Neuromuscular Orthodontics
Neuromuscular orthodontics is an approach to orthodontic diagnosis and treatment that emphasizes the functional relationship between teeth, masticatory muscles, the temporomandibular joints (TMJs) and associated neuromuscular control.[1][2] It employs electronic diagnostic tools such as computerized mandibular tracking, surface electromyography (sEMG) and, in some protocols, transcutaneous electrical nerve stimulation (TENS) to help identify and maintain a mandibular position considered physiologic for the patient, rather than relying solely on static dental occlusion as the primary determinant of treatment goals.[1][3]
Neuromuscular orthodontics is generally regarded as a subspecialized application of neuromuscular dentistry, which views teeth, masticatory muscles and TMJs as components of a single functional system and relates occlusal disturbances to temporomandibular disorders (TMD), craniofacial pain and postural adaptations.[2] Within orthodontics, the neuromuscular approach has been proposed as a means to improve functional stability, assist in the management of TMD symptoms and optimize facial esthetics by integrating muscle physiology and joint function into treatment planning.[1][4]
History
Concepts underlying neuromuscular approaches in dentistry developed in the context of occlusal rehabilitation and temporomandibular disorder management, in which electronic devices were introduced to record mandibular motion and muscle activity.[2] The modern framework of neuromuscular dentistry is commonly traced to the work of prosthodontist Bernard Jankelson, who in the 1960s and 1970s introduced low-frequency TENS, mandibular kinesiography and clinical surface EMG to record jaw function and advocated that muscle physiology, rather than purely skeletal or tooth-based relationships, should guide occlusal treatment.[5][6]
Early work on the relationship between occlusion, muscle function and mandibular placement framed the idea of a neuromuscular position as the mandibular posture with minimal muscle accommodation, suggesting that occlusal schemes should be built on a physiologic, muscle-determined mandibular position rather than purely on skeletal or tooth-based references.[7] Subsequent literature on neuromuscular dentistry described the use of computerized mandibular scanning, EMG and joint vibration analysis to evaluate and treat patients with TMD and occlusal dysfunction.[2][8]
With the wider availability of computerized mandibular scanners and sEMG equipment, neuromuscular principles were progressively applied to orthodontic diagnosis and treatment. Clinical reports and technical descriptions of neuromuscular orthodontics presented protocols in which mandibular tracking, sEMG and neuromuscular deprogramming were incorporated into orthodontic case analysis and appliance design.[3][1] Academic articles have described departments and university units devoted to neuromuscular orthodontics and cranio–mandibular orthopedics, reflecting institutional interest in this field.[6]
Narrative and critical reviews have placed neuromuscular dentistry and neuromuscular orthodontics alongside other occlusal and TMD paradigms, noting both the availability of advanced instrumentation and the relative scarcity of high-quality randomized controlled trials.[5][2]
Principles
Neuromuscular orthodontics is based on the concept of a physiologic or neuromuscular mandibular position—a reproducible posture of the mandible associated with minimal muscle strain and balanced temporomandibular joint (TMJ) loading.[1][7] Rather than considering teeth, muscles and joints as isolated entities, the discipline treats them as components of an integrated functional system whose harmony underpins craniofacial stability and comfort.[2][9]
Core principles described in the literature include:
- Treating teeth, masticatory muscles, neural pathways and temporomandibular joints as a single functional system, with occlusal and neuromuscular parameters analyzed together.[2][7]
- Identifying a mandibular rest and occlusal position characterized by relaxed or minimally active elevator muscles, typically following neuromuscular deprogramming using low-frequency transcutaneous electrical nerve stimulation (TENS) or comparable muscle-directed procedures.[3][10]
- Evaluating dynamic mandibular kinematics—including opening, closing and excursive movements—rather than relying solely on static intercuspal contacts.[3][11]
- Considering occlusal and mandibular position influences on upper airway space, cervical posture and craniofacial function.[10][2]
- Using surface electromyography (sEMG) to assess masticatory muscle activity and symmetry as indicators of neuromuscular balance and physiologic mandibular alignment.[1][12]
