Temporomandibular Disorders: A Position Paper of the ...

COOPER ICCMO POSITION PAPER

Temporomandibular Disorders: A Position Paper of the InternationalCollege of Cranio-Mandibular Orthopedics (ICCMO)

"Measure what is measurable and what is not measurable, make measurable." Galileo Galilei

This position paper is endorsed by the Board of Regents of the International College of Cranio-Mandibular Orthopedics, 2011.

ABSTRACT: Purpose. Two principal schools of thought regarding the etiology and optimal treatment of temporomandibular disor-ders exist; one physical/functional, the other biopsychosocial. This position paper establishes the scientific basis for the physi-cal/functional. The ICCMO Position: Temporomandibular disorders (TMD) comprise a group of musculoskeletal disorders, affectingalterations in the structure and/or function of the temporomandibular joints (TMJ), masticatory muscles, dentition and supportingstructures. The initial TMD diagnosis is based on history, clinical examination and imaging, if indicated. Diagnosis is greatlyenhanced with physiologic measurement devices, providing objective measurements of the functional status of the masticatorysystem: TMJs, muscles and dental occlusion. The American Alliance of TMD organizations represent thousands of cliniciansinvolved in the treatment of TMD. The ten basic principles of the Alliance include the following statement: Dental occlusion mayhave a significant role in TMD; as a cause, precipitant and /or perpetuating factor. Therefore, it can be stated that the overwhelm-ing majority of dentists treating TMD believe dental occlusion plays a major role in predisposition, precipitation and perpetuation.While our membership believes that occlusal treatments most frequently resolve TMD, it is recognized that TMD can be multifaceted and may exist with co-morbid physical or emotional factors that may require therapy by appropriate providers. TheInternational College of Cranio-Mandibular Orthopedics (ICCMO), composed of academic and clinical dentists, believes that TMDhas a primary physical/functional basis. Initial conservative and reversible TMD treatment employing a therapeutic neuromuscularorthosis that incorporates relaxed, healthy masticatory muscle function and a stable occlusion is most often successful. This isaccomplished using objective measurement technologies and ultra low frequency transcutaneous electrical neural stimulation(TENS). Conclusion: Extensive literature substantiates the scientific validity of the physical/functional basis of TMD, efficacy ofmeasurement devices and TENS and their use as aids in diagnosis and in establishing a therapeutic neuromuscular dental occlu-sion. Clinical Implications: A scientifically valid basis for TMD diagnosis and treatment is presented aiding in therapy.

I. IntroductionThe International Collegeof Cranio-

Mandibular Orthopedics (ICCMO)was founded in 1979 as an indepen-dent dental organization to encourageresearch, improve clinical practiceand education related to objectivemeasurements of the physiology ofthe stomatognathic system. Studiesby Dr. Bernard Jankelson of the phys-iology of human dental occlusion,published in 1955' resulted in recog-nition of the scientific need to quan-tify the function of the masticatorysystem. These studies were a drivingforce in the development, and thenintroduction, of a physiologicallybased, objectively measured conceptof dental occlusion, called neuromus-cular occlusion. Dr. Jankelson's stud-ies of the physiology of human dental

occlusion, were precursors to the neu-romuscular occlusion concept he intro-duced in 1973. Clinically usabledevices to measure the function of thecomponents of the masticatory system,the TMJ, muscles and dental occlu-sion were subsequently invented.2-4

Objective measurements of mastica-tory function and dental occlusion,established the scientific validity ofthe neuromuscular occlusion conceptand its clinical utility.

Like other medical disciplinesresponsible for diagnosis and treat-ment of musculoskeletal disorders,the use of objective measurementfacilitates differential diagnosis andresults in improved treatment out-comes for multi-etiologic conditions.Hence, these modalities are tools fordiagnosis and treatment of TMD.

ICCMO fosters neuromuscular con-cepts and practices to alleviate painfulconditions related to malocclusion,mandibular, head and neck muscu-loskeletal dysfunction, including tem-poromandibular disorders. Membersare in both clinical practice and acad-emic institutions, with sections in theUSA, Canada, Japan, Italy, Germany,France and South America.

ICCMO members recognize thattemporomandibular disorders (TMD)most commonly have a physi-cal/physiological basis with dentalmalocclusion as a major etiologicagent. They employ neuromuscularocclusal therapies as primary modali-ties to improve muscle and joint func-tion, utilizing objective measurementdata to optimize treatment outcome.These clinical modalities are applied

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ICCMO POSITION PAPER COOPER

to the treatment of patients with TMDand others who require significantalteration or restoration to a physio-logical dental occlusion.

II. Temporomandibular DisordersTemporomandibular disorders

(TMD) comprise a group of muscu-loskeletal disorders that affect alter-ations in the structure and/or functionof one or more of the following: tem-poromandibular joints (TMJ), masti-catory muscles, the dentition and itssupporting structures, and the com-plex neuromuscular system attachedthereto. TMD can coexist with othermusculoskeletal disorders within thehead and neck area. Each TMD patienthas a unique composite of differentelements, which can involve the TMjoint and masticatory muscle systems,often with the pain and dysfunction ofphysical causes leading to manifesta-tion of psychological stress.

Signs and symptoms determinedupon clinical examination are variedand their prevalences have been thesubject of extensive research pub-lished in the medical and dental liter-ature. In a classical article publishedin 1934, Costen, an otolaryngologist,observed that posterior condylar dis-placement in the TM joint created bythe dental malocclusion was the causeof otological symptoms in a group ofhis patients. Costen inserted a dentaldevice and the symptoms wereresolved.5-6 In a 2007 study performedon 4,528 TMD patients, certain signsand symptoms were found present inextremely large percentages, whichhelped in the characterization of theTMD patient. In that study, symp-toms most commonly reportedincluded: pain 96%, headache 79%,TM joint discomfort or dysfunction75%, and ear discomfort or dysfunc-tion 82%. The most prevalent exami-nation findings were tenderness topalpation of the lateral and/or medialpterygoid muscles 85% and TM joint

tenderness to palpation 62%.7 Inthe medical literature related toTMD, the most commonly reportedsymptoms are headache and otolaryn-gological.8'10

III. The Role of Dental Occlusionin TMD

Dental occlusion is the cornerstoneof stability of the craniomandibularsystem, comprised of dentition, mas-ticatory muscles and the TM joints.Malocclusion is a destabilizing factor,representing a major predisposingcondition for TMD. A number of stud-ies have substantiated an associationbetween dental occlusion and TMD.These studies have documented therole of occlusion as a predisposing,initiating and/or perpetuating factorin the etiology of TMD."-24

In other studies that investigatedthe cause-effect relationship, theauthors experimentally induced TMDin asymptomatic subjects by intro-ducing occlusal interferences intohealthy subjects and studied the de-velopment of signs and symptomsof TMD. Changes in subjectivesymptoms and clinical indicatorsof dysfunction were recorded.25'34

Asymptomatic subjects in all of thesestudies developed signs and symp-toms of TMD, some after only a fewhours. According to De Boever, etal.27 who performed a scientificreview of the literature on therelationship between occlusion andTMD, "These studies have shownthat artificially introduced occlusalinterferences can provoke immediateresponses in the contraction pattern ofjaw muscles and they may induce jawmuscle hyperactivity and pain in somesubjects."

