Contraction 1	30	614.2	42.2
Contraction 2	30	614.2	42.2	Contraction 2	30	614.3	42.2
Contraction 3	30	614.3	42.5	Contraction 3	30	614.3	42.4
Contraction 4	30	614.7	42.2	Contraction 4	30	614.7	42.2

^a Contraction muscle.

^b N: Newton.

^c p < 0.05; Kruskal–Wallis H test.

^d p < 0.05; analysis of variance test.

Patients with old prostheses obtained constant lower values during the four contractions with a mean of 372.4 N, but the values were higher for the prosthesis installed without occlusal adjustment. For the prosthesis installed with occlusal adjustment, greater muscle strength was achieved, with no variation of forces observed after 1 month of control ([Table 1]).

The muscular assessment of the right masseter muscle showed that it exerted lesser force as compared with the left masseter, in case of old prostheses. When the prosthesis was installed without occlusal adjustment, both sides showed similar forces. In dentures with occlusal adjustment, a force of 614.2 N was observed on the right side, compared with 614.3 N on the left side. After 1 month of control, the muscle strength was maintained on both sides ([Table 2]).

Table 2 Comparison between the right and left masseter muscles

Right masseter describes 95% confidence interval for the mean
Patients[a]	N[b]	Media (N)[c]	Of (N)[d]	Lower limit[e]	Upper limit	Minimum[f]	Maximum
Old complete denture	30	372.3	59.5	350.1	394.6	299.1	478.8
Complete denture immediate installation without occlusal adjustment	30	533.8	89.4	500.5	567.2	350.6	681.7
Complete denture immediate installation with occlusal adjustment	30	614.2	42.3	598.4	630	538.3	703.5
Complete dentures 1 month after control	30	614.2	42.3	598.4	630	538.3	703.5
Total	120	533.6	116.2	512.6	554.7	299.1	703.5
Left masseter describes 95% confidence interval for the mean
Patients[a]	N[b]	Media (N)[c]	Of (N)[d]	Lower limit[e]	Upper limit	Minimum[f]	Maximum
Old complete denture	30	372.6	59.6	350.3	394.8	299.1	478.4
Complete denture immediate installation without occlusal adjustment	30	533.8	89.1	500.5	567	349.8	681
Complete denture immediate installation with occlusal adjustment	30	614.3	42.3	598.5	630.1	538.9	701.2
Complete dentures 1 month after control	30	614.3	42.2	598.5	630	538.3	703.5
Total	120	533.7	116.1	512.7	554.7	299.1	701.2

^a Subject of the study.

^b N: Newton.

^c Standard deviation.

^d Error rate.

^e p < 0.05; Kruskal–Wallis H test.

^f p < 0.05; analysis of variance test.

The right temporalis muscle with old prosthesis presented a lower force than the left temporalis, 394.6 N. In the prosthesis installed without occlusal adjustment, 560 N, there was an increase to 630.3 N on the left side compared with the right side. In dentures with occlusal adjustment, the forces were maintained 1 month after installation, 630.2 N ([Table 3]).

Table 3 Comparison between the right and left temporalis muscles

Right temporalis describes 95% confidence interval for the mean
Patients[a]	N[b]	Media (N)[c]	Of (N)[d]	Lower limit[e]	Upper limit	Minimum[f]	Maximum
Old complete denture	30	372.4	59.4	350.2	394.6	299	478.2
Complete denture immediate installation without occlusal adjustment	30	527.1	88	494.2	560	350.3	681.3
Complete denture immediate installation with occlusal adjustment	30	614.4	42.5	598.6	630.3	539	700.9
Complete dentures 1 month after control	30	614.4	42.3	598.6	630.2	539	700.9
Total	120	532.1	116.1	511.1	553.1	299	700.9
Left temporalis describes 95% confidence interval for the mean
Patients[a]	N[b]	Media (N)[c]	Of (N)[d]	Lower limit[e]	Upper limit	Minimum[f]	Maximum
Old complete denture	30	372.7	59.4	350.5	394.8	299.3	478.9
Complete denture immediate installation without occlusal adjustment	30	527.8	87.9	495	560.6	350	682.1
Complete denture immediate installation with occlusal adjustment	30	614.3	42.3	598.5	630.1	538.9	701.2
Complete dentures 1 month after control	30	614.9	42.2	599.1	630.6	540	702.1
Total	120	532.5	116.1	511.6	553.5	299.3	702.1

^a Subject of the study.