Within this framework, some clinicians advocate establishing the neuromuscular mandibular position first—guided by muscle relaxation and EMG findings—before performing orthodontic or occlusal correction. This approach aims to minimize muscular compensation, reduce joint strain and improve long-term functional balance.[7][1]
Diagnostic methods
Neuromuscular orthodontic protocols employ a combination of electronic and clinical diagnostic tools to complement conventional radiographic and cephalometric analyses.[1][2]
Computerized mandibular tracking
Computerized mandibular scanners and kinesiographs record three-dimensional jaw movements during opening, closure, swallowing and excursive function. These measurements allow clinicians to assess deviations, asymmetries and changes in mandibular trajectory before and after neuromuscular deprogramming or appliance therapy.[3][6][13]
Surface electromyography
Surface electromyography (sEMG) measures muscle activity in the masseter, temporalis and related elevator muscles at rest and during function. Neuromuscular protocols interpret amplitude and symmetry changes as indicators of muscular balance or hyperactivity across mandibular positions.[3][2][9] Recent clinical research has demonstrated significant correlations between occlusal asymmetries and EMG-derived neuromuscular parameters, supporting its relevance in evaluating craniomandibular function.[12][11] While sEMG provides objective data on muscle activity, interpretation of these measurements in relation to optimal occlusal function remains debated in the literature.
Transcutaneous electrical nerve stimulation
Low-frequency TENS is applied bilaterally over regions innervated by branches of the trigeminal and facial nerves to relax masticatory muscles and allow the mandible to assume its physiologic rest position. The post-stimulation (deprogrammed) mandibular position is then recorded and used as a neuromuscular reference for analysis or appliance fabrication.[3][7] This “muscle-directed” concept of occlusal positioning is shared with physiologic and hydrostatic paradigms of occlusion.
Temporomandibular joint evaluation
Neuromuscular protocols may include joint vibration analysis, auscultation and imaging (e.g., MRI, CBCT) to evaluate disc position, joint space and loading under different mandibular positions.[10][3] Modern diagnostic frameworks often integrate EMG, mandibular tracking and TMJ imaging to characterize the functional environment for orthodontic tooth movement and occlusal stabilization.[3][2][14] Integrated approaches combining EMG, mandibular tracking, and TMJ imaging have been described as part of multimodal diagnostic systems for assessing jaw function.
Occlusal splint and neuromuscular analysis
Randomized and observational studies have employed neuromuscular analysis systems to evaluate splint efficacy in bruxism and temporomandibular disorders. In one clinical trial, occlusal splints analyzed via EMG and computerized occlusal systems (K7–J5, Dental Prescale II) demonstrated significant reductions in masseter and temporalis muscle activity with modified anterior splint designs.[15] Complementary systematic reviews report that adjustable or biofeedback-based splints can reduce electromyographic activity and improve subjective outcomes in sleep bruxism.[16] A multi-arm randomized trial combining EMG, T-Scan and joint vibration analysis also found measurable improvements in TMD symptoms following orthodontic and splint interventions.[17]
Clinical applications
Neuromuscular orthodontics has been applied to a range of clinical situations, often in combination with other orthodontic and restorative procedures.[1][2]
Orthodontic treatment planning
In orthodontic cases, neuromuscular records may be used to select a target mandibular position and occlusal scheme, with tooth movement planned to support that position.[3] Orthotic appliances fabricated in the neuromuscularly determined position can be worn prior to or during fixed appliance therapy to guide mandibular posture and assess patient comfort and function.[3] In some full-mouth rehabilitation cases, mandibular tracking and EMG have been used to determine an increased occlusal vertical dimension considered compatible with muscular balance, and orthodontic or prosthetic measures are then coordinated with that position.[6][7]
Temporomandibular disorder management
Neuromuscular concepts have been incorporated into the management of TMD, particularly in patients presenting with muscle-related pain, restricted opening or dysfunction associated with suspected occlusal factors.[2] In such cases, neuromuscular diagnostics are used to establish a jaw position in which EMG and mandibular tracking appear more favorable, and orthopedic or neuromuscular appliances are constructed to position the mandible accordingly.[8] Orthodontic or restorative procedures may follow after symptoms have been reassessed in the neuromuscular position.[8] Systematic reviews on occlusal splints for TMD report that splints can reduce pain and may influence neuromuscular or postural parameters, although findings are heterogeneous and not specific to neuromuscular protocols.[18]
