Journal of Dental Research

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Occlusal Forces in Normal- and Long-face Adults

W.R. Proffit, H.W. Fields and W.L. Nixon
J DENT RES 1983 62: 566
DOI: 10.1177/00220345830620051201

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Occlusal Forces in Normal- and Long-face Adults
W. R. PROFFIT, H. W. FIELDS, and W. L. NIXON
Department of Orthodontics, UNC School of Dentistry, Chapel Hill, North Carolina 27514
Using both quartz- and foil-based piezo-electric force transducers,
occlusal forces during swallow, simulated chewing, and maximum
effort were evaluated in 19 long-face and 21 normal individuals.
Forces were measured at 2.5 mm and 6.0 mm molar separation.
Long-face individuals have significantly less occlusal force during
maximum effort, simulated chewing, and swallowing than do
individuals with normal vertical facial dimensions. No differences in
forces between 2.5- and 6.0-mm jaw separation were observed for
either group.
J Dent Res 62(5):566-571, May 1983
Introduction.
Although studies of the forces generated by occlusal con-
tact of the teeth date back to the 19th century, new
interest in these forces has been generated by an apprecia-
tion of their possible role in controlling the eruption of
teeth and by the availability of new piezo-electric instru-
mentation. Piezo-electric force transducers using quartz
crystals as the active element are now readily available
commercially and can be used quite satisfactorily for
measuring occlusal forces at several millimeters of jaw
separation. Recently, it has become possible to manu-
facture piezo-electric polymers which can be produced as
thin foil sheets. Using piezo-foil as the active element, we
have been able to fabricate an occlusal force transducer less
then 2 mm in thickness, which allows us to measure occlu-
sal forces with much less jaw separation than in previous ex-
periments. The sensitivity of both types of piezo-electric
transducers makes it possible to study not only maximum
biting force, but also forces generated both during simu-
lated chewing and when the jaw is stabilized for swallowing
by contraction of the elevator muscles.
The relationship between occlusal forces and facial mor-
phology received little scientific consideration until re-
cently. The square jaw (relatively acute gonial angle) and
short lower face height of the "powerful individual" are
part of the usual caricature, despite a lack of data to
demonstrate that occlusal forces are greater in individuals
with this facial morphology. Case reports have demon-
strated a lengthening of facial dimensions in individuals
with muscular weakness.1 Finn2 reported that maximum
biting force in the molar region was twice as great for
normal as compared to dolichofacial (long-face) subjects
(128 vs. 66 pounds), while brachyfacial (short-face) sub-
jects had still higher maximum force. These data were ob-
tained with a quartz crystal transducer producing about
10 mm of jaw separation. Whether the biting force dif-
ferences play a role in determining the ultimate facial
morphology or merely reflect the mechanical advantage
obtained by the muscles in the different facial types has
become a matter of some controversy.
In this paper, we report developments in occlusal force
transducers which allow accurate measurement of occlusal
forces in humans down to 2.5-mm jaw separation, and pro-
Received for publication May 12, 1982
Accepted for publication September 23, 1982
This research was supported by NIH Grants DE-05215 and
DE-05198 from the National Institute of Dental Research.
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566
vide data for normal- and long-face adults which indicate
that there are clear differences in occlusal forces between
the two groups, not only in maximum force, but also in
other occlusal contacts. The differences are present at both
2.5- and 6-mm jaw separation.
Materials and methods.
Development of thin occlusal force transducers.-Dis-
covery of the piezoelectric properties of various polymeric
materials culminated in the development in the 1970's
of poly(vinylidine fluoride) foil as an exceptional piezo-
electric material. The foil is available in sheets which are
30 ,u thick,* and can be cut to any desired shape. Work-
ing in our laboratory at North Carolina, Fry3 developed
an occlusal force transducer only 0.5 mm thick, consist-
ing of a sheet of the foil sandwiched between thin layers
of thermoplastic material for insulation. The foil covered
most of the occlusal surface of a tooth. It was not possible
to specify the direction of force applied against the foil
during occlusion, since the complex shape of the tooth
surface was reflected in the contour of the thin transducer.
The output from this transducer consisted of a summation
of lateral- and axially-directed occlusal forces. Because of
this, accurate calibration was not possible, and data were
not comparable to measurements obtained from any di-
rectional transducers. In addition, the transducer was often
damaged by maximum biting force.
To overcome these problems while retaining as much as
possible of the potential thinness of a piezo-foil transducer,
a new transducer was developed, which consisted of a sheet
of poly(vinylidine fluoride) foil placed between flat metal
plates in a small stainless steel casing. This transducer, de-
veloped initially by Cummings in our laboratory,4 could be
calibrated and proved successful in intra-oral measurements.
Continued development and modification of Cummings'
design led to the transducer design illustrated in Fig. 1.
Piezo-electric transducers based on quartz crystals have
been available commercially for several years.t Except that
the sensing element is quartz rather than PVF foil, and
therefore a thicker casing is required, these transducers are
similar to the ones described above. The smallest quartz
Cusp Contact Plate Ground Wire
Spike
I2 AE-10 Epoxy
2mm
-ISIt _ _, ;Signal Wire
4f
/ /
Casing Piezofoil
.- 3mm
Fig. 1 -Schematic of piezo-foil occlusal force transducer.
*Kreha Corp., Tokyo, Japan
tKistler Corp., New York
Vol. 62 No. S OCCL USA L FORCES IN NORMAL- A tD LONG-FA CE ADUL TS 56 7

