Mechanism of mastication

CONTENTS
 Introduction
 Definition
 Muscles of mastication
 Function of mastication
 Chewing stroke
 Muscular activity during mastication
 Mandibular movements during
mastication
 Tooth contact during mastication
 Forces of mastication
 Role of soft tissue in mastication
 Chewing reflexes
 Control of mastication
 Mastication in denture bearer
 Mayofascial pain dysfunction
 Prosthetic management of masticatory
muscle disorder
 Conclusion
 References
2

INTRODUCTION
 Mastication is one of the main functions of the stomatognathic system.
Mastication is also an important factor and a stimulus for normal craniofacial
growth.
 The masticatory system is a functional unit composed of the teeth; their
supporting structures, the jaws; the temporomandibular joints; the muscles
involved directly or indirectly in mastication (including the muscles of the lips
and tongue); and the vascular and nervous systems supplying these tissues.
 Mastication is the action of breaking down of food, preparatory to deglutition.
This breaking down action is highly organized complex of neuromuscular and
digestive activities.
3

DEFINATIONS
 Mastication: the process of chewing food for swallowing and digestion. (GPT-9)
 Masticatory system: the organs and structures primarily functioning in mastication; these
include the teeth with their supporting structures, craniomandibular articulations, mandible,
positioning and accessory musculature, tongue,lips, cheeks, oral mucosa, and the associated
neurologic complex. (GPT-9)
 Masticatory efficiency: the effort required to achieve a standard degree of comminution of
food. (GPT-9)
 Masticatory movements: mandibular movements used for chewing food. (GPT-9)
4

• MUSCLES OF MASTICATION
 Muscles of mastication moves the mandible during mastication and speech.
 They develop from the mesoderm of the first branchial arch at the starting of
7th week and are supplied by the mandibular nerve which is the nerve of that
arch.
1. BD Chaurasiya’s human anatomy; temporal and infratemporal region; 4th edition, CBS Publisher 2004. p.144
6

• CLASSIFICATION OF
MUSCLES OF
MASTICATION
6
MUSCLES OF
MASTICATION
PRIMARY
Masseter
Temporalis
Lateral
pterygoid
Medial
Pterygoid
ACCESSARY
Digastric
Stylohyoid
Mylohyoid
Geniohyoid

• PRIMARY MUSCLES OF
MASTICATION
7

8
2. Wheeler’s dental anatomy, physiology and occlusion;9th edition;2012.p. 266

1. Masseter
9
 Origin  Action
 Nerve supply
 Insertion
Active during forceful
jaw closing and may
assist in protrusion of
the mandible.
Masseteric nerve, a
branch of anterior
division of
mandibular nerve
• Superficial layer (largest):
from anterior 2/3rd of
zygomatic acrh and
adjoining zygomatic
process
• Middle layer: from
anterior 2/3rd of deep
surface and posterior
1/3rd of border of
zygomatic arch
• Deep layer: from deep
surface of zygomatic
• Superficial layer: into
lower part of lateral
surface of ramus
• Middle layer: into
middle part of ramus
• Deep
layer(zygomaticomand
ibular muscle): into
upper part of ramus
and coronoid process
of the mandible

2. Temporalis
10
 Nerve supply
 Insertion
• Principal positioner
of mandible during
elevation.
• The posterior part is
active in retruding
the mandible.
• The anterior part is
synergistic to
masseter in
protrusion and helps
in clenching.
Two deep temporal
nerve from anterior
division of
mandibular nerve
• Temporal fossa
excluding zygomatic
bone
• Temporal fascia
• Margins and deep
surface of coronoid
process
• Anterior border of
ramus of mandible

11
Position of masseter and temporalis muscle

3. Lateral Pterygoid
12
 Nerve supply
 Insertion
• Depress mandible to
open mouth with
suprahyoid muscle.
• Protrude the
mandible.
• Left lateral pterygoid
and right medial
pterygoid turn the
chin to left side as
part of grinding
movements.
Nerve from anterior
division of
mandibular nerve
• Upper head (small): from
infratemporal surface
and crest of greater wing
of sphenoid bone.
• Lower head (large): from
Lateral surface of Lateral
Pterygoid plate.
• Pterygoid fovea on
the anterior surface of
neck of the mandible.
• Anterior margin of
articulator disc and
capsule of
temporomandibular
joint. (insertion is
posterolateral and
slightly higher level
than origin.)

