CLINICAL RESEARCH

Comparison of clinical and electromyographic rest vertical

dimensions in dolichofacial and brachyfacial young adults: A
cross-sectional study
Arturo Manns, DDS, Dr med dent,a Catalina Valdivieso, DDS,b Victor Rojas, DDS,c
Constanza Valdés, DDS,d and Valeria Ramírez, DDSe

Changing the occlusal vertical ABSTRACT

dimension (OVD) is a com- Statement of problem. Therapeutic procedures that increase occlusal vertical dimension (OVD)
mon procedure in restorative may have different responses in patients with different craniofacial vertical patterns. The effect on
dentistry when patients are these patients of increasing their OVD is not well understood.
treated for temporomandib-
Purpose. The purpose of this clinical study was to compare measurements of vertical jaw sepa-
ular disorders or orthodontic ration (VJS) in patients with brachyfacial and dolichofacial craniofacial patterns in 2 vertical di-
problems, or when they mensions: the clinical rest/postural vertical dimension (CR/PVD) and electromyographic rest vertical
require orthognathic surgery.1-3 dimension (EMGRVD).
Long-term studies have re-
Material and methods. Sixty healthy dental students were selected at random after a lateral skull
ported an adaptation of face radiograph was made. The Ricketts (VERT index) analysis was used to determine 30 brachyfacial (G1)
height after an increase of OVD and 30 dolichofacial (G2) types. The VJS was measured for G1 and G2 types in the 2 rest vertical
with fixed restorations. One dimensions specified. CR/PVD was recorded using 2 methods: swallowing (CR/PVD-P1) and the
study showed stability in the phonetic breathing method (CR/PVD-P2). The Shapiro-Wilk test was used for data distribution, and
occlusal face height after the the Mann-Whitney U test was used to accept or reject the null hypothesis (a=.05).
OVD was increased by an Results. Mean VJS in CR/PVD-P1 was 1.92 ±1.14 mm for the brachyfacial and 1.36 ±0.58 mm for the
average of 1.9 mm in 12 of 19 dolichofacial facial group (P=.05). The mean VJS in CR/PVD-P2 was 1.89 ±1.17 mm for the
patients after 5.5 years.1 The brachyfacial and 1.31 ±0.58 mm for the dolichofacial group (P=.03). The mean VJS in EMGRVD
functional adaptation was re- was 8.23 ±2.21 mm for the brachyfacial and 16.55 ±4.29 mm the dolichofacial group (P<.001).
ported to be highly individual. Conclusions. CR/PVD measurements in dolichofacial individuals were lower than those in bra-
Another study discussed adap- chyfacial individuals. EMGRVD measurements were higher in dolichofacial individuals than those in
tation to increased occlusal brachyfacial individuals. Biomechanical, physiological, and behavioral reasons might explain such
facial height from a single pa- diversity. (J Prosthet Dent 2018;-:---)
tient, showing it to be stable
after 10 years, in spite of wear and increased overlap of the The vertical separation of occlusal devices has been
restorations.2 More recent results have shown that the reported to be positively correlated with therapeutic
increased adaptive resting face height remains stable after outcome in patients with temporomandibular disorders.
the OVD was increased over 1 and 2 years in 8 The increase in OVD with occlusal devices decreases the
participants.3 activity of the jaw elevator muscles.4-6 In relation to the

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.

