Journal of Oral Rehabilitation 1999 26; 932–935
Occlusal force distribution on the dental arch during
various levels of clenching
H. KUMAGAI*, T. SUZUKI†, T. HAMADA*,
H. NIKAWA* *Department of Prosthetic Dentistry, School of Dentistry, Hiroshima University, Hiroshima, †Department of Geriatric
Dentistry, Faculty of Dentistry, Tokyo Medical and Dental University, Tokyo, Japan, and ‡Department of Operative Dentistry, School of
Dentistry, Hiroshima University, Hiroshima
SUMMARY The purpose of this study was to explore
the occlusal force distribution on the dental arch in
the intercuspal position and to evaluate the rela-
tionship between the clenching strength and the
occlusal force distribution. These variables were
recorded using the Dental Prescale System in 16
healthy young adults. The number of tooth con-
tacts, occlusal force and occlusal contact area in-
creased linearly as clenching strength increased.
The distribution of the occlusal force was greatest
Introduction
Understanding the nature of contacts is important for
the better diagnosis and treatment of stomatognathic
diseases (Ehrlich & Taicher, 1981). Occlusal equi-
librium in the intercuspal position especially, is of great
importance. Regarding the number and the area of
occlusal contact in the intercuspal position, some in-
vestigations have examined this variable (Korioth,
1990). However, few researchers reported an analysis
on the distribution pattern of occlusal contacts in the
intercuspal position (Korioth & Hannam, 1994; Sato,
1997).
In clinical research on occlusion, various techniques
are used to assess the nature of occlusal contacts in the
intercuspal position (Battistuzzi, Eschen & Peer, 1982).
However, few techniques can make quantitative analy-
sis of occlusal contact area and occlusal force.
The Dental Prescale System* is able to make quanti-
tative analysis of occlusal contact area and occlusal
* Fuji Photo Film, Tokyo, Japan.
© 1999 Blackwell Science Ltd
P. SONDANG*, M. FUJITANI‡ &
at the molar region followed by the premolar and
anterior teeth region. The proportion of occlusal
force (occlusal force at each region/total occlusal
force) on molar regions increased as clenching
strength increased. On the contrary, the proportion
of occlusal force on the premolar and anterior teeth
regions decreased as clenching strength increased.
These findings suggest that control of occlusal force
is important in diagnosis of the nature of occlusal
contacts.
force at every contact point. Dental Prescale is flexible
and permits natural occlusion and prevents mandibular
displacement during clenching (Suzuki et al., 1997).
The purpose of this study was to evaluate the oc-
clusal force distribution on the dental arch during vari-
ous levels of clenching measured by the Dental
Prescale System.
Materials and methods
Thirteen males and three females with an average age
of 23·2 years were selected as subjects. All of the sub-
jects had complete dentition without third molars, and
none of them had signs or symptoms of cran-
iomandibular disorders. The subjects understood the
nature of the research project and consented to
participate.
The subjects were asked to clench in the intercuspal
position at 20, 40, 60, 80 and 100%, respectively, of
the maximum voluntary contraction (MVC) of the
masseter muscles for 2 s. The subjects were able to
932
 O C C L U S A L F O R C E D I S T R I B U T I O N O N T H E DE N T A L A R C H 933

dental arch. The recordings were repeated five times in

every condition.
The dental arch of each subject was divided into five
regions, right-molar, right-premolar, anterior teeth, left-
premolar and left-molar region. The location of tooth
contacts on the Dental Prescale were identified by
polyether interocclusal records†.
Three parameters, occlusal force, occlusal contact
area, and proportion of occlusal force in each region of
the dental arch were analysed. The proportion of oc-
clusal force was calculated using the formula:

Proportion of occlusal force =

occlusal force in each region/total occlusal force.

