Thickness and marking quality of different occlusal contact registration strips

www.scielo.br/jaos
http://dx.doi.org/10.1590/1678-775720140117

Thickness and m arking quality 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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ABSTRACT

O

bj ect ives: Evaluat e t he t hickness and t he m arking qualit y of different occlusal cont act
regist rat ion st rips ( OCRS) and a possible correlat ion bet ween t hem . Mat erial and
0HWKRGV7KHIROORZLQJ2&56ZHUHVHOHFWHG$FFX¿OP,,%.%.%.%.%.
and BK31. The t hickness was m easured in t hree point s of t he OCRS wit 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 were phot ographed wit h a
st ereoscopic m icroscope ( St em i SV11) and processed and analyzed by t he 550- Leica Qwin ®
DQDO\]HU 5HVXOWV 9DOXHV NjP  IRXQG LQ WKH st and 2 nd t hickness m easurem ent s were:
$FFX¿OP,,DQG%.DQG%.DQG%.DQG
8.7; BK23 - 9.8 and 7.9; BK28 - 12.8 and 10.0; and BK31 - 8.4 and 8.0, respect ively. The
m ean ( m m 2 YDOXHVIRXQGLQWKHPDUNDUHDVZHUH$FFX¿OP,,%.%.
- 0.045; BK22 - 0.012; BK23 - 0.022; BK28 - 0.024; and BK31 - 0.024. The result s were
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 2 nd m easurem ent , t he OCRS t hickness observed was sim ilar t o t he value indicat ed
E\WKHPDQXIDFWXUHUVWKH$FFX¿OP,,DQGWKH%.VWULSVVKRZHGWKHEHWWHUPDUNVDQG
no correlat ion was found bet ween t he t hickness and t he m arking area.
Keyw ords: Dent al occlusion. Occlusal adj ust m ent . Prosthodontics. Dentistry. Oral diagnosis.

I N TROD UCTI ON

posit ion are required 8 .
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, absence of t ight cont 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.
I n t h e p r esen ce of occl u sal d i sh ar m on y
associat ed w it h t em porom andibular j oint s ( TMJ)
p h y siolog ical an d f u n ct ion al im b alan ce, som e
st ress m ay t rigger various delet erious effect s, such
as t oot h m obilit y and/ or sensit iv it y, per iodont al
problem s, incoordinat ion or hyperfunct ion of t he
m ast icat or y m uscles, and lat eral occlusal loads,
am ong ot hers3,5,7 .

Wit h a v iew t o t h e p r eser v at ion of d en t al,
periodont al, art 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 at i c o ccl u si o n , si m u l t an eo u s,
bilat eral, and hom ogeneous cont act s should be
observed bet ween t he m axillary and m andibular
t eet h; absence of r ot at ion and cr ow ding, t ight
cont act s, pr oper m esio- dist al cr ow n angulat ion
and labio- lingual crown inclinat ion, and m oderat e
over j et and over bit e 1 . Wit h r egar d t o funct ional
m ovem ent s of t he j aw, canine guidance wit 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
J Appl Oral Sci.

516

2014;22(6):516-21

Thickness and marking quality of different occlusal contact registration strips

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. However,
som e unfavorable aspect s have been perceived,
such as m oist ur e failing ( saliva) , low elast icit y,
WKLQ EDVH DQG UHODWLYHO\ LQÀH[LEOH EDVH PDWHULDO
All t hese fact ors m ay result in large num bers of
pseudocont act s9 .
Silk st r ip s h av e b een con sid er ed t h e b est
m at erial for t his purpose due t o t heir soft t ext ure,
which 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. However, 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 ere: 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.

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
den t ist s t o per f or m r ou t in e an aly sis of den t al
occlusion and check cont act bet ween t he m axillary
and m andibular arches. For t his purpose, occlusal
contact registration strips ( OCRS) are recom m ended
f or r ecor d in g occlu sal con t act s, as an aid 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
IRUFKHFNLQJDQGGH¿QLQJRFFOXVDOFRQWDFWVVXFKDV
waxes, carbon paper, m et al sheet s, plast ic sheet s,
silk st rips, as well 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
WKRVHLQGLFDWHGIRUWKHYHUL¿FDWLRQDQGLGHQWL¿FDWLRQ
of cont act s, whereas in t he quant it at ive m et hod, t he
“ T- scan” and “ phot o- occlusion” are used 9 .
Som e fact ors need t o be considered in choosing
t he m ost appropriat e OCRS for checking occlusal
co n t a ct s, su ch a s t h i ck n e ss, st r e n g t h , a n d
elast icit y 6 . 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,
ZKLFK UDQJHV IURP  WR  NjP 5HVLVWDQFH
refers t o t he OCRS ability t o wit hst and t he m oist oral
HQYLURQPHQWZLWKRXWLPSDLULQJLWVDELOLW\WRGH¿QH
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 act 4 .
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 ion 9 .
Carbon paper is a widely used m at erial because
of it s low cost and ease of use of it s widt h, t hickness

M ATERI AL AN D M ETH OD S
Sa m ple
Sam ples of seven t ypes of OCRS ( n= 10) were
select ed ( Figure 1) and st andardized t o a lengt h of
5.5 cm and widt h of 3.0 cm .