^b N: Newton.

^c Standard deviation.

^d Error rate.

^e p < 0.05; Kruskal–Wallis H test.

^f p < 0.05; analysis of variance test.

Discussion

When an older adult presents edentulism, masticatory performance, phonation, self-esteem, and aesthetics are affected; with the use of total prostheses to replace the lost teeth, it is intended to improve their lifestyle.[13] Automated and computerized methods used allow the visualization of neuromuscular adaptability in an objective way. Surface EMG during isometric contraction of the mandibular elevator muscles and recording of bite force have good reproducibility in clinical use.[14]

The EMG activity in the temporal muscles (bilateral chewing force)[15] with old total prostheses generated 372.7 N of strength; with new prostheses installed in the mouth, it increased to 527.8 N of strength; and with the respective occlusal adjustment, it increased to the month of control, 614.9 N of force.[4]

Alfaro et al showed that relative masticatory muscle activity is 2.57 times higher in patients carrying total prostheses than in toothed ones; the duration of the masticatory sequence was increased with the crushing force of food.[16] The study showed significant changes mainly in EMG silence, both in its duration and in the percentage of inhibition. When comparing the muscular forces in masseters (right and left) in new prostheses without occlusal adjustment, 533.8 N of force was obtained, increasing with occlusal adjustment to 614.2 N, a value that was maintained a month after installation. Herrero et al[17] demonstrated, during the maximum bilateral muscle contraction of the masseter, that the differences between old and new prostheses are significant, greater strength in prostheses new results coincident with the study.[17]

In the present study, the analysis of the muscular activity of the right masseter muscle showed lower values with old complete dentures (372.3 N). The value was 533.8 N for complete dentures installed without occlusal adjustment, while dentures installed with occlusal adjustment showed an increased strength with a value of 614.2 N. One month after the complete denture installation, the value of 614.2 N was still maintained, thus showing that there is no difference in forces between complete denture with occlusal adjustment and control. The changes in the masticatory function of the complete denture were examined with respect to any adverse effects on the muscles.

The complete denture with occlusal adjustment showed a force of 614.3 N for the left masseter. One month after installation, it still presented a force of 614.3 N, indicating that there was no variation in the force. However, with complete dentures installed without occlusal adjustment and old complete dentures, the values were lower at 533.8 N and 372.6 N, respectively.[18]

Regarding the right temporalis muscle, the values were lower with old complete dentures with a muscle force of 372.4 N. For complete dentures installed without occlusal adjustment, a force of 527.1 N was demonstrated, whereas the complete dentures installed with occlusal adjustment showed a force of 614.4 N that was significantly higher. After 1 month of control after installation, the force was maintained at 614.4 N.

The left temporalis muscle of the old complete dentures showed a slight increase compared with the right temporal muscle with a force of 372.7 N. For complete dentures without occlusal adjustment, a lower force of 527.8 N as compared with complete dentures with occlusal adjustment showing a force of 614.9 N was observed. After 1 month of complete denture control, the force of 614.9 N was maintained.[19]

Peeran et al mention that during the maximum voluntary contraction of the masseter muscle, the force was 231.93 N on the right side and 230.60 N on the left side with old complete dentures and 163.13 N on the right side and 171.73 N on the left side with new complete dentures after 5 months of follow-up.[20] [21] The difference between the old and new complete dentures with respect to the activity of the masseter muscle on the right and left sides was 68.8 N and 58.8 N, respectively. Hence, it was inferred from these values that the right-side masseter muscle was more efficient than the left. Statistical analysis revealed a highly significant increase in muscle efficiency (p = 0.000, p = 0.002) in participants with the new complete denture after 5 months of follow-up compared with that in participants with a previous complete denture during maximum voluntary contraction.[22]

