Occlusal Force Analysis With T-scan and Innobyte in Adult Patients: A Prospective Study

Occlusal Force Analysis With T-scan and Innobyte in Adult Patients: A Prospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Occlusal Force Analysis With T-scan and Innobyte in Adult Patients: A Prospective Study Mauro Lorusso, Fariba Esperouz, Elena D’Angelo, Michele Tepedino, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8887279/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract This prospective study investigated differences in occlusal force among adult patients with various vertical skeletal patterns and evaluated the association between total occlusal force and the centre of force position. Ninety-six subjects (46 females, 50 males; mean age 26.4 ± 0.4 years) with Angle Class I malocclusion were enrolled and classified as hyperdivergent, normodivergent, and hypodivergent according to the SN-MP angle. Digital occlusal analysis was performed using the T-Scan Novus system to assess occlusal contact time and centre of force position at maximum intercuspation, while maximum occlusal force was recorded using the Innobyte device. The centre of force was classified as anterior, centred, or posterior based on its spatial location within the dental arch. Intergroup comparisons were conducted using Welch ANOVA with Games-Howell post hoc tests, and a generalized linear model evaluated the association between occlusal force and centre of force position (α = 0.05). Hypodivergent subjects showed the highest total occlusal force and occlusion time (513 N, 7.9 s), while hyperdivergent individuals exhibited the lowest (399.54 N, 6.93 s). In hypodivergent subjects, the centre of force was mainly anterior (70.7%), whereas in hyperdivergent individuals it was predominantly posterior (76.41%). A significant association was observed between total occlusal force and centre of force position (p < 0.001). Pairwise comparisons showed higher occlusal force (+ 54.61 N, p < 0.05) associated with an anterior centre of force (+ 116.78 N; p < 0.001) compared with the posterior group. Overall, increased occlusal force correlated with an extended time required to reach maximum intercuspation. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research T-Scan Innobyte Digital occlusal analysis Vertical growth Centre of force Occlusal force Figures Figure 1 Figure 2 INTRODUCTION Occlusal force analysis is a fundamental aspect of orthodontic and prosthetic treatment planning. Previous studies have demonstrated that occlusal function cannot be fully understood by static evaluation of dental arches and supporting skeletal structures alone, as mastication depends on the dynamic interaction among teeth, jaws, masticatory muscles, and surrounding soft tissues, including lips and cheeks [ 1 ]. For this reason, assessment of occlusal forces has been widely recognised as an important indicator of functional balance within the stomatognathic system. Optimization of masticatory function is a fundamental objective of orthodontic treatment, particularly in patients with complex malocclusions. Modifications of occlusal contacts can significantly influence masticatory dynamics and neuromuscular activity, requiring careful planning to achieve a new functional equilibrium [ 2 , 3 ]. This consideration is especially relevant in cases involving dental impactions, where alterations in occlusal relationships may affect both force distribution and functional stability [ 4 , 5 ]. Previous investigations have also highlighted the importance of evaluating changes in the occlusal plane with respect to facial growth pattern and dental arch morphology [ 6 ]. Furthermore, gradual introduction of occlusal changes has been recommended to allow physiological adaptation of the stomatognathic system, thereby minimising the risk of periodontal overload and temporomandibular joint dysfunction [ 7 , 8 ]. Several diagnostic tools have been developed to evaluate occlusal force and occlusal dynamics. Among these, the T-Scan system has been widely used to provide quantitative information on occlusal contacts, centre of force (COF), intercuspation timing, and relative force distribution between hemiarches [ 9 ]. The T-Scan device also facilitates assessment of the occlusal centre of gravity, which is defined as the point where the resultant of all occlusal forces is applied. From a functional perspective, identification of the location of the centre of gravity is critical for understanding the coordination of the neuromuscular system and its role in maintaining occlusal equilibrium and functional stability [ 10 ]. While the T-Scan system can be used to conduct a detailed qualitative assessment of occlusal dynamics, including contact timing, distribution, and centre of force, it does not provide absolute quantification of occlusal force [ 10 ]. Accurate measurement of occlusal force is complex, because it is modulated by several factors, including: craniofacial morphology, dental contact patterns, occlusal scheme, and the presence of malocclusions or parafunctional habits. These variables must be carefully considered in order to accurately interpret occlusal data in both clinical and research settings [ 11 ]. Occlusal forces are not uniformly distributed along the dental arch, but instead follow a biomechanical gradient shaped by occlusal anatomy, which is the pattern of tooth contacts, and the functional dynamics of the masticatory system. Evidence from the literature indicates that the region of Maximum Occlusal Load (MOL) is typically localised at the mesiopalatal cusp of the maxillary first molars[ 12 ]. The magnitude and distribution of occlusal forces are influenced by specific occlusal characteristics, which determine the number, location, and quality of tooth contacts. A physiologically balanced occlusion promotes biomechanically efficient force distribution, whereas, malocclusions can compromise these dynamics by reducing occlusal forces during mandibular elevation, potentially compromising masticatory efficiency [ 13 , 14 ]. Recent evidence supports an association between craniofacial morphology, particularly vertical divergence and masticatory muscle characteristics that may influence occlusal force generation. A systematic review and meta-analysis [ 15 ] reported that hyperdivergent individuals present significantly reduced masseter muscle dimensions compared with normodivergent and hypodivergent subjects, suggesting a morphological substrate for lower force capacity across vertical skeletal patterns. Consistently, clinical studies evaluating maximum bite force across facial morphologies have reported differences attributable to vertical pattern classifications and related cephalometric features [ 16 ]. In addition, skeletal indicators linked to vertical morphology, such as the gonial angle, have been shown to correlate inversely with maximum occlusal force in posterior regions, reinforcing the biomechanical relationship between craniofacial form and occlusal loading [ 17 ]. Beyond force magnitude, computerized occlusal analysis has enabled objective assessment of occlusal force distribution and centre of force parameters under different functional and occlusal conditions, providing a reliable tool for quantitative analysis [ 18 ]. However, evidence linking these parameters to craniofacial growth patterns remains limited. Despite the recognised importance of occlusal loading in clinical diagnostics and treatment planning, the quantitative relationship between occlusal force magnitude and skeletal divergence remains insufficiently investigated. Furthermore, the association between occlusal force magnitude and the spatial position of the occlusal centre of force remains unclear. A clearer understanding of these relationships is essential for comprehensive functional evaluation of the stomatognathic system and for improving orthodontic treatment planning. While various factors influence occlusal loading, including skeletal and arch morphology [ 6 ], muscle function, and dental occlusion, the relationship between craniofacial growth patterns and occlusal force remains insufficiently explored. Therefore, the objective of the present study was to investigate whether different craniofacial growth patterns are associated with variations in occlusal force magnitude and to evaluate the correlation between occlusal force and the position of the occlusal centre of force. MATERIALS AND METHODS All procedures described in this research protocol were conducted in accordance with the Declaration of Helsinki and received approval from the Ethics Committee of the University of Foggia. (approval number 46/CE/2025). This study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational research [ 19 ]. Ninety-six participants (46 females and 50 males), with a mean age of 26.4 ± 0.4 years were enrolled based on the following inclusion criteria: Angle Class I malocclusion and a symmetrical dental arch. Exclusion criteria were: the presence of dental agenesis; periodontal disease; loss of one or more teeth; extensive dental restorations; fixed or removable prostheses; temporomandibular joint (TMJ) disorders; and current or previous orthodontic treatment. All study participants were healthy adults, and all were undergraduate students at the University of Foggia, who were prospectively enrolled after signing an informed consent form to participate. Participants were prospectively enrolled from 01/2025 to 09/2025. Study participants were divided into three groups according to their facial divergence. To classify subjects according to vertical divergence, the SN-MP angle cut-off values reported by the Italian Board of Orthodontics (IBO) and the European Board of Orthodontics (EBO) were used: Hyperdivergent subjects: SN-MP > 35.5° Normodivergent subjects: 30.5 ≤ SN-MP ≤ 35.5° Hypodivergent subjects: SN-MP < 30.5° The cephalometric characteristics of the study sample are listed in Table 1 . A priori power analysis was performed using G*Power (version 3.1.9.2; Franz Faul, Universität Kiel, Germany). To detect an effect size of 0.4 using a one-way Anova test with an alpha level of 0.05 and a statistical power of 0.90 (1 − β), a minimum sample size of 28 participants per group was required [ 20 ]. The measurements were carried out at the university dental clinic by two of the authors, both experienced orthodontists. To minimize random errors, cephalometric measurements were repeated after a 15-day interval by a single calibrated examiner. The random error was calculated using Dahlberg’s formula ( S =√∑ d 2 / 2 N ), where d is the difference between the first and second measurements and N the number of radiographs evaluated ([ 21 , 22 ]. The random error ranged between 0.2 and 0.3 degrees. Measurement Protocol The T-Scan Novus system (Tekscan Inc., South Boston, MA, USA) was used for digital occlusal analysis [ 23 ]. The system includes a handpiece connected to a computer via USB and a support base for mounting interchangeable piezoelectric sensor foils, 100 µm in thickness and available in various sizes. The sensor is pressure-sensitive and records occlusal forces by detecting changes in electrical resistance during tooth contact. Data acquisition occurs in real time, allowing the system to record key parameters, including the timing, location, contact distribution, and relative force percentages of occlusal contacts. This enabled a detailed, dynamic evaluation of occlusal function during mandibular closure into maximum intercuspation. Occlusal analysis was first performed using the T-Scan Novus system (Tekscan Inc., Boston, MA, USA), a computerized device that enables dynamic recording of occlusal contacts. All recordings were conducted with participants seated upright in a dental chair, with their heads relaxed and supported by the headrest. For each subject, a sensor of appropriate size was selected based on the individual’s specific dental arch morphology. The sensor was accurately positioned between the upper and lower central incisors, ensuring that the handle remained parallel to the occlusal plane throughout the recording process. The sensor was placed intraorally, and the patient was instructed to occlude in maximum intercuspation (MI). An initial single recording of approximately 5–7 seconds was captured, followed by three consecutive recordings to ensure reproducibility. The T-Scan software