The Myo-monitor and the myo-facial pain dysfunction syndrome

Wessberg GA., Dinham, Richard: "The Myo-monitor and the myo-facial pain dysfunction syndrome".  Journal of the Hawaii Dental Association.  vol. 10, No. 2, Aug. 1977.

Summary:
Thirty patients presented symptoms with the Myo-facial Pain Dysfunction Syndrome.  All of these patients received Myo-monitor oriented therapy and nearly all of them professed some initial relief or total remission of their symptoms during the short time  span of this study,

The data presented is based largely on clinical observations and patient response to comparison of their symptoms before and after treatment.  Symptoms evaluated were generally related to muscle tenderness and mandibular mobility.
Conclusion:
Due to clinical observations and patient response in this investigation, it is concluded that:

1. The centric occlusion position is seldom coincident with the myo-centric position of occlusion in patients who exhibit symptoms associated with Myofacial Pain Dysfunction Syndrome.
2. A Myo-monitor generated occlusal position affords some relief if not complete remission of symptoms in 90% of cases treated.
3. Long-term follow-up studies are necessary to evalutate the success of treatment.

Effects of TENS on EMG and Kinesiographic Activity

Monaco, A, Sgolastra, F, Ciarrocchi, I, Cattaneo, R.: "Effects of transcutaneous electrical nervous stimulation on electromyographic and kinesiographic activity of patients with temporomandibular disorders: a placebo-controlled study". J Electromyogr Kinesiol. 2012 Jun:22(3):463-8. doi: 10.1016/j.jelekin.2011.12.008. Epub 2012 Jan 14.

University of L'Aquila, Department of Health Sciences, L'Aquila, Italy. 

Abstract

The purpose of this study was to assess the effect of a single 60 min TENS application on sEMG and kinesiographic activity in TMD patients in remission, and to assess the sEMG and kinesiographic effect of TENS in placebo and untreated groups. Sixty female subjects, selected according to the inclusion/exclusion criteria, suffering from unilateral TMD in remission were assigned to one of the following group: Group TENS, that received a single session of 60 min of TENS; Group Placebo that received a single session of 60 min of sham TENS; Group Control, that received no treatment. Pre- and post-treatment differences in sEMG of TA, MM, SCM, and DA and interocclusal distance values within groups were tested using the Wilcoxon test. Differences in sEMG and kinesiographic data, among the three groups, were assessed by Kruskal-Wallis test. Significant differences were only observed in the TENS group, for masticatory muscles of both sides; one-way analysis of variance revealed that sEMG values of masticatory muscles of both sides in the TENS group were significantly reduced, in comparison with placebo and control groups. Kinesiographic results showed that the vertical component of the interocclusal distance was significantly increased after TENS only in the TENS group. TENS could be effective to reduce the sEMG activity of masticatory muscles and to improve the interocclusal distance of TMD patients in remission; the placebo effect seems not present in the TENS application.

Myomonitor Efficacy and Myofacial Pain

Wessberg Geroge A., Dinham, Richard, DMD.  "The Myo-monitor and the myo-facial pain dysfunction syndrome."  Journal of the Hawaii Dental Association.  vol. 10, No. 2, Aug. 1977.

The Myofacial Pain Dysfunction Syndrome (MPD, TMJ Syndrome, Craniocervical Syndrome) has plagued dentistry for many years. Therapy for this type of pain  has been highly imaginative.  A few of the more common modalities mentioned (Ramfjord  1971) are occlusal adjustment, occlusal bite splints, immobilization of the mandible, drug therapy, placebo, diathermy, physical therapy, sclerosing agents, psychotherapy, and surgery.  Recent studies of mandibular  movement (Jankelson 1976) stress the importance of a "muscularly oriented occlusal position" for the treatment of the MPD Syndrome.

....Jankelson (Jankelson 1976) assumes a compromise in these trends of thought actually exists.  He describes a relatively precise PRPM at any given stage of development that fluctuates within a minimal range of normal as determined by states of equilibrium within the mandibular musculature.

