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CLINICAL SCIENCE

The Instantaneous Hinge Axis - Its Reproducibility and Use as an Indicator for Dysfunction
S.M.

LUPKIEWICZ,* C.H. GIBBS,? P.E. MAHAN, H.C. LUNDEEN,$ M. ARIET,* and S.L. SINKEWIZt

*Computer Sciences Division, Department of Medicine, College of Medicine, University of Florida, Box J-372, Gainesville, Florida 32610, fDepartment of Basic Dental Sciences, College of Dentistry, University of Florida, Box J424, Gainesville, Florida 32610, and $Department of Occlusion and Fixed Prosthodontics, College of Dentistry, University of Florida, Box J-407, Gainesville, Florida 32610 Materials and methods. This study investigated irregularities in hinge movement in 113 subjects. These irregularities were analyzed by computer with an Patient recordings. - Jaw motions were measured and instantaneous three-dimensional "screw axis method." The variation with the replicator (Fig. 1). The replicator recorded in hinge movement was measured by the dispersion of the hinge axis on tape, jaw motion in six degrees of freedom, so recorded, centers was muscle instant centers. instant greater for Dispersion of of any point on the mandible could be movement that the pain patients than for the normal, indicating that instant center data studied. The tape-recorded information can be analyzed by could make a contribution to diagnosis and treatment planning. computer or played back to move casts which duplicate the exact motion of the subject's jaw. The maximum error in J Dent Res 61(1):2-7, January 1982 the measurement system was less than 0.125 mm, and the Introduction. total measuring instrumentation attached to the patient weighed only 100 g. The special design of the clutches,
Patients experiencing pain in the muscles used in mastication or of the temporomandibular joint (TMJ) often are unable to allow the jaw to move easily into retruded positions or swing freely in hinge axis movement. KroghPoulsen and Olsson1 have included ease of jaw manipulation as one indicator of dysfunction. Roura and Clayton2 and Crispin et al. 3 used a method of quantifying irregularities in border movements (from pantographic tracings) as a diagnostic indicator of dysfunction. In these studies, the more single-valued, reproducible border movements are associated with symptom-free patients. This study investigates the reproducibilities and irregularities in the hinge movements of the jaw for possible use in diagnosing the dysfunction patient. The reproducibility of determining a hinge axis (line of rotation) is in itself an important issue, since the mounting of dental arch casts in relation to the condylar control elements in an articulator is based on a hinge axis. Reproducibility of a hinge axis is also important in jaw motion studies for defining the posterior "condylar" recording point, especially when data from different subjects are compared. Reproducibility of hinge axis position is the first topic of this study. The second topic of this study is the irregularity of hinge movement in relation to diagnosing the dysfunction patient. In preliminary studies by Gibbs et al.4 and Lupkiewicz et al.,5 it was shown that pain patients had more irregularity in hinge axis movement than did the symptomfree patients, which encouraged this larger study involving 113 subjects. Irregularities in the hinge movement were analyzed by computer with an instantaneous three-dimensional "screw axis" method. Computer application was feasible, since the patient data had been measured electronically in all three dimensions (six degrees of freedom) and recorded on computer-compatible magnetic tape. The screw axis method of analysis was chosen since it is
an exact and sensitive method of describing rigid body motion in all three dimensions. This is in contrast to approximate two-dimensional methods used previously by Bennett6 and Ulrich.7 The screw axis is a sensitive indicator of irregularities in rotational movement. In this article only hinge movement data are presented. Chewing motions, investigated with the instantaneous screw axis method, will be presented in a later article. Received for publication August 5, 1980 Accepted for publication October 30, 1980 This research was supported by NIDR Grant No. DE-04157.

cemented to the facial surfaces of the teeth, allowed natural mastication without interference from the clutches. A more detailed explanation of these methods has been

reported previously.4,8,9

JAW MOVEMENT RECORDING AND REPRODUCING SYSTEM

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_

oi"-pute
Il

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Replicator with Subject's
Costs

Tape Recorder

Computer

Focebows with 6 Transducers

Fig. 1
ments.

