Obtaining measurable biiateral simuitaneous

occiusai contacts with computer-anaiyzed and

guided occlusal adjustments
Robert B. Kerstein, DMDVKen Grundset,

Numerous authors and textbooks have advocated the concept of bilateral simultaneous occlusal contacts
as one of the necessary components of an optimum occlusal condition. All occluding surfaces should meet
at the same moment of time during a mandibular closure. Articulating paper labeling that appeared widely
distributed throughout the arch was thought to represent this advocated occlusal condition. However, com-
puterized occlusal analysis shows that true bilateral occlusal contact time simultaneity is not accurately
represented by widespread paper labeling. Articulating paper labeling is an inadequate indicator of per-
ceived occlusal contact time simultaneity as it renders no occlusal contact force or time sequencing. When
occlusal adjustments are guided by computerized occlusal analysis, occlusal contacts on all potentially
occluding teeth can be approximated to occur within .2 second. This technique report describes a clinical
procedure that employs computerized occlusal analysis to guide sequential occlusal adjustments to obtain
measurable bilateral occlusal contact simultaneity Additionally, the phenomenon of how articulator paper
labeling can be a misleading indicator of occlusal contact timing and force content is presented.
(Quintessence Int 2001:32:7-18)

Key words: bilateral simultaneous occlusal contacts, center of force (COF) trajectory, computerized
analysis, paper labeling, timed sequence

umerous authors and textbooks have advocated
N the concept of bilateral simultaneous occlusal
contacts^-^ as one of the necessary components of an
optimum occlusal condition. All occluding surfaces of
opposing maxillary and mandibular teeth should make
occlusal contact simultaneously.
Articulating paper labeling widely distributed
throughout the arch was thought to represent this
ideal condition. Similar color intensity labeling, which
was present on all occluding surfaces combined with a
"hollow shell" sound from a himanually manipulated^
centric relation occlusal contact pattern were thought
to indicate contact simultaneity.
True occlusal contact time simultaneity, by defini-
tion, means that zero seconds of time passes between
the first and last occlusal contact. This, in actuality, is
extremely difficult to achieve when performing occlusal
adjustments, and is a virtually impossible clinical reality
'Assistant Clinical Professor of Fixed and Removable Prosthodontics, Tufts
University School of Dental Medicine, Department of Restorative Dentistry,
Boston, Massachusetts.
^Lecturer at the Center for Advanced Dental Education, St. Petersburg,
Florida.
Reprint requests: Robert B. Kerstein, DMD, 665 Beacon St. #204, Boston,
Massachusetts 02215. E-mail:Tmjdoc@IX.Netcom.com
without the aid of computer analysis to illustrate the
sequence and duration of individual tooth contacts.
In this report, clinical observation of computer-ana-
lyzed occlusal contact sequences recorded from teeth
with widespread articulating paper labeling present on
all occluding surfaces, reveals that widespread paper
labeling does not represent bilateral simultaneous
occlusal contacts. Because articulating paper lacks
quantitative time- and force-descriptive capacity, it is
incapable of measuring tooth contact events. Therefore,
its appearance should not be interpreted as a measure
of tooth contact time simultaneity or force content.
Conversely, the real-time recording capability of the
T Scan II Occlusal Analysis System (Tekscan) can
record a given occlusal contact sequence in .01-sec-
ond increments. The duration of time in which teeth
make occlusal contact, as contacts proceed from first
contact through to maximum intercuspation, can be
recorded and visualized. Using the occlusal contact
sequence as a guide for corrective occlusal adjust-
ments improves the operator's ability to create a mea-
surable, bilateral simultaneous contact sequence.
This report describes a clinical technique that uti-
lizes computerized occlusal analysis of occlusal con-
tact time and force information to guide the occlusal
adjustments of a mandibular closure to obtain true
and measurable bilateral occlusal contact simultaneity.