In a three-part study conductedat Karolinska Institute, Riise andSheikholeslam28"30 investigated theinfluence of an intercuspal occlusalinterference that was introduced in 11healthy subjects with no signs and

symptoms of functional disorders.According to this study, in less than12 hours following the insertion ofthe interfering amalgam filling, signsand symptoms of functional disordershad developed in eight subjects, ac-companied by an increase in the EMGpostural activity of the anterior tem-poralis and masseter muscles. Thesubjects complained of pain, tender-ness and fatigue in their facial mus-cles. The authors concluded that"Within a week after the occlusalinterference was removed, the symp-toms gradually subsided . . . and pos-tural EMG activity had returned al mostto its original pattern in all subjects."

In a randomized double-blind studyat University of Turku in Finland, LeBell, et al.31'33 conducted their studyon two groups of subjects, all women,that consisted of 26 healthy subjects,and a matched group of 21 subjectswith a prior history of TMD who weresuccessfully treated. Each group wasrandomly divided into two groups ofplacebo and true interference groups.Experimental occlusal interferencewas introduced in the true interfer-ence groups and simulated in theplacebo groups. The investigatorsmonitored the clinical signs of sub-jects in the resulting four groups fortwo weeks. Additionally, all subjectsrated the intensity of their symptomson a scale relative to their experienceof TMD pain and discomfort. Theauthors concluded, "subjects with aTMD history and true interferenceshowed a significant increase in clini-cal signs and reported stronger symp-toms than subjects with no TMDhistory and placebo interferences."

These studies demonstrate the pres-ence of several factors when an occlu-sal interference is introduced. Theseinclude the effect of the interferenceon muscles and joints, the inherentadaptive capacity of the subject, andthe influence of suggestion (placeboeffect). The results clearly substanti-

238 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE JULY 2011, VOL. 29 NO. 3


ate the role of occlusion in the onsetand perpetuation of TMD and a returnto normal masticatory function whenocclusal harmony is restored.

It is commonly agreed, among den-tists who treat patients with TMD,that conservative, reversible therapiesshould be employed, whenever possi-ble, in the initial phase of treatment.Several studies have concluded thatTMD patients experience the greatestclinical success after receiving treat-ments that involve restoration ofoptimum function of the mandible,muscles and TM joints, through useof intraoral orthotic appliances of var-ious designs.35 4I The neuromuscularocclusion orthosis recommended byICCMO is one form of conservativetreatment. Some patients, after under-going successful initial reversibleforms of therapy, do not requirelong-term occlusal stabilization treat-ment, while others do require long-term continued maintenance of atherapeutic occlusal position to per-petuate initially affected resolution ofTMD. The long-term treatment mayinvolve permanent alteration of theocclusal relationship or continueduse of precision orthoses. A smallnumber of patients actually requireTM joint surgery to treat dysfunc-tional joints.

IV. Neuromuscular OcclusionNeuromuscular occlusion is in

harmony with relaxed, healthy mus-cles and properly functioning tem-poromandibular joints. It is a stablemaxillo-mandibular position of dentalocclusion arrived at by isotoniccontraction of relaxed masticatorymuscles, achieved by stimulation ofthose muscles on a trajectory (arc)beginning at a muscularly restedmandibular position.39 Healthy tem-poromandibular joint (TMJ) functionmust be accompanied by a stabledental occlusion, freely entered andexited without interferences, dictated

by and directed by healthy relaxedmasticatory muscles for long-termstability of all of the interrelatedstructures.

Joints do not initiate or dictatefunction; they permit function andadapt to functional demands. HealthyTM joint function is not primary, butsecondary to a physiological dentalocclusion. Form follows function: theshape of hard structures results fromthe function which they are requiredto perform.40 To protect the hard struc-tures (joints, alveolar bones), healthyfunction must be provided to the softtissues (muscles, periodontium andligaments). Hence, it is valuable toanalyze function before form tounderstand how and why anatomicalform was changed. For example, it isvaluable to analyze the genesis of thesevere attrition seen on incisor teethprior to treatment planning for porce-lain laminate veneers, or the sameconditions untreated can cause failureof the new restorations. The conceptof a neuromuscular dental occlusionhas not changed since its introductionin 1973; only the technology used toestablish this therapeutic occlusionhas been developed and refined.3

V. Technologies Used in Neuro-muscular Dentistry

It is an accepted physiologicalaxiom that muscles function opti-mally from their full resting length: arested state.41 Implementation of therecognition of the essential role ofrelaxed masticatory muscles as a pre-requisite for the establishment of anergonomic, optimally physiologicocclusion was the impetus for thedevelopment of an instrument capa-ble of affecting true physiologicalmasticatory muscle relaxation. Theclinical device developed to relaxmandibular elevator and depressormuscles is a neuromuscular stimula-tor (TENS device) that delivers anintermittent minute, low voltage, low

amperage, fixed rate neural stimulussimultaneously to all of the mastica-tory muscles through the mandibulardivision of the trigeminal nerve ap-plied over the mandibular coronoidnotch.42-44 The stimulator used is sim-ilar to other medical nerve mediatedultra-low frequency TENS devicesused to affect relaxation of muscles.In the case of TMD; the mandibularelevator and depressor muscles arethe stimulated muscles.45'51

Proper diagnosis of any medical/dental condition is made by the treat-ing doctor and begins with obtaininga history of the illness and perform-ing a comprehensive clinical exami-nation of the affected area, employingimaging studies when indicated. Thediagnostic process and treatment planare greatly enhanced using technolo-gies that can scrutinize the anatomicand functional components of themasticatory system, providing reli-able and precise objective measure-ment data. Because of the diversity ofstructures involved and variability inchronicity and intensity of TMD pre-sentations between patients, there canbe no single diagnostic test with anacceptable level of "specificity" torule TMD in or out. In medicine, thereare many devices considered valuableas diagnostic aids, such as radiographs,MRI, and cardiac stress tests that arenot free-standing diagnostic devices.Sometimes, more than one device isused to obtain a proper diagnosis.

Within the past four decades, threecomputerized measurement deviceshave been developed and refined torecord and analyze, with high degreesof precision, masticatory musclefunction (EMG), mandibular move-ments (CMS), TMJ joint sounds(ESG), and dental occlusion as dy-namic phenomena.

