Clin Oral Invest (2018) 22:773–782
DOI 10.1007/s00784-017-2152-9
ORIGINAL ARTICLE
Does a face-bow lead to better occlusion in complete dentures?
A randomized controlled trial: part I
Manja von Stein-Lausnitz 1 & Guido Sterzenbach 1 & Iven Helm 1 &
Antje Zorn 1 & Felix H. Blankenstein 1 & Sebastian Ruge 2 &
Bernd Kordaß 2 & Florian Beuer 1 & Ingrid Peroz 1
Received: 15 December 2015 / Accepted: 8 June 2017 / Published online: 4 July 2017
# Springer-Verlag GmbH Germany 2017
Abstract
Objectives In a double-blinded randomized controlled clinical
trial, the impact of face-bow registration for remounting com-
plete dentures (CDs) on the occlusal parameters (part I) was
evaluated.
Materials and methods New CDs of 32 patients were dupli-
cated and mounted after intraoral pin registration according to
mean settings (group 1) and (group 2) using a face-bow (ar-
bitrary hinge axis). The vertical dimension was reduced to the
first occlusal contact point, and a bite record was fabricated in
the articulator. The number of contacts and the number of
teeth in contact were evaluated by a computer program (labo-
ratory result). After randomization, half of the CDs were ad-
justed according to protocol of group 1 and group 2 and de-
livered to the patients. After 3 days (T1) and 84 days (T2),
clinical static contact points and teeth in contact were counted.
Contact points and teeth in contact of both groups (laboratory
results) and at different moments (clinical results) were ana-
lyzed statistically with the F test and bootstrapping.
Results Laboratory: No. 2 (face-bow) showed more occlusal
contact points than no. 1 (mean setting), p > 0.05. The number
Manja von Stein-Lausnitz and Guido Sterzenbach are co-first authors;
both authors contributed equally to this article.
* Manja von Stein-Lausnitz
manja.von-stein-lausnitz@charite.de
1
Department of Prosthodontics, Geriatric Dentistry and
Craniomandibular Disorders, Charité – Universitätsmedizin Berlin,
corporate member of Freie Universität Berlin, Humboldt-Universität
zu Berlin, and Berlin Institute of Health, Aßmannshauser Str 4-6,
14197 Berlin, Germany
2
Department of Digital Dentistry – Occlusion and Function Therapy,
Centre of Dentistry and Oral Health, Ernst Moritz Arndt University
of Greifswald, 17475 Greifswald, Germany
of teeth with at least one occlusal contact was significantly
higher in no. 2 (p = 0.027). Clinic: The mean number of teeth
with at least one clinical contact point was significantly higher
in no. 1 (no. 1 = 7.13, no. 2 = 5.31; p = 0.042). Extent of the
vertical shift poorly correlated with number of laboratory oc-
clusal contact points (R2 = 0.017).
Conclusions Considering the complex multistep study de-
sign, a limited number of participants, and referring to one
specific arbitrary face-bow, the following conclusion could
be drawn: no substantial difference by the use of the arbitrary
face-bow compared to a mean setting could be determined,
when changing the vertical dimension in the articulator within
a remounting procedure of complete dentures.
Clinical relevance Further research is necessary to determine
the effects of different arbitrary face-bows on the fabrication
and adaptation of removable dentures.
Keywords Complete dentures . Face-bow . Occlusal
adjustment . Remounting procedure . Randomized controlled
trial . Removable denture
Introduction
The face-bow and its application have been an integral part of
prosthodontic literature for decades [1, 2]. If there is a need to
change the vertical dimension of casts in the articulator for
fabricating indirect dental prostheses, occlusal contact errors
will occur [3]. These occlusal errors are described by
Morneburg et al. with an extent of ≥440 μm with mean value
mounting and a Balkwill angle of 17° (10% probability).
Furthermore, a direct proportionality between the extent of
change of the vertical dimension (i.e., vertical shift) and oc-
clusal errors has been described [4, 5]. The registration of the
upper jaw according to an arbitrary but patient-related hinge
774
axis using a face-bow was assumed to minimize these occlusal
errors [6–8]. While there are some studies evaluating the im-
pact of face-bow registration, there are few trials that examine
the use of a face-bow in context of the fabrication of complete
dentures and occlusal splints [2, 9–12]. In particular, face-bow
registration as the only difference between the respective test
