US3593422A - Method of producing a muscularly balanced closure of the human mandible - Google Patents

Method of producing a muscularly balanced closure of the human mandible Download PDF

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Publication number
US3593422A
US3593422A US855480A US3593422DA US3593422A US 3593422 A US3593422 A US 3593422A US 855480 A US855480 A US 855480A US 3593422D A US3593422D A US 3593422DA US 3593422 A US3593422 A US 3593422A
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mandible
muscle
muscles
closure
occlusion
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US855480A
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Bernard Jankelson
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C19/00—Dental auxiliary appliances
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/36014—External stimulators, e.g. with patch electrodes
    • A61N1/3603—Control systems
    • A61N1/36034—Control systems specified by the stimulation parameters

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  • Balanced simultaneous action of the muscle groups involved'in opening and closing the mandible is not possible by voluntary action on the part of the patient as voluntary closure is subject to deviation from the myocentric position of occlusion by existing unilateral contracture or spasms, by propn'oception of deflective areas on teeth or biterims or by shiftingv denture bases.
  • the invention relates to a method of closing the humanmandible by stimulating, from their relaxed position, simultaneous group action of all the masticatory and facial muscles by. an electrical current, and particularly to the method of producing a muscularly balanced closure of the human mandible by simultaneously and evenly stimulating the motor roots' of the mandibular and facial nerves on both sides of the face.
  • Input electrodes are placed in intimate-contact with the skin on both sides of theface directly over the mandibular notch to stimulate the motor roots of the mandibular and facial nerves.
  • a number of diagnostic and clinical techniques are possible by electrical programmed stimulation of the motor nerves controllingthe masticatory and facial muscles.
  • FIG. I is a perspective view of the human head showing the position of the input electrodes on each side of the face.
  • FIG. 2 is a cross-sectional view of the human head showingin phantom the position of the input electrodes and their relation to the motor roots of the mandibular and facial nerves.
  • FIG. 3 is a side view of the .human head illustrating the facial nerve. its position relative to the ear lobe. and its branches to the various muscles of the face and mandible:
  • FIG. 4- is a view ofthe base ofthe human skull cut to show roofs ofthe right maxillary and left ethmoidal sinuses.
  • the muscle complex referred-to above is innervated by the motor 'branch of the fifth and seventh cranial nerves.
  • the mandibular orfifth cranial nerve innervates the following muscles: masseter. posterior and anterior temporal, internal pterygoid. external pterygoid. anterior belly of the digastric, mylohyoid, buccinator, outer fascie of buccinator, and the muscles of the upper and lower lips.
  • the facial or seventh cranial nerve innervates the following muscles:
  • input electrodes 10 and 12 are placed on each'side of the face as shown and a common dispersal electrode 14 placed in contact. preferably. with the skin adjacent the cervical spine.
  • the electrodes are connected to a pulse generator 16"by lead wires 18 and 20.
  • Controls for the pulse generator are located in the front of the housing of the generator.
  • Theoutput selector 22 controls delivery of current through the left. right or both input electrodes.
  • the amplitude selector 24 controls the intensity of current delivered-through the input electrodes. the current being pulsed at a particular rate, usually 40 pulses/minute.
  • the voltage used is in the range of 10 to 35 volts at relatively low milliamperage.
  • the overclosure selector 26 controls the intensity ofcurrent delivered through the input electrodes at a higher pulse rate, usually I10 pulses/minute.
  • the overclosure 1 control functions separately from the amplitude control.
  • a milliampere meter 28 is operatively connected to a test circuit controlled by selector 29 to determine the current flow from each of the input electrodes to the common dispersal electrode. The necessity of doing this will be explained in detail.
  • the fifth and seventh cranial nerves are stimulated by an electrical current fl'owingthrough input electrodes 10 and 12 placed on each side of the face to the nerves and out-through a common disposal electrode placed. preferably. over the cervical spine. Placement of the input electrodes is important for simultaneous and even stimulation of the fifth and seventh cranial'nerves.
  • FIGS. 1. 2 and 3 show the placement of the input electrodes. In general they are placed directly over the mandibular notch on each side of the face and contiguous to the lower lobe of the ear.
  • the posterior edge of the coronoid process 30 'forms the anterior border of the mandibular notch 31 and limits in front the interval lift between'the lower border of the posterior path of the zygomatic arch 32 and the upper hollowed edge of the ramus 33. Looking from one mandibular'notch the floor ofthe infratemporal fossa. or base of the skull (not shown) may be seen.
  • Placement of the input electrodes is important. It is likewise important that the nerves on each side of the face be stimulated simultaneously and at the same intensity. To insure that the current delivered to each of the electrodes is equal. the current from the pulse generator to each electrode emanates from the same terminal. The amount of stimulus transferred from the input electrodes to the motor nerves through each side of the face depends on skin resistance.
  • the relative impedance of the current passing from the input electrodes on each side of the face of the common dispersal electrode is measured by disconnecting the pulsing current delivered to the input electrodes and applying a 1.5-volt DC current across the electrodes and measuring by milliampere meter 28 the current flow from each input electrode to the dispersal electrode.
