Comparison of direct and indirect occlusal contact examinations with different clenching intensities

The aims of this study were to examine the change of occlusal contact area following the increment of clenching intensity using silicone materials and electromyography (EMG) in normal subjects and to compare direct intra‐oral examination with indirect examination using dental casts mounted by means of two impression methods. Participants were 7 men and 5 women with no more than one missing tooth per quadrant and no pain in the head and neck region. During the task, intercuspal position was maintained with minimal force, 20% maximum voluntary contraction (MVC) and 40% MVC using electromyography visual feedback. Three types of occlusal contact examinations were performed with the aid of blue silicone material in randomised order: (i) intra‐oral direct occlusal contact examination (DE), (ii) indirect occlusal contact examination with dental casts using conventional impression method (IEC) and (iii) using occlusal impression method (IEO). Total occlusal contact area during DE and IEO significantly increased from baseline to 20% MVC and from baseline to 40% MVC, but not during IEC. Total occlusal contact area during DE in all tooth clenching conditions was significantly larger compared to IEO and IEC (P < 0·05). At 40% MVC, total occlusal contact area during IEO was significantly larger than during IEC (P < 0·05). These findings suggest that indirect occlusal contact examinations may not accurately reflect the intra‐oral occlusal condition. If the intra‐oral condition is reproduced using dental casts, these findings also suggest the occlusal impression method was more accurate compared to the conventional method (240 words).     

Influence of the thickness of silicone registration material as a means for occlusal contact examination – an explorative study with different tooth clenching intensities

This study explored the influence of the thickness of silicone registration material on evaluation of the occlusal contact area and number of occlusal contact points, during increasing tooth clenching conditions in normal subjects. Twenty‐four subjects with no more than one missing tooth per quadrant participated. Surface electro‐myography was recorded from the masseter muscle. As a baseline measurement, intercuspal position was maintained with minimal force, and occlusal contact was recorded using blue silicone material. Occlusal contact was also recorded at 20% maximum voluntary contraction (MVC) and 40% MVC using visual feedback. The occlusal contact area and number of occlusal contact points were analysed using five levels of thickness of silicone registration material: Level 1 (0–149 μm); Level 2 (0–89 μm); Level 3 (0–49 μm); Level 4 (0–29 μm); and Level 5 (0–4 μm). The anterior part and the left and right posterior regions of the dental arch were analysed separately. At all detection levels, the occlusal contact area significantly increased from baseline to 20% MVC and to 40% MVC in the molar area (P < 0·05). In the anterior part, the occlusal contact area significantly increased from baseline to 20% MVC and to 40% MVC only when using Level 5. The number of occlusal contact points significantly increased from baseline to 20% MVC and to 40% MVC only when using Level 5 in the molar area (P < 0·05). It suggested that occlusal contacts may be different at low tooth clenching intensity with potential effects on the teeth or periodontal tissues.     

Association between near occlusal contact areas and mixing ability

This study investigated the relationship between occlusal contact and near contact areas defined by clenching intensity using electromyograms (EMGs) and mixing ability assessed with colour‐changeable chewing gum. Participants comprised 44 dentate adults (24 men, 20 women) with a mean age of 28·2 ± 6·8 years. Silicone material was used to measure the occlusal contact and near contact areas (the area of each type of tooth, the total area of the first molar and second molar, the second premolar to the second molar and the first premolar to the second molar) defined by clenching intensity at 10% maximum voluntary contraction (MVC). Colour‐changeable chewing gum was used to assess mixing ability. A colorimeter was used to measure colour changes, and the calculated colour difference (ΔE) was used as a measure of mixing ability. Correlation analysis of ΔE and occlusal contact and near contact areas revealed a significant positive correlation of 0·47 at 0–160 μm thicknesses of the silicone registration material of the second molar (P < 0·01). The near contact area with a thickness up to 200 μm was correlated with mixing ability, with the correlation strengthening as the interocclusal distance increased up to 160 μm. Notably, occlusal contact and near contact areas of the second molar were strongly correlated with mixing ability in dentate adults.     

