Original Article Periodontal Mechanoreceptors Stimulated Study of Human

Masseter Reflex Control Prior and During Fixed and

To cite: Jayanthi M S,
Functional Orthodontic Appliance Therapy
Selvarani R, S.
1
Jayanthi M S, 2S elvarani R, 3S. Premkumar
1
Premkumar, Periodontal Senior Assistant Professor, Assistant Professor, 3Professor
Mechanoreceptors 1-3
Department of Orthodontics, Government Dental College and Hospital Chennai, India
Stimulated Study of
Human Masseter Reflex
Control Prior and During ABSTRACT
Fixed and Functional Background: The role of periodontal mechanoreceptors (PMRs) in the reflex control of the
Orthodontic Appliance
jaw muscles has been mainly derived from animal studies and few human studies. This
Therapy
study investigated the response of the PMRs in the activity of the masseter muscles in
J Contemp Orthod humans to controlled orthogonal stimulation of the upper left central incisor, both before and
2018;2(4):33-38. during orthodontic treatment.
Received on: Materials and methods: Surface EMG of sixteen neurologically normal male subjects
18-10-2018 (mean age 13.2) were recorded following a rapid stimuli of 3Newtons. 8 class II patients
Accepted on: with retrognathic mandible were treated with twin block and 8 class I patients were treated
23-11-2018 with pre adjusted fixed appliance. Pre-treatment and during treatment EMG of masseter
Source of Support: Nil were recorded in both the groups in three stages namely without stimulus in rest position,
Conflict of Interest: None with stimulus in rest position without splint and with both stimulus and splint.
Results: The class I subjects showed a statistically significant (p<0.05) decrease in latency
Corresponding Author:
period when compared to class II subjects. This showed that the class I malocclusions had
Sridhar Premkumar
Prof. & Head quicker excitation of PMR stimulated masseteric reflex when compared to class II div I
Department of Orthodontics malocclusion. Both the groups showed variations in post-treatment post-stimulus response
Tamilnadu govt. dental when compared to pre-treatment response. There was a statistically significant reduced
college and hospital. latency period.
Chennai
Conclusions: This study has shown that periodontal mechanoreceptors supply information
regarding position and forces applied to the tooth. Large scale studies are needed to
validate these findings.
Key Words: Periodontal mechanoreceptors, Masseteric reflex and tooth movement.

tooth movement, it is logical to assume that function and or

INTRODUCTION
response of mechanoreceptors could be interfered during or after
The connective tissue structure, periodontal ligament [PDL] orthodontic treatment. The neuromuscular reflex pattern changes
suspends teeth in their socket by linking the cementum and following the teeth movement is a poorly elucidated topic. There
alveolar bone. With diverse functions, PDL is innervated are little studies regarding the neuromuscular reflex and its
richly by nerve endings and receptors that are involved in relation to positional changes in tooth. The available literatures
proprioception and neuromuscular reflex. The application of are mostly limited to animal studies. 6-8 The scientific literature is
orthodontic force induces a cascade of biophysical, silent in this aspect of research and therefore this study was done
bioelectrical and biochemical changes which results in to highlight the role of periodontal mechanoreceptors in reflex
alveolar translocation, where in the tooth along with its control of human masticatory system and also following
attachment apparatus is moved from one position to another. orthodontic treatment. Stimulation of the periodontal
The orthodontic appliance therapy remodels PDL and alveolar mechanoreceptors can be achieved by mechanical means and the
bone simultaneous to the altered teeth position. Numerous easiest way to mechanically stimulate teeth is by means of
studies had extensively dealt with these tissue changes tapping the labial surface of incisor teeth with a probe
observed in PDL, bone tissues and TMJ. 1-4 McNamara stated (orthogonal stimulation).
that during functional jaw orthopaedic treatment the orofacial
system undergoes considerable change and the mandible Experiments in animals indicate that a large amount of feedback
presumably attains an altered functional position.5 Occlusal for jaw-closing muscles comes from periodontal
9, 10
alterations also result from modifications of respective mechanoreceptors (PMRs). Human reflex studies can be used
skeletal bases and from migration and tipping of teeth in the to investigate the synaptic connections between afferent systems
maxillary and mandibular dentitions. and moto neurons. The principle muscle reflexes evoked by
stimulation of periodontal mechanoreceptors involve only the
Subsequent to the remodeling of PDL during orthodontic jaw closing muscles and the measurement can be done by