4. Medial Pterygoid
13
 Nerve supply
 Insertion
• Elevates the
mandible
• Helps in protrusion
of mandible.
• Lateral positioning of
mandible.
Nerve to medial
pterygoid, branch
from main trunk of
mandibular nerve
• Superficial head (small):
from tuberosity of
maxilla and adjoining
bone.
• Deep head (large): from
medial surface of lateral
pterygoid plate and
adjoining process of
palatine bone.
• Roughened areas
on medial surface
of angle and
adjoining surface of
mandible ramus,
below and behind
the mandibular
foramen and
mylohyoid groove.

14
Position of lateral and medial pterygoid muscle

• ACCESSARY MUSCLES OF
MASTICATION
15

5. Digastric
16
 Nerve supply
 Insertion
• Depress the
mandible
• Elevates the hyoid
bone
• Anterior belly:
nerve to
mylohyoid branch
of mandibular
nerve
• Posterior belly:
facial nerve
• Anterior belly: from
digastric fossa of
mandible
• Posterior belly: From
mastoid notch of
temporal bone
• Both heads meet at
the intermediate
tendon which
perforates
suprahyoid muscle
and is held by
fibrous pulley to
the hyoid bone.

6. Stylohyoid
17
 Nerve supply
 Insertion
• Pulls hyoid bone
upward and
backword
• With other hyoid
muscle fixes the
hyoid muscle.
• Facial nerve
• Posterior surface of
styloid process
• Junction of body
and greater cornua
of hyoid bone
BD Chaurasiya’s human anatomy; temporal and infratemporal region; 4th edition, CBS Publisher 2004. p.158

7. Mylohyoid
19
 Nerve supply
 Insertion
• Elevates the floor of
mouth
• Helps in depression
of mandible and
elevation of hyoid
bone
• Nerve to
mylohyoid
• Mylohyoid line of
mandible.
• Posteriors fibers:
body of hyoid bone
• Middle and anterior
fibers: median
raphe, between
mandible and
hyoid bone

8. Geniohyoid
20
 Nerve supply
 Insertion
• Helps in depression
of mandible and
elevation of hyoid
bone
• C1 through
hypoglossal nerve
• Inferior mental spine.
• Anterior surface of
body of hyoid bone

1. Masticatory Myofascial pain
2. Masticatory myalgia
3. Masticatory myospasm
4. Myofibrotic contracture
5. Myositis
6. Bruxism
7. Temporomandibular joint dysfunction
8. Tumor
21
• Pathology related to masticatory
muscle
3. Basit H, Tariq MA, Siccardi MA. Anatomy, Head and Neck, Mastication Muscles. StatPearls [Internet], 2020.

 Break up food as the first stage of digestion. The surface area of food is
increased, allowing for increased nutrient absorption.
 stimulate the hippocampus in the brain. The act of chewing transmits nerve
impulses to the hippocampus in the central nervous system and also increases
blood flow to the brain. Stimulation of the hippocampus is critical for learning
and spatial memory.
22
• Functions of mastication
4. Helmenstine, Anne Marie, Ph.D. "Mastication: Definition and Functions." ThoughtCo, Aug. 29, 2020.

• Chewing stroke
 Mastication is made up of rhythmic and well-controlled separation and closure
of the maxillary and mandibular teeth.
 This activity is under the control of the CPG (central pattern generator) located
in the brainstem.
 tear-shaped movement pattern.
 Each chewing cycle lasts approximately 0.8-1.0 s.
23
Chewing
stroke
Opening
phase
Closing
phase
Crushing
phase
Grinding
phase
5. JEFFREY P
. OKESON MANAGEMENT OF TEMPOROMANDIBULAR DISORDERS AND OCCLUSION, EDITION 6 p39

• In frontal plane
24
5. JEFFREY P

25
Mandible drops downward from the intercuspal position to a
point where the incisal edges of the teeth are about 16 to 18 mm
apart.
It then moves laterally 5 to 6 mm from the midline as the
closing movements begins.
The first phase of closure traps the food between the teeth and
is called the crushing phase. As the teeth approach each other,
the lateral displacement is lessened so that when the teeth are
only 3 mm apart the jaw occupies a position only 3 to 4 mm
lateral to the starting position of the chewing stroke.
 When the mandible is traced in the frontal plane during a single chewing stroke, the
following sequence occurs:
Opening phase:
Closing phase:
Crushing phase:

