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a
Professor, Department of Restorative Dentistry and Oral Function, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile.
b
Instructor, Department of Restorative Dentistry and Oral Function, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile.
c
Instructor, Department of Orthodontics; Restorative Dentistry and Oral Function, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile.
d
Assistant Professor, Department of Restorative Dentistry and Oral Function, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile.
e
Assistant Professor, Department of Public Health and Epidemiology, Faculty of Dentistry, Universidad de los Andes, Santiago, Chile.
Figure 2. A, Lateral skull radiograph for brachyfacial type. B, Lateral skull radiograph for dolichofacial type.
dolichofacial. No sex differences were found for CR/PVD- to as long-faced or more vertical hyperdivergent type)
P1 (P=.51), CR/PVD-P2 (P=.54), or EMGRVD (P=.30). have greater temporalis muscle tonic activity in CR/
The mean VJS in CR/PVD-P1 for the swallowing PVD22,23 and also under low levels of muscle effort24,25
method was 1.92 ±1.14 mm for brachyfacial participants compared with mesofacial and brachyfacial individuals.
and 1.36 ±0.58 mm for dolichofacial participants (P=.05). This is relevant because the temporalis muscle is
The mean VJS in CR/PVD-P2 for the phonetic breathing mainly a postural jaw muscle.26 Consequently, the
method was 1.89 ±1.17 mm for brachyfacial participants higher temporalis tonic EMG activity could partly
and 1.31 ±0.58 mm for dolichofacial participants (Table 2) explain the lower freeway space or the lower values of
(P=.03). Mean VJS in EMGRVD was 8.23 ±2.21 mm for VJS recorded in CR/PVD for dolichofacial individuals.
brachyfacial participants and 16.55 ±4.29 mm for doli- These higher values of temporalis tonic activity in
chofacial participants (Table 2) (P<.001). dolichofacial individuals may be related to the form
and position of the mandible as well as to a gravita-
tional component.27 Concerning the compensatory
DISCUSSION
self-awareness factor, individuals with brachyfacial and
This study involved a simultaneous comparison of VJS dolichofacial patterns might look for esthetic-
measurements in relation to 2 vertical dimensions (CR/ functional compensation in terms of their facial lower
PVD and EMGRVD) between 2 groups of participants third height in CR/PVD. Because of their long-faced
with vertically opposite morphological craniofacial pat- aspect, dolichofacial individuals try to keep their
terns: brachyfacial and dolichofacial. CR/PVD was mandible less separated from the maxilla and therefore
measured using 2 techniques: a swallowing method attain a smaller freeway space or VJS in CR/PVD,
(CR/PVD-P1) and a phonetic breathing method (CR/ diminishing the long-faced appearance. In brachyfacial
PVD-P2). VJS in CR/PVD-P2 was significantly greater in individuals, this pattern might be the opposite.
brachyfacial participants then dolichofacial ones (P=.03). Dissatisfaction with appearance could be considered a
These results are consistent with the VJS values in CR/ main factor for patients seeking treatment.28 This
PVD found in previous studies, which determined a esthetic-functional compensatory factor should be
mean between 1.1 and 3.1 mm (±0.8) in high-angle closely related to higher EMG activity of the temporalis
groups and a mean between 2.0 and 4.6 mm (±1.35) muscles in dolichofacial individuals.
in low-angle groups of participants.12-16 The findings for Unlike CR/PVD, EMGRVD defines a vertical jaw
both techniques implemented in this study are more position determined by the minimal tonic EMG activity
closely related to the lower values found in these of the jaw-closing muscles, in particular the masseter
studies. muscles, because they show a more defined decline at
The differences in values found for VJS in CR/PVD this point.17,18,40 EMGRVD occurs at a higher VJS than
between brachyfacial and dolichofacial individuals can with CR/PVD; consequently, both vertical positions of
be explained in 2 ways: the level of jaw tonic muscle the jaw must be considered as a separate concept.
