Measurement of intraoral load has a long history dating back to1681 when Borelli studied the intraoral mastication load using a mechanical ‘Gnathodynamometer’ (Brawley et al. in 1938). Several researchers continued to study this subject as many devices were invented and designed to gain more insight to occlusion. Over the years, the mechanical devices developed into electrical systems such as lever-spring, monometer-spring, levers and micrometered devices to measure occlusal load. The technological advancement gave way to the first generation of T-Scan computerized occlusal analysis system developed in 1987 by Tekscan Inc. (South Boston, MA, USA.www.tekscan.com) that has the ability to accurately analyze the patient’s occlusal data in realtime.
T-Scan III software version 8.0 is the newest generation of this occlusal analysis technology (Fig 1) that allows the clinician to record and explore the patient’s occlusion with precision. The measurable capacity of T-Scan III provides force over time irregularities, premature contacts, occlusion time, disocclusion time, percentage of force on individual tooth as well as on either side of the arch during maximum intercuspation. The occlusal data is represented as dynamic 2D and 3D images with coloured columns ranging from BLUE (optimum force) to RED/PINK (high force) seen on the computer screen when the patient bites on the occlusal sensor (Fig 2). This measurable occlusal data enhances the clinician’s ability to make precisely targeted adjustments during occlusal equilibration following prosthetic, restorative, orthodontic or implant procedures.
T-Scan Occlusal Analysis System is also referred to as “Digital Proprioception” for its ability to map occlusal contact location, sequence of closure, measure intensity of those contacts, track Center of Force trajecory, interprit force distribution, bring about measurable time delay for implant prosthesis and monitors the generation of bilateral simultaneity in the arch. Digital Occlusal Analysis technology can be used in everyday clinical practice for initial patient exam, prosthetic case finishing, TMD treatment without appliances, locating painful occlusal contacts, post-orthodontic occlusal assessment and abfraction management, to gain a comprehensive insight to patient’s occlusion in order to provide necessary maintenance.
The conventional non-digital occlusal indicators commonly used by dentists for occlusal adjustments are articulation papers, shim stock foils, impression waxes and patient’s subjective “feel” feedback. The reliability of these static materials is questionable as none of these methods employed in clinical practice have the ability to detect the force of contact, sequence of closure or applied occlusal load when the patient bites on strips of articulation paper or shimstock foils. Studies show these markings do not quantify the occlusal force and time or assess the contact sequence, and that the ink substrate left on the teeth is not an accurate indicator with which to judge a tooth contact’s relative occlusal force (Qadeer et. al., 2012; Carey, Kerstein, & Radke, 2007) (Fig 3). Subjective interpretation of the applied occlusal load based upon the surface appearance characteristics of these traditional occlusal indicators has no scientifically demonstrated capacity to quantify occlusal force levels required to render objective occlusal adjustments.
The goal of a dentist is to establish a well balanced, harmonious occlusion following dental treatment. The repeatable capacity demonstrated by the T-Scan III occlusal analysis system effectively isolates and pinpoints to the modern dental clinician, excessive occlusal force contacts for selection during occlusal balancing procedures to provide successful prosthetic treatment outcome.
Adding modern digital technology to dental practice can put the paper marks into perspective by providing an insight to patient’s occlusion from first point of contact into maximum intercuspation to an accuracy of over 100 frames per second recorded in the form of a movie in realtime window. T-Scan occlusal analysis leaves the guesswork out of dental practice as this evidence based, repeatable, non-subjectice occlusal insight not only enhances the clinician’s ability to make precise adjustments based on measurable data but also engages the patient’s attention through visual, comprehensive information during dental adjustment procedures. T-Scan III digital occlusal analysis technology ensures better patient care in the rapidly changing dental scenario in today’s world of digital technology.
Fig 1. T-Scan III System with Version 8.0 graphi
Fig 2. T-Scan Multi-bite Screen Capture showing 2D, 3D, Graph and Zoom Graph Window
Fig 3. Paper mark misconception
Subjective interpretation based on appearance characteristics of paper marks along side T-Scan occlusal force data. A faint small paper mark on the second molar contains the heaviest force represented in PINK column in T-Scan window, while a bigger paper mark on second premolar shows optimal occlusal force associated with it when analyzed by computerized technology. Which mark would you choose for occlusal adjustments…??