CLINICAL PRACTICE

Mastication, EMG Activity and Occlusai Contact Area

in Subjects with Different Facial Types
Simone Guimares Farias Gomes, D.D.S., M.Sc; William Custodio, D.D.S., M.Sc;
Juliana Silva Moura Jufer, D.D.S., M.S.; Altair Antoninha Del Bel Cury, Ph.D.; Renata
Cunha Matheus Rodrigues Garcia, Ph.D.

0886-9634/2804274$05.00/0, THE
JOURNAL OF
CRANIOMANDIBULAR
PRACTICE,
Copyright 2010
by CHROMA, Inc.

Manuscript received
July 9, 2009; revised
manuscript received
October 14,2009; accepted
October 19, 2009
Address for correspondence:
Dr. Renata C. M. R. Garcia
Dept. of Prosthodontics
and Periodontology
Piracicaba Dental School
State University of Campinas
Avenida Limeira, 901
Piracicaba, Sao Paulo
13414-903 Brazil
E-mail:
regarcia@fop.unicamp.br

ABSTRACT: Dentofaciai morphology may affect orofacial functions, therefore the aim of the current
study was to evaluate the influence of craniofacial morphology on masticatory function, occlusai contact
area (OCA), and masticatory muscles activity. Seventy-eight (78) subjects were divided into three
groups according to vertical facial pattern: 1. mesofacial; 2. brachyfacial; and 3. dolichofacial. Artificial
material and the sieving method were used to access masticatory efficiency (ME). OCA was determined
by registration of posterior teeth. Electromyographic (EMG) activity of the masseter and anterior temporal (AT) muscles was accessed bilaterally at rest and at maximal vertical clenching (MVC). ME (%) was
significantly higher in brachyfacial and lower in dolichofacial subjects. Brachyfacials presented the highest OCA (mm^) followed by meso and dolichofacial subjects. The EMG of the masseter and AT at rest
and at MVC showed that dolichofacial subjects presented the lowest activity values, while brachyfacial
subjects presented significantly higher measurements. Craniofacial morphology affected masticatory
function, OCA, and EMG activity of the masticatory muscles.

asticatory function, which is ohjectively defined

as masticatory performance and masticatory
efficiency,' is highly correlated with dentofaciai morphology.2 Masticatory function is affected by
several factors, such as loss of post canine teeth, severity
of maloeclusion, body size, age, gender, food texture and
taste, sensory feedback, occlusai contact area, and bite
force,''3 which are only some of the masticatory predictors linked to vertical facial pattern. However, occlusai
factors and bite force seem to be the key determinants,'
controlling 48%'' and 36%^ of masticatory performance,
respectively.
Craniofacial vertical pattern and bite force have been
shown to be related, in that individuals with a strong bite
force present a more uniform facial morphology, reduced
anterior face height,'^ larger posterior face height, less
inclination of the mandibular plane,''^ and a higher
mandibular ramus.' These reports indicate that short
faced individuals (brachyfacials) present greater bite
force when compared to long faced individuals (dolichofacials), and medium faced individuals (mesofacials),' sug-

Dr. Simone Guimares P'arias Gomes

received her D.D.S. degree from the
Federal University of Pentambuco iti
2003 and her M.Sc. degree in prosthodontics in 2008 at the Piracicaba Dental
School, State Utiiversity of Catnpinas.
Currently, she is pursuing a Ph.D. at the
same university.

274

GOMES ET AL.

