Ebook Handbook of research on computerized occlusal analysis technology applications in dental medicine: Part 1

Part 1 book “Handbook of research on computerized occlusal analysis technology applications in dental medicine” has contents: Evolution of the T-Scan technology, the T-scan 8 system, clinical use technologies that complement the T-scan system in daily dental practice, occlusal trauma and computerized occlusal analysis.

Former clinical professor at Tufts University School of Dental Medicine, USA

& Private Dental Practice Limited to Prosthodontics and Computerized Occlusal Analysis, USA

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Handbook of Research on Computerized Occlusal Analysis Technology Applications in Dental Medicine / Robert Kerstein, editor

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Includes bibliographical references and index

ISBN 978-1-4666-6587-3 (hardcover) ISBN 978-1-4666-6588-0 (ebook) ISBN 978-1-4666-6590-3 (print & perpetual access)

I Kerstein, Robert B., editor

[DNLM: 1 Malocclusion diagnosis 2 Dental Occlusion 3 Dental Stress Analysis instrumentation 4 Image ing, Computer-Assisted methods 5 Jaw Relation Record instrumentation 6 Malocclusion radiography WU 440] RK523

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Handbook of Research on Computerized Occlusal Analysis Technology Applications in Dental Medicine

Robert B Kerstein, DMD (Former clinical professor at Tufts University School of Dental Medicine, USA & Private Dental Practice Limited to Prosthodontics and Computerized Occlusal Analysis, USA)

Medical Information Science Reference • copyright 2015 • 1093pp • H/C (ISBN: 9781466665873) • US $475.00 (our price)

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Applications, Challenges, and Advancements in Electromyography Signal Processing

Ganesh R Naik (University of Technology Sydney (UTS), Australia)

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Innovative Technologies to Benefit Children on the Autism Spectrum

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Assistive Technology Research, Practice, and Theory

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Disability Informatics and Web Accessibility for Motor Limitations

Georgios Kouroupetroglou (University of Athens, Greece)

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Ray Becker, Baltimore College of Dental Surgery, USA

Julia Cohen-Levy, Paris 7 University, France

Tom Coleman, SUNY at Buffalo School of Dental Medicine, USA

Sushil Koirala, Mysore University, India & National Dental Hospital Complex, Nepal & Vedic Institute

of Smile Aesthetics (VISA), Nepal & Thammasat University, Thailand

Bernd Koos, University Medical Center Schleswig-Holstein, Germany

Sarah Qadeer, Thammasat University, Thailand

John Radke, BioResearch Associates, Inc., USA

Roger Solow, University of the Pacific School of Dentistry, USA

List of Reviewers

Nick Yiannios, Private Practice, Rogers, Arkansas, USA

Rob Anselmi, McGill University, Canada & Tekscan, Inc Boston, Massachusetts, USA

Anselmi, Robert / McGill University, Canada10.4018/978-1-4666-6587-3.ch004::2 10.4018/978-1-4666-6587-3.ch004::295

Becker, DDS, FAGD, Ray M / International Certifying and Interpretation Instructor of the Total

BioPAK System, Private Practice, USA10.4018/978-1-4666-6587-3.ch006::1 10.4018/978-1-4666-6587-3.ch006::1215

Cohen, DDS, MS, PhD, Nicolas / Private Practice, France & University of Paris, France10.4018/978-1-4666-6587-3.ch018::1 10.4018/978-1-4666-6587-3.ch018::1791

Cohen-Levy, DDS, MS, PhD, Julia / Private Practice, France10.4018/978-1-4666-6587-3.ch011::1 10.4018/978-1-4666-6587-3.ch011::1523

Coleman, DDS, Thomas A / Private Practice, USA10.4018/978-1-4666-6587-3.ch009::1 10.4018/978-1-4666-6587-3.ch009::1429

Droter, DDS, John R / The Pankey Institute, USA10.4018/978-1-4666-6587-3.ch015::1 10.4018/978-1-4666-6587-3.ch015::1672

Kerstein, DMD, Robert B / Former Clinical Professor at Tufts University School of Dental

Medicine, USA & Private Dental Practice Limited to Prosthodontics and Computerized

Occlusal Analysis, USA10.4018/978-1-4666-6587-3.ch001::1 10.4018/978-1-4666-6587-3.ch001::11,10.4018/978-1-4666-6587-3.ch004::195,10.4018/978-1-4666-6587-3.ch007::1269

Kim, DDS, MS, PhD, Jinhwan / Seoul National University, South Korea & Oneday Dental

Clinic, South Korea & Theodental Ltd., South Korea10.4018/978-1-4666-6587-3.ch012::1 10.4018/978-1-4666-6587-3.ch012::1562

Koirala, Sushil / Thammasat University, Thailand & Vedic Institute of Smile Aesthetics (VISA),

Nepal10.4018/978-1-4666-6587-3.ch020::1 10.4018/978-1-4666-6587-3.ch020::1905

Koos, Bernd / University Medical Center Schleswig-Holstein, Germany10.4018/978-1-4666-6587-3.ch003::1 10.4018/978-1-4666-6587-3.ch003::165

Qadeer, BDS, MSD, Sarah / Thammasat University, Rangsit Campus, Thailand10.4018/978-1-4666-6587-3.ch002::1 10.4018/978-1-4666-6587-3.ch002::136

Radke, BM, MBA, John C / BioResearch Associates, USA10.4018/978-1-4666-6587-3.ch005::1 10.4018/978-1-4666-6587-3.ch005::1153

Sierpińska, Teresa / Medical University of Bialystok, Poland10.4018/978-1-4666-6587-3.ch010::1 10.4018/978-1-4666-6587-3.ch010::1467

Solow, DDS, Roger / The Pankey Institute, USA10.4018/978-1-4666-6587-3.ch013::1 10.4018/978-1-4666-6587-3.ch013::1602,10.4018/978-1-4666-6587-3.ch014::1649

Stevens, DDS, Christopher J / Private Practice, USA10.4018/978-1-4666-6587-3.ch016::1 10.4018/978-1-4666-6587-3.ch016::1705

Supple, DMD, Robert C / Private Practice, USA10.4018/978-1-4666-6587-3.ch019::1 10.4018/978-1-4666-6587-3.ch019::1830

Westersund, DDS, Curtis / ICCMO, Canada10.4018/978-1-4666-6587-3.ch017::1 10.4018/978-1-4666-6587-3.ch017::1744

Yiannios, DDS, Nick / Private Practice, USA10.4018/978-1-4666-6587-3.ch008::1 10.4018/978-1-4666-6587-3.ch008::1358

Foreword 10.4018/978-1-4666-6587-3.chfwd xix

Preface 10.4018/978-1-4666-6587-3.chpre xxii

Acknowledgment 10.4018/978-1-4666-6587-3.chack xxviii

Chapter 2 10.4018/978-1-4666-6587-3.ch002

The.Limitations.of.Traditional.Non-Digital.Occlusal.Indicators.When.Compared.to.the.T-Scan.Computerized.Occlusal.Analysis.Technology 3610.4018/978-1-4666-6587-3.ch002

