Occlusion

Computerized occlusal analysis as an

alternative occlusal indicator
Kelvin I. Afrashtehfar1, Sarah Qadeer2
1
Prosthodontics and Restorative Dentistry Division, Faculty of Dentistry, McGill University, Montreal, QC,
Canada, 2Department of Prosthodontics and Occlusion, Faculty of Dentistry, Thammasat University, Rangsit
Campus, Thailand

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.
Keywords: Occlusion, Occlusal registration, Computerized occlusal analysis, T-Scan for dental

Introduction makes occlusal or near-occlusal contact with the

Knowledge about occlusion is critical to achieving
satisfactory clinical outcomes in dental practice.
Luckily, clinicians have shown an increased interest
in the biomechanical elements associated with occlu-
sion.1,2 Based on the glossary of Prosthodontics
terms (2005),3 dental occlusion is the static relation-
ship between the incising or occlusal surfaces of the
maxillary or mandibular teeth or tooth analogues. The
occlusion should be balanced and as stress free as
possible. However, the clinical concept of occlusion
incorporates dynamic interactions of the movement
of the mandible and to the static morphological teeth
contact interactions. The dynamic morpho-functional
interactions include the entire masticatory system,
namely the teeth, the periodontal tissues, the neuro-
muscular system, the temporomandibular joint, and
the craniofacial bones.46
An occlusal contact may be defined by its shape,
size and position regardless of whether it actually
Correspondence to: Kelvin I. Afrashtehfar, Faculty of Dentistry, McGill
University, Rm M65, 3640 University St., Montreal, QB H3A 0C7, Canada.
Email: kelvin.afrashtehfar@mail.mcgill.ca
W. S. Maney & Son Ltd 2014
DOI 10.1179/2151090314Y.0000000024 CRANIOH: The Journal of Craniomandibular & Sleep Practice
opposing teeth. Occlusal contact refers to the contact
between teeth when the inter-occlusal distance
between the occluding areas is less than 50 mm;
whereas near-occlusal contacts occur when the
distance is between 50 and 350 mm.7 For proper
functioning, occlusal contacts must be synchronized
with the stomatognathic system.
Mutually protected occlusal scheme has been
accepted as the optimum occlusal relationship when
dynamic interactions between maxillary and mandib-
ular teeth are considered. In this occlusal relation-
ship, the posterior teeth contact simultaneously and
the contacts are equally distributed in centric occlu-
sion (or intercuspal position). During lateral excur-
sion movements, the canines disclude the posterior
teeth, whereas during protrusion the anterior teeth
disclude the posterior teeth.8
Occlusal Analysis
All disciplines of dentistry require that the clinicians
assess the articulation of the teeth/prosthesis with
respect to simultaneous contacts, bite force and
timing. However, measuring dental occlusal forces
2014 VOL. 000 NO. 000 1
Afrashtehfar and Qadeer Computerized occlusal analysis
often requires complex yet inaccurate interpretation
based on non-digital occlusal indicators used in
clinical practice, along with patients feedback.9
Therefore, these methods lack objective accuracy
during occlusal adjustment procedures.
Therefore, assessment of the occlusion is crucial to
remedying the various occlusal issues mentioned
previously. This article reviews the advantages and
limitations of a quantitative occlusal indicator whose
use is indicated in clinical practice to analyze and
remedy the discrepancies during occlusal balancing
procedures. The justification for developing an
alternative occlusal indicator (quantitative) requires
reducing the current inadequacies of conventional
registration technologies (qualitive). Therefore, the
reader will be first introduced to the potential risks of
bias in qualitative occlusal methods followed by a full
description of quantitative occlusal technology.
Qualitative Occlusal Registration Technologies
These technologies are the conventional methods such
as articulating paper,10 shim stock,11,12 waxes,13,14 and
silicone impressions.15 They are not ideal occlusal
analyzers due to their static nature, subjective inter-
pretation, and limiting factors. Moreover, current
literature does not provide sufficient evidence of their