transducer, 6.0 immn in height, was chosen to obtain occlusal
force values at a larger bite opening.
Psezo-electric transducers, whether based on foil or
quartz crystals, produce a signal in the formii of a smiiall elec-
trical charge and, therefore, must be used with a charge
amplifier. If a steady load is applied to a piezo-electric
m-iaterial, a charge will appear when the load is applied, but
then will fade away. When the load is released, an equiv-
alent charge spike is observed in the opposite direction.
Selection of an appropriate time constant in the amplifier
system is important if signals which portray the dynamic
course of occlusal loading are desired. Since occlusal loads
may be maintained for a few hundred ins, a relatively long-
time constant (seconds) works best for occlusal force
measurenments.
Calibration of both the quartz and foil transducers was
accomplished on a load-amplifying balance developed for
this purpose. Each transducer was placed on the calibration
platforml so that the force bolt of the balance contacted the
center of the cusp contact plate. With a weight placed on
the balance platform, the balance was operated so that the
transducer was loaded and unloaded. The balance, designed
theoretically to give lOX amplification of weights placed on
the platform, proved to be perfectly linear and to give a
10.57 amiiplification. ihis feature allowed us to calibrate
conveniently over a I -1 00 kg range.
Both the quartz and foil transducers were highly linear
and quite reproducible. The correlation for both between
applied load and output was 0.99.
Selection of' subjects.-Adult patients with vertical
dentofacial dysplasia of the long-face type are seen regu-
larly at the Dentofacial Clinic of the UNC School of Den-
tistry for evaluation and surgical-orthodontic treatment.
Long-face subjects were selected from this patient pool.
Subjects with normiial vertical dimiiensions were selected
from patients presenting for routine orthodontic treatmiient.
From clinical examinations by three orthodontists,
subjects were classified initially as having long or normal
vertical facial dimensions. Twenty-five angular and linear
measurements were made on a lateral cephalomiietric radio-
graplh of each patient, and these were compared between the
two groups. Statistically significaint differences (p < .05)
were found in SN- nandibular plane angle, gonial angle,
palatal plane-mandibular plane angle, interlabial gap, and
anterior/posterior face helight ratio. The cephalometric
analysis confirmed the clinical iinpression that the two
groups had different vertical imorphology.
The normal group consisted of nine males and 12 fe-
males with a mean age of 26.9 yr (S.D. 4.4); the long-face
group included six males and 13 females with a mean age
of 22.7 yr (S.D. 4.9). All subjects were in good health, with
no underlying systemic problems as determined by nedical
history. All had intact dentition with periodontal and sup-
porting tissues within normnal liiitlts. No signs or symptomiis
of teinporoinandibular joint dysfunction were present in
any of the subjects.
Procedures for evaluating occlusal force. --For this study,
a single transducer was placed on the distobuccal cusp of
the lower first maolar parallel to the occlusal surface. Either
the right or the left side was usecd. Teeth with large restora-
tions were avoidced. The interdigitation of the posterior
teeth was evaluated on the casts mountedi in centric oc-
clusion. The side with the best cusp-fossa relationshiip was
chosen for mounting the transducer. With the transducer
positioned on the cusp tip of the lower first miiolar and the
lead wire extending anteriorly, the vertical adjustmiient
screw of the articulator was set to provide very slight (less
than 1 mm) clearance between the transducer and the

