Hinge Axis I

I. History
. Mandibular movements
We can view the Iace in the Irontal, sagittal, and horizontal planes. The mandible rotates in each
oI the three planes around an axis. This axis can be stationary or moving .
Movement occurs in the horizontal plane when the mandible moves into a lateral excursion. The
center oI rotation is the vertical axis extending through the rotating condyle.
The mandible also rotates around the sagittal axis when the orbiting side drops down during a
lateral excursion.
In the sagittal plane the mandible makes a purely rotational opening and closing border
movement around the Transverse Horizontal Axis.
Quick summary oI mandibular movement
III. How do we deIine hinge axis today?
Transverse Horizontal Axis: An imaginary line around which the mandible may rotate. (GPT-6)
This rotation averages about 12
o
or 18-25mm oI incisal opening according to Rahn, and occurs
during centric relation.
How do we deIine centric relation: The relation oI the maxilla to the mandible when the condyles
are in the uppermost and rearmost position in the glenoid Iossae. This position may not be able
to be recorded in the presence oI dysIunction oI the masticatory system.
IV. Is there any controversy concerning hinge axis?
OI course there is. It has been present since 1921. Controversy has arisen over the presence oI a
single axis, the methods used to locate the axis, the method and validity oI recording the
positions on the skin Ior Iuture reIerence, and the relation oI the terminal hinge position to the
position oI centric relation.
On with the controversy?
Does a single axis exist? (a line needs only two points and thereIore anatomic symmetry oI the
condyles is not necessary) So why was there a controversy?
Page says "Lack oI training in the basic sciences lies behind the plausible but groundless
arguments against (hinge axis)"
Page says again " A condyle rotates; thereIore, any argument against its doing so around
rotational centers or a hinge axes is an argument against the truth."
Can a single point in the condyle be located and can it be transIerred to the articulator? Page says
no! So what is Page's opinion on hinge axis? (Intracondylar or Intercondylar, Two arcs oI
rotation)
Is Page right? Does each condyle have its own axis oI rotation? Does it matter?
Granger says something else! What does Granger say? (Intercondylar, Why?)
Can one arc result Irom compound mandibular movements?
V. Four theories oI the location or existence oI the hinge axis.
1. Absolute location oI the axis
The hinge axis is a component oI every masticatory movement and can not be disregarded. II the
hinge axis oI the articulator is not the same as the hinge axis oI the patient then the mechanical
reproduction oI iaw motions are impossible.
2. Arbitrary location oI the axis
The value oI actually locating the exact hinge axis is not worth the eIIort. This group Iails to
recognize that iI the hinge axis oI the articulator does not coincide with the hinge axis oI the
patient, the paths oI closure will not be the same.
3. Nonbelievers in the transverse axis location
This group does not believe the hinge axis can be accurately located or believes other
movements are involved and can not be reproduced by an articulator simulating one axis;
thereIore, an arbitrary axis is iust as good.
4. Split axis theory
This group believes there are two axis oI rotation ( one in each condyle) and they parallel each
other.
What did Arthur E. Aull Iind out about the hinge axis? Who's study supported him?
1. The horizontal axis is a hypothetical line connecting the two horizontal rotation centers oI the
two condyles oI the mandible.
2. There is one hinge location!
3. Beard and Clayton reproduced a 1967 study by Trapozzano and Lazzari that obtained
evidence to the contrary oI Aull. Beard and Clayton Iound there is only one hinge axis!
VI. What is the signiIicance oI a hinge axis mounting?
Remember the purpose oI the articulator is to reproduce on a mechanical instrument the
relationship oI the teeth as they come together in the mouth.
The hinge axis provides the means oI transIerring the patient to the lab to construct the
restorations. It must be considered. What else must be considered.?
Can a simple protrusive registration accurately allow the settings oI an articulator to resemble the
movement oI the mandible? ( No way Jose!!)
So locating the hinge axis is iust one step in attempting to reproduce mandibular movement. It is
however very important because all movement starts at the axis and returns there. See above
drawing. Draw some mandibular movements iI anyone desires.
Review.
Why is it important to know about the hinge axis or to determine where it is located.?
What will happen to the arc oI closure iI the hinge axis is mistakenly placed anterior, posterior,
superior, or inIerior the true hinge axis?
How does this pure hinge movement aIIect dentistry? (Arc oI closure)
Is the path oI closure the same as the arc oI closure? (No)
The path results Irom closing rotation and a gliding path.
VII. Does everyone believe that the mandible closes on an axis?
What, Who said so? What did they do and how did they reach their conclusions?
Shanahan and LeII in 1962 and Ferrario, et al. in 1996
VIII. Locating the axis
How accurate are individuals in locating a true hinge axis?
- Kurth and Feinstein said within 2 mm when restricting opening to / inch at the incisal pin.
- Borgh and Posselt said within 1.5 mm when a 10 degree arc was used and within 1.0 mm when
a 15 degree arc was used.
- Lauritzen and WolIord were able to achieve an accuracy oI 0.2 mm when using a 10 degree arc
oI movement.
What are some methods oI locating a true hinge axis?
Observing the motion oI a stylus on an axis bow, as created by iaw movements, in relation to a
Ilag Iixed over the patients axis area. When the stylus no longer translates but rotates then the
point is accepted.
Geometric principles can also be used to aid in locating the point as described by Getz
3
.
Gunderson and Parker described a technique similar in thought to Getz.
How accurate is an arbitrarily selected axis?
Scallhorn Iound that 95° oI the axis points located 13 mm anterior to the posterior margin oI the
tragus on the tragus-canthus line to be within a 5 mm radius oI the kinematically located axis.
Beyron Iound that approximately 87° oI the located points were within a 5 mm radius oI the
arbitrary points.
Lauritizen and Bodner Iound only 33° oI the true axis points to be located with in a 5 mm radius
oI the arbitrary points. Teteruck and Lundeen Iound similar results.
Walker Iound that 20° oI the true axis points were located within 5 mm Irom the arbitrarily
selected point.
Palik, Nelson, and White Iound that the earpiece Iace-bow related the maxillary cast to the hinge
axis only 50° oI the time. 92° oI the time the arbitrary axis was located anterior to the terminal
hinge axis.
What are some methods oI arbitrarily selecting an axis?
Schlosser described palpating the condyles as the patient opens. He also described drawing a 25
mm line Irom the upper margin oI the external auditory meatus to the outer canthus oI the eye.
At a point 13 mm in Iront oI the tensed anterior margin oI the meatus a line is drawn crossing the
Iirst line at right angles.
Brandrup-Wognsen described a point on a line extending Irom the tragus to the lateral angle oI
the eye, a point is marked at about 12 mm in Iront oI the posterior margin oI the most prominent
point oI the tragus.
Prothero recommends placing a Richy condyle marker in the external auditory meatus then
placing a ruler Irom the top oI the marker to the outer canthus oI the eye and drawing a line. The
condyle marker is then rotated to make a line 13 mm Irom the anterior side oI the metal part oI
the marker.
Weinberg recommended adiusting the Iace bow pins to a point 11 to 13 mm anterior on a
reIerence line drawn Irom the middle and posterior border oI the tragus oI the ear to the corner oI
the eye.
What does Simpson have to say about arbitrary mandibular hinge axis location?
Use a point on Camper's line 10 mm Irom the superior border oI the tragus!
IX. Does the mandible Ilex and why do we care?
Yes it does. This response is a Iunction oI the mechanical properties oI the bone as well as the
type, magnitude, direction, and point oI application oI the Iorce.
The later pteygoid muscle is most Irequently cited as inducing mandibular Ilexure.
- What are the clinical implications oI the mandible Ilexing?
- Producing an inaccurate cast iI Ilexure occurs during impressions
- Producing an inaccurate maxillo-mandibular relationship iI Ilexure occurs during a CR
registration
- Mandibular Ilexure may inIluence stress on abutment teeth
- Adduction oI the mandible may eIIect the ultimate stability oI a lower denture
What width changes were seen in various mandibular positions and manipulations in the Gates
and Nichols article?
Opening 0-0.3 mm decreased value in arch width
Protrusion 0.1-0.5 mm decreased value in arch width
Horizontal retruding Iorce 0.11 mm increased value in arch width
ThereIore the amount oI mandibular arch width change during impression making can be
minimized by preventing any protrusive movement and /or opening beyond 20 mm.
- Abstracts -
03-001. Page. H.L. Some confusing concepts in articulation. D Digest 64: 71-76. 1958.
Purpose: The purpose oI the article is to discuss issues on articulation an encourage criticism.
Discussion: Criticism has been expressed about the terminology oI new principles, as being too
"complicated". It is claimed that publication has been oI no value Ior the average dentist since
they will not bother to read the diIIicult material. ThereIore the task is leIt to teachers and leaders
to absorb the new concepts and to inIiltrate the new philosophies into clinical practice.
As a proIession we should awaken to the Iact that something is wrong with our teaching and
practice. Probably some conIusion arises because oI the great variety and complexity oI methods
and material oIIered, but more probably it is that inIormation given to them is incorrect and
Iounded upon wrong concepts. ConIusion also arises Irom the Iact that there are as many ways to
solve a problem oI iaw relations and occlusions as there are dentist.
No one questions that the condyles are asymmetrically sized, shaped, and positioned.
No one can argue that the condyles are ioined at the symphysis and not by any connective tissue
mechanism running through the head Irom condyle to condyle.
Shift of the mandible in function- is not merely a " bodily side shiIt oI the mandible in lateral
excursion" as described by Granger, it is a bodily shiIt oI the mandible in vertical Iunction with
each condyle moving in any one or in all three dimensions.
Importance given to the Bennett movement- Granger also endows the Bennett movements with
extraordinary powers. It determines the Iorm and position oI the sulci and marginal ridges. The
power movement as the muscles on the working side contract. It determines the direction oI
stress on the supporting structures and thereIore whether the cusps are pathologic or physiologic.
II the Bennett movement is so important , it would be helpIul to know more about it.
Cause of movement claimed- Granger also considers a Bennett movement to be limited to a
bodily side-to-side shiIt oI the mandible occurring only during lateral excursions. He states that
the limitation oI movement against the inner curbing oI the glenoid Iossa determines the Bennett
movement.
Explanation of movement required- an unsupported statement cannot be accepted as a scientiIic
Iact . A condyle, "balancing" or otherwise, does not ride the "inner curbing" or any other part oI
a Iossa under its own power, Ior it is the mobile part oI a universal ioint. Yet, no explanation is
given to show how a " balancing" condyle can maintain unaided so Iirm a contact with the bone
ceiling and above and medial to it that Iorces the working side oI the head to move outward. In
the absence oI a valid explanation, what becomes oI those powers oI the Bennett movement?
Manv hinge-axes exist- there are at least twelve hinge-axes in every head; three in each
temporomandibular ioint and three in each mandibular angle. Only the three in each ioint require
consideration: (1) the transverse hinge-axes that govern iaw rotation in the sagittal plane
(opening and closing), (2) the vertical hinge-axes that govern iaw rotation in the horizontal plane
(side-to-side), and (3) the sagittal hinge-axes that govern iaw rotation in the transverse plane (iaw
rocking).
03-002. Preston. 1. D. A reassessment of the mandibular transverse horizontal axis theory.
1 Prosthet Dent 41: 605-613. 1979.
Purpose: to brieIly review the history and development oI the theory and practice oI the
transverse horizontal axis location, its applications and some controversies that have surrounded
its use.
Discussion and Conclusions: A single transverse horizontal axis can usually appear to be located.
(within the limits oI accuracy oI operators, equipment and patients.)
- When a kinematic axis is located, this is a worthwhile clinical procedure to transIer the arc oI
rotation in the sagittal plane Irom patient to the articulator
- No one has proved or disproved the presence oI colinear or noncolinear condvle arcs.
- The right angle-non right angle concept is misleading and generally not indicated Ior use.
- Anatomic asymmetries oI the axis transIer procedure may result in cast dislocations that
produce undesirable changes in esthetic tooth positions.
- The single transverse horizontal axis exists as fact in articulating instruments and as a theorv in
the human craniomandibular complex.
- The term "transverse horizontal mandibular axis" ("hinge axis") should be used instead oI
"condylar or intercondylar" axis.
03-003. Granger. E. R. Clinical Significance of the Hinge Axis Mounting. DCNA. Mar
1959:205-213.
Discussion: The relationship oI the teeth as they come together is determined by the relation oI
the condyle to the glenoid Iossa. The hinge axis governs the art oI closure in every contacting
position oI the teeth. The rotation oI the asymmetrical condyles and the asymmetrical mandible,
is guided by the Iorm oI the surIace on the meniscus.
The purpose oI an articulator is to reproduce on a mechanical instrument the relations oI the teeth
as they come together in the mouth. The hinge axis provides the means oI transIerring the patient
to the laboratory bench.
Locating the hinge axis and reproducing the protrusive path (anterior slant and curvature oI the
condylar path) and lateral paths (Bennett movement) allows all combinations oI movements to
be made. To locate the hinge axis with a hinge bow, a clutch is mounted on the mandibular teeth.
The chin is dropped open with pure hinge motion while a stylus records the position opposite the
condyle. No gliding oI the condyle should be allowed. The hinge axis must be located in the
most posterior superior position oI the condyle which is centric relation.
The point oI the stylus will reach the stationery point and the patient can be tattooed Ior Iuture
reIerence. Mounting the cast on the articulator can be accomplished by using the hinge bow as a
transIer or Iace bow. The FrankIurt Plane is used to relate the Iace bow instead oI the ala-tragus
plane.
Method oI choice to register the paths oI motion oI the axis is the pantograph. Stone check bites
may be used Ior edentulous patients. Wax check bites are worthless.
The hinge axis determines the arc oI closure in every contacting position oI the teeth. The path oI
closure is diIIerent Irom each open position oI the mandible to tooth contact. This path results
Irom the closing rotation combined with a gliding path oI the axis.
03-004. Aull. Arthur E. A study of the transverse axis. 1 Pros Dent 13:469-479. 1963.
Purpose: To demonstrate the Iallacy oI the hinge axis theory.
Materials and Methods: The hinge axis was to be located using extra long arms and Iour Ilags
and styluses. The extra two Ilags were placed 4 to 5 inches outside the inner Ilags. A hole was
drilled were the hinge axis was located and a light was shown through the hole to see iI there was
one line.
Results: One line was produced.
Conclusion: There are Iour main schools oI thought regarding hinge axis theory.
Group 1. Absolute location oI the hinge axis. These people believe the hinge axis is a component
oI every masticatory movement oI the mandible and cannot be disregarded.
Group 2. Arbitrary location oI the axis. These people believe the hinge axis is oI some value, but
not worth the eIIort to locate.
Group 3. Nonbelievers oI the transverse axis theory. They believe the hinge axis is theoretical,
but not practical.
Group 4. Split-axis rotation. They believe in the transograph theory. That each condyle has its
own center oI rotation. i.e. two axes that parallel each other.
Aull's study disproved the transograph theory
03-005. Shanahan. T E1 and Leff. A. Mandibular and articulator movements. Part III. The
Mandibular Axis Dilemma. 1 Prosthet Dent 12: 292-297. 1962.
Purpose: Sustained protrusion
To observe mandibular movements to conIirm or deny the presence oI an axis in the region oI
the condyles.
Methods & Materials: Photographic records were made oI the normal opening and closing
movements oI the mandible Irom both side and Iront.
Lights were placed to lower and upper incisors and side and view records oI the movements
oI the lights were obtained by placing the camera at the side oI the Iace and a mirror in Iront oI
the subiect at an angle oI 45 degrees to the camera.
Observations & Recordings: Observing the mandibular movements Irom the Iront, the mandible
did not open and close on an axis; Irom the side, the rotation center oI the pseudo arc was not in
the region oI the condyle. These two views oI opening and closing movements were not tracings
oI axis movements and thereIore did not support the mandibular axis theory. From the side there
was no evidence oI rotation about a mandibular axis in the region oI the condyle with a
concomitant anterior translation.
Bilateral Deviation: It was evident Irom the light that the mandible may deviate to the right or
leIt during opening and closing movements.
Chewing Tests Fox Axis Determination: A subiect chewed a piece oI hard cracker three times to
explore the possibility oI the presence oI mandibular axis during the mastication oI Iood. None
oI the movements showed evidence oI a natural mandibular axis.
ArtiIicial Mandibular Axis: The term artiIicial mandibular axis designates an axis that is the
result oI Iorcing the mandible backward. This axis cannot be Iound during normal physiologic
mandibular movements. An artiIicial mandibular axis can be produced in one oI two ways: the
patient may voluntarily retrude the mandible as Iar as possible during the opening and closing
movements, or the dentist can apply Iirm, backward pressure to the chin during movements.
Conclusion: The authors concluded that an artiIicially produced mandibular axis, iaw movement,
iaw position is not a normal physiologic movement.
There was no evidence oI rotation about a mandibular axis in the region oI the condyles with
concomitant anterior translation in these studies oI the opening, closing, and masticating
movements.
03-006. Schalhorn. R. G. A study of the arbitrary center and kinematic center of rotation
for facebow mounting. 1 Prosthet Dent 7: 162-169. 1957.
Purpose: Discuss certain advantages oI the Iace bow when used properly, and its merits in
prosthetic dentistry.
Discussion: The kinematic Iace bow is expensive, and a rather lengthy and diIIicult procedure.
II the advantages are enough to oIIset the disadvantages, then by all means, its general use
should be established. It has been stated by Arstad Thor, in his study on mandibular movements,
that an error oI 5mm Irom the hinge axis results in an error oI only 0.2 mm, in the articulator, the
molar oI the lower iaw model will have contact with its antagonist 0.2 mesial or distal to the
intraoral occlusal position oI the molar aIter a corresponding mandibular movement oI 2mm.
Because oI this 5mm tolerance with the resultant negligible error, many Ieel that it is not
necessary to determine the axis accurately.
Materials & Methods:
1. Seventy dental students with normal occlusion and at least 28 teeth were selected Ior the
study.
2. Alginate impressions and study casts were made. Large undercut areas were Iilled with Tenax
wax, and a splint was molded over the teeth with selI-curing acrylic resin.
3. The Iace-bow was embedded in the resin splint while plastic, and the acrylic resin was allowed
to cure. The Iork was then removed Irom the cast. The splint was then trimmed.
4. The patient was then instructed to practice opening and closing the mandible in centric
relationship through and arc oI about 10mm at the incisor region.
5. Marks were placed over the condylar area, and a line was drawn Irom the center oI the tragus
to the outer canthus oI the eye. On this line, the arbitrary axis was plotted 13 mm. Anterior to the
posterior margin oI the tragus, and the tape was identiIied by the side and the number oI the
determination.
6. The Iork was then Iastened to the splint and the Hanau model H Iace-bow attached to the Iork.
By a process oI trial and error, the axis was plotted and marked on each type.
7. Rechecking was done Ior reproducibility, and oI the 30 or more actual cross-checks, only one
such check was more than 1.5 mm Irom the original plotting. In most cases, the error oI
reproducibility was at a radius oI less than 1 mm Irom the original plotting.
Conclusion:
1. In over 95 ° oI the subiects with normal iaw relationships, the kinematic center lies within a
radius oI 5mm Irom the arbitrary center, which is considered by Arstad and others to be within
the limits oI negligible error.
2. The arbitrary axis oI rotation as set by Snow, Gilmer, Hanau, Gysi and others, oI 13mm,
anterior to the tragus on the trageal-canthus line comes very close to an average determined axis
on individual with normal iaw relationships.
3. The author agrees with other authors that determining the kinematic center oI rotation is not
nearly as important as obtaining proper centric and vertical records.
03-007. Lauritzen. A. G.. and Bodner. G. H. Variations in location of arbitrary and true
hinge axis points. 1 Prosthet Dent 11: 224-229. 1961.
Purpose: to determine the variations in the location oI the true hinge axis points Irom the location
oI the hinge axis points determined by arbitrary means.
Materials & Methods: a technique Ior easy and accurate location oI the true hinge axis was
developed by researchers oI the Lauritzen Research Group. This technique included a special
tray (anterior portion oI a rim lock tray) secured to the mandible utilizing alginate impression
material. The hinge axis point was located utilizing readings Irom the hinge axis locator . ( 1 cm.
square oI millimeter graph paper was attached to the skin in an area anterior to the tragus oI the
ear. The above method was utilized on IiIty patients, thus locating 100 true hinge axis points.
Conclusions: The study Iound that in locating true hinge axis points, 67° were Irom 5 to 13 mm.
away Irom the arbitrarily marked hinged points (using surIace landmarks).
This means that arbitrary marking of the hinge axis may result in inaccurate mounting of
casts to an articulator. and occlusal discrepancies if the centric relation record is made with
separation between the upper and lower teeth.
ThereIore, the accurate location oI the true hinge axis points is recommended by the authors.
03-008. Walker. P. M. Discrepancies Between Arbitrary and True Hinge Axis. 1 Prosthet
Dent 43:279-285. 1980.
Purpose: Analysis oI a clinical study to determine iI there exists an anatomic average
measurement to use Ior arbitrary hinge axis point locations.
Methods & Materials: 222 undergraduates had their true anatomic hinge axis point locations
determined using a Denar hinge axis locator. Each had a Iull complement oI teeth. The reIerence
line chosen was tragus-canthus line. These points were compared with a 12mm anterior reIerence
and 5mm inIerior arbitrary axis point locations.
Results: No consensus Ior arbitrary hinge axis location existed. Most oI the locations will give a
6mm or more error with a minimum oI 5mm expected. The largest percentage oI locations will
be inIerior to the tragus-canthus line at the superior border oI the tragus oI ear. Very Iew people
had the same true axis point located on both sides oI the Iace.
Conclusion: Any chosen arbitrary location would not reliably represent the true anatomic hinge
axis.
03-009. Beard. C.C. and Clayton. 1.A. Studies on the validity of the terminal hinge axis. 1
Prosthet Dent 46:185-191. 1981.
Purpose: To determine whether the results oI Trapozzano and Lazzari's study would have been
diIIerent had they used a diIIerent recording apparatus.
Materials and Methods: Hinge axes were located by drawing arcs on the paper rather than iust
visualizing the stylus.
Results: One not multiple hinge axes were located.
Conclusion: The Trapozzano and Lazzari study showed multiple hinge axes but with the use oI
drawing arcs on paper this study showed only one hinge axis.
03-010. Gates. G.N. and Nicholls. 1. I. Evaluation of mandibular arch width change. 1
Prosthet Dent 46(4):385-392.1981.
Purpose: To evaluate width changes oI the mandibular arch at various mandibular positions and
manipulations so that dentists can minimize problems during dental treatment.
Materials & Methods: A light sensing photo-diode (Pin-SC/4D, United Detector Technology,
Inc, Santa Monica, CA) a light detector source (In-sight light, American Midwest, Des Plaines,
Ill) and a 0.020 inch plastic Iiberoptic strand (Edmonds ScientiIic Supply, Barrington, NJ)to
transmit the light to the photodiode surIace. To compare arch width changes with mandibular
opening or protrusion, a linear variable diIIerential transIormer (LVDT) mounted extraorally
measured millimeters oI opening, protrusion while the photodiode measured mandibular arch
width changes. The device was attached to the mandibular teeth with minimal Iorce to reduce
mobility by natural teeth.
Ten men between 20 and 50 years oI age who had a Iull complement oI natural teeth with no
evidence oI periodontitis were evaluated. The data measured provided the Iollowing
comparisons:
a. opening, protrusion, and sustained opening and protrusion, vs. arch width change
b. arch width change vs. mandibular manipulation using chin point guidance
c. arch width change vs. maximal biting Iorces in the cuspid/ Iirst premolar locations both
unilaterally and bilaterally
d. subiects were premedicated with Banthine tablets to decrease salivary Ilow
e. Iive sustained max protrusions, openings , and Iive continuous mand. manipulations
I. aIter each movement passive or resting states were recorded to return to "zero" driIts
Conclusion:
a. The width oI the mandible is inIluenced by intrinsic and extrinsic Iorces.
b. Maximal opening, protrusion, and biting Iorces cause the mandible to decrease in arch
width.
c. A horizontal retruding Iorce on the mandible caused an increase in arch width
d. The amount oI mandibular arch width change during impression making can be minimized
by preventing any protrusive movement and/or opening beyond 20 mm.
03-011. Simpson. 1.W. . Hesby. R.A. . Pfeifer. D.L. and Pelleu. G.B. Arbitrary mandibular
hinge axis locations. 1 Prosthet Dent 51: 819-822. 1984.
Purpose: Compare the location oI selected arbitrary hinge axis points and an experimental
arbitrary axis point with the kinematic axis.
Materials & Methods:
1. FiIty subiects 19-60 years old, with acceptable occlusion and no clinical signs oI TMJ
dysIunction were selected.
2. TMJ INSTRUMENT HINGE axis Ilags were positioned on the Iace slightly anterior to the
tragus oI the ear.
3. Five arbitrary axis points were recorded on graph paper:
(a) Beyron`s point was located 13mm anterior to the posterior margin oI the tragus oI the ear on
a line Irom the center oI the tragus to the outer canthus oI the eye.
(b) Gysi`s point was located 10mm anterior to the posterior margin oI the tragus on a line Irom
the center oI the tragus to the outer canthus oI the eye.
(c) Bergstrom`s point was marked 11 mm anterior to the posterior margin oI the tragus on a line
parallel to and 7 mm below the FrankIort horizontal plane.
(d) Teteruck and Lundeen`s point was located 13 mm anterior to the tragus on a line Irom the
base oI the tragus to the outer canthus oI the ear.
(e) The experimental arbitrary point selected was placed 10mm anterior to the superior border
oI the tragus on Camper`s line. (Camper`s line connects the superior border oI the tragus and the
inIerior border oI the ala oI the nose).
4. The Almore mandibular hinge axis locator was used to locate the kinematic axis.
5. The true axis point was recorded on the same graph paper as the arbitrary axis points. The °
oI arbitrary axis points that Iell within 5mm oI the kinematic axis was calculated Ior each point,
the distance between each point and the kinematic axis was measured.
Discussion:
1. The study shows that 78° oI experimental axis points were located within 5mm oI the
kinematic axis. Arstad and Weinberg reported that a 5 mm error in locating the mandibular hinge
axis results in a negligible occlusal error oI 0.2 mm at the second molar.
2. 80° oI the kinematic axis points were located below a reIerence line drawn Irom the superior
border oI the tragus to the outer canthus oI the ear, and posterior to a point 12 mm anterior to the
superior border oI the tragus on the same reIerence line.
3. An experimental arbitrary axis point was located below Walker`s reIerence line and closer to
the superior border oI the tragus.
4. The experimental point was located on Camper`s line, 10 mm anterior to the superior border
oI the tragus.
Conclusion:
1. In a review oI the hinge axis theory, Preston stated that a superior-inIerior error in axis
location results in a larger discrepancy than an error in anterior-posterior location. Beyron, Gysi
and Bergstrom showed an inIerior-anterior tendency.
2. The arbitrary points oI Beyron, Gysi, and Bergstrom showed directional tendencies, whereas
the experimental arbitrary points were evenly distributed around the kinematic axis, and closely
and consistently approximated the kinematic axis.
3. The clinical use oI a point on Camper`s line, 10 mm Irom the superior border oI the tragus,
results in a more accurate transIer oI the maxillary cast to the articulator.
03-012. Gordon. S.R.. Stoffer. W.M. and Connor. S.A. Location of the terminal hinge axis
and its effect on the second molar cusp position. 1 Prosthet Dent 60:553-559. 1988
Purpose: to mathematically calculate the amount oI cusp height and mesiodistal error at the
second molar, resulting Irom locations 5 and 8mm (anterior, superior, posterior and inIerior) to
the kinematically located hinge axis. The maxillomandibular relationships were measured by
interdental records oI 3 to 6mm thick at the incisal region.
Methods & Materials: Calculations were based on the Iollowing:
a. a distance Irom the midpoint oI the hinge axis to the mandibular incisal edges oI 87.9 mm
calculated Irom
Bonwill`s triangle.
b. the Balkwill angle equals 18 degrees
c. cusp inclines in a mesiodistal direction equal 30 degrees
d. 5-8 mm erroneous locations oI the hinge axis (anterior, superior, posterior, and inIerior), as
stated above
e. iaw relation records oI 3 and 6 mm thick at the incisors, measured along the arc oI closure
Summary/ Conclusions: Irom the criteria stated above, the errors in cusp height at the second
molar ranged Irom 0.15 mm open space to 0.4 mm excess height. The mesiodistal error ranged
Irom 0.51 mm toward the distal to 0.52 mm to the mesial.
O the CR record should be recorded at a vertical dimension close to the planned vertical
dimension oI occlusion
O locating the kinematic hinge point prior to extensive treatment Ior dentulous patients
results in a better occlusion and also saves time
O when no change in vertical dimension (hence kinematic hinge point is not applicable)
other techniques may be used
03-013. Palik. 1. F.. Nelson. D. R. and White. 1. T. Accuracy of an Ear Piece Face-bow. 1
Prosthet Dent 53:800-804. 1985.
Purpose: To record variations between the kinematic axis and earpiece determined axis and
measure the magnitude and direction between the two points on selected subiects. Also, to
evaluate the signiIicance oI the diIIerence between the kinematic axis and the earpiece
determined axis and the repeatability oI the ear Iace-bow method statistically.
Methods: The earpiece Iacebow used the external auditory meati and the inIerior orbital rim as
reIerence points, while the kinematic Iacebow used the terminal hinge axis and the inIerior
orbital rim as reIerence. Points.
inematic location of terminal hinge axis: The area oI the true hinge axis was located by
palpating the subiect`s condyles during opening and closing oI the mandible. A clutch tray was
aIIixed to the mandibular teeth with Impregnum. With the mandible in centric relation the axis
points were tattooed on the skin. A biteIork was adapted o the occlusal surIaces oI the maxillary
teeth with black modeling compound. The biteIork was used Ior both kinematic and arbitrary
Iacebow recordings. ModiIied Plexiglas disks were positioned on the lateral aspect oI each oI the
condylar element oI the articulator parallel to the sagittal plane. On each disk a graph circle was
placed with the 0,0 coordinate point coinciding with the horizontal and vertical line intersection
to simulate a x-y graph. The subiect`s identiIication, side oI articulator (r or L ) and
anteroposterior positions were identiIied on the graph circles.
ocation of arbitrarv hinge axis. The same biteIork previously used with the kinematic Iacebow
was repositioned intraorally on the maxillary occlusal surIace and stabilized with Iinger pressure.
The Hanau earpiece Iacebow was attached to the biteIork and the ear rods adiusted in the
subiect`s external auditory meati until pressure was equally distributed bilaterally.
Results: Most arbitrary axis locations were anterior and inIerior to the true hinge axis. 56 ° oI
the arbitrary axis locations were anterior an inIerior to the terminal hinge axis, while 36° were
anterior and superior to the terminal hinge axis. ONLY 50° oI the arbitrary hinge axes were
within a 5mm radius oI the true hinge axis, while 89° were within a 6-mm radius.
Discussion: In comparison studies oI variations between arbitrary axis and the kinematic axis,
results varied Irom 20° to 95° oI the arbitrary hinge axis points, Ialling within a 5 mm radius oI
the true hinge axis point. This study compared Iavorably with that o Lauritzen and Bodner and
Iirmly supported Teteruck and Lundeen. However, it did not support the Iindings oI Beyron and
Schallhorn. The statistical analysis demonstrated that the earpiece Iacebow is not statistically
reliable or repeatable. This does not suggest that it is unsuitable clinically. The nylon earpiece
should be modiIied to increase repeatability.
Summary: This investigation demonstrated a signiIicant statistical diIIerence between the
arbitrary axis located with an ear-bow and the terminal hinge axis. Additional study is needed to
determine the practical value oI the arbitrary Iacebow and to pursue modiIications to improve its
accuracy.
Conclusions:
1. The earpiece Iacebow related the maxilla to the hinge axis with the 5mm acceptable range
50° oI the time.
2. The earpiece Iacebow recorded the arbitrary hinge axis anterior to the terminal hinge axis
92° oI the time.
3. The earpiece Iacebow measurement in this study was not statistically repeatable.
- Summary of Authors and Concepts -

Page. Many hinge axes exist
Preston. Arc may result Irom compound movements
Granger. There is only one position oI the hinge axis.
Aull. Only one hinge axis.
Shanahan. Study oI natural motion does not show a hinge axis
Schallhorn. 95° oI patients true axis is within 5mm oI the arbitrary hinge Axis (13 mm anterior
to the tragus on the tragus- canthus line.
Lauritzen and Bodner. 33° oI a patients true hinge axes are within 5 mm oI the patients true
axis.
Walker. 20° were within 5mm
Beard and Clayton. One hinge axis
Gates and Nichols. The width oI the mandible changes due to intrinsic and extrinsic Iorces.
Simpson. Use a point 10mm Irom the superior border oI the tragus on Camper's line Ior an
arbitrary hinge axis. 78° within 5 mm.
Gordon. Keep your centric relation record thin.
Palik. Hanau ear bow. 50° within 5mm Hinge axis was located anterior
Getz. Geometric location oI the hinge axis
Gunderson and Parker. Geometric location again
Ferrario. Pure rotation did not occur.
Section 04: Hinge Axis II
(Handout)
Terms:
Centric relation - the maxillomandibular relationship in which the condyles articulate with the
thinnest avascular portion oI their respective disks with the complex in the anterior-superior
position against the shapes oI the articular eminences.
Centric occlusion - the occlusion oI opposing teeth when the mandible is in centric relation.
This may or may not coincide with the maximum intercuspation position.
Terminal hinge position ÷ Retruded contact position - that guided occlusal relationship
occurring at the most retruded position oI the condyles in the ioint cavities. A position that may
be more retruded than the centric relation position.
Maximum intercuspation - the complete intercuspation oI the opposing teeth independent oI
the condylar position.
Border movements - mandibular movement at the limits dictated by anatomic structures, as
viewed in a given plane.
Rotation - the movement oI a rigid body in which the parts move in circular paths with their
centers on a Iixed line called the axis oI rotation.
Translation - that motion oI a rigid body in which a straight line passing through any two points
always remains parallel to its initial position.
Hinge axis ÷ Terminal hinge axis ÷ Transverse axis ÷ Transverse horizontal axis ÷
Transverse hinge axis - an imaginary line around which the mandible may rotate within the
sagittal plane.
Hinge axis point ÷ posterior reference points - two points, located one on each side oI the Iace
in the area oI the transverse horizontal axis, which together with an anterior reIerence point,
establish the horizontal reIerence plane.
Kinematic face-bow - (Hinge bow) Iace-bow with adiustable caliper ends used to locate the
transverse horizontal axis oI the mandible.
Arbitrary face-bow - a device used to arbitrarily relate the maxillary cast to the condylar
elements oI an articulator. The position oI the transverse horizontal axis is estimated on the Iace
beIore using this device.
Average axis face-bow - a Iace-bow that relates the maxillary teeth to the average location oI
the transverse horizontal axis.
HISTORICAL PERSPECTIVE - Winstanley, R. B. The hinge axis: A review oI the literature.
In this review we can try to answer the Iollowing questions:
1. Can the mandible open/close as a hinge in the sagittal plane? Is it normal?
2. Should the axis be located when carrying out restorative procedures?
3. II located, how accurate is it? Where is it located?
Campion (1902-1905) - No one axis, but a complex one. First rotation, then down and Iorward.
Bennett (1908) No single Iixed center oI rotation, constantly shiIting in sagittal plane. Mandible
can rotate, translate. Criticized Ior working on himselI; no general conclusions.
Gysi (1910) Treatise on History oI Articulators. "Condyles not truly rotational points, but Iixed
guides oI the mandible in its movements." "The mandible opens/closes and rotates on another
rotational center which has no inIluence in the setting up oI the teeth on articulators. ThereIore,
need not be considered in the construction oI an articulator.
Needles (1923) agrees with Bennett: hinge ioint ¹ sliding ioint. 1927 used heads oI condyles as
reIerence point Ior axis on articulators which can open considerably without error in the
occlusion. 1924 relation with prosthodontic dentistry: no center oI rotation in temporomandibular
ioint itselI. Instantaneous and constantly shiIting centers.
Wadsworth (1925) Anatomist's view: Iirst movement around transverse axis through condyles
which remain seated in Iossae. 2nd movement on eminentia.
Stansbery (1928) Dubious about Iace-bows and adiustable articulators. Plain line hinge
articulator was iust as eIIective.
Hall (1929) Gave credit to Balkwill Ior recognizing mandibular movements which were hinge
like and Iorward and back in the Iossae. Quoted Luce: "Condyle is not the center oI rotation."
McLean (1937) Hinge portion oI ioint is the great equalizer Ior disharmonies between the
gnathodynamic Iactors oI occlusion. Inherently the place where vertical dimension oI occlusion
is controlled. In denture construction:
- Hinge axis Premature contact on patient
- Denture interocclusal alteration done in mouth or by using a hinge-axis articulator.
McCollum (1939) Publishes a very important series oI articles on restorative remedies. Leading
advocate oI the hinge-axis theory: "Amount oI gliding depends on size oI pin, but center oI
action is an imaginary axis through center oI pin." External landmarks are oI little use. Noted
variation between sides oI same individual (asymmetry).
Rotation occurs during 0.5 inch at incisors Ior most people, some can open 1 inch.
Stuart (1939) Complemented the work oI McCollum. Together pioneer Gnathology theory:
-3D location oI rotational centers
-Hinge axis location as a point
-Border movements are to be recorded
-Movements are reproduced on articulators
-Delayed canine guidance
-Point vs. Area contact
-Condylar guidance dominant
Higley (1940) Discussed development, adaptive changes in the ioints, muscles inIluencing
movement, and movement patterns oI the mandible and condyle.
With Logan (1941) Showed that as the mandible dropped Irom occlusion 15 mm, there was
retrusive movement oI the chin point, and the head oI the condyle dropped progressively.
With an opening oI 10 mm, 95° oI cases showed a Iorward shiIt oI the head oI the condyle.
When the mandible was opened 15 mm, all subiects showed a Iorward movement oI the condyle.
McLean (1944) Stated: " the diagnosis oI pathological occlusion depended on the Iact that the
Iinal phase oI iaw closure was pure hinge movement."
Oldies but Goldies
Brandstad (1950) The adiustable articulator was as important in oral diagnosis as the
microscope was in pathological or bacteriological investigation. (Gnathological society)
Kurth and Feintein (1951) Investigated the determination oI hinge-axis mathematically. They
concluded that because oI all the variables (perception, anatomy, physiology, patient ability to
Iollow instructions, preiudices oI operator) it was unlikely that the hinge-axis could be located
accurately
Eberle (1951) Hinge axis movement was a component oI every motion oI the mandible, and
mechanically more important than the inclination oI glenoid Iossa.
Lauritzen (1951) discussed the physiology oI the TMJ. He thought articulation would be
understood more easily iI the ioint were regarded as two separate ioints. The only movement
which could take place in the 'menisco-condylar' part oI the ioint was opening and closing - a
purely rotational movement. In all patients, the anterior teeth could be separated by at least 12
mm in the rotational hinge relation.
`Lauritzen and Wofford (1961) - Hinge axis location on an experimental basis - To study the
accuracy oI hinge axis location techniques. A special device was designed to test the hinge axis
location at 5, 10, 15 degrees oI movement. Five subiect groups each with diIIerent experience
levels were tested. Results: Training led to better scores; interest played a strong part in accuracy
attained; physical characteristics (e.g. visual acuity) had an eIIect on the results; subiects who
used loupes were more accurate.
Conclusion: with 10 degrees oI opening experienced clinicians are able to locate a hinge axis to
0.2 mm area.
Sloane (1951) Denture Iabrication - Axis is a demonstrable biomechanical Iact.
Clapp (1952) Amer. pupil oI Gysi. Agreed with Gysi, that a number oI axes existed Ior opening
movements oI the mandible which are located outside the mandible. The inIrahyoid muscles
open straight vs. external pterygoids.
Granger (1952) Centric relation is the only position where hinge axis is common to both
mandible and maxilla.
Craddock & Symmons (1952) Small opening, the axis passes through condyles; on wider
opening axis becomes displaced downward. Accurate determination is oI academic interest
because it is Iound within a Iew mm oI assumed center oI condyle.
Posselt (1952) Hinge opening is obtained iI patient is in passive, or trained active motion. He
could not prove this movement was habitual. Hinge-axis opening ÷ 20 mm.
Page (1952) praised McCollum's hinge bow as "one oI the most important contributions to
dental service."
Lucia (1953) Simple rotation on the lower surIace oI meniscus could happen at any point along
the condylar path. The correct transIer oI casts to the articulator is oI tremendous importance.
Without a hinge-axis transIer he thought it impossible to diagnose an occlusal problem because
the teeth on the models would not meet in the same way as they would in the mouth.
Brandrup-Wognsen (1953) Discussed the theory and history oI Iace-bows. Quoted Beyron who
demonstrated that the axis oI movement oI the mandible did not always pass through the centers
oI the condyles. Complicated Iorms oI registration were rarely necessary Ior practical work.
Granger (1954) The mandible is capable oI an inIinite variety oI paths oI movement; one
condyle could be undergoing only rotational movement while the other condyle was both
rotating and gliding, or both could be rotating and gliding simultaneously.
It was only in the retruded relation that the condyle could make pure rotatory movements
without gliding. This position was centric relation. He pointed out that the split hinge-axis theory
was not possible. SuccessIul treatment depended upon the correct orientation oI the teeth to each
other and to the hinge-axis.
Sicher (1954) Terminal hinge-axis is the most retruded position oI the mandible that the
individual can assume under the action oI his mandibular musculature and is, thereIore, an
unstrained position.
Thompson (1954) was concerned with Iull mouth reconstruction oI the natural dentition. He
described the importance oI recreating the same hinge-axis relationship on the articulator as it is
in the patient's mouth.
Page (1955) criticized the report oI the oIIicial Nomenclature Committee Meeting oI 1952 Ior its
deIinition and explanation oI hinge opening position. He said that it was a misconception and
had Iailed to recognize that none oI the groups who used kinematic location oI the hinge-axis
considered this a signiIicant component oI mandibular opening. These groups stressed that the
important mandibular movement to be recorded was Iunctional hinge closing. Page also stated
that the iaw relaxed with the condyles dropping into the hammock and capsular ligaments.
(Compare with Eberle's view)
Collett (1955) There is no agreement on the existence oI the hinge-axis. The recording oI the
opening axis and the transIerence oI it to an articulator were oI considerable value in the
diagnosis and treatment oI occlusal malIunction.
Kornfield (1955) The location oI the hinge-axis was the basis oI all articulator transIer.
Incorrectly articulated casts would lead to restorations that would not meet in the mouth,
unveriIiable CR registration, cusps harmony would not match the arc oI closure, any change in
the VDO would produce disharmonies.
Levao (1955) Mandibular movements were a combination oI rotation and translational
movements diIIerent Irom habitual opening and closing movements and this could be clearly
seen in his diagram oI the envelope oI sagittal rotation.
Trapozzano (1955) Hinge-axis represented a border movement that could be recorded
repeatedly with unIailing accuracy.
Cohen (1956) He used McCollum's Gnathoscope and Gnathograph to prove the existence oI
mandibular hinge-axis within the range oI vertical dimension used.
Beck and Morrison (1956) Non-arcon type articulator can record beginning and end points oI
mandibular movement. Arcon type can reproduce mandibular movements in between.?
Nevakari (1956) With cephalometric studies Iound it impossible to determine whether the
movement actually occurred around a stationary axis oI whether it was complex (rotational and
translational) taking place at diIIerent times.
Schallhorn (1957) Compared the advantages and disadvantages oI arbitrary versus kinematic
hinge-axis location Ior Iace-bow transIer. In over 95° oI individuals with normal iaw
relationships the kinematic center was Iound within 5 mm radius Irom the arbitrary center. This
was within the limits oI negligible error.
*Posselt (1957) Terminal hinge movement oI the mandible.
To analyze terminal hinge movement, up to 20 mm oI hinge opening by checking the relation
oI the axis points to the condyles and by recording the shiIt oI the kinematically established
hinge axis. The results show that the median section oI the terminal hinge axis lay within the
outlines oI the condyles, and that three diIIerent experimental methods, which gave Iairly similar
results, suggest that the terminal hinge movement can be regarded as rotation around an axis
passing through the condyles.
Trapozzano (1957) Transograph - disagreed with theory and practice because mandible would
have to bend or have to be broken.
Borgh & Posselt (1958) ConIirmation oI inherent inaccuracies in hinge-axis recording.
`Sheppard (1958) The eIIect oI hinge axis clutches on condyle position.
He Iound that clutches immediately altered the closed position oI the condyles in most oI the
ioints studied and could also limit the extent oI condylar movement. ThereIore, hinge axis
recordings oI Iunctional condylar movement may have an inaccurate starting and record
abnormal behavior oI the condyle.
Beck (1957) Compared the Iour Iollowing axes oI rotation:
(1) Bergstrom's axis: 10 mm anterior to center oI auditory meatus and 7 mm below FrankIort
plane.
(2) Gysi's arbitrary axis: on line Irom upper border oI ext. aud. meatus to canthus oI the eye, 13
mm ant oI margin oI meatus.
(3) Beyron's arbitrary axis: 13 mm ant. to post. margin oI tragus, on tragus-canthus line.
(4) Kinematic axis (McCollum)
The Bergstrom points were most Iavorable with the kinematic points, within radius oI 5 mm.
Next came Beyron's axis points, while the Gysi points showed a greater diIIerence Irom the
kinematic points.
*Beck (1959) A critical evaluation oI the arcon concept oI articulation - Bergstom Arcon vs. the
Hanau H. Conclusion: no conclusive evidence could be recorded Irom duplicate dentures which
were constructed on the arcon and the condylar type instruments.
`Weinberg (1959) The transverse hinge axis: Real or imaginary? (Engineering principle)
Some highlights:
Gnathologists - one THA common to both condyles; tattooing
Transographics - diIIerent THA Ior each condyle
Hanau - anatomic average; exact duplication impossible
Arcon/Non-arcon reversal oI relationship would not change guidance
He also:
O described the hinge-axis
O described geometrical and clinical methods Ior Iinding it
O described its use
O determined whether there were one or two transverse hinge-axes
O discussed the mandibular movement pattern Ior the opening and closing movements
O gave clinical evidence oI the transverse hinge-axis
O determined iI pin point accuracy in the location oI the transverse hinge-axis was
necessary, and
O related these Iactors to clinical practice.
*Trapozzano and Lazzari (1961) A study oI hinge axis determination. To investigate whether
there is a terminal hinge axis, and whether or not only one exists. 52° oI the subiects showed
more than one hinge axis point. These Iindings indicate that, since multiple condylar hinge axis
points were located, the high degree oI inIallibility attributed to hinge axis points may be
seriously questioned.
* Boucher (1961) Limiting Iactors in posterior movement oI mandibular condyles.
Does the capsular ligaments oI the TMJ limit the posterior movements oI the mandible?
Measurements oI gothic arch tracings done beIore and aIter severing the TMJ and capsular
ligaments were identical, indicating that they are not responsible Ior limiting posterior border
movement oI the mandible.
` Regli and Kelly (1967) The phenomenon oI decreased mandibular arch width in opening
movements.
Does the cross-arch distance change in mandibular opening? The deIormation oI the mandible
(0.03 mm inter-bicuspid, 0.09 mm inter-molar) that occurs during opening is oI clinical
signiIicance and could aIIect the Iit oI an RPD or FPD. Impressions should not be taken in a
wide open mandible, and rigidly ioining the lower teeth in a cross-arch manner is questionable.
Further investigation is indicated.
* Gonzalez (1968) Evaluation oI planes oI reIerence Ior orienting maxillary casts on articulators.
(Dentures)
Using lateral cephalogram tracings (21 patients) oI the FrankIort horizontal plane running
Irom the right and leIt porion and the orbitale, the arbitrary condylar axis (Beyron), the maxillary
residual ridge plane, the tip oI the incisal edge oI the leIt maxillary central incisor, and the crest
oI the mesiobuccal cusp oI the leIt maxillary molar. None oI the three planes oI reIerence were
parallel to the FrankIort horizontal; the maxillary residual ridge plane was the closest to being
parallel, but was the most variable. The distance oI condylar axis to the FrankIort horizontal
plane was the least variable and measured 7.1 mm, which is in accord with Bergstrom's Iindings.
The points oI reIerence on the articulators, condylar axis rods and the orbital indicators were at
the same level. The mean angle between the plane oI occlusion and the FrankIort plane was -9
degrees Ior the group oI 21 patients.
To compensate Ior the error in the location oI reIerence points on the articulator the orbital
pointer on the Iacebow can be placed 7 mm below the orbitale on the patient. Another method
would be to place the the pointer 7 mm above the indicator on the articulator during the transIer.
`Winstanley (1979) Hinge axis location on the articulator.
To see how accurately the center oI sagittal rotation oI an articulator could be determined
when using clinical methods. This study would give an indication oI the minimum errors which
could be expected to occur beIore clinical methods are taken into account.
The best results were obtained when using a microdot pattern Ilag than a plain record, and
when anterior opening was 15 mm instead oI 10 mm. Errors were Iound to occur up to a
diameter oI 2.4 mm . Greatest inaccuracy was when location was 1.2 mm in Iront and 1.0 mm
below true center. More inaccuracy occurred in the horizontal direction than vertical.
* Gordon (1984) Location oI the terminal hinge axis and its eIIect on the second molar cusp
position.
Incorrect location oI the terminal hinge axis oI 5 and 8 mm to the anterior, posterior,
superior,and inIerior was examined. With iaw relation records 3 and 6 mm thick at the incisors,
the errors in cusp height at the second molar ranged Irom 0.15 mm open space to 0.4 mm excess
height. The mesiodistal error ranged Irom 0.51 mm distally to 0.52 mm mesially. Conclusions:
1. The centric iaw relation record should be recorded at a vertical dimension close to the planned
vertical dimension oI occlusion. Keep the CR record thin.
2. Location oI a kinematic hinge point prior to treatment Ior dentulous patients who require
extensive treatment saves time and results in a more satisIactory occlusion.
3. Techniques that do not require a change oI vertical dimension on the articulator are useIul
when a kinematic hinge axis is not applicable.
4. The diIIiculty oI accurately reIining a balanced occlusion in the mouth where complete
dentures with anatomic teeth have been used, supports the use oI nonanatomic teeth.
`Palik (1985) Accuracy oI an ear piece Iace bow. This is a popular arbitrary method.
(Walker Iound only 20° within 5 mm oI true location, 60° were 6 mm or more. Schallhorn
Iound 95° to be within 5 mm oI true hinge axis).
18 randomly selected patients were used. The validity oI the Hanau ear-bow to transIer an
arbitrary hinge axis to a Hanau 158-3 Arcon articulator was compared with the Hanau kinematic
Iace-bow. Results: only 50° oI the arbitrary hinge axes were within a 5 mm radius oI the true
hinge axis, while 89° were within a 6 mm radius. The discrepancy was signiIicant in the
anteroposterior direction but not in the superior-inIerior direction.
92° oI the clinically located THA were posterior to the ear-bow position. ThereIore this
method is not statistically reliable.
* Gunderson (1987) An alternative technique Ior location oI the hinge axis.
Use oI intersecting lines to locate the hinge axis on graph paper then transIerred to patient
seems to be as time consuming as using a kinematic Iace-bow.
`Getz (1988) Application oI a geometric principle Ior locating the mandibular hinge axis
through the use oI a double recording stylus.
Theorem #1. A line drawn through the center oI a circle perpendicular to a chord meets it as its
midpoint and bisects the arcs determined by the chord;
theorem #2. The line ioining the center oI a circle to the midpoint oI a chord is perpendicular to
the chord.
Using a modiIied Satellite Bow with double recording styli at a distance oI 2 to 4 inches Irom the
estimated axis area, 12 determinations on 2 subiects were made. It was possible to deIine the axis
point between 0.1 to 1.0 mm.
` Pitchford (1991) A reevaluation oI the axis-orbitale plane and the use oI orbitale in a Iacebow
transIer record.
The use oI a Iacebow in coniunction with the orbitale as the anterior reIerence point
Irequently results in an overly steep anterioposterior angulation oI the occlusal plane.
It is the vertical relationship which may result in esthetic Iailures, balancing side occlusal
errors in complete dentures, and nonworking occlusal interIerences in Iixed restorations.
A correction oI 7 mm is concurs with other authors (Gonzales, Kingery, Nowlin, Stade).
This study noted that the use oI the porion-orbitale plane was originally adopted at an
anthropologic congress in FrankIort, Germany, in 1882. Later, the axis-orbitale plane was used
as a reIerence by the early designers oI articulators and Iacebows. In 1955 the Research Report
by McCollum and Stuart solidiIied this concept by stating that the axis-orbitale plane is
horizontal or nearly so when the body is erect. The Glossary oI Prosthodontic Terms made this
concept a Iact. Use oI the orbitale as the anterior reIerence point, will place the maxillary central
incisors an average distance oI 54 mm below the condylar plane. In 1866 Balkwill Iound the
incisal edges oI mandibular teeth to be 35 mm below the condylar plane, while the results oI this
study place the incisal edges oI the maxillary teeth 36 mm below the condylar plane.
1. FrankIort plane nor axis-orbitale plane is parallel to the reIerence horizontal in the esthetic
reIerence position. The use oI either oI these planes will place the maxillary cast too low in the
articulator.
2. Esthetic reIerence position places orbitale 18.5 mm higher than the axis, axis-orbitale plane
will Iorm a 13 degree angle with reIerence horizontal. Orbitale averages 11.45 mm higher than
the porion in the esthetic reIerence position, and the FrankIort plane will Iorm an angle oI 8
degrees to the horizontal reIerence.
3. In the esthetic reIerence position the incisal edge oI the maxillary central incisors will be 36
mm below the condylar plane. Minor alterations oI the Iacebow, orbitale indicator, or the
position oI the pointer will allow an average value transIer oI the esthetic reIerence position to
the articulator.
` Nairin (1994) The position and Iunction oI the mandibular hinge axis.
Beyron's point was used Ior this study. Ten patients who were having routine
orthopantomograms (OPG) were used. The hinge axis point was marked on the side oI the Iace
with a 'O' about 5 mm in diameter. Lateral skull radiographs oI ten other subiects were also
studied.
Results: the average hinge axis is seen to lie over the condylar neck rather than the head oI the
condyle. The mandibular axis oI hinge like movement is located automatically in the region oI
the neck oI the mandibular condyle and not in the condyle itselI. This conclusion is supported by
the anatomy oI the ioint with particular reIerence to the TM ligament.
In the final analysis. the true value of our individual work can be measured only by the
degree of fineness with which we practice the art of dentistry rather than by the particular
school of thought to which we adhere. Weinberg (1959)