Sarah Qadeer, BDS, MSD, Thammasat University, Rangsit Campus, Thailand 10.4018/978-1-4666-6587-3.ch002::1

Thomas A Coleman, DDS, Private Practice, USA 10.4018/978-1-4666-6587-3.ch009::1

Clinic, South Korea & Theodental Ltd., South Korea 10.4018/978-1-4666-6587-3.ch012::1

Curtis Westersund, DDS, ICCMO, Canada 10.4018/978-1-4666-6587-3.ch017::1

Foreword 10.4018/978-1-4666-6587-3.chfwd xix

Preface 10.4018/978-1-4666-6587-3.chpre xxii

Acknowledgment 10.4018/978-1-4666-6587-3.chack xxviii

Robert B Kerstein, DMD, Former Clinical Professor at Tufts University School of Dental

Medicine, USA & Private Dental Practice Limited to Prosthodontics and Computerized Occlusal Analysis, USA 10.4018/978-1-4666-6587-3.ch001::1

Since.its.inception.in.1984,.Computerized.Occlusal.Analysis.technology.has.revolutionized.both.dental.Occlusal.Science.and.daily.clinical.practice,.by.bringing.objective.precision.measurement.to.the.largely.subjectively.analyzed.Dental.Medicine.discipline.of.Occlusion The.evolution.of.this.technology.has.required.much.iteration.over.the.past.30.years.beginning.with.T-Scan.I,.then.T-Scan.II.for.Windows®,.to.T-Scan.III.with.Turbo.recording,.to.the.present.day.version.known.as.T-Scan.8 Numerous.authors.since.the.mid-1980s.have.studied.the.various.T-Scan.versions,.which.inspired.the.manufacturer.to.improve.the.hardware.and.its.recording.sensors.to.be.more.accurate,.repeatable,.and.precise The.software.has.also.evolved.such.that.the.present.day.T-Scan.8.includes.many.high-tech.measurement.tools.that.aid.the.clinician.in.diagnosing.and.treating.a.wide.range.of.occlusal.abnormalities This.chapter’s.specific.aims.are.to.detail.the.evolution.of.the.differing.T-Scan.system.versions.while.describing.the.many.scientific.studies.that.inspired.important.system.improvements.to.the.T-Scan’s.accuracy.and.repeatability.from.version.to.version.10.4018/978-1-4666-6587-3.ch001

Chapter 2 10.4018/978-1-4666-6587-3.ch002

The.Limitations.of.Traditional.Non-Digital.Occlusal.Indicators.When.Compared.to.the.T-Scan.Computerized.Occlusal.Analysis.Technology 3610.4018/978-1-4666-6587-3.ch002

Sarah Qadeer, BDS, MSD, Thammasat University, Rangsit Campus, Thailand

Section 2 10.4018/978-1-4666-6587-3.chs02

The T-Scan 8 System 10.4018/978-1-4666-6587-3.chs02

Chapter 4 10.4018/978-1-4666-6587-3.ch004

T-Scan.8.Recording.Dynamics,.System.Features,.and.Clinician.User.Skills 9510.4018/978-1-4666-6587-3.ch004

Robert B Kerstein, DMD, Former Clinical Professor at Tufts University School of Dental

Medicine, USA & Private Dental Practice Limited to Prosthodontics and Computerized Occlusal Analysis, USA 10.4018/978-1-4666-6587-3.ch004::1

Robert Anselmi, McGill University, Canada 10.4018/978-1-4666-6587-3.ch004::2

Chapter 6 10.4018/978-1-4666-6587-3.ch006

Joint.Vibration.Analysis.(JVA) 21510.4018/978-1-4666-6587-3.ch006

Ray M Becker, DDS, FAGD, International Certifying and Interpretation Instructor of the

Total BioPAK System, Private Practice, USA 10.4018/978-1-4666-6587-3.ch006::1

This.chapter.describes.Joint.Vibration.Analysis.(JVA).technology.that.assesses.pathological.changes.that.can.occur.within.the.Temporomandibular.joints Joint.Vibration.Analysis.(JVA).uses.tissue.accelerometers.to.objectively.capture.vibrations.given.off.by.structurally.compromised.internal.TM.Joint.anatomy The.structural.breakdown.leads.to.altered.mandibular.movement.patterns.during.chewing.function Different.attributes.of.representative.JVA.vibrations.have.been.shown.to.indicate.the.presence.of.various.disease.states.often.seen.within.the.Temporomandibular.Joint.complex After.being.recorded,.the.JVA.software.displays.the.various.vibration.waveforms.for.clinician.analysis.to.determine.the.specific.internal.derangement.present This.chapter.provides.an.overview.of.the.various.vibratory.waveforms.that.indicate.TM.Joint.pathology.and.illustrates.the.utility.of.Joint.Vibration.Analysis.as.a.Temporomandibular.Joint.diagnostic.adjunct.10.4018/978-1-4666-6587-3.ch006

Chapter 9 10.4018/978-1-4666-6587-3.ch009

Detecting.and.Quantifying.Cervical.Dentin.Hypersensitivity.Using.Air.Indexing.Combined.with.the.T-Scan.System 42910.4018/978-1-4666-6587-3.ch009

Thomas A Coleman, DDS, Private Practice, USA 10.4018/978-1-4666-6587-3.ch009::1

This chapter introduces the Air Indexing method for detecting and quantifying cervical dentin.hypersensitivity.as.a.companion.to.the.T-Scan.Occlusal.Analysis.System,.which.evaluates.occlusal

Chapter 12 10.4018/978-1-4666-6587-3.ch012

Digitalized.Implant.Occlusion.with.the.T-Scan.System 56210.4018/978-1-4666-6587-3.ch012

Jinhwan Kim, DDS, MS, PhD, Seoul National University, South Korea & Oneday Dental

Clinic, South Korea & Theodental Ltd., South Korea

Chapter 13 10.4018/978-1-4666-6587-3.ch013

Computerized.Occlusal.Analysis.in.Occlusal.Splint.Therapy 60210.4018/978-1-4666-6587-3.ch013

Roger Solow, DDS, The Pankey Institute, USA 10.4018/978-1-4666-6587-3.ch013::1

Occlusal.splints.are.used.to.protect.teeth,.relieve.orofacial.pain,.and.preview.the.patient.response.to.a.simulated.occlusal.correction This.chapter.outlines.proper.occlusal.splint.fabrication.that.employs.T-Scan.analysis.to.verify.a.therapeutic.occlusion The.T-Scan.provides.objective.relative.occlusal.force.and.timing.data.that.guides.the.refinement.of.a.splint’s.occlusal.scheme Therefore,.this.chapter.explains.adjusting.an.occlusal.splint’s.contact.pattern.with.ink.ribbon.followed.by.the.T-Scan It.also.addresses.the.controversy.regarding.the.existence.of,.or.lack.thereof,.a.relationship.between.occlusal.interferences.and.masticatory.muscle.dysfunction The.author.postulates.that.the.research.studies.that.argue.against.the.existence.of.a.relationship.are.absent.of.occlusal.measurement.and.lack.a.scientific.basis.to.deny.a.relationship.exists Lastly,.recommendations.are.made.to.include.the.T-Scan.in.Temporomandibular.Disorder.treatment.studies.with.both.occlusal.splints.and.natural.teeth,.so.that.researchers.might.resolve.this.controversy.for.dental.clinicians.10.4018/978-1-4666-6587-3.ch013