Journal of Contemporary Orthodontics, October-December 2018 Volume 2 Issue 4 (page 33-38) 33

 Jayanti M. S, et. al.

studying the surface EMG changes in masseter. visually identified in the signal. Therefore, a total of sixteen
participants were available for inclusion in the current study.
The aim of the study was to study the role of PDL
The sample was divided into 2 groups of 8 subjects each. Groups
mechanoreceptors in neuromuscular reflex after orthogonal
1 had Angles class II div I malocclusion on a class II skeletal
stimulation on the labial surface of the central incisor before
base with retrognathic mandible and Group 2 had Angles class I
and during orthodontic and functional jaw orthopaedic
malocclusion with increased over jet on a class I skeletal base.
treatment. The contribution of PMR is assessed by the reflex
All these subjects had reported for correction of malocclusion.
response of human masseter reflex control by stimulated
The study models were prepared and the routine clinical
periodontal mechanoreceptors using surface electromyogram
photographs and lateral cephalometric radiographs were taken
[EMG].
for the subjects both before and during the orthodontic appliance
therapy.
METHODS General protocol. The bilateral surface EMG recording of
Ethical approval. Written informed consent was obtained masseter was done after mechanical stimulation prior to and
from all the subjects who participated in the study. The during orthodontic treatment. The group 1 subjects underwent
protocol was approved by the Institutional Ethics committee Twin block Functional appliance therapy with 6 mm advanced
and all procedures used conformed to the Declaration of construction bite and vertical opening of 2mm above the freeway
Helsinki. space. The group 2 subjects underwent extraction of bilateral
Subjects. Sixteen neurologically normal male subjects with maxillary first premolar and treatment with pre-adjusted
healthy teeth and gums, and no history of orthodontic edgewise fixed appliance therapy as part of routine orthodontic
treatment or dysfunction aged between 9–15 years (mean age treatment. The subjects were made to be seated in postural rest
of 13.2) participated in the study. Consumption of analgesics position with Frankfort horizontal plane parallel to the floor. A
24 hours before the study was not allowed. A total of 37 fixed nosepiece was used to minimize the movement of the
participant records were initially reviewed. Eleven subject’s head, which also counteracted the axial forces applied

Table 1: Recorded EMG values of both the groups with and without splints.
Pre-treatment
Rt.masseter Rt.masseter With Lft. masseter Lft. masseter With splint
Without splint splint Without splint
(silent period, latency period)
(silent period, (silent period, (silent period,
latency period) latency period) latency period)
Group 1 350ms, 250ms, 350ms, 200ms,
21ms 31ms 16ms 20ms

Group 2 200ms, 200ms, 275ms, 250ms,

17ms 14ms 17ms 13ms

Post-treatment
Group 1 400ms, 250ms, 200ms, 250ms,
17ms 12ms 20ms 25ms

Group 2 250ms, 200ms, 200ms, 200ms,

18ms 13ms 12ms 9ms

The silent period was followed by an inhibitory response with a latency period.
participants were excluded because they failed to meet the to the tooth. The masseter muscle EMG location was determined
inclusion criteria and therefore did not participate in the by palpating the area while the participant clenched and relaxed
experimental session. Six participated in the recording jaw muscles. The skin around the area of the masseter muscle
session, but due to reasons like non-compliance in wearing of was then cleaned with an alcohol wipe to clear away any debris
the functional appliance were excluded. Four participants or dead skin. Then, a piece of biomedical tape was dabbed on
were excluded due to insufficient signals, not following the area to remove any excess debris or dead skin. Finally, an
directions, or because three stage sequences could not be adhesive interface was placed on the sensor and the sensor was

