Reliability and Validity of T-scan and 3D Intraoral Scanning

for Measuring the Occlusal Contact Area

Raul Ayuso-Montero, DDS, PhD ,1,2 Yumaysla Mariano-Hernandez, DDS,3 Laura Khoury-Ribas, DDS,1,2
Bernat Rovira-Lastra, DDS,PhD, Eva Willaert, DDS, PhD,1,2 & Jordi Martinez-Gomis, DDS, PhD1,2
1,2

1
Department of Prosthodontics, School of Dentistry, Faculty of Medicine and Health Sciences, University of Barcelona, IDIBELL, Spain
2
Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
3
Private Practice, Santo Domingo, Dominican Republic

Keywords
Dental occlusion; intraoral scan; occlusal
registration; Tekscan; validity.
Correspondence
Raul Ayuso-Montero, Department of
Prosthodontics, Campus Bellvitge, Universitat
de Barcelona, C/ Feixa Llarga s/n, 08907
L’Hospitalet de Llobregat, Barcelona, Spain.
E-mail: raulayuso@ub.edu
The authors deny any conflicts of interest in
regards to this study.
Accepted June 26, 2019
doi: 10.1111/jopr.13096
Abstract
Purpose: To determine the reliability of T-scan and 3D intraoral scan techniques for
assessing the occlusal contact area (OCA), compared to occlusal registration and also
to assess the validity of the techniques.
Materials and Methods: Thirty-one dentate adults participated in this cross-sectional
study. T-scan records were used to measure the OCA at maximum bite force and at
50% of maximum force using the software’s bite force selection tool. A second method
measured the OCA between 2 virtual models scanned intraorally using a 3D surface
scan and considering the occlusal contact at 2 interocclusal distances (0-100 and
0-200 µm). The third method measured OCA using occlusal registration at moderate
and maximum occlusal force, and considering contact at the 2 interocclusal distances
(0-100 and 0-200 µm). Images obtained using the 3 methods were analyzed using
ImageJ software. Test-retest reliability was assessed by the intraclass correlation
coefficient (ICC) and validity by Pearson correlations.
Results: ICCs ranged from 0.56 to 0.79 (p < 0.001) for the T-scan; 0.37 to 0.61
(p < 0.05) for 3D surface scan; and 0.92 to 0.95 (p < 0.0005) for occlusal registration.
The highest OCA values were obtained using the T-scan, and the lowest using the 3D
surface scan. Occlusal registration measurements had the highest correlations with
those of the other techniques.
Conclusions: T-scan is a reliable method for measuring the OCA, but the 3D surface
scan is not. Occlusal registration showed a high validity.

One of the main objectives of prosthodontic treatment is to
restore or improve masticatory function (i.e., masticatory per-
formance, chewing pattern, and masticatory efficiency).1-8 The
key factors in masticatory performance are, on the one hand,
bite force, and on the other, the number of occlusal units
in partially edentulous people or the occlusal contact area
(OCA) in individuals with natural complete dentition.9-14 Fur-
thermore, the side with the larger OCA is more likely to
be used for chewing.15-17 Several methods have been used
to measure OCA quantitatively. Although articulating paper
and occlusal foils are the most widely applied methods for
occlusal adjustment in clinics, they seem to be unsuitable
for quantitative and objective assessment of the OCA18 in
research.19-21
The most common method used to measure the OCA is oc-
clusal registration obtained with a silicone material in the inter-
cuspal position. These records are then scanned to obtain a 2D
image by means of a flatbed scanner with a light source and an-
alyzed using image processing computer software, considering
occlusal contact at different interocclusal distances.10,12-14,22
However, the bite force produced by the individual during the
process influences the OCA values.15,23
Several new technologies have become available that can
be used for occlusal assessment.24-26 T-scan is a computer-
ized technology that records the distribution of occlusal con-
tacts in a time sequence, and it has been described in several
studies.18,27-29 It provides a reliable estimation of the total oc-
clusal force under laboratory conditions in consecutive mea-
surements and can analyze the distribution of biting pressure
within dental arches.30,31 Although T-scan was not designed to
assess the OCA, the images that this technology produces can
be used to measure it.
Virtual casts can be obtained by means of scanning cast mod-
els, from interocclusal records, or from intraoral scanning. The
maxillary and mandibular models can then be positioned virtu-
ally in static and dynamic relationships.32-34 Some 3D scanning

