ABSTRACT
Introduction:
In stomatology, the evaluation of bite power is crucial. It is considered a significant objective approach to evaluating masticatory performance. Bite force has become a significant outcome analysis index for various therapies in dentistry research. Presently several devices being used globally have their graces and faults. They are costly and also not available easily to the general dental practitioner.
Objectives:
Development of a novel indigenous instrument for the measurement of human bite force.
Methods:
This paper describes an indigenously developed and researched instrument to measure human bite force. The sensor data (change in electronic resistance under applied force) will be read by the microprocessor and converted to force values in newton. The bite force result will be instantly displayed on the screen of the instrument and the device with which it is connected.
Results:
The developed instrument is handy and user-friendly and can measure bite force accurately and repeatedly.
Conclusions:
In this research paper, an economical, lightweight, user-friendly, accurate, and reproducible human bite force measurement device is explained, which has been developed indigenously.
KEYWORDS: Bite force, economical, medical device, masticatory performance, wireless
INTRODUCTION
The bite force is regarded as an objective indicator of oral function. Biting force, regardless of occlusal state, is a critical factor in determining masticatory performance.[1-4] So, in restorative dentistry, evaluating bite force is regarded as a crucial step in diagnosis and treatment planning. Moreover, both in clinical and epidemiological contexts, it is thought to be a relevant indicator for examining the relationship between oral and general health.
Several commercially available tools exist today to measure bite force. The T-Scan (Tekscan, USA) system performs occlusal assessments employing a thin pressure sensing sheet.[5,6] Despite its reputation as a reliable instrument for assessing bite force and pressure distribution, it is unreliable for determining the greatest bite force.[7] Dental Prescale (GC Corp., Japan) is another system available that employs pressure-sensitive sheets.[8,9] It is comparatively more economical than the T-scan system. This system can very effectively assess the bite force and pressure distribution but an extra specific tool is needed to scan the pressure-sensitive sheet. Additionally, only after clenching at the intercuspal location can it map the pressure distribution. Another technology is the MPX5700 (Motorola, USA) pneumatic pressure transducer system. This device can only be used with air as a medium to maintain precision and reliability.[10,11] Another device is the GM10 Occlusal Force-Meter (NAGANO KEIKI Co., Ltd., Japan), which comprises a vinyl biting part with a hydraulic pressure gauge.[7] Other systems that are available and used in various investigations include those based on strain gauges[12,13] and optical fibers.[14] Because of their larger size and mass, these devices may be inappropriate for measurements.
Considering the importance of bite force measurement in dentistry and the unavailability of a simple, handy, economical, and precise instrument to measure bite force this study was undertaken to develop an indigenous novel device.
METHODS
In this study, an affordable, wireless, modular instrument has been developed to precisely measure bite forces. Two basic structures make up the measurement system head and body [Figure 1a and b]. The body encases firmware for data collecting, and the head has a sensor for measuring the bite force.
Figure 1.
(a): Schematic diagram of the device. (b): Actual device
The body is made up of polypropylene plastic, having dimensions 116.56 mm × 34.5 mm × 34.50 mm. The body has a switch on and off button, and a charging unit in which any standard USB charger will work. It contains lithium-ion batteries which will be fully charged in ~1.5 hours and the device can be operated for a week. The body has an Organic light-emitting diode (OLED) screen of size 0.96” where we can see the output force in newton, pressure in kilopascal, and weight in grams. The body has a logo on top of the OLED screen and a small torch at top of the body over the logo. A torch may help in positioning the head part better intraorally. Also, here there is a Bluetooth low energy (BLE) indicator that shows the status of the connectivity of the instrument with a computer or smartphone.
The head part of the device is made up of stainless steel, having dimensions 69.12 mm × 10 mm × 6.6 mm. It consists of two plates of stainless steel carefully designed and accurately machined. A biting portion of the head is having a circular biting platform of dimension 10 mm diameter and 18 mm height. The compression forces are measured by a commercially available piezoresistive sensor called the FlexiForce force Sensor (Tekscan, Boston, MA, USA). The polyester-coated pressure sensor measures 191 mm in length and has a 9.53 mm-diameter sensing surface. Additionally, it can function between −40°C and 60°C. For precise measurements, it is crucial to apply forces just to the sensors 9.53 mm-diameter detecting region.
