Accuracy of Dynamic Virtual Articulation: Trueness

and Precision
Michael R. Hsu, DDS, Carl F. Driscoll, DMD, FACP, Elaine Romberg, PhD, & Radi Masri, BDS, MS, PhD,
FACP
Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland, Baltimore, MD

Keywords
Condylar inclination; pin opening; precision;
trueness; virtual articulator.
Correspondence
Radi Masri, BDS, MS, PhD, FACP,
Department of Advanced Oral Sciences and
Therapeutics, School of Dentistry, University
of Maryland, 650 W Baltimore St., MD 21201.
E-mail: rmasri@umaryland.edu
This project was supported a grant from the
American College of Prosthodontists
Educational Foundation.
The authors deny any conflicts of interest
related to this study.
Accepted February 5, 2019
doi: 10.1111/jopr.13035
Abstract
Purpose: To study the effects of altering condylar settings and pin openings on the
trueness and precision of virtual articulators vs. mechanical articulators.
Materials and Methods: Maxillary and mandibular typodonts with fiducial markers
were mounted on a mechanical Artex-CR articulator, and the mandibular teeth were
prepared to allow guidance solely by the posterior determinants of the articulator and
the incisal table. The relationship of the mounted typodonts was preserved digitally
by scanning using manufacturer transfer plate adaptors. On the mechanical articula-
tor, pattern resin was allowed to set between the maxillary and mandibular occlusal
surfaces (area #25-30) at the endpoints of dynamic movements at 3 condylar inclina-
tions (SCI): 10°, 30°, and 45°, n = 12/inclination, or at 3 incisal pin openings (2, 5,
and 10 mm, n = 12/opening). All other articulator settings were kept constant. Resin
specimens attached to the typodonts were scanned within 5 minutes of setting, then
removed, and the articulated typodonts rescanned. Fixed dental prostheses (FDPs)
#25-30 were designed on the virtual articulator using identical parameters to the me-
chanical articulator. Dynamic virtual movements were used to sculpt the design, and
a file of the design was saved. The files of both types of samples were aligned and
overlaid. Interocclusal separation was measured in triplicate at the indentation created
by the mesiolabioincisal point angle on the incisal edge of #8 and the mesiobucco-
occlusal point angle of #3. Trueness and precision of both types of articulators were
calculated and compared using one-way ANOVA, followed by the Tukey HSD test
(α = 0.05).
Results: There was no statistically significant difference at altered pin openings in
either trueness (F = 0.202, p = 0.37) or precision (F = 3.134, p = 0.09) for the majority
of measurements. The only significant difference was in the precision between the 2
types of articulators at 5 mm incisal opening, and only at the anterior measurement
point (F = 15.134, p = 0.0008); however, these differences were less than 100 μm.
When the SCI was altered, there was no statistically significant difference (F = 3.624,
p > 0.05) between the virtual and mechanical articulators in trueness for 5 of the 6
measurements obtained (F = 3.624, p = 0.07) or for all of the precision measurements
(F = 3.529, p = 0.07). The one trueness measurement that was significantly different
(F = 9.237, p = 0.006) occured at SCI of 10°, and it was less than 100 µm.
Conclusions: Dynamic movements on the virtual articulator were shown to be as
true and precise as to the mechanical articulator. When there were deviations, these
deviations were less than 100 µm and thus, these deviations may not be clinically
relevant.

An articulator is a mechanical instrument representing the
temporomandibular joints and jaws, to which maxillary
and mandibular casts may be attached to simulate some
or all mandibular movements.1 They can be programmed
using average values or using custom values obtained from
individual patients.2 The articulator allows practitioners to
save valuable chair time, increase patient comfort, magnify
and amply light the workspace, and increase treatment
efficiency.3-5
Recent breakthroughs in digital dentistry promise increased
accuracy, lower costs, unprecedented speed, and increased
practicality.5,6 Digital workflows could minimize laboratory