Chapter 14 10.4018/978-1-4666-6587-3.ch014

Centric.Relation.Records.and.T-Scan.Occlusal.Analysis.of.Centric.Relation.Prematurities 64910.4018/978-1-4666-6587-3.ch014

Roger Solow, DDS, The Pankey Institute, USA 10.4018/978-1-4666-6587-3.ch014::1

Occlusal.analysis.is.the.examination.and.diagnosis.of.the.forces.generated.by.the.contacting.surfaces.of.teeth The.clinician.can.use.both.mounted.diagnostic.casts.and.the.T-Scan.Occlusal.Analysis.system.to.understand.the.role.of.adverse.forces.in.a.patient’s.dentition These.casts.should.be.mounted.in.Centric.Relation.so.that.they.replicate.the.patient’s.hinge.axis.maxillomandibular.relationship,.absent.of.tooth.contact Diagnostic.casts.can.demonstrate.the.mandibular.slide.into.maximum.intercuspation,.as.well.as.illustrate.the.excursive.contacts The.T-Scan.not.only.records.the.location.of.tooth.contacts.present.in.Centric.Relation,.maximum.intercuspation,.and.lateral.excursions,.but.also.detects.the.timing.and.relative.force.of.all.contacts The.rapid.display.of.recorded.tooth.contact.data.in.the.2-.and.3-Dimensional

Chapter 17 10.4018/978-1-4666-6587-3.ch017

Transcutaneous.Electrical.Nerve.Stimulation.(TENS).Combined.with.the.T-Scan.System:.A.Case.Report 74410.4018/978-1-4666-6587-3.ch017

Curtis Westersund, DDS, ICCMO, Canada 10.4018/978-1-4666-6587-3.ch017::1

Masticatory.muscle.hyperactivity.has.been.considered.a.significant.factor.in.promoting.and.perpetuating.dysfunctional.symptoms.observed.in.Temporomandibular.Disorder.patients Many.therapeutic.modalities.have.evolved.within.Dental.Medicine.that.attempt.to.lessen.or.resolve.the.varying.symptoms.frequently.reported.by.dysfunctional.patients One.such.method,.known.as.Ultra.Low.Frequency.(ULF).Transcutaneous.Electrical.Neural.Stimulation.(TENS),.has.been.used.to.relax.the.masticatory.musculature.by.applying.an.electrical.stimulus.to.the.efferent.motor.fibers.of.the.Vth.and.VIIth.cranial.nerves,.such.that.TENS.can.result.in.pain.analgesia.and.patient.sedation,.restore.compromised.muscle.physiology,.and.increase.muscle.resting.length TENS.also.aids.in.establishing.a.neuromuscular.maxillomandibular.relationship.by

Chapter 18 10.4018/978-1-4666-6587-3.ch018

Periodontal.Treatment.and.Computerized.Occlusal.Analysis 79110.4018/978-1-4666-6587-3.ch018

Nicolas Cohen, DDS, MS, PhD, Private Practice, France & University of Paris, France 10.4018/978-1-4666-6587-3.ch018::1

This.chapter.addresses.the.ongoing.controversy.regarding.occlusion’s.role.in.the.progression.of.periodontal.disease Occlusal.force.has.been.considered.a.non-factor.in.the.initiation.of.periodontal.attachment.loss However,.the.absence.of.a.validated.measuring.device.or.quantifying.method.for.analyzing.the.occlusion.has.contributed.to.the.confusion.that.still.exists.in.the.scientific.community.today.about.the.relationship.between periodontal disease and occlusion The development of the T-Scan occlusal measurement.technology,.which.is.independent.of.a.clinician’s.occlusal.contact.force.level.subjective.assessment,.may.change.the.scientific.opinion.about.occlusion’s.role.in.periodontal.disease This.chapter.illustrates.how.the.T-Scan.8.system.aids.in.treating.patients.who.have.tissue.loss.and.occlusal.issues Notably,.after.the.major.etiologic.risk.factors.of.periodontal.disease.have.been.controlled,.adjusting.the.occlusion.with.the.T-Scan.improves.healing.outcomes.resulting.in.less.inflammation,.decreased.probing.depths,.and.bone.level.stability.10.4018/978-1-4666-6587-3.ch018

Compilation of References 10.4018/978-1-4666-6587-3.chcrf xxx

About the Contributors 10.4018/978-1-4666-6587-3.chatc lxxxv

Index 10.4018/978-1-4666-6587-3.chidx xcii

of dental disease states, and improve the treatment modalities that are used on patients In this era of Digital Dentistry, these technological advances have led to better treatment outcomes, more comfortable patients, and a healthier dental community.

Within Dental Medicine, there have been innovators who have questioned existing beliefs held within the traditionally accepted protocols and methods This questioning has often led to disruption, while also introducing refreshing new theories and corollaries that improve the clinician’s ability to manage, treat, and better understand conditions that cause patients discomfort Sometimes the innovators have reconfigured existing methodologies to accommodate new computer-based approaches In the restorative disciplines, for example, the advent of CAD/CAM has modernized the artful creation of superstructures and crowns, where the well-accepted principles of waxing up teeth, are now being employed by computer technology In other instances, the innovator may make adaptations to existing materials or create new ones that have only become available through scientific advancement, which make rendered treatments safer and more predictable for patients An example of this type of innovation is the replication of Bone Morphologic Protein (BMP) Its use with bone grafting has increased the predictability of successfully grafting synthetic bone to human bone and has aided in successful osseointegration of implants that are placed into graft sites

Yet, the most exciting innovators of the past 20 years have been those that have been involved with hard technologies that allow a clinician to integrate measurable data information into the explanation of a patient’s condition These technologies enhance the clinician’s observations, improve treatment outcomes, and can monitor long-term stability or changes in a patient’s clinical condition Dr Robert Kerstein is an innovator who has extensively studied and helped to evolve an objective technology that utilizes at least

point in time to educate the patient about the state of their existing occlusal scheme or to identify the existence of either occlusal health or untoward degenerative changes, where future restorative decisions made depend upon the status of the existing occlusal scheme In this way, occlusal measurement with the T-Scan system can both predict ongoing and future risk, diagnostically, as well as ensure treatment outcomes are predictable and optimal, when it is employed as a treatment performance adjunct.

