CC BY
33
https://doi.org/10.29013/ELBLS-21-3-9-14
Yarov Svitlana, Dental Department 2, Kramatorsk, Ukraine
Turchenenko Sergii, Dental Department 2, Kramatorsk, Ukraine
Yarov Yurii,
Dental Department 2, Kramatorsk, Ukraine
Komlev Andrii, Donetsk National Medical University, Dental Department 2, Kramatorsk, Ukraine E-mail: Kaf.stomatologii2@ykr.net; stsergeyroyal@gmail.co
APPLICATION OF ELECTROMYOGRAPHY METHOD FOR DIAGNOSIS AND TREATMENT OF STOMATOLOGY DISEASES
Abstract. The analysis of the bioelectric activity of masticatory muscles allows assessment to determine the degree of functional alterations and provides the ability to monitor the functional rehabilitation of the patient. Electromyographic studies of dental defects and dentognathic anomalies demonstrate an increased activity of the masticatory muscles, which can be normalized with an adequate treatment. Significant changes detected in the activity of masticatory muscles and functional changes of the maxillodental system in patients with dental defects, dentognathic anomalies, temporomandibular joint dysfunction, and the pathology of periodontal tissues indicate the expediency and importance of using electromyography to diagnose and control the effectiveness of treatment.
Keywords: electromyographic study, masticatory muscles, stomatological pathology.
Introduction. Despite the development and implementation of numerous treatment methods and prevention measures aimed at reducing the level of dental morbidity rates at the early stage of initial treatment for dental caries, the prevalence and intensity remain at a high level still [30]. This often leads to tooth loss and persistent abnormal morphological and functional changes of the maxillodental system. Results of medical and statistical studies indicate an increased incidence of tooth loss, reaching up to 70% in some regions of Ukraine. Timely unsubstituted dental defects cause the maxillo-dental deformities and violations in occlusal correlations. The loss of a large number of teeth in lateral areas results in reduced occlusal vertical dimension. In addition, at the bilateral defects the lower jaw is displaced distally, at
the unilateral- asymmetrically towards the direction of defect; and teeth which have lost antagonists, are moved beyond the occlusal plane. If the dental restoration is not performed in timely manner, the temporo-mandibular joints become involved in the pathological process [3]. The bioelectric activity ofmasticatory muscles is associated with a number of stimuli that form a certain functional system, so-called «dynamic stereotype». Therefore, the assessment of the functional state of the biodynamics of the motor apparatus and its active component- the muscular system, represents an importance in theoretical and practical perspectives [5]. The method of electromyography is widely used in masticatory muscle activity evaluation under normal and pathological conditions. Elec-tromyographic studies are based on the evaluation
of muscle fiber biopotentials functioning as a part of the motor units: a functional unit of the arbitrary and reflexive bioelectric activity of the neuromuscular apparatus. The masticatory muscles electromyographic activity during chewing is characterized by a variable activity of examined organs, a coordinated function of antagonists and synergists, and a clear change in the activity and resting phases during one single chewing movement, which is not observed at muscular pathology [18; 19]. The evaluation of indicators of bioelectric activity of masticatory muscles under the pathological conditions of the chewing apparatus allows to determine the degree offunctional alterations, as well as to control the functional rehabilitation status of the patient after the appropriate treatment [4; 9; 12; 18; 19]. All of the above suggests the relevance of this problem, expedience and perspectivity of its further study taking into account new technological possibilities and originality of approaches.
The aim was to study scientific works about the role of masticatory muscles physiology in various pathological conditions of the tooth-jaw system, namely: the presence of defects in dentition, dental maxillary anomalies, neuromuscular pathology, pathology of the temporomandibular joints, periodontal disease as well as the dynamics of the rehabilitation period on the basis of the literary data analysis that reflect the results of electromyography.
Material and methods. The review of scientific works is conducted in that the presented results of evaluation of the masticatory muscles functional state was carried out by functional electromyogra-phy which consisted in the registration of muscle bioelectic potentials prior to medical and preventive measures as well as after appropriate treatment. The myograph measures and records the electrical activity (biopotential) of eight muscles at the same time at the state of rest and during jaw compression in one record without phase shift, representing a valuable diagnostic information in assessing the position of the mandible and the state of all masticatory muscles. The use of surface electrosensors attached to the
skin at the site of the muscles in question projection makes it possible to determine the degree of hypertonic (spasm) of these muscles. The signals of the miograph are displayed on the display with the preservation of the waveform in a given time interval and the display of averages, which give information about the patterns of contraction and relative intensity.
