Journal of Prosthetic Dentistry

Evaluation of two different occlusal patterns on single posterior implant-supported crowns: A 12-month prospective study of occlusal analysis

  • Ru Zhang
    Attending, Department of Prosthodontics, Capital Medical University School of Stomatology, Beijing Stomatological Hospital, Beijing, PR China
    Search for articles by this author
  • Xiaoyu Hao
    Graduate Student, Department of Prosthodontics, Capital Medical University School of Stomatology, Beijing Stomatological Hospital, Beijing, PR China
    Search for articles by this author
  • Kaiyu Zhang
    Corresponding author: Dr Kaiyu Zhang, Department of Oral and Maxillofacial Surgery, Capital Medical University School of Stomatology, Beijing Stomatological Hospital, NO.4, Tian Tan Xi Li, Dong Cheng District, Beijing, 100050, PR China
    Associate Chief, Department of Oral and Maxillofacial Surgery, Capital Medical University School of Stomatology, Beijing Stomatological Hospital, Beijing, PR China
    Search for articles by this author


      Statement of problem

      According to the concept of implant-protected occlusion, light occlusion and late contact could prevent implants from occlusal overload. However, clinical data demonstrating how light occlusion differs from normal occlusion are lacking.


      The purpose of this prospective clinical study was to characterize the occlusal variation of single posterior implant-supported crowns with or without light occlusion.

      Material and methods

      Participants with a single missing posterior maxillary or mandibular molar who were to receive implant-supported zirconia ceramic crowns were enrolled. The participants were divided into a light occlusion group, in which a 12-μm articulating film could be removed from the implant-supported crown and opposing natural teeth under the intercuspal position, and a normal occlusion group, in which the articulating film could not be removed. All participants underwent occlusal examinations using the T-scan III system, answered a satisfaction questionnaire using a visual analog scale (VAS), and received regular follow-ups. The participants were evaluated at 0.5, 3, 6, and 12 months after implant-supported crown delivery. The relative occlusal force of the implant-supported crowns, mesial teeth, control teeth (corresponding natural tooth on the dentition contralateral to each implant), and the occlusal contact time of implant-supported crowns were recorded. Moreover, the asymmetry index of the occlusal force and the VAS score were calculated. Two independent-sample tests were used to compare the 2 groups. The Wilcoxon rank sum and Mann‒Whitney tests were used to compare nonnormally distributed data (α=.001).


      Fifty study participants with a mean ±standard deviation age of 36.97 ±7.34 years (23 men and 27 women aged 20 to 50 years) were followed for 0.5 to 12 months. No obvious complications of overloading were observed in either group. The mean ±standard deviation of the relative occlusal force of implant-supported crowns in the light occlusion group (from 4.91 ±3.52% to 10.34 ±4.35%) was always lower than that in the normal occlusion group (from 10.45 ±4.32% to 18.15 ±4.80%), while the mean ±standard deviation of the occlusal contact time in the light occlusion group (from 0.38 ±0.26 seconds to 0.10 ±0.07 seconds) was significantly later than that in the normal occlusion group (from 0.12 ±0.08 seconds to 0.04 ±0.02 seconds) (P<.001). The value of the asymmetry index of occlusal force remained within the normal range (10%). The VAS score in the normal occlusion group was significantly higher than that in the light occlusion group (P<.001).