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The

replicator instrumentation for study of jaw move-

Jaw hinging data from 36 good occlusion adults, 42 malocclusion adults without muscle pain, 15 malocclusion adults with muscle pain, and 20 children aged from four to ten with good occlusion were recorded. For an adult to be classified as having good occlusion, the following requirements were necessary: 1) From 28 to 32 teeth were present in good arch alignment and apposition; 2) the teeth were free of involved restorations, such as inlays and compound fillings; 3) teeth intercuspated with their respective antagonists according to Angle's Class I type of occlusion; 4) the teeth showed no abnormal wear or mobility; 5) the

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gingival tissues were normal; and 6) no dysfunction signs or symptoms were noted. Approximately ten jaw closing strokes were analyzed for each subject run. The wide-open translatory range and occlusal contact range were avoided. Jaw manipulation was performed by one or sometimes two operators utilizing the thumb to retrude the jaw, the fingers to support the jaw at

CHILD Fig.05-second intervals instead of 0.10 Since Routh's description is not easily accessible in modern literature. different operators were involved in recording the information for all 113 subjects. If the axis of rotation is chosen so that the translation is parallel to the axis of rotation.01-second interval for hinge movement. Hinge axes were calculated for each 1/100-second interval and smoothed over 1/20-second intervals. it is desired to reduce the motion of every particle to as few independent variables as possible.01-second intervals. 4). to move the measuring instrument about a line of rotation constant to within 0. however. recordings were taken with a mechanical "perfect" hinge which was built for calibration purposes. 3). the jaw is undergoing some motion other than pure rotation. which reduced the error to about 0. describe the complex motion of the mandible. the ISA's and ISC's would repeat in the same place (hinge axis). . The description of the screw axis was attributed to Chasles and was described in detail by Routh. Because of the previously mentioned translation of the jaw at times when the movement does not represent hinging (near closure or at maximum opening). The intersections of the ISA's with these planes produced points termed Instantaneous Screw Centers (ISC's). The positions of the hinge axes were observed as points (instant centers) on sagittal viewing planes through the right and left condyles (Fig. For example. The instantaneous relative motion of two rigid bodies can be described to the first order as rotation of the whole body about some axis (line) and a motion of translation.The data were recorded on digital magnetic tape and transferred to a HewlettPackard 2100 system. An ISA is. Instantaneous screw centers defined. for calibration purposes. a more recent presentation of the mathematical equations was published4 and is available from the authors upon request.15 inch from the actual center." This model can be analyzed mathematically for large movements or for small movements when the rotation is considered to be infinitely small. Including translatory movements in an average axis would be misleading.85 inches from the actual center. and the axis is termed the "screw axis. The clinician disregards the translatory movements while adjusting the face bow to the motionless points. a screw-type motion results. It is possible for both to exist outside the physical borders of the mandible.0005 inches.ADULT 12rmm MEDIAL TO SKIN . Data analysis. Removing the translation data mathematically is analogous to the action taken by the clinician when he removes unwanted translatory movement by watching the mounted kinematic face bow to see when the patient's hinge movements may be interrupted by translation into protrusion. Computerized analysis.0005 inches. both the ISA's and ISC's will exist at infinity. the pivotal line or axis of rotation. forcing the jaw downward and open. In order to completely. The intersections of the ISA's with these planes produced points termed instantaneous screw centers (ISC's) (Fig. and a graphical display was produced (Fig. the ISA's and ISC's will continually move. Twelve 20rmm SAGITTAL PLANE \ THROUGH CONDYLE MEDIAL TO SKIN. An instantaneous method was used so that translatory movements of the jaw could be separated and eliminated from the hinge movements. If the jaw were truly hinged. 3). if the jaw were to first hinge about a finite axis and then translate (hinge about an axis at infinity). the computer only selects points which are between the top and bottom of the . the velocity approximation was improved by calculating across position changes for 0. Each of the small x's represents one coordinate of one of the ISC's. The computer calculated the ISC's for each 0. 61 No. If the jaw undergoes pure translation. for an instant. 2). The measurement error caused these points to be as far as 0. 1 INSTANTANEO US HINGE AXIS 3 the light downward pressure on the subject's chin. This error is a function of the position and geometry of the measuring instrument. This mechanical screw axis device was constructed. 3 The Instantaneous Screw Axes were intersected with sagittal planes through the right and left condyles. The jaw was hinged by applying angle of the mandible on each side (Fig. Since this error was large. One graph for the analysis of the motion of a "perfect" mechanical hinge is shown in Fig. The irregularity in hinge movement was measured by the dispersion of the instant center points in both superior-inferior and anteriorposterior directions on the right and left sides. as well as its velocity of movement.The instantaneous screw axes (ISA's) were intersected with sagittal planes through the right and left condyles. . These theoretical points move perpendicular to the direction of translatory motion of the jaw. All ISC's of the jaw were calculated at both right and left condyles and displayed for the anterior-posterior and superior-inferior directions. In a similar fashion.Vol. It moved the measuring instrument about a line of rotation constant to within 0. it would average together as infinite. iI Fig. yet as simply as possible. 4. 2 - Dentist's hand on jaw showing - hinging manipulation. If.

