..

UDC: 531.78, 539.4

An experimental analysis of the forces exerted
by perioral muscles on the dental arches
by F.P. Branca, P. Cappa, F. Mastrantonio
Department of Mechanic9 and Aeronautics, University of Rome "La Sapienza," Via Eudossiana, 18-00184 Rome, Italy
Abstract
During the various oralfunctions, as is known, perioral
muscles interact with dental tissues, g ingivae and alveolar
hone. Since the jorces they exert during this interaction
may ajfect teeth position, it appears very important in
orthodontics to acquire means jor monitoring and
measuring them. Nevertheless,from an analysis ofliterature
on this specijic subject a lack ofknowledge conceming the
amount of load exerted by perioral muscles emerges, so
that its contribution so far to teethdisplacement is unknown.
11te aimofthe presentwork is the "in vivo" evaluation of
the actual forces applied by perioral muscles on dental
arches by an automatic measurement chain carri ed out by
means oftwo miniaturised load cells (full scale=9.81 N)
placedon the upper incisors. Preliminary results permitted
an estimation ofthe maximum value ofthe appliedforce
range for various phonema. which proved to be in every
case lower than about 1.98 N.
Key words: Force measurements, perioral muscle, teeth
movement
lntroduction
As teeth movement, namcly their translation and/orrotation
with respect to the alveolare bone, results from prolonged
force application, many studies bave been conducted to
evaluate the loads exerted by oral muscles during usual
oral functions.
It is supposed, in fact, that these forces, wben coronally
applying on teeth, may cause a displacement of their initial
position on the dental arcb by a mechanism in whicb there
is bone resorption on one side of the tooth, and a bone
formation on the other side (Fig. 1).
/
Glnglval Margln.
llllen!nce fO( "pocket deptll'
Cementoenamet Junctlon (CE.I)
Rti'ltntnce fO( 'altliellment level'
A variety of researchers bave been therefore carried out to
examine experimentally the maximum lip and cheek
pressure
1

3
, the occlusal forces exerted during mastication
and biting "-
7
, the lateral forces applied by muscle on the
dental arches
8
, and, fmally, the relationship ofmaximum
perioral muscle pressure and tonic resting pressure
9

Not withstanding all these studies, only in recent times
bave some researchers pointed out the role of perioral
musculature in orthodontic treatment
10
Tbese muscles (i.e.
the facial muscles of the perioral zone, the buccinator and
orbicularis oris muscle) are placed in the lip and cheek area
andtheycontractduringvariousoralfunctionse.g.chewing,
swallowing, speaking and facial mimic (Fig.2). lt is
supposed that these contractions cause a pressure on the
dental arch antero-lateral zones both in the rest position
and during their functions. If the previously indicated
bypotheses are verified, these muscles might affect the
underlying bone, that is, the dental arcb sbape and tooth
position. Furthermore, this could explain the results
obtained by some authors
11
according to whom orthodontic
treatment of 66 per cent of the patients gave unstable
results and failure in about six years time.
Cementum
oris
musei e
.
Perlodonlal Altachment.
lllllrillcm sfentof ptOblng
., - Supportlng Bone
Ag. 1 Basic tooth anatomy
'Strain', November 1994
Fig. 2 Perioral muscle
131
From the above considerations the importance, in
orthodontics, of confmning such an assumption in order to
establish the correct orthodontic treatment planning
becomes evident.
An analysis of literature ha-; pointed out a lack of detailed
knowledge of perioral cavity muscles anatomy, believed
for many years to be of no significance in dentistry.
Some authors even disagree on insertion sites, disposal
and correlation existing between orbicularis oris muscle,
facial muscle of perioral zone and buccinator muscle t w.
This serious deficiency in knowledge implies, as is obvious,
remarkable gaps regarding the effects produced by these
muscleson dental tissues and, specifically, pressure exerted
during the various functional activities has not been
recognised.
The aim ofthe presentpaper is the experimental evaluation
of the actual force applied by perioral muscles on the
dental arches of patients studied when performing the
main oral functions.
In the preliminary pha-;e of this study the force, exerted by
the orbicularis oris muscle (which is able to contract and
push lips against teeth, thus exerting a load on them), was
monitored by means of a simple experimental apparatus
able to minimise the insertion error.
The adopted methodology consisted of applying, in the
region between orbicularis muscle and dental tissues, two
miniaturised load cells attached to theoral cavity by means
of a suitable insert de vice. The transducer outputs, together
with oral temperature, were gathered by an automatic
digitai data acquisition system via a IEEE-488 bus.
Experimental set up
To monitor the forces exerted by perioral muscles on
dental tissues without introducing appreciable insertion
errors, it was decided to use two load cells about 4 mm
thick.