- Abstracts -
04-001. Weinberg. L. The transverse hinge axis: Real or imaginary? 1 Prosthet Dent 9:775-
787. 1959.
04-002. Posselt. U. Terminal hinge movement of the mandible. 7:787-797. 1957.
04-003. Trapozzano and Lazzari. A study of hinge axis determination. 1 Prosthet Dent
11:858-863. 1961.
04-004. Boucher. L. 1. Limiting factors in posterior movement of mandibular condyles. 1
Prosthet Dent 11:23-25. 1961.
04-005. Winstanley. R. B. The hinge-axis: A review of the literature. 1 Oral Rehabil 12:135-
159. 1985.
04-006. Winstanley. R. B. Hinge axis location on the articulator. 1 Prosthet Dent 42:135-
144. 1979.
04-007. Beck. H. 0. A critical evaluation of the arcon concept of articulation. 1 Prosthet
Dent 9:409-421. 1959.
04-008. Sheppard. I. M. The effect of hinge axis clutches on condyle position. 1 Prosthet
Dent 8:260-263. 1958.

04-009. Lauritzen. A.G.. and Wofford. L. Hinge Axis Location on an Experimental Basis. 1
Prosthet Dent 11:1059-1067; 1961.
Purpose: Measurable errors in the occlusal surIaces are produced when the position oI the
articulator hinge axis does not coincide with the patient's anatomical hinge axis.
Subiect: The article examines the ability oI the practitioner to accurately locate the hinge axis.
Methods and materials: A special experimental apparatus was designed and constructed to
measure experimental accuracy at recording hinge axis. A number oI operators oI varied
experience made Iive attempts at registering hinge axis with a range oI movement varying Irom
5 to 15 degrees. A total oI 190 measurements were made.
Results:
1. Training and experience led to better results
2. Poor vision led to more diIIiculties
3. Binocular loupes led to more accurate results
4. For experienced practitioners, 10 or 15 degrees oI movement produced more than 95° oI
locations within 0.2 mm. With only 5 degrees oI movement, accurate location was more diIIicult.
Conclusion: A ten degree range oI movement is suIIicient Ior hinge axis location, and in the
experienced operator can attain 0.2mm accuracy.
04-010. Regli. C. P. and Kelly. E. K. The phenomenon of decreased mandibular arch width
in opening movements. 1 Prosthet Dent 17:49-53. 1967.
Missing abstract .......
04-011.
Missing abstract .......
04-012. Gordon. S.R. et al. Location of the terminal hinge axis and it`s effect on second
molar cusp position. 1 Prosthet Dent 52:99-105. 1984.
Missing abstract .......
04-013. Palik. 1. F. Accuracy of an earpiece face-bow. 1 Prosthet Dent 53:800-804. 1985.
Previous studies are conIlicting:
Walker - 20° oI true axis were within 5 mm oI the arbitrary location situated 13 mm anterior to
the tragus. 60 ° were 6 mm or more.
Schallhorn - 95 ° oI true hinge axis were within 5 mm radius oI an arbitrary axis.
Materials and methods:
Hanau No 158-3 arcon articulator
Plexiglas disks were used on the articulator record the exact point oI the terminal hinge axis on
the articulator.
SelI adhesive TMJ graph circle placed on the plexiglas.
Hanau No. 159-4 earpiece Iacebow.
Earbow record repeated 4 times.
Results:
1. Arbitrary axis were, anterior and inIerior to true hinge axis 56° and anterior and superior
36°. anterior 92 ° oI the time.
2. Only 50° were within a 5 mm radius oI the true hinge axis.
3. 89° were within a 6 mm radius.
4. The arbitrary axis located with the ear Iace-bow was signiIicantly diIIerent Irom the true axis
in an anteroposterior direction but not in a superior-inIerior direction.
The earpiece Iace-bow was not repeatable.
Discussion:
No inIerence should be made that the earpiece Iacebow does not possess a practical clinical
value. However there is no consensus that the earbow approximates the terminal hinge axis
within the acceptable range.
2. ModiIications are needed in the condylar compensators oI the arbitrary Iacebow to increase its
accuracy. This study suggests that the arbitrary location oI the terminal hinge axis incorporated
into the condylar compensators oI this ear-bow is misleading, because 92° oI the clinically
located terminal hinge axes were posterior to the ear-bow position. This suggested that the
arbitrary hinge axis should be located less than 13 mm Irom the external auditory meati.
04-014. Getz. E.H. et al. Application of a geometric principle for locating the mandibular
hinge axis through the use of a double recording stylus. 1 Prosthet Dent 60:553-559. 1988.
Missing abstract .......
04-015. Pitchford. 1.H. A reevaluation of the axis-orbital plane and the use of orbitale in a
facebow transfer record. 1 Prosthet Dent 66:349-55. 1991.
Missing abstract .......
04-016. Nairin R.I. The Position and Function of the mandibular Hinge Axis. Aust
Prosthodont 1 8:19-22. 1994.
Purpose: To relate the average hinge axis position to the mandibular condyle.
Method: Hinge axis location chosen Ior this study was Beyron's point, 13 mm anterior to the
posterior border oI the tragus oI the ear, on a line between the mid-posterior margin oI the tragus
and the outer canthus oI the eye. In any single case, the hinge axis location, empirical or average
will probably lie within the same circle oI about 5 mm diameter (Beyron 1942, Schallhorn 1957,
Weinberg 1961, Brandrup-Wognsen 1953). Walker (1980) Iound that 80° oI 444 point locations
were below the tragus-canthus line running to the superior border oI the tragus. Lauritzen and
Bodner (1961) came to the same conclusion. The average point will be within ¹/-2.5 mm.
Subiects. Ten patients who were having routine orthopantomograms (OPG) Ior clinical purposes
were used. The average hinge axis point was marked on the side oI the Iace with a lead letter 'O'
about 5 mm in diameter.
Lateral skull radiographs oI ten other subiects were also studied. Landmarks were traced on
the ten lateral skull radiographs.
Results: The average hinge axis point as denoted by the marker appears to lie over the anterior
border oI the condylar neck more than 1 cm Irom the center oI the shadow oI the condylar head.
A similar situation holds on the other side. In a series oI ten OPGs no variation Irom this
appearance was observed.
Discussion: In this study the average hinge axis point is seen to lie over the condylar neck rather
than the condylar head on both sides oI 10 orthopantomograms, on ten lateral skull radiographs
oI diIIerent subiects and on a skull extrapolation. This coincidence must reduce the possibility
that these appearances are due to radiographic distortion. The view that the hinge axis lies within
the condyle appears to arise Irom an uniustiIied and untested assumption or Irom experimental
error, e.g. the use oI tomograms in which almost nothing clear can be seen, or by the use oI
geometrical extrapolations Irom mandibular tracings made at points remote Irom the condyle. It
remains to postulate a mechanism Ior the hinge movement compatible with its anatomical
position. The temporomandibular, or lateral, ligament is a substantial thickening oI the capsule
and when under tension will provide an area oI restricted mobility Ior the mandible. Such
ligamentous tension will be present when the hinge-axis is located and it seems reasonable to
suppose that it provides the Iulcrum Ior the hinge like movement. Obviously any opening
movement around an axis through the condyle would require Iurther lengthening oI the already
tense and unstretchable ligament.
Conclusion: The mandibular axis oI hinge like movement is located automatically in the region
oI the neck oI the mandibular condyle and not in the condyle itselI. This conclusion is supported
by the anatomy oI the ioint with particular reIerence to the temporomandibular ligament.
04-017. Gonzales. 1.B.. Kingery. R.H. Evaluation of planes of reference for orienting
maxillary casts on articulators. 1ADA 76:329-36. 1968.
Missing abstract .......
04-018. Gunderson. R. B. and Parker. M. H. An alternative technique for location of the
hinge axis. 1 Prosthet Dent 58:448-450. 1987.
Missing abstract .......
Section 05: Eccentric Movements
(Handout)
Definitions:
1. eccentric: adi. 1. not having the same center 2. deviating Irom a circular path 3, located
elsewhere
than at the geometric center 4. any position oI the mandible other than that which is normal
position.
2. border movement: mandibular movement at the limits dictated by anatomic structures, as
viewed
in a given plane
3. laterotrusion: n. condylar movement on the working side in the horizontal plane. This term
may be
used in combination with terms describing condylar movement in other planes, Ior example
laterodetrusion, lateroprotrusion, lateroretrusion, and laterosurtrusion. (also called Bennett's
movement).
4. laterodetrusion n. lateral and downward movement oI the condyle on the working side.
5. laterosurtrusion n. lateral and upward movement oI the condyle on the working side.
6. lateroretrusion n. a lateral and backward movement oI the condyle on the working side.
7. lateroprotrusion n. a protrusive movement oI the mandibular condyle in which there is a
lateral component.
8. mandibular translation the translatory (medio-lateral) movement oI the mandible when
viewed in the Irontal plane. While this has not been demonstrated to occur as an immediate
horizontal movement when viewed in the Irontal plane, it could theoretically occur in an
essentially pure translatory Iorm in the early
part oI the motion or in combination with rotation in the latter part oI the motion or both.
(mandibular lateral translation also called Bennett's side shiIt).
a. immediate mandibular lateral translation the translatory portion oI lateral movement in
which the nonworking side condyle moves essentially straight and medially as it leaves the
centric relation position.
b. early mandibular lateral translation the translatory portion oI lateral movement in which the
greatest portion occurs early in the Iorward movement oI the nonworking side condyle as it
leaves centric relation.
c. progressive mandibular lateral translation 1. the translatory portion oI mandibular
movement when
viewed in a speciIied body plane 2. the translatory portion oI mandibular movement as viewed in
a speciIic body plane that occurs at a rate or amount that is directly proportional to the Iorward
movement oI the nonworking condyle.
9. Bennett angle obs. the angle Iormed between the sagittal plane and the average path oI the
advancing condyle as viewed in the horizontal plane during lateral mandibular movements
(GPT-4).
10. Fischer angle eponvm Ior the angle Iormed by the intersection oI the protrusive and
nonworking condylar paths as viewed in the sagittal plane.
11. pantograph n. 1. an instrument used Ior copying a planar Iigure to any desired scale in
dentistry, an instrument used to graphically record in one or more planes paths oI mandibular
movement and to provide inIormation Ior the programming oI an articulator.
12. pantographic tracing a graphic record oI mandibular movement in three planes as
registered by the styli on the recording tables oI a pantograph; tracings oI mandibular movement
recorded on plates in the horizontal and sagittal planes.
History:
Bonwill- described a 4 inch triangle between mandibular incisors and each condyle. Also
proposed
a concept oI bilateral balanced occlusion.
Balkwill discovered that during lateral iaw movement, the translating condyle moved
medially.
VonSpee- observed that the occlusal plane oI the teeth Iollowed a curve in the sagittal plane.
(curve oI Spee).
Christensen (1901) observed the opening oI posterior teeth in mandibular protrusion.
Bennett (1908) described immediate side shiIt (Bennett movement).
Gysi (1910) develops one oI Iirst articulators to allow Ior Balkwill-Bennett movements.
Monson (1916) develops spherical theory, one oI Iirst three dimensional occlusal concepts.
Hanau (1921) advocated bilateral balanced occlusion with eccentric mandibular
movements.
Pankey-Mann (1920`s) amalgamation oI Monson theory and Meyer Iunctionally generated
path to obtain bilateral balance. Pankey-Mann-Schuyler eliminated balancing side contacts,
emphasized incisal guidance, and proposed long centric.
McCollum (1920`s) Gnathology study mandibular movement:
1. Propose colinear hinge axis,
2. Develop pantographic recording oI three dimensional envelope oI motion
3. Maximum intercuspation oI teeth when condyles are in hinge position
4. Bilateral balance with eccentric iaw movement.
Movement of the Mandible:
1. Posselt examined mandibular movement using a Gnatho-Thesiometer to measure the
mandibular position oI natural teeth. Recordings were made oI both habitual and extreme
positions with opposing teeth in occlusion. How were his measurements made?
What were his observations and conclusions?
2. Mandibular movement during chewing can vary greatly within the prescribed envelope.
Gibbs, et.al. , perIormed a study oI chewing and border movements oI Iive subiects with good
occlusion and two subiects with malocclusions. What did they observe about opening and
closing strokes? Closing and opening strokes diIIered markedly. Opening strokes were typically
anterior and medial to closing strokes.
Chewing movements were Iound to diIIer greatly until Iinal closure, where a similarity was
noted. Most chewing paths nearing Iinal closure coincided or nearly coincided with the working-
side lateral border path in both Irontal and sagittal views.
The movement oI the Iirst molar on the working side had a small anterior component during
closure. What does this indicate? Chewing Iunction occurred in the lateral retrusive range until
gliding tooth contact occurred. (Retrusive slides are seldom seen on the working side during
chewing)
How did the working side movement compare to the non-working side? The non-working
Iirst molar
closed Irom an anterior medial aspect and had a posterior component oI movement.
What did they conclude regarding neuromuscular control and occlusal interIerences?
How did this compare to what Clayton, et.al., Iound in their study oI pantographic tracings oI
mandibular movements?
3. Condylar movement determines tooth occlusal patterns. Or do tooth occlusal patterns
determine condylar movement? Aull described nine possible variations in the direction oI the
condylar path oI the working (rotating) condyle. Describe these nine variations:
Which one did he Iail to observe in his study oI 50 patients(100 condyles)?
Did he Iind a symmetry in condylar inclinations? No, only one pair oI 50 was symmetrical.
Side shiIt is the only condylar determinant that aIIects both the vertical and horizontal
components oI the posterior teeth. What general eIIect will an increase in laterotrusion have on
occlusal morphology? shorter cusps, gentler cusp slopes, shallower, broader Iossae.
Laterotrusion accompanied by an upward movement oI the same condyle has what eIIect on
the
cusp length?
Laterotrusion accompanied by downward movement has what eIIect on cusp length?
As intercondylar distance is increased, what happens to the angle Iormed by the transverse
and oblique
path oI the cusp in its movements?
As laterotrusion increases, what happens to this angle?
Did Kurth agree with Aull's conclusions?
What did Levinson report regarding the nature oI side shiIt in mandibular movement?
What impact would the presence oI (or lack oI) an immediate side shiIt have on articulator
selection?
4. The clinical signiIicance oI lateral mandibular movements is controversial. What did
Preiskel conclude?
What are some oI the diIIiculties encountered in studying the lateral side shiIt oI the mandible
(as discussed by Simonet)
What were Hobo's conclusions regarding lateral side shiIt Irom the use oI an electronic
measuring system?
5. Mandibular motion is produced by muscle activity. According to McCollum, is the path oI
mandibular movement determined primarily by the anatomy oI the ioint or the activity oI the
musculature?
Would Gysi concur?
The masseter and temporalis muscles Iunction to close and retrude the mandible. Do they
contribute
to lateral movements?
Which muscles are the most active participants in lateral movements?
What happens to the activity oI the masseter and medial pterygoids in retruded contact
position?
What did Santos, et.al. determine regarding the relationship between cusp steepness and
Iorces generated?
Recording mandibular movement:
1. Fabrication oI an esthetic and Iunctional restoration Ior the patient routinely requires the
eIIective use oI an appropriate articulator. One oI the roles oI the prosthodontist is to transIer
inIormation Irom the patient to the articulator in such a manner so that the articulator closely
simulates mandibular movement to the degree required by the restoration. Attempts to record
mandibular movement are as historical as the study oI mandibular movement itselI, and include a
variety oI intraoral and extraoral tracing mechanisms, as well as photographic, radiographic,
electronic, and electromyographic studies.
Stuart describes the recording oI mandibular movement. Which movements does he record,
and how are they registered?
What is the signiIicance oI recording border movements? Border movements are constant
enough in position, direction, and path as to be dependable and repeatable. When the true
boundary movements are recorded and transIerred, all other movements are automatically
included in the circumscribed areas oI movement.
Upon which issues do Boucher and Stuart agree?
disagree?
2. According to Mongini and Capurso, what Iactors inIluence the tracing patterns oI
mandibular border movements?
What eIIect does an internal derangement have on tracings?
What eIIect does severe muscle tension have on tracings?
What can be done to help address the eIIect oI severe muscle tension?
What eIIect did Theusner, et.al., observe regarding the tracings obtained Irom symptomatic
patients?
Were these considered to be adaptive or pathologic changes?
3. Lundeen and Wirth recorded mandibular movement by engraving plastic blocks and
photographing the engravings. Did they observe immediate side shiIt?
Was a greater side shiIt observed with Iirm lateral guidance oI the body oI the mandible by
the dentist, or with passive guidance at the chin point?
Did the length oI the central bearing screw aIIect the engravings?
4. Clayton, et.al. examined the eIIect oI various Iactors on graphic tracings. What did they
determine regarding the eIIect oI changes in the occlusal vertical dimension?
Regarding changes in the central bearing guiding surIace?
Regarding tooth guidance?
Summary: The intricacies oI mandibular movement, while intensely studied, discussed, and
debated, are still Iraught with uncertainties. Nevertheless, these questions should not deter the
diligent practitioner Irom the pursuit oI additional understanding and the eIIective restoration oI
his patients based upon the prevailing standard oI care and evidence based decision making.
- Abstracts -
05-001. Posselt. U. Movement areas of the mandible. 1 Prosthet Dent 7:375-385. 1957.
Purpose: To elucidate the shape and dimension oI the contact area oI movement oI the anterior
measuring point, and oI the points on the condyles. Individual variations were also studied.
Literature Review: Hanau and Fischer described the shape oI this contact movement area.
Fischer described this contact movement area in dentulous subiects as " broken and more or less
uneven". Fehr writes that the condyle movement area is larger Ior the leIt side than the right.
Gysi and Fischer illustrate the areas oI movement a rhomboid. Gysi carried out his investigations
on edentulous persons. No investigations were on record at that tie concerning the contact area oI
movement oI a point in the anterior part oI the mandible or Ior the condyles.
Materials & Methods: 5 people with almost complete dentitions were measured with a Gnatho-
thesiometer. The positions oI the measuring points (1 close to the inIradentale and 2 in the
middle oI each condyle) were enlarged and traced on paper in the 3 planes at right angles. Stone
models were made with the help oI the drawings.
Results/Discussion: The area oI movement oI a point on the anterior part oI the mandible can be
proiected on a plane surIace by graphic registration in both dentulous and edentulous subiects
provided that any vertical cusp guidance has been eliminated. The triangle, which connects the
three measuring points, corresponds to BONWILL`s Triangle.
Contact area oI movement oI the anterior measuring point: rhomboid shape but markedly
asymmetric. In the vertical plane, diIIerent levels were noted and individual variations evident.
Areas oI movement oI the condylar points: the shapes in all 3 planes diIIered widely along
with the extreme and in extreme positions.
Summary/Conclusion: The areas oI movement Ior three points on the mandible were recorded in
the 3 planes with the aid oI a Gnatho-thesiometer. The paths oI movement cannot be measured
with a Thesiometer. Lines can be drawn Irom one point to another and an approximation
secured. The results oI this investigation support observations Irom previous studies that
diIIerences exist between habitual and extreme positions.
05-002. Aull. AE. Condylar determinants of occlusal patterns. 1 Prosthet Dent15:826-
846.1965.
Condylar tracings Irom 50 patients were analyzed. A Stuart Iacebow, axis-orbital plane
indicator, pantographic tracing device, and articulator were used. The Iollowing Iindings were
obtained.
Condylar variation: Only one oI the IiIty pairs oI condyles had bilateral symmetry. The
average steepness Ior the right and leIt sides were 36.6
O
and 37.7
O
Intercondylar distance: The
average distance is 55.5 mm. Range was 45 -70 mm Bennett movement: All had mandibular
movement with a side shiIt.
Summary oI condylar determinants on occlusion by Aull:
1. Increasing the steepness oI the eminencies increases the requirements Ior steeper sloping cusp
on the balancing side.
2. Increasing the curvature oI the eminencies has the same eIIect on the tracings as iI the
eminencies is increased.
3. As laterotrusion (side shiIt) is increased shorter cusp are required (mainly the balancing side is
eIIected). II the rotating condyle also moves upward the working side cusps are more eIIected.
4. Laterotrusion accompanied by downward movement requires longer cusps on both sides
(mostly on working).
5. As intercondylar distance is increased, the more acute the angle becomes between the
transverse and oblique paths oI the cusps points.
6. Increase intercondylar distance, increase eminence slant, increase laterotrusion, the more
obtuse the angle between the transverse and oblique paths oI the cusps points.
7. An immediate laterotrusion which equals a distributed laterotrusion will have a more blunt
angle, and the balancing lines will diverge more in the central Iossa.
8. When the laterotrusive rotating condyle retrudes, the angle made between the working and
balancing tracing is more obtuse than that made between the same type oI tracings made with a
protruding laterotrusive rotating condyle.
9. As the slant or curvature oI the eminencies is increased, the slant oI the pure protrusive tracing
is also increased.
Kurth. LE. Discussion. 1 Pros Dent 15:847-849. 1965.
Kurth said iI you are not trying to achieve bilateral balanced occlusion there is no need Ior all the
diagnostic tracings.
05-003. Stuart. C. E. Accuracy in measuring functional dimensions and relations in oral
prosthesis. 1 PROSTHET DENT 9: 220-236. 1959.
Purpose: Discuss the use oI the articulator as a diagnostic tool.
Discussion:
A. Purpose oI the articulator
1. Record
a. Receive and register craniodental and maxillo-mandibular relations.
b. Receive and register the three dimensions oI the oral organ.
c. Receive and register the axes oI mandibular rotations.
d. Guide the dentist to incorporate all these Iactors into the prosthesis.
e. Store all the dimensional inIormation .
B. Anatomy and physiology oI the articulator
1. It should be put together in such a way that it can be reproducible, without compromise. It
should Iit the anatomy and physiology oI the oral organ.
C. Hinge axis
1. To provide a point in the third dimension, a line is extended Irom the hinge axis to the
lower border oI the orbit , to the right side oI the nose and marked.
D. Mandibular movement recorder
1. Two parts
a. Upper bow- holds vertical and horizontal recording plates in the condylar areas and
carries writing styluses in the anterior crossbar.
b. Mandibular bow- carry vertical and horizontal styluses in the condylar areas and
horizontal recording plates on the Iront bar.
2. The recorder has two styluses to write the Gothic arch tracing, two to write the eIIect oI the
anterior condylar glidings, and two to write the eIIects oI the lateral condylar glidings.
3. Border movements are used because in such a simple movement as straight protrusion the
patient seldom can make the same movement twice. The habitual positions vary according to
postures, health, muscular and nervous states. When they are transIerred to the articulator they
become boundary positions, and automatically all other movements are included in the
circumscribed areas oI movements.
E. Condylar path tracings: The tracing is composed oI two parts: a Iorwardly drawn tracing and a
backward tracing. Each tracing in itselI is made up oI two parts ioined at the point oI centric
relation as indicated by the stylus.
1. The two Gothic arch tracings show the eIIects oI the lateral and anterior movements oI the
condyle, and they are inIluenced by any opening and closing.
2. The reverse tracing oI each anterior condyle serves as an index oI the upward or downward
path direction oI the outward rotating condyle. The reverse tracing oI the Bennett line is an index
oI the backward or Iorward path direction oI the outward moving rotating condyle.
F. Magnetic styluses: Tracings are written by a Irictionless ball-point stylus magnetically
controlled, and preserved with adhesive cellophane. AIter the record lines are made and covered,
the upper and lower Iace-bows are cemented together in centric relation with stone.
G. TransIer oI iaw relations: The recorded lines are used to set the articulator. The articulator
consists oI two main Irames, and upper and a lower.
1. Upper Irame- centered on the lower and maintained in centric relation by a spring-loaded
arm. Carries all the cams that direct the gliding oI the condyle mechanisms, the right and leIt
glides Ior the sideshiIts (the Bennett movements), and the right and leIt Iossa cusps carry the
eminentias under which the condyles glide.
2. Lower Irame- carries the mechanical condyles and simulates the mandible. The cams, or
guide controls oI the mechanical condyles, when set, remain Iixed in relation to the upper teeth
and dental arch. The mechanical condyles and their axes remain Iixed in relation to the lower
teeth.
Boucher. C.O. Discussion. 1 Prosthet Dent 9: 237-239. 1959.
Purpose: Discussion by Dr. Charles E. Stuart.
Discussion: Dr. Boucher states that any instrument that is adiusted solely by a series oI these
records can be absolutely correct only in the exact positions at which the records were made. He
says that any movements made by the patient when the teeth are out oI contact are oI no
importance to the arrangement oI teeth. It is desirable to have any movements that may be made
while the teeth are in contact reproduced on the articulator. This is necessary so the occluding
surIaces oI the teeth can be shaped in harmony with each other, in any position in which they
came in contact. The articulator should approximate these movements oI the mandible that may
occur when teeth are in contact, this involves: (1) the correct relation oI the two casts to the
opening axis oI the instrument, (2) the establishment oI the correct centric relation, (3) the
development oI guiding surIaces in the mechanical counterparts oI the TMJ so the casts may
assume the same relations to each other that the denture Ioundations have to each other in the
mouth while the teeth are in contact.
Dr. Boucher states that orientation oI the Iace-bow and the cast to the arbitrary Iacial and
cranial landmarks seems unnecessary, except Ior the convenience oI observing the anterior teeth
and the occlusal curvature on the articulator. The directions oI the styluses should not be
mistaken with the directions oI the actual movements oI the mandible. A posterior movement by
the working side condyle is likely to be developed by the Iact that the tracing is made as an
extension oI the horizontal axis oI the mandible.
The use oI magnetic styluses appears to be a problem, since there is a possibility oI the weight
oI the recording device altering the normal position and movements oI the mandible. This would
be diIIicult to demonstrate or prove.
The clutches must be cemented to the teeth during registrations, making it impossible Ior
denture construction. This is important since the resiliency oI the supporting tissues would likely
produce errors in the registrations.
Dr. Boucher emphasizes Dr. Stuarts suggestion oI using an interocclusal record to mount the
casts in centric relation, otherwise all other articulator adiustment would be incorrect
05-004. Clayton. 1. A.. Kotowicz. W. E. and Zahler. 1. M. Pantographic tracings of
mandibular movements and occlusion. 1 Prosthet Dent 25:389-396. 1971.
Purpose: To determine the relationship oI Iunctional movements (chewing) to the border tracings
recorded by a pantograph.
Methods & Materials: Clutches were Iastened to the maxillary and mandibular teeth oI Iour
subiects so as not to interIere with tooth contacts during Iunction. Border tracings were made
Irom centric relation guided by the author and unguided tracings Irom centric occlusion. The
subiects were then instructed to chew test Ioods: gum, uncooked carrots, and peanuts. These
movements were recorded and compared to the initial sets oI tracings. AIter the recordings were
completed one patient had occlusal interIerences removed and a second set oI tracings made.
Results: The Iunctional movements contacted the border tracings Irequently. The movements did
not go beyond the border tracings. The chewing pattern was heaviest on the patients Iavored
side. The tougher the consistency oI the Iood the more the patient Iavored one side versus the
other. The two subiects who had no occlusal interIerences had a larger area oI coverage than the
two patients who had interIerences. AIter removal oI the interIerences one oI the subiects
produced recordings that were closer to the border tracings.
Conclusions: the authors conclude that subiects can Iunction to the border tracings provided that
no interIerences are present which may deIlect the Iunctional movements away Irom the border
tracings. They also conclude that occlusion in harmony with border tracings may be the most
physiologic. These conclusions are pretty amazing considering the Iact that there were only Iour
subiects.
05-005. Lundeen. H.C.. Wirth. C.G. Condylar movement patterns engraved in plastic
blocks. 1 Prosthet Dent 30:866-875. 1973.
Purpose: To report Iindings oI an investigation designed to test the reliability and reproducibility
oI a method oI three-dimensional tracing oI mandibular movements in plastic blocks.
Methods & Materials: 50 patients without pain or limited mandibular movement utilized. All
patients were premedicated with 0.4mg oI atropine sulIate, 150mg sodium pentobarbital, and 50
mg meperidine as intravenous medication prior to recording session. Condylar movement
patterns were recorded as three-dimensional engravings in clear plastic blocks using turbine air
drills. The drills cut a pathway in the plastic block that corresponds to movements oI the
mandible. The blocks are attached to the upper bow oI the recorder assembled on the patient`s
transverse hinge axis and secured by locking the bows to the clutches with attachment tubes
Iilled with plaster. The engravings oI the condylar movement patterns made by the turbine air
drills in the plastic blocks were photographically enlarged to permit comparisons between
patients.
Results: The protrusive pathways oI 50 superimposed tracings oI the recordings showed
similarity oI the right and leIt sides. At a point corresponding to 5mm oI protrusive movement,
the angle Iormed with the axis-orbital plane was a minimum oI 25 degrees, a maximum oI 65 to
75 degrees, with a median oI approximately 40 degrees. The tracings oI the lateral pathways
were also similar on the right and leIt sides. At a point corresponding to 5mm oI lateral
movement oI the balancing condyle, the angle Iormed with the axis-orbital plane was a minimum
oI 25 degrees, a maximum oI 75 degrees, with a median oI 45 to 50 degrees. A superior view oI
the recordings showed the immediate side shiIt (Bennett movement) and the Bennett angle as
two identiIiable portions oI the lateral movement. Once the immediate side shiIt had occurred,
very little variation was seen in the rest oI the movements Ior the diIIerent subiects.
Conclusion: The results oI the recordings oI condylar movements oI the 50 subiects were
superimposed and compared in three views showing the protrusive and lateral pathways as well
as the superior view oI the immediate side shiIt. Similarities in the tracings were noted in all
three views Ior the 50 subiects tested. The study was designed to compare the shapes oI the
lateral boundaries oI condylar movement. No attempt was made to relate these characteristics to
the occlusal relations oI the teeth.
05-006. Gibbs. C.H. et al. Chewing movements in relation to border movements at the first
molar. 1 Prosthet Dent 46:308-322. 1981.
Purpose: To identiIy movements during chewing which are characteristic oI subiects with
malocclusion.
Materials & Methods: There were seven adults in this study, Iive with good occlusion and two
with malocclusion. Data was collected with unilateral chewing oI cheese, raisins, gum, carrots
and peanuts. He iaw movements were measured with photo-optical transducers mounted between
maxillary and mandibular Iacebows. Clutches were well designed and cemented to the Iacial
surIaces oI teeth (well below the chewing surIaces.)
The patient sat upright, with head unrestrained during the chewing recording. The data was
processed by computer, and the overall accuracy was 0.125 mm.
Results: In the first malocclusion, a 28 year old woman with minor posterior interIerences,
dysIunction symptoms (pain on palpation oI lateral pterygoid muscle).
The Iirst molar movement on the working side had a small anterior component during closure,
indicating that chewing Iunction occurred on the lateral retrusive range Ior chewing soIt as well
as hard Iood. Chewing closure movements occurred posterior to the lateral borders until tooth
gliding occurred. Retrusive slides are seldom seen on the working side during chewing.
In the second malocclusion, there was a 67 year old man with severe wear. His iaw motion was
continuous as teeth slid over one another Irom working to non working side.
Conclusions: In certain malocclusions, the neuromuscular system exerts Iine control during
chewing to avoid particular occlusal interIerences. Present restorative procedures based on lateral
border registration are applicable to Iunctional chewing movements.
The region between the terminal hinge axis and the working-side lateral border path is seldom
used and does not involve tooth contact. The harder the Iood , the more lateral and rearward the
closing movement. In adults, opening is usually medial to the closing movement when viewed in
the Irontal plane.
05-007. Mongini. F. and Capurso. U. Factors influencing pantographic tracings of
mandibular border movements. 1 Prosthet Dent 48:585-598. 1982.
Purpose: To study how the characteristics oI the pantographic tracings can be utilized as a
diagnostic aid and to evaluate the inIluence oI anatomic and neuromuscular Iactors on the tracing
pattern.
Methods and Materials: Three diIIerent studies were perIormed. The Iirst study consisted oI 50
patients all with the signs oI dysIunction oI the somatognathic system; the second study, 20
patients Irom the Iirst group, underwent occlusal rehabilitation. The third study oI 20 patients
utilized 10 patients Irom the second study and underwent bioIeedback induced muscle
relaxation. Temporomandibular ioint radiographs, noises, condylar location and shape, patient
tenderness and spasms, and mandibular movements were parameters considered. Two
pantographs were made and evaluated Ior immediate side shiIt, sagittal displacement, deviation,
restrictions and other abnormalities.
Results: See article Ior pantographic tracings and correlation.
Conclusion:
1. Articular and neuromuscular Iactors inIluence the tracing patterns oI the mandibular
border movements.
2. Internal derangement oI the TMJ with the condylar disk incoordination leads to typical
pantographic tracings. The shape oI the condyle also aIIects the type oI tracing.
3. Severe muscle tension leads to very irregular tracings and are dramatically improved aIter
relaxation. An initial protrusion oI the movement oI the orbiting condyle probably
accounts Ior the incoordination oI the lateral pterygoid muscles.
4. BioIeedback therapy is a valuable therapeutic tool in dysIunctional patients. This
conIirms their value as a therapeutic tool in dysIunctional patients.
5. Improvements in the tracings aIter therapy may be equally due to the improvement oI the
articular situation or increased muscle relaxation and coordination.
05-008. Gibbs. C. H.. Mahan. P. . Wilkinson. T.M. and Mauderli. A. EMG activity of the
superior belly of the lateral pterygoid muscle in relation to other jaw muscles. 1 Prosthet
Dent 51: 691-702. 1984.
Purpose: The paper describes the activities oI the superior lateral pterygoid (SLP) and the
inIerior lateral pterygoid (ILP) in relation to the masseter, temporal, anterior belly oI the digastric
and medial pterygoid muscles during some basic iaw positions and movements.
Methods and Materials: Eleven subiects were monitored in individual sessions oI about 3 hours
duration.
The EMG activities oI the SLP, ILP and medial pterygoid muscles were monitored using Iine
insulated wire electrodes inserted directly into the muscles. The masseter, temporal and digastric
muscles were monitored by means oI electrodes placed on the skin over the muscles.
Results/Conclusions:
1. The EMG activity oI the SLP was similar but not identical to the EMG activity oI the
anterior Iibers oI the temporal muscle. The SLP muscle was active in clenching, especially
clenching in retruded contact. It was moderately active in ipsilateral movement and showed little
activity in other basic iaw positions.
2. In contrast to the SLP muscle, ILP muscle was active in protrusive, opening and
contralateral positions. It was minimally active during clenching in retruded contact, while the
SLP muscle achieved its greatest EMG activity at this position.
3. The anterior Iibers oI the temporal muscle are active in elevating the mandibular condyles
and mandible during clenching. They also assist the digastric muscles in retruding and posturing
the mandible ipsilaterally.
4. The anterior belly oI the digastric muscle depresses and retrudes the mandible. In
protrusion it opposes the masseter and medial pterygoid muscles to keep the teeth separated
while the ILP protrudes the mandible. It is active in isometric clenching, which stiIIens it to
protect the teeth in the event oI an unexpected rapid closing movement such as Iracture oI brittle
Iood.
5. The medial pterygoid and superIicial masseter are strong elevators during clenching in the
intercuspal position and assist in the protrusion oI the mandible by the prevention oI wide
opening. The medial pterygoid muscle is active during lateral movements as an agonist and
antagonist, but its activity diminishes to a low level at the extreme ipsilateral position.
6. Activity oI the elevating superIicial Iibers oI the masseter and medial pterygoid muscles is
greatly reduced in the retruded contact position. Perhaps this is a mechanism that protects the
posterior band oI the disc Irom iniury by the condyle during bruxing and chewing.
7. Simultaneous EMG activity (cocontraction) oI shortening and lengthening muscles is
commonly involved in basic iaw movements and appears to be important Ior Iine control,
mandibular stability and stiIIening oI antagonistic muscles to provide protection in the event oI
unexpected rapid mandibular movement.

