Proposing an Optimal Occlusal Angle for Minimizing Masticatory and Cervical Muscle Activity in the Supine Position: A Resting EMG and Mixed-Effects Modeling Study.

The occlusal angle (OA), influenced by pillow height, may affect muscle tension in the head and neck. However, its optimal range for minimizing muscle activation has not been clearly defined. This study aimed to investigate the effects of OA on the resting muscle activity of masticatory and cervical muscles and to identify an optimal OA range using cluster analysis and linear mixed-effects modeling. The resting muscle activities of the masseter (MAS), temporalis (TEM), sternocleidomastoid (SCM), and posterior vertebral muscles (PVM) were measured at OA conditions modulated by pillow heights of 0, 5, and 10 cm at 0, 1, and 5 min in the supine position. Intraclass correlation coefficients (ICCs) assessed measurement reliability. Statistical analyses included ANOVA, ROC curve analysis, k-means clustering, and linear mixed-effects models. MAS and TEM resting muscle activity ratio (RMR) significantly increased with larger OA values ( < 0.001), while SCM showed decreased activation ( = 0.001). An OA range of 105°-111° was identified as the center of a low-activity cluster, and an upper cut-off of 138° was associated with potential muscular overload. ICC values for MAS and SCM ranged from 0.82 to 0.89, indicating excellent test-retest reliability. OA modulated by pillow height is a modifiable factor that influences muscle activity. An OA of 105°-111° may serve as a practical comfort zone, especially for individuals at risk of TMDs.