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Table of Contents   
ORIGINAL RESEARCH  
Year : 2013  |  Volume : 24  |  Issue : 5  |  Page : 550-554
A study to correlate the incidence of cross arch balance and working side occlusal wear facets among different age groups: An in vivo study


1 Department of Prosthodontics, A B Shetty Memorial Institute of Dental Sciences, Derlakatte, Mangalore, Karnataka, India
2 Department of Conservative and Endodontics, A B Shetty Memorial Institute of Dental Sciences, Derlakatte, Mangalore, Karnataka, India

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Date of Submission29-Sep-2012
Date of Decision27-Jul-2013
Date of Acceptance05-Sep-2013
Date of Web Publication21-Dec-2013
 

   Abstract 

Introduction: The prevalence of group function and canine guided occlusion is common in natural dentition, but cross arch balance is not often seen. Hence, a study was carried out with following objectives: Analysis of incidence of cross arch balance in different age groups and working side occlusal wear facets in following subjects.
Materials and Methods: A total of 200 patients with natural dentition were included in the study. Subjects with cross arch balance were analyzed for working side occlusal wear facets. Data were analyzed statistically by Chi-square test.
Results: The incidence of cross arch balance in the study group was 0.7%. On examination, subjects with group function on the working side and cross arch balance on the non-working side had more occlusal wear facets.
Conclusion: From the study, it was observed that there was no significant variation in the number and extent of wear facets between the cross arch and without cross arch subjects due the smaller sample size hence it was difficult to conclude the relationship non-working side contact as interference and its influence in wearing of dentition in this study.

Keywords: Canine protected, cross arch balance, group function, non-working side, occlusal wear facets, working side

How to cite this article:
Dandekeri SS, Prasad KD, Hegde C, Shetty M, Sowmya M K, Bhandary S. A study to correlate the incidence of cross arch balance and working side occlusal wear facets among different age groups: An in vivo study. Indian J Dent Res 2013;24:550-4

How to cite this URL:
Dandekeri SS, Prasad KD, Hegde C, Shetty M, Sowmya M K, Bhandary S. A study to correlate the incidence of cross arch balance and working side occlusal wear facets among different age groups: An in vivo study. Indian J Dent Res [serial online] 2013 [cited 2019 Nov 17];24:550-4. Available from: http://www.ijdr.in/text.asp?2013/24/5/550/123364
The masticatory system is a highly complex functional unit of the body primarily responsible for chewing, phonation and deglutition. Components also play a major role in tasting and breathing. The system is made up of bones, joints, ligaments, teeth and muscles. In addition, an intricate neurologic controlling system regulates and coordinates all the structural components. A sound understanding of its functional anatomy and biomechanics is hence essential to the study of occlusion. [1]

During the first part of this century, balanced occlusion was generally advocated because stabilization of the mandible through the occlusion was thought to improve function and to protect the tissues involved. The necessity of balanced occlusion or distribution of occlusal stress over the greatest possible supporting area has for many years been emphasized by both prosthodontists and periodontists. However, during the recent years, opinion has switched to avoid these contacts in favor of a concept of mutually protected occlusion. The concept of balanced occlusion was developed from Bonwill's concept about the geometric and mechanical laws of articulation. This concept was further developed by Spee and his observations of the mandibular movements guided by the path of the condyle and the surfaces of the teeth fitted to each other in a harmonious manner. The focus on balanced occlusion as a concept continued into the twentieth century with the involvement of researchers such as Gysi and Christensen. At first, the concept was particularly a goal for treatment with removable dentures. [2],[3],[4],[5] In total, six types of contact patterns can occur during eccentric mandibular movements: (1) Contacts between the incisors only (referred to as incisal guidance); (2) contacts between canines (canine guidance); (3) contacts involving several teeth on the laterotrusion side but no contacts on the mediotrusive side (group function); (4) single contact behind the canine on the laterotrusive side (laterotrusive side interference); (5) contacts on both the laterotrusive and the mediotrusive side simultaneously (balanced occlusion); and (6) contact on the mediotrusive side only (mediotrusive side interference). [6],[7],[8] In addition, sometimes during lateral excursion if there is simultaneous contact of the buccal and lingual cusps of the working side maxillary teeth with the opposing buccal and lingual cusps of the mandibular teeth, concurrent with contact of the non-working side maxillary lingual cusps with the mandibular buccal cusps, it is then referred to as cross arch balanced occlusion. [9]

Recently, it has been proposed that mediotrusive/non-working/balancing side contacts have a protective effect on the temporomandibular. Within the limitations of the study, working side occlusal wear facets were analyzed in individual with cross arch balance are evaluated.