gesting an indirect association of craniofacial morphology and masticatory function. One predictor of bite force
and masticatory function is masticatory muscles electromyographic (EMG) activity. While chewing, muscle
activity is required to move the jaw and to exert forces in
order to cut or grind food.' It is suggested that significant
differences exist in muscle EMG activity based on different vertical facial skeletal types;'"'^ however, controversial findings have been reported in previous EMG studies
conducted to determine this relationship.''"*
The association between masticatory function and
occlusion is clear.'5 Tooth shape, preferred chewing side,
number of teeth, and occlusal contact area have been
referred to as occlusal factors; the number of occlusal
contacts being the most significant occlusal variable.''
However, the relationship between occlusal contacts and
facial vertical pattern has not been explained. It has been
reported that morphology and orientation of jaw-closing
muscles may have a complex correlation to a weaker and
unbalanced occlusal force, as well as to a lower occlusal
contact area in patients with skeletal mandibular asymmetry.""
A better understanding of the real and direct role of the
craniofacial morphology of oral function is needed, since
many actions can be taken to prevent, facilitate, and
better indicate prosthetic and orthodontic therapy. To
report what has not been analyzed yet or to explain some
controversies, the aim of this study was to evaluate masticatory efficiency and two of its predictors: masticatory
muscle activity and occlusal contact area, of individuals
with different craniofacial vertical patterns.
Materials and Methods
Seventy-eight (78) individuals (39 males and 39
females) with a mean age of 23.5 years participated in the
current study. Subjects with good general and oral health,
without facial deformities, presenting a complete dentition (except for missing third molars), and no malocelusion were selected. Subjects with a history of maxillofacial
surgery or jaw injuries, orthodontic treatment concluded
in the last two years, temporomandibular disorders, and
parafunctional habits were excluded from the study. All
subjects were selected among students and staff of the
Piracicaba Dental School, as well as among patients who
sought dental treatment at the same institution. The
Ethics Committee of the Piracicaba Dental School,
University of Campinas approved the research protocol
(number 059/2004), and all participants signed a written
informed consent.
The selected subjects who elected to participate in this
study had their weight (in kilograms - kg) and height (in

OCTOBER 2010, VOL. 28, NO. 4

FACIAL TYPES AND EMG ACTIVITY

meters - m) measured with their body in an upright position and barefoot (Mechanical anthropomtrie scale
Rl 10, Welmy, Santa Brbara D'Oeste). The subjects also
had a lateral cephalogram image exam, using the standard
protocols and the same radiographie unit (Elipsopantomograph Funk X-15, Macrotec Industria e comercio de equipamentos Ltda., Sao Paulo). The cephalograms were processed with an automatic processor
(Macrotec MX-2, Macrotec Industria e comercio de
equipamentos Ltda, Sao Paulo) and analyzed using digital cephalometric analyzing software (Radiocef v.4.0.
Radio Memory Ltda, Belo Horizonte). The VERT Index
was used to determine the facial vertical pattern of the
participants, who were divided into three groups (n=26)
according to the facial type: 1. mesofacial (VERT Index
between -0.49 and -t-0.49); 2. brachyfacial (VERT Index
>0.5); and 3. dolichofacial (VERT Index <-0.5)." The
cephalometric analysis and the classification of the subjects by facial pattern were accomplished after all the
tests had been executed, i.e., the two operators were blind
to facial pattern during the tests.
Masticatory Efficiency
Masticatory efficiency was evaluated using an artificial test material for chewing and a sieve method of
analysis. The artificial material was made of a siliconbased rubber (Optosil, Heraeus Kulzer, Hanau), which
was manipulated according to the instructions of the
manufacturer and inserted into a metal mould to create
cubes with 5.6 mm of edge. After setting, the silicon
cubes were removed from the mould and individually
weighed for standardization. The silicon cubes were
transported to an electric oven for 16 hours at 60C to
ensure complete reticulation."* After the silicon cubes
cooled down to room temperature, they were disinfected
in a 2% glutaraldehyde solution for 30 minutes, washed,
dried with absorbent paper, and weighed once again.
Portions of 17 silicon cubes (approximately three cm' or
3.4 g) were separated and stored in plastic containers
until testing. One portion of the silicon cubes was given
to each participant, who was asked to chew it in the habitual way. The operator counted 20 chewing strokes and
asked the subjects to expectorate the chewed particles
into a paper filter sitting on a glass container. Two hundred milliliters of water were used for mouth rinses to
completely cleanse the oral cavity and then expectorated
into the same filter. The mouths of the subjects were then
examined for any retained pieces of the fragmented artificial test material. After totally draining off the water, the
paper filter was stored in an electric oven for 25 minutes
at 80C'' and finally taken to the sieving system, which
was composed of ten sieves with gradually decreasing