Fernández et al pointed out in their study with EMG that the temporalis and masseter muscles showed a decrease with increasing vertical dimension and change in the mandibular angle, giving it better coefficients of inclination. This was commonly observed in men, and greater mandibular angle was associated with lower EMG activity in overdenture implants.[20] Chewing strength was statistically assessed using the t-test, and the mean bite strength of patients wearing implant-retained overdentures was found to be more than double than that of patients wearing conventional complete dentures.[23]

There were significant differences determined in the study. During the first contraction with an installed complete denture with occlusal adjustment, an average force of 614.1 N was observed, which was maintained even after 1 month of control. The complete dentures installed without occlusal adjustment presented lower average force of 533.8 N, while the old complete dentures presented the lowest value of 372.4 N. There were no significant differences in the chewing efficiency, and similar results to this study were observed even after 1 year of follow-up. Considering the quality criteria of the complete denture, no improvement in the stability of the mandibular complete dentures was observed with the new dentures (p = 0.157), and only small changes were observed between the preexisting and new complete dentures. Therefore, this limitation probably influenced the chewing efficiency.[24] [25]

The present study determined that the mean force of the muscle during the four contractions in the old complete denture wearers was 372.4 N, which differed significantly from the results of the previous study.[24] [25] The bite force in users with a conventional complete denture was 128.5 N. The force value of the conventional complete denture wearers also differed from those with implant overdentures by 63.1 N, which may be justified because the evaluation method recorded the bite force values unilaterally. Closer results were obtained at 182.9 N, as the evaluation was performed with the bite bilateral force transducer, similarly to the present study. The evaluation of this study assessing the muscle strength of patients with complete dentures without occlusal adjustment showed a value of 527.1 N, which increased by performing the occlusal adjustment to 614.7 N in patients with complete dentures with occlusal adjustment. Moreover, the force was maintained at 614.7 N after 1 month of control.

Poli et al determined that the masticatory bite force is higher in men than in women, both in older adult patients with complete natural dentition, rehabilitated patients with conventional complete dentures, overdentures, and total edentulous ones, regardless of the presence or absence of teeth. In patients with complete denture or overdentures, there are no differences between men and women; prostheses improve compared with edentulous patients, considering it higher with overdentures prostheses; the subjects' chewing force in complete natural dentition is even higher; there are no differences between the chewing forces based on various body mass index categories. Older people who use prosthetics require special attention from a nutritionist to avoid the risk of malnutrition.[26]

Ruttitivapanich et al determined the bite force in the maximum intercuspation position between patients observing subjectivity. When measuring, they indicated the patient to bite on the right or left side or on both, and asked the same to indicate where he feels that bite more. That is why advanced systems such as the T-scan III were used; it coincides with the subjective management in the study at the moment of determining the chewing force in geriatric patients with their old and new prostheses. When placing the gum, we do not assess the real force—on the right, left, and both sides—we only receive what the patient expresses to us. The use of articulating paper does not determine chewing force; it only discovers the point of contact in the prostheses.[27] [28]

In the group with conventional complete dentures, the difference between the initial total score and total score after 3 months was not significant (p = 0.117), except in the pain subscale, which showed an improvement over time (p = 0.003). All other subscale scores were not significantly different. A significant difference in chewing efficiency was found between before and after rehabilitation with implant overdentures (p < 0.001). For the conventional complete denture group, no significant differences were observed after 3 months (p = 0.889).[29] [30]

The impact of oral health on the quality of life was significantly lesser in the implant overdenture group than in the conventional complete denture group (p = 0.001). Chewing efficacy significantly correlated with the implant overdenture results in the conventional complete denture group (p > 0.05). However, no correlation was found in the implant overdenture group (p < 0.05).[31] [32] [33]