Quintessence International
• Kerstein/Grundset
LITERATURE REVIEW
In the middle to late 1980s, there was a series of pub-
lished articles that reported that thefirstT Scan I system
was difficult to use clinically, and its recording sensor
yielded unreliable tooth contact location data. It was
reported by Patyk et al,-" Yamamura and Takahashi,^ and
Harvey et al'' that the T Scan sensor and graphical inter-
face gave varying tooth contact location representations
from one recording to the next. The sensor was deemed
inflexible,"* illustrated a lack of sensibility on some of its
recording surface area,^ and failed to reliably reproduce
tooth contact location after 2 uses.^ Specifically
described was the inflexibility of an intraoral recording
device that was found to result in occasional mandibu-
lar shifting during closure that rendered the tooth con-
tact location data unreliable.''
Conversely, other authors found consistent measur-
ing capacity when analyzing time data'^ and reported
clinical reliability in data analysis. Kerstein, in 1997,
reported statistically significant comparable multiple
daily disclusion time measurements for individual sub-
jects and subject group mean values. These disclusion
time means were reproduced on 4 to 5 distinct mea-
surement dates, and were statistically consistent
between subjects, within individual subjects, and
across subject groups.^ Kerstein also reported reliable
disclusion time means using the T Scan I sensor in
1991. Both pre- and post-treatment disclusion time
means for 7 female myofascial pain dysfunction syn-
drome (MPDS) patients were statistically reliable.'"
Recently, 3 studies accomplished by Sequeros et
al^^"'' have illustrated that consistent force and con-
tact location data can be obtained with the newer T
Scan II sensor. These studies analyzed tooth contact
location reproducibility in maximum intercuspation,"
the number of tooth contacts reproduced in maxi-
mum, intercuspation, protrusion, and right and left lat-
erotrusion,i2 a^j tooth contact time reproducibility of
tooth contacts in maximum intercuspation.'^ All 3
studies concluded that the newer T Scan II sensor
could be utilized at least 4 times and reliably match
differing bites recorded from the same subject. This
finding is twice the usage reported by Harvey et al
who reported that the sensor failed to be reliable after
2 uses. All 3 studies recorded at least 8 trials per sen-
sor, to gather significantly more data than Harvey
reported.^ One study reported a sensor precision level
of 90% to 93% reliability through 4 uses.'^ However,
in another of the studies, the time analysis differed
slightly from the force analysis in the reproduction of
the number of tooth contacts.'^
These authors reported that the T Scan is a simple
methodology to measure and reproduce tooth contact
positions, while simultaneously quantifying occlusal
contact force and time data. This statement was in
agreement with other authors who have reported valu-
able diagnostic capability of the T Scan system.'"•-''
T SCAN II OCCLUSAL ANALYSIS SYSTEM
T Scan II is a Microsoft Windows (Microsoft) com-
pliant system that has been integrated into a clinical,
diagnostic computer workstation. An IBM compatible
PC, a Pentium processor, and a minimum of 4 to 8
megabytes of RAM are required to properly operate
the system. The graphic interface uses familiar
Windows toolbar icons to display the software fea-
tures that are utilized to analyze occlusal contact
information.''
Real-time recording is accomplished by measuring
the recorded tooth contact events for their actual
elapsed time at a rate of 80 Hz (80 times/sec). By re-
cording a force movie^* of a guided mandibular closure
into centric relation, or self closure into maximum
intercuspation, the sequential tooth contact order and
duration is captured in .01-second increments.
The incremental playback of the tooth contact time
can illustrate the exact order of tooth contacts, as well
as their force content. The combination of contact
order, contact duration that precedes the next occlusal
contact, contact location within the arch, and contact
force content all determine the degree of simultaneity
present in a particular occlusal scheme.
By making corrective occlusal adjustments that are
guided by successive computer recordings and by
studying relative occlusal contact time changes that
result from these occlusal adjustments, the operator
can establish an occlusal scheme that contains true
time simultaneity (occlusal contact sequence
approaching .2 second duration or less). The resultant
contact sequence displays a high degree of right side
to left side force balance (approximately 50% right to
50% left), as both halves of the dental arch add
sequential contacts equally.
CENTER OF FORCE TRAJECTORY FEATURE
The COF (Center of Force) Trajectory'« software fea-
ture displays the history of the path of the center of
force from the beginning of the force movie recording
to the current displayed frame. The movement of the
COF trajectory can be observed by playing a force
movie one frame at a time (.01-second incremental
playback) with the COF trajectory selected from the
tool bar. The trajectory is represented on the computer
screen by a red and white line that trails the COF
marker (Figs 1 and 2).
Volume 32, Number 1
 Kerstein/Grundset •

T-Scan II - Reallime2
Eile Edil View ûptions Movie Jools Window Help

Fig 1 T Scan II tool bar with Center of Force Trajectory button selected.