A p I

Fig. 2 (A) Piezo-foil transducer placed over cusp of lower mnolar, with lead wires extending out to buccal. Wax relief over teeth and soft
tissue prevents silicone carrier from contacting teetlh or tissue-there is no wax relief directly under the transducer. (B) Completed transducer
assembly with silicone carrier. The carrier guides the occlusion so that occlusal contact occurs through the transducer at the predetermined
position.
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568 PROFFITETAL. J Dent Res May 1983

56-
X Mean
48- +
±1 Standard Deviation
X Mean
(I ±1I Standard Deviation
E 40-
0
E 32- x
0m)
0 24-
._

16-
2.5mm 6.0mm
Normal Long 8-
Swallow 0-
Fig. 3 - Occlusal forces during swallowing, long-face vs. normal
2.5mm 6.0mm 2.5mm 6.0mm
adults. Normal Long Face
Maximum Biting Force
40- Fig. 5 - Occlusal forces during maximum effort.

32 X Mean
± 1 Standard Deviation
Two transducer assemblies were prepared in similar
24H fashion for each patient, at 2.5 mm molar separation
using a UNC piezo-foil transducer, and at 6 mm using
a Kistler quartz transducer. During the recording session,
20 forces at 2.5 mm separation were evaluated first. Forces
during swallowing were recorded by placing 2 ml of water
16- into the patient's mouth, asking him to swallow the water,
and then recording occlusal forces when the patient swal-
lowed again upon command, immediately after swallowing
12- the water. Forces during simulated chewing were then
recorded by asking the subject to "chew with the same
force you would use chewing steak." The last step was to
8- record maximum biting force. Seven repetitions of each
activity were obtained. The same procedure was followed
with the wider jaw separation.
4-
u u x
ELL

