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Adv Prosthodont. 2024 Oct;16(5):278-289. English.<br>Published online Oct 28, 2024.<br><a class="article-meta-doi-link" href="https://doi.org/10.4047/jap.2024.16.5.278">https://doi.org/10.4047/jap.2024.16.5.278</a> </div> <div>© 2024 The Korean Academy of Prosthodontics </div> </div> <div id="article-front-meta-right" class="flex-shrink-1"><div><div id="crossref-crossmark" style="display:none;"><a data-target="crossmark"></a></div></div></div> </div> <div class="clearfix"></div> </div></div> <div id="article-front-bibliographic"> <div class="article-type">Original Article</div> <div class="article-title"><h1 class="content-title">Relationships between maxillofacial morphology and oral function on the habitual and non-habitual chewing sides </h1></div> <div class="article-contrib"> <span class="capture-id"><span id="ORCID_0009-0001-6814-0443" class="ORCID"><a href="ORCID/0009-0001-6814-0443">Tatsuhiro Suzuki</a></span><a href="https://orcid.org/0009-0001-6814-0443" target="_blank"><img style="vertical-align:middle; margin-left:0.2em; margin-right:0.05em; padding-bottom: 0.5em;" src="/image/icon-orcid.jpg"></a>,<span class="article-icon-corresp"></span><sup>1</sup></span> <span class="capture-id"><span id="ORCID_0009-0004-4928-9535" class="ORCID"><a href="ORCID/0009-0004-4928-9535">Naoki Asanuma</a></span><a href="https://orcid.org/0009-0004-4928-9535" target="_blank"><img style="vertical-align:middle; margin-left:0.2em; margin-right:0.05em; padding-bottom: 0.5em;" src="/image/icon-orcid.jpg"></a>,<sup>2</sup></span> <span class="capture-id"><span id="ORCID_0000-0002-4914-211X" class="ORCID"><a href="ORCID/0000-0002-4914-211X">Yuko Watarai</a></span><a href="https://orcid.org/0000-0002-4914-211X" target="_blank"><img style="vertical-align:middle; margin-left:0.2em; margin-right:0.05em; padding-bottom: 0.5em;" src="/image/icon-orcid.jpg"></a>,<sup>2</sup></span> and <span class="capture-id"><span id="ORCID_0000-0002-0699-0637" class="ORCID"><a href="ORCID/0000-0002-0699-0637">Fumi Mizuhashi</a></span><a href="https://orcid.org/0000-0002-0699-0637" target="_blank"><img style="vertical-align:middle; margin-left:0.2em; margin-right:0.05em; padding-bottom: 0.5em;" src="/image/icon-orcid.jpg"></a><sup>1</sup><sup>,</sup><sup>2</sup></span> </div> <div class="article-front-meta-sub-tab mt-3 mb-0"><div class="d-inline-flex flex-wrap"> <div class=""><a class="btn btn-outline-article" data-bs-toggle="collapse" href="#article-front-meta-id-aurthorinfo" role="button" aria-expanded="false" aria-controls="article-front-meta-id-aurthorinfo">Author information</a></div> <div class=""><a class="btn btn-outline-article" data-bs-toggle="collapse" href="#article-front-meta-id-articlehistory" role="button" aria-expanded="false" aria-controls="article-front-meta-id-articlehistory">Author notes</a></div> <div class=""><a class="btn btn-outline-article" data-bs-toggle="collapse" href="#article-front-meta-id-license" role="button" aria-expanded="false" aria-controls="article-front-meta-id-license">Copyright and License</a></div> </div></div> <div class="article-front-meta-sub"> <div class="collapse multi-collapse" id="article-front-meta-id-aurthorinfo"><div class="card card-body"><ul class="list-group list-group-flush"> <li class="list-group-item"><div class="article-afilliations"><ul> <li> <sup>1</sup>Functional Occlusal Treatment, The Nippon Dental University Graduate School of Life Dentistry at Niigata, Niigata, Japan.<br> </li> <li> <sup>2</sup>Department of Removable Prosthodontics, The Nippon Dental University School of Life Dentistry at Niigata, Niigata, Japan.<br> </li> </ul></div></li> <li class="list-group-item"><div class="article-author-notes"><span class="capture-id"><div> <span class="gen"></span><span class="article-icon-corresp"></span>Corresponding author: Tatsuhiro Suzuki. Functional Occlusal Treatment, The Nippon Dental University Graduate School of Life Dentistry at Niigata, 1-8 Hamaura-cho, Chuo-ku, Niigata 951-8580, Japan. Tel +81 25 267 1500, <span class="author-email">Email: <A href="mailto:tatsu@ngt.ndu.ac.jp">tatsu@ngt.ndu.ac.jp</A></span> </div></span></div></li> </ul></div></div> <div class="collapse multi-collapse" id="article-front-meta-id-articlehistory"><div class="card card-body"><div class="article-received-accepted-date">Received July 23, 2024; Revised September 27, 2024; Accepted October 22, 2024.</div></div></div> <div class="collapse multi-collapse" id="article-front-meta-id-license"><div class="card card-body"><div class="article-license"> <p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<a href="http://creativecommons.org/licenses/by-nc/4.0" target="_blank">http://creativecommons.org/licenses/by-<wbr/>nc/4.0</a>) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> </div></div></div> <div id="article-citedby"></div> <div id="article-relate-articles"></div> </div> <div><div class="article-abstract"> <div class="article-section-header"> <div class="__SECTION__" id="__ID_SECTION_0" data-section-name="Abstract"><div class="dropdown"> <a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_0" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_0"></div> </div></div> <h2>Abstract</h2> </div> <div> <h3>PURPOSE</h3> <p>This study aimed to investigate the relationships between reference planes and oral functions on the habitual and non-habitual chewing sides.</p> </div> <div> <h3>MATERIALS AND METHODS</h3> <p>Thirty-four subjects with no abnormalities in the maxillofacial region and oral functions were enrolled in this study. Relationships between angles between the reference plane (Frankfort horizontal plane, Camper’s plane, and occlusal plane) and masticatory performance, occlusal force, and occlusal contact area by chewing side were examined. Regarding the measurement of reference planes, a creatively modified three-plane measuring device was used to measure angles between the reference planes. Images were taken from the right and left sides and angles between reference planes were measured. Masticatory performance was examined by measuring the amount of glucose extracted from a gummy jelly on the habitual and non-habitual chewing sides separately. Occlusal force and occlusal contact area were measured by occluding against pressure-sensitive film, and values on the habitual and non-habitual chewing sides were calculated and analyzed.</p> </div> <div> <h3>RESULTS</h3> <p>The angle between Camper’s plane and the occlusal plane correlated with masticatory performance on both the habitual chewing side (r = 0.47, <i>P</i> < .01) and the non-habitual chewing side (r = 0.36, <i>P</i> < .05). A correlation was observed between masticatory performance and occlusal force on the habitual chewing side (r = 0.46, <i>P</i> < .01).</p> </div> <div> <h3>CONCLUSION</h3> <p>Masticatory performance became higher as occlusal plane inclination increased. This result represents essential knowledge for prosthetic treatment.</p> </div> </div></div> </div> </div> <div id="article-level-0-end-metadata" class="fm"> <div class="my-3"><div> <div class="article-keyword-group-title">Keywords</div> <div> <span class="capture-id">Reference plane</span>; <span class="capture-id">Masticatory performance</span>; <span class="capture-id">Occlusal force</span>; <span class="capture-id">Occlusal contact area</span>; <span class="capture-id">Chewing side</span> </div> </div></div> </div> <div id="article-level-0-body" class="body"> <div> <div><div class="article-section-header"> <div class="__SECTION__" id="__ID_SECTION_1" data-section-name="INTRODUCTION"><div class="dropdown"> <a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_1" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_1"></div> </div></div> <h2>INTRODUCTION</h2> </div></div> <p>The human body and face develop and grow in broad symmetry.<span class="xref"><span id="XREF_B1" class="ref-destination-back"></span><a href="#B1" data-id="XREF_B1" data-toggle="ref-popover" data-trigger="manual" data-placement="right">1</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B2" class="ref-destination-back"></span><a href="#B2" data-id="XREF_B2" data-toggle="ref-popover" data-trigger="manual" data-placement="right">2</a></span> However, no one has a completely symmetrical face.<span class="xref"><span id="XREF_B2" class="ref-destination-back"></span><a href="#B2" data-id="XREF_B2" data-toggle="ref-popover" data-trigger="manual" data-placement="right">2</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B3" class="ref-destination-back"></span><a href="#B3" data-id="XREF_B3" data-toggle="ref-popover" data-trigger="manual" data-placement="right">3</a></span> The lines connecting the right and left pupils, ala nasi, and angle of mouth are thus not parallel, respectively. A significantly more active side of the human body is thus present even when each side of the human body works in a coordinated manner, and the human body and face would thus be asymmetrical.