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Hsu et al
steps, reduce the need for specialized training, increase patient
comfort, and vastly increase efficiency.6,7 Most current den-
tal digital design software offers virtual articulators designed
to replicate the functions of mechanical articulators. Like me-
chanical articulators, virtual articulators can be set using user-
defined inputs to define the relationships between maxillary and
mandibular teeth. Digital restorations are designed to exhibit
intimate static occlusal and proximal contacts. Contemporary
digital dental design programs also allow for the dynamic sim-
ulation of the movement between the maxilla and mandible.
With these digital settings, the planning and design phases of
occluding dental restorations can be adapted to each patient’s
dentition before intraoral try-in.
Several studies investigated the clinical utility of static digital
articulation.8-10 Gartner and Kordass compared mechanical and
virtual articulators by analyzing contact point patterns at max-
imum intercuspation, but did not analyze individual condylar
or other articulator settings in detail and did not test alterations
to those settings, finding no significant difference between the
mechanical and virtual articulators.8 Others have evaluated
deviations in virtual articulation using 2D or 3D analysis soft-
ware to superimpose and calculate distortions between images
of virtual models but only at a static relationship in maximum
intercuspation and without movements. These studies demon-
strated that accuracy between mechanical and virtual models
was comparable.11,12 Common to all of these studies is testing
the static relationship of maxillary and mandibular teeth/models
in the static maximum intercuspation position. To the authors’
knowledge, no studies have been published on the trueness and
precision of virtual articulators when dynamic movements are
considered and how they are influenced by different articulator
settings.
Dynamic virtual articulation is the virtual movement of dig-
ital casts using user-defined information to dictate condylar
element settings and simulate mandibular movements. True-
ness of the system can be defined as the value by which the
measured result deviates from the true measurement and rep-
resents mean deviation (error) of a group of measurements
from an original structure or a reference (in this case, the me-
chanical articulator). Precision refers to the amount of devia-
tion between various readings13,14 and represents mean devi-
ation between repeated measurements. Precision of an instru-
ment can be determined by calculating mean absolute devia-
tions between all possible pairs of measurements within each
group.13,15-17
Depending on its type and classification, an articulator can
accept user-defined settings including, for example, settings
for sagittal condylar inclination (SCI), immediate lateral
translation, incisal pin opening/arc of closure, and lateral
condylar inclination. SCI is the angle formed by the path
of the moving condyles within the sagittal plane compared
with the horizontal plane and influences the anterior-posterior
movement of the articulator.1 Increasing the SCI will increase
the space that occurs between opposing posterior occlusal sur-
faces during mandibular protrusion, known as the Christensen
phenomenon.18 Measuring this separation, generated during
mandibular protrusion, makes it possible to assess the effect of
altering SCI settings on point separations at defined locations
for articulators.
Journal of Prosthodontics 28 (2019) 436–443 
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Accuracy of Dynamic Virtual Articulation
The arc of closure is the circular or elliptical arc created by
closure of the mandible, most often viewed in the mid-sagittal
plane, in relation to a reference point on the mandible.1 The arc
of closure of the mechanical articulator has been established
as an important factor in accurate fabrication of esthetic and
functional dental prostheses.19-21
Virtual articulators are assumed to be identical to mechanical
articulators in terms of trueness and precision; however, this has
not been independently verified. For virtual articulators to be
used acceptably, trueness and precision should be comparable
to that of the mechanical articulator.
In this study, the following null hypotheses were tested: There
is no significant difference in the trueness and precision of a
prosthesis designed using virtual and mechanical articulators
when the incisal pin opening is altered (openings of 2, 5, and
10 mm) and when sagittal condylar inclination is altered (angles
of 10°, 30°, and 45°).
Materials and methods
Mechanical and virtual model preparation
Fully dentate maxillary and mandibular models (Nissin;
Kilgore, Nakagyoku, Kyoto) were used to simulate human
dentition. The casts were mounted using low expansion
lab plaster (Whip Mix, Louisville, KY) into a single new,
calibrated mechanical ARCON type Artex-CR articulator
(Amann Girrbach, Koblach, Austria) that allows adjustment
of SCI, immediate mandibular lateral translation (IMLT),
protrusion, retrusion, and distraction, but not intercondylar
distance (Fig 1A). This articulator was chosen because it
allowed the most variables to be tested virtually.
The plaster was allowed to set for 48 hours. The occlusion
was adjusted to ensure bilateral even occlusal contacts were
present in maximum intercuspation between maxillary and
mandibular teeth using 20 µm articulating paper (Accufilm
II; Parkell, Edgewood, NY) and 8 µm shimstock (Coltene
Whaledent, Cuyahoga Falls, OH) at a 0 mm incisal pin
opening. All mandibular teeth were prepared to approximately
2 mm occlusal clearance, and teeth #25-30 were prepared
for full-coverage restorations (Fig 1B). The mandibular teeth
were prepared to allow guidance solely by the posterior
determinants of the articulator and the incisal table, without
any interference from the cusps of the mandibular teeth during
dynamic movement of the articulator.
Fiduciary markers (Grade G25, 1/4” spheres, 0.25” spheric-
ity; BC Precision, Chattanooga, TN) were attached to the
maxillary and mandibular models using cyanoacrylate adhesive
(Permabond, Pottstown, PA). These markers were placed 1 cm
apical to the cemento-enamel junction (CEJ) of the canines
and first molars in both the maxillary and the mandibular
models (Fig 1C, D). The mounted models were sprayed with
titanium dioxide power (Quickcheck; Vacalon, Pickerington,
OH) scanned using a D2000 Dental Lab Desktop Scanner
(3Shape, Copenhagen, Denmark), and the surface scans were
saved in an open source surface tessellation language (STL)
file format (Fig 2A). Virtual articulation was generated using
the Dental Designer Software (v17.2.1; 3Shape) using the
manufacturer protocol and transfer plates (Adesso/Artex one
437
Accuracy of Dynamic Virtual Articulation Hsu et al