26
At this point the teeth are so positioned that the buccal cusps
of the mandibular teeth are almost directly under the buccal
cusps of the maxillary teeth on the side to which the mandible
has been shifted.
As the mandible continues to close, the bolus of food is
trapped between the teeth.
During the grinding phase the mandible is guided by the
occlusal surfaces of the teeth back to the intercuspal position,
which causes the cuspal inclines of the teeth to pass across each
other, permitting shearing and grinding of the bolus of food.
Grinding phase:
5. JEFFREY P. OKESON MANAGEMENT OF TEMPOROMANDIBULAR DISORDERS AND OCCLUSION, EDITION 6

• IN THE SAGITTAL
PLANE OF THE
WORKING SIDE.
28
• During opening, the incisor moves slightly anterior to
the intercuspal position (ICP) and then returns from a
slightly posterior position.
• The molar begins with an anterior movement during
the opening phase and a more posterior movement
during the closing stroke.
• The working side condyle also moves posteriorly during
the closing stroke until final closure, when it shifts
anteriorly to the intercuspal position.
6. Lundeen HC, Gibbs CH: Advances in occlusion, Boston, 1982, John Wright PSG

29

• IN THE SAGITTAL PLANE
OF THE NON WORKING
SIDE.
30
• The first molar initially drops from the intercuspal
position (IP) almost vertically with little to no anterior
or posterior movement.
• The final stage of the closing stroke is also almost
completely vertical.
• The condyle on the nonworking side moves anteriorly
during opening and follows almost the same pathway
on its return.
• The nonworking side condyle is never situated
posterior to the intercuspal position.

31

• When food is initially introduced into the
mouth, the amount of lateral movement is
great and then becomes less as the food is
broken down.
• The amount of lateral movement also varies
according to the consistency of the food.
• The harder the food, the more lateral the
closure stroke becomes.
• The hardness of the food also has an effect
on the number of chewing strokes necessary
before a swallow is initiated: the harder the
food, the more chewing strokes needed.
32
5. JEFFREY P. OKESON MANAGEMENT OF TEMPOROMANDIBULAR DISORDERS AND OCCLUSION, EDITION 6 p42

• Muscular activity during mastication
6.
6. Lavelle, Christopher L.B. (1988). Applied Oral Physiology || Mastication. , (), 12–24.
33
 During both the opening and beginning of the closing phases, the masticatory muscles undergo
isotonic contraction or relaxation. In the latter part of the closing and occlusal phases, however,
tension builds up in the elevator muscles.
 Elevator muscular contraction is strictly isometric only when the teeth are in contact or when there is a
hard unyielding object in between them. During chewing, the change from isotonic to isometric
contraction is usually not abrupt but rather a gradual change during the latter part of the closing
phase.
 During the closing phase of mastication, the temporalis muscle on the working side is the first to
become active, followed by both masseters and the temporalis of the balancing (non-working) side.

34
 The masseter and medial pterygoids are the first to become active during an incisive
movement. The lateral pterygoid muscle is active during both mandibular protrusion and
opening, although it is not strictly a mandibular depressor.
 The suprahyoid muscles (digastric, geniohyoid and mylohyoid muscles) become active during
jaw opening, although hyoid stabilization through infrahyoid and stylohyoid muscle contraction
is a necessary prerequisite. During the initial phase of isotonic closing from an open position,
the depressor muscles are first activated. The depressor muscles then gradually relax to allow
the mouth to be closed by the passive tension in the elevator muscles and ligaments.
 The muscles responsible for mandibular opening may be placed in the following order of
activity:
(1) Mylohyoid. (2) Digastric. (3) Lateral pterygoid.
This serves to stabilize the mandibular condyle or move the condyle anteriorly or posteriorly during
opening, closing and protrusive mandibular movements.
The primary muscles responsible for mandibular closing include:
(1) The temporalis on the working side. (2) The temporalis on the balancing side and both
masseters after a 50-100 ms delay. (3) Both masseter and medial pterygoid muscles.

