Digital Occlusal Force Distribution Patterns (DOFDPs): Theory and Clinical Consequences

Digital Occlusal Force Distribution Patterns (DOFDPs): Theory and Clinical Consequences

Robert C. Supple, DMD (Private Practice, USA)
DOI: 10.4018/978-1-4666-6587-3.ch019
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This chapter describes the many clinical applications of Digital Occlusal Force Distribution Patterns (DOFDPs) recorded with the T-Scan Computerized Occlusal Analysis system. Movements made by the Center of Force trajectory as force travels around the dental arches during the occlusion and disocclusion creates these patterns. The repetitive occlusal contact data points locate the force distribution received when teeth occlude against each other. These force distribution patterns correlate to intraoral compromised dental anatomy found in radiographs, photographs, and during the clinical examination of teeth and their supporting tissues. Moreover, they directly influence the envelope of motion, the envelope of function, and head and neck posture. This chapter illustrates with clinical examples the correlation between Stomatognathic System structural damage and repeating patterns of abnormal occlusal force distribution. The T-Scan technology isolates these damaging regions of excess microtraumatic occlusal force, absent of clinician subjectivity, thereby helping clinicians make an accurate, organized, and documented occlusal diagnosis.
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Technological Innovation and Dental Medicine

New paradigms brought on by technological advances offer fresh perspectives and solutions to old problems. As an example, the Hubble telescope is a technological advance that changed humanity’s perception of the universe (Figure 1). Concepts evolve over years or decades, and sometimes over centuries. Technology can validate concepts developed by master teachers of the past, not by seeking to change the definition or the parameters of a concept, but rather to provide undeniable proof of a concept’s inherent soundness.

Figure 1.

T-Scan Sensor technology and Hubble Telescope were both major innovations in their respective disciplines, because they made visible what was previously invisible

The science of occlusion has developed using traditional, accepted definitions (contained within the Glossary of Prosthodontic Terms) as a method of standardizing the interpretation of concepts related to the Stomatognathic system. Traditional occlusion is the study of spatial relationships that uses non-digital tools, such as stone casts, facebow transfers, and articulators, to assess these spatial relationships. Modern dental technologies, such as digital photography and radiology, enhance the diagnosis made with traditional, non-digital methods, which then further develop the science.

Digital applications will continue to grow as dental professionals keep finding ways of incorporating technology into the diagnosis and treatment of many dental conditions. Implementation must be simple, make sense to patients, and motivate them to seek comprehensive treatment. Digital data should also be affordable, productive, organized, and practical for clinicians to employ. Currently, digital technologies assist during diagnosis, treatment sequencing, and treatment. They also electronically document, educate, and monitor patient progress. Specialized software applications can image, design, and fabricate restorations while facilitating future diagnostic and treatment innovations. In Dental Medicine’s digital evolution, computer-based applications are becoming instruments of change. Ultimately, economic benefits that provide a win-win situation for both patients and practitioners will transform evolution into revolution, providing Dental Medicine with new and innovative solutions.

In the oral cavity, articulating paper is the “Standard of measurement” used by every dentist worldwide, to “measure” and analyze occlusal contact pressure. Interestingly, articulating paper does not actually measure occlusal force or occlusal contact pressure (Carey et. al., 2007; Saad, et. al., 2008; Qadeer et. al., 2012), but is widely believed (surprisingly) to be able to do that by its appearance characteristics. Presently, no published study shows articulating paper markings can measure occlusal force.

Alternatively, the T-Scan system’s recording sensor (HD Sensor, Tekscan Inc., S. Boston, MA, USA) transcends the analog generation of occlusal tools by acquiring differing relative occlusal contact force levels from all contacting teeth, thereby removing the occlusal contact force, pressure, and timing information from within the oral cavity, and displaying it on a computer monitor for instantaneous clinician viewing and analysis. In the same way that telescopes and microscopes opened our eyes to objects that had never been seen before to produce new theories that challenged our imaginations, the T-Scan technology opens new perspectives and possibilities for occlusal research, while offering occlusal solutions for every clinician who marks occlusal contacts with articulating paper, and then chooses the contacts for treatment by subjectively interpreting the marking’s appearance (Kerstein & Radke, 2013).

Today’s reality for diagnosing and improving the Standard of patient care, is correctly oriented and sized data images that are viewable in multiple dimensions. Diagnostic relative occlusal force scans record high-quality data measurements which are then archived in clinical records. With the T-Scan technology (Version 8, Tekscan Inc., S. Boston, MA, USA), form, function, and anatomy in motion can be imaged in a video format that explores the possibilities of advancing occlusal knowledge, while achieving healthy, efficient, occlusal function for patients.

Key Terms in this Chapter

Digital Occlusion: The applied concept of using digital technology to diagnose and treat the envelope of motion and the envelope of function.

Plane of Occlusion: The 3-Dimensional occlusal plane is a wave-like shape that is unique to every individual. Force cycle patterns highlight the mandible’s challenge in engaging the maxillary occlusal plane efficiently.

Measure, Predict, and Prevent: Adult force distribution patterns measure resistance to the mandible’s favored pathway within the envelope of function. Elevated and prolonged force intensity often can predict the location of where pathology to the system and to the anatomy, will likely evolve. The concept of prevention is to identify and correct pathologic force before destruction occurs.

Condylar Orientation (The First Determinant of Occlusion): Healthy condylar function and posterior force distribution are balanced vertically, horizontally, and transversely.

Force Cycle: The occlusal force transfer from the mandible to the maxilla during the entire occlusion-occlude-disocclusion process, which captures the intensity, direction, and sequence of every occlusal contact, and creates a patient’s unique force distribution pattern. It can also be described as the summation of all frames of occlusal force that evolve from the first occlusal contact into MIP, until the last contact out of MIP. A force cycle defines the recorded envelope of force that occurs within the envelope of function.

Anterior Controls: The first points of contact (tooth, teeth, or prosthetic dentistry) anterior to the condyles when the mandible engages the occlusal plane.

Anterior Orientation (The Second Determinant of Occlusion): The front half of the arch should be free of occlusal interference and function in harmony with the envelope of motion.

Occlusion, Occlude, and Disocclusion: The three phases of a force distribution cycle within the mandible’s envelope of function during its engagement (occlusion), at stopping time (occlude), and during its release (disocclusion). Each patient “tap” onto a sensor records all three phases.

Favored Pathway: The mandible has an engrained anatomic envelope of motion that favors a path of least resistance. An unbalanced force distribution in function alters the system’s preferred mandibular pathway. The orientation of the mandible’s favored pathway is determined by contributory anatomic factors; the head and neck posture, the condylar position, the posterior occlusal plane, and the anterior occlusal plane.

Equilibrium: The Stomatognathic system seeks equilibrium throughout a lifetime of function. Motion in harmony with design provides the best chance for the system to maintain physiologic function. Maintaining or recreating harmony between motion, function, and design over time, is the ultimate goal when seeking equilibrium for Stomatognathic therapy.

Occlusal Interference: In analog dentistry, interference is not defined. In digital dentistry, data defines the intensity, duration, and sequence of every contact point. Cusps and grooves that are not in harmony with an efficient envelope of function can now be identified, studied, and corrected.

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