A B
C D
Figure 1 Recording dynamic movement on the mechanical articulator:
(A) the Artex-CR mechanical articulator with magnetic mounting plates;
(B) prepared teeth #25-30 taken and reduced occlusal of all mandibu-
lar teeth, lingual view; (C) pattern resin specimen after dynamic move-
ments, buccal view. Stainless steel ball bearings were used as fidu-
cial markers; and (D) occlusal view of pattern resin specimen made of
dynamic movement.
Mechanical articulation
The opening of the mechanical Artex-CR articulator was
increased by changing the settings for the incisal pin (2, 5, and
10 mm). Separating medium (Vaseline; Unilever, Trumbull,
CT) was applied to the maxillary and mandibular teeth.
Low-shrinkage Pattern Resin (GC America Inc, Alsip, IL) was
mixed according to manufacturer instructions and applied to the
occlusal surfaces of mandibular teeth #25-30 (Fig 1C, D). The
articulator was closed until the incisal pin was in contact with
the incisal table allowing the maxillary teeth to occlude and dis-
place the pattern resin. Before the pattern resin was completely
set, the articulator was dynamically opened and closed several
times (Fig 1C, D). Twelve specimens were evaluated for each
incisal pin opening. Specimens remained on the mandibular
models, and the entire assembly was sprayed with titanium
dioxide powder (Quickcheck), before scanning on the articula-
tor transfer plates to obtain an STL file of the surface scan for
further analysis (Fig 1). This facilitated comparison with results
from virtual articulation. The method of measurement is likely
to introduce errors in measurement. Thus, the same method
was used for both mechanical and virtual experiments. The
only way to do this was to use resin patterns for measurements.

stripe and two stripes; 3Shape) (Fig 2B-G) and 2 occlusal
calibration objects (3Shape), thus ensuring that the relationship
between the mechanical models and the mechanical articulator
was preserved in virtual articulation.
Measurement of effect of altering pin opening
The effect of altering incisal pin opening on the separation
of maxillary and mandibular casts was evaluated on both the
mechanical and virtual articulators. Three incisal pin open-
ings were tested: 2, 5, and 10 mm. Condylar element settings
were kept constant using the following values: Bennett angle:
8°,22-24 SCI: 30°,25 IMLT: 0 mm, and 0° incisal table inclination
(Fig 2D).
Virtual articulation
Dental Designer Software (3Shape v17.2.1) was used to design
a fixed dental prosthesis (FDP) from #25-30 at 2, 5, and 10 mm
openings. These FDPs mimicked the design of the pattern resin
specimens generated by the mechanical articulator while allow-
ing multiple prepared teeth to serve as reference markers. The
FDP was designed with a circular 6 mm connector and deselec-
tion of ‘remove undercuts’ and ‘drill compensation’ (Fig 2B,
C). The virtual pin opening was set before the occlusal surface
of the FDP #25-30 was raised until complete overlap of the
maxillary occlusal surface was achieved (Fig 2D). Contact was
set to be guided by the incisal plate before virtually opening
and closing the articulator (Fig 2E-F) and using the ‘Adjust to

A B C

D E F G

Figure 2 Recording dynamic movement on the virtual articulator: (A) occlusal view of prepared teeth #25-30 with fiducial markers; (B) defining
insertion direction; (C) designing copings without drill compensation or cement gap; (D) defining posterior determinants of occlusion; (E) dynamic
movement performed and recorded in the occlusal surfaces; (F) ‘Adjust to Articulator’TM function performed, and dynamic movement recorded in the
occlusal surface of FDP #25-30; and (G) design saved after dynamic movement recording was completed.