Surface Electromyography (EMG)is a well-accepted modality with whichto evaluate muscle function. A signif-icant body of the scientific literature



published in peer-reviewed journalsover the past 50 years has concludedthat the TMD patient population hasan elevated resting EMG muscle activ-ity and weak or asymmetrical func-tional EMG muscle activity.52-% EMGmeasures electrical activity in masti-catory muscles at rest and in function.This measured activity aids in identi-fication of mandibular rest position asa reference for the selection of theneuromuscular occlusion position, aswell as evaluation of the quality ofthe dental occlusion through the analy-sis of patterns of muscle motor unitrecruitment. Numerous studies havesubstantiated the reliability and repro-ducibility of surface electromy-ography in the evaluation of the statusof the masticatory muscles.97~108

While "normal or physiological val-ues" for electromyographic (EMG)have been published, because mor-phologic variations from patient topatient can affect EMG readings,EMG data is utilized to compare elec-trical activity in selected masticatorymuscles before and after treatment fora given patient. In research studies,collective data for a group of subjectsare similarly compared. The combi-nation of surface electromyographyof masticatory muscles and electronicjaw tracking is a clinically useful andobjective method of quantifying thephysical components of temporo-mandibular disorders in patientsscreened for treatment. '09-120

Computerized Mandibular Scans(CMS) measure and record mandibu-lar ranges of motion, direction, veloc-ity and fluidity of jaw movements,rest position of the mandible anddental occlusion, both natural andtherapeutic.

Electrosonography (ESG) recordsand provides spectral analysis of TMjoint sounds, identifying their magni-tude and specific frequencies pro-duced by mandibular movementsduring mouth opening and closing

with greater precision than stetho-scopic auscultation.|2'-124

These three technologies are notfree-standing diagnostic devices; theyare precision objective measurementinstruments, which aid the dentist inestablishing a diagnosis. These de-vices underwent the review processesof the US FDA in 1997 and 1998125-126

and the ADA Council on ScientificAffairs in!986 and 1993127-128 andhave been recognized as safe andeffective aids in the diagnosis andtreatment of patients with temporo-mandibular disorders.

According to the ADA's Councilon Scientific Affairs129-130 "Surfaceelectromyography, or EMG, is usedin dentistry to assess the status of themuscles of mastication.131 It allowsthe clinician to assess the restingactivity of muscles and determine ifmuscle spasms are present.132-133 Inparticular, EMG instruments measurestatic and functional muscle activity,including postural hypertonicity andcontinuous muscle contraction.133

Evaluation of muscle activity isincluded among the diagnostic crite-ria for TMD as given in the ADACouncil's Guidelines.... Muscle spasmis included in the counsel's classifica-tion system (Section 11.8.3 in theAppendix), and among the diagnosticcriteria is continuous muscle contrac-tion at rest. Surface electromyogra-phy is one method that can measuresuch muscle hyperactivity.... There isconsiderable agreement among bothclinicians and researchers that masti-catory muscle activity is increased insymptomatic patients compared tonormal subjects, and electromyogra-phy is one tool that can be used tostudy such differences."134 Therefore,EMG devices "were found to meetthe [ADA] Council's Guidelines forInstruments as Aids in the Diagnosisof Temporomandibular Disorders."130

Neuromuscular measurement de-vices objectively document patient

status, create objective milestones inplanning treatment, and documentpatients' response to treatment.135'152

The three devices, computerized jawtracking, electromyography and elec-trosonography, provide objectivedocumentation of the pretreatmentstatus of patients with regard tomandibular and masticatory musclefunction and permit evaluation oftreatment outcomes.

Together with these measurementdevices, Transcutaneous ElectricalNeural Stimulation (TENS) is anactive therapeutic device that affectsrelaxation of masticatory and man-dibular postural muscles by use oflow frequency, low current stimula-tion of the mandibular division of thetrigeminal nerve (CN V) and a branchof the superficial facial nerve (CNVII).42'45 It is used during the treat-ment to achieve true rest position ofthe mandible and a therapeutic neuro-muscular occlusal position.153 161

Thereafter, TENS is employed as anaide in performing occlusal adjust-ments of the anatomical surface of theneuromuscular TMD orthosis.

Without objective measurement offunction, treatment planning and out-come evaluation are subjective andmay be imprecise and possibly inac-curate.162-163 With objective measure-ment, treatment planning, as well astreatment outcome, whether success-ful or not, can be scrutinized and eval-uated. Treatment can be modified,continued or discontinued, based uponprecise objective measurementstogether with a patient's needs anddesires; rather than relying only onsubjective evaluations of success bythe patient and dentist.

VI. ConclusionThe overwhelming majority of

dentists worldwide, treating thou-sands of patients annually, and whosepatients had not previously experi-enced resolution of theirpainful and/or



dysfunctional symptoms, support theconcl usions reached by a large numberof studies that TMD is a physi-cal/functional disorder most oftenresulting from the mal-relationshipamong the dental occlusion, mastica-tory muscles, and TM joint func-tion. n-34,39,164 Tney finci that theirpatients are most often conservativelyand successfully treatable initiallywith reversible occlusal orthosis ther-apy. Members of ICCMO adhere tothis principal and treat to establish ahealthy craniomandibular relation-ship through the use of a physiologi-cally balanced neuromuscularocclusion that is in harmony withrelaxed, healthy masticatory muscleswith improved function and properlyfunctioning TM joints. This achievesa stable, physiologically sound dentaland craniomandibular position thatdoes not cause noxious neural inputto the central nervous system withresultant adaptive/accommodativefunction and behavior. In addition toits use in the treatment of patientswith TMD, the neuromuscular occlusalphilosophy canbe successfully appliedto all forms of dental treatment thatinvolve major alteration of dentalocclusion, including orthodontics,full arch or full mouth reconstructionand complete dentures.

Successful treatment of temporo-mandibular disorders using neuro-muscular occlusion techniques isdirected towards elimination of thecause of the disease, not just symp-tom relief. If the cause is not success-fully identified and treated, the acutephysical/physiological form of TMDmay unfortunately degenerate into achronic pain condition, rarely cured,and at best, attempted to be managedwith pharmacologic and other med-ical/behavioral therapies. Such symp-tom-only oriented treatment canadversely affect the patients' abilityto work or have normal social interac-tions, resulting in an overall reduction

in quality of life. Published researchdata demonstrate that the establish-ment of a neuromuscular therapeuticocclusion provides improved man-dibular and masticatory function in alarge group of TMD patients withnotably significant reduction or reso-lution of symptoms.39-152

ThelnternationalCollegeofCranio-Mandibular Orthopedics supports theconsensus among its members andthousands of neuromuscular dentistsworldwide that TMD has a primaryphysical/functional component that ismost often successfully treated withneuromuscular dental occlusion ther-apy, based on objective measure-ments.

Barry C. Cooper, D.D.S.Lawrence, New YorkEmai 1: tmjbcooper® aol. com

References1. Jankelson B: Physiology of human dental occlu-

sion. J Am Dent Assoc 1955; 50:664-680.2. Jankelson B, Swain C: Kineseometric instru-

mentation: a new technology. J Am DentAssoc 1975; 90(4)834-840.

