ABSTRACT
Thickness and m arking qualit y of different occlusal
cont act regist rat ion st rips
Maria Fernanda de Souza Mauá Serapião TOLEDO1, Renata Pilli JÓIAS2, Yves Santini MARQUES-IASI1, Ana Christina Claro NEVES3, Sigmar de Mello RODE4
1- Private Practice, São Paulo, SP, Brazil.
2- Department of Bioscience and Oral Diagnosis, Oral Biopathology Graduate Program, School of Dentistry, Science and Technology Institute, Univ. Estadual Paulista (UNESP), São José dos Campos, SP, Brazil.
3- Department of Dentistry, University of Taubaté (UNITAU), Taubaté, SP, Brazil.
4- Department of Dental Materials and Prosthodontics, School of Dentistry, Science and Technology Institute, Univ. Estadual Paulista (UNESP), São José dos Campos, SP, Brazil.
Corresponding address: Sigmar de Mello Rode - Departmento de Materiais Odontológicos e Prótese - Instituto de Ciência e Tecnologia - Univ. Estadual Paulista (UNESP) - R. Eng Francisco José Longo, 777 - Jardim São Dimas - São José dos Campos - SP - Brazil - 12245-000 - e-mail: sigmarrode@uol.com.br
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bj ect ives: Evaluat e t he t hickness and t he m arking qualit y of different occlusal cont act r egist rat ion st r ips ( OCRS) and a possible cor r elat ion bet w een t hem . Mat er ial and0HWKRGV7KHIROORZLQJ2&56ZHUHVHOHFWHG$FFX¿OP,,%.%.%.%.%.
and BK31. The t hickness was m easured in t hree point s of t he OCRS w it h an elect ronic m easuring device ( TESA) , and t he m ean was calculat ed. To produce t he m arks on t he st rips, com posit e resin specim ens were adapt ed t o a universal t est ing m achine ( Versat 2000) wit h 40 kgf load cell at a speed of 1.0 m m / m in. The m ark im ages w ere phot ographed w it h a st ereoscopic m icroscope ( St em i SV11) and processed and analyzed by t he 550- Leica Qwin®
DQDO\]HU5HVXOWV9DOXHVNjPIRXQGLQWKHst and 2nd t hickness m easurem ent s w ere:
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8.7; BK23 - 9.8 and 7.9; BK28 - 12.8 and 10.0; and BK31 - 8.4 and 8.0, respect ively. The m ean ( m m2YDOXHVIRXQGLQWKHPDUNDUHDVZHUH$FFX¿OP,,%.%. - 0.045; BK22 - 0.012; BK23 - 0.022; BK28 - 0.024; and BK31 - 0.024. The result s w ere subm it t ed t o t he Kruskal-Wallis ( p< 0.05) and Pearson’s correlat ion t est s. Conclusions: Only in t he 2nd m easurem ent , t he OCRS t hickness observed was sim ilar t o t he value indicat ed
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no correlat ion was found bet w een t he t hickness and t he m arking area.
Keyw ords: Dent al occlusion. Occlusal adj ust m ent . Prost hodont ics. Dent ist ry. Oral diagnosis.
I N TRODUCTI ON
Wit h a v iew t o t h e p r eser v at ion of d en t al, per iodont al, ar t icular, and m uscular healt h, it is im port ant t o observe adequat e st at ic and funct ional o ccl u si o n . I n st a t i c o ccl u si o n , si m u l t a n eo u s, bilat eral, and hom ogeneous cont act s should be observed bet w een t he m axillary and m andibular t eet h ; absen ce of r ot at ion an d cr ow din g, t igh t cont act s, pr oper m esio- dist al cr ow n angulat ion and labio- lingual crow n inclinat ion, and m oderat e over j et and over bit e1. Wit h r egar d t o funct ional
m ovem ent s of t he j aw, canine guidance w it hout int erference or prem at ure cont act s on bot h sides and m ut ually prot ect ed occlusion in t he prot rusive
posit ion are required8.
I nappropriat e occlusal cont act s can be t riggered by occlusal int er fer ences, ser ious discr epancies bet ween cent ric relat ion ( CR) and cent ric occlusion ( CO) , loss of t eet h , absen ce of t igh t con t act s, m alocclusion, bruxism , loss of vert ical dim ension, and increased t oot h m obilit y, am ong ot her fact ors.