438 Journal of Prosthodontics 28 (2019) 436–443 

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Hsu et al Accuracy of Dynamic Virtual Articulation

10 degree
30 degree Virtual

interocclusal separation (in mm)

Mechanical
A B
45 degree

C D

Figure 3 Virtual rendering of scanned models: (A) Occlusal view of over-

laid specimens of identical movements on the virtual and mechanical
articulators. Fiducial markers were used to verify alignment; (B) Buccal
Anterior Posterior
view of overlaid specimens; (C) Fiducial markers were used to generate
a horizontal reference plane. Measurements were made to this plane
from the mesiolabioincisal point angle on the incisal edge of #8 and
B
the mesiobucco-occlusal point angle of #3; (D) Occlusal view of overlaid
specimens with points chosen. 2mm
Virtual
5mm Mechanical

interocclusal separation (in mm)

10mm

Articulator’ function within the software to dynamically sculpt

the virtual design (Fig 2G). As described above, constant condy-
lar element settings were maintained, using the same values
(Fig 1E). The final design of the occlusal overlay was exported
in an STL file format and aligned with the original surface scan
data using the best fit function of Meshmixer (Autodesk, San
Rafael, CA) with 500+ solve iterations and a tolerance of less
than 0.0001 mm (Fig 3A, B).

Obtaining measurements
The trueness and precision of the mechanical and virtual articu-
lators were evaluated by analyzing the STL data obtained. The
aligned files were uploaded and overlaid in Geomagic Control
X metrology software (Geomagic v2018.0.1) as in Figures 3A
and B. Correct alignment was verified by matching at the fidu-
cial spheres. This process of alignment allowed comparison of
both scanned files at the same location. Changing the artic-
ulator opening altered the interocclusal separation anteriorly-
posteriorly relative to the horizontal reference plane. The first
point in the anterior was measured at the mesiolabioincisal point
angle on the incisal edge of #8 in contact with the FDP. The sec-
ond point in the posterior was at the mesiobucco-occlusal point
angle of #3 in contact with the FDP (Fig 3C, D). The fiducial
markers were segmented, and the centers of the spheres were
used to generate a horizontal reference plane (Fig 3C, D). The
linear distances from the horizontal reference plane to the two
points on the FDP were measured (Fig 3C). To minimize opera-
tor error, distances were measured in triplicate, and the average
value was used as measurement for each specimen.
Trueness was assessed by comparing differences in the
means of the interocclusal separations anteriorly and poste-
riorly between the two systems. These average interocclusal
separations are reported as linear measurements in millimeters
(Fig 4). Precision was assessed by calculating the absolute
mean difference of the interocclusal separation anteriorly and
posteriorly and comparing these differences between the two
systems (Tables 1 and 2).
Anterior Posterior
Figure 4 Interocclusal separation when SCI was altered: Trueness of
Virtual and Mechanical Articulators (A) Trueness of sagittal condylar in-
clination. When the SCI was altered, there was no statistically significant
difference (p > 0.05) between the virtual and mechanical articulators in
trueness for 5 of the 6 measurements obtained (p > 0.07) or for all of
the precision measurements (p = 0.07). The one trueness measurement
that was significantly different (p = 0.006) occurs at SCI of 10°, and it
was less than 100 µm. (B) Trueness of pin opening. There was no sta-
tistically significant difference at altered pin openings in either trueness
(p > 0.37) or precision (p > 0.09) for the majority of measurements. The
only significant difference was in the precision between the 2 types of
articulators at 5 mm incisal opening, and only at the anterior measure-
ment point (p = 0.0008); however, these differences were less than
100 µm.
Measurement of effect of altering SCI
The trueness and precision of the mechanical and virtual ar-
ticulators were also assessed when the SCI was altered during
protrusive movements (Fig 4). Three SCI angles were eval-
uated: 10°, 30°, 45°. The Bennett angle was set to 0° as a
constant. A 6 mm protrusive movement was chosen on the vir-
tual articulator because that was the maximum allowed setting
of the screw locking mechanism on the mechanical articulator
for a protrusive movement.

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Accuracy of Dynamic Virtual Articulation Hsu et al