3. Jankelson B: Neuromuscular aspects of occlu-sion: effects of occlusal position on the phys-iology and dysfunction on the mandibularmusculature. Dent Clin North Am 1979;23:157-168.

4. Jankelson B: Measurement accuracy of themandibular kinesiograph: a computerizedstudy. J Prosthet Dent 1980; 44(6);656-666.

5. Costen JB: A syndrome of ear and sinus symp-toms dependent upon disturbed function ofthe temporomandibular joint. Ann Otol RhinolLaryngol 1934; 43:1-5.

6. Costen J: Neuralgia and ear symptoms associ-ated with disturbed function of the temporo-mandibular joint. JAMA 1936; 107:252-256.

7. Cooper BC. Kleinberg I: Examination of alarge patient populat ion for presence ofsymptoms and signs of temporomandibulardisorders. J Craniomandib Pract 2007;25(2): 114-126.

8. Cooper BC, Cooper DL: Recognizing otolaryn-gologic symptoms in patients with temporo-mandibular disorders. J Craniomandib Pract1993; ll(4):260-267.

9. Tuz H, Onder E, Kinisi R: Prevalence of oto-logic complaints in patients with temporo-mandibular disorder. Am J Orthod DentofacOrthop 2003; 123:620-623.

10. Cooper B, Kleinberg T: Relationship of tem-poromandibular disorders to muscle andtension-type headaches and a neuromus-cular orthosis approach to treatment.J Craniomandib Pract 2009 27(2): 101-108.

11. Kirveskari P. Alanen P, Jamsa T: Associationbetween craniomandibular disorders andocclusal interferences. J Prosthet Dent 1989;

62(l):66-69.12. Kirveskari P, LeBell Y, Salonen M, Forssell H,

Grans L: Effect of elimination of occlusalinterferences on signs and symptoms of cran-iomandibular disorder in young adults. /OralRehabil 1989; 16(l):21-26.

13. Fushima K, Akimolo S, Takamot K, Kamei T.Sato S, Suzuki Y: Incidence of temporo-mandibular joint disorders in patients withmalocclusion. Nihon Ago Kansetsu GakkaiZasshi 1989; 1(1):40-50.

14. Raustia AM, Pirttiniemi PM, Pyhtinen J:Correlation of occlusal factors and condyleposition asymmetry with signs and symp-toms of temporomandibular disorders inyoung adults. J Craniomandib Pract 1995;13(3):152-156.

15. Raustia AM, Pyhtinen J, Tervonen O: Clinicaland MR1 findings of the temporomandibularjoint in relation to occlusion in young adults.J Craniomandib Pract 1995; 13(2):99-104.

16. Liu JK. Tsai MY: Association of functionalmalocclusion with temporomandibular disor-ders in orthodontic patients prior to treat-ment. Funct Orthod 1998; 15(3):17-20.

17. Kirveskari P, Jamsa T, Alanen P: Occlusaladjustment and the incidence of demand fortemporomandibular disorder treatment.J Prosthet Dent 1998; 79(4):433-438.

18. Mao Y, Duan XH: Attitude of Chinese ortho-dontists towards the relationship betweenorthodontic treatment and temporomandibu-lar disorders. Int Dent J 2001; 51(4):277-281.

19. Sonnesen L, Bakke M, Solow B: Malocclusiontraits and symptoms and signs of temporo-mandibular disorders in children with severemalocclusion. Eur J Orthod 1998: 20(5):543-559.

20. Celic R, Kraljevic K, Kraljevic S, Badel T,Panduric J: The correlation between tem-poromandibular disorders and morphologicalocclusion. Ada Stomatoiogica Croatica2000; 34(1).

21. Kirveskari P, Alanen P, Jamsa T: Associationbetween craniomandibular disorders andocclusal interferences in children. J ProphetDent 1992; 67(5):692-696.

22. Fushima K, Inui M, Sato S: Dental asymmetryin temporomandibular disorders. J OralRehabil 1999; 26(9):752-756.

23. Kloprogge MJ, van Griethuysen AM:Disturbances in the contraction and co-ordi-nation pattern of the masticatory muscles dueto dental restorations. An electromyographicstudy. J Oral Rehabil 1976 3(3):207-216.

24. Bcitollahi JM, Mansourian A, Bozorgi Y.Farrokhnia T. Manavi A: Evaluating the mostcommon etiologic factors in patients withtemporomandibular disorders: A case controlstudy. J Applied Sciences 2008: 8(24):4702-4705.

25. Christensen LV, Rassouli NM: Experimentalocclusal interferences. Part I. A review.J Oral Rehabil 1995; 22(7):515-520.

26. Randow K, Carlsson K, Edlund J, Oberg T: Theeffect of an occlusal interference on the mas-ticatory system. An experimental investiga-tion. Odontol Rev 1976; 27(4):245-256.

27. De Boever JA, Carlsson GE, Klineberg IJ:Need for occlusal therapy and prosthodontictreatment in the management of temporo-mandibular disorders. Part 1. Occlusal inter-ferences and occlusal adjustment. J OralRehabil 2000; 27(5):367-379.

28. Riise C, Sheikholeslam A: The influence ofexperimental interfering occlusal contacts on



the postural activity of the anterior temporaland masseter muscles in young adults. J Oral 44. JRehabil 1982; 9:419-425.

29. Sheikholeslam A, Riise C: Influence of experi-mental interfering occlusal contacts on theactivity of the anterior temporal and masseter 45.muscles during submaximal and maximalbite in the intercuspal position. J Oral Rehabil1983; 10:207-214. 46.

30. Riise C, Sheikholeslam A: The influence ofexperimental interfering occlusal contacts on 47.the activity of the anterior temporal and mas-seter muscles during mastication. ./ OralRehabil 1984; 11:325-333.

31. Le Bell Y, Jamsa T, Korri S, Niemi PM, AlanenP: Effect of artificial occlusal interferences 48.depends on previous experience of temporo-mandibular disorders. Ada Odontol Scand2002;60(4):219-222.

32. Niemi PM, Jamsa T, Kylmala M, Alanen P:Subjective reactions to intervention with arti- 49.ficial interferences in subjects with and with-out a history of temporomandibular disorders.Acta Odontol Scand 2006; 64(l):59-63.

33. Niemi PM, Le Bell Y, Kylmala M, Jamsii T,Alanen P: Psychological factors andresponses 50.to artificial interferences in subjects with andwithout a history of temporomandibular dis-orders. Acta Odontol Scand 2006; 64(5):300-305.

34. Li J, Jiang T, Feng H, Wang K. Zhang Z, 51.Ishikawa T: The electromyographic activityof masseler and anterior temporalis duringorofacial symptoms induced by experimentalocclusal highspot. J Oral Rehabil 2008;35(2):79-87. 52.

35. Williamson EH, Rosenzweig BJ: The treatmentof temporomandibular disorders throughrepositioning spl int therapy: a follow-upstudy. JCraniomandibPract 1998; 16(4):222- 53.225."

