The occlusalgraph: a graphic representation of photocclusion data

Bite force of patients with tooth pain

Objectives

Material and Methods

Results

Conclusions

This study was designed to measure the bite forces of patients with clinical tooth pain and healthy individuals. It is hypothesized that patients with tooth pain would have lesser bite forces as compared to healthy individuals.

Determination of the reliability and repeatability of a quantitative occlusal analyzer by using a piezoelectric film sensor: An in vitro study

STATEMENT OF PROBLEM

A digital quantitative occlusal analyzer with claimed lower cost and easier maneuverability has been introduced to replace conventional methods. However, information regarding its performance is scarce.

PURPOSE

The purpose of this in vitro study was to evaluate the reliability and repeatability of a newly introduced digital occlusal analysis device (Accura) and to compare it with an established occlusal analyzer (T-scan Novus).

MATERIAL AND METHODS

The sensor films of both devices were positioned between titanium maxillary and mandibular models that were equilibrated and arbitrarily mounted on a semiadjustable articulator. Compressive force was applied to the upper arm of the articulator with a universal testing machine, increased gradually to 50 N, and then released automatically. The time and force measurements from the universal testing machine and the tested devices were recorded by operating software programs. Five articulating film sensors of each device were tested 3 times each by 2 examiners and were repeated on consecutive days, totaling 60 trials per device. Reliability was defined as an agreement between the loaded force and measured force. Repeatability was defined as an agreement between repeated measurements of the Accura and T-scan Novus. Intraclass correlation coefficient was calculated for the statistical analysis (α=.05).

RESULTS

The calculated intraclass correlation coefficient of the Accura and the universal testing machine was 0.952. The intraclass correlation coefficient of the T-scan Novus and the universal testing machine was 0.963. Intraclass correlation coefficients that were calculated to compare the data acquired from different days were 0.938 for the Accura and 0.911 for the T-scan Novus.

CONCLUSIONS

The experimental results indicated that the reliability of both the Accura and T-scan Novus was excellent for measuring occlusal forces. In addition, both the Accura and T-scan Novus exhibited excellent repeatability.

Changes in bite force after orthognathic surgical correction of mandibular prognathism: a systematic review

Patients requesting treatment for mandibular prognathism seek functional and aesthetic improvements. Improvements in bite force and efficiency are generally used as measures of better function. It is unclear what effect the surgical correction of mandibular prognathism will have on the patient's occlusal forces. The literature was searched using medical subject heading (MeSH) and key word terms 'bite force', 'osteotomy', 'orthognathic surgery', and 'prognathism'. A total of 17 articles were included in this review. These included a total of 697 patients, who ranged in age from 15 to 44 years. Male patients outnumbered female patients in only one study. Five hundred and thirty-two patients underwent bilateral sagittal split osteotomy, 108 patients underwent intraoral vertical ramus osteotomy, and 24 patients underwent extraoral vertical ramus osteotomy (approach unspecified). In general, masticatory efficiency at 3 months after surgery was greater than that found pre-surgically; the increase was significant at 6 months after surgery. The occlusal contact area and points tended to increase from 3 months after surgery, and there was a significant increase at 12 months after surgery. Occlusal forces, although improved, will be lower in corrected prognathic patients than in normognathic patients even at 2 years after surgery.

Computerized occlusal analysis as an alternative occlusal indicator

BACKGROUND

All disciplines of dentistry require that clinicians assess the articulation of the teeth/prosthesis with respect to simultaneous contacts, bite force and timing.

AIMS

This article intends to describe the advantages and limitations of the data acquired when using a computerized occlusal analysis as a dynamic occlusal indicator.

METHODOLOGY

A search of the literature was completed (Medline, PubMed) using the keywords occlusion, occlusal registration, computerized occlusal analysis and T-Scan for dental.

RESULTS

According to the evidence available, the computerized occlusal analysis system is the only occlusal indicator that demonstrates the ability to provide quantifiable force and time variance in a real-time window from the initial tooth contact into maximum intercuspation.

CONCLUSION

The reported advantages to accurately indicate occlusal contacts make the computerized occlusal analysis system a better occlusal indicator when compared with other non-digital convention indicator materials available.