THE JOURNAL OF CRANIOMANDIBULAR PRACTICE

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FACIAL TYPES AND EMG ACTIVITY

openings from 5.6 to 0.5 mm, a bottom plate, and a sieving machine (Bertel Industria Metalrgica Ltda., Caieiras)
for 20 minutes. The fragmented test material present in
each sieve and in the bottom plate was weighed in a
O.OOOl g analytical balance (Mark, 2060, Bel Engineering
s.r., Monza). Masticatory efficiency was calculated by
the weight percentage of the fragmented material which
passed the 10-mesh sieve (2 mm aperture),''-' i.e., the particles <2 mm.
Electromyograpliic Activity
Activities of masseter and anterior temporal muscles
were measured during rest and triaximal clenching, using
a BioEiylG electromyographic amplifier (Bioresearch
Inc., Milwaukee, MN) and the BioPAK program (Microsoft Corp., Redmond, WA). BioEMG is an 8-channel Eunit with a 30 to 600 Hz band-pass filter. Silver/silver
chloride bipolar passive surface electrodes (Bioresearch,
Milwaukee) were placed bilaterally in the direction of the
muscles fibers, on the most prominent point of the masseter''* and anterior temporal muscles during contraction.
Before placement of the electrodes, the skin of the subjects was cleansed with alcohol to reduce any impedance
between skin and the electrodes.'^
Subjects were seated in a dental chair and instructed to
maintain the head in the Frankfort Plane parallel to the
ground and asked to avoid head and body movements
during the test. The EMG activity of the masseter and
anterior temporal muscles was studied bilaterally, with
the mandible at the rest position and during maximal voluntary clenching (MVC). For the MVC recording, the
subjects were instructed to close their jaws in occlusion
as forcefully as possible'^ for seven seconds with a twominute interval between contraction measurements. The
EMG activity during rest and MVC of the masseter and
anterior temporal muscles were conducted three times
and data was obtained by the arithmetic means of the
three repetitions. The average EMG activities of the contralateral muscles were summed" and expressed as mean
and standard deviations (S.D.). In addition, EMG was
normalized to the activity obtained during maximal voluntary contractions (MVC).
Method error (Se) was calculated using Dahlberg's
formula. The measurernent error was small, not exceeding for the recording of EMG activity, 0.69 |iV (0.2%) in
the masseter muscle, \yhile in the temporal muscle it was
found to be higher, up to 1.36 |JV (2.9%).
Occlusal Contact Area
Silicone-based occlusal registrations of the posterior
teeth (molars and preiiiolars) were obtained bilaterally^
with the subjects in maximum intercuspation. Additional

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GOMES ET AL.

silicone (RE'CORD, Bosworth Company, Skokie, IL)

was applied to plastic frames (Big Bite Tray, Bosworth
Company, Skokie, IL) with the gauze mesh removed, and
placed into the mouth of the subjects on the mandibular
posterior teeth. The subjects were asked to close their
teeth in the maximum intercuspal position and instructed
to hold that position until complete setting of the silicone
was determined.2' The record was carefully removed
from the subject's mouth and for each record, preparation
for the image analysis was performed.2'
Each occlusal registration was digitalized using a
desktop scanner (2400, Hewlett Packard Development Company, Barueri, Brazil). Registrations were
placed on the scanner bed with the mandibular occlusal
surface facing downward.^ Adobe Photoshop CS3 software (Adobe Systems Inc., San Jose, CA) was used to
dis-color, invert, and adjust the images of the occlusal
registrations.ThesoftwareprogramlmageTool (University
of Texas Health Science Center, San Antonio, TX) was
used to manually trace the occlusal contact areas of the
posterior teeth of the image magnified x3. The traced
occlusal contact areas were automatically calculated by
the software using the frequency distributions of pixels
corresponding to each of 256 gray scales.2" Pieces of
additional silicone of known thickness, measured with a
digital caliper (Digimess Instrumentos de Preciso Ltda.,
Sao Paulo, Brazil) was analyzed by the Image Tool program and used to establish the relationship between
each of the 256 gray scales and the thickness of the
occlusal registration on the basis ofthe pixels density per
unit area.^*"
Data were evaluated according Gurdsapsri et al.,2' who
considered that occlusal contact areas present less than 50
|am thickness of the impression material and near contact
area, from 50-350 yun thickness.^
Statistical Analysis
Anthropomtrie characteristics may influence some
masticatory parameters, therefore a one-way ANOVA
was used to analyze homogeneity ofthe sample, concerning weight and height of the meso, brachy, and dolichofacial subjects. The same consideration was given for age,
which was analysed using ANOVA on Ranks.
Comparison between masticatory efficiency, masticatory muscle activity, and the occlusal contact area of subjects with different facial morphology was accessed.
Normality or equal variance testing failed for all variables
studied; therefore, ANOVA on Ranks and Student
Newman-Keuls were used for all data. Statistics were
performed at a 0.05% significance level using the
SigmaStat software (Version 3.5, Systat Software, Inc.
Chicago, IL).