<span class="xref"><span id="XREF_B4" class="ref-destination-back"></span><a href="#B4" data-id="XREF_B4" data-toggle="ref-popover" data-trigger="manual" data-placement="right">4</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B5" class="ref-destination-back"></span><a href="#B5" data-id="XREF_B5" data-toggle="ref-popover" data-trigger="manual" data-placement="right">5</a></span></p> <p>Humans unconsciously eat foods on the side for which chewing is easier. The side on which chewing is easier is defined as the habitual chewing side.<span class="xref"><span id="XREF_B6" class="ref-destination-back"></span><a href="#B6" data-id="XREF_B6" data-toggle="ref-popover" data-trigger="manual" data-placement="right">6</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B7" class="ref-destination-back"></span><a href="#B7" data-id="XREF_B7" data-toggle="ref-popover" data-trigger="manual" data-placement="right">7</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B8" class="ref-destination-back"></span><a href="#B8" data-id="XREF_B8" data-toggle="ref-popover" data-trigger="manual" data-placement="right">8</a></span> Masticatory performance and occlusal force are reportedly significantly higher on the habitual chewing side than on the non-habitual chewing side.<span class="xref"><span id="XREF_B6" class="ref-destination-back"></span><a href="#B6" data-id="XREF_B6" data-toggle="ref-popover" data-trigger="manual" data-placement="right">6</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B8" class="ref-destination-back"></span><a href="#B8" data-id="XREF_B8" data-toggle="ref-popover" data-trigger="manual" data-placement="right">8</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B9" class="ref-destination-back"></span><a href="#B9" data-id="XREF_B9" data-toggle="ref-popover" data-trigger="manual" data-placement="right">9</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B10" class="ref-destination-back"></span><a href="#B10" data-id="XREF_B10" data-toggle="ref-popover" data-trigger="manual" data-placement="right">10</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B11" class="ref-destination-back"></span><a href="#B11" data-id="XREF_B11" data-toggle="ref-popover" data-trigger="manual" data-placement="right">11</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B12" class="ref-destination-back"></span><a href="#B12" data-id="XREF_B12" data-toggle="ref-popover" data-trigger="manual" data-placement="right">12</a></span> However, the habitual chewing side shows greater susceptibility to caries and attrition, and more easily suffers from aggravation of the symptoms of temporomandibular joint disorders.<span class="xref"><span id="XREF_B13" class="ref-destination-back"></span><a href="#B13" data-id="XREF_B13" data-toggle="ref-popover" data-trigger="manual" data-placement="right">13</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B14" class="ref-destination-back"></span><a href="#B14" data-id="XREF_B14" data-toggle="ref-popover" data-trigger="manual" data-placement="right">14</a></span></p> <p>Research into oral functions and facial profile has been performed using cephalometric radiography.<span class="xref"><span id="XREF_B15" class="ref-destination-back"></span><a href="#B15" data-id="XREF_B15" data-toggle="ref-popover" data-trigger="manual" data-placement="right">15</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B16" class="ref-destination-back"></span><a href="#B16" data-id="XREF_B16" data-toggle="ref-popover" data-trigger="manual" data-placement="right">16</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B17" class="ref-destination-back"></span><a href="#B17" data-id="XREF_B17" data-toggle="ref-popover" data-trigger="manual" data-placement="right">17</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B18" class="ref-destination-back"></span><a href="#B18" data-id="XREF_B18" data-toggle="ref-popover" data-trigger="manual" data-placement="right">18</a></span> Studies on oral function and maxillofacial morphology have reported that masticatory performance, occlusal force, and occlusal contact area are related.<span class="xref"><span id="XREF_B16" class="ref-destination-back"></span><a href="#B16" data-id="XREF_B16" data-toggle="ref-popover" data-trigger="manual" data-placement="right">16</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B19" class="ref-destination-back"></span><a href="#B19" data-id="XREF_B19" data-toggle="ref-popover" data-trigger="manual" data-placement="right">19</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B20" class="ref-destination-back"></span><a href="#B20" data-id="XREF_B20" data-toggle="ref-popover" data-trigger="manual" data-placement="right">20</a></span> However, relationships between reference planes such as the Frankfort horizontal plane (FP), the Camper’s plane (CP), and the maxillary occlusal plane (OP) have not been clarified on the chewing side. Although efficient mastication might be presumed to occur on the habitual chewing side, no research has yet confirmed relationships between the occlusal plane and oral functions on the habitual chewing side. Determination of the occlusal plane is necessary for the production of accurate prostheses.</p> <p>The null hypothesis for this study was that no relationships exist between maxillofacial morphology and oral functions. The aim of this study was to investigate the relationships between reference planes and oral functions on the habitual and non-habitual chewing sides.</p> </div> <div> <div><div class="article-section-header"> <div class="__SECTION__" id="__ID_SECTION_2" data-section-name="MATERIALS AND METHODS"><div class="dropdown"> <a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_2" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_2"></div> </div></div> <h2>MATERIALS AND METHODS</h2> </div></div> <p>Thirty four subjects (17 men, 17 women; mean age 23.2 ± 2.6 years) participated in this study. Subjects were students and staff of The Nippon Dental University School of Life Dentistry at Niigata. Inclusion criteria for subjects were: 1) no abnormalities in the maxillofacial region; and 2) no missing teeth other than the third molars. Exclusion criteria were: 1) any previous or current orthodontic treatment; or 2) any history of dental treatment for occlusal surfaces. This study was approved by the Ethics Committee of The Nippon Dental University School of Life Dentistry at Niigata (approval no. ECNG-R-490) and was conducted after obtaining written consent from all subjects.</p> <p>The angles formed by each reference plane (FP, CP, and OP) were measured using a three-plane measuring device (<span class="fig-table-link"><a href="#F1">Fig. 1</a></span>). The occlusal plane guide (Nippon Dental University style occlusal plane guide; Takamiya Kogyo, Saitama, Japan) (<span class="fig-table-link"><a href="#F1">Fig. 1a, d</a></span>) was attached to this device. The FP, CP, and OP can be referenced simultaneously using this device. The FP was defined as the plane connecting the infraorbital point and the superior margin of the opening of the external acoustic meatus (<span class="fig-table-link"><a href="#F1">Fig. 1c</a></span>).<span class="xref"><span id="XREF_B21" class="ref-destination-back"></span><a href="#B21" data-id="XREF_B21" data-toggle="ref-popover" data-trigger="manual" data-placement="right">21</a></span> The CP was defined in this study as the plane connecting the inferior margin of the ala nasi and the inferior margin of the tragus (<span class="fig-table-link"><a href="#F1">Fig. 1d</a></span>). The OP was defined in this study as the plane connecting the maxillary central incisor and the right and left maxillary molars (<span class="fig-table-link"><a href="#F1">Fig. 1e, f</a></span>). Subjects were instructed to keep the plate (<span class="fig-table-link"><a href="#F1">Fig. 1e</a></span>) by fingers with touching the maxillary central incisor and the right and left molars (<span class="fig-table-link"><a href="#F2">Fig. 2B</a></span>). To measure angles between the three planes (FP, CP, and OP; <span class="fig-table-link"><a href="#F2">Fig. 2A</a></span>), images were taken from the right and left with the distance between the digital camera (EX-ZRA1100; Casio, Tokyo, Japan) and ear rod fixed at 20 cm (<span class="fig-table-link"><a href="#F2">Fig. 2B</a></span>). After images were obtained, the angles formed by each reference plane were measured using image processing software (Image J ver. 1.53t; National Institutes of Health, Bethesda, MD, USA). Images were taken and the measurements were made by one author (T.S.). Measurement parameters were the angle between the FP and CP (FP-CP), the angle between the CP and OP (CP-OP), and the angle between the FP and OP (FP-OP). CP-OP was considered plus value under the conditions in which the distance between the upper and lower anterior teeth was small and that between the posterior teeth was large (posteriorly inclined; <span class="fig-table-link"><a href="#F2">Fig. 2Ca</a></span>). CP-OP was considered minus value when the distance between the upper and lower anterior teeth was large and that between the posterior teeth was small (anteriorly inclined; <span class="fig-table-link"><a href="#F2">Fig. 2Cb</a></span>).