Determination of daytime clenching events in subjects with and without self‐reported clenching

To confirm the validity of self‐awareness of daytime clenching, specific electromyogram (EMG) characteristics of clenching behaviour were determined using surface EMG recordings. Temporal muscle EMGs were recorded for 5 h in 13 subjects with self‐reported clenching (clenching group: 27·5 ± 3·8 years old) and 12 subjects without self‐reported clenching (control group: 28·6 ± 7·1 years old). All EMG data were recorded and stored on a portable EMG apparatus. The device was similar in size to a hearing aid, and suitable to record daytime EMG without restriction of daily activities. A clenching event was defined as muscle activity exceeding 10% of the maximum voluntary contraction. Furthermore, simultaneous voice recording was also performed to identify the corresponding EMG event as functional or parafunctional. The mean number of clenching events was 192·8 ± 228·8 and 24·8 ± 26·5 in the clenching and the control groups, respectively (P < 0·05, Mann–Whitney U‐test); the number of functional events was not significantly different between the groups. Because there was a significant difference in the number of clenching events between the groups, self‐reported daytime clenching is considered to be a reliable screening parameter for awake bruxism.     

Occlusal‐supporting ability of individual maxillary and mandibular teeth

This study aimed to analyse occlusal force, area and pressure for individual maxillary and mandibular teeth by assessing their occlusal‐supporting abilities. Ninety‐nine subjects (49 men and 50 women; average age, 24·7 ± 3·4 years; range, 20–37 years) performed maximal voluntary clenching twice for 3 s in both the intercuspal position and the intercuspal position with sliding movement from edge‐to‐edge occlusion, with a pressure‐sensitive sheet placed between the maxillary and mandibular dental arch. Occlusal force, area and pressure of individual teeth were calculated by colour development in the pressure‐sensitive sheet with special analytical equipment and software. Occlusal contact condition of individual teeth was confirmed using the intra‐occlusal record. All data were analysed using unpaired Student's t‐test, Kruskal–Wallis test and Scheffe's test for multiple comparisons with a significance level of P < 0·05. The occlusal pressure in the intercuspal position with sliding movement from edge‐to‐edge occlusion was adopted as the representative occlusal‐supporting ability for each individual tooth, although there were, in part, statistically significant differences in the effects of laterality, performance and gender. Overall, the occlusal pressure increased gradually from the central incisor, peaked at the canine or first premolar and decreased sharply–and significantly (P < 0·01)–towards the second molar. We conclude that the occlusal pressure of individual teeth can be used as an indicator of occlusal‐supporting ability. This is therefore proposed as a possible suitable parameter for epidemiologic research, specifically for verifying the relationship between occlusal‐supporting ability and status of residual periodontal ligament support.     

Development of a speech‐discriminating electromyogram system for routine ambulatory recordings for the low‐level masseter muscle activity

Previous work suggests a relationship between sustained low‐level tooth clenching and the aetiology of myogenous temporomandibular disorder (TMD) pain. This study aimed to establish a reliable system with which to evaluate low‐level electromyographic (EMG) activity related to low‐level tooth clenching while discriminating speech activity, which is one of the most common facial muscle activities to be discriminated from low‐level clenching. This device should facilitate the clinical evaluation of awake muscle activity in TMD patients. Eight female and eight male subjects (38·9 ± 11·3 years) participated in the study to evaluate the validity of estimation of speech duration. Actual speech duration was defined by one examiner by pointing out the timing of beginning and end point of each speech on wave‐editing software. Speech duration, as detected by a voice sensor system, which was activated by a voice loudness of 54·71 ± 5·00 dB, was significantly correlated with the above actual speech duration (P < 0·01, R² = 0·9935). An actual recording with the system was carried out in one TMD patient and one healthy volunteer and revealed that the duration of diurnal EMG activity higher than 5% MVC was 1649·16 s and 95·99 s, respectively. As the voice sensor system adopted in this study could define the exact onset and offset of each segment of speech, EMG activity during speech could be precisely discriminated. The results of this study demonstrate that the EMG system with voice sensor system would be an effective tool for the evaluation of low‐level masticatory muscle activity.     

