Maximum bite forces in healthy adults with complete natural dentition: A systematic review

To systematically review and synthesize the available scientific evidence on maximum masticatory forces in adults with complete natural dentition, analyzing differences by anatomical region of the dental arch and by sex, and the influence of the recording protocol and measurement device.

A systematic review was conducted following PRISMA guidelines and registered in PROSPERO (CRD42024575463). Three databases (PubMed, Scopus, and Web of Science) were searched without date restrictions. Studies reporting maximum bite force values in healthy adults (18-65 years) with complete dentition were included. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Quantitative synthesis was performed using a random-effects meta-analysis (DerSimonian-Laird model) to estimate pooled mean values. Heterogeneity was assessed using the I² statistic and investigated through subgroup analyses stratified by measurement device, recording protocol (unilateral/bilateral), sex, and dental region, as well as meta-regression for age.

A total of 30 studies met the inclusion criteria. Seventeen out of these 30 studies (56.67%) were rated as high quality, 7 (23.33%) as moderate quality, and 6 (20%) as low quality. Meta-analysis confirmed a significant anteroposterior gradient, peaking in the whole dental arch, where the highest mean forces were recorded (males: $874.63N$ ; females: 637.22 $N$ ). Significant sexual dimorphism was confirmed across all regions ( ), with male values in the molar region ( $592N;95\%\mathrm{CI}:523-661$ ) consistently exceeding those of females ( $449N;95\%\mathrm{CI}:382-516$ ). Meta-regression revealed that a model adjusting for age, sex, and region explains $84.5\%$ of the variance, identifying the measurement device and anatomical location as the dominant drivers of heterogeneity.

Maximum masticatory force varies significantly across dental arch regions and between sexes, with posterior teeth showing higher force values. While sexual dimorphism and age are critical biological modulators, reported values are highly dependent on the measurement device and recording protocol (unilateral vs. bilateral). These findings provide stratified reference values for clinical use while underscoring the need for protocol and technological standardization.