Clinical investigation of the correlation between tooth wear and dynamic functional occlusal condition in Chinese cohort

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This study aimed to investigate the correlation between tooth wear severity and dynamic occlusal patterns in Chinese adults, while evaluating age and gender as risk factors. Methods A cross-sectional study enrolled 300 patients (aged 18–76 years) without parafunctional habits. Dynamic occlusion patterns were classified as canine protected occlusion or group function occlusion. Tooth wear severity was assessed via the Smith & Knight Index across six sextants. Statistical analyses included independent t-tests, ANOVA, chi-square, and binary logistic regression. Results Age ≥ 45 years ( OR = 33.44, P < 0.001), male gender ( OR = 2.20, P = 0.048), and group function occlusion ( OR = 2.21, P = 0.045) independently predicted severe wear. group function occlusion prevalence increased with age (60.9–85.5%), correlating with higher wear severity ( P < 0.001). Males exhibited greater wear than females ( P < 0.05). Posterior molars and mandibular incisors showed predominant dentin exposure. Conclusions Dynamic occlusion patterns, age, and gender significantly influence tooth wear in Chinese adults. The age-dependent shift from canine protected occlusion to group function occlusion reflects biomechanical adaptations to cumulative masticatory forces. An age-stratified strategy should be recommended for prosthodontic rehabilitation: canine protected occlusion preservation in younger patients and GFO-adapted digital restorations for elderly cohorts. Population-specific guidelines addressing Chinese dietary and temporomandibular joint (TMJ) traits are essential for optimizing outcomes. Trial registration Not applicable. Tooth wear Age Gender Dynamic occlusion condition Canine protected occlusion Group function occlusion Chinese population Figures Figure 1 Figure 2 Figure 3 Introduction Tooth wear, defined as the non-carious pathological is the irreversible loss of dental hard tissue caused by mechanical, chemical, or biomechanical factors[ 1 ]. Epidemiological studies report its prevalence ranging from 26.9–90% in adults, with severe cases leading to dentin hypersensitivity, pulpitis, and temporomandibular disorders (TMD)[ 2 – 5 ]. Beyond functional impairments, excessive wear compromises occlusal stability, masticatory efficiency, and facial aesthetics, necessitating complex restorative interventions[ 6 ]. Despite its clinical significance, the multifactorial etiology of tooth wear, particularly its interplay with dynamic occlusal characteristics, remains insufficiently characterized. Risk factors for tooth wear include age, gender, dietary habits, toothbrushing methods, and parafunctional behaviors[ 7 ]. While static occlusal parameters (e.g., overbite, overjet) have been extensively studied[ 8 – 10 ], dynamic occlusal patterns during mandibular movement, such as canine protected occlusion (CPO) versus group function occlusion (GFO), are poorly understood. These patterns govern force distribution across teeth during functional excursions, potentially modulating wear progression. For instance, CPO confines lateral forces to canines, whereas GFO distributes forces across posterior teeth, theoretically accelerating wear in multi-tooth contact zones[ 11 ]. However, evidence linking dynamic occlusion to wear patterns remains scarce, especially in populations with distinct dietary and occlusal traits, such as Chinese adults. The clinical relevance of dynamic occlusion lies in its implications for prosthodontic rehabilitation. Conventional occlusal reconstruction prioritizes static relationships, often neglecting functional movements. This induces the risks of biomechanical mismatch, prosthesis failure, or iatrogenic TMD. The development of digital tools (e.g., electronic axiography, virtual articulators) enable precise analysis of dynamic occlusal trajectories, offering opportunities to optimize restorative designs[ 12 , 13 ]. Nevertheless, population-specific data on dynamic occlusion-to-wear correlations are in absence and need to be investigated. This study aimed to (1) investigate the correlation between tooth wear severity and dynamic lateral occlusion patterns (CPO vs. GFO) in a Chinese cohort and (2) evaluate age and gender as modulating factors. The null hypothesis of this study is that there is no significant correlation between dynamic occlusion and tooth wear. Materials and methods Study population This cross-sectional study consecutively enrolled 300 patients seeking prosthodontic consultation or treatments at the Stomatology Hospital of The Fourth Military Medical University (Xi’an, China) between September 2023 and October 2024. Participants were recruited through convenience sampling after providing informed consent. Ethical approval was obtained from the Ethics Committee of Institutional Review Board, School of Stomatology, The Fourth Military Medical University (IRB-REV-2022135). Inclusion and exclusion criteria Patients were initially included in the study if they presented all of the following conditions: Age ≥ 18. Absence of parafunctional habits (e.g., bruxism) or dietary risk factors (hard/acidic food consumption) Complete or minimally compromised dentition (≤ 2 missing teeth excluding third molars) Ability to comply with clinical examinations. Patients were excluded from the study if they presented one of the following conditions: Severe wear precluding occlusal assessment. Extensive dentition defect (> 2 missing teeth per arch or edentulism). Refusal to participate. Clinical assessment The gender, age, the lateral functional pattern and the wear of occlusal surfaces were collected at the first visit of the participants. Dynamic occlusal evaluation: Lateral functional patterns were classified as CPO or GFO through standardized clinical observation. Participants performed lateral excursions while the examiner visualized working-side contacts using a piece of articulating paper (100 µm thick, BK52, Bausch Germany GmbH, Hainspitz, Thüringen, Germany). CPO was defined as exclusive canine contact on the working side during lateral movement. GFO was defined as tooth contacts between two or more pairs of posterior teeth on the working side, except the canines. Tooth wear quantification: only occlusal wear of incisors, canines, premolars, and molars was scored using the validated Smith & Knight Index[ 14 ]: 0: Intact enamel surface; 1: Enamel surface features lost; 2: Dentin exposure 1/3 surface/incisal loss; 4: Complete loss of occlusal/ incisal enamel, pulp/secondary dentin exposure. The dentition was divided into six sextants: maxillary/mandibular anterior teeth, right/left posterior quadrants. The highest wear score per sextant was recorded, with total wear severity calculated as the sum of sextant scores. Participants were stratified into "no/mild wear" (total score ≤ 2) or "significant wear" (total score > 2). Before the final investigation, a pre-investigation was conducted under standardized conditions