  • the electrical stimulus is delivered through each of the input electrodes through the skin to the nerves repetitively.
  • the duration and number of pulses delivered is that which is optimum for the stimulation of muscle repeatedly without fatigue.
  • the intermittent or pulsing current used has a duration of about 2 milliseconds and a frequency of about 40 pulses/minute, the duration approximating that of natural stimuli and the frequency below that which would cause muscle exhaustion. Variations from these preferred standards are possible. however.
  • the above described method for simultaneously and bilaterally stimulating group action of all the masticatory and facial muscles can be used in a number of clinical and diagnostic techniques by the dentist. some of which will be described in some detail.
  • the method can be used (I) to diagnose the comparative degree of relaxation or contracture of the muscle groups on each side of the face. (2) to cause the mandible to close to the horizontal myocentric position of occlusion. (3) to determine the vertical position of occlusion, (4) to take denture impressions (5) to relax muscle spasms associated with Temporomandibular Joint Syndrome. and (6) to reduce postoperative swelling and discoloration by causing gentle massage as the muscles contract.
  • Diagnosis of the existence of bilateral or unilateral muscle contracture is important in clinical procedures. Equal relaxation of the muscles on both sides of the face is an essential prerequisite to obtaining an even closure of the mandible to the occlusal position most favorable to the musculature. If. in adjusting occlusion. fitting dentures or fixed appliances. muscle spasm exists when the dentist registers the position of occlusion at which he fits the opposing teeth together. the mandible will be deviated because one side of the face is less mobile. The position of occlusion thus registered will be the result of uneven closure by musculature which is not evenly relaxed on both sides. lfthe position of occlusion is registered when muscle spasms exist. the muscles. from then on.
  • the comparative degree of relaxation or contracture of the muscle groups on each side of the face is determined by measuring and comparing the threshold contraction of the muscles of both sides of the face.
  • the threshold contraction is defined as the amount of current necessary to produce a slight twitch in the muscle.
  • An electrical current of the same intensity is delivered simultaneously to the motor nerves that control themuscle groups of each side of the face as shown in FIG. 1.
  • the comparative muscle response to each side of the face is observed or palpated.
  • An equal response of muscle on each side of the face indicates an equal state of relaxation. if one side remains immobile at the threshold. stimulus it indicates that the muscles of that side are in a state of spasm or contracture as compared to the muscles of the other side of the face. As shown in FIG.
  • the input electrodes emanate from a common terminal. Electrical pulses of predetermined duration and intensity are delivered to the input electrodes by a pulse generator. To insure that current flow from the input electrodes through the tissues of the nerves is bilaterally equal to positive pulse generator is disconnected and a 1.5-volt DC. current applied across the electrodes. A O to 50 milliampere meter 28 is used to measure the current flow from each'of the input electrodes 10 and 12 to the common dispersal electrode 14. If the needle remains relatively constant when the output selector knob 22 is moved from left to right or right to left the current input is equal on both sides. If the measurement varies it indicates that the current flow through one electrode is not exactly equal to the current flow on the opposite side.
  • the current flow through the electrodes out theough the dispersal electrode may not be equal.
  • the skin is cleansed prior to positioning of the input electrodes in order to remove skin oil. cosmetic makeup or other materials.
  • An electrolyte solution is used to moisten the electrodes to insure good electrical contact with the skin.
  • the dentist can then proceed to determine the myocentric or vertical position of occlusion as may be desired. If one side remains immobile at the threshold stimulus it may be necessary for the dentist to repetitively stimulate the muscle groups in contracture for a sufficient length of time to allow the muscle groups to relax to their resting length between each pulse.
  • anelectrical stimulus is delivered to muscles that are in contracture or spasm. the stimulus produces first a latent heat and then heat of contraction as t he rnus les beginto contract. The muscles in contracture or spasm warm up" and relax to their resting length between each pulse. The mandible then is at rest position.
  • Each recurring stimulus is spaced far enough apart in time so that the muscle fibers of the muscle group shorten with a single contraction and then relax completely to rest position before the next succeeding stimulus arrives.
  • the lower jaw or mandible closes from rest position to the position it reaches at the height of the twitch.
  • Myocentric occlusion is that position of occlusion to which the musculature would carry the mandible if no deflective areas existed on teeth or biterims and no shifting of bases occurred during closure from rest position to occlusion.
  • the myocentric position of occlusion has heretofore been unobtainable in the presence of existing deflections. 1n the past the dentist has had to make decisions. based on assumptions which may or may not be correct. about the "centric" position of occlusion in the horizontal plane.
  • the centric or habitual occlusion is not necessarily synonymous with myocentric occlusion.
  • the centric occlusion may be a deviated position to which the mandible is guided by proprioception of existing obstructions or by muscles which are in a state of sustained guard or contraction on one or both sides. producing deviated closure of the mandible.
  • the dentist has. in the past. either manipulated the jaw or instructed the patient to close voluntarily, or made use of both procedures simultaneously.