5-009. Levinson. E. The nature of side shift in lateral mandibular movement and its
implications in clinical practice. 1 Prosthet Dent 52:91-98. 1984.
Purpose: To investigate mandibular side shiIt.
Materials and Methods: Skulls were examined, tracings Irom patients and a Iully adiustable
articulator were examined.
Results: ISS would not occur iI the condyles were Iully seated.
Conclusion: When using a one handed push back technique the centric relation position can be
improperly recorded and an ISS can be evident. However this article supports Dawson that the
immediate side shiIt does not occur when the condyle are Iully seated. ThereIore, a
semiadiustable articulator is adequate Ior the laboratory phase oI occlusal reconstruction.
010. Simonet. P. Influence of TM1 dysfunction on Bennett movement as recorded by a
modified pantograph. Part I: Literature review. 1 Prosthet Dent 46:437-442. 1981.
Purpose: To review the literature regarding Bennett movement.
Subiect: Examining the importance oI and diIIiculties encountered in studying Bennett
movement (lateral side shiIt oI the mandible), based on reviewing existing literature.
Discussion: While Bennett is generally given credit Ior his description oI lateral shiIt, credit
should be shared with Ferrein (1748) , Bell (1831), and Ulrich (1896). Bennett used two
incandescent light bulbs attached to the mandible, and using lenses, Iocused the images on the
wall, where they were traced during mandibular motion.
In 1926, Gysi repeated Bennett's study, developed an articulator allowing some lateral
component. He believed that incisal guidance was more important than condylar guidance in
determining cusp inclination. Landa proposed no movement in the working condyle, but
disregarded the role oI the lateral pterygoids, which was studied by Sicher.
The important role oI neuromusculature was presented by Boucher, Jacoby, and McMillan.
The inIluence oI TMJ dysIunction on neuromuscular activity and Bennett movement has been
speculated in diIIerent studies. DePietro applied the concept oI instantaneous centers oI rotation
to the movement. Mongini, comparing lateral polytomographics oI the TMJ with pantographic
tracings perIormed on subiects with TMJ dysIunction, Iound a signiIicant relationship between
condylar shapes and tracing patterns.
Credit Ior the development oI the pantograph is given to the Gnathological Society. Cotte, in
1969 Iound that, although lateral movements could be registered, side shiIt oI the mandible was
minimal or absent. In 1978, Lundeen, using the same instrumentation, Iound an average shiIt oI
0.75mm, with 80° shiIting 1.5mm or less. Gibbs Iound average lateral movement was around
0.4mm. In 1979, Bellanti and Martin Iound only 13° demonstrated Bennett movement oI more
than 0.2mm.
Conclusion: This review points out the diIIiculties in studying lateral side shiIt, as well as
contradictory results Irom various investigations. It seems reasonable to conclude that 1) Bennett
movement accompanies most lateral iaw movements, but the amount and timing varies between
individuals, and may be inIluenced by muscle incoordination and TMJ dysIunction. 2) the axis
around which all lateral movements occur may be oblique rather than vertical and perpendicular
to the subiect's hinge axis. Disagreement still exists regarding: 1) the immutability oI its
magnitude throughout occlusal therapy and 2) the possible relationship between TMJ
dysIunction and Bennett movement
05-011. Hobo. S. A kinematic investigation of mandibular border movement by means of
an electronic measuring system. a. Part II: A study of the Bennett movement. 1 Prosthet
Dent 52:642. 1984.
Purpose: To analyze the motion oI the working condyle during lateral movement oI the
mandible.
Methods and Materials: FiIty adults Irom 20 to 50 years oI age with an orthognathic
maxillomandibular relationship and no apparent TMJ disorders were selected Ior evaluation oI
Bennett movement (lateral shiIt oI the working condyle) kinematically via an electronic
measuring device with an accuracy oI ¹ 0.06mm. Intraoral custom made clutches containing
sensors recorded right and leIt border movements. Calculations made external to the TMJ at
intervals oI 52-58 mm Irom the mid-sagittal plane were compared to the computer-assisted
electronic recordings made at the condylar axis.
Results: Bennett movement is the lateral shiIt oI the working condyle along the terminal hinge
axis (transverse horizontal axis). The orbits oI the working side on the horizontal and Irontal
planes were more eIIected as the distance Irom the mid-sagittal changed as compared to the
orbits in the sagittal plane. When the distance was small, the working condyle moved Iorward
and downward. When the distance was large, the working condyle moved backward and upward.
When the distance Irom the mid-sagittal plane was an average oI about 55mm, the condyle
moved in a straight lateral direction.
Conclusions: It was Iound that at orbits 55mm Irom the midpoint oI the terminal hinge axis the
orbits shiIt straight laterally on the terminal hinge axis and do not show any deviation in the
sagittal plane. Based on these Iindings, it was believed that the Bennett movement was a straight
lateral shiIt oI the working condyle along the terminal hinge axis. It was stated that the previous
reports that the working condyle rotates and translates in various directions, which created the
impression that Bennett movement is complex, might have been caused by mislocation oI the
targets Ior measurement.
05-011b. Hobo. S. A kinematic investigation of mandibular border movement by means of
an electronic measuring system. Part III: Rotational center of lateral movement. 1 Prosthet
Dent 52: 66-72. 1984.
Purpose: To explain and illustrate the rotational center oI the mandible.
Methods and Materials: FiIty adults Irom 20 to 50 years oI age with an orthognathic
maxillomandibular relationship and no apparent TMJ disorders were studied. Terminal hinge
reIerence points 12mm anterior to the external auditory meatus Iormed the posterior points oI a
plane whose anterior reIerence point was 43mm above the incisal edge oI tooth #8. Maxillary
and mandibular reIerence points were secured in acrylic resin Stuart clutches. Right- and leIt-
lateral border movements oI the 50 subiects were recorded and the average movement oI the
Iield oI the intercondylar axis and the targets on the intercondylar axis 65mm Irom the midpoint
was computed.
Results: A converging point was identiIied on the working side where the Iield oI motion
became a minute region approximately 0.3mm long in a vertical direction and 0.1mm wide in an
anteroposterior direction in the sagittal plane. The converging point existed approximately 55mm
Irom the midpoint oI the terminal hinge axis.
Conclusions: This converging point was at the point oI intersection between the terminal hinge
axis and the intercondylar axis, which appeared at the conclusion oI the lateral movement. The
net side-shiIt caused by translation oI the mandible along the terminal hinge axis is equal in the
nonworking and the working sides. A point approximately 55mm Irom the midpoint on the
intercondylar axis is the kinematic rotational center oI the mandible during lateral movement.
05-012. Preiskel. H.W. Lateral translatory movements of the mandible: Critical review of
investigations. 1 Prosthet Dent 28: 46-57. 1972.
Purpose: Discuss the movements executed by the condyle on the working side.
Discussion: With wide opening and the iaw moving to the right, the working condyle moved in
an almost direct lateral line. This has been termed the " Bennett movement". He only
investigated his own iaw movement, his right side was larger than his leIt side, and he was
missing the mandibular posteriors. Bennett was aware oI the risks oI drawing general
conclusions Irom this.
The condyle is pear shaped when viewed Irom above, and the glenoid Iossa is wedge shape
with the lateral section opening out sharply. The medial section oI the condyle was rigidly
contained within bone, but the lateral aspect has Ireedom oI movement. Fischer, a Swiss dentist,
suggested that lateral mandibular movements occur about an axis inclined Iorward, inward, and
medially, involving the working-side condyle in rotation in the Irontal plane.
Sicher, points out that mandibular movements are described by muscle activity rather than by
bone contacts or ligaments. He Ieels that the temporomandibular ligament limits mandibular
displacement so that the condyles cannot brace themselves against the Iossa.
The neurophysiology oI this area is unclear, since the ligament contains nerve endings
susceptible to stretching, but there may be an absence oI muscle spindles in the external
pterygoid muscle.
Photographic methods have Iound: (1) the pathway oI the working side condyle on voluntary
lateral sliding movements was diIIerent Irom that oI lateral movements made with the teeth out
oI contact, (2) a direct lateral movement oI the condyle was present in voluntary lateral
movements oI the mandible. This is one oI the best designed experiments, however only two
subiects were discussed.
CineIluorographic studies show the absence oI lateral translation. Electromyographic studies
cannot diIIerentiate between isotonic and isometric contractions, and no direct conclusions can
be drawn by the action oI individual muscles.
Tracing devises usually have a clutch, that may alter the centric occlusion and alter iaw
movements. Lateral movements are assessed at an increased vertical dimension oI occlusion.
Some pantographs were unable to reproduce consistent results Irom one patient. Another
pantograph was ioined to an articulator and eccentric records were made. The line records were
reproduced, but the diIIerences in articulator settings were considerable. Isaacson modiIied
McCollums recording device and Iound the Bennett movement near the vertical dimension oI
occlusion in all 26 patients examined.
Conclusion: Lateral translatory movements oI the human mandible have yet to be completely
evaluated.
05-013. McCollum. B. B. and Stuart. C. E. A Research Report. Scientific Press. South
Pasadena. CA.
See reIerence:
05-014. Santos. 1.. et al. Vectorial analysis of the static equilibrium of forces generated in
the mandible in centric occlusion. group function and balanced occlusion relationships. 1
Prosthet Dent 65:557-567. 1991.
Purpose: Mechanical analysis based on a static equilibrium oI Iorces in an eIIort to support
various and prevailing stomatognathic concepts oI occlusal Iunction.
Materials & Methods: Two-dimensional mechanical models were designed to represent Irontal
proiections oI maxillomandibular relations Iocusing on only the coronal aspect oI molars and
both condyles. The obiective was to ascertain the instantaneous static equilibrium oI Iorces when
diIIerent interocclusal eccentric relationships were imposed on these models. Templates
representing a Iunctional proiection oI the maxilla and the mandible were Iabricated. The buccal
and lingual occlusal inclines were assigned steeper angles on the right side than the leIt. The
relationships were imposed on a centric occlusion position, a group Iunction and a cross arch
balanced occlusion relationship.
Results & Discussion: All oI the studies in this area have values and limitations inIluenced by the
complexity oI the biomechanical elements added to the artiIicially created models. Biologic
systems demonstrate ranges oI variability. Neuromuscular control may contribute to or override
a condition oI static equilibrium. For any load applied to a given body, there will be a reaction oI
equal intensity and direction, provided the Iorce is exerted on a Ilat surIace. When Iorces are
applied against inclined surIaces they will be decomposed into vectors with diIIerent directions
and magnitudes.
1. The concentration oI Iorces generated in a stable centric occlusion produces less loading
response in the ioints.
2. The working side oI the dentition accepts increased load and increased reaction in the
contralateral balancing condyle in an observation oI balanced occlusion.
3. The best approach Ior a uniIorm distribution oI Iorces acting upon the masticatory position
is erect cusps with similar angulations Ior both sides oI the dental arches. When cusps are less
steep, resultant Iorces in the dentition increase.
Summary & Conclusions: This study, using a mechanical model, simulates a system in Iunction
and provides a vectorial analysis based on static equilibrium oI Iorces generated in a mandible at
10 diIIerent positions(1 in centric and 9 in eccentric positions). Positions were in a balanced
occlusion and in group Iunction. The most revelant conclusion seems to be the Iindings that cusp
inclines and condylar path inclination have a proIound inIluence on the Iorces acting within the
ioints and dentition.
05-015. Theusner. 1.. et al. Axiographic tracings of temporomandibular joint movements. 1
Prosthet Dent 69:209-215. 1993.
Purpose: To investigate the spatial patterns oI condylar movements and to determine iI they
diIIer between individuals who are symptom-Iree and those who have subclinical symptoms.
Also the biomechanics oI the TMJ were documented by studying the range oI condylar
movements during maximum iaw movements.
Materials & Methods: Forty-nine volunteers (24 men and 25 women) between 22 and 56 years
were selected. The only criteria Ior their selection was that they were not in or seeking TMD
therapy. On all 49 volunteers (symptomatic and asymptomatic), three dimensional condylar
movements were recorded with a hinge axis tracing system axiograph during maximum opening
, protrusion, and mediotrusion. Tracings that were displayed in sagittal and Irontal planes were
measured to evaluate the biomechanics oI the TMJ.
Results & Conclusions: The only diIIerences between the groups (symptomatic and
asymptomatic) were in the right ioint, recorded in the sagittal plane during maximal opening an
the Bennett angle. The symptomatic group had a much longer condylar path. and a smaller
Bennett angle compared with the asymptomatic group.
These results were interpreted to be indication oI adaptive morphologic instead oI pathologic
changes. The authors concluded that alterations in condylar tracings should be cautiously
considered as an indicator oI ioint pathology.
05-016. Clayton. 1. A.. Kotowicz. W. E. and Meyers. G. A. Graphic recordings of
mandibular movements: Research criteria. 1 Prosthet Dent 25:287-298. 1971.
Purpose: To determine whether or not graphic tracings oI mandibular movements could be
aIIected by:
1. Changes in the VDO
2. Changes in the central bearing guidance surIace
3. Tooth guidance
Vertical Dimension Changes: The orientation oI the styli and recording table aIIected graphic
tracings oI mandibular movement when the VDO was changed. Cusps gliding on inclines
involved changes in vertical dimension. Studies oI mandibular movements should have the
recording device oriented to the terminal hinge axis so that changes in vertical dimension do not
cause diIIerent tracings. Inconsistencies previously recorded by other studies, could be due to
mechanical errors in the positioning oI the recording device.
Central Bearing SurIaces, Shapes and Graphic Tracings: The shape oI the central bearing
surIace can aIIect graphic tracings depending on the angulation oI the styli recording movement.
Graphic tracings oI mandibular movements recorded against diIIerent bearing surIaces will
coincide iI the styli is "zeroed." Graphic tracings will be diIIerent Ior each surIace iI the styli are
angled backward or Iorward Irom the "zeroed" position.
Tooth Guidance, Chewing and Graphic Tracings: Unguided tracings made by the patient with
the teeth in contact may not be true border tracings. Tooth interIerences and muscles may deIlect
movement away Irom the border position. Border tracings should be guided when teeth are in
contact, or a central bearing surIace should be used to eliminate the inIluence oI tooth
interIernces and muscle conditioning on theses interIerences. The position oI the styli can aIIect
the graphic recording oI Iunctional movements. the angle oI the styli and the positions oI the
styli in relationship to the terminal hinge axis should be reported.
Graphic Tracings v.s. Pantographic Tracings: Graphic tracings are recordings made on the
patient Irom which conclusions are drawn about mandibular movements directly Irom the
tracings. Pantographic tracings are recordings oI mandibular movements Irom a patient that are
transIerred to an articulator and then conclusions are drawn aIter the movement oI the casts on
the instrument.
Section 06: Incisal Guidance
(Handout)
DeIinitions:
Incisal guidance: 1. The inIluence oI the contacting surIaces oI the mandibular and maxillary
teeth on mandibular movements. 2. The inIluence oI the contacting surIaces oI the guide pin and
guide table on articulator movements. (GPT-6)
Incisal guide angle: 1. Anatomically, the angle Iormed by the intersection oI the plane oI
occlusion and a line within the sagittal plane determined by the incisal edges oI the maxillary and
mandibular central incisors when the teeth are in maximum intercuspation. 2. On an articulator,
that angle Iormed in the sagittal plane, between the plane oI reIerence and the slope oI the
anterior guide table, as viewed in the sagittal plane. (GPT-6)
Anterior guidance: 1. The inIluences oI the contacting surIaces oI the anterior teeth on tooth-
limiting mandibular movements. 2. The inIluence oI the contacting surIaces oI the guide pin and
the anterior guide table on articulator movements. 3. The Iabrication oI a relationship oI the
anterior teeth preventing posterior tooth contact in all eccentric mandibular movements. (GPT-6)
Mutually protected articulation: An occlusal scheme in which the posterior teeth prevent
excessive contact oI the anterior teeth in maximum intercuspation, and the anterior teeth
disengage the posterior teeth in all mandibular excursive movements. (GPT-6)
Anterior protected articulation: A Iorm oI mutually protected articulation in which the vertical
and horizontal overlap oI the anterior teeth disengage the posterior teeth in all mandibular
excursive movements. (GPT-6).
Canine protected articulation, Canine guidance, Canine protection, A Iorm oI mutually
protected articulation in which the vertical and horizontal overlap oI the canine teeth disengage
the posterior teeth in the excursive movements oI the mandible. (GPT-6)
Group function: multiple contact relations between the maxillary and mandibular teeth in lateral
movements on the working side whereby simultaneous contacts oI several teeth act as a group to
distribute occlusal Iorces. (GPT-6).
Anterior protected articulation. canine protected articulation. or group function.
What do we use and why?
D. Blake McAdam summarized some similarities and diIIerences in his article.
Similarities:
Both must provide a multiple posterior contact with intercuspal position (centric occlusion)
located either coincident with centric relation contact position or within 1mm oI protrusion in a
straight sagittal direction. Where these positions are not coincident they should be ioined by
continuous bilateral contact oI pairs oI teeth as described by Beyron or a Ilat area or "long
centric" as described by Schuyler in 1969.
There must be an absence oI posterior contact during mediotrusion.
There should be no posterior contact during anterior incision whenever the anatomic
arrangement permits.
There should be an anterior group-Iunctional guidance during the protrusive movement
accompanied by a posterior disclusion where the anatomic arrangement permits.
Both schemes try to keep horizontal Iorces to a minimum although they accomplish the task
diIIerently.
Differences:
The manner in which the teeth Iunction in laterotrusion.
In canine guidance the horizontal Iorces are minimized by limiting the contact oI the support
cusp to their opposing Iossa at or near their intercuspal position. All other lateral contacts are
prevented by the steeper inclines oI the canines. This results in the chewing stroke being more
sagittal in a Irontal view.
In group Iunction the Iirst contact is not made between the supporting cusp and opposing Iossa,
but instead at a lateral location Iollowed by a slide to centric occlusion. This will exert some
horizontal Iorces, but these Iorces can be minimized by the Iollowing:
O Striking simultaneously as many working side contacts as possible.
O Reduce the angle oI the incline so the resultant Iorce is more along the long axis oI the
tooth.
O Reduce Iriction by removing any roughness or irregularities.
O Slightly round the Iacial occlusal line angle.
A possible disadvantage for group function
Working group Iunction occurring on relatively steep inclines can be damaging since it may
generate excessive horizontal loading. This situation is usually seen in the transition between a
worn occlusion with canine guidance and an early group Iunction type oI occlusion.
Tooth mobility in both types of occlusions?
It would seem that with more horizontal Iorces present in group Iunction the teeth would exhibit
more mobility. However, O'leary, Shanley, and Drake Iound iust the opposite. They Iound that
teeth in a group Iunction occlusion had less mobility than teeth in cuspid protected occlusion.
Siebert Iound that canine protected occlusion is necessary to limit tooth mobility. Why all the
diIIering Iindings??
What is more common. Canine guidance or group function?
ScaiIe and Holt examined 1200 young people and observed that most North Americans under the
age oI 25 had canine guidance either bilaterally or unilaterally. However, clinical observation
suggest that most people over 40 years oI age have group Iunction guidance. Weinberg Iound
only 19 oI 100 people had cuspid protected occlusion.
McAdam suggest that both occlusions are normal and a dentist restoring only a portion oI an
occlusion should not change the occlusal scheme. Obviously some qualiIying remarks should be
made with this statement now with the emergence oI implant restorations.
Implants
Jemt, Lundquist, and Hedegard looked at group Iunction v. canine guidance in implant restored
patients and Iound the chewing cycles to be consistent with patients having a natural dentition.
(i.e. more vertical chewing in canine protection)
How does this Iit in with implant supported occlusion?
What about paraIunction v. masticatory movement oI the mandible?
Muscle Activity
Williamsom and Lundquist discussed the eIIects oI anterior guidance on the temporal and
masseter muscles and Iound that posterior disclusion reduced the elevating activity oI the
temporal and masseter muscles. This also makes us think about paraIunction v. masticatory
movement when deciding on an occlusion.
FMA
What eIIect does the FMA have on occlusion in prosthodontics and what arguments can be made
Ior each type oI occlusion in high or low FMA patients. Did DePietro and Moergeli ever look at
FMA related to canine guidance or group Iunction?
Occlusion
AIter reviewing some basic concepts about occlusion what type oI occlusion does Reynolds
suggest and why? This article was written one year prior to O'leary's.
Schuyler wrote that incisal guidance equals or surpasses the temporomandibular ioints in its
inIluence upon the Iunctional occlusion oI the dentition. How does incisal guidance relate to
condylar guidance.
Kohno states the incisal path should equal the condylar path. When rotation oI the condyle
occurs; however, the incisal path may be increased, but not more than 25 degrees.
Schuyler discussed incisal guidance in oral rehabilitation. He incorporated Ireedom oI movement
in centric occlusion be the addition oI a pin in the anterior guide table.
Schuyler lists his obiective oI an occlusal rehabilitation to be:
O A static centric occlusion in harmony with the centric maxillomandibular relation.
O An even distribution oI stress in centric occlusion over the maximum number oI teeth.
O Lateral and anteroposterior Ireedom oI movement in centric occlusion.
O Masticatory eIIiciency which involves uniIorm contact and an even distribution oI stress
on eccentric Iunctional tooth inclines which are coordinated with the incisal guidance and
normal Iunctional condylar movements.
O Reduction oI the buccolingual width oI the occlusal surIaces oI the teeth
O Reduction oI the balancing incline contacts as a means Ior reducing a potentially
traumatogenic load on the structures supporting the dentition.
Dawson discussed anterior guidance and Iirmly believes anterior guidance should be related to
condylar guidance. Dawson does not believe in allowing the posterior teeth to share the load in
eccentric movement stating "Even when anterior teeth are weakened by loss oI supporting
structure, it is preIerable to have them carry the whole load during iaw excursions because by
doing so we actually lessen the load on the anterior teeth because oI reduction oI elevator muscle
contraction to only one actively contracting muscle on each side." His support Ior this statement
may come Irom Williamson's article.
Dawson states maximum comIort and stability may be achieved iI the Iollowing criteria are met:
O Stable holding contacts Ior each anterior tooth
O Centric relation contacts occurring simultaneously with equal intensity posterior tooth
contacts.
O Position and contour oI anterior teeth in harmony with the envelope oI Iunction.
O Immediate disclusion oI all posterior teeth the moment the mandible leaves centric
relation.
O Position and contour oI all anterior in harmony with the neutral zone and lip closure path.
How does Dawson "Harmonize the Anterior Guidance" ?
O Lower anterior teeth reshaped and restored
O Posterior equilibrated
O Establish coordinated centric relation stops on all anterior teeth
O Extend centric stops Iorward at the same vertical to include light closure Irom the
postural rest position.
O Establish group Iunction (oI the anterior teeth)in straight protrusion.
O Establish ideal anterior stress distribution in lateral excursions.
AIter doing this Dawson will Iabricate an anterior guide table.
Cusp angle as the occlusal determinant
Hobo will Iabricate two guide tables and use cusp angle instead oI condylar path or incisal path
as a basis Ior the occlusion. This diIIers Irom any other technique we have studied. How does he
do this and what are the advantages? What is his reasoning?
His steps are listed on the next page. His reasoning is cusp angle may be the most reliable Iactor
to build an occlusion to. His basis Ior this is condylar guidance is inIluenced by occlusion, and
thereIore iI you precisely simulate mandibular movement that is inIluenced by traumatic
occlusion you will only duplicate that occlusion.
Steps Ior the twin stage procedure:
O A cast with a removable anterior segment is Iabricated.
O Remove the anterior segment.
O Set the condylar path and incisal guide table to 25 degrees. Set the Bennett angle at 15
degrees and the lateral wings oI the guide table to 10 degrees. Wax the posterior teeth to a
balanced occlusion. This will produce a 25 degree cusp angle.
O Adiust the condylar path to 40 degrees and the sagittal inclination oI the anterior guide
table to 45 degrees, adiust the lateral wings to 20 degrees and wax the anterior guidance.
A standard amount oI disocclusion will be obtained on the molars and a physiologic anterior
guidance will be Iabricated.
Hobo's limitations
Some limitations oI this technique are iI the condylar inclination oI the patient is less than 16
degrees cuspal interIerences will occur. (There is an 8° occurrence rate oI condylar paths less
than 16 degrees and Hobo states these interIerences can be removed intraorally.)
Hobo's contraindications
The twin stage procedure is contraindicated in the Iollowing cases:
O Abnormal curve oI Spee
O Abnormal curve oI Wilson
O Abnormally rotated tooth
O Abnormally inclined tooth.
Helpful laboratory guide
II the anterior guidance is predetermined intraorally Clements describes an incisolingual index
that will record the inIormation Ior the lab tech to adapt wax or porcelain to. This technique was
originally described by Fox.
A matrix oI acceptable provisional restorations is also helpIul in contouring the Iacial esthetics.
Basic review of anterior guidance and esthetics
Heilein discusses how to establish anterior guidance. Incisal edge position is determined by
phonetics and esthetics. His technique does not diIIer greatly Irom Dawson's.
O Establish coordinated centric relation stops.
O Centric stops in a postural position must have the same vertical dimension as those Ior
centric relation.
O ReIine protrusive excursions.
O Establish canine guidance in lateral border movements.
O Check lateral protrusive movements.
O Make sure there is a smooth transition to a cross over position.
- Abstracts -
06-001. Scaife and Holt. Natural occurrence of cuspid guidance. 1 Prosthet Dent 22:225-
229. 1969.
Purpose: To examine the natural occurrence oI cuspid guidance in eccentric positions.
Materials and Methods: 1200 young men between the ages oI 17 and 25 were examined.
Subiects with multiple missing or carious teeth, missing maxillary Iirst bicuspids or cuspids, or
those who had restorations involving the occlusion oI the maxillary or mandibular cuspids were
not included in the study. An Angle classiIication was recorded Ior each subiect. The presence or
absence oI gross wear Iacets was noted. The subiect was instructed to close on their back teeth
and side the teeth to protrusion, right and leIt laterotrusion. Contact was noted during the
movements. Contact oI the cuspids in centric occlusion was also noted.
Results: The results are displayed in two tables.
Conclusion: Cuspid protected occlusion in lateral movement was present bilaterally in 57° oI
the subiects, unilaterally in 16° and none in 26°. In protrusion, 99.4° lacked a cuspid
protected occlusion. 91.5° had cuspid contact in centric occlusion.
06-002. Schuyler. C. H. The function and importance of incisal guidance in oral
rehabilitation. 1 Prosthet Dent 13:1011-1030. 1963.
abstract missing ........
06-003. Anterior Guidance. Evaluation. Diagnosis. and Treatment of Occlusal Problems. C.
V. Mosby. St Louis. 1974. Chapter 16. Anterior Guidance. pp. 146-165.
Posterior teeth that are not protected Irom lateral or protrusive stresses by the discluding
eIIect oI the anterior teeth will, in time, almost certainly be stressed or worn detrimentally.
The anterior teeth are all Iorward oI the closing muscle power, so to exert stress on the
anterior teeth, the mechanical result oI the closing muscles would be like trying to crack a walnut
by placing it at the tips oI the handles oI a nutcracker and squeezing the handles back at the
hinge. This is the unique position oI the resistance to stress that the anterior teeth enioy by virtue
oI their relationship to the condylar Iulcrum and the source oI muscle power.
It is popular Iallacy, that whatever path the condyles Iollow must be duplicated in the lingual
surIaces oI the upper anterior teeth so the lower anterior teeth can Iollow the same path. This is
wrong. Condylar paths do not dictate anterior guidance, and there is no need or even advantage
to try to make the anterior guidance duplicate condylar guidance. Advocates oI such a concept
have Iailed to recognize that the condyles can rotate as they move along their protrusive
pathways. This allows the Iront end oI the mandible to Iollow a completely diIIerent path
without interIering with the condylar path.
Patients may have the same outer limits oI motion, but each may have a diIIerent envelope oI
Iunction. Even though condylar guidance is the same, the anterior teeth would have to be
contoured diIIerently Ior each patient.
Since Iunctional movements occur within the envelope oI motion borders, merely recording
the outer limits oI motion would not supply enough needed inIormation Ior optimally restoring
anterior teeth. The envelope oI Iunction that controls the anterior relationship must be treated as
a separate entity.
Anterior guidance cannot be determined on an articulator regardless oI how perIectly the
condylar path is duplicated. It is a separate entity and must be determined in the mouth where the
determinants oI anterior tooth position can be observed in Iunction.
Disclusion oI all posterior teeth in eccentric iaw position reduces muscle contraction in two oI
the three elevator muscles.
The moment any posterior tooth comes into premature excursive contact, not only the anterior
guidance looses its capability Ior shutting oII elevator muscle contraction, but also the elevator
muscles are hyperactivated by the posterior contact.
Because oI our new understanding oI muscle responses to posterior disclusion, we no longer
attempt to bring posterior teeth into working side group Iunction to help weak anterior teeth.
Even when anterior teeth are weakened by loss oI supporting structure, it is preIerable to have
them carry the whole load during iaw excursions because by doing so we actually lessen the load
on the anterior teeth because oI the reduction in elevator muscle contraction to only one actively
contracting muscle on each side.
6-004. Hobo. S. Twin-tables Technique for Occlusal Rehabilitation: Part II - Clinical
Procedures. 1 Prosthet Dent 66:471-477. 1991.
The deviation oI the incisal path in an individual is less than that oI the condylar path. The
incisal path inIluences disocclusion at the second molar twice as much as that oI the condylar
path during a protrusive movement, three times as much on the non-working side and Iour times
as much on the working side during lateral movement. The cusp angle is considered to be the
most reliable reIerence Ior occlusion. The standard cusp angle values were determined to be 25H
during protrusive movement, 15H on the working side, and 20H on the non-working side during
lateral movement.
In order to provide disocclusion, the cusp angle should be shallower than the condylar path.
To make a shallower cusp angle, it is necessary to produce balanced articulation so the cusp
angle becomes parallel to the cusp path oI a opposing teeth during eccentric movement. The twin
stage procedure uses a cast with a removable anterior segment and Iabricates the posterior teeth
in a balanced occlusion. The anterior segment is replaced and anterior guidance is established.(
1mm during protrusive movement)
In Hobo`s article a description is given to create a custom incisal guide table, and a technique
to simulate the protrusive movement on the articulator is detailed. In his text book, values have
been determined and can be programmed into a semi-adiustable articulator.
Stage I: The sagittal condylar path inclination 25H ; Bennett angle 15H ; sagittal inclination oI
the incisal guide table 25H ; and the lateral wing angle 10H .The anterior segment oI the maxillary
and mandibular casts are removed using dowel pins and the casts are adiusted so they do not
disclude during eccentric movements. Wax the occlusal morphology oI the posterior teeth so the
maxillary and mandibular teeth contact during eccentric movements (balanced articulation).
Stage II: The sagittal condylar path inclination 40H ; Bennett angle 15H ; sagittal inclination oI
the incisal guide table 45H ; and the lateral wing angle 20H .The anterior segment oI the maxillary
and mandibular casts is replaced. Wax the palatal contours oI the maxillary anterior teeth so the
incisors contact during protrusive movement, and the canines on the working side contact during
a lateral movement. Anterior guidance is established and disclusion is produced.
II the sagittal condylar path oI the patient is steeper than the articulator adiustment value (40H
), disclusion increases. II the path is less than 40H , then the amount oI disclusion decreases. II
the patient has less than 16 H (only about an 8° occurrence rate), cuspal interIerences will occur.
II the incisal path is more than 5H steeper than the condylar path, patients complain oI
discomIort( Mc Horris 1979).
06-005. Reynolds. 1. M. The organization of occlusion for natural teeth. 1 Prosthet Dent
26:56. 1971.
abstract missing......
06-006. Heinlein. W. D. Anterior teeth: Esthetics and function. 1 Prosthet Dent 44:389-393.
1980.
abstract missing.........
06-007. Broderson. S. P.: Anterior Guidance-The Key to Successful Occlusal Treatment. 1
Prosthet Dent 39: 396-400. 1978.
Purpose: To show that the relationship between the maxillary and mandibular anterior teeth is the
most important Iactor in the restoration and maintenance oI the ideal occlusion. Ideal in this case
is characterized by minimal wear, a healthy periodontium and temporomandibular ioint, and
maintains a quiet neuromuscular mechanism.
Materials & Methods: This literature review Iocused on the gnathologic approach Ior the
treatment oI anterior teeth by C. E. Stuart, who stated that the lingual surIaces oI the maxillary
anterior teeth are entirely controlled by condylar border movements, and the Pankey-Mann-
Schuyler philosophy which stated that the lingual surIaces oI anterior teeth are independent Irom
condylar border movements and are dictated by a need Ior long centric.
Results: The author discussed the determinants oI anterior guidance as being:
1. esthetics
2. phonetics
3. condylar border movements
4. positional relationship oI the maxillary and mandibular anterior teeth.
Without the boundaries oI the anterior teeth and the neuromuscular system the masticatory
apparatus would destroy itselI or muscle dysIunction would occur.
The Iunctions oI anterior guidance are:
1. to incise Iood
2. to aid in speech
3. to aid in esthetics
4. to protect the posterior teeth, by directing the teeth together in centric occlusion so that the
closing Iorces will be vertically directed onto the posterior teeth.
The anterior teeth must also allow the Bennett movement to occur so that the Iinal closure Iorces
will be directed along the long axis oI the posterior teeth. This is oI particular importance Ior the
restoration oI the canines. As more Bennett movement is introduced and the angle oI the
eminence is reduced more lingual concave curvature is needed. In contrast a steep eminence will
be in harmony with a small amount oI lingual curvature.
Discussion: Regardless oI philosophical approach to restoring the dentition, anterior guidance
must be developed to restore and maintain a healthy masticatory system. Diagnostic casts and
wax-ups, protrusive registrations, pantographs, Iunctionally generated paths, resin provisional
restorations, all contribute to Iabricating a Iinal restoration which maintains the harmony
between the anterior teeth and the condylar movements.
Conclusion: Anterior guidance is an important component oI occlusal treatment designed to
protect the posterior teeth Irom eccentric Iorces, and allowing the posterior teeth to protect the
anterior teeth by absorbing the vertical Iorces in centric position.
06-008. DiPietro. G.1. Significance of the Frankfort-mandibular plane angle to
Prosthodontics. 1 Prosthet Dent 36:624-635. 1976.
The FMA is an angle Iormed by the intersection oI the FrankIort horizontal plane and the
mandibular plane. Normal FMA ~25 plus or minus 5 degrees, high angle ~ 30 degrees or more
(open bite skeletal patterns), and low angle ~ 20 degrees or less (closed bite skeletal patterns) and
not to be conIused with open or closed bite dental patterns.
Clinically open bite skeletal type is associated with decreasing biting Iorce and a low FMA
(deep bite skeletal patterns) are associated with increased biting Iorces. "Sassouni" believed that
with a deep bite molars are directly under the impact oI the masticatory Iorces and that in the
open bite patient the posterior vertical chain oI muscles is arcuate, and the masseter is posterior
to the molars and the premolars and thereIore the patient had less powerIul masticatory muscles.
In the attempt to increase VDO, it is contraindicated in the low FMA patient as they tend to
return to their Iormer occlusion. Additionally, these teeth are more susceptible to abrasion. A
prime importance in deciding to render a patient edentulous with a low FMA is that the increased
biting Iorces and resorption may Iurther complicate stability and retention and may also result in
Iractured resin dentures.
With a high FMA, the glenoid Iossa is situated superiorly and posteriorly and the low FMA
patient, it is situated anteriorly and inIeriorly. Constancy oI the relationship between the position
oI the glenoid Iossa and the FMA can be used in modiIying the location oI a particular arbitrary
center oI rotation ( Beyron, Bergstrom, and Gysi) Ior Iace bow mountings. ThereIore using the
Bergstrom point as a standard, the position oI this arbitrary center can be modiIied superiorly and
posteriorly Ior high FMA and anteriorly and inIeriorly Ior low FMA. Additionally, the types oI
Iace bows using ear rods and anatomic averages can be modiIied to reIlect the variation in
position oI the condyles as determined by the FMA.
06-009. McAdam. D. B. Tooth loading and cuspal guidance in canine and group function
occlusions. 1 Prosthet Dent35:283-290. 1976.
abstract missing ...........
06-010. Williamson and Lundquist. Anterior guidance: Its effect on electromyographic
activity of the temporal and masseter muscles. 1 Prosthet Dent 49:816-823. 1983.
Purpose: To determine the eIIect oI anterior guidance or posterior contact in excursive
movements on the temporal and masseter muscles.
Materials and Methods: Five women were selected, Iour had previous symptoms oI dysIunction
or pain associated with the TMJ. Maxillary acrylic resin splints were made that allowed Ior
anterior guidance. SurIace electrodes Irom a Teca EMG unit were attached to the right and leIt
temporal and masseter muscles. The subiect was instructed to close Iirmly and maintain pressure
against the splint while moving into right laterotrusion, back to retruded contact position, into
leIt laterotrusion, back to retruded contact position, and the into protrusion. Recording were
printed with a paper speed oI 10 cm/sec and a microvoltage oI 500 microvolts. AIter the
recording were made the anterior guidance was eliminated Irom the splint and the recording were
repeated.
Results: The electromyogram strips are copied in the article. When the anterior guidance was
eliminated Irom the splint more muscle activity was recorded.
Conclusion: This study showed the elimination oI posterior contacts will exhibit less muscle
activity than an occlusion that allows posterior contacts. However; the altered splint allowed
bilateral posterior contacts that are not consistent with group Iunction and possibly less drastic
results may have been obtained without balancing contacts.
06-011. OLeary. T. 1.. Shanley. D. B. and Drake. R. B. Tooth mobility in cuspid protected
and group function occlusions. 1 Prosthet Dent 27:21-25. 1972.
abstract missing .......
06-012. 1emt. T. . Lundquist. S. and Hedegard. B. Group function or canine protection. 1
Prosthet Dent 48;719-724. 1982.
D`Amico - states that canine protection Iavors a vertical chewing pattern and prevents wear oI
teeth.
Beyron - states group Iunction, implies contact and stress on several teeth in lateral occlusion and
indicates abrasion as a positive and inevitable adiustment.
- Angle oI departure was steeper than the approach angle, and these angles were slightly greater
with group Iunction than with canine protection.
- Lateral displacement and total displacement oI the mandible, was greater with group Iunction.
- Mandibular velocity was greater with group Iunction.
- Duration oI chewing cycle was stable between the two.
All results indicate that the chewing pattern may be inIluenced by the type oI occlusion.
06-013. Kohno and Nakano. The Measurement and Development of Anterior Guidance. 1
Prosthet Dent 57:620-625. 1987.
Purpose: To describe a method oI measuring condylar and incisal angles in developing a criteria
Ior anterior guidance in clinical practice.
Methods and Materials: 35 subiects were measured using a speciIic apparatus to record the iaw
movements. A metal splint was attached to the lower teeth.
A Iacebow with three small light bulbs was used with cameras to record the path oI iaw
movements.
Results: The average inclination oI the incisal path was 46H . The average condylar path was 38H.
Conclusion: The inclination oI the incisal path should be equal to the inclination oI the condylar
path. The incisal path should not be more than 25H steeper than the condylar path. A ierky
condylar movement will result Irom an incisal path that is Ilatter than the condylar path. II the
incisal path is shallower than the condylar path, the condyle rotates in a reverse direction during
protrusive movements.
06-014. Siebert. G. Recent results concerning physiological tooth movement and anterior
guidance. Oral Health Rehabil 8:479-493. 1981.
abstract missing .......
06-015. Clements. William G. Predictable anterior determinants. 1 Prosthet Dent 49:40-45.
1983.
Purpose: To describe a method to predictably Iabricate anterior restorations.
Materials and Methods: Author's description oI a clinical and lab technique.
Results: None
Conclusion: Prior to make the tooth preparations on the anterior teeth resin composite
restorations are placed that will determine the size and shape oI the Iinal crowns. Diagnostic cast
are made when the patient is comIortable and pleased with the resin composite restorations.
Provisional restorations are made Irom this cast in the laboratory. At the Iollowing appointment
the teeth are prepared and provisional restorations are placed. A Iace bow transIer and centric
relation record are made at the next appointment. The provisional restorations are evaluated and
an impression is made oI the provisional restorations. A Iace bow transIer and centric relation
record are made with the provisional restorations in place. A custom incisal guide table is
Iabricated Irom the articulated provisional and lower opposing cast to reconIirm the excursions
in the completed restorations.
When the case is Iorwarded to the laboratory an incisolingual index is Iabricated. To Iabricate
the incisolingual index the maxillary cast with the provisional restorations is attached to the
upper member oI the articulator and a new mounting plate is attached to the lower member.
Boxing wax is wrapped around the lower mounting plate one inch short oI the maxillary cast.
The cavity is Iilled with mounting stone and the exposed surIace roughened to create undercuts.
Lab putty is placed over the mounting stone, catalyst is placed on the maxillary cast to act as a
separating medium. The centric lock is engaged and the articulator is then closed. The putty
gives an index to which the wax pattern or porcelain can be compared with.
06-016. Kahnm. A. E. The importance of canine and anterior tooth positions in occlusion. 1
Prosthet Dent 37:397-410. 1977.
abstract missing .....

Section 07: Articulators I - Overview
(Handout)
I. DeIinition: A mechanical instrument that represents the temporomandibular ioint and iaws, to
which maxillary and mandibular cast may be attached to simulate some or all mandibular
movements. (GPT-6)
II. ClassiIication:
A. The Glossary oI Prosthodontic Terms classiIies articulators into Iour classes.
Class I. A simple holding instrument capable oI accepting a single static registration. Vertical
motion is possible.
Class II. An instrument that permits horizontal as well as vertical motion but does not orient the
motion to the temporomandibular ioints.
Class III. An instrument that simulates condylar pathways by using averages or mechanical
equivalents Ior all or part oI the motion.. These instruments allow Ior orientation oI the cast
relative to the ioints and may be arcon or nonarcon instruments. (Arcon articulator - An
articulator that maintains anatomic guidelines by the use oI condylar analogs in the mandibular
element and Iossa assemblies in the maxillary element.)
Class IV. An instrument that will accept three dimensional dynamic registrations. These
instruments allow Ior orientation oI the cast to the temporomandibular ioints and replication oI
all mandibular movements. (GPT-6)
B. Awni Rihani published an article in JPD in 1980 discussing the classiIication oI
articulators that appears to be the accepted terminology to date.
A nonadjustable articulator can accept one or two oI the Iollowing records: Face bow, centric
iaw relation or protrusive record.
A semi adjustable articulator can accept all three oI those records.
A fully adjustable articulator can accept the Iollowing Iive records: Face bow, centric iaw
relation, protrusive, lateral records, and intercondylar distance record.
O A class I articulator is a nonadiustable articulator.
O A class II or III articulator is a semiadiustable articulator.
O A class IV articulator is a Iully adiustable articulator.
For a review oI the previous names Ior classiIying articulators review the Rihani article at J Pros
Dent 43: 344-347, 1980.
III. Occlusion and occlusal theories in addition to mechanical theories drove the development oI
articulators. (J Pros 2:33-43, 1993)
A. Occlusion.
1. Bonwill 1858 Triangular theory oI occlusion
2. Balkwill 1866 Translating iaw moved medially
3. Von Spee 1890 Occlusal plane oI teeth Iollow a curve
4. Snow 1899 Facebow
5. Christensen 1901 Opening oI posterior teeth in protrusion
6. Bennett 1908 Immediate side shiIt
7. Gysi 1910
Demonstrated use oI incisal guide pin. One oI the Iirst to allow
Ior side shiIt
8. Monson 1916 Spherical theory oI occlusion
9. Hall 1918 Conical theory
10.Hanau 1921 Rocking chair denture occlusion
11.Stanbury 1929 Positional records Tripod.
12.Meyer 30's Chew in technique
13.Avery Brothers 1930 Anti-Monson Reverse curve oI Wilson
14.Pleasure 1930 Anti-Monson except 2
nd
molars in balance
15.PMS 20's Eliminate balance, Incisal guidance important, Long centric
16.Gnathology 20's Pantograph, need to reproduce mandibular movements
17.Page 1950 Transographics. Page is dead and so is Transographics.
18.Gelb 1970
Cranial Orthopedics. The condyles assume a certain shape based
on mandibular movements.