The COF trajectory illustrates how the summation

of occlusal force changes location as sequential tooth
contacts occlude throughout the recorded mandibular
closure. The trajectory movement indicates where the
force summation is directed when more of the
patients' teeth sequentially come together.
By studying the trajectory pathway from the first
tooth contact through to the point of static occlusal
intercuspation and adjusting the earliest occlusal con-
tacts that drag the COF marker away from both the
palatal midline and the COF ellipse (Figs 3a to 3e), it
is possible to develop a simultaneous contact sequence
of less than .2 second (Figs 4a to 4c).
In Figs 3a to 3e, the COF trajectory commences in
the anterior maxilla outside the COF ellipse. It begins
at .280 second, with anterior and right side contacts
(Fig 3a). At .388 second, additional right-sided contacts
Fig 2 Force plot showing center of force trajeotory marker and
appear and increase in force. Teeth 17[2] and 13 [6] are red and white line trailer. The trailer displays the history of the path
accompanied hy light forces on tooth 26[14] (hlue con- of the Center of Force from the beginning of the force movie
tacts), which causes the trajectory to first move poste- recording to the current displayed frame-
rior, right, and then slightly to the left (Fig 3h). The tra-
jectory moves further to the left side but not across the
midline at .469 second, as the distobuccal cusp of tooth
26 increases in force. Note that not all teeth on the left The Accufilm (Parkell) labeling seen in Figs 3f and
half of the arch are in occlusal contact at the time that 3g appears to indicate that all of the teeth, anterior (Fig
the COF trajectory has reached its most posterior loca- 3g) and bilateral (Fig 3f), are occluding at the same
tion (Fig 3c). At .519 second (Fig 3d), the trajectory time. The true sequence is not observable. Only the
moves out to the right again, because the right side endpoint of the contact sequence is stamped onto the
adds more force while the left side decreases in force occlusal surfaces by the paper labeling. The clinical
content. At .699 second (Fig 3e), the left side completes problem when solely using articulating paper as a force
occlusal contact .311 second after the right side com- and time indicator is that it offers no quantitative time
pletes occlusal contact at .388 second (.699 - .388 sec- or force data about the sequential order of occlusal
ond). Static intercuspation has now been reached. contacts. It is this author's opinion that clinical paper
There is a significant force imbalance to the right half labeling misinterpretation is widespread throughout the
of the dental arch of 62.9% in the right as compared to profession. Until current computer analysis became
37.1% in the left. clinically useful, the actual occlusal contact timing
This COF trajectory path illustrates a right-sided pre- sequence was not attainable with paper labeling.
mature contact sequence that required .419 second to Conversely, Figs 4a to 4c illustrate a closure COF
elapse from first contact to static intercuspation (.699 - trajectory that is indicative of bilateral simultaneous
.280 second = .419 second). To correct this right-sided, occlusal contacts. This was accomplished by adjusting
noncentered, and nonsimultaneous contact sequence, the contact sequence seen in Figs 3a to 3e until both
significant contact sequence adjustment to the contacts halves of the arch occluded together in a very short
in the right half of the dental arch will he required. time frame.

Quintessence International
• Kerstein/Grundset

Fig 3a Force plot illustrating COF trajectory of the earliest con- Fig 3b Force plot illustrating progression of the COF trajectory of
tacts of a non-simultaneous mandibular closure into static inter- the same nonsimultaneous mandibular closure at .388 second.
cuspation at .280 second.

