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Digital occlusal analysis using T scan: Its role, mechanism, accuracy and
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PERSPECTIVE
CASE REPORT ARTICLE 24(105), September - October, 2020

Medical Science
ISSN
2321–7359
EISSN
2321–7367

Digital occlusal analysis using T scan: Its role,

mechanism, accuracy and application
Arihant Bathiya1, Sweta Kale Pisulkar2
1PhD scholar, Department of Prosthodontics and Crown & Bridge, Shard Pawar Dental college and Hospital, Datta Meghe Institute
of Medical Sciences, (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India; Email: arihantbathiya@gmail.com
2Associate Professor, Department of Prosthodontics and Crown & Bridge, Shard Pawar Dental college and Hospital, Datta Meghe
Institute of Medical Sciences, Deemed to be University, Sawangi (Meghe), Wardha, Maharashtra, India; Email: drsweta15@gmail.com


Corresponding author
Associate Professor, Department of Prosthodontics and Crown & Bridge, Shard Pawar Dental College and Hospital, Datta Meghe
Institute of Medical Sciences; deemed to be University, Sawangi (Meghe), Wardha, Maharashtra, India;
Email: drsweta15@gmail.com

Article History
Received: 05 June 2020
Reviewed: 06/June/2020 to 11/July/2020
Accepted: 12 July 2020
E-publication: 18 July 2020
P-Publication: September - October 2020

Citation
Arihant Bathiya, Sweta Kale Pisulkar. Digital occlusal analysis using T scan: Its role, mechanism, accuracy and application. Medical
Science, 2020, 24(105), 2826-2834

Publication License

This work is licensed under a Creative Commons Attribution 4.0 International License.

General Note
Article is recommended to print as color digital version in recycled paper.

ABSTRACT
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Occlusal considerations play a vital role for in any treatment success. Occlusion is speciality of interdisciplinary science. It attracts the
interest of various specialties like Prosthodontics, Oral surgery, Implantology, Periodontics, Pedodontics, Endodontics. Various
method and techniques are available for adjusting occlusion, articulating paper being one of the common and traditionally used
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methods. But it has certain considerable drawbacks like inability to measure force and time and the sequence of teeth contacts.
These inherent shortcomings are totally overcome using T scan. In various field like myofuctional and temporomandibular joint

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 PERSPECTIVE ARTICLE

dysfunction, T scan is proven advantageous. The purpose of this review article is to offer an insight on T scan treatment modality,
with its mechanism, assemblage, advantages, limitations for better understanding and clinical applications.

Keywords: T scan, Computerized Occlusal analysis, Digital Analysis

1. INTRODUCTION
Correct occlusal diagnosis can be achieved by an objective measurement of occlusion (Pyakurel et al., 2013). Articulating papers are
used currently and were also been used previously for determination of the amount of force and location of contact for occlusal
contacts. But there is always an interrogation on the reliability of this procedure and modality. Articulating paper can also be
deformed due to presence of saliva. Various methods are available currently for occlusion evaluations; with T scan being one of the
modern technologies to evaluate occlusion (Sidana et al., 2013). Sensitivity, reliability, reproducibility are the major advantages when
T scan is used for the digital occlusal analysis (Koos et al., 2010), (Kerstein et al., 2017), (Cerna et al., 2015) as it has the ability to
record the very first contact of tooth, relative force and timing (Pyakurel et al., 2013). The current version of T scan used recently is T
scan III.

2. HISTORICAL BACKGROUND
Manness et al. in 1984 was the first to invent T scan and Tekscan commercially marked it in 1987. Maness, Benjamin, Podoloff,
Bobick and Golden gave the first literature updates regarding T scan in 1987. They stated use of both force and time method. It is
one of the first grid based technology (Sidana et al., 2013). From T Scan I, it is upgraded to T scan III (Cerna et al., 2015). Kerstein RB
& Wright N in 1991 studied disocclusion reduction time with T scan generation 1 sensor. They evaluated the myofacial pain of
patient by using T scan. A complete Treatment plan was established along with the determination of anterior guidance. Post-
treatment, T scan and EMG reports suggested that the muscular activity become normal in reduced time. Bernd Koos et al. in 2010
conducted a study consisting of 45 patients (19 female and 23 male average ages 26). He concluded that T scan possesses accuracy
and repeatability.
Garg AK in 2007 studied the role of T scan in implantology and found that it had a significant role in it. He described role of T
scan III in dental implant occlusion and bruxism, and concluded that T scan occlusal analysis assist practitioners for betterment
treatment, uniformity in data aggregation, placing and repair of dental implant. The various T scan types, the stage wise
development, the year of its modification and recording time is described in Table 1 & 2.

