Comparison of direct and indirect occlusal contact examinations with different clenching intensities

The aims of this study were to examine the change of occlusal contact area following the increment of clenching intensity using silicone materials and electromyography (EMG) in normal subjects and to compare direct intra‐oral examination with indirect examination using dental casts mounted by means of two impression methods. Participants were 7 men and 5 women with no more than one missing tooth per quadrant and no pain in the head and neck region. During the task, intercuspal position was maintained with minimal force, 20% maximum voluntary contraction (MVC) and 40% MVC using electromyography visual feedback. Three types of occlusal contact examinations were performed with the aid of blue silicone material in randomised order: (i) intra‐oral direct occlusal contact examination (DE), (ii) indirect occlusal contact examination with dental casts using conventional impression method (IEC) and (iii) using occlusal impression method (IEO). Total occlusal contact area during DE and IEO significantly increased from baseline to 20% MVC and from baseline to 40% MVC, but not during IEC. Total occlusal contact area during DE in all tooth clenching conditions was significantly larger compared to IEO and IEC (P < 0·05). At 40% MVC, total occlusal contact area during IEO was significantly larger than during IEC (P < 0·05). These findings suggest that indirect occlusal contact examinations may not accurately reflect the intra‐oral occlusal condition. If the intra‐oral condition is reproduced using dental casts, these findings also suggest the occlusal impression method was more accurate compared to the conventional method (240 words).     

Association between near occlusal contact areas and mixing ability

This study investigated the relationship between occlusal contact and near contact areas defined by clenching intensity using electromyograms (EMGs) and mixing ability assessed with colour‐changeable chewing gum. Participants comprised 44 dentate adults (24 men, 20 women) with a mean age of 28·2 ± 6·8 years. Silicone material was used to measure the occlusal contact and near contact areas (the area of each type of tooth, the total area of the first molar and second molar, the second premolar to the second molar and the first premolar to the second molar) defined by clenching intensity at 10% maximum voluntary contraction (MVC). Colour‐changeable chewing gum was used to assess mixing ability. A colorimeter was used to measure colour changes, and the calculated colour difference (ΔE) was used as a measure of mixing ability. Correlation analysis of ΔE and occlusal contact and near contact areas revealed a significant positive correlation of 0·47 at 0–160 μm thicknesses of the silicone registration material of the second molar (P < 0·01). The near contact area with a thickness up to 200 μm was correlated with mixing ability, with the correlation strengthening as the interocclusal distance increased up to 160 μm. Notably, occlusal contact and near contact areas of the second molar were strongly correlated with mixing ability in dentate adults.     

Influence of different narrative instructions to record the occlusal contact with silicone registration materials

This study examined the influence of narrative instructions on the occlusal contact area, occlusal contact point and masticatory muscle activities in normal subjects. Twelve healthy men and 12 healthy women with no more than one missing tooth per quadrant participated. Surface EMG was recorded from the masseter and temporal muscle. As a control measurement, intercuspal position was maintained to produce a habitual clenching record (NCR) while the occlusal contact area and occlusal contact point was recorded by means of silicone material. Subsequently, the occlusal contact area was recorded with the narrative instruction for minimum clenching record (MCR), light clenching record (LCR) and strong clenching record (HCR). While the EMG activity (%MVC) increased modestly from MCR to LCR (from 9·3 ± 2·0% to 11·5 ± 1·5%), the occlusal contact area increased rapidly (from 17·2 ± 11·3 mm² to 26·8 ± 15·6 mm²) (P < 0·05). Both EMG activity and occlusal contact area increased gradually from LCR to NCR (to 17·7 ± 2·0% and to 31·4 ± 14·2 mm², respectively). Finally, EMG activity still increased from NCR to HCR (to 44·5 ± 3·7%) (P < 0·05), but the occlusal contact area remained stable (to 36·8 ± 16·6 mm²). Occlusal contact points at left posterior, right posterior, anterior and total area were not significantly different between each task. This study showed that narrative instructions while recording the bite can result in largely stable occlusal contact area. An adequate narrative instruction may therefore contribute to taking a stable occlusal recording in natural dentition.     

