MANDIBULAR MUSCLES AND

THEIR IMPORTANCE IN
ORTHODONTICS

Presented to
Dr. Anil Chandna
Dr. DK Agarwal
Dr. Preeti Bhattacharya
Presented by Dr. Ankur Gupta
Dr. Surabhi Saxena Dr. Juhi Ansar
(JR1) Dr. Ravi Bhandari
Dr. Shivani Singh
 CONTENTS

 Introduction
 The mandible

 Mandibular muscles

 Craniofacial morphology

 Position, orientation and mechanical advantage

 Muscle function and craniofacial morphology

 Specific aspects of orthodontic treatment

INTRODUCTION
 THE MANDIBLE
 Largest and strongest bone of the face
 Horseshoe shaped body which lodges the teeth

 Pair of rami which projects upwards from the posterior

ends of the body
 THE BODY

 Outer and inner surface

 Upper and lower border
•Outer surface presents
• Symphysis menti
• Mental protuberance
• Mental foramen
• Oblique line
• Incisive fossa
•Inner surface presents
• Mylohyoid line
• Submandibular fossa
• Sublingual fossa
• Genial tubercles
• Mylohyoid groove
 THE RAMUS

 2 surfaces,4 borders and the coronoid and condylar processes

 Lateral surface-flat

 Medial surface presents

 Mandibular foramen
 Lingula
 Mylohyoid groove
ATTACHMENTS AND RELATIONS OF THE
MANDIBLE
MANDIBULAR MUSCLES AND JAW
MOVEMENTS
Action Muscle involved
Elevation of the jaw Masseter
Temporalis
Medial pterygoid
Depression of the jaw Lateral pterygoid and assisted by
digastric, mylohyoid and
geniohyoid muscle
Protraction of the jaw Lateral pterygoid
Retraction of the jaw Temporalis
Lateral movement of the jaw Medial and lateral pterygoid
 GENERAL CONSIDERATIONS

 The simplest concept of neural control of mandibular posture is of

the mandible maintained against gravity by the stretch reflex in the
mandibular elevators.

 Electromyographic (EMG) studies of postural position have shown

that the inframandibular group of muscles are more active than the
levator muscles.
 Brodie'o conceived of head posture as determined by a chain
of muscles ventral to the vertebral column opposed by
another chain dorsal to the cervical vertebrae.

 Extension of the head results in an increase in freeway space,

while flexion results in a decrease. Changes in head posture
also affect the anteroposterior position of the mandible in
postural position
 Masseter
Origin- Zygomatic arch and maxillary
process of zygomatic bone
Insertion-angle and lateral surface
of ramus of mandible, coronoid
process
Nerve supply-Mandibular nerve (V3)
Actions-Elevation (as in closing of the
mouth) and protrusion of mandible
 Temporalis
Origin-temporal lines on the parietal
bone of the skull and the superior
temporal surface of the sphenoid
bone
Insertion-coronoid process of
the mandible and retromolar fossa
Nerve supply-deep temporal nerves,
branch(es) of the anterior division of
the mandibular nerve (V3)
Action-
elevation and retraction of mandible
 Medial pterygoid
Origin - Deep head: medial side of lateral pterygoid
plate behind the upper teeth
-Superficial head: pyramidal process of palatine
bone and maxillary tuberosity
Insertion- Medial angle of the mandible
Nerve supply- Mandibular nerve via nerve to medial pterygoid
Actions- Elevates mandible, closes jaw, helps lateral
pterygoids in moving the jaw from side to side
 Lateral pterygoid
Origin Superior head: infratemporal fossa.
 Inferior head: lateral pterygoid plate
Insertion
Superior head: anterior side of the condyle.
Inferior head: pterygoid fovea
Nerve supply-Lateral pterygoid nerve from the mandibular nerve
Actions -depresses mandible, protrude mandible, side to side
movement of mandible
 Mentalis
Origin- incisive fossa of mandible
Insertion- skin of the chin
Nerve supply- vii cranial nerve
Action- elevates and wrinkles the chin,
pulls lower lip out as in pouting
 Buccinators
Origin- from the alveolar
processes of maxilla  and mandible,
and temporomandibular joint
Insertion- In the fibers of the orbicularis
oris
Nerve- Buccal branch of the facial
nerve(vii cranial nerve)
Actions- The buccinator compresses the
cheeks against the teeth and is used in
acts such as blowing. It is an assistant
muscle of mastication(chewing) and in
neonates it is used to suckle.
 Platysma
Origin- subcutaneous tissue of
infraclavicular and supraclavicular
regions
Insertion- base of mandible; skin of
cheek and lower lip; angle of mouth;
orbicularis oris
Nerve supply- cervical branch of
the facial nerve
Actions- draws the corners of
the mouth inferiorly and widens it (as
in expressions of sadness and fright).
Also draws the skin of
the neck superiorly when teeth are
clenched
 Depressor labii inferioris
Origin- oblique line of the mandible, between
the symphysis and the mental foramen
Insertion- integument of the lower lip
Nerve supply- facial nerve-mandibular branch
Action- depression of the lower lips
 Depressor anguli oris
Origin- tubercle of mandible
Insertion- modiolus of mouth
Nerve supply- mandibular branch of facial
nerve
Action- depresses angle of mouth
 Genioglossus
Origin- superior part of mental spine of mandible (symphysis menti)
Insertion- underside of tongue and body of hyoid
Nerve supply- hypoglossal nerve
Action- inferior fibers protrude the tongue, middle fibers depress
the tongue, and its superior fibers draw the tip back and down
 Geniohyoid
Origin-Inferior mental spine of mandible
Insertion- Hyoid bone
Nerve supply-C1 via the hypoglossal
nerve
Actions-Carry hyoid bone and the tongue
upward during deglutition
 Mylohyoid
Origin-Mylohyoid line (mandible)
Insertion-Body of hyoid bone and median ridge
Nerve supply- Mylohyoid nerve, from inferior
alveolar branch of mandibular nerve
Actions- Raises oral cavity floor, elevates
hyoid, elevates tongue, depresses mandible
 Digastrics
Origin
Anterior belly - digastric fossa (mandible)
Posterior belly - mastoid notch of temporal bone
Insertion- Intermediate tendon (hyoid bone)
Nerve supply- Anterior belly- mandibular division(v3) of
the trigeminal (CN V) via the mylohyoid nerve
-Posterior belly - facial nerve (CN VII)
Actions- Opens the jaw when the masseter and
the temporalis are relaxed.
 THE RELATIONSHIP BETWEEN
CRANIOFACIAL MORPHOLOGY AND
THE MANDIBULAR MUSCLES
Bite-force and facial morphology
•Dolichofacial subjects-smaller maximum molar bite forces
than in mesofacial and brachyfacial subjects.