Clinical course of masticatory function recovery following arthrocentesis in patients with unilateral mandibular condyle head fracture

The aim of this study was to investigate the clinical course of masticatory function recovery following arthrocentesis. Patients with a unilateral condylar head fracture who underwent arthrocentesis for therapeutic reasons were evaluated and compared with patients with a unilateral condylar head fracture who did not undergo arthrocentesis. At 3 months after treatment, the occlusal contact area and maximum bite force in patients with a fracture treated with arthrocentesis were greater than in those who did not receive arthrocentesis at the same time points, although the differences were not significant. Moreover, at 1 and 3 months following arthrocentesis, mean (±SD) occlusal contact area (1 month: 1.99 ± 0.55 mm², p = 0.01; 3 months: 2.90 ± 1.36 mm², p = 0.03) and maximum bite force (1 month: 82.45 ± 15.04 N, p = 0.01; 3 months: 101.11 ± 14.53 N, p = 0.01) on the fractured side in patients who underwent that treatment were significantly reduced when compared with those on the non-fractured side. The authors conclude that if the priority is to avoid open reduction and internal fixation, then the arthrocentesis approach might be a less invasive alternative, albeit with the price of a prolonged healing interval.     

Stable tooth contacts in intercuspal occlusion makes for utilities of the jaw elevators during maximal voluntary clenching

Data are inconsistent concerning whether the level of the surface electromyographic (SEMG) activity of jaw‐closing muscles increases when biting forces elevated during maximal voluntary clenching (MVC). In this study, T‐Scan III system and BioEMG III system were used to record bite force, occlusal contacts and SEMG activity of the anterior temporalis (TA) and of the masseter muscles (MM) simultaneously. Recordings were obtained from 16 healthy young adult males during different conditions: (i) a fast MVC from resting position to intercuspal position (ICP); (ii) mandibular movements from ICP to protrusive or lateral edge‐to‐edge positions with teeth in contact with biting; (iii) a fast MVC in protrusive and lateral edge‐to‐edge positions. A higher level of SEMG activity was associated with a higher bite force during occluding movements (P < 0·05). However, during fast MVC from rest to ICP, the largest number of occlusal contacts was achieved and distributed more symmetrically, the highest level of biting force was obtained, but the SEMG activity of the jaw elevator muscles was reduced compared with its maximum level (P < 0·05). This phenomenon was not observed during the fast MVC in protrusive or lateral edge‐to‐edge positions. The present results that a lower SEMG activity was associated with the largest number of occlusal contacts and the highest level of bite force during centric MVC demonstrated a complex integration of jaw‐closing muscles when a stable occlusion is present.     

Effects of interocclusal distance on bite force and masseter EMG in healthy participants

The aim of this study was to investigate effects of interocclusal distance (IOD) on bite force and masseter electromyographic (EMG) activity during different isometric contraction tasks. Thirty‐one healthy participants (14 women and 17 men, 21·2 ± 1·8 years) were recruited. Maximal Voluntary Occlusal Bite Force (MVOBF) between the first molars and masseter EMG activity during all the isometric‐biting tasks were measured. The participants were asked to bite at submaximal levels of 20%, 40%, 60% and 80% MVOBF with the use of visual feedback. The thickness of the force transducer was set at 8, 12, 16 and 20 mm (= IOD), and sides were tested in random sequence. MVOBF was significantly higher at 8 mm compared with all other IODs (P < 0·001). Only in women, IOD always had significant influence on the corresponding root‐mean‐square (RMS) value of EMG (P < 0·011). When biting was performed on the ipsilateral side to the dominant hand, the working side consistently showed higher masseter EMG activity compared with the balancing side (P < 0·020). On the contralateral side, there was no difference between the masseter EMG at any IODs. The results replicated the finding that higher occlusal forces can be generated between the first molars at shorter IODs. The new finding in this study was that an effect of hand dominance could be found on masseter muscle activity during isometric biting. This may suggest that there can be a general dominant side effect on human jaw muscles possibly reflecting differences in motor unit recruitment strategies.     