Having est ablished t he im port ance of balanced an d h ar m on iou s occlu sion , it is im p or t an t f or d en t ist s t o p er f or m r ou t in e an aly sis of d en t al occlusion and check cont act bet w een t he m axillary and m andibular arches. For t his purpose, occlusal cont act regist rat ion st rips ( OCRS) are recom m ended f o r r eco r d i n g o ccl u sal co n t act s, as an ai d t o diagnosis, enabling proper t reat m ent planning and m inim izing or solving occlusal disorders.
There is a large num ber of m at erials available
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waxes, carbon paper, m et al sheet s, plast ic sheet s, silk st rips, as w ell as different m et hods t o m easure t hese cont act s. Am ong t hese m et hods, t here are bot h qualit at ive and quant it at ive t ypes; t hus, t he form er t ype is used t o locat e t he cont act point s, and t he lat t er, t o set t heir sequence and densit y. The qualit at ive m et hod requires t he sam e m at erials as
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of cont act s, whereas in t he quant it at ive m et hod, t he “ T- scan” and “ phot o- occlusion” are used9.
Som e fact ors need t o be considered in choosing t he m ost appropriat e OCRS for checking occlusal c o n t a c t s , s u c h a s t h i c k n e s s , s t r e n g t h , a n d elast icit y6. I f t he OCRS is ext rem ely t hick, it m ay
int er fer e w it h t he pat ient ’s occlusal per cept ion,
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refers t o t he OCRS abilit y t o wit hst and t he m oist oral
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t he occlusal cont act s. The elast icit y is t he OCRS abilit y t o st ret ch wit hout t earing when it is pulled out of t he oral cavit y aft er checking t he cont act4.
I t is recom m ended t hat t he OCRS should be used only once t o m ark t he cont act s, because, ot herwise, t he num ber of cont act s m ay decrease due t o t he m at erial det eriorat ion9.
Carbon paper is a w idely used m at erial because of it s low cost and ease of use of it s widt h, t hickness
and t he t ype of ink on it s surface are relat ed t o t he m arks it produces on t he t oot h surface. How ever, som e unfavorable aspect s have been per ceived, such as m oist ur e failing ( saliva) , low elast icit y,
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All t hese fact ors m ay result in large num bers of pseudocont act s9.
Si l k st r i p s h av e b een co n si d er ed t h e b est m at erial for t his purpose due t o t heir soft t ext ure, w hich does not produce pseudocont act s2, alt hough
t hey could be dam aged by saliva. I t is advisable t o st ore silk st rips in a cool and closed place9.
Plast ic st rips are t hinner m at erials t hat provide m ore accurat e occlusal cont act regist rat ions, which are m ore easily visualized. How ever, as t hey are not capable of regist ering low- pressure sit uat ions ( st raight and shiny surfaces) , t hey need t o be used under st rong pressure.
Based on t he lack of st udies evaluat ing t he accu r acy o f m at er i al s u sed t o m ar k o ccl u sal cont act s, t he obj ect ives of t his st udy w er e: 1 - evaluat e t he t hickness of different OCRS; 2 - assess t he qualit y of t he m arking each OCRS produces; and 3 – correlat e t he OCRS t hickness and t he qualit y of m arks.
MATERI AL AN D METHODS
Sam ple
Sam ples of seven t ypes of OCRS ( n= 10) w ere select ed ( Figure 1) and st andardized t o a lengt h of 5.5 cm and w idt h of 3.0 cm .
Measuring t he OCRS t hickness
The t hickness evaluat ion was perform ed t hree t im es at t hree point s, one cent ral and t he ot hers at each ext rem it y, using t he elect ronic m easuring dev ice TESA ( TESA, Micr ont esa, Kem pt on Par k ,
Kind Brand Thickness Color
$FFX¿OP,, Parkell, Farmingdale, N.Y.,
USA
ȝP Black/red
BK 20- Folha de Articulação
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Bausch, Nashua, NH, USA ȝP Black (single-side) BK 21- Folha de Articulação
$UWLIROXOWUD¿QD
Bausch, Nashua, NH, USA ȝP Red (single-side) BK 22- Folha de Articulação
$UWLIROXOWUD¿QD
Bausch, Nashua, NH, USA ȝP Green (single-side) BK 23- Folha de Articulação
$UWLIROXOWUD¿QD
Bausch, Nashua, NH, USA ȝP Blue (single-side) BK 28- Folha de Articulação
$UWLIROXOWUD¿QD
Bausch, Nashua, NH, USA ȝP Black/red
BK 31- Arti-fol Metallic Folha de Shimstock
Bausch, Nashua, NH, USA ȝP Red (single-side)
Gaut eng, Sout h Afr ica) w it h a clock m icr om et er
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t hickness values.
