Anterior guidance: Its effect on electromyographic

activity of the temporal and masseter muscles

E. H. Williamson, D.D.S., M.S.,* and D. 0. Lundquist, D.D.S.**
Medical College of Georgia, School of Dentistry, Augusta, Ga

I n his classic article D’Amico’ states: “When the

canines are in normal interlocking position, the lateral
and forward movement is limited so that when an
attempt is made to move the mandible laterally or
forward, there is an involuntary reaction when the
canines comein contact. The reaction is an immediate
break in the tension of the temporal and masseter
muscles, thus reducing the magnitude of the applied
force. Regardless of how hard the individual tries to
tense these muscles, as long as the canines are in
contact, it is impossible for these muscles to assume full
tension.” He continues: “The length of the roots of the
canines and the anatomical structure of the supporting
alveolar process gives testimony to nature’s intention as
Fig. 1. Maxillary splint with verified occlusal
to the function intended. What may appear as trauma contacts.
as they come in contact is not trauma at all, because
when contact is made, muscular tension is involuntarily
reduced, thus reducing the magnitude of applied developed. A face-bow was used to mount the maxil-
force.” lary cast on an arcon-type articulator. An interocclusal
The purpose of our study was to determine the effect registration was made while using a leaf gauge2with
of two occlusal schemes on the temporal and masseter the technique reported by Williamson et a1.,3and the
muscles. The first occlusal scheme used anterior guid- mandibular cast was mounted on the articulator. A
ance to eliminate all contact of posterior teeth in maxillary acrylic resin splint was developed using the
eccentric movements. The second occlusal scheme “sprinkle on” technique with relief from undercuts
allowed selective posterior occlusal contact in eccentric provided by adapting 0.001~inch lead foil over the
movements. These occlusal schemes were developed maxillary cast. An arbitrary anterior guidance was
using maxillary occlusal splints. developed on the articulator. The mandibular cusps
In addition, it was desired to determine if the contact that occlude in centric occlusion (centric cusps) con-
of the canines or the elimination of posterior tooth tacted a flat maxillary occlusalplane developedby the
contacts reduced muscle tension. splint. The splint was adjusted in the mouth for
retention by relining with autopolymerizing acrylic
MATERIAL AND METHODS resin. The occlusion was developed with the splint so
Five subjects, all women, were selected. Four sub- that all opposing contacting teeth held 0.0005 shim
jects reported a history of dysfunction or pain associ- stock with the condyles physiologically seated in the
ated with the temporomandibular joint. The history of mandibular fossae(Fig. 1). The anterior guidance was
the fifth subject was negative for symptoms normally adjusted so that all posterior teeth discluded during
associated with temporomandibular joint dysfunction. eccentric movements as determined by articulating
Accurate maxillary and mandibular casts were tape.
Surface electrodes from a Teca EMG unit (Teca
Corp., Pleasantville, N.Y.) were attached to the right
*Associate Professor, Department of Orthodontics. and left temporal and massetermuscles.The electrodes
**Professor and Coordinator for Occlusion. to the temporal muscleswere placed 1 inch posterior

816 JUNE 1983 VOLUME 49 NUMBER 6

ANTERIOR GUIDANCE

Fig. 2. Muscle activity while subject was biting against splint with mandible in re-
truded contact position (centric relation). All muscles demonstrated electromyo-
graphic activity.

Fig. 3. Electromyogram made during a left laterotrusive movement with natural

dentition in contact. All muscles were actively contracting.

and 1 inch superior to the outer canthus of the eye. The occlusal splint with an acrylic resin bur until contact of
,location of the electrodes to the masseter muscles was the posterior teeth was established in eccentric move-
determined by palpation, and they were placed on ments. Then the tests with the second occlusal scheme
the body of the muscle midway between the origin were conducted.
and insertion. The subjects were comfortably seated Recordings were made of each subject without the
in an upright position. Recordings were printed with splint, using the same sequence to provide a standard
a paper speed of 10 cm/set and a microvoltage of for comparison.
500 pv.
All recordings were produced in the same sequence RESULTS
for both occlusal schemes. The subject was instructed to Anterior guidance provided by the splint
close firmly and maintain pressure against the splint Fig. 2 is a recording produced as subject C.B. was
while moving into right laterotrusion, back to retruded biting against the splint in the retruded contact position
contact position, into left laterotrusion, back to (centric relation). All recorded muscles demonstrate
retruded contact position, and then into protrusion. marked electromyographic activity.
Following the tests for the first occlusal scheme, the Fig. 3 demonstrates electromyographic activity as
anterior guidance was eliminated by adjusting the the same subject made a left laterotrusive movement

THE JOURNAL OF PROSTHETIC DENTISTRY 817

 WILLIAMSON AND LUNDQUIST

Fig. 4. Electromyogram made during a left laterotrusive movement with splint provid-
ing anterior guidance and posterior disclusion. Posterior disclusion was initiated as
indicated by vertical line. Reduced activity was recorded.

