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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 12  |  Issue : 2  |  Page : 86-94

A comparative evaluation of bite pressure between single implant prosthesis and natural teeth: An in-vivo study


1 Department of Prosthodontics, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
2 Crown & Bridge Including Implantology, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India

Date of Submission11-Jun-2021
Date of Decision07-Nov-2022
Date of Acceptance07-Nov-2022
Date of Web Publication10-Jan-2023

Correspondence Address:
Dr. M K Singhal
17-B Prakashpuram, Opposite Private Ward Gate of Civil Hospital, Saharanpur - 247 001, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdi.jdi_10_21

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   Abstract 

Aim of the Study: To evaluate and compare bite pressure among individuals with implant prosthesis on one side and natural dentition on the contralateral side in the mandibular first molar region using the Nupai bite scan system.
Materials and Methods: A total of 30 individuals (15 in which implant prosthesis on the right side and 15 in which implant prosthesis on the left side) with implant prosthesis on one side and natural dentition on the contralateral side participated in the study. The bite pressure was measured at the first molar area on both sides using Nupai bite scan.
Results: Maximum bite pressure, average bite pressure, and the amount of the pressed area were found to be more on the natural dentition side in comparison to the side with implant prosthesis. The average pressure on natural teeth was 25.33 MPa and on implant prosthesis, 21.27 MPa.
Conclusion: The present study concludes that the measured bite pressure at the natural dentition side is found to be higher than those at the fabricated implant prosthesis side. P value for average bite pressure is 0.033, which is significant (P < 0.05).

Keywords: Bite pressure, bite sensor, group function occlusion, screw-retained implant prosthesis


How to cite this article:
Singhal M K, Budakoti V, Pratap H, Chourasiya P, Waghmare A. A comparative evaluation of bite pressure between single implant prosthesis and natural teeth: An in-vivo study. J Dent Implant 2022;12:86-94

How to cite this URL:
Singhal M K, Budakoti V, Pratap H, Chourasiya P, Waghmare A. A comparative evaluation of bite pressure between single implant prosthesis and natural teeth: An in-vivo study. J Dent Implant [serial online] 2022 [cited 2023 Jan 29];12:86-94. Available from: https://www.jdionline.org/text.asp?2022/12/2/86/367487


   Introduction Top


Determination of individual bite force levels in dentistry has been widely used to understand the mechanics of mastication for evaluation of the therapeutic effects of prosthetic devices and to provide reference values for studies on the biomechanics of prosthetic devices. The measurement of bite force is useful in evaluating muscle function and is also an adjunct in assessing the performance of prosthesis. Measurements related to bite force are difficult to detect, and the reliability of the result depends on the large number of factors, such as gender, age, craniofacial morphology, occlusal factors, presence of pain, and temporomandibular disorder. Apart from these physiological factors, recording devices and techniques play a major role and are important factors in bite pressure measurement. To evaluate bite pressure, various techniques and devices are utilized, including portable hydraulic pressure gauges, the bite fork, force sensing resistors, strain gauge transducers, pressurized rubber tubes, foil transducers, pressure sensitive sheets, and the gnathodynamometer.[1]

The fitness of the masticatory framework relies mostly upon alignment and occlusion of dentition. Improper occlusal contacts, inappropriate head postures are considered to be the main causes for the start of pain in the temporomandibular joint (TMJ) later followed by TMJ disorders.[2] Bone is the ultimate bearer of the occlusal load as dental implants are placed. Maximum bite force generated by patients is not uniform. The posterior jaw occlusal biting load is about three times more than that of anterior biting load. Bone loss around the implant and failure of the fixture can be due to overloaded implant prosthesis by patients' biting force. When planning dental implant treatment, bite force measurement may be an important parameter. Luxation of the fixture and subsequent loss of osseointegration may occur in patients generating extreme biting loads. Long-term successful outcomes, even with poor anatomical bone qualities, can be seen in patients with low biting force. There is an increased risk for late component fracture or implant failure in patients with a high bite force.[3]

It has been documented that the human mean maximum bite force is 738 N. Significant values were found for gender-related mean maximum bite force, whereas the correlation coefficients for age, stature, weight, and body type were found to be low. Raadsheer et al. (1999) reported similar results, and average value of the maximal voluntary bite forces in men was 545.7 N, and in females, it was reported at 383.6 N.[4],[5] In a dentate person, the average force has been measured at 150–250 psi in the first molar region.[6] Forces of mastication are not constant in all individuals and vary person to person, according to these studies.