68 2.f. with malocclusion and with a malunion of an old fracture of the ramus. . female.s--- Fig. 4). female.'* ..157 inches (Fig. after correction of the crossbite. 6 .4 L UPKIEWICZ ETAL. 6 shows an adult female. i an A i A II 0 z -J N %--] .malocclusion with joint and muscle pain.31 2J1 3.05 X-DISPLACEMENT CONDYLE. before and after correction of the crossbite.Adult . Here there is a great increase in the dispersion. o . .1 1. 4 .18 2.05 RIGHT 2. The average represents one coordinate of the hinge axis with respect to the skull. Fig. The standard deviation of 0. which is reflected in a standard deviation of 0.68 3.. To demonstrate the use of this method for analysis of treatment. For those ISC's which are between these borders. 4 was performed on a mechanical hinge.054 inches). age 45 (GST1S1).18 0. Fig.05 1 1. w CONDYLE. . 8).Ad' -r O. (.3 0. _ _ s --: . . X-DISPLACEMENT Fig. age 45.-v . - ei _'::.1 - 4 .437 inches. .* .~~~~S s2 CY 0. 5 shows the instant center plot of an adult with good occlusion for the right condyle in the anterior-posterior direction. ADULT . for both sides. 5-9 reflect definite trends as reflected in the standard deviation of 0.:..GOOD OCCLUSION FEMALE AGE 21 (CMT1S1) IC IN to. .68 1.. with joint and muscle pain. Fig. -- z ( woC WN {:!¢ .18 1. ' . Here dispersion of the ISC's is relatively small. X-DISPLACEMENT good occlusion.. z .. 0 41 X."Perfect" mechanical hinge (SHT 1S3). The examples shown in Figs. .81 2. ADULT. Because the analysis of Fig. z a---:. a child with a unilateral crossbite was measured 0 . 9 shows the same child one year later. r- w CD an C'j 0 o P.1 0. J Den t Res January 1 982 vertical hinge line drawn by the computer (line A. j 0.771 G2 SD - - Adult - LM 0. is small (as reflected in the standard deviation of less than 0. .-:-4. . Fig. 5 RV 1.31 1.) - . o _N LJ 0 -I c. age 21 (CMT1S1). Fig. the computer calculates an average and standard deviation which are shown in the lower right hand corner of the graph.j 0o Ccli '.68 RIGHT z b . The preoperative analysis resulted in a standard deviation of 0. "PERFECT" MECHANICAL HINGE 0) IZ w o (SHTIS3) .05 inches). with a much lower standard deviation (0.- CO} cs Z 0) w F. age 50. . .. the dispersion of the ISC's in both directions. U z I(M 27 .31 3.05 3.MALOCCLUSION WITH JOINT a& MUSCLE PAIN FEMALE AGE 45 ^^ '' (GWT1S1) ' ----. The standard deviations represent the reproducibility of hinge axis position and were used to study hinge movement as a possible tool for the diagnosis of dysfunction. I N U) .-i i.027 inches.18 3.81 RIGHT CONDYLE. Fig. C) e Q 15 00 2 OD ( . 7 shows an adult male. -- .' ' .129 is nearly five times that of the good occlusion adult. .

