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J Gandhara Med Dent Sci
October - December 2026
ORIGINAL ARTICLE
How to cite this article
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OCCLUSAL ASSESSMENT OF PORCELAIN-FUSED-TO-METAL (PFM) CROWNS DURING TRY-
IN APPOINTMENT IN THE PROSTHODONTICS DEPARTMENT, SAIDU COLLEGE OF DENTISTRY
Sadiq Ullah
1
, Abdullah
2
, Humaira Malik
3
Ullah S, Abdullah, Malik H. Occlusal
Assessment of Porcelain-Fused-to-
Metal (Pfm) Crowns During Try-In
Appointment in the Prosthodontics
Department, Saidu College of
Dentistry. J Gandhara Med Dent Sci.
2026;13(4):20-24.
Date of Submission: 16-04-2026
Date Revised: 19-09-2026
Date Acceptance: 19-09-2026
2
Assistant Professor
Dentistry, Saidu Sharif, Swat
3
Senior Registrar, Department of
, Department of
Correspondence
1
Sadiqullah, Post Graduate Resident,
Department of Prosthodontics, Saidu
College of Dentistry, Saidu Sharif
Swat
+92-333-8473200
Sadiqsbdc3200@gmail.com
Prosthodontics, Saidu College of
ABSTRACT
OBJECTIVES
To assess the quality of occlusal contacts in PFM crowns during try -in
appointments using modied FDI criteria at the Prosthodontics Department,
Saidu College of Dentistry.
METHODOLOGY
This cross-sectional observational study involved 193 patients receiving PFM
crowns. Occlusal contacts were assessed using 12-µm and 100-µm
articulating papers. Contacts were categorised as excellent, good,
satisfactory, or unsatisfactory. Demographic and clinical data were analysed
using SPSS v25, and associations were evaluated via chi-square tests (p ≤
0.05).
RESULTS
Among 193 patients (54.9% female, mean age: 41.2 years), 35.2% had
excellent, 29.0% good, 22.3% satisfactory, and 13.5% unsatisfactory occlusal
contacts. Age was signicantly associated with occlusal outcomes (p =
0.038), with older patients more likely to exhibit unsatisfactory contacts. No
signicant dierences were observed by gender or tooth location.
CONCLUSION
Most PFM crowns exhibited acceptable occlusal contacts during try-in. Age
inuenced occlusal quality, emphasising the need for heightened clinical
scrutiny in older patients. Articulating papers of varying thickness eectively
detected contact discrepancies, reinforcing their role in ensuring optimal
prosthetic t and function prior to cementation.
KEYWORDS: Occlusal Assessment, Try-In Appointment, Prosthodontics,
Articulating Paper, Dental Restor ations
INTRODUCTION
Restorative and prosthodontic dentistry aims to create a
harmonious and useful occlusion. Numerous clinical
issues, such as occlusal trauma, interferences,
temporomandibular joint (TMJ) disorders, and faster
wear of restorative and natural dentition, can arise from
a poorly repaired occlusion.
1,2
In order to maintain the
health of the masticatory system, which includes the
teeth, periodontium, masticatory muscles, and TMJs, it
is crucial that physiologic occlusal relationships be
restored during restorative operations.
3
A major area of
dentistry called prosthodontics focuses on using xed,
removable, and implant-supported prostheses to help
patients who have lost or impaired teeth. Because of
their advantageous mechanical qualities,
biocompatibility, and aesthetics, porcelain-fused-to-
metal (PFM) crowns have continued to be a standard
among xed restorations.
4,5
PFM crowns are still
frequently used in clinical practice, particularly in
posterior locations where functional demands are
higher, even if all-ceramic alternatives are becoming
more popular.
6
The try-in appointment is a crucial stage
in the delivery of PFM crowns because it provides an
intraoral evaluation of the restoration prior to nal
cementation. Clinicians evaluate a number of factors at
this point, including shade matching, proximal contacts,
marginal t, andabove all-occlusal associations.
7
If
left untreated, improper occlusion at this stage can
result in TMJ problems following cementation, cracked
restorations, and loss of periodontal support.
8
Making
sure the restoration blends in perfectly with the patient's
current occlusal scheme is the main objective of the
occlusal assessment performed during the try-in. This
entails examining the arch for appropriate force
distribution, the lack of deective contacts in functional
and parafunctional movements, and even and stable
central contacts.
9
Occlusal discrepancies may require
recurrent chairside adjustments or remakes if they are
not detected and adjusted during this stage, which
would lengthen treatment times and increase costs
while lowering patient satisfaction.