that teeth dried under dental chair light, using WHO probes and magnifying loupes (3.5×) so that the kappa coefficient value between the main examiner and the reference examiner was greater than 0.80. Statistical analysis Data were analyzed using SPSS 27.0 software. Continuous variables (wear scores) are presented as mean ± SD; categorical variables (age, gender, occlusion type) as frequencies. Age was categorized into three groups: 18–29, 30–44, and ≥ 45 years. Between-group differences were assessed via independent t-tests or ANOVA with LSD post-hoc comparisons. Chi-square tests compared lateral occlusion type distributions. Binary logistic regression identified risk factors for significant wear. Significance was set at α = 0.05. Results Sample characteristics The study included 300 participants (138 males, 46.0%; 162 females, 54.0%) aged 18–76 years (mean 36.34 ± 13.38). A total of 7,900 teeth were evaluated. The overall mean score of tooth wear index (TWI) was 0.81 ± 0.50. Age-related wear progression Participants were stratified into three age groups: 18–29 years (23.87 ± 3.26), 30–44 years (36.05 ± 4.45), and ≥ 45 years (56.72 ± 7.90). Figure 1 shows the distribution of the wear severity in different age groups. The proportion of intact enamel surfaces (Smith & Knight score = 0) decreased progressively from 62.7% in the youngest cohort to 11.5% in the ≥ 45-year group, while dentin exposure (score ≥ 2) increased from 3.1–34.3% with the increase of age. Spatial analysis revealed age-dependent topographic patterns in Fig. 2 . Posterior dentin exposure predominated in molars, whereas anterior exposure localized to mandibular incisors. These distributions remained consistent across age strata ( P > 0.05 for positional variation by age). Age and gender disparities in tooth wear severity Table 1 shows the differences of tooth wear severity among different age and gender groups. Age stratification revealed significant differences in tooth wear severity ( P < 0.001). Post-hoc analyses demonstrated progressive wear escalation across different age cohorts. Male participants exhibited higher mean wear scores than female ( P < 0.05). This gender disparity persisted across all age strata. Table 1 Differences of tooth wear severity among different age and gender groups Variables(n) Tooth Wear( \(\:\overline{x}\:\) ± s) F/t P value Age 18 ~ 29 (110) 0.40 ± 0.29 a 133.79 < 0.001 30 ~ 44 (121) 0.89 ± 0.40 b ≥ 45 (69) 1.30 ± 0.41 c Gender Female (162) 0.74 ± 0.44 -2.52 0.012 Male (138) 0.89 ± 0.55 a, b, c different superscript lowercase letters indicate a significant difference in the age groups ( P < 0.05) Dynamic occlusion patterns The distributions of lateral functional pattern differed significantly across age groups (Table 2 ). CPO prevalence declined from 39.1% (18–29 years) to 14.5% (≥ 45 years), while GFO prevalence increased from 60.9% (18–29 years) to 85.5% (≥ 45 years). No sex-based differences were observed ( P > 0.05). Table 2 The proportion of lateral functional patterns among different age and gender groups CPO (%) GFO (%) Total χ 2 P value 18 ~ 29 43 (39.1) 67 (60.9) 110 12.25 0.002 30 ~ 44 38 (31.4) 83 (68.6) 121 ≥ 45 10 (14.5) 59 (85.5) 69 Female 43 (26.5) 119 (73.5) 162 2.39 0.122 Male 48 (34.8) 90 (65.2) 138 Among the 300 participants, 91 subjects (27.6%) exhibited bilateral CPO versus 209 (71.6%) with bilateral GFO. Independent t-tests revealed substantially greater wear severity in GFO cases compared to CPO ( P < 0.001), consistent across sextant-based analyses (Table 3 ). Table 3 Differences in the severity of the wear of occlusal surfaces of different lateral functional patterns Area Lateral functional pattern Variables(n) Tooth Wear ( \(\:\overline{x\:}\) ± s) t P value Anterior teeth CPO 182 0.51 ± 0.41 -5.22 < 0.001 GFO 418 0.72 ± 0.50 Premolars CPO 182 0.53 ± 0.50 -5.22 < 0.001 GFO 418 0.79 ± 0.69 Molars CPO 181 0.86 ± 0.69 -6.96 < 0.001 GFO 413 1.31 ± 0.81 Complete dentition CPO 182 0.61 ± 0.40 -7.27 2) as demonstrated in Fig. 3 : Age ≥ 45 years ( OR = 33.44, P < 0.001), Male gender ( OR = 2.20, P = 0.048), as well as GFO ( OR = 2.21, P = 0.045). Participants with GFO exhibited significantly greater odds of severe wear compared to CPO cases, independent of age and sex effects ( OR > 1, P < 0.05). Discussion This cross-sectional study systematically evaluated the correlation between dynamic functional occlusion and tooth wear progression in a Chinese cohort. The findings demonstrated significant correlations between dynamic lateral occlusion patterns, age, gender, and occlusal wear severity. Therefore, the null hypothesis is rejected. Specifically, GFO, advanced age (≥ 45 years), and male gender emerged as independent risk predictors for accelerated tooth wear ( OR > 1, P < 0.05). The dynamic convert from CPO to GFO in Chinese adults with the increase of age was presented in the study. These results align with biomechanical principles of force distribution during functional excursions and for the first time provide population-specific insights into occlusal wear dynamics. The age-dependent escalation of wear severity corroborates global epidemiological trends[ 15 , 16 ], with dentin exposure (Smith & Knight score ≥ 2) rising from 3.1% in young adults (18–29 years) to 34.3% in individuals (≥ 45 years). The result is consistent with previous studies[ 17 , 18 ]. Cumulative masticatory loading cycles, along with progressive biochemical degradation of enamel over time, and age-related physiological declines in salivary buffering capacity and reparative dentinogenesis efficiency, may collectively contribute to the tooth wear in aging populations[ 19 ]. Notably, posterior molars and mandibular incisors exhibited disproportionate wear, reflecting their biomechanical roles. Molars endure vertical compressive forces during mastication (100–500 N in adults)[ 20 ], while incisors experience shear stresses during protrusive guidance. This topographic pattern underscores the need for age-stratified preventive strategies, particularly targeting high-risk zones in elderly patients through early enamel reinforcement or minimally invasive restorations. Gender disparities in wear severity (males: 2.202-fold higher risks than females) persisted across all age strata. This is also consistent with previous reports[ 3 , 4 , 21 – 23 ]. Sex-based differences in masticatory muscle dynamics likely contribute significantly to the observed discrepancy. Males exhibit greater bite forces and a higher prevalence of parafunctional habits, such as bruxism and habitual hard food mastication[ 7 ]. These factors collectively suggest the necessity for gender-specific monitoring protocols in clinical practice, including bite force analysis and dietary counseling for high-risk males. The age-dependent transition from CPO to GFO emerged as a critical pathway mediating occlusal wear progression in the studied Chinese cohort. Significant disparities in lateral functional patterns were observed across age strata ( P < 0.05), with CPO prevalence declining from 39.1% (18–29 years) to 14.5% (≥ 45 years), while