Effects of load and indicator type upon occlusal contact markings

STATEMENT OF PROBLEM

Clinicians use occlusal indicators to identify tooth contacts. However, the reliability of these indicators has been questioned. At times occlusal contacts are not identified or false positive occlusal contacts are observed.

PURPOSE OF STUDY

This study was designed to compare the number and size of occlusal indicator marks from both thick and thin occlusal indicator materials with different loads.

MATERIALS AND METHODS

Ivorine casts were articulated and mounted on an Hana Mate nonadjustable articulator. Loads of 100N, 150N, and 200N were applied with Accufim (25 microm thick, Parkell, Farmingdale, NY) and Articulating Paper (60 microm thick, G.E. Rudischauer Dental Articulating Paper, Brooklyn, NY) as the occlusal indicators. A fresh piece of indicator was used for each trial. Comparisons were made of the number and size of the contacts for both the thick and thin occlusal indicators at the different loads.

RESULTS

Observation of the marks recorded with the thicker occlusal indicator demonstrated both a greater number marks and a larger size to the marks when compared to the thinner Accufilm, p < or = 0.02-0.0001. However, there was no significant increase in the number or size of the marks with an increased load for either material.

Functional assessment of the stomatognathic system

Clinically objective assessment of the occlusal function remains largely, even today, in the research laboratory instead of in the clinical setting, as part of the routine assessment along with the morphologic documentation. Functional outcomes of the stomatognathic system can be measured in terms of occlusal contact area, maximal voluntary bite force, maximal voluntary excursions, masticatory force, masticatory cycle pattern and masticatory performance. It should be emphasized, however, that many of these measures remain to be standardized and validated as tools relevant for assessment of patients who have dentofacial skeletal deformities. This remains a promising area of active research.

The effect of periodontal surgery on bite force, occlusal contact area and bite pressure

BACKGROUND

Tooth mobility resulting from the loss of periodontal support or trauma induced by periodontal surgery may change the amount of bite force (BF) and bite pressure (BP) and number of occlusal contact areas (OCAs). The aim of the authors' study was to compare BF, BP and OCA of teeth with periodontal disease before and after periodontal surgery with similar values of healthy teeth.

METHODS

The authors performed quantitative analysis of BF, BP and OCA using a pressure measurement film. Ten patients with periodontitis who needed periodontal surgery served as the test group. The authors took measurements of BF, BP, OCA and mobility (using Miller's Mobility Index) just before surgery and at one, four and 12 weeks after surgery. They also measured clinical attachment levels (CAL) before surgery and 12 weeks after surgery. Ten subjects without periodontitis served as the control group.

RESULTS

Although BF and OCA increased the first week after periodontal surgery, analysis of variance (ANOVA) showed no statistically significant differences at a 95 percent confidence interval. There were statistically significant differences between first-week mobility and that at four and 12 weeks (P = .001). A factorial ANOVA showed significant interaction between BF and mobility (P < .05).

CONCLUSIONS

The authors' findings suggest that changes in BF, BP and OCA were not affected by periodontal surgery. However, mean mobility values and BF are correlated. Further investigations of this measurement method involving larger study populations and a longer follow-up period are needed.

CLINICAL IMPLICATIONS

It seems to be helpful to follow occlusal changes after periodontal surgery using a pressure measurement film. It also may be suggested that this measurement method could be used to evaluate the treatment prognosis.

A mathematical model of mandibular movement on the Hanau articulator and computerized simulation system of dynamic occlusion for complete denture

This study is concerned with the construction of a mathematical model of mandibular movement on the Hanau articulator and a complete denture occlusion simulation system (CDOSS) in the field of dental restoration. On the basis of the theory of spatial mechanisms, degrees of freedom in the kinematic chain of the Hanau articulator are analysed, and a hypothesis of constraints is presented to obtain constrained motion. Then, a series of mathematical expressions are derived to describe the three dimensional mandibular movement on the Hanau articulator. By adopting techniques and tools such as laser scanning, computer graphics, and computer databases, a 3D digitized model of complete denture is reconstructed, and a CDOSS is developed. With the aid of this software, the visualization and diagnosis of mandibular movement can be easily realized. One edentulous case discussed in this study shows that CDOSS provides a useful tool to deal with the functional aspects of occlusal morphology in a diagnostic and therapeutic sense.

