Number and location of occlusal contacts in intercuspal

position
T. W. P. Korioth, B.Od., Cir. Dent.
Vancouver, B.C., Canada

Records of intercuspal position were made in 46 healthy young adults with

morphologically normal occlusions. The observed perforations were analyzed
according to the frequency of occlusal contacts. Most subjects had asymmetric
distribution in number and location of occlusal contacts. Regardless of symmetry, a
significantly higher number of subjects had approximately seven contacts on each
side that were located between all posterior teeth. Contacts were most frequent
between maxillary and mandibular first and second molars. (J PROSTHET DENT
1990;64:206-10.)

I ntsrcuspal position (IP), also called centric occlu-
sion (CO) or habitual occlusion, is the intermaxillary tooth
relationship most often used during the last stages of
chewing. rW4 The frequency of occlusal contact in IP seems
to vary, being greatest and of increased duration during the
last part of mastication.l* 2
Basically two different approaches have been used to
evaluate occlusal contacts in IP. In the first one, the area
of occlusion is quantified on the basis of differences in ra-
diographic densit+ 6and passageof light’s& or air9 through
the interocclusal registration material. Although in some
studies no differences in occlusal surfaces between subjects
were found,6l g it is nevertheless possible to have large vari-
ations in size and location of contacts (for example, perfo-
rations in the interocclusal registration material).g
The second approach attempts to measure the type,
number, and location of occlusal contacts by use of differ-
ent techniques and types of materials such as wax,r”-i4
soot,16 carbon black/oil,16 impression materials,17-1g oc-
clusal registration strips,so-2s or pressure-sensitive de-
vices.26>27
Studies have shown different results for the average
number of posterior contacts in IP, varying between 9.6
contacts (total of 192 posterior contacts in 20 subjects15),
10.8 and 17.6 contacts respectively for light and hard bit-
ing pressure,z1 18.5 (total of 272 posterior contacts in 15
subject@) and 24.8 contacts (total of 248 posterior con-
tacts in 10 subjectsr’j. These data contrast with suggestions
for an ideal normal occlusion (Angle class I), where 24 to 40
contacts are thought to exist between opposing posterior
101112Q274
permanent teeth (including canines), without taking third
molars into account.28-30
Regarding tooth location of posterior contacts in IP, only
a few investigations have examined this variable. Some of
these studies refer to anterior or posterior tooth location
only,ll* l3 whereas others determined the highest number of
contacts to be located on molars.14*lg*22Beyro# found the
occlusal contacts in IP to be distributed bilaterally between
second molars and first premolars in 16 of 24 young Aus-
tralian aborigines, which differs from results in young
Scandinavian adults, where approximately 50 % had asym-
metric distribution of contacts.22 None of the studies,
however, reported an analysis on the distribution pattern
of contacts in IP.
This investigation analyzed the number and location of
occlusal tooth contacts in IP between canines and second
molars in a group of selected young adults with clinically
sound, unrestored natural dentitions. Of special interest
was the presence of symmetry in the distribution of
contacts.
METHODS AND MATERIAL
Forty-five male subjects aged 17 to 24 years were selected
from a group of 752 young healthy adults. The following
criteria were used in the selection:
1. Complete unrestored permanent natural dentition (ex-
cept for missing thiid molars)
2. Bilateral Angle class I first permanent molar and canine
relation with no prior orthodontic treatment
8. Presence of overbite (vertical overlap) and overjet,
(horizontal overlap) with coinciding upper and lower
dental midlines
4. Absence of pathologic periodontal condition
5. Absence of clinical mandibular dysfunction31

206 AUGUST 1890 VOLUME 64 NUMBER 2

OCCLUSION IN INTERCUSPAL POSITION

Table I. Dentition data for 45 subjects

Age (years) Number of teeth Horizontal overlap (mm) Vertical overlap (mm)