Table 1 Comparison of absolute mean deviations (precision) at different in an STL file format and aligned to the scanned models with
pin openings (mm) 500+ solve iterations and a tolerance of less than 0.0001 mm
as described above (Fig 3).
Pin opening Mechanical Virtual
Anterior Mean ± SD Mean ± SD F p
Obtaining measurements
2 mm 0.04 ± 0.03 0.06 ± 0.05 1.184 0.29
5 mm 0.04 ± 0.03 0.11 ± 0.05 15.134 *
0.0008 The trueness and precision of the mechanical and virtual artic-
10 mm 0.10 ± 0.10 0.18 ± 0.20 1.506 0.23 ulators was evaluated by analyzing the STL data obtained using
Pin Opening Mechanical Virtual both articulators to obtain the means and absolute mean differ-
Posterior Mean Mean F p ences of the anterior and posterior separation. These average
2 mm 0.07 ± 0.04 0.09 ± 0.08 0.235 0.63 separations were reported as linear measurements in millime-
5 mm 0.06 ± 0.03 0.11 ± 0.09 3.134 0.09 ters (Fig 4B).
10 mm 0.14 ± 0.22 0.15 ± 0.25 0.006 0.94
*
Significant difference.
Statistical analysis
One-way ANOVA was used to compare the means (trueness)
Table 2 Comparison of absolute mean deviations (precision) at different and absolute mean differences (precision) of the groups for pin
SCI (mm) opening (2, 5, and 10 mm) and of the groups for SCI (10°, 30°,
SCI Mechanical Virtual
and 45°). The absolute value of the difference of all possible
Anterior Mean ± SD Mean ± SD F p
pairs of the triplicate measurements were compared by one-way
ANOVA. Tukey’s Honest Significant Difference (HSD) test was
10° 0.08 ± 0.05 0.10 ± 0.06 0.792 0.38 planned a priori, if necessary, for post-hoc analysis; p < 0.05
30° 0.08 ± 0.04 0.13 ± 0.08 3.529 0.07 was considered significant. Results are reported as mean ± SD.
45° 0.09 ± 0.05 0.09 ± 0.07 0.020 0.89
SCI Mechanical Virtual
Posterior Mean Mean F p Results
10° 0.07 ± 0.04 0.08 ± 0.06 0.244 0.63 Altering incisal pin opening
30° 0.09 ± 0.04 0.13 ± 0.18 0.894 0.35
45° 0.07 ± 0.03 0.09 ± 0.04 0.771 0.39
Trueness was tested by comparison of the means. Precision was
tested by comparison of the absolute mean deviations. An n of
12 was used for each pin opening (2, 5, and 10 mm). Results
are reported as (value ± standard deviation). Each specimen
Mechanical articulation was measured in triplicate, and the mean reported as the mea-
The same articulated models described above were used for surement value of the specimen (Fig 4A).
evaluation of SCI; sufficient occlusal clearance was given to As the pin opening was increased, overall measurement of
prevent interference from the dentition during protrusive move- interocclusal separation increased. Figure 4A shows results
ment. On the mechanical Artex-CR articulator, Pattern Resin obtained on each type of articulator. For both articulators,
was applied to mandibular teeth #25-30 (Fig 1C, D). The artic- the anterior measurement of separation, measured at the
ulator was closed until the pin touched the incisal table to allow mesiolabioincisal point angle on the incisal edge of #8,
the maxillary teeth to occlude in the pattern resin as before, increased proportionally more than the posterior, measured at
and 6 mm protrusive movement was performed. Twelve spec- the mesiobucco-occlusal point angle of #3 (Fig 4A).
imens were evaluated at each SCI. These specimens, with the
corresponding maxillary and mandibular casts were scanned Trueness
on transfer plates to obtain an STL file to facilitate comparison
At a 2 mm pin opening, there was no significant difference
with results from virtual articulation (Fig 3A, B).
in the mean posterior separation for the mechanical articulator
(1.01 ± 0.65 mm) and the virtual articulator (0.90 ± 0.61 mm)
Virtual articulation
when values of posterior separation were compared (F = 0.202,
Within the Dental Designer software, FDP #25-30 were de- p = 0.66). No significant difference was found in mean ante-
signed at SCI 10°, 30°, 45° (Fig 2D). Other posterior determi- rior measurements between the mechanical articulator (1.60 ±
nants were kept constant, and the incisal table was kept at 0° 0.50 mm) and the virtual articulator (1.19 mm ± 0.01 mm)
inclination (Fig 1E). Adjustments were made to the FDP by when these values were compared (F = 0.274, p = 0.61) as
the software, with the Adapt Designs software function in the seen in Figure 4B.
virtual articulator, using a 6 mm protrusive movement setting At a 5 mm pin opening, there was no significant difference
entered directly in the settings menu. This allowed for dy- in the mean posterior separation for the mechanical articulator
namic anterior-posterior adaptation of the prosthesis based on (2.45 ± 0.58 mm) and the virtual articulator (2.25 ± 0.58 mm)
articulator SCI settings (Fig 2D-G). Adaptations to the design when values of posterior separation were compared (F = 0.652,
suggested by the virtual articulator, based on these movements, p = 0.43). No significant difference was found in mean ante-
were accepted without further user input. Twelve specimens rior measurements between the mechanical articulator (3.73 ±
were evaluated at each SCI. The resulting design was exported 0.44 mm) and the virtual articulator (3.62 ± 0.46 mm) when