" I (F) 27.0% (F) 73.0%

Fig 3c Force plot Illustrating the oompleted COF trajectory at Fig 3d Force plot at .519 second: the COF trajectory moves out
.469 second, to the right.

Fig 3e Force plot at .699 second; the left side completes

occlusal contact after the right side by .311 second.

10 Volume 32, Number 1, 2001

 Kerstein/Grundset •

Figs 3f and 3g The Accufilm labeling of the closure in Figs 3a to 3e appears to indicate that all of the
teeth are bilaterally occluding at the same time. The true sequence is not observable with paper labeling.

y ^ »
Fig 4a Force plot illustrating COF trajectory of the earliest con- Fig 4b Force plot illustrating COF trajectory of the progressing
tacts of a simultaneous mandibular closure into static intercuspa- occlusal contacts of a simuitaneous mandibular closure into static
tion at .185 seccnd. intercuspation at .235 second.

This simultaneous contact sequence seen in Figs 4a

to 4c is represented by a trajectory position that sits
along the palatal midline of the T Scan II force plot.
This indicates that as more and more teeth make
occlusal contact, both halves of the dental arch
sequentially contact together. As the COF trajectory
advances toward the posterior, a consistent right side
to left side force balance is observed while more teeth
successively occlude. This bilateral simultaneous con-
tact sequence requires .111 second to elapse from first
contact to static intercuspation (.296 - .185 = ,111
second). This adjusted sequence shortened the original
sequence by ,308 second (,419 - ,111 = ,308 second).
This is a 76% reduction in the required time between
the first contact and static intercuspation. Despite
approaching simultaneity, zero seconds of elapsed
time appears to be a clinical impossibility.
Fig 4c Force plot iliustrating the completed COF trajectory of a
simultaneous mandibuiar closure into static intercuspation at .296
second.

Quintessence International 11
Kerslein/Grundset
Fig 5 T Scan M recording handle positioned for recording a
patient "self-closure" procedure.
CLINICAL INDICATION
The following procedural description can be applied to
any clinical situation in which bilateral indications
include: complete dentures, fixed and removable com-
binations, complete arch reconstruction involving solely
dental implants for support and retention; complete
arch reconstruction with fixed partial dentures, natural
tooth occlusal adjustment procedures such as occlusal
equilibration^"'^ and disclusion time reduction,'-'" and
occlusal splints and mandibular repositioning devices.
METHOD
Articulating paper is needed in occlusal adjustment
procedures to label the contact location that is shared
between opposing occlusal surfaces. Location and sur-
face area can be discerned from paper labeling.
Initial occlusal adjustments should be accomplished
on all occlusal contacts at the chosen vertical dimen-
sion of occlusion. When widespread occlusal contact
labeling is present and patient adaptation has been ini-
tially confirmed, the occlusal adjustment procedure to
develop bilateral simultaneous occlusal contacts can
commence. The degree of nonsimultaneity that was
achieved through utilizing subjective patient percep-
tion of occlusion in combination with articulator
paper labeling is then assessed by computer analysis.
Recording technique
Prior to recording a bimanual manipulation-guided cen-
tric relation force movie or a patient self-closure into
maximum intercuspation, the T Scan II recording han-
dle, with a sensor and arch support in place, is placed
between the patient's maxillary central incisors. For a
12
centric relation bimanual manipulation procedure, the
patient should be lying parallel to the floor with the
chairside assistant positioning the recording handle per-
pendicular to the floor.2' For a self-closure into maxi-
mum intercuspation, the patient should be seated
upright in the dental chair with the operator positioning
the recording handle parallel to the floor (Fig 5).
The recording should be initiated by depressing and
releasing the recording button that is located on the
top surface of the recording handle. A computer
prompt sounds, that marks the beginning of the real-
time recording, after the bimanual manipulation or
patient-controlled self-closure is commenced. The
mandible is closed into tooth contact through the sen-
sor until complete occlusal intercuspation is achieved.
The patient should maintain full intercuspation with-
out making any excursive movements.
The playback of the recording with the COF trajec-
tory activated will reveal the sequential changes of the
center of force that transpire as the first contact is
sequentially followed by all contacts. The track of the
trajectory viall move closer to or farther away from the
COF ellipse as the number of occlusal contacts increase
during the mandibular closure.
The resultant force plot is presented to the opera-
tor, divided in halves mediolaterally with the left half
outlined in green and the right half outlined in red.
This force plot 2-quadrant division is also described by
a force vs. time graph that the software automatically
generates (Fig 6) following each force movie record-
ing. This graph can be used to quickly locate the earli-
est contacts of the contact sequence.
Each 2-quadrant graph contains 3 distinct descriptive
force lines and one time line (see Figs 6, 8, and 10 to 13):
1. The maximum force line: The dark green line repre-
sents changes in the percentage force of the maxi-
mum achieved by the occlusion as teeth engage dur-
ing closure or disengage during excursive function.
2. The left side force line: The light green hne repre-
sents changes in the forces of the left half of the
arch as time elapses.
3. The right side force line: The red Hne represents
changes in the forces of the right half of the arch as
time elapses.
4. The time line: The black vertical line indicates the
moment in time of the recorded force movie that is
being displayed in the divided force plot. The time
line can be moved from one moment in the record-
ing to another moment by placing the mouse inside
the graph, at the newly desired time to observe, and
clicking once on the left mouse button. The time line
will move to the new moment within the recorded
movie, and the force plot will display the new con-
tact arrangement that is present at that chosen time.
Volume 32, Number 1, 2001
 Kerstein/Grundset •