Journal of Prosthodontics 00 (2019) 1–7 

C 2019 by the American College of Prosthodontists 1
T-Scan and Intraoral Scan Measuring Occlusal Contact Area
software packages can illustrate OCA, highlighting the differ-
ent interocclusal distances in different colors. Although 3D
scanning has recently been used to measure the OCA in plaster
models, the reliability of the method was not reported.25,26 Re-
liability measures the degree of reproducibility and discrimina-
tion between individuals and thus relates the measurement error
to the variability between subjects.35 Validity is the degree to
which an instrument measures the construct to be measured.35
Virtual 3D casts and occlusal registration techniques de-
tect similar numbers of occlusal contacts in the intercuspal
position;36 however, in a population with complete natural den-
tition, functional occlusion can be better assessed using the
OCA.13,14 To the best of our knowledge, T-scan and 3D sur-
face intraoral scanning techniques have not been validated as
methods to measure the OCA. The objective of this study was
therefore to determine the reliability of T-scan and 3D surface
scanning techniques for OCA assessment and to compare it
with that of occlusal registration. We also aimed to explore
the validity of these methods for OCA assessment. The null
hypothesis was that T-scan and 3D surface intraoral scanning
techniques would not be reliable for OCA assessment.
Materials and methods
In this cross-sectional clinical study, 31 dentate adults (27
women and 4 men, age range 21 to 26 years, mean age 22)
were recruited from students at the the University of Barcelona
Dental School (Catalonia, Spain). Individuals with fewer than
24 natural teeth, severe malocclusion, or fixed prostheses, those
undergoing active orthodontic treatment and those suffering
orofacial pain were excluded. The sample size was determined
by considering a type I error of 0.05 and a power of 0.80 to find
a correlation between methods of r = 0.50. Participants signed
an informed consent form approved by the local ethics com-
mittee (Code 2015/41). All the experiments were conducted
in accordance with the principles of the Helsinki Declaration.
Three types of occlusal records were obtained for each partic-
ipant, in random order. A test–retest check was performed in
all the participants, with the retest between 1 and 2 weeks
after the first measurements and in the same chronological
order.
The first method used to obtain an occlusal record was the
T-scan (v.9; Tekscan Inc., Boston, MA). Each participant was
instructed to open and close their mouth, bringing it into the
intercuspal position 3 times using maximum force, with a
100 µm thick sensor foil placed intraorally. The T-scan soft-
ware generated a dynamic report showing an occlusal image of
the relative bite force. From this dynamic report, 1 image of
the 2D occlusal picture at maximum force and 2 other images
at 50% of the maximum force were captured to compare oc-
clusal registration at different clenching levels. These 2 images
were captured by selecting the 2 frames in which the partici-
pant applied 50% of maximum force before and after reaching
the maximum force. Each image was coded and analyzed us-
ing computer software (ImageJ; National Institutes of Health,
Bethesda, MD). The distance was calibrated using the known
distance between 2 points of the sensor. Pixels that represented
occlusal contact were selected using hue 112 to 255, saturation
71 to 255, and brightness 0 to 255 as a range of color character-
2 Journal of Prosthodontics 00 (2019) 1–7 
Ayuso-Montero et al
istics. These ranges of values were chosen in order to select the
OCA regardless of the occlusal force. The area selected was
measured using the software measurement tool, and the val-
ues of the 2 images at 50% of maximum force were averaged
(Fig 1). OCA was measured in the T-scan records, and an in-
terocclusal distance of 100 µm was considered as representing
contact because it corresponds to the thickness of the sensor
foil.
The second method of occlusal registration used a 3D sur-
face intraoral scan (Trios 3 Shape; 3Shape A/S, Copenhagen,
Denmark). Teeth in the maxillary and mandibular dental arch
were scanned intraorally following the manufacturer’s instruc-
tions. The intermaxillary relationship was recorded after in-
structing the participant to maintain the jaw in intercuspal po-
sition with moderate force, at half of the maximum bite force.
This relationship was captured once, scanning a minimum of
3 occlusal pairs for 3 regions: the right posterior region, the
anterior region, and the left posterior region. The distance be-
tween the mandibular canines was measured using a digital
micrometer (IP40; Vogel, Kevelaer, Germany) in each partic-
ipant for calibration. An occlusal view of the 3D models was
selected, and the software was programmed for automatic se-
lection of OCA, considering contact as an interocclusal distance
of 0 to 100 µm and 0 to 200 µm, to be compared with occlusal
registration at these different interocclusal distances. Each 2D
occlusal image obtained at the different interocclusal distances
was recorded, coded, and analyzed with ImageJ software. Each
image was size calibrated with the known intercanine distance,
and pixels representing the occlusal contact were selected us-
ing hue 0 to 86, saturation 164 to 255, and brightness 0 to
255 as a range of color characteristics. These ranges of val-
ues were chosen in order to select the occlusal contact area
regardless of the interocclusal distance, for 0 to 100 µm or 0
to 200 µm (Fig 2). The area selected was estimated using the
software measurement tool at the two different interocclusal
distances.
The third method, occlusal registration, was analyzed at dif-