10
Traditional
instruments like articulating paper, shimstock foil, and
occlusal indicator wax, as well as more recent digital
approaches like intraoral scanners and virtual occlusion
analysis, are used in clinical settings for occlusal
examination during the try-in.
11,12
These instruments
facilitate the detection of early interactions and direct
specific occlusal modications. A study by Sadaf et al.
found that a considerable percentage of PFM crowns
Dentistry, Saidu Sharif, Swat
Prosthodontics, Saidu College of
http://doi.org/10.37762/jgmds.13-4.883
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J Gandhara Med Dent Sci
October - December 2026
had contact point inconsistencies, such as tight or open
contacts, highlighting the signicance of careful
intraoral examination before cementation.
13
Although
this try-in phase is clinically signicant, little is known
about the real-time occlusal assessment procedures used
in teaching hospitals, especially in environments with
limited resources. Gaps in training, standardisation, and
clinical execution can be identied by examining the
pragmatic approach taken by postgraduate students and
clinicians during PFM crown try-ins. In order to
identify these areas for clinical improvement and raise
the standard of prosthodontic care provided, this study
intends to assess the occlusal assessment of porcelain-
fused-to-metal (PFM) crowns during the try-in
appointment using modied FDI World Dental
Federation criteria.
METHODOLOGY
This study was conducted as a cross-sectional
observational study in the Prosthodontics Department
of Saidu College of Dentistry. The study was completed
over a period of six months following the approval of
the research synopsis. (Ref No. 04-ERB/024, 15-01-
2024) The research took place in the Prosthodontics
Department at Saidu College of Dentistry, Swat,
Pakistan. The required sample size was calculated using
the WHO sample size calculator. Based on an
anticipated proportion of satisfactory occlusal contact
points of 56.7%, with a 7% margin of error and a 95%
confidence level, the nal sample size was determined
to be 193 patients. A non-probability consecutive
sampling technique was employed for the inclusion of
participants. Patients receiving porcelain-fused-to-metal
(PFM) crowns as part of prosthodontic therapy between
the ages of 18 and 60 were included in the study. A
Simplified Oral Hygiene Index (OHI-S) score of 1.2 or
less showed that participants had nished prosthetic
tooth preparations and practised appropriate oral
hygiene. Every participant was accessible for follow-up
and had a Visual Analogue Scale (VAS) pain score of
less than 2. Patients with acute or chronic
temporomandibular joint (TMJ) abnormalities,
inadequate prosthetic preparations, or parafunctional
habits such as bruxism and clenching were excluded.
Patients who had a history of mental or sensory
problems or who were unable to provide informed
consent were not included in the study. The College of
Physicians and Surgeons Pakistan (CPSP) and the
Institutional Review Board of Saidu Medical College
and Hospital provided their ethical approval. The
Prosthodontics Department's outpatient services were
used to enrol patients who satised the inclusion
requirements. Following an explanation of the study’s
goals, methods, possible dangers, and advantages,
informed consent was acquired. Age, gender,
urban/rural domicile, education level, occupation,
socioeconomic situation (as determined by the
Kuppuswamy scale), and whether the aicted tooth
was maxillary or mandibular were among the baseline
demographics that were documented. The PFM crown
try-in appointment included the occlusal evaluation. In
the dentist’s chair, patients were sitting erect and
comfortably. To assess occlusal contacts, two
articulating paper types, 12-micron and 100-micron,
were utilised in succession. During closure, articulating
paper was positioned between the PFM crown and the
opposing tooth after it had been set onto the prepared
tooth. Under the guidance of a consulting
prosthodontist, the principal investigator visually
examined and evaluated the occlusal marks. Based on
predetermined criteria, the results were categorised into
four groups: excellent, good, satisfactory, and
unsatisfactory (refer to operational denitions). Every
finding was recorded in a standardised proforma
created especially for this investigation. Version 25 of
IBM SPSS Statistics was used to analyse the data. The
Shapiro-Wilk test was used to determine whether
quantitative information, including age, height, weight,
and BMI, had a normal distribution. These variables
