Mandibular Jaw Movement and Masticatory Muscle Activity during Dynamic Trunk Exercise.

The examination of jaw movement during exercise is essential for an improved understanding of jaw function. Currently, there is no unified view of the mechanism by which the mandible is fixed during physical exercise. We hypothesized that during strong skeletal muscle force exertion in dynamic exercises, the mandible is displaced to a position other than the maximal intercuspal position and that mouth-opening and mouth-closing muscles simultaneously contract to fix the displaced mandible. Therefore, we simultaneously recorded mandibular jaw movements and masticatory muscle activities during dynamic trunk muscle force exertion (deadlift exercise) in 24 healthy adult males (age, 27.3 ± 2.58 years). The deadlift was divided into three steps: Ready (reference), Pull, and Down. During Pull, the mandibular incisal point moved significantly posteriorly (-0.24 mm, p = 0.023) and inferiorly (-0.55 mm, p = 0.019) from the maximal intercuspal position. Additionally, temporal, masseter, and digastric muscles were activated simultaneously and significantly during Pull (18.63 ± 17.13%, 21.21 ± 18.73%, 21.82 ± 19.97% of the maximum voluntary contraction, respectively), with maintained activities during Down (p < 0.001). Thus, during dynamic trunk muscle force exertion, the mandibular incisal point moved to a posteroinferior position without tooth-touch (an open-mouth position). Simultaneously, the activities of the mouth-opening digastric muscles and the mouth-closing temporal and masseter muscles led to mandibular fixation, which is a type of mandible fixing called bracing.

Mechanical sensitivity and psychological factors in patients with burning mouth syndrome.

OBJECTIVES: The aim of this study was to compare mechanical sensitivity on the tongue using quantitative sensory testing (QST) and psychological factors using the General Health Questionnaire (GHQ) between burning mouth syndrome (BMS) patients and healthy participants. MATERIALS AND METHODS: Participants comprised 20 female BMS patients (68.1 ± 7.4 years) and 20 healthy females (65.4 ± 4.6 years). Psychological factors were evaluated with GHQ. Tactile detection thresholds (TDT) and filament-prick pain detection thresholds (FPT) were used to evaluate mechanical sensitivity on the tongue in all participants. TDT and FPT were measured on the tongue within both the painful area and the non-painful area in BMS patients, and on the tongue on both sides in healthy participants. As controls, TDT and FPT were measured with Semmes-Weinstein monofilaments on the skin of the mentum and palm in all participants. RESULTS: GHQ scores were significantly higher in BMS patients than in healthy participants (P = 0.024). No significant differences in TDT or FPT on the tongue, mentum, or palm were seen between BMS patients and healthy participants (P > 0.05). BMS patients showed no significant differences in TDT or FPT between the painful and non-painful areas on the tongue (P > 0.05). There were no significant correlations among TDT/FPT and GHQ score in BMS patients (P > 0.05). CONCLUSIONS: These findings could indicate a more important role for psychological factors than mechanical sensitivity in BMS pathophysiology. CLINICAL RELEVANCE: Pain on the tongue in elderly female patients with BMS may be more related to psychological factors.

Referred Pain and Sensations Evoked by Standardized Palpation of the Masseter Muscle in Healthy Participants.

AIMS: To determine if standardized palpation of the masseter muscle can evoke referred pain and/or sensations in healthy individuals and to compare the mechanical sensitivities in response to three different levels of palpation force. METHODS: A total of 32 pain-free individuals participated. The right masseter muscle was divided into 15 test sites. Mechanical sensitivity of the masseter was assessed with three mechanical stimuli (0.5 kg, 1.0 kg, or 2.0 kg) applied by palpometers to the 15 test sites for 5 seconds each site. Participants scored the perceived intensity of pain and unpleasantness of each of the three mechanical stimuli on 0-100 numeric rating scales (NRS). After each stimulus, the duration of aftersensation was measured, and the participants were also asked to indicate areas within the orofacial region with referred pain/sensations. Data were tested using analysis of variance, Tukey post hoc, and McNemar's tests with a 5% level of significance. RESULTS: Referred pain/sensations were most commonly evoked with the 2.0-kg stimulus (34.4% of participants; P < .05) compared to the 1.0-kg (12.5%) and 0.5-kg stimuli (3.1%). There were significant effects of stimulus intensity on NRS scores for pain and unpleasantness, as well as for aftersensation (P < .05). There were significant effects on NRS scores for pain and unpleasantness for the 1.0- and 2.0-kg stimuli (P < .05) and on aftersensation for the 2.0-kg stimulus (P < .05). CONCLUSION: These results indicate that referred pain/sensations in the orofacial region are frequent phenomena among healthy individuals during standardized palpation of the masseter muscle.