reliability and reproducibility.
Limitations of qualitative occlusal analysis
methods
Articulating papers cannot measure occlusal load,
since there is no scientific correlation between the depth
of the color and the mark, its surface area, amount of
force, or the contact timing sequence that results as that
paper mark is made.16,17 In addition, articulating
papers are susceptible to being destroyed by saliva;
they are subject to tearing and crumpling under bite
force, are usually thick, and have a relatively inflexible
base material. These factors are believed to result in a
high proportion of pseudo contact markings.10,18,19
Similarly, shim stock strips (12 mm thick), occlusal
waxes, and silicone pastes do not accurately reproduce
occlusal contacts.9,10,1215,20,21 In addition, the sensi-
tivity and reliability of these techniques is highly
susceptible to inaccuracy due to the thickness, strength
and elasticity of the materials in the oral environment,
resulting in distortion of the impressed marks. An
indicator should ideally mark only the designated
contacts by negating positional errors influenced by
tooth displacement and extended mandibular move-
ments.22 Nevertheless, a false contact may occur when
the indicator interferes with closure. A false contact is
an area registered that does not exist, although it may
be reproduced across multiple tests. Near occlusal
2 CRANIOH: The Journal of Craniomandibular & Sleep Practice
contacts may also appear as actual contact areas,
depending on the type of marking indicator used.22
Most importantly, the accuracy of occlusal analysis
using these systems is highly dependent upon
subjective interpretation and may vary between
clinicians.10,2225 Furthermore, these methods are res-
tricted to measuring the position and quantity of
tooth contacts with no capacity to quantify occlusal
load.
Quantitative Occlusal Registration Technologies
Quantitative occlusal analysis techniques have been
developed to overcome the limitations of qualitative
assessment, such as subjective interpretation. More-
over, the sequence and density of the contacts can be
differentiated from the quantitative methods. Photo-
occlusion and the T-Scan system are the most
commonly known quantitative systems for determin-
ing occlusal relationships.19,26,27
Photo-occlusion system
The photo-occlusion system consists of a rather rigid
photoplastic film layer that is positioned on the
occlusal surface of the teeth,20 making it difficult to
measure the acting occlusal force precisely.28 The
patient bites on the 98 mm (0.1 mm) thick film for 10
20 seconds, and then the film layer is inspected under
a polariscope light to obtain the relative tooth
contact intensity.29 It has been shown that the
photoelastic wafer enhances posterior contact inten-
sity and diminishes that of the anterior region.
Furthermore, investigators have concluded that the
photo-occlusion method consists of a complicated
technique used for occlusal analysis30 and is not
highly reproducible.3133
T-Scan system
In 1987, the T-Scan Occlusal Analysis system
manufactured by Tekscan, Inc. (South Boston, MA,
USA) was developed by Professor William L. Maness
in partnership with M.I.T.19 The T-Scan III system
consists of a hand-held device with a USB port to be
connected to a laptop or a Windows-based PC; the
hand-held device contains a U-shaped pressure-
measuring sensor that fits into the patients mouth
between the occluding teeth. The pressure-measuring
sensor is a grid-based, Mylar-encased recording
sensor that is 60 mm (0.06 mm) thick and consists
of 1500 compressible sensitive receptor points made
of conductive ink. When the patient bites on the
sensor, the electrical resistance of the conductive
sensor is lessened, since the force applied compresses
the particles together; this is recorded as quantitative
force data.19,26,27 It records the sequence of occlusal
contacts from the first point of contact to maximum
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 Afrashtehfar and Qadeer Computerized occlusal analysis

Figure 1 Subjective interpretation based on appearance characteristics of paper marks (right) alongside the computerized
occlusal force data (left).

