{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T19:33:33Z","timestamp":1785440013332,"version":"3.56.0"},"reference-count":28,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T00:00:00Z","timestamp":1613692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and objectives: The aim of this study is to evaluate mandibular elevator muscles activity and pain on palpation in the early stages of orthodontic treatment with clear aligners using surface electromyography (sEMG). Materials and methods: Surface electromyography (sEMG) activity and pain level on muscle palpation of masseter and anterior temporalis muscles were recorded in a sample of 16 adult subjects (aged 18\u201332 years; mean 22.5 +\/\u2212 3.5 SD) undergoing orthodontic treatment with clear aligners before the treatment (T0), after 1 month of treatment (two clear aligners) (T1), and after 3 months of treatment (T2) (six clear aligners). A chi-square test for nominal data, a Friedman test, and a Wilcoxon-signed rank test as post hoc analysis were applied. Results: No statistically significant differences in muscular pain were observed. At T1, the sEMG activity of masseter muscles at mandibular rest position showed a statistically significant reduction, but after 3 months (T2), the data appeared similar to T0 (p = 0.03 and p = 0.02). Conclusions: During the treatment with clear aligners, subjects could experience an initial reduction in the masseter basal activity after 1 month of treatment. This effect tends to decrease to baseline levels after 3 months of therapy.<\/jats:p>","DOI":"10.3390\/medicina57020178","type":"journal-article","created":{"date-parts":[[2021,2,19]],"date-time":"2021-02-19T09:06:10Z","timestamp":1613725570000},"page":"178","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Short-Term Effect of Orthodontic Treatment with Clear Aligners on Pain and sEMG Activity of Masticatory Muscles"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3651-1251","authenticated-orcid":false,"given":"Alessandro","family":"Nota","sequence":"first","affiliation":[{"name":"Dental School, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Caruso","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Science, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shideh","family":"Ehsani","sequence":"additional","affiliation":[{"name":"Dental School, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1723-106X","authenticated-orcid":false,"given":"Gianmaria Fabrizio","family":"Ferrazzano","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Reproductive and Oral Science, School of Paediatric Dentistry, University of Naples \u201cFederico II\u201d, 34012 Naples, Italy"},{"name":"Unesco Chair in Health Education and Sustainable Development, University of Naples \u201cFederico II\u201d, 34012 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Gatto","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Science, University of L\u2019Aquila, 67100 L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2986-1114","authenticated-orcid":false,"given":"Simona","family":"Tecco","sequence":"additional","affiliation":[{"name":"Dental School, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, 20132 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/ocr.12177","article-title":"Efficiency, effectiveness and treatment stability of clear aligners: A systematic review and meta-analysis","volume":"20","author":"Zheng","year":"2017","journal-title":"Orthod. Craniofacial Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"302.e1","DOI":"10.1016\/j.ajodo.2006.05.031","article-title":"A comparison of treatment impacts between Invisalign aligner and fixed appliance therapy during the first week of treatment","volume":"131","author":"Miller","year":"2007","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12903-019-0880-8","article-title":"Impact of molar teeth distalization with clear aligners on occlusal vertical dimension: A retrospective study","volume":"19","author":"Caruso","year":"2019","journal-title":"BMC Oral Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Caruso, S., Darvizeh, A., Zema, S., Gatto, R., and Nota, A. (2020). Management of a Facilitated Aesthetic Orthodontic Treatment with Clear Aligners and Minimally Invasive Corticotomy. Dent. J., 8.","DOI":"10.3390\/dj8010019"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/cre2.261","article-title":"Salivary concentrations of Streptococcus mutans and Lactobacilli during an orthodontic treatment. An observational study comparing fixed and removable orthodontic appliances","volume":"6","author":"Mummolo","year":"2019","journal-title":"Clin. Exp. Dent. Res."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Mummolo, S., Nota, A., Albani, F., Marchetti, E., Gatto, R., Marzo, G., Quinzi, V., and Tecco, S. (2020). Salivary levels of Streptococcus mutans and Lactobacilli and other salivary indices in patients wearing clear aligners versus fixed orthodontic appliances: An observational study. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0228798"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"404","DOI":"10.4103\/1305-7456.163218","article-title":"Periodontal health status in patients treated with the Invisalign\u00ae system and fixed orthodontic appliances: A 3 months clinical and microbiological evaluation","volume":"9","author":"Levrini","year":"2015","journal-title":"Eur. J. Dent."},{"key":"ref_8","first-page":"367","article-title":"Clinical evaluation of salivary indices and levels of Streptococcus mutans and Lactobacillus in patients treated with Occlus-o-Guide","volume":"15","author":"Mummolo","year":"2014","journal-title":"Eur. J. Paediatr Dent."