Journal of Oral Rehabilitation 2005 32; 714719

The influence of altered occlusal guidance on condylar

displacement during submaximal clenching
N. OKANO, K. BABA & T. OHYAMA

Removable Prosthodontics, Tokyo Medical and Dental University, Tokyo, Japan

SUMMARY As cited in literatures, canine protected

occlusion has a potential to reduce clenching induced temporomandibular joint loadings. However,
these previous studies did not perform a control of
the clenching level which differed with the depending occlusal conditions. This result may be due
largely to an associated reduced jaw closing muscle
activity. The present study has investigated clenching induced condylar displacements with controlled
clenching level. Twenty healthy human subjects (15
males and five females with an average age of
265 years) volunteered to participate in this study.
Metallic occlusal overlays were fabricated for the
lower working side canine and overlaid to the
second molar and the non-working side second
molar in order to simulate a canine protected
occlusion, group function occlusion and bilateral
balanced occlusion. Electromyographic (EMG) activity from the bilateral masseter, anterior temporalis,
and posterior temporalis was recorded. These signals were rectified, summarized, and presented to
each subject using an oscilloscope screen. Using this
visual feedback, subjects were asked to perform

Introduction
During the lateral jaw movement, tooth contacts can
occur between opposing teeth on the working and
non-working sides. Although the role of the lateral
occlusal pattern has been considered to be not significant in development of dysfunctional signs and
symptoms of the masticatory system (15), it is
responsible for the distribution of force results from
unfavourable parafunctional activities such as grinding
or clenching (6).
2005 Blackwell Publishing Ltd

clenching tasks at a 50% level of maximal voluntary

contraction exerted with simulated group function
occlusion and three-dimensional condylar displacements were recorded. An experimental occlusal
pattern that shows statistically significant affects
on condylar displacements (ANOVA: P < 0001) was
found. When compared with the simulated canine
protected occlusion, the simulated group function
occlusion caused smaller working side condylar
displacement and the simulated bilateral balanced
occlusion caused significantly smaller non-working
side and working side condylar displacements.
These results suggest that the increased working
side tooth contacts have a potential to reduce
working side joint loadings, and a balancing side
contact has a potential to reduce non-working side
joint loadings, under the laboratory condition
where the clenching level is controlled.
KEYWORDS: balancing contact, canine protection,
clenching, condylar displacement, group function,
masticatory muscle, occlusal guidance
Accepted for publication 4 January 2005

Several studies have revealed that introduction of an

artificial canine guidance reduces the total muscle
activity during maximal voluntary contraction in the
lateral mandibular position (78). These studies suggested that the canine guidance has potential to reduce
muscle activity during parafunctional activities and
therefore reduces clenching induced non-working side
condylar elevations. Unfortunately, these studies only
reported that the clenching induced mandibular displacements, but did not evaluate the condylar displacements that could predict the nature of joint loadings.

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Recently, one study investigated the clenching induced
temporomandibular (TM) joint displacement during
maximum voluntary contraction (9). Unlike previous
studies, this study predicted that a significant elevation
of the non-working side condyle occurs when canine
guidance was simulated and bilateral tooth contacts
reduced the amplitude of mandibular displacements.
This finding was in agreement with a clinical observation by Minagi et al. (10), who suggested that the nonworking side contacts have a protective role for the
ipsilateral TM joint.
Although parafunctional activities such as sleep
bruxism events as strong as, or stronger than, the
maximal clenching level were recorded by means of
electromyographic (EMG), most of the events were
reported to occur at sub-maximal levels (11). Furthermore, the reduced EMG level measured when the
canine guidance was simulated was best explained
using the concentration of the occlusal force on a single
anterior tooth with a greater density of mechanoreceptors with low stimulus thresholds (12, 13). However,
Rugh et al. (14) reported no significant difference in the
EMG levels between simulated artificial canine guidance and working side molar guidance in sleeping
subjects, which suggested that the periodontal mechanoreceptors feedback did not seem to have an important role during sleeping.
For all these reasons, the aim of this study was to
investigate relationships between the altered occlusal
guidance and condylar displacements during controlled
sub-maximal clenching. The null hypothesis of this
study was the condylar displacements would not be
influenced by the change in the lateral occlusal pattern.

