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Number 3 March 1978

Ill Prosthodontics Report 1601 Page 7

Original article:

The Myo-monitor: Its use and abuse (II)
Bernard Jankelson, D.M.D., F.I.C.D., F.A.C.P., F.A.G.D. (Hon)
Diplomate American Board of Prosthodontists
John C. Radke, B.M., Research Director
Address: 1451 Medical Dental Building, Seattle, Washington 98101

In the previous issue (Part I) the Myo- It is perhaps to be expected that with
monitor® was described as a neuro- a background of half a century of in-
muscular stimulator^-^,,3 that is used in doctrination with the conventional
dentistry to relax the muscles of mas- gnathological condylar procedures,
tication. It is subsequently used to ac- researchers would use these same meth-
complish a variety of clinical purposes ods to measure and evaluate neuro-
to record a neuromuscular occlusal muscular occlusion. A review of the
position, to obtain a functional occlusal literature shows that this has indeed
diagnosis, to obtain border molded occurred. A description of some of the
denture impressions, to precisely iden- mechanical, technical, and conceptual
tify functional prematurities (coron- inconsistencies should be of help in
plasty), and to provide for the diagnosis avoiding these abuses in the future.
and more successful treatment of Some examples of things to avoid are
T.M.J.-M.P.D. dysfunction syndrome'. given below:
To successfully bring the benefits of 1. Introduction of mechanical devices
neuromuscular occlusion to his prac- Any mechanical device, when intro-
tice, the dentist must discard the con- duced into the mouth, adds mass and
dylar border positioning concepts that weight to the mandible and/or maxilla
have dominated occlusion for the and induces neuromuscular excitement.
greater part of a century. We must bear The introduction of such devices cons-
in mind that the complex, cumbersome titutes a violation of the technique and
armamentarium and the manipulative will negate the possibility of producing
procedures for recording centric rela- an accurate myocentric result.
tion and border pathways induce muscle An obvious example of mechanical in-
tension that is quite incompatible with terference is the use of clutches attached
the requirement of a relaxed neuro- to the teeth. The additional weight, the
musculature, the basis for a neuro- proprioceptive effects, and the inter-
muscular occlusion. Because neuro- ference with the occlusion obviate the
muscular occlusion represents a signi- possibility of producing an undisturbed
ficant break with the past, in effect a neuromuscular response. In one pub-
new era with occlusion, it requires lished reporf', the authors used intra-
instrumentation and technology de- oral clutches to attach a 750-gram
signed to achieve and maintain a re- Stuart Pantograph to the subject. They
laxed neuromusculature. then attempted to record the myocen-

"Quinl 35
Number 3
Report 1601
March 1978
Page 8 III

Fig. 5 MKG® recording of
a gothic arch (horizontal
plane) tracing beginning
at centric occlusion (CO),
retruding to centric relation
(CR), moving right (R) and
back to CR, and moving
left (L) and back to CR.
Note the erratic nature of
the movement due to the
muscle tension and the
lack of consistency between
outward and inward lateral
movements from CR

trie position. Since the presence of the myocentric closure. Yet, one study^
apparatus excites the neuromusculature utilized metal-reinforced wax for re-
and alters the neuromuscular response, gistering myocentric position! Because
the procedure reflects a basic lack of Myo-monitor'-induced closures termi-
understanding of the nature of myo- nate with minimal force, such metal-
centric occlusion. In another, similar reinforced wax resists penetration dur-
report^ intra-oral clutches were wired to ing the closure; thus the wax, rather
the teeth to support protruding mem- than the musculature, determined ver-
bers, a vertical screw, and a tracing tical dimension. Though the investigator
device (Hight tracer*). These procedures failed to monitor or control the vertical
are totally inappropriate and must be or lateral dimensions, it can be
avoided when recording the neuromus- safely assumed from the data that the
cular occlusal position. registrations were taken at an exces-
sive vertical dimension*. It is interest-
2. Inappropriate registration material ing that even under such adverse con-
and technique ditions the antero-posterior position
The introduction of any registration only varied ± 0.2 mm (approximately
material over the teeth alters the neuro- the thickness of two pieces of paper) in
muscular response to the Myo-monitor^'' the average of ten successive recordings
stimulus. The procedures to minimize on the same subject.
and correct the effect are detailed in
the Myo-monitor® registration manuaF. 3. Improper electrode interface
To conform to the requirements, re- It is important to realize that the elec-
gistration material (Myo-print) was trode interface between the Myo-
formulated to retain its shape (not monitor® and the patient was specifi-
slump) and yet offer almost no resis- cally engineered for the purpose and is
tance to the Myo-monitor®-induced a significant part of the design^. When
* The average myocentric position was found to
* Hanau Teledyne Dental Equipment Co., Buf- be posterior to the average centric occlusal posi-
falo, New York. tion indicating an "over-open" condition.
Number 3 March 1978
Ill Report 1601 Page 9

