Section 03 - Hinge axis

Handout Abstracts Summary 001. Page, H. L. Some confusing concepts in articulation. D Digest 64: 1- 6, 1!"#. 00$. Preston, %. D. & reassessment of t'e man(i)ular trans*erse 'ori+ontal axis t'eor,. % Prost'et Dent 41:60"-613, 1! !. 003. -ranger, .. /. 0linical significance of t'e 'inge axis mounting. D01& 2ar 1!"!:$0"-$13. 004. &ull, &. .. & stu(, of t'e trans*erse axis. % Prost'et Dent 13:46!-4 !, 1!63. 00". S'ana'an an( Leff. 2an(i)ular an( articulator mo*ements, Part 333: 4'e man(i)ular axis (ilemma. % Prost'et Dent 1$:$!$-$! , 1!6$. 0L3130&L H31-. &53S L60&4361 006. Sc'al'orn, /. -. & stu(, of t'e ar)itrar, center an( 7inematic center of rotation for face)o8 mounting. % Prost'et Dent :16$-16!, 1!" . 00 . Laurit+en, &.-., an( 9o(ner, -. H. :ariations in location of ar)itrar, an( true 'inge axis points. % Prost'et Dent 11:$$4-$$!, 1!61. 00#. ;al7er, P. 2. Discrepancies )et8een ar)itrar, an( true 'inge axis. % Prost'et Dent 43:$ !$#", 1!#0. 00!. 9ear(, 0. 0. , an( 0la,ton, %. &. Stu(ies on t'e *ali(it, of t'e terminal 'inge axis. % Prost'et Dent 46:1#"-1!1, 1!#1. 010. -ates, -. 1., an( 1ic'olls, %. 3. .*aluation of man(i)ular arc' 8i(t' c'anges. % Prost'et Dent 46:3#"-3!$, 1!#1. 011. Simpson, %.;., Hes),, /.&., Pfeifer, D.L. an( Pelleu, -.9. &r)itrar, man(i)ular 'inge axis locations. % Prost'et Dent "1:#1!-#$$, 1!#4. 01$. -or(on, S./., Stoffer, ;.2. an( 0onnor, S.&. Location of t'e terminal 'inge axis an( its effect on t'e secon( molar cusp position. % Prost'et Dent 60:""3-""!, 1!## 013. Pali7, %. <., 1elson, D. /. an( ;'ite, %. 4. &ccurac, of an .ar Piece <ace-)o8. % Prost'et Dent "3:#00-#04, 1!#".

Section 03: Hinge Axis I (Handout) 3. Histor, 0re(it for t'e i(ea of t'e mec'anical location of an axis 8as gi*en to Dr. /o)ert Harlan. 4'e first actual 7inematic location 8as e*ol*e( t'roug' t'e 0alifornia -nat'ologic Societ, un(er t'e lea(ers'ip of Dr. 9.9. 2c0ollum. 33. 2an(i)ular mo*ements ;e can *ie8 t'e face in t'e frontal, sagittal, an( 'ori+ontal planes. 4'e man(i)le rotates in eac' of t'e t'ree planes aroun( an axis. 4'is axis can )e stationar, or mo*ing . 2o*ement occurs in t'e 'ori+ontal plane 8'en t'e man(i)le mo*es into a lateral excursion. 4'e center of rotation is t'e *ertical axis exten(ing t'roug' t'e rotating con(,le. 4'e man(i)le also rotates aroun( t'e sagittal axis 8'en t'e or)iting si(e (rops (o8n (uring a lateral excursion. 3n t'e sagittal plane t'e man(i)le ma7es a purel, rotational opening an( closing )or(er mo*ement aroun( t'e 4rans*erse Hori+ontal &xis. =uic7 summar, of man(i)ular mo*ement 333. Ho8 (o 8e (efine 'inge axis to(a,> 4rans*erse Hori+ontal &xis: &n imaginar, line aroun( 8'ic' t'e man(i)le ma, rotate. ?-P4-6@ 4'is rotation a*erages a)out 1$o or 1#-$"mm of incisal opening accor(ing to /a'n, an( occurs (uring centric relation. Ho8 (o 8e (efine centric relation: 4'e relation of t'e maxilla to t'e man(i)le 8'en t'e con(,les are in t'e uppermost an( rearmost position in t'e glenoi( fossae. 4'is position ma, not )e a)le to )e recor(e( in t'e presence of (,sfunction of t'e masticator, s,stem. 3:. 3s t'ere an, contro*ers, concerning 'inge axis> 6f course t'ere is. 3t 'as )een present since 1!$1. 0ontro*ers, 'as arisen o*er t'e presence of a single axis, t'e met'o(s use( to locate t'e axis, t'e met'o( an( *ali(it, of recor(ing t'e positions on t'e s7in for future reference, an( t'e relation of t'e terminal 'inge position to t'e position of centric relation. 6n 8it' t'e contro*ers,>

Does a single axis exist> ?a line nee(s onl, t8o points an( t'erefore anatomic s,mmetr, of t'e con(,les is not necessar,@ So 8', 8as t'ere a contro*ers,> Page sa,s ALac7 of training in t'e )asic sciences lies )e'in( t'e plausi)le )ut groun(less arguments against ?'inge axis@A Page sa,s again A & con(,le rotatesB t'erefore, an, argument against its (oing so aroun( rotational centers or a 'inge axes is an argument against t'e trut'.A 0an a single point in t'e con(,le )e locate( an( can it )e transferre( to t'e articulator> Page sa,s noC So 8'at is PageDs opinion on 'inge axis> ?3ntracon(,lar or 3ntercon(,lar, 48o arcs of rotation@ 3s Page rig't> Does eac' con(,le 'a*e its o8n axis of rotation> Does it matter> -ranger sa,s somet'ing elseC ;'at (oes -ranger sa,> ?3ntercon(,lar, ;',>@ 0an one arc result from compoun( man(i)ular mo*ements> :. <our t'eories of t'e location or existence of t'e 'inge axis. 1. &)solute location of t'e axis 4'e 'inge axis is a component of e*er, masticator, mo*ement an( can not )e (isregar(e(. 3f t'e 'inge axis of t'e articulator is not t'e same as t'e 'inge axis of t'e patient t'en t'e mec'anical repro(uction of Ea8 motions are impossi)le. $. &r)itrar, location of t'e axis 4'e *alue of actuall, locating t'e exact 'inge axis is not 8ort' t'e effort. 4'is group fails to recogni+e t'at if t'e 'inge axis of t'e articulator (oes not coinci(e 8it' t'e 'inge axis of t'e patient, t'e pat's of closure 8ill not )e t'e same. 3. 1on)elie*ers in t'e trans*erse axis location 4'is group (oes not )elie*e t'e 'inge axis can )e accuratel, locate( or )elie*es ot'er mo*ements are in*ol*e( an( can not )e repro(uce( ), an articulator simulating one axisB t'erefore, an ar)itrar, axis is Eust as goo(. 4. Split axis t'eor, 4'is group )elie*es t'ere are t8o axis of rotation ? one in eac' con(,le@ an( t'e, parallel eac' ot'er. ;'at (i( &rt'ur .. &ull fin( out a)out t'e 'inge axis> ;'oDs stu(, supporte( 'im>