Within the last 100 years, the question of how a human being functions has led to the development

of the focused Dental Medicine discipline known as “Occlusion.” Occlusion is the study of the way the teeth, the Temporomandibular Joints, and the mandible and maxilla, all interrelate This book represents the initial attempt to report on the last 30 years of struggle against a compromised set of beliefs and values that pervade Dental Medicine worldwide These beliefs have resulted from the (incorrect) idea that visual inspection of intercuspating and excursing teeth, and the appearance of articulating paper markings or wax imprints can reliably describe masticatory function without there being any true mea-surement of the occlusion used as a basis for these beliefs These traditional concepts have been applied quite unsuccessfully; when clinicians and researchers attempt to answer questions regarding occlusal contact quality and force quantity, the T-Scan technology readily answers in a recorded format, which allows the clinician to display, analyze, and make targeted accurate treatment decisions about clearly defined and problematic occlusal contact forces

For most of the study of occlusion, the only tool available to measure or prove occlusal theories was articulating paper ink markings of occlusal contacts Thirty years ago, the T-Scan I system was introduced, which provided a measured method of identifying what each articulating occlusal contact ink mark meant in terms of force content, time order, and time duration This innovation gave Dental Medicine not simply an intellectual method of understanding occlusion but also a sophisticated digital method that aided the clinician when rendering occlusal treatment to patients

During this modern-day technology era in Dental Medicine, the science of Occlusion is undergoing

an awakening that is being led by the collaborators who created this book It is this author’s opinion that this awakening is actually a revolution As in other revolutions that change thought processes, whether

in science or in governmental policies, there are leaders In this occlusal revolution, it is this author’s contention that the leader must be identified as Dr Robert Kerstein I am pleased to point out that Dr Kerstein has consistently, since 1989, published many peer-reviewed research studies using T-Scan data, which have answered a number of previously unanswered occlusal science questions Moreover, he has influenced multi-disciplinary groups that are represented here by the many authors from all over the world, whom advocate within their own sphere of influence the need for widespread T-Scan implementation These authors are all experts in their own disciplines who have recognized that measured occlusion is a major diagnostic and treatment advance, which benefits both patients and clinicians in many, many ways.This first Computerized Occlusal Analysis text is historic and compliments Dental Medicine’s need

as a profession to place measurement of the occlusion into our general dental concepts My hope is that within the coming decade, the T-Scan will become a fundamental technology used routinely in general dentistry worldwide

To the reader of this book, please enjoy its detailed content and note and submit your questions, concerns, and ideas for future editions to continue to drive forward the study of this important occlusal measurement innovation, known as the T-Scan

Paul Mitsch received his DMD degree in 1977 from Washington University, St Louis, Missouri He purchased Augusta Family

Dentistry in Augusta, Kansas, in 1979 In 2005, Dr Mitsch created Dental Impact, a publication written by area dentists and distributed through Butler and Sedgwick counties In 2008, Dr Mitsch founded American Family Dentistry Training Center AFD Training Center was established to aid in the training of those in the dental industry It has been his mission to offer classes and seminars from skilled professionals in the dental field for those who wish to refine their skills and bring a higher level of care to their practices Dr Mitsch has lectured on the implementation of state-of-the-art technology in dentistry throughout the nation He holds fellowships with the Academy of General Dentistry, the Academy of Dentistry International, and the Interna- tional Congress of Oral Implantologists with a distinguished fellowship from the American Academy of Craniofacial Pain Dr Mitsch has also completed his Mastership from BioResearch, Inc.

The subject of Computerized Occlusal Analysis has evolved over a 30-year span beginning in 1984 to where many clinical and research applications that utilize the T-Scan technology have been developed in many of Dental Medicine’s disciplines The clinical implementation of the T-Scan with dental patients

is a major diagnostic and treatment advance over the traditional, non-digital occlusal indicator ods that dentists have employed over the past 100 years Computerized Occlusal Analysis has brought

meth-occlusal force and timing measurement to a significant portion of daily dental practice that, until the

inception of the Scan, had always been subjectively interpreted by the clinician Because of the Scan’s relative occlusal force and timing measurement capabilities, applying its data has been shown in studies to definitively improve occlusal design end-result precision As such, the field of Computerized Occlusal Analysis has grown to not only include the science and practice of Dental Occlusion but also encompasses Fixed and Removable Prosthodontics, Implant-Supported Prosthodontics, Periodontics, Orthodontics, Aesthetic Dentistry, Tooth Sensitivity, Temporomandibular Disorders and Mandibular Orthosis, and Body Posture and Balance

T-Today, Computerized Occlusal Analysis technology offer solutions to the many commonly observed and frequently encountered occlusal problems that practicing dental clinicians regularly attempt to manage (and often struggle with), without the aid of digital occlusal measurement Despite the clear superiority of the T-Scan method over traditional occlusal indicators, presently, the T-Scan technology still faces significant challenges in gaining academic acceptance and widespread clinical use with dental patients Notwithstanding that the T-Scan method has proven itself in published studies to be reliable, reproducible, and accurate, the T-Scan technology has been somewhat overlooked by Dental Medicine

in favor of the routinely used traditional, non-digital occlusal indicators that are incapable of actually measuring occlusal force and timing In this era of Evidenced-Based Dental Medicine, it is surprising that articulated stone casts, occlusal wax, silicone imprints, and articulating paper strips and foils are still widely believed to be capable of reporting occlusal force levels by their appearance characteristics These non-scientifically based beliefs have limited the perceived need for the T-Scan technology in clinical dental practice, despite the fact that none of the traditional occlusal indicators have been proven scientifically capable of measuring occlusal force levels, reproducing the reporting of consistent occlusal force levels trial to trial, or measuring and reporting on occlusal contact timing sequences

This Handbook of Research of Computerized Occlusal Analysis Applications in Dental Medicine is

a comprehensive compilation designed to illustrate to modern Dental Medicine the scope and breadth

of the field of Computerized Occlusal Analysis Its intended audience is dental healthcare providers that practice within the many disciplines of Dental Medicine, Dental Medicine educators and researchers,

program directors, and graduate students in Prosthodontics, Implant-Supported Prosthodontics, odontics, Orthodontics, and Temporomandibular Disorders It should also be read by dental hygienists and chairside assistants, as these axillaries are often called upon by their employer-dentist to use the technology with new patients, as one component of a comprehensive patient examination.

