original article

J. Stomat. Occ. Med. (2010) 3: 95105

DOI 10.1007/s12548-010-0051-7
Printed in Austria
Springer-Verlag 2010

Angle classication of occlusion and human mastication

pattern: an explorative study using planar calculations
of fragmented chewing sequences
G. Slavicek1 , C. Schimmer2, M. I. Soikher3, M. G. Soikher3, A. Gritzenko3 , I. Makarevitsch3 , E. Shor3, K. Bulatova3

1
Steinbeis Transfer Institute Biotechnology in Interdisciplinary Dentistry der Steinbeis Hochschule Berlin, Stuttgart, Germany
2
ING, Hundsheim, Austria
3
Institute of Biotechnology and Interdisciplinary Dentistry, Moscow, Russia

Received February 28, 2010; Accepted April 4, 2010

The aim of this explorative study was to investigate the inu- Introduction
ence of occlusion, indexed by angle classication, on human
Different approaches to investigate the inuence of occlusal
mastication pattern. Planar calculations of fragmented chew-
type on human mastication parameters have been described
ing sequences were used to quest the clinical observation of
in the literature. Improvement of masticatory performance is
variations in chewing pattern in subjects with different types of
one major goal in daily dental work. Malocclusion is often said
angle malocclusion.
to be a causal factor for decreased chewing function and,
Twenty-four subjects (13 males and 11 females) with a
consequently, quite frequently treatment indications are de-
mean age of 35.7 years (39.3 yr in male and 32.7 yr in female
duced from this causality chain concept. Masticatory efcien-
participants, respectively) were enrolled in this study. Chew-
cy as well as occlusal classication was investigated in a
ing sequences, performed on the right and left side, were
prospective observational cohort study [7]. The so-called
recorded by condylography, using a standard food model
normal occlusion subjects showed a better masticatory ef-
(yellow, medium hardness). Occlusion was evaluated and the
ciency than subjects with orthodontically treated as well as
subjects were classied into 4 groups: dental Class I (n 7, 2
untreated Class II malocclusions. Subjective and objective
males and 5 females), dental Class II/1 (n 6, 3 males and 3
parameters for judging the efciency of mastication were
females), dental Class II/2 (n 5, 2 males and 3 females), and
analyzed. The orthodontically treated group as good as the
dental Class III (n 6, 4 males and 2 females). In case of
normal group perceived that their chewing capacity improved
different dental classication on the right and left side, the
after the orthodontic treatment. Interestingly, objective mea-
subjects were not included in the study. The condylographic
surements of masticatory efciency demonstrated an increase
data were exported for sides, working and the nonworking
signicantly in all three groups within the study period [7]. The
side. Sagittal and transversal calculations of planar areas
authors concluded that normal occlusion subjects provide a
bordered by condylographic tracings were used to compute
better masticatory efciency than subjects with orthodonti-
unilateral and bilateral ratios.
cally treated as well as untreated Class II malocclusion.
Within this study population and within the limitations of
Malocclusion and functional parameters are inuencing
this study, no signicant correlation could be detected be-
bite force and the symmetry in muscle activity during chewing
tween chewing patterns expressed by unilateral and bilateral
and swallowing [1]. Posterior cross bite is correlated with an
ratios of fragmented chewing sequence and Angle classica-
increased anterior Temporalis muscle and a decreased Mas-
tion of occlusion. Furthermore, it may be assumed that other
seter activity on the cross bite side in children. No information
occlusal parameters are affecting typical chewing pattern in
on objective or subjective judgment of chewing efciency is
malocclusions.
provided within this paper. Nevertheless, the impact of mal-
Keywords: Human mastication, standard food model, occlusion on functional parameters of the stomatognathic in
segmentation of chewing sequence, planar calculation, children with mixed dentition is obvious [1].
condylography, biomechanics, chewing, angle classication But not only angle classication seems to be able to serve
as biomarker for masticatory performance. Other occlusal
factors seem to be important and inuencing as well. The
correlation of the presence of occlusal interferences and
altered chewing pattern has been investigated. Occlusal param-
eters inuence the activity of the chewing muscles. The
Correspondence: Gregor Slavicek, Transfer Institute Biotechnology presence of interferences during lateral excursions produces
in Interdisciplinary Dentistry, Steinbeis Hochschule Berlin,
Filderhauptstrae 142, 70599 Stuttgart, Germany. an increase in the activity of nonworking Temporalis anterior
E-mail: gregor.slavicek@shb-sba.de muscle and Masseter muscle [2]. Bite force and chewing

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efciency, dened as the ability to grind a certain portion of a Parameters such as laterotrusive and mediotrusive inter-
test food during a given time, seem to be inuenced by age, ferences are possible factors to alter mandibular movements
and therefore consequently by age-dependent deterioration during function. A unilateral interference causes changes in
of the dentition [5, 6]. Clear associations were found between motor facilitation on the working and nonworking side during
chewing efciency and dental state. The number of occluding
pairs of teeth was closely correlated with chewing efciency
and individuals with less than 20 teeth had a higher index
score than those with more than 20 teeth. The values noted for Tab. 1: Explorative analysis of the demographic
a number of chewing strokes, swallowing and chewing time data, overview (for details see text)
were smaller for those with a good chewing efciency, but the
variation was not linear and not always signicant [6].