Analysis of brain and muscle activity during low‐level tooth clenching – a feasibility study with a novel biting device

In electromyographic (EMG) and functional magnetic resonance imaging (fMRI) studies, muscle and brain activity was compared during low levels of tooth clenching using a novel biting device to control bite force. A total of 21 healthy subjects performed motor tasks, comprising tooth clenching at 5, 10 and 20 N. During all measurements, subjects kept the novel bite device between the anterior teeth during tooth clenching. The EMG study (n = 15) characterised jaw muscle activity for the three motor tasks and demonstrated significant differences in root mean square (RMS) EMG amplitude between 5‐, 10‐ and 20‐N tooth clenching (F = 46·21, P < 0·001). There were no differences in variability of muscle activity between the three tooth‐clenching levels. In an fMRI pilot study (n = 6), statistical comparisons were used to identify brain regions with significant activation in the subtraction of baseline from 5‐ or 20‐N tooth‐clenching activity. 5‐ and 20‐N tooth clenching significantly and bilaterally activated the sensorimotor cortex, supplementary motor area, cerebellum and basal ganglia (P < 0·05, corrected for multiple comparisons). However, activation of each brain region did not differ significantly between two tooth‐clenching tasks. Based on these preliminary findings, we propose that the novel biting device may be useful in further fMRI studies on controlled jaw muscle activation patterns in different craniofacial pain conditions. In addition, our fMRI result suggests that there are no significant differences in brain activity within low levels of tooth clenching with controlled force.     

Daily chewing gum exercise for stabilizing the vertical occlusion

Summary We investigated the effects of a chewing gum exercise program on occlusal conditions and evaluated compliance of subjects. Thirty‐five healthy adult volunteers (26 males and nine females) were asked to chew gum for 10–15 min before or after three meals daily for four weeks. Occlusal conditions were recorded as occlusal parameters, such as occlusal contact area, occlusal contact force, and pressure using dental prescale films. These parameters were evaluated by an Occluzer before the exercise period commenced, after four weeks of exercise, and then one month after the end of the exercise period. These parameters were statistically compared using one‐way ANOVA. We found that: (i) after four weeks of exercise, anterior and posterior occlusal contact areas and forces were significantly (P < 0·05) increased and the increments were significantly (P < 0·05) higher in the anterior occlusal contact area and force than in the posterior occlusal contact area and force, (ii) the anteroposterior ratio of occlusal contact area and force increased, but not markedly, (iii) increased parameters had significantly (P < 0·05) decreased within one month after the end of the four‐week exercise period, (iv) most participants did not complain for discomfort or stress during the exercise. The chewing gum exercise program could increase occlusal contact area and force and also move the anteroposterior occlusal balance forward. Patient compliance with the exercise is likely high enough to keep them exercising.     

Influence of Different Centric Functions on Electromyographic Activity of Elevator Muscles

This study compares eight different occlusal centric functions with splint contact on different teeth in order to determine their influence on mandibular elevator electromyographic (EMG) activity.

Maxillary occlusal splints were built for eight subjects without craniomandibular dysfunction. Investigators divided each splint into three parts, in order to record different occlusal schemes in the same subject without varying the vertical dimension. EMG activity in the left masseter and anterior temporal muscles was registered during maximum voluntary clenching.

