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Journal of Prosthodontic Research 56 (2012) 130135

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Original article

Effect of occlusal contact stability on the jaw closing point

during tapping movements
Keisuke Nishigawa DDS, PhDa,*, Yoshitake Suzuki DDSa, Teruaki Ishikawa DDS, PhDb,
Eiichi Bando DDS, PhDa
a

Department of Fixed Prosthodontics, Institute of Health Biosciences, The University of Tokushima Graduate School,
3 Kuramoto-cho, Tokushima 770-8504, Japan
b
Center for Advanced Dental Health Care, Tokushima University Hospital, Tokushima, Japan
Received 13 January 2011; received in revised form 6 April 2011; accepted 20 April 2011
Available online 1 July 2011

Abstract
Purpose: We studied the relationship between tapping point reproducibility and stability of occlusal contacts at maximum intercuspation.
Methods: Tapping movements of 12 adult volunteers who had dentition with natural teeth were recorded, and distances between the tapping point
(TP) and the intercuspal position (ICP) at the incisal point were calculated. Occlusal contacts at the ICP of individual subjects were also evaluated
with black-colored silicone impression material. The correlation between TPICP distance and occlusal contact stability was studied.
Results: TPICP distance exhibited negative correlations with the total number of teeth showing occlusal contact at the ICP. Standard deviations of
TPICP distance also negatively correlated with the extension of occlusal contact area over dentition.
Conclusions: This finding indicates that occlusal contacts at the ICP affect the kinematic behavior of tapping movements. The results of this study
also suggest that jaw movement data may provide useful clinical information for the evaluation of occlusal contact at ICP.
# 2011 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
Keywords: Tapping point; Jaw movement; Occlusal contact

1. Introduction
Jaw closing position, obtained by tapping movement from
the mandibular rest position, i.e., the tapping point, is known to
coincide with the maximal intercuspal position [1]. Therefore,
tapping movement is frequently used for occlusal adjustment
and occlusal registration in dental practice. Tapping movement
has also been reported to affect tapping speed (frequency),
range of mouth opening, head and body posture, etc. [28].
Ueno et al. [9] reported that experimental alternation of
occlusal contact pattern with maxillary occlusal splint affected
tapping point distribution. They concluded that change in the
occlusal contact resulted in a deviation of the tapping point
from the original maximum intercuspal position (ICP).
ICP is one of the most important occlusal positions for jaw
function such as mastication. Interference and/or insufficient
occlusal support disturbs this position and may cause

* Corresponding author. Tel.: +81 88 633 7350; fax: +81 88 633 7391.
E-mail address: keisuke@dent.tokushima-u.ac.jp (K. Nishigawa).

unsatisfactory jaw function. Thus, occlusal contacts at the ICP

or during kinematic jaw movement may represent functional
aspects of dental occlusion. Since tapping point is referred to as
ICP, it follows that insufficient stability of the ICP could affect the
tapping point; that is, the movement may not be reproducible and
vice versa.
The overall purpose of this research is to develop a
functional examination method for dental occlusion by
evaluating jaw movement data. The current research presents
the relationship between occlusal contact stability at ICP and
tapping point reproducibility.
2. Materials and methods
2.1. Participants
Twelve adult volunteers (9 male and 3 female; mean age,
27.2  4.3 years) from among the faculty and students of
Tokushima University Dental School participated in this research.
Oral examinations were performed, and the questionnaires and
clinical protocol of the Temporomandibular Disorder Clinic,

1883-1958/$ see front matter # 2011 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.
doi:10.1016/j.jpor.2011.04.005

K. Nishigawa et al. / Journal of Prosthodontic Research 56 (2012) 130135

131

Fig. 1. Recording of tapping movement. Subjects are seated in a dental chair in

the upright position, with the jaw-tracking device (CS-IIi) connected to
mandibular and maxillary dentition.

Tokushima University Dental Hospital, were administered to all

participants. All the subjects had dentition of natural teeth without
full veneer crown restoration. None of the subjects had missing
teeth except for the third molar and exhibited signs or symptoms
of periodontal disease or temporomandibular disorders. All
subjects had Angle class I dentition, and severe occlusal
anomalies, such as mandibular or maxillary protrusion, and
open bite were not found. This research was approved by the
Research Ethics Committee of Tokushima University Hospital,
and informed consent was obtained from all participants.

Fig. 2. Occlusal contact area was detected by passing translucent light through
the black silicone occlusal registration record. A thickness gauge made with the
same silicone material was utilized to evaluate the thickness of the silicone film
from the gradation of the translucent light.