M e a su r in g t h e OCRS t h ick n e ss
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
$UWLIROXOWUD¿QD

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)

Figure 1- Occlusal contact registration strips (OCRS) used to record occlusal contacts
J Appl Oral Sci.

517

2014;22(6):516-21

TOLEDO MFSMS, JÓIAS RP, MARQUES-IASI YS, NEVES ACC, RODE SM

Spe cim e n

Gaut eng, Sout h Africa) wit h a clock m icrom et er
UHDGLQJVFDOHVNjPNjPNjPXP
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t hickness values.
For t he t hickness evaluat ion, each OCRS was
SODFHG EHWZHHQ WKH IHHOHU DQG D ÀDW WDEOH DQG
t he reading scale was set t o zero, so t hat all t he
m easurem ent s were 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 Zwick/ Roell, São Bernardo do Cam po,
SP, Brazil) wit 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
WKHVDPHSRLQWWKDWKDGUHFHLYHGWKH¿VWSXQFWXUH
load , f ollow in g ex act ly t h e sam e p r ot ocol as
GHVFULEHGLQWKH¿UVWPHDVXUHPHQW

Th e sp ecim en s con sist ed of n y lon d ev ices
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 widt h x 2 m m in dept h. To obt ain t he t en
VSHFLPHQVWKHF\OLQGHUZDV¿OOHGZLWKFRPSRVLWH
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.

M a r k in g t h e con t a ct s
The com pression t est was also perform ed wit 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 here w ere predet erm ined
areas where t he cont act s would be dist ribut ed on
t he surface of t he com posit e resin t o enable t he area
WREHLGHQWL¿HGDQGPHDVXUHG7KHUHZDVDQLQWHUYDO
wit h a m inim um dist ance of 6.5 m m bet ween t he
m arks ( Figure 2) .
The bilat eral surface OCRS were t est ed on t he
VDPH VLGH LQ WKH ¿UVW ¿YH VSHFLPHQV DQG RQ WKH
RSSRVLWHVLGHLQWKHQH[W¿YHVSHFLPHQV

Sca n n in g a n d im a ge a n a lysis
The m arks were photographed with a stereoscopic
PLFURVFRSH DW [ PDJQL¿FDWLRQ 6WHPL 69
Zeiss, Oberkochen, Baden-Württem berg, Germ any) ,
and t he im ages were processed wit h t he Qwin ®
Leica 550 ( Leica Microsyst em s I m age Solut ions SA,
Wet zlar, Hessen, Germ any) , in which t he higher
int ensit y pix els w er e r ecognized 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 m 2 ( Figures 3a, b) .

Figure 2- Contact marks

Figure 3-$FFX¿OP,,PDUNEHIRUHDQGDIWHUWUHDWPHQWRIWKHDUHDE\/HLFDDQDO\]HU
J Appl Oral Sci.

518

2014;22(6):516-21

0.1584

RESULTS
7KH WKLFNQHVV YDOXHV REWDLQHG LQ WKH ¿UVW DQG
second m easurem ent s ( Table 1) were st at ist ically
different .
ANOVA showed t hat t he “ p” values were lower
t han 0.05 in all groups ( Table 2) , m eaning t hat t here
ZHUHVLJQL¿FDQWFKDQJHVLQDOOWKH2&56DIWHUWKH
m arks were perform ed.
7KH 3HDUVRQ FRUUHODWLRQ FRHI¿FLHQW U 3HDUVRQ
0.3495) showed no correlat ion bet ween 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 wo 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.

0.6660

0.9877

0.2910

0.2771

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
dat a did n ot adh 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
OHYHORIVLJQL¿FDQFHRI$129$IRUWZRSDLUHG
sam ples was used t o visualize t he difference t hat
RFFXUUHGEHWZHHQWKH¿UVWDQGWKHVHFRQGWKLFNQHVV
m easu r em en t ( sig n if ican ce lev el of 5 % ) . Th e
Pearson correlat ion t est was applied in order t o
¿QGRXWZKHWKHUWKHUHZDVDQ\SRVVLEOHFRUUHODWLRQ
bet ween t he OCRS t hickness and t he area of t he
m ark.

