Journal of

Oral Rehabilitation

Journal of Oral Rehabilitation 2015 42; 10--17

Influence of balancing-side occlusal interference on

smoothness of working-side condylar movement and intraarticular space in chewing efforts
K. YASHIRO*, K. YAMAMOTO*, K. TAKADA, S. MURAKAMI, Y. UCHIYAMA
& S . F U R U K A W A *Department of Orthodontics and Dentofacial Orthopedics, Graduate School of Dentistry and Center for
Advanced Medical Engineering and Informatics, Osaka University, Suita, Japan, Discipline of Orthodontics and Paediatric Dentistry,
Faculty of Dentistry, National University of Singapore, Singapore City, Singapore and Department of Oral and Maxillofacial Radiology,
Graduate School of Dentistry, Osaka University, Suita, Japan

Response of temporomandibular joint

(TMJ) articulation adapting to occlusal alteration
has been sparsely known. For 10 healthy adults
with acceptably good occlusion, an artificial occlusal
interference (OI) was introduced to the lower molar
on the balancing side of unilateral chewing.
Subjects were asked to chew a gum on their
preferred side. The chewing jaw movements with/
without the OI were recorded using a video-based
optoelectronic system. The mandibular movements
were generated in each individuals TMJ model
reconstructed by magnetic resonance images. The
smoothness of local condylar point movements
towards the normal direction of the condylar
surface and interarticular space on the working side
SUMMARY

Introduction
There have been findings of significant (1) and not
significant (2) influences of experimentally placed
occlusal interference (OI) upon jaw movements in
human. The OI caused increased and decreased jaw
elevator muscle activities on ipsilateral and contralateral side, respectively (3). Some studies showed mild
tenderness of jaw muscle (4), pain (5) and joint clicking (6) with the presence of the OI. The OI induced
irregularity of condylar movements and joint clicking
(6). More importantly, dynamic stereometry (7) has
permitted the assessment of contact and compression
areas between the joint articular surfaces. The method
revealed that the insertion of occlusal splint led to sig 2014 John Wiley & Sons Ltd

was measured. Overall, the smoothness of condylar

point movements in the closing phase was impaired
immediately after introduction of the OI. In the
intercuspal phase, the OI increased the joint space.
After about 60 chewing cycles, the movement
smoothness and joint space began to recover. These
findings suggest that OI on the balancing side
induced irregular stress field translation on the
working-side condylar surface followed by acute
recovery process.
KEYWORDS: kinematics,
mastication, normalised
jerk cost, motor adaptation, intra-articular space
Accepted for publication 30 July 2014

nificant increase in condyle-fossa distances, both during habitual closure and sliding movements (8). In
addition, joint clicking led to changes in trajectory of
minimum condyle-fossa distances during movement
and intercuspation (9). These data suggest that,
although the likelihood of a predisposition of developing joint dysfunction such as clicking or masticatory
muscle tenderness is moderately low, the influences
of the OI are not absent. Overall, it should be concluded that the OI does induce accommodative and
adaptive motor behaviours such as irregular movements and joint clicking (10). These effects might be a
predisposition of developing joint dysfunction resulting
from adaptation of neuromuscular system (11). However, because of a lack of quantification for diagnosis
doi: 10.1111/joor.12225

SMOOTHNESS OF CONDYLAR MOVEMENT

of either the predisposition of joint dysfunction or
favourable adaptive changes in temporomandibular
joint (TMJ) articulation, no data are available as to
indicate progress or limitation that suggests capability
of the TMJ to adapt to the OI. Therefore, study needs
measures that clearly indicate degrees of condylar
movement modifications in response to the OI (10).
The change in TMJ intra-articular space towards
bony shape-specific direction (normal or tangential
(vertical or horizontal) to condylar surface) is essential
to infer compressive or translational cartilage loading
mechanism (7). Anomalous acceleration or jerk proved
to be a symptom of poor human joint function (12).
Accordingly, changes in movement acceleration (jerk)
directed towards normal/tangential to condylar surface
need to be addressed to predict instability of dynamic
stress and its translation within joint. It has been
shown that smoothness of incisor point movement
quantifies acute adaptive responses after insertion of
the OI (13). In need for clinical diagnosis of dysfunction of human knee and hip joints, effectiveness of
measuring joint instability in terms of acceleration and
jerk-based parameters have been demonstrated as reliable indicators of ageing (14), adaptation to arthroplasty (12) and motor disorders (15). For these
reasons, it can be postulated that progress or limitation
of TMJ adaptation to the OI may be clearly understood
by measuring the smoothness of condylar movement
and intra-articular space after insertion of the OI.
It has been found that the mandibular movements
during mastication changes after insertion of balancing-side OI (11). We hypothesised that balancing-side
OI may induce significant acute modification of working-side condylar movement smoothness and interarticular space during chewing. Therefore, the aim of
this study was to investigate whether/how the adaptive response of working-side TMJ articulation in
terms of smoothness (jerk) optimisation progress with
the balancing-side OI in gum chewing efforts. Results
may provide us insights into capability of TMJ motor
adaptation to the acute occlusal alteration.

