J Oral Maxillofac Surg

69:2879-2882, 2011

Comparative Study Between 2 Methods of

Mounting Models in Semiadjustable
Articulator for Orthognathic Surgery
Gabriela Mayrink, DDS,* Renato Sawazaki, DDS, MsD, PhD,†
Luciana Asprino, DDS, MsD, PhD,‡
Márcio de Moraes, DDS, MsD, PhD,§ and
Roger William Fernandes Moreira, DDS, MsD, PhD㛳

Purpose: Compare the traditional method of mounting dental casts on a semiadjustable articulator and
the new method suggested by Wolford and Galiano, 1 analyzing the inclination of maxillary occlusal
plane in relation to FHP.
Materials and Methods: Two casts of 10 patients were obtained. One of them was used for mounting
of models on a traditional articulator, by using a face bow transfer system and the other one was used
to mounting models at Occlusal Plane Indicator platform (OPI), using the SAM articulator. After that, na
analysis of the accuracy of mounting models was performed. The angle made by de occlusal plane and
FHP on the cephalogram should be equal the angle between the occlusal plane and the upper member
of the articulator.
Results: The measures were tabulated in Microsoft Excell® and calculated using a 1-way analysis
variance. Statistically, the results did not reveal significant differences among the measures.
Conclusion: OPI and face bow presents similar results but more studies are needed to verify its
accuracy relative to the maxillary cant in OPI or develop new techniques able to solve the disadvantages
of each technique.
© 2011 American Association of Oral and Maxillofacial Surgeons
J Oral Maxillofac Surg 69:2879-2882, 2011

Model surgery is an important step in the presurgical
treatment planning for dentofacial corrections, espe-
cially in double-jaw orthognathic surgery. This allows
for preoperative analysis of the jaw movements and
confection of the intermediate and final splints, nec-
essary for accurate repositioning of the maxilla and
mandible at surgery.
Received from the Department Oral and Maxillofacial Surgery,
Piracicaba Dental School, Piracicaba, Brazil.
*Postgraduate Student.
†Collaborative Professor.
‡Collaborative Professor.
§Associate Professor.
㛳Associate Professor.
Address correspondence and reprint requests to Dr Mayrink:
Piracicaba Dental School CP 52, State University of Campinas–
UNICAMP 13.414-903, Piracicaba, SP, Brazil; e-mail: gabrielamayrink@
fop.unicamp.br
© 2011 American Association of Oral and Maxillofacial Surgeons
0278-2391/11/6911-0035$36.00/0
doi:10.1016/j.joms.2010.12.030
Traditionally, the patient’s facial analysis is trans-
ferred to a prediction tracing and then to an articula-
tor, by use of the regular face bow, to replicate the
correct relationship of the patient’s skull and the
occlusal plane. However, the traditional transfer
method can show erroneous maxillary spatial posi-
tion. According to Wolford and Galiano,1 the reasons
for the inaccuracies with the traditional face bow are:
1) the vertical, anteroposterior, and mediolateral po-
sition of the patient’s external meati or condyles may
be asymmetric from side to side compared with the
stable and symmetric position of the face bow rods on
the articulator; 2) the Frankfort horizontal plane
(FHP) may be different on the articulator and in asym-
metric patients; 3) the face bow may be improperly
positioned or can move during the registration pro-
cedure; and 4) cranial base and jaw aberrations are
not reproducible on the articulator.
Walker et al2 explain that the semiadjustable artic-
ulators were designed for dental prosthetics and have
limitations when used for orthognathic purposes.
With a purpose to minimize errors in mounting
models on an articulator, Ellis et al3 describe a method

