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- permanent teeth (including canines), without taking third
sion (CO) or habitual occlusion, is the intermaxillary tooth molars into account.28-30
relationship most often used during the last stages of Regarding tooth location of posterior contacts in IP, only
chewing. rW4 The frequency of occlusal contact in IP seems a few investigations have examined this variable. Some of
to vary, being greatest and of increased duration during the these studies refer to anterior or posterior tooth location
last part of mastication.l* 2 only,ll* l3 whereas others determined the highest number of
Basically two different approaches have been used to contacts to be located on molars.14*lg*22Beyro# found the
evaluate occlusal contacts in IP. In the first one, the area occlusal contacts in IP to be distributed bilaterally between
of occlusion is quantified on the basis of differences in ra- second molars and first premolars in 16 of 24 young Aus-
diographic densit+ 6and passageof light’s& or air9 through tralian aborigines, which differs from results in young
the interocclusal registration material. Although in some Scandinavian adults, where approximately 50 % had asym-
studies no differences in occlusal surfaces between subjects metric distribution of contacts.22 None of the studies,
were found,6l g it is nevertheless possible to have large vari- however, reported an analysis on the distribution pattern
ations in size and location of contacts (for example, perfo- of contacts in IP.
rations in the interocclusal registration material).g This investigation analyzed the number and location of
The second approach attempts to measure the type, occlusal tooth contacts in IP between canines and second
number, and location of occlusal contacts by use of differ- molars in a group of selected young adults with clinically
ent techniques and types of materials such as wax,r”-i4 sound, unrestored natural dentitions. Of special interest
soot,16 carbon black/oil,16 impression materials,17-1g oc- was the presence of symmetry in the distribution of
clusal registration strips,so-2s or pressure-sensitive de- contacts.
vices.26>27
Studies have shown different results for the average METHODS AND MATERIAL
number of posterior contacts in IP, varying between 9.6 Forty-five male subjects aged 17 to 24 years were selected
contacts (total of 192 posterior contacts in 20 subjects15), from a group of 752 young healthy adults. The following
10.8 and 17.6 contacts respectively for light and hard bit- criteria were used in the selection:
ing pressure,z1 18.5 (total of 272 posterior contacts in 15
1. Complete unrestored permanent natural dentition (ex-
subject@) and 24.8 contacts (total of 248 posterior con- cept for missing thiid molars)
tacts in 10 subjectsr’j. These data contrast with suggestions 2. Bilateral Angle class I first permanent molar and canine
for an ideal normal occlusion (Angle class I), where 24 to 40 relation with no prior orthodontic treatment
contacts are thought to exist between opposing posterior 8. Presence of overbite (vertical overlap) and overjet,
(horizontal overlap) with coinciding upper and lower
dental midlines
4. Absence of pathologic periodontal condition
101112Q274 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 bution of the number and location of occlusal contacts
ruler from the labial surface of the lower central incisor to was analyzed for subjects and type of contacting tooth
the midpoint of the incisal edge of the upper central inci- pairs.
sor. The distance was measured to the nearest 0.5 mm in
the occlusal plane perpendicular to the arch. Where there Number of contacts
was attrition of the upper incisor, measurements were A total of 666 posterior occlusal tooth contacts were re-
made to the labial edge of the worn surface. corded between canines and molars, 346 contacts for the
Vertical overlap was evaluated on the lower central inci- right side (mean 7.7 contacts; range: 1 to 15) and 320 for the
sor from the incisal edge to the same point as for the hor- left side (mean 7.1 contacts; range: 3 to 14). The unilateral
izontal overlap. The reference point was marked with a frequency distribution of the number of contacts is given
sharp pencil. The distance was measured with sliding cal- in Table II. Approximately 50% of the subjects had
lipers to an accuracy of 0.5 mm. between seven to nine contacts on the riglit side and six to
A technique suggested and used by Ingervall,32 using in- eight contacts on the left side, the difference in number
dexes of alginate (irreversible hydrocolloid) impression of contacts between classes being significant for each side
material was applied to record the number and location of (p < 0.001). Six subjects had an equal distribution in the
posterior occlusal tooth contacts, including canines. The number of contacts between right and left sides, and 39
selected subjects rested their backs and heads on a reclined subjects had differences in number of either one or more
dental chair (approximately 30 degrees to the floor). After contacts between sides (see Table III). The difference be-
spatulation, the impression material was applied to the oc- tween subjects with and without bilateml symmetry in
clusal surfaces of all lower canines, premolars, and molars number of occlusal contacts was statistically significant
on both sides. Subjects were then instructed to close the (p < 0.001).
mouth slowly and press the teeth together with light to
moderate pressure until the impression material was set. Location of contacts
All impressions were made at the same period of time dur- Nine subjects had an equal pattern in the location of
ing the day. After their careful removal, the left and right contacts between right and left sides and 36 subjects had