Table 1 The types, years and the modifications in the T-scan (Kerstein, 2020)

Recording of
T scan Year Development contact timing
in Seconds

Intraoral relative force occlusal contact timing,

T scan I 1984 an epoxy-based, sensor having conductive with 0.01
ink columns and rows Generation 1 sensor

T scan for windows Saving patients data base,

2D, 3D evaluation, 256 force levels, customize
dental arches, force versus time graph, the
T scan II 1995 0.01
quadrant force divide tool, percentage force,
center of force and trajectory
Generation 1,2,3 sensor

Saving patients data base, 2D, 3D evaluation,

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256 force levels, customize dental arches, force

2004-
T scan III versus time graph, the quadrant force divide 0.003
2006
tool, percentage force, Center of force and
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trajectory, customized desktop view, zoom

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graph of force versus time, software addition,

synchrony with EMG, individual time of tooth
Generation 4 sensor

Saving patients data base, 2D, 3D evaluation,

256 force levels, customize dental arches, force
T scan III
versus time graph, the quadrant force divide
(Software 2004 0.003
tool, percentage force, center of force and
5,6,7)
trajectory synchrony with EMG
Generation 4 sensor

In addition to above, speedy recording thrice

T scan III with
2008 more efficient 0.003
Turbo mode
Generation 4 sensor

In addition to above, it is more simple

T scan 8 2012 graphical version for easy learning Generation 0.003
4 sensor

In addition to above, Novus handle,

T scan 9 ergonomically 0.003
Generation 4, 5 sensor

In addition to above, Novus handle, state of

art, sensitivity wizard, digital impression
T scan 10 2018 0.003
overlay, implant warning features
Generation 5 sensor

Table 2 The development of Sensor generation (Kerstein, 2020)

Generation Make up Advantages Year Thickness

Mylar laminated ink grid

which is sensitive to 93.98
1 Records occlusal contact 1984
pressure made up of epoxy microns
matrix

More flexible, more resistant to

Mylar casing instead of
cracking, more half-life, new 93.98
2 epoxy matrix, dielectric 1992
pressure ink within row and microns
made from urethane
column

Two layers of Mylar

enclosing a screen-printed
Improved hysteresis, drift, 82.82
3 grid of pressure resistive ink 1997
temperature stability microns
rows and columns in
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between the Mylar

Two layers of Mylar High definition (HD), 33 %

82.82
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4 enclosing a screen-printed active recording area increased, 2002

microns
grid of pressure resistive ink 50% non-recording reduced

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rows and columns in

between the Mylar

Two layers of Mylar Approximate

Novus Handle (HD) recording
encasing a grid of resistive ly 100
5 sensors HD. Lager than 2018
ink rows and columns microns
generation 4
printed between them

Figure 1 Depicts the T-scan 10 window- software view

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Figure 2 Depicts handle of the T-scan

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 PERSPECTIVE ARTICLE

T-SCAN MACHINE - HANDLE , SUPPORTER,

SENSOR AND SOFTWARE

Figure 3 Depicts handle, supporter, sensor and the software window

The Assemblage (Description of the parts of the system)

a. Sensor: It is thin film composed of polyester 0.1 mm in thickness (Pyakurel et al., 2013). Two type of sensor are there: small and
large. The large one has the dimensions as follows: anteroposteriorly 56 mm, mediolateraly 66 mm, 1370 sensel. Smaller one has the
dimensions as follows: anteroposteriorly 51 mm, mediolateraly 58 mm (Sidana et al., 2013).
b. Handle: It acts as supporting system for sensor; it records and scans the data at the rate of 0.003 sec time interval (Kerstein, 2020).
It acquires the data, works on it and is presented on computer screen (Sidana et al., 2013)
c. Sensor Calibration: Calibration is must for reliable registration of data (figure 1, 2 & 3). In order to register reliable data, reduction
of the variance due to positioning and soaking of each sensel is done by asking patient to bite on sensor in order to get accustomed
to the bite adaptation of sensor. After variance is normalized or the sensors are stabilized it depicts patient’s natural bite (Pyakurel et
al., 2013).

The Working
There are two working modes: a) Time mode b) Force mode.
a) Time mode: It displays all the contact on screen with spotlight showing earliest three contacts with their relative time value. It can
be viewed in 3D (Kerstein, 1991).
b) Force mode: Mode of force analysis presents the data on the basis of location of contact and force. Lower limit of force
measurement is 100 gm., at any given point whereas the higher limit is 1.1 kg. Occlusal information in form of data 2D and 3D
graphic can be viewed. It can be displayed in the form of a movie (Sidana et al., 2013).