groups is characterized in only one study [2]. The trials differ
in several aspects of study design, procedure of denture pro-
duction, inclusion criteria, and outcomes. The latter were den-
ture retention [9], denture stability [9], number of occlusal
contacts [2, 13], time needed for chairside occlusal adjustment
[2, 14], chewing ability, and patient satisfaction [15].
Aspects of the change in the vertical dimension combined
with the use of a face-bow have not been evaluated in any
randomized controlled trial.
The aim of this double-blinded randomized controlled trial
is to evaluate the impact of an arbitrary face-bow record on the
number of laboratory and clinical occlusal contact points after
changing the vertical dimension in the articulator by means of
casts transferred to the articulator using intraoral pin-
supported registration.
The following null hypotheses were stated:
If the vertical dimension is changed in the articulator, the
use of a face-bow compared to a mean setting has no
impact on.
Null hypothesis I: the number of laboratory occlusal con-
tact points
Null hypothesis II: the number of clinical occlusal contact
points
A second part of this trial investigated how participants
perceive the use or absence of a face-bow. Using the oral
health impact profile (OHIP-G49), a patient-based outcome
will be measured and should enlighten questions for the clin-
ical relevance of the face-bow [16].
Materials and methods
This study was intended and realized according to the revised
Consolidated Standards of Reporting Trials (CONSORT)
statement [17]. Methods and design are additionally described
for Part II of this study in von Stein-Lausnitz et al. 2017 [16].
Trial design
The trial was designed as a randomized controlled, parallel
arm, double-blinded trial. The protocol was approved by the
institutional ethics committee under register number EA4/
033/11.
Clin Oral Invest (2018) 22:773–782
Participants
Eligible participants were adults and patients of the Department
of Prosthodontics, Geriatric Dentistry and Craniomandibular
Disorders, Berlin, Germany. The patients were admitted to the
study according to the following inclusion criteria:
1. New complete dentures (CDs) in the upper and lower jaw,
worn at least 2 weeks and at most 1 month.
2. Absence of temporomandibular disorders, assessed with a
standardized instrument (Research Diagnostic Criteria for
Temporomandibular Disorders [18]) by an experienced
dentist in the field of TMD diagnostic and treatment.
3. CDs were screened by an experienced prosthodontist for
optimal fabrication, i.e., correct occlusal plane, correct
vertical and horizontal dimension, equilibration of static
occlusal contact points, and canine or unilateral group
function for dynamic occlusion.
4. Informed consent was obtained from all individual partic-
ipants included in the study.
The fabrication of the CDs presented the following character-
istics: all CDs were fabricated in the dental students’ course of
the Department of Prosthodontics, Geriatric Dentistry and
Craniomandibular Disorders, Berlin, Germany. The concept in-
cluded impressions using a silicone-based precision condensa-
tion curing impression material (Xantopren Blau, Heraeus
Kulzer, Hanau, Germany), a zinc oxide and eugenol impression
material (SS White, S.S. White Group, Gloucester, England), or
a thermoplastic impression material (Ex-3-N Gold, Johannes
Meist, Feuchtwangen, Germany). Individual conditions of the
participants did not allow using one impression material
exclusively.
Full anatomic artificial teeth (Artegral, Merz Dental,
Lütjenburg, Germany) were taken for all CDs.
According to our concept of the fabrication of CDs, an
overbite of 2–3 mm and an overjet of at most 2–3 mm were
intended.
The occlusal concept depended on individual characteris-
tics of participants. All CDs presented at least one static oc-
clusal contact point per teeth referring to the contact of palatal
working cusps in the mandibular centric fossae. Due to the
fact that the outcome of the trial defined static occlusion as-
pects, CDs with different concepts of dynamic occlusion were
included. Dynamic occlusion concepts were participant-
dependent canine-guided occlusion, unilateral balanced occlu-
sion, or bilateral balanced occlusion.
Interventions
Participants were randomly allocated into two groups accord-
ing to Fig. 1:
Clin Oral Invest (2018) 22:773–782 775