Relation between clenching strength and occlusal force distribution in primary dentition

The aim of this study was to investigate the relation between clenching strength and occlusal force distribution in primary dentition. Twenty healthy children with normal occlusions: 11 boys and 9 girls, ages 3.2-5.8 years (avg. 4.5 years) were selected. Setting the bilateral masseter muscular activity at maximum clenching in full intercuspation as 100%, the occluding forces at 20, 40, 60, 80 and 100% clenching were recorded with pressure-sensitive sheets (Dental Prescale 50H, type R, Fuji Photo Film Co.), and the force of each primary tooth was analysed by computer (Occluzer FPD703). Occlusal force distribution was expressed as a percentage of the total occlusal force of each tooth and was compared between each clenching. There were no significant differences between various clenching strengths in the occlusal force distribution in primary dentition [one-way repeated-measures analysis of variance (ANOVA)]. Thus, the results of the present study suggest that the distribution of occluding forces on a primary dental arch had its own pattern and that the clenching strength had no effect on that pattern. These patterns may be useful in determining occlusal function in children.

Changes in occlusal state of patients with mandibular prognathism after orthognathic surgery: a pilot study

This study examined the occlusal state of patients with mandibular prognathism and compared it with that of adults with normal occlusion (controls). It also examined changes in occlusal state after orthognathic operations in these patients. The values of occlusal contact area and bite force in patients before operation were significantly lower than in controls, and occlusal pressure in patients was higher than in controls. The occlusal contact area and bite force of the patients 1 month after the operation had decreased to below preoperative values. These values 12 months after the operation had increased by 2.0 and 1.8 times in women and 1.4 and 1.4 times in men, respectively, compared with preoperative values. However, absolute values remained extremely low compared with those of controls. In contrast to the above, occlusal pressure reached its maximum value 1 month after the operation and at 12 months it was close to the value for controls.

Influence of clenching intensity on bite force balance, occlusal contact area, and average bite pressure

It has been difficult for investigators to simultaneously and reliably evaluate bite force in the intercuspal position with the area and location of occlusal contacts. This study was designed to investigate the variations in these parameters with respect to two factors: three levels of clenching and the preferred chewing side. Human subjects with normal occlusion were examined with a recently developed system (Dental Prescale Occluzer, Fuji Film, Tokyo, Japan). The three levels of clenching intensity were assessed by masseteric EMG activity and included the maximum voluntary contraction, and 30% and 60% of the maximum. The results indicated that the bite force and occlusal contact area on the whole dental arch increased with clenching intensity. In contrast, the average bite pressure, obtained by dividing the bite force by the contact area, remained unchanged regardless of the clenching intensity. As the clenching intensity increased, the medio-lateral position of the bite force balancing point shifted significantly (P<0.01) from the preferred chewing side toward the midline. The antero-posterior position remained stable in a range between the distal third of the first molar and the mesial third of the second molar. The bite force and occlusal contact area, which were mainly on the molars, increased with the clenching intensity, whereas the proportions of these two variables on each upper tooth usually did not change significantly. The exception was the second molar on the non-preferred chewing side. When comparisons were made between pairs of specific upper teeth of same name, usually no significant difference was found in bite force or occlusal contact area, regardless of the clenching level. Again, the exception to this observation was the second molar on the preferred chewing side, which had a larger area at the 30% clenching level. The results in normal subjects suggest that as the clenching intensity increases in the intercuspal position, the bite force adjusts to a position where it is well-balanced. This adjustment may prevent damage and overload to the teeth and temporomandibular joints.

The association among occlusal contacts, clenching effort, and bite force distribution in man

The contact area during habitual biting can vary according to the activity of the jaw musculature. Forceful masticatory muscle activity may also induce deformations of the dento-alveolar tissues and the supporting skeleton, yielding various tooth loads despite an apparently even distribution of tooth contacts. To investigate this variability, we measured bite forces simultaneously at multiple dental sites during maximum-effort clenching tasks. In each of four healthy adults with complete natural dentitions, four strain-gauge transducers in the right side of an acrylic maxillary appliance occluded with the lower canine, second premolar, and first and second molars. These, and matching contralateral contacts, were balanced by means of articulating paper and a force monitor (type F appliance). Bite forces were recorded when the subjects, without visual feedback, clenched maximally on the appliance. Similar recordings were made when contralateral molar and all contralateral contacts were removed (type R and type U appliances, respectively). Although the relation between individual forces often changed during the initial increase in force, it was generally constant around the maximum. The maximum forces at the four dental locations varied in distribution between subjects, but were characterized by posteriorly increasing forces. Forces in the anterior region (especially at the canine) significantly increased (up to 10 times) when clenching took place on unilateral contacts only (type U) as compared with fully balanced ones (type F). Bite force distribution thus changed with biting strength and the location of occlusal contacts. Increased force in the canine region during unilateral clenching seems related to the pattern of jaw muscle co-activation and the physical properties of the craniomandibular and dental supporting tissues which induce complex deformations of the lower jaw.