      Providing light occlusion to reduce occlusal force and delay the contact time was not stable over time. The relative occlusal force and occlusal contact time showed a similar development trend in both groups, and no obvious signs of occlusal overloading were observed in this study. Long-term follow-up is necessary for implant-supported prostheses because of the continuous increase in occlusal force.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Prosthetic Dentistry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Van velzen F.J.
        • Ofec R.
        • Schulten E.A.
        • Ten B.C.
        10-year survival rate and the incidence of peri-implant disease of 374 titanium dental implants with an SLA surface: a prospective cohort study in 177 fully and partially edentulous patients.
        Clin Oral Implants Res. 2015; 26: 1121-1128
        • Pjetursson B.E.
        • Asgeirson A.G.
        • Zwahlen M.
        • Sailer I.
        Improvements in implant dentistry over the last decade: comparison of survival and complication rates in older and newer publication.
        Int J Oral Maxillofac Implants. 2014; 29: 308-324
        • Pjetursson B.E.
        • Thoma D.
        • Jung R.
        • Zwahlen M.
        • Zembic A.
        A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years.
        Clin Oral Implants Res. 2012; 23: 22-38
        • Curtis D.A.
        • Sharma A.
        • Finzen F.C.
        • Kao R.T.
        Occlusal considerations for implant restorations in the partially edentulous patient.
        J Calif Dent Assor. 2000; 28: 771-779
        • Priest G.F.
        Failure rates of restorations for single-tooth replacement.
        Int J Prosthodont. 1996; 9: 38-45
        • Pjetursson B.E.
        • Tan K.
        • Lang N.P.
        • Brägger U.
        • Egger M.
        • Zwahlen M.
        A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years.
        Clin Oral Implants Res. 2004; 15: 667-676
        • Thoma D.S.
        • Sailer I.
        • Ioannidis A.
        • Zwahlen M.
        • Makarov N.
        • Pjetursson B.E.
        A systematic review of the survival and complication rates of resin-bonded fixed dental prostheses after a mean observation period of at least 5 years.
        Clin Oral Implants Res. 2017; 28: 1421-1432
        • Wittneben J.G.
        • Buser D.
        • Salvi G.E.
        • Bürgin W.
        • Hicklin S.
        • Brägger U.
        Complication and failure rates with implant-supported fixed dental prostheses and single crowns: a 10-year retrospective study.
        Clin Implant Dent Relat Res. 2014; 16: 356-364
        • Koyano K.
        • Esaki D.
        Occlusion on oral implants: current clinical guidelines.
        J Oral Rehabil. 2015; 42: 153-161
        • Zembic A.
        • Kim S.
        • Zwahlen M.
        • Kelly R.
        Systematic review of the survival rate and incidence of biologic, technical, and esthetic complications of single implant abutments supporting fixed prostheses.
        Int J Oral Maxillofac Implants. 2014; 29: 99-116
        • Schulte W.
        Implants and the periodontium.
        Int Dent J. 1995; 45: 16-26
        • Kitamura E.
        • Stegaroiu R.
        • Nomura S.
        • Miyakawa O.
        Biomechanical aspects of marginal bone resorption around osseointegrated implants: considerations based on a three-dimensional finite element analysis.
        Clin Oral Implants Res. 2004; 15: 401-412
        • Kim Y.
        • Oh T.J.
        • Misch C.E.
        • Wang H.L.
        Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale.
        Clin Oral Implant Res. 2005; 16: 26-35
        • Carlsson G.E.
        Dental occlusion: modern concepts and their application in implant prosthodontics.
        Odontology. 2009; 97: 8-17
        • Madani A.S.
        • Nakhaei M.
        • Alami M.
        • Haghi H.R.
        • Moazzami S.M.
        Post-insertion posterior single-implant occlusion changes at different intervals: a t-scan computerized occlusal analysis.
        J Contemp Dent Pract. 2017; 18: 927-932
        • Luo Q.
        • Ding Q.
        • Zhang L.
        • Xie Q.
        Analyzing the occlusion variation of single posterior implant–supported fixed prostheses by using the T-scan system: a prospective 3-year follow-up study.
        J Prosthet Dent. 2019; 123: 79-84