THE JOURNAL OF PROSTHETIC DENTISTRY 1

2 Volume
Clinical Implications
Restoring the occlusal vertical dimension (OVD) is
possible by introducing smaller increases in patients
with short faces or brachyfacial tendencies. For
patients with long faces or dolichofacial tendencies,
the opposite is advisable. Therefore, the vertical
craniofacial morphology pattern of the patient
should be considered when a clinical procedure to
increase the OVD is selected.
decreased electromyographic (EMG) activity with
increased OVD, one study has analyzed the effect of
changes in vertical jaw relation on motor unit recruitment
behavior in different regions of the masseter muscles
during feedback-controlled submaximum occlusal tasks.7
The EMG activity diminished with increased vertical
distance despite the development of a constant occlusal
force, which is in accordance with previous findings in
which surface electrodes were used.8-10
In these studies, procedures to increase OVD were
based, biologically and clinically, on 2 rest vertical di-
mensions: clinical rest/postural vertical dimension (CR/
PVD) and the electromyographic rest vertical dimension
(EMGRVD). The CR/PVD, or the clinical rest position of
the mandible, is traditionally used as a vertical reference
to establish the OVD in a complete denture. CR/PVD is
also called the habitual postural position of the
mandible because it is maintained by a definite EMG
tonically or postural jaw elevator activity. To record
OVD, participants were instructed to rest their jaws
with teeth slightly apart to establish the so-called
freeway space. EMGRVD is an EMG-determined ver-
tical jaw position where minimal tonic EMG activity of
the elevator muscles occurs.11-16 According to experi-
mental studies of EMGRVD, tonic elevator EMG activity
decreases gradually particularly in the masseter when
the mandible moves from intercuspation to maximal
opening, reaching its minimum at 8 to 12 mm of vertical
jaw separation (VJS) and then increasing gradually to
achieve its highest level at maximum opening.17-21
EMGRVD occurs at a higher VJS (8 to 12 mm)
in comparison with CR/P-P (1 to 3 mm), and conse-
quently both vertical positions of the jaw must be
considered as a separate concept or as independent
entities.14,18,19,21
Studies related to CR/PVD have reported that the
freeway space is inversely related to the vertically oppo-
site morphological craniofacial patterns: brachyfacial/
dolichofacial or short/long faces. Accordingly, freeway
space has been found to be smaller in individuals with
longer faces than those with shorter faces.12-14 These
differences are possibly related to their temporalis
THE JOURNAL OF PROSTHETIC DENTISTRY
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muscle activity,22-27 esthetic-functional compensation,28
masseter muscle orientation,29 or elevator jaw muscles
cross-sectional area.30-34 However, other studies have
only reported a low correlation value between CR/PVD,
the electrically stimulated jaw position, and the
mandibular plane/sella-nasion angle.15,16 Regarding
EMGRVD, results are contradictory: some state that there
are no differences in VJS when EMGRVD is recorded
between low-angle and high-angle individuals;12-14
others indicate that there are differences, reporting
higher VJS average values in EMGRVD in low-angle
individuals.11
The purpose of this clinical study was to compare VJS
for the 2 vertical jaw positions, CR/PVD and EMGRVD,
between brachyfacial and dolichofacial individuals, as
well as to identify these vertical jaw positions in both
vertically opposite facial patterns based on biomechan-
ical, physiological, and behavioral considerations,35-37
along with their clinical applications.
MATERIAL AND METHODS
Eighty-nine healthy, fully dentate men and women,
dental students between the ages of 18 and 27, partici-
pated in this study after undergoing lateral skull radi-
ography. The participants were recruited by convenience
sampling from a single institution, Faculty of Dentistry,
Universidad de los Andes. The study was approved by
the ethics committee of the Universidad de los Andes. All
were volunteers and signed an informed consent to
participate in this study in accordance with the Decla-
ration of Helsinki. Table 1 shows the sociodemographic
characteristics of the sample.
Inclusion criteria required participants to have
healthy, full permanent dentition, except for third molars
and premolars removed as part of orthodontic treatment.
Exclusion criteria comprised active periodontal disease,
temporomandibular disorders, lip incompetence, and
medically compromised individuals.