Data for the superior-inferior right side and both directions on the left side (not shown) follow the same patterns shown in Fig. 9 Child (RAT6S1). Fig.UNILATERAL CROSSBITE MALE AGE 7 PRE-OP (RAT1S1) W in the standard deviations of the ISC's.Vol.97 RIGHT CONDYLE. pre-op increases in the same manner." The horizontal axis represents the standard deviation of the ISC's.o Z N -J e N C . Z w -0. This is a consequence of the mathematical model of the instant centers. therefore.16 RIGHT CONDYLE. 7 .GOOD OCCLUSION MALE AGE 8 POST-OP (RAT6S1) a i- AGE 50 (BST3SI) 0 V.437 . 10. The averages for three of the graphs are essentially the same.65 RIGHT CONDYLE. :i .5 3 .. However.15 2.47 0. . the number of "extreme" cases increases steadily from the adult good occlusions.MALOCCLUSION MAL-UNION OF FRACTURE OF THE RAMUS MALE NC -- CHILD . Fig.66 1. but for the anterior-posterior direction on the patient's left side.47 2. I :-. X-DISPLACEMENT unilateral crossbite. indicating extremely good repeatability for their ISC's. 1.r uf3 0 or lJ en S CD a! I= X 0 CD I·.4 Visually. age 50 (BST3S1). The mechanical hinge averages are marked by "SH. NC 0. Fig.054 I Fig.16 3.689 SD . . the bulk of each of the four groups falls within these margins. 8 - Child unilateral crossbite. post-op Fig. to the adult malocclusions without pain. Z 0 a . Q -J o ·r tiZ W O 2 CY w . . 0 -0.65 2. . and to the adult malocclusions with pain.47 1.97 1. Also. a0 N Q) 0 .65 1. .malocclusion with mal-union of a fracture of the ramus.15 1.16 1.15 3. The dispersions in the anterior-posterior direction represent the looseness of the condyle in the superior-inferior direction. X-DISPLACEMENT % RV 2. to the children. The mechanical hinges (SH) are all included in the low end of the graphs. the average appeared significantly higher. ':_. considering from 0. age seven. male. N( :dS C-0.97 2. 11 compares the two perspectives (A-P and S-I) for each of the sides for the adults with good occlusion. X-DISPLACEMENT - (RATIS1).03 0. but the shown were not present in every case.1 inches as the most common region.157 0. .0 to 0.66 2. 1 INSTANTANEOUS HINGE AXIS 5 ADULT .Adult . 10 compares the four population groups for only the anterior-posterior movements on the right side. male.' .66 3. patterns C] cr 0 Z m la -J O Q Z z( W t" pi I I RV 2.242 SD .66 4. the average for each population (shown as a vertical dotted line) . age seven. a larger value indicates a greater looseness of the condyle.332 SD . male..16 2.i O CW RV 1 . This means there was greater condylar looseness in the Results.65 3. - CHILD . 61 No.