Nupai bite scan enables anyone to measure pressure easily, just by inserting sensor between two surfaces. Measures pressure by color density. Not just force at a single location, it measures the distribution of it. No power source required just cut and fit any dimensions. Nupai bite scan (Digital) converts pressure density date into MPa. Precise measurement of bite pressure, pressure distribution, and pressure balance can be done with the help of prescale film. Pressurized area of the film will change its color to red on the application of pressure, and the color density varies according to the various pressure levels. The current study compares the biting pressure within the same patient on the mandible where one side has natural dentition, and the contralateral side has been restored with an implant prosthesis using Nupai Bite Scan System.


   Materials and Methods Top


The current study is an in vivo study that was conducted in the Department of Prosthodontics and crown and bridge and SN Enterprise (NUPAI bite Scan), Delhi. Thirty patients were selected for the study.

Inclusion criteria

  • Successfully osseointegrated single posterior dental implant prosthesis with respect to any of the mandibular first molar regions in occlusion with natural dentition
  • Sound natural mandibular first molar tooth on contra lateral arch in occlusion with natural dentition.
  • Proper neuromuscular coordination.


Exclusion criteria

  • Temporomandibular disorders
  • Implant prosthesis other than mandibular 1st molar
  • More than one implant prosthesis
  • History of bruxism, and traumatic occlusion
  • Faulty implant prosthesis
  • Oral infection
  • Soreness
  • Ulceration
  • Inflammation.


Materials

  1. Articulating paper (Bausch, Germany)
  2. Nupai Bite sheets (Fuji, Tokyo, Japan)
  3. Bite sheet holder [NUPAI, S. N Enterprise, Delhi, [Figure 1].
Figure 1: Holder with sensor (bite sheet)

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Methodology

A thorough case history of the patient was taken. A clinical examination of the patient was done to meet the inclusion criteria and rule out the exclusion criteria. Thirty patients were divided into two groups. Group 1: having implant prosthesis on the right side and Group 2: having implant prosthesis on the left side.

During first appointment, the occlusion of the implant prosthesis was checked, and the health of the implant and peri-implant tissues was evaluated with the help of orthopantomogram [Figure 2]. As natural teeth are periodontally sound, and implant prosthesis is osseointegrated. There is a difference in vertical movement of the natural tooth and implant prosthesis. The patient is asked to bite into centric relation with a very light force on thin articulating paper to evaluate occlusal contacts. The implant crown should have no contact with light biting force. Any contact with the implant prosthesis is removed. Then, the patient was asked to apply greater occlusal force to the articulating paper as equal to normal food chew force so that equal contact of implant crown and natural teeth occur. This “timed” contact will account for the mobility differences between the teeth and implant prosthesis.
Figure 2: Postoperative orthopantomogram

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During second appointment, the bite of the patient was taken. The patient was asked to sit straight and the position of the head was adjusted so that it was straight. The bite sheet within a thin plastic pouch [Figure 1] to prevent saliva contamination was inserted in the holder so that the shiny surface of the sheet would face downward. The sheet and holder were inserted in the patient's mouth [Figure 3]. The patient was asked to bite a single time over the bite sheet with maximum force. The red markings [Figure 4] on the sheet, as a result obtained were sent for Nupai bite scan analysis. [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13] depict the different stages of the vivo study.
Figure 3: Patient biting on sensor

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Figure 4: Sensors with bite pressure recorded (red markings)

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Figure 5: Centric occlusion

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Figure 6: Protrusive occlusion

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Figure 7: Left lateral: Protrusive occlusion

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Figure 8: Right lateral: Protrusive occlusion

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Figure 9: Maxillary occlusal view

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Figure 10: Mandibular occlusal view

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Figure 11: Left occlusion view: Centric relation

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Figure 12: Right occlusion view: Centric relation

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Figure 13: Result showing right and left side bite pressure values

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Results and Statistical analysis