1. 4'e 'ori+ontal axis is a ',pot'etical line connecting t'e t8o 'ori+ontal rotation centers of t'e t8o con(,les of t'e man(i)le. $. 4'ere is one 'inge locationC 3. 9ear( an( 0la,ton repro(uce( a 1!6 stu(, ), 4rapo++ano an( La++ari t'at o)taine( e*i(ence to t'e contrar, of &ull. 9ear( an( 0la,ton foun( t'ere is onl, one 'inge axisC :3. ;'at is t'e significance of a 'inge axis mounting> /emem)er t'e purpose of t'e articulator is to repro(uce on a mec'anical instrument t'e relations'ip of t'e teet' as t'e, come toget'er in t'e mout'. 4'e 'inge axis pro*i(es t'e means of transferring t'e patient to t'e la) to construct t'e restorations. 3t must )e consi(ere(. ;'at else must )e consi(ere(.> 0an a simple protrusi*e registration accuratel, allo8 t'e settings of an articulator to resem)le t'e mo*ement of t'e man(i)le> ? 1o 8a, %oseCC@ So locating t'e 'inge axis is Eust one step in attempting to repro(uce man(i)ular mo*ement. 3t is 'o8e*er *er, important )ecause all mo*ement starts at t'e axis an( returns t'ere. See a)o*e (ra8ing. Dra8 some man(i)ular mo*ements if an,one (esires. Review. ;', is it important to 7no8 a)out t'e 'inge axis or to (etermine 8'ere it is locate(.> ;'at 8ill 'appen to t'e arc of closure if t'e 'inge axis is mista7enl, place( anterior, posterior, superior, or inferior t'e true 'inge axis> Ho8 (oes t'is pure 'inge mo*ement affect (entistr,> ?&rc of closure@ 3s t'e pat' of closure t'e same as t'e arc of closure> ?1o@ 4'e pat' results from closing rotation an( a gli(ing pat'. :33. Does e*er,one )elie*e t'at t'e man(i)le closes on an axis> ;'at, ;'o sai( so> ;'at (i( t'e, (o an( 'o8 (i( t'e, reac' t'eir conclusions> S'ana'an an( Leff in 1!6$ an( <errario, et al. in 1!!6 :333. Locating t'e axis Ho8 accurate are in(i*i(uals in locating a true 'inge axis>

- Furt' an( <einstein sai( 8it'in $ mm 8'en restricting opening to G inc' at t'e incisal pin. - 9org' an( Posselt sai( 8it'in 1." mm 8'en a 10 (egree arc 8as use( an( 8it'in 1.0 mm 8'en a 1" (egree arc 8as use(. - Laurit+en an( ;olfor( 8ere a)le to ac'ie*e an accurac, of 0.$ mm 8'en using a 10 (egree arc of mo*ement. ;'at are some met'o(s of locating a true 'inge axis> 6)ser*ing t'e motion of a st,lus on an axis )o8, as create( ), Ea8 mo*ements, in relation to a flag fixe( o*er t'e patients axis area. ;'en t'e st,lus no longer translates )ut rotates t'en t'e point is accepte(. -eometric principles can also )e use( to ai( in locating t'e point as (escri)e( ), -et+3. -un(erson an( Par7er (escri)e( a tec'niHue similar in t'oug't to -et+. Ho8 accurate is an ar)itraril, selecte( axis> Scall'orn foun( t'at !"I of t'e axis points locate( 13 mm anterior to t'e posterior margin of t'e tragus on t'e tragus-cant'us line to )e 8it'in a " mm ra(ius of t'e 7inematicall, locate( axis. 9e,ron foun( t'at approximatel, # I of t'e locate( points 8ere 8it'in a " mm ra(ius of t'e ar)itrar, points. Lauriti+en an( 9o(ner foun( onl, 33I of t'e true axis points to )e locate( 8it' in a " mm ra(ius of t'e ar)itrar, points. 4eteruc7 an( Lun(een foun( similar results. ;al7er foun( t'at $0I of t'e true axis points 8ere locate( 8it'in " mm from t'e ar)itraril, selecte( point. Pali7, 1elson, an( ;'ite foun( t'at t'e earpiece face-)o8 relate( t'e maxillar, cast to t'e 'inge axis onl, "0I of t'e time. !$I of t'e time t'e ar)itrar, axis 8as locate( anterior to t'e terminal 'inge axis. ;'at are some met'o(s of ar)itraril, selecting an axis> Sc'losser (escri)e( palpating t'e con(,les as t'e patient opens. He also (escri)e( (ra8ing a $" mm line from t'e upper margin of t'e external au(itor, meatus to t'e outer cant'us of t'e e,e. &t a point 13 mm in front of t'e tense( anterior margin of t'e meatus a line is (ra8n crossing t'e first line at rig't angles. 9ran(rup-;ognsen (escri)e( a point on a line exten(ing from t'e tragus to t'e lateral angle of t'e e,e, a point is mar7e( at a)out 1$ mm in front of t'e posterior margin of t'e most prominent point of t'e tragus.