Since instant centers move perpendicular to translatory movements.1 I i II 0.6 8 L UPKIEWICZ ET AL. The instrumentation showed no = Fig. RIGHT SIDE ADULTS - ANTERIOR 5 4 - POSTERIOR.05).1 02 0. there were individual recordings which did appear inconsistent. An Analysis of Variance was performed for the data listed in the Table. ADULTS MALOCCLUSION ANTERIOR . 11 Distribution of standard deviations of ISC's for the adults with good occlusion for the A-P and S-I for both the right and left sides. ADULTS .7 0. In general.5 06 0 0.I 0.0 0. Dispersions in the anterior-posterior direction were greater than those in the superior-inferior direction (a 0. No inter.05).INFERIOR.6 1I 1 0.7 2 CHILDREN AVERAGE AGE 6. As one would expect.GOOD OCCLUSION SUPERIOR .5 0.7 ADULTS .I 0. - . all four subject groups showed more looseness at the TM joints (greater instant center standard deviation) in both directions than did the mechanical hinge (a = 0.4 1 I- 0. statistical difference between right and left sides.I 1 I' J 0. 10 Distribution of standard deviations of ISC's for each of the four populations for the anterior-posterior direction and right side only.3 0. 8 7- J Denzt Res January 1 982 7. this indicated that there was more mechanical looseness superior-inferiorly than anterior-posteriorly.POSTERIOR .POSTERIOR. These were important findings because operator effects could have masked or created nonreal differences among subject groups.5 0. .4 I I 05 6 0.4 0.05). .4 0. Instant center dispersions for the "perfect" mechanical hinge indicated that there was a small instrumentation effect. SH . adult malocclusion without muscle pain.3 0.0 Ilu.6 0. RIGHT SIDE 8 ADULTS . 6 5 4 3 2 SH I' 0.3 0. RIGHT SIDE P*LIIE I 0.3 0.0 0.or intra-operator variability was found (a = 0.7 0.2 0.INFERIOR. RIGHT SIDE 8765- 5T 3 i SH | AVG . 0.05) in both the anterior-posterior and superior-inferior directions.6 0.AVG m I.3 0.2 0.4 0.2 0.6 0.GOOD OCCLUSION SUPERIOR . - WITH PAIN RIGHT SIDE 21 Fig.3 6 5 4 3 AVG 04 0. The sensitivity in .GOOD OCCLUSION ANTERIOR .0 J II (1I.2 - I 0.l AVG 6 5-t 43 2 - t I .I 0. The reproducibility of the instant centers using the mechanical hinge indicates that the instrumentation and mathematics are an accurate method for determining location of the hinge axis. This same trend was observed in each of the three other populations (adult malocclusion with muscle pain. When tested for statistical significance.3 I 1 0.POSTERIOR. when one or two operators recorded the same subject several times.or intra-operator effects were found (a = 0.05).2 ANTERIOR . I - 0.3 - I. instant center dispersions for the normal and malocclusion without pain groups were greater in the anterior-posterior direction than in the superior-inferior direction (a = 0.4 0. The normal Discussion.7 ADULTS ANTERIOR - GOOD OCCLUSION POSTERIOR. AVG 00 I I lI _ 'l I o0 02 I 0..2 0. In addition to the instrumentation effects. 0.7 ADULTS .. RIGHT SIDE 54 SH SH AVG 7 -- 2 _ _ _ 0.5 06 0.5 0.4 1 0.5 I0 I 0.POSTERIOR. no inter. Occasionally.0. 0. GOOD OCCLUSION LEFT SIDE S AVG 2 8 7 6 4 - - 0.0 0 01 0 0.MALOCCLUSION WITHOUT PAIN ANTERIOR. and normal children). the results appeared reproducible. LEFT SIDE group showed more instant center dispersion on the left side than on the right side (a = 0. Dispersion of the instant centers was greater for pain patients than for normal subjects (a = 0.05).05).7 superior-inferior direction.