Peri-Most notably, the authors have targeted this book at the dentist clinician, as it is the clinician who is regularly called upon to treat occlusal problems in daily dental practice By reading this compilation, a practicing clinician will be greatly aided in their daily practice of Occlusion by applying the T-Scan use principles and measured occlusal concepts described herein Specific efforts have be made to provide a scientific foundation for the included T-Scan-based treatment procedures illustrated, so that clinicians

who utilize this book as a Clinical Guide will be learning to treat occlusal problems with an

evidence-based approach rather than with a subjective one

Although the book is not specifically directed at researchers in the field of Dental Occlusion, the relative occlusal force and time-sequence measurement capabilities of the T-Scan technology make it ideal for documenting occlusal function in a study environment Researchers are encouraged to read this book to gain proper T-Scan use skill knowledge prior to designing their own T-Scan occlusal function studies, or when replicating existing, previously published T-Scan studies In this way, future T-Scan researchers will better understand how to properly employ T-Scan data sets, which will make any results reported from future T-Scan-based research studies far more reliable than if the same researchers were

to employ poor T-Scan technique from a lack of adequate T-Scan use knowledge

ORGANIZATION OF THE BOOK

This book has been divided into 6 sections:

Section 1, “Evolution of the T-Scan Technology,” introduces the history of the T-Scan system from its initial inception in 1984 through until the present day Chapter 1 details the four T-Scan system versions and describes the scientific studies that inspired important system accuracy and repeatability improvements that were incorporated into each version’s development

Chapter 2 compares the various commercially available, commonly employed, traditional non-digital occlusal indicators to the T-Scan technology for their relative occlusal force measurement capability, the ability to detect occlusal force excess, and whether they possess time-sequence measurement and

reporting capability Additionally, a section of this chapter is devoted to whether the clinician’s tive Interpretation involved in using non-digital, traditional occlusal indicators makes them potentially maximally invasive when compared to the T-Scan, whose measurement capability eliminates the clini- cian’s Subjective Interpretation, making it a minimally invasive treatment technology.

Subjec-The emphasis of Chapter 3 is to demonstrate the accuracy and reliability of the T-Scan occlusal measurement method, assess the reproducibility of the recording sensor and the system’s force output

images and image captions for illustrated descriptions of the capabilities of the many T-Scan 8 software features This chapter illustrates to the reader how the T-Scan’s occlusal force and timing software fea-tures are displayed and analyzed and what occlusal characteristics they represent The last portion of this chapter details the three Learning Levels of T-Scan Mastery and necessary clinical user skills that

a T-Scan clinician must effectively develop to become a competent T-Scan clinician

Section 3, “Clinical Use Technologies that Complement the T-Scan System in Daily Dental Practice,” includes chapters that showcase other digital dental technologies, which enhance and complement the T-Scan system’s clinical use Each chapter includes at least one Clinical Case example that illustrates how to employ these complementary technologies alongside the T-Scan technology Chapter 5 discusses several dental technologies (in addition to the T-Scan system) that all provide objective, bio-physiologic measurements of different masticatory functions, Surface Electromyography, Magnet-Based 3-Di-mensional Electrognathography, and Temporomandibular Joint Vibration Analysis This chapter also addresses the need for biometric measurement inclusion during the examination of patients and in the assessment of treatment outcomes

Chapter 6 describes in detail how Joint Vibration Analysis (JVA) technology can measure pathological changes that occur within the Temporomandibular joints This chapter details how the attributes of the detected TM joint vibrations are representative of various disease states present within the Temporo-mandibular joint anatomy

Chapter 7 explains the clinical utilization of the T-Scan 8/BioEMG synchronization system in the treatment of Occluso-Muscle Disorder patients This chapter describes the neuroanatomy and physiol-ogy of how prolonged in time, excursive movement occlusal surface friction induces masticatory muscle hyperactivity and Occluso-Muscle Disorder symptomatology This chapter also explains in great detail

the very therapeutic, rapid, and evidenced-based T-Scan-guided occlusal treatment known as Disclusion Time Reduction (DTR) A significant TMD treatment advance that DTR affords both the patient and the

clinician is that it requires no appliance or orthotic device be used, as its highly therapeutic effect results from within the patient’s own neurophysiology

Section 4, “Occlusal Trauma and Computerized Occlusal Analysis,” describes the consequences

of occlusal microtrauma, Dentin Hypersensitivity from occlusal flexure, abfraction formation, and occlusal wear Each chapter explains how the T-Scan technology can aid in detecting and treating an aspect of occlusal microtrauma Chapter 8 explains the many differing theories and postulated etiolo-gies of Dentin Hypersensitivity, while introducing a new potential occlusal etiology termed, Frictional Dental Hypersensitivity (FDH) Successful treatment of FDH is illustrated in a pilot study that assessed pre- and post-treatment Dentinal Hypersensitivity changes in patients who underwent Disclusion Time Reduction treatment

Chapter 9 discusses the detection, diagnosis, and treatment of the clinical symptoms of Cervical Dentin Hypersensitivity (CDH), using the Air Indexing method as a companion to the T-Scan system Air Indexing quantifies differing degrees of Cervical Dentin Hypersensitivity that can be correlated to occlusal force and timing aberrations detectable on the CDH sensitive teeth with the T-Scan system.Lastly, Chapter 10 presents the numerous etiologies of occlusal wear, details the clinical consequences

of advanced tooth wear, and describes in detail the prosthodontic rehabilitation of advanced occlusal wear Chapter 10 illustrates that occlusal wear can be successfully minimized when treated and maintained with the T-Scan 8/BioEMG synchronized system

diagnostic, treatment, and maintenance phase advantages, which computerized occlusal analysis fers to clinicians who provide computer-guided occlusal therapy within the differing Dental Medicine disciplines All chapters in the section include clinical case examples of how the T-Scan can be used in each described discipline.

of-Chapter 11 explains the T-Scan’s role in the case finishing procedures and post-treatment occlusal endpoint assessments of fixed appliance Orthodontic treatment, which often does not produce ideal tooth contacts and ideal occlusal force relationships, despite the orthodontic end result “appearing” visually ideal.Chapter 12 addresses how the rigid dental implant occlusion can benefit from T-Scan control of occlusal force excess, which can be obtained through timing order corrections that minimize both deos-seointegration and implant restorative part material breakage The T-Scan’s Tooth Timing software is explained in detail, such that readers can understand how to properly implement the time-delay principle

in mixed arches with natural teeth near dental implants

Chapter 13 describes occlusal splint fabrication methodology and the combining of the T-Scan measurements with ink-ribbon occlusal contact markings to greatly improve the force distribution char-acteristics of a delivered occlusal splint This chapter addresses the controversy regarding the existence

of, or lack of, a relationship between occlusal interferences and masticatory muscle dysfunction, and suggests that the research studies that argue against the existence of a relationship are absent of occlusal measurement and, therefore, lack a scientific basis to deny a relationship exists

Chapter 14 highlights Centric Relation theory and discusses the clinical technique, advantages, and rationale for identifying the Centric Relation prematurity using either mounted diagnostic casts or the T-Scan system when performing Bimanual Manipulation

Chapter 15 examines how to employ the T-Scan’s graphical force data in a patient educational strategy that can lead patients to accept needed treatment procedures that would directly benefit them over the long-term This chapter outlines the four stages of creating optimum dental health, the steps required to perform both effective teaching and learning, the differing learning and teaching styles routinely utilized, and explains how to employ the Feature, Function, and Benefit technique

Chapter 16 discusses Occlusion as a component of Aesthetic Dentistry by illustrating how the T-Scan can improve the insertion of CAD/CAM machine-milled aesthetic restorations fabricated from digital impressions The positionally unstable adhesive restoration cannot be tried-in for occlusal contact evalu-ation prior to bonding them to place The lack of try-ins compounds occlusal spatial errors, which can

be predictably managed using the T-Scan system

Chapter 17 discusses TENS use in pain analgesia, patient sedation, and as a treatment for mandibular Disorders symptoms when establishing a neuromuscular maxillomandibular relationship This chapter details how TENS induces a muscularly contracted involuntary arc of closure, where the resultant occlusal contacts can be recorded with the T-Scan guide the occlusal installation of a neuro-muscular orthotic

Temporo-Lastly, Chapter 18 details the scientific evidence behind the long-standing controversy regarding

oc-Chapter 19 proffers the theory of how occlusal force is delivered to the occlusion through repetitive patterns of force, termed Digital Occlusal Force Distribution Patterns (DOFDPs) Long-term clinical observation has revealed that DOFDP location within the arches coincides with structural adaptive changes in the health of the occlusion, the teeth, the periodontium, and the Temporomandibular joints The six known DOFDPs are described in detail using many clinical examples that illustrate the dental tissue damage that poor occlusal force distribution can cause.