Left side

(F) 36.8% (F) 63.2%

Relative force vs time

100 ._. _.
PI
80 / • ^ ' ••'' "
—

— t_
60
40 — i'y
20
_—- ' •

0.0 0.5 1.0 1.5 2.0

Time (second

Fig 6 Force plot and corresponding 2-quadrant graph with time

line located at .280 second.

für T-Scan II - JackBOI.fsx - Bienda Jackson - cr 1st contacMst dial tt14 d

File Edit View Options Movie Jools Window Help

Fig 7 T Scan II tool bar illustrating the location of the "1 frame-at-a-time forwards" button.

In order to locate the earliest contacts, the mouse
should be placed into the graph where the maximum
force line begins to rise from the graph horizontal
baseline, and the left mouse button should be clicked.
This will move the time line to the time in the contact
sequence where the earliest contacts have been
recorded (Fig 6). The force plot displays the point in
the force movie that is located just before the earliest
contacts have been recorded.
Next, the force movie should be advanced 1 frame
at a time (.01-second increments) by placing the mouse
over the appropriate playback button on the tool bar
(Fig 7) and clicking the left mouse button once. As
each successive frame is displayed, the COF trajectory
will move in the direction of the earliest, most forceful,
and most prolonged tooth contacts. The 1-frame-at-a-
time playback should be continued until complete sta-
tic intercuspation has been reached (Fig 8). Static
intercuspation is represented within the graph where
the red and green lines become horizontal.
In Fig 6, the earliest contacts that drag the COF tra-
jectory out of the palatal midline are in the right cen-
tral incisor, canine, and the first and second molar
area. These contacts need force and time reductions in
order to allow similar time and force loading of the
left side. By adjusting these areas, the trajectory icon
will begin to track closer to the midline.
The articulating paper labeling seen in Figs 9a and 9b
represents the posterior quadrant contacts. It describes
the end point contacts that are the summation of the
earliest contacts and those that follow through static
intercuspation until maximum intercuspation is reached.

Ouintessence International 13
Kerstein/Grundset

Left side

Relative force vs time

100 -
P-—-—-^-
— 1—
— - . ,

60 • -i 1
40 _ 1—. -. -^

20
\
0.0 0.5 1.0 1.5 2.0

Fig 8 Force plot and corresponding 2-quadrant graph with time

line located at .608 second where static interouspation is reached.

Fig 9a The articulating paper labeling of Fig 9b The articulating paper labeling of
the right posterior quadrant. the left posterior quadrant.

