Australian Dental Journal 2010; 55: 4550

SCIENTIFIC ARTICLE

doi: 10.1111/j.1834-7819.2009.01174.x

Location of main occluding areas and masticatory ability in

patients with reduced occlusal support
Y Nakatsuka,* S Yamashita,* H Nimura, S Mizoue,* S Tsuchiya, K Hashii*
*Department of Oral and Maxillofacial Biology, Matsumoto Dental University, Nagano, Japan.
Department of Fixed Prosthodontics, Matsumoto Dental University, Nagano, Japan.

ABSTRACT
Background: The purpose of this study was to investigate the differences in location of the main occluding area with
reduction of occlusal support and to evaluate the subsequent impairment in masticatory ability.
Methods: One hundred and two patients were recruited according to the Eichners index, which is based on the number of
occlusal support zones. Each subject was instructed to clench a piece of temporary stopping in the particular occluding area
that was preferably used during mastication. The main occluding area was judged by locating the tooth on which the
temporary stopping rested. Subjective masticatory ability was self-assessed by means of a questionnaire.
Results: Group classification depending upon the location of the main occluding area was significantly associated with
the category of the Eichners index. The level of masticatory ability was significantly associated with the category of the
Eichners index. Moreover, masticatory ability was significantly more impaired in subjects with main occluding areas at
the premolar regions compared to those at the molar regions.
Conclusions: The location of the main occluding area may differ under the influence of the remaining natural teeth. The
location of the main occluding area and the masticatory ability are likely to be closely related.
Keywords: Main occluding area, occlusal support, Eichners index, masticatory ability, first molar.
Abbreviations and acronyms: CD = complete denture; OSZ = occlusal support zones; RPD = removable partial denture.
(Accepted for publication 1 June 2009.)

INTRODUCTION
Mastication requires well-controlled separation and
closure of the maxillary and mandibular teeth. This
movement is believed to be under the control of a
central pattern generator located in the brain stem.1,2
While chewing may occur bilaterally, unilateral chewing occurs in most of the population, with an apparent
preference for a particular side.3 Kato et al.4 located
the occlusal area which was used unilaterally during
crushing hard food and this limited area was named as
the main occluding area. They found that in most
subjects, the main occluding area was located between
upper and lower first molars on the preferred chewing
side. They analysed the reason of the main occluding
area being coincident with the first molar and concluded that the maximal biting force might be exerted
in the first molar region. Many other investigators have
also stated that bite force varies in each region of the
oral cavity, the greatest being in the first molar area and
only about one-third to one-quarter of that when
measured between the incisors.58
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On the other hand, in the partially or fully edentulous

condition with reduced occlusal support, the occluding
area is considerably limited and the food platform area
changes accordingly to enable mastication using the
remaining natural teeth as well as the artificial teeth.
Hashii et al.9 stated that when the chewing region was
changed from the first molar to the first premolar, the
patient would be forced to chew with minimal lateral
deviation of the mandible in spite of the toughness of the
food. Therefore, it is important to know the location of
the main occluding area in such patients when providing
instructions on how to use their jaws during mastication
with reduced occlusal support. However, no studies
have investigated the difference in the location of the
main occluding area in relation to the reduced remaining
occlusal support. The purpose of this study was to
investigate the difference in the location of the main
occluding area when the posterior occlusal support was
reduced and evaluate the subsequent impairment of
masticatory ability.
We hypothesized that the location of the main
occluding area might differ under the influence of the
45

Y Nakatsuka et al.
remaining natural teeth and that the location of the
main occluding area and masticatory ability might be
closely related.
MATERIALS AND METHODS
Subject selection
One hundred and two patients (57 males and 45
females) attending the prosthodontic clinic at Matsumoto Dental University were recruited as subjects for this
study. Their ages ranged from 19 to 84 years (mean age:
51.1). These subjects were selected according to the
Eichners index.10 This index is based on the number of
occlusal support zones (OSZ) which consist of occlusal
contacts of the existing natural teeth or fixed prostheses
in the premolar and molar regions. The healthy natural
dentition is composed of four OSZs (Fig 1).
The inclusion criteria for the subjects were as
follows: (i) patients classified as Eichners A1 (A2 and
A3 were excluded), B or C categories; (ii) for Eichners
B or C categories, reduced OSZs were replaced
with removable prostheses; (iii) patients without any
complaints regarding their masticatory function; (iv)
patients without painful teeth; and (v) patients without