O- 2.5mm 6.0mm
Normal
Chew
Fig. 4 - Occlusal forces during simulated chewing.
central fossa of the upper molar. Composite resin was
mixed and placed on the transducer, and the articulator
was closed down, forming a composite matrix which would
distribute occlusal force evenly to the upper molar.
After the resin had polymerized and was reduced to
eliminate any interferences, silicone rubber was forced be-
tween the casts around the transducer assembly, extending
from the canine to the second molar region. This material
was trimmed to eliminate soft tissue contacts and tooth
contacts in the mandibular arch. It then served to guide the
patient into contact with the transducer at the planned jaw
position. There was no tooth contact with the rubber
matrix at that position, so it did not reduce the force
delivered to the transducer (Fig. 2).
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Results.
2.5mm 6.0mm Both the foil and quartz transducers proved quite satis-
factory. Although the foil transducers are slightly less sen-
Long sitive, both transducers were used with the same charge
amplifier and were equally linear. With both types of trans-
ducer, failure occurs if the casing distorts or insulation
cracks so that moisture can penetrate. It is probably be-
cause of their smaller and thinner casings that the foil
transducers are much more subject to this mode of failure.
With a supply of casings available, foil transducers can be
readily produced in the laboratory at small cost. The lab-
oratory must be prepared to rebuild them as needed.
Data for occlusal forces in normal and long-face subjects
for swallowing, simulated chewing, and maximum effort
are shown in the Table and are displayed graphically in
Figs. 3-5.
Using a linear multivariate model,5 differences in the
three occlusal force measurements (swallow, chew, and
MBF) between the long and normal groups were tested
at a = .05. In addition, a co-variance matrix was manipu-
lated to produce the equivalent of unpaired t tests between
the individual measurements. The following null hypotheses
were tested:
Vol. 62,Vo. 5 OCCL USAL FORCES IN NORMAL- AND LONG-FACE ADUL TS 569
TABLE
HA: No difference in occlusal Swallow: p =.04 MEAN OCCLUSAL FORCES IN NORMAL- AND
forces between groups Chew : p = .0005 LONG-FACE ADULTS
at 2.5 mm opening MBF : p = .0002
Overall: p = .002 Normal Long Face
HB: No difference in occlusal Swallow: p = .01 n=21 n= 19
forces between groups at Chew p = .007 2.5 mm 6.0 mm 2.5 mm 6.0 mm
6.0 mm opening MBF : p = .0002 Opening Opening Opening Opening
Overall: p = .003 Swallow x 2.9 kg 4.8kg 1.1 kg 1.8 kg
Hc: No difference in occlusal Swallow: p = .009 S.D. 3.7 4.8 0.9 1.2
forces between groups Chew : p = .001 Chew x 13.5 16.2 4.2 6.8
overall MBF p=.0001 S.D. 10.4 13.8 3.2 4.6
Overall: p = .0007 MBF x 31.0 35.6 11.2 15.5
In all cases, the null hypotheses were rejected. Signifi- S.D. 20.0 18.7 7.9 10.5
cant differences existed between the long and normal
groups for swallowing, chewing, and maximum biting forces
at 2.5- and 6.0-mm bite openings. teeth often come together toward the end of a normal
The influence of bite opening on occlusal forces was chewing cycle, and usually are brought together during
analyzed within each facial group using the same linear swallowing. Maximum effort probably occurs more when a
multi-variate model with a = .05. The following null hy- subject clenches his teeth than under any other circum-
potheses were tested: stance. Occlusal forces obtained when the jaws are closely
HD: No difference in occlusal Swallow: p = .26 approximated are relevant to all these activities.
forces at 2.5 mm and Chew : p = .14 Different occlusal force values are obtained with an
6.0 mm opening in the MBF p = .13 object between the posterior teeth unilaterally (as in this
long group. Overall: p = .42 study) or bilaterally.11 Force values are greater with both
HE: No difference in occlusal Swallow: p = .003 sides involved, but not twice as great. Since a bolus is typi-
forces at 2.5 mm and Chew : p = .12 cally placed on one side for mastication, normal function is
6.0 mm opening in the MBF p = .15 simulated better with a unilateral transducer, and most
normal group. Overall: p = .03 occlusal force data in the literature come from unilateral
HF: No difference in occlusal Swallow: p = .004 recordings.
forces at 2.5 mm and Chew : p = .04 The values for maximum biting force (MBF) reported in
6.0 mm opening overall. MBF p = .04 this study compare favorably to those reported in the past
Overall: p .03 = decade by Linderholm and Wennstrom12 and by Linder-
There were no significant differences in occlusal forces holm et al. 13 Our MBF values, however, are significantly
at the 2.5- and 6.0-mm for the long-face group. When lower than those reported by Finn,2 whose instrumentation
variables were comnpared for the normal group, the mean was most similar. Finn reported an average MBF of 58.1 kg
force was significantly different for swallowing between in normal subjects and 29.9 kg in long-face subjects, as
2.5 and 6.0 mm, but not for the other variables. When the compared to our normal of 35.6 kg and long of 15.5 kg.
normal- and long-face groups were combined, significant The major difference between Finn's procedure and ours
differences were evident for each variable between 2.5 and was a greater degree of molar separation in his subjects,
6.0 mm. This resulted from a consistency of direction in with approximately 10 mm of opening compared to our
differences between the two groups. wider opening of 6 mm. Whether this explains the differ-
ence remains to be seen.
Discussion. Only a few groups have previously studied forces during
chewing. Several studies have been conducted utilizing
We had expected that occlusal forces would decrease transducers built into crowns, bridges, and removable
when the jaws were brought closer together, but this oc- prostheses. Various types of food have been used, and force
curred only for the normal group for swallowing. Six mm levels differed among the food types. Brudevold14 and
or more of molar separation is commonly required when Yurkstas and Curbyt5 used strain gauges in removable
foods are chewed, but the teeth rarely come all the way prostheses and reported chewing forces in the range of 0.5-
together during heavy chewing. There probably are dif- 1.5 kg, with maximum forces up to 12 kg. Since it is gen-