GFO increased concomitantly from 60.9–85.5%. The fundings represents a critical biomechanical adaptation to cumulative masticatory loading. Younger individuals benefit from CPO’s protective mechanism, canines dissipate most of the lateral shear forces through their robust root morphology and dense trabecular bone support, thereby shielding posterior teeth from eccentric loading[ 24 ]. Our regression models confirm GFO as an independent wear accelerator ( OR = 2.208, P < 0.05), with posterior molars exhibiting dentin exposure cases, a consequence of sustained vertical forces combined with lateral stress concentrations. Posterior teeth are optimized for vertical loading and would suffer from microfractures and abrasive losses under eccentric forces[ 22 ]. This CPO-GFO transition aligns with physiological aging patterns carries clinical implications for occlusal rehabilitation. These findings underscore the necessity of dynamic occlusal analysis in prosthodontic planning, particularly in populations exhibiting accelerated posterior wear patterns. Occlusal reconstruction for severe tooth wear involves multiple disciplines and remains a consistently challenging issue in prosthodontics. The present study highlights the critical role of dynamic occlusion in prosthodontic rehabilitation and TMD management. The views on the optimal lateral guidance design in dynamic occlusion remain controversial in literature. Advocates of CPO emphasize its biomechanical advantages, citing the lower masticatory muscle electromyography (EMG) activity and reduced joint loading compared to GFO[ 25 – 27 ]. Conversely, opposing studies reported comparable EMG profiles between CPO and GFO configurations, suggesting that increased occlusal contact areas during progressive wear may mitigate cuspal stress through force dispersion, thereby negating clear superiority of either occlusal scheme[ 28 ]. Technological advancements now enable precise integration of dynamic occlusion into treatment planning. The digital integration of cone-beam computed tomography (CBCT), intraoral scans, and electronic axiography data could significantly enhance restoration accuracy[ 29 ]. According to the results of our study, a progressive rehabilitation strategy similar to age-specific protocols was recommended to Chinese adults[ 30 , 31 ]. For younger patients with preserved canine anatomy, CPO-oriented designs optimize force distribution and delay posterior wear. For older patients with established GFO, restorations should replicate acquired functional trajectories using virtual articulators and digital occlusal mapping to prevent joint overloading. However, population-specific norms remain scarce, particularly for Asian cohorts with distinct dietary patterns (e.g., high fibrous food intake) and smaller temporomandibular joint (TMJ) eminence angles altering lateral guidance. Although we gained valuable results, this study has several limitations. First of all, the cross-sectional study design restricts the ability to draw causal inferences about the progression of tooth wear. Furthermore, this study focus on Xi’an, China and it may not fully represent other regions of China. 300 subjects were surveyed in this study, future studies could investigate more areas and subjects in China, which can be conduct further research on the correlation between tooth wear and dynamic occlusal conditions. Conclusions This study identifies GFO, advanced age (≥ 45 years), and male gender as key risk factors for severe tooth wear in Chinese adults. The age-dependent shift from CPO to GFO pattern reflects biomechanical adaptations to cumulative masticatory forces, particularly affecting molars and mandibular incisors. Gender disparities highlight sex-specific biomechanical and behavioral influences. Clinically, age-stratified strategies are recommended for patients undergoing occlusal reconstruction due to severe tooth wear. Specifically, conservative approaches focusing on CPO preservation are advised for younger patients, while elderly cohorts may benefit from GFO-adapted digital restorations. These findings emphasize the need for population-specific guidelines addressing Chinese dietary and TMJ morphological traits to optimize prosthodontic outcomes. Abbreviations CPO Canine protected occlusion GFO Group function occlusion TMJ Temporomandibular joint TMD Temporomandibular disorders EMG Electromyography CBCT Cone-beam computed tomography Declarations Ethics approval and consent to participate The study was received approval from the Ethics Committee of Institutional Review Board, School of Stomatology, The Fourth Military Medical University (IRB-REV-2022135). Informed consent was obtained from the patients prior to data collection. Consent for publication Not applicable. Availability of data and materials The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Funding Financial support from General Project of the State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration (2024MS05), PR China; Xi'an Science and Technology Plan Project (24YXYJ0140); Clinical Research Project of The Fourth Military Medical University (2022LC2242); Clinical New Technology and New Business Project of the Stomatology Hospital of The Fourth Military Medical University (LX2022 - 404); Science and Technology Development Fund of the Stomatology Hospital of The Fourth Military Medical University (2023JZ009); The Special Project of National Clinical Research Center for Oral Diseases (LCC202205); 2024 New Nursing Technology Project of Stomatology Hospital of The Fourth Military Medical University (HX2024 - 007). Authors' contributions C. Guo contributed to investigation, analysis, and interpretation, drafted manuscript; C.Y. Yang contributed to analysis; Y. Li contributed to interpretation; X.Y. Zhang contributed to analysis; Z.R. Liu contributed to analysis; B.Y. Qiu contributed to interpretation, critically revised manuscript; H.H. Yu contributed to interpretation, critically revised manuscript; M. Meng contributed to conception and design, critically revised manuscript; L. Zhang contributed to conception and design, critically revised manuscript. All authors gave their final approval and agree to be accountable for all aspects of the work. Acknowledgements We would like to express our sincere gratitude to the patients for their consent and cooperation. References Loomans B, Opdam N, Attin T, Bartlett D, Edelhoff D, Frankenberger R, Benic G, Ramseyer S, Wetselaar P, Sterenborg B, et al. Severe Tooth Wear: European Consensus Statement on Management Guidelines. 