Sex
f
III m

II/2
Dental class

II/1

0 1 2 3 4 5
Count

Fig. 1: Distribution of the study population, clustered by dental class:

dental Class I (n 7 or 29.2%, 2 males (m), 5 females (f)), dental Class II/1
(n 6 or 25%, 3 m, 3 f), dental Class II/2 (n 5 or 20.8%, 3 m, 2 f), dental
Class III (n 6 or 25%, 4 m, 2 f)

*
50

40
Age (years)

30

20

I II/1 II/2 III

Dental class

Fig. 2: Explorative analysis of the demographic data, to survey the

possible confounder age within the study population: Dental Classica-
tion versus age: a signicant difference (
) for the mean age could be
found for dental class II/1 and dental class III (p > 0.05) only

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Tab. 2: Denitions of parameters and abbreviations used in the study

(for details see text)

y y
Transversal (bilateral) ratio

Axy x Axy
Vertical (Unilateral) ratio
Vertical (Unilateral) ratio

y y

Axz Sagittal (bilateral) ratio

Axz

z z

Fig. 3: The theoretical approach to fragmented chewing sequence analysis, using the area of single chewing cycles, in the sagittal and transversal
plane. Bilateral and unilateral ratios are used. Areas and ratios are calculated for right and left chewing sequences, working and non working chewing
pattern can be analyzed in details

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Fig. 4: Fragmented chewing sequence. The condylographic data are used to identify each single chewing cycle. The vertical lines are indicating the
start and endpoint of one chewing cycle. A semi-automatic identication process is used for the correct localization of the start and endpoints. For each
chewing cycle, the start and end time and the areas in sagittal, transversal and frontal plane are displayed. These data are exported for further use within
a statistical program

Sex Sex
f f
m m
III III

II/2 II/2
Dental class

II/1 II/1

I I

1.000 2.000 4.000 6.000 8.000 10.000 0.000 1.000 2.000 3.000 4.000
rWAxz rnWAxz

Fig. 5: Comparison of sagittal planar areas (mean, standard deviation), bordered by condylographic tracings for the segmented chewing sequences,
categorized by angle classication and clustered by sex. The results for the right chewing sequences for the working (left graph) and non working (right
graph) is shown. The vertical lines indicate the mean value for the total sample (n 24)

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clenching [4]. The roles of anterior and canine guidance are
controversially discussed in the literature. Occlusal concepts,
such as canine protected occlusion, are not supported by
evidence-based medicine and are not predominant in nature.
Occlusion and consistently malocclusions have to be judged
only in relation to masticatory performance, craniofacial
morphology and stress management function of the stoma-
tognathic system [7].
Quality of life (QoL) and chewing performance are inter-
related [5]. However, the evidence on this particular subject is
not as clear as someone may expect. Much controversy exists
about the impact of malocclusion on QoL and the effect of
different treatment concepts on QoL. There is a need for a
more comprehensive and rigorous assessment of the impact
of malocclusion and its treatment on QoL, employing stan-
dardized, valid and reliable data collection instruments [12].
In this study, the fragmented chewing model [9, 10] was
used to describe the inuence of different types of occlusion,
based on the angle classication, on human mastication.
Material and method
Twenty-four subjects (13 males (m) and 11 females (f)) with a
mean age of 35.7 years (39.3 yr in male subjects and 32.7 yr
in female subjects, respectively) were enrolled in this study.
Chewing sequences, performed on the right and left sides
independently, were recorded with condylography, using a
standard food model (yellow, medium hardness). A paraoc-

Tab. 3: Descriptive data analysis: range, minimum, maximum, sum, mean, standard deviation
and variance, for the calculated areas, clustered by Angle classication
Descriptive Statistics for calculated areas