Fig. 1 Flowchart of clinical and Group 1 Group 2

laboratory procedures
face-bow registration face-bow registration

intraoral pin-supported registration intraoral pin-supported registration

dental lab dental lab

mounting of the casts / mean setting mounting of the casts / arbitrary hinge axis

removal of the pin-registration set and removal of the pin-registration set and
lowering of the casts lowering of the casts

occlusal adjustment occlusal adjustment

clinical room clinical room

incorporation of incorporation of
adjusted complete dentures adjusted complete dentures

Group 1: a mean setting as given by the Bonwill triangle
and the Balkwill angle for the transfer of complete den-
tures into a semiadjustable articulator
Group 2: face-bow-aided transfer into the articulator ac-
cording to the arbitrary hinge axis
adjustment achieved at least one static contact point per
posterior tooth.
6. Participants then incorporated their prostheses, while no
further chairside adjustment was performed. The mainte-
nance procedure was performed after 3 days of interven-
tion and as clinically needed.

To construct a setting with a change of the vertical dimension,

a clinical remount technique using pin-supported registration was
performed. The procedure included the following steps:
1. A face-bow registration (Protar 7, KaVo, Germany) was
performed for all participants by two secondary operators.
They were intensively calibrated for the technique of face-
bow registration.
2. One experienced dentist and main operator adjusted the pin
registration set (Gerber® Stützstiftregistrat, Set Nr. 105,
Condylator, Zürich, Switzerland). He screwed the central
stylus up to the minimal required distance needed to elimi-
nate any occlusal guidance. Gothic arch tracing was con-
ducted, and the prostheses were intraorally fixed with a bite
registration material (addition-curing silicone, Memoreg,
Heraeus Kulzer, Germany) at the top of the Gothic arch [19].
3. In the dental laboratory, remounting of the prostheses into a
semiadjustable articulator (Protar 7, KaVo, Germany) was
done according to a randomization procedure (secondary
operators): CDs from patients of group no. 1 were mounted
corresponding to a mean setting. CDs from patients of
group no. 2 were mounted using the face-bow record.
4. The pin registration set was removed, and CDs were
lowered, limited by the first contact points between the
upper and lower prostheses. The respective vertical shift
was measured by calculating the difference in millimeters
after lowering CDs (Fig. 5).
5. CDs were adjusted by one dental technician. She was
blinded with regards to the mounting procedure. Occlusal
Measurements and examinations
The number of clinical occlusal contact points was recorded
three times in both groups: day 0 (T0) before intervention,
days 3 (T1) and 84 (T2) after intervention.
Laboratory occlusal contact analyses were performed as
follows: the CDs were doubled via the use of silicone forms.
Then, two pairs of casts were made from each participant. The
casts were mounted into the articulator correspondent to a
mean setting and the face-bow setting using the intraoral bite
registration mentioned above. Afterwards, the casts were
lowered up to the first occlusal contact point and a bite regis-
tration (addition cured silicone, Memoreg, Heraeus Kulzer,
Germany) was performed. Thereafter, pictures were taken
from each silicone bite record by fixing it on a pad with trans-
mitted light. Standardization was realized using a camera-
table with fixed position of the camera (Canon® EOS 5D,
Canon®, Tokyo, Japan, OBJ Canon Macro Lens EF
100mm, 1:2.8-32) at a distance of 51 cm. The pictures were
edited by one operator with expertise in the field of digital
imaging using the software GEDAS 2 Reader (Greifswald
Digital Analyzing System, Ernst Moritz Arndt University,
Greifswald, Germany). The software converted the thickness
of registrations by calculating a threshold of brightness value.
Visualization was implemented by color-coded contact points
(Fig. 2). A calibration was done to define the threshold of
brightness value. For the bite material used in this trial, a value
