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Review Article
Anterior point of reference: Current
knowledge and perspectives in
prosthodontics
Prince Kumar, Ashish Kumar1, Roshni Goel2, Ashish Khattar3
Department of Prosthodontics and Oral Implantology, Shree Bankey Bihari Dental College and Research
Centre, and 1ITS Dental College, 2Conservatice Dentistry and Endodontics, IDST Dental College, Modinagar,
Ghaziabad, Uttar Pradesh, 3Private Practitioner, Pitampura, New Delhi, India
ABSTRACT
The opening and closing mandibular axis is not a purely theoretical postulation, but an
absolutely demonstrable biomechanical entity. It is very crucial to accurately record and
transfer to articulators for the purpose of maxillofacial rehabilitation. Following the Face
bow record and transfer of the mandibular axis to an anatomic articulator, we can then
mount the casts so that they open and close on the articulator in the same fashion as the
patient’s jaws. For this reason one of the fixed factors presented by the patient is taken into
the consideration, which if properly considered, can be of inestimable value in all phases
of dental treatment. This paper has sought to review the current concepts and practical
implications regarding anterior point of reference in prosthodontics.
Orbitale
Figure 1: Various anterior reference points
Orbitale is the lowest point of the infraorbital rim of
skull which can be palpated on the patient through the
overlying tissues and the skin. One orbitale and the two
posterior points that determine the horizontal axis of
rotation will define the axis – orbital plane.[11]
Most articulators do not have a reference point for this same distance is measured above the existing or planed
landmark. Gonzalez’ pointed out that this posterior incisal edges on the patient, and its uppermost point is
tissue landmark on the average lies 7 mm superior to marked as the anterior point of reference on the face.
the horizontal axis.[1] The recommended compensation This point can be recorded for future use by measuring
for this discrepancy is to mark the anterior point of vertically downward to it from the inner canthus of the
reference 7 mm below orbitale on the patient or to position eye and recording this measurement. The inner canthus
the orbital pointer 7 mm above the orbital indicator of is used because it is accessible unchanging landmark on
the articulator. Later on Bergstrom developed Arcon the head. It must be documented that this method does
articulator that automatically compensates for this not relate the Frankfort plane or the axis‑orbital plane
error by placing the orbital index 7 mm higher than parallel to the horizontal plane. Additionally, only the
the condylar horizontal axis. In either technique, the incisal edges or the most anterior portion of the occlusal
Frankfort horizontal plane of the patient becomes the plane will be midway between the upper and lower
horizontal plane of reference in the articulator.[5] articulator arms.[19,20]
The laboratory technician may then arrange the anterior 10. Lundstrom F, Lundstrom A. Natural head position as a basis
teeth and the occlusal plane as though the Frankfort for cephalometric analysis. Am J Orthod Dentofacial Orthop
1992;101:244‑7.
horizontal plane were being used. The result will be an 11. Ercoli C, Graser GN, Tallents RH, Galindo D. Face‑bow record
occlusal plane that rises severely from anterior to posterior without a third point of reference. Theoretical considerations and
in the patient’s mouth and maxillary anterior teeth that an alternative technique. J Prosthet Dent 1999;82:237‑41.
may be excessively positioned lingually. The following 12. Bailey JO Jr, Nowlin TP. Evaluation of the third point of reference
for mounting maxillary casts on the Hanau articulator. J Prosthet
technique can be used as more convenient, practical and
Dent 1984;51:199‑201.
less time‑consuming alternative option:[28‑31] 13. Pitchford JH. A reevaluation of the axis‑orbital plane and the
• If the Camper’s line‑horizontal reference plane is use of orbitale in a facebow transfer record. J Prosthet Dent
used, raise the back of the articulator to achieve the 1991;66:349‑55.
effect of the Frankfort horizontal plane mounting 14. Gonzales JB, Kingery RH. Evaluation of planes of reference
for orienting maxillary casts on articulators. J Am Dent Assoc
• If the Frankfort horizontal plane reference is used,
1968;76:329‑36.
raise the anterior of the articulator to achieve the 15. Galindo D, Tallents RH, Graser GN, Ercoli C. Face‑bow record
effect of paralleling the occlusal plane and Camper’s without a third point of reference: Theoretical considerations and
line with the horizontal. an alternative technique. J Prosthet Dent 1999;82:237‑41.
