Review Article

T- Scan a digital pathway to occlusal perfection: a review

Reeta Jain1, Ravudai Jabbal2, Shweta Bindra3, Swati Aggarwal4
1
Professor & Head, 2Reader, 3,4PG Student, Department of Prosthodontics, Genesis Institute of Dental Sciences &
Research, Ferozepur(Punjab)

Corresponding Author:
Reeta Jain
Professor & Head, Department of Prosthodontics, Genesis Institute of Dental Sciences & Research,
Ferozepur(Punjab)
E-mail: rtjn132@gmail.com

Abstract
For years, dental occlusion had been largely a matter of guess work for dentists. Articulation paper marks,
waxes, pressure indicator paste, etc. were the only tools available to access and balance the bite force. These
methods do not detect simultaneous contact, nor do they quantify time and force. With the advent of T-SCAN the
scenario has changed. The evolution of T SCAN from 1st generation to 8th generation (1847-2015) has revolutionized
the concept of occlusal analysis. The modern version of T SCAN system released in 2012 i.e. T SCAN 8 was
purposefully designed to minimize the T SCAN 3 user interface complexity. T SCAN 8 has reversed desktop graphics
for simpler data display with less software, toolbar buttons and icons. The system comprises of Microsoft windows
based software, associated hardware and patented thin disposable sensor. Patient is asked to bite on ultra-thin
senor. The occlusal contact is transferred to the computer and presented in a dynamic movie format. It thereafter
allows for full color 3 or 2 dimensional graphics. It depicts the percentage of force per tooth. The software enables
the doctor to dynamically visualize the patient bite from beginning to end and everything in between. The analytic
software displays such as centre of force (COF) and COF trajectory provides an in depth understanding of the
overall balance of occlusion.

Key words: T-Scan, Digital Occlusal Analysis, Bite force.

Introduction contact information quantitatively.[5] T- Scan l was

The conventional methods used in clinical invented 25 years ago, and since then, the entire
practice for guiding contact selection during system has undergone hardware and software
occlusal adjustment are using articulating paper, revisions such that today T-Scan lll system
impression waxes and shim stock foil which are all (version 7) is vastly improved over the earliest T-
often combined with patient occlusal feedback. Scan l system.[6]
The use of articulating paper is most commonly The occlusal forces that are applied to an
method used to determine excessive force in implant prosthesis can be a potentially destructive
differing occlusal contacts[1]. Despite the apparent factor in shortening the potential longevity of any
clinical success with use of paper mark size as an implant prosthesis. Both material failures and
occlusal contact selection guide, it appears that implant deosseointegration have been attributed to
using mark size as a force guide can result in poor excessive occlusal loading to dental implants[7,8].
force applications to the occlusion. Published Poorly directed and non-uniform occlusal loading
studies about articulating papers are analyses of will torque a prosthesis and apply stresses that
the physical properties (thickness, composition, may ultimately result in prosthetic failures. With
ink substrate and plastic deformation)[2],[3],[4]. In the aid of the T-Scan II Occlusal Analysis System,
this era of immobile dental implants and brittle all occlusal forces that are applied to an implant
ceramic restorative materials more precise prosthesis can be quantitatively represented for
occlusal force control is required to ensure the improved correction through occlusal adjustments.
longevity of prosthesis. One of the most The resultant occlusal force distribution can then
innovative systems for quantitative occlusal be far less destructive to the prosthesis, and the
analysis was developed by Maness. He developed underlying implant-bone interface.
the T- Scan system, which is considered as a One of a doctor’s roles is to educate patients
computerized device capable to interpret occlusal with regards to their health (ADA, 2010). The
Annals of Prosthodontics and Restorative Dentistry, October-December, 2015;1(1):32-35 32
Reeta Jain et al. T- Scan a digital pathway to occlusal perfection: a review