enabled dynamic analysis of occlusal function, allowing for the evaluation of the following parameters: Occlusal centre of force: defined as the spatial position of the occlusal centroid during MI, and categorised as anterior, central, or posterior. Occlusal contact time: defined as the duration (in seconds) from the initial occlusal contact to the achievement of MI (point B). This parameter was automatically calculated by the software as the time interval between the first detected contact and the point of maximum force distribution. The position of the centre of force (COF) was determined during the bite registration phase, at maximum intercuspation, ensuring full engagement of the teeth in their natural occlusal relationship. Using the T-Scan system, the COF was recorded as the point where the resultant occlusal load was concentrated. Based on its spatial location relative to the dental arch, the COF was classified into one of three categories: Anterior: indicating that the COF was localised toward the anterior region (incisor/canine area) of the dental arch; Centred: indicating that the COF was located precisely at the geometric centroid of the occlusal contact area; Posterior: indicating that the COF was localised toward the posterior region (premolar/molar area) of the dental arch. Figure 1 illustrates the centre of force position across the three study groups. The Innobyte [Kube Innovation Inc.] system is a medical device designed to measure maximum occlusal force, both unilaterally and across the entire dental arch [ 11 ]. It consists of two main components: a handheld measuring unit and a fluid-filled mouthpiece. The device is capable of recording occlusal forces ranging from 0 to 2000 N, with a measurement accuracy of ± 5%. When the patient bites down on the mouthpiece, the applied force is transmitted uniformly through the fluid medium, allowing for accurate detection by internal sensors in the instrument. The measured force values are displayed in real time on the LED screen of the main unit, with output provided in Newtons. Each reading provides the total occlusal force, as well as the occlusal force distribution between the left and right sides of the arch. For each measurement, the recording sensor was positioned intraorally between the dental arches, and the central notch was aligned with the patient's maxillary and mandibular central incisors. Data acquisition was initiated by activating the control button on the handpiece, and the patient was instructed to perform a maximal voluntary clench. Upon completion of the force recording, the mouthpiece was carefully removed, and the patient was asked to swallow. After swallowing, the patient was told to maintain a relaxed mandibular rest position for 10 seconds before the subsequent measurement. To ensure data consistency and minimize intra-individual variability, a multibite scan protocol was implemented, consisting of three consecutive bite recordings per study participant. During measurements, the standardized thickness of the mouthpiece positioned between the dental arches prevented physiological occlusion by maintaining a controlled interocclusal separation. Figure 2 shows the Innobyte device used for the measurements. Statistical analysis Data were analysed using GraphPad Prism software 6.0 (GraphPad Prism Software, San Diego, CA, USA). The primary null hypothesis stated that no significant correlation existed between facial growth pattern and occlusal force; the secondary null hypothesis stated that no significant correlation existed between occlusal force and the position of the centre of force. Table 2 presents the descriptive statistics of occlusal force and occlusion time for the study sample, categorised according to skeletal divergence, along with the Kolmogorov-Smirnov normality test. The occlusion time, obtained from the T-Scan system, was calculated as the time interval between the first occlusal contact during mandibular closure and achievement of maximum intercuspation. Table 3 reports the values of the centre of force position, categorisation of the COF as anterior, or posterior and results from the Kolmogorov-Smirnov normality test. Because the variances were not homogeneous, a Welch ANOVA test was performed, followed by a Games–Howell post hoc test, in order to compare total occlusal force and occlusion time among the groups (Tables 4 A-B). The Holm-Bonferroni correction for multiple testing was also performed. Finally, a generalised linear model (GLM) was applied to determine if the total occlusal force was associated with the position of the centre of force (Tables 5 and 6 ). Statistical significance was set at p < 0.05. No missing data were recorded for the variables of interest. RESULTS All eligible subjects agreed to participate in the study, and no dropouts were recorded during data collection. Preliminary analyses showed no statistically significant differences between males and females in the main outcome variables. Accordingly, sex was not retained as a relevant factor in subsequent analyses, and the sample was analysed as a single cohort because the distribution of males and females was homogeneous across the analysed groups. Table 2 highlights a significant finding: the hypodivergent group exhibited the highest total occlusal force and occlusion time (513 N and 7.9 seconds, respectively), while the hyperdivergent group showed the lowest values (399.54 N and 6.93 seconds) for these parameters. Moreover, Table 3 shows that in the hypodivergent group, the centre of force was predominantly located anteriorly (70.7%), whereas in the hyperdivergent group, the COF was found to be mainly positioned posteriorly (76.41%). Figure 3 illustrates the mean total occlusal force among the three groups. Differences in total force and occlusion time between groups were found to be statistically significant (both p < 0.001); and post hoc pairwise comparisons using the Games–Howell test (Table 4 B) revealed significant differences in total occlusal force among the groups. Specifically, normodivergent patients demonstrated a total occlusal force that was 54.61 N higher than that measured for the hyperdivergent group (p < 0.05). Moreover, hypodivergent patients exhibited significantly greater forces compared to both normodivergent and hyperdivergent groups, with increases of 62.17 N and 116.78 N, respectively (p < 0.01). In addition to occlusal force differences, occlusion time durations for normodivergent patients were also significantly longer, by 0.96 seconds, than for hyperdivergent patients, while hypodivergent patients showed a 0.88 second increase in occlusion time duration relative to the hyperdivergent group (p < 0.05). Application of a generalised linear model revealed a statistically significant association between total occlusal force and the position of the centre of force ( p < 0.001). Regarding sex distribution, no statistically significant differences were observed (p = 0.176). Pairwise comparisons (Table 6 ) further indicate that individuals with a centred COF exhibited a total occlusal force 54.61 N greater than those with a posteriorly located centre of force ( p < 0.05). Moreover, study subjects with an anteriorly localised centre of force demonstrated the highest occlusal force values, with an increase of 116.78 N compared to those with a posterior COF ( p < 0.001). Therefore, both the primary and secondary null hypothesis were rejected. Table 1 Cephalometric data of the sample SAMPLE DIVERGENCE ANGLE(SN-GoMe) STANDARD DEVIATION MINIMUM MAXIMUM HYPERDIVERGENT (15F, 17M n = 32) 36.1 0.4 34.4 37.6 NORMODIVERGENT (16F,16M n = 32) 32 0.5 30.6 33.1 HYPODIVERGENT (15F,17M n = 32) 29.4 0.6 26.9 28.2 Table 2 Descriptive statistics of occlusal force and occlusion time for the sample categorized by skeletal divergence NORMODIVERGENT(n = 32) HYPERDIVERGENT(n = 32) HYPODIVERGENT(n = 32) Force Timing Force Timing Force Timing Mean 455.91 7.74 399.54 6.93 513.3 7.9 Median 456.17 8 395.67 6,92 500.33 7.29 standard deviation 90.2 1.38 122.03 0.89 125.32 1.54 minimum 348 5.68 227.67 5.66 300.67 5 maximum 667 10,.35 709 8.85 699.33 10.21 passed normality test YES YES YES YES YES YES Table 3 Descriptive statistics of center of force position categorized as anterior or posterior expressed in percentage CENTER OF FORCE NORMODIVERGENT HYPERDIVERGENT HYPODIVERGENT Ant. (%) Post. (%) Ant. (%) Post. (%) Ant. (%) Post. (%) mean 48.56 51.43 23.59 76.41 70.07 29.93 median 47.9 52.1 23.4 76.6 68.9 31.1 standard deviation 3.84 3.84 4.35 4.35 5.06 5.06 minimum 42.3 44.3 14.9 69.1 60.7 20.4 maximum 55.7 57.7 30.9 85.1 79.6 39.3 passed normality test YES YES YES YES YES YES Table 4 A: Welch-Anova test for the total force and the occlusion time between the group Statistic df1 df2 p Total force 15.439 2 129.243 0.000** Occlusion time 14.640 2 127.083 0.000** **p < 001; Table 4 B: Games-Howell’s post hoc test and Holm-Bonferroni correction for multiple tests Dependent variable Group (I) Group (J) Mean difference (I-J) Std.error Sig. Holm-Bonferroni correction Lower bound (CI 95%) Upper bound (CI 95%) Normo Hyper 54.607** 16.736 0.004 0.012 14.926 94.288 TOTAL FORCE Hypo Normo 62.169** 19.779 0.006 0.012 15.186 109.152 Hypo Hyper 116.776** 21.143 0.000 0.0000 66.627 166.925 Normo Hyper 0.956** 0.192 0.000 0.000 0.500 1.412 OCCLUSION TIME Hypo Normo -0.079 0.261 0.95 0.95 -0.700 0.540 Hypo Hyper 0.876* 0.245 0.002 0.008 0.293 1.460 **p < 001; Table 5 Results of the generalized linear model (GLM) assessing the effect of center of force position on total occlusal force. Origin Type III Wald Chi-square df Sig. (Intercept) 134399.809 1 0.000 Center of force 37.048 2 0.000 Dependent variable: TOTAL FORCE Model: (Intercept), CENTER OF FORCE Table 6 Pairwise comparison of the center of force position categorized as anterior, posterior, and centered Center of force (I) Center of force (J) Mean difference (I-J) Std. errr df Sig. Lower bound (CI 95%) Upper bound (CI 95%) Centered Posterior 54.607 ** 18.062 1 0.003 19.204 90.010 Anterior Centered 62.169 ** 20.593 1 0.003 21.806 102.531 Anterior Posterior 116.776** 19.467 1 0.000 78.620 154.933 **p < 001; DISCUSSION The present study explored the complex relationships between occlusal force and position of the centre of force in adult patients. This interaction is clinically relevant in orthodontics and related disciplines such as prosthodontics and gnathology, because it can be used to guide the planning and execution of effective therapeutic strategies. In modern populations, the force required to chew most foods is substantially lower than the maximum voluntary bite force. However, maximum occlusal force reflects the biomechanical and neuromuscular capacity of the craniofacial system rather than routine masticatory demands. Although not fully utilized during daily chewing, it appears to play a relevant role during growth in influencing craniofacial morphology. Bite force is known to vary with the degree of gape. However, in the present study, force recordings were performed using a mouthpiece of standardized thickness, ensuring a consistent degree of gape across all participants. Variations in the fluid within the device were dependent solely on the magnitude of the applied biting force. Additionally, all subjects were adults with stable neuromuscular and skeletal characteristics (CS5), minimizing potential confounding effects related to growth. Detailed data analysis revealed a statistically significant correlation between craniofacial morphology and functional occlusal parameters, such as occlusion time and total occlusal force. Total occlusal force was significantly greater in the hypodivergent group (513.3N), followed by the normodivergent group (455.91N), while the hyperdivergent subjects exhibited the lowest occlusal force values of the entire study sample (399.54N). These findings align well with the known biomechanical characteristics of each group. For example, hypodivergent individuals are characterised by a compact craniofacial morphology and an anteriorly rotated mandible with a relatively horizontal mandibular plane and have been shown to exhibit enhanced masticatory efficiency [ 24 ]. This increased efficiency is largely attributed to greater functional capacity and hypertrophy of the masseter and temporalis muscles [ 25 , 26 ]. In contrast, hyperdivergent individuals typically present with a long-face skeletal pattern and reduced masticatory muscle development, often accompanied by functional weakness of the masticatory apparatus. This diminished muscular performance likely contributes to decreased masticatory efficiency and, subsequently, lower occlusal force generation. Occlusion time at maximum intercuspation was found to be clearly associated with vertical skeletal divergence, and statistically significant differences were indentified among the groups. Specifically, hypodivergent individuals had the longest occlusion times and hyperdivergent subjects had the shortest occlusion times, while occlusion time durations were intermediate for normodivergent patients. This pattern closely parallels the total occlusal force distribution observed for each group, further supporting the interplay between craniofacial morphology and functional occlusal dynamics. Analysis of the total occlusal force and occlusion time revealed a notable trend: higher occlusal force was associated with a longer occlusion time in order to reach maximum intercuspation. This finding suggests that increased force generation may require a more gradual or controlled mandibular closure, potentially reflecting adaptive neuromuscular coordination in response to greater occlusal load. The present findings corroborate previous evidence indicating greater occlusal stability among hypodivergent individuals. As reported by Gomes et al.