A1

B1

A2

B2

C1

A3

B3

C2

B4

C3

Fig 1. Schematic representation of the Eichners index. The shadings

of the teeth indicate occlusal contacts of the existing natural teeth or
xed prostheses in the premolar and molar regions that construct the
occlusal support zones (OSZ). A category contains four OSZs.
A1: complete dentition. A2: missing teeth in one arch. A3: missing
teeth in both arches. B category contains one to three OSZs or
contacts in the anterior area only. B1: three OSZs. B2: two OSZs.
B3: one OSZ. B4: contacts in the anterior area only. C category has no
OSZ at all. C1: teeth in both arches. C2: teeth in one arch.
C3: edentulous.
46

subjective symptoms of temporomandibular disorders.

The numbers of subjects belonging to Eichners A1, B1,
B2, B3, B4, C1, C2 and C3 categories were 44, 7, 6, 13,
9, 4, 9 and 10, respectively.
The study protocol was approved by the Ethics
Committee of Matsumoto Dental University (#0042)
and informed consent was obtained from all subjects.
Observation of the main occluding area
The main occluding area was identified by using a
4-mm-long temporary stopping (GC Inc., Tokyo,
Japan), which was a temporary sealing material made
of polyisopropylene, zinc oxide and wax. Prior to
examination, a piece of temporary stopping was placed
in the centre of the dorsal aspect of the tongue as test
food, then each subject was instructed to clench the
temporary stopping at the particular occluding area that
was preferably used during mastication. The clenching
level was set at approximately similar force levels as in
chewing. The main occluding area was judged by
locating the tooth on which the temporary stopping
rested during clenching (Fig 2). The same procedure was
repeated at least three times to ensure the location of the
main occluding area. If the location of the main
occluding area varied with every measurement, the
patient was not included in the experiment as a subject.
In the present study, the subjects were divided into
two groups depending upon the location of the main
occluding area, premolar group (PM group) and molar
group (M group), with the main occluding areas at the
premolar regions and molar regions, respectively. The
number of the subjects belonging to each group was
calculated for all categories of the Eichners index.
Self-assessed masticatory ability
Masticatory ability was self-assessed by means of a
questionnaire designed by Sato et al.11 The survey
included questions on the chewing of the following 20
items arranged from easy- to hard-to-chew food: tofu,
omelette, boiled potato, boiled carrot, bean sprouts,
fish cake, potato chips, burdock, rice-cake cubes, roast
meat, peanuts, pickled radish, hard cracker, hard rice
cracker, cockle, hard pickled radish, dried squid, dried
scallop, chewing gum, and whole apple. The subject
was asked to classify each of the 20 food items as easy
to chew, difficult to chew, or impossible to chew
without exception. The level of masticatory ability was
obtained by calculating the percentage of food judged
as easy to chew.
Statistical analysis
By comparing the number of subjects in the PM group
and M group of all categories of the Eichners index
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Location of main occluding areas

(%)

(a)

20

40

60

80

100

A1
B1
B2
PM group

B3

M group

B4
C1
C2
C3

Fig 3. The ratio of the PM group to the M group for each category of
the Eichners index.