        • Misch C.E.
        • Bidez M.W.
        Implant-protected occlusion: a biomechanical rationale.
        Compendium. 1994; 15: 1330-1334
        • Davies S.J.
        • Gray R.J.
        • Young M.P.
        Good occlusal practice in the provision of implant borne prostheses.
        Br Dent J. 2002; 192: 79-88
        • Jacob S.A.
        Occlusal principles and considerations for the osseointegrated prosthesis.
        IOSR J Dent Med Sci. 2013; 3: 47-54
        • Kerstein R.B.
        Nonsimultaneous tooth contact in combined implant and natural tooth occlusal schemes.
        Pract Proced Aesthet Dent. 2001; 13: 751-755
        • Koos B.
        • Godt A.
        • Schille C.
        • Göz 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: 403-410
        • Cerna M.
        • Ferreira R.
        • Zaror C.
        • Navarro P.
        • Sandoval P.
        Validity and reliability of the T-Scan III for measuring force under laboratory conditions.
        J Oral Rehabil. 2015; 42: 544-551
        • Ayuso-Montero R.
        • Mariano-Hernandez Y.
        • Khoury-Ribas L.
        • Rovira-Lastra B.
        • Willaert E.
        • Martinez-Gomis J.
        Reliability and validity of T-scan and 3D intraoral scanning for measuring the occlusal contact area.
        J Prosthodont. 2020; 29: 19-25
        • Bozhkova T.P.
        The T-SCAN system in evaluating occlusal contacts.
        Folia Med (Plovdiv). 2016; 58: 122-130
        • Frost H.M.
        Bone “mass” and the “mechanostat”: a proposal.
        Anat Rec. 1987; 219: 1-9
        • Ogiso M.
        • Tabata T.
        • Kuo P.T.
        • Borgese D.
        A histologic comparison of the functional loading capacity of an occluded dense apatite implant and the natural dentition.
        J Prosthet Dent. 1994; 71: 581-588
        • Miyata T.
        • Kobayashi Y.
        • Araki H.
        • Ohto T.
        • Shin K.
        The influence of controlled occlusal overload on peri-implant tissue: A histologic study in monkeys.
        Int J Oral Maxillofac Implants. 1998; 13: 677-683
        • Duyck J.
        • Vandamme K.
        The effect of loading on peri-implant bone: a critical review of the literature.
        J Oral Rehabil. 2014; 41: 783-794
        • Chang M.
        • Chronopoulos V.
        • Mattheos N.
        Impact of excessive occlusal load on successfully-osseointegrated dental implants: a literature review.
        J Investig Clin Dent. 2013; 4: 142-150
        • Naert I.
        • Duyck J.
        • Vandamme K.
        Occlusal overload and bone/implant loss.
        Clin Oral Implants Res. 2012; 23: 95-107
        • Kaidonis J.A.
        Tooth wear: the view of the anthropologist.
        Clin Oral Investig. 2008; 12: S21-S26
        • Mundhe K.
        • Jain V.
        • Pruthi G.
        • Shah N.
        Clinical study to evaluate the wear of natural enamel antagonist to zirconia and metal ceramic crowns.
        J Prosthet Dent. 2015; 114: 358-363
        • Lambrechts P.
        • Braem M.
        • Vuylsteke-Wauters M.
        • Vanherle G.
        Quantitative in vivo wear of human enamel.
        J Dent Res. 1989; 68: 1752-1754
        • Oesterle L.J.
        • Cronin R.J.J.
        Adult growth, aging, and the single-tooth implant.
        Int J Oral Maxillofac Implants. 2000; 15: 252-260
        • Heij D.G.
        • Opdebeeck H.
        • van Steenberghe D.
        • Kokich V.G.
        • Belser U.
        • Quirynen M.
        Facial development, continuous tooth eruption, and mesial drift as compromising factors for implant placement.
        Int J Oral Maxillofac Implants. 2007; 98: 88
        • Daftary F.
        • Mahallati R.
        • Bahat O.
        • Sullivan R.M.
        Lifelong craniofacial growth and the implications for osseointegrated implants.
        Int J Oral Maxillofac Implants. 2013; 28: 163-169
        • Yamada K.
        • Hanada K.
        • Sultana M.H.
        • Kohno S.
        • Yamada Y.
        The relationship between frontal facial morphology and occlusal force in orthodontic patients with temporomandibular disorder.
        J Oral Rehabil. 2000; 27: 413-421
        • Roque M.A.
        • Gallucci G.O.
        • Lee S.J.
        Occlusal pressure redistribution with single implant restorations.
        J Prosthodont. 2017; 26: 275-279