<div class="image-at-section"><div class="article-figure-table" id="F1"><div class="article-figure-table-card" id="FIGURE-F1" data-type="F" data-afn="170_JAP_16_5_278" data-fn="jap-16-278-g001_0170JAP"><div class="card border-0 my-3"><div class="row no-gutters"> <div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> <a href="#" class="article-figure-table-btn" data-type="F"><img class="align-top" src="/ArticleImage/0170JAP/jap-16-278-g001-m.jpg"></a> </div></div> <div class="col-md-8"><div class="card-body"> <p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="F">Fig. 1</a> </span><span class="capture-id"><br><span class="capture-id">The three-plane measuring device used in the present study. (a) Ear rod. This is the posterior reference point of the Frankfort horizontal plane and Camper’s plane. The ear rods were inserted into the opening of external acoustic meatus. (b) Infraorbital point. This is the anterior reference point of the Frankfort horizontal plane. (c) Frankfort horizontal plane. The Frankfort horizontal plane connects the ear rod (a) and the infraorbital point (b). (d) Camper’s plane. The Camper’s plane connects the inferior margin of the ala nasi and the inferior margin of the tragus. (e) The area touched by the maxillary central incisor and the right and left molars. (f) Maxillary occlusal plane. In this study, the occlusal plane was set at the maxillary occlusal plane.</span></span></p> <ul class="list-inline"> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="F">Click for larger image</a></li> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=FP&id=F1&afn=170_JAP_16_5_278&fn=jap-16-278-g001_0170JAP" target="_blank">Download as PowerPoint slide</a></li> </ul> </div></div> </div></div></div></div></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"><div class="article-figure-table" id="F2"><div class="article-figure-table-card" id="FIGURE-F2" data-type="F" data-afn="170_JAP_16_5_278" data-fn="jap-16-278-g002_0170JAP"><div class="card border-0 my-3"><div class="row no-gutters"> <div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> <a href="#" class="article-figure-table-btn" data-type="F"><img class="align-top" src="/ArticleImage/0170JAP/jap-16-278-g002-m.jpg"></a> </div></div> <div class="col-md-8"><div class="card-body"> <p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="F">Fig. 2</a> </span><span class="capture-id"><br><span class="capture-id">Measurement of reference plane. (A) Reference plane for measurement. FP; Frankfort horizontal plane. CP; Camper’s plane. OP; Maxillary occlusal plane. (B) The photographing condition of the three-plane measuring device and a digital camera. The images were taken with the digital camera 20 cm from the ear rod, with the ear rod placed at the center of the digital camera lens. (C) Classification of angles between the CP and OP. (a) Posteriorly inclined indicates the distance between the upper and lower anterior teeth was small and that between the posterior teeth was large. (b) Anteriorly inclined indicates the distance between the upper and lower anterior teeth was large and that between the posterior teeth was small.</span></span></p> <ul class="list-inline"> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="F">Click for larger image</a></li> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=FP&id=F2&afn=170_JAP_16_5_278&fn=jap-16-278-g002_0170JAP" target="_blank">Download as PowerPoint slide</a></li> </ul> </div></div> </div></div></div></div></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"></div></p> <p>Masticatory performance was examined using gummy jelly (Glucolam; GC, Tokyo, Japan) as a test food (<span class="fig-table-link"><a href="#F3">Fig. 3A</a></span>). The amount of glucose extracted from 2 g of gummy jelly was measured using a glucose-measuring device (GS-II; GC, Tokyo, Japan) (<span class="fig-table-link"><a href="#F3">Fig. 3B</a></span>).<span class="xref"><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B23" class="ref-destination-back"></span><a href="#B23" data-id="XREF_B23" data-toggle="ref-popover" data-trigger="manual" data-placement="right">23</a></span> First, the gummy jelly was allowed to be chewed freely before the start of measurements to decide the habitual chewing side and familiarize the subject with the gummy jelly as the test food.<span class="xref"><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B23" class="ref-destination-back"></span><a href="#B23" data-id="XREF_B23" data-toggle="ref-popover" data-trigger="manual" data-placement="right">23</a></span> The gummy jelly was then chewed for 20 seconds on one side (<span class="fig-table-link"><a href="#F3">Fig. 3C</a></span>), and the subject was instructed to add 10 ml of water to their mouth (<span class="fig-table-link"><a href="#F3">Fig. 3D</a></span>). The water in the mouth was then spit out into a filtered cup together with the gummy jelly (<span class="fig-table-link"><a href="#F3">Fig. 3E</a></span>), and the filtrate was stirred for 10 seconds (<span class="fig-table-link"><a href="#F3">Fig. 3F</a></span>). The filtrate was applied to the chip of the glucose-measuring device (<span class="fig-table-link"><a href="#F3">Fig. 3G</a></span>), and the amount of glucose extracted was measured (<span class="fig-table-link"><a href="#F3">Fig. 3H</a></span>). Measurements were taken twice each on the habitual and non-habitual chewing sides, and the average values of the two measurements were used for analysis. The measurement interval was 2 minutes.<div class="image-at-section"><div class="article-figure-table" id="F3"><div class="article-figure-table-card" id="FIGURE-F3" data-type="F" data-afn="170_JAP_16_5_278" data-fn="jap-16-278-g003_0170JAP"><div class="card border-0 my-3"><div class="row no-gutters"> <div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> <a href="#" class="article-figure-table-btn" data-type="F"><img class="align-top" src="/ArticleImage/0170JAP/jap-16-278-g003-m.jpg"></a> </div></div> <div class="col-md-8"><div class="card-body"> <p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="F">Fig. 3</a> </span><span class="capture-id"><br><span class="capture-id">Method of measuring masticatory performance with gummy jelly. (A) The gummy jelly test food (Glucolam). (B) Equipment used for masticatory performance test. (C) Chewing of the gummy jelly. (D) Pouring 10 ml of water into the mouth. (E) Chewed gummy jelly and included water being spit out into a cup with a filter. (F) Removal of gummy jelly filtered from the spat-out water. (G) Extracted glucose was attached to a brush and measured with a glucose-measuring device (GS-II). (H) Results from the glucose-measuring device.</span></span></p> <ul class="list-inline"> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="F">Click for larger image</a></li> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=FP&id=F3&afn=170_JAP_16_5_278&fn=jap-16-278-g003_0170JAP" target="_blank">Download as PowerPoint slide</a></li> </ul> </div></div> </div></div></div></div></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"></div></p> <p>Occlusal force and occlusal contact area were measured using a pressure-sensitive film (Dental Prescale II; GC, Tokyo, Japan) (<span class="fig-table-link"><a href="#F4">Fig. 4A</a></span>) and an occlusal force measurement system (Bite Force Analyzer; GC, Tokyo, Japan).