SOOAIV

I
.I sec.

Fig. 5. Electromyogram made while samesubject asin Fig. 4 executed a right latcrotru-
sive movement with natural dentition in contact. All muscleswere involved.

without the splint. The posterior teeth remained in with the posterior teeth in contact. There was continu-
contact during the movement. All musclescontinued to ous involvement of all musclesduring this movement.
respond with marked electromyographic activity. In Fig. 6, a right laterotrusive movement with the
The splint was reinserted and the subject instructed splint in position and occlusalcontact only on the right
to execute a left laterotrusive movement (Fig. 4). Once canine, a pattern similar to the left laterotrusive
movement was initiated, the only occlusal contact was movement with the splint was recorded. Once move-
betweenthe left canine and the splint. As the movement ment was initiated, the musclesof the laterotrusive side
was executed, there was an immediate decrease in showeda decreasein amplitude; but the decreasewas
electromyographic activity of all muscles.The greatest not as marked as that of the mediotrusive side. This
reduction of activity was seenin the right temporal and continuous activity at a decreasedamplitude on the
massetermuscles.There was a significant reduction in laterotrusive side was noted on four of the five subjects.
activity of the left temporal muscle. Some activity The four subjectshad a history of previous problems
continued in the left massetermuscle, but the ampli- associatedwith the temporomandibular joint.
tude was greatly reduced. Marked differenceswere noted between the electro-
Fig. 5 is the recording of the subjectC.B. executing a myographic activity of the involved muscles as the
right laterotrusive movement without the splint and subject madea protrusive movement without the splint

818 JUNE 1983 VOLUME 49 NUMBER 6

ANTERIOR GUIDANCE

Fig. 6. With splint inserted, electromyogram shows a significant decrease in activity as a

similar movement as depicted in Fig. 5 was executed.

LHT MASSETER

Fig. 7. Electromyogram made during a protrusive movement with teeth in contact.

Activity continued throughout range of movement.

I
500 yv

RfQiT -IS -I
.I sec.

RIQiT MASSETER

Fig. 8. Splint provided anterior guidance in this protrusive movement. Decreased

activity was noted as posterior teeth discluded (vertical line).

THE JOURNAL OF PROSTHETIC DENTISTRY 819

 WILLIAMSON AND LUNDQUIST

Fig. 9. This subject had a relatively good occlusion with few posterior contacts in
eccentric movements. Electromyogram shows decreasedactivity as most posterior teeth
discluded (vertical line) during left laterotrusive movement.

500
&Iv
_I
.I sec.

Fig. 10. When splint was inserted in samepatient as in Fig. 9 and all posterior teeth
discluded (vertical line), a dramatic decrease in electromyographic activity was
observed.

(Fig. 7) and with anterior guidance between the splint made during a left laterotrusive movement without a
and the upper anterior teeth (Fig. 8). Significant splint, and Fig. 10 is a recording with the splint
decreasein all muscleactivity was noted except for the providing anterior guidance.
left massetermuscle.It is postulated that splint therapy
prior to theserecordingswould have producedan effect Anterior guidance eliminated from the splint
that would have shown greater reduction in electro- When the anterior guidance of the splint was
myographic activity. eliminated, bilateral posterior contacts between the
Subject S.M. showed the pattern of electromyo- teeth remained during the laterotrusive, mediotrusive,
graphic activity associatedwith an individual who has and protrusive movements.A typical example of these
not had a history of temporomandibular joint involve- recordings is seen in Figs. 11 and 12. Fig. 11 is a
ment. This subject had an occlusion with an anterior recording madeof subjectJ.S. during a right laterotru-
guidance that allowed only minimal contacts of poste- sive movement with the splint providing anterior
rior teeth in eccentric movements.Fig. 9 is a recording guidance. Minimal electromyographic activity contin-

820 JUNE 1983 VOLUME 49 NUMBER 6

ANTERIOR GUIDANCE

Fig. 11. Electromyogram made during an eccentric movement while splint provided
anterior guidance. Vertical line indicates disclusion of posterior teeth.

