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A newer technique to program a semi adjustable articulator

Article  in  Journal of Pharmacy and Bioallied Sciences · July 2014

DOI: 10.4103/0975-7406.137421 · Source: PubMed

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Dental Science - Original Article
A newer technique to program a semi
adjustable articulator
R. Venkateshwaran, Suma Karthigeyan1, P. S. Manoharan2, Jagadish Konchada3,
Manikandan Ramaswamy4, Bhuminathan

Departments of ABSTRACT
Prosthodontics,
Introduction: The difficulty in reproducing accurate angle of condylar guidance in semi‑adjustable articulators.
Sree Balaji Dental College,
Bharath University,
Purpose: The purpose of this study was to determine the correlation between the angle of horizontal condylar
Pallikaranai, Chennai, inclination obtained on a semi‑adjustable articulator and the corresponding angle traced on a temporomandibular
1
Rajah Muthaiah Dental joint (TMJ) radiograph in completely edentulous subject. Materials and Methods: The horizontal condylar
College, Chidambaram, inclination angle was obtained in a semi‑adjustable articulator by means of height tracer (extra oral tracing
4
KSR Dental College, device) and interocclusal records to program the articulator in 21 subjects. TMJ radiograph were recorded by
Erode, Tamil Nadu, the same operator with same orthopantomogram (OPG) machine (planmeca). Tracings of inclines of articular
2
Indra Gandhi Dental eminence on the radiograph were compared with the angle obtained on a semi‑adjustable articulator. Each
College, Puducherry, measurement was made using manual methods of measuring angle. The results were subjected to the Pearson
3
Sree Sai Dental College
correlation statistical analysis (α =0.01). Results: The outline of the articular eminence in a TMJ tomogram
and Research Institute,
Srikakulam, Andra
radiographic image was identified and traced. A significant correlation was found between the horizontal
Pradesh, India condylar inclination on a semi‑adjustable and the corresponding TMJ tomogram radiographic image for both
right (R = 0.789; P = 0.001) and left (i = 0.747; P = 0.004) sides. Conclusion: The articular eminence
Address for correspondence: traced on a TMJ tomogram image represents the horizontal condylar inclination with a mean difference of
Dr. R. Venkateshwaran, 5° in 21 subjects evaluated.
E‑mail: dr.venkateshwaran@
gmail.com

Received : 30-03-14
Review completed : 30-03-14
Accepted : 09-04-14 KEY WORDS: Horizontal condylar inclination, Programming, TMJ tomogram

I n completely edentulous, radiographic image of the

slopes of articular eminence on a TMJ tomogram when
traced can be used in programming the semi‑adjustable
articulator.
A semi‑adjustable articulator allows adjustment to replicate
average mandibular movements Glossary of prosthodontic
terms.[1] It is possible only if the degrees of anatomical slopes
are accurately recorded. The exact replication of mandibular
movements has been a clinical challenge in order to achieve
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DOI:
10.4103/0975-7406.137421
a perfectly harmonized occlusion. The anatomic slopes of
articular eminence are represented as the horizontal condylar
inclination in the articulator. These programming are done
by means of using protrusive and lateral inter occlusal
records.[2] Arbitrary setting of the condylar elements will
provide an entirely satisfactory representation of condylar
movements.[2] Numerous studies have shown the inconsistency
in recording and reproducing these angles in a semi‑adjustable
articulator.[3,4] The setting condylar inclination at a flatter
than the average value to ensure disocclusion of the posterior
teeth during excursions.[5] Interocclusal record material used
in programming the articulator has also shown variation up
to 21-64°.[6] The individual inclination of the eminence is
very steep or flat, guidance obtained from the average value
settings may differ sufficiently to cause problems in achieving
particular clinical objectives, such as posterior disocclusion
or balanced occlusion. The use of additional aids, such as
dynamic registration or imaging, may resolve this potential
problem.

How to cite this article: Venkateshwaran R, Karthigeyan S, Manoharan PS, Konchada J, Ramaswamy M, Bhuminathan. A newer technique to program a semi
adjustable articulator. J Pharm Bioall Sci 2014;6:S135-9.