• Mandibular movements during
mastication
 During opening, there is usually a lateral mandibular shift to the working (functional) side. The mandible
then swings back during closure into the intercuspal position.
 The working-side condyle moves laterally during the opening phase, whereas the opposing condyle on
the balancing side moves medially downwards and forwards.
 The working-side condyle rapidly resumes its position within its fossa early in the closing phase, whereas
the balancing-side condyle moves back into its fossa in the later phase of closing.
 Such mandibular movement patterns are not fixed, however, but may be affected by a number of factors,
including food bolus consistency, individual masticatory habits and the state of the dentition.
35

• Tooth contacts during mastication
 Early studies35 suggested that the teeth do not actually contact during mastication.
 It was speculated that food between the teeth, along with the acute response of the neuromuscular
system, prohibits tooth contacts.
 Other studies, however, have revealed that tooth contacts do occur during mastication.
 When food is initially introduced into the mouth, few contacts occur.
 As the bolus is broken down, the frequency of tooth contacts increases.
36
Tooth
contacts
during
mastication
Gliding (60%)
which occurs as the cuspal inclines pass by each
other during the opening and grinding phases
mastication
Single (56%)
which occurs in the maximum intercuspal
position
5. JEFFREY P

37
 The average length of time for tooth contact during mastication is 194 ms.
 It has even been demonstrated that the occlusal condition can influence the entire chewing
stroke.
 During mastication the quality and quantity of tooth contacts constantly relay sensory
information back to the CNS regarding the character of the chewing stroke.
 This feedback mechanism allows for alteration in the chewing stroke according to the
particular food being chewed.
 Generally, tall cusps and deep fossae promote a predominantly vertical chewing stroke,
whereas flattened or worn teeth encourage a broader chewing stroke.

38
 When the posterior teeth contact in undesirable lateral movement, the malocclusion
produces an irregular and less repeatable chewing stroke
 Normal persons masticate with chewing strokes that are well rounded, are more repeated,
and have definite borders.
 When the chewing strokes of persons with TMJ pain are observed, a less frequent repeat
pattern is noted.
 The strokes are much shorter and slower and have an irregular pathway.
 These slower, irregular but repeatable pathways appear to relate to the altered functional
movement of the condyle around which the pain is centered.
9. Anderson DJ, Picton DCA: Tooth contact during chewing, J Dent Res 36:21-26, 1957.

• Forces of mastication
 The maximum biting force that can be applied to the teeth varies from individual to individual. It is
generally found that males can bite with more force than can females.
 it was reported that a female’s maximum biting load ranges from 79 to 99 lb (35.8 to 44.9 kg), whereas
a male’s biting load varies from 118 to 142 lb (53.6 to 64.4 kg).The greatest maximum biting force
reported is 975 lb (443 kg).
 It has also been noted that the maximum amount of force applied to a molar is usually several times that
which can be applied to an incisor. In another study44 the range of maximum force applied to the first
molar was 91 to 198 lb (41.3 to 89.8 kg), whereas the maximum force applied to the central incisors was
29 to 51 lb (13.2 to 23.1 kg).
 The maximum biting force appears to increase with age up to adolescence. It has also been
demonstrated that individuals can increase their maximum biting force over time with practice a high
percentage of tough foods will develop a stronger biting force. This concept may explain increased biting
strength in the Eskimo population.
39
5. JEFFREY P

40
 Increased biting strength may also be attributed to facial skeletal relationships. Persons
with marked divergence of the maxilla and mandible generally cannot apply as much
force to the teeth as can persons with maxillary and mandibular arches that are relatively
parallel.
 A study by Gibbs et al.50 reports that the grinding phase of the closure stroke averaged
58.7 lb on the posterior teeth. This represented 36.2% of the subject’s maximum bite
force.
 The tooth pain or muscle pain reduces the amount of forced used during chewing.
 During chewing greatest amount of force is placed on the first molar region.
 With tougher foods, chewing occurs predominantly on the first molar and second
premolar areas.
 The biting force of subjects with complete dentures is only one fourth that of subjects
with natural teeth.
 Edentulous bite force at canine/premolar area =25.8lbs
8. Brekhus PH: Stimulation of the muscles of mastication, J Dent Res 20:87-92, 1941.