IV. Basic anatomic principles and movements that need to be applied to articulators were
discussed by Weinberg in 1963. He also discussed an outdated classiIication system.
A. The hypothetical patient.
O Protrusive condylar inclination oI 400
O The 2
nd
molars located 50mm Irom the hinge axis in the horizontal plane and 32mm
below it.
O The incisal edge oI the mandibular incisors is located 100mm Irom the hinge axis on the
horizontal plane and 32mm below it.
B. The basic elements oI mandibular motion
O Protrusion
O Incisal guidance
O Balancing condylar path
O Balancing cusp inclines
O Working condylar motion -- Basic types oI working condylar motion
C. Tooth contact dominates mandibular motion.
D. Two essential steps in a Iace bow mounting.
1. Hinge axis
2. Anterior point oI orientation
E. EIIects oI raising or lower the occlusal plane and changing the condylar inclination have
on tooth morphology.
V. Contributions oI speciIic individuals
A. Bonwill
O Philosophy oI mastication
O Anatomy oI the human iaws
O The Bonwill articulator
O The method oI using Bonwill's articulator
O SigniIicance oI the equilateral triangle.
B. Gysi
Gysi used the gothic arch tracing and a tracing oI the sagittal inclination oI the condylar path.
The average angle oI the gothic arch is 120
0
and the average sagittal inclination oI the condyle is
30
0
.
The two condyle and incisor point determine interdigitation.
In the edentulous patient the movement Irom incisive to protrusive is completely lost.
Gysi does not regard lateral movements oI the mandible important except in unusual cases and
suggest an average condylar path oI 15
0
.
The Iollowing Iour Ieatures are required oI an articulator:
O centric relation oI the mandible
O control oI lateral incisor point movements
O sagittal inclinations oI the condylar path
O incisor path
Four methods oI adapting the articulator
O The intra-oral checkbite method with plastic material
O The intra-oral checkbite method with plaster
O The extra-oral graphic method with the Iace-bow (Gysi preIers)
O The intra-oral dentographic method
A Iaulty cuspid relation is a Irequent cause oI denture displacement.
The lateral incisor paths are more important than the condylar paths because the teeth lie closer
to the incisor point and the lateral paths oI the condyles are more diIIicult to reproduce.
Use oI a Iacebow is necessary to accurately place the cast on the articulator especially when the
sagittal condylar path diIIers Irom the incisor path.
Denture teeth should be placed over the ridge to insure stability and guard against tipping or
dislodging oI the dentures.
Teeth should be set to conIorm to the alveolar ridge.
C. Monson The various phases oI occlusion oI the teeth in
O The developing iaws
O The bones adiacent to the maxillary bones Iorming the masticating organs oI man
O The segments or teeth mounted in this mechanism, Iorming the masticating members
O The normal construction oI the human iaw
O Anatomical malIormations oI the mandibular mechanism
O The construction oI crowns and bridge work
D. Hall
His role in the development oI articulators
His love Ior Gysi
VI. In today's dental schools we have diIIerent articulators Ior Iixed v. removable restorations.
What about in the "real world".
O In dental school, the Whip-Mix and Denar are the most commonly used articulators used
Ior Iixed restorations while a Hanau model is more commonly used Ior removable.
(Smith JPD 54:296-302, 1985)
O Mohamed (JPD 36:319-325, 1976) Iound that 64° oI practicing dentist used a hinge or
simple articulator, 26° used a semi-adiustable, and 10° used a Iully adiustable
articulator.
O Schweitzer Iound that he had equal amounts oI success using diIIerent articulators. (JPD
45:492-498, 1981)
Board Questions
AlIred Gysi was the Iirst to produce an articulator which could reproduce downward and Iorward
movements.
The Iirst articulator to record downward and Iorward motion at the condyles was the Balkwill
articulator.
William Walker developed an adiustable articulator Ior individual mandibular movements,
making registrations oI the inclinations oI individual condylar paths extraorally.
The Fournet and Hageman articulators are examples utilizing the spherical theory.
Instruments that encompass the "terminal orbital Iunction" are the Gnathoscope, the Wadsworth
articulator, the Transograph, the Denar D-5A, and the Stuart
Gnatholator, Denar, and Stuart are Iully adiustable articulators
Hanau, Whip-Mix, and Dentatus articulators are semi adiustable.
The Whip-Mix, Hanau University, and Stuart are examples oI articulators with adiustable
intercondylar distance.
Walker Iirst recorded mandibular movement
- Abstracts -
07-001. Bonwill. W.G.A. The Scientific Articulation of the Human Teeth as Founded on
Geometrical. Mathematical. and Mechanical Laws. Dent. Items of Interest. pp. 617-643.
October 1899. In Vol. I.. Classic Prosthodontic Articles. A.C.O.P.. pp. 1-28.
Theory of Mastication: Only one side oI the iaw can Iunction at a time. He relates how
millstones are grooved to the leIt Irom the center oI the stone and the upper stone is revolved to
the right to allow clearing oI the grain to the outside. He recommends using articulation rather
than occlusion because it was a word oI action.
Anatomy of the Human 1aw: 95° oI cases will have the upper teeth proiect over the lower,
and the depth oI overbite varies as the depth oI the cusps oI the bicuspids are deep or shallow.
The ramus will be Iound to come upward and backward in relative proportion to the length oI the
cusps and the overbite.
Tripod arrangement oI the lower iaw Iorming an equilateral triangle Irom the center oI one
condyloid process to the other, Iour inches is average. From the condyloid process to the inIerior
centrals touch at the cutting edge is also Iour inches. It varies slightly, but not more than / oI an
inch.
Ordinary brass articulators are ioined as iI the iaw was iointed at the pharynx. The cuspids to
molars are in a straight line to enable them to keep the largest proportion oI surIace presented Ior
mastication.
Overbite or underbite will be in proportion to their depth and to the length oI the cusps oI the
cuspids, bicuspids and molars. The length oI the cusps on bicuspids will never be more than 1/8
inch oII.
Bonwill Articulator: As oI 1858, the Bonwill Articulator corresponds to the shape and
movements oI the mechanism oI the iaw. The base with its movements Iorms one part and the
two bows another. It is made oI 1/8 inch diameter brass wire.
Method of Using the Articulator: Always model the upper wax (record base) Iirst, iudging the
length oI incisors and trial placement oI anterior teeth Ior shade, shape, length and width. To
articulate the lower cast, use a pair oI dividers Iour inches apart with the center oI the lower teeth
at the median line iust Iour inches Irom the condyles on either side. The Iirst bicuspid should
only have one cusp. A groove in the upper teeth should be placed nearer the buccal side, and Ior
the lower on the lingual.
Proposes "bilateral balance" to equalize the pressure and action oI the muscles on both sides
or parts oI the dental arches. The incisors never touch when the iaws are in lateral movement.
One side oI the mouth can be used at the same instant, leaving the other Iree to balance the other
side at work.
Significance of the Equilateral Triangle: The center oI each condyle being the center oI
motion, rotating on one condyle only, the other describing the arc oI a circle by moving in the
glenoid cavity. Bonwill claims to have examined 4,000 dead iaws and at least 6,000 living iaws.
The size oI the lower iaw must be 1/12 oI the main circle drawn around the equilateral
triangular iaw. The six incisors mean diameter, in line, measure the same as the two bicuspids
and two molars on either side Iorming an equilateral triangle.
07-002a. Weinberg L. A. An evaluation of basic articulators and their concepts. Part I.
Basic concepts. 1 Prosthet Dent 13. 622-644. 1963.
Evaluation and associated concepts oI articulators compared to that oI a hypothetical patient and
the clinical implications. The maxillary arch is the Iixed base Irom which mandibular motion is
recorded. The importance oI Iacebow transIer and CR records to the starting position oI
mandibular motion is emphasized. The condyles and incisors are the three points used to study
mandibular motion. Incisal guidance is the dominant determinant oI mandibular motion due to
it's mechanical leverage. TransIer oI a kinematic axis requires the rods oI the articulator are
moved to meet the pins oI the Iacebow Ior accuracy. Bennett Angle, Fischer Angle and Bennett
movement are discussed.
07-002b. Weinberg L. A. An evaluation of basic articulators and their concepts. Part II.
Arbitrary. Positional. Semiadjustable Articulators. 1 Prosthet Dent 13. 644-663. 1963.
Arbitrary: Monson's spherical Theory and the 8" sphere do not consider individual variations but
has value in establishing a general curve oI the occlusal plane.
Positional: Stansbury Tripod oI limited use, any change in VDO requires new records.
Semiadiustable: Hanau Model H.
rientation of the Maxillarv Cast
O Anatomic average Ior hinge axis. Anterior point oI reIerence can be the orbital pointer or
by aligning the incisal edges oI the teeth or the wax rim to the notch on the incisal pin.
O CR record, the Gysi Gothic arch tracing is the most desirable. Interocclusal wax records
or other records are acceptable.
O !rotrusive record gives condylar inclination
O Balancing Condvlar motion- downward, mesial and Iorward. The protrusive is used Ior
the downward component . Bennett movement is determined by Iormula ( h/8 ¹12).
Mathematical study oI the Hanau Model H


Approximate Error at the second molar cusp
height

Balancing Working Type oI error
1. Anatomic average hinge axis .2 .2 ant/post
2. Arbitrary anterior point oI reIerence .2 .0 neg
3. Straight condylar path .2 .2 pos
4. No Fischer angle .1 0.0 pos
5. No individual working condylar motion .0 .8 neg

O Arbitrary hinge axis
O CR record, Gothic arch desirable, wax records acceptable
O Protrusive record gives condylar indication and Bennett Angle
O Bennett movement oI working condyle gives up, back and out movement only, can only
vary amount
O Condylar indication changed by arbitrary third point oI reIerence
O Fischer angle unaccounted Ior
O Lack oI adiustment oI working condyle could cause negative error oI.8mm
The most signiIicant error is produced by the lack oI working condylar motion. Overall, most
oI the errors tend to cancel each other out rather than compound.. The error produced is oIten
negative and tends to produce Ilatter cusps. The error in the working condylar guidance eIIects
posterior teeth more than anterior teeth. Decreasing the Bennett angle oI the opposite balancing
condylar guidance produces more rotation and less lateral shiIt oI the working condyle and ,
thereIore increases posterior working cusp inclines.
07-003. Celeza. F. V. An analysis of articulators. DCNA 23: 305-326. 1979.
Purpose: RedeIine the articulator.
Discussion: An articulator is deIined as a "mechanical device which represents the
temporomandibular ioints and iaw members, to which maxillary and mandibular casts may be
attached". Many devices that are called articulators do not satisIy this deIinition. Some oI these
devices make no attempt to represent the TMJ ( Iacebow transIer) or their paths oI motion
(eccentric registrations).
Noneccentric movement articulators diIIer in the approach to the occlusal position.
The mandibular pathways are all curved and only one oI these pathways can be registered.
Eccentric movement articulators must all be oriented to the TMJ and thereIore, require
registrations oI centric relation as a starting or reIerence position. The reason Ior using an
instrument that allows eccentric movement is to minimize adiustments and preserve anatomical
detail. The more adiustments required, the greater the loss oI anatomical Iorm, since all
adiustments are subtractions only.
When selecting an articulator Ior prosthodontic use, Iirst determine what type oI occlusal
scheme is most desirable. II centric occlusion is to be used as the position oI MIP, then only a
registration oI that position with the remaining teeth in contact should be taken. The working
casts cannot be ioint oriented because centric occlusion is not a border position. ThereIore, the
precise end point oI centric occlusion must be maintained by the articulator.
II centric occlusion is going to be used as the position oI MIP, it would be most advantageous
to use a ioint-oriented technique such as the Iace-bow transIer. In this way the endpoint (centric
relation) can be preserved on the articulator with slight changes in vertical dimension. Eccentric
pathways can be dynamically registered either graphically (pantographic method) or
stereographically (engraving method), positionally registered (checkbite method), determined by
the articulator (mechanical equivalents), or adiusted entirely on the patient.
ClassiIication oI cast relators:
1. Class I - simple holding instruments capable oI accepting a single static registration. The
eccentric movements permitted oIIer no advantage because they are not registered and are
thereIore inaccurate. The exception to this is the Subdivision C instrument. Class I instruments
are suitable Ior crown and bridge, and operative instruments. Important Ieatures are positive
stops and locks at the mounted position.
O $:-/;s43 A: vertical motion is possible. Ex: Corelator, Venticulator.
O $:-/;s43 B: vertical motion is ioint related. Ex: Centric Relator.
Class II - instruments that permit horizontal as well as vertical motion but do not orient the
motion to the TMJ.
O $:-/;s43 A: eccentric motion is unrelated to patient motion. Ex: Gysi Simplex.
O $:-/;s43 B: eccentric motion permitted is based on theories oI arbitrary motion. Ex :
ShoIu Handy II.
O $:-/;s43 C: eccentric motion permitted is determined by the patient by using
engraving methods. Ex: Gnathic Relator.
Class III: instruments that simulate condylar pathways by using averages or equivalents Ior all
or part oI the motion. They allow Ior ioint orientation oI the casts and may be arcon or nonarcon
instruments. All the examples are arcon instruments, accept Iacebows, and have mounting plates
Ior unlimited case load.
These instruments can IulIill the requirements Ior complete denture construction.
Desirable Ieatures would be good centric lock, progressive and immediate side shiIt controls,
protrusive inclination, intercenter distance adiustment, a simple mounting procedure, a good
sturdy design, and an arcon arrangement.
O $:-/;s43 A: accept static protrusive registrations. Ex: Hanau Arcon II.
O $:-/;s43 B: accept static lateral protrusive registrations. Ex: Denar Mark II, Whip
Mix, Case Articulator Simulator, Panadent model P, Hanau Model 130-22, TMJ
Mechanical Fossa Instrument.
Class IJ: instruments that will accept three dimensional dynamic registrations.
These instruments allow Ior ioint orientation oI casts. These articulators are the instruments oI
choice Ior complete reconstructions. These instruments should hold adiustments, contain good
centric locking mechanism, versatile incisal guide tables, and stable mounting Ieatures, and be
precision engineered.
O $:-/;s43 A: the cams representing the condylar paths are Iormed by registrations
engraved by the patient. Ex: TMJ.
O $:-/;s43 B: instruments that have condylar paths that can be angled and customized.
Ex: Stuart Gnathological Computer, Denar Model 5A, Denar Model SE.
07-004. Hall. R. E. An analysis of the development of the articulator. 1ADA 17:3-51. 1930.
In Vol II. Classic Prosthodontic Articles A.C.O.P.. 1978. pp. 53-101.
Purpose: To increase knowledge and understanding oI the development oI the articulator in an
eIIort to end the controversy over 2D (gothic arch) vs 3D (anatomic) articulators.
Discussion:
A). Review history oI development:
-Gariot (1805): original invention; simple hinge
-Snow: Iacebow(1st evidence oI 3D relations)
-Hayes: articulating caliper
-Broomell: planes oI orientation to plane oI occlusion, ala-tragal
-Evans(1840): given credit Ior the 2nd articulator
-Cameron: the real 2nd contributor; 1D opening & closing movement
-Bonwill (1858): Iather oI anatomic/balanced occlusion, equilateral triangle
-Walker (1896): real pioneer but Gysi took credit, varied axes oI lateral movement, condyle path
and rotation point theory adiustable condylar guidance, incisal guidance and Balkwill-Bennett
movement were, only real changes prior to 3D
-Hayes (1899): downward movement oI the condyle
-Luce (1911): incisal pin and support guide; 3D but plastic
-Gysi (1910): Balkwill-Bennett movement; incisal guidance and pin
-Hall: adiustable 3D anatomic articulator; universal mandibular movements, adiustable incisal
guide
-Gysi Trubyte and Wadsworth: components oI all previous articulators
-Hanau (1920): engineer; 2D
B). Warring camps oI Gysi(2D) and Hall(3D)
2D: gothic arch tracing; cannot reproduce arcuate movement oI the mandible and accurately
check 3D bites
3D: working condyle moves in all directions, no restraining hinge ioint; automatic
C). Other notable credits:
Davis & Leuchenring: intercondylar width adiustment
Monson: divider Ior determining basic curves disk locating center Ior proiecting curves
07-005a. Donald L. Mitchell. DDS. MS. and Noel D. Wilkie. DDS. Articulators through the
years. Part I. Up to 1940. 1 Prosthet Dent 39:330-338. 1978.
A pictorial history oI the articulators at the National Naval Dental Center is presented. All
articulators in the article will be listed with a unique attribute noted.
The Plaster Articulator. Plaster extensions oII the distal portions oI the cast articulated the cast
together. Credited to Philip PIaII oI Berlin who was the dentist oI Frederick the Great.
The Barn Door Hinge. Heavy duty hinge modiIied by bending each arm 90 degrees to Iorm a
L-shaped upper and lower member.
The Adaptable Barn Door Hinge. Has an anterior vertical stop. Usually a machine bolt.
The Kerr Articulator. Hinge is on the same plane as the occlusal plane. Fixed protrusive and
lateral movement.
The New Century Articulators. Snow in 1906. Rotational centers placed 4 inches apart.
The Acme Articulator. Elaboration oI the New Century articulators. Three diIIerent models to
allow Ior three ranges oI intercondylar distance.
The Gysi Adaptable and Simplex. The adaptable was introduced in 1906 but was too technical
and cost too much so the simplex was introduced in 1914. The condylar guidance was Iixed at
33
0
and has a S-shaped curve in proIile.
The Bixby Attachment. A Iorerunner oI the Iacebow in attempted to regulate the
anteroposterior position oI the cast on the articulator. (1894)
The Maxillomandibular Instrument. Designed by Monson in 1918 based on the spherical
theory. Average radius oI the sphere was 4 inches but could be changed.
The Stephan Articulator. Developed in 1921. Has a Iixed condylar inclination and allows Ior
an arbitrary lateral movement.
The Hanau Model M Kinoscope. Early 1921. Four post. The Bennett angle is adiusted by
changing the eccentric cone on the outboard post.
The Homer Relator. Developed in 1923 by Joseph Homer. TMJ uses a similar principle in
relating cast.
The Wadsworth Articulator. Flag Ieature and an adiustable intercondylar distance.
The Hanau Model H110. Designed to encompass mechanical averages.
L÷ H/8 + 12
The Hanau Model H110 Modified. Introduced the incisal guide table.
The Hageman Balancer. 1920's. Based on the spherical theory oI occlusion. Mandibular teeth
constructed Iirst.
The Phillips Student Articulator (Model C). Developed around 1929. It's developer claimed it
could Iollow any graphic record.
The Stanbery Tripod Instrument. Reproduces positions not movements.
The House Articulator. Developed in the 1920's. Rotary milling device.
The Precision Coordinator. Developed in the early 1930's by Terrell. Curvilinear condylar
guides.
The Hanau Crown and bridge Articulator. Small articulator that can simulate working and
balancing side excursions oI 15
0
and protrusive oI 30
0
.
The Phillips Occlusoscope. Phillips believed in only two (condylar) determinants oI occlusion
thereIore the incisal pin rested on a Ilat plane.

07-005b. Donald L. Mitchell. DDS. MS. and Noel D. Wilkie. DDS. Articulators through the
years. Part II. From 1940. 1 Prosthet Dent 39:451-458. 1978.
A pictorial history oI the articulators at the National Naval Dental Center is presented. All
articulators in the article will be listed with a unique attribute noted.
The Stephan Articulator (Modified). 1940. Simple hinge ioint with longer upper and lower
members than the 1921 model and a Iixed condylar path oI 30
0
.
The Stephan Articulator Model P. An incisal pin and Iixed 10
0
incisal guidance.
The Fournet Articulator. No lateral movement.
The 1ohnson - Oglesby and Moyer Articulators. The Johnson - Oglesby instrument is a small,
nonadiustable, Ilexible articulator developed around 1950. The upper member oI the Moyer has a
ball and socket adiustment. It is a mean value articulator.
The Coble Articulator. A hinge articulator that maintains vertical dimension and centric
relation but does not allow Ior Iunctional movements.
The Galetti Articulator. The cast are held mechanically without plaster.
The Panky-Mann Articulator. Occlusal plane oI the mandibular teeth are based on the
Spherical theory.
The Stuart Articulator. The settings are programmed by using pantographic tracings Irom the
patient.
The Hanau Model H2 Series. Increased the distance between the upper and lower member Irom
95mm to 110mm and added an orbital indicator to the upper member.
The Dentatus ARL Articulator. Allows Ior the transIer oI cast Irom one articulator to another
while the same relationship is maintained.
The Improved New Simplex Articulator. Average movements. Condylar inclination oI 30
0
.
Bennett movement oI 7.5
0
. The incisal guide table adiust Irom 0
0
to 30
0
.
The Verticulator. Developed to be used with the Iunctionally generated path technique and
quadrant trays.
The Ney Articulator. No locking device between upper and lower members. Varying
intercondylar distances. Can use custom ground plastic inserts in the condylar elements.
The Hanau Model 130-21 Articulator. One oI the Hanau university series. Introduced in 1963.
The Whip-Mix Articulator. A simpliIied version oI Stuart's Iully adiustable articulator. Can not
be set to all positional records.
The Simulator. A Iully adiustable articulator that can be set Irom pantographic tracings,
positional records, and other tracings.
The Denar D4A Articulator. A Iully adiustable articulator. Programmed Irom tracings made
with a pneumatically controlled pantograph.
The Dentatus ARO Articulator. A moveable arm that holds the mandibular cast allows Ior
repositioning the mandibular cast without remounting.
07-006. Mohamed. S.E.. Schmidt. 1.R. and Harrison. 1.D. Articulators in Dental Education
and Practice. 1 Prosthet Dent 36:319-325. 1976
Discussion: Survey sent to 305 labs in the East Coast and in Illinois. They received a response
Irom 106 laboratories. The survey results were interpreted to identiIy dentist`s use oI articulators
aIter training. Only a small percentage oI students continued to use or prescribe articulators.
Responses Irom 98 labs disclosed the type oI articulators dentists were submitted : 64° were
hinge or simple articulators, 26° were semi-adiustable articulators, and 10° were Iully
adiustable. The most common complaints oI the lab technicians were poor registration records
and poor impressions. They preIerred that the dentist articulated the casts prior to reIerring them
to the lab.
Authors thought it would be better to place emphasis on the selection oI an articulator
dependent upon the diIIiculty encountered with each patient, rather than learning to use one
articulator - i.e. semi-adiustable.
07-007. Smith. D. Does one articulator meet the needs of both fixed and removable
prosthodontics? 1 Prosthet Dent 54:296-302. 1985.
Purpose: Survey oI dental school's Fixed and Removable department as to the type oI
Articulatores required oI their students.
Methods: Surveys were sent to each dental school and their respective Fixed and Removable
Departments.
Conclusion: Fixed Departments preIerred an articulator that allows separation oI the maxillary
and mandibular members and in Removable departments preIer those that do not.
07-008. Awni Rihani. DDS. MSc. Classification of articulator. 1 Prosthet Dent 43:344-347.
1980.
Purpose: To discuss a classiIication system Ior articulators.
Discussion: Articulators have been classiIied in several ways by several diIIerent people. Rihani
suggest classiIying articulators as nonadiustable, semiadiustable, or Iully adiustable. This is
based on the type oI records they can accept.
O A nonadjustable articulator can accept one or two oI the Iollowing records: Face bow,
centric iaw relation or protrusive record.
O A semi adjustable articulator can accept all three oI those records.
O A fully adjustable articulator can accept the Iollowing Iive records: Face bow, centric
iaw relation, protrusive, lateral records, and intercondylar distance record.
07-009. Monson G. S. Occlusion as Applied to Crown and Bridge Work. 1 Nat Dent Assoc
7:399-413. 1920. In Vol II. Classic Prosthodontic Articles. A.C.O.P. pp. 1-15.
Purpose: To achieve well balanced geometric proportions to the Iace and optimum Iunction, one
can relate all iaws to a sphere whose radius is approximately Iour inches . The center is equi-
distant Irom the occlusal surIace oI the teeth and the center oI each condyle.
Discussion:
First - The Developing Jaw
The Iunction oI mastication is essential in developing the normal iaw and the base oI the
cranium. Food and Iunction play the key role in development and will create the ideal
masticatory Iorces and Iacial Iorm.
Second - The Bones Adiacent to the Maxillary Bones Forming the Masticating Organs oI Man
The total action oI the muscles converge to a common center.
Function oI these muscles are the main Iactor in developing well balanced geometrically
proportioned Iace.
Third - The segments or Missing teeth Mounted in This Mechanism Forming the Masticating
Members
No matter what positions the mandible may take, the masticatory Iorces are directed down the
long axis oI the teeth. The center oI the applied Iorces converge to a common radial point about
Iour inches Irom the occlusal surIaces and the head oI the condyles. Tooth attrition is the greatest
disturbance to this geometric balance.
Fourth - The Normal Construction oI the Jaw
The normally constructed iaw will exhibit Bonwill's equilateral triangle. Lines Irom each corner
oI the triangle are drawn upward to Iorm a pyramid. From that common point, radii can be drawn
to each occlusal surIace Iorming a sphere oI eight inches in diameter.
FiIth - Anatomical MalIormations oI the Mandibular Mechanism
MalIormations are any deviation Irom the equilateral triangle oI Iour inches. These will lead to
improper Iunction and poor development as well as contribute to possible obscure disorders
according to the author.
Sixth - The Construction oI Crowns and Bridgework in Such a Manner As To Allow Freedom oI
Range oI Occlusion, Producing the Harmonious Action and Permanent Health oI the Units
All patients should be restored in accordance with the spherical pyramid oI which Bonwill's
triangle is the base
Summary: The dentist should provide more than iust proper mastication with his restorations.
His responsibility is to see that the proper Iacial and cranial dimensions are achieved.
07-010. Alfred Gysi. DDS. Practical application of research results in denture construction.
1ADA 16:199-223. 1929.
Several topics are discussed. Important bullets are listed below.
O Gysi used the gothic arch tracing and a tracing oI the sagittal inclination oI the condylar
path .
O The average angle oI the gothic arch is 120
0
and the average sagittal inclination oI the
condyle is 30
0
.
O The two condyle and incisor point determine interdigitation.
O In the edentulous patient the movement Irom incisive to protrusive is completely lost.
O Gysi does not regard lateral movements oI the mandible important except in unusual
cases and suggest an average condylar path oI 15
0
.
The Iollowing Iour Ieatures are required oI an articulator:
1. centric relation oI the mandible
2. control oI lateral incisor point movements
3. sagittal inclinations oI the condylar path
4. incisor path
Four methods oI adapting the articulator
1. The intra-oral checkbite method with plastic material
2. The intra-oral checkbite method with plaster
3. The extra-oral graphic method with the Iace-bow (Gysi preIers)
4. The intra-oral dentographic method
A Iaulty cuspid relation is a Irequent cause oI denture displacement.
The lateral incisor paths are more important than the condylar paths because the teeth lie closer
to the incisor point and the lateral paths oI the condyles are more diIIicult to reproduce.
Use oI a Iacebow is necessary to accurately place the cast on the articulator especially when the
sagittal condylar path diIIers Irom the incisor path.
Denture teeth should be placed over the ridge to insure stability and guard against tipping or
dislodging oI the dentures.
Teeth should be set to conIorm to the alveolar ridge.
07-011. Schweitzer. 1.M. An evaluation of 50 years of reconstructive dentistry. Part II:
Effectiveness. 1 Prosthet Dent 45: 492-498. 1981
Purpose: Evaluation oI reconstructive therapy Ior patients that were under observation Ior at least
10 years.
Discussion:
A. Documentation
- Observations
- Patients must be receptive to the program.
- Record keeping.
B. Prognosis
- Extent and type oI disease, which may be systemic, local, or emotional.
- Etiology, which includes local environmental Iactors, some which may be correctable or not.
- Physical health and habits oI the patient, the number and distribution oI remaining teeth, and
the health oI the periodontium.
- Retention oI questionable teeth, alteration in occlusal vertical dimension, and alteration oI
interocclusal distance.
- Problems created by uncooperative patients, inadequate home care, or Iailure to return Ior
postoperative examination and therapy.
- Biological problems- postural changes induced by disease and aging which may alter the
position oI the mandible, malocclusion, growth anomaly, and systemic disease.
C. Results
- The goal oI reconstructive therapy is to provide the patient with an esthetic, Iunctioning,
stomatognathic system, in which the progress oI degenerative disease is arrested or at least
retarded.
- A large maiority oI the patients with good prognoses maintained good dental health.
- A lesser percentage oI patients with Iair or poor prognoses improved with time.
- Women held a slight advantage over men in maintaining good dental health.
- Age Iavored patients under 50 years when the prognosis was good.
- Increasing the vertical dimension oI occlusion did not consistently inIluence the results.
- Prostheses in which working and balancing occlusion were produced Ior 27 patients Iailed to
demonstrate superior results.
- For some patients, both an increased vertical dimension oI occlusion and balancing occlusion
was provided.
- The treatment plan included increasing vertical dimension oI occlusion and establishing
balanced occlusion. This was attained with Iixed temporary prostheses, Ior a trial period.
- The patient adapted well to the increases vertical dimension oI occlusion, and the permanent
restorations were inserted 8 months later. The increased vertical dimension and balanced
occlusion were included in the Iinal restorations.
Conclusion: Dental therapy must reiect the concept oI permanence. Mutilated dentitions may be
restored to health and serve to create a nonpathogenic stomatognathic system Ior a satisIactory
period.
07-012. Becker C.M. and Kaiser D.A. Evolution of Occlusion and Occlusal Instruments. 1
Prosthod 2:33-43. 1993.
Purpose: To review the historical origins and evolution oI occlusal concepts.
Materials & Methods: None
Results: None
Discussion: Occlusal concepts proposed during the period oI 1800 to 1930 (age oI occlusal
theories) were basically Iormulated Ior complete denture patients stressing bilateral balance.
1920-1940's Pankey, Mann, Schuyler and Gnathology were developing. The concepts oI
transographics, cranial orthopedics, and mandibular centricity (centric relation) are Iurther
discussed. Biologic occlusion is a Ilexible concept with the goal to achieve an occlusion that
Iunctions and maintains health. Goals: 1. No interIerence between CR-MI. 2. No balancing
contacts. 3. Cusp to Iossa occlusal scheme. 4. A minimum oI one contact per tooth. 5. Cuspid
rise or group Iunction. 6. No posterior contacts with protrusive iaw movements. 7. No cross tooth
balancing contacts. 8. Eliminate all possible Iremitus. 9. Obtain and maintain a neurological
release.
Conclusion: It is recommended to avoid occlusal therapy Ior individuals who appear to be
Iunctioning in health, even iI their occlusal scheme does not Iit a concept oI optimum occlusion.
When therapy is unavoidable it is suggested to treat within the guidelines oI a biologic occlusion.
Section 08: Articulators II - SemiAdjustable
(Handout)
Semiadjustable articulator: an articulator that allows adiustment to replicate average
mandibular movements-called also Class III articulator (GPT-6)
A Class III articulator, an instrument that simulates condylar pathways by using averages or
mechanical equivalents Ior all or part oI the motion. These instruments allow Ior orientation oI
the cast relative to the ioints and may be arcon or nonarcon instruments. (GPT-6)
The semiadiustable articulator has evolved to become the "workhorse" articulator in
prosthodontics. In the Iirst articulators seminar, history was reviewed and it was shown how
sophisticated and complex articulators such as the Hanau Model M Kinoscope and the Stuarts
articulator were simpliIied into the Hanau Model H110 series and Whip Mix articulators in
common use today.
To brieIly review, Rihani developed a modern system based on adiustment capabilities oI the
articulators, and this has simpliIied the process.
Table I ClassiIication oI articulators:
ARCON and NON ARCON articulators
Bergstrom coined the term arcon Irom articulating condyle, this articulator has the condylar
elements on the lower member oI the articulator and the condylar path elements on the upper
member. The non arcon or condylar articulator has the reverse sequence with the condylar
element on the upper member oI the articulator.
The angle between the condylar inclination and the occlusal plane is Iixed on the arcon, this is
not so with the nonarcon articulator.
What clinical implication does this diIIerence have?
What is Weinberg`s view about Iabricating restorations on these articulators?
In his investigations, what did Beck have to say about the advantages oI the arcon articulator?
In his classic article, Weinberg reviewed the use and mathematical study oI the Hanau Model H
Hanau stated the less realeII, the more the instrument would simulate mandibular movements.
Use oI the Model H (designed primarily Ior complete dentures)
Orientation oI the maxillary cast: anatomic average Ior the hinge axis, anterior point oI reIerence
can be orbital pointer, or lining up the incisal edges oI teeth, or the wax rim to the notch on the
incisal pin
Centric relation record:"Gysi Gothic arch" tracing, interocclusal wax records acceptable
Protrusive record: records condylar inclination (Christensen's method)
Balancing condylar motion: motion is downward, Iorward and medial (medial or Bennett angle
is determined by H/8 ¹12
Working condylar motion: the Hanau Model H has no individual accommodation, the
intercondylar rod passes laterally through the working condylar ball. This produces an upward,
backward and lateral motion. The Bennett movement varies only in amount rather than direction
Mathematical study oI the Model H:
The most signiIicant error is produced by the lack oI working condylar motion. Overall, many
errors tended to cancel each other out.
When comparing usage Ior complete dentures versus fixed prostheses, the negative error is due
to the lack oI working condylar guidance, which produce Ilatter posterior cusps.
Compensation Ior this negative error can be done by decreasing the Bennett angle oI the opposite
balancing condylar guidance, which produces more rotation and less lateral shiIt oI the working
condyle in question, thus increasing the working cusp inclines.
As stated in Rihani`s table of capabilities of articulators above there are distinct differences
in the semi and fully adjustable articulators.
Bellanti compared the capabilities of the semi and fully adjustable articulators.
He stated the semiadjustable articulator (Whip-Mix) guides only the lateral c42543e3t of
the rotating condylar element. whereas the fully adjustable articulator (Denar 4A) may be
set to simulate all c42543e3ts of mandibular movement.
What were his criteria/findings and what is needed to reproduce the effects of mandibular
movements with reasonable accuracy?
From Bellanti`s first article it was noted that an immediate side shiIt (ISS) produced a large
difference in the cusp pathways of the opposing dentition. If this ISS occurs in patients. an
excessive amount of intraoral adjustment may be needed due to occlusal interferences..
What percentage of the subjects in this study demonstrated an immediate side shift?
IMMEDIATE SIDE SHIFT: deIined as a mandibular side shiIt in which the orbiting condyle
moves essentially straight medially as it leaves centric relation (Guichet)
The ISS occurs at the beginning oI lateral iaw movement, since the teeth are not, or only slightly
separated when this movement occurs, the presence and degree oI immediate side shiIt aIIects
the shape oI the occlusal surIaces oI the teeth. (Aull) This must be considered, movement in all
three planes along with the timing (4
th
dimension), when selecting an articulator, in recontouring
the existing occlusal surIaces and developing the morphology oI dental restorations.
Wachtel and Curtis also addressed the immediate side shiIt in both their articles involving the
limitations oI semiadiustable articulators. The Iirst did not provide Ior an ISS setting to the
articulator, while the second article did so by providing patient lateral interocclusal records.
The article noted that most semiadiustable articulators lack adiustments Ior the ISS, surdetrusion
oI the superior wall, proretrusion oI the posterior wall, and the intercondylar distance. Also there
is no provision Ior motion along curved pathways.
What were the signiIicant Iindings Irom these two articles?
HANAU`S FORMULA - In 1930 Hanau introduced his Iormula (L ÷ H/8 + 12)
Used in the setting oI the lateral condylar guidance, Ior Hanau and some other type oI
articulators. How accurate is this Iormula?
What did Javid and Porter recommend when precise restorative procedures were indicated?
In Taylors article how did he compensate Ior discrepancies when immediate shiIt was present?
How did the intercondylar distance aIIect this?
(In Lundeen`s study with the plastic blocks and air turbine drills the average Bennett angle was
Iound to be 7 ½ degrees)
FACEBOW TRANSFER (on the Hanau articulator)
To review, the Iacebow measures the glenomaxillary relationship in three planes, this is
anteroposteriorly, laterally and vertically. The anteroposterior and lateral positions are
anatomically determined by their relationship to the maxilla and glenoid Iossa.
It is the vertical relationship, ie. the anterior reIerence point that is determined by several
techniques. Weinberg stated that iI the Iace-bow mounting is oriented 16mm too high on the
articulator, a disclusion oI 0.2mm will be noted on the balancing occlusal side.
What did Lauciello Iind as the most accurate method to orient the maxillary cast to the
articulator?
HANAUS QUINT coordinates the ten main laws oI articulation. It records the inIluence oI one
Iactor, governing the establishment oI balanced articulation. one other factor. while the
remaining factors remain unchanged. Each fifth of the quint represents a factor and the
change is indicated with a heavily drawn arrow.
Dr. Thielmann`s formula helps to visualize the interrelationships of the "Quint".
Thielmanns Formula:
CG x IG ÷ Balanced Occlusion
CH x CC x OP
CONDYLAR GUIDANCE
INCISAL GUIDANCE
CUSP HEIGHT
COMPENSATING CURVE
OCCLUSAL PLANE
ARTICULATOR SELECTION FOR RESTORATIVE DENTISTRY
(HOBO/SHILLINGBURG/WHITSETT)
Although the semiadiustable articulator has its limitations as noted above, it is very popular
because oI its stability, durability and ease oI manipulation.
QUESTIONS TO CONSIDER
What are the problems with using a small hinge articulator? (shorter radius oI movement, steeper
are oI closure)
How does the semiadjustable articulator decrease the errors noted above?
DeIine positive error and negative error (Which is more beneIicial Ior Iixed/removable?)
What are the sources oI error when using a semi-adiustable articulator?
- Abstracts -
08-001. Weinberg. LA. An evaluation of basic articulators and their concepts. Part II:
Arbitrary. positional. and semiadjustable articulators. 1 Prosthet Dent 13:645-663.1963.
- Only a summary oI the semiadiustable is presented in this abstract.
- Weinberg discussed the use and a mathematical study oI the errors oI the Hanau
Use oI the Model H.
- Orientation oI the Maxillary cast: Anatomic average Ior the hinge axis. Anterior point oI
reIerence can be the orbital pointer or by aligning the incisal edges oI the teeth or the wax rim to
the notch on the incisal pin.
- Centric relation record: Hanau states the Gysi gothic arch tracing is the most admired method.
Interocclusal wax records or other methods are acceptable.
- Protrusive record: The condylar inclination oI the patient is recorded by a protrusive record.
- Balancing condylar motion: Is downward, Iorward, and mesial. The protrusive is used Ior the
downward component. The medial or Bennett angle is determined by H/8 ¹ 12.
- Working condylar motion: The intercondylar rod passes laterally through the working condylar
ball. This produces an upward, backward, and lateral motion. The Bennett movement varies only
in amount rather than in direction.
Mathematical study oI the Hanau Model H
Approximate error at the second molar cusp height
Balancing Working
type oI error
1. Anatomic average hinge axis 0.2 0.2 anterior-posterior
2. Arbitrary anterior point oI reIerence 0.2 0.0 Neg
3. Straight condylar path 0.2 0.2 Pos
4. No Fischer angle 0.1 0.0 Pos
5. No individual working condylar motion 0.0 0.8 Neg
The most signiIicant error is produced by the lack oI working condylar motion. Overall, most
oI the errors tend to cancel each other out rater than add up. The error produced is oIten negative
and tends to produce Ilatter cusps. The error in the working condylar guidance aIIects posterior
teeth more than anterior teeth. Decreasing the Bennett angle oI the opposite balancing condylar
guidance produces more rotation and less lateral shiIt oI the working condyle and, thereIore,
increases posterior working cusp inclines.
Overall: The instrument is oI practical value and within the accuracy oI the records used Ior
complete dentures.
08-002. Hobo. S.. Shillingburg. H. T. and Whitsett. L. D. Articulator Selection for
Restorative Dentistry. 1 Prosthet Dent 36:35-43. 1976.
Discussion: Maximum intercuspation is a static position and would require only a simple hinge
articulator. The mandible, however, is not a simple hinge and can rotate about axes in three
planes. There are Iour types oI occlusal interIerences: centric occlusion interIerence, working
occlusal interIerence, nonworking occlusal interIerence, and protrusive occlusal interIerence.
Centric occlusal interIerence is an occlusal prematurity which causes the mandible to deIlect
Iorward and/or laterally and may lead to bruxism. Working occlusal interIerence occurs during a
lateral mandibular movement on the side corresponding to the direction in which is moving. A
nonworking occlusal interIerence occurs on the side opposite to the direction the mandible is
moving. This is the most damaging interIerence and can disrupt normal Iunction. The protrusive
occlusal interIerence can prevent posterior teeth Irom being disoccluded by the incisors.
Errors in occlusal restorations can be classiIied into two categories - positive and negative. A
positive error on the occlusal surIace occurs when the articulator undercompensates Ior the
mandibular movement causing a cusp tip or ridge that is too high. A negative error occurs when
the articulator overcompensates Ior the mandibular movement and grooves are wider or cusp are
more narrow. II contacts are maintained in centric relation, negative errors will result in a
slightly Ilatter occlusal surIace and can still be acceptable
A Iacebow transIers the distance between the hinge axis and the tooth being restored Irom the
patient to the articulator. II the hinge axis is not kinematically located (arbitrary), the
interocclusal record must be made at the correct vertical dimension oI occlusion. A small hinge
articulator has a shorter radius oI movement when closing in centric position. A tooth will travel
a steeper arc oI closure on a small articulator than in the mouth. A slight positive error occurs on
the mesial incline oI maxillary teeth and the distal incline oI mandibular teeth on casts mounted
on a small articulator and no increase in VDO. II the intercondylar distance oI the articulator is
greater than the mandible, the paths oI movement will be distal to the ones in the mouth. II the
condylar inclination on the articulator is set at a steeper angle than the patient, the restoration
will have a positive error on the protrusive or nonworking side. A negative error occurs when the
angle is less steep than the patient and will give greater clearance in excursive movements. A
negative error is acceptable as long as centric occlusal contacts are maintained.
A nonadiustable articulator with a Iixed condylar path is acceptable Ior single restorations. A
shallow 20H Iixed condylar inclination is desirable because the error will usually be a negative
error. Multiple restorations or FPD`s can be Iabricated on a semiadiustable articulator. A
Iacebow transIer will minimize tooth hinge axis errors. The Iully adiustable articulator is
indicated Ior extensive treatment oI the occlusion, signiIicant side shiIt movements, and restoring
lost vertical dimension oI occlusion.