of 250 in a range of 0 to 765 as brightness between white and
776
Fig. 2 Software-based visualization of static contact points with the
GEDAS 2 Reader (Greifswald). Yellow and red areas mark hard
contacts, blue and green areas mark soft contacts
black was codified and determined as the standard value for all
bite records. The GEDAS 2 Reader discriminates Bhard^ (yel-
low and red) and Bsoft^ (blue and green) contact points.
Yellow- and red-colored domains correlate with areas where
the bite material is perforated (= hard contacts). Domains col-
ored blue and green still showed a thin layer of bite material
and were marked as soft contacts.
One operator counted the number of hard and soft contact
points and the number of teeth with at least one contact for all
bite registrations.
Outcomes
The primary outcome was the group-dependent comparison of
the number of laboratory and clinical occlusal contact points
after changing the vertical dimension in the articulator.
The secondary outcome was the evaluation of the extent of
the vertical shift in relation to the number of laboratory occlu-
sal contact points.
Sample size
Sample size estimation was performed a priori. We assumed a
mean of clinical contact points after occlusal adjustment in
group 1 = 11 and group 2 = 14. The estimated deviation was
σ = 2.9, and accordingly, the effect size was 0.238. To reach a
statistical power of 80% by level of significance of 0.05, the
calculated (nQuery Advisor 7.0) number of subjects per group
was n = 15.
Randomization
Each participant was assigned to one identification number.
By blocking with a block length of 4, restricted random
Clin Oral Invest (2018) 22:773–782
allocation was performed based on a computer-generated ran-
dom list. Participants were randomly assigned to one of the
two groups. Consecutively numbered, sealed envelopes were
stored by two independent operators. They opened the enve-
lope immediately before CDs were mounted into the
articulator.
Blinding
Participants were blinded up to the last follow-up after 84 days.
The main operator who performed the intraoral pin registra-
tion and the dental technician who adjusted the CDs were
blinded; every participant clinically received a face-bow reg-
istration. Its use was randomly chosen according to the ran-
dom list by a second operator in the dental laboratory. Hence,
neither the main operator, the participant, nor the dental tech-
nician had knowledge of whether the face-bow was used in
the laboratory or not.
Statistical methods
For analyses of between-group differences, the Kolmogorov-
Smirnov test was used to assess normal distribution of clinical
data. The F test was used to analyze the change in the number
of clinical contact points over the time. For a comparison
between occlusal contact points of the plaster models in the
dental laboratory setting, bootstrap methods were used, be-
cause normal distribution was not given. The level of signif-
icance was set at p < 0.05. Secondary outcomes were analyzed
with a linear model with the calculation of the coefficient of
determination R2. An asymptotic generalized Cochran-
Mantel-Haenszel test was used to analyze relations between
the change in vertical dimension and anterior contact points in
both groups.
All calculations were done with SPSS statistics Version 20
by an independent expert in statistics.
Results
Participant flow
Figure 3 shows the CONSORT flow diagram.
Recruitment
A sample of 44 participants was preliminarily assessed for the
eligibility to participate, in consideration of the inclusion
criteria (flow chart). Thirty-two participants were finally in-
cluded. Baseline demographic characteristics of both groups
are shown in Table 1. Figure 3 specifies the participant flow.
Over the course of the trial, one participant had to be excluded
after a failure of material during laboratory remounting steps
Clin Oral Invest (2018) 22:773–782 777

Fig. 3 CONSORT flow diagram Assessed for eligibility (n=44)

of participants (OHIP = Oral
Health Impact Profile; assessed Exluded (n=12)
for part II of this trial) TMD (n=9),
Inadequate protheses (n=2)
No compliance (n=1)
Randomized (n=32)