36. Lundh H, Westesson P-L, Kopp S, Tillstrom B:Anterior repositioning splint in the treatment 54.of temporomandibular joints with reciprocalc l ick ing ; comparison with a flat occlusalsplint and an untreated control group. OralSurg Oral Med OralPathol 1985; 60(2):131- 55.136.

37. Lundh H. Westesson P-L, Jisander S, ErikssonL: Disc-repositioning onlays in the treatmentof temporomandibular joint disk displace-ment: comparison with a flat occlusal splint 56.and with no treatment. Oral Surg Oral MedOral Pathol 1988; 66(2):155-162.

38. Simmons HC III, Gibbs SJ: Anterior reposi-tioning appliance therapy for TMJ disorders: 57.specific symptoms relieved and relationshipto disc status on MRI. / Craniornandib Pract2005, 23(2):89-99.

39. Cooper B, Kleinberg I:. Establishment of a 58.temporomandibular physiological state withneuromuscular orthosis treatment affectsreduction of TMD symptoms in 313 patients. 59.J Craniornandib Pract 2008; 26(2):104-117.

40. Moss ML: Functional matrix hypothesis. In:Vistas in orthodontics. Kraus B, Riedel R,eds. Philadelphia: Lea & Febiger, 1962. 60.

41. Guyton AC: Textbook of medical physiology.6th ed. Philadelphia: WB Saunders, 1981:137.

42. Jankelson B, Swain CW: Physiological aspects 61.of masticatory muscle stimulation: theMyomonitor. Quintessence Int 1972; 3:57-62.

43. Jankelson B, Sparks S, Crane PF, Radke JC: 62.Neural conduction of the Myo-monitor stim-ulus: a quantitative analysis. J Prosth Dent

1975;34(3):245-253.ankelson B. Radke J: The myo-monitor: its use

and abuse Parts I and It. Quintessence 63.International Dem Digest, Special Report1601. 1978; 9(2):35-39, 9(3):47-52.

Dixon HH. O'Hara M: Fatigue contracture ofskeletal muscles. J Northwest Med 1967;66:813-816.

Dixon HH. O'Hara M: Tension headache. 64.J Northwest Med 1967; 66:817-820.

Wessberg GA, Carroll WL, Dinham R, WolfordLM: Transcutaneous electrical stimulation asan adjunct in the management of myofacialpain dysfunction syndrome. J Prosthet Dent 65.1981; 45(3): 304-314.

Kawazoe Y, Kotani H, Mitani T. et al.: Theslopes of the fatigued muscle voltage tensioncurves decreased to a greater degree with per- 66.cutaneous stimulation than with rest alone.Arch OralBUA 1981; 26:796-801.

Bazzotti L: Electromyography tension and fre-quency spectrum analysis at rest of somemasticatory muscles before and after TENS. 67.Electromyography Clin Neurophysiol 1997;37(6):365-378.

Kamyszek G, Ketcham R, Garcia R Jr.:Electromyographic evidence of reduced 68.muscle activity when ULF-TENS is appliedto the Vth and Vllth cranial nerves.J Craniomandib Pract 2001; 19(3):I62-168.

Elbo OS, Jonas IE, Kappert HF: Transcuta- 69.neous electrical nerve stimulation (TENS):its short-term and long-term effects on themasticatory muscles. J Orofac Ortltop 2006;61(2):100-111. 70.

Jarabak JR: An electromyographic analysis ofmuscular and temporomandibular joint dis-turbances due to imbalances in occlusion.Angle Ortlmd 1956; 26:170-190. 71.

Perry HT: Muscular changes associatedwith temporomandibular joint dysfunction.Journal of Am Dent Res 1957; 54:644-653.

Lous L, Sheikholeslam A, Moller E: Postural 72.activity in subjects with functional disordersof the chewing apparatus. Scand J Dent Res1970; 78:404-410.

Moller E. Sheikholeslam A, Lous L: Deliberaterelaxation of the temporal and masseter mus- 73.cles in subjects with functional disorders ofthe chewing apparatus. Scand J Dent Res1971:79:478-482.

Munro RR: Electromyography of the masseterand anterior temporalis muscles in patients 74.with atypical facial pain. Australian Dent J1972:131-139.

Moss JP, Chalmers CF: An electromyographicinvestigation of patients with a normal jawrelationship and a class III jaw relationship. 75.Am J Orthod 1974; 665:538-556.

Yemm R: Neurophysiologic studies of tem-poromandibular joint dysfunction. OralScience Rev 1976; 7:31-53.

Kotani H. Kawazoe Y, Hamada T, Yamata S: 76.Quantitative clectrotnyographic diagnosis ofmyofascial pain dysfunction syndrome.J Prosthet Dent 1980; 43:450-456.

Sheikholeslam A, Moller E, Lous L: Pain, ten-derness and strength of human mandibular 77.elevators. Scand J Dent Res 1980; 88:60-66.

Sheikholeslam A, Moller E, Lous L: Posturaland maximal activity in elevators of mandiblebefore and after treatment of functional dis-orders. Scand J Dent Res 1982; 90:37-46.

Riise C, Sheikholeslam A: The influence of 78.experimental interfering occlusal contacts onthe postural activity of the anterior temporal

and masseter muscles in young adults. J OralRehabil 1982; 9:419-425.

Sheikholeslam A, Riise C: Influence of experi-mental interfering occlusal contacts on theactivity of the anterior temporal and massetermuscles during submaximal and maximalbite in the intercuspa! position. J Oral Rehabil1983; 10:207-214.

Riise C. Sheikholeslam A: The influence ofexperimental interfering occlusal contacts onthe activity of the anterior temporal and mas-seter muscles during mastication. J OralRehabil 1984; 11:325-333.

Moller E, Sheikholeslam A, Lous L: Responseof elevator activity during mastication totreatment of functional disorders. Scand JDent Res 1984; 90:37-46.

Keefe FJ. Dolan EA: Correlation of pain behav-ior and muscle activity in patients withmyofascial pain-dysfunction syndrome.J Craniomandib Disord Facial Oral Pain1984; 2:181-184.

Sherman RA: Relationships between jaw painand jaw muscle contraction level: Underlyingfactors and treatment effectiveness. 7/YojrtoDenf 1985;54(1):114-118.

Naeije M, Hansson TL: Electromyographicscreening of myogenous and arthrogenousTMJ dysfunction patients. J Oral Rehabil1986; 13(5):433-44I.

Balciunas BA, Staling LM, Parente FL:Quantitative electromyographic response totherapy for myo-oral facial pain: a pilot study.J Prosth Dent 1987; 58(3):366-369.

Burdette BH, Gale EN: The effects of treatmenton masticatory muscle activity and mandibu-lar posture in myofascial pain-dysfunctionpatients. / Dent Res 1988: 67(8): 1126-1130.