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Cite Share Download PDF Status: Published Journal Publication published 29 Sep, 2025 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 09 May, 2025 Reviews received at journal 08 May, 2025 Reviews received at journal 07 May, 2025 Reviewers agreed at journal 29 Apr, 2025 Reviewers agreed at journal 25 Apr, 2025 Reviewers invited by journal 24 Apr, 2025 Editor invited by journal 21 Apr, 2025 Editor assigned by journal 19 Apr, 2025 Submission checks completed at journal 19 Apr, 2025 First submitted to journal 15 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6454764","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":448501123,"identity":"74937ee4-cd70-405f-bc88-f55584e32cbe","order_by":0,"name":"Chang Guo","email":"","orcid":"","institution":"Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chang","middleName":"","lastName":"Guo","suffix":""},{"id":448501124,"identity":"ca3fe5e5-c425-41e1-9f8c-bb0e9d38e963","order_by":1,"name":"Chuangyang Yang","email":"","orcid":"","institution":"Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chuangyang","middleName":"","lastName":"Yang","suffix":""},{"id":448501125,"identity":"5239eca4-2d2b-4696-8a77-1a27e88b9468","order_by":2,"name":"Yan Li","email":"","orcid":"","institution":"Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Li","suffix":""},{"id":448501126,"identity":"084f4e9f-24b0-427e-a76e-caeb5c898674","order_by":3,"name":"Xinyi Zhang","email":"","orcid":"","institution":"Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xinyi","middleName":"","lastName":"Zhang","suffix":""},{"id":448501127,"identity":"fa6bc67c-825c-45f6-ab24-683338f9130d","order_by":4,"name":"Biying Qiu","email":"","orcid":"","institution":"Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Biying","middleName":"","lastName":"Qiu","suffix":""},{"id":448501128,"identity":"093d44e5-c79f-4ad8-89ac-299168a981db","order_by":5,"name":"Haohan Yu","email":"","orcid":"","institution":"Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Haohan","middleName":"","lastName":"Yu","suffix":""},{"id":448501129,"identity":"47ca00b7-7e1a-4439-86de-90c8a4126a0e","order_by":6,"name":"Zengrui Liu","email":"","orcid":"","institution":"Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zengrui","middleName":"","lastName":"Liu","suffix":""},{"id":448501130,"identity":"194e1776-1c74-403b-b279-b5b10e289a45","order_by":7,"name":"Meng Meng","email":"","orcid":"","institution":"Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University","correspondingAuthor":false,"prefix":"","firstName":"Meng","middleName":"","lastName":"Meng","suffix":""},{"id":448501131,"identity":"3920b4f2-cedc-4886-b486-5aa195af03f2","order_by":8,"name":"Ling Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYBACPgYeMM3YAMQPKkBMZuYGvFrYEFqYmQ3OgLUwEq+FTeIM3EZ8WvjPHvxc8ItBtl+6/1jFgYrD0fztQC0/KrbhseVcsvTMPgbjmXMOs904cCYtd8ZhxgbGnjO3cWth7DGQ5u1hSNxwI5nt9sc2m9wGoBZmxjY8Wph5jH+DtOwHaik42CaRO5+gFjYeM2meH0BbJJLZGA4CbdlAUAsPj5k1b4OE8YwbycYSIL9sBGo5iM8v/PxnjG/z/LGR7Z+R+PADMMRy550/fPDBjwrcWsCAsU0CVeAAfvUg8IewklEwCkbBKBjBAACCl1cBJQh/SQAAAABJRU5ErkJggg==","orcid":"","institution":"Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University","correspondingAuthor":true,"prefix":"","firstName":"Ling","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2025-04-15 12:23:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6454764/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6454764/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-025-06924-0","type":"published","date":"2025-09-29T15:57:13+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82122429,"identity":"14e46e71-35bf-473a-a16e-487aaf181365","added_by":"auto","created_at":"2025-05-07 03:29:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":11070,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of the wear severity in different age groups\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6454764/v1/29a9b095e38db8b2ba16d840.png"},{"id":82122432,"identity":"10e7dbf6-0d42-4994-8a5a-325e48c195cd","added_by":"auto","created_at":"2025-05-07 03:29:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30163,"visible":true,"origin":"","legend":"\u003cp\u003eAge-dependent topographic distribution of dentin exposure (Smith \u0026amp; Knight Index ≥ 2) by tooth position\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6454764/v1/aacb5f9fbe57078176c0741f.png"},{"id":82122431,"identity":"b35a59e1-60a1-4576-96e3-ac49708440cf","added_by":"auto","created_at":"2025-05-07 03:29:02","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":29776,"visible":true,"origin":"","legend":"\u003cp\u003eRisk factor analysis of occlusal wear within different groups\u003c/p\u003e","description":"","filename":"Onlinefloatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6454764/v1/fa5e2197887a4a2fe8aeff68.png"},{"id":92884141,"identity":"d70ef155-3c9c-426a-b54a-a6f6fa1cb06b","added_by":"auto","created_at":"2025-10-06 16:12:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":831693,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6454764/v1/4a4043b6-3e90-439d-8425-c7eacecf4a27.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical investigation of the correlation between tooth wear and dynamic functional occlusal condition in Chinese cohort","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTooth wear, defined as the non-carious pathological is the irreversible loss of dental hard tissue caused by mechanical, chemical, or biomechanical factors[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Epidemiological studies report its prevalence ranging from 26.9\u0026ndash;90% in adults, with severe cases leading to dentin hypersensitivity, pulpitis, and temporomandibular disorders (TMD)[\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Beyond functional impairments, excessive wear compromises occlusal stability, masticatory efficiency, and facial aesthetics, necessitating complex restorative interventions[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Despite its clinical significance, the multifactorial etiology of tooth wear, particularly its interplay with dynamic occlusal characteristics, remains insufficiently characterized.\u003c/p\u003e \u003cp\u003eRisk factors for tooth wear include age, gender, dietary habits, toothbrushing methods, and parafunctional behaviors[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. While static occlusal parameters (e.g., overbite, overjet) have been extensively studied[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], dynamic occlusal patterns during mandibular movement, such as canine protected occlusion (CPO) versus group function occlusion (GFO), are poorly understood. These patterns govern force distribution across teeth during functional excursions, potentially modulating wear progression. For instance, CPO confines lateral forces to canines, whereas GFO distributes forces across posterior teeth, theoretically accelerating wear in multi-tooth contact zones[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, evidence linking dynamic occlusion to wear patterns remains scarce, especially in populations with distinct dietary and occlusal traits, such as Chinese adults.\u003c/p\u003e \u003cp\u003eThe clinical relevance of dynamic occlusion lies in its implications for prosthodontic rehabilitation. Conventional occlusal reconstruction prioritizes static relationships, often neglecting functional movements. This induces the risks of biomechanical mismatch, prosthesis failure, or iatrogenic TMD. The development of digital tools (e.g., electronic axiography, virtual articulators) enable precise analysis of dynamic occlusal trajectories, offering opportunities to optimize restorative designs[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Nevertheless, population-specific data on dynamic occlusion-to-wear correlations are in absence and need to be investigated.