ferent occlusal forces and with different interocclusal distances
considered as representing contact. Two occlusal registrations
in the maximum intercuspal position were obtained: one using
moderate occlusal force and the other using maximum occlusal
force. For each registration, Occlufast Rock (Zhermack, Ba-
dia Polesine, Italy) was applied to all the mandibular teeth,
and participants were asked to bite, using maximum force or
half of the maximum force, in the maximum intercuspal posi-
tion for 1 minute. The resulting mold was removed and coded,
and excess portions were trimmed. The occlusal registration
mold was placed facing downwards on the scanner bed without
coming into contact with the top-lit active transparency adapter
and was then scanned (HP Scanjet G4050; Hewlett Packard,
Palo Alto, CA). The image of each occlusal registration was
converted into a greyscale image and analyzed by means of
ImageJ software. To establish the relationship between each of
the 256 greys and the thickness of the occlusal registration, a
stepped wedge of Occlufast was used and then measured with an
external digital micrometer. The calibration curve obtained was:
thickness (µm) = 688.948 – 6.371PD + 0.016(PD)2 (where
PD = pixel density) with a correlation coefficient of 0.993.
Spatial calibration was performed using a known distance
C 2019 by the American College of Prosthodontists
Ayuso-Montero et al
Figure 1 Occlusal contact area obtained with T-Scan applying: (A) 50%
of the maximum bite force and (B) maximum force.
Figure 2 Occlusal contact area obtained with 3D surface scan consider-
ing contact as an interocclusal distance of: (A) 0 to 100 µm and (B) 0 to
200 µm.
Figure 3 Occlusal contact area obtained with occlusal registration con-
sidering contact as an interocclusal distance of: (A, C) 0 to 100 µm and
(B, D) 0 to 200 µm; and the force applied by the participant as: (A, B)
moderate and (C, D) maximum.
measured with a digital caliper. The OCA was calculated con-
sidering contact as an interocclusal distance of 0 to 100 or 0 to
200 µm (Fig 3).10,11,13
The same operator conducted all procedures and assess-
ments. In each session and for each participant, 2 values using
the T-scan method, 2 using the 3D surface scan, and 4 using
occlusal registration were obtained. Normality and homogene-
ity of variances were confirmed using the Shapiro-Wilk and
Levene tests, respectively. Test–retest reliability was assessed
Journal of Prosthodontics 00 (2019) 1–7 
C 2019 by the American College of Prosthodontists
T-Scan and Intraoral Scan Measuring Occlusal Contact Area
by the intraclass correlation coefficient (ICC) using a mixed
model with a random effect for the individual. Absolute OCA
values obtained using each of the techniques were reported as
means (95%CI). Pearson correlations were used to assess the
validity of the techniques. A mean value obtained from the
2 sessions was calculated to establish the level of agree-
ment and the correlation between the different techniques.
All analysis was performed using the IBM Statistics for Win-
dows v23.0 software package (IBM Corp., New York, NY)
(p < 0.05).
Results
The reliability of T-scan was good when the subjects bit using
maximum force (ICC = 0.79; p < 0.0005), while the reliability
of the 3D surface scan was poor regardless of the interoc-
clusal distance considered as occlusal contact (ICC = 0.37 and
ICC = 0.42; p < 0.05) (Table 1). The occlusal registration
method produced the highest ICC values and was not signifi-
cantly influenced by the force applied by the participant or by
the interocclusal distance considered as occlusal contact. The
highest values of OCA were obtained using T-scan with max-
imum force; the lowest, using the 3D surface scan technique
considering contact as an interocclusal distance of 0 to 100 µm
(Table 2).
Table 3 is a matrix of the correlation coefficients obtained
for the different methods. The highest correlation values were
obtained between T-scan and occlusal registration, regardless
of the occlusal force applied or the interocclusal distance. Al-
though the 3D surface scan OCA values exhibited a high degree
of correlation at 100 and 200 µm, this method correlated poorly
with the T-scan technique and occlusal registration.
Discussion
The present results suggest that the T-scan technique is reliable
and valid for measuring the OCA, especially when the subject
closes their mouth applying maximum occlusal force. Although
T-scan was designed to analyze the occlusal contact distribution
with regard to biting pressure, it can also be used to assess the
OCA objectively for research purposes. In the clinical setting,
computerized occlusal analysis using T-scan is straightforward,
and is therefore recommended for assessing the quality of end
results and minimizing occlusal imbalances in prosthodontic
treatments or orthodontics.28,29 Thus, T-scan may also be useful
for assessing OCA in clinical practice.
T-Scan is more reliable when the subject closes his/her mouth
applying maximum occlusal force than when using moderate
force. The sensor foil thickness (100 µm) may make it diffi-
cult for participants to close in the intercuspal position when
using moderate force, but when using maximum force, they
were more likely to close near this position. T-scan was ap-
proximately 3 times more sensitive to the occlusal force ap-
plied by the participant than occlusal registration when mea-
suring the OCA. This high sensitivity is in accordance with the
40% reduction in the number of posterior occlusal contacts at
50% of maximal voluntary bite.23,37 Additionally, the thickness
and other physical characteristics of the sensor foil may affect
the accuracy of the OCA measurement, obtaining higher than
3
T-Scan and Intraoral Scan Measuring Occlusal Contact Area Ayuso-Montero et al