<span class="xref"><span id="XREF_B24" class="ref-destination-back"></span><a href="#B24" data-id="XREF_B24" data-toggle="ref-popover" data-trigger="manual" data-placement="right">24</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B25" class="ref-destination-back"></span><a href="#B25" data-id="XREF_B25" data-toggle="ref-popover" data-trigger="manual" data-placement="right">25</a></span> Before measurements, clenching practice was performed. The subject was seated on the dental unit and positioned with the FP parallel to the floor. The subject was instructed to perform maximum clenching of the pressure-sensitive film for 3 seconds in the maximal intercuspal position. Measurements were performed three times within a measurement interval of 2 minutes. Occlusal force and occlusal contact area were measured using the automatic cleaning function of the occlusal force analyzing system (<span class="fig-table-link"><a href="#F4">Fig. 4B</a></span>). The average values of the three measurements from each of the habitual and non-habitual chewing sides were used for analysis.<div class="image-at-section"><div class="article-figure-table" id="F4"><div class="article-figure-table-card" id="FIGURE-F4" data-type="F" data-afn="170_JAP_16_5_278" data-fn="jap-16-278-g004_0170JAP"><div class="card border-0 my-3"><div class="row no-gutters"> <div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> <a href="#" class="article-figure-table-btn" data-type="F"><img class="align-top" src="/ArticleImage/0170JAP/jap-16-278-g004-m.jpg"></a> </div></div> <div class="col-md-8"><div class="card-body"> <p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="F">Fig. 4</a> </span><span class="capture-id"><br><span class="capture-id">Instrument and measurement screen for measuring occlusal force and occlusal contact area. (A) The pressure sensitive film used in the present study. (B) Screen of the occlusal force measurement system. The automatic cleaning function was used to remove the area that do not actually represent occlusal contact. The plot shows the occlusal state obtained using the pressure sensitive film. The crosshair in the center of the screen shows the center of gravity of the occlusal force. (a) Occlusal contact area (mm<sup>2</sup>), (b) Average pressure (MPa), (c) Maximum pressure (MPa), (d) Occlusal force (N), (e) Right side indicator, (f) Left side indicator.</span></span></p> <ul class="list-inline"> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="F">Click for larger image</a></li> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=FP&id=F4&afn=170_JAP_16_5_278&fn=jap-16-278-g004_0170JAP" target="_blank">Download as PowerPoint slide</a></li> </ul> </div></div> </div></div></div></div></div><div class="image-at-section"></div></p> <p>Normality was analyzed using the Shapiro-Wilk test, and all values showed normal distributions. The sample size was determined using Pearson’s correlation coefficient (statistical test: correlation; type of power analysis: a priori; alpha error, 0.05; statistical power, 80%; and correlation ρ H1, 0.5) and the paired t-test (statistical test: difference between two dependent means; type of power analysis: a priori; alpha error, 0.05; statistical power, 80%; and effect size, 0.5) using power analysis software (G*Power version 3.1.9.7; Heinrich-Heine Universität, Düsseldorf, Germany). As a result, 29 subjects were required for Pearson’s correlation coefficient, and 34 subjects were required for paired t-testing. Relationships between the reference plane and masticatory performance, occlusal force, and occlusal contact area on both the habitual and non-habitual chewing sides were analyzed using Pearson’s correlation coefficient. Relationships between masticatory performance, occlusal force, and occlusal contact area on both the habitual and non-habitual chewing sides were determined using Pearson’s correlation coefficient. Comparisons between the habitual and non-habitual chewing sides for reference planes and oral functions were analyzed using the paired t-test. Values of <i>P</i> < .05 were considered significant in all analyses. Statistical analysis was performed using SPSS for Windows statistical software (ver. 28.0; SPSS, Chicago, IL, USA).</p> </div> <div> <div><div class="article-section-header"> <div class="__SECTION__" id="__ID_SECTION_3" data-section-name="RESULTS"><div class="dropdown"> <a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_3" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_3"></div> </div></div> <h2>RESULTS</h2> </div></div> <p>Relationships between the reference planes (FP, CP, and OP), oral functions (masticatory performance and occlusal force), and occlusal contact area are shown <span class="fig-table-link"><a href="#T1">Table 1</a></span>. Positive correlations were found between CP-OP and masticatory performance on both the habitual chewing side (r = 0.47, <i>P</i> < .01) and non-habitual chewing side (r = 0.36, <i>P</i> < .05). A positive correlation was also found between CP-OP and occlusal force on the non-habitual chewing side (r = 0.40, <i>P</i> < .05). Negative correlations were observed between FP-OP and masticatory performance on the habitual chewing side (r = −0.56, <i>P</i> < .01), between FP-OP and occlusal force on both the habitual chewing side (r = −0.35, <i>P</i> < .05) and non-habitual chewing side (r = −0.48, <i>P</i> < .01), and between FP-OP and occlusal contact area on the non-habitual chewing side (r = −0.34, <i>P</i> < .05). No correlations were observed between FP-CP and oral functions or occlusal contact area.<div class="image-at-section"><div class="article-figure-table" id="T1"><div class="article-figure-table-card" id="TABLE-T1" data-type="T" data-afn="170_JAP_16_5_278" data-fn="jap-16-278-i001_0170JAP"><div class="card border-0 my-3"><div class="row no-gutters"> <div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> <a href="#" class="article-figure-table-btn" data-type="TH"><img class="align-top" src="/ArticleImage/0170JAP/jap-16-278-i001-m.jpg"></a> </div></div> <div class="col-md-8"><div class="card-body"> <p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="T">Table 1</a> </span><span class="capture-id"><br><span class="capture-id">Results of correlation between the reference planes, masticatory performance, occlusal force, and occlusal contact area</span></span></p> <ul class="list-inline"> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="T">Click for larger image</a></li> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="TH">Click for full table</a></li> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=TX&id=T1&afn=170_JAP_16_5_278&fn=jap-16-278-i001_0170JAP" target="_blank">Download as Excel file</a></li> </ul> </div></div> </div></div></div></div></div></p> <p>Relationships between masticatory performance, occlusal force, and occlusal contact area on the habitual and non-habitual chewing sides are shown in <span class="fig-table-link"><a href="#T2">Table 2</a></span>. Positive correlations were found between masticatory performance and occlusal force on the habitual chewing side (r = 0.46, <i>P</i> < .01), between masticatory performance and occlusal contact area on the habitual chewing side (r = 0.36, <i>P</i> < .05), and between occlusal force and occlusal contact area on both the habitual chewing side (r = 0.94, <i>P</i> < .01) and the non-habitual chewing side (r = 0.91, <i>P</i> < .01).<div class="image-at-section"><div class="article-figure-table" id="T2"><div class="article-figure-table-card" id="TABLE-T2" data-type="T" data-afn="170_JAP_16_5_278" data-fn="jap-16-278-i002_0170JAP"><div class="card border-0 my-3"><div class="row no-gutters"> <div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> <a href="#" class="article-figure-table-btn" data-type="TH"><img class="align-top" src="/ArticleImage/0170JAP/jap-16-278-i002-m.jpg"></a> </div></div> <div class="col-md-8"><div class="card-body"> <p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="T">Table 2</a> </span><span class="capture-id"><br><span class="capture-id">Results of correlation between masticatory performance, occlusal force, and occlusal contact area on the habitual and non-habitual chewing sides</span></span></p> <ul class="list-inline"> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="T">Click for larger image</a></li> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="TH">Click for full table</a></li> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=TX&id=T2&afn=170_JAP_16_5_278&fn=jap-16-278-i002_0170JAP" target="_blank">Download as Excel file</a></li> </ul> </div></div> </div></div></div></div></div></p> <p><span class="fig-table-link"><a href="#T3">Table 3</a></span> shows the mean, standard deviation, and <i>P</i> value of angles between the reference planes (FP, CP, and OP), oral functions (masticatory performance and occlusal force), and occlusal contact area. There were no statistically significant differences between the habitual and non-habitual chewing sides in FP-CP (<i>P</i> = .06), FP-OP (<i>P</i> = .20), and CP-OP (<i>P</i> = .65). Mean FP-CP and FP-OP tended to be larger on the habitual chewing side than on the non-habitual chewing side. Mean CP-OP tended to be larger on the non-habitual chewing side than on the habitual chewing side. Significant differences were found between the habitual and non-habitual chewing sides in masticatory performance (<i>P</i> < .01, <span class="fig-table-link"><a href="#F5">Fig. 5A</a></span>). No significant differences in occlusal force (<i>P</i> = .27, <span class="fig-table-link"><a href="#F5">Fig. 5B</a></span>) or occlusal contact area (<i>P</i> = .37, <span class="fig-table-link"><a href="#F5">Fig. 5C</a></span>) were apparent between the habitual and non-habitual chewing sides. Mean values for occlusal force and occlusal contact area tended to be larger on the habitual chewing side than on the non-habitual chewing side.