2879
2880
for verifying and, if necessary, modifying the position
of the maxillary cast before mounting on the articu-
lator. Wolford and Galiano,1 however, described a
different technique using a new device, the occlusal
plane indicator (OPI), for mounting of dental models,
as well as the SAM articulator (SAM-Prazisionstechnik,
München, Germany). This method relies on the pa-
tient’s clinical and cephalometric evaluations to
mount the dental models on the articulator without
use of a face bow.
In this study we aimed to compare the traditional
method of mounting dental casts on a semiadjustable
articulator and the new method suggested by Wolford
and Galiano,1 analyzing the inclination of maxillary
occlusal plane in relation to FHP, using the method
proposed by Ellis et al.3
Materials and Methods
This research was first submitted to and approved
by the Ethics Committee in Research of Piracicaba
Dental School–Unicamp, Piracicaba, São Paulo, Brazil.
Five PhD postgraduate students with extensive ex-
perience in mounting models on an articulator using
a face bow were responsible for 10 patients.
Two casts of each patient were obtained. The first
was used for mounting of models on a traditional
articulator, by use of a regular face bow transfer
system. The other group was used for mounting of
models on the OPI (SAM 3 articulator).
To perform the face bow transfers, the ear rods
were used to locate the position of the external audi-
tory (meatus) and nasion was the third point of refer-
ence. The bite fork was positioned with observation
of the dental and facial midline. After the desired
position was achieved, the lock nut was secured and
the face bow and maxillary cast were transferred to a
semiadjustable articulator.
Using the other cast of the same patient, the same
student used the OPI for mounting models. Wolford
and Galiano1 in their article showed the advantages of
OPI. According to them, the first step is correction for
radiographic magnification of linear measurements
taken from the cephalometric analysis by use of the
following formula:
AM ⫽ X ⫺ XY
where AM indicates adjusted measurement, X indi-
cates cephalometric linear measurement, and Y indi-
cates percentage of magnification. The percentage of
magnification of the cephalostat used in this study
was 5%.
The OPI platform is then mounted on the articula-
tor and appropriately adjusted, and dental models are
mounted following the sequence suggested previ-
SEMIADJUSTABLE ARTICULATOR MODEL SURGERY
ously.3 The maxillary occlusal plane angulation and
vertical and anteroposterior position of the maxillary
central incisor are obtained from lateral cephalomet-
ric analysis and transferred to the OPI platform. The
transverse cant of the occlusal plane is duplicated by
tipping the OPI platform after facial analysis of the
patient. Finally, the maxillary dental model is posi-
tioned on the OPI platform with the dental midline
aligned appropriately to the platform midline, and the
model is stabilized.
Once the maxillary casts have been mounted by use
of the OPI platform and face bow transfer system (Fig
1), an analysis of the accuracy of the mounting was
performed. According to Ellis et al,3 only the transfer
of the angle between the occlusal plane and FHP to
the articulator was evaluated.
The same cephalometric analysis used for mount-
ing the OPI platform was used to evaluate accuracy. A
compass was used to record the distance between the
maxillary incisor tip and the inferior part of the upper
member of the articulator mounting ring. This dis-
tance was taken to the lateral cephalometric tracing,
and while the point of the compass was placed on the
incisor tip, a pencil was used to score an arc superi-
orly. The same technique was used for the mesial
cuspid of the first molar. Once the incisor and molar
arcs were drawn, a line was drawn tangent to the 2
arcs. The angle between this line and the FHP was
calculated by digitizing both lines in the tracings.
The angle should be 0° for a properly transferred
case (the angle made by the occlusal plane and FHP
on the cephalogram should be equal to the angle
between the occlusal plane and the upper member
of the articulator).
The mounting by face bow and OPI was evaluated
by this method.
Results
The angle between the occlusal plane and FHP
obtained by the OPI and the arbitrary face bow trans-
fer system was calculated, and as expected, it was 0°.
The measures were tabulated in Microsoft Excel
(Microsoft, Redmond, WA) and calculated by use of a