three most prevalent diseases dentists regularly  Intel

treat are caries, periodontal disease and occlusal Core™2 Duo Processor or newer
disease (Christensen, 2001). Occlusal disease is  a2 GB RAM
under treated by many practitioners (Christensen,  5 GB Disk Space
1995), which is partially due to the difficultly of  Dedicated video card
having a patient understand the benefits that (2011 or newer)
occlusal therapies offer in the treatment of  VMware
occlusal pathologies. Utilizing the T-Scan  MacBook Pro
Computerized Occlusal Analysis System (T-Scan 5 or Parallels
8, Tekscan, Inc. S. Boston, MA, USA) in Desktop 7
combination with a well-planned strategy for Virtualization Software
patient education, can improve the number of  8 GB RAM
patients who accept occlusal therapies that likely
 75 GB
would benefit them.[9]
Imaging technology in the form of T Scan
device can reveal much of the invisible world of System Components
occlusion and associated diagnostic capability.  Software CD
Many of the most influential tooth contacts in  1 Evolution Handle (USB-based)
occlusion are so subtle that they cannot be  20 T-Scan Sensors – 1 box each large and
identified through simple observation.[10] small
 4 Sensor Supports – 1 box each large and
Applications small
 Abfraction Formation and Root Recession  Dental Practice Marketing Kit CD
Defects  Hands-on and online training sessions
 Adhesive and Esthetic Prostheses included
 Cosmetic Restorations
 Full Mouth Reconstruction Discussion
 Implant Prosthodontics Reliability and reproducibility of occlusal
analysis is an important dimension of planning
 Natural Tooth Occlusal Function
evidence-based clinical decisions, in clinical
 Orthodontics
dental treatments and research.[11] The
 Prosthodontics conventional static occlusal indicators such as
 Splint/Orthotic Therapy articulating paper and waxes only reveal the
 Temporomandibular Disorders contact size and location, whereas the T-Scan has
an additional ability of quantifying occlusal
Benefits contact timings and forces.[12]
 Improved diagnosis Although the role of occlusal disturbances as
 Increased quality of care one of the etiological factors in the multifactorial
 Decreased treatment time TMDs is controversial,[13] correction of the
 Increased comfort of dental prosthetics occlusal disturbance in various cases has been
 Reduced risk of implant failure, traumatized shown to reverse the condition and provide relief
teeth, unstable dentures, ineffective splints, to the myalgia.[14] It has been shown that lower
and porcelain fractures surface electromyographic (SEMG) activity is
 Legal documentation of outcome associated with higher number of contacts and the
 Enhanced patient education maximum level of bite force during centric
 Build your practice maximal voluntary clenching.[15] The T-Scan
 Increased referral business from other system presents a superior alternative to
physicians conventional occlusal registration methods due to
its ability to record dynamic tooth contact
Windows System Requirements relationships.[16] In contrast, a study on articulating
Based Virtual Windows Based paper marks made at various occlusal force loads
 Windows XP, Vista, 7 and 8 showed that more than 80% of the marks have no
correlation between the mark size and the load
Annals of Prosthodontics and Restorative Dentistry, October-December, 2015;1(1):32-35 33
Reeta Jain et al. T- Scan a digital pathway to occlusal perfection: a review

applied.[17] This establishes the inadequacy of AP to increased intensity of otherwise relatively low
marks in describing the occlusal load.[16] T-Scan bite forces which become focused onto a small
has a higher sensitivity and specificity as a area and produce high pressure. This may also
diagnostic tool for assessing guided closure lead to inaccurate recording of the occlusal contact
contacts, when compared to articulating paper, and/or artifacts in the produced images. The T-
waxes and other conventional occlusal Scan system is able to reproduce occlusal
indicators.[18] interferences only exceeding 0.6mm in dimension.
Although the T-Scan sensors are available in Also, the two different modes of the system (force
two different sizes to accommodate arches of and time analysis modes) may reproduce different
different dimensions, the literature search did not occlusal contact data. Time mode has been shown
identify any articles reporting the use of this to register the maximum number of contacts, while
system in children and patients with limited mouth the force mode has been shown to present the least
opening and hence, no conclusions can be drawn variability. However, these differences are small.
about their benefits or limitations in these cases.
An important aspect of the T-Scan system that Conclusion
should be considered is that the contact timing and Compared to conventional occlusal indicators,
the force analysis can be studied on the software. the T-Scan system clearly has more clinical utility
Thus T-Scan is able to provide a definitive in diagnosing and treating cases of
diagnosis of the occlusal force balance and temporomandibular disorders when caused due to
masticatory muscular function.[19, 20] occlusal disturbances. Computerized occlusal
The product is now marketed in its third analysis with the T-Scan II can be applied to
version as T-Scan III with software version 8.0. analyze the relative time of initial occlusal contact
Moreover, the newer software provides a better of natural teeth and dental implant prostheses, so
representation of the intraoral dental arch in the that it is possible to separate them as they come
analysis program of the software when compared under occlusal loading. T-Scan system
to previous versions.[21] demonstrates sufficient sensitivity and specificity
as a diagnostic tool and presents higher reliability
Safety Issues in intra-oral conditions with presence of saliva.
T-Scan systems are classified as Class I This technology reduces the subjective
devices by the FDA. They have low-risk profiles interpretation of occlusal analysis data and also
since they are not “life-supporting, life-sustaining provides registration of dynamic occlusal
or of substantial importance in preventing information. Therefore it is recommended that the
impairment of health nor present a potential use of T-Scan system should be supported in
unreasonable risk of illness or injury”. clinical practices for the diagnosis and occlusal
optimization in cases of occlusal disturbance
Limitations of the T-Scan System related temporomandibular disorder, due to its
It has been shown that thinner occlusal capability of measuring occlusal force and contact
registration materials provide more consistent timing.
records of the contact points. To fulfill the
technological demands, the T-Scan sensors are References
made as thin as possible (0.1mm). However, these 1. Qadeer S, Kerstein RJ, Jin R, Jung-Bo Huh, Sang Wan
Shin. Relationship between articulation paper mark size
sensors are still relatively thicker as compared to and percentage of force measured with computerized
occlusal indicators like articulating silk. This may occlusal analysis J Adv Prosthodont 2012;4:7-12.
significantly alter the functional occlusion and 2. Schelb E, Kaiser DA, Brukl CE. Thickness and marking
even affect the activity of the masticatory muscles. characteristics of occlusal registration strips. J Prosthet
Dent 1985;54:122-6.
Alteration of occlusion is shown to occur with all 3. Halperin GC, Halperin AR, Norling BK. Thickness,
occlusal registration products, and clinicians strength, and plastic deformation of occlusal registration
should be aware of these limitations when strips. J Prosthet Dent 1982;48:5758.
4. Millstein P, Maya A. An evaluation of occlusal contact
functional adjustments are planned in the marking indicators-a descriptive method. J Am Dent
occlusion. Furthermore, the sensors may be Assoc 2001;132:1280-6.
damaged when forces are concentrated over a 5. Maness WL. Force movie: a time and force view of
occlusal contacts. Compend Contin Educ
small area, such as, a sharp tooth cusp. This is due Dent.1989;10:404-408.