08-002. Hobo. S.. Shillingburg. H. T. and Whitsett. L. D. Articulator Selection for
Restorative Dentistry. 1 Prosthet Dent 36:35-43. 1976.
This is a review article on selecting an articulator Ior restorative dentistry. The article looks at
various aspects oI using the various classes oI articulators. The highlights include:
Occlusal InterIerences: There are Iour types oI occlusal interIerences: (1) in centric (2) in
working (3) in nonworking and (4) in protrusive. The centric occlusal interIerence will cause the
mandible to be deIlected Iorward or laterally Irom the optimum mandibular position. A working
side interIerence will occur on the Iacial aspect oI the maxillary lingual cusps and on the lingual
aspect oI the mandible Iacial cusps. A nonworking side interIerence will occur on the lingual
aspect oI the maxillary Iacial cusps and the Iacial aspect oI the mandibular lingual cusps.
Protrusive occlusal interIerences occur on the mesial aspect oI mandibular centric holding cusps
and on the distal aspect oI the maxillary holding cusps.
Positive vs. Negative Errors: By deIinition a positive error is one that occurs on the occlusal
surIace when the articulator undercompensates Ior the mandibular movement. What one will see
on the restoration is a positive Ieature on the restoration where that Ieature should be smaller or
nonexistent.
A negative error is when the articulator overcompensates Ior a mandibular movement. One
will see a Iossa or groove that is wider than ideal or a ridge or cusp that is narrower than normal.
If contacts are maintained in CR. negative errors mav be acceptable.
Condylar Inclination and Occlusal Morphology: The steeper the condylar inclination the steeper
the cuspal inclines and the occlusal morphology can be; the reverse is true with a Ilatter condylar
inclination.
EIIect oI Intercondylar Distance:
- When the intercondylar distance on the articulator is greater than that oI the mouth, the paths oI
movement on the articulator are slightly distal to the paths traced in the mouth.
- When the intercondylar distance on the articulator is less than that oI the mouth, the cusp paths
traveled on the articulator will be slightly mesial to the paths traced in the mouth.
Summary: A Iully adiustable articulator should be utilized in the Iollowing situations: extensive
treatment in which opposing quadrants are being restored, Ior reconstruction oI the entire mouth
and patients with considerable side shiIt during lateral movement.
08-003a. Neal D. Bellanti. DDS. MA. The significance of articulator capabilities Part I.
Adjustable vs. semiadjustable articulators. 1PD. Mar 1973.
Orbiting condyle - moves medially, anteriorly, and inIeriorly.
Rotating condyle - moves laterally within the conIines oI a cone whose apex is at the terminal
hinge position and whose axis lies on the terminal hinge axis. The direction oI movement oI the
condyle within this cone is determined by the contours oI the glenoid Iossa. This movement in
turn determines the cusp height, Iossa depth, and ridge and groove direction on the occlusal
surIaces oI the prostheses.
The semiadiustable articulator guides only the lateral component oI the rotating condylar
movement, whereas the Iully adiustable articulator may be set to simulate all components oI
mandibular movement.
Purpose: measure the discrepancies that may exist in articulator capability due to incomplete
movement simulation. The eIIects on cusp positions produced by variations oI intercondylar
width, the shape oI the condylar housing, and the timing and direction oI the side shiIt were
ascertained.
* Intercondylar Width: The semiadiustable articulator is capable oI three intercondylar width
settings, with a 7mm interval between each two (48, 55, and 62mm. measured Irom the midline).
To determine the eIIicacy oI the 7mm. interval, 48mm. was compared with one halI oI the
interval to the next larger setting, or 51.5mm. Also, the largest possible setting, 62mm., was
compared with the maximum patient width oI 70mm. reported by Aull.
Results - The variance in mesiodistal cusp tip position between the
1) 48mm. and the 51.5mm. widths was:
.2mm on the working side
.2mm on the nonworking side
62mm. and the 70mm. widths was:
.2mm. on the working side
.5mm. on the nonworking side
Conclusions - The 7mm. interval between the settings is adequate to provide clinical accuracy
within a correctable range. However, the 62mm. or large, width is to narrow to accommodate all
patients at a correctable discrepancy.
The error incorporated at the wide extreme would require more than minimal intraoral
adiustment at insertion.
* Timing OI The Progressive Side ShiIt: To study the eIIect oI the timing oI the mediotrusion on
the mesiodistal cusp position, the Ilat medial wall oI the condylar Iossa, the control, was
compared with a maximum early side shiIt insert. Results - eIIect oI the early progressive side
shiIt on the mesiodistal cusp tip position was:
.1mm on the working side
.5mm on the nonworking side
Conclusions - The variation is beyond the range oI clinical acceptability Ior the nonworking side.
The semiadiustable articulator is incapable oI reproducing any variation in the timing oI
mediotrusion. The variation oI the progressive mediotrusion timing would require substantial
occlusal adiustment at insertion.
Shape OI The Condylar Housing: The eIIect oI the shape oI the superior wall oI the condylar
housing on the vertical cusp tip position was studied with the use oI the Ilat insert as control and
the 3/8 inch radius convex curvature insert as experimental.
Results - The variance produced by a curved superior wall was
a .1mm. longer cusp on the working side and
a .2mm. shorter cusp on the nonworking side.
Conclusions - The eIIects oI the superior wall shape are within a clinically correctable range.
* Direction OI The Side ShiIt: The eIIects oI the directional components oI the side shiIt on both
vertical and mesiodistal cusp positions were studied with only the working side adiusted and
again with both condylar housings adiusted. Control was simple laterotrusion
Results - variations produced by altering the direction oI the side shiIt are varied Irom 0 - .6mm
change, with ranges oI 1.2mm. mesiodistally and .5mm vertically.
Conclusions - the variance oI the total possible combinations at the settings measured is greater
than could be controlled clinically.
The semiadiustable articulator is capable oI only a simple laterotrusion.
In those patients with a backward or upward component in laterotrusion, the eccentric error
would represent the variance proportional to the amount oI backward or upward movement in the
laterotrusion.
In those patients with a Iorward or downward component in laterotrusion, the error would
represent the variance shown, proportional to the amount oI Iorward or downward movement in
laterotrusion.
Occlusal adiustments cannot be considered minimal.
* Immediate Side ShiIt:
Results - Figures show changes ranging Irom 0 - 2.4mm, with ranges oI 4.4mm mesiodistally
and 1.7mm. vertically.
Conclusions - The variance oI the total possible combinations at the settings measured is greater
than could be controlled clinically.
Summary: An articulator with a wide range oI intercondylar width adiustment and with
adiustable posterior, medial, and superior Iossa walls is needed to reproduce the eIIects oI
mandibular side shiIt with reasonable accuracy.
08-003a. Neal D. Bellanti. DDS. MA. The significance of articulator capabilities Part I.
Adjustable vs. semiadjustable articulators. 1 Prosthet Dent Mar 1973.
Purpose: To compare the capabilities oI adiustable and semiadiustable articulators.
Subiect: Comparisons were made between a Whip-mix semiadiustable and a Denar D4A Iully
adiustable articulators
Methods and materials: Dental casts were articulated on the Iully adiustable Denar, all posterior
teeth were removed, styli were placed in the position oI the mesiolingual cusp tip oI the
maxillary Iirst molars, and recording tables parallel to the occlusal plane at the level oI the
central pit oI the mandibular Iirst molars. The adiustments oI the semiadiustable articulator were
simulated on the Iully adiustable articulator by making only the adiustments available on the
semiadiustable articulator. Examined were the intercondylar width, timing oI the progressive
side shiIt, shape oI the condylar housing, direction oI the side shiIt, and immediate side shiIt.
Results/Conclusions: Intercondylar width: The semiadiustable articulator is capable oI three
settings: 48, 55, and 62mm measured Irom the midline. (A maximum patient width oI 70mm was
reported by Aull). For widths between 48 and 62mm, discrepancies oI .2mm were measured on
the working and non working side, which was considered a correctable discrepancy. However at
the maximum oI 70mm, a .5mm discrepancy was measured on the nonworking side, considered
to be in excess oI a correctable discrepancy.
Timing oI the progressive side shiIt: an early progressive side shiIt produced an error oI .5mm on
the nonworking side, considered to be beyond the range oI acceptability.
Shape oI the condylar housing: A curved superior wall produced a .1mm longer working cusp
and a .2mm shorter nonworking cusp, considered clinically acceptable.
Direction oI the side shiIt: Variations produced by altering the direction oI side shiIt varied Irom
0 to .6mm, with a range oI 1.2mm mesiodistally and .5mm vertically. This variance was
considered to be greater than could be controlled clinically.
Immediate side shiIt: Changes ranged Irom 0 to 2.4mm, with ranges oI 4.4mm mesiodistally and
1.7mm vertically. (Note that these measurements were recorded with a setting oI 2mm side shiIt
added.)
Conclusion: The error produced by the use oI a semiadiustable articulator may result in a need
Ior more than minimal eccentric occlusal adiustment or uncontrolled amounts oI disocclusion oI
Iixed prostheses. An articulator with a wide range oI intercondylar width adiustment and with
adiustable posterior medial and superior Iossa walls is needed to reproduce the eIIects oI
mandibular side shiIt with reasonable accuracy.
08-003b. Neal D. Bellanti. DDS. MA. The significance of articulator capability. Part II: The
prevalence of immediate side shift. Sep 1979. Vol 42. Num 3. pp255-256.
Purpose: To determine the prevalence and extent oI immediate side shiIt oI the mandible in a
sample population.
Results: 24 oI 80 (30°), demonstrated an immediate side shiIt with a mean length oI .3mm. Six
subiects presented immediate side shiIts bilaterally and eighteen subiects unilaterally.
The presence oI immediate side shiIt oI the mandible increases the potential Ior working and
nonworking side tooth contacts. Although the mean length oI the immediate side shiIt was Iound
to be .3mm, only 13° demonstrated an immediate side shiIt greater than .2mm. With such a low
prevalence, it is possible that intraoral adiustment could eliminate the undesirable occlusal
contacts more easily than use oI a more complex articulator system. Observing Ior the presence
oI these interIerences immediately adiacent to the centric relation contacts is especially
important.
Conclusion: the prevalence and degree oI immediate side shiIt do not indicate that a Iully
adiustable articulator is required Ior all patients.
08-003b. Neal D. Bellanti. DDS. MA. The significance of articulator capability. Part II: The
prevalence of immediate side shift. Sep 1979. Vol 42. Num 3. pp255-256.
Purpose: In Part I, 1973, it was asserted that a semi adiustable.
articulator may produce a signiIicant error when used to Iabricate Iixed prostheses Ior a patient
with immediate side shiIt. This article addresses the prevalence oI immediate side shiIt in a
sample population.
Subiect: Eighty subiects evenly divided into Iour groups: men 15-30, men over 30, women 15-
30, women over 30
Methods and materials: Acrylic resin clutches Iabricated, hinge axis located, a pantographic
tracing made and veriIied by repetition Ior each patient.
Results: 24 oI 80 (30°) demonstrated an immediate side shiIt with a mean length oI 0.3mm. Six
subiects presented immediate side shiIt bilaterally and eighteen subiects unilaterally.
Conclusion: The prevalence and degree oI immediate side shiIt do not indicate that a Iully
adiustable articulator is required Ior all patients. The decision to use or not use a Iully adiustable
articulator must remain an individual one, based on a careIul analysis oI the patient's movements.
08-004. Hanau RL. Articulation Defined. Analyzed and Formulated. 1ADA 13:1694-1709.
1926.
Purpose: To discuss Hanau`s theoretical basis Ior the laws that govern balanced articulation in
the Iabrication oI satisIactory dentures, and the concept oI Hanau`s Quint.
Discussion: Articulation is the change Irom one occlusion to another occlusion while the
masticatory surIaces maintain contact. The maintenance oI balanced contact oI the masticatory
surIaces is designated as balanced articulation.
Hanau Iurther deIines variations on the original deIinition oI articulation to explain the many
combinations oI interarch relationships and denture designs, namely:
Natural- is physiologic
Unnatural- is not conIorming to accepted physiologic requirements
Anatomic- inIers the articulation oI natural dentures in the mouth
Prosthetic- inIers the articulation oI prosthetic dentures in the mouth individual occlusions being
associated with analogous iaw relations
Semiprosthetic- is not always associated with like iaw relations
Ordinary- is always balanced within admitted resilient limits
Malarticulation- lacks balance
Mixed- balanced only during part oI masticatory stroke
Unbalanced- balanced is interrupted or lacking
Strained- Iunction while pressure is applied
Unstrained- Iunction while pressure is not applied
Balanced anatomic- natural dentures in changing balanced occlusion associated to analogous iaw
relations to other corresponding associations
Balanced prosthetic- prosthetic dentures in changing balanced occlusion associated to analogous
iaw relations to other corresponding associations
Balanced Semiprosthetic- prosthetic dentures in changing balanced occlusion not always
associated with analogous jaw relation to other corresponding associations. while the
masticatory surfaces maintain contact.
HANAU`S QUINT
Each IiIth represents one oI the Iive Iactors governing articulation. They are:
Condylar Guidance
- anteroposterior guidance horizontal inclination Iorward and downward excursion along
protrusive guidance.
- lateral guidance sagittal inclination Iorward, downward and inward excursion on the
balancing side
- lateral aberration the lateral excursion on the working side
Compensating Curve
- Tooth alignment is characterized as a horizontal, vertical, and Irontal proiection.
Incisal Guidance
The mandibular incisors (including cuspids) may be considered as one large cusp having a
curved ridge, and the maxillary incisors (including cuspids) considered as a large sulcus.
SimpliIied, it is an ordinary cusp guidance with its protrusive and bilateral guiding surIaces.
Relative Cusp Height
Includes the cusp guidance inclines Ior protrusive, lateral and balancing sides. The cusp height is
only relative iI it is compared with its "basal radius" which is the proiection on the cusp base oI
the movement oI a point directed along the incline Irom the base to the cusp summit.
Position oI Triangle oI Orientation (Denture Position)
The triangle oI orientation is a plane through the central incisal contact point and the occlusal
terminations oI the second molar buccal grooves. These three points are the corners oI the
triangle oI orientation, through there may be a plane of orientation.
THE LAWS OF BALANCED ARTICULATION
Articulation is a purely mechanical Iunction and must be explained by geometry, cinematics and
mechanics. The Quint gives a combination oI the most essential laws oI articulation in
convenient Iorm. Each IiIth represents a Iactor undergoing a change. The changes indicated are
accompanied by heavy arrows. The light arrows in each IiIth reIer to the other Iactors. The
direction oI the light arrows indicates the sense in which to read the inIluence oI a respective
Iactor on the Iactor they identiIy.
08-005. Weinberg. L. A. Arcon Principle in the Mechanism of Adjustable Articulation. 1
Prosthet Dent 13:263-268.1963.
Purpose: To evaluate the condylar articulator with the Arcon articulator. An Arcon articulator
has the condylar Iixed to the upper member and the ball attached to the lower member. The
condylar articulator (non-Arcon) has the condylar slot that keeps changing angulation to the
upper member. The Arcon articulator has the condylar slot in a constant angulation to the
maxillary dental arch.
Methods and Materials: The protrusive and lateral records were placed on both types oI
instruments and readings were calculated mathematically. The non-Arcon (condylar type)
articulator has a constant angulation oI the condylar slot to the lower member. In protrusive
movements, the angulation changes between the upper member and the condylar slot oI the
articulator. In the Arcon articulator, the upper member remains constant in relation to the
condylar slot. In a protrusive movement, the angulation oI the condylar slot changes to the lower
member.
Results: In protrusive position, both instruments measured the same. The balancing condylar
positions were identical on both articulators. Bennett angle readings were diIIerent on the two
instruments due to the mechanical method oI producing the motion. The position oI the
balancing condyle and motion were identical on each instrument.
Conclusion: Both the Arcon and non-Arcon articulators produce the same motion because
condylar guidance is the result oI the interaction oI a condylar ball on an inclined plane.
Reversing the relationship does not change the guidance produced. Only the numbers used to
record the inclination are changed. Mathematical evidence proves that neither instrument has any
speciIic advantage over the other.
08-005. Weinberg. L. A. Arcon Principle in the Mechanism of Adjustable Articulation. 1
Prosthet Dent 13:263-268.1963.
Purpose: To evaluate the condylar articulator with the Arcon articulator. An Arcon articulator
has the condylar Iixed to the upper member and the ball attached to the lower member. The
condylar articulator (non-Arcon) has the condylar slot that keeps changing angulation to the
upper member. The Arcon articulator has the condylar slot in a constant angulation to the
maxillary dental arch.
Methods & Materials: The protrusive and lateral records were placed on both types oI
instruments and readings were calculated mathematically. The non-Arcon (condylar type)
articulator has a constant angulation oI the condylar slot to the lower member. In protrusive
movements, the angulation changes between the upper member and the condylar slot oI the
articulator. In the Arcon articulator, the upper member remains constant in relation to the
condylar slot. In a protrusive movement, the angulation oI the condylar slot changes to the lower
member.
Results: In protrusive position, both instruments measured the same. The balancing condylar
positions were identical on both articulators. Bennett angle readings were diIIerent on the two
instruments due to the mechanical method oI producing the motion. The position oI the
balancing condyle and motion were identical on each instrument.
Conclusion: Both the Arcon and non-Arcon articulators produce the same motion because
condylar guidance is the result oI the interaction oI a condylar ball on an inclined plane.
Reversing the relationship does not change the guidance produced. Only the numbers used to
record the inclination are changed. Mathematical evidence proves that neither instrument has any
speciIic advantage over the other.
08-006. Wagner.AG. and Rennels. KE. The effect of the articulator settings on the cusp
inclines as measured by a coordinate measuring machine. 1 Prosthodon 2: 19-23.1993.
Purpose: To learn the eIIect oI various articulator settings on cusp inclines during working,
nonworking and protrusive movements.
Materials and Methods: a reIerence point oI the maxillary Iirst molar (mesiolingual cusp) was
Iixed to the upper member oI the 96H2 Hanau articulator. A coordinate measuring machine
(CMM) recorded the position oI the reIerence point in centric relation, working, nonworking and
protrusive. Articulator setting were changed (ie the condylar angles and anterior guide angles)
Ior a total oI 432 diIIerent cusp angles were measured at the Iirst molar by the coordinate
measuring machine.
Results: The data collected was used to produce Iormulas, three Iormulas were produced, the
working angle, nonworking angle and protrusive angle.
These Iormulas were used to calculate the working, nonworking and protrusive cusp angles
produced as a result oI 72 diIIerent articulator settings.
Discussion&Conclusion: The Numerex coordinate measuring machine is useIul in taking
measurement oI articulator movements. Further research is needed to determine the cusp angles
oI manuIactured teeth, as then coordination could be made with the cusp angles oI the teeth and
the cusp inclines Iound Irom the articulator. In the Iuture comparisons can also be made between
articulators (ie arcon vs non-arcon)
08-007. 1avid. N.S. and Porter. M.R. The importance of the Hanau formula in construction
of complete dentures. 1 Prosthet Dent 34:397-404.1975.
Purpose: To determine the accuracy oI the Hanau Iormula Ior use in the construction oI complete
dentures.
Materials and Methods: Six articulators (two Denar D4-A, two Whipmix and two Hanau model
130-28) were used. Maxillary and mandibular alginate impressions were made and duplicated Ior
Iive patients. The Denar hinge axis Iacebow kit was used to transIer the upper cast oI all patients
to the articulators. The mandibular casts were articulated in maximum intercuspation. Protrusive
and lateral interocclusal records were made Ior each patient. The horizontal and lateral condylar
inclinations were adiusted on all articulators using the protrusive and lateral records. The
adiustments were repeated twenty times Ior each articulator. The actual recording were
compared to the values obtained by using Hanau`s Iormula.
Discussion: In studying the Iive patients, the diIIerence oI the means oI the protrusive condylar
guidance inclinations between the two Hanau articulators was 3 degrees on the right side (30.4
27.4 ÷ 3) and 2.8 degrees on the leIt side (30.6 33.4 ÷ 2.8). The range oI means oI the 20
readings oI the protrusive condylar guidance oI the Hanau articulator No. 1 Ior Iive patients was
Irom 18 to 42 degrees on the right side and 22 to 42 degrees on the leIt side. This range Ior the
Hanau articulator No. 2 was 22 to 36 degrees on the right side and 20 to 39 degrees on the leIt
side. The range oI the means in the Iive patients with the protrusive condylar guidance oI the
same articulators adiusted by lateral interocclusal records varied (1) Irom 22 to 32 degrees on the
right side and Irom 26 to 41 degrees on the leIt side with the Hanau articulator No. 1 and (2)
Irom 22 to 36 degrees on the right side and 20 to 39 degrees on the leIt side with the Hanau
articulator No. 2. SigniIicant diIIerences in the means oI condylar guidance readings existed in
the Hanau articulators, when adiusted with the use oI the records and the Hanau Iormula, in the
readings oI the right and leIt sides oI the Hanau articulator No. 1 and in the leIt side oI the Hanau
articulator No. 2. Further study oI the lateral condylar guidance oI the same patients in the other
articulators clearly indicated that the range oI the lateral condylar guidance in diIIerent
articulators varied Irom 0 to 50 degrees and the means oI the Iive patients varied Irom 1 to 34
degrees. The range oI means oI lateral condylar guidances oI the Hanau articulators adiusted by
using the Hanau Iormula was only Irom 14 to 17 degrees. This small possibility oI variation in
the lateral condylar guidances will aIIect the balanced occlusion oI the complete dentures when
the are placed in the patient`s mouth, assuming a wider variation existed in the mouth.
Conclusion: The range oI means oI lateral condylar guidances oI Hanau articulators using the
Hanau Iormula was small. This small possibility oI variation in the lateral condylar guidance
would suggest the use oI lateral interocclusal records when precise restorative procedures are
necessary
08-008. Laucello. F.R. Anatomic comparison to arbitrary reference notch on Hanau
articulators. 1 Prosthet Dent 40:676-681. 1978.
Purpose: to determine the average orbitale-maxillary incisal edge distance and to compare this
measurement to the incisal reIerence notch oI the Hanau articulators.
The Iacebow registers the glenomaxillary relationship in three planes(anteroposteriorly,
laterally, and vertically). The anteropostererior and lateral positions are determined by the
anatomic relationship between the maxilla and the glenoid Iossa. The vertical position , i.e., the
anterior reIerence point, has been determined various techniques.
One recommended method oI locating vertical position when using Hanau articulators is to
elevate the maxillary cast while the Iacebow is still attached to the articulator until the maxillary
incisal edges are aligned to the level oI a groove on the incisal guide pin. This groove is 30 mm
below the horizontal condylar plane ( a plane described by the center oI the condylar spheres and
the inIraorbital indicator) and is called the "incisal reIerence notch". UnIortunately the location
oI this groove bears no relation to the anatomic anterior reIerence point (orbital). In other words,
the 30 mm measurement is not calibrated to approximate the average distance between the
orbital and the maxillary incisal edges.
Literature review:
Snow - recommended that the occlusal plane be parallel to Campers plane(ala-tragus line) and
oriented to the articulator so that it is parallel to the maxillary and mandibular bows oI the
articulator.
Gysi and Kohler - reIerred to "the prosthetic plane".
Recent investigators noted that the FrankIort horizontal plane(porion to orbital) is usually
parallel to the Iloor. It would seem logical to orient the maxillary cast to this plane so that the
articulator would more accurately represent the patient. Clinically a maxillary cast is oriented to
the FrankIort horizontal plane by using an inIraorbital pointer that is attached to the Iacebow.
The end oI the pointer is placed at the lowest margin oI the orbital rim. When transIerred to the
articulator, the end oI the pointer is placed level with the condylar plane by utilizing the
inIraorbital indicator, thus orienting the maxillary cast to the (condylar) axis-orbital plane, which
closely parallels the FrankIort horizontal plane. Thus the plane oI occlusion, when viewed on the
articulator, will be similar to that oI the patient in an upright position.
Gonzalez and Kingery disputed this concept. They determined cephalometrically that the
FrankIort horizontal plane was not parallel to the axis-orbital plane. The condylar axis was 7.1
mm below the cephalometrically determined porion. They suggested compensating Ior this error
by adiusting the orbital pointer 7 mm above the orbital indicator or by placing the orbital pointer
7 mm below the orbitale oI the patient during the Iacebow transIer. This has been compensated
Ior in part by selecting the inIraorbital Ioramen instead oI the orbitale as the anterior reIerence
point.
An alternative to the use oI the inIraorbital pointer is the incisal reIerence notch on the Hanau
incisal guide pin.
The Hanau XP-51 has an incisal pin reIerence notch which measures 51 mm Irom the
condylar plane. It was thought that this arbitrary measurement might better approximate the
average orbitale-maxillary incisal edge distance.
Methods & Materials:
- 60 patients oI diIIerent sex, race, and age with complete natural dentition
- Orbitale located by the point on the lower margin oI the orbit which is directly below the pupil.
- A bar was positioned intraorally, recording the incisal edges oI the teeth in compound.
- A Boley gauge was placed Ilush with the inIerior surIace oI the bar, while the other arm was
positioned level to the orbitale.
Results: The average orbitale-maxillary incisal edge distance determined Irom the representative
population use in the study was 53.99 mm.
Discussion: According to Weinberg, iI the Iacebow mounting is oriented 16 mm too high on the
articulator, a disclusion oI .2 mm will be noted on the balancing occlusal side. Manly states that
complete denture patients can distinguish thicknesses down to.18 mm. Brill states complete
denture patients can perceive obiects at .6 mm.
Results: Results show a signiIicant diIIerence between the average orbitale-maxillary incisal
edge distance and the 30 mm incisal reIerence notch measurement on the Hanau incisal guide
pin. The average diIIerence was 24 mm.
Gonzalez and Kingery noted that the porion was 7.1 mm above the condylar axis point.
Taking this inIormation into consideration, the average determination oI 54 mm was adiusted to
47 mm, thus more accurately paralleling the axis-orbital and FrankIort horizontal planes.
ThereIore iI an incisal reIerence notch is to be used as a third point oI orientation Ior the
Iacebow, it should be calibrated 47 mm Irom the condylar plane. ThereIore, it is suggested that
using the orbital pointer when making the Iacebow transIer and adiusting the pointer 7 mm
above the condylar plane oI the articulator is the most accurate method oI anatomically orienting
the maxillary cast.
Conclusion:
1. The average orbitale-maxillary incisal edge distance Ior the representative population used in
this study was Iound to be signiIicantly greater than the 30 mm incisal reIerence notch on the
incisal guide pins oI the Hanau articulators.
According to the present anatomic data, the incisal reIerence notch on Hanau articulators
should be calibrated 47 mm below the condylar plane.
2. Due to the wide range oI measurements recorded Ior the orbitale-maxillary incisal edge
distance, it is suggested that the use oI the orbital pointer when making the Iacebow transIer and
adiusting the pointer 7 mm above the condylar plane oI the articulator is the most accurate
method oI anatomically orienting the maxillary cast to the articulator.
08-009. Taylor T D et al. Analysis of the lateral condylar adjustments of nonarcon
semiadjustable articulators. 1 Prosthet Dent 54:140-143.1985.
Purpose: A method to set the lateral condylar adiustment oI the non arcon semiadiustable
articulator to simulate border movements oI the mandible more closely.
Materials and methods: A Denar D5A Iully adiustable articular was used as the simulated
patient. Pantographic tracings were done using only the anterior horizontal tables and transIerred
to the semiadiustable articulator.
Results: The semiadiustable articulator was able to duplicate the simulated patient tracings with a
high degree oI accuracy Ior the patient simulations without immediate side shiIt. It is suggested
the semiadiustable articulator may be adiusted to simulate border movements more accurately by
reducing the lateral condylar adiustment below the suggested range oI 15-10 degrees. A single
gothic arch tracing may be used to set the lateral adiustment or the articulator settings can be
predicted by obtaining an intercondylar distance measurement with an arbitrary Iacebow. II
ICD~÷to 110 then lateral condylar adiustment should be set to 0 degrees. II·100 set to a slightly
higher amount (8 degrees Ior ICD 100). II a more lateral cusp path is desired then set to 20-30
degrees.
Conclusions: Immediate side shiIt cannot be simulated by a slot rack semiadiustable articulator.
SigniIicant errors in cusp position and groove orientation may result. The results indicate that the
Hanau Iormula or an arbitrary setting oI 150-10 degrees does not provide the most accurate
articulator setting possible.
08-010. Wachtel. HC and Curtis DA. Limitations of semiadjustable articulators. Part I:
Straight line articulators without setting for immediate side shift. 1 Prosthet Dent 58:438-
442.1987.
Purpose: To measure the amount and direction oI error at the Iirst molar when using a
semiadiustable articulator.
Materials and methods: A Denar D5A articulator was used as a model Ior this study and
programmed to simulate mandibular movements with the reported average values. Lateral and
protrusive plaster records were made on the D5A and transIerred to both the Hanau H2 and TMJ
instruments and adiusted. A tracing was made on the D5A model articulator. The same tracing
plate was transIerred to one oI the test articulators and a second line was scribed in the same
plane. Tracings were completed in this manner Ior each oI the tested articulators in each plane.
The starting reIerence point oI the tracings was the mesiolingual cusp tip oI the upper Iirst molar.
Duplicate recordings were made with two diIIerent immediate side shiIt settings. The separation
oI lines in the recordings was measured 1 mm and 3 mm Irom the reIerence point in nonworking,
working and protrusive movements.
Results: The Hanau H2 and TMJ articulators demonstrated positive error in the Irontal plane. A
comparison oI tracings demonstrated that errors increased signiIicantly when immediate side
shiIt was increased. Errors were greater in the horizontal than in the Irontal plane. Negative error
was recorded in the sagittal plane.
Conclusion: The semiadiustable articulators adiusted with interocclusal records but without rear
wall, top wall, and intercondylar distance settings demonstrated limitations in all three planes oI
measurement.
To minimize the errors oI straight line articulators in the horizontal plane, additional
clearance should be made distal to the occlusal groove on mandibular teeth. For patients with
less than 0.75mm oI immediate side shiIt, chairside correction oI the errors in the horizontal
plane is possible. Errors in the sagittal plane were negative and small. The results demonstrated
the need Ior incorporating immediate side shiIt into articular movements.

08-010. Wachtel. H C and Curtis. D A. Limitations of semiadjustable articulators Part I:
Straight line articulators without setting for immediate side shift. 1 Prosthet Dent 58:438-
442.1987.
Purpose: Controversy exists concerning the complexity oI the articulator to accurately simulate
mandibular movements. This study measured the amount and direction oI error at the Iirst molar
when using a semiadiustable articulator.
Methods: A Denar D-5A was used. A 37 degree condylar inclination, an immediate side shiIt oI
0.75mm, progressive side shiIt oI 7.5 degrees condylar insert was used and intercondylar
distance oI 110 mm was used. Lateral and protrusive interocclusal records were used on the
semiadiustable articulator. Casts were mounted on TMJ and Hanau H Ior comparison.
Results:
Frontal plane: Errors increased signiIicantly when ISS was increased Irom 0.75 mm to2mm. The
greatest errors were in nonworking direction where 1 mm oI error was recorded 3mm Irom the
reIerence position
Horizontal plane: Errors were greater in horizontal than Irontal plane, again highest in the
nonworking direction where 2,2 mm oI error was recorded 3mm Irom the reIerence position.
Sagittal plane: Negative error in the sagittal plane was noted Ior the Hanau H-2 and TMJ
articulators. Negative error measured 1mm Irom the reIerence position was 0.20 mm with Hanau
and 0.30 mm with TMJ articulator.
Conclusion: the average arbitrarily adiusted settings oI a straight-line articulator should have a
condylar inclination oI 45 degrees and a progressive side shiIt oI more than 30 degrees.
- errors in the sagittal plane were negative and small
- in the Irontal and horizontal planes errors increased signiIicantly when ISS was elevated Irom
0.75 mm to 2 mm.
- the results demonstrated the need Ior incorporating ISS into articulator movements.
08-011. Curtis. D A and Wachtel H C. Limitations of semiadjustable articulators with
provision for immediate side shift. Part II. 1PD 58:569-573. 1987.
Purpose: This study determined the error when a semiadiustable articulator with a provision Ior
setting ISS was used.
Methods: Same as previous study with Denar D5 A and TMJ articulators.
Conclusions:
- adding ISS settings to a semiadiustable articulator signiIicantly improved accuracy in the
horizontal plane compared with Iully adiustable articulator model
- errors in the Irontal plane emphasize the importance oI the top wall setting.
- when ISS is less than 0.75 mm both TMJ and Mark II articulators provide a satisIactory
mechanical equivalent to mandibular movement.xsu po
08-011. Curtis. DA and Wachtel. HC Limitations of semiadjustable articulators with
provision for immediate side shift. 1 Prosthet Dent 58: 569-573. 1987.
Purpose: To determine the error when a semiadiustable articulator straight-line articulator with a
provision Ior setting ISS (Immediate Side ShiIt) is used.
Materials&Methods: A Denar D-5A articulator programmed with average values was used to
simulate mandibular movements. Values were condylar inclination 37 degrees, ISS 0.75 mm,
progressive side shiIt 7.5 degrees, condylar insert / inch, and intercondylar distance 110 mm.
The Mark II and TMJ articulators were used as a comparison, with the intercondylar distance set
at 110 mm and Ilat guiding surIaces to represent condylar inclination. Duplicate maxillary and
mandibular typodont casts were prepared, and the maxillary cast was secured to the articulators
with an average Iace-bow setting. Lateral and protrusive interocclusal records were made in an
edge to edge relationship on the Denar-5A and transIerred to the other articulators. Acrylic resin
plates (transIerable) were Iabricated Ior tracings made in the Irontal, horizontal and sagittal
planes at the Iirst molar. Two tracings were made in each plane, Iirst on the Denar D-5A, then
the tracing was transIerred to the articulator tested, and another line was scribed in the same
plane. Recordings were made with an ISS oI 0.75 mm and also at 2 mm, measurements were
taken at 1 mm and 3 mm Irom the reIerence points.
Results: In the Irontal plane, both the Mark II and TMJ articulators showed a positive error (ie
the articulator undercompensates resulting in positive adiustment when the restoration is
transIerred to the patient.) Errors increased appreciably when the sideshiIt was increased to 2
mm. In the horizontal and sagittal planes, both articulators showed minute error when compared
with the model articulator.
Discussion: This research supports work done by Gibbs, in that a patient with average Bennett
movement (·.75 mm) and an acceptable anterior guidance, can have restorations made on semi-
adiustable articulators with minimal eccentric interIerences.
The addition oI ISS provided greater accuracy in the horizontal plane on semiadiustable
articulators, in the Irontal plane, the error was due to the top wall (ie surtrusion-detrusion oI the
working condyle is not represented.)
Conclusions: When ISS settings are added to the semiadiustable articulator improved accuracy in
the horizontal plane, errors in the Irontal plane were due to the top wall setting not being
represented. When ISS is less than 0.75 mm both TMJ and Mark II articulators are satisIactory
Ior mandibular movement, but when the ISS is 2 mm or more these articulators are unreliable Ior
movement in the Irontal plane at the Iirst molar.
08-012. Beck. H.O.. and Morrison. W.E. Investigation of an Arcon Articulator. 1 Prosthet
Dent 6:359-372.1956.
Purpose: To investigate the arcon articulator introduced by Bergstrom.
Discussion: The new Ieatures introduced which vary Irom most condylar articulators are: 1. A
Iace-bow registration which employs the FrankIort horizontal. 2. The axis equivalent guide,
which is adiustable Irom 0 to 90 degrees, is Iixed to the upper member oI the arcon instrument
and has a convex curvature oI 0.022mm. The Bennett angle is Iixed at 15 degrees.
The articulator is constructed so cases may be transIerred Irom one articulator to another.
The upper member is Ireed by locks so as not to distort the interocclusal record during setting the
articulator. The centric position can be altered in a retrusive manner.
The Iacebow registration uses FrankIort horizontal which is an orientation oI the external
auditory meatus to the leIt orbitale on the patient. Some limitations may be the location oI
orbitale on the patient and the Iact that the external auditory meatus in relation to the condyles
may vary greatly not only between patients, but in the same patient Irom right side to leIt.
Since the axis guide is Iixed to the upper member the occlusal plane will maintain its
relationship to the adiusted arcon indication in any position oI the upper bow oI the instrument.
This relationship does not exist in the condylar articulator. This Iact, according to the authors,
results in an articulator that may better reproduce mandibular movement. One important Iact to
remember is the intercondylar distance must be accurate to gain the beneIit oI the arcon design,
especially in lateral motion.
Section 08: Articulators III - Fully Adjustable
(Handout)
DeIinitions:
-articulator n: a mechanical instrument that represents the temporomandibular ioints and iaws, to
which maxillary and mandibular casts may be attached to simulate some or all mandibular
movements-usage articulators are divisible into Iour classes Class I articulator: a simple holding
instrument capable oI accepting a single static registration. Vertical motion is possible - see
NONADJUSTABLE A. Class II articulator: an instrument that permits horizontal as well as
vertical motion but does not orient the motion to the temporomandibular ioints. Class III
articulator: an instrument that simulates condylar pathways by using averages or mechanical
equivalents Ior all or part oI the motion. These instruments allow Ior orientation oI the casts
relative to the ioints and may be arcon or nonarcon instruments- see SEMI-ADJUSTABLE A.
Class IV articulator: an instrument that will accept three dimensional dynamic registrations.
These instruments allow Ior orientation oI the casts to the temporomandibular ioints and
simulation oI mandibular movements--see FULLY ADJUSTABLE A., FULLY ADJUSTABLE
GNATHOLOGIC A.
-Iully adiustable articulator: an articulator that allows replication oI three dimensional movement
oI recorded mandibular motion- called also Class IJ articulator.
-Iully adiustable gnathologic articulator: an articulator that allows replication oI three
dimensional movement plus timing oI recorded mandibular motion- called also Class IJ
articulator.
Developmental History (oI the Iully adiustable articulator)
What group was devoted to the study oI the physiologic movement oI the iaw and was
instrumental in the development oI the Iully adiustable articulator? Gnathological Societv of
California (Contino, p68)
Led by researchers such as McCollum, Stuart, and Stallard the gnathologists studied mandibular
movement in three dimensions, and developed what we know as the pantograph. Great eIIorts
were then directed to develop a sophisticated three-dimensional adiustable articulator that would
accept and reproduce the measurements recorded by the pantograph.
The Denar system was developed by Guichet. What was one oI his purposes in developing this
system?
Guichet´s efforts aimed to simplifv the pantograph and bring gnathologv into everv dental office.
Guichet also advocated overcompensation oI the gnathologic instrument settings to provide
increased disclusion.
The development oI the TMJ articulator, as discussed by WipI, used a stereographic method oI
recording mandibular movement. This was actually a modiIication oI an engraving method
introduced to dentistry by Warnekros in 1892 and later taught by House and Needles. What two
elements oI the system allow vertical dimension to be maintained during the recording
procedures?
A central bearing screw in the mandibular clutch and a central bearing plate in the maxillarv
clutch. (WipI p 271)
(Ior more inIormation, see Becker and Kaiser, Evolution of cclusion and cclusal Instruments
JPROSTH 1993; 2:33-43, included in Articulators I seminar)
Characteristics oI the Iully adiustable articulator (see Weinberg)
What are three essential requirements oI a gnathologic system? To maintain the same
relationship of the pantographs to the stvli as the transfer is made from the patient to the
instrument. 2. The instrument must be three-dimensionallv able to accept the records. 3. The
final casts must be articulated in exactlv the same relationship to the motion recorded as it
occurred in the patient. (Weinberg p1042)
What Ieatures should we expect to Iind on the Iully adiustable articulator? Adiustable
intercondvlar distance. horizontal and vertical condvlar adiustments. either a curved or straight
horizontal condvlar guide. Bennett guide adiustment. and provision for Fischer´s angle (Beck
p630)
Pantograph/Stereograph Utilized Ior the conveyance oI inIormation Irom the patient to the
articulator.
DeIinitions
pantograph: an instrument used to graphically record in one or more planes, paths oI mandibular
movement and to provided inIormation Ior the programming oI an articulator
pantographic tracing: a graphic record oI mandibular movement in three planes as registered by
the styli on the recording tables oI a pantograph; tracings oI mandibular movement recorded on
plates in the horizontal and sagittal planes.
stereograph: n. an instrument that records mandibular movement in three planes. Engraving,
milling, or burnishing the recording medium by means oI styli, teeth, abrasive rims, or rotary
instruments obtains the record.
stereographic record an intraoral or extraoral recording oI mandibular movement as viewed n
three planes in which the registrations are obtained by engraving, milling, or burnishing the
recording medium by means oI studs, rotary instruments, styli, teeth, or abrasive rims.
Is it always necessary to locate the kinematic hinge axis?
!recise location of the hinge axis offers no advantage when centric relation is recorded at the
vertical dimension of the restoration. If the treatment requires centric relation be recorded at
other than the vertical dimension of the restoration. a kinematic hinge axis should be located.
(Guichet p248-9, Weinberg p1044)
What should be used Ior an anterior point oI orientation (third point oI reIerence)?
The anterior point of orientation can be completelv arbitrarv in a three dimensional svstem of
recording. but must be accuratelv and consistentlv used for orientation. (Weinberg p1044-45)
Shields and Clayton investigated a possible relationship between TMJ and muscle dysIunction
and the ability to reproduce pantographic border tracings, (which was quantiIied by means oI a
pantographic reproducibility index- PRI) What was their conclusion? The !RI can be an aid to
the detection of TMJ dvsfunction and muscular incoordination. and can be used to assess the
severitv of dvsfunction.
Types oI Iully adiustable articulators
Stuart (Stuart) Describe the relationship between the styli and recording tables Ior the pantograph
used with the Stuart articulator. The recording stvli are attached to the mandibular frame
element. while the recording tables are attached to the maxillarv element. Thus the recording
stvli move with the mandibular element. while the recording tables remain stationarv.
Denar (Guichet) Describe the relationship between the styli and recording tables Ior the
pantograph used with the Denar articulator. The recording stvli are attached to the maxillarv
frame element. while the recording tables are attached to the mandibular element (the reverse
relationship compared to the Stuart) Thus the recording tables move while the stvli remain
stationarv.
TMJ (WipI, Swanson) Four styli on maxillary clutch inscribe Iour "diamond shaped" tracings on
acrylic added to mandibular clutch.
Swanson describes a technique Ior Iabrication oI a complete denture on a TMJ articulator. What
is used instead oI clutches in the edentulous patient? The actual final maxillarv and mandibular
impressions. The TMJ clutch forming bite fork is used to make the recording platform on the trav
of the mandibular impression. and the central bearing screw is attached. The four studs are
placed in preplanned canine and molar areas on the maxillarv impression trav. along with the
central bearing plate. (p499-500)
What are the advantages oI using the TMJ articulator Ior complete dentures? What are the
disadvantages?
Selection oI an articulator or Why use the Iully adiustable instrument?
Accuracy (Stuart, Weinberg)
According to Stuart, what should be the goal oI the Iully adiustable articulator?
It should be able to "reproduce" without compromise. the border and habitual phvsiologic
movements of the patient. (Stuart p221)
Which aspects oI the movements oI the rotating (working) condyle does Stuart indicate should
be addressed?
How far the condvle travels in its lateral movement. anv upward. downward. forward or
backward component. and the timing of the movement (Mandibular lateral translation) (Stuart
p222-223)
What did McCollum think about the importance oI properly recording mandibular lateral
translation (Bennett movement)?
He felt that it had as much or probablv more influence upon the articulating surfaces of the teeth
than anv other component of iaw movement (Weinberg p. 1038)
What did Weinberg think? He indicates that a mathematical investigation supports this view.
(Weinberg p. 1038).
Reproducibility (Winstanley, Solberg)
What did Winstanley's experiments conclude regarding the reproducibility oI the adiustments oI
the Denar articulator? He found that most of the articulator adiustments were reproducible with
a reasonable degree of accuracv. (p. 671)
Which adiustments did he Iind were oI questionable value? The rear wall and top wall
adiustments (p671) Why? The tracings were short and large variations in the settings cause onlv
small deviations of the stvli. (p 666)
What eIIect did Iamiliarity/experience with the technique have on reproducibility? Familiaritv
increased the accuracv in reproducing the settings. (p.671)
What did Solberg and Clark Iind regarding the reproducibility oI molded condylar controls using
a stereographic recording system? Thev found that the error in the technique appeared to be
within acceptable limits. (p. 527) What was the net eIIect oI the error they observed? The error
produced a slightlv smaller horizontal condvlar inclination than actuallv existed in the"patient"
(p. 527)
What eIIect did Iamiliarity/experience with the technique have on reproducibility? The
inexperienced dentist was capable of making acceptable registrations. but had some difficultv in
registering maximum Bennett movement. (p. 527)
Did they Iabricate the condylar controls with a single mix oI acrylic? No. thev discarded the
single mix technique in favor of the optional reline technique.(p. 526)
Reliability (Beck)
Beck examined whether an articulator (the Denar D5A and the Hanau 130-21) set to a subiect's
records either positional records (Ior the Hanau) or a pantographic tracing (Ior the Denar)
accurately reproduced that subiect's mandibular motion. A computerized iaw-motion sensing
apparatus was used. What type oI clutches were used? Ticonium.
What did he conclude? Both the Denar D5A and the Hanau 130-21 adequatelv reproduced iaw
motion for the 5 subiects tested.
Variability (Coye)
Coye studied the variability (between 7 diIIerent dentists) involved in setting a Iully adiustable
articulator to a pantographic tracing oI known parameters. What did he use Ior a "patient"? A
pantographic tracing was made from a fullv adiustable articulator arbitrarilv set to randomlv
chosen values (p 460-61)
What were his Iindings? His analvsis showed that there was a statisticallv significant difference
in both the magnitude and variabilitv of the error encountered. but the magnitude of that error
was verv small.(p464)
What was the eIIect oI these errors on the occlusal surIaces oI the teeth? The error was found to
be barelv perceptible. (p.464)
Potential sources oI error (Javid, Manary)
Javid used static protrusive and lateral interocclusal records to set the condylar guidance angles
using two each oI Denar D4A, Whip mix, and Hanau 130-28 articulators. What were his
conclusions? A comparison of the mean difference of the means of the left and right protrusive
condvlar guidance readings showed no significant difference between the two Denar
articulators. however. there was a significant difference in the Hanau and Whip mix articulators.
on the left side onlv. He concludes the condvlar guidances of the Denar are more stable than the
Hanau or Whip mix.
Manary examined the eIIectiveness oI the TMJ articulator to reproduce the border movements oI
a patient model. What did he use Ior his "patient"? A Stuart articulator. What were his results?
n the posterior vertical tables. both the right and left scribings were superior to the patient´s
(less steep). The right and left protrusive scribings were also consistentlv superior to the patient
model. n the posterior horizontal tables. the right and left scribings were lateral to the patient
model scribing (a decreased lateral condvlar inclination-Bennett angle)
What eIIects would these diIIerences have on restorations? !osterior restorations would have a
reduced cusp height. and could have an error in cusp-groove orientation (a more acute angle
formed bv the orbiting and rotating paths of the mandibular molar). (p. 278-9)
What did he Iind with regards to immediate mandibular lateral translation? The TMJ articulator
simulated the "immediate side shift" of the patient. (p. 279)
What was his conclusion? The small difference consistentlv observed between the pantographic
scribings of the patient model and the TMJ articulator suggests that the TMJ svstem can have
significant clinical application. (p. 280)
Summary
The choice oI an articulator is dependent upon the patient's occlusal requirements, type oI
restoration(s) planned, and also the operator's philosophy, ability, and experience.
- Abstracts -
09-001. Stuart. C. E. Accuracy in Measuring Functional Dimensions and Relations in Oral
Prosthesis. 1 Prosthet Dent 9:220-236. 1959.
Purpose: To describe the movements oI the mandible and to emphasize the importance oI
reproducing those border and habitual movements with the articulator.
Discussion: The articulator should suit the anatomy and physiology oI the oral organ and not the
converse. Movement in the temporomandibular ioint can be described as occurring about three
axes. The possible movements within the ioint with respect to those axes are described. OI the
rotating and gliding movements, the latter is the more important and should be IaithIully
reproduced in the articulator. The mechanics oI a mandibular movement recorder, as well as the
procedure Ior transIerring the obtained inIormation to an articulator, is described. The Stuart
articulator is described and a basic explanation oI it's set-up procedure is given.
Conclusion: The use oI the Iully adiustable articulator is an accurate method oI studying
mandibular movement which "becomes a Iascinating game". Understanding the masticatory
system is basic to progressing in our learning in the Iield oI dentistry.
09-002. Guichet. N. E. The Denar System: Its Application in Everyday Dentistry. DCNA
23:243-257. 1979.
I. Anatomical Considerations as they Relate to the Denar System: A brieI discussion oI the
movements oI the mandible is presented. How they can be reproduced on the Denar instrument is
also presented. When restorations include the last Iew teeth in the arch, the author Ieels that the
use oI the Denar D5A and pantograph is time eIIective. Treatment sequencing is given Ior the
use oI the Iully adiustable articulator in the rehabilitation oI the posterior dentition.
II. The Denar System
A. Instrument systems
1. Pantograph
2. Fully adiustable articulator (D5A)
3. Laboratory Relator
4. Field Inspection Gage
5. Semi-adiustable articulator (Mark II)
B. Educational Programs
1. OIIice Tutor
2. Patient Tutor
3. Protocol Ior Dentist-Laboratory Relations and Laboratory Support
09-003. Beck D. B. and Knap F. 1. Reliability of Fully Adjustable Articulators using a
Computerized Analysis. 1 Prosthet Dent 35:630-642. 1976.
Purpose: The purpose oI this study is:
a. to determine whether an articulator set to a subiect's records, accurately reproduces that
subiect's mandibular motion
b. to compare the accuracy oI an articulator set to positional records with one set to
pantographic tracings.
Methods & Materials: Five subiects were examined, all oI whom had either a Iull complement oI
natural teeth or Iixed partial dentures. Using ticonium clutches and aluminum pin-and-plate
assemblies, mandibular movements were evaluated with a digital computer. Additionally, casts
were Iabricated and articulated using a Iully adiustable articulator with positional records (Hanau
130-21) and a Iully adiustable articulator with pantographic tracings (Denar D5A). The computer
sensor was attached to the articulators in the same manner as it was attached to the subiects. Data
was collected and evaluated Ior each subiect and each set oI articulators.
Results: At the 95° level, no signiIicant diIIerence was Iound between the data obtained Irom
the subiect-articulator or articulator-articulator comparisons.
Conclusion:
1. Statistical analysis oI the graphic data showed no signiIicant diIIerence between the
Denar D5A and Hanau 130-21 articulators Ior the Iive subiects tested.
2. Both the Denar D5A and Hanau 130-21 articulators adequately reproduced mandibular
movement Ior the Iive subiects tested.
09-004. Wipf. H. Pathways to Occlusion: TM1 Stereographic Analog and Mandibular
Movement Indicator. DCNA 23: 243-257.1979.
Purpose: TMJ technique article.
Is unique among Iully adiustable articulators. It provides precise curvilinear paths oI the TMJ
articulator Iossae elements.
Method Ior recording mandibular movement is known as the stereographic analog.
Material used to record the analog is autopolymerizing acrylic resin.
At the time the TMJ articulator was developed, there was only a Iew Iully adiustable
articulators available.
Procedure:
1. Induce initial side shiIt - measured in millimeters using the tapered end oI the TMJ ruler.
2. One-IiIth oI a millimeter is measured Ior each millimeter oI ingress.
3. Clutches Iabricated indirectly or directly.
Similarities with pantographs:
1. central bearing screw.
2. clutches.
3. terminal hinge and orbital reIerence point.
Dissimilarities with pantographs:
1. recording styli are Iour in number and are Iixed, the media is acrylic resin.
2. pantographs are recorded extraorally
3. pantographs have two vertical plates to record vertical changes whereas the vertical
controls oI the stereographs are on the Iloor oI all Iour analogs which are in a solid state.
4. both systems record the horizontal records in Iour areas.
The task oI Iollowing and coordinating six lines Ior each oI the two border and protrusive
movements can be a considerable endeavor iI precision is the goal. Each movement recorded is
dependent on the ability to see all lines at once and hold them while the instruments are adiusted.
The lack oI interpolation and eye and muscle coordination as well as the lack oI numerous
screws to adiust, make the stereograph a convenient and practical system oI recording spatial
movement.
09-005. 1avid. N. A comparative study of sagittal and lateral condylar paths in different
articulators. 1 Prosthet Dent 31:130-136. 1974.
Purpose: To determine the condylar guidance angles Ior protrusive and lateral progressive side
shiIt in three diIIerent kinds oI articulators.
Methods & Materials: Two Denar D4-A, two Whip-Mix, and two Hanau model 130-28
articulators were used. Five patients whose kinematic axis have been located were used.
Protrusive and lateral interocclusal records were made oI acrylic. The protrusive and lateral
condylar guidances oI all six articulators were adiusted with both the protrusive and lateral
interocclusal records. The procedure was repeated 20 times.
Results: Use oI the Denar articulators and comparison oI the mean diIIerence oI the means oI the
leIt and right protrusive condylar guidance readings oI two similar articulators showed there was
no signiIicant diIIerence between the two Denar articulators. There was a signiIicant diIIerence
with the Hanau and Whip-Mix articulators.
Conclusion: The condylar guidances oI the Denar articulator are more stable than the Hanau or
Whip-Mix used in this study.
09-006. Coyer. R. B. A Study of the Variability of Setting a Fully Adjustable Gnathologic
Articulator to a Pantographic Tracing. 1 Prosthet Dent 37:460-465. 1977.
Purpose: To determine the variability involved in setting a Iully adiustable gnathologic
articulator to a pantographic tracing oI known parameters, thereby eliminating the problem oI
setting the articulator with incorrect inIormation.
Methods & Materials: A pantographic tracing was made on a Iully adiustable gnathologic
articulator. Patient tracing were not used. The instrument was arbitrarily set and tracings were
made in the normal manner. Seven dentists were given the articulator and a still-mounted
pantographic tracing and were asked to set the articulator. Seven sets oI tracing were used. The
original random settings were used as the standard and deviations determined.
Results: Statistical signiIicant diIIerence was noted Ior the Iollowing settings:
O Immediate side shiIt
O Progressive side shiIt
O Top wall
Operator consistency was compared by plotting the variable error and constant error Ior each
operator Ior each tracing. Operators tended to set the articulator in excess oI the original setting.
Conclusions: There is an inherent system variability and that mechanical and operator errors
were involved only in the actual setting oI the instrument.
09-007. Winstanley. R.B. Observations on the use of the Denar Pantograph and
Articulator. 1 Prosthet Dent 38:660-672. 1977.
Denar D4A and pantograph used to transIer settings to articulator. Participants attempted to
duplicate settings by Iollowing the tracing.
Results:
1. Most articulator adiustments were reproducible with a reasonable degree oI accuracy but
not to the extent one would hope.
2. Rear and top wall adiustments were very inaccurate, probably because the tracings were
short and large variations in the setting caused only small deviations oI the styli.
3. Familiarity improves results.
4. Reciprocal actions - when articulator adiusted to move one stylus, it may have a mutual
or reciprocal inIluence on other styli, should Iollow instructions in manual.
09-008. Solberg. W.K. And Clark. G.T. Reproducibility of Molded Condylar Controls with
an Intraoral Registration Method. Part I. Simulated Movement. 1 Prosthet Dent 32:520-
528. 1974.
An articulator with molded Iossa boxes served as the patient, three dentists made 4 stereographic
tracings and molded 4 Iossa boxes each. The right condylar controls were compared in
protrusion, latero and mediotrusion by a computerized measuring machine to the master condylar
control.
Results:
1. Error oI stereographic technique is WNL.
2. Sagittal component oI protrusion and mediotrusion resulted in a condylar inclination
which was slightly less than that oI the patient (neg error).
3. More experience operators had less variation.
09-009. Weinberg. L.A. An Evaluation of Basic Articulators and their Concepts. Part IV.
Fully Adjustable Articulators. 1 Prosthet Dent 13:645-663. 1963.
Purpose: To discuss the principles that apply to Iully adiustable articulators.
Discussion: In the eIIort to create an articulator that will take into account the varying degrees oI
curvature oI the articular eminence and the potential mandibular lateral translation, the Iully
adiustable articulator was designed. Records oI centric relation, protrusive, right and leIt lateral
border positions, and intermediate three-dimensional border paths oI motion are used to set the
articulator with the aid oI a pantograph.
The pantograph is an enlarged tracing oI mandibular movement obtained by Iixing a writing
plate to one iaw and a stylus to the other. The three-dimensional motion oI the condyle can be
reproduced by combining the inIormation attained by the six plates oI the pantograph. It is not
necessary Ior the pantograph to be exactly oriented in each oI the three planes oI space but their
arrangement must remain constant during the recording oI mandibular movements. All tracings
start at the terminal hinge axis and are recorded on these three pair oI plates:
Symphyseal pantograph- the typical Gothic arch tracing is produced.
Sagittal pantograph- records the vertical components oI movement. The protrusive and balancing
paths traced Iorm the Fischer angle. A short "backlash" tracing is the vertical component oI the
working condylar movement. This "backlash" is a proiection oI the axis oI the mainly rotating
working condyle as the tracing element is extended beyond the actual condyle.
Inclined Horizontal pantograph- records oI the horizontal components oI motion. The Bennett
angle is created by the protrusive and balancing tracings. The lateral component oI the working
condylar movement is represented by the backlash.
The essential requirements Ior duplicating these motions are:
1. To maintain the same relationship oI the pantograph to the styli and transIerring it Irom
the patient to the instrument.
2. The instrument must be three-dimensionally adiustable to accept records.
3. The Iinal casts must be mounted in the exact relationship to the motion recorded as it
occurred in the patient.
An anterior point oI orientation (usually the inIraorbital point) can be completely arbitrary but
once established must be consistent. Tattooing the patient is recommended to insure
reproducibility. Condylar readings are not obtained Irom the instrument but are recorded in the
tracings and transIerred to the instrument. The curved condylar path eliminates the 0.4 mm error
associated with rectilinear path articulators. The pantograph's recording oI the Fischer angle can
eliminate the 0.1 mm error produced in the second molar cusp height.
The gnathologic instrument conceptually produces no occlusal errors although discrepancies
can occur. From day to day, however, ones Iacial muscles vary in the degree oI tonus. Pressure
on the central bearing point may cause a rock in the mandible and create deviations. The weight
and bulk oI the equipment can alter the reproduction oI tracings as well as head position and
respiration. There can also be inaccuracies with the materials used in record making, Iabrication
and cementation oI the restoration. The author does not agree that all possible movements in
between the border movements are automatically reproduced by the Iully adiustable articulator
as the patient tends to chose the most comIortable path oI motion.
Conclusion: Fully adiustable articulators are extremely accurate in duplicating the three-
dimensional motion oI the condyle. Semiadiustable articulators are adequate Ior complete
denture construction and their settings are based on clinical averages. The most serious error that
is created by semiadiustable articulators is a space between the posterior teeth during lateral
excursions on the working side due to negative error. Fully adiustable articulators can reduce the
amount oI intraoral corrections to be made and will accept all non-pathologic records.
09-009. Weinberg. L. A. An Evaluation Of Basic Articulators And Their Concepts. Part IV.
Fully Adjustable Articulators. 1 Prosthet Dent 13:645-663. 1963.
Purpose: To discuss the principles that apply to Iully adiustable articulators.
Concept: Three-Dimensional Pantographs
Three-dimensional motion can be reproduced iI simultaneous pantographs are obtained
containing the three planes oI space. To reproduce the original motion, the pantographs must be
in the same relationship to each other and to the styli on the instrument as they were on the
patient. Simultaneous tracing oI these pantographs on the instrument eIIectively recreates the
motion.
It is not necessary Ior the pantographs to be exactly oriented in each oI the three planes oI
space. However, their arrangement must contain the three planes oI space and remain constant
during the recording and during the reproduction oI the motion.
Contents oI each tracing
Each writing table contains the tracings oI the three border movements starting Irom the
terminal hinge position. These movements are represented characteristically on all six
pantographs.
Symphyseal Pantograph - The typical Gothic arch (needlepoint) tracing is produced.
Sagittal Pantograph - records the vertical components oI condylar motion. During eccentric
condylar movements it traces the protrusive path, the balancing path, and Iorms the Fisher angle
in between these two paths. The short curved line, resembling a "backlash," is the tracing oI the
vertical component oI the working condylar movement.
Inclined Horizontal Pantographs - record the horizontal components oI condylar motion. The
Bennett angle is recorded by the angle between the protrusive and the balancing condylar
tracings. The lateral component oI the working condylar motion is again represented by a short
curved "backlash" tracing.
Method:
The gnathologic system oI duplicating motion has three essential requirements:
O To maintain the same relationship oI the pantographs to the styli as the transIer is made
Irom the patient to the instrument.
O The instrument must be three dimensionally adiustable to accept the records.
O The Iinal casts must be mounted in exactly the same relationship to the motion recorded
as it occurred in the patient.
Instrument settings:
O Protrusive Inclination - Condylar slots oI the appropriate radius are placed on the
condylar ball and the inclination is adiusted so that the styli trace the same protrusive
path on the instrument as has been recorded on the patient.
O Intercondylar Distance - The symphyseal pantographs capture the vertical axis oI each
working condyle. The condylar mechanism is adiusted sideways until the styli trace the
lateral border movement along both symphyseal pantographs.
O Balancing condylar motion - is adiusted by combining the individual condylar path
curvature, vertical angulation, and Bennett angle obtained Irom the pantographs.
O Working condylar motion - Bennett shiIt, iI any, is recorded by the horizontal
pantographs and transIerred to the Bennett guide in the midline oI the instrument. The
Bennett guide can be shaped by grinding iI necessary. The condylar rod can be adiusted
to any angulation in all three planes permitting individual working condylar motion away
Irom the original hinge axis line to its eccentric position.
O Face-bow - The hinge axis and inIraorbital tattoos allow the casts to be remounted at any
Iuture time without repeating the procedure, unless speciIically desired.
O Arbitrary Location oI the Anterior Point oI Orientation - Three -dimensional motion, as
recorded in the pantographs, is Iixed in relation to the two iaws and transIerred in total to
the instrument. No error is produced by the arbitrary orientation oI the plane oI occlusion.
O Curved Condylar Path - The .4mm condylar error associated with a straight condylar
mechanism is eliminated.
O Balancing Condylar Movement - Fischer angle is recorded in the pantographs and used
Ior the adiustment oI the instrument. This eliminates the .1mm error produced at the
second molar cusp height when the protrusive inclination is used Ior the balancing
inclination.
O Working Condylar Movements - On a theoretical basis, no mathematical error is
produced at the cusp level.
Summary: A gnathologic instrument in which three-dimensional pantographs are used is
extremely accurate in duplicating three-dimensional motion. Theoretically, no occlusal error is
produced.
Factors oI muscle tone, pressure oI the central bearing point, head position, respiration and
weight oI the instruments attached to the iaws should be kept in mind in relation to the above
conclusion.
09-010. Shields. Clayton. and Sindledecker. Using pantographic tracings to detect TM1
and muscle dysfunctions. 1 Prosthet Dent 39:80-87. 1978.
Purpose: To determine iI a relationship existed between clinical Iindings and uncoordinated
mandibular movements.
Methods & Materials: Forty-six subiects with varying degrees oI dysIunction were examined.
HDI (Helkimo dysIunction index) and pantographic tracings were completed on the patients. The
degree oI reproducibility was scored Ior the tracings (PRI). The scores are as Iollows:
O 00-10 Reproducible
O 11-16 Slightly reproducible
O 17-30 Moderately reproducible
O 31-¹ Severely nonreproducible
The subiects were divided into groups according to there clinical symptoms and Iurther divided
based on the state oI occlusion.
Results: The PRI detected diIIerences between the group with moderate dysIunction and the
groups with no dysIunction. Subiects with poor occlusion had slightly higher PRI scores.
Conclusion: The PRI can aid in detecting TMJ dysIunction.
09-011. Manary. D AND Holland. G. Evaluation of Mandibular Movement Recording and
Programming Procedures for a Molded Condylar Control Articulator System. 1 Prosthet
Dent 52:275-280. 1984.
Purpose: To analyze the eIIectiveness oI the TMJ articulator to reproduce the border movements
oI a patient model.
Materials & Methods: Stuart articulator was programmed to serve as a laboratory model Ior a
patient. A Stuart pantograph was attached and pantographed 20 times by one operator. The
scribings were photographed and then compared with the scribings Irom a programmed TMJ
articulator.
Results: All centric relation points were the same on the 20 sets oI Iossae and the patient model.
On the posterior vertical tables, the TMJ orbiting and protrusive paths were consistently superior
to (less steep than) the patient model scribings.
Conclusion: The error associated with the development oI the TMJ stereograph and custom
Iossae resulted in a decrease in steepness oI the articular eminentia. The immediate side-shiIt is
simulated by the TMJ stereograph and Iossae Iormation. The horizontal orbiting path oI the
programmed TMJ articulator was consistently lateral to the orbiting path oI the patient model
(decreased Bennett angle). The horizontal rotating path oI the programmed TMJ articulator was
consistently medial to the rotating path oI the patient model (retruded laterotrusive). As the
operator gained experience, the TMJ articulator more closely simulated all the movements oI the
patient model. The small diIIerence consistently observed between the pantographic scribings oI
the patient model and the TMJ articulator suggests that the TMJ system can have signiIicant
clinical application.
09-012. Swanson. K. H. Complete Denture Using the TM1 Articulator. 1 Prosthet Dent
41:497-506. 1979.
Purpose: To review a technique Ior use oI the TMJ articulator in the Iabrication oI a complete
denture.
Methods & Materials:
House's technique is reviewed and the TMJ technique described:
1. A Face-bow mounting oI the maxillary cast, an arbitrary axis can be used, but a
kinematic hinge is preIerred.
2. Secure accurate impressions with custom acrylic trays. A Ilat metal plated secured to the
maxillary tray. Trays trimmed to correct extension, border molded and reIined with a
wash oI silicone impression material.
3. Plane oI mandibular occlusion on which to make the mandibular movement recording is
planned. This is done by putting both impressions in the mouth, and the mandibular
handle reduced so that as the patient closes the iaws the handle on the mandibular tray
will stop closure, and by adiusting the handle a preliminary vertical dimension oI
occlusion can be determined.
4. The TMJ clutch Iorming bite Iork is used to make the recording platIorm on the tray oI
the mandibular impression.
5. Central bearing screw is placed on the convex side in one oI the two holes in the bite
Iork.
6. Autopolymerizing acrylic is placed around the central a bearing screw, at putty stage the
portion oI the bite Iork around the central bearing screw is covered to the size oI the
mandibular impression tray and brought to place on the tray side oI the mandibular
impression.
7. Another mix oI autopolymerizing resin, Iour studs are placed in the preplanned canine
and molar areas on the maxillary impression tray.
8. Impressions with attachments are tried in the mouth and the central bearing point
adiusted to support established VDO.
9. AIter patient has been trained to make excursive movements the surIace oI the maxillary
tray and studs are lubricated. TMJ resin is made and a pat placed on the mandibular
platIorm in each area where the studs will move.
10.Mandibular impression is placed in the mouth and the patient instructed to close on the
central bearing screw and instructed to move in the previously rehearsed mandibular
movements.
11.The impressions are removed, and some oI the material is removed around each
recording, the central bearing screw is lowered about an eighth to a quarter oI a turn,
pathways lubricated, and record reinserted. Patient ask to reIine tracings with cutting
studs.
12.When recording is satisIactory, a Iace-bow is made. It is made with the Iour studs in
modeling compound.
13.Impressions are poured in artiIicial stone, and are not removed until they have been
mounted on the articulator.
14.Maxillary is mounted via the Iace-bow. The mandibular is related by attaching the
recordings together with modeling compound with the Iour studs in their respective
points oI the Iour Gothic arch recordings. Incisal guidance pin is set at zero.
15.TMJ Iossa and tray acrylic is placed in each Iossa box, the controls are molded.
09-013. Contino. R.M. and Stallard. H. Instruments Essential for Obtaining Data Needed
in Making a Functional Diagnosis of the Human Mouth. 1 Prosthet Dent 7:66-77. 1957.
Purpose: A discussion oI knowledge and instrumentation needed Ior acquiring and implementing
data in making a Iunctional diagnosis oI the mouth.
Summary:
- Basic condyle motions- limited to 2 kinds oI movement/rotation and sliding; in many
combinations which make all mandibular movements possible
- Condyle slidings- 2 types oI condyle sliding movements:1) Iore and rear, 2) outward and
inward/Bennett movement
- Pure anatomical inIormation- hinge-sliding ioint/ginglymoarthrodial ioint; capsule- bandage oI
tissue surrounding the condyle and the disc; lateral pterygoid muscle- attaches to the disc; no
retracting muscles are directly attached to the condyle
- SigniIicance oI ioint anatomy- a) the maxilla: temporal suspension oI the ioint, the eminences,
mandibular Iossa and the upper compartments oI the ioints; b) the mandible: lower
compartments oI the ioints, the meniscuses, the condyles, the lower synovial cavities, the lower
portions oI the capsules and the condylar axes
- Expectations oI an articulator- the individual expression oI the condylar movements oI the
patient; McCollum- condylar slots; Stuart- discarded the horizontal axis Ior a Iunctional axle,
grinding oI the cams Ior Bennett timing, replaceable eminences Ior various condyle paths,
articulator to accept data Iound by iaw writing instruments
- History oI iaw writings- Goldberg- too complex; Snow- Iacebow, Harlan- modiIied the
Iacebow by Iastening it to the lower teeth; the mandibular clutch; the maxillary clutch and
Iacebow; Gnathologic society's greatest contribution- the pattern oI condyle movements is Iixed
and independent oI teeth and muscles; Gysi was unable to do this- writing device not rigidly
Iastened, writing card not always Iixed in the same place and dissimilar starting points
- Inadequacies oI interocclusal records- at best, they can only register the end position oI a path
- Adaption oI Iace-bows to write iaw motions- MacQueen, Stuart and Wightman;
jaw writing device- tridimensional caliper, consisting oI a maxillary Irame to hold the record
Ilags and a mandibular Irame to carry the writing points that can be used to determine the
dimensional relation oI the teeth and iaws to the cams and axes oI the ioint movements. Purpose-
produce data Irom which the dentist can determine and locate the centric axis position oI the
opening-closing action oI the mandible, establish the slant and curvature oI the condyle paths, set
and direct the amount and direction oI the Bennett paths
Functional diagnosis- can only be made by studying the relationship oI the iaws, the
interrelations oI the opposing teeth and the relation between the dental Iactors and the condyle
Iactors oI articulation as they are revealed when dental casts are mounted on a duplicating
instrument