intercuspation (MIP), which can be seen as a movie in
real-time on the computer screen to analyze occlusal
contact information.34,35 The occlusion is scanned in
time increments of 0.01 seconds to record the relative
forces among the occlusal contacts, teeth with
excessive forces, and occlusal contact timing
sequences, which illustrates the exact order of tooth
contacts and the intensity of the associated forces.
These forces are represented as bars and columns on
the three-dimensional window, ranging from blue,
which is optimum force, to green, yellow, orange, red
and pink as the forces increase. The output as shown
in the figure displays the percentage force per tooth
and a two-dimensional arch view that can be divided
into quadrants (Fig. 1).
Proponents of this occlusal analysis system claim
that the recorded data on occlusal force and contact
timing provides much improved information to the
clinicians (Table 1), as compared to the conventional
methods that require subjective judgments.16,17,34,3645
The common applications in dentistry claimed by the
T-Scan III promoters include those crucial to natural

Table 1 Diagnostic information summary

Occlusal forces and timing data

1. Force distribution on individual teeth as well as on either side of the arch.
2. Evidence of occlusal force discrepancies in the arch.
3. The presence of bilateral simultaneity (bilateral balance) and anterior to posterior force distribution at any point during closure.
4. Occurrence of high points or excessive contact location in the arch for individual patient
5. The timing of the detrimental occlusal forces as they develop in the arch to detect their precise location.
Muscle related benefits
1. The effectiveness of guidance patterns that provide somato-sensory muscle control.
2. Muscular imbalance and weak muscle activity during closure.
3. Underlying muscle fatigue.

CRANIOH: The Journal of Craniomandibular & Sleep Practice 2014 VOL . 000 NO . 000 3
Afrashtehfar and Qadeer Computerized occlusal analysis
dentition with occlusal disturbances, implant placement
(fractional time delay on implant prosthesis), ortho-
dontics, myofacial pain, restorative dentistry and
prosthodontics (checking for high points and excessive
contact locations), patient education (treatment accep-
tance, improved longevity, enhanced comfort, eliminat-
ing extra visits), occlusal diagnosis and equilibration. In
essence, the computerized analysis system is a diag-
nostic tool that assesses dental occlusion and finds
utility in any field that requires diagnosis of the
occlusion and/or occlusal balancing.
Advantages of the computerized occlusal
analysis technology
The conventional static occlusal indicators such as
articulating paper and waxes only reveal the contact
size and location, whereas the T-Scan has an
additional ability of quantifying occlusal contact
timings and forces.46
The computerized system presents a superior
alternative to conventional occlusal registration meth-
ods due to its ability to record dynamic tooth contact
relationships as force and timing data. Additionally,
the computerized system can display the relative
occlusal force variance from the first point of contact
to MIP, in real time.17 In contrast, a study on
articulating paper marks made at various occlusal
force loads showed that more than 80% of the marks
have no correlation between the mark size and the load
applied.16 This establishes the inadequacy of articulat-
ing paper marks in describing the occlusal load. The
study mentioned earlier on paper mark inaccuracy
demonstrated that the largest mark corresponds to the
highest force load only 38% of the time and that the
dentists would be subjected to choosing and modifying
the wrong tooth at least 62% of the time.17
The data available during T-Scan recordings
improves the precision and treatment outcome of the
occlusal adjustment procedure. Occlusal analysis tech-
nology adds dynamic and quantifiable value to the
many non-digital, conventional occlusal indicators;
thereby, clinicians no longer have to rely completely on
subjective interpretation using static indicators.
Figure 1 demonstrates the subjective interpretation
based on the appearance characteristics of paper marks
alongside T-Scan occlusal force data. A faint small
paper mark on the second molar contains the heaviest
force represented in the red column in the T-Scan
window, while a bigger paper mark on the second
premolar shows optimal occlusal force associated with
it when analyzed by this computerized technology.
The new feature of synchronization of the compu-
terized occlusal system data with electromyography is
also able to demonstrate the abnormal dysfunction of
4 CRANIOH: The Journal of Craniomandibular & Sleep Practice
the musculature via the center of force patterns and
the disclusion timing. Therefore, the T-Scan is able to
provide precise, definitive diagnosis of the occlusal
force balance and masticatory muscular function for
the clinician, and it is a comprehensive educational
tool for the patient undergoing occlusal balancing
procedures.40,43
Limitations of the computerized occlusal analysis
technology
While T-Scan occlusal analysis technology provides
quantifiable time and force variance from the first
point of contact to MIP as the subject bites onto the
occlusal sensor, it does not have the capacity to measure
absolute bite force. The sensor thickness is 100 mm (0.1
mm) that compresses down to 60 mm under bite force,
which may arguably interfere with intercuspation. The
company claims that the highly compressible capacity
of the sensor also provides bilateral interference during
mandibular movement, providing improved occlusal
force data when compared with unilateral interference
of articulation paper strips that are frequently used to
determine excessive contact areas on one side of the
arch only.
The challenge many clinicians face is the increased
chair-time during computerized occlusal adjustment
procedures, since a good T-Scan recording requires
a number of skills. The significant learning curve
involves getting familiar with appropriate sensitivity
settings, orally guiding the patient through the
needed mandibular movements, observing the screen
to follow the center of force trajectory, and recogniz-
ing what is taking place within the recording. By
interpreting and analyzing the recorded data, clin-
icians can target the teeth for adjustments
(Appendix). While clinicians may feel that operating
the device may be too time-consuming, the increased
chair-time allows them to complete their objective
accurately, without having to make multiple adjust-
ments common among conventional practices.47
As described in the advantages of the computer-
ized occlusal analysis technology section, there is
vast evidence that supports this technology use and
benefits as an occlusal indicator. However, evidence
must be interpreted with caution, since most studies
are case series reports. Therefore, further studies,
such as clinical trials, are recommended to confirm
the computerized technology superiority over the
conventional occlusal indicators.
Conclusions
According to the evidence available, the computer-
ized occlusal analysis system is the only occlusal
indicator that demonstrates the ability to provide
2014 VOL . 000 NO . 000