Prot'ero recommen(s placing a /ic', con(,le mar7er in t'e external au(itor, meatus t'en placing a ruler from t'e top of t'e mar7er to t'e outer cant'us of t'e e,e an( (ra8ing a line. 4'e con(,le mar7er is t'en rotate( to ma7e a line 13 mm from t'e anterior si(e of t'e metal part of t'e mar7er. ;ein)erg recommen(e( a(Eusting t'e face )o8 pins to a point 11 to 13 mm anterior on a reference line (ra8n from t'e mi((le an( posterior )or(er of t'e tragus of t'e ear to t'e corner of t'e e,e. ;'at (oes Simpson 'a*e to sa, a)out ar)itrar, man(i)ular 'inge axis location> Jse a point on 0amperDs line 10 mm from t'e superior )or(er of t'e tragusC 35. Does t'e man(i)le flex an( 8', (o 8e care> Kes it (oes. 4'is response is a function of t'e mec'anical properties of t'e )one as 8ell as t'e t,pe, magnitu(e, (irection, an( point of application of t'e force. 4'e later pte,goi( muscle is most freHuentl, cite( as in(ucing man(i)ular flexure. - ;'at are t'e clinical implications of t'e man(i)le flexing> - Pro(ucing an inaccurate cast if flexure occurs (uring impressions - Pro(ucing an inaccurate maxillo-man(i)ular relations'ip if flexure occurs (uring a 0/ registration - 2an(i)ular flexure ma, influence stress on a)utment teet' - &((uction of t'e man(i)le ma, effect t'e ultimate sta)ilit, of a lo8er (enture ;'at 8i(t' c'anges 8ere seen in *arious man(i)ular positions an( manipulations in t'e -ates an( 1ic'ols article> 6pening 0-0.3 mm (ecrease( *alue in arc' 8i(t' Protrusion 0.1-0." mm (ecrease( *alue in arc' 8i(t' Hori+ontal retru(ing force 0.11 mm increase( *alue in arc' 8i(t' 4'erefore t'e amount of man(i)ular arc' 8i(t' c'ange (uring impression ma7ing can )e minimi+e( ), pre*enting an, protrusi*e mo*ement an( Lor opening )e,on( $0 mm. Abstracts 03 00!. "age# H.$. Some con%using concepts in articu&ation. ' 'igest (): *! *(# !+,-.

Purpose: 4'e purpose of t'e article is to (iscuss issues on articulation an encourage criticism. Discussion: 0riticism 'as )een expresse( a)out t'e terminolog, of ne8 principles, as )eing too Acomplicate(A. 3t is claime( t'at pu)lication 'as )een of no *alue for t'e a*erage (entist since t'e, 8ill not )ot'er to rea( t'e (ifficult material. 4'erefore t'e tas7 is left to teac'ers an( lea(ers to a)sor) t'e ne8 concepts an( to infiltrate t'e ne8 p'ilosop'ies into clinical practice. &s a profession 8e s'oul( a8a7en to t'e fact t'at somet'ing is 8rong 8it' our teac'ing an( practice. Pro)a)l, some confusion arises )ecause of t'e great *ariet, an( complexit, of met'o(s an( material offere(, )ut more pro)a)l, it is t'at information gi*en to t'em is incorrect an( foun(e( upon 8rong concepts. 0onfusion also arises from t'e fact t'at t'ere are as man, 8a,s to sol*e a pro)lem of Ea8 relations an( occlusions as t'ere are (entist. 1o one Huestions t'at t'e con(,les are as,mmetricall, si+e(, s'ape(, an( positione(. 1o one can argue t'at t'e con(,les are Eoine( at t'e s,mp',sis an( not ), an, connecti*e tissue mec'anism running t'roug' t'e 'ea( from con(,le to con(,le. Shift of the mandible in function- is not merel, a A )o(il, si(e s'ift of t'e man(i)le in lateral excursionA as (escri)e( ), -ranger, it is a )o(il, s'ift of t'e man(i)le in *ertical function 8it' eac' con(,le mo*ing in an, one or in all t'ree (imensions. Importance given to the Bennett movement- -ranger also en(o8s t'e 9ennett mo*ements 8it' extraor(inar, po8ers. 3t (etermines t'e form an( position of t'e sulci an( marginal ri(ges. 4'e po8er mo*ement as t'e muscles on t'e 8or7ing si(e contract. 3t (etermines t'e (irection of stress on t'e supporting structures an( t'erefore 8'et'er t'e cusps are pat'ologic or p',siologic. 3f t'e 9ennett mo*ement is so important , it 8oul( )e 'elpful to 7no8 more a)out it. Cause of movement claimed- -ranger also consi(ers a 9ennett mo*ement to )e limite( to a )o(il, si(e-to-si(e s'ift of t'e man(i)le occurring onl, (uring lateral excursions. He states t'at t'e limitation of mo*ement against t'e inner cur)ing of t'e glenoi( fossa (etermines t'e 9ennett mo*ement. Explanation of movement required- an unsupporte( statement cannot )e accepte( as a scientific fact . & con(,le, A)alancingA or ot'er8ise, (oes not ri(e t'e Ainner cur)ingA or an, ot'er part of a fossa un(er its o8n po8er, for it is t'e mo)ile part of a uni*ersal Eoint. Ket, no explanation is gi*en to s'o8 'o8 a A )alancingA con(,le can maintain unai(e( so firm a contact 8it' t'e )one ceiling an( a)o*e an( me(ial to it t'at forces t'e 8or7ing si(e of t'e 'ea( to mo*e out8ar(. 3n t'e a)sence of a *ali( explanation, 8'at )ecomes of t'ose po8ers of t'e 9ennett mo*ement> Many hinge-axes exist- t'ere are at least t8el*e 'inge-axes in e*er, 'ea(B t'ree in eac' temporoman(i)ular Eoint an( t'ree in eac' man(i)ular angle. 6nl, t'e t'ree in eac' Eoint reHuire consi(eration: ?1@ t'e trans*erse 'inge-axes t'at go*ern Ea8 rotation in t'e sagittal plane ?opening an( closing@, ?$@ t'e *ertical 'inge-axes t'at go*ern Ea8 rotation in t'e 'ori+ontal plane ?si(e-to-si(e@, an( ?3@ t'e sagittal 'inge-axes t'at go*ern Ea8 rotation in t'e trans*erse plane ?Ea8 roc7ing@.