[ 27 ], hypodivergent patients typically exhibit more stable and evenly distributed occlusal contacts. The demonstrated synergy between increased occlusal force and prolonged occlusion time in hypodivergent subjects likely reflects a more efficient functional balance, characterised by a controlled and coordinated mandibular closure pattern. In contrast, individuals with increased vertical skeletal dimensions displayed faster occlusal dynamics, which may be indicative of reduced stability. This accelerated occlusal time, coupled with lower occlusal forces, suggests less efficient neuromuscular and masticatory function, potentially predisposing these patients to functional imbalances [ 28 , 29 ]. An important finding emerging from the present study is the significant relationship between the location of the centre of force and total occlusal force. Study participants exhibiting an anteriorly positioned centre of force demonstrated significantly greater occlusal forces compared to those with a central or posteriorly localised COF. This observation suggests that an anteriorly directed occlusal load may enable more favourable and efficient masticatory function, potentially due to enhanced intercuspation and optimised load distribution across the dental arches. In contrast, subjects with a posteriorly localised centre of force showed reduced occlusal force values, which may indicate compromised functional efficiency. This pattern could be attributed to less stable intercuspation and unfavourable occlusal contact distribution [ 30 ]. Hypodivergent subjects exhibited an anteriorly positioned centre of force along with higher occlusal force values. Their skeletal-muscular configuration provides mechanical advantages to the masticatory muscles, allowing for more efficient function and a greater ability to generate occlusal forces. This may be attributed to a more compact facial structure, which is often characterised by a shorter mandibular ramus and reduced vertical dimension, which could promote a more functionally efficient distribution of occlusal loads [ 31 ]. In contrast, hyperdivergent individuals exhibited a posterior centre of force, associated with lower occlusal force values. This morphological pattern appears to be linked to a reduced ability to generate high-intensity occlusal forces. In hyperdivergent subjects, mandibular retrusion combined with increased vertical dimension and posterior mandibular rotation likely compromises occlusal stability, resulting in a narrower and less-balanced distribution of occlusal loads [ 32 ]. Biomechanically, the mandible can be considered to be a third-class lever, where the force is applied between the fulcrum and the resistance. The fulcrum corresponds to the temporomandibular joint (TMJ), while the force is generated at the insertion point of the masticatory muscles (ideally at the mandibular angle), and the resistance is represented by the occlusal load, ideally located at the site of maximum dental contact [ 33 , 34 ]. Although the mandible maintains the characteristics of a third-class lever, its function becomes significantly more mechanically advantageous in hypodivergent individuals, because of anatomical adaptations that alter the spatial relationships between the fulcrum, the applied force, and the resistance. In this context, the occlusal load (i.e. the resistance) is positioned more anteriorly, thereby maximizing the lever arm of the elevator muscles. This morphotype is typically characterised by a reduced vertical facial dimension and a shorter, more robust mandibular ramus. The resulting mechanical advantage leads to greater neuromuscular efficiency and increased resistance to fatigue, as the masticatory muscles are able to generate higher forces with reduced effort. Conversely, hyperdivergent subjects are often characterised by longer and thinner bony bases, associated with an increased distance between the temporomandibular joint and the mandibular angle, and thus an increased lever arm. Thus, the distance between the applied force and the resistance relative to the fulcrum increases, as both the power and resistance arms are positioned farther from the fulcrum, and the system requires greater muscular effort to overcome the resistance. However, this configuration allows for wider and faster movements. Consequently, to lift a load (resistance) and apply the necessary force for movement, the masticatory muscles must generate greater force, resulting in increased energy expenditure. This dynamic has direct neurophysiological implications, because hyperdivergent individuals must apply greater muscular effort. This leads to increased recruitment of motor units within type II muscle fibres (which are stronger but less fatigue-resistant) to compensate for the biomechanical disadvantage. The consequent overload of type II muscle fibres contributes to the overall reduced occlusal force and earlier onset of neuromuscular fatigue Application of a generalised linear model revealed a particularly noteworthy finding: occlusal force was significantly associated with the position of the centre of force. Specifically, the highest force values were observed in individuals with an anteriorly positioned centre of force, corresponding to hypodivergent subjects; conversely, the lowest occlusal force values were found in subjects with a posteriorly positioned centre of force, corresponding to hyperdivergent individuals. The variation in occlusal force as a function of the position of the centre of force and craniofacial morphology can be explained by considering the complex neurophysiological and biomechanical mechanisms of the masticatory muscles, particularly those involving the recruitment of motor units. The force generated by a muscle depends on the number of motor units activated and the frequency of their discharge. According to Henneman’s size principle, motor units are recruited in an orderly fashion from the smallest to the largest, based on an increasing threshold [ 35 , 36 ]. Smaller motor units are associated with a lower threshold, smaller diameter motor neurons and typically innervate type I slow-twitch muscle fibres. These muscle fibres are highly fatigue-resistant and are recruited during low-intensity, sustained activities. As the demand for force increases, larger motor units with high-threshold motor neurons are progressively recruited. These innervate type II fast-twitch muscle fibres, which, in contrast, are more susceptible to fatigue [ 37 ].This graded recruitment pattern has also been proposed for the masticatory muscles. It has been proposed that hypodivergent individuals tend to recruit a greater proportion of type II muscle fibres, whereas hyperdivergent individuals rely more heavily on type I fibres. The consequent overload of type II muscle fibres contributes to an overall reduced occlusal force and earlier onset of neuromuscular fatigue. Maximum occlusal force is a multifactorial parameter influenced not only by craniofacial morphology but also by several biological and behavioural variables. Body mass index has been reported to correlate positively with occlusal force, likely reflecting greater overall muscle mass and an increased cross-sectional area of the masticatory muscles[ 13 , 38 ]. Similarly, masticatory muscle thickness, particularly of the masseter and temporalis muscles, plays a key role in force generation, as greater muscle thickness is associated with enhanced neuromuscular recruitment and higher force-producing capacity [ 25 , 39 ]. Parafunctional habits such as bruxism and clenching may further modulate occlusal force by inducing adaptive changes in muscle activity and morphology [ 40 ]; depending on individual neuromuscular response, these habits may result either in increased maximal force due to muscle hypertrophy or in reduced efficiency secondary to fatigue and altered motor control [ 10 ]. In addition, sex-related differences in occlusal force have been widely reported and are generally attributed to differences in muscle mass and hormonal influences. However, these differences tend to be less pronounced in homogeneous adult samples with completed craniofacial growth. Nevertheless, in the present study no statistically significant sex-related differences were detected. This finding may be attributed to comparable lifestyle patterns, genetic backgrounds, and similar dietary habits within the analyzed sample, which may have contributed to minimizing sex-related variability. The data obtained in the present study indicate that a hypodivergent craniofacial morphotype is associated with a configuration that optimises masticatory biomechanics, enhancing neuromuscular efficiency and resulting in an increased capacity to generate occlusal forces. From a clinical perspective, the present findings highlight the importance of considering craniofacial morphology when evaluating occlusal function. Differences in occlusal force magnitude, occlusion time, and centre of force position among vertical skeletal patterns suggest that hypodivergent and hyperdivergent patients exhibit distinct functional and biomechanical characteristics. Incorporating digital occlusal analysis into orthodontic diagnosis may provide valuable information beyond static occlusal relationships, allowing clinicians to better identify functional imbalances and adapt treatment strategies accordingly. In particular, assessment of occlusal force distribution and centre of force position may support more individualized treatment planning, potentially improving functional stability and reducing the risk of occlusal overload or dysfunction following orthodontic therapies. Limitations of the study The absence of electromyographic analysis of the masticatory muscles represents a limitation, and other variables known to influence occlusal force, such as body mass index or muscle thickness, were not specifically evaluated. Although the study had a prospective design, causal inferences cannot be fully established. In addition, the inclusion of young adult subjects limits the generalizability of the findings. Future investigations involving larger sample sizes and integrated electromyographic assessments are necessary to validate and expand upon the present findings. CONCLUSIONS Hypodivergent individuals have a biomechanical advantage, characterised by higher occlusal forces and prolonged contact times, in contrast, hyperdivergent subjects have diminished occlusal force and altered contact dynamics. Normodivergent individuals represent an intermediate phenotype, maintaining balanced occlusal function and force distribution. These findings suggest that considering craniofacial morphology and occlusal centre of force analyses may contribute to more complete diagnosis and treatment planning in occlusal and orthodontic therapies, potentially supporting improved functional outcomes and minimising dysfunction. Declarations DATA AVAILABILITY STATEMENT: The data supporting the findings are available from the corresponding author upon reasonable requests. AUTHOR CONTRIBUTION: M.T.: Conceptualization; M.L.: Data Curation; L.L.M.: Formal Analysis; E.D.: Investigation; E.D. AND F.E: Methodology; L.L.M.: Project Administration; F.E.: Resources; A.P.C.: Software; L.L.R. AND D.C.: Supervision; L.L.R. Validation; A.P.C.: Visualization; M.L.: Writing – Original Draft Preparation; D.C. AND M.L.: Writing – Review & Editing. COMPETING INTERESTS: The authors declare no competing interests. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. ACKNOWLEDGMENT: Bando PRA 2023 - University of Foggia CORRESPONDING AUTOR: Dott.ssa Elena D’Angelo; e-mail: [email protected] References Velasquez, B. et al. Occlusal Analysis in Natural Dentition: Systematic Review. Eur. J. Dent. 17 (3), 615–622 (2023). Lorusso, M. et al. The Efficacy of the RME II System Compared with the Sander Bite-Jumping Appliance: A Retrospective Study . J. Clin. Med. , 14 (11). (2025). Therkildsen, N. M. & Sonnesen, L. Bite Force, Occlusal Contact and Pain in Orthodontic Patients during Fixed-Appliance Treatment . Dent. J. (Basel) , 10 (2). (2022). Ciavarella, D. et al. Treatment of Mandibular Impacted Canine in a Patient with Class II Division 1 Malocclusion with Reverse Pin: A Case Report . Med. (Kaunas) , 59 (10). (2023). Di Carlo, G. et al. Prevalence of maxillary canine impaction in skeletal Class III malocclusions compared to Class I malocclusions. J. Clin. Exp. Dent. 11 (3), e264–e268 (2019). Ciavarella, D. et al. The Correlation between Mandibular Arch Shape and Vertical Skeletal Pattern . Med. (Kaunas) , 59 (11). (2023). Staderini, E. et al. Analysis of the Changes in Occlusal Plane Inclination in a Class II Deep Bite Teen Patient Treated with Clear Aligners: A Case Report . Int. J. Environ. Res. Public. Health , 19 (2). (2022). Qadeer, S. et al. Comparison of excursive occlusal force parameters in post-orthodontic and non-orthodontic subjects using T-Scan(R) III. Cranio 36 (1), 11–18 (2018). Popa, A. D. et al. Aspects of Occlusal Recordings Performed with the T-Scan System and with the Medit Intraoral Scanner . Diagnostics (Basel) , 14 (13). (2024). Chowdhary, R. & Sonnahalli, N. K. Clinical applications of the T-Scan quantitative digital occlusal analysis technology: a systematic review. Int. J. Comput. Dent. 27 (1), 49–86 (2024). Ciavarella, D. et al. Evaluation of occlusal force in Class II subdivision malocclusion. J. Oral Rehabil . 51 (9), 1813–1820 (2024). Wang, Q. et al. In vivo evaluation of T-Scan in quantifying occlusal contact. J. Oral Rehabil . 51 (9), 1675–1683 (2024). Kaur, H. et al. Effect of various malocclusion on maximal bite force- a systematic review. J. Oral Biol. Craniofac. Res. 12 (5), 687–693 (2022). Tariq, M. et al. Assessment of Changes in Craniofacial Structures, Bite Force and Periodontal Status Following Fixed Functional Appliance Therapy. Turk. J. Orthod. 36 (1), 22–29 (2023). Togninalli, D., Antonarakis, G. S. & Papadopoulou, A. K. Relationship between craniofacial skeletal patterns and anatomic characteristics of masticatory muscles: a systematic review and meta-analysis. Prog Orthod. 25 (1), 36 (2024). Shirai, M. et al. Effects of gum chewing exercise on maximum bite force according to facial morphology. Clin. Exp. Dent. Res. 4 (2), 48–51 (2018). Miwa, S. et al. Gonial Angle Measured by Orthopantomography as a Predictor of Maximum Occlusal Force. J. Prosthodont. 28 (1), e426–e430 (2019). Cohen-Levy, J. et al. Is the quality of occlusal contacts comparable after aligner and fixed orthodontic therapy? A non-randomized cohort comparison using computerized occlusal analysis during 6 months of retention. Cranio 42 (6), 788–800 (2024). von Elm, E. et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int. J. Surg. 12 (12), 1495–1499 (2014). Cohen, J. Statistical Power Analysis. Curr. Dir. Psychol. Sci. 1 (3), 98–101 (1992). Houston, W. J. The analysis of errors in orthodontic measurements. Am. J. Orthod. 83 (5), 382–390 (1983). Dahlberg, G. Statistical Methods for Medical and Biological Students (G. Allen & Unwin Limited, 1940). Reich, K. M. et al. A comparative study of digital and conventional occlusal indicators: accuracy and reliability of the T-Scan Novus, wax occlusogram, and articulating silk in clinical application. J. Dent. 156 , 105695 (2025). Yoon, Y. J. et al. Correlation of masticatory muscle activity and occlusal function with craniofacial morphology: a prospective cohort study. Clin. Oral Investig . 27 (9), 5367–5376 (2023). Ispir, N. G. & Toraman, M. The relationship of masseter muscle thickness with face morphology and parafunctional habits: an ultrasound study. Dentomaxillofac Radiol. 51 (8), 20220166 (2022). Pumklin, J. et al. Effects of occlusal conditions on masseter and temporalis muscle activity: An electromyographic evaluation. Saudi Dent. J. 35 (8), 946–952 (2023). Gomes, S. G. et al. Masticatory features, EMG activity and muscle effort of subjects with different facial patterns. J. Oral Rehabil . 37 (11), 813–819 (2010). Okkesim, A. & Misirlioglu, M. Assessing masseter muscle volume and activity in relation to craniofacial morphology: a 3D CBCT study. Oral Radiol. 41 (1), 25–32 (2025). Simoes, J. C. M. et al. Relationship between bite force, occlusal contact area, and three-dimensional facial soft tissue in dentofacial deformities. Codas 36 (3), e20230203 (2024). Gomes, S. G. et al. Chewing side, bite force symmetry, and occlusal contact area of subjects with different facial vertical patterns. Braz Oral Res. 25 (5), 446–452 (2011). Liaw, J. J. L. & Park, J. H. Orthodontic considerations in hypodivergent craniofacial patterns. J. World Fed. Orthod. 13 (1), 18–24 (2024). Knigge, R. P. et al. Geometric morphometric analysis of growth patterns among facial types. Am. J. Orthod. Dentofac. Orthop. 160 (3), 430–441 (2021). Gingerich, P. D. The human mandible: lever, link, or both? Am. J. Phys. Anthropol. 51 (1), 135–137 (1979). Daqiq, O. et al. Finite element analysis of the human mandible: a systematic review with meta-analysis of the essential input parameters. Sci. Rep. 15 (1), 19582 (2025). Henneman, E., Somjen, G. & Carpenter, D. O. Functional Significance of Cell Size in Spinal Motoneurons. J. Neurophysiol. 28 , 560–580 (1965). Rivas, C. A. et al. Motor unit activity during maximal-intent dynamic muscle actions varies by intensity and sex in healthy adults. J. Neurophysiol. 134 (3), 940–951 (2025). Raikova, R., Krutki, P. & Celichowski, J. Skeletal muscle models composed of motor units: A review. J. Electromyogr. Kinesiol. 70 , 102774 (2023). Yoshimura, S. et al. Relationship between body mass index and masticatory factors evaluated with a wearable device. Sci. Rep. 12 (1), 4117 (2022). Takeuchi-Sato, T. et al. Relationships between craniofacial morphology and masticatory muscle activity during isometric contraction at different interocclusal distances. Arch. Oral Biol. 98 , 52–60 (2019). Matusz, K. et al. Common therapeutic approaches in sleep and awake bruxism - an overview. Neurol. Neurochir. Pol. 56 (6), 455–463 (2022). Additional Declarations No competing interests reported. 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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-8887279","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":597357901,"identity":"4ac15c46-ac5f-49b3-be31-df7f2a6ce62f","order_by":0,"name":"Mauro Lorusso","email":"","orcid":"","institution":"University of Foggia","correspondingAuthor":false,"prefix":"","firstName":"Mauro","middleName":"","lastName":"Lorusso","suffix":""},{"id":597357905,"identity":"22a56ac8-b573-47ea-ac17-4200e7600f99","order_by":1,"name":"Fariba Esperouz","email":"","orcid":"","institution":"University of 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Foggia","correspondingAuthor":false,"prefix":"","firstName":"Lucio","middleName":"Lo","lastName":"Russo","suffix":""},{"id":597357920,"identity":"7bdcb4a5-b493-4e99-9094-e92f508a6db6","order_by":7,"name":"Domenico Ciavarella","email":"","orcid":"","institution":"University of Foggia","correspondingAuthor":false,"prefix":"","firstName":"Domenico","middleName":"","lastName":"Ciavarella","suffix":""}],"badges":[],"createdAt":"2026-02-15 16:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8887279/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8887279/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104169855,"identity":"49bd3828-b3fb-4c48-99e8-98ff9c024b08","added_by":"auto","created_at":"2026-03-08 14:40:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":290708,"visible":true,"origin":"","legend":"\u003cp\u003eHeat map images illustrating the position of the centre of force (COF): anterior (left, hypodivergent), centred (center, normodivergent), and posterior (right, hyperdivergent).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8887279/v1/502ff88fae94e989318e4c99.png"},{"id":104169857,"identity":"a04d386d-c60a-4193-900e-079d96785fec","added_by":"auto","created_at":"2026-03-08 14:40:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":211113,"visible":true,"origin":"","legend":"\u003cp\u003eMeasurement of bite force using the Innobyte device\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8887279/v1/c579a8211a6562cb5cda38e3.png"},{"id":104404498,"identity":"f9b1bf26-2d48-487d-bbf8-31bc4c916923","added_by":"auto","created_at":"2026-03-11 12:20:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1425364,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8887279/v1/2262f31d-689f-4e66-ab95-352d13cba008.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eOcclusal Force Analysis With T-scan and Innobyte in Adult Patients: A Prospective Study\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eOcclusal force analysis is a fundamental aspect of orthodontic and prosthetic treatment planning. Previous studies have demonstrated that occlusal function cannot be fully understood by static evaluation of dental arches and supporting skeletal structures alone, as mastication depends on the dynamic interaction among teeth, jaws, masticatory muscles, and surrounding soft tissues, including lips and cheeks [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. For this reason, assessment of occlusal forces has been widely recognised as an important indicator of functional balance within the stomatognathic system.\u003c/p\u003e \u003cp\u003eOptimization of masticatory function is a fundamental objective of orthodontic treatment, particularly in patients with complex malocclusions. Modifications of occlusal contacts can significantly influence masticatory dynamics and neuromuscular activity, requiring careful planning to achieve a new functional equilibrium [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This consideration is especially relevant in cases involving dental impactions, where alterations in occlusal relationships may affect both force distribution and functional stability [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Previous investigations have also highlighted the importance of evaluating changes in the occlusal plane with respect to facial growth pattern and dental arch morphology [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Furthermore, gradual introduction of occlusal changes has been recommended to allow physiological adaptation of the stomatognathic system, thereby minimising the risk of periodontal overload and temporomandibular joint dysfunction [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral diagnostic tools have been developed to evaluate occlusal force and occlusal dynamics. Among these, the T-Scan system has been widely used to provide quantitative information on occlusal contacts, centre of force (COF), intercuspation timing, and relative force distribution between hemiarches [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe T-Scan device also facilitates assessment of the occlusal centre of gravity, which is defined as the point where the resultant of all occlusal forces is applied. From a functional perspective, identification of the location of the centre of gravity is critical for understanding the coordination of the neuromuscular system and its role in maintaining occlusal equilibrium and functional stability [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. While the T-Scan system can be used to conduct a detailed qualitative assessment of occlusal dynamics, including contact