Mean Range Mean Range Mean Range Mean Range

20.2 17-24 30 28-32 2.4 2-3.5 2.8 2-4

Table II. Frequency distribution of the number of Table III. Bilateral frequency distribution of the
occlusal contacts in IP number of occlusal contacts in IP
Number Difference in number

1-3 4-6 7-9 10-12 13-15 Total Yes

Subjects No 1 2 3 4 6 Total
Right side 4 10 22 6 3 45
Left side 3 16 19 4 3 45 No. of subjects 6 12 10 9 3 5 45

Horizontal overlap was assessed with an endodontic
ruler from the labial surface of the lower central incisor to
the midpoint of the incisal edge of the upper central inci-
sor. The distance was measured to the nearest 0.5 mm in
the occlusal plane perpendicular to the arch. Where there
was attrition of the upper incisor, measurements were
made to the labial edge of the worn surface.
Vertical overlap was evaluated on the lower central inci-
sor from the incisal edge to the same point as for the hor-
izontal overlap. The reference point was marked with a
sharp pencil. The distance was measured with sliding cal-
lipers to an accuracy of 0.5 mm.
A technique suggested and used by Ingervall,32 using in-
dexes of alginate (irreversible hydrocolloid) impression
material was applied to record the number and location of
posterior occlusal tooth contacts, including canines. The
selected subjects rested their backs and heads on a reclined
dental chair (approximately 30 degrees to the floor). After
spatulation, the impression material was applied to the oc-
clusal surfaces of all lower canines, premolars, and molars
on both sides. Subjects were then instructed to close the
mouth slowly and press the teeth together with light to
moderate pressure until the impression material was set.
All impressions were made at the same period of time dur-
ing the day. After their careful removal, the left and right
indexes were examined against light, and the number and
location of perforations were registered as occlusal tooth
contacts for each subject. The chi-square test was used to
determine any statistically significant differences between
the right and left sides for the observed number and loca-
tion of contacts. A difference was determined to be signif-
icant at p 50.05.
RESULTS
The age distribution and data on the dentition are given
in Table I. The unilateral and bilateral frequency distri-
bution of the number and location of occlusal contacts
was analyzed for subjects and type of contacting tooth
pairs.
Number of contacts
A total of 666 posterior occlusal tooth contacts were re-
corded between canines and molars, 346 contacts for the
right side (mean 7.7 contacts; range: 1 to 15) and 320 for the
left side (mean 7.1 contacts; range: 3 to 14). The unilateral
frequency distribution of the number of contacts is given
in Table II. Approximately 50% of the subjects had
between seven to nine contacts on the riglit side and six to
eight contacts on the left side, the difference in number
of contacts between classes being significant for each side
(p < 0.001). Six subjects had an equal distribution in the
number of contacts between right and left sides, and 39
subjects had differences in number of either one or more
contacts between sides (see Table III). The difference be-
tween subjects with and without bilateml symmetry in
number of occlusal contacts was statistically significant
(p < 0.001).
Location of contacts
Nine subjects had an equal pattern in the location of
contacts between right and left sides and 36 subjects had
differences in location of occlusal tooth contacts between
sides. The difference between subjects with and without
bilateral symmetry of contacts was statistically significant
(p < 0.001).
Because not all of the 45 subjects had third molars in oc-
clusion, the location of contacts was analyzed only between
maxillary and mandibular canines to second molars. Twen-
ty-four different patterns in the location of occlusal con-
tacts between maxillary and mandibular teeth were found,
15 for the right and the left sides (although some were dif-
ferent between sides) and four patterns bilaterally (Table