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"374","DOI":"10.3357\/AMHP.4115.2015","article-title":"Infrared Thermographic Analysis of Craniofacial Muscles in Military Pilots Affected by Bruxism","volume":"86","author":"Baldini","year":"2015","journal-title":"Aerosp. Med. Hum. Perform."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1111\/j.1365-2842.2007.01788.x","article-title":"An electromyographic evaluation of bilateral symmetry of masticatory, neck and trunk muscles activity in patients wearing a positioner","volume":"35","author":"Tecco","year":"2008","journal-title":"J. Oral Rehabil."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1093\/ejo\/cjn052","article-title":"Surface electromyographic patterns of masticatory, neck, and trunk muscles in temporomandibular joint dysfunction patients undergoing anterior repositioning splint therapy","volume":"30","author":"Tecco","year":"2008","journal-title":"Eur. J. Orthod."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1016\/j.jelekin.2011.08.004","article-title":"sEMG activity of masticatory, neck, and trunk muscles during the treatment of scoliosis with functional braces. A longitudinal controlled study","volume":"21","author":"Tecco","year":"2011","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1179\/crn.2012.007","article-title":"The Prognosis of Myofascial Pain Syndrome (MPS) During a Fixed Orthodontic Treatment","volume":"30","author":"Tecco","year":"2012","journal-title":"CRANIO\u00ae"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2270","DOI":"10.3760\/cma.j.issn.0366-6999.20130613","article-title":"Effect of occlusal splints for the management of patients with myofascial pain: A randomized, controlled, double-blind study","volume":"126","author":"Zhang","year":"2013","journal-title":"Chin. Med J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4517042","DOI":"10.1155\/2018\/4517042","article-title":"Pain of Temporomandibular Disorders: From Etiology to Management","volume":"2018","author":"Wieckiewicz","year":"2018","journal-title":"Pain Res. Manag."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"354759","DOI":"10.1155\/2015\/354759","article-title":"Temporomandibular Disorders and Oral Parafunctions: Mechanism, Diagnostics, and Therapy","volume":"2015","author":"Boening","year":"2015","journal-title":"BioMed Res. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"416","DOI":"10.12659\/MSM.883927","article-title":"Surface electromyography in orthodontics\u2014A literature review","volume":"19","author":"Mehr","year":"2013","journal-title":"Med Sci. Monit."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"246","DOI":"10.12659\/MSM.893111","article-title":"Impact of Functional Appliances on Muscle Activity: A Surface Electromyography Study in Children","volume":"21","author":"Wozniak","year":"2015","journal-title":"Med. Sci. Monit."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.jelekin.2011.03.005","article-title":"Effects of interceptive orthodontics on orbicular muscle activity: A surface electromyographic study in children","volume":"21","author":"Saccucci","year":"2011","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e25","DOI":"10.1016\/j.ajodo.2020.08.012","article-title":"Evaluation of masticatory muscle response to clear aligner therapy using ambulatory electromyographic recording","volume":"159","author":"Lou","year":"2021","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_21","first-page":"15","article-title":"Invisalign in TMD treatment","volume":"20","author":"Miller","year":"2009","journal-title":"Int. J. Orthod."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1016\/j.jelekin.2015.04.003","article-title":"Frenulectomy of the tongue and the influence of rehabilitation exercises on the sEMG activity of masticatory muscles","volume":"25","author":"Tecco","year":"2015","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1111\/joor.13088","article-title":"Impact of clear aligner therapy on tooth pain and masticatory muscle soreness","volume":"47","author":"Tran","year":"2020","journal-title":"J. Oral Rehabil."},{"key":"ref_24","first-page":"1","article-title":"The chewing apparatus. An electromyographic study of the action of the muscles of mastication and its correlation to facial morphology","volume":"280","author":"Moller","year":"1966","journal-title":"Acta Physiol. Scand. Suppl."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Mummolo, S., Nota, A., Tecco, S., Caruso, S., Marchetti, E., Marzo, G., and Cutilli, T. (2018). Ultra-low-frequency transcutaneous electric nerve stimulation (ULF-TENS) in subjects with craniofacial pain: A retrospective study. CRANIO\u00ae, 6.","DOI":"10.1080\/08869634.2018.1526849"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.jelekin.2014.08.007","article-title":"The association between Occlusion Time and Temporomandibular Disorders","volume":"25","author":"Baldini","year":"2015","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.oooo.2011.10.039","article-title":"Occlusal risk factors associated with temporomandibular disorders in young adults with normal occlusions","volume":"114","author":"Wang","year":"2012","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/j.1600-0722.1980.tb00722.x","article-title":"Distortion of maximal elevator activity by unilateral premature tooth contact","volume":"88","author":"Bakke","year":"1980","journal-title":"Eur. J. Oral Sci."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/2\/178\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:26:13Z","timestamp":1760160373000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/2\/178"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,19]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["medicina57020178"],"URL":"https:\/\/doi.org\/10.3390\/medicina57020178","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,19]]}}}