timing, distribution, and centre of force, it does not provide absolute quantification of occlusal force [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Accurate measurement of occlusal force is complex, because it is modulated by several factors, including: craniofacial morphology, dental contact patterns, occlusal scheme, and the presence of malocclusions or parafunctional habits. These variables must be carefully considered in order to accurately interpret occlusal data in both clinical and research settings [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOcclusal forces are not uniformly distributed along the dental arch, but instead follow a biomechanical gradient shaped by occlusal anatomy, which is the pattern of tooth contacts, and the functional dynamics of the masticatory system. Evidence from the literature indicates that the region of Maximum Occlusal Load (MOL) is typically localised at the mesiopalatal cusp of the maxillary first molars[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The magnitude and distribution of occlusal forces are influenced by specific occlusal characteristics, which determine the number, location, and quality of tooth contacts. A physiologically balanced occlusion promotes biomechanically efficient force distribution, whereas, malocclusions can compromise these dynamics by reducing occlusal forces during mandibular elevation, potentially compromising masticatory efficiency [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecent evidence supports an association between craniofacial morphology, particularly vertical divergence and masticatory muscle characteristics that may influence occlusal force generation. A systematic review and meta-analysis [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] reported that hyperdivergent individuals present significantly reduced masseter muscle dimensions compared with normodivergent and hypodivergent subjects, suggesting a morphological substrate for lower force capacity across vertical skeletal patterns. Consistently, clinical studies evaluating maximum bite force across facial morphologies have reported differences attributable to vertical pattern classifications and related cephalometric features [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In addition, skeletal indicators linked to vertical morphology, such as the gonial angle, have been shown to correlate inversely with maximum occlusal force in posterior regions, reinforcing the biomechanical relationship between craniofacial form and occlusal loading [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Beyond force magnitude, computerized occlusal analysis has enabled objective assessment of occlusal force distribution and centre of force parameters under different functional and occlusal conditions, providing a reliable tool for quantitative analysis [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, evidence linking these parameters to craniofacial growth patterns remains limited.\u003c/p\u003e \u003cp\u003eDespite the recognised importance of occlusal loading in clinical diagnostics and treatment planning, the quantitative relationship between occlusal force magnitude and skeletal divergence remains insufficiently investigated. Furthermore, the association between occlusal force magnitude and the spatial position of the occlusal centre of force remains unclear. A clearer understanding of these relationships is essential for comprehensive functional evaluation of the stomatognathic system and for improving orthodontic treatment planning. While various factors influence occlusal loading, including skeletal and arch morphology [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], muscle function, and dental occlusion, the relationship between craniofacial growth patterns and occlusal force remains insufficiently explored. Therefore, the objective of the present study was to investigate whether different craniofacial growth patterns are associated with variations in occlusal force magnitude and to evaluate the correlation between occlusal force and the position of the occlusal centre of force.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e All procedures described in this research protocol were conducted in accordance with the Declaration of Helsinki and received approval from the Ethics Committee of the University of Foggia. (approval number 46/CE/2025). This study complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational research [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNinety-six participants (46 females and 50 males), with a mean age of 26.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 years were enrolled based on the following inclusion criteria: Angle Class I malocclusion and a symmetrical dental arch. Exclusion criteria were: the presence of dental agenesis; periodontal disease; loss of one or more teeth; extensive dental restorations; fixed or removable prostheses; temporomandibular joint (TMJ) disorders; and current or previous orthodontic treatment. All study participants were healthy adults, and all were undergraduate students at the University of Foggia, who were prospectively enrolled after signing an informed consent form to participate. Participants were prospectively enrolled from 01/2025 to 09/2025.\u003c/p\u003e \u003cp\u003eStudy participants were divided into three groups according to their facial divergence. To classify subjects according to vertical divergence, the SN-MP angle cut-off values reported by the Italian Board of Orthodontics (IBO) and the European Board of Orthodontics (EBO) were used:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eHyperdivergent subjects: SN-MP\u0026thinsp;\u0026gt;\u0026thinsp;35.5\u0026deg;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNormodivergent subjects: 30.5\u0026thinsp;\u0026le;\u0026thinsp;SN-MP\u0026thinsp;\u0026le;\u0026thinsp;35.5\u0026deg;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHypodivergent subjects: SN-MP\u0026thinsp;\u0026lt;\u0026thinsp;30.5\u0026deg;\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe cephalometric characteristics of the study sample are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eA priori power analysis was performed using G*Power (version 3.1.9.2; Franz Faul, Universit\u0026auml;t Kiel, Germany). To detect an effect size of 0.4 using a one-way Anova test with an alpha level of 0.05 and a statistical power of 0.90 (1\u0026thinsp;\u0026minus;\u0026thinsp;β), a minimum sample size of 28 participants per group was required [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The measurements were carried out at the university dental clinic by two of the authors, both experienced orthodontists. To minimize random errors, cephalometric measurements were repeated after a 15-day interval by a single calibrated examiner. The random error was calculated using Dahlberg\u0026rsquo;s formula (\u003cem\u003eS\u003c/em\u003e =\u0026radic;\u0026sum; \u003cem\u003ed\u003c/em\u003e \u003csup\u003e2\u003c/sup\u003e / 2\u003cem\u003eN\u003c/em\u003e ), where \u003cem\u003ed\u003c/em\u003e is the difference between the first and second measurements and \u003cem\u003eN\u003c/em\u003e the number of radiographs evaluated ([\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The random error ranged between 0.2 and 0.3 degrees.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMeasurement Protocol\u003c/h2\u003e \u003cp\u003eThe T-Scan Novus system (Tekscan Inc., South Boston, MA, USA) was used for digital occlusal analysis [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The system includes a handpiece connected to a computer via USB and a support base for mounting interchangeable piezoelectric sensor foils, 100 \u0026micro;m in thickness and available in various sizes. The sensor is pressure-sensitive and records occlusal forces by detecting changes in electrical resistance during tooth contact. Data acquisition occurs in real time, allowing the system to record key parameters, including the timing, location, contact distribution, and relative force percentages of occlusal contacts. This enabled a detailed, dynamic evaluation of occlusal function during mandibular closure into maximum intercuspation.\u003c/p\u003e \u003cp\u003eOcclusal analysis was first performed using the T-Scan Novus system (Tekscan Inc., Boston, MA, USA), a computerized device that enables dynamic recording of occlusal contacts. All recordings were conducted with participants seated upright in a dental chair, with their heads relaxed and supported by the headrest.\u003c/p\u003e \u003cp\u003eFor each subject, a sensor of appropriate size was selected based on the individual\u0026rsquo;s specific dental arch morphology. The sensor was accurately positioned between the upper and lower central incisors, ensuring that the handle remained parallel to the occlusal plane throughout the recording process. The sensor was placed intraorally, and the patient was instructed to occlude in maximum intercuspation (MI). An initial single recording of approximately 5\u0026ndash;7 seconds was captured, followed by three consecutive recordings to ensure reproducibility. The T-Scan software enabled dynamic analysis of occlusal function, allowing for the evaluation of the following parameters:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eOcclusal centre of force: defined as the spatial position of the occlusal centroid during MI, and categorised as anterior, central, or posterior.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eOcclusal contact time: defined as the duration (in seconds) from the initial occlusal contact to the achievement of MI (point B). This parameter was automatically calculated by the software as the time interval between the first detected contact and the point of maximum force distribution.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe position of the centre of force (COF) was determined during the bite registration phase, at maximum intercuspation, ensuring full engagement of the teeth in their natural occlusal relationship. Using the T-Scan system, the COF was recorded as the point where the resultant occlusal load was concentrated. Based on its spatial location relative to the dental arch, the COF was classified into one of three categories:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAnterior: indicating that the COF was localised toward the anterior region (incisor/canine area) of the dental arch;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCentred: indicating that the COF was located precisely at the geometric centroid of the occlusal contact area;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePosterior: indicating that the COF was localised toward the posterior region (premolar/molar area) of the dental arch.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the centre of force position across the three study groups.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe Innobyte [Kube Innovation Inc.] system is a medical device designed to measure maximum occlusal force, both unilaterally and across the entire dental arch [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It consists of two main components: a handheld measuring unit and a fluid-filled mouthpiece. The device is capable of recording occlusal forces ranging from 0 to 2000 N, with a measurement accuracy of \u0026plusmn;\u0026thinsp;5%. When the patient bites down on the mouthpiece, the applied force is transmitted uniformly through the fluid medium, allowing for accurate detection by internal sensors in the instrument. The measured force values are displayed in real time on the LED screen of the main unit, with output provided in Newtons. Each reading provides the total occlusal force, as well as the occlusal force distribution between the left and right sides of the arch.\u003c/p\u003e \u003cp\u003eFor each measurement, the recording sensor was positioned intraorally between the dental arches, and the central notch was aligned with the patient's maxillary and mandibular central incisors. Data acquisition was initiated by activating the control button on the handpiece, and the patient was instructed to perform a maximal voluntary clench. Upon completion of the force recording, the mouthpiece was carefully removed, and the patient was asked to swallow. After swallowing, the patient was told to maintain a relaxed mandibular rest position for 10 seconds before the subsequent measurement. To ensure data consistency and minimize intra-individual variability, a multibite scan protocol was implemented, consisting of three consecutive bite recordings per study participant. During measurements, the standardized thickness of the mouthpiece positioned between the dental arches prevented physiological occlusion by maintaining a controlled interocclusal separation. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the Innobyte device used for the measurements.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData were analysed using GraphPad Prism software 6.0 (GraphPad Prism Software, San Diego, CA, USA). The primary null hypothesis stated that no significant correlation existed between facial growth pattern and occlusal force; the secondary null hypothesis stated that no significant correlation existed between occlusal force and the position of the centre of force.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the descriptive statistics of occlusal force and occlusion time for the study sample, categorised according to skeletal divergence, along with the Kolmogorov-Smirnov normality test. The occlusion time, obtained from the T-Scan system, was calculated as the time interval between the first occlusal contact during mandibular closure and achievement of maximum intercuspation. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e reports the values of the centre of force position, categorisation of the COF as anterior, or posterior and results from the Kolmogorov-Smirnov normality test.\u003c/p\u003e \u003cp\u003eBecause the variances were not homogeneous, a Welch ANOVA test was performed, followed by a Games\u0026ndash;Howell post hoc test, in order to compare total occlusal force and occlusion time among the groups (Tables\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003eA-B). The Holm-Bonferroni correction for multiple testing was also performed. Finally, a generalised linear model (GLM) was applied to determine if the total occlusal force was associated with the position of the centre of force (Tables\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e5\u003c/span\u003e and \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e6\u003c/span\u003e). Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. No missing data were recorded for the variables of interest.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eAll eligible subjects agreed to participate in the study, and no dropouts were recorded during data collection. Preliminary analyses showed no statistically significant differences between males and females in the main outcome variables. Accordingly, sex was not retained as a relevant factor in subsequent analyses, and the sample was analysed as a single cohort because the distribution of males and females was homogeneous across the analysed groups.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e highlights a significant finding: the hypodivergent group exhibited the highest total occlusal force and occlusion time (513 N and 7.9 seconds, respectively), while the hyperdivergent group showed the lowest values (399.54 N and 6.93 seconds) for these parameters. Moreover, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that in the hypodivergent group, the centre of force was predominantly located anteriorly (70.7%), whereas in the hyperdivergent group, the COF was found to be mainly positioned posteriorly (76.41%). Figure\u0026nbsp;3 illustrates the mean total occlusal force among the three groups.\u003c/p\u003e \u003cp\u003eDifferences in total force and occlusion time between groups were found to be statistically significant (both \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001); and post hoc pairwise comparisons using the Games\u0026ndash;Howell test (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003eB) revealed significant differences in total occlusal force among the groups. Specifically, normodivergent patients demonstrated a total occlusal force that was 54.61 N higher than that measured for the hyperdivergent group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, hypodivergent patients exhibited significantly greater forces compared to both normodivergent and hyperdivergent groups, with increases of 62.17 N and 116.78 N, respectively (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In addition to occlusal force differences, occlusion time durations for normodivergent patients were also significantly longer, by 0.96 seconds, than for hyperdivergent patients, while hypodivergent patients showed a 0.88 second increase in occlusion time duration relative to the hyperdivergent group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eApplication of a generalised linear model revealed a statistically significant association between total occlusal force and the position of the centre of force (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Regarding sex distribution, no statistically significant differences were observed (p\u0026thinsp;=\u0026thinsp;0.176). Pairwise comparisons (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e6\u003c/span\u003e) further indicate that individuals with a centred COF exhibited a total occlusal force 54.61 N greater than those with a posteriorly located centre of force (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, study subjects with an anteriorly localised centre of force demonstrated the highest occlusal force values, with an increase of 116.78 N compared to those with a posterior COF (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Therefore, both the primary and secondary null hypothesis were rejected.\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\u003eCephalometric data of the sample\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=\"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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSAMPLE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDIVERGENCE ANGLE(SN-GoMe)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSTANDARD DEVIATION\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMINIMUM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMAXIMUM\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHYPERDIVERGENT (15F, 17M n\u0026thinsp;=\u0026thinsp;32)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e37.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNORMODIVERGENT (16F,16M n\u0026thinsp;=\u0026thinsp;32)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHYPODIVERGENT (15F,17M n\u0026thinsp;=\u0026thinsp;32)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e28.2\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\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\u003eDescriptive statistics of occlusal force and occlusion time for the sample categorized by skeletal divergence\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNORMODIVERGENT(n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eHYPERDIVERGENT(n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eHYPODIVERGENT(n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eForce\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eTiming\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eForce\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eTiming\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eForce\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eTiming\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e455.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e399.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e513.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e456.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e395.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6,92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e500.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003estandard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e122.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e125.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eminimum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e227.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e300.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emaximum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10,.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e699.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e10.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epassed normality test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYES\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\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\u003eDescriptive statistics of center of force position categorized as anterior or posterior expressed in percentage\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCENTER OF FORCE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eNORMODIVERGENT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eHYPERDIVERGENT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eHYPODIVERGENT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eAnt. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003ePost. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eAnt. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ePost. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eAnt. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003ePost. (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e29.93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003estandard deviation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eminimum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e69.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emaximum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e79.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e39.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epassed normality test\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eYES\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\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eA: Welch-Anova test for the total force and the occlusion time between the group\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=\".\" 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\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003edf1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003edf2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal force\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.439\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e129.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOcclusion time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e127.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e**p\u0026thinsp;\u0026lt;\u0026thinsp;001;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eB: Games-Howell\u0026rsquo;s post hoc test and Holm-Bonferroni correction for multiple tests\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\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 \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup (I)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup (J)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean difference\u003c/p\u003e \u003cp\u003e(I-J)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStd.error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eHolm-Bonferroni correction\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLower bound\u003c/p\u003e \u003cp\u003e(CI 95%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUpper bound\u003c/p\u003e \u003cp\u003e(CI 95%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNormo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eHyper\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.607**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16.736\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e14.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e94.288\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTOTAL FORCE\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHypo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNormo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.169**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19.779\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e15.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e109.