THE JOURNAL OF PROSTHETIC DENTISTRY 207

 KORIOTH

Table IV. Frequency distribution of the location of occluaal contacts in IP

Location of contacts

Maxillary Mandibular Subjects

Pattern C Pm1 Pm2 Ml MS C Pm1 Pm2 Ml MI Right side Left side Bilateral

1
2
@
@ @
@
@
@ @-- @
@
@
@
@
@
3
4 - @
@ :@ @ @
@
@
@
5
6
@
-
@
@ --
@
-
@
@

--
I @ @ @
8
9
@
@ - @
@
@
@
10
11 : @
zi @
@
-
@
@
@
12
13 @”
@
@
@
@- @ @
@
@ @
@
14
15 @
@
@
- @ @ -
@ @ @
@
16
17 @ @
@
@
@
@
@
@
@
- 1
18
@ @
@ - @ @
- --
19 - @ - -
20
21
@
@
-@ -
@
-
@
@
1
1
22
23
24
@
-
@
@ @ z @
-
@
-
@
@
1
1
1
-
Total ii 3s s
@ Denotes contacting tooth; - denotes noncontacting tooth; C, canine; Pm, premolar; M, molar.

Table V. Frequency distribution of the type of contacting tooth pairs according to number of contacts in IP
Type of contacting tooth pairs

Superior C C Pm1 Pm1 Pm2 Pm2 Ml Ml Ma M2 MS

h pi pA pi Ph I I I I I I
Inferior 1 1 2 2 MI MI M2 M2 MS MS

Subjects(n = 45)
Right side contacts One 14 16 20 19 22 22 19 16 14 5 5
TWO 1 3 2 2 4 1 14 3 14 1 2
Three - - - - - - 6 - 11 - 2
Four - - - - 1 - 1 - 1 - -
Five _ _ - _ _ _ 1 - - - -
Six - 1 - - - -
Total 15 19 22 21 27 23 42 19 40 6 9

Left side contacts One 9 10 17 23 16 19 14 13 17 3 9

TWO 1 - 3 - 6 1 17 3 16 - 3
Three - - - - - - 9 - 9 - 1
Four _ - _ - - - 2 - - - -
Five - - 1 - -
Total 10 10 20 23 32 20 42 16 43 3 13

C, Canine; Pm, premolar; M, molar.