<div class="image-at-section"><div class="article-figure-table" id="F5"><div class="article-figure-table-card" id="FIGURE-F5" data-type="F" data-afn="170_JAP_16_5_278" data-fn="jap-16-278-g005_0170JAP"><div class="card border-0 my-3"><div class="row no-gutters"> <div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> <a href="#" class="article-figure-table-btn" data-type="F"><img class="align-top" src="/ArticleImage/0170JAP/jap-16-278-g005-m.jpg"></a> </div></div> <div class="col-md-8"><div class="card-body"> <p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="F">Fig. 5</a> </span><span class="capture-id"><br><span class="capture-id">Results of the comparisons between the habitual and non-habitual chewing sides in masticatory performance, occlusal force, and occlusal contact area. (A) Masticatory performance, (B) Occlusal force, (C) Occlusal contact area. <sup>**</sup> Statistically significant differences (<i>P</i> < .01).</span></span></p> <ul class="list-inline"> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="F">Click for larger image</a></li> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=FP&id=F5&afn=170_JAP_16_5_278&fn=jap-16-278-g005_0170JAP" target="_blank">Download as PowerPoint slide</a></li> </ul> </div></div> </div></div></div></div></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"><div class="article-figure-table" id="T3"><div class="article-figure-table-card" id="TABLE-T3" data-type="T" data-afn="170_JAP_16_5_278" data-fn="jap-16-278-i003_0170JAP"><div class="card border-0 my-3"><div class="row no-gutters"> <div class="col-md-4 mx-auto d-flex justify-content-center flex-wrap align-middle"><div class="card-body"> <a href="#" class="article-figure-table-btn" data-type="TH"><img class="align-top" src="/ArticleImage/0170JAP/jap-16-278-i003-m.jpg"></a> </div></div> <div class="col-md-8"><div class="card-body"> <p class="card-text"><span class="label"><a href="#" class="article-figure-table-btn" data-type="T">Table 3</a> </span><span class="capture-id"><br><span class="capture-id">Mean, standard deviation, and <i>P</i> value of angles between the reference planes, masticatory performance, occlusal force, and occlusal contact area on the habitual and non-habitual chewing sides</span></span></p> <ul class="list-inline"> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="T">Click for larger image</a></li> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm article-figure-table-btn" data-type="TH">Click for full table</a></li> <li class="list-inline-item"><a role="button" class="btn btn-outline-article btn-sm" href="ViewImagePopup.php?Type=TX&id=T3&afn=170_JAP_16_5_278&fn=jap-16-278-i003_0170JAP" target="_blank">Download as Excel file</a></li> </ul> </div></div> </div></div></div></div></div></p> </div> <div> <div><div class="article-section-header"> <div class="__SECTION__" id="__ID_SECTION_4" data-section-name="DISCUSSION"><div class="dropdown"> <a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_4" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_4"></div> </div></div> <h2>DISCUSSION</h2> </div></div> <p>This study examined the relationships between angles formed by reference planes (FP, CP, and OP), oral functions (masticatory performance, occlusal force), and occlusal contact area on the chewing side.</p> <p>The three-plane measuring device (<span class="fig-table-link"><a href="#F1">Fig. 1</a></span>) used in this study was newly fabricated to measure three planes (FP, CP, and OP) simultaneously. The CP is used as the reference plane for determining occlusal planes in dentulous and edentulous patients for prosthesis fabrication. The CP is defined by the inferior margin of the ala nasi and the superior margin of the tragus.<span class="xref"><span id="XREF_B21" class="ref-destination-back"></span><a href="#B21" data-id="XREF_B21" data-toggle="ref-popover" data-trigger="manual" data-placement="right">21</a></span> Numerous researchers have confirmed that all three parts of the tragus (i.e., the superior, middle, and inferior parts of the tragus) could guide occlusal plane orientation in edentulous patients.<span class="xref"><span id="XREF_B26" class="ref-destination-back"></span><a href="#B26" data-id="XREF_B26" data-toggle="ref-popover" data-trigger="manual" data-placement="right">26</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B27" class="ref-destination-back"></span><a href="#B27" data-id="XREF_B27" data-toggle="ref-popover" data-trigger="manual" data-placement="right">27</a></span> Sharab <i>et al.</i><span class="xref"><span id="XREF_B28" class="ref-destination-back"></span><a href="#B28" data-id="XREF_B28" data-toggle="ref-popover" data-trigger="manual" data-placement="right">28</a></span> suggested redefining the CP with a line extending from the inferior border of the ala nasi to the inferior border of the tragus instead of the superior border. Based on previous studies,<span class="xref"><span id="XREF_B26" class="ref-destination-back"></span><a href="#B26" data-id="XREF_B26" data-toggle="ref-popover" data-trigger="manual" data-placement="right">26</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B27" class="ref-destination-back"></span><a href="#B27" data-id="XREF_B27" data-toggle="ref-popover" data-trigger="manual" data-placement="right">27</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B28" class="ref-destination-back"></span><a href="#B28" data-id="XREF_B28" data-toggle="ref-popover" data-trigger="manual" data-placement="right">28</a></span> the line connecting the inferior margin of the ala nasi and the inferior margin of the tragus was used in this study to define the CP (<span class="fig-table-link"><a href="#F2">Fig. 2A</a></span>). The OP is defined as the plane established by the incisal and occlusal surfaces of the teeth; generally, this is not strictly a plane but represents the planar mean of the curvature of these surfaces.<span class="xref"><span id="XREF_B21" class="ref-destination-back"></span><a href="#B21" data-id="XREF_B21" data-toggle="ref-popover" data-trigger="manual" data-placement="right">21</a></span> The occlusal plane of the upper jaw was used as the OP in this study because the design of the device did not allow the OP to be recorded in the maximal intercuspal position. In addition, measurements of reference planes can be performed without using X-rays, such as cephalometric radiographs. This avoids the deleterious effects of exposure to radiation, so the device applied in this study was considered useful for measuring angles between the reference planes.<div class="image-at-section"></div><div class="image-at-section"></div></p> <p>Direct and indirect examination methods are used in the measurement of masticatory performance.<span class="xref"><span id="XREF_B29" class="ref-destination-back"></span><a href="#B29" data-id="XREF_B29" data-toggle="ref-popover" data-trigger="manual" data-placement="right">29</a></span> Direct examination methods involve direct determination from masticated samples, whereas indirect methods involve indirect measurements from other elements involved in mastication. The sieve method has long been used to measure masticatory performance, but shows significant limitations, in that the procedure is complicated and the analysis is time-consuming.