Participants were shortlisted according to facial third
proportion and mandibular rotation. Individuals were
considered brachyfacial (G1) if they had a shorter lower
facial third and a low gonial angle. They were considered
dolichofacial (G2) if they had a longer lower facial third
and a high gonial angle. The 89 participants were
selected accordingly, and the vertical facial pattern for
each participant was determined by using the Ricketts
VERT index analysis. For that purpose, a cephalometric
diagnostic method was used by means of a lateral skull
radiograph to confirm the vertical craniofacial pattern of
the participants.
Craniofacial patterns were determined by using digital
cephalometric software (Nemochep), which allowed the
vertical growth direction of each participant to be clas-
sified. Vertical facial patterns were determined using the
Manns et al
- 2018 3

Table 1. Sociodemographic characteristics of sample

Sex Age (y)
Median
Craniofacial Mean (Interquartile Total
Pattern Men Women (SD) Range) (n)
Brachyfacial 11 19 24 (1.70) 24 (1) 30
Dolichofacial 9 21 23 (2.14) 23 (2) 30
Total 20 40 60

VERT index, which is the arithmetic mean of the differ-

ence between 5 cephalometric measurements: facial axis
(Ba-Na to Pt-Gn), facial depth (FH to N-pg), mandibular
plane angle (FH to Go-Me), lower face height (ANS-Xi to
Xi-Pm), and mandibular arch (Pm-Xi to Xi-Dc) divided
by the standard deviation of those measurements (Fig. 1). Figure 1. Cephalometric measurements used to define vertical facial
The facial pattern of each participant (Fig. 2) was classi- pattern through Ricketts (VERT index) analysis. 1, Facial axis 90 ±3
fied as either brachyfacial (VERT index more than +1.0) degrees. 2, Facial depth 87 ±3 degrees. 3, Mandibular plane 26 ±4
or dolichofacial (VERT index less than −1.0). Of the 89 degrees. 4, Lower facial height 47 ±4 degrees. 5, Mandibular arch
initial volunteers, 60 participants were included in the 26 ±4 degrees.
sample, 30 in group G1 and 30 in group G2.
EMGRVD defines a vertical jaw position as deter-
The CR/PVD and EMGRVD were measured by an
mined by the minimal tonic EMG activity of the jaw-
experienced clinician (A.M.) at the oral physiology labo-
closing muscles, in particular the masseter muscles,
ratory at Universidad de los Andes. The clinician was not
because it shows a more defined decline at this
informed of the participants’ VERT index. The partici-
point.7,18,40 Masseteric EMG activity was recorded using
pants were seated upright in a dental chair with their
2 self-adhesive and gel-free EMG surface electrodes
heads supported, the bipupilar plane parallel to the floor,
(Bioflex; Bio Research Associates Inc) and 1 neutral
and their eyes open while looking straight ahead. The
electrode on the forehead, according to the electromy-
base of the nasal septum and the most prominent part of
ography recording procedures previously described.41
the chin, both coincident with the facial midline, were
The participants were instructed to open their mouths
marked with a pen. A compass (Zielinsky DP-725; Aes-
slowly and progressively from the intercuspal position,
culap) and digital calipers (Scale Digital Caliper; Mitutoyo
keeping their facial muscles as relaxed as possible during
Co) were used to record the vertical dimension between
opening until the minimum digital value of tonic
the points. The tips of the calipers were placed without
masseteric activity was identified with the micro-
any pressure to avoid distortion of the skin. VJS was
voltmeter. The vertical dimension was then measured
calculated in hundredths of millimeters (10 mm accuracy)
(Fig. 3C). VJS was calculated by subtracting the vertical
by subtracting the vertical dimension value recorded in
dimension in intercuspal position from the obtained
the intercuspal position (Fig. 3A) from the vertical
value in EMGRVD.
dimension values obtained for CR/PVD (Fig. 3B) and
Quantitative variables were described with their me-
EMGRVD (Fig. 3C).