\u003c/p\u003e \u003cp\u003eThis study aimed to (1) investigate the correlation between tooth wear severity and dynamic lateral occlusion patterns (CPO vs. GFO) in a Chinese cohort and (2) evaluate age and gender as modulating factors. The null hypothesis of this study is that there is no significant correlation between dynamic occlusion and tooth wear.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThis cross-sectional study consecutively enrolled 300 patients seeking prosthodontic consultation or treatments at the Stomatology Hospital of The Fourth Military Medical University (Xi\u0026rsquo;an, China) between September 2023 and October 2024. Participants were recruited through convenience sampling after providing informed consent. Ethical approval was obtained from the Ethics Committee of Institutional Review Board, School of Stomatology, The Fourth Military Medical University (IRB-REV-2022135).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion and exclusion criteria\u003c/h3\u003e\n\u003cp\u003ePatients were initially included in the study if they presented all of the following conditions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;18.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAbsence of parafunctional habits (e.g., bruxism) or dietary risk factors (hard/acidic food consumption)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eComplete or minimally compromised dentition (\u0026le;\u0026thinsp;2 missing teeth excluding third molars)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAbility to comply with clinical examinations.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003ePatients were excluded from the study if they presented one of the following conditions:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eSevere wear precluding occlusal assessment.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eExtensive dentition defect (\u0026gt;\u0026thinsp;2 missing teeth per arch or edentulism).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eRefusal to participate.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e\n\u003ch3\u003eClinical assessment\u003c/h3\u003e\n\u003cp\u003eThe gender, age, the lateral functional pattern and the wear of occlusal surfaces were collected at the first visit of the participants.\u003c/p\u003e \u003cp\u003eDynamic occlusal evaluation: Lateral functional patterns were classified as CPO or GFO through standardized clinical observation. Participants performed lateral excursions while the examiner visualized working-side contacts using a piece of articulating paper (100 \u0026micro;m thick, BK52, Bausch Germany GmbH, Hainspitz, Th\u0026uuml;ringen, Germany). CPO was defined as exclusive canine contact on the working side during lateral movement. GFO was defined as tooth contacts between two or more pairs of posterior teeth on the working side, except the canines.\u003c/p\u003e \u003cp\u003eTooth wear quantification: only occlusal wear of incisors, canines, premolars, and molars was scored using the validated Smith \u0026amp; Knight Index[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]:\u003c/p\u003e \u003cp\u003e0: Intact enamel surface;\u003c/p\u003e \u003cp\u003e1: Enamel surface features lost;\u003c/p\u003e \u003cp\u003e2: Dentin exposure\u0026thinsp;\u0026lt;\u0026thinsp;1/3 surface/incisal loss;\u003c/p\u003e \u003cp\u003e3: Dentin exposure\u0026thinsp;\u0026gt;\u0026thinsp;1/3 surface/incisal loss;\u003c/p\u003e \u003cp\u003e4: Complete loss of occlusal/ incisal enamel, pulp/secondary dentin exposure.\u003c/p\u003e \u003cp\u003eThe dentition was divided into six sextants: maxillary/mandibular anterior teeth, right/left posterior quadrants. The highest wear score per sextant was recorded, with total wear severity calculated as the sum of sextant scores. Participants were stratified into \"no/mild wear\" (total score\u0026thinsp;\u0026le;\u0026thinsp;2) or \"significant wear\" (total score\u0026thinsp;\u0026gt;\u0026thinsp;2).\u003c/p\u003e \u003cp\u003eBefore the final investigation, a pre-investigation was conducted under standardized conditions that teeth dried under dental chair light, using WHO probes and magnifying loupes (3.5\u0026times;) so that the kappa coefficient value between the main examiner and the reference examiner was greater than 0.80.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS 27.0 software. Continuous variables (wear scores) are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD; categorical variables (age, gender, occlusion type) as frequencies. Age was categorized into three groups: 18\u0026ndash;29, 30\u0026ndash;44, and \u0026ge;\u0026thinsp;45 years. Between-group differences were assessed via independent t-tests or ANOVA with LSD post-hoc comparisons. Chi-square tests compared lateral occlusion type distributions. Binary logistic regression identified risk factors for significant wear. Significance was set at α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSample characteristics\u003c/h2\u003e \u003cp\u003eThe study included 300 participants (138 males, 46.0%; 162 females, 54.0%) aged 18\u0026ndash;76 years (mean 36.34\u0026thinsp;\u0026plusmn;\u0026thinsp;13.38). A total of 7,900 teeth were evaluated. The overall mean score of tooth wear index (TWI) was 0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAge-related wear progression\u003c/h3\u003e\n\u003cp\u003eParticipants were stratified into three age groups: 18\u0026ndash;29 years (23.87\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26), 30\u0026ndash;44 years (36.05\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45), and \u0026ge;\u0026thinsp;45 years (56.72\u0026thinsp;\u0026plusmn;\u0026thinsp;7.90). Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the distribution of the wear severity in different age groups. The proportion of intact enamel surfaces (Smith \u0026amp; Knight score\u0026thinsp;=\u0026thinsp;0) decreased progressively from 62.7% in the youngest cohort to 11.5% in the \u0026ge;\u0026thinsp;45-year group, while dentin exposure (score\u0026thinsp;\u0026ge;\u0026thinsp;2) increased from 3.1\u0026ndash;34.3% with the increase of age. Spatial analysis revealed age-dependent topographic patterns in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Posterior dentin exposure predominated in molars, whereas anterior exposure localized to mandibular incisors. These distributions remained consistent across age strata (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05 for positional variation by age).