• Role of soft tissues in mastication
 As food is introduced into the mouth, the lips guide and control intake, as well as seal off the oral cavity.
The lips are especially necessary when liquid is being introduced.
 The tongue plays a major role, not only in taste but also in maneuvering the food with In the oral cavity
for sufficient chewing.
 When food is introduced, the tongue often initiates the breaking- up process by pressing it against the
hard palate. The tongue then pushes the food onto the occlusal surfaces of the teeth, where it can be
crushed during the chewing stroke.
41
JEFFREY P

42
During the opening phase of the next chewing stroke, the tongue repositions the partially
crushed food onto the teeth for further breakdown. While it is repositioning the food from
the lingual side, the buccinator muscle (in the cheek) is accomplishing the same task from
the buccal side. The food is thus continuously replaced on the occlusal surfaces of the teeth
until the particle size is small enough to be swallowed efficiently.
 The tongue is also effective in dividing food into portions that require more chewing and
portions that are ready to be swallowed. After eating, the tongue sweeps the teeth to
remove any food residue that has been trapped in the oral cavity.
JEFFREY P. OKESON MANAGEMENT OF TEMPOROMANDIBULAR DISORDERS AND OCCLUSION, EDITION 6 p44

• Chewing reflex
43
Presence of a bolus of food in mouth first initiates reflex
inhibition of the muscle of mastication , which allows lower jaw
to drop.
The drop in turn initiates a stretch reflex of the jaw muscles
which leads to rebound contraction.
Automatically raises the jaw to cause closure of teeth, but it also
also compresses the bolus again against the linings of mouth,
which inhibits jaw muscles once again, allowing the jaw to drop
and rebound another time.

• Control of mastication
44
 Action of mastication is mostly a reflex process.
 It is carried out voluntarily also.
 The center for mastication is situated in medulla and cerebral cortex.
 Responsible nerve for reflex mechanism : mandibular division of 5th cranial (trigeminal) nerve.
7. Sembulingam K, Sembulingam P
. Essentials of medical physiology. JP Medical Ltd; 2012 Sep 30.

• Mastication in denture bearer
 The quality of the prosthetic service may have a direct bearing on the denture wearer’s
masticatory performance. The maximal bite force in denture wearers is five to six times less
than that in dentulous individuals. Edentulous patients are clearly handicapped in masticatory
function, and even clinically satisfactory complete dentures are a poor substitute for natural
teeth.
 The pronounced differences between persons with natural teeth and patients with complete
dentures are conspicuous in this functional context:
 (1) the mucosal mechanism of support as opposed to support by the periodontium;
 (2) the movements of the dentures during mastication;
 (3) the progressive changes in maxillomandibular relations and the eventual migration
of dentures; and
 (4) the different physical stimuli to the sensor motor systems
45
10.Kumar L, Biomechanics and clinical implications of complete edentulous state, Journal of Clinical Gerontology & Geriatrics (2014),

46
The denture-bearing tissues are constantly exposed to the frictional contact of the overlying denture
bases. Dentures move during mastication because of the dislodging forces of the surrounding
musculature. These movements manifest themselves as displacing, lifting, sliding, tilting, or rotating of the
dentures. Furthermore, opposing tooth contacts occur with both natural and artificial teeth during function
and parafunction when the patient is both awake and asleep.
Apparently, tissue displacement beneath the denture base results in tilting of the dentures and tooth
contacts on the nonchewing side. In addition, occlusal pressure on the dentures displaces soft tissues of
the basal seat and allows the dentures to move closer to the supporting bone. This change of position
under pressure induces a change in the relationship of the teeth to each other.
10. Kumar L, Biomechanics and clinical implications of complete edentulous state, Journal of Clinical
Gerontology & Geriatrics (2014),

• Myofascial pain dysfuntion
 Etiology:
1. Occlusal disturbances
2. Intracapsular disorders
3. Emotional turmoil
4. Direct or indirect trauma
5. Spine pathology
6. Psychogenic influences like stress and
strain
7. Habits like bruxism
 Pathophysiology
47
12. Dr. Preethi Poonja et al, ARC Journal of Dental Science Volume 3, Issue 3, 2018, PP 1-4 ISSN No. 2456-0030

48
• Mpds trigger points
Trigger points are small exquisitely tender areas, which causes pain to the distant region,
called the referred Pain Zone.
 They are activated by pressure, movement, change of barometric pressure and tension
 TAUT BAND- It is the group of tense muscle fibers extending from a trigger point to the
muscle attachments, the tension being caused by contraction knots that are located in trigger
point region
• Clinical features
TMJ sounds
Impaired or irregular mandibular movement
Limitation in mouth opening
Preauricular pain
Facial pain
Headaches
Jaw tenderness on function

49
• A trigger point in the occipital belly of
the occipitofrontalis muscle can produce
referred headache pain behind the eye.
• Trigger points located in the trapezius muscle
refer pain to behind the ear, the temple, and the
angle of the jaw.
• Trigger points located in the sternocleidomastoideus
refer pain to the temple area.