without occlusal interference in habitual maximum

intercuspal (CO) position, and no clinical sign of jaw
dysfunction was selected. For all participant, canine
guidance was observed at the lateral occlusion. The
ICON scores (16) of <20 were judged as acceptably
good occlusion. The subjects had given their consent
to participate in the experiment after receiving a full
explanation of the aims and design of the study. The
Ethics Committee of the Dental School approved the
experiment (permission #H16-4-1).
Test food
Soft cohesive chewing gum (width 9 length 9 depth,
15 9 30 9 1 mm; weight, 2 g; Bloom strength, 80 g)
was used.
Artificial occlusal contact
The plaster cast of the upper dentition for each subject
was fabricated and transferred to a semi-adjustable
articulator* through a face bow. The cast of the lower
dentition was then mounted with bite registration. The
bite registration was taken at the full intercuspal position. The OI was fabricated by piling up the light curing
composite resin (Solidex ) on the plaster cast of the lingual cusp of the lower second molar (Fig. 1). The obstacles were designed to raise the incisor pin of the
articulator by 0
5 mm, and it was cemented to the lingual cusp of the lower second molar on the balancing
side using a glassionomer cement (Hybond Glass
ionomer cement CX). The experimentally placed OI
worked as high onlay to interfere the molar to occlude
antagonistic cusp. The shape of obstacle (artificial cusp)
was designed not to allow mandible to deviate during
intercuspation. For all participant, canine guidance was
observed at the lateral occlusion with the OI. There
were no muscle tenderness and pain throughout the
experiment, nor irreversible effects such as difficult
feeling in chewing after removing the OI.
Tasks and experimental sessions

Materials and methods

Subjects
Ten adult female subjects aged from 24 to 33 years
(mean age, 27 years 6 months) participated in this
study. All subjects having acceptably good occlusions
2014 John Wiley & Sons Ltd

Each subject was seated in the upright position. Subjects were first asked to keep their CO position and

*Panadent, Panadent Corp., Grand Terrace, Cl, USA.

Shofu Inc., Kyoto, Japan.

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K . Y A S H I R O et al.

(a)

(b)

Fig. 1. System to measure maxillary and mandibular movements and artificial occlusal contact. Left column, coordinate system to
measure maxillary and mandibular movements; I, mandibular infrared reflection markers; II, maxillary infrared reflection markers;
the parasagittal plane (PSP) was defined as a plane passing the three markers attached to the triangle near the TMJ. The parahorizontal plane (PHP) was defined as a plane oriented in parallel to the Frank-fort horizontal plane. Right column, artificial occlusal contact;
(a), Posterior view; (b), Occlusal view.

were then asked to chew the gum on their preferred

side without introducing the OI (Session 0). In Session 0, the mandibular movements were recorded
after the gum bolus was fully softened. In each session, the 20 chewing cycle data were recorded. The
obstacle was cemented immediately after the end of
Session 0 so that the subject can start chewing after
taking 5 min rest. To quantitatively asses the adaptive
process in terms of recovery of the smooth condylar
movements after insertion of the OI, chewing trial
was repeated three times with interval of 5 min. The
intervals between sessions for 5 min rest were to minimise accommodation of muscle fatigue in this experiment. After a 5 min recess, they were asked to chew
the gum bolus with the artificial occlusal contact on
balancing side (Session 1). Five subjects were asked to
repeat this task with balancing-side OI for three sessions. After removing the OI, the magnetic resonance
(MR) imaging was performed within 30 min.
Dynamic TMJ model for measuring condylar movement
smoothness and intra-articular space
The instability of condylar movement in terms of normalised jerk cost (NJC) (13) and intra-articular space
was measured by means of dynamic stereometry of
the TMJ. The dynamic model for each individuals
TMJ was developed from MR imaging and jaw tracking data. Thorough description and validity of this
method has been presented elsewhere (17). Briefly,