OCTOBER 2010, VOL. 28, NO. 4

GOMES ET AL.

FACIAL TYPES AND EMG ACTIVITY

Results
Anthropomtrie and sample characteristics are shown
in Table 1. A homogeneous distribution among groups
can be observed (p>.05). .
Differences in facial morphology affected the reduction of the artificial material test (p<.0001). Long-faced
subjects (dolichofacials) presented lower masticatory
efficiency, while short-faced (brachyfacials) subjects pulverized the silicone cubes better, presenting higher percentage of fragmented material <2 mm (Table 2).
Occlusal contact area differed between the three facial
morphologies (p<.0001), being larger in brachyfacial
subjects, followed by mesofacial and dolichofacial participants (Table 2).
:

cal pattern and masticatory efficiency. These findings are

important and could be used during prosthetic planning to
evaluate the need to compensate for the functional disadvantages of some patients, e.g., when determining the
number bf teeth to be replaced in removable conventional
dentures.
'
'
Subjects with lower masticatory efficiency, e.g.,
dolichofacials, presented significantly smaller occlusal
contact area, while brachyfacials, who presented higher
masticatory efficiency, showed significantly larger
occlusal contact area.^
However, it was found that during adulthood, decreases
in occlusal contact area influence the amount of sternocleidomastoid and trapezius, auxiliary masticatory
muscle activity.23

Table 1
Characteristics of the Subjects (Means SD)
iVIale (no.)
Age (yrs.)
BMI
Female (no.
Age (yrs.)
BMI

Mesofacial
13

23.5 2.9
25.8 2.9
13
25.2 5.7
22.3 4.7

Brachyfacial
13
23.9 4.5
23.9 2.6
13
23.2 4.6

Discussion
In the present study, masticatory efficiency measurements were significantly different between the three
groups studied, demonstrating that the shorter the face the
better the masticatory function, since short faced subjects
present greater mechanical advantage of elevator muscle,'
as well as greater bite force,^" which is one of the key
determinants of masticatory function.^ No other study
was found in the literature associating craniofacial verti-

OCTOBER 2010, VOL 28, NO. 4

13

22.9 3.8
24.9 3.3
13

22.1 2.2
21.7 1.9

22.3 2.5

Total (no.)
26
26
Age (yrs.)
24.4 4.5
23.7 4.3
BMI
21.6 5.2
24.1 4.3
BMI: Body mass index calculated by the formula, weight/height^

Significant differences among groups were observed in

masseter muscles at rest (p<.001) and during MVC
(p<.001), as well for anterior temporal muscles in both
contraction conditions (p<.001), being the higher values
observed in the brachyfacial group, followed by mesofacial and dolichofacial groups respectively (Table 3).

Dolichofacial

26

22.5 3.1
23.3 3 1

Total
39
23.5 3.7
24.9 1.0

39
23.6 4.4
22.1 0.3
78
23.5 4.0
23.3 1.3

Table 2
Masticatory Efficiency (%) and Occlusal Contact
Area (mm2) of Subjects with Different Facial
Morphology (Means S.D.)
Mesofacial
Brachyfacial
Dolichofacial

Masticatory
efficiency
8.8 5.0 a
14.0 6.8 b
4.4 3.8 c

Occlusal
contact area
122.4 13.9 a

144.1 27.8 b
97.5 23.9 c

Different letters show statistical differences among groups

(p<.05)

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FACIAL TYPES AND EMG ACTIVITY

GOMES ET AL.