Cram JR, Klemons TM: EMG: Comparisons incraniofacial muscles following therapy forhead and neck pain. Med Electr 1988:106-110.

Gervais RO, Fitzsimmons GW, Thomas NR:Masseter and temporalis electromyographicactivity in asymptomatic, subclinical andtemporomandibular joint dys func t ion pa-tients. J Craniomandib Pract 1989; 7:52-57.

Chong-Shan S, Hui-Yun W: Postural and max-imum activity in elevators during mandiblepre- and post-occlusal split treatment of tem-poromandibular joint disturbance syndrome.J Oral Rehabil 1989; 16:155-161.

Chong-Shan S, Hui-Yun W: Value of EMGanalysis of mandibular elevators in open-close-clench cycle to diagnosing TMJ distur-bance syndrome. J Oral Rehabil 1989;16:101-107.

Shi CS. Proportionality of mean voltage ofmasseter muscle to maximum bite forceapplied for diagnosing temporomandibularjoint disturbance syndrome. J Prosthet Dent1989:62(6):682-684.

Harness DM, Donlon WC, Eversole LR:Comparison of clinical characteristics inmyogenic, TMJ internal derangement andatypical facial pain patients. Clin J Pain1990; 6(1):4-17.

Choi J: A study on the effects of maximal vol-untary clenching on the tooth contact pointsand masticatory muscle activities in pa-tients with temporomandibular disorders.J Craniomandib Disord Facial Oral Pain1992; 6:41-46.

Kroon GW, Naeije M: Electromyographic evi-dence of local muscle fatigue in a subgroupof patients with myogenous craniomandibu-



lar disorders. Arch Oral Biol 1992; 37(3):215-218.

79. Visser A, McCarrollRS, Costing J, Naeije M: 94.Masticatory electromyographic activity inhealthy young adults and myogenous cran-iomandibular disorder patients. JOral Reluibi!1994; 21(l):67-76.

80. Abekura H. Kotani H. Tokuyama H, HamadaT: Asymmetry of masticatory muscle activityduring intercuspal maximal clenching in 95.healthy subjects and subjects with stomatog-nathic dysfunction syndrome. J Oral Rehabil1995; 22(9):699-704.

81. Erlandson PM, Poppen R: Electromyographicbiofeedback and rest position training ofmasticatory muscles in myofascial pain-dys-function patients. J Prosthet Dent 1998;62:335-338. 96.

82. Liu ZJ, Yamagata K, Kasahara Y, Ho G:Electromyographic examination of jaw mus-cles in relation to symptoms and occlusion ofpatients with temporomandibular joint disor-ders. ./ Oral Rehabil 1999; 26(0:33-47. 97.

83. Pinho JC, Caldas FM, Mora MJ, Santana-Pem'nU: Electromyographic activity in pat ientswith temporomandibular disorders. J Oral 98.Rehabil 2000: 27(11):985-990.

84. Alajbeg IZ. Valentic-Peruzovic M, Alajbeg I,Illes D: Influence of occlusal stabilizationsplint on the asymmetric activity of mastica- 99.tory muscles in patients with lemporo-mandibular dysfunction. Coll Antropol 2003;27(0:361-371. 100.

85. Glaros AG, Burton E: Parafunctional clench-ing, pain, and effort in temporomandibulardisorders. J Behav Med 2004; 27(1):91-100.

86. Pallegama RW. Ranasinghe AW, Weerasinghe 101.VS, Sitheeque MA: Influence of masticatorymuscle pain on electromyographic activitiesof cervical muscles in patients with myoge-nous temporomandibular disorders. J Oral 102.Rehabil 2004; 31(5):423-429.

87. Bodere C, Tea SH, Giroux-Metges MA, WodaA: Activity of masticatory muscles in sub-jects with different orofacial pain conditions. 103.Pain 2005; 116(l-2):33-41.

88. da Silva MA, Issa JP, Vitti M, da Silva AM,Semprini M. Regalo SC: Electromyograph-ical analysis of the masseter muscle in dentu-lous and partially toothless patients 104.with temporomandibular joint disorders.Electromyogr Clin Neurophysiol 2006:46(5):263-268. 105.

89. Tosato Jde P. Caria PH: Electromyographicactivity assessment of individuals with andwithout temporomandibular disorder symp-toms. J Appl Oral Sci 2007; 15(2): 152-155.

90. Ries EG, Alves MC, Berzin F: Asymmetric 106.activation of lemporalis, masseter, and stern-ocleidomastoid muscles in temporomandibu-lar disorder patients. J Craniomandib Pracl2008; 26(0:59-64.

91. Tartaglia GM. Morcira Rodrigues da SilvaMA, Bottini S, Sforza C, Ferrario VF: 107.Masticatory muscle activity during maxi-mum voluntary clench in different researchdiagnostic criteria for lemporomandibulardisorders (RDC/TMD) groups. Man Ther 108.2008; 13(5):434-440.

92. Bodere C, Woda A: Effect of a jig on EMGactivity in different orofacial pain conditions.IntJProsthodont200&;2\(3):253-25&.

93. Tecco S, Tete S.D'AttilioM.PerilloL, Festa F: 109.Surface electromyographic patterns of masti-catory, neck, and trunk muscles in temporo-mandibular joint dysfunction patients

undergoing anterior repositioning splint ther-apy. Eur J Orthod 2008; 30(6):592-597. 110.

Santana-Mora, U. Cudeiro J, Mora-BermudezMJ, Rilo-Pousa B, Ferreira-Pinho JC. Otero-Cepeda JL, Santana-Penin U: Changes inEMG activity during clenching in chronicpain patients with un i la te ra l temporo- 1 1 1 .mandibular disorders. J Electromyographyand Kinesiology 2009; I9(6):e543-549.

Ardizone I. Celcmin A, Aneiros F, del Rio J,Sanchez T, Moreno I: Electromyographic 112.study of activity of the masseter and anteriortemporalis muscles in patients with temporo-mandibular joint (TMJ) dysfunction: com- 113.parison with the clinical dysfunction index.Med Oral Patol Oral Cir Ritcal 2010;

Botelho AL, Silva BC, Gentil FH, Sforza C, da 114.Silva MA: Immediate effect of the resilientsplint evaluated using surface electromyog-raphy in patients with TMD../ CraniomandibPrac/2010; 28(4):266-273. 115.

Hermens HJ, Boon KL, and Zilvold G: Theclinical use of surface EMG. Medica Phvsica1986; 9:1 19-130.

Goldensohn E: Electromyography. In: Disord-ers of {he temporomandibular joint. Lazlo 1 16.Schwartz, cd. Philadelphia/London: W.B.SaundersCo., 1966:163-176.

Lloyd AJ: Surface electromyography duringsustained isometric contractions. J AppliedPhysiology 1971; 30(5):713-719. 1 3 7 .

Burdette BH, Gale EN: Intersession reliabilityof surface electromyography. Journal ofDental Research, [Abstract No. 1370], Vol66. 1987.