Simulation of occlusal conditions

Specially designed overlays were set onto lower dentition so that the lateral occlusal relationship was
changed experimentally. First, silicone impressions of
upper and lower full arches were made and an
occlusal registration was taken in the canine edge-toedge mandibular position for each subject. The master
casts were fabricated using dental stone and then
mounted on a rigid articulator (Gysi simplex
OU-TYPE)* using the occlusal registration. Individual
overlays were fabricated on the master cast for the
lower working side canine to second molar and the
non-working side second molar with gold-silver-palladium alloy. Each overlay had a dimple of approximately 1 mm diameter, which fitted to the opposing
cusp. Final adjustments were performed in the subjects mouth with the aid of thin articulating paper
until simultaneous teeth contacts were achieved
(Fig. 1). Therefore, original occlusal vertical dimension
in the lateral occlusal position was maintained when
these overlays were in place.
A combination of these overlays allowed the simulation of the four occlusal patterns (Fig. 2). (i) Group
function occlusion plus balancing contact (GF + BC):
canine to second molar contacts on the working side
and second molar balancing contact, (ii) GF: canine to
second molar contacts on the working side, (iii) semiGF: canine to second premolar contacts on the working
side derived from GF by cutting the molars and
(iv) canine protected occlusion (CP): canine contact
derived from semi-GF by cutting the premolars.

Mandibular displacement measurements

Materials and methods

Subjects
Twenty healthy adult subjects consisting of 15 males
and five females with a mean age of 265 years (
16)
gave informed consent and volunteered for this study.
All of the subjects were in good general health and had
intact bilateral occlusal contacts in the intercuspal
position and the cuspid protected occlusion in the
canine edge-to-edge lateral mandibular position determined by clinical examination. Any of the subjects with
a history of orofacial pain, TM disorders, and those
undergoing any kind of dental treatment were excluded
from this study.

Mandibular displacements were measured using the

Gnasthohexagraph system that is capable of recording
mandibular movements with 6 degrees of freedom at a
sampling frequency of 100 Hz. The system, using a
stereo image processing method, had two charge
coupled device (CCD) cameras attached to the head
frame and the mandibular face bow and detected the
positions of three light-emitting diodes (LEDs). The
head frame that was fastened to the head and mandibular face bow was attached to the labial surface of the
lower anterior dentition by a ready-made clutch. The
*Onuki Dental Co., Tokyo, Japan

Ono Sokki Co., Tokyo, Japan

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electrodes with an interelectrode distance of 15 mm.
In all subjects, electrode placement was chosen by
palpation of the muscles prior to the session. Skin
impedance was reduced with an alcohol scrub, and the
electrodes were placed parallel to the main direction of
muscle fibres. A ground electrode was attached to the
right ear-lobe.

Clenching level
Fig. 1. Schematic drawings of the overlays. (a) Sagittal view of
the working side canine overlay. Note that this overlay does not
exclude the contact between maxillary and mandibular canines.
(b) Frontal view of the working side premolar and molar overlays,
which contact buccal cusp of corresponding maxillary tooth.
(c) Frontal view of the balancing side second molar overlay, which
contacts the lingual cusp of corresponding maxillary tooth.

After filtering, which eliminated frequencies above

1 kHz and below 33 Hz, the sum of the fully rectified
signals from the six muscles was shown to each subject
on an oscilloscope screen. This visual feedback enabled
the subjects to control their clenching force level.
Subjects were asked to perform clenching tasks at the
50% level of maximal voluntary contraction with
simulated group function occlusion.

Experimental procedure
For each task, the subjects were initially instructed to
keep their mouths closed with their teeth in contact
and their jaw muscles relaxed for 3 s. They were then
asked to perform designated clenching efforts in the
canine edge-to-edge lateral occlusal position with the
overlays in place. Each clenching lasted for 5 s after a
signal was given. For each task, clenching was repeated
four times. Three minute resting periods were imposed
between each clenching with a 5-min rest interval
between tasks.
Fig. 2. The combination of overlays in four occlusal patterns.

Data analysis

measurement error for the mandibular movements was

<015 mm (15). The condylar measuring points, kinematic axis points on facial surface were chosen according to the method described by Yatabe et al. (16).

Electromyography measurements
Electromyography activities in the anterior temporalis
and the masseter were recorded bilaterally using
bipolar silver surface electrodes with a fixed interelectrode distance of 15 mm. The EMG activities in the
posterior temporalis were also recorded using needle

Unique Medical Co., Tokyo, Japan.

Using Gnasthohexagraph software, the positions of the

bilateral central condylar points, which were 25 mm
inside from afore-mentioned kinematic axis points,
were calculated and analysed. These were performed
on the three-dimensional coordinate system, which
was defined by Frankfort plane (xy plane) and the line
between bilateral superior borders of tragus (y-axis).
Therefore, the x-, y-, and z-axes represented the
anteriorposterior, lateral, and inferiorsuperior directions, respectively (Fig. 3). The signals recorded during
two 500 ms periods, which corresponded before and
during clenching, were selected manually and averaged. For each condyle, relative condylar position
during clenching in relation to the condylar position
before clenching was calculated three-dimensionally.

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CLENCHING INDUCED CONDYLAR DISPLACEMENTS

tests were conducted at the 5% level of significance as a
post hoc comparison.