<span class="xref"><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B23" class="ref-destination-back"></span><a href="#B23" data-id="XREF_B23" data-toggle="ref-popover" data-trigger="manual" data-placement="right">23</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B30" class="ref-destination-back"></span><a href="#B30" data-id="XREF_B30" data-toggle="ref-popover" data-trigger="manual" data-placement="right">30</a></span> Current research therefore generally uses color-changing chewing gum,<span class="xref"><span id="XREF_B31" class="ref-destination-back"></span><a href="#B31" data-id="XREF_B31" data-toggle="ref-popover" data-trigger="manual" data-placement="right">31</a></span> paraffin wax,<span class="xref"><span id="XREF_B6" class="ref-destination-back"></span><a href="#B6" data-id="XREF_B6" data-toggle="ref-popover" data-trigger="manual" data-placement="right">6</a></span> silicone,<span class="xref"><span id="XREF_B16" class="ref-destination-back"></span><a href="#B16" data-id="XREF_B16" data-toggle="ref-popover" data-trigger="manual" data-placement="right">16</a></span> fuchsin beads,<span class="xref"><span id="XREF_B32" class="ref-destination-back"></span><a href="#B32" data-id="XREF_B32" data-toggle="ref-popover" data-trigger="manual" data-placement="right">32</a></span> and gummy jelly.<span class="xref"><span id="XREF_B8" class="ref-destination-back"></span><a href="#B8" data-id="XREF_B8" data-toggle="ref-popover" data-trigger="manual" data-placement="right">8</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B9" class="ref-destination-back"></span><a href="#B9" data-id="XREF_B9" data-toggle="ref-popover" data-trigger="manual" data-placement="right">9</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B11" class="ref-destination-back"></span><a href="#B11" data-id="XREF_B11" data-toggle="ref-popover" data-trigger="manual" data-placement="right">11</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B12" class="ref-destination-back"></span><a href="#B12" data-id="XREF_B12" data-toggle="ref-popover" data-trigger="manual" data-placement="right">12</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B23" class="ref-destination-back"></span><a href="#B23" data-id="XREF_B23" data-toggle="ref-popover" data-trigger="manual" data-placement="right">23</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B30" class="ref-destination-back"></span><a href="#B30" data-id="XREF_B30" data-toggle="ref-popover" data-trigger="manual" data-placement="right">30</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B33" class="ref-destination-back"></span><a href="#B33" data-id="XREF_B33" data-toggle="ref-popover" data-trigger="manual" data-placement="right">33</a></span> In the present study, masticatory performance was measured using gummy jelly with standardized physical properties and shapes. Shiga <i>et al.</i><span class="xref"><span id="XREF_B23" class="ref-destination-back"></span><a href="#B23" data-id="XREF_B23" data-toggle="ref-popover" data-trigger="manual" data-placement="right">23</a></span> reported that this method is characterized by using gummy jelly as a test food that can be standardized in terms of physical properties and shape, with easy hygiene management and simple procedures and analyses. The measurement errors of glucose extracted from gummy jelly are reportedly low.<span class="xref"><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B23" class="ref-destination-back"></span><a href="#B23" data-id="XREF_B23" data-toggle="ref-popover" data-trigger="manual" data-placement="right">23</a></span> In terms of masticatory performance, a correlation has been reported between measured values from glucose leaching and measured values from the sieve method.<span class="xref"><span id="XREF_B33" class="ref-destination-back"></span><a href="#B33" data-id="XREF_B33" data-toggle="ref-popover" data-trigger="manual" data-placement="right">33</a></span> Test for masticatory performance using gummy jelly is useful because it can measure masticatory performance objectively. In this study, masticatory performance was determined using a direct examination method with gummy jelly, and occlusal force was measured using an indirect examination method.</p> <p>The habitual chewing side is not acquired at birth. Arai <i>et al.</i><span class="xref"><span id="XREF_B7" class="ref-destination-back"></span><a href="#B7" data-id="XREF_B7" data-toggle="ref-popover" data-trigger="manual" data-placement="right">7</a></span> showed that changes in the oral environment may alter the habitual chewing side. The current oral environment must therefore be determined to identify the habitual chewing side. Several methods can be used to determine the habitual chewing side, including the gum chewing method,<span class="xref"><span id="XREF_B10" class="ref-destination-back"></span><a href="#B10" data-id="XREF_B10" data-toggle="ref-popover" data-trigger="manual" data-placement="right">10</a></span> determining the average path of mandibular movements during free movement,<span class="xref"><span id="XREF_B19" class="ref-destination-back"></span><a href="#B19" data-id="XREF_B19" data-toggle="ref-popover" data-trigger="manual" data-placement="right">19</a></span> and the side on which the majority of chewing occurs. Previous studies<span class="xref"><span id="XREF_B8" class="ref-destination-back"></span><a href="#B8" data-id="XREF_B8" data-toggle="ref-popover" data-trigger="manual" data-placement="right">8</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B11" class="ref-destination-back"></span><a href="#B11" data-id="XREF_B11" data-toggle="ref-popover" data-trigger="manual" data-placement="right">11</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B12" class="ref-destination-back"></span><a href="#B12" data-id="XREF_B12" data-toggle="ref-popover" data-trigger="manual" data-placement="right">12</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B23" class="ref-destination-back"></span><a href="#B23" data-id="XREF_B23" data-toggle="ref-popover" data-trigger="manual" data-placement="right">23</a></span> have determined the habitual chewing side by having the subject chew gummy jelly before the experiment, and interviewing subjects. Highly reliable measurements can also be obtained when subjects become accustomed to chewing the test food before the experiment.<span class="xref"><span id="XREF_B22" class="ref-destination-back"></span><a href="#B22" data-id="XREF_B22" data-toggle="ref-popover" data-trigger="manual" data-placement="right">22</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B23" class="ref-destination-back"></span><a href="#B23" data-id="XREF_B23" data-toggle="ref-popover" data-trigger="manual" data-placement="right">23</a></span> This study was therefore conducted with the subject chewing the gummy jelly before measurements.</p> <p>For measurements of occlusal force and occlusal contact area, two types of measurement can be taken<span class="xref"><span id="XREF_B24" class="ref-destination-back"></span><a href="#B24" data-id="XREF_B24" data-toggle="ref-popover" data-trigger="manual" data-placement="right">24</a></span>: those that measure the full dentition<span class="xref"><span id="XREF_B6" class="ref-destination-back"></span><a href="#B6" data-id="XREF_B6" data-toggle="ref-popover" data-trigger="manual" data-placement="right">6</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B9" class="ref-destination-back"></span><a href="#B9" data-id="XREF_B9" data-toggle="ref-popover" data-trigger="manual" data-placement="right">9</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B10" class="ref-destination-back"></span><a href="#B10" data-id="XREF_B10" data-toggle="ref-popover" data-trigger="manual" data-placement="right">10</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B11" class="ref-destination-back"></span><a href="#B11" data-id="XREF_B11" data-toggle="ref-popover" data-trigger="manual" data-placement="right">11</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B12" class="ref-destination-back"></span><a href="#B12" data-id="XREF_B12" data-toggle="ref-popover" data-trigger="manual" data-placement="right">12</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B17" class="ref-destination-back"></span><a href="#B17" data-id="XREF_B17" data-toggle="ref-popover" data-trigger="manual" data-placement="right">17</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B24" class="ref-destination-back"></span><a href="#B24" data-id="XREF_B24" data-toggle="ref-popover" data-trigger="manual" data-placement="right">24</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B25" class="ref-destination-back"></span><a href="#B25" data-id="XREF_B25" data-toggle="ref-popover" data-trigger="manual" data-placement="right">25</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B34" class="ref-destination-back"></span><a href="#B34" data-id="XREF_B34" data-toggle="ref-popover" data-trigger="manual" data-placement="right">34</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B35" class="ref-destination-back"></span><a href="#B35" data-id="XREF_B35" data-toggle="ref-popover" data-trigger="manual" data-placement="right">35</a></span>; and those that measure a single tooth.