Table 1 Test–retest reliability (ICC; 95%CI) of the methods used to measure the OCA according to the interocclusal distance defined as contact and
the occlusal force applied during the process

Intraclass correlation coefficient (ICC) (95%CI)

Method Interocclusal distance Moderate bite force Maximum bite force

T-scan 100 µm 0.56 (0.26 to 0.77) 0.79 (0.60 to 0.89)

3D surface scan 100 µm 0.42 (0.08 to 0.68)
Occlusal registration 100 µm 0.92 (0.85 to 0.96) 0.94 (0.88 to 0.97)
3D surface scan 200 µm 0.37 (0.03 to 0.64)
Occlusal registration 200 µm 0.95 (0.90 to 0.98) 0.93 (0.86 to 0.97)

ICC- 2-way random, absolute agreement for single measurement.

Table 2 Mean values (95%CI) of the OCA according to the method used, the interocclusal distance defined as contact, and the bite force applied
during the process

Occlusal contact area

Moderate Maximum Relative difference between OCA applying

Method Interocclusal distance occlusal force occlusal force maximum vs moderate occlusal force∗

T-scan 100 µm 85.97 (73.96 155.29 44.89 (42.71 to 47.06)

to 97.97) (134.92 to
175.66)
3D surface scan 100 µm 12.13 (9.74 to
14.52)
Occlusal registration 100 µm 48.49 (38.26 56.16 (46.34 16.39 (7.94 to 24.83)
to 58.72) to 65.98)
3D surface scan 200 µm 40.45 (34.14
to 46.75)
Occlusal registration 200 µm 98.66 (83.14 106.37 (91.83 8.78 (2.63 to 14.92)
to 114.17) to 120.91)

OCA, Occlusal contact area (mm2 ). 95%CI, 95% Confidence interval. * Percentage = ((Maximum – Moderate) × 100/Maximum).