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHypo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eHyper\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e116.776**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e66.627\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e166.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eNormo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eHyper\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.956**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.412\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOCCLUSION TIME\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHypo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNormo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e-0.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.540\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eHypo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eHyper\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.876*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.460\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e**p\u0026thinsp;\u0026lt;\u0026thinsp;001;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the generalized linear model (GLM) assessing the effect of center of force position on total occlusal force.\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOrigin\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eType III\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWald Chi-square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e(Intercept)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134399.809\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCenter of force\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eDependent variable: TOTAL FORCE\u003c/p\u003e \u003cp\u003eModel: (Intercept), CENTER OF FORCE\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\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePairwise comparison of the center of force position categorized as anterior, posterior, and centered\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCenter of force (I)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCenter of force (J)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean difference (I-J)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStd. errr\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLower bound\u003c/p\u003e \u003cp\u003e(CI 95%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUpper bound\u003c/p\u003e \u003cp\u003e(CI 95%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCentered\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePosterior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54.607\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e18.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e19.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e90.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnterior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCentered\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.169\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e20.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21.806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e102.531\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnterior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ePosterior\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116.776**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e19.467\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e78.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e154.933\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e**p\u0026thinsp;\u0026lt;\u0026thinsp;001;\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe present study explored the complex relationships between occlusal force and position of the centre of force in adult patients. This interaction is clinically relevant in orthodontics and related disciplines such as prosthodontics and gnathology, because it can be used to guide the planning and execution of effective therapeutic strategies. In modern populations, the force required to chew most foods is substantially lower than the maximum voluntary bite force. However, maximum occlusal force reflects the biomechanical and neuromuscular capacity of the craniofacial system rather than routine masticatory demands. Although not fully utilized during daily chewing, it appears to play a relevant role during growth in influencing craniofacial morphology.\u003c/p\u003e \u003cp\u003eBite force is known to vary with the degree of gape. However, in the present study, force recordings were performed using a mouthpiece of standardized thickness, ensuring a consistent degree of gape across all participants. Variations in the fluid within the device were dependent solely on the magnitude of the applied biting force. Additionally, all subjects were adults with stable neuromuscular and skeletal characteristics (CS5), minimizing potential confounding effects related to growth.\u003c/p\u003e \u003cp\u003eDetailed data analysis revealed a statistically significant correlation between craniofacial morphology and functional occlusal parameters, such as occlusion time and total occlusal force. Total occlusal force was significantly greater in the hypodivergent group (513.3N), followed by the normodivergent group (455.91N), while the hyperdivergent subjects exhibited the lowest occlusal force values of the entire study sample (399.54N). These findings align well with the known biomechanical characteristics of each group. For example, hypodivergent individuals are characterised by a compact craniofacial morphology and an anteriorly rotated mandible with a relatively horizontal mandibular plane and have been shown to exhibit enhanced masticatory efficiency [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. This increased efficiency is largely attributed to greater functional capacity and hypertrophy of the masseter and temporalis muscles [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In contrast, hyperdivergent individuals typically present with a long-face skeletal pattern and reduced masticatory muscle development, often accompanied by functional weakness of the masticatory apparatus. This diminished muscular performance likely contributes to decreased masticatory efficiency and, subsequently, lower occlusal force generation.\u003c/p\u003e \u003cp\u003eOcclusion time at maximum intercuspation was found to be clearly associated with vertical skeletal divergence, and statistically significant differences were indentified among the groups. Specifically, hypodivergent individuals had the longest occlusion times and hyperdivergent subjects had the shortest occlusion times, while occlusion time durations were intermediate for normodivergent patients. This pattern closely parallels the total occlusal force distribution observed for each group, further supporting the interplay between craniofacial morphology and functional occlusal dynamics. Analysis of the total occlusal force and occlusion time revealed a notable trend: higher occlusal force was associated with a longer occlusion time in order to reach maximum intercuspation. This finding suggests that increased force generation may require a more gradual or controlled mandibular closure, potentially reflecting adaptive neuromuscular coordination in response to greater occlusal load. The present findings corroborate previous evidence indicating greater occlusal stability among hypodivergent individuals. As reported by Gomes et al.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], hypodivergent patients typically exhibit more stable and evenly distributed occlusal contacts. The demonstrated synergy between increased occlusal force and prolonged occlusion time in hypodivergent subjects likely reflects a more efficient functional balance, characterised by a controlled and coordinated mandibular closure pattern. In contrast, individuals with increased vertical skeletal dimensions displayed faster occlusal dynamics, which may be indicative of reduced stability. This accelerated occlusal time, coupled with lower occlusal forces, suggests less efficient neuromuscular and masticatory function, potentially predisposing these patients to functional imbalances [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. An important finding emerging from the present study is the significant relationship between the location of the centre of force and total occlusal force. Study participants exhibiting an anteriorly positioned centre of force demonstrated significantly greater occlusal forces compared to those with a central or posteriorly localised COF. This observation suggests that an anteriorly directed occlusal load may enable more favourable and efficient masticatory function, potentially due to enhanced intercuspation and optimised load distribution across the dental arches. In contrast, subjects with a posteriorly localised centre of force showed reduced occlusal force values, which may indicate compromised functional efficiency. This pattern could be attributed to less stable intercuspation and unfavourable occlusal contact distribution [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHypodivergent subjects exhibited an anteriorly positioned centre of force along with higher occlusal force values. Their skeletal-muscular configuration provides mechanical advantages to the masticatory muscles, allowing for more efficient function and a greater ability to generate occlusal forces. This may be attributed to a more compact facial structure, which is often characterised by a shorter mandibular ramus and reduced vertical dimension, which could promote a more functionally efficient distribution of occlusal loads [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In contrast, hyperdivergent individuals exhibited a posterior centre of force, associated with lower occlusal force values. This morphological pattern appears to be linked to a reduced ability to generate high-intensity occlusal forces. In hyperdivergent subjects, mandibular retrusion combined with increased vertical dimension and posterior mandibular rotation likely compromises occlusal stability, resulting in a narrower and less-balanced distribution of occlusal loads [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBiomechanically, the mandible can be considered to be a third-class lever, where the force is applied between the fulcrum and the resistance. The fulcrum corresponds to the temporomandibular joint (TMJ), while the force is generated at the insertion point of the masticatory muscles (ideally at the mandibular angle), and the resistance is represented by the occlusal load, ideally located at the site of maximum dental contact [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Although the mandible maintains the characteristics of a third-class lever, its function becomes significantly more mechanically advantageous in hypodivergent individuals, because of anatomical adaptations that alter the spatial relationships between the fulcrum, the applied force, and the resistance. In this context, the occlusal load (i.e. the resistance) is positioned more anteriorly, thereby maximizing the lever arm of the elevator muscles. This morphotype is typically characterised by a reduced vertical facial dimension and a shorter, more robust mandibular ramus. The resulting mechanical advantage leads to greater neuromuscular efficiency and increased resistance to fatigue, as the masticatory muscles are able to generate higher forces with reduced effort. Conversely, hyperdivergent subjects are often characterised by longer and thinner bony bases, associated with an increased distance between the temporomandibular joint and the mandibular angle, and thus an increased lever arm. Thus, the distance between the applied force and the resistance relative to the fulcrum increases, as both the power and resistance arms are positioned farther from the fulcrum, and the system requires greater muscular effort to overcome the resistance. However, this configuration allows for wider and faster movements. Consequently, to lift a load (resistance) and apply the necessary force for movement, the masticatory muscles must generate greater force, resulting in increased energy expenditure. This dynamic has direct neurophysiological implications, because hyperdivergent individuals must apply greater muscular effort. This leads to increased recruitment of motor units within type II muscle fibres (which are stronger but less fatigue-resistant) to compensate for the biomechanical disadvantage. The consequent overload of type II muscle fibres contributes to the overall reduced occlusal force and earlier onset of neuromuscular fatigue\u003c/p\u003e \u003cp\u003eApplication of a generalised linear model revealed a particularly noteworthy finding: occlusal force was significantly associated with the position of the centre of force. Specifically, the highest force values were observed in individuals with an anteriorly positioned centre of force, corresponding to hypodivergent subjects; conversely, the lowest occlusal force values were found in subjects with a posteriorly positioned centre of force, corresponding to hyperdivergent individuals.