For t he t hickness evaluat ion, each OCRS was
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t he reading scale was set t o zero, so t hat all t he m easurem ent s w ere perform ed at t he sam e point , using t he sam e references for st andardizat ion.
A u n iv er sal t est in g m ach in e ( Ver sat 2 0 0 0 , Panam bra Zw ick/ Roell, São Bernardo do Cam po, SP, Brazil) w it h a 40 kgf load cell was used t o m ake t he OCRS m arks on t he specim ens. Aft er t his, t he second t hickness m easurem ent was evaluat ed at
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l o ad , f o l l o w i n g ex act l y t h e sam e p r o t o co l as
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Specim en
Th e sp eci m en s co n si st ed o f n y l o n d ev i ces m easur ing 3 cm in height x 5 cm in diam et er, w it h a cen t r al ch an n el of 3 cm d iam et er x 5 m m in w idt h x 2 m m in dept h. To obt ain t he t en
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resin Filt ek Z350 ( 3M, ESPE, Sum aré, SP, Brasil) using t he incr em ent al t echnique and 30- second poly m er izat ion ( Ult ralux , Dabi At lant e, Ribeir ão Pret o, SP, Brazil) . Decreasing granulat ions of wat er abrasive papers were used t o polish t he specim ens.
Marking t he cont act s
The com pression t est was also perform ed w it h t he 2000 Versat m achine, using a 500 kg load cell and 40 kgf at a speed of 1 m m / m in. A st ainless st eel ball 2.5 m m in diam et er was coupled t o t he t op of t he m achine, t o m ake t he OCRS punct ure t oward t he specim en.
I n t he specim ens, t her e w er e pr edet er m ined areas w here t he cont act s w ould be dist ribut ed on t he surface of t he com posit e resin t o enable t he area
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w it h a m inim um dist ance of 6.5 m m bet w een t he m arks ( Figure 2) .
The bilat eral surface OCRS w ere t est ed on t he
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Scanning and im age analysis
The m arks were photographed with a stereoscopic
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Zeiss, Oberkochen, Baden-Würt t em berg, Germ any) , and t he im ages w er e pr ocessed w it h t he Qw in®
Leica 550 ( Leica Microsyst em s I m age Solut ions SA, Wet zlar, Hessen, Germ any) , in w hich t he higher in t en sit y pix els w er e r ecogn ized by a soft w ar e and highlight ed in red, and t he area around t hem was also grouped. Finally, for each specim en, t he m arking area was calculat ed in m m2 ( Figures 3a, b) .
Figure 2- Contact marks
St at ist ical analysis
Dat a an aly sis w as car r ied ou t by m ean s of t he D’Agost ino nor m alit y t est , and because t he d at a d id n ot ad h er e t o t h e n or m al cu r v e, t h e nonparam et ric Kruskal-Wallis t est was applied at a
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sam ples was used t o visualize t he difference t hat
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m easu r em en t ( sig n if ican ce lev el of 5 % ) . Th e Pear son cor r elat ion t est was applied in or der t o
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bet w een t he OCRS t hickness and t he area of t he m ark.
RESULTS
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second m easurem ent s ( Table 1) w ere st at ist ically different .
ANOVA show ed t hat t he “ p” values w ere low er t han 0.05 in all groups ( Table 2) , m eaning t hat t here
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m arks w ere perform ed.
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0.3495) show ed no correlat ion bet w een t he OCRS t hickness and t he area of t he m ark. I n t he diagram ( Figure 4) , hom ogeneous dispersion of t he point s in t he t w o OCRS t hickness t racks can be observed. Thus, t his dat a, com bined wit h t he low “ r ” value, indicat es t hat t here is no correlat ion.
DI SCUSSI ON
Th e in t er est in inv est igat in g t h e OCRS w as aroused due t o t he lack of research and art icles relat ed t o t his t opic. There have been few st udies t hat have t est ed t he accuracy and r eliabilit y of t hese m at er ials and concer ning t he t echniques used for m arking occlusal cont act s, considering t hat t he occlusal analysis m ade w it h t hese OCRS is of param ount im port ance in m any dent al procedures. I t is w ell know n t hat t he effect of t he pressure
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and viscosit y of t he periodont al ligam ent , but t his
in v it r o st udy pr ov ides an init ial under st anding
regarding t he OCRS qualit y of m arking since t he load applied is pat t erned.