Annals of Prosthodontics and Restorative Dentistry, October-December, 2015;1(1):32-35 34

Reeta Jain et al. T- Scan a digital pathway to occlusal perfection: a review

6. Jin-Hwan Kim. Computerized Occlusion using T- Scan

lll. E-book, pg 5.
7. Kohavi D. Complications in the tissue integrated
prostheses components: clinical and mechanical
evaluation. J Oral Rehabil 1993 Jul;20(4):413-422.
8. Isidor F, Clin Oral Implants Res. 1997 Feb;8(1):1-9.
Histological evaluation of peri-implant bone at implants
subjected to occlusal overload or plaque accumulation.
9. Droter JR, T- Scan as a patient education Tool, 2015.
Handbook of Research on Computerized Occlusal
Analysis Technology Applications in Dental Medicine’,
pp.672-73.
10. Sidana, V, Pasricha, N, Makkar, M, Banwait, S. ‘Indian
Journal of Dental Sciences. June, 2013, Vol.5, no.2:141-
44.
11. Davies S, Al-Ani Z, Jeremiah H, Winston D, Smith P.
Reliability of recording static and dynamic occlusal
contact marks using transparent acetate sheet. J Prosthet
Dent. 2005;94(5):458-61. Epub 2005/11/09.
12. Maness WL. Laboratory comparison of three occlusal
registration methods for identification of induced
interceptive contacts. J Prosthet Dent. 1991;65(4):483-7.
13. Winocur E, Emodi-Perlman A. Occlusion, Orthodontic
Treatment and Temporomandibular Disorders: Myths and
Scientific Evidences. Bourzgui PF, editor: In Tech; 2012.
14. Kerstein RB, Wright NR. Electromyographic and
computer analyses of patients suffering from chronic
myofascial pain-dysfunction syndrome: before and after
treatment with immediate complete anterior guidance
development. J Prosthet Dent. 1991;66(5):677 86.
15. Wang XR, Zhang Y, Xing N, Xu YF, Wang MQ. Stable
tooth contacts in intercuspal occlusion makes for utilities
of the jaw elevators during maximal voluntary clenching.
J Oral Rehabil. 2013;40(5):319-28. Epub 2013/03/14.
16. Qadeer S, Kerstein R, Kim RJ, Huh JB, Shin SW.
Relationship between articulation paper mark size and
percentage of force measured with computerized occlusal
analysis. J Adv Prosthodont. 2012;4(1):7-12.
17. Carey JP, Craig M, Kerstein RB, Radke J. Determining a
relationship between applied occlusal load and
articulating paper mark area. Open Dent J. 2007;1:1-7.
18. Saracoglu A, Ozpinar B. In vivo and in vitro evaluation
of occlusal indicator sensitivity. J Prosthet Dent.
2002;88(5):522-6.
19. Koos B, Godt A, Schille C, Goz G. Precision of an
instrumentation-based method of analyzing occlusion
and its resulting distribution of forces in the dental arch. J
Orofac Orthop. 2010;71(6):403-10.
20. Kerstein RB. Combining technologies: a computerized
occlusal analysis system synchronized with a
computerized electromyography system. Cranio.
2004;22(2):96-109.
21. Kerstein RB, Radke J. Masseter and temporalis excursive
hyperactivity decreased by measured anterior guidance
development. Cranio. 2012;30(4):243-54.

Annals of Prosthodontics and Restorative Dentistry, October-December, 2015;1(1):32-35 35