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eAge and gender disparities in tooth wear severity\u003c/h3\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the differences of tooth wear severity among different age and gender groups. Age stratification revealed significant differences in tooth wear severity (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Post-hoc analyses demonstrated progressive wear escalation across different age cohorts. Male participants exhibited higher mean wear scores than female (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This gender disparity persisted across all age strata.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDifferences of tooth wear severity among different age and gender groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariables(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTooth Wear(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\overline{x}\\:\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn; s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF/t\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026thinsp;~\u0026thinsp;29 (110)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.29 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e133.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026thinsp;~\u0026thinsp;44 (121)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;45 (69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale (162)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale (138)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003csup\u003ea, b, c\u003c/sup\u003e different superscript lowercase letters indicate a significant difference in the age groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eDynamic occlusion patterns\u003c/h2\u003e \u003cp\u003eThe distributions of lateral functional pattern differed significantly across age groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). CPO prevalence declined from 39.1% (18\u0026ndash;29 years) to 14.5% (\u0026ge;\u0026thinsp;45 years), while GFO prevalence increased from 60.9% (18\u0026ndash;29 years) to 85.5% (\u0026ge;\u0026thinsp;45 years). No sex-based differences were observed (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe proportion of lateral functional patterns among different age and gender groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCPO (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGFO (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026thinsp;~\u0026thinsp;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (39.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e12.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026thinsp;~\u0026thinsp;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (31.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83 (68.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59 (85.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (26.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119 (73.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (34.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90 (65.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the 300 participants, 91 subjects (27.6%) exhibited bilateral CPO versus 209 (71.6%) with bilateral GFO. Independent t-tests revealed substantially greater wear severity in GFO cases compared to CPO (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), consistent across sextant-based analyses (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDifferences in the severity of the wear of occlusal surfaces of different lateral functional patterns\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArea\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLateral functional pattern\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVariables(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTooth Wear\u003c/p\u003e \u003cp\u003e(\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\overline{x\\:}\\)\u003c/span\u003e\u003c/span\u003e\u0026plusmn; s)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAnterior teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCPO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-5.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGFO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePremolars\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCPO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-5.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGFO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMolars\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCPO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.86\u0026thinsp;\u0026plusmn;\u0026thinsp;0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-6.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGFO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eComplete dentition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCPO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e-7.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGFO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e418\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e0.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eRisk factors analysis\u003c/h2\u003e \u003cp\u003eBinary logistic regression identified three independent predictors of significant occlusal wear (total TWI\u0026thinsp;\u0026gt;\u0026thinsp;2) as demonstrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e: Age\u0026thinsp;\u0026ge;\u0026thinsp;45 years (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;33.44, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), Male gender (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.20, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048), as well as GFO (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.21, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.045). Participants with GFO exhibited significantly greater odds of severe wear compared to CPO cases, independent of age and sex effects (\u003cem\u003eOR\u003c/em\u003e \u0026gt; 1, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis cross-sectional study systematically evaluated the correlation between dynamic functional occlusion and tooth wear progression in a Chinese cohort. The findings demonstrated significant correlations between dynamic lateral occlusion patterns, age, gender, and occlusal wear severity. Therefore, the null hypothesis is rejected. Specifically, GFO, advanced age (\u0026ge;\u0026thinsp;45 years), and male gender emerged as independent risk predictors for accelerated tooth wear (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;1, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The dynamic convert from CPO to GFO in Chinese adults with the increase of age was presented in the study. These results align with biomechanical principles of force distribution during functional excursions and for the first time provide population-specific insights into occlusal wear dynamics.