Journal of Pharmacy and Bioallied Sciences July 2014 Vol 6 Supplement 1 S135 
 Venkateshwaran, et al.: A newer technique to program a semi adjustable articulator

Materials and Methods

A study was conducted at the Department of Prosthodontia,

Rajah Muthiah Dental College and Hospitals, Annamalai
University. 21 subjects requiring complete denture treatment
were chosen randomly from the outpatient department. The
inclusion criterion was patient should have good neuromuscular
coordination to produce good tracing of mandibular border
movements.
Figure 1: Centric record and protrusive record
All steps of complete denture procedures were done. A tentative
jaw relation was performed and the maxillary cast was oriented
to the articulator using a Hanau spring bow. Using the nick
and notch method a static record of centric relation was
obtained using Zinc Oxide Eugenol (ZOE) impression paste
as interocclusal recording material. Once, the cast was oriented
in articulator. Extra oral tracer height tracing device was used
in this study. The patient was trained for tracing of mandibular
border movements in the way as prescribed by Ney mandibular
excursion guide. The completely edentulous subjects were
trained for tracing of mandibular movement until a sharp arrow
point tracing was obtained. Measuring 6 mm from the apex of
the tracing a point is marked over the transparent sheet and this
will represent the protrusive position. Once this is accomplished
nick are made in the occlusal rim of both maxilla and mandible
correspondingly in canine and molar region. Then the surface
of the occlusal rim is coated with petrolatum and using the
polyvinyl siloxane material (3M CAD BITE, ESPE, Virtual CAD
bite registration material, Ivoclar, Zurich, Switzerland) as an Figure 2: Protrusive record in position to program the articulator
interocclusal record centric record is obtained [Figure 1]. Then
the patient is asked to close the mandible in a forward position
to represent the protruded position of mandible such that the
stylus is positioned on the 6 mm marking on the tracing plate.
Interocclusal record material is injected to obtain a protrusive
record. The interocclusal record material flows easily and should
be rigid on setting.

Once the protrusive and centric records have been obtained,

these records are used to program the semi‑adjustable
articulator using Lauritzen’s split cast technique [Figure 2].
With the centric record in position, the cast oriented and
articulated in exact centric position. Using the protrusive
record the articulator is programmed to determine the
horizontal condylar inclination. Once, the required horizontal
condylar inclination has been determined in an articulator.
Then the Bennett angle was obtained using the formula
L = H/8 + 12. Figure 3: Positioning light grid on patient

Then the patient is referred to Department of Oral Medicine

and Radiology for temporomandibular joint (TMJ) tomogram.
Radiographs were made at 70 Kv at a fixed distance in a
planmeca radiograph machine. Cassettes were loaded with OPG
film and the patient was positioned in the machine using head
positioner. The positioning of the patient head was standardized
using the positioning light grid in the machine [Figure 3].
This grid was designed to be parallel to Frankfort horizontal
plane (FHP) in the patient. The anteroposterior positioning
of the head was based on the correction scale provided by the
manufacturer. The position of the head was confirmed with
the grid lines in the machine as the crossing point of the light
is to be focused on the tip of the nose. In the midline, the mid
nasal and anterior nasal spine were used to vertically align the
sagittal plane. The exposure for radiograph was done at 70 Kv
and 68 Kv at 10 mA in both open mouth and closed mouth
position, respectively for increased contrast between the two
positions. All radiographs were made by the same operator at
the same time and with same panaromic radiographic unit.
TMJ tomogram was made of each subject with the FHP and
upper border of radiograph parallel to the floor. Due to circular