14 Volume 32, Number 1, 2001


Left side
Relative force vs time
Time (seconds)
Fig 10 Force plot and graph showing maximum intercuspation.
The T Scan II force pattern of the first part of static
intercuspation will not be as complete as tbe point in
the force movie where maximum intercuspation
occurs (compare Figs 8 and 10). Maximum intercuspa-
tion can be viewed where the maximum force line is at
the highest vertical point in the graph. This always
occurs after static intercuspation is reached.
From static intercuspation to maximum intercuspa-
tion, the mandible clenches opposing teeth together
forcefully, because it is braced against the maxilla. This
braced condition is what is represented by the end-
point contact labeling seen in Figs 9a and 9b.
Occlusal adjustment
The earliest contacts should be labeled with Accufilm,
and tbe labeling should be removed with a high-speed
round or football-shaped diamond bur. All contacts tbat
preceded static intercuspation on the right side, which
has time prematurities, require adjustment. When all of
these contacts have been adjusted, a new force movie
should be recorded by repeating the mandibular closure
and observing the change in the trajectory path.
Quintessence International
Kerstein/Grundset •
Tbe early contact analysis should be repeated again
and adjusted as previously described. This process will
be repeated until the path of tbe trajectory is overlying
the palatal midline and a sbort elapsed time is
observed. Figures 11 and 12 illustrate tbe trajectory
pathway changes (assessed at 2 and 4 adjustment
sequences) brought about by a series of occlusal
adjustments that are guided by the contact sequence
revealed in follow-up force movie recordings.
Figure 11 illustrates a trajectory pathway tbat moves
from the midline to tbe right and then back to the left
side. It does not travel straight down tbe palatal mid-
line. Figure 12 illustrates a trajectory pathway tbat is
nearly balanced bilaterally, but travels next to the
palatal midline on tbe right half of tbe dental arch. As
static intercuspation is reached, tbe patb is drawn to
tbe left side as more left-sided tooth contacts occlude.
Tbe final trajectory (seen in Figs 4a to 4c) is posi-
tioned correctly over tbe palatal midline. Tbis patb
describes a contact sequence with near bilateral force
equality throughout the closure sequence. Tbe final
force balance at static intercuspation is 51.9% right
and 48.1% left (Fig 4c).
Note tbat as the bilateral sequence improves (Figs
10 to 13), the red and green lines witbin each graph
overlap each other wben static intercuspation is
reached. Figure 13 describes the equal force balance
between tbe two balves of the dental arch. Whereas,
in the pretreatment condition displayed in Fig 6, the
red line is above the green line. This describes a force
discrepancy between tbe two balves of tbe dental
arcb. Figures 14a to 14c are tbe final Accufilm labels of
the bilateral simultaneous contact sequence. Note tbat
no time information can be ascertained from tbe
paper patterns.
DISCUSSION
Tbe consistently advocated concept of bilateral
simultaneous occlusal contacts is virtually impossible
to attain clinically, witbout being able to visualize
tbe contact sequence in increments of fractions of
seconds.
Additionally, the widely accepted clinical percep-
tion tbat articulating paper labeling can indicate time
simultaneity and force balance also appears to be
somewhat erroneous. As can be seen by comparing
tbe clinical photographs (Figs 9a and 9b), the occlusal
contact labeling appears similarly colored bilaterally.
This labeling appearance has been perceived to indi-
cate tbat the occlusal forces are similar. Yet, com-
puter-analyzed force computation of tbe occlusal con-
tact pattern describes the right side as significantly
more forceftil than tbe left (68% right and 32% left).
15
 Kerstein/Grundset

Left side

(F) 53.9% (F) 46.1%

Relative force vs time Relative force vs time

100'
<|-

80
60 -''1 K- • / '

40 —^••J 1
20
\:
00 0.5 1.0 1.5 '

Time (seconds) Time (seconds)

Fig 11 Trajectory after 2 adjustment sequences. Fig 12 Trajectory after 4 adjustment sequences.

a light contact. The computerized occlusal analysis

Relative force vs time seen in Fig 3e illustrates this contact as red, or force-
1 100 p ful, not light in force. Another example can be seen on
1 80 1 /^-•^ " t 3
the transverse ridge of tooth 26 on the distobuccal
1 60
portion of the occlusal surface (Fig 9b), The labeling is
o 40
ä? small and light, but the computer assessment is red, or
20