• Positive correlations have been reported between the cross-

sectional areas of the masseter and medial pterygoid and the
maximum molar bite force.
Position, orientation and mechanical advantage
of the mandibular muscles
•According to Takada et al, a short posterior face height with steep
mandibular plane and large gonial angles is often associated with
an anteriorly inclined superficial masseter relative to the occlusal
plane and a superior positioning of its insertion on the mandible.
•Throckmorton et al explained that the significantly smaller bite
force of dolichofacial subjects is due to the reduced mechanical
advantage of the mandibular muscles.

•Sasaki et al, found that the variation of maximum bite force could
be accounted for largely by muscle cross sectional areas rather than
simply by muscle lever arms.
 CAUSE AND EFFECT RELATIONSHIP
BETWEEN MUSCLE FUNCTION AND
CRANIOFACIAL MORPHOLOGY
•Human subjects with strong bite forces tend to have brachyfacial
patterns, in contrast to those with weak bite forces, who tend to have
dolichofacial patterns.

•Similarly, Ingervall and Helkimo suggested that the interindividual

form of the face is smaller in persons with strong muscles than in those
with weak muscles.
 CONSIDERATION OF THE MANDIBULAR
MUSCLES AND VERTICAL FACIAL PATTERN
DURING ORTHODONTIC TREATMENT

•Schudy and Creekmore claimed that the vertical dimension is the most
important to the clinical orthodontist.

•This importance has been borne out by the pioneering work of Bjork,
who used metallic implants to show that the mandibular corpus rotates
during growth, with the shape kept stable by associated substantial
surface remodeling.
•According to Schudy, if condylar growth is greater than vertical
growth in the molar region, the mandible rotates forward, resulting
in a more horizontal movement of the chin with less ultimate
increase in anterior facial height.

•Conversely, if vertical growth in the molar region is greater than

that at the condyles, the mandible would rotate backward, resulting
in a greater anterior facial height with less effective horizontal
projection of the chin.

•To describe these 2 patterns, Schudy coined the terms

hypodivergent and hyperdivergent.
•Dolichofacial patients present problems in the prevention, correction,
and retention of open bites.

•A backward rotation of the mandible can easily occur in these

patients if the facial pattern is not considered during treatment. This
can lead to a detrimental increase in profile convexity in some
patients.

•In general, most brachyfacial patients require bite-opening mechanics

during orthodontic treatment.
CONSIDERATION OF THE MANDIBULAR
MUSCLES AND HORIZONTAL FACIAL
PATTERN
 The masseter muscle thickness is significantly more in males
than females with no significant difference in muscle thickness
between class1 and class2 groups

 Masseter muscle thickness show a positive correlation with

maxillary dental arch width, effective mandibular length,
midfacial length and corpus length and a negative linear
correlation with jarabak’s ratio and ramal height
 SPECIFIC ASPECTS OF ORTHODONTIC
TREATMENT WITH REFERENCE TO THE
MANDIBULAR MUSCLES AND VERTICAL
FACIAL PATTERN
 THE FORM AND FUNCTION QUESTION
 The model of Throckmorton et al., demonstrates the unfavourable
mechanical position of the mandibular muscles in dolichofacial
subjects, implying that muscular function is influenced by the
genetic skeletal form.