 S136 Journal of Pharmacy and Bioallied Sciences July 2014 Vol 6 Supplement 1
 Venkateshwaran, et al.: A newer technique to program a semi adjustable articulator
rotation of the radiographic recorder, this results in the upper
border of radiograph being parallel to the FHP image.
Once the tomograms were obtained, tracing papers were
attached to the radiograph. Tracings were made of the images
of each radiograph on parchment paper along the border of
slopes of articular eminence. Horizontal reference lines were
drawn parallel to the upper border of radiograph, contacting,
and identifying the most superior and inferior point of each
curve. The outline of each curvature and the flat reference line
were traced. On tracing a line was drawn connecting the most
superior and inferior points of curvature representing the mean
curvature line. These two points were connected by a straight
line representing a mean curvature line [Figures 4 and 5].
Angles made by the intersection of mean curvature line and
the horizontal reference line (FHP) were measured. Each
measurement was repeated twice by the operator. Data were
subjected to Pearson’s correlation statistical analysis.
Results
The radiographic image of the outline of articular eminence
was seen distinctly in a TMJ tomogram. The outline if this was
traced to obtain the angle of horizontal condylar inclination
of the respective side and compared with the values obtained
after programming the articulator. Radiographic values were on
average 5° greater than anatomic values [Table 1].
From the correlation analysis in the following results are arrived.
Among the 21 subjects, significant correlation was found between
the angles obtained in the articulator to that of the corresponding
radiographic image. The calculation of articulator value versus
TMJ value of right and left in the right the correlation value (r)
is 0.789 and 0.747 at the level of 1%, respectively. The calculated
value is higher than the table value and significant at 1% level.
Hence, the angle obtained in articulator versus TMJ tomogram
is very closely correlated. Hence, there is no significant variation
among the both views [Table 2].
From the descriptive analysis in the following results are arrived.
The 21 respondents are taken into the analysis calculation of the
mean value of angle in articulator left is 25.714, standard deviation
value is 10.159 and standard error is 1.822. Condylar inclination
in TMJ tomogram view left value of mean 30.476 and standard
deviation 8.352 in the same standard error (1.822) [Table 3].
Figure 4: Tracing done on a temporomandibular joint tomogram using
a parchment paper
Journal of Pharmacy and Bioallied Sciences July 2014 Vol 6 Supplement 1 S137 
From the descriptive analysis in the following results are arrived.
The 21 respondents are taken into the analysis calculation of
articulator right value of the mean is 25.238, standard deviation
value is 9.417 and standard error is 1.721. Condylar inclination
in TMJ tomogram view right value of mean 30.476 and standard
deviation 7.890 in the same standard error (1.721) [Table 4].
Discussion
Among the 21 subjects, significant correlation was found
between the angle obtained on the articulator and the TMJ
tomogram radiographic image. The Pearson’s correlation
analysis test was conducted at a confidence interval of 99%.
The results show a higher correlation (r) value of articulator
versus TMJ tomogram on the right and left as 0.789 and
0.747, respectively. This shows that the angles obtained on the
articulator are very closely correlated to that obtained on a TMJ
tomogram radiograph. There was statistically no significant
variation in horizontal condylar inclination angle obtained from
both methods. The high correlation value shows that it can be
used as a reliable tool in programming the articulator. In terms
of difference in horizontal condylar inclination angle, a mean
difference of 5° was obtained between the angles obtained on
an articulator to that of the TMJ tomogram. The mean value
of error obtained between the left side and right side of the
articulator and TMJ tomogram was 4.7° and 5.2°, respectively.
Among all TMJ imaging technique, TMJ tomogram is a
specialized view for imaging TMJ. It represents the composite
sagittal inclination of the articular eminence of both sides
in open mouth and closed mouth position. TMJ tomogram
presents better image quality, as all other forms of radiographic
visualization of TMJ had overlap of the image to some extent.
The controlled radiation exposure at proper interval ensures that
there is no image overlap and the TMJ alone is radiographed
on the film.
Gilboa et al.[7] have reported that the radiographic outline of
the articular fossa and articular eminence provided an accurate
representation of the equivalent outline in 25 human skulls
Figure 5: Angles obtained from temporomandibular joint tomogram
radiograph
 Venkateshwaran, et al.: A newer technique to program a semi adjustable articulator