0.8714
0.0001* 0.0009* 0.0000* 0.0001* 0.0000* 0.0055 0.0000* 0.0000* 0.1452
10

D I SCUSSI ON
The int er est in inv est igat ing t he 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 wit h t hese OCRS is of
param ount im port ance in m any dent al procedures.
I t is well known t hat t he effect of t he pressure
DUHDRQWKH2&56LVLQÀXHQFHGE\WKHUHVLOLHQFH
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 ypes 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) when
FRQVLGHULQJ$FFX¿OP,,DQG%.
Depending on t he OCRS phy sical pr oper t ies
( t hickness, plast ic defor m at ion and r esist ance) ,
there m ay be interference in the m arking processes;
t hus, a product m ay m ark a real cont act area;
produce a false m ark, or m ark an area t hat has
no occlusal cont act 10 . St udies have shown t hat t he

*statistically different values

0.0763
0.0878

St a t ist ica l a n a lysis

0.8472 0.0015* 0.1081

-

-

-

-

0.0719

-

0.0763

0.2007
0.7229
0.8593
0.7229

0.4409
9

0.0191 0.0357* 0.2414 0.0022* 0.0018* 0.0843

0.0110* 0.0005* 0.0004* 0.0000* 0.0001* 0.0030* 0.0000* 0.0000* 0.9631
8

0.3277

0.1484 0.0059* 0.1047 0.0334* 0.6029

0.3550
0.0038* 0.0259 0.0001* 0.0042* 0.0000* 0.0907 0.0000* 0.0003* 0.6886
7

0.5324

0.2704

-

-

-

0.8593
0.0004* 0.0009* 0.0000* 0.0001* 0.0000* 0.0052* 0.0000* 0.0000* 0.3053
6

-

-

-

-

-

0.0125* 0.0016* 0.0005* 0.0002* 0.0001* 0.0089* 0.0000* 0.0000*

-

5

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

0.0512
0.3353

0.2414

0.4363
0.1967

0.7432
0.5922

-

0.1837

0.0218* 0.1573
4

0.3164
2

3

0.5249

-

-

-

-

-

4
3
2
1
p

-

-

-

-

-

6
5

-

-

7

-

9
8

-

2nd
1st
2nd

Measurement

1st
2nd

Measurement

1st
2nd

Measurement

1st
2nd

Measurement

1st
2nd

Measurement

1st
2nd

Measurement

1st
2nd

Measurement

1st
2nd

Measurement

Table 1-2FFOXVDOFRQWDFWUHJLVWUDWLRQVWULSV 2&56 WKLFNQHVV³S´YDOXHV VLJQL¿FDQFHOHYHO ±¿UVWDQGVHFRQGPHDVXUHPHQWV

1st

Measurement

Thickness and marking quality of different occlusal contact registration strips

J Appl Oral Sci.

519

2014;22(6):516-21

TOLEDO MFSMS, JÓIAS RP, MARQUES-IASI YS, NEVES ACC, RODE SM

Table 2-2FFOXVDOFRQWDFWUHJLVWUDWLRQVWULSV 2&56 WKLFNQHVV³S´YDOXHV VLJQL¿FDQFHOHYHO PDUNLQJDUHD
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*

*statistically different values
t he m arker subst ance affect ed t he size of t he m ark.
The r ed OCRS r egist er ed com parat iv ely lar ger
m arks t han t he ot her st rips of sim ilar t hickness,
w hile t hinner poly est er plast ic st r ips pr oduced
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 pr odu ced lar ger an d sm aller m ar k s, so
t here was no correlat ion bet ween t he t hickness
m easurem ent and t he m arking area. Thus, based
RQWKHUHVXOWVLWLVQRWSRVVLEOHWRDI¿UPWKDWWKH
t hicker t he st rip t he bigger t he m ark produced, in
disagreem ent wit 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 ure 9 ,
t he result s were not coincident . The t wo m et hods
are sim ilar, but wit 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.

Figure 4- Pearson’s correlation test dispersion diagram thickness x marking area
presence of m oist ure ( saliva) in t he oral cavit y
negat ively affect s t he base of paper st rips, causing
t ear ing and/ or fragm ent at ion 4,9 , or dist or t ion of
cont act m arks10 , in addit ion t o showing t hat t here
is a difference bet ween t he num ber of cont act s
m ar ked on a dr y and on a w et t oot h sur face 9 .
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 when m arking t he occlusal cont act s was
lim it ed and const ant .
9HUL¿FDWLRQRIWKH2&56WKLFNQHVVVKRZHGWKDW
only t he second m easurem ent values were 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
XQLIRUPPDUNVZHUH$FFX¿OP,,DQG%.,WVKRXOG
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.
7KHWKLFNQHVVDQGWKHPDWHULDORIWKH¿OPDQG
J Appl Oral Sci.

CON CLUSI ON
I t w as con clu d ed t h at on ly in t h e secon 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;
WKH $FFX¿OP ,, DQG WKH %. VWULSV VKRZHG WKH
m ost accurat e m arkings; and no correlat ion was
found bet ween t he t hickness and t he m arking area.

520

2014;22(6):516-21

Thickness and marking quality of different occlusal contact registration strips

REFEREN CES

6- Millst ein P, Maya A. An evaluat ion of occlusal cont act m arking
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