\u003c/p\u003e \u003cp\u003eThe variation in occlusal force as a function of the position of the centre of force and craniofacial morphology can be explained by considering the complex neurophysiological and biomechanical mechanisms of the masticatory muscles, particularly those involving the recruitment of motor units. The force generated by a muscle depends on the number of motor units activated and the frequency of their discharge. According to Henneman\u0026rsquo;s size principle, motor units are recruited in an orderly fashion from the smallest to the largest, based on an increasing threshold [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Smaller motor units are associated with a lower threshold, smaller diameter motor neurons and typically innervate type I slow-twitch muscle fibres. These muscle fibres are highly fatigue-resistant and are recruited during low-intensity, sustained activities. As the demand for force increases, larger motor units with high-threshold motor neurons are progressively recruited. These innervate type II fast-twitch muscle fibres, which, in contrast, are more susceptible to fatigue [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].This graded recruitment pattern has also been proposed for the masticatory muscles. It has been proposed that hypodivergent individuals tend to recruit a greater proportion of type II muscle fibres, whereas hyperdivergent individuals rely more heavily on type I fibres. The consequent overload of type II muscle fibres contributes to an overall reduced occlusal force and earlier onset of neuromuscular fatigue.\u003c/p\u003e \u003cp\u003eMaximum occlusal force is a multifactorial parameter influenced not only by craniofacial morphology but also by several biological and behavioural variables. Body mass index has been reported to correlate positively with occlusal force, likely reflecting greater overall muscle mass and an increased cross-sectional area of the masticatory muscles[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Similarly, masticatory muscle thickness, particularly of the masseter and temporalis muscles, plays a key role in force generation, as greater muscle thickness is associated with enhanced neuromuscular recruitment and higher force-producing capacity [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Parafunctional habits such as bruxism and clenching may further modulate occlusal force by inducing adaptive changes in muscle activity and morphology [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]; depending on individual neuromuscular response, these habits may result either in increased maximal force due to muscle hypertrophy or in reduced efficiency secondary to fatigue and altered motor control [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In addition, sex-related differences in occlusal force have been widely reported and are generally attributed to differences in muscle mass and hormonal influences. However, these differences tend to be less pronounced in homogeneous adult samples with completed craniofacial growth. Nevertheless, in the present study no statistically significant sex-related differences were detected. This finding may be attributed to comparable lifestyle patterns, genetic backgrounds, and similar dietary habits within the analyzed sample, which may have contributed to minimizing sex-related variability.\u003c/p\u003e \u003cp\u003eThe data obtained in the present study indicate that a hypodivergent craniofacial morphotype is associated with a configuration that optimises masticatory biomechanics, enhancing neuromuscular efficiency and resulting in an increased capacity to generate occlusal forces.\u003c/p\u003e \u003cp\u003eFrom a clinical perspective, the present findings highlight the importance of considering craniofacial morphology when evaluating occlusal function. Differences in occlusal force magnitude, occlusion time, and centre of force position among vertical skeletal patterns suggest that hypodivergent and hyperdivergent patients exhibit distinct functional and biomechanical characteristics. Incorporating digital occlusal analysis into orthodontic diagnosis may provide valuable information beyond static occlusal relationships, allowing clinicians to better identify functional imbalances and adapt treatment strategies accordingly. In particular, assessment of occlusal force distribution and centre of force position may support more individualized treatment planning, potentially improving functional stability and reducing the risk of occlusal overload or dysfunction following orthodontic therapies.\u003c/p\u003e"},{"header":"Limitations of the study","content":"\u003cp\u003eThe absence of electromyographic analysis of the masticatory muscles represents a limitation, and other variables known to influence occlusal force, such as body mass index or muscle thickness, were not specifically evaluated. Although the study had a prospective design, causal inferences cannot be fully established. In addition, the inclusion of young adult subjects limits the generalizability of the findings. Future investigations involving larger sample sizes and integrated electromyographic assessments are necessary to validate and expand upon the present findings.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eHypodivergent individuals have a biomechanical advantage, characterised by higher occlusal forces and prolonged contact times, in contrast, hyperdivergent subjects have diminished occlusal force and altered contact dynamics. Normodivergent individuals represent an intermediate phenotype, maintaining balanced occlusal function and force distribution. These findings suggest that considering craniofacial morphology and occlusal centre of force analyses may contribute to more complete diagnosis and treatment planning in occlusal and orthodontic therapies, potentially supporting improved functional outcomes and minimising dysfunction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eDATA AVAILABILITY STATEMENT: The data supporting the findings are available from the corresponding author upon reasonable requests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAUTHOR CONTRIBUTION:\u0026nbsp;M.T.: Conceptualization; M.L.: Data Curation; L.L.M.: Formal Analysis; E.D.: Investigation; E.D. AND F.E: Methodology; L.L.M.: Project Administration; F.E.: Resources; A.P.C.: Software; L.L.R. AND D.C.: Supervision; L.L.R. Validation; A.P.C.: Visualization; M.L.: Writing \u0026ndash; Original Draft Preparation; D.C. AND M.L.: Writing \u0026ndash; Review \u0026amp; Editing.\u003c/p\u003e\n\u003cp\u003eCOMPETING INTERESTS: The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eFUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eACKNOWLEDGMENT: Bando PRA 2023 - University of Foggia\u003c/p\u003e\n\u003cp\u003eCORRESPONDING AUTOR: Dott.ssa Elena D\u0026rsquo;Angelo; e-mail: \u003cu\[email protected]\u003c/u\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVelasquez, B. et al. Occlusal Analysis in Natural Dentition: Systematic Review. \u003cem\u003eEur. J. 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Pol.\u003c/em\u003e \u003cb\u003e56\u003c/b\u003e (6), 455\u0026ndash;463 (2022).\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":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"T-Scan, Innobyte, Digital occlusal analysis, Vertical growth, Centre of force, Occlusal force","lastPublishedDoi":"10.21203/rs.3.rs-8887279/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8887279/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis prospective study investigated differences in occlusal force among adult patients with various vertical skeletal patterns and evaluated the association between total occlusal force and the centre of force position. Ninety-six subjects (46 females, 50 males; mean age 26.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 years) with Angle Class I malocclusion were enrolled and classified as hyperdivergent, normodivergent, and hypodivergent according to the SN-MP angle. Digital occlusal analysis was performed using the T-Scan Novus system to assess occlusal contact time and centre of force position at maximum intercuspation, while maximum occlusal force was recorded using the Innobyte device. The centre of force was classified as anterior, centred, or posterior based on its spatial location within the dental arch. Intergroup comparisons were conducted using Welch ANOVA with Games-Howell post hoc tests, and a generalized linear model evaluated the association between occlusal force and centre of force position (α\u0026thinsp;=\u0026thinsp;0.05). Hypodivergent subjects showed the highest total occlusal force and occlusion time (513 N, 7.9 s), while hyperdivergent individuals exhibited the lowest (399.54 N, 6.93 s). In hypodivergent subjects, the centre of force was mainly anterior (70.7%), whereas in hyperdivergent individuals it was predominantly posterior (76.41%). A significant association was observed between total occlusal force and centre of force position (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Pairwise comparisons showed higher occlusal force (+\u0026thinsp;54.61 N, p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) associated with an anterior centre of force (+\u0026thinsp;116.78 N; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) compared with the posterior group. Overall, increased occlusal force correlated with an extended time required to reach maximum intercuspation.\u003c/p\u003e","manuscriptTitle":"Occlusal Force Analysis With T-scan and Innobyte in Adult Patients: A Prospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-08 14:40:44","doi":"10.21203/rs.3.rs-8887279/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-23T07:06:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-19T13:28:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-17T10:55:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"45274410108239152357400428096398344140","date":"2026-03-16T09:46:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76000003515001856168972368847766715365","date":"2026-03-13T10:13:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T14:22:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"13751702728413076845131866052233167952","date":"2026-03-11T09:19:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"327231407162823601077116354706024143946","date":"2026-03-11T06:53:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-04T01:55:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"114181189028163624368280617656014385305","date":"2026-02-26T06:27:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-26T05:35:58+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-25T16:21:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-19T10:17:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-02-19T10:13:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3dc8a1c7-020c-41f5-a3e5-d62c50138c0e","owner":[],"postedDate":"March 8th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":63758218,"name":"Health sciences/Diseases"},{"id":63758219,"name":"Health sciences/Health care"},{"id":63758220,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-04-30T08:09:59+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-08 14:40:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8887279","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8887279","identity":"rs-8887279","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}