Review and discussion. The study of chewing muscles bioelectric activity indicators allows us to determine the degree of functional disorders in the pathological states of the masticatory apparatus and to further control the degree of functional rehabilitation of patients after treatment. It has been established that the patients with defects in dentition in comparison with the norm have a prolonged chewing period and decrease in chewing efficacy, the ratio of excitatory and inhibitory processes in chewing muscles sharply deteriorates, the term of bioelectric activity increases due to reduction of the relative bioelectric rest period, discoordination of chewing muscles activity progresses [7; 14]. In the case of the defects in dentition timely replacement by orthopedic structures based on dental implants with the number of installed dental implantscorresponding to the number of lost teeth in one month after fixation on abutments of permanent orthopedic structures the bioelectric activity of the masticatory muscles did not have statistically significant differences from the norm, which evidenced about the full functional rehabilitation of persons under research [1; 2]. Using the method of masticatory muscles surface electromyography the control of the prosthesis effectiveness and the degree of adaptation in the prosthetics of patients with end defects in the dentition was carried out using implantable replacement structures with high resistance. The approximation of masticatory muscles bioelectric potentials to norm after 3 months of using these prostheses is shown [24]. A study was conducted to determine the activity of chewing muscles of patients requiring dental implantation in different observation periods (before implantation, after 3, 6 and 12 months), depending on the time after the removal ofthe teeth, the
time of implantation and the time of functional load presentation on the implant. It has been shown that the functional activity of chewing muscles depends, first of all, on the period after the removal of the teeth and the installation of implants: the more time passed after the removal, the more obvious changes can there be and vice versa. In addition, it was found that the functional activity of chewing muscles also depends on the period of optimal functional load reproduction: activity is more likely to be normalized with early functional loads transmitted through temporary orthopedic constructions [8]. The comparison of chewing muscles electromyography quantitative indices was conducted during adaptation of patients to complete removable dentures without the use of drugs and against the background of therapeutic and prophylactic use of drugs with adaptogenic properties. It is proved that the total absence of teeth typical for elderly and aged people is characterized by changes in the parameters ofmasticatory muscles electromyography in the course of an arbitrary chewing test consisting in lowering the amplitude, increasing the frequency of biopotentials, increasing the time of activity in the dynamic cycle. The use of completely removable dentures during 30 days leads to improvement of the electromyography but does not lead to completeness in the new stereotype of chewing. The use ofAveit and Piracetam preparations accelerates the development of adaptive changes in electromyographic parameters of chewing muscles [10]. Thus, electromyographic studies of maxillofacial area muscles can serve as an objective criterion for the adequacy of orthopedic treatment and may reveal a neuromuscular imbalance in the manufacture of poor-quality orthopedic structures. Pathological types of bite are characterized not only by the deviation of the teeth position and their occlusive relationships, but also by pronounced decline in function, primarily chewing. It is known that the functional characteristic of masticatory muscles in distal occlusion (class II of dental maxillary anomalies by Engle) is high muscular activity m. tmporales compared with m. masseter, which leads to the de-
velopment of less physiological temporal chewing type [11]. In addition to the well-known two-way deviations of the second class according to Engle there are cases where the distal ratio is observed only on one side. It was established that in unilateral class II the functional dominance of m. temporales was determined by qualitative and quantitative indicators, which is the functional reason to consider this type of bite as pathological [16]. One of the pathogenetic mechanisms of tooth rows distal ratio development with protrusion of teeth is the violation ofthe myody-namic equilibrium between the muscles of the external and internal muscular circles of the mouth, which is confirmed by electromyographic examination of 6-9 years old children. The study of the tooth-jaw area functional state before and during orthodontic correction with the use of myotrains showed that in 3 months the patients improved the function of the muscles under study, namely: the amplitude of the biopotentials reductionis growing and approaching the normal values [15]. Electromyographic studies of children aged 8-9 and adolescents aged 16-17 found that at distal occlusion not only increases the length of the masticatory period and the number of chewing movements, but also the total time ofbioelectric activity of the chewing and front of the temporal muscles in comparison with the norm. At the same time the maximum amplitude of chewing and temporal muscles is much lower than normal. It has been established that children's difference between temporal and chewing muscular biopotentials and the norm reaches, on average, 30%, whereas adolescents have it at 17 to 47%, which indicates an increase in functional imbalance with age [21]. At the orthodontic treatment reception the proportion of patients with tooth-jaw abnormalities complicated by accumulation of teeth makes 70-80%. It is proved that in the complex diagnosis of such cases it is extremely important to determine the functional state of the temporal, actually the chewing muscles and the coliform muscle of the mouth, which provides the possibility of a systemic objective approach [6; 17].