It is necessary to underline that it wa-; decided to measure
the force applied by muscles instead of the pressure exerted
by them as suggested by Lear etal
8
; in fact, these researchers
observed that muscle contact is not always evenly
distributed over the entire sensing area of the pressure
transducer. Therefore, the commonly employed pressure
transduction devices are unsuitable for this type of
examination. A force detection device, such as the one
described, is necessary for investigation in this field.
To piace the load cells on the upper incisor (Fig.3), a U-
shaped clip was inserted in t o the oral cavity. Such an
apparatus was realised by means of orthodontic steel wire
and was attached to the dental tissue with a photoactivable
polymer that was activated by means of a halogen lamp
(A.::470nm).
132
Fig. 3 Load cells and ctamplng devlce
Fig.4 shows the adopted experimental set-up used to
monitor the transducers output as a function of time. It
consisted of (l) two load cells based on electrical resistance
strain gauges, (2) strain gauge signal conditioning units
with a D.C. amplifler, specifically for dynamic
measurements. (3) To monitor the environmental
temperature variations a chromel-alumel thermocouple,
se t in proximity of the sensors, was utilised and finally, ( 4)
to collect, to analyse and to store the experimental data an
automatic data acquisition system interfaced to the devices
by means of the IEEE-488 bus wa-; utilised.
DATA ACQUISITION SYSTEM
Available High speed
slots DVM
Load celi no.2
Thermocouple
""DJ--
Fig. 4 Scheme of lhe experlmenlal setup.
The automatic dataacquisition system may be schematized
as a computer controlling the measurement instruments
and a data acquisition unit (DACS) equipped with a solid
state relay multiplexer (capable of completing the
thermocouple circuit with a cold junction and of
automatically compensating the cold junction temperature
differences from 0C) and a highspeed digitai voltmeter
(measurement rate up to l()()()()() readings/s and 13 bit
resolution).
Metrologlcal performance of the measurement
system
It was decided to conduct static calibration test-; before
'Strain', November 1994
carrying out the analysis on patients in order to evaluate,
from a metrological point of vie w, the measurement cbain
after the load cells.
S ucb amethodology was necessary, as is obvious, because
of the need to de termine the effects of error causes always
present in the signal conditioning block and perhaps induced
by affecting quantities as, for example, temperature.
A calibration unit specific for Wbeatstone bridges was
utilised. Tben three sets of calibration tests were conducted
applying three differentamplification gains. It was decided
to carry out eacb set by means of five tests.
Plots relative to inaccuracy and standard deviation of the
set wbicb gave the best are sbown in Fig. 5 (a. b).
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Fig. 51naccuracy (a) and standard devlatlon (b) as a function of the eleclrlcally
simulated strain
In order to test possible zero sbift pbenomena of the
automatic measurement system, the following drift tests
were conducted: (l) four zero sbift tests and (2) two drift
tests imposing strains equal to +l 000 ,J.UU/m and -l 000 J.UOI
m, that is, equivalent for the utilised strain gauges to
+4.66N and -4.66 N.
These force values bave been deduced from the study
carriedoutby Learetal. according towbominanycase4.9
N far exceeds maximum forces exerted by orofacial
muscles during normal oral activities.
Results obtained with the test<; now described bave sbown
irrelevant drift pbenomena pointed out from the four
bour test in wbicb the zero sbift was al ways in the range 2
J.UU/m(0.09N)equivalentto0.4percentofthemaximum
value of the range of the forces recorded during a
subsequently in vivo conducted test.
'Strain', November 1994
Experimental procedure and first results
Tests of acquisition in vivo were then performed on three
adult male patients on wbose dental arcbes the previously
described devices had been applied. In particular, the
sensing element of the transducer bad been placed near the
upper incisors, those being the most prominent teeth of the
upper arcb, and those that reasonably absorb the major part
of the loads exerted by perioral muscles. Three labial
pbonemes were then recorded and for eacb one 10
acquisitioncycles,eacb madeof200measurementssampled
at the frequency of50 Hz, wereconducted. Sucb asampling
frequency was fixedaccording to the nature ofthe biological
pbenomenon that seems to be slowly variable in time and
i t was perfectly compatible with the dynamic performances
of the transducer wbose bandwidth at -3 db was about
1kHz. To minimise the insertion error of the sensor that
causes an increment of the loads on teeth wbicb may be
measured with null muscular activity, a waiting period of
about 2.5 bours was imposed between the application of
the abovementionedsensors and the beginning ofthe tests.
It was felt that sucb an interval of time would be necessary
toallowfortheoraltissuetoadjusttothenewconfiguration.