Occlusal‐supporting ability of individual maxillary and mandibular teeth

This study aimed to analyse occlusal force, area and pressure for individual maxillary and mandibular teeth by assessing their occlusal‐supporting abilities. Ninety‐nine subjects (49 men and 50 women; average age, 24·7 ± 3·4 years; range, 20–37 years) performed maximal voluntary clenching twice for 3 s in both the intercuspal position and the intercuspal position with sliding movement from edge‐to‐edge occlusion, with a pressure‐sensitive sheet placed between the maxillary and mandibular dental arch. Occlusal force, area and pressure of individual teeth were calculated by colour development in the pressure‐sensitive sheet with special analytical equipment and software. Occlusal contact condition of individual teeth was confirmed using the intra‐occlusal record. All data were analysed using unpaired Student's t‐test, Kruskal–Wallis test and Scheffe's test for multiple comparisons with a significance level of P < 0·05. The occlusal pressure in the intercuspal position with sliding movement from edge‐to‐edge occlusion was adopted as the representative occlusal‐supporting ability for each individual tooth, although there were, in part, statistically significant differences in the effects of laterality, performance and gender. Overall, the occlusal pressure increased gradually from the central incisor, peaked at the canine or first premolar and decreased sharply–and significantly (P < 0·01)–towards the second molar. We conclude that the occlusal pressure of individual teeth can be used as an indicator of occlusal‐supporting ability. This is therefore proposed as a possible suitable parameter for epidemiologic research, specifically for verifying the relationship between occlusal‐supporting ability and status of residual periodontal ligament support.     

Stable tooth contacts in intercuspal occlusion makes for utilities of the jaw elevators during maximal voluntary clenching

Data are inconsistent concerning whether the level of the surface electromyographic (SEMG) activity of jaw‐closing muscles increases when biting forces elevated during maximal voluntary clenching (MVC). In this study, T‐Scan III system and BioEMG III system were used to record bite force, occlusal contacts and SEMG activity of the anterior temporalis (TA) and of the masseter muscles (MM) simultaneously. Recordings were obtained from 16 healthy young adult males during different conditions: (i) a fast MVC from resting position to intercuspal position (ICP); (ii) mandibular movements from ICP to protrusive or lateral edge‐to‐edge positions with teeth in contact with biting; (iii) a fast MVC in protrusive and lateral edge‐to‐edge positions. A higher level of SEMG activity was associated with a higher bite force during occluding movements (P < 0·05). However, during fast MVC from rest to ICP, the largest number of occlusal contacts was achieved and distributed more symmetrically, the highest level of biting force was obtained, but the SEMG activity of the jaw elevator muscles was reduced compared with its maximum level (P < 0·05). This phenomenon was not observed during the fast MVC in protrusive or lateral edge‐to‐edge positions. The present results that a lower SEMG activity was associated with the largest number of occlusal contacts and the highest level of bite force during centric MVC demonstrated a complex integration of jaw‐closing muscles when a stable occlusion is present.     

Relationship between occlusal tooth contact patterns and tightness of proximal tooth contact

summary   The aim of this study was to investigate the relationship between occlusal tooth contact patterns and the tightness of proximal tooth contact (TPTC) during clenching. Twenty young adult volunteers with healthy dentition participated in the study. TPTC between the left second premolar (P2) and the first molar (M1) was measured during clenching at the 50% maximum voluntary contraction level in the intercuspal position (ICP). A silicone impression material was used to make an interocclusal record at the ICP in each subject, and interocclusal records were analysed using an image-processing system. Subjects were classified according to the presence or absence of each type (A, B or C) of occlusal contact. Statistical analysis was performed using the Mann–Whitney U -test. The results of this study exhibited a relationship between B-type contact and the TPTC of maxillary teeth. The experimental group with a lack of B-type contact on maxillary P2 and/or M1 showed a statistically greater TPTC than the group with B-type contact on both of these teeth ( P  < 0·01). These results suggest that occlusal tooth contact patterns have an influence on TPTC during clenching.     