03 00.. "reston# /. '. A reassessment o% t0e mandibu&ar transverse 0ori1onta& axis t0eory. / "rost0et 'ent )!: (0, (!3# !+*+. Purpose: to )riefl, re*ie8 t'e 'istor, an( (e*elopment of t'e t'eor, an( practice of t'e trans*erse 'ori+ontal axis location, its applications an( some contro*ersies t'at 'a*e surroun(e( its use. Discussion an( 0onclusions: & single trans*erse 'ori+ontal axis can usuall, appear to )e locate(. ?8it'in t'e limits of accurac, of operators, eHuipment an( patients.@ - ;'en a 7inematic axis is locate(, t'is is a 8ort'8'ile clinical proce(ure to transfer t'e arc of rotation in t'e sagittal plane from patient to t'e articulator - 1o one 'as pro*e( or (ispro*e( t'e presence of colinear or noncolinear condyle arcs. - 4'e rig't angle-non rig't angle concept is mislea(ing an( generall, not in(icate( for use. - &natomic as,mmetries of t'e axis transfer proce(ure ma, result in cast (islocations t'at pro(uce un(esira)le c'anges in est'etic toot' positions. - 4'e single trans*erse 'ori+ontal axis exists as fact in articulating instruments an( as a theory in t'e 'uman cranioman(i)ular complex. - 4'e term Atransverse 0ori1onta& mandibu&ar axis2 (20inge axis2) s'oul( )e use( instea( of Acon(,lar or intercon(,larA axis. 03 003. 3ranger# 4. R. 5&inica& Signi%icance o% t0e Hinge Axis 6ounting. '57A# 6ar !+,+:.0, .!3. Discussion: 4'e relations'ip of t'e teet' as t'e, come toget'er is (etermine( ), t'e relation of t'e con(,le to t'e glenoi( fossa. 4'e 'inge axis go*erns t'e art of closure in e*er, contacting position of t'e teet'. 4'e rotation of t'e as,mmetrical con(,les an( t'e as,mmetrical man(i)le, is gui(e( ), t'e form of t'e surface on t'e meniscus. 4'e purpose of an articulator is to repro(uce on a mec'anical instrument t'e relations of t'e teet' as t'e, come toget'er in t'e mout'. 4'e 'inge axis pro*i(es t'e means of transferring t'e patient to t'e la)orator, )enc'. Locating t'e 'inge axis an( repro(ucing t'e protrusi*e pat' ?anterior slant an( cur*ature of t'e con(,lar pat'@ an( lateral pat's ?9ennett mo*ement@ allo8s all com)inations of mo*ements to )e ma(e. 4o locate t'e 'inge axis 8it' a 'inge )o8, a clutc' is mounte( on t'e man(i)ular teet'. 4'e c'in is (roppe( open 8it' pure 'inge motion 8'ile a st,lus recor(s t'e position opposite t'e con(,le. 1o gli(ing of t'e con(,le s'oul( )e allo8e(. 4'e 'inge axis must )e locate( in t'e most posterior superior position of t'e con(,le 8'ic' is centric relation. 4'e point of t'e st,lus 8ill reac' t'e stationer, point an( t'e patient can )e tattooe( for future reference. 2ounting t'e cast on t'e articulator can )e accomplis'e( ), using t'e 'inge )o8 as a transfer or face )o8. 4'e <ran7furt Plane is use( to relate t'e face )o8 instea( of t'e ala-tragus plane. 2et'o( of c'oice to register t'e pat's of motion of t'e axis is t'e pantograp'. Stone c'ec7 )ites ma, )e use( for e(entulous patients. ;ax c'ec7 )ites are 8ort'less.

4'e 'inge axis (etermines t'e arc of closure in e*er, contacting position of t'e teet'. 4'e pat' of closure is (ifferent from eac' open position of t'e man(i)le to toot' contact. 4'is pat' results from t'e closing rotation com)ine( 8it' a gli(ing pat' of t'e axis. 03 00). Au&&# Art0ur 4. A study o% t0e transverse axis. / "ros 'ent !3:)(+ )*+# !+(3. Purpose: 4o (emonstrate t'e fallac, of t'e 'inge axis t'eor,. 2aterials an( 2et'o(s: 4'e 'inge axis 8as to )e locate( using extra long arms an( four flags an( st,luses. 4'e extra t8o flags 8ere place( 4 to " inc'es outsi(e t'e inner flags. & 'ole 8as (rille( 8ere t'e 'inge axis 8as locate( an( a lig't 8as s'o8n t'roug' t'e 'ole to see if t'ere 8as one line. /esults: 6ne line 8as pro(uce(. 0onclusion: 4'ere are four main sc'ools of t'oug't regar(ing 'inge axis t'eor,. -roup 1. &)solute location of t'e 'inge axis. 4'ese people )elie*e t'e 'inge axis is a component of e*er, masticator, mo*ement of t'e man(i)le an( cannot )e (isregar(e(. -roup $. &r)itrar, location of t'e axis. 4'ese people )elie*e t'e 'inge axis is of some *alue, )ut not 8ort' t'e effort to locate. -roup 3. 1on)elie*ers of t'e trans*erse axis t'eor,. 4'e, )elie*e t'e 'inge axis is t'eoretical, )ut not practical. -roup 4. Split-axis rotation. 4'e, )elie*e in t'e transograp' t'eor,. 4'at eac' con(,le 'as its o8n center of rotation. i.e. t8o axes t'at parallel eac' ot'er. &ullDs stu(, (ispro*e( t'e transograp' t'eor, 03 00,. S0ana0an# 8 4/ and $e%%# A. 6andibu&ar and articu&ator movements. "art III. 80e 6andibu&ar Axis 'i&emma. / "rost0et 'ent !.: .+. .+*# !+(.. Purpose: Sustaine( protrusion 4o o)ser*e man(i)ular mo*ements to confirm or (en, t'e presence of an axis in t'e region of t'e con(,les. 2et'o(s M 2aterials: P'otograp'ic recor(s 8ere ma(e of t'e normal opening an( closing mo*ements of t'e man(i)le from )ot' si(e an( front. Lig'ts 8ere place( to lo8er an( upper incisors an( si(e an( *ie8 recor(s of t'e mo*ements of t'e lig'ts 8ere o)taine( ), placing t'e camera at t'e si(e of t'e face an( a mirror in front of t'e su)Eect at an angle of 4" (egrees to t'e camera. 6)ser*ations M /ecor(ings: 6)ser*ing t'e man(i)ular mo*ements from t'e front, t'e man(i)le (i( not open an( close on an axisB from t'e si(e, t'e rotation center of t'e pseu(o arc 8as not in t'e region of t'e con(,le. 4'ese t8o *ie8s of opening an( closing mo*ements 8ere not tracings of axis mo*ements an( t'erefore (i( not support t'e man(i)ular axis t'eor,. <rom t'e si(e t'ere 8as no e*i(ence of rotation a)out a man(i)ular axis in t'e region of t'e con(,le 8it' a concomitant anterior translation. 9ilateral De*iation: 3t 8as e*i(ent from t'e lig't t'at t'e man(i)le ma, (e*iate to t'e rig't or left (uring opening an( closing mo*ements. 0'e8ing 4ests <ox &xis Determination: & su)Eect c'e8e( a piece of 'ar( crac7er t'ree times to explore t'e possi)ilit, of t'e presence of man(i)ular axis (uring t'e mastication of foo(. 1one of t'e mo*ements s'o8e( e*i(ence of a natural man(i)ular axis. &rtificial 2an(i)ular &xis: 4'e term artificial man(i)ular axis (esignates an axis t'at is t'e