were described using either the median and interquartile
range (IQR) or the mean standard deviation (SD), as
applicable. Frequencies and percentages were used to
represent qualitative factors such as gender, place of
residence, education, occupation, socioeconomic
position, kind of tooth restored, and occlusal result
category. Age, gender, BMI, socioeconomic level, and
the type of restored tooth were among the possible
confounding factors that were taken into account when
stratifying the occlusal result groups (excellent, good,
satisfactory, and unsatisfactory). When appropriate, the
Chi-square or Fisher's exact test was used for post-
stratication analysis. Statistical signicance was
defined as a p-value of less than 0.05. Operational
Definitions: Occlusal contact assessment was carried
out clinically using articulating paper. Two thicknesses
of articulating paper (12-micron and 100-micron) were
used to assess contact points between the PFM crown
and opposing dentition. The evaluation was supervised
by a consultant prosthodontist. Contact points were
categorised as: Excellent: Equal, strong occlusal
contacts on the crown and adjacent teeth; Good:
Unequal but strong occlusal contacts on the crown and
adjacent teeth; Satisfactory: Occlusal contact only on
the crown, indicating supraocclusion; and
Unsatisfactory: Absence of occlusal contact on the
crown, indicating infraocclusion. A PFM crown is a
fixed dental restoration made of a metal substructure
covered with a layer of porcelain. It is designed to
restore the form, function, and esthetics of a damaged
Occlusal Assessment of Porcelain-fused-tometal (pfm) Crowns
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J Gandhara Med Dent Sci
October - December 2026
or missing tooth. The term "try-in appointment"
describes a particular clinical phase of prosthodontic
treatment in which the prepared tooth is temporarily
supported by the manufactured PFM crown. Prior to
final cementation, this stage enables a clinical
assessment of occlusal connections, crown t, and
aesthetics.
RESULTS
Over the course of six months, 193 patients who
satised the inclusion requirements were added to the
study at Saidu College of Dentistry's prosthodontics
department. Table 1 displays the clinical and
demographic details of the subjects.
Table 1: Demographic and Clinical Characteristics of Study
Participants (n = 193)
Variable Frequency (n) (%age)
Gender
Male 87 45.1
Female 106 54.9
Age Group (years)
1830 44 22.8
3145 76 39.4
4660 73 37.8
Residence
Urban 111 57.5
Rural 82 42.5
Education Level
No formal education 28 14.5
Primary to Secondary 71 36.8
Higher Secondary and Above 94 48.7
Socioeconomic Status
Upper Class 13 6.7
Upper Middle Class 51 26.4
Lower Middle Class 76 39.4
Lower Class 53 27.5
Tooth Type
Maxillary 113 58.5
Mandibular 80 41.5
Both 12-micron and 100-micron articulating paper were
used for the occlusal contact evaluation during the try-
in session. Four categories were used to classify contact
quality: exceptional, acceptable, satisfactory, and poor.
Table 2 displays the distribution of these occlusal
assessment results.
Table 2: Occlusal Contact Outcomes of PFM Crowns at Try-In
Appointment (n = 193)
Occlusal Contact Outcome Frequency (n) (%age)
Excellent 68 35.2
Good 56 29.0
Satisfactory 43 22.3
Unsatisfactory 26 13.5
Gender, age group, and type of repaired tooth were
among the selected variables used to stratify the
occlusal contact results further. The relationship
between these factors and the occlusal contact result is
shown in Table 3. A p-value ≤ 0.05 was deemed
statistically signicant when using the chi-square test.
Table 3: Stratication of Occlusal Contact Outcomes by Selected
Variables (n = 193)
Variable
Excellent
n (%age)
Good n
(%age)
Satisfactory
n (%age)
Unsatisfact
ory n(%age)
p-value
Gender
0.172
Male 28
(32.2%)
25
(28.7%)
20
(23.0%)
14
(16.1%)
Female
40
(37.7%)
31
(29.2%)
23
(21.7%)
12
(11.3%)
Age
Group
0.038
1830 18
(40.9%)
11
(25.0%)
10
(22.7%)
5
(11.4%)
3145 30
(39.5%)
23
(30.3%)
15
(19.7%)
8
(10.5%)
4660 20
(27.4%)
22
(30.1%)
18
(24.7%)
13
(17.8%)
Tooth
Type
0.096
Maxilla
ry
45
(39.8%)
35
(31.0%)
22
(19.5%)
11
(9.7%)
Mandibu
lar
23
(28.8%)
21
(26.3%)
21
(26.3%)
15
(18.8%)
*Statistically signicant (p ≤ 0.05)
DISCUSSION
The study found that 64.2% of porcelain-fused-to-metal
(PFM) crowns were categorised as excellent or good,
indicating that most of them showed positive occlusal
contact results during the try-in session. This result is
consistent with earlier studies that highlight how
important accurate occlusal modications are for
lowering technical issues and extending crown
longevity.