16. Bergstrom G. On the reproduction of dental articulation by means
of articulators. Acta Odontol Scand Suppl 1950;9:3‑149.
CONCLUSION 17. McWilliam JS, Rausen R. Analysis of variance in assessing
registrations of natural head position. Swed Dent J 1982;15:239.
As we all know that three points in space determine 18. Krueger GE, Schneider RL. A plane of orientation with an extracranial
the position of the maxillary cast in an articulator. anterior point of reference. J Prosthet Dent 1986;56:56‑60.
19. Frankel R. The applicability of the occipital reference base in
So the dentists especially Prosthodontists are more
cephalometrics. Am J Orthod 1980;77:379.
repeatedly concerned with selecting the posterior two of 20. Beck. A clinical evaluation of the Arcon concept of articulation. J
the three reference points. Though one must be aware Prosthet Dent 1959;9:409.
of the relative significance of posterior reference points 21. Augsburger KI. Occlusal plane relation to facial type. J Prosthet
and should consider anterior reference point as one of Dent 1953;75:5.
22. Bjerin R. A comparison between the Franklorr horizontal and the
the critical dimension during face bow transfer. Such Sella Turcica‑Nasion as reference planes in cephalometric analysis.
assessment will definitely affect the development of Acta Odontol Scand 1957;1:15.
normal occlusion and associated dentofacial aesthetics. 23. Downs WB. The role of cephaiometrics in orthodontics. Case
Furthermore dentist must have thorough knowledge of analysis and diagnosis. Am J Orthod 1952;38:162.
these reference planes and points and should utilize them 24. Lundstrom A. Head posture in relation to slope of the sella‑nasion
line. Angle Orthod 1982;5:279.
depending on the case without any misunderstanding 25. Brandrup‑Wognsen T. Face‑bow, its significance and application.
with the laboratory personals. J Prosthet Dent 1953;3:618‑30.
26. Dos Santos Junior J, Nelson SJ, Nummikoski P. Geometric analysis
REFERENCES of occlusal plane orientation using simulated ear‑rod facebow
transfer. J Prosthodont 1996;5:172‑81.
27. Olsson A, Posselt U. Relationship of various skull reference lines.
1. Wilkie ND. The anterior point of reference. J Prosthet Dent
J Prosthet Dent 1961;11:1045‑9.
1979;41:488‑96.
28. Hanau RL. Articulation defined, analyzed and formulated. J Am Dent
2. Weinberg IA. An evaluation of the face‑bow mounting. J Prosthet
Assoc 1926;13:1694‑707.
Dent 1961;11:32.
29. Freitas A de. A comparison of the radiographic and prosthetic
3. Page HL. The cranial plane. Dent Digest 1955;61:152.
4. Foster TD, Howat AP, Naish PJ. Variation in cephalometric reference measurement of the sagittal path movement of the mandibular
lines. Br J Orthod 1981;8:183. condyle. J Oral Surg 1970;30:631‑8.
5. McCollum BB. The mandibular hinge axis and a method of locating it. 30. Owen EB. Condyle path: Its limited value in occlusion. J Am Dent
J Prosthet Dent 1960;10:428‑35. Assoc 1948;36:284‑90.
6. Lauritzen AG, Wolford LW. Hinge axis location on an experimental 31. Kumar JS, Gupta G, Bansal S, Gupta P. Variability and validity of
basis. J Prosthet Dent 1961;11:1059‑67. the anterior point of reference”: A cephalometric study. Baba Farid
7. Zarb GA, Bergman B, Clayton JA, MacKay HF. Prosthetic treatment Uni Dent J 2011;2:107-11.
for partially edentulous patients. St. Louis: The C. V. Mosby Co.,
1978. p. 193.
How to cite this article: Kumar P, Kumar A, Goel R, Khattar A.
8. The Glossary of Prosthodontic Terms. 8th ed. J Prosthet Dent Anterior point of reference: Current knowledge and perspectives in
2005;94:10‑92 prosthodontics. J Orofac Sci 2012;4:96-9.
9. Solow B, Tallgren A. Natural head position in standing subjects.
Source of Support: Nil, Conflict of Interest: None declared
Acta Odontol Stand 1971;29:591.