1-way analysis of variance. Statistically, the results did
not show significant differences among the measures.
Discussion
The use of a face bow is an accepted method in the
literature to copy the skull base and the occlusal plane
relationship to the semiadjustable articulator. How-
ever, some imprecision can appear when the tradi-
tional method is used, especially in patients with
asymmetric external meati.
MAYRINK ET AL
FIGURE 1. Dental casts of same patient mounted in semiadjustable articular and SAM articulator.
Mayrink et al. Semiadjustable Articulator Model Surgery. J Oral Maxillofac Surg 2011.
Many authors have discussed the undesired conse-
quences that this imprecision represents during or-
thognathic reconstructive surgery, which has led
other authors to suggest different methods to repro-
duce this problematic relationship.1-6
The OPI appears to be an alternative to the use of
the regular face bow. According to Wolford and
Galiano,1 this method duplicates the clinical and
cephalometric relationship with increased accuracy
over the traditional face bow technique and elimi-
nates the additional chair time required for face bow
registration, thus eliminating patient discomfort. The
transfer of the cephalometric measures to the articu-
lator provides this technique a real relationship be-
tween skull base, FHP, and maxillary occlusal plane.
Another important advantage is the simplification and
demystification of mounting on an articulator. In ad-
dition, the presence of the patient is not necessary in
this step, in contrast to the traditional technique.
On the other hand, the suggested technique can
suffer from operator subjectivity regarding landmark
definitions. The modification of Wolford and Galiano1
requires perfect anatomic landmark locations to de-
termine the ideal occlusal plane and correct angula-
tion to the FHP, and this feature can lead to additional
imprecision and cause mistakes when the occlusal
plane is determined by this new method. Several
2881
questions appear when the OPI is used, including the
fact that the OPI does not have manual instructions,
which hampered and delayed the initial operation. If
the face bow is a method that finds many imprecision,
the OPI have some variables that can cause impreci-
sion, too. For example, the positioning of the cepha-
lostat and the degree of radiographic magnification
could be prejudicial with regard to the final result.
The determination of the maxillary cant is totally
empirical, because this new method does not men-
tion a complementary radiographic examination,
such as posterior-anterior radiography, to define the
exact final spatial maxillary position; for initiates, this
feature can generate difficulty in reproducing maxil-
lary position. Moreover, the new method requires the
clinical skills of the operator to locate the anatomic
landmarks. We agree that this new method is an
evolution of the traditional technique, but it also re-
quires training for proper use.
The statistical analysis showed no significant dif-
ference between OPI and face bow. Nevertheless,
we analyzed only the inclination of the occlusal
plane from the anteroposterior position, not the
mediolateral position. Undoubtedly, the face bow of-
fers a more reliable reproduction of the maxillary cant.
The OPI and face bow present similar results, but more
studies are needed to verify the OPI’s accuracy relative
2882
to the maxillary cant and to develop new techniques able
to address the disadvantages of each technique.
References
1. Wolford LM, Galiano A: A simple and accurate method for
mounting models in orthognathic surgery. J Oral Maxillofac Surg
65:1406, 2007
2. Walker F, Ayoub A, Moos K, et al: Face bow and articulator for
planning orthognathic surgery: 1 face bow. Br J Oral Maxillofac
Surg 46:567, 2008
SEMIADJUSTABLE ARTICULATOR MODEL SURGERY
3. Ellis E III, Tharanon W, Gambrell K: Accuracy of face-bow
transfer: Effect on surgical prediction and postsurgical result.
J Oral Maxillofac Surg 50:562, 1992
4. Gateno J, Forrest KK, Camp B: A comparison of 3 methods of
face-bow transfer recording: Implications for orthognathic sur-
gery. J Oral Maxillofac Surg 59:635, 2001
5. Bamber MA, Firouzai R, Harris M, et al: A comparative study of
arbitrary face-bow transfer systems for orthognathic surgery
planning. Int J Oral Maxillofac Surg 25:339, 1996
6. Sharifi A, Jones R, Ayoub A, et al: How accurate is model
planning for orthognathic surgery? Int J Oral Maxillofac Surg
37:1089, 2008