2.2. Recording of tapping movement

2.3. Evaluation of occlusal contacts
Jaw movements of the subjects were recorded with a custommade jaw-tracking device, CS-IIi (Fig. 1). This device consists of
a pairs of small sensor coil units that were connected to the frontal
surface of the maxillary and mandibular dentitions with acrylic
jig. The small size and light weight (each sensor unit weighs 7 g,
excluding the electrical cable and acrylic jig) of the device
allowed measurement of six-degree-of-freedom jaw movement
with minimum restriction for the subject. A calibration study
revealed the accuracy of this device to be about 48 mm for
translation and 0.0358 for rotation. A more detailed description of
this device has been presented elsewhere [8,10]. To record
tapping movement, each subject was asked to sit on a dental chair.
The back of the dental chair was raised to its maximum height and
no headrest was used. The Frankfort plane was adjusted so that it
was horizontal. For jaw movement recording, the subjects were
asked to perform rapid- and light-force jaw opening and closing
movement with a minimum range of jaw opening, i.e., tapping
movement. Tapping movement was recorded for 5 s and repeated
3 times for all subjects. Jaw movement recording was performed
with a 100-Hz data acquisition rate.

Occlusal registration record at the ICP was obtained with

black-colored silicone impression material (GN-I CAD
SILICONE; GC Corp., Tokyo, Japan). While the black silicone
record was being obtained, subjects were seated on a dental
chair in the upright position. Impression material was spread on
the mandibular dental arch with a cartridge dispenser, and the
subjects were asked to keep their jaw clenched for 60 s until the
impression hardened. Occlusal contacts of the subjects at the
ICP were evaluated as follows. A black silicone record with a
thickness gauge (made of the same silicone material) was
placed on an illuminator that was mounted on a close-up table.
The translucent image from the black silicone record was
captured with a digital camera (FinePix S1 Pro; Fujifilm Corp.,
Tokyo, Japan). After comparison of the gradation of the
thickness gauge and translucent color on the black silicone
record film, areas less than 30 mm thick were detected as
occlusal contact areas (Fig. 2). Images of occlusal contact areas
were superimposed on images of the dental cast stone to
confirm the occlusal contact region. The occlusal contact area

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K. Nishigawa et al. / Journal of Prosthodontic Research 56 (2012) 130135

Fig. 3. Occlusal contact extent area is drawn with lines connecting the outer
edge of the occlusal contact area with convex angles. The size of this area
indicates the stability of maximum intercuspation.

extent was calculated by drawing a polygon connecting the

occlusal contact areas with convex angles (Fig. 3). The number
of maxillary teeth with occlusal contacts, area of occlusal
contacts, and the occlusal contact extent area were utilized to
evaluate the stability of the occlusal contacts at ICP.
2.4. Data analysis
The initial 5 strokes of the 5-s tapping movement were used
for the following analysis. Jaw movement pathway at the incisal
point during tapping movement was evaluated. During the
closing phase of tapping movement, the minimum distance of
the jaw movement pathway, up to maximum intercuspation,
was calculated, and the incisal point at this jaw position was
detected as the tapping point. For the same tapping movement,
the maximum distance of the jaw movement pathway, from the
ICP, was utilized to evaluate the range of mouth opening. Since
3 tapping movement recordings were conducted for each
subject, a total of 15 tapping points and jaw-opening data were
obtained. The mean distances from the tapping point to the
maximum intercuspal position (TPICP) for 15 individual
tapping points were obtained. Standard deviations of TPICP
distance were utilized to evaluate the reproducibility of the
tapping point.
The time interval between acquisition of each sequential
tapping point was used to evaluate the frequency of tapping
movement. Frequency of tapping movement and range of
mouth opening were evaluated to confirm whether the TPICP
distance was affected by the kinematics of tapping movement.
The correlation among all the above kinematic and occlusal
contact parameters were calculated to evaluate the relationship
between tapping point reproducibility and occlusal contact
stability. Statistical analysis was performed with JMP1 (SAS
Institute Inc., Japan).

Fig. 4. Horizontal views of tapping point distribution. The central cross

indicates the incisal point at maximum intercuspation. The black rhombi
indicate representative tapping points obtained by averaging 15 individual
tapping points.