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clusal xation of the lower face bow was used in order to
inuence mandibular movement during mastication as little
as possible. Occlusion was evaluated and the subjects were
classied into 4 groups, based on the Angle classication:
dental Class I (n 7; 2 males and 5 females), dental Class II/1
(n 6; 3 males and 3 females), dental Class II/2 (n 5; 2 males
and 3 females), and dental Class III (n 6; 4 males and 2
females). In case of different dental classication on the right
and left sides, the subject was not included in the study. The
demographic data of the study population are shown in Fig. 1.
Age is known as inuencing factor in human mastication
performance [10, 11]. Therefore, an ad hoc statistical signi-
cance test was performed to explore the possible inuence of
age on masticatory performance pattern (Fig. 2). Mean age
and standard deviation of age showed no signicant difference
between the groups (angle classication), apart from dental
Class II/1 and dental Class III. An overview of the demographic
data of the study population is presented in Table 1.
The data of the standardized chewing sequences were
recorded with the Cadiax Diagnostic System from Gamma
Med.wiss.Fortbildung GmbH (Josef Brenner Strae 10,
3400 Klosterneuburg, Austria). Planer calculations for all chew-
ing cycles were analyzed and different areas of the fragmented
chewing sequence were calculated. Furthermore, several ratios
(sagittal, transversal, bilateral, and unilateral) were calculated.
Denitions and abbreviations of the calculated parameters are
presented in Table 2 and Fig. 3. An example of a fragmented
chewing sequence is presented in Fig. 4.

Tab. 4: Descriptive data analysis: range, minimum, maximum, sum, mean, standard deviation
and variance, for the calculated ratios, clustered by Angle classication
Descriptive Statistics for calculated ratios

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Sex Sex
f f
III m III m

II/2
Dental class

II/2

II/1 II/1

I
I

0.000 1.000 2.000 3.000 4.000 0.000 1.000 2.000 3.000 4.000 5.000 6.000
IWAxz InWAxz

Fig. 6: Comparison of sagittal planar areas (mean, standard deviation), bordered by condylographic tracings for the segmented chewing sequences,
categorized by angle classication and clustered by sex. The results for the left chewing sequences for the working (left graph) and non working (right
graph) is shown. The vertical lines indicate the mean value for the total sample (n 24)

Sex Sex
f f
m m
III III

II/2 II/2
Dental class

II/1 II/1

I I

0.000 1.000 2.000 3.000 4.000 5.000 6.000 0.000 2.000 4.000 6.000 8.000 10.000 12.000
rWAxy rnWAxy

Fig. 7: Comparison of transversal planar areas (mean, standard deviation), bordered by condylographic tracings for the segmented chewing
sequences, categorized by angle classication and clustered by sex. The results for the right chewing sequences for the working (left graph) and non
working (right graph) is shown. The vertical lines indicate the mean value for the total sample (n 24)

Sex Sex
f f
m m
III III

II/2 II/2
Dental class

II/1 II/1

I I

0.000 2.000 4.000 6.000 8.000 10.000 12.000 0.000 1.000 2.000 3.000 4.000 5.000 6.000
rWAxy rnWAxy

Fig. 8: Comparison of transversal planar areas (mean, standard deviation), bordered by condylographic tracings for the segmented chewing
sequences, categorized by angle classication and clustered by sex. The results for the left chewing sequences for the working (left graph) and non
working (right graph) is shown. The vertical lines indicate the mean value for the total sample (n 24)

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Sex Sex
f f
m m
III III

II/2 II/2
Dental class

II/1 II/1

I I

0.000 1.000 2.000 3.000 0.000 1.000 2.000 3.000 4.000

rSR ISR

Fig. 9: Comparison of sagittal ratio for the right and left side. The sagittal ratio (SR) is dened as WAxz/nWAxz (rWAxz/rnWAxz for right chewing
sequences and lWAxz/lnWAxz for left chewing sequences, respectively). The results are presented by angle classication and clustered by sex. The
vertical lines indicate the mean value for the total sample (n 24)

Sex Sex
f f
m III m
III

II/2 II/2
Dental class

II/1 II/1

I I

0.000 1.000 2.000 3.000 4.000 0.000 1.000 2.000 3.000 4.000 5.000 6.000
rSR IHR

Fig. 10: Comparison of transversal ratio for the right and left side. The transversal ratio (HR) is dened as WAxy/nWAxy (rWAxy/rnWAxy for right
chewing sequences and lWAxy/lnWAxy for left chewing sequences, respectively). The results are presented by angle classication and clustered by
sex. The vertical lines indicate the mean value for the total sample (n 24)

Sex Sex
f f
m m
III III

II/2 II/2
Dental class

II/1 II/1

I
I

0.000 1.000 2.000 3.000 4.000 5.000 0.000 1.000 2.000 3.000
rWR IWR

Fig. 11: Comparison of unilateral, working side ratio for the right and left side. The working side ratio (WR) is dened as WAxz/nWAxy (rWAxz/rnWAxy
for right chewing sequences and lWAxz/lnWAxy for left chewing sequences, respectively). The results are presented by angle classication and
clustered by sex. The vertical lines indicate the mean value for the total sample (n 24)