Analysis of brain and muscle activity during low‐level tooth clenching – a feasibility study with a novel biting device

In electromyographic (EMG) and functional magnetic resonance imaging (fMRI) studies, muscle and brain activity was compared during low levels of tooth clenching using a novel biting device to control bite force. A total of 21 healthy subjects performed motor tasks, comprising tooth clenching at 5, 10 and 20 N. During all measurements, subjects kept the novel bite device between the anterior teeth during tooth clenching. The EMG study (n = 15) characterised jaw muscle activity for the three motor tasks and demonstrated significant differences in root mean square (RMS) EMG amplitude between 5‐, 10‐ and 20‐N tooth clenching (F = 46·21, P < 0·001). There were no differences in variability of muscle activity between the three tooth‐clenching levels. In an fMRI pilot study (n = 6), statistical comparisons were used to identify brain regions with significant activation in the subtraction of baseline from 5‐ or 20‐N tooth‐clenching activity. 5‐ and 20‐N tooth clenching significantly and bilaterally activated the sensorimotor cortex, supplementary motor area, cerebellum and basal ganglia (P < 0·05, corrected for multiple comparisons). However, activation of each brain region did not differ significantly between two tooth‐clenching tasks. Based on these preliminary findings, we propose that the novel biting device may be useful in further fMRI studies on controlled jaw muscle activation patterns in different craniofacial pain conditions. In addition, our fMRI result suggests that there are no significant differences in brain activity within low levels of tooth clenching with controlled force.     

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.     

Evaluation of proximal tooth contact tightness at rest and during clenching

The aims of this study were to develop a device for measuring the tightness of proximal tooth contact and to evaluate the proximal contact tightness using this device at rest and during clenching. Twenty young adult volunteers with healthy dentition participated in this experiment. The tightness of proximal tooth contact between the second premolar and the first molar of both the maxilla and the mandible was measured by pulling a stainless steel strip between them at rest, and at 20 and 50% clenching levels of maximum voluntary contraction of masseter muscles at intercuspal position. Proximal contact tightness increased as the clenching levels of both the maxilla and the mandible increased. At rest, proximal contact tightness was less in the maxilla than in the mandible, whereas during clenching it was less in the mandible. These results indicate that during clenching, the teeth are displaced and they contact appropriately with adjacent teeth, making it possible to exert sufficient occlusal force while maintaining the integrity of dental arches.     

Computerised occlusal analysis of mini-dental implant-retained mandibular overdentures: A 1-year prospective clinical study

Occlusal analysis is a substantial tool for the functional improvement evaluation after using implant-retained overdenture comparing to complete denture without dental implant retaining. To evaluate occlusal pattern, chewing force distribution in mini-dental implant-retained mandibular overdentures by computerised occlusal analysis system and to compare patient satisfaction after 1-year function. Thirty-one patients wearing complete dentures were included in the study. Prior to mini-dental implant-retained treatment, all patients were assessed for occlusion and force distribution using computerised occlusal analysis system (T-Scan^®), and then, all patients received two mini-dental implant-retained mandibular overdentures. Mini-dental implants were immediately loaded using low vertical profile attachments (Equator^®). T-Scan^® was used to evaluate chewing force and force distribution at 1 day, 3 months, 6 months and 12 months. The patient satisfactions before implant placement and after 1 year were evaluated using questionnaires which included satisfaction of denture quality, psychosocial behaviour and chewing efficiency modified from the validated questionnaires. Clinical evaluation of two mini-dental implant-retained mandibular overdentures showed 100% success rate after 1 year. T-Scan^® demonstrated that maximum occlusal contact force increased continuously. The force distribution; the tooth contact number increased over the period. At 1-year follow-up, overall patient satisfaction was significantly greater than before receiving mini-dental implant treatment (P < .001). Using computerised occlusal analysis, mini-dental implants improve complete denture function significantly in terms of maximum occlusal contact force, tooth contact number without the impairment of force distribution. The oral function of the patients has been enhanced.     