Results showed higher masseter activity with the splint than without, and anterior temporal activity was similar. There was a significant decrease of EMG activity with the anterior section of the splint. There were no significant differences between the remaining centric functions and clenching with the complete splint, except for the centric function with contralateral posterior contact, in which elevator activity was significantly reduced.

Results suggest that bilateral posterior occlusal stabilization is critical for maximum interocclusal force.     

The effect of experimental balancing interferences on masticatory performance

Immediate adaptation to experimental‐balancing interferences is known to affect jaw kinematics and electromyographic activity (EMG). However, little is known about the influence on masticatory performance parameters. This study hypothesises that balancing‐side interferences significantly reduce the performance of the masticatory system. Twenty‐one healthy subjects (eleven female, mean age: 24·1 ± 1·2 years) chewed standardised silicone cubes performing 15 masticatory cycles on the right side under three experimental conditions: (i) natural dentition (ND), (ii) splints with structured occlusal profiles (SS) (iii) splints with balancing interferences in the left molar region (OI). The particle size distribution was determined by a validated scanning procedure and curve fitted with the Rosin–Rammler function to determine X₅₀‐values. The EMG of both temporalis and masseter muscles was recorded simultaneously, and the total muscle work (TMW) was calculated. A jaw‐tracking device recorded the incisal movement path (IMP). The functional parameters under the experimental conditions were compared by repeated‐measures analysis of variance. The findings confirm our hypothesis. The X₅₀‐values differed significantly (P < 0·01) between ND and OI (4·34 vs. 4·60 mm), and between SS and OI (4·34 vs. 4·60 mm), respectively. In contrast, no significant differences (P > 0·05) were observed between SS and ND. There was no significant difference in both TMW (1269·0 vs. 1284·9 vs. 1193·9 μV*s) and IMP (720·2 vs. 735·3 vs. 723·1 mm) amongst the three conditions (P > 0·05). These findings confirm the assumption that the disturbance of the habitual chewing cycles by balancing‐side interferences significantly reduces the masticatory performance in the short term. Occlusal balancing‐side interferences are common technical failures of dental restorations. Simulation of this condition caused deterioration of masticatory performance in healthy young adults. Further studies should be carried out, on whether the observed effect is long‐term and whether masticatory performance decreases even more in patients with reduced adaptive capacity.     

Correlation between periodontal status and biting force in patients with chronic periodontitis during the maintenance phase of therapy

Aim: The association between periodontal status and biting force is unclear. The aim of this study was to investigate the relation between periodontal status and biting force in patients with chronic periodontitis during the maintenance phase of periodontal treatment. Material and Methods: A total of 198 patients, who had entered a periodontal maintenance programme, were examined for the presence of restorations on the occlusal surface, probing pocket depth, clinical attachment loss (CAL), bleeding on probing, and mobility of teeth. Quantitative analysis of total biting force, occlusal contact area and biting pressure (defined by biting force per 1 mm² of occlusal contact area) was performed using microcapsular pressure‐sensitive sheets. Results: A multiple stepwise regression analysis showed that total biting force and occlusal contact area were positively associated with the number of present teeth and negatively associated with female gender, mean CAL and mean probing pocket depth. Biting pressure was positively associated with CAL. Conclusions: Reduced periodontal support was found to be associated with decreased total biting force and with increased biting pressure (defined as force per 1 mm² of occlusal contact area).     

Computerised occlusal analysis of mini-dental implant-retained mandibular overdentures: A 1-year prospective clinical study