indexes were examined against light, and the number and differences in location of occlusal tooth contacts between
location of perforations were registered as occlusal tooth sides. The difference between subjects with and without
contacts for each subject. The chi-square test was used to bilateral symmetry of contacts was statistically significant
determine any statistically significant differences between (p < 0.001).
the right and left sides for the observed number and loca- Because not all of the 45 subjects had third molars in oc-
tion of contacts. A difference was determined to be signif- clusion, the location of contacts was analyzed only between
icant at p 50.05. maxillary and mandibular canines to second molars. Twen-
ty-four different patterns in the location of occlusal con-
RESULTS tacts between maxillary and mandibular teeth were found,
The age distribution and data on the dentition are given 15 for the right and the left sides (although some were dif-
in Table I. The unilateral and bilateral frequency distri- 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 Fig. 1. Lateral view of maxillary and mandibular dental
mandibular premolars and molars (six subjects), followed arches in contact. Dotted lines indicate 11 different types
by five subjects who had contacts between maxillary and of contacting tooth pairs (C, canine; Pm, premolar; M, mo-
mandibular adjacent premolars and molars. The difference lar).
in location of contacts between patterns was significant for
the right side (p < 0.001) and nonsignificant for the left than the type and thickness of occlusal marking devices,
side (0.10 < p < 0.25). relevant variables such as bite force,s1p22 head/body
posture,12,35 and time6pg,20,23 should also be taken into
Type of contacting tooth pairs consideration.
In this study, contacts involving permanent teeth only In a study where the number of occlusal tooth contacts
were found between 11 different types of contacting tooth in IP was compared between subjects using light and hard
pairs on each side (Fig. l), although up to 24 pairs have been bite force, a significantly smaller number of contacts was
described for mixed deciduous and permanent dentition.32 found at light pressure.21On the other hand, it seems that
Regarding the location of contacts, most subjects had changing head posture in the sagittal plane results in an
contacts between maxillary and mandibular first molars alteration in the habitual closing pattern.35 Graded changes
and second molars on both sides. On the right side, there in body position toward an upright position and unilateral
was a slightly higher frequency of contacting first molars electrical stimulation of the superficial masseter muscle
(42 subjects) when compared to the left side where the sec- resulted in an increase and a more forward location of oc-
ond molars were the most frequent type of contacting tooth clusal contacts in IP.12
pairs (43 subjects). These frequencies were followed in de- In the present investigation of young adults with mor-
creasing order by maxillary and mandibular premolars, phologically normal occlusion and a relative absence of
first and second molars, canines and first premolars, and symptoms of functional disturbances of the masticatory
finally maxillary and mandibular canines. system, most subjects had asymmetry in number and loca-
Because a contact is formed by two opposing tooth sur- tion of occlusal contacts in IP. Although in this study the
faces, and none, one, or several contacts may occur between posture and time variables were held constant, no attempt
these surfaces, the number of contacts was also examined was made to control the bite force, which might have been
according to type of contacting teeth. The highest number a possible source of variability in the results. This is par-
of contacting tooth pairs had one contact, followed in tially opposed by the finding that the asymmetric distri-
decreasing order by those with two, three, four, and five bution of contacts does not necessarily change significantly
contacts, respectively (see Table V). Only one pair of con- at hard pressure.22
tacting first molars showed six contacts. Maxillary and A recent study has shown a higher electromyographic
mandibular pairs of first and second molars showed the activity of the masseter muscle at the side with the higher
highest variety in number of contacts, with the presence of number of tooth contacts.36 Although it is tempting to cor-
one to three contacts on each type of tooth pair quite fre- relate occlusal asymmetry with epidemiologic findings of
quent. muscle or articular dysfunction, caution is advocated in
doing so, because the selected sample in the present inves-
DISCUSSION tigation was apparently symptom-free. Asymmetry is bet-
Measurement of occlusal contacts by visual examination ter interpreted as a reflection of variability within the pop-
alone does not seem to be a valid method. Some type of ulation.
material interposed between upper and lower tooth arches Regardless of the observed asymmetric frequency distri-
must be used to reflect contacting teeth, but at the same bution of the number and location of contacts between
time, the material should be as thin and precise as subjects, a significantly higher number of subjects had ap-
possible.33p34In selecting an impression materials such as proximately seven contacts on the right and left sides, lo-
irreversible hydrocolloid for this study, a small setting time cated usually between maxillary and mandibular canines to
and good reproducibility was meant to be ensured.32Other second molars on the right side and maxillary canines to

THE JOURNAL OF PROSTHETIC DENTISTRY 209

OCCLUSION IN INTERCUSPAL POSITION

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210 AUGUST 1980 VOLUME 64 NUMBER 2