3. Results
Fig. 4 shows a horizontal view of all tapping points. A total
of 180 points (15 points for 12 subjects) and 12 average
representative individual tapping points are seen in the graph.
Table 1 presents all the parameters of tapping movement and
occlusal contact stability. Table 2 presents a list of teeth that
showed occlusal contacts at the ICP. Correlation coefficient
among all the variables is shown in Table 3.
4. Discussion
In normal dentition, occlusal contacts at the ICP are found
on the occlusal surface of all molar teeth. These occlusal
contacts function to stabilize the mandible at this position.
Absence of teeth and/or insufficient dental restoration may
cause poor occlusal contacts and result in unstable ICP. Such
occlusal contacts may not exhibit satisfactory masticatory
efficiency and is sometimes found in patients with temporomandibular dysfunction [11]. In this research, we focused on
whether tapping point reproducibility could also influence
occlusal contact stability. Since tapping movement was
performed rapidly with a small range of mouth opening, the
jaw-closing point during this movement was close to the
muscular position [12]. Maximum distance from the tapping
point to the ICP was less than 0.40 mm in all subjects; from this,
it can be said that the muscular positions of these subjects
nearly coincide with the ICP.
However, detailed evaluation of the TPICP distance
showed that this distance positively correlated with individual
distribution of TPICP distance (Table 3). When the tapping
point was closer to the ICP, the distribution of the tapping point
was smaller, while longer TPICP distance was associated with

K. Nishigawa et al. / Journal of Prosthodontic Research 56 (2012) 130135

133

Table 1
Kinematic parameters of tapping movements and occlusal contact parameters that represent intercuspal position stability in all subjects.
Subject

Tapping movement

Occlusal contacts

TPICP
distance (mm)

TPICP S.D.
(mm)

Frequency
(Hz)

Mouth opening
(mm)

Occlusal contacts
area (mm2)

Occlusal contact
extent area (mm2)

Occlusal contact
teeth (num)

1
2
3
4
5
6
7
8
9
10
11
12

0.02
0.03
0.03
0.08
0.10
0.11
0.15
0.18
0.20
0.22
0.36
0.39

0.010
0.013
0.015
0.030
0.026
0.013
0.010
0.038
0.032
0.093
0.049
0.042

3.26
4.11
2.66
2.59
2.69
4.96
3.61
3.39
3.96
2.27
3.41
3.54

1.96
1.15
6.24
6.92
5.73
0.95
3.43
3.87
2.44
2.53
1.20
2.16

16.09
21.96
31.10
40.16
41.14
33.09
20.43
4.66
16.47
6.24
22.19
6.94

1638
1668
2447
1746
2272
2209
1858
1065
1874
1107
1426
1337

9
13
16
11
16
13
14
6
11
7
10
4

Mean

0.16

0.031

3.37

3.22

21.71

1721

10.8

Table 2
List of teeth that showed occlusal contacts at the intercuspal position in all subjects. +with occlusal contact; blank, without occlusal contacts; /, missing tooth.
Subject
1
2
3
4
5
6
7
8
9
10
11
12

18
/
+
+
+
/
/
/
/
/
/
/

17

16

15

14

+
+
+
+
+
+
+

+
+
+
+
+
+
+
+
+
+
+

+
+
+
+
+
+
+

+
+
+
+
+
+
+

+
+
+
+

+
+

+
+
+
+

13
+
+
+
+
+
+

12

11

21

+
+

+
+

+
+

+
+
+
+
+

+
+
+

+
+

22

+
+
+
+
+
+

23

24

25

26

27

+
+
+
+
+
+
+

+
+
+
+
+
+
+

+
+
+
+
+
+
+
+
+

+
+
+
+
+
+
+
+
+
+
+

+
+
+
+
+
+
+
+
+
+
+
+

+
+
+
+

28
/
+
/
+
/
/
/
/
/
/

Table 3
Correlation coefficients between variables of tapping movement and occlusal contacts.
TPICP distance
TPICP S.D.
Frequency
Mouth opening
Occlusal contacts area
Occlusal contact extent area
Occlusal contact teeth
*
**

TPICP S.D.

Frequency

Mouth opening

Occlusal contacts area

Occlusal contact extent area

0.5042
0.3658
0.3567

0.8013**
0.7998**

0.885**

0.5938
0.0373
0.3567
0.4988
0.55
0.6245*

0.4772
0.0958
0.4786
0.6537*
0.5778*

0.6766*
0.0437
0.1474
0.0539

p < 0.05.
p < 0.01.