Christensen LV: Reliability of maximum static 1 18.work efforts by the human masseter muscle.Aw J Orthod Dentofacial Onhop 1989:95(l):42-45.

Burdette BH, Gale EN: Reliability of surfaceelectromyography of the masseleric and ante- 119.rior temporal areas. Arch Oral Biol 1990;35(9):747-751.

Ferrario VF, Sforza C: Coordinating elec-tromyographic activity of the human mas-seter and temporalis anterior muscles during 120.mastication. Eur J Oral Sci 1996: 104(5-6):531-517.

Buxbaum J, Mylinski N, Parente FR: SurfaceEMG re l iab i l i ty using spectral analysis . 121.J Oral Rehabil 1996; 23(1 l):77I-775.

Castroflorio T. Icardi K, Torsello F. DeregibusA, Debernardi C, Bracco P: Reproducibil-ity of surface EMG in the human masseter 122.and anterior temporalis muscle areas.J Craniomandib Pract 2005; 23(2):130-137.

Castroflorio T, Icardi K, Becchino B, Merlo E,Debernardi C, Bracco P,Farina D: Repro-ducibility of surface EMG variables in iso- 123.metric sub-maximal contractions of jawelevator muscles. J Electromyogr Kinesiol2006;16(5):498-505. Epub 2005 Nov 15.

Castroflorio T, Bracco P, Farina D: Surfaceelectromyography in the assessment of 124.jaw elevator muscles. / Oral Rehabil 2008;35(8):638-645. Epub 2008 May 9.

De Felfcio CM, Sidequersky FV, TartagliaGM, Sforza C: Electromyographic standard-ized indices in healthy Brazilian young adults 125.and data reproducibility. J Oral Rehabil2009; 36(8):577-583. Epub 2009 Jun 22.

Pantaleo T, Prayer-Galletti F, Pini-Prato G, 126.Prayer-Galletti S: An electromyographicstudy in patients with myofacial pain- dys-function syndrome, Bulletin Group. Int Rech

scStomatetOdontl9&3;2(,:\67-tl9.Stohler C, Yamada Y, Ash MM: Antagonistic

muscle stiffness and associated behavior inthe pain dysfunctional state. Helv Odont Acta1985; 29:2, also in Schn-ei-. Mschr. Zahnmed1985; 95:719-726.

SlohlerC, Ash MM: Demonstration of chewingmotor disorder by recording peripheral corre-lates of mastication. J Oral Rehab 1985;12:49-57.

Cooper BC, Alleva M, Cooper D. Lucente FE:Myofacial pain dysfunction: analysis of 476patients. Laryngoscope 1986; 96:1099-1106.

Nielsen I, Miller AJ: Response patterns of cran-iomandibular muscles with and without alter-ations in sensory feedback. J Prosthet Dent1988; 59(3):352-362.

Mongini F, Tepia-Valenta, G, Conserva E:Habitual mastication in dysfunction: a com-puter-based analysis. J Prosthet Dent 1989;1:484-494.

Williamson EH, Hall JT, Zwemer JD: Swal-lowing patterns in human subjects with andwithout temporomandibular dysfunct ion.Am J Orthod Dentofac Onhop 1990: 98:507-511.

Nielsen IL, McNeill C, Danzig W. Goldman S,Levy J, Miller AJ: Adaptation of craniofaciaimuscles in subjects with craniomandibulardisorders. Am J Orthod Dentofac Orthop1990; 97(0:20-34.

Kuwahara T, Miyauchi S, Maruyama T: Clinicalclassification of the patterns of mandibularmovements during mastication in subjectswith TMJ disorders. Int J Prosthodont 1992;5(2):122-129.

Tsolka P. Fenion M, McCullock A, Preiskel H:Controlled clinical, electromyographic andkincsiographic assessment of craniomandibu-lar disorders in women. J Orofacial Pain1994; 8:80-89.

Kuwahara T, Bessette RW, Maruyama T:Chewing pattern analysis in TMD patientswith unilateral and bilateral internal derange-ment. J Craniomandib Pracl 1995:13(3):167-172.

Cooper BC: The role of bioelectronic instru-ments in documenting and managing TMD.New York State Dental Journal 1995;November:48-53.

Heffez L. Blaustein D: Advances in sonogra-phy of the temporomandibular joint. OralSurg Oral Med Oral Pathol 1986; 62(5):486-495.

Gay T, Bertolami CN, Donoff RB, Keith DA,Kelly JP: The acoustical characteristics of thenormal and abnormal temporomandibularjoint. J Oral Maxillofac Surg 1987; 45(5):397-407.

Ishigaki S, Bessette RW, Maruyama T: A clin-ical study of temporomandibular joint (TMJ)vibrat ions in TMJ dysfunction patients.J Craniomandib Pracl 1993: 11(1) :7-13;[Discussion. 14],

Deng M. Long X. Dong H. Chen Y. Li X:Electrosonographic characteristics of soundsfrom temporomandibular joint disc replace-ment. Int J Oral Maxillofac Surg 2006;35(5):456-460.

US Food and Drug Administration. Re-reviewof Devices for Diagnosis and Management ofTMJ/TMD, October 20, 1997

U.S. Food and Drug Administration: Meetingofihe Dental Products Advisory Panel regard-ing the Classification of Devices for theTreatment and/or Diagnosis of Temporo-



mandibular Joint Dysfunction and/or Oro-facialPain. Augusts, 1998.

127. ADA Council on Dental Materials, Instrumentsand Equipment: Seal of Recognition. January3, 1986.

1 28. ADA Council on Dental Materials, Instrumentsand Equipment: Seal of Acceptance, June 16,1993.

129. Report on Acceptance of TMD Devices. ADACouncil on Scientific Affairs. J Am DentAssoc 1996; 127;1615-1616.

130. Council on Dental Materials: Instruments andEquipment: Acceptance Program Guidelinesfor Instruments as Aids in the Diagnosis ofTemporomandibular Disorders. ChicagoAmerican Dental Association, 1 99 1 .

131 . Dahlstrom L: Electromyographic studies ofcraniomandibular disorders: a review of theliterature. J Oral Rehab 1989; 16:1-20.

132. Travel] JG, Simons DG: Myofascial pain anddisfunction. Baltimore: Williams & Wilkins1983:169-170.

1 33. Talley RL, Murphy GJ, Smith SD, Baylin MA,Haden JL: Standards for the history, exami-nation, diagnosis, and treatment of temporo-mandibular disorders: a position paper.J Craniomandib Pract 1990; 8:60-64.

1 34. McCall WD Jr.: A textbook of occlusion. CarolStream, IL: Quintessence; 1988.

135. Moller E: Clinical electromyography in den-tistry. Ini DentJ 1969; 19:250-266.

136. Kawazoe Y. Kotani H, Hamada T, Yamada S:Effect of occlusal splints on the electromyo-graphic activities of masseter muscles duringmaximum clenching in patients with myofas-cial pain dysfunction syndrome. J ProsthetDent 1980; 43:578-580.