Allocated to group 1: Mean setting Allocated to group 2: Face-bow

(n = 16) (n = 16)

Baseline / OHIP – T0 Baseline / OHIP – T0

(n = 16) (n = 16)

Remounting procedure Remounting procedure

(n = 16) (n = 16)
Drop-out
failure of material
3-day 3-day (n=1)
follow-up/occlusion check/ OHIP – follow-up/occlusion check/OHIP –
T3 T3
(n=16) (n=15)
Drop-out
Relining of the CD
84-day 84-day (n=1)
follow-up/occlusion check/OHIP – follow-up/occlusion check/OHIP –
T84 T84
(n=16) (n=14)

(group 2). One other participant had to be excluded between
T1 and T2 because the CD had to be relined (group 2).
For analyzing clinical contact points, for group 1 (mean
setting) data of 16 participants were analyzed, in group 2
(face-bow record) data of 15 participants were analyzed at
T1, data of 14 at T2.
Laboratory occlusal contact points were assessed with
doubled casts from each participant, as described above.
This resulted in a number of totally 62 pairs of casts. Finally,
from each participant a mean value-based as well as a face-
bow-associated situation in the articulator were digitally ana-
lyzable with the described registrations.
Baseline data
Table 1 presents baseline characteristics of participants at T0.
Primary outcome
Laboratory occlusal contact points
The results of laboratory occlusal contact points are shown in
Table 2. Due to the fact of cast duplication, the number of
analyzed bite registrations was equal in groups 1 and 2 (both
n = 31). After removal of the pin registration set and lowering
the casts, group 2 (face-bow) presented more occlusal contact
points than group 1 (mean setting), but no statistically signif-
icant difference. The number of teeth with at least one contact
was higher in group 2 (p = 0.027). A detailed analysis for
anterior teeth shows that group 2 presented more anterior teeth
in contact (p = 0.007). The number of posterior teeth in contact
shows no statistical difference (p = 0.428).
Clinical occlusal contact points
Over the time, the number of clinical contact points was
shown as not statistically different for either group for anterior
and posterior teeth (Table 3). The number of clinical contact
points per tooth decreased from T0 to T1 and increased in the
long run to T2. The number of teeth with at least one contact
decreased from T0 to T1 and increased over the course of the
study. At T2, groups 1 and 2 showed a difference (7.13 and
5.31), which is statistically significant (p = 0.042).
Secondary outcome: impact of the vertical shift
The impact of the extent of the vertical shift during pin-
supported registration was evaluated by calculating a coeffi-
cient of determination R2. In Table 4, the values for the extent
are shown in millimeters. The mean value for shifting was
4.89 mm. The low values of R2 (Table 5) shows that there is
Table 1 Baseline characteristics of participants at T0
Group 1 Group 2 Total
Age (years) 62–98 44–93 44–98
Gender (n)
Female 79 13 3 20 12
Male
778 Clin Oral Invest (2018) 22:773–782

Table 2 Comparison of
laboratory occlusal contact Contacts Group Mean value 95% CI p value
points after lowering the casts in
the articulator Hard contacts Mean setting 2.97 2.41–3.52 0.156
Face-bow record 3.29 2.74–3.84
Soft contacts Mean setting 3.1 1.95–4.24 0.1
Face-bow record 3.94 2.7–5.17
Hard + soft contacts Mean setting 6.06 4.69–7.44 0.13
Face-bow record 7.23 5.77–8.68
Hard + soft contacts (anterior teeth) Mean setting 0.1 0.03–0.17 0.005
Face-bow record 0.4 0.2–0.6
Number of teeth in contact Mean setting 3.03 2.48–3.59 0.027
Face-bow record 3.9 3.19–4.62
Number of anterior teeth in contact Mean setting 0.1 0.02–0.17 0.007
Face-bow record 0.37 0.19–0.56
Number of posterior teeth in contact Mean setting 1.82 1.51–2.13 0.428
Face-bow record 2,02 1,64–2,39