greater distribution. On the other hand, TPICP distance did not

show remarkable correlation with tapping movement frequency
or range of mouth opening. Thus, jaw motion during the jawopening phase of tapping movement was not relevant to TP
ICP distance in these subjects.
The jaw tracking device CS-IIi, which was used in this study,
utilizes 2 sensor coil units for the detection of jaw position. The
primary sensor coil unit, which generates a magnetic wave
field, was attached to the maxilla, and the secondary sensor coil
unit, which detects signals from magnetic waves, was attached

to the mandible. The accuracy of this device is influenced by the

distance between these sensor coil units. The lowest accuracy,
that is 48 mm, was found at an intersensor distance of
145.7 mm. Near the ICP, the intersensor distance is controlled
to around 90 mm, and this device exhibits higher resolution and
detects jaw movement accurately at the level of 3 mm, which is
the required level for evaluation of jaw movement with occlusal
contacts [8,10].
Occlusal registration records were obtained with silicone
impression material. Quantitative evaluation of occlusal

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K. Nishigawa et al. / Journal of Prosthodontic Research 56 (2012) 130135

contact is possible by application of the thickness gauge and

digital image analysis [1315]. Gurdsapsri et al. [16] reported
that the pressure of clenching affected the occlusal contact area
that was recorded with black silicone. In this research, the
subjects were asked to clench their jaws with the maximum
possible force, so the clenching level was controlled to nearly
the maximum voluntary contraction until occlusal force was
reduced because of muscle fatigue. It makes sense that the
larger the occlusal contact area is, the more stable the ICP will
be; however, if occlusal contact is wide only in the case of a few
teeth, it is not enough to satisfactorily stabilize the ICP. Local
attrition of anterior teeth or a few extruded teeth may cause such
wide occlusal contacts. Evenly distributed contact on large
dental arches should allow for better stability of ICP. Therefore,
we think that the contact extent area indicates the range of
distribution of occlusal contacts on the dental arch for
individuals with completely natural dentition.
In this research, none of the participant had serious
malocclusions. However, slight irregularities of the dental
arch caused by minor rotation and inclination of teeth were
found in most cases. This irregularity could be responsible for
the difference in occlusal contact parameters between subjects.
Since statistical analysis revealed positive correlations among
all the variables for the evaluation of occlusal contact stability,
these occlusal contact parameters are not independent but
represent the occlusal support level partially (Table 3). For
example, the total number of teeth was not the same in some
subjects. If the total number of teeth was different, the size of
the dental arch cannot be the same; thus, the occlusal contact
stability of the dentition will not be identical. Since the occlusal
contact extent area indicates the broadness of the occlusal
supporting area, we think that it is valuable for evaluating
occlusal stability in the case of dentition with different number
of teeth.
Number of teeth with occlusal contacts were negatively
correlated with TPICP distance and standard deviation of TP
ICP distance (Table 3 and Fig. 5). Occlusal contact extent area
was also negatively correlated with standard deviation of TP
ICP distance (Table 3). The result of this finding indicates that
unstable occlusal contacts at ICP may result in the lack of
reproducibility of the tapping point. Since initial contact during
tapping movement is influenced by muscle memory, i.e.,
engrams, of occlusal contact [1,12], stable occlusal contact
could lead to better reproducibility of tapping points. During
dental restoration, before occlusal adjustment is performed,
pre-adjusted restoration disturbs the maximum intercuspation
of the patient. In such cases, initial occlusal contacts found on
pre-adjusted restoration during tapping movement are marked
with articulating paper. These occlusal contacts are considered
to interfere with adequate ICP and should be removed to
achieve equalized occlusal contacts. However, disturbed ICP
may elicit unreliable tapping movement, and unreliable tapping
movement could result in irrelevant occlusal contacts; this can
also occur in patients with malocclusion. Unstable occlusion
may cause unreliable jaw movement that could result in
irrelevant occlusal contacts. This negative repetition may
prevent the detection of occlusal contact, which should be

Fig. 5. Scatter plot graphs of tapping point to intercuspal position (TPICP)

distance and number of teeth with occlusal contacts. Colored areas represent
95% confidence ellipses for each pair of coefficients.

eliminated to achieve equalized maximum intercuspation.

Therefore, dental clinicians should be careful when they detect
initial occlusal contacts, especially in cases with unstable
occlusal contacts.
The results of this study also indicate that the kinematic
behavior of tapping movement could be influenced by the
morphology of the dental occlusion. This suggests that jaw
movement data may contain clinical information that could be
useful for evaluating the functional aspects of dental occlusion.
Other morphological factors, such as angle of the incisal and
condylar path, cusp angle, over jet and over bite, and level of teeth
attrition, may also effect tapping movement. Further study will
be required to determine the relationship between the functional
factors of dental occlusion and kinematics of tapping movement.

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