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Cranio. 2014 Jan;32(1):13-23.

Clinician accuracy when subjectively interpreting articulating paper markings.



The aim of this study was to determine whether Subjective Interpretation of paper markings is a reliable method for identifying the relative occlusal force content of tooth contacts.


295 clinicians selected the "Most Forceful" and "Least Forceful" occlusal contacts in six occlusal-view photographs of articulating paper marks that were later compared against computerized occlusal analysis relative occlusal force measurements of the same tooth contacts. Means and standard deviations were calculated by years in clinical practice and by number of occlusion courses taken. A Chi-square analysis was also performed.


The mean correct for 295 participant dentists was 1.53 (+/- 1.234). There were no significant differences found for years in practice (P>0.16) or number of occlusion courses taken (P>0.75). The Chi-square analysis showed a sensitivity of 12.6%, a specificity of 12.4%, a positive predictive value of 12.58%, and a negative predictive value of 12.42%. Chance was calculated at 12.5% correct.


Subjective Interpretation is an ineffective clinical method for determining the relative occlusal force content of tooth contacts. The reported low scores obtained from a large group of participant dentists suggest clinicians are unable to reliably differentiate high and low occlusal force from looking at articulating paper marks. This longstanding method of visually observing articulating paper marks for occlusal contact force content should be replaced with a measurement-based, objective method.

[Indexed for MEDLINE]

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