440 Journal of Prosthodontics 28 (2019) 436–443 

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Hsu et al
these values were compared (F = 0.358, p = 0.56), as shown
in Figure 4B.
At a 10 mm pin opening, there was no significant differ-
ence in the mean posterior separation for the mechanical ar-
ticulator (5.09 ± 0.45 mm) and the virtual articulator (4.90 ±
0.43 mm) when values of posterior separation were compared
(F = 0.847, p = 0.37). No significant difference was found
in mean anterior measurements between the mechanical artic-
ulator (7.41 ± 0.37 mm) and the virtual articulator (7.41 ±
0.37 mm) when these values were compared (F = 0.221, p =
0.64) as demonstrated in Figure 4B.
Precision
Full details for precision are described in Table 1. At a 2 mm
pin opening, there was no significant difference between the
mechanical articulator (0.07 ± 0.04 mm) and the virtual articu-
lator (0.09 ± 0.08 mm) when values of absolute mean deviation
of posterior separation were compared by one-way ANOVA
(F = 0.235, p = 0.63). When values of anterior separation were
compared, no significant difference was found between the me-
chanical articulator (0.04 ± 0.03 mm) and the virtual articulator
(0.06 ± 0.05 mm; F = 1.184, p = 0.29), as shown in Table 1.
At a 5 mm pin opening (Table 1), there was no signifi-
cant difference between the mechanical articulator (0.06 ±
0.03 mm) and the virtual articulator (0.11 ± 0.09 mm) when
values of posterior separation were compared (F = 3.134, p
= 0.09). A significant difference was found in the anterior
measurement between the mechanical articulator (0.04 ±
0.03 mm) and the virtual articulator (0.11 ± 0.05 mm) when
these values were compared (F = 15.134, p < 0.0008).
At a 10 mm pin opening (Table 1), there was no signif-
icant difference between the mechanical articulator (0.14 ±
0.22 mm) and the virtual articulator (0.15 ± 0.25 mm) when
values of posterior separation were compared (F = 0.006,
p = 0.94). No significant difference was found between the
mechanical articulator (0.10 ± 0.10 mm) and the virtual ar-
ticulator (0.18 ± 0.20 mm) when these values were compared
(F = 1.506, p = 0.23).
Overall, when pin opening was changed, no statistically
significant difference was found in trueness between the virtual
and mechanical articulator. One statistically significant differ-
ence was found between the mechanical and virtual Artex-CR
articulator in measurements of interocclusal separation. A
statistically significant difference was found when values for
the absolute mean difference for 5 mm anterior measurement
were compared.
Altering condylar inclination
The SCI was altered on both the virtual and mechanical artic-
ulator from 10° to 30° to 45°. An n of 12 was used for each
SCI. Each specimen was measured in triplicate and the mean
reported as the measurement value of the specimen. As the SCI
was increased, overall measurement of interocclusal separa-
tion increased. Graphical representation is found in Figure 4B,
which shows an increase in both anterior and posterior separa-
tion, with a proportionally greater increase in the posterior.
Journal of Prosthodontics 28 (2019) 436–443 
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Accuracy of Dynamic Virtual Articulation
Trueness
At a 45° SCI (Fig 4A), there was no significant difference in
the mean posterior separation for the mechanical articulator
(2.81 ± 0.04 mm) and the virtual articulator (2.82 ± 0.24 mm)
when values of posterior separation were compared (F = 0.020,
p = 0.89). No significant difference was found in mean ante-
rior measurements between the mechanical articulator (2.02 ±
0.03 mm) and the virtual articulator (1.99 ± 0.26 mm) when
these values were compared (F = 0.170, p = 0.68).
At a 30° SCI (Fig 4A), there was no significant difference
in the mean posterior separation for the mechanical articulator
(2.15 ± 0.42 mm) and the virtual articulator (2.04 ± 0.46 mm)
when values of posterior separation were compared (F = 0.406,
p = 0.53). No significant difference was found in mean ante-
rior measurements between the mechanical articulator (1.66 ±
0.23 mm) and the virtual articulator (1.47 ± 0.26 mm) when
these values were compared (F = 3.624, p = 0.07).
At a 10° SCI (Fig 4A), there was no significant difference
in the mean posterior separation for the mechanical articu-
lator (0.21 ± 0.06 mm) and the virtual articulator (1.19 ±
0.01 mm) when values of posterior separation were compared
(F = 0.521, p = 0.48). One significant difference was found
in the mean anterior measurements between the mechanical
articulator (1.06 ± 0.11 mm) and the virtual articulator (0.89
± 0.30 mm) when these values were compared (F = 9.237,
p = 0.006).
Precision
Absolute mean deviation of the measurements between the
mechanical and virtual articulators were compared by one-way
ANOVA. The results, showing no significant difference
between the mechanical and virtual articulators, are shown in
Table 2.
At a 45° SCI, there was no significant difference between the
mechanical articulator (0.07 ± 0.03 mm) and the virtual artic-