activity or a compensatory self-awareness factor in When VJS in EMGRVD was compared between
terms of an individual’s perception of self-appearance brachyfacial and dolichofacial participants, VJS was
regarding the lower third height of the face. significantly greater (P<.001) in the dolichofacial group
Regarding the level of jaw tonic muscle activity, studies (mean, 16.60 ±4.29 mm) than in the brachyfacial group
have shown that dolichofacial individuals (also referred (mean, 8.23 ±2.21 mm). Conversely, other studies
Table 2. Statistical variables (in mm of vertical jaw separation) for brachyfacial and dolichofacial groups in 2 rest vertical dimensions: clinical rest/
postural vertical dimension (CR/PVD) and electromyographic rest vertical dimension (EMGRVD)
Brachyfacial (n=30) Dolichofacial (n=30)
Variable Median (IQR) Mean (SD) Range Median (IQR) Mean ±SD Range P*
CR/PVD-P1 1.70 (0.87) 1.92 ±1.14 0.48-5.71 1.31 (0.94) 1.36 ±0.58 0.46-2.46 .51
CR/PVD-P2 1.67 (1.10) 1.89 ±1.17 0.2-5.71 1.24 (0.93) 1.31 ±0.58 0.46-2.46 .39
EMGRVD 8.04 (2.60) 8.23 ±2.21 4.6-13.68 15.97 (7.20) 16.55 ±4.29 9.45-23.9 <.001
CR/PVD-P1, swallowing method; CR/PVD-P2, phonetic breathing method; IQR, interquartile range. *Mann-Whitney test.
form of myofascial pain in patients with temporo- The advantages of this study compared with other
mandibular disorders),44 but also by an overall studies10-16 include a larger sample of young adults;
decrease in EMG elevator activity with increased strict criteria for skeletal cephalometric classification
OVD, despite the development of a constant occlusal groups; all comparative measurements expressed as
force.7-11 Previous studies have reported that VJS in millimeters; and standardized conditions for
EMGRVD recordings, especially for masseter activity, head-neck and body posture.46 The limitations of this
have shown a considerable decrease in the first 3 to 5 study include the fact that no direct electronic devices
mm; after this interval, it dropped to a minimum level were used to measure VJS.
of between 8 and 12 mm.14,40 These findings suggest
that a few millimeters of interocclusal dimension are CONCLUSIONS
critical for jaw muscle relaxation.45 This can be
On the basis of the findings of this clinical study, the
accomplished by introducing smaller increases in OVD
following conclusions were drawn:
in this 3 to 5 mm space in patients with short faces or
brachyfacial tendencies. For patients with long faces or 1. VJS in CR/PVD in dolichofacial individuals was
dolichofacial tendencies, the opposite procedure is lower than in brachyfacial individuals.
advisable. Therefore, the vertical craniofacial 2. The higher VJS values in EMGRVD in brachyfacial
morphology pattern of the patient should be consid- individuals compared with dolichofacial individuals is
ered when choosing a clinical procedure that increases explained by 2 skeletal muscle properties: variations in
the OVD. sarcomeric length and changes in passive tension.
Figure 4. Open/closing mandibular paths of movements. A, Brachyfacial individual. B, Dolichofacial individual. C, D, Intercuspal position of brachyfacial
and dolichofacial individuals. E, F, Eight-millimeter interincisal opening with corresponding molar vertical space in brachyfacial and dolichofacial
individuals. At same interincisal distance of 8 mm in brachyfacial types higher molar interocclusal space is promoted in comparison with dolichofacial
types due to more vertical path of opening/closing mandibular movements. Arrows in C to F represent orientation of masseter muscles. Modified from
Farella M, Iodice G, Michelotti A, Leonardi R. The relationship between vertical craniofacial morphology and the sagittal path of mandibular movements.
J Oral Rehabil 2005;32:857-62. P, posterior; A, anterior.
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J Oral Rehabil 2010;37:813-9. Copyright © 2017 by the Editorial Council for The Journal of Prosthetic Dentistry.