14
Similar ndings were described by Jamal et
al., who found that open contacts and occlusal
discrepancies were important causes of crown failure,
especially in middle-aged patients.
14
In keeping with
research showing age-related decreases in occlusal
force and masticatory eciency brought on by
neuromuscular and tooth wear factors, we found that
older patients had a higher prevalence of poor occlusal
contacts.
15
This implies that being older increases the
likelihood of occlusal discrepancies, highlighting the
necessity of increased professional attention during try-
in to prevent supra- or infraocclusion and associated
problems. Occlusal contact quality was not signicantly
impacted by gender, which is consistent with earlier
research that demonstrated no signicant variations in
prosthodontic results between males and females.
14
Gender-specic biomechanical variations do exist, but
they do not seem to have a signicant impact on
clinical occlusal t in PFM crowns, underscoring the
critical role that clinical expertise and technical
accuracy play.
16
It is widely known that mandibular
molars frequently withstand higher occlusal stresses
Occlusal Assessment of Porcelain-fused-tometal (pfm) Crowns
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J Gandhara Med Dent Sci
October - December 2026
and may create additional obstacles during crown
manufacture and adjustment, even though our
investigation found no discernible dierence between
maxillary and mandibular crowns.
16
Our centre’s
consistent clinical procedures and balanced sample
probably helped to reduce variations in arch positions.
Compared to research done in facilities with
sophisticated laboratory and digital workows, where
occlusal discrepancies at try-in are less common, the
percentage of satisfactory and unsatisfactory occlusal
contacts was marginally greater.
17
This highlights how
important it is to perform a thorough intraoral occlusal
examination during the try-in phase in order to prevent
long-term issues such as marginal breakdown and
secondary caries.
17
In line with Kohorst et al.'s
recommendations for multimodal occlusal evaluation
techniques to ensure optimal prosthetic function and
durability, the use of articulating papers of varying
thicknesses (12 µm and 100 µm) proved useful for
detecting subtle variations in contact strength.
18
Timely
identification is crucial because inadequate occlusal
interactions might increase the risk of wear and
fracture.
18
Furthermore, Sara et al. conrmed our
method of classifying contacts into four quality levels
to aid in clinical decision-making by showing that
occlusal contact patterns and adjustments have a
substantial impact on the mechanical stability and wear
resistance of crowns under functional loading.
19
For a
prosthetic to be successful over the long term, precise
occlusal alignment during try-in is essential. The
accuracy of crown ts and patient comfort are enhanced
by occlusal assessment protocols that use both clinical
and digital tools, according to a recent systematic
review by Khan et al.
20
This supports the use of new
technologies in clinical practice to support more
conventional approaches.
LIMITATIONS
Subjective occlusal contact evaluation without
objective force measurement tools and a cross-sectional
design that prevented long-term clinical outcome
follow-up were two of the study's limitations. However,
the data's consistency and dependability were
guaranteed by the use of standardised evaluation
criteria and the participation of a skilled prosthodontist.
CONCLUSIONS
The study concluded that most PFM crowns displayed
satisfactory occlusal contacts during the try-in session,
underscoring the need for a comprehensive occlusal
evaluation in guaranteeing prosthetic success. While
gender and tooth position had no eect on occlusal
dierences, age was found to be a major determinant.
Subtle occlusal discrepancies were successfully
detected using articulating papers of dierent
thicknesses, highlighting the importance of careful
clinical examination before nal cementation. The
durability of PFM restorations is ultimately inuenced
by these results, which highlight the signicance of
standardised occlusal assessment procedures for
maximising crown t, function, and patient satisfaction.
CONFLICT OF INTEREST: None
FUNDING SOURCES: None
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Sadiq
Ullah
-
Concept & Design; Data Acquisition;
Data
Analysis/Interpretation;
Drafting Manuscript;
Critical
Revision;
Supervision;
Final Approval
Abdullah
-
Concept & Design; Data Acquisition;
Data
Analysis/Interpretation;
Drafting Manuscript;
Critical
Revision;
Supervision;
Final Approval
Humaira Malik
-
Concept & Design; Data Acquisition;
Data
Analysis/Interpretation;
Drafting Manuscript;
Critical
Revision;
Supervision;
Final Approval
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AUTHORS CONTRIBUTION
The authors accept responsibility for all aspects of the work
and will ensure that any concerns regarding the accuracy or
integrity of any part are properly investigated and resolved.
Occlusal Assessment of Porcelain-fused-tometal (pfm) Crowns
