title: A prospective cross-over study to evaluate the effect of two different occlusal concepts on the masseter muscle activity in implant-retained mandibular overdentures.
abstract: BACKGROUND
  The purpose of this prospective cross-over study is to evaluate the effect of bilateral balanced occlusion and canine guidance occlusion on the masseter muscle activity using implant-retained mandibular overdentures.
  
  
  METHODS
  After evaluation of 12 completely edentulous patients using cone beam computed tomography (CBCT), mucoperiosteal flaps were reflected exposing the mandibular interforaminal region. Two implants were placed in the interforaminal region for each of the 12 patients. After a healing period of 3 months, acrylic maxillary complete dentures and mandibular overdentures were fabricated with bilateral balanced occlusion for 6 patients and canine guidance occlusion for the other 6 patients. Electromyographic evaluation of the masseter muscles, during clenching on a silicon index and chewing peanuts and cake, was conducted on the patients after using their dentures for 4 weeks. Each occlusion concept was then converted into the other concept using the same dentures, and the procedure of evaluation was repeated after 4 weeks. The recordings were analyzed statistically using Wilcoxon signed ranks test. p < 0.05 was considered statistically significant.
  
  
  RESULTS
  The highest electromyographic activity of the masseter muscles was recorded during clenching on a preformed silicon index followed by chewing peanut then cake for both occlusal concepts. The recordings of the masseter muscle associated with canine guidance occlusion were higher than bilateral balanced occlusion but with no statistically significant difference except between the right masseter muscles during clenching (p = 0.042*).
  
  
  CONCLUSIONS
  Both bilateral balanced occlusion and canine guidance occlusion can be used successfully in implant-retained mandibular overdentures without affecting masseter muscle activity.
authors.affiliation: Prosthodontics Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abdelhamid
authors.affiliation: Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt. kendahanno@gmail.com.
authors.forename: Kenda I
authors.initials: KI
authors.lastname: Hanno
authors.affiliation: Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Imam
keywords: Balanced occlusion; Canine guidance; Electromyography; Implant-retained overdentures; Muscle activity