   Materials and Methods Top


A total of 200 subjects belonging to different age groups, of equal sex distribution were selected from the patients, students population visiting our institution.

The investigation was planned as follows:

Selection of subjects:

  • Recording the nature of occlusion
  • Observation of the occlusal wear facets.


Recording nature of occlusion

The non-working contacts are detected by using dental floss, which is looped around distal teeth on both sides and is drawn anteriorly holding the two ends of the floss. If the floss is held in place it indicates the presence of tooth contact [Figure 1].
Figure 1: Non-working side contact identified by dental floss method

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Observation of occlusial wear facets

Wear facets are caused by attrition of the tooth surface. These are identified as broad area contacts and are recorded by using blue articulating foil (Arti-Fol 12 μ of Bausch Company) on the rounded inclines of tooth. These area contacts will be visualized and their number, extent and location are noted in each quadrant during working side contact in subjects with cross arch balance.

Results

[Table 1] shows the incidence of subjects having cross arch balance in three different age groups. Out of 200 patients examined, nearly 29% of subjects in the age group of 18-25 years, 35% of subjects in the age group of 26-35 years and 36% of subjects in the age group of 36-45 years showed balancing contacts [Figure 2].
Figure 2: Percentage of subjects having cross arch balance in three different age groups

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Table 1: Percentage of subjects having cross arch balance in three different age groups


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[Table 2] shows the evaluation of working side contacts in subject with cross arch balance. Among the subjects with cross arch balance 35.5% showed canine protected occlusion and 65.5% showed group function occlusion.
Table 2: Percentage of subjects with cross arch balance having working side contacts


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[Table 3] shows the distribution of a number of wear facets in cross arch balance subjects with canine protected and group function occlusion in working side within three different age groups. On examination of the cross arch balance subjects, canine protected occlusion had the least number of wear facets as compared to group function occlusion in the working side in all three age groups. Statistical significant difference was observed between the number of wear facets and age. Chi-square value is 13.125 and P = 0.012 which was significant.
Table 3: Distribution of a number of wear facets in cross arch balance subjects with canine protected and group function occlusion in working side within three different age groups


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[Table 4] shows the extent of wear facets in three different age groups. Statistical significant difference was observed between the extent of wear facets and age. With an increase in age, the wear facets were extending in to enamel and dentine. Chi-square value is 6.470 and P = 0.039 which was significant [Figure 3], [Figure 4], [Figure 5].
Figure 3: Distribution of the extent of wear facets in occlusion in the age group 18-25 years

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Figure 4: Distribution of the extent of wear facets in occlusion in the age group 26-35 years

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Figure 5: Distribution of the extent of wear facets in occlusion in the age group 36-45 years

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Table 4: The extent of wear facets in three different age groups


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[Table 5] shows the location of wear facets in three different age groups. With an increase in age, there is an increase in number of wear facets in all age group. Minimum wear facets were observed in the premolar region in the age group of 18-25 years and the maximum wear facets were observed in the molar region in the age group of 36-45 years. On statistical analysis of [Table 5] using Chi-square test shows no significant difference between location of wear facets and the age groups. Chi-square value is 1.102 and P = 0.576 which was insignificant [Figure 6], [Figure 7], [Figure 8].
Figure 6: Distribution of the extent of wear facets in location in the age group 18-25 years

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Figure 7: Distribution of the extent of wear facets in location in the age group 26-35 years

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Figure 8: Distribution of the extent of wear facets in location in the age group 36-45 years

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Table 5: The location of wear facets in three different age groups


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   Discussion Top


Occlusion plays a dominant role in various fields of dentistry because of its influence on the various structures such as the teeth, alveolar bone and temporomandibular joint. A healthy and ideal occlusion provides the stimulation that is necessary for the physiologic functioning and health of these three structures. Any deviation in the direction and magnitude of the forces may produce strain and breakdown of the periodontium and also affects the health and function of temporomandibular joint. [10],[11],[12]