34
 Periodontal Mechanoreceptors Stimulated Study of Human Masseter Reflex Control…

then placed onto the various areas. group 1 and 2 subjects. If the p value calculated is < .05 it was
Silver chloride gel was applied on the bilateral masseter considered statistically significant. Correlation test been done
muscles. Surface electrodes were placed on the skin overlying with Pearson 2-tailed test to correlate significance difference
the left and right masseter muscles in order to detect the within group1 and group2. The significance was set at the level
SEMG activity. Grounding of the subject was achieved by the of .01 and .05 respectively. Paired T-Test was done to compare
use of a hand wrist electrode and mastoid bone was used as pre-treatment and post treatment changes of group 1 and group
the bony area of reference (Figure 1). The masseter reflex 2. NPar Tests- Wilcoxon Signed Ranks Test were used which
activity was recorded using 9mm wide electrode in 3 stages . was a non-parametric test that compared the median of a column
The EMG of normal masseter reflex in this rest position was of numbers against a hypothetical median. In our study it was
recorded (stage 1). Without changing the postural rest done for the post and pre-treatment silent period values which
position, the orthogonal mechanical stimulation was given to exceeded normal mean parameters. The data collected were
the maxillary left central incisor on its labial surface by an assessed using SPSS statistical software (version 20.0, SPSS
impact hammer of digital storage oscilloscope which ensured Inc., Chicago, IL, USA).
uniform force of 3 Newton and the EMG activity was
RESULTS
recorded (stage 2). The stimulus was delivered after the start
of the oscilloscope sweep. For uniform posterior disclusion, a The Pearson 2-tailed test was used to correlate significance
3mm thick acrylic occlusal splint with relief on labial aspect difference within groups 1 and 2 and the significance were at the
and covering on lingual aspect was used. The EMG activity level of .01 and .05 respectively. There was statistical
was recorded after mechanical stimulation on the labial significance in pre-treatment records within group 1 (at 0.01
surface of the same incisor with occlusal splint and in the level) and within group 2 (at 0.05 level) right and left latency
same postural rest position (stage 3). To avoid change in periods with and without splint. There was statistical
EMG due to anticipation of the stimulus, it was necessary to significance in post-treatment records within group 1 at 0.05
apply the stimuli at random intervals so the subject could not level (table 2) and within group 2 at 0.05 level (table 3) right and
predict when they would occur. 11 All the EMG recordings left latency periods without and with splint (Figure 2 and 3).
were amplified, full wave rectified, filtered with sensitivity of However in group 2, the latency period was decreased in left
20mV, Frequency 50Hz-500Hz and stored in the computer. side both with splint and without splint.
The entire procedure was repeated after 6 weeks of The p-value of groups 1 and 2 subjects were done using T-test
orthodontic treatment. The changes in the incisor position and values less than 0.05 were considered statistically
were also recorded after 6 weeks in both groups. The results significant. There was a statistical significance between group 1

Table 2. Tabulation of group 1 post treatment correlations.

Correlations Rt - Post Lt - Post RS - Post LS - Post
Treatment Treatment Treatment Treatment
Rt - Post Treatment Pearson Correlation 1
nt .330
nt .783*
nt .807*
Sig. (2-tailed) .424 .022 .016
N 8 8 8 8
Lt - Post Treatment Pearson Correlation .330 1 -.122 .599
Sig. (2-tailed) .424 .774 .117
N 8 8 8 8
RS - Post Treatment Pearson Correlation .783* -.122 1 .620
Sig. (2-tailed) .022 .774 .101
N 8 8 8 8
LS - Post Treatment Pearson Correlation .807* .599 .620 1
Sig. (2-tailed) .016 .117 .101
N 8 8 8 8
*Correlation is significant at the 0.05 level (2-tailed).There was a statistical significant difference in post treatment
records within group 1 right and left latency periods both with and without splints
were tabulated (Table 1) and statistically analyzed. and group 2 in the pre-treatment latency period at p <0.05. There
Statistics. T-test was done to calculate the p-value for the was a decrease in the latency period in group 2 [Rt-21.13, Lt-

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 Jayanti M. S, et. al.