Two-way ANOVAs were performed to find whether

Fig. 1. The number of occlusal contacts during various levels of
clenching.
control their electromyographic (EMG) level through
visual feedback by looking at a voltmeter displaying the
summated rectified EMG signal of both masseter mus-
cles. The subjects rested for 3 min between each clench-
ing condition to avoid muscle fatigue. The subjects were
seated in a relaxed upright position with the Camper’s
plane orientated horizontally. The occlusal force distri-
bution was recorded in the intercuspal position by the
Dental Prescale System, which consists of pressure sen-
sitive sheets (Dental Prescale) and an analysing com-
puter (Occluzer). On occlusion, the midline of the
Dental Prescale was matched with that of the subject’s
statistically significant differences were present between
the variables on the dental arch and clenching strength.
Results
The number of occlusal contacts during various levels of
clenching is shown in Fig. 1. The number of
tooth contacts increased linearly as clenching strength
increased. The distribution of the occlusal force was
greatest at the molar region followed by the premolar
and anterior teeth region (Table 1, Fig. 2). The occlusal
force and occlusal contact area increased linearly as
clenching strength increased (Figs 2 and 3). The distribu-
tion of the occlusal contact area was similar to that of
the occlusal force. The relationship between clenching
strength and the proportion of occlusal force on

Table 1. Mean value and standard deviation of occlusal force and occlusal contact area

Clenching strength

20% 40% 60% 80% 100%

Occlusal force (N) R-molar 72·2 9 61·4 122·9991·6 200·5 9136·2 247·1 9144·6 365·29 159·0 **
R-premolar 20·0 9 22·6 29·7928·1 41·9 9 37·9 51·3945·8 64·59 46·3 **
Anterior teeth 27·8 9 43·8 33·8945·3 42·2 9 54·2 51·7957·3 65·39 54·4 **
L-premolar 13·39 18·0 21·7923·3 31·5 9 32·6 45·3 942·7 56·99 49·7 **
L-molar 58·0953·3 108·1987·8 180·29 129·8 235·7 9142·1 353·49 171·9 **

Occlusal contact area (mm2) R-molar 1·9 9 1·7 3·592·7 5·6 9 4·0 7·094·3 10·0 94·9 **
R-premolar 0·5 9 0·6 0·79 0·8 1·1 91·1 1·391·2 1·7 91·3 **
Anterior teeth 0·79 1·2 0·991·4 1·19 1·7 1·5 91·9 1·8 92·1 **
L-premolar 0·390·4 0·690·7 0·8 90·9 1·2 91·2 1·5 91·4 **
L-molar 1·6 91·5 3·292·7 5·3 9 4·0 6·894·4 9·5 95·2 **

** PB0·01.
†
Ramitec, ESPE, Seefeld, Germany.

© 1999 Blackwell Science Ltd, Journal of Oral Rehabilitation 26; 932 – 935
934 H . K U M A G A I et al.
Fig. 2. The occlusal force during various levels of clenching.
Fig. 3. The occlusal contact area during various levels of clench-
ing.
each region of the dental arch is shown in Fig. 4 and
Table 2. The proportion of occlusal force on molar
regions increased as clenching strength increased. On
the contrary, the proportion of occlusal force on the
premolar and anterior teeth region decreased as
clenching strength increased.
Discussion
Occlusal contacts in the intercuspal position have sig-
nificance in the analysis of dental health. The evalua-
© 1999 Blackwell Science Ltd, Journal of Oral Rehabilitation 26; 932–935
tion of the area and force of occlusal contact is helpful
for diagnosing the occlusal state of patients.
Recently some diagnostic devices have been devel-
oped such as photocclusion (Amsterdam, Purdum, &
Purdum, 1987), the T-scan system (Maness et al., 1987)
and the Dental Prescale System (Suzuki et al., 1997)
using image analysis technology. The photocclusion
system uses a rather rigid material for occlusal exami-
nation, making it difficult to measure the acting oc-
clusal force precisely. The T-scan system has been
criticized as offering only a narrow measurement range
for the occlusal force, a sensitivity that varies at differ-
ent measuring locations, and a rigid sensor structure
that could invite mandibular dislocation during clench-
ing. Suzuki et al. (1997) reported that the Dental
Prescale System has some advantages as follows: (1)
the thin material induces only a small change in the
occlusal vertical dimension, making measurements at a
position near the intercuspal position possible; (2) it is
not necessary to prepare special measurement equip-
ment; (3) many patients may be evaluated in a short
period of time; (4) record storage, even for an extended
period, is simplified; and (5) it is easy to explain the
treatment to patients by using dental images.
Riise (1982) found that there was a smaller number
of occlusal contacts at light pressure than at hard pres-
Fig. 4. The proportion of occlusal force on each region during
various levels of clenching.
 O C C L U S A L F O R C E D I S T R I B U T I O N O N T H E DE N T A L A R C H 935