Changes in gnathosonic and tooth contact characteristics induced by experimental occlusal interferences created using a full-cast double crown

Occlusal sounds, contact timings and time moments were measured and analysed on 10 subjects onto whom an occlusal interference was created experimentally. A full-cast double crown was unilaterally set on the upper first molar of each subject, then gradually elevated for 0.06, 0.10, 0.20 and 0.30 mm by inserting a pre-calibrated metal folio. Occlusal sound was measured with an analyser designed for the purpose. Timings and time moments were analysed with a T-scan system. All measurements were performed at least 10 times per subject. The results showed that prolonged occlusal sound duration, changes in acoustic signal waveform and increased shift of the centre of effort were observed concomitantly with crown elevation. Differences in these values at 0.06 mm as compared with those at baseline were not statistically significant. This could be explained through a physiological compensation by the periodontal ligament. The differences with baseline were statistically significant from 0.10 mm ongoing. The distribution of occlusal conacts was determined by the use of a newly developed parameter. Referred to as 'Tap Score', the parameter consists of converting contact timings occurring in seven ranges into least-square-based weighted scores. Analysis of the tap score disclosed evident imbalance between the crowned and the non-crowned side starting from 0.10 mm elevation, whereby a forward shift of the major contact point was observed on the non-crowned side. Our study demonstrated that evident changes in gnathosonic and T-scan parameters are likely to occur at a crown elevation within a 0.06-0.10 mm range.(ABSTRACT TRUNCATED AT 250 WORDS)

Electromyographic analysis of the masticatory muscles of patients after complete rehabilitation of occlusion with protection by non-working side contacts

Surface electromyography was used to study the function of the anterior temporal, surface masseter, deep masseter and anterior digastric muscles of 14 patients after complete rehabilitation of occlusion with fixed prostheses and/or removable partial prostheses. All patients had a balanced occlusion with protection by non-working side contacts during lateral excursion. Mean resting myoelectric activity was 2.5-3.8 microV, showing no hypertonia or muscular spasm. When patients clenched their teeth (i.e. exerted maximum voluntary occlusal force in centric occlusion), the anterior temporal muscles were the most active, followed by the surface masseters; the digastrics were significantly less active. During lateral displacements, the muscles exhibiting significantly higher potentials than the other muscles monitored were the working side anterior temporal muscle and the contralateral surface masseter. During mastication, the muscle that was most active in relation to its contralateral homologue was the working side surface masseter, the difference between the two being statistically significant.

Use of the occlusalgraph in patients with parafunctional habits

Dental patients with parafunctional habits (clenching and grinding of the teeth) may pose unique treatment problems for the dentist. Several patients suffering from such muscle hyperactivity disorders were studied longitudinally by use of the occlusalgraph method to preserve the photocclusal data recorded by each patient. This report suggests that the use of the described technique provides a quick and simple method of visualizing the problem and long-term monitoring of the treatment.

Distribution of occlusal contacts in maximum intercuspation

This study describes the use of the T-Scan system to record and analyze tooth contact data by calculating time moment statistics in the sagittal and transverse axes of the occlusal plane and reports the results of this method to analyze the occlusion of 93 normal subjects. Results confirm the findings of previous investigators and indicate that in a normal dentition there is a tendency for bilateral equality of the tooth contacts about the sagittal axis and that the center of effort for tooth contacts anteroposteriorly is located in the region of the first molar and is symmetrical bilaterally. Because of the rapid and accurate ability of the T-Scan system to identify the distribution of the tooth contacts, it shows great promise as a clinical diagnostic screening device for occlusion.