Digitizing the Facebow:

A Clinician/Technician Communication Tool

Les Kalman, BSc (Hon), DDS1/Julia Chrapka, BSc (Hon)2/Yasmin Joseph3

Communication between the clinician and the technician has been an ongoing problem in
dentistry. To improve the issue, a dental software application has been developed—the Virtual
Facebow App. It is an alternative to the traditional analog facebow, used to orient the maxillary
cast in mounting. Comparison data of the two methods indicated that the digitized virtual
facebow provided increased efficiency in mounting, increased accuracy in occlusion, and
lower cost. Occlusal accuracy, lab time, and total time were statistically significant (P < .05).
The virtual facebow provides a novel alternative for cast mounting and another tool for
clinician-technician communication. Int J Prosthodont 2016;29:35–37. doi: 10.11607/ijp.4748

C ommunication between the clinician and the tech-

nician is required to ensure clarity and quality in
the fabrication of prostheses. However, communica-
tion has shown to be a challenge, with limited records
being employed.1
Prosthodontic treatment requires carefully es-
tablished diagnoses and treatment planning.2 The
mounting of the patient’s diagnostic cast remains a
convenient step, as it allows the assessment of criti-
cal factors such as occlusion, abutment position, and
force direction.3 A digital alternative to analog and
arbitrary mounting was developed to address the
shortcomings of the traditional facebow and provide
additional clinical information to arbitrary mounting.
Materials and Methods
Patients with recently restored dental implants were
recruited to participate in the study at the Schulich
Dental Clinic. These patients were selected as the
occlusion on the implant was exact. The patient was
seated and impressions were taken of both arches
using Counterfeit (Clinician’s Choice) impression ma-
terial. Quick Bite (Clinician’s Choice) was used to
establish the maxillomandibular relationship in maxi-
mum intercuspation. These procedures were com-
pleted by independent clinicians. Clinician A took a
timed analog facebow (AF) and recorded the max-
illomandibular relationship with wax. Clinician B
employed the virtual facebow (VF) and timed the
process. Fig 1 depicts the clinical steps required with
the VF.
Two separate sets of models were poured in
Microstone (Whip Mix), one for each clinician.
Clinician A used the AF and wax bite, and Clinician
B used the VF and record of occlusion to mount the
models on a semiadjustable articulator (Whip Mix).
Both processes were timed. The clinicians also re-
corded the number of occluding teeth on the mounted
models using 8-µm shim stock. A percentage of the
total number of occluding teeth in the patient’s origi-
nal occlusion was then calculated.
Results

Various factors from both facebow methods were an-

alyzed to determine the more efficient method. Time,
occlusal contact replication, and cost were compared
1AssistantProfessor, Restorative Dentistry; Chair, DOCS Program, Western for the two methods.
University, London, Ontario, Canada.
2DDS Candidate 2016, Western University, London, Ontario, Canada.
3BSc Candidate 2016, Western University, London, Ontario, Canada.
Time Comparison

Correspondence to: Dr Les Kalman, Schulich School of Medicine &
Dentistry, Western University London, ON N6A 5C1.
Fax: 519.661.3416. Email: lkalman@uwo.ca
©2016 by Quintessence Publishing Co Inc.
The AF and VF were timed with regard to clinical, lab,
and total time (Fig 2). To compare the times, t tests
were conducted at P < .05. Results indicated an over-
all time efficiency for the VF.

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Digitizing the Facebow

a b c

e g

d f

Fig 1   Virtual facebow method. (a, b) Patient

positioning. (c) Face and dentition capture
with reference grid and gyroscope. (d) Skull-
face overlay for anatomic reinforcement and
reference. (e, f) Occlusal contact checklist.
(g) Positioning of maxillary cast. (h) Cast and
face overlay. (i) Cast, face, and skull overlay.

h i

Occlusal Replication Comparison Cost Comparison

A t test was performed at P < .05, and statistical sig- The comparison of equipment and materials costs
nificance was found (Fig 3). On average, the VF suc- used in both methods suggested that the VF is more
cessfully replicated 89.47% of the patient’s original cost effective than the AF (Table 1).
occlusion, compared to 46.14% with the AF.

36 The International Journal of Prosthodontics

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 Kalman et al

1,200 Lab time 120

Clinical time

Average replicated occlusion (%)

1,000 100
Average time (s)

800 80

600 60

400 40

200 20

0 0
Traditional Virtual Traditional Virtual
Facebow type Facebow type

Fig 2   Average times for AF vs VF. The difference in average clinical Fig 3   Occlusal contact replication. Patient casts were mounted and
time was not statistically significant. Differences in lab time and total occlusion was assessed.
time were statistically significant.

Discussion Table 1   Cost Comparison of Both Facebow Methods

Traditional ($) Virtual ($)
Based on the limited pilot study, the VF seems to Facebow and articulator 947 Tablet 349
provide an efficient, accurate, and cost-effective al-
PVS impression material 55 Virtual facebow app 10
ternative to the AF. Alignment of the maxillary cast
was not assessed as the VF had technology that of- Bite registration wax 4 Stands 8
fered extremely accurate spatial positioning. The AF Level 3
can prove uncomfortable for the patient, as the ear
Simple hinge articulator 15
canal projections, bite fork, and nose bridge can ap-
ply pressure and pain. It can be frustrating for the Total 1,006 Total 385
clinician due to the subjective positioning and mul-
tiple adjustments.4,5,6 The VF provided a simple and
straightforward approach without comfort issues.
Although arbitrary mounting may suffice, the VF pro-
vides patient information that may prove valuable for
the laboratory.

Conclusions References

The VF provides a novel approach for clinical data  
acquisition and a process for the mounting of diag-
nostic casts. The VF embraces mobile technology to
 
offer an accessible alternative to assist with diagno-
ses and treatment planning. The efficiency, accuracy,
cost, and comfort of the VF provides the clinician an  
alternative tool for records and essential technician
communication.
 
Acknowledgments
 
Research was supported by the IRG grant at the Schulich School
of Medicine & Dentistry. Additional support was provided by
Research Driven, Inspiratica, and Clinician’s Choice. The conduct-  
ed methods and obtained results were supervised by the author.
Recommendations and opinions are entirely those of the author.
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