dian and interquartile range because they displayed an
The following 2 methods were used to measure the
asymmetric distribution, which was evaluated using the
distance between points A and B. In the swallowing
Shapiro-Wilk test (a=.05). Categorical variables were
method (CR/PVD-P1), participants were asked to
described by frequencies and percentages. The Mann-
moisten their lips first and then swallow saliva while in
Whitney U test for nonparametric data was used to
the intercuspal position and then relax their jaw with
compare brachyfacial and dolichofacial groups (a=.05).
their lips remaining in slight contact. The vertical
All statistical analyses were performed with Stata v12.1
dimension was recorded immediately (Fig. 3B).38 In the
software (StataCorp).
phonetic breathing method (CR/PVD-P2), participants
were asked to say the word “sip.” On pronouncing the
RESULTS
“p” phoneme, they were instructed to exhale through
the nose and relax their jaw with their lips remaining Eighty-nine volunteer dental students between 18 and 27
in slight contact. The vertical dimension was recorded years of age were recruited. Only 60 students fulfilled the
(Fig. 3B).39 For each method, VJS was calculated by inclusion criteria: 40 women and 20 men. Nineteen
subtracting the vertical dimension in the intercuspal women (63.33%) and 11 men (36.67%) were brachyfa-
position from the obtained value in CR/PVD. cial; 21 women (70%) and 9 men (30%) were

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4 Volume
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-
P1 (P=.51), CR/PVD-P2 (P=.54), or EMGRVD (P=.30).
The mean VJS in CR/PVD-P1 for the swallowing
method was 1.92 ±1.14 mm for brachyfacial participants
and 1.36 ±0.58 mm for dolichofacial participants (P=.05).
The mean VJS in CR/PVD-P2 for the phonetic breathing
method was 1.89 ±1.17 mm for brachyfacial participants
and 1.31 ±0.58 mm for dolichofacial participants (Table 2)
(P=.03). Mean VJS in EMGRVD was 8.23 ±2.21 mm for
brachyfacial participants and 16.55 ±4.29 mm for doli-
chofacial participants (Table 2) (P<.001).
DISCUSSION
This study involved a simultaneous comparison of VJS
measurements in relation to 2 vertical dimensions (CR/
PVD and EMGRVD) between 2 groups of participants
with vertically opposite morphological craniofacial pat-
terns: brachyfacial and dolichofacial. CR/PVD was
measured using 2 techniques: a swallowing method
(CR/PVD-P1) and a phonetic breathing method (CR/
PVD-P2). VJS in CR/PVD-P2 was significantly greater in
brachyfacial participants then dolichofacial ones (P=.03).
These results are consistent with the VJS values in CR/
PVD found in previous studies, which determined a
mean between 1.1 and 3.1 mm (±0.8) in high-angle
groups and a mean between 2.0 and 4.6 mm (±1.35)
in low-angle groups of participants.12-16 The findings for
both techniques implemented in this study are more
closely related to the lower values found in these
studies.
The differences in values found for VJS in CR/PVD
between brachyfacial and dolichofacial individuals can
be explained in 2 ways: the level of jaw tonic muscle
activity or a compensatory self-awareness factor in
terms of an individual’s perception of self-appearance
regarding the lower third height of the face.
Regarding the level of jaw tonic muscle activity, studies
have shown that dolichofacial individuals (also referred
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to as long-faced or more vertical hyperdivergent type)
have greater temporalis muscle tonic activity in CR/
PVD22,23 and also under low levels of muscle effort24,25
compared with mesofacial and brachyfacial individuals.
This is relevant because the temporalis muscle is
mainly a postural jaw muscle.26 Consequently, the
higher temporalis tonic EMG activity could partly
explain the lower freeway space or the lower values of
VJS recorded in CR/PVD for dolichofacial individuals.
These higher values of temporalis tonic activity in
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
self-awareness factor, individuals with brachyfacial and
dolichofacial patterns might look for esthetic-
functional compensation in terms of their facial lower
third height in CR/PVD. Because of their long-faced
aspect, dolichofacial individuals try to keep their
mandible less separated from the maxilla and therefore
attain a smaller freeway space or VJS in CR/PVD,
diminishing the long-faced appearance. In brachyfacial
individuals, this pattern might be the opposite.