normal values because a stronger bite force is exerted. More-
over, the foil sensel size is 1.02 mm squared, according to the
manufacturer’s specifications, spaced with 0.25 mm between
sensels. This design allows the sensel to be activated regardless
of the relative area inside the sensel in contact. Future research
should focus on modifying the image analysis procedures to
compensate the activation of sensels with an OCA smaller than
the sensel size. Moreover, the system has an ASCII output op-
tion that can create each scan in a file compatible with Microsoft
Excel, thus allowing direct quantification of the OCA.
OCA values obtained using 3D surface scanning offered low
ICC scores and low correlation coefficients with other meth-
ods, regardless of the interocclusal distance considered. Better
accuracy for measuring OCA could be achieved for single-
unit digital occlusal registration than for larger records.38 The
results also suggest that 3D surface scanning provides low
OCA values. The 3D virtual models allow perforations during
the acquisition procedure. The perforations are later corrected
mathematically to complete the 3D construction; this may aff-
ect the OCA measures, reducing not just the reliability but also
the OCA values. Although high resolution was obtained using
the 3D surface scanning method, the algorithms used by the
software for generating the 3D models did not consider the
function of periodontal tissues, which would allow better oc-
clusal accommodation when occlusal force is applied. If the
algorithms considered the amount of mobility produced by the
periodontal tissues and the maximum bite force of each subject,
the validity of the OCA values obtained with the 3D surface
scan would be higher. This hypothesis could be tested in further
research.
Occlusal registration was the most reliable method for mea-
suring the OCA, regardless of the interocclusal distance con-
sidered as contact or the amount of occlusal force applied by
the participant during the registration. Moreover, the measure-
ments of the OCA using occlusal registration correlated highly
with measurements of OCA using T-scan or 3D surface scan-
ning, thus indicating good validity. Using the occlusal regis-
tration method, the OCA increased by between 9% and 16%
when applying maximum bite force, compared to moderate
force, in agreement with the results of a previous study.39,40
Our results therefore support the use of occlusal registration as
a reliable method to measure the OCA in research, in the fields
of prosthodontics or orthodontics.12,41
One of the limitations of this study was that these results
may be not applicable to populations wearing a prosthesis or
braces. Further, inter-rater reliability was not assessed. Another
weakness of this study was that the occlusal force applied by
the participant in the occlusal registration and 3D surface scan

4 Journal of Prosthodontics 00 (2019) 1–7 

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 Ayuso-Montero et al

Table 3 Matrix of Pearson correlation coefficients for the different methods used to measure the OCA

Occlusal Occlusal Occlusal Occlusal

registration, registration, registration, registration,

Journal of Prosthodontics 00 (2019) 1–7 

T-Scan, 100 µm, T-Scan, 100 µm, 100 µm, 100 µm, 200 µm, 200 µm,
maximum moderate 3D surface scan, maximum moderate 3D surface scan, maximum moderate
occlusal force occlusal force 100 µm occlusal force occlusal force 200 µm occlusal force occlusal force

T-Scan, 100 µm, 1

maximum occlusal
force
T-Scan, 100 µm, 0.96∗∗∗ 1
moderate occlusal
force
3D surface scan, 100 0.24 0.26 1
µm
Occlusal registration, 0.65∗∗∗ 0.61∗∗∗ 0.29 1
100 µm, maximum

C 2019 by the American College of Prosthodontists

occlusal force
Occlusal registration, 0.64∗∗∗ 0.60∗∗∗ 0.31 0.92∗∗∗ 1
100 µm, moderate
occlusal force
3D surface scan, 200 0.27 0.25 0.89∗∗∗ 0.49∗∗ 0.48∗∗ 1
µm
Occlusal registration, 0.67∗∗∗ 0.61∗∗∗ 0.27 0.98∗∗∗ 0.89∗∗∗ 0.50∗∗ 1
200 µm, maximum
occlusal force
Occlusal registration, 0.67∗∗∗ 0.61∗∗∗ 0.26 0.93∗∗∗ 0.97∗∗∗ 0.48∗∗ 0.94∗∗∗ 1
200 µm, moderate
occlusal force
*
p < 0.050; ** p < 0.010; *** p < 0.001.