Table 1: The average angles, standard deviation between supporting the bases in order to achieve uniform simultaneous
mean curvature line and the reference line (FHP) on the contact of denture.
radiograph and in the subject
Condylar inclination Mean Standard deviation N The Gothic arch tracing is considered as the most ideal
Articulator right 25.2381 9.41756 21 method in programming the articulator. This method has
Articulator left 25.7143 10.15944 21 some minor drawbacks like, the positioning of the tracer
TMJ tomogram right 30.4762 7.89062 21 doesn’t allow the lip to be passive and hinders the rest
TMJ tomogram left 30.4762 8.35236 21 position of the mandible, excessively resorbed ridges, flabby
FHP: Frankfort horizontal plane, TMJ: Temporomandibular joint ridges, inadequate inter arch distance, large tongue. In
subjects with TMJ arthropathy, there are chances of obtaining
Table 2: The correlation between the angle of inclination in aberrant tracing that are faulty. These faulty tracings may
articulator and TMJ tomogram radiograph lead to results that do not represent the actual horizontal
condylar inclination of the patient and has no significance
Condylar inclination n r Significant at 0.01%
in programming the articulator.
Articulator right versus 21 0.789** 0.000
TMJ tomogram right
Articulator left versus 21 0.747** 0.000
The temporomandibular X‑ray film reproduces the actual
TMJ tomogram left form and angles of the osseous structure of the joint. On the
other hand, the functional registrations indicate the condylar
**Correlation is significant at the 0.01 level (one‑tailed, Pearson
correlation). TMJ: Temporomandibular joint
path angles by means of the path traversed by the condyle
along the slopes of the articular eminence. In recording
horizontal condylar inclination errors up to 21-64° has been
Table 3: Descriptive statistics among the condylar inclination observed among the same operators, technique and material.
in articulator left versus TMJ tomogram view left By examining the angle of the osseous structure of the joint
n Mean SD Standard Degree directly on the film, and making a transfer from the film to
error error
the instrument, a more specific condylar path angle can be
Condylar inclination 21 25.7143 10.15944 1.82263 4.7619 determined.
in articulator left and 21 30.4762 8.35236
condylar inclination in
TMJ tomogram view left The articular eminence inclination in the radiographic image
was traced from the most superior to the most inferior points of
TMJ: Temporomandibular joint, SD: Standard deviations
curvature representing mean inclination of curve. This may be
different from guiding inclination with approximately 4-6 mm
Table 4: Descriptive statistics among the condylar inclination of protrusion, which is clinically significant range of protrusion
in articulator right and TMJ tomogram right and condylar guidance.
n Mean SD Standard Degree
error error When dynamic extraoral tracings are used, the starting
Condylar inclination in 21 25.2381 9.41756 1.72187 5.2381 point (centric relation), individual curved path, and eccentric
articulator right and position are recorded. With static records, only the centric
condylar inclination in 21 30.4762 7.89062
relation and eccentric positions are recorded, the midpoint
TMJ tomogram view right
of the excursion produces the maximum error with a straight
SD: Standard deviation, TMJ: Temporomandibular joint condylar slot. The maximum difference between a straight
condylar path and one that has a 1/2 inch radius is 0.4 mm.
with a mean difference in inclination of 7°. Images in a TMJ A maximum condylar error of 0.4 mm produces a 0.2 mm error
tomogram provide composite sagittal representations of the at the second molar.
skeletal structures. TMJ tomogram presents better image
quality and outline of the articular eminence of the temporal The sensitivity of the Hanau Wide‑Vue 183-2 closed tract
bone without any image overlap. A variety of interocclusal semi‑adjustable articulator is of the order 5°. From the values
record materials are used in recording horizontal condylar obtained a mean difference of 5° was obtained between the
inclination, are impression plaster, polyvinyl siloxane, waxes, angles obtained on an articulator to that of the TMJ tomogram.
acrylic resin and ZOE paste. Inter occlusal record even though The mean value of error obtained between the left side of the
they are considered as the most ideal way of programming the articulator and TMJ tomogram was 4.7° and on the right side
articulator. Preti et al. have reported that average interocclusal it was 5.2°. This shows that the 5° error is minimal or almost nil
registration values of the condylar guidance inclination vary compared to other methods of recording horizontal condylar
from 21° to 64°. inclination.

Various interocclusal record material has been used in the past, The current study concluded that TMJ tomogram accurately
the difficulty in recording wax inter occlusal record was uneven represents the outline of the articular eminence and the angle
softening and uneven thickness of the recording material. of the slopes of articular eminence traced on it can be used
Boucher recommends that the centric relation should be made as an aid in setting the condylar guidance inclination on a
with minimal pressure to prevent displacement of the tissues semi‑adjustable articulator.
 S138 Journal of Pharmacy and Bioallied Sciences July 2014 Vol 6 Supplement 1
 Venkateshwaran, et al.: A newer technique to program a semi adjustable articulator
Conclusion
The radiographic outline of the articular fossa and articular
eminence provided an accurate representation of the equivalent
outlines in 21 subjects with a mean difference in inclination
of 5°. The image of the articular eminences in a TMJ tomogram
may be used to provide an indication of the degree of inclination
of the articular eminence and may be of value as an aid in setting
the condylar guidance in semi‑adjustable articulators. A new
method for programming the articulator has been suggested
in this study that is more reliable, repeatable, ease of use with
minimal drawbacks.
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Source of Support: Nil, Conflict of Interest: None declared.
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