Received: 29 July 2017 | Accepted: 27 September 2017

DOI: 10.1111/jerd.12343

RESEARCH ARTICLE

Thickness evaluation of articulating papers and foils

Jo~ao Malta Barbosa DDS, MSc1,2,3 | Adolf Brian Urtula DDS4,5 |

Ronaldo Hirata DDS, MSc, PhD6 | Jo~ ^s DDS, PhD7,8
ao Carame

1
Resident, Jonathan and Maxine Ferencz
Advanced Education Program in Abstract
Prosthodontics, New York University College
of Dentistry, New York, New York
Articulation and occlusion test materials are tools used in daily prosthodontic and restorative pro-
2
Prosthodontist, Department of Oral cedures that aid the clinicians in the evaluation of adjacent and opposing natural and/or artificial
Rehabilitation, Implantology Institute, Lisbon, tooth contacts. A precision micrometer (Series 293, Mitutoyo, Japan) with a resolution of
Portugal
0.001 mm was used to measure the thickness of five articulating papers and six articulation foils.
3
Volunteer Researcher, Department of
Four of the articulating foils tested presented thicknesses inferior or equal to 21 lm, confirming
Biomaterials and Biomimetics, New York
University College of Dentistry, New York, their adequacy for the evaluation of natural dentitions. Clinicians and researchers should be aware
New York that some labeled and actual papers/foils thicknesses are not in accordance.
4
Resident, Ashman Department of
Periodontology and Implant Dentistry, New Clinical Significance
York University College of Dentistry, New
York, New York
The thickness of articulating papers and foils reported by some manufacturers is not accurate. The
5
Periodontist, Emagen Dental, New York, information provided in this article may aid clinicians and researchers to better select the most
New York appropriate materials for the evaluation of static and dynamic occlusion.
6
Assistant Professor, Department of
Biomaterials and Biomimetics, New York KEYWORDS
University College of Dentistry, New York,
New York articulating paper, occlusion, prosthodontics
7
Full Professor, College of Dentistry, Lisbon
University, Lisbon, Portugal
8
Clinical Director, Implantology Institute,
Lisbon, Portugal

Correspondence
Jo~ao Malta Barbosa, Implantology Institute,
Av. Columbano Bordalo Pinheiro n. 50,
1070-064, Lisbon, Portugal.
Email: joaomaltabarbosa@gmail.com

1 | INTRODUCTION A commonality amongst most manufacturers is the comercial avail-

Articulation and occlusion test materials are daily tools used in prostho-
dontics. A plethora of materials and techniques have been described
for marking static as well as dynamic inter-dental contacts, including
impression material records (eg, alginate, polyether, polyvinyl siloxane),
typewriter ribbon, acetate sheets, wax, articulating paper, silk strips,
foil, liquid contact pigments, occlusal sprays, photoplastic and pressure
sensitive films, sonography, and computerized occlusal analysis tools
(eg, T-Scan, Tekscan Inc.).1
Despite the plethora of available materials and means, articulating
papers and foils remain the gold standard to which newer technologies
1,2
are compared to and are amongst the most used in the clinical evalu-
ation of adjacent and opposing natural or artificial tooth contacts.3
ability of papers and foils of different colors and thicknesses: color var-
iations aim to facilitate discrimination between static and dynamic
contacts4; thickness variations have been shown to be related to the
surface area of the occlusal markings, allowing the clinician to select
the paper or foil considered most adequate to evaluate a particular
type of restoration (tooth, implant or soft-tissue supported) or to better
achieve the goals of a specific occlusion philosphy.5
Historically, manufacturers have used qualitative non-standardized
descriptions of their products thicknesses (ie, microthin, extra thin,
extra-extra thin, and thick),5 leaving to researchers the study and quan-
titative description of these materials.6
Presently, some manufacturers label their products with a quanti-
tative description of their thickness, however, to our knowledge, no

J Esthet Restor Dent. 2017;1–3. wileyonlinelibrary.com/journal/jerd V

C 2017 Wiley Periodicals, Inc. | 1
2 | MALTA BARBOSA ET AL.