The aging factor could be related to the reduced values of bite force in conventional complete denture users.[34] [35] Decrease in the mass and force observed in the aging process is due to the nutritional decrease and consequent reduction in protein synthesis.[36] [37]

The possibility of increasing the bite force and, consequently, the chewing function for patients with conventional complete denture can be considered with implant rehabilitation.[30] The use of implant-retained overdentures increases the chewing force from 43 to 53% compared with a conventional denture.[38] Analysis of the EMG activity of the right and left temporalis muscles in previous studies showed that they were more active than the masseter muscles. The temporalis muscle is one of the main active muscles involved in maintaining the mandibular posture.[39] [40]

Conclusions

The chewing force evolved in patients with complete dentures, and an increase was observed when occlusal adjustment was performed. The study was done to measure the limitation of masticatory forces with only the EMG; nonetheless the relative occlusal force was not measured with other devices (T-scan) even though it is recommended for studies in the future to consider this variant to conclude with the effectiveness of the occlusal scheme used.

Conflict of Interest

The authors have explicitly stated that there are no conflicts of interest in connection with this article. The authors also received no support or funding for this report.

Acknowledgment

The authors would like to express their special thanks to Universidad de Las Américas.

Authors' Contribution

Byron Velásquez-Ron was involved in preparation of paper, review, and recollection of information in the Prosthesis Department postgraduate unit of Oral Rehabilitation UDLA.

María Galárraga-Criollo was involved in preparation of paper, review, and recollection of information in the Prosthesis Department postgraduate unit of Oral Rehabilitation UDLA.

María Romero-Guerrero was involved in preparation of paper, review, and recollection of information in the Prosthesis Department postgraduate unit of Oral Rehabilitation UDLA.

Maria Rodriguez-Tates was involved in correction of the paper in the Prosthesis Department postgraduate unit of Oral Rehabilitation UDLA.

Flavio Pineda-Lopez was involved in maintenance and calibration of EMG used in the study; review of date found.