Effect of experimental jaw muscle pain on EMG activity and bite force distribution at different level of clenching

Bite force at different levels of clenching and the corresponding electromyographic (EMG) activity in jaw‐closing muscles were recorded in 16 healthy women before, during and after painful stimulation of the left masseter muscle. Experimental pain was induced by infusion of 5·8% hypertonic saline (HS), and 0·9% isotonic saline (IS) was infused as a control. EMG activity was recorded bilaterally from the masseter and temporalis muscles, and static bite force was assessed by pressure‐sensitive films (Dental Pre‐scale) at 5, 50 and 100% of maximal voluntary contraction (MVC) during each session. Visual feedback was applied by showing EMG activity to help the subject perform clenching at 5, 50 and 100% MVC, respectively. EMG activity at 100% MVC in left and right masseter decreased significantly during painful HS infusion (1·7–44·6%; P < 0·05). EMG activity at 5% and 50% MVC was decreased during HS infusion in the painful masseter muscle (4·8–18·6%; P < 0·05); however, EMG activity in the other muscles increased significantly (18·5–128·3%; P < 0·05). There was a significant increase in bite force in the molar regions at 50% MVC during HS infusion and in the post‐infusion condition (P < 0·05). However, there were no significant differences in the distribution of forces at 100% MVC. In conclusion, experimental pain in the masseter muscle has an inhibitory effect on jaw muscle activity at maximal voluntary contraction, and compensatory mechanisms may influence the recruitment pattern at submaximal efforts.     

Influence of occlusal contact on cervical muscle activity during submaximal clenching

The aim of this study was to clarify the relationship between changes in the occlusal contact area and cervical muscle activity. A decreases in the occlusal contact area using bite planes (stage 1: full contact bite plane, stage 2: bilateral molar removed from contact, and stage 3: bilateral molar and premolar removed from contact) was experimentally simulated in seven subjects (aged 23-25 years) with normal dentition, and muscle activity of the sternocleidomastoid muscle (SCM) and trapezius muscle (TRM) during 50 and 10% of maximum voluntary contraction (MVC) was measured by surface electromyography. The SCM activity during 50% MVC was stage 1: 31.2 +/- 9.4 microV and stage 3: 35.3 +/- 12.3 microV. The TRM activity during 50% MVC was stage 1: 15.2 +/- 0.7 microV and stage 3: 18.3 +/- 2.9 microV. At the 50% MVC, stage 3 showed significant differences in comparison with stage 1 (P < 0.05, anova). These findings suggested that the sternocleidomastoid and TRM play roles in the exertion of occlusal force, and decreases in the occlusal contact area influence the amount of SCM and TRM activity.     

Daily chewing gum exercise for stabilizing the vertical occlusion

Summary We investigated the effects of a chewing gum exercise program on occlusal conditions and evaluated compliance of subjects. Thirty‐five healthy adult volunteers (26 males and nine females) were asked to chew gum for 10–15 min before or after three meals daily for four weeks. Occlusal conditions were recorded as occlusal parameters, such as occlusal contact area, occlusal contact force, and pressure using dental prescale films. These parameters were evaluated by an Occluzer before the exercise period commenced, after four weeks of exercise, and then one month after the end of the exercise period. These parameters were statistically compared using one‐way ANOVA. We found that: (i) after four weeks of exercise, anterior and posterior occlusal contact areas and forces were significantly (P < 0·05) increased and the increments were significantly (P < 0·05) higher in the anterior occlusal contact area and force than in the posterior occlusal contact area and force, (ii) the anteroposterior ratio of occlusal contact area and force increased, but not markedly, (iii) increased parameters had significantly (P < 0·05) decreased within one month after the end of the four‐week exercise period, (iv) most participants did not complain for discomfort or stress during the exercise. The chewing gum exercise program could increase occlusal contact area and force and also move the anteroposterior occlusal balance forward. Patient compliance with the exercise is likely high enough to keep them exercising.     