Section 10: Centric Relation
(Handout)
Definitions:
Centric Relation (CR): the maxillomandibular relation in which the condyles articulate with the
thinnest avascular portion oI their respective discs with the complex in the anterior-superior
position against the shapes oI the articular eminences. This position is independent oI tooth
contact. This position is clinically discernible when the mandible is directed superiorly and
anteriorly. It is restricted to a purely rotary movement about the transverse horizontal axis.
Deprogrammer: various types oI devices or materials used to alter the proprioceptive mechanism
during mandibular closure.
Maximum Intercuspation (MI): the complete intercuspation oI the opposing teeth independent oI
condylar position.
Anatomy influence on Centric Relation:
1. Atwood states that there are two basic concepts oI CR.
a. anatomic concept - the most posterior border position is established by ligaments.
b. pathophysiologic concept - the most posterior unrestrained iaw relationship (not a border
position)
established by muscle action.
The posterior limit oI the mandible is established by structures anterior and lateral to the
condyles (lateral pterygoid and temporomandibular ligament) rather than posterior to them. The
temporomandibular ligaments contain proprioceptive nerve endings, susceptible to stretching,
leading to inhibition oI the retrusive muscles (temporalis and digastrics), and stimulation oI the
protrusive antagonist muscles (lateral pterygoids).
The term "unrestrained " relates to no undo Iorce causing distortion oI the tissues.
Does reproducibility assure correctness?
2. Moss stated that:
a. CR is a nonIunctional position that is not habitual or common.
b. Are the Iunctional surIaces oI the TMJ capable oI adaptation over long periods oI time?

c. When would these changes occur?
d. The dynamically Iluctuant state oI the neuromuscular apparatus makes it reasonably certain
that
variation in CR position can exist. Ex. Pain caused by a high restoration.
e. As mandibular Iunction begins, and muscles contract, the Iunctioning ioint surIaces are
brought
into a compressive articulation and the condylar heads are not in CR.
3. What is Levy`s dynamic concept oI centric relation?
a. A quasi-Iixed position oI temporary duration which exists in a state oI equilibrium
established by
the neuromusculature and ligaments.
b. Does this mean that the TMJ and musculature can adapt by remodeling to the newly
acquired
intercuspation?
c. According to Levy, does this mean that a Iixed retruded positional concept can lead to
unnecessary
treatment?
Dawson stated that in CR:
a. Proper alignment oI the condyle disk assembly is required and the condyles should be
against the
eminentia.
b. The medial pole plays the predominant stop oI upward movement oI the condyle.
c. The muscles surrounding the ioint pull the condyle disk assembly Iirmly against the
eminentia.
d. Elevator muscles (temporalis, masseter, and medial pterygoid) pull superiorly.
e. The medial pterygoid pulls the medial pole oI the condyle into the buttressed part oI the
glenoid
Iossa. The medial pole oI the condyle braced against the glenoid Iossa can have no posterior
movement without moving inIeriorly.
I. The anterior pole oI the condyle rests against the eminence and prevents Iorward movement.
g. The medial pole oI the condyle (superior-anterior) seated in CR can make a rotary
movement.
The lateral pole oI the condyle can translate during opening and closing oI the mandible
while in
CR due to angulation. This anatomy allows occlusal relationship records to be taken at
varying
vertical dimensions oI occlusion as long as the correct horizontal axes are recorded.
h. Lateral pterygoid muscles resist the elevator muscles and deviate the mandible to avoid
occlusal
interIerence`s.
i. Centric relation is a Iunctional position and relates to the muscle harmony oI the patient.
i. Occlusal interIerence`s to the uppermost centric relation position mean that the lateral
pterygoids
must deviate the mandible to conIorm to the maximum occlusal position and they cannot
deviate
to that position without serving as a holding muscle against the elevator muscles. This can
progress
into a clenching pattern, and incoordinated musculature.
k. Bilateral manipulation is the method preIerred to determine optimum TMJ condyle position.
Where are the Iingers placed Ior this method?
5. According to Gilboe, is it possible to place the condyle in a position so posterior that the
condyle-disk assembly is no longer in contact with the eminence?
II an internal derangement exists, the most posterior position could be pathologic. With an
anteriorly displaced disk, the condylar articular surIace bears on the posterior band oI the intra-
articular tissue.
II restored in this position, can an iatrogenically induced derangement oI the TMJ occur?
Does reproducability imply desirability?
Restorative services should be postponed until CR has been established and conIirmed by the
absence oI symptoms.
Centric Relation. Why is it important?
CR is a bone to bone position and MI is a tooth to tooth position.
CR is the only clinically repeatable (veriIiable) iaw relation. It is the logical position to Iabricate
a prosthesis.
CR and MI are coincidental in only 10° oI the population. The discrepancies between
CR and MI can be observed on articulated study casts.
When is it needed? An accurate CR recording should be made to reduce time spent making
intraoral adiustments at delivery. Applicable situations include:
a. MI not clearly deIined due to restored dentition.
b. Changing VDO
c. Occlusal scheme - group Iunction rather than mutual protection.
d. TMJ disorder patients with occlusal discrepancies as part oI the etiology oI the TMD.
e. Angles` class II patients requiring Ireedom to move Irom CR to a pseudo - class I
(protrusive)
position.
I. When the number oI artiIicial teeth out number the natural teeth.
Systems for recording Centric Relation:
Static Recording ( interocclusal check bite) - teeth or supporting tissues as predominant Iactors.
Oldest and most commonly used method used today. CR recording should always be veriIied
against a second recording. There should be no tooth contact through the CR records. II contact
occurs, undetected mandibular translation may occur due to deIlective contacts or neuromuscular
avoidance mechanism. When a slide to MI is present, the Iirst contacts in CR are usually the
most posterior teeth, and the molars can act as a Iulcrum to cause the condyles to move down
and backward initially and then Iorward as the teeth slide into MI.
Graphic Recording - intraoral or extraoral Gothic arch tracings.
Physiological / Functional Recording - usually recorded on wax rims or wax cones during
unguided / unassisted patient movement.
Cephalometric Recording - cephalometric radiography to determine optimal position oI the
condyles. Impractical and seldom used.
Deprogrammer: Deprogramming devices are used to eliminate muscle engrams, prevent the
activation oI the neuromuscular avoidance mechanism, and allow the mandible to more easily
achieve the CR position. While the concept oI using deprogramming devices to record CR is
widely accepted, controversy and variation in technique abound. Current literature tends toward
agreement that deprogramming takes about 30 minutes. More time (several hours or overnight)
does not provide beneIit. Some oI the maior techniques include:
1. Bite on cotton roles: used with chin point guidance. This was the norm when the deIinition oI
CR was the most retruded position.
2. Lucia iig: a Duralay iig was made indirectly and Iitted during deprogramming, adiusted with a
slight incline until a gothic arch tracing was demonstrated with articulating paper. The CR record
is made with a hard material on a wax waIer and the patient closed Iirmly onto the iig. The
criticism oI this technique today revolves around the incline oI the iig and the choice oI wax to
make the record. Elastomeric materials were not available.
3. LeaI gauge: this device was very popular in the seventies and eighties. The patient closed into
a thick gauge and leaves were removed until the teeth were minimally separated in what was
assumed to be CR. The record was made with the leaI gauge in place. Drawbacks included the
incline oI the leaI gauge may Iorce the condyles posterior. Williamson recommended less biting
Iorce to allow the physiologic placement oI the condyles in the glenoid Iossa.
4. Anterior Ilat plane: essentially a Lucia iig, but without any inclines. Used in the power centric
recording.
Recording techniques:
Chin-point guidance: not recommended due to the posterior displacement and stress on the
bilaminar zone.
Bimanual technique (Dawson): patient is deprogrammed using an anterior device or leaI gauge.
Fingers are at right angles with upward pressure, thumbs on chin with downward pressure.
Manipulate into pure hinge movement (romancing the mandible). This technique is accurate and
has support in the literature. It can also be technique sensitive. The operator must be careIul not
to over-manipulate the patient and place the condyles in a more posterior position.
What does McKee say about this technique?
McKee stated that the most important criteria Ior CR is the complete release oI the inIerior
lateral pterygoid muscle during iaw closure. II not released, the condylar position will be
inIerior.
Single-handed technique: same as the bimanual but with one hand, Iingers at the angles and the
base oI the thumb at the chin. The Iree hand is used to place the recording medium. Many say
that it is not as accurate as bimanual manipulation.
4. Myotronics: not very popular today. Electrodes measure muscle activity. Records are diIIicult
to veriIy and are anterior to CR compared to other techniques.
What does Jankelson say about the neuromuscular aspects oI occlusion?
Unassisted Iree closure by the patient (swallowing, pull tongue back): no anterior deprogrammer.
Records tend to be anterior to repeatable CR compared to bimanual guidance.
6. Unassisted Iree closure by patient (with anterior deprogrammer): What did Campos Iind?
7. Power Centric (Roth): this excellent technique is a modiIication oI Lucia`s original work. A
Ilat plane anterior deprogrammer (to prevent activating the neuromuscular avoidance
mechanism) is combined with Iree closure by the patient to eliminate operator induced error. The
use oI the Ilat plane allows the elevator muscles (masseter and temporalis) to seat the condyles in
a superior anterior position. The anterior deprogrammer is made without indentations to register
the mandibular incisal edges. The original technique, used a two piece wax bite. More stable
registration materials like acrylic resins can be used Ior the deprogrammer and an elastomeric
recording material.
a. The patient is Iitted with the anterior deprogrammer so the teeth are minimally separated.
b. During the deprogramming the patient is taught to move into CR without assistance.
c. The recording material is introduced posteriorly and the patient exerts Iirm anterior biting
pressure on the
deprogrammer in the CR position while the material sets.
Hickey stated that artiIicial teeth will contact in CR when the proprioception oI natural teeth is
absent. Three methods oI recording CR are discussed:
a. Physiologic technique - swallowing procedures and chew in records. Problems - movement
oI rims on the
tissues, patient not reaching the most retruded position as he chews side to side, and
resistance oI the
material may result in a lack oI consistency in the mandibular position.
b. Graphic indication oI mandibular position intraoral or extraoral tracing devices. Problems -
supported by
movable tissues, discrepancy in opposing ridge size or position.
Direct interocclusal records - made by interposing recording medium between occlusal rims.
Recommended by Hickey because oI its simplicity. Problem - Accuracy dependent on clinical
iudgement by the dentist.
Recording Materials:
CR recording should always be veriIied against a second recording.
CareIul trimming oI the interocclusal recording material is critical because the soIt tissue is
recorded in a compressed state. The stone casts record the soIt tissue in an uncompressed state.
The two areas that must be trimmed are the gingival tissues oI the maxillary teeth (palatal) and
the distal tissue oI the terminal maxillary tooth.
Waxes: Hard baseplate or reinIorced (Aluwax, Coprawax): Many variations in technique. The
material is generally considered too unstable and inaccurate Ior CR (ok iI used immediately,
must be no proprioception, must harden quickly, Ex. Delar wax.), but can be used successIully
Ior static (positional) lateral checkbites.
Compound (modeling plastic): accurate but are technique sensitive. Need to have uniIorm
soItening to prevent uneven pressure while recording CR.
Plaster and ZOE: accurate and stable but diIIicult and messy to use.
Elastomeric (Stat BR, Blu Mousse, etc.): stable, easy to use and acceptable accuracy. Several
variations in technique. Widely accepted as the current norm.
Factors that affect Centric Relation records:
The resiliency oI the supporting tissues.
The stability oI the recording bases.
The TMJ and associated neuromuscular mechanisms.
The character oI the pressure applied in making the recording.
The technique used in making the recording and the associated recording devices used.
The skill oI the dentist.
The health and cooperation oI the dentist.
The maxillomandibular relationship.
Character and size oI the residual alveolar arch.
The size and position oI the tongue.
What did Kingery say about problems associated with CR?
1. Requirements:
a. Record correct horizontal relationship
b. Equal vertical contact oI arches
2. Errors:
a. Positional - incorrect horizontal and vertical contact, excessive pressure on closing.
b. Technical - poor rims, pin moved, processing errors.
How are the errors maniIested clinically?
Vertical -
Horizontal -
Recording
a. Extraoral and intraoral tracing - use a central bearing point to establish equal contact.
b. Direct check bite - occluding surIaces must not touch. Recording medium must be soIt.
c. Functional recording ÷ chew in - gothic arch tracing made with pressure - be careIul with
displaceable
tissue.
ShaIagh Iound what about CR and diurnal variance?.
What is his suggestion ?
Guichet:
- How does the SCM muscle aIIect iaw position?
- Can a dentist reprogram the musculature and condylar position?
- What is the protective reIlex?
- How is equilibration related to iaw separation?
Williamson - What does he say biting hard does to the condyles?
- What does he say about IorceIully retruding the mandible vs. a physiologic position using the
anterior guidance technique?
- The temporalis has more inIluence on CR than the masseter when an anterior guidance
appliance is used (Williamson).
Campos - what did he say about recording positions oI CR in upright or supine positions? Which
one is better? Did they have a diIIerence in reproducability?
Articulation:
1. The choice oI the articulator is dependent on the intended occlusal scheme (group Iunction,
mutually protected) to be developed, the complexity oI the restoration.
2. Semi-adiustable articulators are commonly used, along with arbitrary Iacebows.
3. CR records should be less than 3 mm to minimize the arc oI closure errors.
4. The degree oI sophistication chosen will be negated iI accurate centric relation records are not
obtained and excessive intraoral adiustments -may be required.
Prosthesis fabricated in centric relation or centric occlusion:
Lucia recommended that centric occlusion should be built to occur at centric relation. Regardless
oI
whether we believe that centric occlusion should be slightly anterior to this terminal hinge
position, this
is the only constant, repeatable position that can be used to check the work as we proceed.
What does he say about proprioceptive impulses?
Glickman evaluated a patient with Iull mouth restorations and placed one set Iabricated in CR
and the
other in CO. What did he Iind?
Serrano used a corrective occlusion prosthesis to try to improve the reproducability oI CR. What
did
he Iind aIter the three month period?
Wood used an interim prosthesis to allow Ior easier CR recording later. What did he
recommend?
Conclusion:
1. The deIinition oI CR has evolved over the years and with greater understanding oI mandibular
movement, it may change again. As the deIinition changed, the techniques Ior recording it oIten
changed or were modiIied. Other modiIications in technique are associated with the improved
materials.
2. CR is an area, a small area.
3. In the 1950`s "the most retruded relationship oI the mandible to the maxilla when the condyles
are in their most posterior unstrained positions in the glenoid Iossa Irom which lateral
movements can be made, at any degree oI iaw separation". The chin point push back technique
was popular.
In the 1980`s "RUM" the rearmost uppermost and midmost position. Dawson and others pointed
out that clinicians tended to emphasize the rearmost aspect and, with manipulation by the
operator, the patient recording could actually end up posterior to CR. Chin point guidance was
Iollowed by the bimanual guided technique, both with and without anterior deprogramming.
The clinician should select a technique and material Ior recording centric relation position based
on the patient`s presentation, proposed treatment, and the clinicians personal philosophy.
ReIerences:
Kapur An evaluation oI CR records obtained by various techniques. JPD 7:770, 1957.
Yurkstas, Factors aIIecting CR records in edentulous mouths. JPD 14:1055, 1964.
Meyers, CR records - historical review JPD 47:141, 1982.
WipI, Pathways to Occlusion: TMJ Stereographic Analog and mandibular movement Indicator.
DCNA 23:271, 1979.
Guichet, Initial reIerence, procedures Ior occlusal treatment, Anaheim, 1969, Denar Corp.
Millstein, determination oI the accuracy oI wax interocclusal registration. Part II JPD 29:40,
1073.
Kinderknecht, The eIIect oI a deprogrammer on the position oI the terminal transverse horizontal
axis oI the mandible. JPD 63:123, 1992.
Lucia, Technique Ior recording CR. JPD 14: 492, 1964.
Long, Locating CR with a LeaI gauge. JPD 29:608, 1973.
Dawson, temporomandibular ioint pain-dysIunction problems can be solved . JPD 29:100. 1073.
Wood, Reproducibility oI CR bite registration technique. Angle Orthod 1994; 64(3):211.
Schalhorn, A study oI the arbitrary center oI rotation and kinematic center oI rotation Ior
Iacebow mounting. JPD 7:162, 1957.