TA BL E 1 Product, type, manufacturer, labeled thickness, and mean measured thickness of occlusion test materials

Labeled Mean thickness

Product Type Manufacturer thickness (standard deviation)

Arti-Fol 8 l Foil Dr. Jean Bausch Gmbh & Co. KG 8 lm 19.8 lm (SD 0.7)

Arti-Fol metallic 12 l Foil Dr. Jean Bausch Gmbh & Co. KG 12 lm 22.2 lm (SD 1.2)

Arti-Check Articulating Paper Paper Dr. Jean Bausch Gmbh & Co. KG 40 lm 46.5 lm (SD 1.0)
ultra-thin 40 microns

PROGRESS 100 Paper Dr. Jean Bausch Gmbh & Co. KG 100 lm 113.2 lm (SD 5.9)

Paper 200 l Paper Dr. Jean Bausch Gmbh & Co. KG 200 lm 181.7 lm (SD 5.2)

Shimstock Metal Foil 8 l Foil Almore International Inc. 8 lm 9.2 lm (SD 2.0)

Shimstock strips 12 l Foil Almore International Inc. 12 lm 13.5 lm (SD 1.4)

AccuFilm I single-sided Foil Parkell Inc. - 21 lm (SD 1.8)

AccuFilm II double-sided Foil Parkell Inc. - 25.5 lm (SD 1.0)

Articulating Paper—Thin Blue Paper Henry Schein Inc. - 76.0 lm (SD 1.9)

Horseshoe Articulating Paper Red/Blue Paper Henry Schein Inc. - 86.0 lm (SD 1.4)

recent studies have been published reporting on the thickness of cur-
rently available articulating papers and foils. Therefore, it is the aim of
our work to provide an update of the thickness of currently available
articulating papers and foils.
2 | MATERIALS AND METHODS
Our methodology followed the one described by Halperin et al. in
1982.6 A precision micrometer (Series 293; Mitutoyo) with a resolution
of 0.001 mm was used to measure the thickness of five articulating
papers and six articulating foils available at the New York University
College of Dentistry Advanced Education Program in Prosthodontics.
Six samples of each articulating paper/foil were evaluated (n 5 6).
Thickness measurements were performed on the center of each sample
by a single evaluator who was blinded to the recorded values.
The measuring device was calibrated before each measurement and
the pressure employed controlled by the clicking sound produced by the
micrometer ratchet (corresponding to a measuring force of 5–10 N).
Mean thicknesses and standard deviations were calculated for
each group. The results are presented on Table 1.
been shown to produce occlusal surface markings of different areas.7,8
This is clinically relevant since the ultimate goal of any dental restoration
is to be fabricated, inserted, and adjusted in harmonious contact relative
to the opposing dentition9 and the clinician and laboratory technician
may be influenced in the need to perform adjustments based on the
observed size of the markings produced by these materials. At the same
time, from a research perspective, studies have been conducted under
the assumption that the thickness reported by the manufacturers is
truthful,7,8 which could have led to misintrepretation of results.
Uniformity of thickness, surface deposition of inks, transferring
media, size of indicator, plastic deformation, and hygienic manufactur-
ing procedures are some of the parameters assessed during quality
control.8 As registered medical device manufacturers, companies pro-
ducing occlusion testing materials are obliged to meet the requirements
of the International Organization for Standardization (ISO) 13485 and
of the Code of Federal Regulations Title 21 (21CFR) Part 820. How-
ever, these seem to provide generic guidelines in what concerns to the
informations required to be present in the product’s labels.