Finally, Chapter 20 details the Force Finishing concept and protocol to use in minimally invasive,

cosmetic, and restorative reconstruction cases When the force components of a restored dentition are not properly addressed, the signs and symptoms of occlusal force disorders can result in masticatory system breakdown In contemporary dental practice, where clinicians focus on the aesthetic end-results but place a low priority on the occlusal force finishing, this digital Force Finishing method aids clinicians

in predictably and repeatedly achieving occlusal force harmony at case insertion

Every chapter in the book, Handbook of Research on Computerized Occlusal Analysis Technology Applications in Dental Medicine, is a contribution from an international expert who has years of experi-

ence working closely with the T-Scan technology within one of the many Dental Medicine disciplines All chapters contain numerous clinical pictures and companion digital occlusal data images that are

both described with matching captions Additionally, each chapter includes a glossary of Key Terms and Definitions that, together with chapter text, explain each chapter’s focus.

Many chapters address in depth two common themes that persist as controversies in modern occlusal thought Firstly, the most widely debated occlusal controversy that exists today is whether or not occlu-sal function plays an etiologic role in the development of Temporomandibular Disorder symptoms To counter those dentists who opine that occlusion is a non-factor in the etiology of Temporomandibular Disorders, the authors of this book offer to the reader (for his or her own contemplation) that prior to the development of occlusal force measurement with the T-Scan system, the studies that were accomplished

on occlusion’s role in Temporomandibular Disorders were markedly flawed because:

• The researchers lacked the capability to measure occlusal function in any quantifiable way and therefore did not know what occlusal problems they were actually treating

• The researchers did know know what improvements (or worsening) were made to the occlusion by employing unmeasured occlusal adjustments as treatment within study protocols

• The researchers were unable to properly categorize what occlusal and TMD conditions they were actually diagnosing and treating because they were unable to quantify the occlusal function of the teeth themselves

Visual assessments of the patient’s intraoral condition and observations of static dental materials that assessed the treatment rendered were the techniques these researchers had at their disposal to attempt to determine occlusal correctness But their visual assessments were wholly subjective, as were the non-digital occlusal indicators used in those studies

It is this idea of non-measurement that leads directly to the second controversial issue that plagues the science of occlusion The current Standard of Care allows clinicians to continue to utilize static oc-clusal indicators that have no force measurement capability, as if they actually do measure occlusal force

by how they look Add to that the highly error-prone technique of clinician Subjective Interpretation of

force content This Standard is antiquated, non-minimally invasive due to the guessing aspect, and is

unfounded in science because no published studies exist that illustrate non-digital occlusal indicators can measure occlusal force Therefore, for the greater good of the human dental patient, this Standard

must be changed to include a measured method that is founded in science and is completely absent of clinician guessing

To that end, each of this book’s authors describe the many exciting and new, computer-based measured

occlusal concepts that not only aid in diagnosis and treatment of Temporomandibular Disorder patients but can also be applied to the reconstructed occlusion to ensure prosthesis material longevity, implant survival, and rapid patient adaptation to their new occlusion These measured treatment approaches have been verified as valid and therapeutic in published studies performed over the past 30 years, and have become available to today’s dental patient solely because of the T-Scan’s capability to measure relative occlusal force and sequence occlusal contact timing

In shaping this book, I committed myself and tasked the authors to make it a well-referenced and scientifically sound compilation Only through the scientific efforts of many engineers, authors, and researchers since 1984 has the T-Scan technology evolved and improved to where presently it brings measurement, scientific method, and precision end-point standards to the field of Dental Occlusion, which has been absent of true measurement for the past century

In conclusion, the diverse and comprehensive coverage within this book will contribute a large ume of never-before-compiled, scientifically based information about the T-Scan technology itself This book’s pages will undoubtedly lead to improved T-Scan clinical implementation from the world’s user base, as well as lead to a better understanding of the evolving field of Computerized Occlusal Analysis This book details every available use that the T-Scan technology has in Dental Medicine and therefore can educate many clinicians, researchers, and academicians to the benefits that Computerized Occlusal Analysis offers patients and clinicians Most importantly, through the dissemination of the information contained within these pages, the clinical practice standards in Dental Occlusion will be elevated from

vol-the subjective to vol-the objective.

Thanks to the very hard-working Editorial Advisory Board members, the chapter reviewers, and to the excellent authors who accepted my invitation to create their own chapter that encompassed T-Scan applications in their own dental discipline, readers may now enjoy a singular book concerned with the T-Scan technology and its many applications in clinical dental practice My hope as the editor is that this book will be a helpful tool for the student who needs an expert reference source for knowledge in the field of Computerized Dental Occlusion and for the clinician and researcher as well, who require clear, concise, and detailed information with which to better understand how to properly employ the T-Scan technology in clinical practice and in research endeavors

Robert B Kerstein, DMD

Former Clinical Professor at Tufts University School of Dental Medicine, USA & Private Dental

The editor sincerely acknowledges the assistance of all persons who were involved in the development process of this book, for without their support, this project would not have been satisfactorily completed.Most notably, deep appreciation and gratitude is due to Tekscan’s hardware and software engineers, the art and graphics team, the sales team, and all of the managers from Tekscan, whom I have worked closely with, and who have continuously supported me all through the T-Scan’s now 30-year-long evo-lution (beginning in 1984) I especially wish to thank Mr Steve Jacobs and Mr Charles Malacaria, for their ongoing efforts to improve, refine, and advance the T-Scan technology’s performance capabilities They have encouraged its continuous evolution and development, so that the T-Scan could best meet the

need for the inclusion of occlusal force and timing measurement within the field of Dental Occlusion.