For no. 1 (mean setting) n = 31 and no. 2 (face-bow) n = 31; italic p values represent statistically significant
differences between group 1 and group 2

a very low correlation between the number of posterior teeth
with at least one contact point and the vertical shift
(R2 = 0.001; Fig. 4). The variable of the method of mounting
the casts (mean versus face-bow setting) shows no correlation
(R2 = 0.006).
The asymptotic generalized Cochran-Mantel-Haenszel test
for the relationship between the extent of the vertical shift and
the number of anterior contact points was defined for a limit of
5 mm, i.e., extents from 1.5 to 5 mm and from 5 to 10 mm
were tested for the relationship between groups 1 and 2. With
p = 0.2463, no statistical significance was shown (Fig. 5).
Discussion
This trial presents the results of two different methods of cast
transfer into an articulator: the use of an arbitrary face-bow
and a mean setting.
If the vertical dimension is changed in the articulator, the
use of a face-bow shows significant differences regarding the
number of laboratory and clinical occlusal contact points com-
pared to a mean setting. Thus, null hypotheses I and II have to
be rejected.
Participants were patients with complete dentures. A
remounting procedure with intraoral pin-supported registra-
tion was chosen to present a clinical example where an in-
crease of the vertical dimension (in this case for non-
occlusal guided Gothic arch tracings) was necessary.
For mounting the prostheses into the articulator, arbitrary
face-bows are a well-accepted device to record the arbitrary
hinge axis and to support a more time-saving procedure than
the localization of the kinematic hinge axis [20, 21]. Only one
clinical trial evaluated the benefit of face-bow utilization as
the main difference between two experimental groups in the
context of the production of complete dentures [22]. Detailed
information concerning the trial design is not described. Thus,
a clear answer to assess the evidence of the use of a face-bow
cannot be given by that study.
The mean setting was chosen as a control group for mount-
ing casts into the articulator. In the literature, a mean value-

Table 3 Comparison of clinical occlusal contact points per teeth and numbers of teeth with at least one contact for T0 (group 1: n = 16, group 2:
n = 16), T1 (group 1: n = 16, group 2: n = 15), T2 (group 1: n = 16, group 2: n = 14)

Type of contact Group T0 T1 T2

Mean value 95% CI p value Mean 95% CI p value Mean 95% CI p value
value value

Number of contact points Mean setting 0.67 0.57–0.77 0.448 0.54 0.43–0.66 0.695 0.87 0.86–1.06 0.589
(posterior teeth) Face-bow record 0.62 0.52–0.72 0.57 0.46–0.69 0.8 0.57–1.02
Number of contact points Mean setting 0.08 0.01–0.16 0.821 0.1 0.0–0.21 0.323 0.26 0.1–0.42 0.579
(anterior teeth) Face-bow record 0.09 0.03–0.16 0.05 0.01–0.09 0.2 0.05–0.35
Teeth with at least one contact Mean setting 6.06 5.25–6.88 0.716 5.5 4.28–6.72 0.718 7.13 5.49–8.31 0.042
Face-bow record 5,88 5,15–6,6 5,25 4,44–6,06 5,31 3,93–6,7