Dissatisfaction with appearance could be considered a
main factor for patients seeking treatment.28 This
esthetic-functional compensatory factor should be
closely related to higher EMG activity of the temporalis
muscles in dolichofacial individuals.
Unlike CR/PVD, EMGRVD defines a vertical jaw
position determined by the minimal tonic EMG activity
of the jaw-closing muscles, in particular the masseter
muscles, because they show a more defined decline at
this point.17,18,40 EMGRVD occurs at a higher VJS than
with CR/PVD; consequently, both vertical positions of
the jaw must be considered as a separate concept.
When VJS in EMGRVD was compared between
brachyfacial and dolichofacial participants, VJS was
significantly greater (P<.001) in the dolichofacial group
(mean, 16.60 ±4.29 mm) than in the brachyfacial group
(mean, 8.23 ±2.21 mm). Conversely, other studies
Manns et al
- 2018
Figure 3. Vertical jaw separation measurements. A, Intercuspal
position (IP). B, Clinical rest/postural vertical dimension (CR/PVD). C,
Electromyographic rest vertical dimension (EMGRVD). Measurements
performed with compass between base of nasal septum and most
prominent part of chin, both coincident with facial midline; information
transferred to file using same compass and numerical measurement of
corresponding vertical dimension performed using digital calipers.
reported higher VJS average values in EMGRVD in
low-angle individuals11 or no significant differences in
EMGRVD between long- and short-angle in-
dividuals.13,15 Our results agree with the resting zone
of bilateral minimum masseter EMG activity found in a
Manns et al
5
group of asymptomatic individuals and performed
under similar experimental EMG settings to this
study.21
The difference in the VJS values regarding
EMGRVD found in this study when brachyfacial and
dolichofacial participants were compared may be
explained on the basis of 2 skeletal muscle properties:
variations in sarcomeric length and changes in passive
tension.42,43 Specifically, both muscle properties are
manifested as the different degrees of masseter muscle
stretch approach the optimal range of sarcomeric
length. Individuals with brachyfacial tendencies
attained this optimal range of sarcomeric length
without opening their jaws as much as dolichofacial
individuals. Also, an earlier increase in passive
masseteric muscular tension occurred. Optimal sarco-
meric length range and passive tension have been
documented by the general length-tension relationship
of skeletal muscles42,43 and length-tension relationship
of jaw-closing muscles.8,9,35-37 Figure 4C and G illus-
trates the different masseter muscle lengthening effects
by means of an interincisal 8 mm jaw opening in those
with brachyfacial and dolichofacial tendencies. In this
example, the brachyfacial biotype had a molar vertical
dimension of 6 mm (Fig. 4D), whereas only a 4 mm
molar vertical dimension was present in the dolicho-
facial biotype (Fig. 4F). This means an earlier and
greater lengthening of the masseter muscle in the
brachyfacial group occurred at a specific interincisal jaw
separation. Furthermore, the anatomic muscle orien-
tation should be considered. Brachyfacial biotypes have
more vertically oriented masseter muscles than doli-
chofacial ones. Dolichofacial biotypes display a more
oblique masseter orientation (Fig. 4C, 4E).29
The elevator jaw muscles in brachyfacial individuals
have a larger cross-sectional area compared with doli-
chofacial individuals, particularly the masseter.30-34
Therefore, this muscle consists of fibers of greater
cross-sectional area with a larger number of parallel
sarcomeres, meaning that more myosin cross-bridges are
available for a particular muscle resting length. As a
result, fewer muscle fibers are required to provide a
definite number of myosin cross-bridges at that given
muscle length, and in turn lower tonic EMG activity in
EMGRVD.