Influences of differences in tray design and impression material on impression pressure at edentulous mandible.

The aim of this study was to examine the effects of tray design and impression material on impression pressure in a clinical simulation model of an edentulous mandible. Two types of polyvinylsiloxane elastomer, one type of polyether elastomer, and one type of alginate were used. The three tray types had no relief, 0.36 mm of relief, or 1.4 mm of relief, with or without escape holes. Impression pressure was measured at the median alveolar crest, the bilateral alveolar crests corresponding to molars, and the bilateral buccal shelves. Impression pressure significantly differed in relation to tray design and sensor position. In trays without escape holes, impression pressure was highest at the median alveolar crest and lowest at the buccal shelves, for all impression materials. However, impression material had no significant effects on impression pressure. Our results suggest that bite-pressure load on alveolar crests can be alleviated by making an impression with a tray that has relief and escape holes, while applying pressure to buccal shelves and almost no pressure to alveolar crests.

Comparing the occlusal contact area of individual teeth during low-level clenching.

The aim of this study was to investigate the occlusal contact area (OCA) in individual teeth during low-level tooth clenching in 24 healthy participants. Before measurements were made, the 100% maximum voluntary contraction (MVC) was determined. At baseline, all subjects were instructed to close their mouth and touch the opposing teeth with minimal force. Occlusal contact was recorded during three jaw motor tasks (baseline, 20% MVC, and 40% MVC) using a blue silicone material. OCA thickness was determined from images and defined on five levels: 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). Premolar and molar OCAs increased significantly from baseline to 20% MVC and 40% MVC. The OCA of each anterior tooth did not change significantly with increasing clenching intensity at all levels. Our findings suggest that premolar and molar OCAs may be altered by low-intensity clenching, affecting the teeth and periodontal tissues.

Somatosensory Profile Changes Evoked by Topical Application of Capsaicin to the Tongue in Healthy Individuals.

AIMS: To assess the effect of topical application of capsaicin to the tongue as a surrogate model of burning mouth syndrome (BMS) on somatosensory sensitivity by using a standardized battery of quantitative sensory testing (QST) in healthy volunteers. METHODS: This study comprised two experimental sessions (experimental [capsaicin] and control [Vaseline]) with QST in 16 healthy women. The examiner applied capsaicin or Vaseline to the tongue tip for 5 minutes. Each participant kept their tongue tip in contact with the capsaicin/Vaseline at the bottom of a disposable cup for 5 minutes, during which time the participant rated the perceived intensity of the tongue pain every 30 seconds on an electronic 0 to 10 visual analog scale (VAS). QST was performed on the tongue tip before and immediately after application in each session. The QST data were analyzed by two-way analysis of variance (ANOVA). RESULTS: Mean ± standard error of the mean (SEM) of VAS pain scores during the capsaicin and control sessions were 8.2 ± 0.5 and 1.9 ± 0.2, respectively. The peak of the perceived pain in the capsaicin session was significantly higher than in the control session (P < .001). In the capsaicin session, the postapplication heat pain threshold (HPT) was significantly higher than the preapplication HPT, and the postapplication cold detection threshold (CDT) and mechanical pain threshold (MPT) were significantly lower than before application (P < .001). The average z scores showed a significant somatosensory loss regarding CDT. In the control session, there were no differences between preapplication and postapplication values. CONCLUSION: Topical application of capsaicin to the tongue tip changed somatosensory sensitivity in healthy participants.

Lip muscle training improves obstructive sleep apnea and objective sleep: a case report.

The present study assessed the potential of lip muscle training for improving sleep. A patient with heavy snoring, daytime sleepiness and dry mouth underwent lip muscle training. Lip closure force LCFmax increased by 67.3% and LCFmin by 152% post-training. AHI decreased from 12.2 to 3.9 events/h by reducing hypopneic episodes. TST, sleep stage N3 and REM sleep increased, and WASO, sleep stage N1, and AI decreased. The patient switched from mouth to nose breathing during sleep and stopped snoring. Improved LCF, by moving the tongue into the anterior-superior oral cavity, may increase upper airway space and reduce the hypopnea index.