\u003c/p\u003e \u003cp\u003eThe age-dependent escalation of wear severity corroborates global epidemiological trends[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], with dentin exposure (Smith \u0026amp; Knight score\u0026thinsp;\u0026ge;\u0026thinsp;2) rising from 3.1% in young adults (18\u0026ndash;29 years) to 34.3% in individuals (\u0026ge;\u0026thinsp;45 years). The result is consistent with previous studies[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Cumulative masticatory loading cycles, along with progressive biochemical degradation of enamel over time, and age-related physiological declines in salivary buffering capacity and reparative dentinogenesis efficiency, may collectively contribute to the tooth wear in aging populations[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Notably, posterior molars and mandibular incisors exhibited disproportionate wear, reflecting their biomechanical roles. Molars endure vertical compressive forces during mastication (100\u0026ndash;500 N in adults)[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], while incisors experience shear stresses during protrusive guidance. This topographic pattern underscores the need for age-stratified preventive strategies, particularly targeting high-risk zones in elderly patients through early enamel reinforcement or minimally invasive restorations.\u003c/p\u003e \u003cp\u003eGender disparities in wear severity (males: 2.202-fold higher risks than females) persisted across all age strata. This is also consistent with previous reports[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Sex-based differences in masticatory muscle dynamics likely contribute significantly to the observed discrepancy. Males exhibit greater bite forces and a higher prevalence of parafunctional habits, such as bruxism and habitual hard food mastication[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These factors collectively suggest the necessity for gender-specific monitoring protocols in clinical practice, including bite force analysis and dietary counseling for high-risk males.\u003c/p\u003e \u003cp\u003eThe age-dependent transition from CPO to GFO emerged as a critical pathway mediating occlusal wear progression in the studied Chinese cohort. Significant disparities in lateral functional patterns were observed across age strata (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with CPO prevalence declining from 39.1% (18\u0026ndash;29 years) to 14.5% (\u0026ge;\u0026thinsp;45 years), while GFO increased concomitantly from 60.9\u0026ndash;85.5%. The fundings represents a critical biomechanical adaptation to cumulative masticatory loading. Younger individuals benefit from CPO\u0026rsquo;s protective mechanism, canines dissipate most of the lateral shear forces through their robust root morphology and dense trabecular bone support, thereby shielding posterior teeth from eccentric loading[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Our regression models confirm GFO as an independent wear accelerator (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.208, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with posterior molars exhibiting dentin exposure cases, a consequence of sustained vertical forces combined with lateral stress concentrations. Posterior teeth are optimized for vertical loading and would suffer from microfractures and abrasive losses under eccentric forces[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This CPO-GFO transition aligns with physiological aging patterns carries clinical implications for occlusal rehabilitation. These findings underscore the necessity of dynamic occlusal analysis in prosthodontic planning, particularly in populations exhibiting accelerated posterior wear patterns.\u003c/p\u003e \u003cp\u003eOcclusal reconstruction for severe tooth wear involves multiple disciplines and remains a consistently challenging issue in prosthodontics. The present study highlights the critical role of dynamic occlusion in prosthodontic rehabilitation and TMD management. The views on the optimal lateral guidance design in dynamic occlusion remain controversial in literature. Advocates of CPO emphasize its biomechanical advantages, citing the lower masticatory muscle electromyography (EMG) activity and reduced joint loading compared to GFO[\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Conversely, opposing studies reported comparable EMG profiles between CPO and GFO configurations, suggesting that increased occlusal contact areas during progressive wear may mitigate cuspal stress through force dispersion, thereby negating clear superiority of either occlusal scheme[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Technological advancements now enable precise integration of dynamic occlusion into treatment planning. The digital integration of cone-beam computed tomography (CBCT), intraoral scans, and electronic axiography data could significantly enhance restoration accuracy[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. According to the results of our study, a progressive rehabilitation strategy similar to age-specific protocols was recommended to Chinese adults[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. For younger patients with preserved canine anatomy, CPO-oriented designs optimize force distribution and delay posterior wear. For older patients with established GFO, restorations should replicate acquired functional trajectories using virtual articulators and digital occlusal mapping to prevent joint overloading. However, population-specific norms remain scarce, particularly for Asian cohorts with distinct dietary patterns (e.g., high fibrous food intake) and smaller temporomandibular joint (TMJ) eminence angles altering lateral guidance.\u003c/p\u003e \u003cp\u003eAlthough we gained valuable results, this study has several limitations. First of all, the cross-sectional study design restricts the ability to draw causal inferences about the progression of tooth wear. Furthermore, this study focus on Xi\u0026rsquo;an, China and it may not fully represent other regions of China. 300 subjects were surveyed in this study, future studies could investigate more areas and subjects in China, which can be conduct further research on the correlation between tooth wear and dynamic occlusal conditions.