ulator (0.09 ± 0.04 mm) when values of posterior separation
were compared (F = 0.771, p = 0.39). No significant differ-
ence was found between the mechanical articulator (0.09 ±
0.05 mm) and the virtual articulator (0.09 ± 0.07 mm) when
the anterior values were compared (F = 0.020, p = 0.89).
At a 30° SCI, there was no significant difference between the
mechanical articulator (0.09 ± 0.04 mm) and the virtual artic-
ulator (0.13 ± 0.18 mm) when values of posterior separation
were compared (F = 0.894, p = 0.35). No significant differ-
ence was found between the mechanical articulator (0.08 ±
0.04 mm) and the virtual articulator (0.13 ± 0.08 mm) when
the anterior values were compared (F = 3.529, p = 0.07).
At a 10° SCI, there was no significant difference between
the mechanical articulator (0.07 ± 0.04 mm) and the virtual ar-
ticulator (0.08 ± 0.06 mm) when values of posterior separation
were compared (F = 0.244, p = 0.63). No significant difference
was found between the mechanical articulator (0.08 mm ±
0.05 mm) and the virtual articulator (0.10 ± 0.06 mm) when
the anterior values were compared (F = 0.792, p = 0.38).
Overall, one statistically significant difference in trueness
between the mechanical and virtual Artex-CR articulators was
found out of 12 total results. This was found at SCI of
10° in the anterior measurement. One statistically significant
441
Accuracy of Dynamic Virtual Articulation
difference was found in precision when values of absolute mean
difference were compared out of 12 results. This was found at
a pin opening of 5 mm in the anterior measurement.
Discussion
The trueness and precision of virtual articulation has not been
tested. In this study, the Artex-CR articulator was investigated
in dynamic movement by altering the incisal pin opening (2, 5,
and 10 mm) and SCI (10°, 30°, and 45°).
When the pin opening was changed, no statistically signifi-
cant difference was found in trueness between the virtual and
mechanical articulator. One statistically significant difference
was found between the mechanical and virtual Artex-CR ar-
ticulator in measurements of interocclusal separation. A sta-
tistically significant difference was found when values for the
absolute mean difference for 5 mm anterior measurement were
compared. Thus, the null hypothesis was rejected.
Overall, one statistically significant difference in trueness
between the mechanical and virtual Artex-CR articulators was
found out of 12 total results. This was found at SCI of 10°
in the anterior measurement. One statistically significant dif-
ference was found in precision when values of absolute mean
difference were compared out of 12 results. This was found at
a pin opening of 5 mm in the anterior measurement.
There were no clinically important differences in trueness
using virtual and mechanical articulators at both the tested
incisal pin opening and SCI. Additionally, there was no
clinically important difference in the precision of a prosthesis
designed using virtual and mechanical articulators when the
incisal pin opening and SCI were altered. It is expected that a
virtual representation of a mechanical articulator should reflect
the original closely. The results of this study confirm this
expectation. There was no significant difference in trueness
between the mechanical and virtual articulator at pin openings
of 2, 5, or 10 mm. Both proportionally increased at the
same rate. The mechanical and virtual systems behaved as
expected and proportionally decreased as the pin was closed
and similarly increased as the pin was opened.
Precision was tested by comparison of the absolute mean
difference of the triplicate measurements of interocclusal sepa-
ration. A statistically significant difference was found in preci-
sion at the anterior measurement of the 5 mm pin opening. The
absolute mean difference was 0.04 ± 0.03 mm for the mechan-
ical and 0.11 ± 0.05 mm for the virtual. This could have been
due to chance and/or the difficulty of measuring small differ-
ences. At any rate, an error of 0.04 mm (40 µm) or 0.11 mm
(110 µm) may not amount to a substantial error clinically.
With the data collected by Riis and Giddon,27 using thin
plastic strips (12.5, 25, 50, and 100 µm thick), Dubner et
al26 described the mean discriminatory capability for unanes-
thetized incisors to be 14 µm and 40 µm for anesthetized
teeth. The clinically relevant interdental sensory threshold can
therefore be estimated to be 14 µm. The differences between
the virtual and mechanical articulators can be adjusted to a
value within this range.
For the precision of SCI measurements, no statistically sig-
nificant difference was found between mechanical and virtual
articulation. No significant differences were found between
442 Journal of Prosthodontics 28 (2019) 436–443 
Hsu et al
the mechanical and virtual articulator at 45° in either trueness
or precision. At 30°, no significant differences were found,
although the posterior measurement approached significance.
It is possible that virtual reproduction of this component is
difficult to achieve accurately. At 10°, there was a significant