19.81, RS-14.25, LS-16.38]. But, there was no statistical stimulated the stretch receptors of the muscles and influenced the
significance between group1 and 2 in post treatment at p reflex response. 12 Therefore in this present study the mechanical
>0.05, with and without splint. stimulation given was brisk taps which were able to deliver force
The paired T-Test was done to compare pre-treatment and of 3N which had been standardized by means of digital storage
post-treatment changes of the subjects of both groups. The oscilloscope. The effects of most of the stimuli used in the
pattern of masseteric reflex in the post-treatment of group 1 present study have been localized to receptors in the periodontal
and group 2 was same as pre-treatment of group 1 and group area.
2 at p >0.05. There was no statistical difference between pre-
The general pattern of response of masseter to the mechanical
treatment silent period in group 1 and also in group 2 subjects
stimulation is that of a silent period which was followed by an
at p>.05; and between post-treatment silent period in
inhibitory response. The averaged electromyography response in
group1and group 2(p>.05).
this study showed a characteristic inhibitory response following
The NPar Test- Wilcoxon Signed Ranks Test were used in
a silent period with a latency of about 18ms. The time gap
this study to compare the silent period values that exceeded
between the inhibitory and excitatory response constitute the
Table 3. Group 2 post treatment correlations
Correlations Rt - Post Lt - Post RS - Post LS - Post
Treatment Treatment Treatment Treatment
Rt - Post Treatment Pearson 1 -.455 .744* .321
Sig. (2-tailed)
Correlation .257 .034 .439
N 8 8 8 8
Lt - Post Treatment Pearson -.455 1 -.245 .121
Correlation
Sig. (2-tailed) .257 .558 .776
N 8 8 8 8
RS - Post Treatment Pearson .744* -.245 1 .205
Correlation
Sig. (2-tailed) .034 .558 .627
N 8 8 8 8
LS - Post Treatment Pearson .321 .121 .205 1
Correlation
Sig. (2-tailed) .439 .776 .627
N 8 8 8 8
*Correlation is significant at the 0.05 level (2-tailed). There is a statistical significance in post treatment records within
group 2 right and left latency periods with and without splint. The latency period is decreased in left side both with splint
and without splint.

normal mean parameters between the before and after latency period. The latency period will be followed by an
treatment initiation stages of the subjects. There was a excitatory reflex, which occurs due to actual contraction of
statistical significance in the post-treatment silent period in masseter muscle and causes closure of mouth. In this study, the
group 2 subjects. There was a decrease in the post-treatment excitatory reflex could not be elicited because the subjects were
silent period latency in the left side with splint. prevented by the splints from closing the mouth. Also the
findings were recorded only in postural rest position. 13 This kind
DISCUSSION
of neuromuscular reflex following stimulation of periodontal
Periodontal mechanoreceptors are special kind of receptors mechanoreceptors without the excitatory reflex considered as
which are directional sensitive and they respond more to the periodontal masseter reflex to distinguish from jaw closing or
direction of force and also temperature sensitive. Human jaw jerk reflex. The inhibitory response seen following the
periodontal mechanoreceptive afferents innervating the mechanical stimulation is essentially a protective reflex. This
anterior teeth respond to loads applied to the teeth and are all serves to reduce the activity of the jaw closing muscles when a
slowly adapting. They are active spontaneously and discharge person bites unexpectedly on heavy objects. 12
regularly in response to forces applied to teeth. They are
similar to type II mechanoreceptors of skin, which are slow
adapting in nature. The periodontal mechanoreceptors can be
stimulated when the tooth is moved within the alveolar bone.
Mechanical stimulatory force delivered more than 5N and it

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 Periodontal Mechanoreceptors Stimulated Study of Human Masseter Reflex Control…

There was a definite change in the response of the masseter

muscle to the periodontal mechanoreceptors. The reflex
inhibition period was shorter in post treatment reflex. This result
is in contrast to the finding of a study by authors. 15, 16 This
could be attributed to the difference in method of stimulation. In
this study orthogonal stimulation was employed in rest position
in contrast to axial stimulation followed by closure of mouth in
their study by the authors. 15, 16 No significant changes were
observed when post treatment post stimulus response of group 1
and group 2 were compared.