Occlusal rehabilitation and vertical dimension
Neuromuscular methods have been used to determine an increased occlusal vertical dimension and mandibular position in full-mouth rehabilitation cases, using mandibular tracking and EMG to monitor functional adaptation.[6] Earlier work on physiologic and hydrostatic occlusal concepts likewise emphasized establishing a mandibular position in which masticatory muscles are minimally accommodated and then reconstructing occlusion around that position.[7]
Airway and posture
Some authors have suggested that neuromuscular orthodontic interventions may influence head and neck posture and upper airway dimensions, particularly in patients who present with both TMD and craniofacial dysfunctions.[10][2] Evidence on postural changes with occlusal interventions remains mixed, with systematic reviews stressing the need for standardized protocols and larger samples.[18]
Professional awareness and adoption
Survey-based research suggests that awareness of neuromuscular concepts among dental professionals is variable, with many respondents expressing interest in further education and a perception that neuromuscular dentistry could enhance patient care, particularly in TMD management and occlusal therapies.[4]
Evidence and criticism
The evidence base for neuromuscular orthodontics and neuromuscular dentistry is heterogeneous, encompassing case reports, observational studies, surveys, narrative reviews and a smaller number of controlled clinical investigations.[3][8] Proponents argue that electronic measurements provide more objective data on mandibular function and muscle activity than purely clinical observation, and that this may lead to improved functional outcomes and patient comfort in selected cases.[1][10]
Clinical and observational studies using neuromuscular instrumentation have reported measurable changes in EMG amplitudes, muscle symmetry and occlusal parameters in response to occlusal splints and other interventions.[15][12][17] In a randomized clinical trial on bruxism, occlusal splints evaluated with neuromuscular and occlusal analysis systems showed significant variations in masticatory muscle activity and occlusal force distribution after appliance use.[15] In another trial on TMD in orthodontic patients, multi-parameter biometric assessment suggested that orthodontic treatment did not aggravate TMD and that splint therapy in combination with orthodontics could improve some clinical signs.[17] An observational study using a standardized EMG device found correlations between occlusal asymmetries and neuromuscular metrics in patients with craniomandibular disorders, supporting the diagnostic relevance of surface EMG for occlusal assessment.[12]
Narrative and critical reviews have nonetheless emphasized that neuromuscular approaches remain controversial and are not universally accepted.[5] Concerns expressed in the literature include the methodological quality and sample sizes of some studies, variability in diagnostic protocols and interpretation of EMG data, the cost and complexity of equipment, and the extent to which electronic measurements translate into clinically meaningful benefits compared with more conventional occlusal and orthodontic paradigms.[2][5] Authors writing specifically on neuromuscular paradigms have recommended further high-quality research, including randomized controlled trials and long-term follow-up studies, to clarify indications, benefits and limitations of neuromuscular techniques in orthodontics and prosthodontics.[7][3][18]
See also
- Orthodontics
- Occlusion (dentistry)
- Temporomandibular joint dysfunction
- Neuromuscular dentistry
- Craniofacial pain
- Occlusal splint
- Surface electromyography (sEMG)
- Transcutaneous electrical nerve stimulation (TENS)
- Temporomandibular joint (TMJ)
References
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 Savastano F. Neuromuscular Orthodontics: A Clinical Guide. Cham: Springer; 2024.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 Khan MT, Verma SK, Maheshwari S, Zahid SN, Chaudhary PK. Neuromuscular dentistry: occlusal diseases and posture. J Oral Biol Craniofac Res. 2013;3(3):146–150. doi:10.1016/j.jobcr.2013.03.003.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Savastano F. Applying neuromuscular techniques in the orthodontic setting. South Eur J Orthod Dentofac Res. 2017;4(2):31–42.