Evaluation of masticatory activity during unilateral single tooth clenching using muscle functional magnetic resonance imaging

Masticatory muscle activity during teeth clenching is affected by occlusal pattern. However, few studies have performed simultaneous evaluation of all masticatory activities during teeth clenching under various occlusal conditions. The aim of this study was to use muscle functional magnetic resonance imaging (mfMRI) to evaluate the effects of changes in occlusal point on masticatory activity during single tooth clenching. Changes in mean proton transverse relaxation time (?T2) as an index of activity in all masticatory muscles during left unilateral clenching at the first molar or first premolar for 1 min were examined in nine healthy volunteers. Bite force was maintained at 40% of the maximum voluntary clenching force. The ?T2 values of the masseter and lateral pterygoid muscles were analysed separately for superficial and deep layers, and for superior and inferior heads. The ?T2 values for the ipsilateral deep masseter were significantly lower, and for the superior head of the ipsilateral lateral pterygoid muscles were significantly higher, after left first premolar clenching compared to left first molar clenching. These results quantitatively demonstrate a significant increase in activity of the superior head of the ipsilateral lateral pterygoid muscle and a significant decrease in activity of the ipsilateral deep masseter muscle with forward displacement of the occlusal contact point during unilateral tooth clenching.     

Influence of Variation in Jaw Posture on Sternocleidomastoid and Trapezius Electromyographic Activity

This study was conducted in order to determine the influence of variation in the occlusal contacts on electromyographic (EMG) cervical activity in 20 patients with myogenic cranio-cervical-mandibular dysfunction. EMG recordings during maximal voluntary clenching were performed by placing surface electrodes on the left sternocleidomastoid and upper trapezius muscles in the following conditions: intercuspal position; edge to edge left laterotrusive contacts (ipsilateral); edge to edge right laterotrusive contacts (contralateral); edge to edge protrusive contacts; and retrusive occlusal contacts. A significant higher EMG activity was recorded in both muscles during maximal voluntary clenching in retrusive occlusal contact position, whereas no significant differences in EMG activity were observed between intercuspal position, ipsilateral, contralateral and protrusive contact positions. The EMG pattern observed suggests that a more frequent intensity and duration of tooth clenching in retrusive occlusal contact position could result in more clinical symptomatology in these cervical muscles in patients with myogenic cranio-cervical-mandibular dysfunction.     

The effect of light premature occlusal contact on tooth pain threshold in humans

The purpose of this study was to assess the influence of an experimentally induced light premature occlusal contact on tooth sensation. This assessment involved monitoring the electric tooth pain threshold (TPT) at multiple times before and after altering the occlusal contact. This alteration was produced by placing high inlays, which were measured with a custom made measuring device in maximum intercuspation. Data were collected on 10 teeth in 5 subjects, all whom were male and between the ages of 24 and 30 years. The contact area of the high inlays varied from 75 μm to 193 μm. The TPT changes in these teeth ranged from –43 to +21% of their baseline level. Seven of these teeth showed a significant decrease (P < 0.05) in the TPT, one showed an increase and two did not show a significant change. Two of the teeth with a decreased TPT had cold water triggered occlusal pain, and 2 teeth had only occlusal pain. After several inlay adjustments to eliminate interferance in maximum intercuspation, all tested teeth returned to their TPT baseline level and all symptoms disappeared. These results suggested that a light premature occlusal contact may change tooth sensation.     