Analysis of correlation between height of residual ridge and bone density of residual ridge crest at edentulous mandible using computed tomography.

PURPOSE: The aim of this study was to investigate the correlation between bone density of the edentulous mandibular ridge crest and residual bone height in edentulous subjects using multidetector computed tomography (MDCT) images. METHODS: A total of 194 bilateral MDCT images from 97 individuals with an edentulous mandible were selected for analysis. The residual ridge ratio (RRR), the CT values at the residual ridge crest, and the CT values at the lowest point of the mandible measured from MDCT images at molar region. RRR was classified into the three groups (Group 1: >2.0, Group 2: 1.5-2.0, Group 3: <1.5). Bone density at the residual ridge crest was evaluated by calculating the ratio of the CT value at the lowest point of the mandible and the CT value of the residual ridge crest ("ratio of CT values"). The relationship between the height of the residual ridge and the bone density of the residual ridge crest was evaluated by ratio of CT values. RESULTS: Median ratio of CT values was 0.62 in Group 1, 0.70 in Group 2, and 0.84 in Group 3, indicating significant differences between all 3 groups (p<0.05). The correlation coefficient for RRR and residual ridge crest bone density was -0.54 in males and -0.55 in females, implying a moderate correlation for both males and females. CONCLUSIONS: The present results suggest a negative correlation between residual bone height and the bone density of the edentulous mandibular ridge crest.

Perceptual distortion of the tongue by lingual nerve block and topical application of capsaicin in healthy women.

OBJECTIVES: The aim of this study was to examine reports of perceptual distortion evoked by transient deafferentation and burning pain as models of aspects of burning mouth syndrome (BMS). MATERIALS AND METHODS: Sixteen healthy women took part in three experimental sessions that included exposure to lingual nerve block, capsaicin, and control substance. In each session, reported perceptual distortion and mechanical detection threshold (MDT) were assessed at four areas (the tongue, lower front teeth, lower lip, and right thumb) before and at 5, 15, 30 min and 1 and 3 h after the injection or application. A numerical rating scale (NRS) and a template matching procedure were used to quantify the perceptual distortions. RESULTS: There was a significantly higher MDT on the tongue during the lingual nerve block session at 5 min up until 1 h, with the perceived tongue size significantly increased at 5, 15, and 30 min and at 1 h compared to baseline (P < 0.05). Although the perceived size determined by the NRS scores during the capsaicin session was significantly larger for the lower lip at 5 min compared to baseline (P < 0.001), there were no significant effects on the MDT or the perceived sizes for the tongue, lower front teeth, or right thumb at any of the time points. CONCLUSIONS: Perceptual distortions of the tongue may be influenced by non-nociceptive somatosensory changes rather than nociceptive activity. CLINICAL RELEVANCE: The perceptual distortion of the tongue was investigated with models of aspects of BMS and may have implications for future studies in clinical populations.

Effect of a repeated tongue-lift motor task for tongue function.

This study investigated the effect of repeated tongue motor tasks on suprahyoid muscle activity and tongue pressure. Fourteen participants performed three series of a standardized tongue-lift training (TLT) task on each of five consecutive days. Electromyographic (EMG) activity from suprahyoid muscles and tongue pressure were recorded. In the first and third TLT series, participants were instructed only to target different force levels. During the second TLT series, visual feedback of the force level was given. One series consisted of three measurements [at 10%, 20%, and 40% of maximum voluntary contraction (MVC), respectively]. The coefficient of determination of the target force level-EMG curve and the target force level-tongue pressure curve was calculated from all series. There were no statistically significant day-to-day differences in EMG-root mean square (RMS) values and tongue pressure during MVC. The coefficients of determination of tongue pressure in the first series on day 1 were statistically significantly lower than the coefficients of determination in the first series on day 5. These findings suggest that the control of tongue pressure improved, while the maximum force remained constant. These results could have implications for treatment paradigms related to learning for patients with compromised tongue function, such as swallowing disorders or dysphagia.