- ↑ 4.0 4.1 Bethala S, Faizee SH, Lawrence XD, Dileep Kumar H. Neuromuscular dentistry: an untapped resource for enhanced patient care. J Contemp Orthod. 2025;9(3):365–370. doi:10.18231/j.jco.v.9.i.3.12.
- ↑ 5.0 5.1 5.2 5.3 Hazra R, Srivastava A, Kumar D, Legha VS, Khattak A. Neuromuscular dentistry – a myth or reality: a literature review. IP Ann Prosthodont Restor Dent. 2022;8(1):14–17.
- ↑ 6.0 6.1 6.2 6.3 6.4 Constantinescu F-E, Savastano F, Perlea P, Constantinescu M-V. Complete morphofunctional oral rehabilitation by physiological increase of occlusal vertical dimension according to computerized mandibular scanner. Rom J Oral Rehabil. 2022.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Lerman MD. A revised view of the dynamics, physiology, and treatment of occlusion: a new paradigm. Cranio. 2004;22(1):50–63.
- ↑ 8.0 8.1 8.2 8.3 Raman P. Physiologic neuromuscular dental paradigm for the management of temporomandibular disorders. Cranio. 2014.
- ↑ 9.0 9.1 Patil S, Doni BR, Patil C, Nawab S, Alam MK. Role of electromyography in dental research: a review. J Res Dent Maxillofac Sci. 2023;8(1):71.
- ↑ 10.0 10.1 10.2 10.3 10.4 Renji, Jewel Elizabeth (10 May 2024). "Neuromuscular orthodontics: a clinical guide". British Dental Journal. 236 (9): 677. doi:10.1038/s41415-024-7335-6.
- ↑ 11.0 11.1 Temelci, Ali (16 January 2024). "Electromyography of Masticatory Muscles: Insights into Function and Clinical Applications". World Journal of Dentistry. 14 (11): 927–928. doi:10.5005/jp-journals-10015-2317.
- ↑ 12.0 12.1 12.2 12.3 Crincoli, Vito; Inchingolo, Alessio Danilo; Marinelli, Grazia; et al. (5 August 2025). "Evaluation of the Possible Correlation Between Dental Occlusion and Craniomandibular Disorders by Means of Teethan® Electromyography: Clinical-Observational Study on 20 Patients". Journal of Clinical Medicine. 14 (15): 5508. doi:10.3390/jcm14155508. PMID 40807129 Check
|pmid=value (help). - ↑ Farook T, Dudley J. Understanding occlusion and temporomandibular joint function using deep learning and predictive modeling. Clin Exp Dent Res. 2024;10:e70028.
- ↑ Naumovich I, Koval YeA. A comprehensive diagnostic analysis of neuromuscular and occlusal-articulatory dysfunctions of the temporomandibular joint caused by prosthetic errors. Ukr Sci Med Youth J. 2024;4(150):7–14.
- ↑ 15.0 15.1 15.2 Lei Q, Lin D, Liu Y, et al. Neuromuscular and occlusion analysis to evaluate the efficacy of three splints on patients with bruxism. BMC Oral Health. 2023;23(1):325.
- ↑ Ainoosah S, Farghal AE, Saini R, Heboyan A. Comparative analysis of different types of occlusal splints for the management of sleep bruxism: a systematic review. BMC Oral Health. 2023;24(1):678.
- ↑ 17.0 17.1 17.2 Maurya RK, Singh H, Talwar B, Sharma P, Kapoor P. Biometric assessment of temporomandibular disorders in orthodontics: a multi-arm randomized controlled trial. Turk J Orthod. 2022;35(4):290–306.
- ↑ 18.0 18.1 18.2 Ferrillo M, Marotta N, Giudice A, et al. Effects of occlusal splints on spinal posture in patients with temporomandibular disorders: a systematic review. Healthcare. 2022;10(4):739.
Category:Orthodontics Category:Dentistry
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