result of forcing t'e man(i)le )ac78ar(. 4'is axis cannot )e foun( (uring normal p',siologic man(i)ular mo*ements. &n artificial man(i)ular axis can )e pro(uce( in one of t8o 8a,s: t'e patient ma, *oluntaril, retru(e t'e man(i)le as far as possi)le (uring t'e opening an( closing mo*ements, or t'e (entist can appl, firm, )ac78ar( pressure to t'e c'in (uring mo*ements. 0onclusion: 4'e aut'ors conclu(e( t'at an artificiall, pro(uce( man(i)ular axis, Ea8 mo*ement, Ea8 position is not a normal p',siologic mo*ement. 4'ere 8as no e*i(ence of rotation a)out a man(i)ular axis in t'e region of t'e con(,les 8it' concomitant anterior translation in t'ese stu(ies of t'e opening, closing, an( masticating mo*ements. 03 00(. Sc0a&0orn# R. 3. A study o% t0e arbitrary center and 9inematic center o% rotation %or %acebow mounting. / "rost0et 'ent *: !(. !(+# !+,*. Purpose: Discuss certain a(*antages of t'e face )o8 8'en use( properl,, an( its merits in prost'etic (entistr,. Discussion: 4'e 7inematic face )o8 is expensi*e, an( a rat'er lengt', an( (ifficult proce(ure. 3f t'e a(*antages are enoug' to offset t'e (isa(*antages, t'en ), all means, its general use s'oul( )e esta)lis'e(. 3t 'as )een state( ), &rsta( 4'or, in 'is stu(, on man(i)ular mo*ements, t'at an error of "mm from t'e 'inge axis results in an error of onl, 0.$ mm, in t'e articulator, t'e molar of t'e lo8er Ea8 mo(el 8ill 'a*e contact 8it' its antagonist 0.$ mesial or (istal to t'e intraoral occlusal position of t'e molar after a correspon(ing man(i)ular mo*ement of $mm. 9ecause of t'is "mm tolerance 8it' t'e resultant negligi)le error, man, feel t'at it is not necessar, to (etermine t'e axis accuratel,. 2aterials M 2et'o(s: 1. Se*ent, (ental stu(ents 8it' normal occlusion an( at least $# teet' 8ere selecte( for t'e stu(,. $. &lginate impressions an( stu(, casts 8ere ma(e. Large un(ercut areas 8ere fille( 8it' 4enax 8ax, an( a splint 8as mol(e( o*er t'e teet' 8it' self-curing acr,lic resin. 3. 4'e face-)o8 8as em)e((e( in t'e resin splint 8'ile plastic, an( t'e acr,lic resin 8as allo8e( to cure. 4'e for7 8as t'en remo*e( from t'e cast. 4'e splint 8as t'en trimme(. 4. 4'e patient 8as t'en instructe( to practice opening an( closing t'e man(i)le in centric relations'ip t'roug' an( arc of a)out 10mm at t'e incisor region. ". 2ar7s 8ere place( o*er t'e con(,lar area, an( a line 8as (ra8n from t'e center of t'e tragus to t'e outer cant'us of t'e e,e. 6n t'is line, t'e ar)itrar, axis 8as plotte( 13 mm. &nterior to t'e posterior margin of t'e tragus, an( t'e tape 8as i(entifie( ), t'e si(e an( t'e num)er of t'e (etermination. 6. 4'e for7 8as t'en fastene( to t'e splint an( t'e Hanau mo(el H face-)o8 attac'e( to t'e for7. 9, a process of trial an( error, t'e axis 8as plotte( an( mar7e( on eac' t,pe. . /ec'ec7ing 8as (one for repro(uci)ilit,, an( of t'e 30 or more actual cross-c'ec7s, onl, one suc' c'ec7 8as more t'an 1." mm from t'e original plotting. 3n most cases, t'e error of repro(uci)ilit, 8as at a ra(ius of less t'an 1 mm from t'e original plotting. 0onclusion:

1. 3n o*er !" I of t'e su)Eects 8it' normal Ea8 relations'ips, t'e 7inematic center lies 8it'in a ra(ius of "mm from t'e ar)itrar, center, 8'ic' is consi(ere( ), &rsta( an( ot'ers to )e 8it'in t'e limits of negligi)le error. $. 4'e ar)itrar, axis of rotation as set ), Sno8, -ilmer, Hanau, -,si an( ot'ers, of 13mm, anterior to t'e tragus on t'e trageal-cant'us line comes *er, close to an a*erage (etermine( axis on in(i*i(ual 8it' normal Ea8 relations'ips. 3. 4'e aut'or agrees 8it' ot'er aut'ors t'at (etermining t'e 7inematic center of rotation is not nearl, as important as o)taining proper centric an( *ertical recor(s. 03 00*. $aurit1en# A. 3.# and :odner# 3. H. ;ariations in &ocation o% arbitrary and true 0inge axis points. / "rost0et 'ent !!: ..) ..+# !+(!. Purpose: to (etermine t'e *ariations in t'e location of t'e true 'inge axis points from t'e location of t'e 'inge axis points (etermine( ), ar)itrar, means. 2aterials M 2et'o(s: a tec'niHue for eas, an( accurate location of t'e true 'inge axis 8as (e*elope( ), researc'ers of t'e Laurit+en /esearc' -roup. 4'is tec'niHue inclu(e( a special tra, ?anterior portion of a rim loc7 tra,@ secure( to t'e man(i)le utili+ing alginate impression material. 4'e 'inge axis point 8as locate( utili+ing rea(ings from t'e 'inge axis locator . ? 1 cm. sHuare of millimeter grap' paper 8as attac'e( to t'e s7in in an area anterior to t'e tragus of t'e ear. 4'e a)o*e met'o( 8as utili+e( on fift, patients, t'us locating 100 true 'inge axis points. 0onclusions: 4'e stu(, foun( t'at in locating true 'inge axis points, 6 I 8ere from " to 13 mm. a8a, from t'e ar)itraril, mar7e( 'inge( points ?using surface lan(mar7s@. 80is means t0at arbitrary mar9ing o% t0e 0inge axis may resu&t in inaccurate mounting o% casts to an articu&ator# and occ&usa& discrepancies i% t0e centric re&ation record is made wit0 separation between t0e upper and &ower teet0. 4'erefore, t'e accurate location of t'e true 'inge axis points is recommen(e( ), t'e aut'ors. 03 00-. <a&9er# ". 6. 'iscrepancies :etween Arbitrary and 8rue Hinge Axis. / "rost0et 'ent )3:.*+ .-,# !+-0. Purpose: &nal,sis of a clinical stu(, to (etermine if t'ere exists an anatomic a*erage measurement to use for ar)itrar, 'inge axis point locations. 2et'o(s M 2aterials: $$$ un(ergra(uates 'a( t'eir true anatomic 'inge axis point locations (etermine( using a Denar 'inge axis locator. .ac' 'a( a full complement of teet'. 4'e reference line c'osen 8as tragus-cant'us line. 4'ese points 8ere compare( 8it' a 1$mm anterior reference an( "mm inferior ar)itrar, axis point locations. /esults: 1o consensus for ar)itrar, 'inge axis location existe(. 2ost of t'e locations 8ill gi*e a 6mm or more error 8it' a minimum of "mm expecte(. 4'e largest percentage of locations 8ill )e inferior to t'e tragus-cant'us line at t'e superior )or(er of t'e tragus of ear. :er, fe8 people 'a( t'e same true axis point locate( on )ot' si(es of t'e face. 0onclusion: &n, c'osen ar)itrar, location 8oul( not relia)l, represent t'e true anatomic 'inge axis.

03 00+. :eard# 5.5. and 5&ayton# /.A. Studies on t0e va&idity o% t0e termina& 0inge axis. / "rost0et 'ent )(:!-, !+!# !+-!. Purpose: 4o (etermine 8'et'er t'e results of 4rapo++ano an( La++ariDs stu(, 8oul( 'a*e )een (ifferent 'a( t'e, use( a (ifferent recor(ing apparatus. 2aterials an( 2et'o(s: Hinge axes 8ere locate( ), (ra8ing arcs on t'e paper rat'er t'an Eust *isuali+ing t'e st,lus. /esults: 6ne not multiple 'inge axes 8ere locate(. 0onclusion: 4'e 4rapo++ano an( La++ari stu(, s'o8e( multiple 'inge axes )ut 8it' t'e use of (ra8ing arcs on paper t'is stu(, s'o8e( onl, one 'inge axis. 03 0!0. 3ates# 3.7. and 7ic0o&&s# /. I. 4va&uation o% mandibu&ar arc0 widt0 c0ange. / "rost0et 'ent )(()):3-, 3+.#!+-!. Purpose: 4o e*aluate 8i(t' c'anges of t'e man(i)ular arc' at *arious man(i)ular positions an( manipulations so t'at (entists can minimi+e pro)lems (uring (ental treatment. 2aterials M 2et'o(s: & lig't sensing p'oto-(io(e ?Pin-S0L4D, Jnite( Detector 4ec'nolog,, 3nc, Santa 2onica, 0&@ a lig't (etector source ?3n-sig't lig't, &merican 2i(8est, Des Plaines, 3ll@ an( a 0.0$0 inc' plastic fi)eroptic stran( ?.(mon(s Scientific Suppl,, 9arrington, 1%@to transmit t'e lig't to t'e p'oto(io(e surface. 4o compare arc' 8i(t' c'anges 8it' man(i)ular opening or protrusion, a linear *aria)le (ifferential transformer ?L:D4@ mounte( extraorall, measure( millimeters of opening, protrusion 8'ile t'e p'oto(io(e measure( man(i)ular arc' 8i(t' c'anges. 4'e (e*ice 8as attac'e( to t'e man(i)ular teet' 8it' minimal force to re(uce mo)ilit, ), natural teet'. 4en men )et8een $0 an( "0 ,ears of age 8'o 'a( a full complement of natural teet' 8it' no e*i(ence of perio(ontitis 8ere e*aluate(. 4'e (ata measure( pro*i(e( t'e follo8ing comparisons: a. opening, protrusion, an( sustaine( opening an( protrusion, *s. arc' 8i(t' c'ange ). arc' 8i(t' c'ange *s. man(i)ular manipulation using c'in point gui(ance c. arc' 8i(t' c'ange *s. maximal )iting forces in t'e cuspi(L first premolar locations )ot' unilaterall, an( )ilaterall, (. su)Eects 8ere preme(icate( 8it' 9ant'ine ta)lets to (ecrease sali*ar, flo8 e. fi*e sustaine( max protrusions, openings , an( fi*e continuous man(. manipulations f. after eac' mo*ement passi*e or resting states 8ere recor(e( to return to A+eroA (rifts 0onclusion: a. 4'e 8i(t' of t'e man(i)le is influence( ), intrinsic an( extrinsic forces. ). 2aximal opening, protrusion, an( )iting forces cause t'e man(i)le to (ecrease in arc' 8i(t'. c. & 'ori+ontal retru(ing force on t'e man(i)le cause( an increase in arc' 8i(t' (. 4'e amount of man(i)ular arc' 8i(t' c'ange (uring impression ma7ing can )e minimi+e( ), pre*enting an, protrusi*e mo*ement an(Lor opening )e,on( $0 mm.