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study identifies GFO, advanced age (\u0026ge;\u0026thinsp;45 years), and male gender as key risk factors for severe tooth wear in Chinese adults. The age-dependent shift from CPO to GFO pattern reflects biomechanical adaptations to cumulative masticatory forces, particularly affecting molars and mandibular incisors. Gender disparities highlight sex-specific biomechanical and behavioral influences. Clinically, age-stratified strategies are recommended for patients undergoing occlusal reconstruction due to severe tooth wear. Specifically, conservative approaches focusing on CPO preservation are advised for younger patients, while elderly cohorts may benefit from GFO-adapted digital restorations. These findings emphasize the need for population-specific guidelines addressing Chinese dietary and TMJ morphological traits to optimize prosthodontic outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCPO Canine protected occlusion\u003c/p\u003e \u003cp\u003eGFO Group function occlusion\u003c/p\u003e \u003cp\u003eTMJ Temporomandibular joint\u003c/p\u003e \u003cp\u003eTMD Temporomandibular disorders\u003c/p\u003e \u003cp\u003eEMG Electromyography\u003c/p\u003e \u003cp\u003eCBCT Cone-beam computed tomography\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was received approval from the Ethics Committee of Institutional Review Board, School of Stomatology, The Fourth Military Medical University (IRB-REV-2022135). Informed consent was obtained from the patients prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFinancial support from General Project of the State Key Laboratory of Oral \u0026amp; Maxillofacial Reconstruction and Regeneration (2024MS05), PR China; Xi\u0026apos;an Science and Technology Plan Project (24YXYJ0140); Clinical Research Project of The Fourth Military Medical University (2022LC2242); Clinical New Technology and New Business Project of the Stomatology Hospital of The Fourth Military Medical University (LX2022 - 404); Science and Technology Development Fund of the Stomatology Hospital of The Fourth Military Medical University (2023JZ009); The Special Project of National Clinical Research Center for Oral Diseases (LCC202205); 2024 New Nursing Technology Project of Stomatology Hospital of The Fourth Military Medical University (HX2024 - 007).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eC. Guo contributed to investigation, analysis, and interpretation, drafted manuscript; C.Y. Yang contributed to analysis; Y. Li contributed to interpretation; X.Y. Zhang contributed to analysis; Z.R. Liu contributed to analysis; B.Y. Qiu contributed to interpretation, critically revised manuscript; H.H. Yu contributed to interpretation, critically revised manuscript; M. Meng contributed to conception and design, critically revised manuscript; L. Zhang contributed to conception and design, critically revised manuscript. All authors gave their final approval and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to the patients for their consent and cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLoomans B, Opdam N, Attin T, Bartlett D, Edelhoff D, Frankenberger R, Benic G, Ramseyer S, Wetselaar P, Sterenborg B, et al. Severe Tooth Wear: European Consensus Statement on Management Guidelines. 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Int Dent J. 1998;48(6):571\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbduo J, Tennant M. Impact of lateral occlusion schemes: A systematic review. J Prosthet Dent. 2015;114(2):193\u0026ndash;204. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.prosdent.2014.04.032\u003c/span\u003e\u003cspan address=\"10.1016/j.prosdent.2014.04.032\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Tooth wear, Age, Gender, Dynamic occlusion condition, Canine protected occlusion, Group function occlusion, Chinese population","lastPublishedDoi":"10.21203/rs.3.rs-6454764/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6454764/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe relationship between tooth wear and dynamic occlusal patterns, such as canine protected occlusion (CPO) versus group function occlusion (GFO), are poorly understood. This study aimed to investigate the correlation between tooth wear severity and dynamic occlusal patterns in Chinese adults, while evaluating age and gender as risk factors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study enrolled 300 patients (aged 18\u0026ndash;76 years) without parafunctional habits. Dynamic occlusion patterns were classified as canine protected occlusion or group function occlusion. Tooth wear severity was assessed via the Smith \u0026amp; Knight Index across six sextants. Statistical analyses included independent t-tests, ANOVA, chi-square, and binary logistic regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;45 years (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;33.44, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), male gender (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.20, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048), and group function occlusion (\u003cem\u003eOR\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.21, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.045) independently predicted severe wear. group function occlusion prevalence increased with age (60.9\u0026ndash;85.5%), correlating with higher wear severity (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Males exhibited greater wear than females (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Posterior molars and mandibular incisors showed predominant dentin exposure.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eDynamic occlusion patterns, age, and gender significantly influence tooth wear in Chinese adults. The age-dependent shift from canine protected occlusion to group function occlusion reflects biomechanical adaptations to cumulative masticatory forces. An age-stratified strategy should be recommended for prosthodontic rehabilitation: canine protected occlusion preservation in younger patients and GFO-adapted digital restorations for elderly cohorts. Population-specific guidelines addressing Chinese dietary and temporomandibular joint (TMJ) traits are essential for optimizing outcomes.\u003c/p\u003e\u003ch2\u003eTrial registration\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Clinical investigation of the correlation between tooth wear and dynamic functional occlusal condition in Chinese cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 03:28:57","doi":"10.21203/rs.3.rs-6454764/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-09T11:59:08+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-08T13:53:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-07T08:04:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37451931804348310028777230942079815807","date":"2025-04-30T01:12:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181893566465097693388815377968298597549","date":"2025-04-25T12:30:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-24T11:45:42+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-21T13:53:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-19T11:02:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-19T10:59:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-04-15T12:11:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"16d72b28-f6a8-42d3-ab3e-34e04fcc9a2d","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T16:08:16+00:00","versionOfRecord":{"articleIdentity":"rs-6454764","link":"https://doi.org/10.1186/s12903-025-06924-0","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2025-09-29 15:57:13","publishedOnDateReadable":"September 29th, 2025"},"versionCreatedAt":"2025-05-07 03:28:57","video":"","vorDoi":"10.1186/s12903-025-06924-0","vorDoiUrl":"https://doi.org/10.1186/s12903-025-06924-0","workflowStages":[]},"version":"v1","identity":"rs-6454764","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6454764","identity":"rs-6454764","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}