0.0
V forceful.
0.5
Fig 13 Force vs. time graph of simultaneous contact sequence
seen in Figs 4a to 4c.
Another erroneous assumption made regarding
paper labeling is that size and color intensity
describes forceful contact, A broad contact that is
dark colored is perceived to mean a forceful contact.
Compare Fig 3e with Fig 9a with respect to the
palatal aspect of tooth 17,
In Fig 9a, there is very small red labeling illustrat-
ing a contact present on that incline. It appears to be
1.0 .5
A possible explanation for this inverse relationship
between the size of contact and its force content is that
the applied pressure of the occlusal force is measured
relative to its surface area such that:
Pressure^ Applied Force
Surface Area
Broad contacts dissipate force over a large area
resulting in low pressure concentrations, whereas, a
small contact will dissipate occlusal force over a small
area. The smaller the surface area that receives a given
force, the more pressure results. Computer analysis
may reveal that our profession has been misreading
the size of paper labeling by reading it inversely. Large
or broad is representative of low pressure, while small
represents high pressure.

16 Volume 32, Number 1. 2001

 Kersfein/Grundset •

Figs 14a to 14c Accutilm labeling of the contact sequence seen in Figs 4a to 4c of the maxil-
lary arch, (b) Right posterior quadrant, (c) Left posterior quadrant.

The only data that appear to be obtainable with
articulating paper labeling are occlusal contact location
and surface area. Color intensity, size of labeling, and
microscratch labeling reveal the presence of an
occlusal contact without revealing any description of
the force content or time sequence data. Paper can
label the time as premature and forceful for occlusal
contacts that are isolated by computer analysis. The
combination of these 2 diftering mediums can guide the
occlusal adjustment procedure to result in a measur-
able bilateral simultaneous occlusal contact sequence.
Presently, there are no known occlusal time para-
meters regarding optimal closure timing. There are,
however, a number of studies regarding disclusion
time^'"''^'' (the opposite of occlusion) that suggest
that muscle function is dramatically improved when
disclusion time (the time required for posterior teeth
to completely disclude in a mandibular excursion)
can be achieved in a less-than-.4-second excursive
commencement through to solely anterior guidance
surfaces in contact. These studies imply that the faster
the patient comes out of occlusal contact, the less

Quintessence International 17
Kerstein/Grundset
contractile muscle activity is required to perform the
excursion. It is logical that the reverse occlusal action
would benefit in a similar manner. Therefore, a short
"occlusal time" should require less contractile muscle
activity than a prolonged occlusion time.
Additionally, with true time simultaneity in
mandibular closure (< .2 second to complete closure),
there appears to be bilateral force distribution that
distributes occlusal forces over both halves of the
dental arch so that the muscular contractions are
more equally shared. The authors of this report note,
however, that this premise needs to be tested scientifi-
cally to validate the clinical .significance of the short-
est possible occlusion time.
Clinical anecdotal observation by this author over
the past 15 years has revealed that patients can "feel"
the difference between apparent paper labeling simul-
taneous contacts and true and measurable simultane-
ous contacts. A more "solid widespread contact sen-
sation" is predictably reported when computer-aided
simultaneity is achieved.
CONCLUSION
By employing computerized occlusal analysis of a
mandibular closure to guide the occlusal adjustments of
the contact sequence, the establishment of true and
measurable bilateral simultaneous occlusal contacts
now can be an attainable clinical reality. The software
features of real-time recording and the center of force
trajectory can isolate .01-second time increments that
show which tooth contacts are prolonging the closure
contact sequence and are interfering with the establish-
ment of true bilateral contact time simultaneity.
Performing the occlusal adjustment that removes these
premature and prolonged occlusal contacts significantly
improves the ability of the operator to develop true and
measurable bilateral simultaneous occlusal contacts.
REFERENCES
1. Okeson ]P. Fundamentals of Occlusion and Temporo-
mandlbular Disorders, ed 1. St Louis: Mosby, 1985:106.
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