The italic p values represents statistically significant differences between group 1 and group 2
Clin Oral Invest (2018) 22:773–782
Table 4 Extent of the vertical shift for Gothic arch tracing using
intraoral pin registration
Vertical shift (mm) 1.5 2 3 3.5 4 4.5 5 6 7 8 10
n 2 2 4 4 14 4 18 6 2 2 4
based position of the casts is reported as unfavorable [23–25].
A remounting procedure of complete dentures is particularly
recommended with the use of a face-bow [25].
The primary outcome of this trial was the record of labora-
tory and clinical occlusal contact points. The former were
recorded qualitatively (hard and soft contacts) and quantita-
tively. With a digital method for analyzing laboratory occlusal
contact points, a standardized procedure should ensure the
quality of recording occlusal contact points [26, 27]. Clinical
occlusal contact points were recorded quantitatively 3 and
84 days after invention. One limitation is the difficult detec-
tion of clinical contact points. Even though shimstock occlu-
sion foil is a reliable material [28], complete dentures are worn
on a resilient tegument. In addition, the subjective detection of
sliding contacts and contacts where the occlusion foil is fixed
shows an operator-dependent variability.
The results for laboratory occlusal contact points show no
statistically significant difference between a mean and a face-
bow setting regarding the total number of contact points.
There was a statistically significant difference of anterior teeth
with at least one contact point in favor of the face-bow group.
Hence, the face-bow seems to provoke anterior contacts after
lowering the vertical dimension in the articulator.
The increase of anterior contact points in the face-bow
group may depend on the use of an earpiece face-bow. It
was shown that 92% of arbitrary hinge axis points transferred
with an arbitrary face-bow are located anterior of the true
hinge axis [29]. Hence, if the arbitrary hinge axis and, as a
consequence, the radius of movement are different from the
true hinge axis, occlusal discrepancies can arise when lower-
ing the casts in the articulator [30]. The authors hypothesize
that the arbitrary hinge axis was determined anterior to the true
hinge axis. This may explain the higher number of anterior
contact points and the number of teeth in contact.
Additionally, a source of system-immanent errors within the
application of a face-bow as incomplete screw fixing and in-
accurate adaption of the registration impression material was
described [31].
Table 5 Impact of the vertical
shift on laboratory occlusal Tested parameters
contact points: calculation of the
coefficient of determination R2 Correlation of posterior teeth with at least one contact and vertical shift in total cases
Correlation of posterior teeth with at least one contact and vertical shift in total cases
and mounting method
Correlation number of contact points (anterior + posterior teeth) and vertical shift in total cases
R2 ranks between 0 and 1; values with tendency to 0 (1) present a low (high) correlation
779
Further aspects are the results of clinical occlusal contact
points. Groups 1 and 2 present no statistical difference in
the number of clinical contact points. Three days after in-
tervention, the number of clinical occlusal contact points
decreased in both groups compared to the value before the
remounting procedure was performed. One reason is possi-
bly that complete dentures have to re-settle after the
remounting procedure on the tissues. Due to a new neuro-
muscular adjustment within the masticatory system, pa-
tients have to adapt to the new optimized, centric related
terminal occlusion [32, 33]. After 84 days, the number of
clinical occlusal contact points increases in both groups. We
assume that over that time the complete dentures got settled
and the patients adapted. The isolated number of clinical
contact points allows for no statement about their distribu-
tion, and the only increase of contact points does not lead to
a better or ideal occlusion. More important are the stabilized
contact relations in terminal occlusion [34]. The distribu-
tion of occlusal contact points can be defined via specifica-
tion of the number of teeth with at least one static contact
point. In group 1 (mean setting), the value increases up to
84 days after intervention. Group 2 shows an opposed
course. In fact, the overall number of clinical contact points
increases up to that point, but the number of teeth with at
least one contact decreases. The magnitude of difference
(T0 = 5.88; T2 = 5.31) is, however, as far our experience
goes, not clinically relevant. After 84 days, group 1 showed
a significantly higher number of teeth with at least one con-
tact than group 2. This cannot be clearly explained with the
absence or the use of a face-bow. It describes rather the
change of occlusal parameters over the course of the first
weeks after the insertion of complete dentures [33, 35, 36].
It should be noted that the procedure in our trial was already
a remounting procedure of incorporated dentures (2–