the six-degrees-of-freedom (6DOF) mandibular movements were recorded using a video-based optoelectronic system (ProReflex). The system allowed
recording of the 3D movements of stroboscopically
illuminated retro-reflective markers fixed to the mandibular and maxillary dental arches (Fig. 1). The sampling frequency of the recording was set at 200 Hz.
The 6DOF mandibular movement in relation to the
head was calculated by coordinate transformation.
The MR imaging focusing on unilateral TMJs was
taken using superconductive type MRI scanner with
TMJ coil (a Signa Horizon 1.5T) with the mandible
at the CO position under the T1-emphasised density
conditions. T1-weighted images of each individual
TMJ and three organogel spheres attached to the
maxilla were obtained in the paracoronal plane. The
slice thickness was 0
5 mm. From traced linear
images, the 3D images of articular surfaces and three
spherical markers were displayed by rendering and
were exported as stereolithography files.
The data for the chewing cycle were divided into
opening, closing and intercuspation phases. The data
for each subject were imported to each individual
TMJ model. A motor learning and adaptation result in
optimal movement smoothness (reverse of irregularity), where the irregularity is quantified by means of

Qualisys, Inc., Gothenburg, Sweden.

GE, Milwaukee, WI, USA.

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SMOOTHNESS OF CONDYLAR MOVEMENT

(c)
(a)

(b)
(d)

Fig. 2. Location and orientation of local coordinate systems to measure NJC and joint space. Upper column, location and orientation
of local coordinate systems to measure NJC. (a), coronal view of the working-side condyle; (b), horizontal view of the working-side
condyle; PSP and PHP, parasagittal and parahorizontal plane that are defined by the three markers attached to the triangle; (c), the
local coordinate system at TP; Ty, vector of lateral axis directed towards tangential to the curve of coronal section (Y curve); Tx, vector of anterior axis directed towards tangential to the curve of sagittal section (X curve). The normal direction was determined by
TxTy
normal unit vector (Nz) as: Nz TxTy , where the tangential vector to the anterior (Tx) and that to the lateral direction (Ty) on
j
j
@r
and
the tangential plane that contains all the lines tangent to a specific point on a surface. The Tx and Ty were defined as: Tx = @x
Ty =

@r
@y,

where r is the approximate curvature [r = r (x, y)] in space; (d) the local coordinate systems at the nine condylar points; y-

axis, laterally directed vector that is in parallel to the condylar long axis. X-axis, anteriorly directed vector that is in parallel to the
PSP. Detailed definition of each point is described elsewhere (17). Lower column, measurement of intra-articular space at local points.

a time integral of squared jerk (jerk cost), where jerk

is defined as a rate of change in acceleration (18). The
normalisation technique has been proposed that generates a measure of jerk cost, which is independent of
movement duration and amplitude (normalised jerk
cost, NJC, (13, 18)). The NJC of condylar point movement along the normal direction (Nz, Fig. 2) was calculated. Figure 2 shows the intra-articular space at
each condylar point that was defined as the distance
2014 John Wiley & Sons Ltd

between each condylar point and point where normal

line to 3D curve at the condylar point crosses the surface of the fossae.
Statistical analyses
Initially, the chi-square test for normality and Levene
test for homogeneity of variance for each variable
were employed. For the multiple comparisons, if the

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K . Y A S H I R O et al.
null hypothesis was not rejected, the repeated measurement analysis of variance (ANOVA) was adopted.
To avoid a type I error, Bonferronis multiple-comparison test was undertaken at the least level of probability. If normality was not inferred, the Freedman test
was used. Subsequently, multiple-comparison test
(SteelDwass test) was undertaken. Aside from multiple comparisons, the probabilities for each pairwise
comparison were calculated using paired t-tests and
Wilcoxon rank-sum tests according to the normality
of the data. The pairwise comparisons were used to
evaluate the degree of differences. These statistical
analyses were conducted using a software program
(SPSS v10.0).

Results
Movement smoothness of the working-side condylar points
and duration of jaw closing
Figures 3 and 4 show the findings of NJCs. As for 10
subjects, the NJC at 4 condylar points (AP, PP, TP and
MP) after the insertion of the occlusal interference was
significantly greater (P 0
0034) as compared with
those without the interference (Fig. 3 upper column).
With respect to the 5 subjects (Fig. 3 lower column),
who performed repeated trials, the NJCs of the same 4
condylar point movements in the Session 1 were greater
than those in the Session 0 (P 0
0138). For all points,
NJCs in the Session 2 were significantly greater than
those in Session 1 (P 0
0001). In Session 3, the NJCs
for all condylar points were significantly decreased as
compared with those in the Session 2 (P 0
0031).
Without the OI performed at the Session 0, the
mean (SD) of jaw closing phase duration was 418 ms
(74 ms). The chewing task with the OI significantly
increased the jaw closing phase durations (Session 1,
472 ms (116 ms); Session 2, 452 ms (96 ms);
P 0
05). However, the repeated chewing tasks significantly reduced the jaw closing phase duration at
Session 3 (403 ms (101 ms); P 0
05), that was not
significantly differed as compared with that at the Session 0 (P = 0
3836).
Overall, the NJC measured at TP was significantly
smaller than those at AP, PP, LP and MP (P 0
0009,
Fig. 4, upper column). The finding of smallest NJCs at

SPSS, Inc., Chicago, IL, USA.