Results

Fig. 3. Frankfort plane was selected as the horizontal reference

plane. x-axis: posterior to anterior direction; y-axis: from the
working side (W) to non-working side (NW) direction; z-axis:
inferior to superior direction.

The mean value of three-dimensional data of four

efforts was calculated for each task for both condyles.
The occlusal pattern was set as an independent variable
and one-way ANOVA was conducted on the length of the
displacement and the x-axis, y-axis, and z-axis components of the displacement. Tukeys multiple comparison

The mean values and s.d. of the displacement data of

the bilateral condyles under the four experimental
occlusal patterns are shown in Figs 47.
The bilateral condyles generally tended to move
anterosuperiorly, which was independent of the occlusal pattern. The results of one-way ANOVA indicate that
the occlusal pattern has a significant effect on the
lengths of the condylar displacement and anterior
posterior displacements of the working and the nonworking condyles (P < 0001, P < 001, P < 0001, and
P < 0001, respectively).
Regarding the displacement lengths, when compared with the simulated canine protected occlusion,
the simulated group function occlusion caused smaller
working side condylar displacement and the simulated
bilateral balanced occlusion caused significantly smaller non-working side and working side condylar
displacements. Similar trend was found for the anteriorposterior displacement of the bilateral condyles.
Additionally, the simulated semi-group function
occlusion also caused smaller working side anterior

Fig. 4. Comparison of the bilateral

condylar displacement lengths during clenching among the four patterns. Tukeys multiple comparison
test (n 20). ***P < 0.001;
**P < 0.01.

Fig. 5. Comparison of the x-axis components (anteriorposterior) of bilateral condylar displacement among
the four patterns. Positive value indicates anterior direction. Tukeys
multiple comparison test (n 20).
***P < 0.001; **P < 0.01.
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Fig. 6. Comparison of the y-axis

components (working to non-working direction) of bilateral condylar
displacement among the four patterns. Positive value indicates nonworking side direction.

Fig. 7. Comparison of the z-axis

components (inferiorsuperior) of
bilateral condylar displacement
among the four patterns. Positive
value indicates superior direction.

displacement than simulated canine protected occlusion.

Discussion
The results from the present experiment let us reject
null hypothesis that the condylar displacements
would not be influenced by the change in the lateral
occlusal pattern. Specifically, the increased working
side tooth contacts reduced the displacement of the
working side condyle, and the non-working side
contact further reduced those of the non-working side
condyle under the clenching level controlled condition. These findings are consistent with some previous
studies, which reported that clenching induced mandibular elevation at the non-working side molar, this
was the largest when canine protected occlusion was
simulated during controlled sub-maximum clenching
and that the introduction of the non-working side
contact reduced the amplitude of the ipsilateral molar
elevation. All these suggested less non-working side
joint loading (17, 18). Furthermore, the expected less
joint loading on the non-working side associated with
ipsilateral molar contacts supports a clinical finding by
Minagi, et al. (10), who discovered a significant
positive correlation between the absence of nonworking side contacts and an increasing prevalence

of joint sounds, and suggested that a non-working side

contact could play a protective role for the ipsilateral
TM joint.
The present study is contrasted with a previous study
(9), which asked the subjects to exert maximal contraction under each altered occlusal condition. Unlike
the present study results, the non-working side condylar displacements were reported to be the smallest
when the canine guidance was simulated. As canine
guidance occlusion has been reported to be associated
with the lower EMG activity (1821), this can be
explained by the difference in the clenching force level
exerted during each occlusal condition.
One limitation of this study was that our study was
conducted in conscious subjects, which did not allow us
to infer effects of the lateral occlusion on joint loadings
during sleep bruxism. As stated in the introduction
section, there is no evidence if clenching force is
dependent upon occlusal pattern during sleep. However, recent studies suggest the role of peripheral
sensory input, such as mechanoreceptors, as insignificant in the modulation of the muscle activity during
sleep (22). Another limitation was that the observed
maximal displacement of the condyle was as small as
06 mm, which is not believed to have a critical adverse
effects on the TMJ. The effect of the short-term occlusal
modification does not allow prediction of the long-term

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CLENCHING INDUCED CONDYLAR DISPLACEMENTS

treatment outcome in relation to occlusal relationships.
Nevertheless, within the above-mentioned limitations,
this study provides us with baseline data that should be
of value to better understand masticatory muscle
reaction and the nature of joint loadings in relation to
occlusal relationships.

11.
12.
13.
14.

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Correspondence: Dr Nobuhiko Okano, Removable Prosthodontics,

Department of Masticatory Function Rehabilitation, Division of Oral
Health Sciences, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo 113-8549, Japan.
E-mail: n.okano.rpro@tmd.ac.jp

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