Many opinions have been presented in the literature during the past regarding so called mediotrusive/balancing/non-working side contact. The issue of whether mediotrusive side contact or interference are good or bad for the function and health of the masticatory system has been the topic of several studies. No consensus has been reached. Confusion still exists regarding such a basic question as the prevalence of the contacts at different ages and changes in contact patterns overtime. [2],[13],[14]

The objective of the study was to analyze the incidence of cross arch balance in different age groups, evaluation of working side contacts in subjects having cross arch balance, assessment of the occlusal wear facets on working side tooth on subjects having cross arch balance. According to this study, the percentage of subjects having cross arch balance in three different age groups was 29% in 18-25 years, 35% in 26-35 years and 36% in 36-45 years. This showed that the incidence of cross arch balance among the 200 subjects studied was comparatively less. As per one of objective of the study was to evaluate the working side contact, it was evaluated as canine protected and group function in the working side and with cross arch balance on the non-working side. In this study, 35.5% subjects with cross arch balance had canine protected occlusion and 65.5% of subjects with cross arch balance had group function occlusion, canine protected occlusion had less cross arch balance when compared to the group function occlusion. [2]

This study was also carried out to assess the number of occlusal wear facets on the working side, so a total of 351 wear facets were found out of which 83 wear facets were seen in canine guided and 268 among group function, this showed that subjects with group function, occlusion had more number of wear facets when compared to canine protected occlusion. This can be explained by the fact that in canine protected occlusion there was total dis-occlusion of posterior teeth while in group function, contacts between several posterior teeth resulted in an increase in number of wear facets, further cross tooth balance and interference also had its influence in unfavorable load distribution. The results of this study was in agreement to that of Scaife and Holt [15] who demonstrated that percentage of patients with wear facets increased in direct proportion to the degree of the of group function. [16]

Another interesting observation was regarding the extent of wear facets. In 18-25 years of age 76.2% had wear facets extending into the enamel and 23.8% into dentine, in 26-25 years of age 71% had wear facets extending into the enamel and 29% into dentine, in 36-45 years of age 60.8% had wear facets extending into the enamel and 39.2% into dentin. The following results showed that among the cross arch balance subjects there is a shift in extent of wear facets from enamel to dentine, with an increase in age. This might be a mere cumulative wearing of teeth with advance in age. Statistically, there was a significant difference observed between the extent of wear facets and age. Chi-square value is 6.470 and P = 0.039 which was significant.

Based on location of wear facets the data reported is as follows in 18-25 years, 33.3% in the premolar region and all 33.3% of wear facets are extended into enamel. In the molar region with a total of 66.7%, 42.9% of wear facets are extended into the enamel and 23.8% into dentine, in 26-35 years 35.5% in the premolar region, all 35.5% of wear facets are extended into enamel. In the molar region with a total of 64.5%, 35.5% of wear facets are extended into the enamel and 29% into dentin, in 36-45 years 39.9% in the premolar region, all 39.9% of wear facets were extended into enamel. In the molar region with a total of 60.1%, 21% of wear facets are extended into the enamel and 39.2% into dentin. These were also analyzed by Chi-square test but these values were highly significant. Most of the wear facets were located on molars when compared to premolars. This increase in wearing of molars might be due to close proximity of location of these teeth to the temporomandibular joint which acts as a fulcrum and exerts more loads on posterior teeth. Subjects showed an increase in muscular activity of the elevator muscles in cross arch balance contribute to increased wearing of posterior teeth. [16],[17] Many theories regarding the non-working side as interference and their role on wearing of teeth are being fluted. [2],[17] However in this study, there was no significant variation in the number and extent of wear facets between the cross arch and without cross arch subjects due to the smaller sample size hence it was difficult to conclude the relationship non-working side contact as interference and its influence in wearing of dentition in this study. Further studies are to be under taken with a larger sample size to obtain appropriate data and to study the relationship between the non-working side contact and its influence in wearing of dentition.