1 37. Myslinski NR, Buxbaum JD, Parente FJ: Theuse of electromyography to quantify musclepain. Meth and Find Exptl Clin Pharmacol1985; 7(10):55 1-556.

138. Sheikholeslam A. Holmgren K, Riise C: A clin-ical and electromyographic study of the long-term effects of an occlusal splint on thetemporal and masseter muscles in patientswith functional disorders and nocturnal brux-ism. JOralRehabil 1986; 13:137-145.

139. Jankelson RR: Analysis of maximal elec-tromyographic activity of the masseter andanterior temporalis muscles in myocentricand habitual centric in temporomandibularjoint and musculoskeletal dysfunction. In:Pathophysiology of head and neck muscu-loskeletal disorders. Bergamini M. PrayerGalletti S, eds, Front Oral Physiol, BaselKarger 1990; 7:83-98.

140. Lynn JM: Craniofacial neuromuscular dysfunc-tion vs. function: A comparison study of thecondylar position and intra-arlicular space.In: Pathophysiology of head and neck muscu-loskeletal disorders. Bergamini M, PrayerGalletti S, eds. Front Oral Physiol, BaselKarger 1990; 7:136-143.

141. Coy RE, Flocken JE, Adib F: Musculoskeletaletiology and therapy of craniomandibularpain and dysfunction. Cranio Clinics Intl1991;163-I73.

142. Lynn JM, Mazzocco M: Intraoral splint ther-apy: muscles objectively. Fund Orthodont1991:11-27.

143. Jankelson RR: Validity of surface electromyo-graphy as the "gold standard" for measuringmuscle postural tonicity in TMD patients. In:Anthology of craniomandibular orthopedics.Vol. II- Coy R, ed. International College ofCranio-Mandibular Orthopedics, Seattle WA

1992:103-125.144. Lynn J. Mazzocco M, Miloser S. Zul lo T:

Diagnosis and treatment of craniocervicalpain and headache based on neuromus-cular parameters, Am J of Pain Mgt 1992;2:(3):143-I51.

145. Hickman DM, Cramer R, Stauber WT. Theeffect of four jaw relations on electromyo-graphic activity in human masticatory mus-cles. Archs Oral Biol 1993; 38(3):26l-264.

146. Bracco P, Deregibus A, Piscetta R, GiarettaGA: TMJ clicking: a comparison of clinicalexamination, sonography. and axiography.J Craniomandib Pract 1997; 15(2):121-126.

147. Hickman DM, Cramer R: The effect of differ-ent condylar positions on masticatory muscleelectromyographic activity in humans. OralSurg Oral Med Oral Pathol Oral Radial

148.

149.

151.

152.

153.

154.

155.

156.

157.

159.

Elfving L, Helkimo M, Magnusson T: Preva-lence of different temporomandibular jointsounds, with emphasis on disk-displacement,in patients with temporomandibular disor-ders and controls. Swed Dent J 2002; 26(1):9-19.

Widmalm SE, Lcc YS, McKay DC: Clinicaluse of qualitative electromyography in theevaluation of jaw muscle function: a practi-tioner's guide. J Craniomandib Pract 2007;25:1-11."

Hugger A. Hugger S, Schindler H: Surfaceelectromyography of the masticatory mus-cles for application in dental practice. Currentevidence and future developments. Int JComput Dent 2008; 11(2):81-106.

Cooper B: The role of bioelectric instrumenta-tion in documenting and managing temporo-mandibular disorders. J Am Dent Assoc 1996;127:1161-1164.

Cooper B: The role of bioelectric instrumenta-tion in the documentation of management oftemporomandibular disorders. Oral SurgOral Med Oral Pathol Oral Radial Endod1997; 83(1): 91-100.

Shpuntoff H. Shpunloff W: A study of physio-logical rest position and centric position byelectromyography. J Prosthet Dent 1956; 6(5):621-628.

Choi B: On the mandibular position regulatedby Myo-monitor stimulation. J JapaneseProsthetic Dent 1973; 17:73-96.

Wessberg GA, Epker BN, Elliot AC: Compar-ison of mandibular rest positions induced byphonetics, transcutaneous electrical stimula-tion and masticatory electromyography.JProsth Dent 1983; 49(1):100-I05.

Williamson E, Marshall D: Myomonitor restposition in the presence and absence of stress.In: Facial orthopedics and temporomandibu-lar arthrography. Williamson E. ed. 1986;3(2):14-17.

Konchak P, Thomas N, Lanigan D, Devon R:Freeway space measurementusingMandibularKinesiograph and EMG before and afterTENS. Angle Orthodontist 1988; 58(4):343-350.

Michelotti A, Farella M, Vollaro S, Martina R:Mandibular rest position and electrical activ-ity of the masticatory muscles. J ProsthetDent 1997; 78:48-53.

Jankelson RR: Effect of vertical and horizontalvariants on the resting activity of the masti-catory muscles. In: Anthology of cran-iomandibular orthopedics. Vol IV, Coy R,ed. Internat ional College of Cranio-Mandibular Orthopedics, Seattle WA. 1997;

69-76.160. Mann A, Miralles R, Cumsille F: Influence of

vertical dimension on masseter muscle elec-tromyographic activity in patients wi thmandibular dysfunction../ Prosth Dent 1985:53(2):243-247.

161. Miralles R, Dodds C, Palazzi C, Jaramillo C,Quezada V, Ormeno G, Vellagas R: Verticaldimension. Part I: Comparison of clinicalfreeway space. J Craniomandib Pract 2001;19(4):230-236.

162. Paesani D, Westesson P-L, Hatala MP, TallentsR. Brooks SL: Accuracy of clinical diagnosisfor TMJ internal derangement and arthrosis.Oral Surg Oral Med Oral Pathol 1992;73:360-363.

163. Gomes MB, Guimares JP, Guimares FC, NevesAC: Palpation and pressure pain threshold:reliability and validity in patients with tem-poromandibular disorders. J CraniomandibPract. 2008; 26(3):202-210.

164. Gaudet EL, Brown DT: Temporomandibulardisorder treatment outcomes: first report of alarge scale prospective study. J CraniomandibPract 2000; 18(1): 9-22.

Dr. Barry Cooper received his D.D.S. degreein 1963 from Columbia University School ofDental and Oral Surgery. He is currently aclinical professor, Division of Translations!Oral Biology of the State University of NewYork (SUNY) Stony Brook School of DentalMedicine. Dr. Cooper has held faculty positionsat Columbia University School of Dental andOral Surgery, New York Medical College, andTemple University School of Dentistry. He ispast international president of the InternationalCollege of Cranio-Mandibular Orthopedics(ICCMO). Dr. Cooper maintains a privatepractice in Hewlett and Manhattan, New York,limited to the treatment of patients with tem-poromandibular disorders.


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