C.B.SUPERIOR.SUPERIORPOSTERIOR INFERIOR POSTERIOR POSTERIOR INFERIOR . 1959 (reprinted from his original publication of 1896). 3) Studies are continuing to refine this method and to test for the 2) This method by itself is not a complete diagnostic 36 42 . and OLSSON..: The Instantaneous Hinge Axis-Possible Indicator for Dysfunction..B. pp. D.C. Eds.042 . or (3) the operator stands on the right side of the subject.. This was not economically practical in this study because of the large number of operators involved.B. 1980. C. H. MA: Publishing Sciences Group. 1978.. N.162 2. J. 4. 193.078 .. Sect.C. H. 10. May-June. RIGHT SIDE. Report No.066 . It was encouraging that.. Cleveland.: Instrumentation for the Investigation of Mandibular Movements. differentiate muscle splinting dispersions from those caused REFERENCES MALOCCLUSION ADULTS WITHOUT MUSCLE PAIN MALOCCLUSION ADULTS WITH MUSCLE PAIN CHILDREN WITH GOOD OCCLUSION 15 .C. MYERS. Littleton. ROUTH..157 . 1969.ANTERIOR. J. P. 442451. H. In press.. LUPKIEWICZ.: A Contribution to the Study of the Movements of the Mandible. T.142 .C. Ohio: Case Western Reserve Univ. GIBBS. A.114 ... pain patients had greater dispersion of the ISC's than did the normal subjects (a = 0. 5 through 9 gives promise that the test may be refined. but the clear visual distinction shown for some subjects in Figs. future studies.: Management of the Occlusion of the Teeth. C.J. and Chayes. GIBBS. therefore the large number. KROGH-POULSEN. Ohio: Case Western Reserve University. and RESWICK. It does. 5. Also..047 GOOD OCCLUSION ADULTS dysfunction patient. 29-34. Proc Roy Soc Med (Odont. L. 1975.191 . MAHAN. CANNON. and LUNDEEN. 4-64-8. This is an important observation for clinical dentistry. J Prosthet Dent 33:4. ULRICH. 8.: Functional Movements of the Mandible. In: Advances in Occlusion.122 (AGES 4-10) .G.182 . G. T. 9. pp. pp. GIBBS. Seventh ed. 184-198. CRISPIN. (2) more operators are right handed.E.A. and CLAYTON. AADR Progr & Abst 59:No.026 1) The Three-dimensional Instant Center Method reproducible approach to finding the hinge "PERFECT" MECHANICAL HINGE 9 .: Elementary Rigid Dynamics. .078 . S. Schwartz. and MESSERMAN. B. 1908.119 20 . W.) I(3):79-98. the data for this study were collected over a period of several years which decreased the availability of the current operators. These aspects should be considered in 3. 1980. 10 and 11 demonstrate clear trends in the diagnostic potential of the Instant Center Screw Axis method.H. Cleveland.: Effects of Occlusal Therapy on Pantographic Reproducibility of Mandibular Border Movements. 7.E.125 . Figs.. J Prosthet Dent 9(3):399-406.118 . LEFT SIDE LEFT SIDE ANTERIOR.. show promise when used in conjunction with other tests..: Pantographic Records on TMJ Dysfunction Subjects Treated with Occlusal Splints. TM joint looseness can be a cause of inaccurate interocclusal records with subsequent inaccuracies in articulator-mounted casts and the fabricated restorations. J. Engineering Design Center.M. 1. ROURA. 236-280.109 .125 by TMJ abnormality. The lack of a clear delineation between populations with this method is disappointing. 1964. Saunders. determining operator effects could have been improved by requiring all operators to record all subjects. 6. appears to be a axis. New York: The MacMillan Co. Engineering Design Center Report No. A Progress Report.A. N.H. J Prosthet Dent 40:1. C. EDC 4-69-24. C.M. J. J. in general. 159-184.H. however.G. RIGHT SIDE. Also.122 .052 . Philadelphia: W. RESWICK. 1969.. In: Facial Pain and Mandibular Dysfunction. 1 INSTANTANEOUS HINGE AXIS 7 TABLE STANDARD DEVIATIONS OF INSTANT CENTER POINTS FOR HINGE MOVEMENTS N Conclusions. and LUNDEEN.H.E. J. 61 No. BENNETT. The fact that the dispersions are greater in the anteriorposterior than in the superior-inferior direction for the normals and malocclusions without pain means that there is greater joint looseness superior-inferiorly. MESSERMAN. Possible explanations for the apparent greater range of dispersions in the anterior-posterior direction for the left side include: (1) More subjects are right handed.: The Human Temporomandibular Joint: Kinematics and Actions of the Masticatory Muscles. and CLAYTON.: Jaw Movements and Forces During Chewing and Swallowing and Their Clinical Significance. Lundeen.05). 1905. Eds.Vol. and Gibbs.