   Conclusion Top


From the foregoing study the following conclusions were drawn:

  • The incidence of cross arch balance in the study group was 7% and among the subjects having cross arch balance in three different age groups was 29% in 18-25 years age group, 35% in 26-35 years age group and 36% in 36-45 years age group
  • Among subjects with cross arch balance, 35.5% showed canine protected occlusion and 65.5% showed group function occlusion in the working side
  • On examination of the cross arch balance subjects, canine protected occlusion had the least number of wear facets when compared to group function occlusion in the working side in all three age groups
  • With an increase in age, there is an increase in number of wear facets in all age group. Minimum wear facets were observed in the premolar region in the age group of 18-25 years and the maximum wear facets were observed in the molar region in the age group of 36-45 years
  • Based on the results obtained, it was concluded that there were less working side wear facets in canine protected occlusion and increase in working side wear facets in group function occlusion.


 
   References Top

1.Okeson J. Functional anatomy and biomechanics of the masticatory system. In: Okeson J, editor. Management of Temporomandibular Disorders and Occlusion. 4 th ed. St. Louis: Mosby Inc.; 1998. p. 2-6.  Back to cited text no. 1
    
2.Marklund S, Wänman A. A century of controversy regarding the benefit or detriment of occlusal contacts on the mediotrusive side. J Oral Rehabil 2000;27:553-62.  Back to cited text no. 2
    
3.Stuart CE, Stallard H. Principles involved in restoring occlusion to natural teeth. J Prosthet Dent I960;10:304-13.  Back to cited text no. 3
    
4.D'Amico A. Functional occlusion of the natural teeth of man. J Prosthet Dent 1961;11:899-915.  Back to cited text no. 4
    
5.Stallard H, Stuart CE. Eliminating tooth guidance in natural dentitions. J Prosthet Dent 1961;11:474-9.  Back to cited text no. 5
    
6.Ingervall B, Hähner R, Kessi S. Pattern of tooth contacts in eccentric mandibular positions in young adults. J Prosthet Dent 1991;66:169-76.  Back to cited text no. 6
    
7.Johansson A, Fareed K, Omar R. Lateral and protrusive contact schemes and occlusal wear: A correlational study in a young adult Saudi population. J Prosthet Dent 1994;71:159-64.  Back to cited text no. 7
    
8.Ogawa T, Ogimoto T, Koyano K. Pattern of occlusal contacts in lateral positions: Canine protection and group function validity in classifying guidance patterns. J Prosthet Dent 1998;80:67-74.  Back to cited text no. 8
    
9.The glossary of prosthodontic terms. J Prosthet Dent 2005;94:10-92.  Back to cited text no. 9
    
10.De Laat A, van Steenberghe D, Lesaffre E. Occlusal relationships and temporomandibular joint dysfunction. Part II: Correlations between occlusal and articular parameters and symptoms of TMJ dysfunction by means of stepwise logistic regression. J Prosthet Dent 1986;55:116-21.  Back to cited text no. 10
    
11.Dawson P. The determinants of occlusion. In: Dawson P, editor. Functional Occlusion: From TMJ to Smile Design. 2 nd ed. St. Louis: Mosby Inc.; 2007. p. 27-32.  Back to cited text no. 11
    
12.al-Hadi LA. Prevalence of temporomandibular disorders in relation to some occlusal parameters. J Prosthet Dent 1993;70:345-50.  Back to cited text no. 12
    
13.Belser UC, Hannam AG. The influence of altered working-side occlusal guidance on masticatory muscles and related jaw movement. J Prosthet Dent 1985;53:406-13.  Back to cited text no. 13
    
14.Agerberg G, Sandström R. Frequency of occlusal interferences: A clinical study in teenagers and young adults. J Prosthet Dent 1988;59:212-7.  Back to cited text no. 14
    
15.Scaife RR Jr, Holt JE. Natural occurrence of cuspid guidance. J Prosthet Dent 1969;22:225-9.  Back to cited text no. 15
    
16.Anderson GC, Schulte JK, Aeppli DM. Reliability of the evaluation of occlusal contacts in the intercuspal position. J Prosthet Dent 1993;70:320-3.  Back to cited text no. 16
    
17.Riise C, Ericsson SG. A clinical study of the distribution of occlusal tooth contacts in the intercuspal position at light and hard pressure in adults. J Oral Rehabil 1983;10:473-80.  Back to cited text no. 17
    

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Correspondence Address:
Shilpa S Dandekeri
Department of Prosthodontics, A B Shetty Memorial Institute of Dental Sciences, Derlakatte, Mangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.123364

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