  • the dentist manipulates the mandible to guide or force it to close into an occlusal position on which he has decided. he also has to decide where to place his hand and in what direction and how hard to press. Most dentists attempt to force the mandible to its most retruded position. which seldom coincides with the myocentric position of occlusion.
  • the alternative of manipulation by the dentist has been instruction to the patient to voluntarily close the mandible. This alternative is subject to deviation by an existing unilateral contracture or spasm. the presence of which the dentist has heretofore had no way of determining.
  • the direction of voluntary closure is also influenced by proprioception of deflective areas on teeth or biterims or by shifting denture bases. As is known, all forms of voluntary muscular contractions are of tetanic nature and are not twitches or jerks.
  • Voluntary contractions are due to the fact that the pyramidal cells of the cerebral cortex send out successive volleys of impulses which are graded as to frequency and duration and which enter the muscle at a rate of 42 to 100 per second. It has been shown that the electromyographic activity of the masseter and temporal muscles involved in closure of the mandible continues for 25 to 60 milliseconds after initial contact of the teeth. During this time the mandible can be deviated by proprioception of any deflective areas, with the final position of the mandible not coinciding with deflection ofthe mandible to the terminal position of occlusion.
  • involuntary closure By contrast. in involuntary closure. during mastication. offset in electromyographic activity occurs immediately after initial contact is made. lt has been shown that duration of contact produced by involuntary closure is considerably shorter than that produced by voluntary closure. Because of the nature of involuntary contraction and the short contact duration. proprioception does not influence the terminal contact position of the mandible as in voluntary closure.
  • involuntary muscle contraction is accomplished and. because it is involuntary, the myocentric position of occlusion is easily determined.
  • an intermittent low frequency current is applied to the motor roots of the mandibular and facial nerves.
  • the conventional method used by dentists when making dentures is to first make an impression or a negative likeness of the denture areas of the jaw from which a cast of the region is produced.
  • the dentist utilizes an impression tray of strong rigid material which conforms generally to the type and size of the denture region of the edentulous jaw.
  • a plastic impression material is adapted to the configuration of the tray and the tray inserted into the the patients mouth to make the impression.
  • the dentist has had to decide where, in what direction and how hard to press against the tray in order to avoid tilting. movement. or excessive pressure which would displace and distort tissue.
  • the body ofthe impression and the borders are imprinted simultaneously by involuntary muscle contraction at the height of the interocclusal space.
  • an electrical current is used to repetitively stimulate the mandibular and facial motor nerves which centre! sto res f ilz fiqwsr i wd r mandible
  • the following steps are generally employed. First a check is made to determine whether there are any existing spasms or contracture of the muscles of either or both sides of the face as described previously. If there are such contractures the electrical current is allowed to stimulate the muscles for a period of time ranging from 3 to 5 minutes or longer. This automatically relaxes the muscles in contracture to their resting length and allows the mandible to go to the rest position. Once the muscles are at their resting length the mandible repetitively closes from rest position to the height of the interocclusal space.
  • the mandible closes repetitively from rest position through the interocclusal space to the horizontal and vertical position of occlusion.
  • Biterims are added to the impression trays and are automatically imprinted at the horizontal and vertical myocentric positions.
  • the spacer is removed from the mandibular tray and replaced with impression material.
  • the muscles automatically take the impression against the supporting tissues without tissue or tray displacement. Surrounding muscles contract simultaneously and mold the impression borders. Occlusal contact is programmed to terminate so rapidly that deflection does not occur. The procedure is repeated as desired for maxillary impression.
  • the pulse normally used to cause the mandible to close is about 40 pulses/minute. the pulses having a duration of about 2 milliseconds. To cause overclosure the frequency is increased to about 110 pulses/ minute.
  • the mandible over- 5 closes allowing the dentist to register with wax. carbon paper or similar materials the tooth areas or points that first contact when the teeth occlude.
  • the method of producing a muscula'rly balanced closure of the mandible by simultaneously and evenly stimulating the motor roots of the mandibular and facial nerves on both sides of the face has been described with reference to several techniques useful to the dentist.
  • the method can also be used in a number of other applications such as in the treatment of Temporomandibular Joint Syndrome and in reduction of swelling or discoloration after surgical operations or accidental injury.
  • the method of claim 1 including measuring and comparing the threshold contraction of the muscle complex of the mandible on each side of the face to determine the degree of relaxation or contracture of the muscle groups of each side of the face and adjusting the electrical current input to each of the input electrodes to produce substantially equal 9t1 ast 9a..9.f..ths EEE FLQPPSQFQQ Side of the faceto the myocentric and vertical positions of occlusion.
  • a method of involuntary closing the human mandible for various clinical objectives comprising, simultaneously bilaterally and electrically stimulating the motor roots of the mandibular and facial nerves on both sides of the face, stimulation of the nerves resulting in coordinated contraction of the masticatory and facial muscles.
  • a method of taking impressions for dentures utilizing involuntary closure of the mandible to imprint an impression material comprising:

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US855480A 1969-09-05 1969-09-05 Method of producing a muscularly balanced closure of the human mandible Expired - Lifetime US3593422A (en)

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JP (1) JPS5438836B1 (enrdf_load_stackoverflow)
CH (1) CH532394A (enrdf_load_stackoverflow)
DE (1) DE2043569C2 (enrdf_load_stackoverflow)
FR (1) FR2061009A5 (enrdf_load_stackoverflow)
GB (1) GB1307126A (enrdf_load_stackoverflow)
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Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0000477A1 (en) * 1977-06-27 1979-02-07 Bernard Jankelson Mandible stimulator
US4595010A (en) * 1984-03-12 1986-06-17 Bio-Research Associates, Inc. Electrical muscle stimulator
US20080215113A1 (en) * 2007-01-31 2008-09-04 Pawlowicz John S Devices and methods for transcutaneous electrical neural stimulation
RU2382658C1 (ru) * 2008-10-22 2010-02-27 Государственное образовательное учреждение высшего профессионального образования "БАШКИРСКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ Федерального Агентства по здравоохранению и социальному развитию" (ГОУ ВПО БГМУ РОСЗДРАВА) Способ лечения взрослых пациентов с дистальной окклюзией методом амплипульстерапии
US20100104998A1 (en) * 2008-10-25 2010-04-29 Stanley Edward Farrell Dental Splint
USD615209S1 (en) 2008-12-31 2010-05-04 Bmr Research & Development Limited Facial stimulation apparatus
US20100152810A1 (en) * 2008-12-11 2010-06-17 Conor Minogue Facial stimulation apparatus
IT201700014367A1 (it) * 2017-02-09 2018-08-09 Epoche S R L Processo di sistema per la determinazione dei rapporti spaziali intermascellari neurocentrici e realizzazione di strutture protesiche in micro-tc.