I also must thank Mr Brent Thompson for creating for me the initial authoring opportunity that led to the producing of this edited book Despite his not being a dentist, Mr Thompson’s long-standing and untiring commitment to the T-Scan technology has played a significant role in the T-Scan gaining im-portance in Dental Medicine Additionally, I must recognize Mr John Radke for performing the many statistical analyses contained within our many co- published T-Scan/BioEMG studies and for his helpful editorial assistance with this book’s completion

I am also greatly indebted to the early adopters of the T-Scan technology These are the clinicians who have already made it a significant part of their daily practice occlusal methods and routinely employ the T-Scan-based occlusal principles that are contained within these chapters Of note is that the early adopters have helped to move Occlusion forward through their study club meetings, and their educational programs, and on-site clinical teaching courses, where they have exposed many more practitioners to the T-Scan technology, who otherwise would not have learned of its many patient and clinician benefits

I also want to express my sincere appreciation to both the book’s Editorial Advisory Board and the Chapter Reviewers During the lengthy review process that each chapter underwent, these clinicians definitively improved all of the book’s content by offering to the authors and me constructive criticisms and suggesting necessary topic inclusions where required

A special thanks goes out to the publishing team at IGI Global whose assistance throughout the entire process from book proposal to final publication has been invaluable In particular, I must express my personal gratitude to Ms Erin O’Dea, who answered every question that I posed to her, while ensuring that I stayed on schedule during all stages of the book’s construction

I must also acknowledge my wife, Kym, for her unfailing love, support, and encouragement during the creation of this book Her patience never wavered, as I sat for hours next to her (and our dogs), daily and nightly, while silently writing on my computer.

In closing, I wish to thank all of the chapter authors for their excellent scientific and clinical contributions made to this book I am forever indebted to each author for his or her willingness to collaborate with me

to create the first book completely devoted to the T-Scan Computerized Occlusal Analysis technology

Robert B Kerstein, DMD

Former Clinical Professor at Tufts University School of Dental Medicine, USA & Private Dental Practice Limited to Prosthodontics and Computerized Occlusal Analysis, USA

July 15, 2014

Evolution of the T-Scan

Technology

Since its’ inception in 1984, Computerized

Oc-Occlusal Analysis technology records and quickly displays for clinical interpretation, tooth contact timing sequences and tooth contact fluctuating

Robert B Kerstein, DMD

Former Clinical Professor at Tufts University School of Dental Medicine, USA & Private Dental

Practice Limited to Prosthodontics and Computerized Occlusal Analysis, USA

record changing tooth-tooth contact interactions

This combination of dynamic tooth contact relative

force and time data affords a clinician detailed,

precise, and unparalleled diagnostic and treatment

occlusal measurement data, with which to address

many differing clinical occlusal pathologies The

displayed relative occlusal force and timing data

aids in the examination and treatment of occlusal

abnormalities on natural teeth, dental prostheses,

and dental implant prostheses (Kerstein, 2010)

The evolution of this technology has required

much iteration over the past 30 years beginning

with T-Scan I in 1984, then T-Scan II for

Win-dows® in 1995, to T-Scan III (software versions

5, 6, and 7) in 2004, with development of Turbo

recording in 2008, to the present day 2014 version

known as T-Scan 8 (Tekscan Inc South Boston,

MA, USA) Numerous authors since the

mid-1980s, have studied the various T-Scan versions,

which inspired the manufacturer to improve the

hardware components and the system’s

record-ing sensors, to be more accurate, repeatable, and

precise These needed improvements combined

with the addition of many relative occlusal force

and timing analysis software tools, ultimately

negated existing system problems that evoked

criticism of the T-Scan system from the Dental

Medicine scientific community

The T-Scan system was developed as a relative

occlusal force measuring system All of the T-Scan

system iterations (T-Scan I, II, III and T-Scan 8)

have never recorded or measured, absolute

oc-clusal force in engineering units (calibrated force

numbers such as in Newtons per square centimeter,

n/cm.2 or pounds per square inch, lb./in.2)

There-fore, throughout the remainder of this book going

forward, all references made to occlusal force,

will be describing relative occlusal force, unless

otherwise denoted as absolute occlusal force

By measuring relative occlusal force, the

T-Scan system(s) detect whether an occlusal force

on one set of contacting opposing teeth is greater,

arches (Kerstein, 2010) Determining relative force

is important to the clinician, as relative force lustrates measured differences of varying applied loads upon all contacting tooth locations at any instant within a recorded functional mandibular movement Relative occlusal force is reported

il-as a percentage of the maximum occlusal force obtained within the recording Detected relative occlusal force variances can be employed clinically

to precisely balance an unbalanced occlusion, by

using targeted time-based and force-based

occlu-sal adjustments, and can diagnose areas of sively high occlusal force concentration present

exces-in one area of the occlusion while simultaneously diagnosing where there is little, moderate, or no occlusal force in other areas of the same occlusion (Kerstein, 2010)

This chapter will detail the evolution of the differing T-Scan system versions from inception until present day (Figure 1), while describing the many scientific studies that gave rise to important sensor and system improvements that genera-tionally from version to version, optimized the T-Scan’s accuracy and repeatability

SECTION I: THE T-SCAN I SYSTEM

Computerized Occlusal Analysis technology was first introduced to Dental Medicine in 1984, when the T-Scan I System (T-Scan 2000, Tek-scan, Inc., Boston, MA, USA) was commercially manufactured from a prototype version (T-Scan 1100,Tekscan, Inc., Boston, MA, USA) (Fig-ures 2a and 2b) Since its inception, the T-Scan technology has been able to record and display for clinical interpretation, tooth contact timing sequences while simultaneously mapping each tooth contacts’ fluctuating relative occlusal force levels which occurred during functional jaw movements The earliest publication about the T-Scan I system appeared in the dental literature

Figure 1 All four T-Scan System generations

Figure 2a T-Scan I stand alone computer in Time Mode, with colored screen display, recording handle, and control buttons for data playback

The T-Scan I was capable of recording and

quantifying 16 levels of varying occlusal force

that were captured in real-time during a 3 - second

long “Force Movie” (Figures 3a, 3b, and 3c, and

Figure 4) (Maness, 1988) A left working excursion

Force Movie of 1.07 seconds duration is shown

in Figures 3a, 3b, and 3c, from intercuspation

(Figure 3a) into group function (Figure 3b), to

when the anterior guidance takes over excursive

control (Figure 3c)

The T-Scan I could display occlusal data in 2

other modes; the Force-Snapshot Mode (Figure

5), which was a static force display of all recorded

contacts, and a Time-Mode where the order of

occlusal contacts were displayed in sequence

(Ma-ness, 1988) Both the relative force and timing data

could be printed out frame-by-frame, by a small

printer contained within the body of the T-Scan

The playback of occlusal contact force and timing data was displayed on an oscilloscope-like screen The clinician controlled forwards

or backwards playback in 0.01 second-long increments, by pressing the four buttons aligned vertically on the right side of the front console (Figure 1) The dental arch was fixed irrespective

of the true patient presentation In the Time-Mode screen, fourteen teeth were represented by tooth

- shaped ovals of increasing proportional sizes (smallest in the anterior region, slightly larger through the premolar region, with the largest in the molar region) During playback when in the Time-mode, all contacts were sequenced in the order of that they were registered upon the sensor

in the 0.01 second-long recorded frames The first three ordered occlusal contacts were denoted for the clinician by three differing colored red and