Pressure dynamics in the trays caused by differences of the various impression materials and thickness of the relief in the maxillary edentulous model.

PURPOSE: The purpose of this study is to compare the pressure dynamics in the trays caused by differences in the various impression materials and in the thickness of the relief provided for the trays. METHODS: In this study, two types of polyvinylsiloxane elastomers, one type of polyether elastomer and one type of alginate impression material were used. Pressure sensors were embedded at eight locations in a model of an edentulous maxilla, and used a simulation model covered with a pseudomucosa. For each impression material, the measurement was performed five times for each of the three types of trays, and the mean values were determined. Statistical analysis was carried out using one-way analysis of variance and the Tukey's HDS method, and the various pressure sensor values for each of the impression materials were compared 10s and 20s after the start of the measurement. Additionally, we compared differences among the three types of trays after 20s. RESULTS: The pressure values for sensors placed in the relief region tended to become uniform. Furthermore, we saw a tendency for the pressure to increase at the alveolar crests of the first molars on the left and right and at the posterior border of the palate, all of which support the denture, when relief was provided. CONCLUSIONS: The above results suggest that making the final impression for the denture using the selective pressure technique, with consideration given to the pressure dynamic, may lead to a good outcome in terms of preservation of the alveolar ridge.

Characteristics of middle-aged and older patients with temporomandibular disorders and burning mouth syndrome.

The aim of this study was to evaluate the relationship between pain intensities and psychosocial characteristics in middle-aged and older patients with temporomandibular disorders (TMDs) and burning mouth syndrome (BMS). Subjects were selected according to the Research Diagnostic Criteria for TMD (n = 705) and International Association for the Study of Pain criteria for BMS (n = 175). Patients were then divided into two age groups: 45-64 years (middle-aged, Group A) and 65-84 years (older, Group B). Pain intensity and depression and somatization scores were evaluated in both groups. In BMS patients, present and worst pain intensities were significantly higher in Group B than in Group A {4.6 [95% confidence interval (CI) = 4.0-5.2] vs. 3.5 [95% CI = 3.1-3.9] and 5.9 [95% CI = 5.2-6.4] vs. 5.0 [95% CI = 4.5-5.6], respectively; P < 0.05}, with no difference observed in TMD patients. The depression and somatization scores were significantly higher in Group A than in Group B among BMS patients [0.57 (95% CI = 0.45-0.69) vs. 0.46 (95% CI = 0.34-0.59) and 0.537 (95% CI = 0.45-0.63) vs. 0.45 (95% CI = 0.34-0.55); P < 0.05], with no difference observed in TMD patients. The results of the present study indicate that pain intensities and psychosocial characteristics in BMS appear to differ between middle-aged and older patients.

Repeated tongue lift movement induces neuroplasticity in corticomotor control of tongue and jaw muscles in humans.

This study investigated the effect of repeated tongue lift training (TLT) on the excitability of the corticomotor representation of the human tongue and jaw musculature. Sixteen participants performed three series of TLT for 41 min on each of 5 consecutive days. Each TLT series consisted of two pressure levels (5 kPa and 10 kPa). All participants underwent transcranial magnetic stimulation (TMS) and electromyographic (EMG) recordings of motor evoked potentials (MEPs) in four sessions: (1) before TLT on Day 1 (baseline), (2) after TLT on Day 1, (3) before TLT on Day 5, and (4) after TLT on Day 5. EMG recordings from the left and right tongue dorsum and masseter muscles were made at three pressure levels (5 kPa, 10 kPa, 100% tongue lift), and tongue, masseter, and first dorsal interosseous (FDI) MEPs were measured. There were no significant day-to-day differences in the tongue pressure during maximum voluntary contractions. The amplitudes and thresholds of tongue and masseter MEPs after TLT on Day 5 were respectively higher and lower than before TLT on Day 1 (P<0.005), and there was also a significant increase in tongue and masseter MEP areas; no significant changes occurred in MEP onset latencies. FDI MEP parameters (amplitude, threshold, area, latency) were not significantly different between the four sessions. Our findings suggest that repeated TLT can trigger neuroplasticity reflected in increased excitability of the corticomotor representation of not only the tongue muscles but also the masseter muscles.

Effect of a repeated jaw motor task on masseter muscle performance.