Families Citing this family (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
FR2175638B1 (enrdf_load_stackoverflow) * 1972-03-16 1974-08-02 Lejeune Seitz A Eline
JPS60256469A (ja) * 1984-06-01 1985-12-18 林原　健 電子治療器
GB8826903D0 (en) * 1988-11-17 1988-12-21 Fakhri O Electrotherapy device for treatment of autoimmune diseases & other conditions resulting from inflammations congestion of tissue fluids & bad circulation

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3279468A (en) * 1963-05-14 1966-10-18 Vine Sidney Le Electrotherapeutic facial mask apparatus
FR2004671A1 (enrdf_load_stackoverflow) * 1968-03-25 1969-11-28 Rabey Graham

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3279468A (en) * 1963-05-14 1966-10-18 Vine Sidney Le Electrotherapeutic facial mask apparatus
FR2004671A1 (enrdf_load_stackoverflow) * 1968-03-25 1969-11-28 Rabey Graham

Cited By (14)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP0000477A1 (en) * 1977-06-27 1979-02-07 Bernard Jankelson Mandible stimulator
US4595010A (en) * 1984-03-12 1986-06-17 Bio-Research Associates, Inc. Electrical muscle stimulator
US7844340B2 (en) 2007-01-31 2010-11-30 Pawlowicz Iii John S Devices and methods for transcutaneous electrical neural stimulation
US20080215113A1 (en) * 2007-01-31 2008-09-04 Pawlowicz John S Devices and methods for transcutaneous electrical neural stimulation
RU2382658C1 (ru) * 2008-10-22 2010-02-27 Государственное образовательное учреждение высшего профессионального образования "БАШКИРСКИЙ ГОСУДАРСТВЕННЫЙ МЕДИЦИНСКИЙ УНИВЕРСИТЕТ Федерального Агентства по здравоохранению и социальному развитию" (ГОУ ВПО БГМУ РОСЗДРАВА) Способ лечения взрослых пациентов с дистальной окклюзией методом амплипульстерапии
US20100104998A1 (en) * 2008-10-25 2010-04-29 Stanley Edward Farrell Dental Splint
US20100152810A1 (en) * 2008-12-11 2010-06-17 Conor Minogue Facial stimulation apparatus
WO2010067145A1 (en) * 2008-12-11 2010-06-17 Bmr Research & Development Limited Facial stimulation apparatus
EP2198915A1 (en) * 2008-12-11 2010-06-23 BMR Research & Development Limited Facial stimulation apparatus
GB2479092A (en) * 2008-12-11 2011-09-28 Bmr Res & Dev Ltd Facial stimulation apparatus
GB2479092B (en) * 2008-12-11 2013-08-07 Bio Medical Res Ltd Facial stimulation apparatus
US8682452B2 (en) 2008-12-11 2014-03-25 Bio-Medical Research Limited Facial stimulation apparatus
USD615209S1 (en) 2008-12-31 2010-05-04 Bmr Research & Development Limited Facial stimulation apparatus
IT201700014367A1 (it) * 2017-02-09 2018-08-09 Epoche S R L Processo di sistema per la determinazione dei rapporti spaziali intermascellari neurocentrici e realizzazione di strutture protesiche in micro-tc.

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GB1307126A (en) 1973-02-14
DE2043569A1 (de) 1971-03-18
CH532394A (de) 1973-01-15
DE2043569C2 (de) 1981-10-15
FR2061009A5 (enrdf_load_stackoverflow) 1971-06-18
JPS5438836B1 (enrdf_load_stackoverflow) 1979-11-24
SE354182B (enrdf_load_stackoverflow) 1973-03-05

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