Though there was unilateral mechanical stimulus applied on the

Fig.1 Diagrammatic representation of the experimental set up. left side, the post stimulus response of the right side showed
The subjects bit into the acrylic splint, with relief on the labial variation from pre stimulus recording in this study. This finding
surface. Movement of the subject was further minimized by correlates with the findings of a previous study, who found that
the use of a fixed nosepiece. A digital storage oscilloscope unilateral electrical stimulus, stimulates bilateral masseteric
then produced the desired force of 3 N. The bony reference moto neurons. 17
area selected was the mastoid bone (the electrodes kept
behind the ears). The bilateral masseter EMG was amplified,
full wave rectified, filtered (band width20-50Hz) with
sensitivity of 20mV, High frequency- 50Hz and low
frequency 500Hz, and stored in the computer.

Analysis of pre-treatment reflex findings showed that

experimental side (left masseter) showed statistically
significant increased silent period followed by a reduction in
latency period. These findings coincide with that of O’Connor Fig.2 Box-plot compares the pre-test and post-test of right and
SJ and Türker KS. 14 The mechanical stimulation of human left masseter without splint.
tooth evokes and increased silent period and there is a
transient excitation of periodontal masseteric reflex which
results in reduction of latency period. Similar results were
obtained in both group 1 and group 2 subjects following
mechanical stimulation. Another significant finding was the
difference in masseteric reflex response between subjects with
class II div I malocclusion (group1) and class I malocclusion
(group 2). Group 2 subjects showed a statistically significant
(p<0.05) decrease in latency period when compared to group
Fig.3 Box-plot compares the pre-test and post-test of right and
1 subjects. The reduction in latency period among subjects
left masseter with splint.
with class I malocclusions showed that these subjects had
quicker excitation of masseteric reflex when compared to This study has shown that periodontal mechanoreceptors supply
slower excitation among subjects with class II div I information regarding position and forces applied to the tooth in
malocclusion. The pattern of masseter EMG reflex in the post accordance with a previous study by authors who discovered that
treatment was the same as pre-treatment silent period the strength of the inhibitory reflex response to a tooth-tap
followed by inhibitory reflex has shown as latency period. stimulus was much larger than previously stated and that
periodontal mechanoreceptors are extremely sensitive tactile
But both group 1 and group 2 subjects showed variations in
sensors present in natural teeth. 18 These sensors provide
post treatment post stimulus response when compared to pre-
information about tooth loads and are located among the
treatment response. Silent period showed no significant
collagen fibres in the periodontal ligament. The changes
difference, but there was a short latency inhibitory reflex
observed in the study indicated that orthodontic force can induce
response shown by a statistically significant reduction in
functional changes in the periodontal mechanoreceptors, which
latency period. This showed that application of orthodontic
was evident in the altered response following application of
force did not change the occurrence of masseteric reflex.

Journal of Contemporary Orthodontics, October-December 2018 Volume 2 Issue 4 (page 33-38) 37

 Jayanti M. S, et. al.

orthodontic force. It remains to be seen whether the altered 8. Takayoshi Ishida, Tadachika Yabushita, Kunimichi Soma.
response is a transient phenomenon and will it revert to Functional changes of temporomandibular joint
original state after completion of orthodontic treatment. mechanoreceptors induced by reduced masseter muscle
Another interesting finding to be explored further is the activity in growing Rats. Angle Orthodontist, 2009; 79:
difference observed in the periodontal masseteric reflex 978–983.
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components facilitating jaw-closing muscle activities in the
This study was carried out by applying rapid orthogonal
rabbit. Exp Brain Res, 1989; 76: 424–440.
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11. Ottenhoff FA, van der Bilt A, van der Glas HW, Bosman
the factors can throw new information on the role of PMRs in
F. Peripherally induced and anticipating elevator muscle
neuromuscular reflex pathways.
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ACKNOWLEDGEMENT Neurophysiol, 1992; 67: 75–83.
We are greatly thankful to Karunanithi C for his support in 12. Yang J, Türker KS. Jaw reflexes evoked by mechanical
completing the study. stimulation of teeth in humans. J Neurophysiol, 1999; 81:
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None to declare. stimulation of periodontal and gingival receptors in man.
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