OBJECTIVE: The aim of this study was to investigate the effects of 5-days repeated jaw-motor tasks on masseter muscle accuracy performance. DESIGN: Sixteen healthy participants performed a tooth-clenching task (TCT) of 58-minutes on five consecutive days. During measurements, electromyography (EMG) of both masseter muscles was recorded. Each day, the 100% maximum voluntary contraction (MVC) level was determined before the TCT. In the first and third TCT series, participants were instructed to target force levels without visual feedback. During the second TCT series, visual feedback on muscle activity level was displayed. One series consisted of three force levels (10%, 20%, and 40% MVC). In the series, participants alternated between a 30-s rest-block and a 30-s task-block for 360 s. In the task-block, participants alternated between a 5-s rest-block and a 5-s task-block. EMG activity during epochs of 5-s was quantified by calculation of the root-mean-square (RMS) values. To evaluate the accuracy of the performance, the coefficient of determination (CD) of the target force level-EMG curve was calculated from all series. RESULTS: No significant day-to-day differences in EMG RMS amplitudes were observed during MVC. CDs differed significantly between the five days (P<0.001). CDs in the first series on day 1 were significantly lower than CDs in the first series on days 4 and 5 (P<0.05). CONCLUSIONS: The findings suggest that a rigorous training paradigm may improve the performance of masseter muscles in terms of accuracy but not MVC. This might have implications for understanding the rehabilitation of patients with functional disorders in the stomatognathic system.

Rheological properties of elastomeric impression materials for selective pressure impression technique.

PURPOSE: The selective impression technique is recommended for removable prosthodontics. However, the viscoelastic rheological properties of impression materials, particularly the time-dependent viscoelastic changes in impression material immediately after tray seating, are unknown. The objective of this study is to clarify the viscoelastic rheological properties of impression materials by focusing on tray seating. METHODS: In this study, eight types of polyvinylsiloxane (PVS), two types of polyether, and two types of alginate impression materials were used. The storage modulus (G'; degree of stiffness) and loss tangent (tanδ; degree of hardening) were determined as functions of time from 0 to 360 s, commencing immediately after the completion of mixing, using a stress control-type rheometer. Thus, G' and tanδ at 0s and 20 s were compared. RESULTS: Stiffness was found to be widely distributed (4.49-0.26 × 10(4)Pa) among PVS-types, even immediately after mixing the impression material. There was also variation among polyethers (1.55-0.5 × 10(4)Pa) and among alginates (0.64-0.21 × 10(4)Pa). The hardening of all impression materials progresses beyond 20 s after the completion of mixing. CONCLUSIONS: The G' values varied with each impression material, even immediately after mixing, and the accurate impression-taking time was determined from the results of tanδ. These results provide unique insight into the selective impression technique.

Age-related associations between psychological characteristics and pain intensity among Japanese patients with temporomandibular disorder.

We investigated the relationship between pain intensity and psychosocial characteristics in patients with temporomandibular disorder (TMD). Participants with painful TMD, according to the Research Diagnostic Criteria for TMD (RDC/TMD), were recruited from our clinic and classified into six age groups: 15 to 24, 25 to 34, 35 to 44, 45 to 54, 55 to 64, and 65 to 85 years (Groups A through F, respectively). Self-reported present pain intensity and worst pain intensity during the past 6 months were ascertained using a numeric rating scale (0 to 10). Depression and somatization scores were evaluated using the RDC/TMD axis II questionnaire. Among women, worst pain intensity was significantly lower in Groups E and F than in Groups B and C (P < 0.05). In Groups A, C, and D, depression scores were significantly higher in women than in men (P < 0.05). Among women, depression score was significantly lower in Group F than in Groups A through C (P < 0.05). In Groups A through D, somatization scores were significantly higher for women than for men (P < 0.05). Depression score and TMD symptom severity appear to decrease with age in women.

Clinical application of removable partial dentures using thermoplastic resin. Part II: Material properties and clinical features of non-metal clasp dentures.

