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by Clayton A. Chan, DDS
Director, Occlusion  Connections™, Las Vegas, NV

The dental profession demands scientific and proven answers, yet many are unwilling to discipline themselves in the understanding and skills required to keep pace with the objective science and principles of occlusal truths.   Today, electromyographic technology is being used to help dentist adjust their patient’s bites (occlusion) at a more detailed level than previously recognized by classic voluntary tap tap, grind grind on the teeth methods.

Dentist are being trained to recognize the differences between adjusting their patients bites using “voluntary muscle closure and occlusal marking paper” verses “involuntary muscle closure into occlusal marking paper” using the J5 Myomonitor TENS.  The basis of neuromuscular occlusion is to eliminate spastic and imbalanced muscle responses along a neuromuscular trajectory (jaw closure path) that are often triggered by micro occlusal premature interferences that can only be identified with involuntary Myomonitor TENS.  The occlusal marks the neuromuscular clinician is attempting to identify go beyond classical tapping of the teeth together on blue marking paper to identify the occlusal  prematuries.  The neuromuscular dentist wants to identify what is unseen (mandibular torque) which is one of the hidden and underlying problems our dental profession overlooks.  This leads to tremendous misunderstanding of the patient’s complaints and leaves the dentist bewildered as to what occlusal marks he/she observed in the patients mouth and the re-occuring complaint from the patient that something is still wrong.

1. Establish Myocentric First – Positioning the mandible to establish freedom of entry and exit to a physiologic (terminal) contact using J5 Myomonitor TENS.
2. Establish Physiologic Mandibular Function – Optimize jaw function and stability along the myo-trajectory.
3. Refine Anatomical Form of the Incline Planes – Eliminate any lateral excursive interferences (cuspid rise/posterior disclusion), Balance the protrusive (anterior incisors) and Balance the retrusive (posterior bicuspids and molars).

Scan 12 is an electromyographical display of muscle activity displaying mandibular torque,to assist the clinician to identify diagnostically initial deflecting contacts that cannot be seen with classical occlusal techniques using  articulating paper techniques during voluntary closure.   

Scan 12 monitors early motor unit recruitment as the patient closes from rest position through freeway space to initial tooth contact.  The Visual Analysis option and referencing the first muscle firing with the high/low chart allows the clinician to use the high low chart to interpret the first tooth contact muscle recruitment pattern. 

Imbalanced Occlusion

 The following picture shows red occlusal marks of a lower removable orthotic during the adjustment phase using Scan 12 EMG early or late muscle recruitment patterns that can be correlated with imbalanced muscle responses of the  both the left and right temporalis anterior and left massetter muscles.  Timing of muscle response at terminal contact is measured objectively within 10-13 microns at a 5.5 mV accuracy.

Example of HIGH, HIGH, HIGH, LOW or (Early, Early, Early, Late muscle response of the left temporalis (LTA), right temporalis anterior muscles (RTA), the left massetter (LMM) and right massetter muscles (RMM) respectively close into first tooth contact of the orthotic.

Right Second Bicuspid Area on the HIGH LOW CHART is identified (HIGH, HIGH, HIGH, LOW) and corresponds to the EMG muscles firing recrutiment timing responses that display occlusal patterns that reference to specific areas of occlusal prematurities at an accuracy of 5.5 mV microvolts.

Note: These precise 5.5 mV EMG occlusal patterns are identified only after the voluntary mandible’s closure pattern synchronized with its involuntary closure pattern (CO=NM) using involuntary low frequency (less than 1 Hz) TENS stimulation.    

Balanced Occlusion

After further occclusal refinement using Myotronics K7′s Scan 12 EMG first tooth test shows a balanced muscle occlusal pattern.

Example of HIGH, HIGH, HIGH, HIGH

Note: The red occlusal marks indicate a balanced occlusal on the lower orthotic after using the Myotronics K7 Scan 12 First Tooth Contact EMG processed mode) to identify the occlusal prematurities. The marks were not determined with voluntary muscle jaw closure, but rather with involuntary muscle stimulus using the J5 Myomomonitor TENS. Low frequency TENS involuntary muscle stimulus is specifically used to remove any proprioceptive and aberrant jaw closure patterns that would be triggered with hypertonic muscles during voluntary jaw closure. Using spastic muscles to refine an occlusion with voluntary closure without removing jaw torque can explain why a patient can appear to have a perfectly refined occlusion (voluntary closure marks), yet still persist with masticatory pain, grinding and clenching responses after occlusal adjustment.

Accufilm (Parkell) articulating  paper shows involuntary occlusal marks with the Myomonitor TENS and voluntary occlusal marks that are now synchronized to an optimized neuromuscular trajectory free of mandibular torques.  Jaw tracking with involuntary TENS and voluntary closure to CO can validate these occlusal  concepts are refined and scientifically determined.