Occlusal analysis is a substantial tool for the functional improvement evaluation after using implant-retained overdenture comparing to complete denture without dental implant retaining. To evaluate occlusal pattern, chewing force distribution in mini-dental implant-retained mandibular overdentures by computerised occlusal analysis system and to compare patient satisfaction after 1-year function. Thirty-one patients wearing complete dentures were included in the study. Prior to mini-dental implant-retained treatment, all patients were assessed for occlusion and force distribution using computerised occlusal analysis system (T-Scan^®), and then, all patients received two mini-dental implant-retained mandibular overdentures. Mini-dental implants were immediately loaded using low vertical profile attachments (Equator^®). T-Scan^® was used to evaluate chewing force and force distribution at 1 day, 3 months, 6 months and 12 months. The patient satisfactions before implant placement and after 1 year were evaluated using questionnaires which included satisfaction of denture quality, psychosocial behaviour and chewing efficiency modified from the validated questionnaires. Clinical evaluation of two mini-dental implant-retained mandibular overdentures showed 100% success rate after 1 year. T-Scan^® demonstrated that maximum occlusal contact force increased continuously. The force distribution; the tooth contact number increased over the period. At 1-year follow-up, overall patient satisfaction was significantly greater than before receiving mini-dental implant treatment (P < .001). Using computerised occlusal analysis, mini-dental implants improve complete denture function significantly in terms of maximum occlusal contact force, tooth contact number without the impairment of force distribution. The oral function of the patients has been enhanced.     

The influence of altered occlusal guidance on condylar displacement

This study investigated mandibular displacement and masticatory muscle activity during clenching in lateral occlusal position in relation to the lateral occlusal pattern. Twenty healthy human subjects (mean = 26.5 years) volunteered for this study. Metallic occlusal overlays were fabricated for the lower working side canine to second molar and non-working side second molar in order to simulate a canine protected occlusion, group function occlusion and bilateral balanced occlusion (balancing contact). Three-dimensional displacements of the bilateral condyle and electromyography (EMG) activities in the bilateral masseter, anterior and posterior temporalis were recorded during maximal clenching. The experimental occlusal pattern was revealed to have statistically significant effects on both condylar displacement and EMG activity (P < 0.001 and P < 0.001, respectively). When compared to the simulated group function occlusion, the simulated canine protected occlusion and balancing contact caused statistically significant smaller superior displacements of the non-working side condyle, which suggests that they may result in reduced temporomandibular joint (TMJ) loading. Furthermore, the simulated canine protected occlusion was associated with the lowest EMG activity, which suggests that this occlusal pattern has the capacity to reduce the level of parafunctional activity.     

Electromyogram biofeedback training for daytime clenching and its effect on sleep bruxism

Bruxism contributes to the development of temporomandibular disorders as well as causes dental problems. Although it is an important issue in clinical dentistry, no treatment approaches have been proven effective. This study aimed to use electromyogram (EMG) biofeedback (BF) training to improve awake bruxism (AB) and examine its effect on sleep bruxism (SB). Twelve male participants (mean age, 26·8 ± 2·5 years) with subjective symptoms of AB or a diagnosis of SB were randomly divided into BF (n = 7) and control (CO, n = 5) groups to undergo 5‐h daytime and night‐time EMG measurements for three consecutive weeks. EMG electrodes were placed over the temporalis muscle on the habitual masticatory side. Those in the BF group underwent BF training to remind them of the occurrence of undesirable clenching activity when excessive EMG activity of certain burst duration was generated in week 2. Then, EMGs were recorded at week 3 as the post‐BF test. Those in the CO group underwent EMG measurement without any EMG BF training throughout the study period. Although the number of tonic EMG events did not show statistically significant differences among weeks 1–3 in the CO group, events in weeks 2 and 3 decreased significantly compared with those in week 1, both daytime and night‐time, in the BF group (P < 0·05, Scheffé's test). This study results suggest that EMG BF to improve AB tonic EMG events can also provide an effective approach to regulate SB tonic EMG events.     

Natural mediotrusive contact: does it affect the masticatory and neck EMG activity during tooth grinding?

Objectives: There is scarce knowledge regarding the influence of a natural mediotrusive contact on mandibular and cervical muscular activity. The purpose of this study was to analyze the EMG activity of the anterior temporalis (AT) and sternocleidomastoid (SCM) muscles during awake grinding in healthy subjects with or without a natural mediotrusive occlusal contact.