Fig. 6 A sweep MKG®
recording of rest position
(10 overlapping traces)
after 30 minutes of Myo-
monitor® pulsing. Note the
stability of the rest position
and the repetitiveness of
the Myo-monitor®-induced
muscle responses

electrodes other than Myo-trodes are sequence of the registrations becomes
used or if the Myo-trodes are installed crucial. The registration of centric re-
improperly (with an inadequate amount lation, even briefly done, excites the
of gel, wrong location, etc.), the results musculature (Fig. 5). The excitement
will be altered. For instance, there is no induced by the retrusion to centric re-
practical way of applying the Myo- lation then makes it impossible to re-
monitor® stimulus to a cat^", given its gister a myocentric position. Subsequent
diminutive size, that would simulate the reduction of tension and relaxation of
actual conditions of a human subject. the musculature as shown in the Man-
Electrodes small enough to be used on dibular Kinesiograph"'' (MKG ) record-
the masseter muscle of an anesthetized ing (Fig. 6) requires 30 to 40 minutes
cat would increase the effective stimulus of subsequent Myo-monitor' pulsing
strength approximately 100 times, al- before proceeding with myocentric re-
lowing the muscle tissue to be de- gistration.
polarized directly by the stimulus rather The ability of the Myo-monitor'^ to
than being stimulated indirectly through produce repetitively accurate myo-
the motor nerve as it is in a human centric closure depends upon first
subject. achieving a relaxed muscular state.
Investigators who did not include this
4. Relaxation of the neuromusculature requirement in the stated conditions
The most crucial technical error in of their experiments reported they were
utilizing the Myo-monitor® is attempt- unable to obtain consistent results.
ing to register myocentric position
without first adequately relaxing the 5. Education in myotronic technology
musculature by pulsing just above With the advent of myotronics, den-
threshold amplitude for at least 30 tistry is being introduced to a new,
minutes"'12, i3_ advanced electronic system that provi-
In studies comparing repetitiveness of des improved capability for the manage-
the gnathological centric relation posi- ment of mandibular function and dys-
tion and the myocentric position, the function. A change of such significance
Number 3 March 1978
Report 1601 Page 10

requires that the researcher and the must be properly located and in-
practitioner become proficient with the stalled.
new methodology through education d) Muscle relaxation must be achieved
and by working in the field. preparatory to the application of
For instance, it has been clearly stress- any Myo-monitor® technique. Such
ed in the literature^, in the technique relaxation must be stated as an im-
manuals"'12,13^ and at all Myo- portant part of the protocols of any
monitor® training courses* that the experiment, and failure to include
overclosure is only to be used briefly to this in the description flaws the
obtain an "over" closure above the investigation and causes questions
normal physiologic vertical occlusal as to the investigator's awareness of
level in the case of a severely worn den- its importance. i
tition. The use of the overclosure In investigations that compare CR '
circuit while recording myocentric posi- position with myocentric position,
tion^ reflects o complete lack of knowl- the sequence of the procedures is
edge of its proper use. an important consideration and
should be specified. Manipulating
6. Control of posture the mandible to CR induces tension
Change in posture shortens some mus- and excitement. To then proceed
cles and lengthens their antagonists. with myocentric registration is futile
When it is realized that postural changes because of the tension induced into
affect the registration of neuromuscular the musculature by the previous
occlusion, precautionary steps can be manipulation to CR.
taken to assure a muscularly balanced e) A new modality requires the
posture during registrationi-'. Balanced acquisition of new knowledge, skill,
posture prior to taking a myocentric re- and education. Investigations based
gistration is essential during clinical on little or no experience with the
use and must be a part of the protocol device serve only to mislead the
of any research project. reader^, e- 8, lo, u. jhey have no place
in science.
Several positive statements can be made Summary
about the Myo-monitor technique from
reviewing the literature to date: In the field of mandibular function and
a) A repetitive myocentric position occlusion, there has been a crying need
cannot be registered while a subject for simplification, timesaving, and a)
is fitted with a clutchmounted pan- greater consistency of results. The in- ™
tograph or tracing devices. creased sophistication represented by
myotronic instrumentation is a large
b) Metal reinforced wax or any re- step in this direction.
sistant or slumping material is not The complicated mechanistic proce-
suitable for myocentric registration. dures and armamentarium of the past
c) Myo-trodes, designed specifically are now giving way to an improved
as a part of the myotronics system. physiologic approach that simplifies
occlusal treatment, that recognizes the
existence and the importance of the
* A list of courses given will be supplied on re- neuromusculature, and that can be ap-
quest. plied in everyday practice.