Recordings technique
T scan has a sensor that is horseshoe shaped that is is pushed in to handle. Sensitivity is customized for every patient by restricting 3
pink bars maximum. Bite of patient on sensor provides the data on screen in pictorial form as 3D, 2D with timing, relative force and
1st, 2nd, 3rd contact in-sequence. Video graphic database format for the same is also created.
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Applications
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Occlusal Corrections after definitive rehabilitation: Overcoming the disadvantages of using Articulating paper which are unable to
record force, balance and timings whereas T scan is capable of recording all these parameters (Kerstein, 2020) and (Sutter, 2014). T

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 PERSPECTIVE ARTICLE

scan is important tool for case finishing. In all functional movements post definitive rehabilitation contact verification followed by
correction can be performed with accuracy using T scan.
Implant dentistry: Occlusal overloading being the proven factor for implants complications. It is very cumbersome task to identify
overloading contact by articulating paper, sometime it not achieved with accuracy. Occlusal overloading can be identified by T scan
(Pyakurel et al., 2013), (Sidana et al., 2013) and (Garg, 2007). Implant occlusion can be successfully managed using T scan (Dario,
1995) and (Luo et al., 2019).
Diagnostic screening: Occlusal trauma is a major cause of occlusal derived pathology. Detrimental forces causing trauma is identified
by T scan (Pyakurel, 2013), (Sidana et al., 2013). As T scan is capable of quantifying relative forces with accurate information about
timing of forces, it is also useful for diagnostic screening.
Orthodontic treatment: Abnormal forces derived due to malocclusion in many patients can be recognized by T-Scan and can help in
normalizing it (Pyakurel et al., 2013), (Sidana et al., and Trpevska et al., 2014). Normalization of post treatment forces results in less
chances of relapse. Thus T scan can prevent complications and is very supportive for successful treatment of orthodontics.
Temporomandibular joint: Extended disocclusion time and abnormal forces resulting from interference ultimately causes TMJ issues
(Ferrato et al., 2017). T-Scan also overcomes the disadvantage of reduction of disocclusion time with accuracy and ability to record
forces and sequence of teeth contact that is not seen with usage of articulating paper.
Fixed and Removable Prosthodontics: Distribution of uniform occlusal force play vital role in Prosthodontics treatment success.
Relative forces can be evaluated by using T scan (Throckmorton et al., 2009). T scan is useful in occlusal load determination in
complete denture (Boening and Walter, 1992).
Posturology: Head posture is affected by occlusal abnormalities; it is improved by occlusal equilibration by T scan (Makofsky et al.,
1991). Various studies demonstrated that body posture is affected by occlusal abnormalities. It can be accurately addressed by T
scan frequently and verified.
Frictional dentinal hypersensitivity: Dentinal hypersensitivity is sharp pain experienced for short duration. Generally it is due to open
dentinal tubules with some exceptions based on other contributing factors in some cases. Abnormal frictional contact force may
cause chronic cold sensitivity; this kind of frictional dental hypersensitivity can be effectively managed by equilibration with T scan
(Yiannios et al., 2017).
Myofunctional pain: Abnormal occlusal functional forces results in Oro-facial related muscular pain. It may be due to extended
disocclusion time. Identification of abnormal forces and disocclusion time reduction can be done by T scan (Kerstein, 1994), which in
turn effectively reduces myofunctional pain.
EMG and JVA (Joint Vibration Analysis): Electromyography helps to evaluate the muscle activity inclusive of Occluso-muscular
disorder. In addition JVA evaluates the internal joint derangement. T scan III can synchronize with EMG and JVA. In combination with
EMG and JVA, T scan is very effective tool for patients for diagnosing the causative factors and thus contributes in formulation of
treatment plan.
Gnathology: Gnathological postural position can affect the performance of professional sport player. Many wear splint during sport
activity. Equilibration of splint with T scan has shown to improvise Gnathological postural position resulting in enhanced sport
performance (Baldini et al., 2012).
Other applications include: Disocclusion reduction time (Kerstein, 2020) Digital work flow, Clenching, Tinnitus and Menniere’s
disease, Di-Berardino et al. in 2016 studied 47 tinnitus patients by using T scan III. Also has proven useful in educating patients,
Splint treatment analysis, Bruxism diagnosis-treatment planning and evaluation, Medico-legal document formulation, Research
Practice builder, Immediate complete anterior guidance development (Kerstein, 1992), CEREC (Kerstein, 2008) (table 3).