3 | DISCUSSION

Halperin et al. (1982) suggested that an ideal occlusal registration strip

should be less than 21 lm thick based on the average proprioception of
patients presenting with natural dentitions.6 Four of the articulating foils
tested presented thicknesses inferior or equal to the previously described
ideal thickness. However, our results show that some of the labeled quan-
titative descriptions of articulating papers and foils and the actual meas-
ured thicknesses are not in accordance (Figure 1). This finding is of
importance both for practicing clinicians as well as for researchers. Clini-
cally, the ability to locate and estimate the magnitude of premature
contacts and interferences may be influenced by the thickness of the FIGURE 1 Measuring device, labeled, and measured thickness
articulating paper or foil since materials of different thicknesses have discrepancy
MALTA BARBOSA ET AL.
Limited studies are available reporting on the thickness of articulating
papers and foils. However, our results seem to be in accordance with the
available studies that followed similar testing methodologies. This com-
parison was limited to two of the tested articulating foils (Accufilm I and
II; Parkell). In 2012, Helms et al. reported a thickness under 20 lm for the
single-sided foil and under 40 lm for the double-sided foil,10 and in 1982
Halperin et al. reported a thickness of 21 lm for the single sided-foil.6
A possible limitation related with the in vitro nature of the
employed methodology is acknowledged since a measuring force of 5–
10 N is reported by the micrometer manufacturer. This is considerably
less than the average and maximum bitting forces reported in
humans,11 however, depending on the elastic deformation characteris-
tics of any given material, if any variation would be expected in this
regard it would be that the measured values be inferior to the thick-
nesses claimed by the manufacturers.
4 | CONCLUSIONS
Qualitative and quantitative descriptions of articulating papers and foils
are currently used by manufacturers. Considerable variations are found
between the labeled thicknesses and actual measured thicknesses for
some of the currently available materials.
CONFLIC T OF I NTE R ES T
The authors do not have any financial interest in the companies
whose materials are included in this article.
RE FE RE NCE S
[1] Sharma A, Rahul GR, Poduval ST, et al. History of materials used for
recording static and dynamic occlusal contact marks: a literature
review. J Clin Exp Dent. 2013;5:e48–e53.
| 3
[2] Maness WL. Laboratory comparison of three occlusal registration
methods for identification of induced interceptive contacts.
J Prosthet Dent. 1991;65(4):483–487.
[3] Kong CV, Yang YL, Maness WL. Clinical evaluation of three occlusal
registration methods for guided closure contacts. J Prosthet Dent.
1991;66(1):15–20.
[4] Goldstein G, Soni A, Broner A. Insertion procedures for complete
dentures. NY State Dent J. 1982;48(6):371–373.
[5] Schelb E, Kaiser DA, Brukl CE. Thickness and marking characteris-
tics of occlusal registration strips. J Prosthet Dent. 1985;54(1):
122–126.
[6] Halperin GC, Halperin AR, Norling BK. Thickness, strength, and plas-
tic deformation of occlusal registration strips. J Prosthet Dent. 1982;
48(5):575–578.
[7] Carossa S, Lojacono A, Schierano G, Pera P. Evaluation of occlusal
contacts in the dental laboratory: influence of strip thickness and
operator experience. Int J Prosthodont. 2000;13:201–204.
[8] Millstein P, Maya A. An evaluation of occlusal contact marking indi-
cators. A descriptive and quantitative method. J Am Dent Assoc.
2001;132(9):1280–1286.
[9] Baba K, Tsukiyama Y, Clark GT. Reliability, validity, and utility of
various occlusal measurement methods and techniques. J Prosthet
Dent. 2000;83(1):83–89.
[10] Helms RB, Katona TR, Eckert GJ. Do occlusal contact detection
products alter the occlusion? J Oral Rehabil. 2012;39(5):357–363.
[11] Koc D, Dogan A, Bek B. Bite force and influential factors on bite
force measurements: a literature review. Eur J Dent. 2010;4(2):223–
232.
How to cite this article: Malta Barbosa J, Urtula AB, Hirata R,
^s J. Thickness evaluation of articulating papers and foils.
Carame
J Esthet Restor Dent. 2017;00:1–3. https://doi.org/10.1111/
jerd.12343