The results of this study will assist clinicians in
making therapeutic decisions when an increase in
OVD is indicated. The therapeutic objective in the in-
crease of the OVD is not only to increase the height of
the occlusion but also to achieve a therapeutic neuro-
muscular advantage and improved neuromuscular
adaptation. The latter is obtained not only by reduction
of the tonic EMG elevator activity, with special refer-
ence to the masseter muscle (the most affected in the
THE JOURNAL OF PROSTHETIC DENTISTRY
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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-
mandibular disorders),44 but also by an overall
decrease in EMG elevator activity with increased
OVD, despite the development of a constant occlusal
force.7-11 Previous studies have reported that
EMGRVD recordings, especially for masseter activity,
have shown a considerable decrease in the first 3 to 5
mm; after this interval, it dropped to a minimum level
of between 8 and 12 mm.14,40 These findings suggest
that a few millimeters of interocclusal dimension are
critical for jaw muscle relaxation.45 This can be
accomplished by introducing smaller increases in OVD
in this 3 to 5 mm space in patients with short faces or
brachyfacial tendencies. For patients with long faces or
dolichofacial tendencies, the opposite procedure is
advisable. Therefore, the vertical craniofacial
morphology pattern of the patient should be consid-
ered when choosing a clinical procedure that increases
the OVD.
The advantages of this study compared with other
studies10-16 include a larger sample of young adults;
strict criteria for skeletal cephalometric classification
groups; all comparative measurements expressed as
VJS in millimeters; and standardized conditions for
head-neck and body posture.46 The limitations of this
study include the fact that no direct electronic devices
were used to measure VJS.
CONCLUSIONS
On the basis of the findings of this clinical study, the
following conclusions were drawn:
1. VJS in CR/PVD in dolichofacial individuals was
lower than in brachyfacial individuals.
2. The higher VJS values in EMGRVD in brachyfacial
individuals compared with dolichofacial individuals is
explained by 2 skeletal muscle properties: variations in
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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- 2018 7

REFERENCES 25. Farella M, Michelotti A, Carbone G, Gallo LM, Palla S, Martina R. Habitual
daily masseter activity of subjects with different vertical craniofacial
morphology. Eur J Oral Sci 2005;113:380-5.
1. Dahl BL, Krogstad O. Long-term observations of an increased occlusal face
26. Yilmaz G, Ugincius P, Sebik O, Türker KS. Tonic activity of the human tem-
height obtained by a combined orthodontic/prosthetic approach. J Oral
poralis muscle at mandibular rest position. Arch Oral Biol 2015;60:1645-9.
Rehabil 1985;12:173-6.
27. Miralles R, Hevia R, Contreras L, Carvajal R, Bull R, Manns A. Patterns of
2. Dahl BL. The face height in adult dentate humans. A discussion of physio-
electromyographic activity in subjects with different skeletal facial types.
logical and prosthodontic principles illustrated through a case report. J Oral
Angle Orthod 1991;61:277-84.
Rehabil 1995;22:565-9.
28. Samsonyanovà L, Broukal Z. A systematic review of individual motivational
3. Ormianer Z, Gross MA. 2-year follow-up of mandibular posture following an
factors in orthodontic treatment: facial attractiveness as the main motiva-
increase in occlusal vertical dimension beyond the clinical rest position with
tional factor in orthodontic treatment. Int J Dent 2014;1:1-7.32.
fixed restorations. J Oral Rehabil 1998;25:877-83.
29. Van Spronsen PH, Weijs WA, Van Ginkel FC, Prahl-Andersen B. Jaw muscle
4. Manns A, Miralles R, Santander G, Valdivia J. Influence of the vertical
orientation and moment-arms of long-face and normal adults. J Dent Res
dimension in the treatment of myofascial pain-dysfunction syndrome.
1996;75:1372-80.
J Prosthet Dent 1983;50:700-9.