difference (p = 0.01) for the anterior measurement, which was
the smallest of all measurements taken and might accordingly
be most affected by errors. There was no significant difference
at the 10° posterior measurement. As the SCI decreased, a
significant difference developed in the anterior region. Tooth #8
is the furthest tooth from the posterior aspect of the articulator,
the location where the SCI is actually changed. A change in
angle is most measureable at a distance furthest away from the
vertex.
Studies on different models of the Artex articulator have
found deficiencies in transferring the information captured in a
mounted articulator with magnetic mounting plates.28,29 With a
virtual articulator, the position of the dental model in 3D space
might be preserved electronically and render moot the problem
of transferring from one articulator to another. In vitro studies
have shown that some mechanical articulator systems are more
accurate and precise than others.30 Hatzi et al30 measured light
transmission through static occlusal registrations as a quantita-
tive measurement of the interchangeability of articulators. This
interchangeability would allow clinicians to use one articulator
and transfer casts to a lab with the assurance that positional ac-
curacy could be maintained on a similar articulator. They found
that no articulator system was exact and that no articulator was
an exact duplicate of another; however, they concluded that
the Artex brand reproduced dental cast positions more con-
sistently than the other systems tested (Whip Mix, Kavo).30
When a virtual articulator is used, it is not necessary to send
a programmed physical articulator to the laboratory, thereby
avoiding all the concomitant risk that may occur in mailing and
transport (damage to the articulator, time cost, financial cost,
etc.) and interchanging articulators.
Transferring patient information can produce errors that will
carry through to the final restoration. One example of this is
the location of the kinematic hinge axis. Articulation without
the correct hinge axis location may produce errors.31 How-
ever, such errors may be small if the arbitrary hinge axis is
within 5 mm of the kinematic hinge axis location.31 In such
an instance, the error produced in a final restoration might be
up to 200 µm. An error of 200 µm, which is greater than the
amount of error found in the present study, was considered
clinically insignificant because intraoral adjustment is easily
achievable.31 Furthermore, an occlusal discrepancy of over 161
µm for metal-ceramic crowns fabricated by casting, milling,
and sintering has been reported.32 Occlusal discrepancy of this
magnitude is within the range reported in the present study and
further suggests that the error between virtual and mechanical
articulator may not be clinically significant.
Virtual dynamic articulation is rising in popularity. No stud-
ies, prior to this one, on the trueness and precision of virtual dy-
namic articulation have been published. No other studies have
supporting data for speculation on the accuracy of the digital ar-
ticulator in dynamic movement. This study provides validation
of another component of the digital workflow. Tools neces-
sary for the use of the digital articulator have been described,
C 2019 by the American College of Prosthodontists
Hsu et al
including a virtual facebow transfer technique for transfer-
ring the location of a digitized cast of the patient to a virtual
articulator.33
This study examined 2 of the possible articulator settings
on the Artex-CR mechanical articulator: pin opening and SCI.
On the virtual articulator, other settings remain untested; how-
ever, the present study provides a methodology by which other
settings affecting virtual dynamic articulation could be tested.
Commonly altered settings were tested within a clinically rel-
evant range (pin openings, 2-10 mm; SCI, 10-45°). Testing a
range and including a midpoint allowed for conclusions to be
drawn about every point along the range without prohibitive
amounts of testing. For each value, 12 specimens were made;
each specimen was measured in triplicate, and the mean of
the three was calculated. Performing this action was aimed at
minimizing effects of operator error.
Conclusions
Trueness and precision of the mechanical articulator were com-
parable to the virtual articulator. While it is arguable that any
discrepancy between the two is unacceptable, the resultant er-
ror for either system remains within the range of correction
at the time of delivery. There is a high probability of an open
system solution for transferring 3D dynamic records of patient
movement electronically to the virtual articulator, possibly even
including the fourth dimension (time) and allowing settings to
be made by the only articulator that matters: the patient. The
trueness and precision of other alterable settings on the Artex
CR remain untested. In addition, other articulator systems and
their associated settings have not been tested.
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