Can bite-force measurement play a role in dental treatment planning, clinical trials, and survival outcomes? A literature review and clinical recommendations

Bite force (occlusal force) may play a significant role in patient treatment outcomes. However, as a diagnostic risk assessment tool, it has been examined in the literature but is not commonly utilized by practicing clinicians and in academic studies. This diagnostic evaluation may assist the dental clinician in planning tooth- and implant-supported restorations, as damage to the tooth, implant, or restoration may be dependent upon a restoration's resistance to loading conditions. The overall bite force has been estimated to be up to 2,000 N, with a clear sexual dimorphism and age dependence. The magnitude of these forces along the dental arch have been shown to be elevated in the posterior compared to the anterior region. The bite force magnitude has been inversely related to the proprioception, as a significant increase in bite force is seen in patients with endodontically treated teeth as compared to their vital teeth. Bite force has been linked to chewing efficiency, quality of life, and implicated in the life expectancy of the restorations. Restoration life expectancies have been associated with the material selection and preparation design parameters, both of which may be affected by masticatory bite force. Treatment planning criteria for preparation strategies affected by bite force include tooth location, material selection, occlusion pathways, and subsequent occlusal reduction amounts. When implants are used in patients with elevated magnitude of bite force, an increase in the number and diameter of the implants as well as occlusions with reduced occlusal tables buccolingually and lighter contacts may be recommended. An understanding of the magnitude and load of a patient's bite force can assist the dental clinician in the design of dental treatments along with other standard risk assessment criteria.