30. Satiroglu F, Arun T, Işik F. Comparative data on facial morphology and
5. Dahlstrom L. Conservative treatment of mandibular dysfunction. Clinical and
muscle thickness using ultrasonography. Eur J Orthod 2005;27:562-7.
electromyographic studies of biofeedback and occlusal appliances. Swed
31. Pepicelli A, Woods M, Briggs C. The mandibular muscles and their impor-
Dent J Suppl 1984;24:1-45.
tance in orthodontics: a contemporary review. Am J Orthodon Dentofacial
6. Moreno-Hay I, Okeson JP. Does altering the occlusal vertical dimension
Orthoped 2005;128:774-80.
produce temporomandibular disorders? A literature review. J Oral Rehabil
32. Hannam AG, Wood WW. Relationships between the size and spatial
2015;42:875-82.
morphology of human masseter and medial pterygoid muscles, the cranio-
7. Terebesi S, Giannakopoulos NN, Brüstle F, Hellmann D, Türp JC,
facial skeleton, and jaw biomechanics. Am J Phys Anthropol 1989;80:429-45.
Schindler HJ. Small vertical changes in jaw relation affect motor unit
33. Raadsheer MC, Kiliaridis S, Van Eijden TM, Van Ginkel FC, Prahl-
recruitment in the masseter. J Oral Rehabil 2016;43:259-68.
Andersen B. Masseter muscle thickness in growing individuals and its rela-
8. Manns A, Spreng M. EMG amplitude and frequency at different muscular
tion to facial morphology. Arch Oral Biol 1996;41:323-32.
elongations under constant masticatory force or EMG activity. Acta Physiol
34. Georgiakaki I, Tortopidis D, Garefis P, Kiliaridis S. Ultrasonographic thick-
Latinoam 1977;27:269-71.
ness and electromyographic activity of masseter muscle of human females.
9. Manns A, Miralles R, Palazzi C. EMG, bite force and elongations of the
J Oral Rehabil 2007;34:121-8.
masseter muscle under isometric voluntary contractions and variations of
35. Mackenna BR, Türker KS. Jaw separation and maximum incising force.
vertical dimension. J Prosthet Dent 1979;48:674-82.
J Prosthet Dent 1983;49:726-30.
10. Lindauer SJ, Gay T, Rendell J. Effect of jaw opening on masticatory muscle
36. Paphangkorakit J, Osborn JW. Effect of jaw opening on the direction and
EMG-force characteristics. J Dent Res 1993;72:51-5.
magnitude of human incisal bite forces. J Dent Res 1997;76:561-7.
11. Van Sickels JE, Rugh JD, Chu GW, Lemke RR. Electromyographic relaxed
37. Arima T, Takeuchi T, Honda K, Tomonaga A, Tanosoto T, Ohata N. Effects of
mandibular position in long-faced subjects. J Prosthet Dent 1985;54:578-81.
interocclusal distance on bite force and masseter EMG in healthy partici-
12. Wessberg GA, Washburn MC, Epker BN, Dana KO. Evaluation of mandib-
pants. J Oral Rehabil 2013;40:900-8.
ular rest position in subjects with diverse dentofacial morphology. J Prosthet
38. Shanahan TEJ. Physiologic vertical dimension and centric relation. J Prosthet
Dent 1982;48:451-60.
Dent 1956;6:741-7.
13. Peterson TM, Rugh JD, McIver JE. Mandibular rest position in subjects with
39. Silverman MM. Vertical dimension measured by phonetics and the closest-
high and low mandibular plane angles. Am J Orthod Dentofacial Orthop
speaking-space. In: Occlusion in prosthodontics and in the natural dentition.
1983;83:318-20.
Washington, DC: Mutual Publishing Co; 1962. p. 1-24.
14. Michelotti A, Farella M, Vollaro S, Martina R. Mandibular rest position and
40. Manns A, Miralles R, Santander H, Valdivia J. Masseter electromyographic
electrical activity of the masticatory muscles. J Prosthet Dent 1997;78:48-53.
changes as a function of vertical dimension in patients with MPD syndrome.