Fig. 12. With anterior guidance eliminated, no decreasein electrical activity occurred
for samepatient as in Fig. 11.

ued when the anterior guidance discludedthe posterior mediotrusive side as the patient moved into a left
teeth. No decreasein activity is observable in Fig. 12 laterotrusive position. Fig. 15 demonstrated that both
after the anterior guidancewas removed, except for the massetermusclescontinued to record high amounts of
right temporal muscle. electromyographic activity while the activity from both
Fig. 13 is the recording made during a protrusive temporal muscles was markedly reduced. Note the
movement with anterior guidance provided by the difference in Fig. 10, which showsthe muscleactivity
splint for subjectJ.S. When the anterior guidancewas while subjectSM. made a left laterotrusive movement
eliminated from the splint and posterior contacts with the splint providing anterior guidance and poste-
remained, greater activity in the muscleswas noted rior disclusion.
(Fig. 14). .
DISCUSSION
Canine contact versus posterior tooth contacts In a previous study reported by Williamson,+ 5
On one subject, S.M., with the splint positioned and symptomatic patients were treated using similar types
providing anterior guidance, one piece of shim stock of splints until the patients became asymptomatic.
0.0005 inch in thickness was placed over the right or Then electromyographic recordings were made. These

THE JOURNAL OF PROSTHETIC DENTISTRY 821

 WILLIAMSON AND LUNDQUIST

Fig, 13. Electromyogram made during a protrusive movement with anterior guidance
shows some decrease in activity.

Fig. 14. With anterior guidance removed, electromyogram for same patient as in Fig. 13
shows no decrease in activity for protrusive movement.

SOo&v
1
.I sec.

Fig. 15. With a piece of shim stock on right occlusal surface, electromyogram made
during a left laterotrusive movement shows that both masseter muscles remained
very active.

822 JUNE1983 VOLUME 49 NUMBER L

ANTERIOR GUIDANCE

recordings demonstrated an even greater reduction in CONCLUSIONS

the electromyographic activity of the temporal and The results of this investigation indicate that only
masseter muscles on the mediotrusive side with anteri- when posterior disclusion is obtained by an appropriate
or guidance. The masseter muscle on the laterotrusive anterior guidance can the elevating art.ivity of the
side also showed a marked reduction in activity. The temporal and masseter muscles be reduced. Further, it
temporal muscle on the laterotrusive side always pro- is not the contact of the canines that decreases the
duced greater electromyographic activity than the mas- activity of the elevator muscles, but the elimination of
seter muscle. When the anterior guidance was elimi- posterior contacts.
nated and posterior guidance established, there was no
apparent decrease in muscular activity on either the REFERENCES
laterotrusive or mediotrusive side of either muscle. I. D’Amtc6. A.: The canine teeth--Normal lunc~cmnal relation of
When leaf gauges were used to prevent poste- the natural teeth of man. J Southern (Z&f I)url )\csoc 261:19X,
rior tooth contacts, minimal activity was recorded in 1958.
2. Long, J. H.: Locating centric relation \\tth 1 lea! gauge. ,J
the masseter muscles.’ The temporal muscles re-
PKOSI‘IIEI’ DENT 29:608, 1973.
mained active, indicating their function as position- 3. Williamson, E. H., Steinke, R. M., Morse. P k., and Swift, ‘1‘.
ing muscles. R.: Centric relation: A comparison of muscle-determined
During eccentric movements, forces are applied to position and operator guidance. Am J Orthod 77:133, 1080.
posterior teeth that are not directed to the midvertical 4. Williamson, E. H.: Occlusion and TMJ dysfuncr~on. Part I. J
Clin Orthod 15:333, 1981.
axis when they remain in contact.6 Only when posteri-
5. Williamson, E. H.: Occlusion and TLIJ dvslunclion. Part II. J
or discfusion is obtained by an appropriate anterior Clin Orthod 15:393, 1981.
guidance can the electromyographic activity of the 6. Guichet, N. E’.: Biological laws governing functions of muscles
elevating muscles be reduced. This would eliminate all that move the mandible. Part 11: Condylar Iwsition J PKOS-
lateral forces to the posterior teeth except those that ‘TFIET DENT 38:35, 1977.
7. (Gibbs. C. I-i., Messerman, T., Reswick, J. K.. and Derda. H.
would be present in the intercuspal position.
J,: Functmnal movements of the mandihlr. J PROSWET DENT
Occlusion may alter muscular activity. Gibbs et al.’ 26~604, 197 I.
demonstrated that condylar position and movement, the
path of mandibular closure, and the sequence of the
timing of mandibular movement in a chewing cycle
were modified by the occlusion of each subject. Addi-
tional research will determine all factors of occlusion
that will provide patients with the most physiologic
range of muscular activity.

THE JOURNAL OF PROSTHETIC DENTISTRY 823