• References

• 1 AlZarea BK. Dental prosthetic status and prosthetic needs of geriatric patients attending the College of Dentistry, Al Jouf University, Kingdom of Saudi Arabia. Eur J Dent 2017; 11 (04) 526-530
• 2 Zhao K, Mai QQ, Wang XD, Yang W, Zhao L. Occlusal designs on masticatory ability and patient satisfaction with complete denture: a systematic review. J Dent 2013; 41 (11) 1036-1042
• 3 Tôrres ACSP, Maciel AQ, de Farias DB, de Medeiros AKB, Vieira FPTV, Carreiro ADFP. Technical quality of complete dentures: influence on masticatory efficiency and quality of life. J Prosthodont 2019; 28 (01) e21-e26
• 4 Watanabe A, Shiga H, Kobayashi Y. Occlusal contacting condition and masticatory function of 2 types of pattern that differ in the closing path of the mandibular incisal point during chewing. J Prosthodont Res 2011; 55 (04) 243-247
• 5 Hazari P, Bhoyar A, Mishra SK, Yadav NS, Mahajan H. A comparison of masticatory performance and efficiency of complete dentures made with high impact and flexible resins: a pilot study. J Clin Diagn Res 2015; 9 (06) ZC29-ZC34
• 6 von der Gracht I, Derks A, Haselhuhn K, Wolfart S. EMG correlations of edentulous patients with implant overdentures and fixed dental prostheses compared to conventional complete dentures and dentates: a systematic review and meta-analysis. Clin Oral Implants Res 2017; 28 (07) 765-773
• 7 Pekiner F, Gumru B, Borahan MO, Aytugar E. Evaluation of demands and needs for dental care in a sample of the Turkish population. Eur J Dent 2010; 4 (02) 143-149
• 8 Sevilha F, de Barros T, Campolongo G, de Barros T, Alves N, Deana N. Electromyographic study of the masseter muscle after low-level laser therapy in patients undergoing extraction of retained lower third molars. Int J Odontostomatol 2016; 10 (01) 107-111
• 9 Żmudzki J, Chladek G, Kasperski J. Biomechanical factors related to occlusal load transfer in removable complete dentures. Biomech Model Mechanobiol 2015; 14 (04) 679-691
• 10 Takayama Y, Yamada T, Araki O, Seki T, Kawasaki T. The dynamic behaviour of a lower complete denture during unilateral loads: analysis using the finite element method. J Oral Rehabil 2001; 28 (11) 1064-1074
• 11 Sinnurkar S, Shakh A, Nadiger R. Analysis of changes in bilateral masseter and anterior temporalis muscle efficiency in complete denture wearers: an EMG study. Int J Adv Res (Indore) 2017; 5: 2672-2683
• 12 Sharma AJ, Nagrath R, Lahori M. A comparative evaluation of chewing efficiency, masticatory bite force, and patient satisfaction between conventional denture and implant-supported mandibular overdenture: an in vivo study. J Indian Prosthodont Soc 2017; 17 (04) 361-372
• 13 Farias-Neto A, Carreiro AdaF. Changes in patient satisfaction and masticatory efficiency during adaptation to new dentures. Compend Contin Educ Dent 2015; 36 (03) 174-177 , quiz 178, 190
• 14 Żmudzki J, Chladek G, Kasperski J. Biomechanical factors related to occlusal load transfer in removable complete dentures. Biomech Model Mechanobiol 2015; 14 (04) 679-691
• 15 Cardoso RG, Melo LA, Barbosa GA. et al. Impact of mandibular conventional denture and overdenture on quality of life and masticatory efficiency. Braz Oral Res 2016; 30 (01) e102
• 16 Alfaro P, Angeles F, Osorno M, Nuñez J, Romero G. Bite force: its importance in chewing, its measurement and its clinical determinants. Part II. Rev ADM 2012; 69 (03) 108-113
• 17 Herrero Babiloni A, Lavigne GJ. Sleep bruxism: a bridge between dental and sleep medicine. J Clin Sleep Med 2018; 14 (08) 1281-1283
• 18 Fernández L, Zanotta G, Kreiner M. A comparative study of the post-stimulus electromyographic complex in edentulous patients who underwent conventional vs. Piezo graphic rehabilitation. Odontoestomatologia 2010; 12 (14) 45-53
• 19 Goiato MC, Garcia AR, dos Santos DM. Electromyographic evaluation of masseter and anterior temporalis muscles in resting position and during maximum tooth clenching of edentulous patients before and after new complete dentures. Acta Odontol Latinoam 2007; 20 (02) 67-72
• 20 Peeran SA, Al SanabaniF, Al-Makramani BMA, Elamin EI. Dental prosthetic status and treatment needs of adult population in Jizan, Saudi Arabia: a survey report. Eur J Dent 2016; 10 (04) 45-63
