Articles - Forum Implantologicum

Article

Feature Article

Mar 04, 2026 // 15 min read

Guidelines for Digital Interocclusal Records: Part 1 – Dentate and Partially Dentate Patients

DOI: 10.63580/ITI.FI.45775

digital scanning digital interocclusal records articulation registration

Abstract

Accurate digital interocclusal registration is fundamental to achieving predictable occlusal relationships in prosthodontic rehabilitation. While digital workflows avoid many material-based limitations of conventional bite records, their accuracy depends on scanner behaviour, scan strategy, and the availability of stable occlusal landmarks. Evidence shows that fully dentate arches can achieve high trueness, whereas accuracy progressively decreases with increasing edentulous span.

This article synthesizes current clinical and scientific evidence on digital interocclusal records for dentate and partially dentate patients. Bilateral buccal scans involving approximately four teeth per side consistently demonstrate the highest accuracy, whereas unilateral and anterior scans show greater susceptibility to lateral drift and alignment error. The article evaluates the role of software-based and AI-assisted alignment tools, emphasizing appropriate use of occlusal collision correction, recognition of algorithmic artefacts, and the need for careful management of soft tissue interference, reflective surfaces, and mandibular deviation during scanning.

In partially dentate cases, accuracy declines significantly once more than three posterior or six anterior teeth are missing. To address geometric discontinuity, auxiliary strategies such as scanning bridges, modified or segmental PVS records, preoperative prosthesis integration, and reference-based alignment through external CAD software are outlined. Verification through occlusal heat maps, articulating paper, or printed prototypes remains essential before definitive prosthesis design.

By combining evidence-based scanning protocols, judicious use of alignment tools, and structured verification, clinicians can achieve predictable and reproducible digital interocclusal relationships across a wide range of dentate and partially dentate clinical scenarios.

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Introduction

Accurate interocclusal registration is central to successful prosthodontic diagnosis and rehabilitation, influencing occlusal harmony, esthetics, and long-term mechanical performance of restorations. Discrepancies at the articulation stage can propagate through the workflow, manifesting as either premature heavy contacts or lack of occlusal contacts, which may require significant chairside adjustment and may lead to increased wear on opposing restorations and technical complications. Digital workflows were introduced to overcome the material and procedural limitations of conventional bite registration; however, they introduce new challenges rooted in software algorithms, surface geometry, and intraoral variability.

In dentate and partially dentate patients, interocclusal records are typically captured at maximum intercuspation (MI) when stable occlusal contacts are present, or in centric relation (CR) when occlusal stability is compromized (Edher et al. 2018; Ren et al. 2020; Revilla-León et al. 2023). Conventional records using wax or elastomeric materials (PVS, polyether) are prone to thermal distortion, elastic recovery, and mounting error (Tejo et al. 2012; Wong et al. 2018; van den Bergh et al. 2024). Digital articulation avoids these material-based issues but relies heavily on the quality of intraoral scan data, stability of occlusal reference points, and the behavior of the underlying alignment algorithms. As reference landmarks decrease with the increase of the edentulous span, the accuracy of best-fit estimation can be compromized, which can distribute alignment error across the dataset, leading to subtle but clinically significant deviations.

This article reviews the clinical techniques and scientific evidence underpinning digital articulation for dentate and partially dentate patients, identifies algorithmic and clinical variables influencing accuracy, and proposes evidence-based clinical strategies to ensure predictable outcomes.

Fig. 1: Example of a) unilateral buccal bite scan, b) bilateral buccal bite scan and c) anterior buccal bite scan

Fig. 2: Intersection of scan data after best fit alignment using the buccal bite scan

Fig. 3: Demonstration of mesh intersection removal when “adjust occlusion” is enabled

Fig. 4: a & b) Deep impinging overbite of the lower anterior teeth into the palatal tissues in a Class II Division 1 malocclusion; c) The intersection between the lower incisors and maxillary soft tissues is visible, and automated software-based intersection correction may introduce significant errors in occlusal registration

Fig. 5: Buccal bite scan which has captured the tongue projection when the patient was in occlusion might reduce the surface area of the teeth for alignment and can influence the accuracy. a) Intraoral photograph showing the tongue projection through the edentulous span; b) buccal bite ccan showing the tongue projection; c) intraoral scans with buccal bite scan (suboptimal alignment can be observed due to the tongue interference)

Fig. 6: Sequential alignment workflow using prosthesis-assisted reference registration. a) Maxillary and mandibular scans with prostheses aligned using a; b) bilateral buccal bite scan; c) into occlusion; d) maxillary and mandibular scans without the prostheses are made and aligned to the scans with the denture using the remaining teeth as references to bring them into the same occlusion; e) final alignment achieved after external software registration of dataset in a to dataset in e, resulting in aligned maxillary and mandibular scans without prostheses