03 0!!. Simpson# /.<. # Hesby# R.A. # "%ei%er# '.$. and "e&&eu# 3.:. Arbitrary mandibu&ar 0inge axis &ocations. / "rost0et 'ent ,!: -!+ -..# !+-). Purpose: 0ompare t'e location of selecte( ar)itrar, 'inge axis points an( an experimental ar)itrar, axis point 8it' t'e 7inematic axis. 2aterials M 2et'o(s: 1. <ift, su)Eects 1!-60 ,ears ol(, 8it' accepta)le occlusion an( no clinical signs of 42% (,sfunction 8ere selecte(. $. 42% 31S4/J2.14 H31-. axis flags 8ere positione( on t'e face slig'tl, anterior to t'e tragus of t'e ear. 3. <i*e ar)itrar, axis points 8ere recor(e( on grap' paper: ?a@ 9e,ronNs point 8as locate( 13mm anterior to t'e posterior margin of t'e tragus of t'e ear on a line from t'e center of t'e tragus to t'e outer cant'us of t'e e,e. ?)@ -,siNs point 8as locate( 10mm anterior to t'e posterior margin of t'e tragus on a line from t'e center of t'e tragus to t'e outer cant'us of t'e e,e. ?c@ 9ergstromNs point 8as mar7e( 11 mm anterior to t'e posterior margin of t'e tragus on a line parallel to an( mm )elo8 t'e <ran7fort 'ori+ontal plane. ?(@ 4eteruc7 an( Lun(eenNs point 8as locate( 13 mm anterior to t'e tragus on a line from t'e )ase of t'e tragus to t'e outer cant'us of t'e ear. ?e@ 4'e experimental ar)itrar, point selecte( 8as place( 10mm anterior to t'e superior )or(er of t'e tragus on 0amperNs line. ?0amperNs line connects t'e superior )or(er of t'e tragus an( t'e inferior )or(er of t'e ala of t'e nose@. 4. 4'e &lmore man(i)ular 'inge axis locator 8as use( to locate t'e 7inematic axis. ". 4'e true axis point 8as recor(e( on t'e same grap' paper as t'e ar)itrar, axis points. 4'e I of ar)itrar, axis points t'at fell 8it'in "mm of t'e 7inematic axis 8as calculate( for eac' point, t'e (istance )et8een eac' point an( t'e 7inematic axis 8as measure(. Discussion: 1. 4'e stu(, s'o8s t'at #I of experimental axis points 8ere locate( 8it'in "mm of t'e 7inematic axis. &rsta( an( ;ein)erg reporte( t'at a " mm error in locating t'e man(i)ular 'inge axis results in a negligi)le occlusal error of 0.$ mm at t'e secon( molar. $. #0I of t'e 7inematic axis points 8ere locate( )elo8 a reference line (ra8n from t'e superior )or(er of t'e tragus to t'e outer cant'us of t'e ear, an( posterior to a point 1$ mm anterior to t'e superior )or(er of t'e tragus on t'e same reference line. 3. &n experimental ar)itrar, axis point 8as locate( )elo8 ;al7erNs reference line an( closer to t'e superior )or(er of t'e tragus. 4. 4'e experimental point 8as locate( on 0amperNs line, 10 mm anterior to t'e superior )or(er of t'e tragus. 0onclusion: 1. 3n a re*ie8 of t'e 'inge axis t'eor,, Preston state( t'at a superior-inferior error in axis location results in a larger (iscrepanc, t'an an error in anterior-posterior location. 9e,ron, -,si an( 9ergstrom s'o8e( an inferior-anterior ten(enc,.

$. 4'e ar)itrar, points of 9e,ron, -,si, an( 9ergstrom s'o8e( (irectional ten(encies, 8'ereas t'e experimental ar)itrar, points 8ere e*enl, (istri)ute( aroun( t'e 7inematic axis, an( closel, an( consistentl, approximate( t'e 7inematic axis. 3. 4'e clinical use of a point on 0amperNs line, 10 mm from t'e superior )or(er of t'e tragus, results in a more accurate transfer of t'e maxillar, cast to t'e articulator. 03 0!.. 3ordon# S.R.# Sto%%er# <.6. and 5onnor# S.A. $ocation o% t0e termina& 0inge axis and its e%%ect on t0e second mo&ar cusp position. / "rost0et 'ent (0:,,3 ,,+# !+-Purpose: to mat'ematicall, calculate t'e amount of cusp 'eig't an( mesio(istal error at t'e secon( molar, resulting from locations " an( #mm ?anterior, superior, posterior an( inferior@ to t'e 7inematicall, locate( 'inge axis. 4'e maxilloman(i)ular relations'ips 8ere measure( ), inter(ental recor(s of 3 to 6mm t'ic7 at t'e incisal region. 2et'o(s M 2aterials: 0alculations 8ere )ase( on t'e follo8ing: a. a (istance from t'e mi(point of t'e 'inge axis to t'e man(i)ular incisal e(ges of # .! mm calculate( from 9on8illNs triangle. ). t'e 9al78ill angle eHuals 1# (egrees c. cusp inclines in a mesio(istal (irection eHual 30 (egrees (. "-# mm erroneous locations of t'e 'inge axis ?anterior, superior, posterior, an( inferior@, as state( a)o*e e. Ea8 relation recor(s of 3 an( 6 mm t'ic7 at t'e incisors, measure( along t'e arc of closure Summar,L 0onclusions: from t'e criteria state( a)o*e, t'e errors in cusp 'eig't at t'e secon( molar range( from 0.1" mm open space to 0.4 mm excess 'eig't. 4'e mesio(istal error range( from 0."1 mm to8ar( t'e (istal to 0."$ mm to t'e mesial.