(b)

Scores (Mean and SD) (%)

0

20

40

60

80

100

A1

B1

*
*

B2

*
*

B3

*
B4
C1
C2
C3
Bonferroni adjustment; *p < 0.05

Fig 2. Observation of the main occluding area. (a) The subject was
instructed to clench a piece of temporary stopping, which was placed
in the centre of the dorsal aspect of the tongue prior to clenching.
(b) The main occluding area was judged by locating the tooth on
which the temporary stopping rested during clenching.

using chi-square test, the interrelationship between the

location of the main occluding area and the category of
Eichners index was analysed. Associations of the level
of masticatory ability with the category of the Eichners
index were analysed by means of one-factor ANOVA.
Pairwise comparisons among the eight categories were
made using Bonferroni adjustment. For the subjects in
Eichners B or C category, the level of masticatory
ability in the PM group and M group was compared
using Students t-test. The level of significance was set
at p < 0.05.
RESULTS
Observation of the main occluding area
Of the subjects in Eichners A1 category, 97.7% had their
main occluding areas in the first molar region and all
subjects were classified as the M group. For the subjects
in Eichners B or C category, the main occluding areas
were located anteriorly compared with Eichners A1
category. This tendency was remarkable in the subjects in
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Fig 4. The score of the self-assessed masticatory ability for each

category of the Eichners index.

Eichners C1 category. Fifty per cent of these subjects

were classified into the PM group (Fig 3). Overall, group
classification was significantly associated with the category of the Eichners index (chi-square test; p < 0.05).
Self-assessed masticatory ability
In comparison with Eichners A1 category, the level of
the masticatory ability was impaired in subjects in both
Eichners B and C categories. The level of masticatory
ability was significantly associated with the category of
the Eichners index (one-factor ANOVA; p < 0.01).
Pairwise comparisons showed significant differences
between the following categories: A1 and B2, A1 and
B3, A1 and B4, A1 and C2, and A1 and C3 (Fig 4).
Moreover, for the subjects in Eichners B or C
category, the level of masticatory ability was significantly more impaired for subjects in the PM group
compared to those in the M group (Student t-test;
p < 0.05) (Fig 5).
DISCUSSION
For most human activities, there exists a tendency to use
one side of the body over the other. While right or left
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Y Nakatsuka et al.

Scores (Mean and SD) (%)

20
40
60
80

100

PM group
*

M group

Student t-test; *p < 0.05

Fig 5. Comparison of the level of masticatory ability between the PM
group and the M group.

handedness appear to be centrally determined, preference for chewing on a particular occluding area is
thought to be influenced by some peripheral factors.12,13
If chewing preference is under peripheral influence, the
choice of a particular area may be made because it has
some selective advantage. However, few studies have
attempted to judge the particular occluding area that is
mainly used during mastication. In the present study, the
main occluding area was identified by observing the
location of the tooth on which the temporary stopping
rested during clenching, according to the method
proposed by Kato et al.4 The validity of such a simple
method of clenching the temporary stopping should be
high and the clenching task used in the present study
would be relevant to the actual chewing on the occlusal
table, since many investigators1416 have analysed
chewing preference by taking the first stroke of mastication as an indicator of lateral chewing preference.
In the present study, subjects were classified into
eight categories (A1, B1-4 and C1-3) according to the
Eichners index.10 This index is a classification system
based on the number of OSZs composed of occlusal
contacts of existing natural teeth or fixed prostheses in
the premolar and molar teeth. The validity of this
classification system has been previously described.1719
Thus, this classification provides a standard for the
degree of morbidity of the dentition and is suitable for
application to studies on morbidity statistics.20
The main occluding areas were located on the first
molars in almost all subjects in Eichners A1 category
(97.7%). This finding was in agreement with a previous
study.4 This could be expected, as the first molar
regionthe most important for masticationis where
the greatest force concentrates during biting.
Except for Eichners A1 category, reduced OSZs
were restored with removable prostheses in all subjects
and they did not have any complaints regarding their
masticatory function. Nonetheless, for subjects in
Eichners B category, the main occluding areas were
located anteriorly compared with Eichners A1 category. These results suggest that, in subjects with
48