5
T-Scan and Intraoral Scan Measuring Occlusal Contact Area
T-Scan and Intraoral Scan Measuring Occlusal Contact Area
methods was not regulated objectively; therefore, the definition
of 50% of the maximum bite force as moderate should be con-
sidered with caution. Although occlusal distribution was not
quantitatively assessed, the distribution of occlusal contacts
does not seem to depend on the method assessed, as shown
in Figures 1 to 3 obtained from the same participant. Finally,
as individuals had to hold their teeth in the intercuspal po-
sition for 1 minute they may have had difficulty maintaining
the same force and the same mandibular position; however,
these aspects did not significantly affect the reliability of this
method.
Conclusion
T-scan is a reliable method for measuring OCA at maximum
bite force. The reliability of measuring OCA with digital models
in the intercuspal position using a 3D surface scan is poor.
Occlusal registration showed the highest reliability and validity
for measuring OCA, regardless of the interocclusal distance
considered as contact or the amount of occlusal force applied
by the participant during the registration.
Acknowledgments
The authors gratefully acknowledge the Oral Medicine Unit
for providing us with the Trios 3D surface scanner. The authors
would like to thank Michael Maudsley and Dr. Christopher
Evans for editing the text.
References
1. Van der Bilt A: Assessment of mastication with implications for
oral rehabilitation: a review. J Oral Rehabil 2011;38:754-780
2. Flores-Orozco EI, Tiznado-Orozco GE, Osuna-González OD,
et al: Lack of relationship between masticatory performance and
nutritional status in adults with natural dentition. Arch Oral Biol
2016;71:117-121
3. Tome W, Yashiro K, Takada K: Orthodontic treatment of
malocclusion improves impaired skillfulness of masticatory jaw
movements. Angle Orthod 2009;79:1078-1083
4. Rovira-Lastra B, Flores-Orozco EI, Salsench J, et al: Is the side
with the best masticatory performance selected for chewing?.
Arch Oral Biol 2014;59:1316-1320
5. Woda A, Hennequin M, Peyron MA: Mastication in humans:
finding a rationale. J Oral Rehabil 2011;38:781-784
6. Salsench J, Martinez-Gomis J, Torrent J, et al: Relationship
between duration of unilateral masticatory cycles and the type of
lateral dental guidance: a preliminary study. Int J Prosthodont
2005;18:339-346
7. Khoury-Ribas L, Ayuso-Montero R, Rovira-Lastra B, et al:
Reliability of a new test food to assess masticatory function.
Arch Oral Biol 2018;87:1-6
8. Flores-Orozco EI, Rovira-Lastra B, Peraire M, et al: Reliability
of a visual analog scale for determining the preferred mastication
side. J Prosthet Dent 2016;115:203-208
9. Van der Bilt A, Olthoff LW, Bosman F, et al: The effect of
missing postcanine teeth on chewing performance in man. Arch
Oral Biol 1993;38:423-429
10. Flores-Orozco EI, Rovira-Lastra B, Willaert E, et al: Relationship
between jaw movement and masticatory performance in adults
with natural dentition. Acta Odontol Scand 2016;74:103-107
6 Journal of Prosthodontics 00 (2019) 1–7 
Ayuso-Montero et al
11. Hatch JP, Shinkai RS, Sakai S, et al: Determinants of masticatory
performance in dentate adults. Arch Oral Biol 2001;46:641-648
12. Owens S, Buschang PH, Throckmorton GS, et al: Masticatory
performance and areas of occlusal contact and near contact in
subjects with normal occlusion and malocclusion. Am J Orthod
Dentofacial Orthop 2002;121:602–609
13. Lujan-Climent M, Martinez-Gomis J, Palau S, et al: Influence of
static and dynamic occlusal characteristics and muscle force on
masticatory performance in dentate adults. Eur J Oral Sci
2008;116:229–236
14. Lepley CR, Throckmorton GS, Ceen RF, et al: Relative
contributions of occlusion, maximum bite force, and chewing
cycle kinematics to masticatory performance. Am J Orthod
Dentofacial Orthop 2011;139:606-613
15. Hidaka O, Iwasaki M, Saito M, et al: Influence of clenching
intensity on bite force balance, occlusal contact area, and average
bite pressure. J Dent Res 1999;78:1336-1344
16. Diernberger S, Bernhardt O, Schwahn C, et al: Self-reported
chewing side preference and its associations with occlusal,
temporomandibular and prosthodontic factors: results from the
population-based Study of Health in Pomerania (SHIP-0). J Oral
Rehabil 2008;35:613-620
17. Martinez-Gomis J, Lujan-Climent M, Palau S, et al: Relationship
between chewing side preference and handedness and lateral
asymmetry of peripheral factors. Arch Oral Biol