38 o n a l " 3/1978
Number 3 March 1978
Ill Report 1601 Page 11

Bibliography and Removable Prosthesis, Seattle, Wash.,
1. Jankelson, B., Sparks, S., Crane, P. F., and 1974,
Radke, J. C. Myo-tronics Resarch, Inc.
Neural Conduction of the Myo-monitor Stim- 8. Noble, W.
utus: A Quantitative Analysis. J. Prosthet. Antero-posterior Position of "Myo-monitor
Dent. 34:245—253, 1975. Centric". J. Prosthet. Dent. 33:4, 398—402,
2. Choi, B. B., and Mitani, H. 1975.
On the Mandibular Position Regulated by 9. Jankelson, B., and Swain, C. W.
Myo-monitor Stimulation. J. Jap. Prosth. Soc. Physiological Aspects of Masticatory Muscle
17:79—06, 1973. Stimulation: the Myo-monitor (A critique of).
Quintessence International 3:12, 57—62, 1972.
3. Fujii, H., and Mitani, H.
Reflex Response of the Masseter and Tempo- 10. DeBoever, J., and McCall, W. E.
ral Muscles in Man. J. Dent. Res. 52:1046, Physiological Aspects of Masticatory Muscle
1050, 1973. Stimulation: the Myo-monitor. Quintessence
International 3:57—58, 1972.
4. Schweizer, Hans
Der Myomonitor. Schweiz. Mschr. Zahnheilk. 11. Myo-monitor Instruction Manual.
Seattle, Wash., 1971, Myo-tronics Research,
81:12, 1187—1194, 1971. Inc.
5. Ott, K., and Winklmair, M. 12. Myo-monitor Instruction Manual.
Zur Anwendung des Myo-monitor® für die Seattle, Wash., 1974, Myo-tronics Research,
Relationsbestimmung. Dtsch. Zahnärztl. Z. Inc.
32:594—598, 1977. 13. Myo-monitor Instruction Manual.
6. Azarbal, M. Seattle, Wash., 1977, Myo-tronics Research,
Comparison of Myo-monitor Centric Position Inc.
to Centric Relation and Centric Occlusion. 14. Remien, J. D., and Ash, M. M.
J. Prosthet. Dent. 38:3, 331—337, 1977. Myo-monitor Centric: An Evaluation. J.
7. Maxillo-mandibular Registration for Fixed Prosthet. Dent, 31:137—145, 1974.

Copper rivets on jeans
(derived from genes, the denim pants worn by Genoan sailors) owe their origins to the
western prospector. Gold nuggets kept ripping overall pockets, so a Nevada tailor named
Jacob Davis reinforced the corners with copper rivets. In 1872 he wrote to Levi Strauss:
"The secratt of them Pants is the Rivits that I put in those Pockots and I found the
demand so large that I cannot make them fast enough. I charge for the Duck $3 and the
Blue ^2.40 a pear. My nabors are getting yealouse of these success and unless I secure it
by Patent Papers it will soon become to be a general thing everybody will make them up
and there will be no money in it, tharefore Gentlemen I wish to make you a Proposition
that you should take out the latters Patent in my name as I am the Inventor of it." Patent
No. 139,121 was granted on May 20, 1873; in the 93 years since, the manufacturer has
deleted only one rivet—from the crotch, after a Levi Strauss president stood too long
in front of a blazing campfire. (Grace Digest)

June 4th-9th, 1978

54th European Orthodontic Society Congress,

Details from:
Secretariat 54th E.O.S.-Congress, c/o Netherlands Congress Centre, P.O. Box 9000,
Churchillplein 10, The Hague, The Netherlands