• 21 Gomes I, Gomes L, Galera da Silva E, Oliveira J, Schmitt G, Pagani C. Masticatory force and electromyographic activity of the mandibular elevator's muscles in different rehabilitation treatments. Braz Dent Sci 2019;22(03): https://doi.org/10.14295/bds.2019.v22i3.1759
• 22 Hafezeqoran A, Koodaryan R, Noorazar SG, Hajialilue-Bonab M, Hassanzadeh M, Yasamineh N. Evaluation of strain in mandibular denture-supporting area in three different occlusal schemes during jaw movements. J Dent Res Dent Clin Dent Prospect 2018; 12 (01) 18-25
• 23 Pan S, Awad M, Thomason JM. et al. Sex differences in denture satisfaction. J Dent 2008; 36 (05) 301-308
• 24 Kohyama K, Mioche L, Bourdiol P. Influence of age and dental status on chewing behaviour studied by EMG recordings during consumption of various food samples. Gerodontology 2003; 20 (01) 15-23
• 25 Kato T, Toyota R, Haraki S. et al. Comparison of rhythmic masticatory muscle activity during non-rapid eye movement sleep in guinea pigs and humans. J Sleep Res 2018; 27 (04) e12608
• 26 Poli O, Manzon L, Niglio T, Ettorre E, Vozza I. Masticatory force in relation with age in subjects with full permanent dentition: a cross-sectional study. Healthcare (Basel) 2021; 9 (06) 700
• 27 Ruttitivapanich N, Tansalarak R, Palasuk J, Pumklin J. Correlation of bite force interpretation in maximal intercuspal position among patient, clinician, and T-scan III system. Eur J Dent 2019; 13 (03) 330-334
• 28 Nicolas E, Veyrune JL, Lassauzay C, Peyron MA, Hennequin M. Validation of video versus electromyography for chewing evaluation of the elderly wearing a complete denture. J Oral Rehabil 2007; 34 (08) 566-571
• 29 Paschetta C, González J. Bite force estimates and its relationship with the characteristics of the diet. Rev Argent Antropol Biol 2014; 16 (01) 39-50
• 30 Dalaie K, Behnaz M, Khodabakhshi Z, Hosseinpour S. Impact of malocclusion severity on oral health-related quality of life in an Iranian young adult population. Eur J Dent 2018; 12 (01) 129-135
• 31 Ribeiro JA, de Resende CM, Lopes AL. et al. Evaluation of complete denture quality and masticatory efficiency in denture wearers. Int J Prosthodont 2012; 25 (06) 625-630
• 32 Manfredini D, Lombardo L, Visentin A, Arreghini A, Siciliani G. Correlation between sleep-time masseter muscle activity and tooth wear: an electromyographic study. J Oral Facial Pain Headache 2019; 33 (02) 199-204
• 33 Loyola BM, Nascimento GC, Fernández RA. et al. Chronic stress effects in contralateral medial pterygoid muscle of rats with occlusion alteration. Physiol Behav 2016; 164 (Pt A): 369-375
• 34 Fiorin R, Franco A, de Souza M, Fontenele D, Luviseti I, Kalinowski H. Case study for monitoring the rhythmic masticatory muscle activity during sleep bruxism episodes by using fiber Bragg gratings. J Lightwave Technol 2019; 37 (18) 4823-4829
• 35 Zhang LD, Liu Q, Zou DR, Yu LF. Occlusal force characteristics of masseteric muscles after intramuscular injection of botulinum toxin A (BTX-A) for treatment of temporomandibular disorder. Br J Oral Maxillofac Surg 2016; 54 (07) 736-740
• 36 Santana-Mora U, López-Ratón M, Mora MJ, Cadarso-Suárez C, López-Cedrún J, Santana-Penín U. Surface raw electromyography has a moderate discriminatory capacity for differentiating between healthy individuals and those with TMD: a diagnostic study. J Electromyogr Kinesiol 2014; 24 (03) 332-340
• 37 Sato M, Iizuka T, Watanabe A. et al. Electromyogram biofeedback training for daytime clenching and its effect on sleep bruxism. J Oral Rehabil 2015; 42 (02) 83-89
• 38 Matsuda S, Yamaguchi T, Mikami S, Okada K, Gotouda A, Sano K. Rhythm and amplitude of rhythmic masticatory muscle activity during sleep in bruxers - comparison with gum chewing. Cranio 2016; 34 (04) 234-241
• 39 Barbosa MA, Tahara AK, Ferreira IC, Intelangelo L, Barbosa AC. Effects of 8 weeks of masticatory muscles focused endurance exercises on women with oro-facial pain and temporomandibular disorders: a placebo randomised controlled trial. J Oral Rehabil 2019; 46 (10) 885-894
• 40 Dzalaeva F, Chikunov S, Bykova M, Deev M, Okromelidze M. Study of the clinical efficiency of an interdisciplinary approach to the treatment of orofacial pain and temporomandibular joint disorders in patients with complete or partial edentulism. Eur J Dent 2020; 14 (04) 657-664

Publication History

Article published online:
27 December 2021