The data were entered on a Microsoft Excel spreadsheet and imported into theStatistical Package for the Social Sciences (SPSS, version 22, IBM, USA) for statistical analysis. Data were present in mean and standard deviation. An Independent t-test was performed to find significant differences in different variables in the group. A P = 0.05 was considered a baseline. [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10] are the collected data (patients) and statistical analysis tables.
Table 1: Group 1 - Mandibular pressure record: Implant prosthesis on the right side and contralateral side natural teeth

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Table 2: Group . 2: Mandibular pressure record: Implant prosthesis on the left side and contralateral side natural teeth

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Table 3: Descriptive table: Group 1 - Implant prosthesis on the right side and contralateral side natural teeth

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Table 4: Descriptive table: Group 2 - Implant prosthesis on the left side and contralateral side natural teeth

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Table 5: Mandibular pressure record: Implant prosthesis on the right side and contralateral side natural teeth (pressed area)

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Table 6: Mandibular pressure record: Implant prosthesis on the right side and contralateral side natural teeth (maximum pressure)

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Table 7: Mandibular pressure record: Implant prosthesis on the right side and contralateral side natural teeth (average pressure)

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Table 8: Mandibular pressure record: Implant prosthesis on the left side and contralateral side natural teeth (pressed area)

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Table 9: Mandibular pressure record: Implant prosthesis on the left side and contralateral side natural teeth (maximum pressure)

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Table 10: Mandibular pressure record: Implant prosthesis on the right side and contralateral side natural teeth (average pressure)

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   Discussion Top


Currently, there are two types of bite force measuring techniques available, i.e., direct and indirect. Direct techniques include gnathodynamometer, lever-spring, manometer-spring and lever, micrometered devices, electronic transducers, strain gauges, digital occlusal force-meters, pressure sensitive foils, pressure transducers, digital dynamometers and dental PreScale System (Nupai bite scan system). They use of a suitable transducer placed between a pair of teeth. It is a convenient way to measure the bite force.

In the indirect method that includes electromyography, the functional relationship between the bite force and physiological variables is evaluated, as these variables are known to be functionally related to the bite force.[7] There are many factors that influence the magnitude of the biting force of an individual. These factors can be categorized into subject-related factors such as age, gender, body mass index, craniofacial morphology, temporomandibular disorders and pain, dental status, and psychological factors. Device-related factors include the type of recording devices, amount of jaw separation as determined by the thickness of the device, type of measurement, device position, and patient position. The bite pressure also varied according to the occlusal schemes.

In the current study, bite force was measured using the Nupai bite scan system. It consists of pressure-sensitive sheets. These sheets consist of pigment microcapsules placed one over the other, which burst according to the amount of pressure applied. The exposed pressure-sensitive foils are analyzed in the occlusal scanner. The scanner reads the area and color intensity of the red dots to assess the occlusal contact area and pressure. It has the following advantages as follows:

  1. The thin material induces only a small change in the occlusal vertical dimension (98 μ thickness) and makes it available to measure at a position near the intercuspal position
  2. It is not necessary to prepare special measurement equipment
  3. Many patients may be examined for a short time
  4. Recording storage, even for an extended period, is simplified and
  5. It is easy to explain the treatment to patients by using dental images.[8]


The study also demonstrated that the maximum bite pressure values at the natural dentition side were significantly different from those of the implant prosthesis side by using the Nupai bite scan. In the current study, a within-subject study design was applied, and the other side of the jaw of the same patients was used as a control. Pressure values were lesser on the implant prosthesis side. The detected difference between implant treated and the natural dentition sides could have been influenced by the chewing side preference as the implant side was edentulous for a longer time.[9],[10] Furthermore, the potential of jaw flexure, as well as variations in muscle tonicity during unilaterally closing down on hard objects, might potentially affect the recorded bite force value. The current study demonstrated that the maximum bite pressure values at the natural dentition sides were significantly different from those at the implant prosthesis. The accuracy and precision of bite pressure measurements might be influenced by the mechanical features of the used bite pressure measuring system.