It is known that the frequency of temporomandibular joint (TMJ) dysfunction of adult population is from 5 to 50%, and among patients who seek dental care it is 70-95%. The key to the development of TMJ dysfunction is the violation of the harmonic occlusion-muscle relationship due to anomalous ar-ticulation-occlusal relationship of teeth, tooth rows and jaws, bite, decrease in the height of central occlusion, joint injuries, bruxism, strain and tension of the masticatory muscles, especially of people with a stress-instable type of personality. With an occlusion-muscular dysharmonia to achieve the lower jaw position of the central relationship the tension of the muscular complex increases which isleading to the development of the main dysfunction symptoms [13]. With an occlusion-muscular dysharmonia to achieve the lower jaw position of the central relationship the tension of the muscular complex increases which is leading to the development of the main symptoms of dysfunction [20]. At the same time there is evidence that in 57-81% of cases the pathology of TMJ is found with persons who have intact dental rows and an orthognathic bite [21]. A serious study requires the problem of adolescents TMJ dysfunction due to the considerable prevalence and variety of clinical manifestations that may affect the psychological and social health of adolescents. A compulsory method of modern diagnostics in such cases is functional examination, namely, electromyography of chewing muscles, most often m. temporalism masseter, which are placed superficially [7]. On the other hand, the elderly with defects in the dentition have a violation of adaptation to the changed conditions of their functioning, especially with complete loss of teeth. Since muscles primarily react to the presence of errors in the construction of occlusion, according to electromyographic studies it is possible to indirectly assess the functional value of the prostheses. The inclusion into the diagnostic algorithm of functional methods can be controlled to provide comfortable conditions for accelerating the timing of adaptation to completely removable prostheses [21]. It is known that electro-
myographic research is one ofthe leading methods of diagnostics in dentistry, in particular, in periodontol-ogy. The problem of qualitative periodontal tissues pathology treatment remains relevant, especially against the background of organism resistance general and local factors reduction as, for example, in the case of herpes virus infection. At the same time the function of the tooth-jaw system including chewing muscles even in the absence of defects in the dentition significantly deteriorates [22]. It is known that in 85% of cases the cause ofperiodontal disease is occlusive disorders, which makes their early diagnosis of great clinical significance. The study of changes in the bioelectric activity of the muscles in the maxillofacial area ofpatients with chronic generalized periodontitis revealed a violation in their coordinated work, which led to more frequent exacerbations of the disease. At the same time, the picture of electromyography was characterized by a significant decrease in the amplitude of biopotentials of chewing and temporal muscles, the presence of all muscle groups spontaneous activity, an increase in the amplitude of the biopotentials of the supradiary muscles which take on the compensatory load [25]. One of the widespread types of periodontal tissues pathology which affects between 15 and 85% of respondents aged 16-60 is a recession of gums. This periodontal disease causes not only an aesthetic defect, but also promotes the development of hypersensitivity of the teeth roots due to the exposure to cement, carious process and abfraction. It is important to study the influence of hypertonic chewing muscles on the development of generalized gum recession. The assessment of the gum recession progression with patients having muscular-tonic syndrome has shown a progression of the process in the absence of appropriate treatment. Herewith the group of maximum risk has been patients with a thin alveolar bone and an increased total potential. Understanding the role of myotonic syndrome in the development of generalized gum recession allows for more effective treatment and prevention and reduces the risk of disease recurrence [21].
Conclusion. The performed researches have revealed significant changes in the activity of chewing muscles and functional changes of the tooth-jaw system of patients with defects in dentition, dental ankles, dysfunction of the temporo-mandibular joint, periodontal tissue pathology
which indicates the expediency and necessity of using electromyography for diagnosis and monitoring of the relevant pathological conditions. It is also important to use functional methods to determine the effectiveness of the treatment and control of its stability.
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