50
Managem
ent
Non
Surgical
Rest Diet
Pharmacological
therapy
Analgesic drugs
Anti-inflammatory
drugs
Anxiolytic drugs
Muscle relaxants
Herbal medicine
Anticonvulsants
Antidepressants
Other methods
TENS
ETOIMS
Magnetic
stimulation
Laser therapy
Surgical
Condylectomy Menisectomy Myotomy Arthroscopy
Botulinum toxin
A injection
Transcutaneous Electric Nerve Stimulation
(TENS)
Electrical Twitch Obtaining Intramuscular
Stimulation (ETOIMS)

• Prosthetic management of masticatory
muscle disorder
 AN OCCLUSAL APPLIANCE is a removable device, usually made of hard acrylic, which
fits over the occlusal and incisal surfaces of the teeth in one arch, creating precise
occlusal contact with the teethof the opposing arch.
 Occlusal appliances have several uses, one of which is to temporarily introduce a stable
occlusal condition that can alter neuromuscular reflex activity, leading to improvement
in certain muscle pain disorders.
 Two types of occlusal appliance can be used:1) stabilization appliance
2)anterior positioning appliance
51
11. Ekberg E, Nilner M: Treatment outcome of appliance therapy in temporomandibular disorder patients with
myofascial pain after 6 and 12 months, Acta Odontol Scand 62(6):343–349, 2004.

52
 The stabilization appliance is sometimes called a muscle relaxation appliance because it is
primarily used to reduce muscle
 The anterior positioning appliance is sometimes called an orthopedic repositioning
appliance, since its goal is to change the position of the mandible in relation to the cranium.
Stabilization splint

• An occlusal view of a well-
adjusted stabilization appliance
when the patient closes in the
musculoskeletally stable position
(centric relation). All centric
relation contacts are even and on
flat surfaces.
53

• A, Relationship of the anterior teeth to
the anterior stop in centric relation.
However, this position does not reduce
pain or clicking associated with the disc
displacement.
• B, The patient’s mandible protrudes
slightly until an opening and closing
movement occurs that eliminates the
painful clicking. The contact area on the
anterior stop is marked with articulating
paper in this position.
• C, The mark labeled as CR is the
musculosk-eletal stable position of the
condyle (centric relation), and the mark
labeled AP is the anterior therapeutic
position of the condyle that eliminates
the TMJ clicking.
54

• Conclusion
 Mastication is oral motor behavior reflecting central nervous system commands,
and many peripheral sensory inputs to modulate the rhythmic jaw movements.
 It is the main function of the dentist to ensure that patients can bite and
masticate their food in an efficient manner.
 The problem is that there is still a dearth of information concerning the 'proper’
method for the opposing teeth to meet together during chewing. As a result,
great care has to be taken to ensure that the patient's masticatory ability is
improved, rather than worsened, by dental treatment.
55

• References
1. BD Chaurasiya’s human anatomy; temporal and infratemporal region; 4th edition, CBS
Publisher 2004.
2. Wheeler’s dental anatomy, physiology and occlusion;9th edition;2012
3. Basit H, Tariq MA, Siccardi MA. Anatomy, Head and Neck, Mastication Muscles.
StatPearls [Internet], 2020.
4. Helmenstine, Anne Marie, Ph.D. "Mastication: Definition and Functions." ThoughtCo,
Aug. 29, 2020.
5. JEFFREY P
. OKESON MANAGEMENT OF TEMPOROMANDIBULAR DISORDERS AND
OCCLUSION, EDITION 6.
56

57
7. Sembulingam K, Sembulingam P
. Essentials of medical physiology. JP Medical Ltd; 2012 Sep30.
8. Brekhus PH: Stimulation of the muscles of mastication, J Dent Res 20:87-92, 1941.
9. Anderson DJ, Picton DCA: Tooth contact during chewing, J Dent Res 36:21-26, 1957.
10. Kumar L, Biomechanics and clinical implications of complete edentulous state, Journal of Clinical
Gerontology & Geriatrics (2014),
11. Ekberg E, Nilner M: Treatment outcome of appliance therapy in temporomandibular disorder patients
with myofascial pain after 6 and 12 months, Acta Odontol Scand 62(6):343–349, 2004.

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