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Sex
Sex
f
f m
III m III

II/2 II/2
Dental class

II/1 II/1

I I

0.000 1.000 2.000 3.000 4.000 5.000 0.000 1.000 2.000 3.000 4.000 5.000
rWR InWR

Fig. 12: Comparison of unilateral, non working side ratio for the right and left side. The non working side ratio (nWR) is dened as nWAxz/nWAxy
(rnWAxz/rnWAxy for right chewing sequences and lnWAxz/lnWAxy for left chewing sequences, respectively). The results are presented by angle
classication and clustered by sex. The vertical lines indicate the mean value for the total sample (n 24)

Tab. 5: Summary of the hypothesis testing procedure

with a non parametric test. There are no signicant
differences among the sagittal and transversal, working
and non working side areas between the groups
(angle class I, II/1, II/2, III) (for details see text)
Hypothesis test summary

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The statistical analysis was performed with PASW Sta-
tistics 18/2010 (SPSS GmbH Software Theresienhhe 13,
80399 Mnchen, Germany). A nonparametric statistical test
(independent-samples KruskalWallis Test) has been chosen
because of the small sample size and the observed absence of
normal distribution of the data within the groups (tested by
Levenes Test for Equality of Variances). In addition, a post hoc
analysis of the data was performed, using hierarchical cluster
analysis; this procedure attempts to identify relatively homo-
geneous groups of cases (or variables) based on selected
characteristics, using an algorithm that starts with each case
(or variable) in a separate cluster and combines clusters until
only one is left.
Results
The descriptive statistics for the calculated areas and ratios,
clustered by Angle classication, are presented in Tables 3
(areas) and 4 (ratios). The results for rWAxz and rnWAxz
calculation are shown in Fig. 5. The mean values of each group
are similar, but data for group II/1 show a higher variance
Tab. 6: Summary of the hypothesis testing
procedure with a non parametric test. There
are no signicant differences among the sagittal
and transversal ratios between the groups
(angle class I, II/1, II/2, III) (for details see text)
Hypothesis test summary
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compared to all other groups. On the contrary, the results for
lWAxz and lnWAxz feature an increased variance for most of the
groups (Fig. 6). The results for rWAxy, rnWAxy, lWAxy and
lnWAxy disclose a different image: while so-called malocclusion
is associated with a high variance for these parameters, the angle
Class I shows very narrow values. The effect of different types of
malocclusion is well represented by transversal parameters
(Figs. 7 and 8). The results for the mean values for the calculated
ratios are presented in Figs. 912.
No statistical signicant differences within the study
population (subgroup allocation by angle classication of
malocclusion) were found for the calculated mean areas and
ratios. The only exception was the nonworking side ratio for
left side chewing cycles (p 0.036). These results suggest that
the angle classication of malocclusion is not a precise pa-
rameter to judge functional involvement. The results are
shown in Tables 5 (signicant tests for mean areas) and 6
(signicant tests for ratios).
The post hoc performed hierarchical cluster analyses
(Fig. 13 for areas, Fig. 14 for ratios) demonstrate that relatively
homogeneous groups of cases are not found within particular

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Dendrogram using average linkage (between groups)
rescaled distance cluster combine
Fig. 13: Post hoc analysis of the data, using sagittal and transversal,
working and non-working areas to detect similarities between subjects.
It can be observed, that the subjects are not sectioned by Angle classes.
Other, unknown parameters and confounders seem to have a substantial
potential to inuence mastication pattern
Dendrogram using average linkage (between groups)
rescaled distance cluster combine
Fig. 14: Post hoc analysis of the data, using sagittal and transversal,
working and non-working ratios to detect similarities between subjects.
It can be observed, that the subjects are not sectioned by Angle classes.
Other, unknown parameters and confounders seem to have a substantial
potential to inuence mastication pattern
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original article
subgroups (dental Classes I, II/1, II/2, and III), but are distrib-
uted in different lines.
Conclusion
No signicant differences between Angle classication of
malocclusion and chewing pattern, measured by spatial cal-
culation of fragmented chewing sequences, could be found.
The study had some limitations: small sample size, especially
in the subgroups; only one possible confounder (age) was
checked; unequal distribution of male and female subjects
within the study; missing information about occlusal param-
eters such as missing teeth and front tooth relation. On the
other hand, the condylographic recordings of the chewing
sequences disclose high individual performance of indivi-
duals during chewing.
It may be concluded that the variance and individuality of
condylographic tracings of chewing sequences are inuenced
and determined not only by the dental classication of mal-
occlusion, but, at least in part, by other occlusal and possible
nonocclusal parameters. Such strong confounders should be
identied and used for treatment indications. The hierarchical
cluster analyses will help in future to identify such confoun-
ders with the aim to control them in new studies on human
mastication.
Furthermore, descriptive concepts of malocclusion are
limited in usefulness. A functional approach to malocclusion
is required, and should serve as tool for clinical decision-
making.
Conict of interest
The authors declare no conict of interest.
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