Figure 2b T-Scan I component and feature schematic diagram (reprinted from Maness, W (1993) Computerized Occlusal Analysis, The High-tech, High care Dentistry Journal, 59, 8, 701-702)

Figure 3a T-Scan I force movie at intercuspation prior to a left excursion at frame 3, at 0.09 seconds (reprinted from Maness, W (1993) Computerized Occlusal Analysis, The High-tech, High care Dentistry Journal, 59(8), 701-702)

Figure 3b During the middle of the left excursive force movie, where group function and balancing contacts are present in frame 13 at 0.40 seconds (reprinted from Maness, W (1993) Computerized Oc- clusal Analysis, The High-tech, High care Dentistry Journal, 59(8), 701-702)

Figure 3c Late in the left excursive force movie when the anterior guidance takes control over the sion in frame 30 at 1.16 seconds (reprinted from Maness, W (1993) Computerized Occlusal Analysis, The High-tech, High care Dentistry Journal, 59(8), 701-702)

excur-Figure 4 A T-Scan I, graphically represented 3 second long Force Movie (reprinted from Maness, W (1993) Computerized Occlusal Analysis, The High-tech, High care Dentistry Journal, 59(8), 701-702)

corresponding teeth Also displayed were the

times at which each contact occurred within the

Force Movie, listed on the screen to the right of

the representative dental arch (Figure 2a) This

was the first created Occlusion Timing table used

in occlusal diagnosis

In the Force Movie Mode, vertical force

col-umns of varying heights that described differing

relative occlusal force intensities would move

up and down incrementally, frame by frame, as

The T-Scan I captured occlusal contact ing and occlusal contact relative force intraorally when a patient occluded into an epoxy-based, electronically charged sensor (Figure 6) that con-tained conductive ink columns and rows (Podoloff

tim-& Benjamin, 1989) The sensor was inserted and locked into a recording handle, which was then connected to a stand-alone computer via a parallel port A functional mandibular movement record-ing was activated by a long central push button

Figure 5 Force Snapshot mode displayed a static force profile of all recorded occlusal contacts printed from Maness, W (1993) Computerized Occlusal Analysis, The High-tech, High care Dentistry Journal, 59(8), 701-702)

(re-change proportionally to the degree of applied

oc-clusal force Larger forces would result in greater

resistance changes and lighter forces would result

in smaller resistance changes The hardware would

then display the relative electronic force data as

rising and falling columns of differing heights,

resultant from the degree of electronic resistance

change captured at each contact point

When introduced, the T-Scan I was the first

ever, occlusal indicating device or material, that

could actually measure relative occlusal contact

force No prior device or dental material was

teeth at any given moment within a functional mandibular movement Yet, Dental Medicine authors strongly believed (and still do today) force measurement was possible by using static occlusal indicators like wax and dental articulating paper However, studies performed since the 1980’s (Halperin, Halperin, & Norling, 1982; Schelb, Kaiser, & Brukl, 1985; Millstein & Maya, 2001; Carey, Craig, Kerstein, & Radke, 2007; Saad, Weiner, Ehrenberg, & Weiner, 2008; Qadeer, Kerstein, Kim, Huh, & Shin, 2012) have repeat-edly shown that common, traditional, non-digital occlusal indicators do not measure occlusal force

or time-sequence occlusal contacts To date, in spite of this scientific evidence, mainstream Dental Medicine continues to believe that non-digital occlusal indicators are able to quantify occlusal contact force and timing

A detailed explanation of how non-digital occlusal indicators do not actually have occlusal force measurement capability can be found in Chapter 2

Longstanding Advocated Ideal Occlusal Force Characteristics

Determining relative occlusal contact force ences has always been deemed important to the science of Dental Occlusion It has been advocated within the literature that occlusal forces present in

differ-a physiologic occlusion should demonstrdiffer-ate the following characteristics:

• Equal forces that are shared bilaterally tween the arch halves

be-• Equal occlusal forces that are shared formly amongst all contacting teeth,

uni-• Occlusal forces that are aligned vertically along the long axes of opposing contacting teeth

However, despite these advocated theoretical

Figure 6 T-Scan I First Generation blue epoxy

recording sensor (reprinted from Maness, W

(1993) Computerized Occlusal Analysis, The

High-tech, High care Dentistry Journal, 59(8),

701-702)

measure occlusal contact relative occlusal force

using traditional non-digital occlusal indicators

Instead, it was believed that the clinician could

observe equal occlusal force within the size

uni-formity of holes in wax imprints, within

articulat-ing paper markarticulat-ings of similar sizes, and from the

patient confirming comfortable occlusal “feel”

Another significant Occlusal Science

innova-tion that was introduced with the T-Scan I

tech-nology, was that occlusal contact timing order in

closure, and frictional contact durations present in

excursive movements were both measurable with

the T-Scan I (Maness, 1989; Kerstein & Wright,

1991) When introduced, the T-Scan I was the first

ever occlusal indicating device or material, that

could actually measure occlusal contact timing

in 0.01second-long increments within a 3-second

long recording No prior device or dental material

was capable of time measurement Yet, Dental

Medicine strongly believed time measurement was

possible to obtain using static occlusal indicators,

like wax and dental articulating paper

Longstanding Advocated Ideal

Occlusal Timing Characteristics

Timing of occlusal contacts has always been

deemed important to the science of Dental

Occlu-sion It has been advocated within the literature

that occlusal contacts present in a physiologic

occlusion should demonstrate the following

tim-ing characteristics:

An optimum occlusal contact timing

arrange-ment should demonstrate:

• Bilateral simultaneously occurring contact

of all contacting teeth during a

mandibu-• No time-premature contacts when the mandible is closed into Centric Relation (Okeson, 2005c)

However, despite these advocated cal timing ideals that clinicians were striving to measure and treat to, it was not possible prior to the development of the T-Scan I technology, to record or measure occlusal contact time sequences Instead, it was believed that the clinician could subjectively determine simultaneous contact timing by observing a widespread distribution of articulating paper markings of similar size that were spread around the dental arches upon all contacting teeth, or by listening to the “sound” of occlusal contact with the patient reporting their occlusion “feels even” Additionally, immediate posterior disclusion was believed to occur within

theoreti-an excursion, if the clinicitheoreti-an could visibly observe the posterior teeth disengaging from each other, as the patient moved laterally out to of intercuspation

to reach the tip of the working side canine teeth None of these subjective clinician visual assess-ments were ever shown in published studies to accurately measure excursive movement contact timing order, simultaneity, or durations

The original T-Scan I software, and all

follow-on T-Scan versifollow-ons, have been able to record contact timing in either 0.01(T-Scan I, II) and 0.003 (T-Scan III software versions 6 and 7, and T-Scan 8) second increments

T-Scan I Performance Studies

Although the T-Scan I represented a significant technological innovation in modernizing occlusal diagnostic procedures, it was highly scrutinized