<span class="xref"><span id="XREF_B18" class="ref-destination-back"></span><a href="#B18" data-id="XREF_B18" data-toggle="ref-popover" data-trigger="manual" data-placement="right">18</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B19" class="ref-destination-back"></span><a href="#B19" data-id="XREF_B19" data-toggle="ref-popover" data-trigger="manual" data-placement="right">19</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B20" class="ref-destination-back"></span><a href="#B20" data-id="XREF_B20" data-toggle="ref-popover" data-trigger="manual" data-placement="right">20</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B32" class="ref-destination-back"></span><a href="#B32" data-id="XREF_B32" data-toggle="ref-popover" data-trigger="manual" data-placement="right">32</a></span> In this study, the habitual and non-habitual chewing sides had to be measured simultaneously, so a device that could measure the full dentition was selected. Measured values also needed to be separated into right and left sides. A pressure-sensitive film that can measure the entire dentition at once was used in this study. Pressure-sensitive films use microcapsules of various sizes placed between two films.<span class="xref"><span id="XREF_B24" class="ref-destination-back"></span><a href="#B24" data-id="XREF_B24" data-toggle="ref-popover" data-trigger="manual" data-placement="right">24</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B25" class="ref-destination-back"></span><a href="#B25" data-id="XREF_B25" data-toggle="ref-popover" data-trigger="manual" data-placement="right">25</a></span> When force is applied to the pressure-sensitive film, the microcapsules split and release a red color. The intensity and area of red coloration are then used to measure occlusal force. An automatic cleaning function removes marks outside areas of occlusal contact in the occlusal force analyzing system.<span class="xref"><span id="XREF_B24" class="ref-destination-back"></span><a href="#B24" data-id="XREF_B24" data-toggle="ref-popover" data-trigger="manual" data-placement="right">24</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B25" class="ref-destination-back"></span><a href="#B25" data-id="XREF_B25" data-toggle="ref-popover" data-trigger="manual" data-placement="right">25</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B35" class="ref-destination-back"></span><a href="#B35" data-id="XREF_B35" data-toggle="ref-popover" data-trigger="manual" data-placement="right">35</a></span> Because the pressure-sensitive film deforms and develops color during clenching, and since the optical scanner can import detailed images, the data would indicate areas that do not actually represent occlusal contact.<span class="xref"><span id="XREF_B24" class="ref-destination-back"></span><a href="#B24" data-id="XREF_B24" data-toggle="ref-popover" data-trigger="manual" data-placement="right">24</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B25" class="ref-destination-back"></span><a href="#B25" data-id="XREF_B25" data-toggle="ref-popover" data-trigger="manual" data-placement="right">25</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B34" class="ref-destination-back"></span><a href="#B34" data-id="XREF_B34" data-toggle="ref-popover" data-trigger="manual" data-placement="right">34</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B35" class="ref-destination-back"></span><a href="#B35" data-id="XREF_B35" data-toggle="ref-popover" data-trigger="manual" data-placement="right">35</a></span> To ensure the indication of the accurate occlusal force and occlusal contact area measurements, the automatic cleaning function was used for measurements in this study.</p> <p>When CP-OP was anteriorly inclined, occlusal force was small (<span class="fig-table-link"><a href="#T1">Table 1</a></span>). This tendency was recognized both on the habitual and non-habitual chewing sides, and positive correlations were found between CP-OP and oral functions. When CP-OP was anteriorly inclined, the anterior side of CP-OP was larger (<span class="fig-table-link"><a href="#F2">Fig. 2Cb</a></span>). The direction of the masseter muscle had a complex relationship with craniofacial morphology, and mainly related to the angle of the occlusal plane.<span class="xref"><span id="XREF_B36" class="ref-destination-back"></span><a href="#B36" data-id="XREF_B36" data-toggle="ref-popover" data-trigger="manual" data-placement="right">36</a></span> Anteroposterior inclination of the OP was shown to affect occlusal force.<span class="xref"><span id="XREF_B37" class="ref-destination-back"></span><a href="#B37" data-id="XREF_B37" data-toggle="ref-popover" data-trigger="manual" data-placement="right">37</a></span> Therefore, the masseter muscle was considered to be inclined anteriorly relative to the CP, and occlusal force was then decreased. The results of this study suggested that the inclination of the OP relative to the CP tended to be associated with occlusal force both on the habitual and non-habitual chewing sides.<div class="image-at-section"></div><div class="image-at-section"></div></p> <p>When FP-OP increased, occlusal force decreased (<span class="fig-table-link"><a href="#T1">Table 1</a></span>). This tendency was shown both on the habitual and non-habitual chewing sides, and negative correlations were found between FP-OP and oral functions. Previous studies have found no significant correlation between FP-OP and occlusal force.<span class="xref"><span id="XREF_B17" class="ref-destination-back"></span><a href="#B17" data-id="XREF_B17" data-toggle="ref-popover" data-trigger="manual" data-placement="right">17</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B38" class="ref-destination-back"></span><a href="#B38" data-id="XREF_B38" data-toggle="ref-popover" data-trigger="manual" data-placement="right">38</a></span> The present results thus differed from those previous studies. Uchida <i>et al.</i><span class="xref"><span id="XREF_B17" class="ref-destination-back"></span><a href="#B17" data-id="XREF_B17" data-toggle="ref-popover" data-trigger="manual" data-placement="right">17</a></span> investigated a smaller cohort than this study, while Kurusu <i>et al.</i><span class="xref"><span id="XREF_B38" class="ref-destination-back"></span><a href="#B38" data-id="XREF_B38" data-toggle="ref-popover" data-trigger="manual" data-placement="right">38</a></span> focused on female subjects. The present study showed a relationship between FP-OP and occlusal force. As FP-OP increased, the masseter muscle was considered to run more forward, resulting in decreased occlusal force both on the habitual and non-habitual chewing sides.<div class="image-at-section"></div></p> <p>Correlations were observed between angles between reference planes (FP-OP or CP-OP) and masticatory performance on the habitual chewing side, and a common index for both angles between reference planes (FP-OP and CP-OP) was the OP. The results of this study suggest that masticatory performance could be improved by changing the OP inclination. Therefore, the OP inclination was considered important for producing an appropriate prosthesis.</p> <p>Positive correlations were found between masticatory performance and occlusal force, between masticatory performance and occlusal contact area, and between occlusal force and occlusal contact area on the habitual chewing side (<span class="fig-table-link"><a href="#T2">Table 2</a></span>). The present study showed the same tendency as previous studies.<span class="xref"><span id="XREF_B11" class="ref-destination-back"></span><a href="#B11" data-id="XREF_B11" data-toggle="ref-popover" data-trigger="manual" data-placement="right">11</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B12" class="ref-destination-back"></span><a href="#B12" data-id="XREF_B12" data-toggle="ref-popover" data-trigger="manual" data-placement="right">12</a></span> Larger occlusal force appears to lead to more efficient chewing, thereby increasing masticatory performance. The results of this study indicated a relationship between masticatory performance and occlusal force on the habitual chewing side.