t'e 0/ recor( s'oul( )e recor(e( at a *ertical (imension close to t'e planne( *ertical (imension of occlusion locating t'e 7inematic 'inge point prior to extensi*e treatment for (entulous patients results in a )etter occlusion an( also sa*es time 8'en no c'ange in *ertical (imension ?'ence 7inematic 'inge point is not applica)le@ ot'er tec'niHues ma, )e use(

03 0!3. "a&i9# /. =.# 7e&son# '. R. and <0ite# /. 8. Accuracy o% an 4ar "iece =ace bow. / "rost0et 'ent ,3:-00 -0)# !+-,. Purpose: 4o recor( *ariations )et8een t'e 7inematic axis an( earpiece (etermine( axis an( measure t'e magnitu(e an( (irection )et8een t'e t8o points on selecte( su)Eects. &lso, to e*aluate t'e significance of t'e (ifference )et8een t'e 7inematic axis an( t'e earpiece (etermine( axis an( t'e repeata)ilit, of t'e ear face-)o8 met'o( statisticall,. 2et'o(s: 4'e earpiece face)o8 use( t'e external au(itor, meati an( t'e inferior or)ital rim as reference points, 8'ile t'e 7inematic face)o8 use( t'e terminal 'inge axis an( t'e inferior or)ital rim as reference. Points.

Kinematic location of terminal hinge axis: 4'e area of t'e true 'inge axis 8as locate( ), palpating t'e su)EectNs con(,les (uring opening an( closing of t'e man(i)le. & clutc' tra, 8as affixe( to t'e man(i)ular teet' 8it' 3mpregnum. ;it' t'e man(i)le in centric relation t'e axis points 8ere tattooe( on t'e s7in. & )itefor7 8as a(apte( o t'e occlusal surfaces of t'e maxillar, teet' 8it' )lac7 mo(eling compoun(. 4'e )itefor7 8as use( for )ot' 7inematic an( ar)itrar, face)o8 recor(ings. 2o(ifie( Plexiglas (is7s 8ere positione( on t'e lateral aspect of eac' of t'e con(,lar element of t'e articulator parallel to t'e sagittal plane. 6n eac' (is7 a grap' circle 8as place( 8it' t'e 0,0 coor(inate point coinci(ing 8it' t'e 'ori+ontal an( *ertical line intersection to simulate a x-, grap'. 4'e su)EectNs i(entification, si(e of articulator ?r or L @ an( anteroposterior positions 8ere i(entifie( on t'e grap' circles. ocation of arbitrary hinge axis! 4'e same )itefor7 pre*iousl, use( 8it' t'e 7inematic face)o8 8as repositione( intraorall, on t'e maxillar, occlusal surface an( sta)ili+e( 8it' finger pressure. 4'e Hanau earpiece face)o8 8as attac'e( to t'e )itefor7 an( t'e ear ro(s a(Euste( in t'e su)EectNs external au(itor, meati until pressure 8as eHuall, (istri)ute( )ilaterall,. /esults: 2ost ar)itrar, axis locations 8ere anterior an( inferior to t'e true 'inge axis. "6 I of t'e ar)itrar, axis locations 8ere anterior an inferior to t'e terminal 'inge axis, 8'ile 36I 8ere anterior an( superior to t'e terminal 'inge axis. 61LK "0I of t'e ar)itrar, 'inge axes 8ere 8it'in a "mm ra(ius of t'e true 'inge axis, 8'ile #!I 8ere 8it'in a 6-mm ra(ius. Discussion: 3n comparison stu(ies of *ariations )et8een ar)itrar, axis an( t'e 7inematic axis, results *arie( from $0I to !"I of t'e ar)itrar, 'inge axis points, falling 8it'in a " mm ra(ius of t'e true 'inge axis point. 4'is stu(, compare( fa*ora)l, 8it' t'at o Laurit+en an( 9o(ner an( firml, supporte( 4eteruc7 an( Lun(een. Ho8e*er, it (i( not support t'e fin(ings of 9e,ron an( Sc'all'orn. 4'e statistical anal,sis (emonstrate( t'at t'e earpiece face)o8 is not statisticall, relia)le or repeata)le. 4'is (oes not suggest t'at it is unsuita)le clinicall,. 4'e n,lon earpiece s'oul( )e mo(ifie( to increase repeata)ilit,. Summar,: 4'is in*estigation (emonstrate( a significant statistical (ifference )et8een t'e ar)itrar, axis locate( 8it' an ear-)o8 an( t'e terminal 'inge axis. &((itional stu(, is nee(e( to (etermine t'e practical *alue of t'e ar)itrar, face)o8 an( to pursue mo(ifications to impro*e its accurac,. 0onclusions: 1. 4'e earpiece face)o8 relate( t'e maxilla to t'e 'inge axis 8it' t'e "mm accepta)le range "0I of t'e time. $. 4'e earpiece face)o8 recor(e( t'e ar)itrar, 'inge axis anterior to t'e terminal 'inge axis !$I of t'e time. 3. 4'e earpiece face)o8 measurement in t'is stu(, 8as not statisticall, repeata)le.

Summary o% Aut0ors and 5oncepts >

Page. 2an, 'inge axes exist Preston. &rc ma, result from compoun( mo*ements

-ranger. 4'ere is onl, one position of t'e 'inge axis. &ull. 6nl, one 'inge axis. S'ana'an. Stu(, of natural motion (oes not s'o8 a 'inge axis Sc'all'orn. !"I of patients true axis is 8it'in "mm of t'e ar)itrar, 'inge &xis ?13 mm anterior to t'e tragus on t'e tragus- cant'us line. Laurit+en an( 9o(ner. 33I of a patients true 'inge axes are 8it'in " mm of t'e patients true axis. ;al7er. $0I 8ere 8it'in "mm 9ear( an( 0la,ton. 6ne 'inge axis -ates an( 1ic'ols. 4'e 8i(t' of t'e man(i)le c'anges (ue to intrinsic an( extrinsic forces. Simpson. Jse a point 10mm from t'e superior )or(er of t'e tragus on 0amperDs line for an ar)itrar, 'inge axis. #I 8it'in " mm. -or(on. Feep ,our centric relation recor( t'in. Pali7. Hanau ear )o8. "0I 8it'in "mm Hinge axis 8as locate( anterior -et+. -eometric location of t'e 'inge axis -un(erson an( Par7er. -eometric location again <errario. Pure rotation (i( not occur.