Fig. 3. NJC in the closing phase of chewing. Upper column,

NJC measured before and after artificial occlusal contact insertion; horizontal lines of each box plot indicate minimum, first
quartile, median, third quartile and maximum. Grey bar, before
insertion (n = 200 cycles, subjects: n = 10); blank bar, Session 1
(n = 200 cycles, subjects: n = 10); vertical axis, normal jerk cost;
horizontal axis, condylar point. ** P 0 .0034, N.S.; P > 0
01.
Lower column, comparison of NJC at each recording session;
horizontal lines of each box plot indicate minimum, first quartile, median, third quartile and maximum. Grey bar, before
insertion (n = 100 cycles, subjects: n = 5); blank bar, Session 1
(n = 100 cycles, subjects: n = 5); black bar, Session 2 (n = 100
cycles, subjects: n = 5); oblique line bar, Session 3 (n = 100
cycles, subjects: n = 5); vertical axis, normal jerk cost; horizontal
axis: condylar points. **P 0 .0001, *P 0
0138.

the TP did not depend on the existence of occlusal

interference (Fig. 4, upper column). The NJC at LP,
MP and AP was significantly greater than at PP and
TP in Sessions 0, 2 and 3 (all P 0
0001, Fig. 4, lower
column).
Intra-articular space during intercuspal phase
After the insertion of the OI, the joint space was significantly enlarged at all condylar points (P 0
0001,
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SMOOTHNESS OF CONDYLAR MOVEMENT

Fig. 4. Comparisons
of
NJC
between different locations of the
condyle. Upper column, overall
comparison
of
NJC
between
different locations of the condyle;
horizontal lines of each box plot
indicate minimum, first quartile,
median,
third
quartile
and
maximum.
Grey
bar,
before
insertion (n = 200 cycles, subjects:
n = 10); blank bar, Session 1
(n = 200 cycles, subjects: n = 10);
vertical axis, normal jerk cost;
horizontal axis: condylar points.
**P 0
0001, *P 0
0009. Lower
column,
comparisons
of
NJC
between different condylar points in
each session; horizontal lines of
each box plot indicate minimum,
first quartile, median, third quartile
and maximum. Grey bar, before
insertion (n = 100 cycles, subjects:
n = 5); blank bar, Session 1
(n = 100 cycles, subjects: n = 5);
black, Session 2 (n = 100 cycles,
subjects: n = 5); oblique line bar,
Session 3 (n = 100 cycles, subjects:
n = 5); vertical axis, normal jerk
cost; horizontal axis, condylar
points. **P 0
0001, *P 0
0237.

Fig. 5, upper column). In the Session 3, the joint

space was significantly decreased (P < 0
05, Fig. 5,
lower column). The decreased joint space was more
significant in the anterior region of the condylar surface (AP and MAP), rather than the central and posterior regions (Fig. 5, lower column).

Discussion
It has been shown that asymptomatic children and
adolescent with disc displacement and corresponding
changes in intra-articular space are a majority rather
than a minority (10), and patients with joint clicking
are not rare even in children (19). Numbers of reports
(8, 20, 21) showed large variation in joint space for
asymptomatic patients in association with varied type
of occlusions. These findings suggest generation of
redistributing contact areas between joint surfaces
responding to the varied occlusions. On the other
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hand, control subjects, who have normal jaw movement, no evidence of loose ligaments or condylar hypermobility, normal occlusion with negligible occlusal
interference and no disc displacement showed optimal
condylar position in intercuspation that coincides with
the starting and end points of all functional jaw
movements (such as intercuspal position during
chewing) in repeatable fashion (19). The standard
deviation of the optimal condylar position in relation
to fossae was extremely small (19). These information
should be a baseline criteria for understanding adaptive process in condylar movement and position during intercuspal phase of chewing in response to the
OI. Based on these data, it is suggested that the OI
induce acute fluctuation of condylar movement followed by recovery within the limitation of ability of
the TMJ function.
Mandibular movement trajectory presents optimal
smoothness in varied chewing conditions (13). By

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K . Y A S H I R O et al.