208 AUGUST 1020 VOLUME 64 NUMBER 2

OCCLUSION IN INTERCUSPAL POSITION
IV). On the right side, among the most frequent patterns
found were those that involved contacts between maxillary
and mandibular adjacent teeth, from canines to second
molars inclusive (nine subjects), followed in decreasing or-
der by patterns that involved contacts between maxillary
canines to second molars and mandibular first premolars to
second molars (eight subjects), and those with contacts be-
tween maxillary and mandibular premolars and molars. On
the left side, among the most frequent patterns found were
those involving maxillary canines to second molars and
mandibular premolars and molars (six subjects), followed
by five subjects who had contacts between maxillary and
mandibular adjacent premolars and molars. The difference
in location of contacts between patterns was significant for
the right side (p < 0.001) and nonsignificant for the left
side (0.10 < p < 0.25).
Type of contacting tooth pairs
In this study, contacts involving permanent teeth only
were found between 11 different types of contacting tooth
pairs on each side (Fig. l), although up to 24 pairs have been
described for mixed deciduous and permanent dentition.32
Regarding the location of contacts, most subjects had
contacts between maxillary and mandibular first molars
and second molars on both sides. On the right side, there
was a slightly higher frequency of contacting first molars
(42 subjects) when compared to the left side where the sec-
ond molars were the most frequent type of contacting tooth
pairs (43 subjects). These frequencies were followed in de-
creasing order by maxillary and mandibular premolars,
first and second molars, canines and first premolars, and
finally maxillary and mandibular canines.
Because a contact is formed by two opposing tooth sur-
faces, and none, one, or several contacts may occur between
these surfaces, the number of contacts was also examined
according to type of contacting teeth. The highest number
of contacting tooth pairs had one contact, followed in
decreasing order by those with two, three, four, and five
contacts, respectively (see Table V). Only one pair of con-
tacting first molars showed six contacts. Maxillary and
mandibular pairs of first and second molars showed the
highest variety in number of contacts, with the presence of
one to three contacts on each type of tooth pair quite fre-
quent.
DISCUSSION
Measurement of occlusal contacts by visual examination
alone does not seem to be a valid method. Some type of
material interposed between upper and lower tooth arches
must be used to reflect contacting teeth, but at the same
time, the material should be as thin and precise as
possible.33p34In selecting an impression materials such as
irreversible hydrocolloid for this study, a small setting time
and good reproducibility was meant to be ensured.32Other
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 1. Lateral view of maxillary and mandibular dental
arches in contact. Dotted lines indicate 11 different types
of contacting tooth pairs (C, canine; Pm, premolar; M, mo-
lar).
than the type and thickness of occlusal marking devices,
relevant variables such as bite force,s1p22 head/body
posture,12,35 and time6pg,20,23 should also be taken into
consideration.
In a study where the number of occlusal tooth contacts
in IP was compared between subjects using light and hard
bite force, a significantly smaller number of contacts was
found at light pressure.21On the other hand, it seems that
changing head posture in the sagittal plane results in an
alteration in the habitual closing pattern.35 Graded changes
in body position toward an upright position and unilateral
electrical stimulation of the superficial masseter muscle
resulted in an increase and a more forward location of oc-
clusal contacts in IP.12
In the present investigation of young adults with mor-
phologically normal occlusion and a relative absence of
symptoms of functional disturbances of the masticatory
system, most subjects had asymmetry in number and loca-
tion of occlusal contacts in IP. Although in this study the
posture and time variables were held constant, no attempt
was made to control the bite force, which might have been
a possible source of variability in the results. This is par-
tially opposed by the finding that the asymmetric distri-
bution of contacts does not necessarily change significantly
at hard pressure.22
A recent study has shown a higher electromyographic
activity of the masseter muscle at the side with the higher
number of tooth contacts.36 Although it is tempting to cor-
relate occlusal asymmetry with epidemiologic findings of
muscle or articular dysfunction, caution is advocated in
doing so, because the selected sample in the present inves-
tigation was apparently symptom-free. Asymmetry is bet-
ter interpreted as a reflection of variability within the pop-
ulation.
Regardless of the observed asymmetric frequency distri-
bution of the number and location of contacts between
subjects, a significantly higher number of subjects had ap-
proximately seven contacts on the right and left sides, lo-
cated usually between maxillary and mandibular canines to
second molars on the right side and maxillary canines to
209
OCCLUSION IN INTERCUSPAL POSITION
second molars and lower premolars and molars on the left
side. These results seem to substantiate the definition of IP
as the intermaxillary relationship with a relatively high
number of contacts between all contacting posterior teeth,
including the canines. 20They do not support the conten-
tion, however, that for young adults with morphologically
good and complete dentitions, the number of contacts
should be as high as 24 or even 40.18v28-30Moreover, there
seems to be no difference in number of contacts between
first and.second molars. These, however, are the tooth pairs
most frequently contacting in IP.
As many as six contacts per contacting tooth pair of mo-
lars were found. It is difficult to compare these results with
the proposed numbers of contacts by others,18p2gbecause
the number of contacts probably depends on the type of
occlusal marking device used. Although the determination
of the type of contact (for example, tripodal centric stop)
was beyond the scope of this study, it is nevertheless pos-
sible that irreversible hydrocolloid indexes do not have
suihcient strength and sensitivity to detect those.
CONCLUSIONS
Asymmetric distribution in the number and location of
occlusal tooth contacts during IP between normal subjects
with morphologically good occlusions is frequent.
The moat frequent contacting pair of teeth are the max-
illary and mandibular first molars and second molars, and
the least frequent contacting tooth pair in intercuspal po-
sition is formed by maxillary and mandibular canines.
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Reprint requests to:
DR. T. W. P. KORIOTH
2199 WFSBROOK MALL
VANCOUVER, B.C. V6T 127
&MDA
AUGUST 1980 VOLUME 64 NUMBER 2