ferences in occlusal forces at wider openings. The force erally accepted that forces are less with a prosthesis in
exerted by all skeletal muscles varies with length. Maximum place, these lower values are not surprising. Haraldson et
tension is exerted at 100-120% of resting length.6 In ani- al. 16 reported forces in chewing of 3 to 5 kg in a normal
mals, it has been shown that maximum tension for different control group, using a bite-fork device. Graf17 reported
jaw closing muscles or sections of muscle occurs at different similar values. Since our simulated chewing values are
jaw positions, smoothing out the curve for occlusal force.7'8 higher than these, it may be that patients tend to use more
Moller's electromyographic data indicate that the situation force for simulated chewing than they would for the real
is similar in man.9 How wide a range of jaw opening is thing, or that our instruction to bite as if they were chew-
compatible with nearly constant occlusal force is not ing steak led them to use more force than they would have
known for humans. In cats, maximum tension can be pro- to chew the generally softer foods tested by previous in-
duced almost at maximum opening.10 Our preliminary vestigators.
efforts have shown that it is almost impossible for patients To our knowledge, there have been no previous reports
to swallow with the jaws more than 10 mm apart, but it is of the force with which the teeth are approximated during
possible to measure maximum effort and simulated chewing swallowing. Most, but not all, normal individuals bring their
with wider degrees of jaw separation, and we plan to pursue teeth together during swallowing.18 About 15% of normal
this further in the future. Since chewing is often done with subjects do not bring their teeth together when they
the jaws widely separated, data for forces during simulated swallow, based on radiographic observation. We did observe
chewing are needed at wider degrees of jaw separation. The in this study that some individuals had no occlusal force
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570 PROFFITETAL.
recorded when they swallowed. It may be that even the
2.5-mm jaw separation produced by our thin transducer
caused us to record forces in some patients who would have
had little or no force if the jaws could have moved closer
together during the swallow. Although occlusal forces were
lower in the long-face group, there were only two indi-
viduals for whom no force was recorded, as compared to
one normal patient who had no force on swallowing. A
sensitive transducer embedded in a restoration would be
needed to study force at zero jaw separation. We believe
that light forces, similar to or less than those at 2.5 mm,
would be recorded during swallowing for most long-face
and normal subjects.
Our data make it plain that there is a significant differ-
ence in the force of occlusal contact between normal- and
long-face adults. On maximum effort, the normal adults
bite two to three times harder, and the differences for
swallowing and chewing are as great or greater. Although
the difference is clear-cut, the reason for it is not. There are
several possibilities, which are not mutually exclusive.
A difference in body build and general muscular strength
certainly could contribute to occlusal force differences.
Large individuals could be expected to produce more force
than small ones, and it seems reasonable that muscular
individuals would be more powerful than slender ones. It
can be readily observed that long-face individuals tend to be
tall and slender. Differences due to body build might be
expected to be greater for MBF than for chew and swallow,
which is not the case. We consider it unlikely that body
build completely accounts for the differences.
A significantly larger number of females than males seek
treatment for dentofacial deformity. This resulted in a
preponderance of females in our long-face group. Since
females have less muscular power than do males, this may
have contributed to the group differences in occlusal force.
If the males are excluded from the control and experimen-
tal groups, however, there is still a significant difference, so
sex is not a major factor.
Another possibility is that the magnitude of occlusal
force reflects the geometric arrangement of the lever system
of the jaw. Throckmorton et al. 19 have demonstrated that
there is a greater mechanical advantage for the elevator
muscles of the mandible if the ramus of the mandible is
upright and the gonial angle is relatively acute. As the go-
nial angle increases, the mechanical advantage of the muscles
decreases, and an equivalent effort by the muscle would
produce less force at the dental occlusion. This view implies
that occlusal force might be another example of function
reflecting form.
It is also possible that the forces of occlusion serve as a
direct control mechanism for eruption of the teeth. A com-
mon finding in long-face individuals is excessive eruption of
posterior teeth, particularly the maxillary molars. As the
long-face individuals grow, there is often a tendency for the
mandibular plane angle to increase as the mandible rotates
downward and backward. Extremes of this pattern of
growth can be seen in syndromes which cause generalized
muscular weakness, implying that relative muscular weak-
ness may precede and contribute to the long-face pattern.
The concept is attractive to clinicians, since it implies
that physical therapy aimed at strengthening the muscles of
mastication might be useful in controlling long-face pat-
terns of development. Differences in the distribution of
muscle fiber types have been observed in biopsy specimens
from the muscles of mastication in normal- and long-face
individuals.20 One cannot decide what is the cause and
what is the effect from measurements of the occlusal
themselves, and it is likely that this point will remain con-
Downloaded fromlong-face
troversial. Since the developing pattern
jdr.sagepub.com at UNIVERSITEcan
J Dent Res May 1983
identified in children, it will be of considerable interest
to see whether the same differences in occlusal forces found
in adults are also present in children.
Acknowledgments.
We thank Mr. H.K. Baumeister, Senior Engineer, IBM,
Research Triangle Park, NC, for design and construction
of the load-amplifying balance and for engineering assist-
ance with this project, and Dr. Ceib Phillips for statistical
consultation.
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