In this study for Group-1: implant prosthesis on the right side and natural teeth on the contralateral side pressed area P value is 0.032, which is statistically significant (P < 0.05). P value for maximum bite pressure is 0.048, which is statistically significant (P < 0.05). P value for average bite pressure is 0.010, which is statistically significant (P < 0.05). For group-2: implant prosthesis on the left side and natural teeth present on the contralateral side pressed area P value is 0.045, which is statistically significant (P < 0.05). P value for maximum bite pressure is 0.038, which is statistically significant (P < 0.05). P value for average bite pressure is 0.033, which is statistically significant (P < 0.05).


   Conclusion Top


In the current cross-sectional study, Nupai Bite Scan System has been used to compare the maximum biting pressure within the same patient on the mandible where one side has natural dentition and the contralateral side had been restored with an implant prosthesis. Within the limitations of this study, the following conclusions are drawn relative to the bite pressure on mandibular implant prosthesis on the first molar region and natural mandibular first molar tooth on the contralateral arch.

  • There is a significant difference between the pressed area on implant prosthesis and on natural tooth. For Group-1: P < 0.05 and for Group-2: P < 0.05
  • There is a significant difference between maximum bite pressure on implant prosthesis and on natural tooth. For Group-1: P < 0.05 and for Group-2: P < 0.05
  • There is a significant difference between average bite pressure on implant prosthesis and on natural tooth. For Group-1: P < 0.05 and for Group-2: P < 0.05.


Maximum bite pressure values can be used to compare and evaluate the health of implant and peri-implant tissues. Implant prosthesis should be prevented from being overloaded with heavy masticatory forces. Poor occlusal system selection can lead to biological and mechanical complications. Heavy masticatory forces can lead to implant failure, early crestal bone loss, screw loosening, uncemented restorations, component failure, porcelain fracture, prosthesis fracture, and peri-implant disease. For the prevention of such consequences Nupai Bite Scan System is very helpful and has the following advantages:

  • The thin material induces only a small change in the occlusal vertical dimension (98 μ thickness)
  • Makes it available to measure at a position near the intercuspal position
  • It is not necessary to prepare special measurement equipment
  • Many patients may be examined for a short time
  • Recording storage, even for an extended period, is simplified and
  • It is easy to explain the treatment to patients by using dental images.


Thus, it can be concluded that maximum bite pressure records using Nupai Bite Scan System can be very helpful in maintaining the health of implant and peri-implant tissues.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Gupta N, Poosala D, Sinha N, Aditya SV, Reddy GV. Analysis of bite force in patients with natural teeth versus fixed partial denture – A within subject comparison. J Dent Sci Res 2015;5:27 31.  Back to cited text no. 1
    
2.
Geethanjali P, Deviprasad N. Occlusion and Posture – A Review. Int J Recent Sci Res 2019;10:33731-4.  Back to cited text no. 2
    
3.
Flanagan D. Bite force and dental implant treatment: A short review. Med Devices (Auckl) 2017;10:141-8.  Back to cited text no. 3
    
4.
Kumararama SS, Chowdhary R. Selection of dental implants based on masticatory load of the patient: A novel approach. Indian J Dent Res 2017;28:309-13.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Raadsheer MC, van Eijden TM, van Ginkel FC, Prahl-Andersen B. Contribution of jaw muscle size and craniofacial morphology to human bite force magnitude. J Dent Res 1999;78:31-42.  Back to cited text no. 5
    
6.
Howell AH, Manly RS. An electronic strain gauze for measuring oral forces. J D Res 1948;27:705-12.  Back to cited text no. 6
    
7.
Hidaka O, Iwasaki M, Saito M, Morimoto T. Influence of clenching intensity on bite force balance, occlusal contact area, and average bite pressure. J Dent Res 1999;78:1336-44.  Back to cited text no. 7
    
8.
Misch CE, Suzuki JB, Misch-Dietsh FM, Bidez MW. A positive correlation between occlusal trauma and peri-implant bone loss: Literature support. Implant Dent 2005;14:108-16.  Back to cited text no. 8
    
9.
Pizolato RA, Gavião MB, Berretin-Felix G, Sampaio AC, Trindade Junior AS. Maximal bite force in young adults with temporomandibular disorders and bruxism. Braz Oral Res 2007;21:278-83.  Back to cited text no. 9
    
10.
Proffit WR, Fields HW, Nixon WL. Occlusal forces in normal and long-face adults. J Dent Res 1983;62:566-70.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12], [Figure 13]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]



 

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