Adaptability and elasticity of the intra-oral muscles bave
indeed often been mentioned in literature (Weinstein et
al.
8
); Wernerl then sbowed that an increase in the transducer
thickness up to 4.5 mm did not intluence bis readings. By
extrapolation it was inferred that the registration would
stili be the same under zero thickness conditions.
The analysis of the results adlieved i<; sununari<;ed in table l in
wbicb the bigbest force values observed for eacb pboneme
are sbown. Sucb a table facilitated the determination ofthe
mean and standard deviation values of the bighest variation
range of the force exerted by perioral muscles on dental
arcbes during the pbonation tests, whicb were 1.260.38 N
and 1.930.29 N for the load celi No. l and No. 2
respectively. Regarding the pboneme No. 3, the data
obtained with the load celi No. l due to erroneous zero
setting of the Wbeatstone bridge bave not been reported. It
can be noticed that, in spite of the symmetrical position of
the transducers se ton the upper arcb, the average values of
the measurements performed with the two sensors differed
by 36 per cent; sucb a difference seems to derive from the
non-complete stability of the clamping de vice, the result of
wbicb was evidently the perturbation of the transducer's
symmetry with relevant effect.
'
Tahle l Maximum range of the applied force on
dental tissues
'PHONEME ,, AFIJiax
AFmn
'
Load celi #1 Load celi# 2
I 1.03N 1.91 N
n 1.49N 1.96N
m
--
1.91 N
133
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Fig. 6 Force variatlons as a functlon of lime for phoneme l; nth: (a) load
celi No. 1, (b) load celi No. 2; aoqulsltlon rnth: (c) load celi No. 1, (d) load celi No. 2
(1000 g force" 9.81 N)
Some acquisitions relative to one of the examined phonemes
bave been reported in Fig. 6 (a, b). This plot shows, as
previously observed, a non-complete repeatability of the
phenomenon that could be due, besides a non-perfect set-
up of the clip devices, to the difflculty in obtaining, during
the tests, the same phonation rate. As an example, even
though one could determine three peaks in almost ali the
acquisition cycles, they were characterised by threedifferent
values of measured force depending on the acquisition
134
cycle examined, in addition to the used sensor. In fact,
during the acquisition cycle of the plot of Fig. 6 (a, b) the
left peak assumed the value 1.23N for cell No. l and 1.08
N for cell No. 2 whereas, according to the plots reported
in Fig. 6 (c, d), forthesamepeaka valueof0.78 N withcell
No.1 and of 1.36 N with cell No.2 bave been measured.
Regarding the centrai peak, in a cycle this achieved the
value of 0.88 N using cell No. l and 0.98 N using cell No. 2
whereasregardingtheotherpeaksthesamevalueof1.37N for
both sensors was measured (Fig. 6 a, b). Similar
measurements performed in correspondence of the third
peak showed that during the acquisition cycle reported in
the plot of Fig. 6 (a, b), the highest recorded force was of
0.98 N with the load cell No. l and of 1.55N with the load
cell No.2. The same measurements showed, as regards the
cycle in the plot shown in Fig. 6 (c, d), a highest value of
0.98 N using cell No. l and 1.13 N with cell No. 2. From
the analysis of this data, apart from the analysis of table l,
it is clear that the forces exerted on dental tissues by
perioral cavity muscles are much lower (roughly three
orders of magnitude) than the forces exerted, for example,
during chewing. Indeed literature
14
gives typical values of
221.7 N for the vertical cmponent ofbiting forces acting
on incisors in adults and 19.6 N for the lateral one.
Nevertheless themeasured forces are of relevantimportance
if one takes into account that chewing occurs a small
number of times during the day compared with the number
oflabio-lingual movements that take piace many thousands
of times a day during physiological oral functions such as
swallowing and speaking. According to J. Parfitt
1
it is
possible to establish that in response to loads measured in
this research, in physiological situations, a tooth
displacement occurs in the labio-lingual direction of about
0.02 mm from the initial position with respect to the
alveolar bone. This value is not obtainable anymore if,
owing to periodontal disease, the tooth is excessively
loose. Be it so, in addition to damage caused by occlusal
forces, movement caused by perioral muscle forces may
bring aboutadditional damage to the periodontal structures.
During the present investigations the oral cavity
temperature, near the zone in which were applied the
transducers, was monitored: this temperature, as expected,
was equal to 36.3 C. Then i t was decided to perform other
measurements of this quantity during various oral functions
including swallowing ( carried out by drinking water taken
at 36 C in order to prevent drastic temperature changes)
and speech; the latter activity results, according to Lear et
al; in a maximum measurement fluctuation of T equal to
1.2C . These investigations demonstrated that the output
of the load cells was no t affected by the temperature inside
the oral environment since this quantity disturbance was
quantifiable at about 0.1 o/o full scale/C.