This position paper reviews physical and mechanical properties of thermoplastic resin used for non-metal clasp dentures, and describes feature of each thermoplastic resin in clinical application of non-metal clasp dentures and complications based on clinical experience of expert panels. Since products of thermoplastic resin have great variability in physical and mechanical properties, clinicians should utilize them with careful consideration of the specific properties of each product. In general, thermoplastic resin has lower color-stability and higher risk for fracture than polymethyl methacrylate. Additionally, the surface of thermoplastic resin becomes roughened more easily than polymethyl methacrylate. Studies related to material properties of thermoplastic resin, treatment efficacy and follow-up are insufficient to provide definitive conclusions at this time. Therefore, this position paper should be revised based on future studies and a clinical guideline should be provided.

Clinical application of removable partial dentures using thermoplastic resin-part I: definition and indication of non-metal clasp dentures.

This position paper proposes a definition and naming standard for removable partial dentures (RPDs) using thermoplastic resin, and presents a guideline for clinical application. A panel of 14 experts having broad experience with clinical application of RPDs using thermoplastic resin was selected from members of the Japan Prosthodontic Society. At a meeting of the panel, "non-metal clasp denture" was referred as the generic name of RPDs with retentive elements (resin clasps) made of thermoplastic resin. The panel classified non-metal clasp dentures into two types: one with a flexible structure that lacks a metal framework and the other having a rigid structure that includes a metal framework. According to current prosthetic principles, flexible non-metal clasp dentures are not recommended as definitive dentures, except for limited cases such as patients with a metal allergy. Rigid non-metal clasp dentures are recommended in cases where patients will not accept metal clasps for esthetic reasons. Non-metal clasp dentures should follow the same design principles as conventional RPDs using metal clasps.

Repeated clenching causes plasticity in corticomotor control of jaw muscles.

This study tested the effect of short-term tooth-clenching on corticomotor excitability of the masseter muscle using transcranial magnetic stimulation (TMS). Fifteen subjects with normal stomatognathic function participated. All subjects performed a tooth-clenching task (TCT) on five consecutive days. The TCT consisted of 10, 20, and 40% of maximum voluntary contraction in a randomized order within 1 h. All subjects underwent TMS in four sessions: pretask day 1 (baseline), post-task day 1, pretask day 5, and post-task day 5. Motor-evoked potentials (MEPs) from the masseter and the first dorsal interosseous (FDI) muscles were obtained using TMS in four sessions. Motor thresholds decreased, after the TCT, for the masseter muscle MEPs. Masseter muscle MEPs were dependent on stimulus intensity and on session, whereas FDI muscle MEPs were only dependent on stimulus intensity. Post-hoc Tukey tests demonstrated significantly higher masseter muscle MEPs post-task on day 5 with 80 and 90% stimulus intensity and above when compared with pre- and post-task day 1 values. Our results suggest that the performance of repeated TCTs can trigger neuroplastic changes in the corticomotor control of the jaw-closing muscles and that such neuroplastic changes may contribute to the mechanism underlying the clinical manifestations of tooth clenching.

Scratch test of thermoplastic denture base resins for non-metal clasp dentures.

PURPOSE: Several thermoplastic denture base resins have been introduced for the fabrication of non-metal clasp dentures. Although the surface of these materials is easily damaged, the surface roughness and characteristics of scratches created have not been evaluated. The purpose of this study was to evaluate the surface roughness of thermoplastic resins using a scratch test for the development of future materials. METHODS: Four thermoplastic (polyamide: Valplast(®); VLP and Lucitone FRS(®); FRS, polyethylene terephthalate: EstheShot(®); ES, and polyester: EstheShot Bright(®); ESB) and two conventional acrylic (Heat-polymerizing: Urban(®); HC, and Pour type auto-polymerizing: Pro-Cast DSP(®); PR) denture base resins were examined. Eight specimens, approximately 10mm×10mm×30mm in size, of each material were fabricated. Scratch test was performed by a scratch tester with a diamond indenter of 10-µm radius and cone angle 90°, applying a constant load of 500mN, and 2-mm-long scratches were made. The scratch marks were studied under 3D laser measuring microscope and cross-section profiles at approximately 0.5mm, 1.0mm, and 1.5mm from the starting point were extracted and measured with analysis software. Data from 24 cross-section profiles in each denture base material were analyzed. RESULTS: The maximum depths of ES, ESB and FRS were greater than VLP, PR and HC, and the scratch widths of ES, ESB, FRS and VPL were greater than PR and HC. CONCLUSIONS: The results showed that the surface of thermoplastic denture base resins was easily damaged compared to polymethyl methacrylate.