Fig. 5. Intra-articular space during intercuspation. Upper column, joint space measured before and after artificial occlusal
contact insertion; grey bar, before insertion (n = 200 cycles, subjects: n = 10); blank bar, Session 1 (n = 200 cycles, subjects:
n = 10); vertical axis, joint space of the mandibular fossa (mm);
horizontal axis, condylar points. **P 0
0001. Lower column,
joint space at each session; grey bar, before insertion (n = 100
cycles, subjects: n = 5); blank bar, Session 1 (n = 100 cycles,
subjects: n = 5); black, Session 2 (n = 100 cycles, subjects:
n = 5); oblique line bar, Session 3 (n = 100 cycles, subjects:
n = 5); vertical axis, joint space of the mandibular fossa (mm);
horizontal axis, condylar points. *P < 0
05.

measuring the NJC of mandibular movements, it is possible to quantitatively assess irregularity in chewing
movements, which are often caused by premature
occlusal contact, and to detect adaptive changes in
response to the OI at varied locations with a high level
of sensitivity (13). Slight positional changes of a molar
cusp during development of dentition often cause acute
unstable occlusal condition as simulated by insertion of
the OI on unilateral side in this study. The not significant difference of the NJC of LP after insertion of the OI
might results from stabilization effects due to condylar
rotation occurred around the lateral pole (LP). This
may be the first step of the motor adaptation. As the
adaptation progress from Session 1 to Session 3, the
more irregular movements of the condylar local points

were observed as compared with that at the centre of

the condylar surface. This finding suggests that an
acute adaptive fluctuation occur at eccentric area of the
condyle having a pivot for condylar rotation at the centric area (TP). Overall, the significantly prolonged jaw
closing phase at the Session 1 was decreased at the Session 3. Moreover, the jaw closing phase duration at
Session 3 did not significantly differ as compared with
that at the Session 0. The greatest reduction (recovery)
in joint space at the antero-superior surface of the condyle (AP and MAP (Fig. 5 lower column)) was determined at the Session 3. Based on these spacio-temporal
findings, it can be inferred that well modified and patterned movement, which could be quantified by
decrease in the NJC and in duration of jaw closing,
may occur after recovery of anticipatory (feed forward)
mechanism (22). In this adaption process, it is suggested that position of the antero-superior area of the
condylar surface might be preceding part of the TMJ
that is controlled by the feed forward mechanism.
The study of the OI showed that the balancing-side
OI changes jaw movement pattern (11) and cause the
TMJ disc dislocation (23). In unilateral submaximal
clenching, altered balancing-side tooth contact has the
potential to reduce joint loading on the ipsilateral side
(24). In experimental chewing condition of this study,
the artificial occlusal contact on the balancing side significantly increased the joint space on the working
side. The enlarged joint space on the working side
might result from self-protective muscle responses to
reduce the joint loading. It can be stated that the
increased articular space on the working side may
allow the condyle to move with greater degrees of freedom to adapt the insertion of the OI. The greater articular space responding to insertion of the OI (Fig. 5)
may be associated with greater fluctuations in condylar
movements at the beginning of the adaptation process.
The comparison of the current parameters between
the Session 1 and 3 revealed the acute adaptive process
of the condylar movements. After about 60 chewing
cycles with the OI (Session 3), the enlarged articular
space was decreased, although the space was larger than
that without the occlusal interference. The decrease of
the joint space was more evident at the anteriorsuperior region of the condylar surface than that at the central and posteriorsuperior regions (Fig. 5). Because the
total jaw elevator muscle tension normally cause the
TMJ loading vector that directs towards antero-superior
direction, the second adaptive changes in terms of
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SMOOTHNESS OF CONDYLAR MOVEMENT

decrease in the anteriorsuperior region of the joint
space suggest beginning of the recovery process of condylar movement, which is driven by normal jaw elevator muscle contraction. The significantly greater NJC
and joint space at Session 3 as compared to Session 0
suggest that it will need more ability of jaw motor system to adapt to the OI in long term (25).

Acknowledgments
The Ethics Committee of the Dental School approved
the experiment (permission #H16-4-1). There is no
conflict of interests. This work was partially supported
by
a
Grant-in-Aid
for
Scientific
Research
(C-05671706) from the Japanese Ministry of Education, Science and Culture.

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Correspondence: Kohtaro Yashiro, Department of Orthodontics and
Dentofacial Orthopedics, Graduate School of Dentistry and Center
for Advanced Medical Engineering and Informatics, Osaka University, 1-8 Yamadaoka, Suita 565-0871, Japan.
E-mail: yashiro@dent.osaka-u.ac.jp

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