Comparative Analysis of Occlusal Indicators in Fixed vs. Removable Denture Wearers

Thesis Abstract

This study addresses the clinical and functional implications of occlusal indicators in fixed versus removable denture wearers, recognizing inconsistencies in occlusal balance assessments that may influence masticatory efficiency, comfort, and appliance longevity. The aim is to compare occlusal indicator profiles between fixed and removable denture wearers and identify associations with patient-reported outcomes and objective functional measures. Specific objectives include (1) quantifying occlusal contact patterns using digital bite analysis and articulating paper, (2) comparing occlusal balance indices (centering, uniformity, and excursive balance) between denture types, (3) examining correlations between occlusal indicators and masticatory performance, bite force, and patient satisfaction, and (4) assessing the predictive value of occlusal indicators for prosthesis stability and wear-related complications. The research adopts a cross-sectional, multicenter design conducted in three university-affiliated dental clinics over 18 months. A total sample of 320 participants will be recruited, comprising 160 fixed-denture wearers and 160 removable-denture wearers, aged 40–85 years, with at least one year of denture experience. Stratified sampling will ensure proportional representation of complete and partial dentures, as well as upper and lower arches. Data collection will integrate objective instrumental assessments and validated questionnaires. Occlusal indicators will be measured using digital occlusal analysis (T-Scan) to derive bite force distribution, time-related occlusal events, and contact symmetry, complemented by articulating paper for qualitative confirmation of contact locations. Masticatory performance will be evaluated via color-changing chewing gums and resultant particle size distribution. Bite force will be quantified using a portable isometric load cell system. Patient-reported outcomes will be captured with the Oral Health Impact Profile (OHIP-14) and a global satisfaction scale. The study will also record prosthetic parameters (type of denture, surface adaptation, retention, and occlusal vertical dimension) and relevant demographic and health variables. Data will be analyzed using a mixed-methods approach. Descriptive statistics will summarize demographic characteristics and occlusal indicators. Inferential analyses will include multivariate analysis of covariance (MANCOVA) to compare occlusal indicators between denture types while controlling for covariates such as age, gender, denture age, and habitual parafunctional activities. Regression analyses (hierarchical and stepwise) will examine associations between occlusal indicators (e.g., contact symmetry index, anterior/posterior contact distribution) and outcomes like masticatory performance, bite force, and OHIP-14 scores. Structural equation modeling (SEM) will explore the theoretical pathways linking occlusal indicators to functional and quality-of-life outcomes, incorporating theoretical constructs from the Equilibrium Theory of Occlusion and the Functional Jaw Relationship framework. The study will perform sensitivity analyses to assess robustness across denture type subgroups (complete vs. partial) and arch location (maxillary vs. mandibular). Reliability will be ensured through calibration sessions with clinicians, intra- and inter-examiner reliability assessments for occlusal measurements (intraclass correlation coefficients >0.80). Validity will be supported by cross-validation of digital occlusal data with articulating paper findings and by convergent validity with masticatory performance measures. Anticipated findings include statistically significant differences in occlusal balance indices between fixed and removable dentures, with fixed dentures showing more centralized and uniform occlusal contacts, while removable dentures may exhibit broader anterior-posterior contact variability. It is expected that favorable occlusal indicators (greater contact symmetry and balanced force distribution) will correlate positively with higher masticatory performance and lower OHIP-14 scores, and that suboptimal occlusal balance will predict prosthesis-related complaints and reduced satisfaction. The study contributes to knowledge by delineating specific occlusal indicators that predict functional outcomes and patient-perceived well-being in different denture modalities, thereby informing individualized prosthodontic management, the design of occlusal schemes, and clinical guidelines for occlusal adjustment procedures. In terms of recommendations, the findings are expected to support standardized digital occlusal analysis protocols as part of routine denture fabrication and adjustment, advocate for denture-specific occlusal target ranges, and suggest training modules for clinicians to optimize occlusal balance in fixed and removable prostheses. The study will conclude with guidance for future longitudinal research to establish causal relationships and to evaluate the impact of occlusal optimization interventions on long-term prosthesis survival and patient satisfaction.