 This is supported by the observation that a dolichofacial skeletal

pattern can be recognized before decreased occlusal forces can be
measured.

 The decreased muscular forces seen in dolichofacial patients are

originally an effect of the skeletal pattern, rather than a direct cause
of it
 NATURAL DENTAL ARCH WIDTHS,
ANTEROPOSTERIOR POSITIONS AND
VERTICAL RELATIONSHIPS
 The more brachyfacial the subject, the broader the natural
facial and dental arch widths are likely to be.

 It is common for the incisors in shorter faces to appear

relatively upright (even retroclined), often with more concave
lip profiles.
 EXTRUSIVE MECHANICS
•Extrusion maintains or increases vertical dimension during
orthodontic treatment.

•Difficult to cause permanent extrusion of the molars and

backward rotation of the mandible.

•Extrusive forces with intermaxillary elastics, headgears should

be avoided in patients with backward-rotating tendencies to limit,
any undesirable backward rotation of the mandible.
 EXTRACTIONS AND TIMING OF
TREATMENT

•Staggers- no significant differences in vertical dimension between

premolar and second molar extraction groups.

•Extrusion of posterior teeth- reason for maintenance of vertical

dimension during treatment involving premolar extractions.
•Muscular patterns, growth rotations of the mandible, profile concavity
or convexity influence premolar extraction decision.

•Pubertal growth and E-spaces are important in orthodontic

management of brachyfacial patients in late mixed dentition without
premolar extractions.
•In dolichofacial patients, treatment begins later.

•According to Gianelly, the leeway space would allow the relief of

crowding in up to 75% of patients, so orthodontic treatment is to
be carried out without premolar extractions.
 THE SIGNIFICANCE OF MANDIBULAR
ROTATION TO THE ORTHODONTIST
•Bjork first drew attention to the mandibular growth rotations that
occur in normal facial growth.

•Brachyfacial patients resist vertical posterior dentoalveolar

development.
 SURGICAL CONSIDERATIONS
•Jacobs and Sinclair -efficiency of treatment, stability, and
esthetic change in orthognathic surgery patients obtained by
postponing the leveling of mandibular curves of Spee until after
surgery.

•In Class II deep-bite patients, it is common practice to leave final

leveling until after surgery so that, at least in theory, postsurgical
extrusion of the posterior teeth will enhance any surgical increase
in lower face height.

•Surgical manipulation of the jaws alters the environment in all 3

dimensions so the teeth can be placed in their final, well-detailed
positions.
•If, on the other hand, presurgical leveling is attempted in
brachyfacial patients, it would have to overcome the heavy bite forces
associated with such patterns.

•In other patients with longer lower anterior facial heights, most of
the leveling should be carried out before surgery to avoid,
postsurgical extrusive effects.

•Arch coordination and preparation are more easily achieved in these

longer-faced patients because of the decreased vertical muscular
anchorage.
 MUSCULAR ANCHORAGE
•In 1978, Bench et al introduced the concept of muscular anchorage.
According to this concept, the facial type described by the
cephalometric morphology reflects a particular underlying muscular
pattern.

•The teeth would be controlled with natural anchorage in a

brachyfacial pattern, where the musculature is strong, but there would
be less muscular anchorage in dolichofacial subjects with weak
mandibular musculature.
•Weaker musculature would be less able to overcome the molar-
extruding and bite-opening effects of orthodontic treatment.

•Ricketts et al claimed that the values for the oral gnomon and
facial gnomon were excellent indicators of mandibular morphology
and the associated muscular function.
 RETENTION
•The position and function of the lips are well accepted to influence
incisor alignment and stability. The facial and mandibular muscles
are also critical influences.

•Ricketts et al said that preferred incisal positions and angulations at

the end of active treatment might vary depending on the underlying
vertical facial type, with brachyfacial patients tolerating more
protrusive and proclined incisors than dolichofacial patients.
•Brachyfacial patterns allow greater expansion of the arches during
treatment, in contrast to dolichofacial patterns with generally weaker
mandibular muscle forces that allow less expansion during
treatment.
CONCLUSIONS
REFERENCES
 General human anatomy
• BD Chaurasia
 Handbook of orthodontics
 Robert E Moyers
 The mandibular muscles and their importance in
orthodontics- a contemporary review
 AJO-DO 2006
 The mandibular muscles and their importance in
orthodontics- a contemporary review
 Australian dental journal