The postural rest position of the mandible (PRPM) is by definition (Academy of Denture Prosthetists, Glossary of Prosthetic Terms, 1956) the mandibular position assumed when the head is in an upright position and the involved muscles, particularly the elevator and depressor groups, are in equilibrium in tonic contraction, and the condyles are in a neutral, unstrained position.

Summary:
Thirty patients presented symptoms with the Myo-facial Pain Dysfunction Syndrome.  All of these patients received Myo-monitor oriented therapy and nearly all of them professed some initial relief or total remission of their symptoms during the short time  span of this study,

The data presented is based largely on clinical observations and patient response to comparison of their symptoms before and after treatment.  Symptoms evaluated were generally related to muscle tenderness and mandibular mobility.
Conclusion:
Due to clinical observations and patient response in this investigation, it is concluded that:

1. The centric occlusion position is seldom coincident with the myo-centric position of occlusion in patients who exhibit symptoms associated with Myofacial Pain Dysfunction Syndrome.
2. A Myo-monitor generated occlusal position affords some relief if not complete remission of symptoms in 90% of cases treated.
3. Long-term follow-up studies are necessary to evalutate the success of treatment.

Myomonitor Efficacy - An Electromyographic Study with Myofacial Pain Dysfunction

Pantaleo, T.,M.D., Prayer-Galletti, F. M.D., Ph.D., Pini-Prato, g., M.D., and Prayer-Galletti, S.,M.D. "An electromyographic study in patients with myofacial pain-Dysfunction syndrome." Bull. Group. int. Rech.sc Stomat. et Odont. Vol. 26, pp. 167-179, 1983.

Recently dental research has turned to neuro-muscular system: many dental procedures, in order to be entirely successful, require that the masticatory muscles are relaxed and perfectly balanced.  The use of the transcutaneous electrical nerve stimulation (TENS) has been introduced, obtrained with adquate stimulators, such as the Myo-moniotr (Myo-tronics) (Jankelson 1975, Jankelson 1978, Wessberg, 1981): TENS has been able to relieve pain and eliminate the sustained muscle tension of the masticatory muscles of patients with myofacial pain-dysfunction (MPD) syndrome (laskin 1969), combined with occlusal malrelation, which may be the primary cause of MPD syndrome (Lindblom 1953, Alling 1977).

Summary:
An electromypgraphic (EMG) study of ipsilateral masseter and temporalis muscles was undertaken in healthy volunteers and in patients with MPD syndrome, with the aim of getting further insight into the pathophysiology of this disease.  Unlike controls, patients had abnormal MKG features and displayed involuntary sustained EMG activity at rest, chiefly in the temporalis muscles.

Transcutaneous electrical nerve stimulation (TENS) performed with the Myo-monitor induced relaxatio and relief of pain: these effects were however revesred by voluntary mouth closures.

The correction of occlusal position by acrylic splints was able to induce  persistant reduction or a suppression of the abnormal EMG activity at rest and a good relief of pain: moreover, after the corretion, higher levels of EMG activity were found during maximal  biting in the intercuspal position.

Mechanisms underlying these effects were discussed and in particular it was suggested that abnormal afferenct activity from periodontium and jaw muscles may contribute to the establishment of sustained contraction leading to muscular pain, which in turn may cause reflex muscle activity i vicious circles.

The Myo-monitor: Its use and abuse

Jankelson, Bernard, (1978) The Myo-monitor: Its use and abuse (I). Quintessence International No. 2: Report 1601, pp 47-51.

SUMMARY
The Myo-monitor transcutaneously stimulates the motor branches of the Vth and VIIth cranial nerves, relaxes the associated musculature, and then records an occlusal position that is compatible with a continued state of relaxation. Additional techniques have been developed for taking denture impressions (or relining old dentures) functional occlusal diagnosis, occlusal adjustment, and treatment of TMJ and MPD syndrome.

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