<div class="image-at-section"></div></p> <p>FP-OP as measured by the three-plane measuring device was approximately 17.3° on the habitual chewing side and 16.7° on the non-habitual chewing side (<span class="fig-table-link"><a href="#T3">Table 3</a></span>). FP-OP in previous studies was reported as 6.79°,<span class="xref"><span id="XREF_B15" class="ref-destination-back"></span><a href="#B15" data-id="XREF_B15" data-toggle="ref-popover" data-trigger="manual" data-placement="right">15</a></span> 8 ± 4°,<span class="xref"><span id="XREF_B18" class="ref-destination-back"></span><a href="#B18" data-id="XREF_B18" data-toggle="ref-popover" data-trigger="manual" data-placement="right">18</a></span> 10.6°,<span class="xref"><span id="XREF_B17" class="ref-destination-back"></span><a href="#B17" data-id="XREF_B17" data-toggle="ref-popover" data-trigger="manual" data-placement="right">17</a></span> and 13.85°<span class="xref"><span id="XREF_B37" class="ref-destination-back"></span><a href="#B37" data-id="XREF_B37" data-toggle="ref-popover" data-trigger="manual" data-placement="right">37</a></span> using cephalometric analyses. Differences in inclination angle were thought to be due to different positions of the OP. Significant differences were not found between the habitual and non-habitual chewing sides in each FP-CP, FP-OP, and CP-OP. The results of this study indicated that the angles between two reference planes would not be differed by the chewing side.<div class="image-at-section"></div></p> <p>A significant difference in masticatory performance was evident between the habitual and non-habitual chewing sides, and masticatory performance was higher on the habitual chewing side (<span class="fig-table-link"><a href="#T3">Table 3</a></span><span class="gen">, </span><span class="fig-table-link"><a href="#F5">Fig. 5A</a></span>). Functional differences have been reported between the habitual and non-habitual chewing sides.<span class="xref"><span id="XREF_B12" class="ref-destination-back"></span><a href="#B12" data-id="XREF_B12" data-toggle="ref-popover" data-trigger="manual" data-placement="right">12</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B23" class="ref-destination-back"></span><a href="#B23" data-id="XREF_B23" data-toggle="ref-popover" data-trigger="manual" data-placement="right">23</a></span><span class="xref"><span class="gen">, </span><span id="XREF_B30" class="ref-destination-back"></span><a href="#B30" data-id="XREF_B30" data-toggle="ref-popover" data-trigger="manual" data-placement="right">30</a></span> The habitual chewing side has been reported to show better masticatory performance because of the stable path of masticatory movement compared to the non-habitual chewing side.<span class="xref"><span id="XREF_B8" class="ref-destination-back"></span><a href="#B8" data-id="XREF_B8" data-toggle="ref-popover" data-trigger="manual" data-placement="right">8</a></span> Masticatory performance was thus higher on the habitual chewing side than on the non-habitual chewing side in this study. No differences in occlusal force or occlusal contact area were seen between the habitual and non-habitual chewing sides (<span class="fig-table-link"><a href="#T3">Table 3</a></span><span class="gen">, </span><span class="fig-table-link"><a href="#F5">Fig. 5B, C</a></span>). Komino <i>et al.</i><span class="xref"><span id="XREF_B12" class="ref-destination-back"></span><a href="#B12" data-id="XREF_B12" data-toggle="ref-popover" data-trigger="manual" data-placement="right">12</a></span> reported that occlusal force differed between the habitual chewing side (446.4 ± 96.0 N) and the non-habitual chewing side (412.9 ± 99.6 N). Values in this study were 446.9 ± 187.0 N on the habitual chewing side and 427.3 ± 167.9 N on the non-habitual chewing side. Standard deviations in this study showed a wider range than in the previous study.<span class="xref"><span id="XREF_B12" class="ref-destination-back"></span><a href="#B12" data-id="XREF_B12" data-toggle="ref-popover" data-trigger="manual" data-placement="right">12</a></span> The difference in occlusal force among subjects was thus larger in this study, with larger standard deviations. Occlusal force was not found to differ between the habitual and non-habitual chewing sides in this study. The present results confirm that masticatory performance is higher on the habitual chewing side than on the non-habitual chewing side.<div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"></div><div class="image-at-section"></div></p> <p>The limitation of this study was that the maxillomandibular relations and facial type were not analyzed. It would be important to consider the maxillomandibular relations and facial type for the investigation of reference planes. It was considered necessary to analyze the relation between reference plane and oral function according to the maxillomandibular relations and facial type in future study. Key limitations of this study were that the sample size was too small to investigate gender differences. In future investigations, the sample size should be increased to allow such analyses. In addition, the relationships of reference planes to other oral functions (tongue pressure and mandibular mastication movements) should be clarified.</p> </div> <div> <div><div class="article-section-header"> <div class="__SECTION__" id="__ID_SECTION_5" data-section-name="CONCLUSION"><div class="dropdown"> <a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_5" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_5"></div> </div></div> <h2>CONCLUSION</h2> </div></div> <p>Relationships between the angle formed by each reference plane on the chewing side, masticatory performance, occlusal force, and occlusal contact area were investigated and the following conclusions were obtained. The angle between the occlusal plane and the Camper’s plane was increased (distance between the upper and lower anterior teeth was small and that between the posterior teeth was large) when masticatory performance was higher, both on the habitual and non-habitual chewing sides. The angle between the Frankfort horizontal plane and the occlusal plane was decreased when masticatory performance was higher on the habitual chewing side. Oral functions changed depending on the inclination of the occlusal plane. Masticatory performance was higher on the habitual chewing side than on the non-habitual chewing side.</p> </div> <div id="supplementary-material"><p></p></div> </div> <div id="article-level-0-figs-and-tables" class="bm bm-figure-tables"> </div> <div id="article-level-0-back" class="bm"> <div class="references"> <div class="__SECTION__" id="__ID_SECTION_6" data-section-name="References"><div class="dropdown"> <a href="#" class="dropdown-goto dropdown-toggle d-none" id="dropdownGoto_6" title="Go to other sections in this page" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false">Go to:</a><div class="dropdown-menu dropdown-menu-right d-none" aria-labelledby="dropdownGoto_6"></div> </div></div> <h3 class="title">References</h3> </div> <div class="bm"> <tr> <td></td> <td></td> </tr> <ol> <li><ol class="references-and-notes-list"><li class="skip-numbering" value="1"> <div id="B1" class="ref-destination"></div> <div class="ref-item"> <span id="XREF_B1_DATA" class="ref-data" valign="top">Thiesen G, Gribel BF, Freitas MP. 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J Prosthodont Res 2015;59:185–193.<div><ul class="list-group list-group-horizontal"> <li class="list-group-item-ref"><a href="https://pubmed.ncbi.nlm.nih.gov/26043889" target="_new"><span>PubMed</span></a></li> <li class="list-group-item-ref"><a href="https://doi.org/10.1016%2Fj.jpor.2015.05.001" target="_new"><span>CrossRef</span></a></li>  </ul></div></span> </div> </li></ol></li> <li><ol class="references-and-notes-list"><li class="skip-numbering" value="1"> <div id="B38" class="ref-destination"></div> <div class="ref-item"> <span id="XREF_B38_DATA" class="ref-data" valign="top">Kurusu A, Horiuchi M, Soma K. Relationship between occlusal force and mandibular condyle morphology. Evaluated by limited cone-beam computed tomography. Angle Orthod 2009;79:1063–1069.<div><ul class="list-group list-group-horizontal"> <li class="list-group-item-ref"><a href="https://pubmed.ncbi.nlm.nih.gov/19852595" target="_new"><span>PubMed</span></a></li> <li class="list-group-item-ref"><a href="https://doi.org/10.2319%2F120908-620R.1" target="_new"><span>CrossRef</span></a></li>  </ul></div></span> </div> </li></ol></li> </ol> </div> </div> </div> </div> <div class="article-portlets col-xxl-3 offset-xxl-1 col-xl-3 col-lg-4 col-xs-12">  <div class="d-lg-none"> <hr></hr> </div> <div id="PortletFormatLink" class="porlet"> <ul class="list-group list-group-flush"> <li class="list-group-item ms-0 ps-0 "> <a class="format-item icon-link CiteDialog" href="#" onclick="" data-article-id=10.4047/jap.2024.16.5.278 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:: JAP :: Journal of Advanced Prosthodontics