Table 2. Mean value and standard deviation of proportion of occlusal force

Clenching strength

20% 40% 60% 80% 100%

Proportion of occlusal force (%) R-molar 34·1 9 18·4 35·6913·5 38·0 9 11·1 36·2911·3 39·0 99·6 **
R-premolar 12·5 9 16·8 9·999·0 8·81 9 7·4 8·396·5 7·1 94·4 **
Anterior teeth 16·8 921·2 12·99 13·8 10·3 911·4 10·79 13·0 9·1 9 10·8 **
L-premolar 8·8 9 14·2 8·5910·0 7·6 9 8·2 7·797·0 6·9 96·5 n.s.
L-molar 27·8 920·0 32·79 18·1 35·1 917·0 35·39 14·9 37·7 9 11·9 **

** PB0·01.
n.s., no significance (P\0·05).

sure in the habitual intercuspal position and concluded
that the aim of occlusal adjustment should be to bring
the number of occlusal contacts in light pressure to
equal that in hard pressure. Kim et al. (1997) reported
that the number of tooth contacts in the intercuspal
position is significantly increased as clenching strength
is increased. In the present study, in which occlusal
force distributions during various levels of clenching
were measured, there was a linear relationship be-
tween clenching strength and some parameters (num-
ber of contacts, occlusal force, occlusal contact area).
This suggests that control of occlusal force is important
in diagnosis of the nature of occlusal contacts.
Ehrlich & Taicher (1981) found the predominance of
supercontacts on the second molars when compared to
the remains of dentition. The study by Korioth & Han-
nam (1994), in which the static bites on a three-di-
mensional finite element model of the human
mandible were simulated, found that the highest oc-
clusal forces were predicted for more posterior tooth
locations during intercuspal clenching. The study by
Sato (1997), in which distribution of occlusal forces on
a dental arch at various clenching strengths were mea-
sured by the Dental Prescale System, concluded that
the distribution of the occlusal force was greatest on
the tooth located more posteriorly in the dental arch.
This study demonstrated a similar tendency.
Sato (1997) in a study of six subjects, reported that
the proportion of occlusal force on each tooth was
stable irrespective of the magnitude of clenching
strength. In contrast, the proportion of occlusal force
on molar regions increased and decreased on premolar
and anterior teeth as clenching strength increased in
this study. The different findings are due to an increase
in the number of subjects. Distribution of occlusal force
on a dental arch should be considered from a view-
point of movement of teeth, distortion of the mandible,
positional relationship between bone and muscle, and
the thickness of measuring device. More data will be
needed before the clinical implications of these findings
become clear.
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Correspondence: Dr Hiroshi Kumagai, Department of Prosthetic
Dentistry, School of Dentistry, Hiroshima University, 1-2-3, Ka-
sumi, Minami-ku, Hiroshima 734-8553, Japan. E-mail: ku-
magero@ipc.hiroshima-u.ac.jp

© 1999 Blackwell Science Ltd, Journal of Oral Rehabilitation 26; 932 – 935