2009;54:101-107
18. Kerstein RB, Radke J: Clinician accuracy when subjectively
interpreting articulating paper markings. Cranio 2014;32:13-23
19. Caro AJ, Peraire M, Martinez-Gomis J, et al: Reproducibility of
lateral excursive tooth contact in a semi-adjustable articulator
depending on the type of lateral guidance. J Oral Rehabil
2005;32:174-179
20. Hutzen D, Rebau M, Kordass B: Clinical reproducibility of
GEDAS–“Greifswald Digital Analyzing System” for displaying
occlusal contact patterns. Int J Comput Dent 2006;9:137-142
21. Martı́nez-Gomis J, Willaert E, Nogues L, et al: Five years of
sleep apnea treatment with a mandibular advancement device.
Side effects and technical complications. Angle Orthod
2010;80:30-36
22. Rovira-Lastra B, Flores-Orozco EI, Ayuso-Montero R, et al:
Peripheral, functional and postural asymmetries related to the
preferred chewing side in adults with natural dentition. J Oral
Rehabil 2016;43:279-285
23. Imamura Y, Sato Y, Kitagawa N, et al: Influence of occlusal
loading force on occlusal contacts in natural dentition.
J Prosthodont Res 2015;59:113-120
24. Jokstad A: Computer-assisted technologies used in oral
rehabilitation and the clinical documentation of alleged
advantages – a systematic review. J Oral Rehabil
2017;44:261-290
25. Lee H, Kim M, Chun YS: Comparison of occlusal contact areas
of class I and class II molar relationships at finishing using
three-dimensional digital models. Korean J Orthod
2015;45:113-120
26. Lee H, Cha J, Chun YS, et al: Comparison of the occlusal contact
area of virtual models and actual models: a comparative in vitro
study on Class I and Class II malocclusion models. BMC Oral
Health 2018;18:109
27. Kerstein RB: Combining technologies: a computerized occlusal
analysis system synchronized with a computerized
electromyography system. Cranio 2004;22:96-109
28. Qadeer S, Yang L, Sarinnaphakorn L, et al: Comparison of
closure occlusal force parameteres in post-orthodontic and
 R
non-orthodontic subjects using T-scan III DMD occlusal
analysis. Cranio 2016;34:395-401
C 2019 by the American College of Prosthodontists
Ayuso-Montero et al
29. Qadeer S, Abbas AA, Sarinnaphakorn L, et al: Comparison of
excursive occlusal force parameters in post-orthodontic and
 R
non-orthodontic subjects using T-Scan III. Cranio 36.
2018;36:11-18
30. Cerna M, Ferreira R, Zaror C, et al: Validity and reliability of the
R
T-Scan III for measuring force under laboratory conditions. 37.
J Oral Rehabil 2015;42:544-551
31. Roque MA, Gallucci GO, Lee SJ: Occlusal pressure
redistribution with single implant restorations. J Prosthodont
2017;26:275-279 38.
32. Maruyama T, Nakamura Y, Hayashi T, et al: Computer-aided
determination of occlusal contact points for dental 3-D CAD.
Med Biol Eng Comput 2006;44:445-450 39.
33. Solaberrieta E, Otegi JR, Goicoechea N, et al: Comparison of a
conventional and virtual occlusal record. J Prosthet Dent
2015;114:92-97 40.
34. Stavness IK, Hannam AG, Tobias DL, et al: Simulation of dental
collisions and occlusal dynamics in the virtual environment.
J Oral Rehabil 2016;43:269-278 41.
35. Mokkink LB, Terwee CB, Patrick DL, et al: The COSMIN study
reached international consensus on taxonomy, terminology, and
Journal of Prosthodontics 00 (2019) 1–7 
C 2019 by the American College of Prosthodontists
T-Scan and Intraoral Scan Measuring Occlusal Contact Area
definitions of measurement properties for health-related
patient-reported outcomes. J Clin Epidemiol 2010;63:737-745
DeLong R, Knorr S, Anderson GC, et al: Accuracy of contacts
calculated from 3D images of occlusal surfaces. J Dent
2007;35:528-534
Wang XR, Zhang Y, Xing N, et al: Stable tooth contacts in
intercuspal occlusion makes for utilities of the jaw elevators
during maximal voluntary clenching. J Oral Rehabil
2013;40:319-328
Iwaki Y, Wakabayashi N, Igarashi Y: Dimensional accuracy of
optical bite registration in single and multiple unit restorations.
Oper Dent 2013;38:309-315
Gurdsapsri W, Ai M, Baba K, et al: Influence of clenching level
on intercuspal contact area in various regions of the dental arch.
J Oral Rehabil 2000;27:239-244
Nishimori H, Iida T, Kamiyama H, et al: Comparing the occlusal
contact area of individual teeth during low-level clenching. J Oral
Sci 2017;59:337-342
Choi TH, Kim BI, Chung CJ, et al: Assessment of masticatory
function in patients with non-sagittal occlusal discrepancies.
J Oral Rehabil 2015;42:2-9
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