Method: Fifteen subjects with natural mediotrusive occlusal contact (Group 1) and 15 subjects without natural mediotrusive occlusal contact (Group 2) participated. Bilateral surface EMG activity of AT and SCM muscles was recorded during unilateral eccentric or concentric tooth grinding tasks. EMG activity was normalized against the activity recorded during maximal voluntary clenching in intercuspal position (IP) for AT muscles and during maximal intentional isometric head-neck rotation to each side, for SCM muscles.

Results: EMG activity of AT and SCM muscles showed no statistical difference between groups. EMG activity of AT muscle was higher in the working side (WS) than in the non-WS (NWS) in Group 1 during concentric grinding (0.492 vs 0.331, p?=?0.047), whereas no difference was observed in Group 2. EMG activity of SCM was similar between working and NWSs in both groups and tasks. Asymmetry indexes (AIs) were not significantly different between groups.

Discussion: These findings in healthy subjects support the assumption that during awake tooth grinding, central nerve control predominates over peripheral inputs, and reinforce the idea of a functional link between the motor-neuron pools that control jaw and neck muscles.     

Relationship between occlusal tooth contact patterns and tightness of proximal tooth contact

summary   The aim of this study was to investigate the relationship between occlusal tooth contact patterns and the tightness of proximal tooth contact (TPTC) during clenching. Twenty young adult volunteers with healthy dentition participated in the study. TPTC between the left second premolar (P2) and the first molar (M1) was measured during clenching at the 50% maximum voluntary contraction level in the intercuspal position (ICP). A silicone impression material was used to make an interocclusal record at the ICP in each subject, and interocclusal records were analysed using an image-processing system. Subjects were classified according to the presence or absence of each type (A, B or C) of occlusal contact. Statistical analysis was performed using the Mann–Whitney U -test. The results of this study exhibited a relationship between B-type contact and the TPTC of maxillary teeth. The experimental group with a lack of B-type contact on maxillary P2 and/or M1 showed a statistically greater TPTC than the group with B-type contact on both of these teeth ( P  < 0·01). These results suggest that occlusal tooth contact patterns have an influence on TPTC during clenching.     

Electromyographic assessment of jaw muscles in patients with All‐on‐Four fixed implant‐supported prostheses

This study evaluated the electromyographic (EMG) characteristics of masticatory muscles in patients with fixed implant‐supported prostheses according to All‐on‐Four^® principles and in control healthy dentate subjects. Twenty‐six subjects aged 50–74 years were examined. Eighteen were edentulous and had been successfully rehabilitated with (i) mandibular All‐on‐Four^® implant‐supported fixed prostheses and maxillary complete dentures (10 patients) and (ii) mandibular and maxillary All‐on‐Four^® implant‐supported fixed prostheses (eight patients). Eight reference subjects had natural dentition. Surface EMG recordings of the masseter and temporalis muscles were performed during maximum voluntary teeth clenching and during unilateral gum chewing. All values were standardised as percentage of a maximum clenching on cotton rolls. During clenching, a good global neuromuscular equilibrium was found in all participants. During chewing, all groups had similar values of working‐side muscle activities and of chewing frequency. No significant differences in the analysed EMG parameters were found between the patients with mandibular and maxillary All‐on‐Four^® implant‐supported prostheses and the reference subjects. In contrast, standardised pooled muscle activities and standardised muscular activities per cycle were larger in patients with a maxillary removable prosthesis than in control subjects (Kruskal–Wallis test, P < 0·01). Also, patients wearing a complete maxillary denture showed a poor neuromuscular coordination with altered muscular pattern and lower values of the index of masticatory symmetry than dentate control subjects (P < 0·01). EMG outcomes suggest that All‐on‐Four^® implant‐supported prostheses may be considered a functionally efficient treatment option for the rehabilitation of edentulous patients with reduced residual bone volume.