15. Konchak PA, Thomas NR, Lanigan DT, Devon RM. Freeway space mea-
IRCS J Med Sci 1981;9:354-5.
surement using mandibular kinesiograph and EMG before and after TENS.
41. Valdés C, Gutiérrez M, Falace D, Astaburuaga F, Manns A. The effect of
Angle Orthod 1988;58:343-50.
tongue position and resulting vertical dimension on masticatory muscle ac-
16. Konchak PA, Thomas NR, Lanigan DT, Devon RM. Vertical dimension and
tivity. A cross-sectional study. J Oral Rehabil 2013;40:650-6.
freeway space. A kinesiographic study. Angle Orthod 1987;57:145-54.
42. Kandel E, Schwartz J, Jessell T. Principles of neural science. 5th ed. New York:
17. Manns A, Miralles R, Guerrero F. The changes in electrical activity of the
McGraw-Hill Medical; 2013. p. 776-82.
postural muscles of the mandible upon varying the vertical dimension.
43. Berne RM, Levy MN, Koeppen BM, Stanton BA. Berne and Levy physiology.
J Prosthet Dent 1981;45:438-45.
7th ed. Philadelphia: Elsevier; 2017. p. 241-2.
18. Rugh JD, Drago CJ. Vertical dimension: a study of clinical rest position and
44. Alonso-Blanco C, Fernández-de-Las-Peñas C, de-la-Llave-Rincón AI,
jaw muscle activity. J Prosthet Dent 1981;45:670-5.
Zarco-Moreno P, Galán-Del-Río F, Svensson P. Characteristics of referred
19. Plesh O, McCall WD, Gross A. The effect of prior jaw motion on the plot of
muscle pain to the head from active trigger points in women with myofascial
electromyographic amplitude versus jaw position. J Prosthet Dent 1988;60:
temporomandibular pain and fibromyalgia syndrome. J Headache Pain
369-73.
2012;13:625-37.
20. Morimoto T, Abekura H, Tokuyama H, Hamada T. Alteration in the bite force
45. Gawriołek K, Gawriołek M, Komosa M, Piotrowski PR, Azer SS. Kinematic
and EMG activity with changes in the vertical dimension of edentulous
modeling of normal voluntary mandibular opening and closing velocity-
subjects. J Oral Rehabil 1996;23:336-41.
initial study. J Prosthodont 2015;24:279-86.
21. Suvinen TI, Reade PC, Könönen M, Kemppainen P. Vertical jaw separation
46. Tingey EM, Buschang PH, Throckmorton GS. Mandibular rest position: a
and masseter muscle electromyographic activity: a comparative study be-
reliable position influenced by head support and body posture. Am J
tween asymptomatic controls and patients with temporomandibular pain and
Orthodon Dentofacial Orthop 2001;120:614-22.
dysfunction. J Oral Rehabil 2003;8:765-72.
22. Ueda HM, Ishizuka Y, Miyamoto K, Morimoto N, Tanne K. Relationship
between masticatory muscle activity and vertical craniofacial morphology. Corresponding author:
Angle Orthod 1998;68:233-8. Dr Arturo Manns
23. Vianna-Lara MS, Caria PH, Tosello DO, Lara F, Amorim MM. Electromyo- Av San Carlos de Apoquindo 2200, Las Condes
graphic activity of masseter and temporal muscles with different facial types. Box 7550000, Santiago
Angle Orthod 2009;79:515-20. CHILE
24. Gomes SG, Custodio W, Faot F, Del Bel CA, Garcia RC. Masticatory features, Email: arturomanns@hotmail.com
EMG activity and muscle effort of subjects with different facial patterns.
J Oral Rehabil 2010;37:813-9. Copyright © 2017 by the Editorial Council for The Journal of Prosthetic Dentistry.

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