reduced posterior OSZs, the occluding area of natural

teeth is considerably reduced and the main occluding
area would shift accordingly to enable mastication
using the remaining teeth, such as premolars. Therefore, the preserved opposing pairs of natural posterior
teeth would be important in determining the main
occluding area.
On the other hand, subjects in Eichners C1 category
did not have an opposing pair, due to the absence of
occlusal contact between the few natural teeth in the
upper and lower jaws. A possible reason for the
remarkable anterior shift of the main occluding area
is that these remaining few natural teeth, located in the
anterior region of the dental arch, may act as the key
determinants of occlusion even if they do not come into
contact with opposing natural teeth.
Interestingly, the main occluding area of the subjects
in Eichners C3 category, who were edentulous, was
located posteriorly compared with Eichners B, C1 and
C2 categories. Although these subjects had already lost
afferent signals from the periodontal ligaments, the
locations of their main occluding areas tended to be
similar to those in Eichners A1 category. This suggests
that the main occluding area should be potentially
located on the first molars to alleviate the adverse
influence of few remaining teeth on the location of the
main occluding area. This finding may be related to the
description that the centre of vertical occlusal forces in
complete denture wearers is observed on the first molar
region.21 In addition, an epidemiologic study involving
both complete denture (CD) and Kennedy Class I
removable partial denture (RPD) wearers showed that
CD wearers were significantly more satisfied with
chewing than RPD wearers.22 This study is also in
agreement with our result.
In the present study, masticatory ability was selfassessed by means of a questionnaire designed by Sato
et al.11 They surveyed the clinical chewing ability of 110
CD wearers to validate the reliability and reported that
the mean score of wearers who were satisfied was 58.7;
partly satisfied, 48.5; and not satisfied, 32.4. These
results suggested that the questionnaire corresponded
closely to masticatory ability and was also useful for
chair-side evaluation. Although this questionnaire was
originally used for CD wearers, our clinic has confirmed
that it could be applied in RPD wearers or fully dentate
patients. From the results of the questionnaire, the level
of masticatory ability was significantly associated with
the category of the Eichners index. In comparison with
Eichners A1 category, the masticatory ability was
impaired for the subjects in both Eichners B and C
categories with reduced OSZs. This finding is in
agreement with previous studies which described that
the number of remaining natural teeth or functional
tooth units were key components of masticatory function.2326 On the other hand, the pairwise comparisons
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Location of main occluding areas

did not show any differences in the masticatory ability
among seven categories belonging to Eichners B or C
category. This result suggests that once one of the OSZs
is lost, the level of subjective masticatory ability does not
associate with the number of reduced OSZs. Additional
studies would be necessary to clarify this problem by
increasing the number of subjects.
For the subjects in Eichners B or C category,
masticatory ability was more impaired in the PM group
compared to the M group. The interrelation between
the location of the main occluding area and the
masticatory ability has not been reported so far. The
current finding adds significant evidence that the molar
region as the main occluding area may be of primary
importance in maintaining the masticatory ability in
good condition, regardless of the main occluding area
being on either natural teeth or artificial teeth. Hashii
et al.9 investigated the changes in mandibular movements when the chewing region was changed from the
first molar to the first premolar. The result demonstrated that when the chewing region was changed from
the first molar to the first premolar, the chewing cycle
referred to as chopping type was predominant, as
observed during the chewing of soft food. Our studies
suggested that a wider lateral mandibular movement
following frequent gliding contacts on the molar region
might be necessary to chew tough or resistant foods
without any masticatory difficulty.
This study supports the hypotheses that the location
of the main occluding area may be under the influence
of the remaining natural teeth and that the location of
the main occluding area and masticatory ability are
closely related.
CONCLUSIONS
The following conclusions were derived regarding the
difference in the location of the main occluding area with
reduced OSZ. For subjects in Eichners B or C category,
the main occluding areas were located anteriorly compared with Eichners A1 category. This tendency was
significant for the subjects in Eichners C1 category. The
location of the main occluding area may differ under the
influence of the remaining natural teeth.
The level of masticatory ability was associated with
the category of the Eichners index. Moreover, the
masticatory ability was more impaired for the subjects
in the PM group compared to those in the M group.
The location of the main occluding area and masticatory ability are likely to be closely related.
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50

Address for correspondence:

Dr Yusuke Nakatsuka
1780 Hirooka-Gobara
Shiojiri
Nagano 399-0781
Japan
Email: yusuke@po.mdu.ac.jp

2010 Australian Dental Association