- Abstracts -
10-001. Atwood. D.A. A critique of research of the posterior limit of the mandibular
position. 1 Prosthet Dent 20:21-36. 1968.
Purpose: To discuss the concept oI centric relation and evaluate past, current, and need Ior Iuture
research.
Discussion: There are two basic concepts oI CR. The anatomic concept which states a most
posterior border position established by ligaments. The pathophysiologic concept states that CR
is the most posterior unstrained iaw relationship not a border position and is established by
muscle action. CR is important as a reIerence position Ior the restoration oI occlusion due to it
being relatively reproducible. But reproducibility does not assure physiologic desirability or
correctness. A number oI clinical and speciIic problem studies are reviewed.
Conclusion: Posterior limit oI the mandible at VDO is established by structures anterior and
lateral to the condyles rather than posterior to them.(lateral pterygoid and temporomandibular
ligament) The temporomandibular ligaments contain proprioceptive nerve endings susceptible to
stretching leading to inhibition oI the retrusive muscles(temporalis and digastrics), and
stimulation oI the protrusive antagonist muscles (lateral pterygoids).
The need Ior a large variety oI Iuture studies is called Ior.
10-002. Moss. M.L. A functional cranial analysis of centric relation. DCNA 19:431-442.
1975.
Purpose: This article is a review oI the inIormation as to the anatomy oI the TMJ and its
relationship to Centric position. The Iollowing conclusions have been made:
1. In biomechanical terms the centric relation is a nonIunctional position.
2. Over relatively long periods oI time, the morphology oI all Iunctional surIaces oI the TMJ is
capable oI signiIicant adaptive alterations. These are normal compensatory responses oI skeletal
units to the prior alterations oI Iunctional matrices.
3. In much shorter time periods, the dynamically Iluctuant state oI the neuromuscular apparatus
makes it reasonably certain that intra-individual variation in condylar positions can exist.
10-003. Levy. PH. Clinical implications of mandibular repositioning and the concept of an
alterable centric relation. DCNA 19:543-570. 1975.
Summary oI important points:
- Early attempts to obtain repeatable positions in treating denture patients resulted in a Iixed
retruded position being standard Ior centric relation. This concept was later used Ior dentate
patients. Levy Ieels this is incorrect. The mandible repostures to a more Iavorable position to
establish a new balance and equilibrium. The condyle and Iossa remodel and adapt to this
position.
- The ioints assume their position as a result oI the intercuspation oI the teeth, iaws, and
neuromusculature.
- Form Iollows Iunction.
10-003. Levy. P.H. Clinical implications of mandibular repositioning and the concept of an
alterable centric relation. DCNA 19:543-570. 1975.
Discussion: A Iixed retruded positional concept is traced to early complete denture attempts to
obtain duplicable bites. This concept, later gained acceptance as a physiologic entity Ior patients
with teeth. Static centric relation, ultimately lead to entirely reproducible systems involving all
mandibular movements. An interpretation oI centric relation as Iixed or static has become the
common cornerstone Ior virtually subspecialties in dentistry. According to Levy, a Iixed retruded
positional concept has lead to unnecessary treatment in certain orthodontic cases and
rehabilitation cases as related to extractions and surgical iaw repositioning.
Reposturing the mandible to a clinically Iavorable " as iI " position determined by the
anatomic Iactors present is an integral aspect oI the reconstruction procedure. Control oI the
situation requires that the newly acquired intercuspation be deIinitely keyed to allow the patients'
musculature to establish a new balance and equilibrium and time Ior the condyles and their
Iossae to readapt and remodel their relationship.
Temporomandibular articulation has a wide range oI adaptability and remodeling capacity.
The ioints assume their position as a result oI interplay oI intercuspation oI teeth , iaws and
neuromusculature. A dynamic concept oI centric relation is presented as a quasi-Iixed position oI
temporary duration which exists in a state oI equilibrium established by the neuromusculature
and ligaments. Adoption oI this concept allows Ior a diagnosis and treatment which is rational in
theory and workable in Iact.
10-004. 1ankelson. B. Neuromuscular aspects of occlusion: Effect of occlusal position on
the physiology and dysfunction of the mandibular musculature. DCNA 23:157-1688. 1975.
Mechanical measurement perIormed under conditions Ior registering condylar (border)
occlusion does not establish whether the repetitiveness is occurring under muscularly relaxed or
muscularly strained conditions. The presence oI mechanical devises, such as clutches, central
bearings, or pantographs, which have been used to measure border positions, elicit a
neuromuscular response by their very presence.
Transcutaneous electrical neural stimulation (TENS) is Iirmly established in physical
medicine as a most eIIective, physiologically rational means oI relaxing speciIic areas oI the
musculature. The Myo-monitor was designed to adapt TENS speciIically to the requirements Ior
the relaxation and control oI the complex oI muscles involved in mandibular Iunction. This is
accomplished by the application oI mild, time-spaced programmed stimuli through the IiIth and
seventh nerves.
Tracings in this study showed:
1. Chewing and swallowing were done at, or in the vicinity oI, centric occlusion and that no
chewing strokes or swallows went to centric relation.
2. Pathways between centric occlusion and centric relation is seldom a symmetric posterior
movement, but involves changes in all dimensions.
3. The muscle tension generated on retrusion Irom centric occlusion to centric relation gives
Iurther support to the Iindings that centric relation represents a neuromuscularly strained
position. (Note: DeIinition oI C.R. used: Rearmost, uppermost, midmost position)
4. Centric occlusion, apparently by Ieedback to proprioceptors, is the dictator and controller oI
the posture and the skeletal relationship oI the mandible to the skull. When centric occlusion
does not coincide with the neuromuscular position, proprioceptive Ieedback Irom the
malpositioned centric occlusion dictates and maintains strained muscle accommodation, and an
accommodative traiectory oI closure. The result is mandible dysIunction characteristic oI
craniomandibular syndrome.
5. Myocentric occlusion oIten coincides with centric occlusion, but in no instance was
myocentric occlusion Iound to coincide with centric relation.
6. Registration oI myocentric occlusion is achieved by isotonic muscle contraction that originates
Irom rest position.
Note: This author lists only 3 reIerences, all oI which are himselI.
This article is nothing more than an advertisement Ior the Myo-monitor.
10-005. Dawson. P.E. Optimum TM1 condylar position in clinical practice. Int 1 Perio Rest
Dent 3:11-31. 1985.
Purpose: To discuss, in length, the optimum condylar position in clinical practice.
Conclusion: DeIinition oI C.R.: When the properly aligned condyle-disk assemblies are in the
most superior position against the eminentia, irrespective oI tooth position or vertical dimension.
C.R. is a horizontal relationship oI mandible to maxilla.
The most important point in regard to condyle-Iossa relationship has been grossly ignored,
and that is the role that the medial pole plays as the predominant stop oI upward movement oI
the condyle.
When we have occlusal interIerences to the uppermost centric relation position, it means that
the lateral pterygoids must deviate the mandible to conIorm to the maximum occlusal position,
and they cannot deviate to that position without also serving as a holding muscle against the
elevator muscles. II this progresses into a clenching pattern, we are going to then have
hypermyotonia and incoordinated musculature. What we are really aIter is a totally harmonious
relationship oI Iunctional harmony.
Bilateral manipulation is the method preIerred to determine optimum TMJ condyle position.
10-006. Kingery. R.H. A review of some problems associated with centric relation. 1
Prosthet Dent 2:307-319. 1952.
Purpose: To discuss Iour problems associated with centric relation:
Methods/Problems discussed:
1. What is required: Problem oI requirements include the position oI the horizontal
relationship oI the mandible to the maxilla with equalization oI vertical contact, is known
as centric relation, or the most retruded unstrained positions oI the heads oI the condyles
in the glenoid Iossa, at any degree oI iaw separation, Irom which lateral iaw movements
can be made. We do not "take" centric relation, we "record" centric relation.
2. Errors: There are two classes oI error. !ositional errors caused by operator error in
recording horizontal or vertical relationship, excessive closing pressures and changes in
supporting area. Technical errors may be caused by ill Iitting occlusion rims,
indiscriminate opening or closing oI the occluding device or articulator, slight shiIting oI
teeth in Iinal wax set-up to the permanent base material.
3. How errors maniIest: Loss oI retention particularly in the mandibular denture, irritation
on the crest oI the lower ridge (localized ulcer usually hyperemic) in a premature contact,
premature contact oI one or several teeth on one side.
4. Recording centric relation: This author Ieels that too many operators are prone to accept
without question CR recordings without questions. Five methods are discussed.
1. Graphic recording: ReIerred to as arrow point tracing and represents the movement oI the
mandible on one plane. The resultant graph will be take the Iorm oI a V. the point reIers
only to the anteroposterior iaw relation and must be registered with equalized vertical
pressure. Error can be made by the amount oI pressure applied by the patient and
displacing the supporting tissue. Stansbery brought out a method to check the correctness
oI the position oI the central bearing point.
2. Extraoral procedure: the gothic arch tracing is developed extraorally, allowing Iull view
at all times. Plaster iniected between the occlusion rims and central bearing point is used
as a recording medium. Allows one to detect any iaw movement Irom the apex oI the
arch tracing and avoids locking a patients iaw in a certain position.
3. Intraoral procedure: Gothic arch developed while the central bearing point is locked at
the apex oI the tracing and plaster is iniected between the occlusion rims and central
bearing point as the recording medium.
4. Direct check bite method: Most common material is wax. (wax distorts) Secured on
occluding surIaces and made with equalized pressure.
5. Functional recording method: Frequently call a chew-in, allows the patient to indicate the
position oI CR by Iunctional movement. Accomplished by abrasive material, wax, or
studs placed on the occlusal rims.
Summery: Many methods are acceptable. The purpose oI this paper is to stimulate more thought
on the problems oI recording CR.
10-007. Wood. G.W. Centric relation and the treatment position in rehabilitating
occlusions: A physiologic approach. Part I: Developing optimum mandibular posture. 1
Prosthet Dent 59:647-651. 1988.
Purpose: The article discussed a physiological clinical approach to developing optimum
mandibular posture and clinical methods oI recording this posture when rehabilitating complete
occlusions.
Methods & Materials: None
Results: None
Discussion: The purpose oI occlusal orthopedic therapy is to give tissues a Iunctional
opportunity to approach their optimum physiologic health. the prosthesis should provide a Iirm
nondeIlective occlusion.
Fabricating occlusal orthopedic interim prosthesis: Make acrylic provisional restorations that
provide optimum occlusion at the proper vertical dimension. Periodic adiustments will be
necessary. This will allow Ior an easier recording later.
Three methods discussed to determine CR are Iree arcing by the patient, resisted arcing with
patient bracing, and manipulated arcing with dentist bracing.
10-008. Hickey. 1.A. Centric relation. a must for complete dentures. DCNA Nov 1964:587-
600.
Complete dentures have no means oI attaching to it bony support so, to maintain stability, it is
necessary Ior the opposing teeth to meet evenly on both sides oI the arch within the normal
Iunctional range. CR is the only position within the Iunctional range that even contacts can be
established and thereIor, it is a must Ior complete dentures. To eliminate error in a Iabricated
denture, CR records must be made at the exact VDO desired and accurately transIerred to the
articulator. Reasons to construct a complete denture in CR are:
1. CR is the only position that can be routinely repeated and reproduced in an edentulous patient.
2. Mounting the casts in CR eliminates the problem oI determining how Iar anteriorly to this
most retruded position centric occlusion should be established.
3. CR must be recorded to permit accurate adiustment oI the condylar guidance oI the articulator
Ior eccentric movements.
4. Opposing artiIicial teeth will likely contact in CR when the proprioception oI the natural teeth
is absent.
5. An accurate CR record orients the lower cast in the correct relationship to the opening axis oI
the articulator.
The author discusses three methods oI recording centric relation.
The physiologic technique includes swallowing procedures and chew-in records. Movement oI
the rims on the supporting tissue, the patient not reaching the most retruded mandibular position
as he chews side to side and resistance oI the material used oIten result in a lack oI consistency
in the mandibular position.
The graphic indication of mandibular position is recorded using intraoral and extraoral tracing
devices. The recording elements being supported by movable tissues and any discrepancy in
opposing ridge size or position can result in erroneous records.
Direct interocclusal records are made by an interposing recording medium between occlusal
rims. The author preIers this method because oI it's simplicity and lack oI mechanical devices.
He warns that accuracy is dependent on clinical iudgement by the dentist and cooperation
between the dentist and patient.
10-009. Glickman. et. Al. Telemetric comparison of centric relation and centric occlusion
reconstruction. 1 Prosthet Dent 31:527-582. 1975.
Purpose: To study a completely reconstructed natural dentition under actual Iunction to
determine whether CR or CO relationships are used during chewing and swallowing.
Discussion: Two Iull mouth restorations were made Ior a patient, one Iabricated with casts set in
intercuspation and the other with casts in CR. Telemetry tests were conducted to determine how
each set-up aIIected the tooth contact patterns during Iunction. No signiIicant change in the
Irequency oI contacts and glides occurred aIter placing either reconstruction except aIter three
weeks oI wearing the set-up built in CR. The Iindings indicated that adiusting to an occlusion set
in CR does not readily happen in the three week testing period. The patient tended to Iunction in
the existing CO position. The author concludes that the use oI the terminal hinge axis in oral
rehabilitation is subiect to question because the patient will not Iunction in this position.
The distance between CR and CO is variable and unpredictable so the use oI the terminal
hinge as a reIerence point is also questionable. CR is tolerated in complete denture set-ups
because the proprioception oI the PDL does not exist anymore.
10-010. Shafagh I. Yoder 1L. Thayer KE. Diurnal variance of centric relation position. 1
Prosthet Dent 34:574-582. 1975.
Purpose: To investigate diurnal changes in centric position within a period oI one day.
Materials/Methods: Ten men and three women with Angle Class 1 occlusions, ranging in age
Irom 20 to 30 years oI age, with no evidence oI systemic or physiologic dysIunction and normal
TMJs. Centric relation was repeatedly recorded Ior thirteen patients at 9:00 a.m., 3:00 p.m., and
9:00 p.m. on a single day. Denar model D4A articulator was used with a kinematic Iacebow at
each appointment Ior consistency. The dentist used the chin point guidance technique Ior
positioning the mandible using an anterior programmer, also called " anterior stop" or "anterior
iig". To avoid subiect Iatigue the entire procedure was done in approximately 25-minute
appointments separated by 5-½ hours rest.
Results/Discussion: Various positions oI the condyles observed on sagittal tables could be
attributed to 1) nonadiustability oI the intersagittal distance oI the instrument to the intercondylar
distance oI each subiect; 2) the inability oI the patients musculature to allow a pure hinge
movement; 3) diurnal variance in the TMJ; 4) variations in location the hinge-axis and
transIerring it to the articulator; 5) invalidity oI the stationary hinge-axis theory.
Conclusions: On the basis oI the analysis oI the data collected in this experiment, the Iollowing
conclusions were made:
1. Centric relation was repeatable Ior a Iew patients but in most there was variation. The
greatest variation
was in the superoinIerior direction. There was no time oI minimum variability.
2. In many patients the condyles were in their most anteroinIerior position in the morning and
in their most
superoposterior position in the evening. This may indicate that there is a diurnal pattern in
the position oI
centric relation possibly related to Iluid content in the ioint.
3. Depending on one's deIinition oI centric relation, one time oI day may be Iavored over
another due to diurnal
bias. II the most retruded and superior position oI the condyles is desired, the evening
seems to be a better
time Ior making CR records.
4. Freedom to move to some degree around a clinically determined centric relation position
may have merit
as a treatment philosophy.
10-011. Gilboe. DR. Centric relation as the treatment position. 1 Prosthet Dent 50:685-689.
1983.
Purpose: To analyze the morphology oI the TMJ not as a bone to bone mechanism, but as a bone
to tissue to bone mechanism.
Materials & Methods: None
Results: None
Discussion: The position oI the disc id important in centric relation as the middle zone or central
bearing area has no vascularity or innervation and thereIore is adapted to accept pressure.
Centric relation redeIined: The most superior position oI the mandibular condyles with the
central bearing area oI the disc in contact with the articular surIace oI the condyle and the
articular eminence. This position may not always be possible to obtain due to anterior dislocation
oI the disc.
10-012. Williamson E.H.. et al. Centric relation: A comparison of muscle determined
position and operator guidance. Am 1 Ortho 77:133-145.
Purpose:
1. To determine the direction and magnitude oI shiIts in condylar position when an interocclusal
record is Iormed by biting hard or easy on a leaI gauge using ZOE as compared to the use oI a
wax interocclusal record.
2. To determine whether the temporal or the masseter muscles are most active in seating the
condyles in centric relation when a leaI gauge is used.
Methods & Materials: The sample consisted oI IiIteen adults, 21-35 years oI age. The Vericheck
instrument was used to compare the condylar position when diIIerent interocclusal records were
made using three separate techniques oI recording centric relation.
1. Hard bite on the leaI gauge Ior 5 min.
2. Bite "halI as hard" as technique #1
3. Bite into pink wax while guided by the operator.
Electromyographic recordings were concomitantly made.
Conclusion:
1. Biting hard tends to cause the condyles to be Iorced posteriorly and away Irom the articulating
surIace oI the eminence.
2. Biting easy with the leaI gauge allow the physiologic placement oI the condyles in the glenoid
Iossa.
3. The temporalis muscles have more inIluence upon centric relation condylar position than the
masseter muscles.
10-013. Serrano. P.T. and Nicholls. 1.I. Centric Relation Change During Therapy with
Occlusal Prostheses. 1 Prosthet Dent 51:97-105. 1984.
Purpose:
1. To evaluate the change in location oI centric relation with time
2. To discover iI CR stabilizes within a period oI 3 months in patients undergoing corrective
occlusion prosthesis therapy
Materials & Methods: Eleven patients, 25-48 years oI age, were selected.
#1 A modiIied Lucia iig was made Ior each patient. The patient's iaw was gently guided to close
until contact was made with the anterior iig/ZOE recording medium. Casts were Iabricated and
mounted using the ZOE record.
#2 A corrective occlusion prosthesis were Iabricated and inserted. Records were made aIter
1,3,7,14,30,and 90 days.
ReIerence points were established on the mounted casts and measurements made.
Results:
1. Corrective occlusion prosthesis therapy did not improve the reproducibility oI centric relation
in asymptomatic patients.
2. Centric relation is not one position but is a range oI positions.
3. The range oI CR variation is greater laterally than antero-posteriorly.
10-014. Lucia. V.0. Centric relation - theory and practice. 1 Prosthet Dent 10:849-856.
1960.
Purpose: To locate a "center" that will enable us to reproduce the patient's movements on a
suitable articulator and execute our work more intelligently and with grater ease.
Principles & BelieI`s:
1. There is one hinge axis.
2. By the use oI twin Gothic arch tracings in the horizontal plane, it is possible to locate the
centers oI lateral movement and can be duplicated on an articulator that has an adiustable
intercondylar distance.
3. Centers oI rotation are made oI two components, the center oI vertical motion and the center
oI lateral motion, one in the same center, one in each condyle.
4. Proprioceptive impulses are responsible Ior the awareness oI the position oI the mandible in
space, natural reIlex acts oI the mandible are to close in a lateral or lateral protruded position.
ThereIore the patient must be deceived by keeping the teeth apart. The patient must be trained
and guided to execute the terminal hinge action.
5. Lucia method to record an interocclusal record to mount the lower cast to the articulator using
Tenax wax, Sure-Set wax and Aluwax.
6. It is necessary to transIer the centers oI lateral motion to an articulator iI the other movements
have been reproduced, this is accomplished by the use oI twin Gothic arch tracings on a suitable
articulator which can be adiusted Ior intercondylar width.
Summary & Conclusion:
1. By having the centric relation oI the mandible to the maxillae properly related on an
articulator, the dentist can develop the centric occlusion accurately according to his own
speciIications.
2. Functional movements must seat the condyle in the terminal hinge position, Centric occlusion
should be built to occur at centric relation.
3. Regardless oI whether we believe that centric occlusion should be slightly anterior to this
terminal hinge position, this is the only constant, repeatable position that can be used to check
the work as we proceed.
10-015a. Guichet. N F. Biological laws governing functions of muscles that move the
mandible. 1 Prosthet Dent 37:648-656. 1977.
Purpose: To clariIy iI occlusal contacts cause speciIic responses in particular muscle groups and
iI there are precise laws which quantiIy the responses oI the muscles to a particular occlusal
contact pattern.
Materials & Methods: Description oI how to Iormulate a study based on clinical observations.
No subiects described other than three generalized groups oI study hypothesis to support clinical
observations.
Clinical Observations: The reciprocal muscle response induced in the SCM muscle by Iunctions
oI the lateral pterygoid muscle to advance the condyle can be demonstrated by grasping the belly
oI the right SCM and pull in a lateral direction; by pressing at the opposite side oI the mandible
at the premolar site a response is Ielt at the SCM.
Lateral pterygoids will be in chronic contraction Ior the patient who has an occlusal condition
that programs both condyles to be maintained in an advanced position so that the teeth can Iit in
MI. Chronic muscle contraction will be Ielt in both SCM muscles which results in chronic pain
in the back oI the head and neck.
Just as the occlusion programs Iunctions to locate the mandible in the horizontal plane, the
occlusion will also program muscle Iunctions to locate the mandible in the vertical plane.
A deIlective contact in CR on the mesial incline oI the lingual cusp oI the maxillary right
second molar causes pain in the right lateral pterygoid muscle (commonly diagnosed as earache)
and in the right SCM (neck pain) or right occipital region at the attachment oI the SCM (pain on
back oI the head). Occlusal contacts can program responses in the muscles that move the
mandible and reciprocal responses in their antagonists to produce symptoms Irequently
diagnosed as " reIerred pain".
Summary: Many Iactors other than proprioception originating Irom occlusal contacts oI teeth
program iaw position and the Iunctions oI the muscles that move the mandible. Once this is
understood, an accurate diagnosis can select the course oI patient treatment.
10-015b. Niles F. Guichet. D.D.S. Biologic laws governing functions of muscles that move
the mandible. Part II. Condylar position. 1 Prosthet Dent 38:35-41. 1977.
Purpose: speciIic muscle responses programmed by speciIic types oI occlusal contacts, based on
clinical observation oI modiIied muscle responses related directly to occlusal treatment
procedures.
The direction oI the resultant Iorce vector to the occlusal loading determined
proprioceptively, governs Iunctions oI the muscles that move the mandible.
II occluding Iorces are applied parallel to the long axis oI the tooth, the tooth has maximum
load bearing ability without proprioceptive sensors signaling Ior inhibition oI the application oI
the load. II the applied Iorces are not in the direction oI the long axis oI the tooth upon
application oI a relatively minor load, certain periodontal ligaments will be stresses to their
physiologic limits, initiating a proprioceptive signal to inhibit Iurther application oI the load.
There is a physiological limit to the amount oI stress which the periodontal Iiber can
withstand.
In order to prevent damage during chewing, periodontal ligaments are equipped with the
proprioceptive mechanism This signal induces a protective muscle response such as an opening
reIlex or inhibited movement.
Condylar position: Condylar positions oI the mandible at rest as it moves to maximum
intercuspation are programmed by the occlusal scheme.
The ability oI the dentist to modiIy the occlusion and reprogram the condylar position and
muscle response is easily demonstrated clinically in occlusal treatment procedures.
When clutches are removed, the teeth do not Iit together properly. AIter several iaw closures
the muscles reprogrammed the condylar position to complement the prevailing occlusion. This
phenomenon illustrates the potential oI the dentist to almost instantly reprogram the musculature
and condylar position by occlusal treatment.
The ability oI the occlusion to program condylar position accounts Ior the patient`s repeated
ability to avoid damage.
Patients avoid occlusal contact on prematurities.
The challenge in obtaining an accurate centric relation record is not so much one oI obtaining
an indexing registration oI the mandibular teeth to the maxillary teeth as it is one oI how to
relieve stress in the muscles or reprogram them so they will allow the condyles to seek and retain
the position oI centric relation.
10-015c. Niles F. Guichet. D.D.S. Biologic laws governing functions of muscles that move
the mandible. Part III: Speed of closure - manipulation of the mandible. 1 Prosthet Dent
38:174-179. 1977.
Purpose: To study the eIIects oI occlusal contacts on the muscles that move the mandible
Discussion: This is the third part oI a series that deals with how speciIic muscle responses are
programmed by speciIic types oI occlusal contacts. The article reviews a model to Iacilitate in
developing iaw-manipulation skills.
There are Iour "independent personalities" in this scenario, the dentist. the patient. the
patients protective reflexes. and the gnathostomatic system.
Basically, when the dentist approaches the patient to make a CR registration the patient
"braces" (protective reIlexes) Ior a potential damaging premature occlusal contact.
Hence, there is a there is a programmed muscular response to brace the condyles in the most
physiologic or protected mandibular position in consideration oI the existing occlusal condition.
The author compares the deIlective occlusal contact to an irritation. As an analogy, iI a patient
had an extremely sore wrist, the doctor must approach the area slowly and careIully so as not to
induce a protective reIlex in a patient. This is in contrast to a patient with a vaguely sore, chronic
wrist pain. Here the doctor could approach the sore part with greater speed beIore a protective
reIlex would be initiated.
The same situation is true with teeth, with respect to the speed the dentist can Iorcibly arc the
mandible in CR, as deIlective occlusal contacts are removed in occlusal equilibration.
Three examples are given Ior centric prematurities on the lingual cusp oI a Iirst molar, cuspal
inclines oI a second molar, and on steep inclines on the posterior segments oI dental arches, the
last example with occlusal contact on steep inclines is the most diIIicult to manipulate the
mandible into centric relation. This is because since the vector oI Iorce is contrary to the long
axis oI the tooth, the ability oI the tooth to tolerate an occlusal contact in CR is limited.
10-015d. Niles F. Guichet. D.D.S. Biologic laws governing functions of muscles that move
the mandible. Part IV: Degree of jaw separation and potential for maximum jaw
separation. 1 Prosthet Dent 38:301-310. 1977.
Purpose: To emphasize that there deIinite principles by which muscles respond to occlusal
contacts.
Discussion: This the Iourth and last part to a series on the biological laws governing Iunctions oI
muscles that move the mandible.
The article discusses how a patient will also exhibit a "protective reIlex" to the hinge opening
oI the mandible depending on the occlusal prematurity in centric relation.
The distance that the patients mandible can be depressed Irom occlusal contact beIore the
patients musculature inhibits Iurther opening (protective reIlex) is termed the physiologic zone oI
iaw manipulation. This is a protective reIlex in the patients musculature, designed to prevent
damage to the tooth that Iirst makes occlusal contact in closure at that condylar position.
The more equilibrated the patient is , the higher the physiologic zone, ie there is a
neuromuscular release and the mandible moves without interIerence Irom the muscle.
An example here is a premolar with a deIlective occlusal contact will allow only 200 stress
bearing units which is the physiologic limit load oI that tooth. This would be equal to 2mm.
In a dentition that had a Iull complement oI teeth, with Iour posterior teeth that had
simultaneous contact, there would be 1300 stress bearing units which would equal to 13mm oI
the physiologic zone of jaw manipulation.
The physiologic zone is also decreased by the loss oI periodontal ligament and the driIting oI
teeth.
A single anterior restoration may cause a deIlective occlusal contact when the mandible is in
CR thus programming the retractor muscles (posterior belly oI the temporal and digastric) to
Iunction and protect the tooth Irom trauma. In some clinical situations, a wax programmer may
be used to promote simultaneous even contact oI the anterior teeth (this relaxes the elevator and
depressor muscles oI the mandible) and Iacilitate a more accurate centric relation record.
In clinical situations, an anterior jig may be used to disengage premature posterior tooth
contacts, which cause splinting oI the condyles by lateral pterygoid muscles.
Conclusion: Neuromuscular release oI the mandible may be accomplished by equilibration oI the
natural occlusion, orthodontics, restorative procedures, or surgery. Most oI the time it is a
combination oI these procedures. The criteria Ior success is not the method utilized, but the
neuromuscular response to the treatment.
Section 11: Centric Relation Recording Methods
(Handout)
Centric relation - The maxillomandibular relation in which the condyles articulate with the
thinnest avascular portion oI their respective discs with the complex in the anterior superior
position against the shapes oI the articular eminences. This position is independent oI tooth
contact. This position is clinically discernable when the mandible is directed superiorly and
anteriorly. It is restricted to a purely rotary movement about the transverse horizontal axis.
Deprogrammer -Various types oI devices or materials used to alter the proprioceptive
mechanism during mandibular closure.
Myocentric - the position to which the muscles carry the mandible iI no deIlective Iactors exist
on the teeth or occlusion rims. Myocentric position is recorded automatically, without
manipulation oI the mandible by the dentist or voluntary closure by the patient, by the use oI an
electronic device called the Jankelson Myo-Monitor.
Interocclusal Record Materials.
1. Accuracy oI baseplate wax, SS White and Hygienic:
Millstein (1973), described eIIects oI initial heating temp - 121, 126, 131, initial closing
pressure - 102 psi, 136, 172, storage environment - cold water at 12 degrees C, tap water at 25
degrees C, air cooling at 25 degrees C and storage time - 2, 6, 48 hours on accuracy oI recordings
made with baseplate wax.
What were the results oI each?
- 102 psi were statistically signiIicant causing increased vertical displacement.
- Initial temp variation was signiIicant Ior Hygienic wax vertical displacement increased at 121
degrees and with double-thickness oI wax.
- Water storage produced greater vertical and rotational changes than air.
- Water storage produced the greatest change and air cooling the least.
- EIIects oI time were inconsistent. No one storage time is preIerred.
2. EIIects oI dimensional change oI gypsum materials described by RoraII:
- Least expansion - yellow stone with slurry .0017"
- Most expansion - impression plaster .0056"
- Shim stock .0005"
- Double mount to minimize the mounting discrepancy caused by linear expansion.
3. Vertical interocclusal error produced by:
- Zinc-oxide eugenol paste - (Super Bite) resulted in open cast relationships.
- Aluwax - most variable and least reliable.
- Silicone putty - least error
- Polyether - least error
Elastomeric`s showed a decrease in vertical with a thicker record and an increase with a thinner
record that were statistically signiIicant but perhaps not clinically important.
4. Fattore evaluated the accuracy oI recording materials:
- Two thicknesses oI base plate wax - wax rarely registers accurate incisal Iorms
- ReinIorced wax
- The waxes were consistently unreliable.
- Zinc oxide eugenol paste - diIIicult to modiIy, dehydrates, cracks, rarely used twice, Ilash may
prevent accurate seating oI the casts - second in accuracy.
- Polyether - may cause casts to open, "spring".
- Polyether with a carrier - second in accuracy.
- Polyether without a carrier - most accurate
Distortion occurred more Irequently in a vertical direction, Iollowed by an anterio posterior
direction.
5. Gysi listed Iour methods oI "adapting" the articulator:
- plastic material - wax or compound.
- plaster
- extra-oral graphic method with Iace-bow
- intra-oral dentographic method (aIter Luce)
- Plastic led to great error. Compound cooled more rapidly were it was thin.
- An error oI 25 degrees was made on the sagittal condylar path.
- Plaster was practicable.
- Extra-oral - most reliable Ior CR, 5 degrees in the condylar path.
6. Balthazar-Hart (1981) examined the accuracy oI:
- Zinc oxide eugenol paste
- Eugenol-Iree-zinc oxide paste
- Silicone putty
- Polyether registration material
While these materials are similar to impression materials, they have been modiIied to give them
diIIerent handling characteristics.
- Eugenol Iree zinc oxide paste exhibited no statistically signiIicant diIIerence in dimensions.
- With polyether, silicone, and zinc oxide eugenol paste there was a statistical diIIerence between
the die and the samples at the immediate reading and throughout the experiment Ior 168 hours.
- Polyether showed the least diIIerence and zinc oxide eugenol paste the greatest.
- All dimensional changes were negative except Ior ZOE during the Iirst hour.
- All were less than .02 ° aIter the Iirst hour.
Recording Methods.
1. What were the methods that Kantor compared in 1973?
a. Swallowing or Iree closure. Patient was told to swallow and hold, manual guidance was
totally avoided.
b. Chin point guidance
c. Chin point guidance with anterior iig. To erase the proprioceptive patterns oI habitual
tooth contact. A wax waIer carries the metallic oxide paste.
d. Bilateral manipulation. They emphasize the importance oI superior placement oI the
condyles. Little eIIort is utilized in gaining a posterior placement. The technique employs a
speciIic superior guidance by the dentists Iinger position. At the same time downward pressure
with the thumb attempts to seat the condyles in their most superior position. An attempt is made
to obtain an arcing motion oI the mandible in its most superior position. They suggest that a
posterior guidance Irom the operator may move the condyles inIeriorly.
i. Free closure or the Myo-monitor produced greatest variability Ior registering CR. Created
the most protrusive positions.
ii. Bilateral manipulation greatest replicability in 85 ° oI patients.
iii. Chin point guidance with anterior iig gave the most posteriorly placed records. Created
the most retrusive records. The deconditioning eIIect oI the iig may allow the condyle to retrude
where it is inIluenced by the posterior slope oI the Iossa, causing an inIerior drop. Condylar drop
may be associate with records made by this method.
iv. Chin point guidance showed less consistency than bilateral manipulation.
Variability results:
Swallowing .4 mm
Myomonitor .38 mm
Chin point guidance .14 mm
Chin point guidance with a iig .07 mm
Bilateral manipulation .05 mm
CR can be located by any one oI many techniques, however there is variability in the results
obtained by any technique.
Does reproducability mean that it is correct? Not according to Atwood.
2. Kapur evaluated CR techniques in 1957. He Iound that intraoral tracing and extraoral tracing
were more consistent as compared to the wax registration method.
- "Flabby"ridges caused less consistency Ior the intra and extraoral methods.
- Wax showed the most consistency on Ilabby ridges.
The mean deviation in mm oI all three methods approached .2-.4mm, which is barely perceptible
clinically.
3. Reproducibility oI CR in three dimensions was evaluated by Hobo in 1985.
Techniques evaluated were :
Unguided closure
Chin point guidance
Bilateral manipulation
a. .2-.3 mm oI maximum condylar displacement was recorded by the three centric relation
registration methods.
b. Bilateral manipulation showed most consistent reproducability.
- Condylar positions obtained by bilateral manipulation and guided closure were similar
anteroposteriorly and superoinIeriorly.
- Unguided closure revealed appreciable lateral displacement, which indicates that muscular
position is less reproducible laterally, and condylar displacement can be expected.
- Chin point guidance placed on the condyle may result in harmIul eIIect on the bilaminar zone,
and inIerior displacement may cause an occlusal discrepancy.
4. Comparison oI articulator mountings to MRI was done in 1993.
- The articulator analysis oI CO and CR is statistically replicable.
- Condylar concentricity was observed in halI oI the sample and remained constant in the other
halI in retruded, CO, and CR. ThereIore the diagnosis oI health on the basis oI concentricity is
not supported by the present data.
- 13 ° demonstrated anteriorly displaced discs that were not inIluenced by posterior condyle
placement.
- The concept oI treating to CR as a preventive measure to improve disc-to-condyle relationships
was not supported by this study.
III. Technique and Materials
1. Lucia Jig Ior recording CR 1964.
- To eliminate patient engram, reIlex closure determined and guided by the teeth. The
proprioceptive mechanism determines the path oI mandibular closure.
- Importance Ior periodontally involved teeth? Unless CO occurs when the mandible is in CR
there will be strain on the periodontal tissues Irom a Iulcrum eIIect on the teeth instead oI the
condyle.
- Split cast to veriIy CR.
- Split cast to veriIy hinge axis using diIIerent VDO`s.
- Train the patient to hinge in upper rearmost position.
- Do not let the teeth touch.
- Scribe a gothic arch on the iig.
- Wax waIer
2. Gothic arch apex relation to dentist assisted CR:
- Many argue that the posterior position oI the mandible locate with Iirm pressure by the thumb
on the mandible may be less variable than the Gothic arch apex and thus be more reliable as a
reIerence position Ior occlusion.
- Myers in 1980 Iound no evidence to support the contention.
3. WoelIel leaI gauge (1986):
- A thin Ilexible waIer is customized. Used with its leaI gauge it helps to guide the mandible
superiorly and posteriorly and to maintain the desired minimum vertical opening.
- The system uses a thin .15-.32 anatomically shaped partially perIorated card laminated on both
sides with .0015 inch Mylar. Each waIer has a combination slot handle Ior holding a new
disposable leaI gauge. The slot tab, when bent down provides the necessary vertical separation
Ior the waIer posteriorly in addition to the amount provided by the leaI gauge. The recording
material oI choice is polyether, next is zinc oxide-eugenol paste.
- The leaI gauge oI minimum incisor separation is necessary to prevent posterior tooth contact
and negate an adaptive closure pattern (engram).The patient will close in the back and hold the
leaI gauge Iirmly. The gauge is centered at a 45 degree posterior upward slope. For centric
registration procedures, the vertical dimension should be opened by the leaI gauge 2-4 leaves
beyond the Iirst premature tooth contact. The leaI gauge assembly is positioned in the mouth and
the dentist guides the mandible until the lower incisor engages the tab on the waIer beneath the
leaI gauge. The paper leaI gauge is narrower and more solid than the plastic leaI gauge and thus
Iorms a better anterior leg oI the tripod with the two condyles on patient guided terminal hinge
closures.
Advantages: economical, anatomically designed, accurate, easy to use, disposable.
4. Ziebert in 1984 described a technique Ior stabilized baseplate interocclusal records Ior
partially edentulous arches with prepared teeth.
- Make an impression oI the prepared teeth.
- Cover the preps with putty on the lingual and incisal to give 1-2 m oI relieI, cover ridges with
Ioil.
- Resin is adapted over the teeth (1-2 mm over the Iacial surIaces oI the anterior teeth) and
ridges.
- Apply adhesive to the ridge areas oI the resin and reline the ridges oI the baseplate on the
working cast.
- Reline the part oI the resin that covers the teeth intraorally with bite registration paste. This will
provide a stable recording base.
- Adiust the occlusal rim to contact the opposing arch evenly at the anticipated VDO.
- Make the vertical and CR record with wax or registration paste on the occlusal surIace oI the
baseplate.
- Protrusive and lateral records can also be made.
5. Christensen described preserving a centric stop Ior interocclusal records particularly when the
distal abutment is the last tooth in the arch. The author relates the working casts at the proper
VDO by using a distal tooth as a vertical stop. Around the selected centric stop, leave an island
oI enamel. Prepare the tooth with the enamel leIt on the cusp tip. Index the island with a 34 bur.
Make Iinal impression. Remove the enamel island.
- Articulate the casts with the island.
- Remove the island Irom the die.
- Fabricate the unit.
IV. Muscle Action and Tissue effects on CR.
1. Lundeen studied the eIIect oI muscle action on CR records in 1974.
- First method involved using manual chin guidance to position the mandible in the terminal
hinge position with both heavy and light contractions oI the muscles to seat the condyles
superiorly.
- Second method employed the Myo-Monitor to stimulate muscle contractions.
- Records were compared using the Buhnergraph.
3 records were compared:
i. Metal reinIorced Aluwax, anterior stop chilled in ice water, posterior soItened at 105 degrees.
Imprints made in soItened wax. This was classiIied as a heavy type oI muscle contraction.
ii. Acrylic resin iig was made, apex oI gothic arch tracing was identiIied. Fiberglass mesh Irame
with ZOE impression paste was used to complete the record. The muscle exertion was Iairly
light.
iii. Resin material was used to record the imprints, while the Myo-Monitor unit stimulated
rhythmic contractions.
- Aluwax showed the greatest number oI superior condylar positions.
- Acrylic iig CR was inIerior to Aluwax by .5 mm on the leIt and .4 mm on the right. These were
the closest to the hinge axis oI the articulator.
- Myo-Monitor were least consistent. They were inIerior to Aluwax 1.75 mm on the leIt and 2.25
mm on the right.
The diIIerences between # 1 and 2 were due to the muscle contraction.
- A technique with heavy contraction seems better. However there is some indication that the
condyles may not remain in their most superior position Iollowing reconstruction. Celenza in
1972 Iound that a small movement space may recur as a result oI tissue changes within the ioint.
This indicates that a physiologic constant may exist between the occlusion and the condyle-to-
Iossa relationship which will re-establish itselI Iollowing the use oI the most superior condylar
position to reconstruct the patient`s occlusion.
- Gibbs pointed out in 1971 that the condyles may not Iunction as pressure bearing ioints in the
healthy dentition and introduced the concept oI a tooth supported ioint. They also suggest that
damage to ioints can Iollow the loss oI posterior teeth, this could indicate that minimum
muscular activity may be more physiologic.
2. Strohaver in 1972 compared articulator mountings made with CR and Myocentric position
records.
- Methods Ior making CR records were selected Ior comparison.
- ForceIul guidance, ZOE paste, Lucia
- ForceIul guidance, wax
- Voluntary retrusion, impression plaster
- ForceIul guidance by dentist, acrylic resin, Stewart iig
- Myo-Monitor, imprint plastic
- Hand articulation
Method 1 was least variable, most posterosuperior.
Hand articulation Ior mounting the mandibular cast was least variable.
Myocentric were the most variable articulator mountings oI the six methods, and produced the
most anteroinIerior (protruded) relationships oI the mandibular cast to the axis oI the articulator.
3. Latta, in 1992 studied the inIluence oI circadian periodicity on reproducibility oI CR records
Ior edentulous patients. Normal changes such as those resulting Irom circadian periodicity, have
been demonstrated to aIIect the Iit oI complete dentures. These same rhythmic changes also
aIIect CR records made Ior edentulous patients. Patients were divided into three groups and the
dentures remounted twice on the same day. Twice in the morning
- Twice in the aIternoon
- Once in the morning and once in the aIternoon.
- Compound was used Ior the record.
The mean change Ior the AM group was .57 mm, PM group was .675 mm, and Ior the AM-PM
group .932 mm.
The circadian periodicity signiIicantly aIIected CR records, suggesting that the denture
Iabrication process should include procedures to accommodate this phenomenon. Treating
patients in the middle oI the day will dilute the eIIect oI circadian variations but is impractical.
Providing occlusal Ireedom is a possible solution.
- Abstracts -
11-001. Millstein. P.L. Determination of the accuracy of wax interocclusal registration. Part
II. 1 Prosthet Dent 29: 40-45. 1973.
Purpose: To study the eIIects oI initial heating temperature, initial closing pressure, storage
environment, and storage time on the accuracy oI recordings made with single and double
thickness samples oI pink baseplate wax.
Methods & Materials: Two diIIerent brands oI pink baseplate wax were tested, S.S. White no. 9
and Hygienic extra-tough baseplate wax. One thousand two hundred samples were Iabricated on
upper and lower dentulous casts. The Iollowing Iactors were varied throughout the experiment:
1. Thickness, 2. Initial heating temperature, 121, 126, and 132 F, 3. Closing pressure, 102, 136,
and 172 psi, 4. Storage environment, cold water, room temperature water and air, 5. Storage time
and 6. Seating pressure. Both rotational and vertical displacement was measured.
Results: Complete closure was never achieved regardless oI the pressures used. The higher the
closing pressure the less vertical displacement. Double thickness wax yielded a greater
displacement than single thickness wax when lower pressures were used. Storage in water led to
greater rotational displacement. S.S. white wax No. 9 oIIered less resistance to closure than
Hygienic wax. The eIIects oI varying storage times were inconsistent.
Conclusions: Exact reproduction oI the original wax registration was never achieved. The use oI
pink baseplate wax as an interocclusal registration will always result in some error.
11-002. Roraff. A.R.. and Stansberry. B.E.. Errors caused by dimensional change in
mounting material. 1 Prosthet Dent 28:247-252. 1972.
Purpose: To investigate the eIIect oI dimensional change oI gypsum mounting materials on the
accuracy oI articulated casts.
Methods and materials: A dental articulator was modiIied by adding custom mounting plates
with a dial micrometer Iixed to the lower plate. Mounting materials tested were Velmix (vacuum
mixed), yellow stone (vacuum mixed), impression plaster (hand mixed), yellow stone and 80cc
slurry water, (hand mixed), laboratory plaster (hand mixed), yellow stone (hand mixed), and
yellow stone and 70cc slurry water (hand mixed). A thickness oI 37.5 mm oI material was used.
Ten samples oI each oI the seven combinations oI materials were measured.
Results: The mean linear expansion measured varied Irom 0.0056 inch with impression plaster to
0.0017 inch using 80cc thick empirical slurry. Expressed as a percentage, this ranged Irom
0.11° to 0.38°.
Conclusion: Compared to the thickness oI 0.0005 inch shim stock, the expansion could be
critical. It is suggested by Kingery and Brewer that a two step procedure Ior articulation be
utilized: Iirst, by initially leaving a small thin space between the cast and mounting material, then
by Iilling the space with a second mix aIter the Iirst mix has set. The reduced quantity oI material
will not produce as much change in the relationship between the casts as a larger amount oI
material would.
11-003. Lucia. V. O. A technique for recording centric relation. 1 Prosthet Dent 14:492-505.
1964.
Problem: The mechanical procedures necessary to relate the mandible to the maxillae present the
problem. There is not a single ideal material that we can place between the teeth that would
allow the patient to close in a perIect terminal hinge position. This is especially true in patients
with strong engrams.
Purpose: To present a technique Ior recording centric relation.
Materials & Method: Critical steps in the technique are described.
1. Locate the centers oI rotation, (a) hinge axis, and (b) centers oI lateral rotation.
2. Prepare the upper cast Ior the split-cast technique.
3. Relate the prepared upper cast to the centers oI rotation by means oI a Iacebow transIer.
4. Form the wax waIer tray.
5. Construct and adiust the centric relation iig in order to interrupt the reIlex action oI the
muscles and permit a normal closure oI the iaws.
6. Check the waIer and iig to make sure there is no tooth impingement against the wax waIer.
7. Make the interocclusal centric relation records.
8. Trim the interocclusal records with a curved tissue shears having serrations on one blade.
9. Replace the records in the mouth to eliminate any possible distortion oI them.
10. Relate the lower cast to the upper cast by means oI the interocclusal record and attach the
cast to the articulator.
11. Check the accuracy oI the mounting by using the second and third interocclusal records and
observing the Iit oI the parts oI the split cast.
Conclusion: This method has enabled us to consistently and accurately check one centric relation
record against another. The important diIIerence between this procedure and others where
anterior stops have been used is that the adiustment oI the DuraLay iig is responsible Ior training
the patient to place his mandible in the centric relation. No special skill is required to carry out
the procedure, and it can be accomplished by any dentist.
11-004. A Study of Interocclusal Record Materials. Mullick. SC et al. 1 Prosthet Dent
46:304-307. 1981.
Purpose: To determine the vertical assembly error in articulating dentulous casts on an articulator
as aIIected by three parameters (materials, the distance between the prepared and opposing teeth,
and operator variability)
Materials and Methods: Alginate impressions Irom a patient having a complete dentition were
poured in stone and articulated to an articulator using a Iacebow and mounting rings. Full crown
preparations were simulated on all posterior teeth except the upper leIt dental arch. The
articulator, used Ior making the interocclusal registration, eliminated patient variability. The
materials used were Super Bite, Aluwax, Input (silicone putty), ColtoIlax silicone putty, Reprosil
(silicone putty), Flexane silicone putty, and Ramitec (a polyether)
For all materials, the Iirst measurements were made with the articulator closed beIore removal
oI the record. The upper member oI the articulator was disassembled, the interocclusal records
were trimmed, and the articulator base with the lower cast and assembly was returned to the
measuring stand Ior second measurements.
Three operators repeated the tests (10 times) Ior every material on both the right and leIt
sides. Two operators were experienced dentists and one was a dental student.
Results and Discussion: The diIIerence between the Iirst and second readings, were errors that
were due to material or operator variability,.
Aluwax (extremely open to closed relationships oI the mounted casts)
Super Bite (extreme variability)
Elastomerics (easy to manipulate, little resistance to closure, accurate cast reproduction)
Both the Aluwax and the Super Bite were disqualiIied by Cochran`s Test Irom
the ANOVA due to extreme variabilities.
Conclusions: Aluwax was the most variable and least reliable oI all materials.
Super Bite consistently resulted in open cast relationships. The Iive elastomers resulted in the
least amount oI errors. The two diIIerent thicknesses oI elastomeric records resulted in
statistically signiIicant mounting discrepancies. The overall average showed that the
inexperienced student perIormed as well as the two experienced dentists.
11-005. Lundeen. H.C. Centric relation records: The effect of muscle action. 1 Prosthet
Dent 31:244-251. 1974.
Purpose: To compare condylar positions obtained by two methods oI making interocclusal
centric relations records.
Methods & Materials: Stone casts were Iabricated Ior 8 dentate adults. Hinge-axis points were
located and a hinge-axis Iacebow used to transIer records to Whip-mix articulator. The mand.
cast was articulated with a CR record. The condylar posts oI the mandibular Irame oI the
articulator were replaced with a bar containing two pointer rods ( Buhnegraph). The pointed rods
were collinear with the opening and closing axis dimples on the sides oI the condylar housings
and opposed graph paper on the outer surIace oI the condylar housing oI the articulator. The axis
point oI the articulator was used as the basic reIerence position Irom which to orient and
compare the three types oI interocclusal records. The Iirst method was the manual chin guidance.
It was keyed by an anterior stop (wax or acrylic). Heavy (Aluwax/record "A") and light (acrylic
resin iig-ZOE/record "B") muscle contractions were used to seat the condyles superiorly, while
Iorming imprints oI the posterior teeth in keyed records. The second method electrically
stimulated muscle contractions using Myo-Monitor (record "C") and a resin recording medium
between the opposing occlusal surIaces oI the teeth. The tips oI the pointer rods were marked on
the graph paper with the record supported casts. Photographic enlargement was used to study the
various recorded average condylar positions.
Results:
the "A" records showed the greatest number oI superior condylar positions.
The "B" records were located inIeriorly to "A".
The "C" records were the least consistent.
The "B" records were closest to the hinge axis oI the articulator.
The diIIerence between the condylar positions obtained with the "A" and the "B" records are
explained in terms oI the magnitude oI muscle contraction: ZOE requires several minutes to
harden and it id diIIicult Ior the patient to maintain heavy muscle contraction throughout. II the
treatment obiective is to develop a new occlusal relationship to coincide with the most retruded
and superior condylar position a centric relation technique employing heavy muscle contraction
will be helpIul
Conclusion: The Buhnegrph device was shown to be an excellent method Ior comparing
condylar positions obtained Irom various types oI interocclusal records.
11-006a and b. Kantor. ME. Silverman. SI. and Garfinkel. L. Centric relation recording
techniques. A comparative investigation. 1 Prosthet Dent 28:593-600. 1972. 1 Prosthet Dent
30:604-606. 1973.
Purpose: To investigate the variability oI centric iaw relation records obtained utilizing diIIerent
clinically acceptable techniques that are currently (1972) in use.
Discussion: (technique evaluation)
Swallowing or Iree closure: Advocated by Shanahan. A preIormed wax waIer was held in
position against the maxillary teeth and the patient was instructed to "swallow and hold." Manual
guidance was totally avoided. There was no contact between the dentist and the patient.
Chin-point guidance: Described by McCollum. Also advocated by KornIeld, Thompson, Aull,
and Sloan.
Chin-point guidance with anterior iig: Described by Lucia. He Ielt an inclined plane attached
to the maxillary incisors would help to Iully seat the condyles in their Iossa and aid in record
making. The anterior iig was made to separate the teeth minimally and , iI possible, to erase the
proprioceptive patterns oI habitual tooth contact.
Bilateral manipulation: Used by those who adhere to the Iunctionally generated path
technique. They emphasized the placement oI the condyles in a superior position. The technique
employs a speciIic superior guidance to the mandible by the dentist Iingers. At the same time, the
dentist applies downward pressure with his thumbs, thereby attempting to seat the condyles in
their most superior position. Little eIIort is made to gain a posterior placement. An attempt is
made to obtain an arcing motion oI the mandible in its most superior position.
Myomonitor: A technique which uses electrodes to provide impulses to the 5
th
cranial nerve,
as well as to the mandibular division oI the 4
th
cranial nerve.
Materials and Methods: FiIteen subiects with complete dentitions and minimal dental
restorations were selected Ior the study. Ages Irom 21 to 45. 12 men and 3 women. No patients
had a removable prosthesis. Twenty-Iour centric relation records were made Ior each patient. Six
record oI each oI the above techniques. Additional records were made using the myomonitor and
evaluated. All records used a wax waIer with a metallic-oxide paste. Cast were made oI each
patient and articulated with a Iace bow record. Attached to the upper member was a Iixed scribe
which when lowered recorded a speciIic point on an interchangeable plate. The interchangeable
plate would be transIerred to a microscope and evaluation oI the mark in an x and y axis was
located at 25x. The six dots were ioined to give an indication oI the degree to which that speciIic
guidance system was replicable and consistent with the others.
Results: The results are expressed as a median variability Ior the amount the records deviated
Irom their mean point. Swallowing records deviated 0.40mm. Chin-point guidance records
deviated 0.14mm. Chin-point guidance with anterior iig records deviated 0.07mm. Bilateral
manipulation records deviated 0.05mm. The myomonitor produced a variability oI 0.38mm.
Conclusion: Bilateral manipulation produced the smallest area oI displacement oI
maxillomandibular relation records when compared to the other techniques tested. The most
protrusive records were made with the Iree-closure or myomonitor technique. The most retrusive
records were made with the chin-point guidance with an anterior iig
11-007. Kapur. K.K. and Yurkstas. A.A.. An evaluation of centric relation records obtained
by various techniques. 1 Prosthet Dent 7:770-785. 1957.
Purpose: To examine various available methods oI recording centric relation.
Subiect: Although several techniques are mentioned in the article, three are speciIically
evaluated Ior comparison purposes: 1) the intraoral tracing procedure (Hardy), 2) the wax
registration procedure (Hanau), and 3) the extraoral tracing procedure (Stansbery)
Methods and materials: A total oI 31 patients were utilized. Three interocclusal records were
made Ior each patient. Ridges were categorized as Ilat, well developed, or Ilabby. Registrations
were compared on a recording tripod and variations were recorded on millimeter graph paper.
Results: The intraoral tracing procedure produced the most consistent results. There was no
statistically signiIicant diIIerence between the intraoral and extraoral tracing methods. The wax
method seemed to be the least consistent. In patients with Ilabby ridges, the tracing procedures
became less consistent as compared to good and Ilat ridges. The wax method showed the most
consistency on Ilabby ridges.
Conclusion: The mean deviation in millimeters oI all three methods approached 0.2-0.4mm. This
amount in the case oI an edentulous patient is barely perceptible clinically.
11-008. Myers. M. L. Centric relation records - historical review. 1 Prosthet Dent 47:141-
145. 1982.
Problem: Many prosthodontists Ieel that recording centric relation is the most diIIicult, yet the
most important step in treating edentulous patients with complete dentures.
Purpose: To review the philosophies and methods oI recording centric relation.
Materials and Methods: Historical review.
Discussion: Centric relation is generally deIined as the most retruded relation oI the mandible to
the maxillae when the condyles are in their most posterior unstrained position in the glenoid
Iossa Irom which lateral movements can be made, at any given degree oI iaw separation. There
are Iour categories oI centric relation records: direct checkbite recordings, graphic recordings
(intraoral and extraoral), Iunctional recordings, and cephalometrics.
Direct Checkbite Interocclusal Recordings
Phillip PIaII (1756): Iirst to describe the imprecise "taking the bite" in wax. Also called mush,
squash, biscuit bite.
Christensen (1905): used impression wax.
Greene (1910): mushbite oI compound and plaster wash. Occlusal rims added later Ior stability.
Had patients hold mouth open 10 seconds to Iatigue muscles. Invented the "Pressometer".
Brown (1954): recommended repeated closures into soItened wax.
Trapozzano: wax checkbite was the technique oI choice Ior recording CR. Light pressure.
Schuyler: modeling compound was preIerable because it soItened more evenly, cools slower and
does not distort as much as wax. Light pressure. VeriIication oI records.
Payne, Hickey, and Boos: plaster is more accurate, less material needed, less pressure.
Hanau: RealeII ÷ resilient and like eIIect. Concern Ior equalization oI pressure when recording
the bite.
Wright: oI the Iour Iactors, resiliency oI tissue, saliva Iilm, Iit oI bases, and pressure, the dentist
cannot control pressure. He thereIore advocated zero pressure
Gysi: plaster is the only accurate material.
Page: centric records were worthless the instant the surIaces are altered.
Graphic Recordings
Balkwill (1866): Gothic arch tracing. Hesse (1897): "needle point tracing". Gysi (1910):
extraoral incisal tracer on maxillary rim traced onto the tracing plate attached to the mandibular
rim.
Phillips developed a plate Ior the upper rim and a tripoded ballbearing mounted on a iackscrew
Ior the lower rim. The occlusal rims were removed and soItened compound was inserted between
the trial bases. This innovation was called the "central bearing point" which supposedly produced
equalization oI pressure on the edentulous ridge.
Stansbery (1929) used a curved plate corresponding to Monson`s curve mounted on the upper
rim. A central bearing screw was attached to a lower plate with a reverse-Monson curve. Plaster
was used to Iorm the centric registration.
Hall (1929) used the Stansbery`s technique but substituted compound Ior the centric relation
record.
Hardy and Pleasure the intraoral tracer called the Coble Balancer.
Robinson designed the Equilibrator with a hydraulic system and Iour bearing pistons.
Silverman used the intraoral Gothic arch tracer to locate the biting point oI a patient.
Hanau conceded that Gysi tracing was satisIactory to check records, but that universal usage was
not good. Tench stated that the Gysi tracing technique was the only means oI recording CR. (5-
degree error vs. 25-degree error oI wax and compound).
Criticism oI Gothic arch tracings: equal pressure unattainable, shiIting bases, diIIicult to see, too
much patient cooperation needed, sore spots cause eccentric tracings.
Functional Recordings
Greene (1910) Wax occlusal rims and plaster index.
Boos used the Gnathodynamometer to determine the vertical and horizontal position at which a
maximum biting Iorce could be produced. His Bimeter was mounted on the lower occlusion rim
with a central bearing point against a plate on the upper occlusion rim. Plaster registrations were
made.
Shanahan placed cones oI soIt wax on the mandibular rim and had the patient swallow several
times to record centric relation.
Cephalometrics
Pyott and SchaeIIer used cephalometric radiographs to record CR and VDO.
This method never gained widespread usage.
Conclusion: In the Iinal analysis the skill oI the dentist and the cooperation oI the patient are
probably the most important Iactors in securing an accurate centric relation record.
11-009. Fattore. L. et al. Clinical evaluation of the accuracy of interocclusal recording
materials. 1 Prosthet Dent 51: 152-157. 1984.
Purpose: To determine the clinical accuracy oI waxes, zinc oxide-eugenol, and polyether dental
materials Ior recording interarch dental relationships.
Materials and Methods: The study utilized thirty-one patients (25-30 years old) with a Iull
complement oI teeth. There were 17 women and 14 men, the criteria included also sparse
restorative treatment and adequate occlusal stops, both posterior and anterior.
Irreversible hydrocolloid impressions were made per arch and poured in stone. An arbitrary
Iacebow was used, articulated to a Whip Mix articulator. The lower cast was hand articulated to
the upper cast in centric occlusion.
Five types oI interocclusal records were made oI each patient, (1) baseplate wax (two
thicknesses) (2) reinIorced wax - Copruwax (3) ZOE paste - Kerr bite registration paste (4)
modiIied, nonrigid polyether recording medium - Ramitec with a carrier (Coe Bite registration
tray (5) polyether without a carrier.
All measurement oI the Iour recording mediums, were compared with that oI the hand articulated
Iull arch models in centric occlusion.
The position oI the hand-articulated mandibular casts with the maxillary casts were recorded on
graph paper (using a Buhnergraph attachment that replaced the condylar spheres). This process
was repeated when the interocclusal record was placed between the two casts. Measurements oI
the right and leIt condyles were recorded Ior each interocclusal record. Any measurements that
deviated Irom the pre-established centric occlusion position in a vertical. anteroposterior, and
declination-rotation direction were noted. The Buehnergraph could not accurately determine
lateral movement.
Results and Discussion: When waxes were compared with other recording mediums they were
inIerior, but still are popular due to cost and ease oI manipulation.
ZOE paste is reliable , but it dehydrates, cracks and tends to stick to teeth. (only a minimal
amount oI ZOE paste is advised)
Polyether is an accurate interocclusal material. However, iI improper technique is used, there is a
"spring" to this material than can cause an error, ie. the casts to "open" in centric occlusion.
Polyether should also be used sparingly avoid excess inaccuracies.
Conclusions: The most accurate interocclusal recording medium was the polyether without a
carrier. Next were the polyether and ZOE pastes with carriers, but this required a very
disciplined technique. Recording waxes were consistently unreliable.
Distortion occurred more Irequently in a vertical direction, Iollowed by an anteroposterior
position
11-010. Myers. M.. Dziejma. R. and Goldberg. 1. Relation of Gothic Arch Apex to Dentist-
Assisted Centric Relation. 1 Prosthet Dent 44:78-81. 1980.
Purpose: To compare centric relation position utilizing a gothic arch tracing and a patient
unassisted recording versus a dentist-assisted recording.
Methods & Materials: Twenty-two subiects between the ages oI 20-30 had clutches Iabricated to
produce a gothic arch tracing at a speciIic vertical dimension oI occlusion Ior each subiect.
Subiects were seated in a dental chair to orient FrankIort horizontal plane parallel to the Iloor.
Three investigators measured recordings independently. Each subiect had consecutive gothic
arch tracings done on the Iirst and seventh days. The unassisted recording was done Iirst, and
measurements were completed. The clutch plate was painted over with draItsmen Iluid, the
clutches were placed in the patient`s mouth, and the dentist-assisted the iaw movement
posteriorly with thumb and IoreIinger on the patient`s iaw.
Results: The dentist-assisted position was posterior to the unassisted position in 9 oI 22 subiects
on the Iirst day and the seventh day. Out oI the 9, only 4 subiects showed the dentist-assisted
position posterior to the unassisted position on both days. The dentist position varied Irom the
Iirst to the seventh day in 20 out oI 22 subiects. The unassisted position varied in all 22 patients.
Results showed no statistically signiIicant diIIerence in the reliability oI one method over
another.
Conclusion: No evidence to support the contention that the dentist-assisted iaw relation is more
reproducible than the gothic arch apex tracing.
11-011. Strohaver. R. A Comparison of articulator mountings made with centric relations
and myocentric position records. 1 Prosthet Dent 28: 379-390. 1972.
Purpose: 1) To determine the precision oI mandibular cast mountings made by several dentists
utilizing Iour diIIerent techniques, 2) to determine whether consistent articulator mountings oI a
mandibular cast could be made using a myocentric position records using a Jenkelson
myomonitor, 3) to evaluate the precision by which mandibular cast mountings could be made
using the hand articulated maximum intercuspation method, 4) to compare the relative
reproducibility oI the iaw relationships produced on the articulator by each oI these six methods.
Materials and Methods: A single subiect with healthy dentitions and a healthy masticatory
system was used Ior the entire study. The subiect`s hinge axis was located by using the Stuart
head Irame and reIerence plate assembly kit. An accurate set oI impressions were made and casts
were poured up in die stone. Holes were drilled into the cast and nine stainless steel rods were
inserted as reIerence points Ior measuring. The rods were positioned so that when the casts were
mounted the ends oI the rods would Iorm triangles in the Irontal plane and the right and leIt
sagittal planes. Five triangles were Iormed by the rods with each other and with the hinge axis on
the articulator using this method. The maxillary cast was mounted to a Hanau OSU model 130-
28 articulator by means oI a kinematic Iacebow transIer. Four centric relation recording methods
were used Ior relating the mandibular cast to the mounted maxillary cast. The Iirst method
(method Z) used a zinc oxide and eugenol paste as the recording material and also involved the
use oI a Lucia iig Ior use as an anterior deprogrammer. The second method (method W) used
Aluwax reinIorced with Ash`s metal. The Aluwax record used an anterior stop also made in
Aluwax to prevent contact oI teeth. The third method (method P) involved the use oI impression
plaster as the recording material and no IorceIul guidance oI the mandible is used. Instead the
patient is asked to pull his lower iaw back as Iar as he can and close into the recording material.
The Iourth method (method A) uses acrylic resin as the recording medium and the end oI a
tongue blade or Popsicle stick is inserted between the incisors as the subiect closes into the
recording material and the dentist pries slightly downward and backward to encourage posterior
closing. Method M is the myocentric position which is made using the Jankelson myomonitor.
Recording material is imprint plastic. The last method (method O) is hand articulation oI the cast
into maximum intercuspation. Method O was basically a control group Ior this study. Three
guests (Dr. HuIIman, Dr. Boucher, and Dr. Stuart) were invited to make a series oI three records
by each oI the methods oI centric relation records using these methods described and an
additional series oI three records using their preIerred method: method Z Ior Dr HuIIman,
method P Ior Dr Boucher and method A Ior Dr Stuart. Casts were mounted and measurements
were made.
Results: Method Z produced the least variability in the mountings made. Method Z also
produced the most posterior-superior relationship oI the mandibular cast to the hinge axis. The
least variable oI all methods Ior mounting casts was method O. Myocentric (method M)
produced the most variability oI all mountings. Method M also produced the most anterior-
inIerior relationship oI the mandibular cast to the hinge axis.
Conclusion: the most retruded articulator mountings were also the most precise in this study.
This retrusion involved IorceIul manipulation by the dentist.
11-012. Gysi. A.. DDS. Practical Application of Research Results in Denture Construction.
1ADA 16. pp.199-223. 1929.
II we are given the rotation points Ior the right and leIt lateral bites and the protrusive
movement, we can determine by purely scientiIic methods(without sharks teeth), the size and
inclination oI each Iacet oI each tooth.
What determines interdentation? The exact interdentation oI the bicuspids and molars during the
masticatory movements is determined by the movements oI the three main points oI the
mandible, that is, the two condyles and the incisor point. Movements toward the right and leIt,
when traced by the mandible on a recording plate, Iorms the gothic arch.
In the edentulous patient, the inclination oI the incising or protrusive movement is entirely
lost, whereas all other movements still exist as iI natural teeth were present. We can vary this lost
inclination at will on the articulator.
Any alteration oI the height oI the bite is a chair operation and not a laboratory operation. II
the height oI the bite is to be changed, it is better to do it at the chair, then to detach one cast
Irom its support and reattach it in a new position, than to seek to change the bite by lengthening
the incisor pin or by any other similar method.
m Relative importance oI the movements:
- The record oI the lateral movements oI the mandibular incisor point is the most important oI all
records oI movements and the sagittal inclination oI the condyle path is the next most important.
It is suIIicient iI the articulator reproduces an average lateral condyle path oI about 15 degrees.
- We need not register the working movement oI either condyle, because, in the horizontal plane,
this is controlled by the balancing movement oI the opposing condyle and the lateral movement
oI the incisor point.
Four methods oI adapting the articulator:
plastic material
plaster
extra-oral graphic method (with Iace-bow)
intra-oral dentographic method (aIter Luce)
Plastic material, wax or compound, led to great error. Compound cooled more rapidly where
it was thin than where it was thick, and made unequal pressure on the bite rims.
An error oI 25 degrees may be made.
Plaster material as a checkbite method is practicable.
The extra-oral method registers both the gothic arch and the sagittal condyle path inclinations.
When the registering point is in the angle oI the gothic arch, the mandible is in centric relation to
the maxilla Ior this height oI bite. This is considered the most reliable method oI establishing
centric relation.
The included angle oI 120 degrees is the average. II the gothic arch is registered Iarther Irom
the incisor point, the included angle will be greater. As intercondylar distance increases, the
gothic arch angle gets smaller. The tracing will control the lateral movements oI the incisor
point, it will locate the axes Ior the lateral movements oI the denture in approximately identical
positions with the axes established by the natural dentition. AIter centric relation, this is perhaps
the most important adiustment in denture construction.
A gothic arch oI 100 degrees requires the Iormation oI relatively steep Iacets on the teeth.
120 degrees requires Iacets with average inclinations.
140 degrees requires Iacets with less than average inclinations.
An error oI 5 degrees may be made with this method.
Condyle path in relation to the occlusal plane varies Irom 0 to 50 degrees. In most cases it is
about 30 degrees.
Bennett angle oI 0, 12, and 24 degrees do not diIIer in the least in their cusp angulations. The
errors that might result Irom diIIerences in the inclination oI this movement are smaller than the
unavoidable errors made during impression making and bite taking, setting up the teeth and the
Ilasking and vulcanizing process. ThereIore, we need not trouble ourselves, provided the
articulator allows an average angle oI 15 degrees.
The gothic arch variation, on the one side, is Irom about 50-70 degrees, a range oI 20 degrees,
while the condyle path may vary Irom 0-50 degrees.
The lateral movements oI the incisor point are more important than are the lateral movements
oI the condyles, because they can be more accurately recorded and are more eIIective in
adiusting the articulator. It is desirable that the articulator resemble the mandible in having
lateral variability at the incisor point. The lateral variability at the condyles is not important.
Errors in the lateral incisor path are important than errors in the lateral condyle path. Second
molars are about halI-way between the incisor point and the condyles, so that practically all oI
the teeth lie in the halI oI the mandible adiacent to the incisor point and are strongly inIluenced
by its lateral movements, while the condyles are so Iar away that they inIluence the lateral
movements oI the teeth little, and control by the incisor point renders that slight inIluence wholly
negative.
The importance oI mounting casts correctly:
The distance above or below the occlusal plane is less important than the distance Irom the
intercondylar axis. To Iar Iorward will decrease the cusp height. To Iar backward will increase
the cusp height. II the condyle path and incisor path are identical, it makes no diIIerence where
the casts are mounted, high, low, Iront or back.
We should not depart greatly Irom the sagittal inclination oI the patient`s condyle path in the
articulator iI we desire good articulation. We must establish a much Ilatter sagittal inclination oI
the incisor path than the patient had with his natural teeth. There will be a wide divergence
between these two path inclinations, and this necessitates the use oI a Iace-bow.
11-013. Latta GH 1r.. Influence of circadian periodicity on reproducibility of centric
relation records for edentulous patients. 1 Prosthet Dent 1992 Nov;68(5):780-3.
Purpose: To evaluate the eIIect oI circadian periodicity on the reproducibility oI centric relation
records Ior edentulous patients.
Materials and Methods: Complete dentures were made Ior 30 edentulous patients. The patients
were divided into three groups and the dentures were remounted twice on the same day in a
Denar Vericheck instrument.
Discussion: The dentures Ior 10 patients were remounted twice in the morning (AM group), Ior
10 patients twice in the aIternoon (PM group), and Ior 10 patients once in the morning and again
in the aIternoon (AM-PM group). Changes in position between the interocclusal records were
measured on both the right and leIt horizontal X and Y axes and the sagittal Y and Z axes.
Results: No signiIicant changes were noted when horizontal versus sagittal or right versus leIt
positions were compared, but signiIicant changes were noted between the AM versus AM-PM
time groups, and between the PM versus AM-PM time groups. The mean variability Ior the AM
group was .577 mm, Ior the PM group was .675mm and Ior the AM/PM was .932mm.
Conclusions: Circadian physiologic changes can have an eIIect on the Iit oI complete dentures
and on the occlusion oI complete dentures. The author suggests Iabricating complete dentures
during the middle oI the day could help by averaging out theses circadian eIIects. It may not be
practical, so another solution may be to include additional occlusal Ireedom to accommodate Ior
this circadian change.
11-014. Hobo. S. Reproducibility Of Mandibular Centricity In Three Dimensions. 1
Prosthet Dent 53: 649-654. 1985.
Purpose: To evaluate diIIerent techniques oI condylar positioning and record the amount oI
displacement oI the condyle in three dimensions with a newly developed electronic mandibular
recording system.
Methods & Materials: Ten adults with complete dentitions and minimal restorations and no
history on TMD were selected as participants. A system Ior measuring the 3 dimensions oI
mandibular movement consisted oI 3 dimensional optical sensors, a point light source, stainless
steel upper and lower clutches, and altitude meter, and a microcomputer. The centric recording
techniques used in this study were: 1. Unguided closure, 2. Chin-pointed guidance, and 3.
Bilateral manipulation.
At least three measurements were produced with each technique, Ior a total oI nine readings
Ior each subiect, and perIormed by one dentist.
Results: The bilateral manipulation technique produced the most consistent data. There were
statistical diIIerences between chin-point guidance and unguided closure and bilateral
manipulation.
Conclusions: Approximately 0.2 to 0.3 mm oI maximum condylar displacement was recorded by
three centric relation record techniques. Bilateral manipulation showed the most consistent
reproducibility and is recommended Ior centric relation records. Condylar position obtained by
bilateral manipulation and unguided closure technique were similar anteroposteriorly and
superoinIeriorly . Unguided closure revealed appreciable lateral displacement, which indicates
that muscular position is less reproducible laterally, and condylar displacement can be expected.
Chin-point guidance placed the condyle posteriorly, inIeriorly, and right-laterally and is not
recommended.
11-015. Woelfel. 1. B. New Device for Accurately Recording Centric Relation. 1 Prosthet
Dent 56:716-727. 1986.
Purpose: To describe a new technique using the O. S. U. WoelIel LeaI WaIer.
Methods & Materials: Centric relation is recorded using a thin, Ilexible perIorated waIer with a
thin mylar coating on both sides. A leaI gauge is used to provide minimum incisor separation
necessary to prevent posterior tooth contact (to prevent an adaptive closure pattern or engram).
An interocclusal recording material such as ZOE is placed on both sides oI the waIer and the
patient closes unassisted into CR position. The material can be trimmed and veriIied intraorally.
The record should be used within 15 minutes to prevent dimensional changes with the recording
material.
Results: Advantages oI a leaI gauge include: patient unassisted closure in CR, periodontal
ligament proprioception is eliminated, and potentially negates patient`s engrams.
Conclusion: Method is quick and easy Ior the patient and multiple records can be made. May be
a concern that the recording is made with patient`s head tipped back and the leaI gauge is not a
Ilat plane Ior the incisors to occlude against. Potential that the record obtained is not a superior
anterior position.
11-016. Alexander. S. R.. et al. Mandibular Condyle Position: A Comparison of Articulator
Mountings and Magnetic Resonance Imaging. Am 1 Orthod Dentofacial Orthop 104:230-
239. 1993.
Purpose: Compared commonly used articulating mounting techniques and Magnetic Resonance
Imaging (MRI)
Methods & Materials: Twenty-eight men, 22-35years old with Class I occlusions and no history
oI TMD dysIunction. Records taken were: Manipulated Retruded position (RE), leaI gauge-
generated Centric Relation (CR), Centric occlusion (CO), and MRI evaluated iaw positions and
anatomic relationships. The mandibular position indicator oI the SAM articulator was used to
determine reproducibility oI CR.
Results: The articulator analysis oI CO and CR is statistically replicable. Condylar concentricity
was observed in halI oI the sample and remained consistent in RE, CO, and CR. OI the sample
13° demonstrated anteriorly displaced disks that were not inIluenced by posterior condyle
placement. The clinical concept oI treating to CR as a preventive measure to improve disk-to-
condyle relationships was not supported by this study.
Conclusion: The data did not support distinct condylar positions Ior RE and CR and do not
suggest CO and CR are coincident. MPI data Iailed to correlate statistically with MRI data
possibly due to lack oI sharp demarcation oI cortical bone on the MRI reducing the accuracy oI
measurements. The premise that the leaI gauge established CR may not be accurate.
11-017. Ziebert. G 1 and Balthazart-Hart. Y. Stabilized base plate technique for
interocclusal records. 1 Prosthet Dent 52: 606-608. 1984.
Purpose: To present a technique oI recording centric and eccentric iaw registrations that can be
accurately transIerred to the working cast.
Materials and methods: The technique described was used Ior recording accurate
maxillomandibular iaw relations intraorally at the predetermined VDO with the Iew remaining
teeth oI partially edentulous arches prepared. The materials and methods used were similar to a
record base technique oI recording VDO on partially dentate arches but with Iew minor
modiIications.
Conclusion: The technique provides Ior accurately recording maxillomandibular relation when
there are Iew teeth and interach stabilization is diIIicult to achieve.
11-018. Christensen. L.C.. Preserving a centric stop for interocclusal records. 1 Prosthet
Dent 50:558-560. 1983.
Purpose: A technique article describing a method oI preserving existing centric stops to relate
working casts Ior a Iixed partial denture
Subiect: A single patient presentation is made where the patient has the distal abutment Ior a
Iixed partial denture as the last tooth in the dental arch.
Methods and materials: Preoperatively, centric stop(s) are marked with articulating paper. Index
grooves are cut around the selected centric stop to leave an "island` oI enamel. Prepare the
remainder oI the tooth, indexing this island at the desired depth oI preparation with an inverted
cone bur. Make the Iinal impression. Remove the enamel island, and deliver the provisional
restoration. Articulate the master cast, then remove the "island" Irom the die. Fabricate the
restoration in an appropriate conventional manner.
Results: The patient`s centric stop is used as a guide to relate the working casts.
Conclusion: The technique reduces the possibility oI dimensional changes and inaccurate cast
relationships oIten observed with conventional materials.
11-019. Balthazar-Hart. Y. et al. Accuracy and dimensional stability of four interocclusal
recording materials. 1 Prosthet Dent 45:586-591. 1981.
Problem: Few studies have been made on Iour materials used to record maxillomandibular
relationships.
Purpose: To examine the accuracy and dimensional stability oI zinc oxide-eugenol paste,
eugenol Iree zinc oxide paste, silicone elastomer, and polyether elastomer in a controlled
laboratory environment.
Material and Methods: 5 samples oI each material were studied. AIter mixing, the material was
carried to a TeIlon die. The die was inverted onto a 2 x 2 inch square glass plate and covered
with a polyethylene sheet. Hand pressure was applied Ior 5 seconds to express material. The die
was submerged in a 32-degree water bath to simulate open mouth conditions. The dies and
materials were separated and the 2 parallel line markers were measured at six diIIerent times.
Results: The eugenol Iree-zinc oxide paste exhibited dimensional stability Ior the 168- hour
period. Each batch oI the polyether, silicone, and zinc oxide-eugenol paste exhibited a statistical
diIIerence between the die and its respective sample. Polyether was the second most accurate and
stable material. 0.3° shrinkage aIter 24 hours. Zinc oxide-eugenol paste was the least accurate
oI the materials tested. Silicone putty is not recommended due to initial inaccuracy and because
its rate oI contraction precludes storage oI the registration.
Conclusion: The eugenol Iree zinc-oxide paste is the most accurate. The remaining three
materials had a statistical diIIerence between the die and the respective samples.
Section 12: Vertical Dimension
(Handout)
1. DeIinitions
A. DeIinition oI Vertical Dimension Rest: The vertical dimension with the iaws in rest relation.
Rest relation is the habitual postural position oI the mandible to the maxillae when the patient is
resting comIortably in the upright position and the condyles are in a neutral unstrained position
in the glenoid Iossa, with minimum tonic contraction oI the mandibular musculature to maintain
posture.
B. Vertical dimension oI occlusion: The vertical dimension oI the Iace when the teeth on
occlusal rims are in contact in centric relation. GPT-6: The distance measured between two
points when occluding members are in contact
C. Interocclusal distance: The distance between the occluding surIaces oI the maxillary and
mandibular teeth when the mandible is in its physiologic rest position. This can be determined by
calculating the diIIerence between the rest vertical dimension and the occlusal vertical
dimension.
D. Speaking space: The interocclusal space which exists between the posterior teeth when the
patient is enunciating $ sounds. It is not related to the interocclusal space oI rest position. It
represents the diIIerence between the vertical dimension oI occlusion and the clearance between
the teeth when $ sounds are spoken.
Other terms: Closest speaking space, Physiologic rest position, Interocclusal rest space.
2. Historical review
a. Hunter 1771: Stated that "In the lower iaw, as in all the ioints in the body, when motion is
carried to its greatest extent, in any direction, the muscles and ligaments are strained and the
persons are made uneasy." Hunter also Ielt that the ioints naturally Iall when we sleep and the
middle extremes oI motion suggests that the muscles and ligaments are equally relaxed.
ThereIore the iaws are naturally and commonly not in contact nor are the condyles positioned as
Iar back as they can go.
b. Wallisch 1906: First to deIine physiologic rest position oI the mandible.
" That the position oI the mandible wherein all muscle action is eliminated and the mandible is
passively suspended. "
c. Anatomists early 1900`s: Believed that at birth the gums were contact and with eruption and
alveolar growth the iaws were Iorced apart increasing the vertical dimension.
3. Concepts: Constancy verses non-constancy
a. Niswonger early 1930`s: First investigator to study the rest position oI the mandible by
recording measurements on patients. What was his theory?
b. Brodie utilized the Broadbent-Boltan cephalometer introduced by broadbent in 1931 and
utilizes bony landmarks oI the head. Brodie stated what?
c. Thompson believed that a balance oI tension in the musculature, which suspends the
mandible determines the rest position. What were his conclusions?
d. Swerdlow "A maior Iailure in denture construction is the establishment oI incorrect VDO."
What did he observe that lead to this statement?
e. Turner stated that the "temptation to restore a youthIul appearance by increasing vertical
dimension must be resisted." Why?
Variability oI Rest Position: non-constancy
a. Harris and Hight theory that the correct vertical opening in edentulous patients was
debatable. Why was it debatable?
b. Duncan and Williams Iound a reduction in pre-extraction Iace height with the teeth in
occlusion, as related to corresponding Iacial height aIter prosthetic treatment. What did they
conclude Irom this?
c. Coccaro and Lloyd- observed that the greatest reduction to be in the mid Iacial region in
denture patients. What did they contribute this to?
d. Atwood one oI the most extensive studies in the country. What was it?
Why is vertical dimension important?
1. What is its signiIicance in a dentate Patient?
2. What is the signiIicance in an edentulous patient?
3. What does it determine overall?
Is there really a "loss"oI vertical dimension?
1. Yes/No
What are the Iactors that may lead to the loss oI vertical dimension?
a. caries
b. periodontal disease
c. attrition
d. traumatic
e. iatrogenic
II there is a "loss" how do we evaluate it? (17 ways to evaluate Vertical dimension)
a. Ceph Brodie, Swerdlow, Thompson, Atwood, Tallgren, Silverman S., Coccaro
b. Electromyography Feldman, Leupold, Weinberg,
c. Gnathodynamometer - Prombonas
d. Sorenson proIile scale Sorenson, Toolson and Smith
e. Occlusal rims Shanahan, Gattozzi
I. Wear Turner, Tallgren
Historical Methods
a. Bimeter Boos and Tueller (closing Iorces/power point)
b. Tapping - Lytle and Timmer (proprioception-tactile sense)
c. Jaw relator Niswonger
d. Standard oI 3mm oI IOD Niswonger, Pleasure and Gillis
More common
a. Pre-extraction records
b. Physiologic rest position
c. Facial dimensions - Kois
d. Open rest
Most common
a. Phonetics (S sound) Silverman M., Pound, (M sound) Wagner, Turrel ("emma" Mississippi)
b. Swallowing Gillis, Shanahan, Ismail and George
c. Esthetics Facial expression: look Ior relaxation around eyes and nares.
Lip proIile will hint at iaw relationship:
Normal (Class I) Lips even and slightly touch
Protruded (Class II) protruded mandible. Lips not touching
Retruded (Class III) retruded mandible. Lips not touching
Can we Ieel conIident that we have recaptured Vertical Dimension
a. Feedback Irom patients
b. Your impression
c. Cephalometrics FMA
d. Denture wax rim stage
e. Postural Class I, II, III, diIIerences in VDR:
a. Variations in interocclusal rest space
Class I 3-5 mm
Class II ~ 5 mm
Class III · 3 mm
FMA normal 25 5 degrees
a. FMA high noncritical ~ 30 degrees
b. FMA low critical · 20 degrees Why is this so critical?
How do you challenge Vertical dimension?
a. stents
b. provisionals
c. duplicate dentures at altered VDO
e. orthotics
- Abstracts -
12-001. Swerdlow. H. Vertical dimension - literature review. 1 Prosthet Dent 15:241. 1965.
abstract missing ......
12-002. Turrell. A. 1. W. Clinical assessment of vertical dimension. 1 Prosthet Dent 28:238-
246. 1972.
abstract missing .......
12-003. Thompson. 1. R. The rest position of the mandible and its significance to dental
science. 1ADA 33:151-180. 1946.
abstract missing .......
12-004. Atwood. D. A. A critique of research of rest position of the mandible. 1 Prosthet
Dent 16:848-854. 1966.
abstract missing .......
12-005. Hickey. 1. C.. Williams. B. H. and Woelfel. 1. B. Stability of mandibular rest
position. 1 Prosthet Dent 11:566-572. 1961.
abstract missing .......
12-006. Lyons. M.F. An electromyographic study of masticatory muscle activity at
increased vertical dimension in complete denture wearers. 1 Prosthet Dent60:346-348.
1988.
abstract missing .......
12-007. Gattazi. 1. G. Variations in mandibular rest positions with and without dentures in
place. 1 Prosthet Dent 36:159. 1976.
abstract missing .......
12-008. Atwood. D. A. Cephalometric studies of the clinical rest position of the mandible.
Part I. 1 Prosthet Dent 6:504-509. 1956.
abstract missing .......
12-009. Niswonger. M. E. Rest position of the mandible and centric relation. 1ADA
21:1572. 1934.
abstract missing .......
12-010. Tallgren. A. The continuing reduction of the residual alveolar ridges in complete
denture wearers: A mixed longitudinal study covering 25 years. 1 Prosthet Dent 27:120-
131. 1972.
abstract missing .......
12-011. Olsen. E. S. Vertical dimension of the face. DCNA 1964:611-622.
abstract missing .......
12-012. Weinberg. L. Vertical dimension: A research and clinical analysis. 1 Prosthet Dent
47:290-302. 1982.
abstract missing .......
12-013. Toolson. L. B. and Smith. D. E. Clinical measurement and evaluation of vertical
dimension. 1 Prosthet Dent 47:236-241. 1982.
abstract missing .......
12-014. Silverman. S. I. Vertical dimension record: A three dimensional phenomenon. a.
Part I: 1 Prosthet Dent 53:420-425. 1985. b. Part II: 1 Prosthet Dent 53:573-577. 1985.
abstract missing .......
12-015. Atwood. D. A. Cephalometric studies of the clinical rest position of the mandible. a.
Part II: 1 Prosthet Dent 7:544. 1957.
abstract missing .......
b. Part III: 1 Prosthet Dent 8:698. 1958.
abstract missing .......
016. Fayz. F.. et al. Use of anterior teeth measurements in determining occlusal vertical
dimension. 1 Prosthet Dent 58:317-122. 1987.
abstract missing .......