Finally a frequency analysis of the load cells' data by
means of FFT at 256 pointo; (applying the zero padding
technique) was performed. It was necessary to filter the
signal offset to avoid masking phenomena. Defore
performing this operation it was decided to appropriately
process the transduceroutput (cutting offfrom therecording
'Strain', November 1994
the amount of data gathered with muscles at rest) to
improve the signal to noise ratio. The results, corresponding
to one ofthesephonemes, obtained bymeans of a waveform
analysis are reported in Fig. 7. From an examination of this
plot the spectral resolution of about 0.7 Hz and the
fondamenta! harmonic frequency also of about O. 7 Hz
emerge. Finally, it is possible to observe that the significant
harmonics of the signal were obtained within the range
from O to 15 Hz. The data obtained by the frequency
analysis may be useful both for choosing the bes t sampling
frequency and for the cross correlation and cross spectrum
of a load celi signal with the vocal (finding out the comrnon
harmonic component) and the electromiographic one
(EMG) that will be gathered in the nextdevelopment of the
research project.
6
l
l
\ (\
~ vvv
V'vvv"'"
t--
HT 4
2
3. Barlow S.M., Rath E.M. "Maximum voluntary closing
forces in the upper and lower lips of humans" Joumal of
Speech and Hearing Research, 28, (1985}, 373-376.
4. Picton, D.C.A., "Some implications of normal tooth
mobility during mastication", Archs.oral Biol., 9, (1964},
565-573.
5. Nyquist, G. and Owall, B. "Masticatory load registrations
during function", Odont. Rev., 19, (1968}, 45-49.
6. Ahlgren, J. and Owall, B., "Muscular activity and
chewing force: a polygraphic study of human mandibular
movements", Arcbs.oral Biol., 15, (1970),.271-280.
7.Kang,Q.S., Updike,D.P.andSalatheEricP. "Theoretical
prediction ofmuscle forces on the mandible during bite",
Joumal of Biomechanical Engineering, 106, (1984), 364-
367.
8. Lear, C.S.C., et al., "Measurement of lateral muscle
forces on the dental arches", Archs.oral Biol., 10, (1965),
669-689.
9. Erwin, C. et al.," A study of the relationship of maximal
o
o 5 10 15 20
Hz
Fig. 7 FFT plllformed during the nth acqulaltlon for phoneme l
25 perioral muscle pressure and tonic resting pressure using
a pneumobydraulic capillary infusion system", The Angle
Orthodontist, 60, 3, (1990}, 215-220.
Conclusions
In this study measurements were performed, which up to
now were not available in literature, of the forces exerted
on dental tissues by the muscle of the perioral cavity.
First results bave made it possible to estimate the highest
value of the range of variation of the applied force that is
always 1 9 6 N. Such a value corresponds to a translation
ofthe upperincisor, in the labio-lingual direction, of:0.02
mm from the initial position with respect to the alveolar
bone. As a concluding remark it seems necessary to
emphasise that these forces though of small value, may
assume, by loading the tooth many thousands of times per
day, a significant role in the failure, observed in 66 per cent
of the cases, of orthodontic treatment.
Acknowledgments
The authors wish to thank Prof. V .Kaisats and Dr G. Cama
for their helpful co-operation and the realisation of the
clamping device.
References
l. Parfitt, G.J., "The dynamics of a tooth in function", J.
Periodont., 32, (1961), 102-107.
2.Gould,M.S.E.andPicton,D.C.A., "Astudyofpressures
exerted by the lips and cheeks on the teeth of subjects with
normal occlusion", Archs.oral Biol., 9, (1964},.469-478.
'Strain', November 1994
10. D'Andrea. M., Caligiuri, F.M., Ripani, M., "Ruolo
della muscolatura penorale nella pianificazione del
trattamento ortodontico", XXIII Congresso della Societa
Italiana di Odontostomatologia e Chirurgia Maxillo-
Facciale, Bologna 30 Novembre-3 Dicembre 1992. (In
Italian)
11. Little, R., Riedel, R., "Mandibular arch length during
mixeddentition", Am. J. Orthod. Dentofac. Orthop., (May,
1990).
12. Frederick S. '"'be perioral muscularphenomenon: part
l", Australian Orthodontic Joumal, 12, (1991), 3-12.
13. Frederick S. '"'be perioral muscularphenomenon: part
II", Australian Orthodontic Journal, 12,(1991), 83-89.
14. Webster J.G. ''Encyclopaedia ofmedical devices and
instrumentation", John Wiley and Sons, 4, (1988},
2776-2787.
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