Sam ples of t he OCRS select ed for t he survey pr esent ed t w o t y pes of base m at er ial ( silk and m et al) , four pigm ent colors ( blue, black, green, and red) and bilat eral st aining ( black/ red) w hen
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Depending on t he OCRS phy sical pr oper t ies ( t hick ness, plast ic defor m at ion and r esist ance) , t here m ay be int erference in t he m arking processes; t hus, a pr oduct m ay m ar k a r eal cont act ar ea; produce a false m ark, or m ark an area t hat has no occlusal cont act10. St udies have show n t hat t he
Figure 4- Pearson’s correlation test dispersion diagram - thickness x marking area
pr esence of m oist ur e ( saliva) in t he oral cav it y negat ively affect s t he base of paper st rips, causing t ear ing and/ or fragm ent at ion4,9, or dist or t ion of
cont act m arks10, in addit ion t o show ing t hat t here
is a difference bet w een t he num ber of cont act s m ar ked on a dr y and on a w et t oot h sur face9.
Therefore, t he survey was conduct ed in t he dry laborat ory in order t o elim inat e t he m oist ure effect ( saliva) , and t he num ber of punct ures m ade by each st rip w hen m arking t he occlusal cont act s was lim it ed and const ant .
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only t he second m easurem ent values w ere sim ilar t o t hose report ed by m anufact urers.
When checking t he ink dist ribut ion pat t ern on t he com posit e resin and com paring t he uniform it y of t he dist ribut ion of t he m arks on t he specim ens, it was observed t hat t he st rips t hat produced m ore
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be not ed t hat t he color of t he pigm ent changes t he OCRS qualit y or capacit y of m arking cont act s, so t hat t he BK23 ( green pigm ent ) produced very sm all m arks and det ached t he least am ount of ink.
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t he m arker subst ance affect ed t he size of t he m ark. Th e r ed OCRS r egist er ed com par at iv ely lar ger m arks t han t he ot her st rips of sim ilar t hickness, w h ile t h in n er poly est er plast ic st r ips pr odu ced sm aller m arks t han t he paper or silk t ypes9.
The correlat ion bet ween t he OCRS t hickness and t he area of t he m ark, by t he Pearson’s correlat ion t est , show ed t hat bot h t he t hicker and t hinner OCRS p r od u ced lar g er an d sm aller m ar k s, so t her e was no cor r elat ion bet w een t he t hickness m easurem ent and t he m arking area. Thus, based
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t hicker t he st rip t he bigger t he m ark produced, in disagreem ent w it h ot her aut hors2,9.
Alt hough t he m et hodology of t his research is very sim ilar t o t hat described in t he lit erat ure9,
t he result s w ere not coincident . The t w o m et hods are sim ilar, but w it h som e changes t hat could have caused t his difference. A possible hypot hesis m ight be: t he sur face m at er ial m ar k ing, t he m ar k ing analysis, t he num ber of m arkings of each OCRS on t he specim ens, and t he t ypes of OCRS st udied.
CON CLUSI ON
I t w as co n cl u d ed t h at o n l y i n t h e seco n d m easurem ent t he OCRS t hickness observed was sim ilar t o t he value indicat ed by t he m anufact urers;
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m ost accurat e m arkings; and no correlat ion was found bet ween t he t hickness and t he m arking area.
p 1 2 3 4 5 6 7 8 9
2 0.1607 - - -
-3 0.3987 0.5763 - - -
-4 0.7933 0.254 0.5606 - - -
-5 0.005* 0.1607 0.0498* 0.011* - - - - -6 0.0744 0.7028 0.3471 0.128 0.3071 - - - -7 0* 0.0008* 0.0001* 0* 0.0516 0.003* - - -8 0.0003* 0.0262* 0.0054* 0.0008* 0.4117 0.0655 0.2605 - -9 0.3108 0.6971 0.8654 0.4524 0.0731 0.4409 0.0002* 0.009* -10 0.0004* 0.035* 0.0077* 0.0012* 0.4807 0.0843 0.2146 0.908 0.0125*
Table 2-2FFOXVDOFRQWDFWUHJLVWUDWLRQVWULSV2&56WKLFNQHVV³S´YDOXHVVLJQL¿FDQFHOHYHOPDUNLQJDUHD
REFEREN CES
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VSHFL¿FDWLRQVFULWLTXH-&UDQLRPDQGLE'LVRUG
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GDWDDQGHPSLULFDOO\LGHQWL¿HGGRPDLQVIURPWKH233(5$FDVH
cont rol st udy. J Pain. 2011; 12( 11 Suppl) : T75- 91.
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