Table 3 explains the advantages and limitations of the T-scan system

Advantages Limitations
3 D evaluations of occlusion Transfer of location of occlusal
Advancement in diagnosis contact is not possible
Improvements in quality of treatment Inability to measure absolute force
Specialty practice Time and force two different mode
Valid medico-legal document Sharp cusp can perforate sensor
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Marketing tool 0.06 mm exceeding interference only

Digital approach with no paper work can be registered
Page

No temporary discoloration of teeth Cost of instrument and sensor is very

like in articulating paper high and continuous up-gradation

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Upper and lower arch can be evaluated requires additional investment

in anterior and posterior quadrant Neuromuscular incoordination of
Centre of force of each arch can be patient affect recording
evaluated
Timing of occlusal contact can be
evaluated
Relative occlusal force can be
evaluated
Saliva do not interfere with recording

Safety issues
It is class I device approved by FDA. It is low risk profile device (Jain et al., 2015).

3. DISCUSSION
One of the modern approaches for occlusion inspection is T scan. It was invented in 1981. Thereafter it continuously upgraded from
T scan I, T scan II, T scan III, T scan III (software 5,6,7), T scan with turbo mode recordings, T scan 8, T scan 9 and T scan 10. It can
record timing of occlusion, maximum intercuspation contact, multi bite record, right and left lateral records, protrusive records,
relative force quadrant wise and with individual tooth. It also creates video-graphic database of bite patterns and forces. The
scanned data can be saved, exported and reports can be generated for multiple patients. It can record maximum bite forces, in
centric occlusion, multibite, protrusive, left and right lateral bite. Relative forces on each tooth, quadrant wise force can also be
evaluated. A customized note can be added to each scan in relation to data or patient. Graphs created for each scan has options of
“Show” or “Hide”. Previously recorded images of intraoral scanner can be overlapped on scan. Upper and Lower both arches can
simultaneously be seen with an added option of viewing one arch with graph. Indicator that detects the handle of the device is
present which eases out the procedure. Force outliner is faculty is present for highest force. Video-graphic data form of the bite
patterns are created which can be reversed and forwarded and speed for the same can be adjusted. Width of each tooth can be fed
or option of creating arch by providing central incisor width. Table indicating the duration is also created.
Dental implant is time tested successful treatment option (Ganji et al., 2013), (Shilpa et al., 2018), (Datarkar et al., 2015) but
implant occlusion is one of critical area for treatment planning, which can be appropriately managed by T scan (Pyakurel et al.,
2013). Starting from diagnosis to case completion, it has wide range of utility. It is more than 35 years old proven technology. World
in dental science is shifting towards digitalization (Sidana et al., 2013). T scan plays a vital role in digital workflow. Medico-legal
issues are rising in leaps and bounds; so medico-legal document validity is highest with T scan (Pyakurel et al., 2013).
Temporomandibular dysfunction evaluation and treatment can be done by T scan successfully (Ferrato et al., 2009). It records force
which is decisive factor in occlusion treatment success, it also record time duration of occlusion additionally earliest three contacts of
the teeth which further benefits in treatment success (Pyakurel et al., 2013), (Sidana et al., 2013). Over all T scan can has great utility
in improving accuracy of treatment.

4. CONCLUSION
Occlusion is one of core critical subject in dental practice. Articulating paper is one of the most common treatment medium used for
occlusion, but force measurements, time measurement are the shortcomings faced in routine practice. T scan overcomes the
mentioned shortcomings efficiently with adequate reliability and sensitivity. T scan is a versatile device with its multitudes of use in
various field of dentistry, like Prosthodontics, Implantology, Oral surgery, Periodontics, Pedodontics and Endodontics (Mukherjee et
al., 2017). The only disadvantage being the cost factor but in future with increased usage and awareness about the device can
overcome this. More awareness of T scan needs to be created for better utility of device and there is also a further scope for
research for creating more scientific data on this specialty.

Future research area

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Occlusal consideration in Implantology and survival rate of prosthesis, periodontal disease progression, temporomandibular
disorders and Posture and body balance. Trigeminal neuralgia, cervical dystonia, Phantom bite syndrome, emotional depression,
migraine, tension headache and muscular related comorbid conditions are common nowadays, which have various etiological
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factors in association. These can be effectively diagnosed and managed (Khanam et al., 2019; Kerstein, 2020). Various musculo-

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 PERSPECTIVE ARTICLE

cutaneous disorders may also be linked to various nerve injuries or pathologies (Sthapak et al., 2018) can be detected and treated
effectively using T scan.

Funding
This research received no external funding

Conflict of Interest
The authors declare that they have no conflict of interest

Ethical clearance
Manuscript doesn’t fall under the category of patient based study also is a literature based review and hence no ethical
consideration was required.

Data and materials availability

All data associated with this study are present in the paper.

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