Table 3
Masticatory Muscles Activity of Masseter and Anterior Temporal Muscles at Rest and MVC (Means S.D.)
Rest
Masseter
Temporalis

Mesotacial

Bracyfacial

Dolichofacial

3,33 0.27 a
3,45 0,36 a

3,60 0,29 b
3,63 0,17 b

3,15 0,31 c
3,37 0,17 c

MVC

Masseter
238,49 17,90 a
258.25 23,91 b
223.09 10,78 c
236,02 26,38 a
Temporalis
245,72 12,12 b
230.31 9,95 c
For each muscle and state ot contraction, different letters show statistical differences among groups (p<.05)

There is much controversy regarding the patterns of

elevator muscles and EMG activity in relation to craniofacial morphology. Earella, et al.,''' reported no influence
of facial morphology on daily masseter muscle activity,
while Ueda, et al.,'" indicated the opposite about the duration of daytime muscle activity, being longer in subjects
with low angle mandibular planes. In the present study,
subjects with different facial vertical patterns showed significantly different EMG activity of masseter and anterior temporal muscles during rest and MVC, being
lower in dolichofacial and higher in brachyfacial subjects. These results are in accordance with other studies,
which showed that there was considerably higher temporal muscle activity in the brachyfacial skeletal pattern
subjects during maximal voluntary clenching^'' and at rest
position.'2 However, these findings are in disagreement
with Cha, et al.," who observed an increased resting temporal muscle activity in subjects with hyper-divergent
faces. This could be due to differences in subjects' characteristics, since long-faced individuals recruited by Cha,
et al." also presented Angle Class III malocclusion and
may cause a higher stimulation of the muscles, leading to
a higher resting activity. Eurthermore, other factors may
also explain the divergent EMG results found in the literature. It has been reported that muscle size and muscular
fiber type seem to be associated with facial vertical morphology, since jaw muscles of long-faced subjects are up
to 30% smaller than those of normal faced individuals,
which may be attributed to a different muscle fiber type
composition.25
Conclusion

tory efficiency, occlusal contact area, and EMG activity

of the masseter and temporal muscles during rest and at
MVC in adults. Eor all variables studied, dolichofacial
subjects presented the lowest measurements, followed in
increasing order by mesofacial and brachyfacial subjects.
Acknowledgments
We would like to thank Dr. Erancisco Haiter Neto, Dr.
Jaime Aparecido Cury, and Dr. Maria Beatriz Duarte
Gaviao for their assistance. The National Council for
Scientific and Technological Development - CNPq supported this research (Grant numbers 476385/2004-0 and
140204/2009-1).
References
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3,
4,
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6,
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According to the basis used to develop this study, it can

be concluded that facial vertical pattern affects mastica-

278

THE JOURNAL OF CRANIOMANDIBULAR PRACTICE

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Dr. William Custodio attetided Piracicaba Dental School, State

University of Catnpitias. where he received his D.D.S. degree in 2005
and his M.Sc. degree in prosthodontics in 2008. He is currently pursuing
a Ph.D. at the same university.

Dr. Juliana Silva Moura Jufer received her D.D.S. degree frotn the
Federal University ofGoicis in 1999 and her M.Sc. attd Ph.D. degrees in
2003 and 2005, respectively, both in prosthodotitics, at the Piracicaba
Dental School, State University of Catnpitias.

Dr. Altair Antoninha Del Bell Cury is a professor at the Departtnent of

Prosthodontics and Periodotitology. Piracicaba Dental School. State
University of Catnpinas. She received her Ph.D. from the University of
Sc'to Paulo in 1992 and took a post doctoral training at the University' of
Rochester in 2006. Sittce receiving her Ph.D. iti dentistry, she has beett
involved in research into oral rehabilitation atid cariology.
Dr. Renata Cunha Matheus Rodrigues Garcia is a professor in the
Departtnetit of Frosthodontics atid Periodotitology at Piracicaba Detital
School, State University of Catnpitias. Since she received her Ph.D. in
prosthodontics in 1995 at the satne university, .she has been involved in
clinical research, tn 1997, she took post doctoral training in craniomandibular disorders at the University ofTe.xas. Health Scietice Cetiter
at San Antonio.

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