When a force is applied to the sensor (the FlexiForce force sensor), the resistance of the sensing element changes and is inversely proportional to the applied load. This resistance change (analog signal) is then transmitted to the microcontroller board where it is converted into digital values by an Arduino UNO development board. The software on the microcontroller board analyses these digital values and produces force values. The results, which are bite force values, are immediately visible on the OLED screen of the device. Simultaneously, these values can also be seen on a computer or smartphone when two devices are connected through WIFI. An application has been designed for this purpose.
Method of operation of device
To operate the device first we must switch on the device. The OLED screen will lighten up and it will show “connect the device.” Also, the BLE indicator will blink. Now we must connect the device to the software preinstalled either in the mobile phone or laptop through Bluetooth or WIFI. At the first time, it will take a minute or two for this setup. Later, both the devices will connect instantly as soon as the software will be opened and the WIFI is on. And when both devices are connected BLE indicator will remain stable. Now the OLED screen and the software both will show a force, pressure, and weight 0 in newton, psi, and kg, respectively. Now the device is ready to take the measurements [Figure 2].
Figure 2.
Schematic representation of the use of the device
A disposable polyethylene plastic bag sleeve must be put on the biting portion of the head part and then the biting circular part will be kept on the tooth where we want to take the record of maximum biting force. As this is a single-tooth variant, placing it directly between the concerned teeth will measure the biting force of that tooth. And if we want to measure the maximum biting force of the segment, that group of teeth, or that quadrant, then we can use the acrylic stents. So as soon as the individual will start biting on that circular biting platform OLED screen and the software will instantly show changes in the reading. When the patient will stop biting, readings will return to zero. The software will show the graph from the initial contact to the last contact. Now we can save the data after putting the name, date, and other details needed. This data can be transferred to any concerned person and also stored for future use.
DISCUSSION
The combined activity of the muscles in the jaw elevator, as modified by the biomechanics of the craniomandibular joint and reflex processes, produces the maximum bite force in humans.[15,16] Its empirical evaluation is widely applied in dentistry, such as when assessing the therapeutic effects of prosthetic devices. A clinician can effectively design a treatment to avoid failure with the knowledge of a maximal bite force. For a clinical assessment to determine whether quick loading of a dental implant is feasible, measurement of the maximum bite force is crucial.
In the literature, a wide range of biting force values have been documented. Both physiological and methodological factors play a major role in this diversity.[17,18] There are numerous techniques and recording tools, from straightforward springs to more sophisticated electronic gadgets.[7,19-21] As contributing factors, general physiological and anatomical traits of the participants including craniofacial morphology, age, gender, periodontal support of teeth, and dental state must be considered.[16]
Several studies have already validated the use of a FlexiForce force sensor (Tekscan, Boston, MA, USA) to estimate bite force.[22,23] A change in the conductance of the sensor caused by forces acting on its sensing region produces an electric current that can be amplified, seen, and recorded.[7,24] These sensors reported 93% reliability. According to some research, 18 mm has been chosen as the height of the biting area since it appears to be the size that is most comfortable for using full jaw force. To assure accuracy, the circular part of the bite section offers a smooth, flat, and consistent surface against the sensor during the force applied. To make the device’s head easily reusable, it is advised that you use a disposable polyethylene plastic bag sleeve. The device with the name “Human bite force measurement device” is under patent process with application number 202131007326.
CONCLUSION AND LIMITATIONS
The reliability, accuracy, user-friendliness, lightweight, wireless capability, upgradability, and affordability of the proposed instrument encourage its application in an experimental and clinical setting. This device might not be easily used for completely edentulous patients. The use of a splint is advised while using the device since the hard metallic surface of the biting part may be discomforting to the patient.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The authors would like to thank Innovatios technology, Bangalore for the engineering part (Development of the software and hardware of the device).
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