4 weeks worn). The results show that occlusal changes of
complete dentures are a continuous process [37], and sub-
sequently, they have to be well maintained.
The secondary outcome in this trial is the extent of the
vertical dimension and its impact on laboratory occlusal
contact points as a function of the mounting method. A
low correlation was measured between the vertical shift
and the number of posterior teeth with at least one contact
in all cases. An additional differentiation in both groups
shows only a low correlation between vertical shift and
R2
0.001
0.006
0.017
780
Fig. 4 Impact of the vertical shift
on laboratory occlusal contact
points: shown is the number of
posterior teeth with at least one
Number of teeth with at least one contact
contact point as a function of the
vertical shift in groups 1 and 2.
The values are scattering around
the regression line and present a
low correlation between both
parameters
occlusal contacts in posterior teeth. Occlusal errors occur
during the determination of the jaw relation between lower
and upper jaw with wax registrations [38], and the dimen-
sion of occlusal errors changes in a direct proportional func-
tion. Hence, an increase in the vertical dimension increases
the occlusal error [5]. It has been described that an occlusal
error of 0.13 mm occurs per 1-mm vertical shift [38]. In our
trial, we recorded the change in the number of contact
points as well as teeth with at least one contact, and did
not calculate an occlusal error. Thus, a direct comparison
with the mentioned literature cannot be conducted. Also, a
significant value in laboratory contact points for anterior
teeth was recorded, but no correlation with a change in the
vertical dimension could be calculated. Morneburg et al.
recommended the location of the terminal hinge axis using
axiographic methods for a vertical shift of ≥4 mm [3]. In our
trial, the mean vertical shift was 4.89 mm. A more individ-
ual axiographic determination of the terminal hinge axis
would have been an option.
The use of a face-bow for dental reconstructive proce-
dures is controversially discussed in the literature [7, 39].
a b
Fig. 5 The vertical shift was measured after demounting the pin registration set and lowering the upper CD in the articulator. a Position before lowering.
b Position after lowering up to first contact points between upper and lower CD occurred
Clin Oral Invest (2018) 22:773–782
6
4
0 2 4 6 8 10
Vertical shift [mm]
One author recommended to save the time a face-bow re-
cord needs in favor of other prosthodontic steps [4]. Other
authors discussed how much time should be spent on lec-
tures about the face-bow for dental students [8, 40]. A
survey in a sample of 36 Chinese dentists showed that
more than 90% think that patients with complete dentures
can be satisfied without the use of a face-bow [41].
Moreover, it was stated that costs related with the use of
a face-bow have to be discussed [10, 39, 40]. Even though
the results of our study did not focus on aspects of dynamic
occlusion, a remounting procedure and also the production
of CDs under the application of a face-bow should be
discussed regarding cost-effectiveness and patient satisfac-
tion. In terms of further studies, a comparable experimental
group design and the utilization of a face-bow as the only
differentiator to the control group should be considered.
This is a well-known essential criterion for meta-analyses
and systematic reviews. Further research is, moreover,
needed to investigate face-bow utilization within the pro-
duction of multiunit fixed partial dentures. Due to the fact
that the therapy of tooth-based fixed partial dentures
Clin Oral Invest (2018) 22:773–782
underlies other conditions concerning impressions, jaw re-
lation, and periodontal tissues as Bdenture base,^ a rash
propagation of the results from a complete denture setting
to fixed prosthodontics is not recommended [8].
Conclusion
Considering the complex multistep study design, a limited
number of participants, and referring to one specific arbitrary
face-bow, the following conclusion could be drawn:
No substantial difference by the use of the arbitrary face-
bow compared to a mean setting could be determined, when
changing the vertical dimension in the articulator within a
remounting procedure of complete dentures.
With regard to the number of occlusal contact points
achieved in both groups, the question arises if the number of
contact points is decisive for the clinical stability of the den-
ture’s occlusion.
Compliance with ethical standards
Conflict of interest The authors declare that they have no conflict of
interest.
Funding The work was supported by the Institute for Dental, Oral and
Maxillary Medicine.
Ethical approval This article contains a study with human participants
performed by the authors. The number of the approval of the ethics
committee is listed in the article under the BMaterials and methodsB
section.
Informed consent For this type of study, informed consent was obtain-
ed from all individual participants included in the study.
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