quantifiable force and time variance in a real-time
window from the initial tooth contact into MIP. The
reported advantages to accurately indicate occlusal
contacts make this system a better occlusal indicator
when compared with other non-digital conventional
indicator materials available. T-Scan occlusal analy-
sis recordings, if done properly, can provide an
insight to occlusion and related discrepancies, thereby
maximizing doctor-patient communication and mini-
mizing complications caused during restorative fol-
low-up visits or occlusal imbalance, as well as
providing a more predictable treatment outcome.
Disclaimer Statements
Contributors Dr. Afrashtehfar and Dr. Qadeer wrote
the article and appraised the manuscript selection.
Funding None.
Conflicts of interest The second author is a speaker
for T-Scan Occlusal Analysis System.
Ethics approval Not applicable.
Acknowledgements
To Tessa Brown and Brad MacDonald, McGill
English PhD candidates, for assistance with editing.
Appendix: Glossary
Time analysis. This mode gives information on the
location and sequence of occlusal contacts, showing
in a different color the location of the first, second
and third or more contacts.
Force analysis. This mode provides the operator
with data on the location and relative force of tooth
contact.
Occlusion Time (OT). OT is the measure of time in
seconds from first point of contact to maximum
intercuspation as the patient bites on the T-Scan
Sensor. (The average OT is .0.2 second)
Disclusion Time (DT). DT is the measure of the
time it takes for all the posterior teeth to disengage
from each other during jaw motion.45 (The average
DT is .0.4 second)
Centre of force (COF) trajectory. COF trajectory
displays the balance or imbalance in occlusion as it
demonstrates the history of the path of closure from
the beginning of the recording to the current frame.
COF analysis. The COF pinpoints the location of
the sum of the total force of occlusal contacts and is
shown in relation to a dual elliptical target, which
represents the ideal location of the center of force for
any maximum inter-cuspation closure, and acts as a
guide with respect to normal occlusion.27
CRANIOH: The Journal of Craniomandibular & Sleep Practice
Afrashtehfar and Qadeer Computerized occlusal analysis
Percentage of force (POF) analysis. POF allows the
clinician to examine the total effect of restorative
dentistry on the patients maximum closure and
excursions, and is as easy as the click of a mouse. It
is a powerful analytical tool that illustrates the
balance of the occlusion in the active Movie or
Real-time window, using a graphic POF marker.
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