Section 13: Recording Vertical Dimension
(Handout)

Handout not yet available Ior this section
- Abstracts -
13-001. Turrell. A. 1. W. Clinical assessment of vertical dimension. 1 Prosthet Dent 28:238-
246. 1972.
Abstracts not yet available Ior this section
13-002. Lytle. R. B. Vertical dimension of occlusion by the patients neuromusculature. 1
Prosthet Dent 14:12. 1976.
Abstracts not yet available Ior this section
13-003. Silverman. M. M. Determination of vertical dimension by phonetics. 1 Prosthet
Dent 6:465. 1956.
Abstracts not yet available Ior this section
13-004. Boucher. L. 1.. et al. Can biting force be used as a criterion for registering vertical
dimension? 1 Prosthet Dent 9:594. 1959.
Abstracts not yet available Ior this section
13-005. Ismail. Y. and Arthur. G. The consistency of the swallowing technique in
determining occlusal vertical dimension in edentulous patients. 1 Prosthet Dent 19:230.
1968.
Abstracts not yet available Ior this section
13-006. Sheppard. I. M. and Sheppard. S. M. Vertical dimension measurements. 1 Prosthet
Dent 34:269. 1975.
Abstracts not yet available Ior this section
13-007. Wagner. A. Comparison of four methods to determine rest position of the
mandible. 1 Prosthet Dent 25:506. 1971.
Abstracts not yet available Ior this section
13-008. McGee. G. Use of facial measurements in determining vertical dimension. 1ADA
35:342. 1947.
Abstracts not yet available Ior this section
13-009. Ekfeldt. A. and 1emt. T. Interocclusal distance measurement comparing chin and
tooth reference points. 1 Prosthet Dent 47:560-563. 1983.
Abstracts not yet available Ior this section
13-010. Silverman. S. I. Vertical dimension record: A three dimensional phenomenon. Part
I. 1 Prosthet Dent 53:420-425. 1985.
Abstracts not yet available Ior this section
13-011. Silverman. M. M. Pre-extraction record to avoid premature aging of the denture
patient. 1 Prosthet Dent 5:465. 1955.
Abstracts not yet available Ior this section
13-012. Smith. D. The reliability of pre-extraction records for complete dentures. 1
Prosthet Dent 25:592. 1971.
Abstracts not yet available Ior this section
13-013. Boos. R. H. Intermaxillary relation established by biting power. 1ADA 27:1192.
1940.
Abstracts not yet available Ior this section
13-014. Shanahan. T. E. Physiologic jaw relations and occlusion of complete dentures. 1
Prosthet Dent 5:319. 1955.
Abstracts not yet available Ior this section
13-015. Pound. E. Controlling anomalies of vertical dimension and speech. 1 Prosthet Dent
36:124. 1976.
Abstracts not yet available Ior this section
Section 14: Functionally Generated Path
(Handout)
Handout not yet available Ior this section
- Abstracts -
14-001a. Meyer. FS. The generated path technique in reconstruction dentistry. Part I:
Complete dentures 1 Prosthet Dent 9:354-366. 1959.
Purpose: To describe a technique useIul in complete denture construction.
Materials and Methods: Author's experience and review oI literature.
Results: None
Conclusion: A technique was described,.
- AIter making impressions and casts, make occlusion rims at the proper location.
- TransIer the occlusion rims to a plain line articulator.
- Make modeling compound occlusion rims.
- Place soIt carding wax on the rims and have the patient glide them together.
- Remove the wax Irom the lower rim.
- Pour stone into the maxillary wax and use the modeling compound on the lower rim Ior its
base.
- This lower stone path is what the upper teeth are set to and is in harmony with the condylar
path.
- The upper posterior teeth are set against the lower stone model.
- The maxillary teeth are checked Ior esthetics.
- The modeling compound on the lower rim is lowered 2mm below the upper incisors so there is
no contact.
- The compound on the lower rim is soItened, the rim is placed in the mouth and the patient is
instructed to protrude and retrude the mandible several times. Then when retruded the patient is
asked to lightly close at the vertical dimension and make an imprint into the compound.
- Cusps and Sulci analysis is perIormed. II the compound ridge is not high enough to contact the
buccal cusp then the sulcus creating it is not deep enough and must be deepened.
- Wax is then placed on the compound rims, soItened and with a Iew lateral and protrusive
movements the wax is Iormed.
- Stone is poured into the wax and the teeth are set to the stone.
- Balance will be obtained.
14-001b. Meyer. F. S. The generated path technique in reconstruction dentistry. Part II:
Fixed partial dentures. 1 Prosthet Dent 9:432-440. 1959.
Abstract not available at this time .......
14-002. McCracken. Functional Occlusion in Removable Partial Denture Construction. 1
Prosthet Dent 8: 955-963. 1958.
A method oI establishing occlusion on the partial denture involves the generation oI occlusal
paths and the use oI an occlusal template to which the denture teeth are occluded and by which
they are modiIied to accept eccentric movements.
Should partial dentures be necessary in both arches, a choice must be made as to which
denture is to be made Iirst on a simple articulator mounting and which denture is to have the
Iunctional occlusal pattern.
By wearing and biting into a wax occlusion rim, a record is made oI the opposing teeth in all
extremes oI iaw movement.
The occlusal path recorded will represent each tooth in its three dimensional aspect and
although the cast poured against the record will resemble the opposing teeth, it will be much
wider than the tooth which carved it because it represents a tooth in all extremes oI movement.
The recording oI occlusal paths in this manner eliminates the problem oI trying to reproduce
mandibular movement on an instrument.
The occlusion on the partial denture will have more complete harmony with the opposing
teeth and the remaining natural teeth by this method than can ever be obtained by adiustments in
the mouth, because corrections to accommodate to voluntary movements does not mean
complete Ireedom Irom occlusal disharmony in postural positions or during stress periods. Also
it is very doubtIul that any dentist can interpret articulation paper markings correctly without an
occlusal analysis, which brings us to the need Ior a complicated instrument as the only
alternative to this method.
It makes possible the obtaining oI iaw relations under actual working conditions, with the new
denture Iramework in its terminal position, the opposing teeth under Iunction, and an opposing
denture, iI present, Iully seated beIore iaw relations are recorded.
In some instances, it makes possible the recovery oI lost vertical dimension, either bilaterally
or unilaterally, where abnormal closure or mandibular rotation has occurred instead oI recording
and perpetuating an abnormal position which is correctable.
The occlusal registration must be converted to an occlusal template by Iilling the wax with
hard stone. It is desirable that stone stops be used to maintain the vertical relation, rather than
relying upon some adiustable part oI the articulating instrument which might be changed
accidentally. By the use oI stone stops and by mounting both the denture cast and the template
beIore separating them, a simple hinge or even a tripod instrument may be used, thereby
eliminating the use oI any but the simplest articulator. The iaw movements having been recorded
and transIerred to a template, eliminates the need Ior articulator adiustments.
Electroplating permits a metallic surIace to be Iormed on the wax record with accuracy and
with greater hardness than low-Iusing metals
ElectroIorming with silver has proved to be the simplest and most satisIactory method.
14-003. Vig. R. G. A modified chew-in and functional impression technique. 1 Prosthet
Dent14:214-220. 1964.
Abstract not available at this time .......
14-004. Zimmerman. E. M. Modifications of the functionally generated path procedure. 1
Prosthet Dent 16:1119-1126. 1966.
Abstract not available at this time .......
14-005. Schnader. Y. E. Symposium on occlusion and function: The stone core intaglio in
restorative dentistry. DCNA 25:493-510. 1981.
Abstract not available at this time .......
14-006a. Dawson. P. E. Evaluation. Diagnosis. and Treatment of Occlusal Problems. Ch. 8.:
The Plane of Occlusion. C.V. Mosby. St. Louis. 1974. pp. 190-205.
Purpose: To establish the plane oI occlusion with the Broadrick Occlusal Plane Analyzer and the
P.M.S. technique.
Material and Method: This descriptive text presented the requirements Ior proper occlusion i.e.
anterior guidance, discluding posterior teeth in protrusion, disclusion oI all teeth on the balancing
side in lateral excursion. It also deIined the Iollowing terms:
1. Curve oI Spee: anteroposterior curvature oI the occlusal surIaces, beginning at the tip oI the
lower cuspid and Iollowing the buccal cusp tips oI the bicuspids and molars and continuing to
the anterior border oI the ramus.
2. Curve oI Wilson: mediolateral curvature oI the cusps as proiected on the Irontal plane
expressed in both arches.
Discussion: II the curve oI Spee is too high in posterior the supporting tissues are prone to
deleterious Iorces. II the curve oI Spee is too low posteriorly it will not interIere with the basic
requirements oI protrusive and balancing side disclusion. It can create a poor esthetic and poor
crown-root ratio on upper teeth. II the curve oI Spee is too high or too low anteriorly the
premolars can contact the upper cuspids in protrusive. Having the lower premolars much lower
than the anteriors is unaesthetic.
The curve oI Wilson deals with the mediolateral slant oI posterior teeth in its relationship with
the lateral anterior guidance angle. The steeper the lateral anterior guidance angle, the higher the
lower lingual cusps may be on the opposite side.
There are 3 practical methods Ior establishing an acceptable plane oI occlusion:
1. Analysis on natural teeth through selective grinding
2. Analysis on models with Iully adiustable instrumentation
3. Pankey-Mann-Schuyler method with the Broadrick Occlusal Plane Analyzer
Conclusion: When the occlusal plane is predetermined prior to preparation oI the teeth only the
most minor occlusal adiustment should be necessary on the Iinished restoration.
14-006b. Dawson. P. E. Evaluation. Diagnosis. and treatment of Occlusal Problems.
Chapter 23: Functionally generated path techniques for recording border movements
intraorally. C. V. Mosby. 1989. 410-433.
Purpose: To review the technique Ior recording and utilizing the Functionally Generated Path
technique (FGP). The chapter describes both the clinical and laboratory procedures.
Subiect: FGP procedures are described as a useIul and accurate method to record all possible
border pathways oI the lower posterior teeth when preparing upper posterior teeth Ior restoration.
Technique is described Ior maxillary Iull arch, single tooth, and quadrant restoration.
Methods and materials: BrieI technique summary Ior bilateral maxillary posterior preparations:
1) prepare teeth 2) alginate impression 3) extra hard baseplate wax base (or acrylic or cast base)
Iabricated to be stable cross-arch, adapted down around each tooth, but thin on prepared occlusal
surIace with no contact 4) Iunctional wax soItened and added to baseplate, enough to be
impressed by about one third oI each lower tooth. 5) patient guided through protrusive and all
lateral excursions 6) wax chilled with ice water and a stone mix applied to wax in the mouth. 7)
upper master die model articulated against FGP stone core. 8) Wax-up can be made against the
Iunctional model, made against an anatomic opposing cast and reIined on the Iunctional model,
or castings Iabricated Irom anatomic model and adiusted against the Iunctional model. Variations
are described Ior single tooth or quadrant preps.
Results: 1) Group Iunction is attained by adiusting the lingual inclines oI the upper buccal cusps
to contact against the Iunctional core. 2) Disclusion is attained when the inclines are taken out oI
contact with the Iunctional core and only centric stops are retained. 3) Balancing contacts will be
reproduced in Iunctional core, thereIore balancing side disclusion must be eIIected by reduction
oI the balancing inclines in restoration or wax pattern.
Conclusions: 1) Anterior guidance and condylar movement determine border pathways oI lower
posterior teeth. By recording and reproducing all possible border pathways oI the lower posterior
teeth, in a Iunctionally generated path, a method can be utilized Ior restoring upper posterior
teeth 2) FGP procedures are not generally used on lower teeth. In lower teeth, Iunctioning
contacts on the buccal cusps and centric contact in the base oI the Iossae can be accomplished in
less time consuming ways than FGP.
Comments: The article provides a cookbook recipe Ior utilizing a FGP Ior accurately restoring
occlusal contours.
14-007. Meyer. F. S. Construction of full dentures with balanced functional occlusion. 1
Prosthet Dent 4:440-445. 1954.
14-008. Mann. AW and Panky. LD. Concepts of occlusion: The PM philosophy of occlusal
rehabilitation. 1 Prosthet Dent 10:135-162. 1960.
The lower is rebuilt to an ideal occlusion using the PM instrument that allows Ior Bonwill's
triangle and Monson's curve. The incisal guidance is then rebuilt by grinding or restoring the
anterior teeth. The maxillary is then reconstructed using the FGP technique describer by Meyer.
The Iour prime obiectives oI oral rehabilitation are (1) optimum oral health, (2) Iunctional
eIIiciency, (3) mouth comIort, and (4) esthetics.
14-009. Mann. A. W. and Pankey. L. D. Oral rehabilitation. 1 Prosthet Dent 10:135-162.
1960.
Abstract not available at this time .......
14-010. Schuyler. An Evaluation Of Incisal Guidance And Its Influence In Restorative
Dentistry. 1 Prosthet Dent 9: 374-378. 1959.
Complete occlusal coordination oI the masticatory mechanism necessitates a coordination oI
posterior guiding tooth inclines with the two extreme guiding Iactors which are the incisal
guidance and the unrestrained movement oI the condyles in the glenoid Iossae. OI these two
extreme Iactors, the incisal guidance is the more inIluential Iactor due to its proximity to the
occlusion and nonresiliency. There is a degree oI resiliency oI Ilexibility in the movement oI the
condyles in the glenoid Iossae.
The controls oI the lateral Iunctional inclinations oI the posterior teeth are the incisal
guidance and the lateral movement oI the condyles in the glenoid Iossae, which is called Bennett
movement.
A steep incisal guidance, or a locked or restricted relationship oI the anterior teeth, or a
Iunctional abnormality oI posterior tooth inclines may inIluence the direction and degree oI the
Bennett movement.
By building posterior occlusal contours to some irregular Iunctional movements oI the
condyles, we may be perpetuating pathology oI the ioints.
The anterior movement oI the condyles upon the articulating eminences oI the glenoid Iossae
has little or no inIluence upon the Iunctional relation oI the posterior tooth surIaces on the
working side. In complete oral rehabilitation, it has little or no inIluence upon the steepness oI
lateral working inclines oI the teeth.
Incisal guidance and the Iorward movement oI the condyles are the Iactors controlling
inclinations oI the posterior teeth on both the balancing side and in the protrusive relationship.
In the evaluation oI Iactors controlling posterior occlusal contours oI the complete oral
rehabilitation oI the natural dentition, we must come to the conclusion that incisal guidance is the
predominating Iactor. ThereIore, the establishing oI the anterior tooth relation, esthetics, and
incisal guidance should be the Iirst step in planning the oral rehabilitation. Posterior tooth
surIaces are then Iormed to Iunction in harmony with this guiding Iactor.
The reduction oI horizontal stresses by a reduction oI the steepness oI posterior occlusal
inclinations may be desirable. This necessitates a reduction oI the lateral guiding inclines oI the
anterior teeth, these being the controlling Iactors to the inclines oI the posterior teeth.
Schuyler - mount casts in the articulating instrument with a retruded, but unrestrained centric
maxillomandibular relation record. AIter this relation record has been checked and proved and
the instrument has been set to the recorded movements, the mandibular member oI the
instrument is advanced by placing a strip oI tin Ioil oI the desired thickness in Iront oI the axis
balls in the slot in the condylar guidances oI the instrument. The thickness commonly used is .5
or.75 mm. The restorations on the teeth are Iinished and milled at this advanced position. Then
the articulator is retruded to its normal position and the occlusal surIaces oI the restorations are
milled again to that position. This procedure provides a slight range oI anteroposterior Ireedom
Ior the mandible and a slight Ireedom in intercuspation. Complete dentures and complete oral
rehabilitation are more readily tolerated when this Ireedom is built into the occlusion.
14-011a. Dawson.P.E. Evaluation. Diagnosis. and Treatment of Occlusal Problems. C.V..
Mosby. St. Louis. 1974. Chapter 8. Pankey-Mann-Schuyler philosophy of complete occlusal
rehabilitation. pp108-110.
The deviation oI the incisal path in an individual is less than that oI the condylar path. The
incisal path inIluences disocclusion at the second molar twice as much as that oI the condylar
path during a protrusive movement, three times as much on the non-working side and Iour times
as much on the working side during lateral movement. The cusp angle is considered to be the
most reliable reIerence Ior occlusion. The standard cusp angle values were determined to be 25H
during protrusive movement, 15H on the working side, and 20H on the non-working side during
lateral movement.
In order to provide disocclusion, the cusp angle should be shallower than the condylar path.
To make a shallower cusp angle, it is necessary to produce balanced articulation so the cusp
angle becomes parallel to the cusp path oI a opposing teeth during eccentric movement. The twin
stage procedure uses a cast with a removable anterior segment and Iabricates the posterior teeth
in a balanced occlusion. The anterior segment is replaced and anterior guidance is established.(
1mm during protrusive movement)
In Hobo`s article a description is given to create a custom incisal guide table, and a technique
to simulate the protrusive movement on the articulator is detailed. In his text book, values have
been determined and can be programmed into a semi-adiustable articulator.
Stage I: The sagittal condylar path inclination 25H ; Bennett angle 15H ; sagittal inclination oI
the incisal guide table 25H ; and the lateral wing angle 10H .The anterior segment oI the maxillary
and mandibular casts are removed using dowel pins and the casts are adiusted so they do not
disclude during eccentric movements. Wax the occlusal morphology oI the posterior teeth so the
maxillary and mandibular teeth contact during eccentric movements (balanced articulation).
Stage II: The sagittal condylar path inclination 40H ; Bennett angle 15H ; sagittal inclination oI
the incisal guide table 45H ; and the lateral wing angle 20H .The anterior segment oI the maxillary
and mandibular casts is replaced. Wax the palatal contours oI the maxillary anterior teeth so the
incisors contact during protrusive movement, and the canines on the working side contact during
a lateral movement. Anterior guidance is established and disclusion is produced.
II the sagittal condylar path oI the patient is steeper than the articulator adiustment value (40H
), disclusion increases. II the path is less than 40H , then the amount oI disclusion decreases. II
the patient has less than 16 H (only about an 8° occurrence rate), cuspal interIerences will occur.
II the incisal path is more than 5H steeper than the condylar path, patients complain oI
discomIort (Mc Horris 1979).
14-011b. Dawson. P. E. Evaluation. Diagnosis. and Treatment of Occlusal Problems. C. V..
Mosby. St. Louis. 1974. b. Chapter 14. The plane of occlusion. pp 190-205.
Abstract not available at this time .......
14-011c. Dawson. P. E. Evaluation. Diagnosis. and Treatment of Occlusal Problems. C. V..
Mosby. St. Louis. 1974. c. Chapter 15. Determining the type of posterior occlusal
morphology. pp. 206-218.
Abstract not available at this time .......

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