Effects of occlusal contact on the level of mandibular elevator muscle activity during maximal clenching in lateral positions

The aim of this study is to clarify the normal relationship between jaw elevator muscle activity and occlusal contact in lateral positions in order to assess the appropriate anterior guidance of lateral jaw movements for occlusal reconstruction and treatment. The EMG-activity of the right and left masseter, anterior temporal, and posterior temporal muscles of 9 healthy subjects with full, natural dentition was measured with bipolar surface electrodes during two different biting efforts, one involves bite registration by a silicone material containing carbonate powder (BRS) and another is maximal voluntary clenching (MVC), at the right and left canines' edge to edge positions and intercuspal position. The difference in muscle activity between MVC and BRS, which was regarded as the actual muscle activity necessary for MVC, was calculated as a representative value for each muscle activity. When working-side occlusal contact was restricted by the anterior teeth, including the canines, the total actual EMG activity of the 6 jaw muscles had a significantly strong correlation with the frontal angle of the lateral incisal path and the occlusal contact area at the lateral occlusion. This result suggested the possibility that canine guidance would control the muscle activity during lateral tooth clenching.     

The effects of salivas on occlusal forces

Contacting surfaces of opposing teeth produce friction that, when altered, changes the contact force direction and/or magnitude. As friction can be influenced by several factors, including lubrication and the contacting materials, the aim of this study was to measure the occlusal load alterations experienced by teeth with the introduction of different salivas and dental restorative materials. Pairs of molar teeth were set into occlusion with a weighted maxillary tooth mounted onto a vertical sliding assembly and the mandibular tooth supported by a load cell. The load components on the mandibular tooth were measured with three opposing pairs of dental restorative materials (plastic denture, all‐ceramic and stainless steel), four (human and three artificial) salivas and 16 occlusal configurations. All lateral force component measurements were significantly different (P < 0·0001) from the dry (control) surface regardless of the crown material or occlusal configuration, while the effects of the artificial salivas compared to each other and to human saliva depended on the crown material.     

Effect of non-working occlusal contacts on vertical condyle position

Summary  The presence of non-working occlusal contacts is often considered harmful for the temporomandibular joint. Thus, the purpose of this study was to investigate the effect of non-working occlusal contacts on the condylar position during submaximal and maximal clenching. The study comprised 22 healthy subjects having a canine-guided occlusion. None of them had a third molar and none of them had a missing tooth or showed tooth mobility. All subjects clenched on (i) the canine, (ii) the canine while a stiff bite registration material was positioned between the second premolar and the first molar on the non-working side. The clenching level was controlled by surface electromyography of the masseter muscle. During clenching, the vertical and horizontal condylar position was predicted using six degrees of freedom ultrasonic motion analyser. Clenching on the canine caused a cranial movement of the non-working side condyle. This movement was reduced by 0·6–0·9 mm when the subjects clenched while the artificial non-working side contacts were in place. These results indicate that the contacts on the non-working side may be able to prevent upward joint movement.     

Status of occlusal contact during sleep bruxism in patients who visited dental clinics – A study using a Bruxchecker®

Objective: Bruxism-induced mechanical load causes various dental problems, and its treatment is challenging. The present study analyzed upper and lower tooth contacts to determine actual occlusal contact during sleep bruxism.

Methods: Tooth contact patterns were analyzed in 49 patients attending dental clinics, using a Bruxchecker®, cephalograms, and condylographs.

Results: Approximately 80% of individuals demonstrated contact from the anterior teeth to the molar region (ICPM); about 96% had mediotrusive grinding and contact. The tooth contact area increased with the flatness of the anterior occlusal plane. The ratio of the contact area of the anterior teeth to the overall tooth contact area increased with overbite. Bilateral ICPM and mediotrusive contact patterns were associated with a high frequency of temporomandibular disorder symptoms, clicking, and/or pain.

Discussion: The tooth contact area, anterior occlusal plane, and overbite are closely related, suggesting that tooth contact with the anterior teeth should be controlled with occlusal therapy.