HINGE AXIS

MODERATOR PRESENTER
DR. KAMAL B.ALEKHYA
II YR PG
 Contents
 Introduction
 Definitions
 History and development of hinge axis concept
 Schools of thought regarding hinge axis
 Significance of hinge axis
 Methods of locating hinge axis
 Review of literature
INTRODUCTION

3
 ORIENTATION OF JAWS

Are those orient the mandible to the cranium in such a way ,that, when
the mandible is kept in its most anterior and superior position , the
mandible can rotate in sagittal plane round an imaginary transverse axis
passing through or near the condyles.
Boucher 12th edition
 The relationship of the maxilla to the cranium in three planes :
Frontal plane, Saggital and transverse plane is called the
orientation jaw relation.

 This is a relationship between the jaws and the axis of

movement, not an anatomic relationship between jaws and TMJ,
except to the extent that the axis of movement might happen to
be near TMJ.
 Introduction
Rotational movement /Hinge
 Introduction
Rotational axes

Sagittal axis Frontal (Vertical) axis Horizontal axis

 Definition
HINGE AXIS

“Hinge axis as an imaginary line passing

through the two mandibular condyles around
which the mandible rotates without translatory
movement”.
GPT – 9
TRANSLATION OR SLIDING MOVEMENT
 HINGE AXIS POINTS

 The left and right centers where condyle exhibits pure

rotation is known as hinge axis points.

 Posterior reference points.

 HINGE AXIS

SYNONYMS
Horizontal axis,
Intercondylar axis,
Terminal hinge axis.
Transverse axis
 Definition
Terminal hinge axis
When the condyles are in their most superior
position in the articular fossae and the mouth
is purely rotated open, the axis around which
movement occurs is called terminal hinge axis.

 Maximum range of terminal hinge

rotation - 12˚

 Inter incisal opening : 18 to 25 mm

Transverse Horizontal Axis
Today with the changing concept of CR, viz antero-superior
bracing, the term transverse horizontal axis is preferred to terminal
hinge axis.

Hinge axis is a horizontal axis around which the condyles rotate

during opening and closing movement up to a range of
•Posselt (1952) 19-25 mm
•Ulrich (1896) 20mm
•Campion (1905) 10-20 mm
•Fischer (1935) 20mm 
Rotational movement of the mandible with the Second stage of rotational movement
condyles in the terminal hinge position. This opening. Note that the condyle is translated
pure rotational opening can occur until the down the articular eminence as the mouth
16

anterior teeth are some 20-25mm apart. rotates open to maximum limit.
 IMPORTANCE OF TERMINAL HINGE AXIS

 THE LOCATION OF THE TRANSVERSE HINGE AXIS SERVES ONLY TO

ORIENT THE MAXILLA AND TO RECORD THE STATIC STARTING POINT FOR
FUNCTIONAL MANDIBULAR MOVEMENTS.

 IT DOES NOT RECORD CENTRIC RELATION OR CONDYLAR MOVEMENTS.

ALLOWS THE TRANSFER OF THE OPENING AXIS OF JAWS TO THE
ARTICULATOR SO THAT OCCLUSION WOULD BE ON THE SAME ARC OF 17

CLOSURE AS IN PATIENTS MOUTH.

 THE HINGE AXIS RECORDING IS REQUIRED TO CHECK THE
ACCURACY OF CENTRIC RECORDS.

 HELPS IN PROPER POSITIONING OF THE CASTS IN RELATION TO

INTER CONDYLAR SHAFT.

 VERTICAL DIMENSION OF OCCLUSION CAN BE ALTERED ON THE

ARTICULATOR.
• LIKE CENTRIC RELATION, HINGE AXIS IS
• STABLE
• LEARNABLE
• RECORDABLE
• REPRODUCIBLE AND
• REPEATABLE

• THEREFORE IT IS USED AS AN IMPORTANT REFERENCE IN MOUNTING CASTS IN

THE ARTICULATOR, SO THAT THE OPENING AXIS OF THE ARTICULATOR COINCIDES
WITH THE TERMINAL HINGE AXIS OF THE PATIENT
19
BIOLOGICAL SIGNIFICANCE
OF HINGE AXIS
 CLINICAL SIGNIFICANCE OF HINGE

AXIS
Alter the VDO on articulator.

 Obtain the centric relation records and verify them at the try-in at an
altered VDO.

 Minimize the remounting procedures to perfect the occlusal scheme.

 Safely use a cusp form (anatomic) posterior tooth where indicated with
minimal occlusal adjustments.
HINGE AXIS: CONCEPTS, THEORIES AND CLINICAL SIGNIFICANCE - A REVIEW
 Develop an occlusion which would preserve and restore
oral function.

 The anatomic or the kinematic hinge axis face-bow transfer

is the first step in recording the relationship of the
maxillary arch to the condylar paths. Once the maxillary
cast is oriented on the articulator, the centric relation
record completes the static, or starting, relationship
between the maxillae and the condyles in the
temporomandibular fossae
 HISTORY
 The hinge like action in the lower compartment of the TMJ was
described in the earliest editions of GRAY’s Anatomy.

 Campion (1902 - 1905)

- First graphic record of mandibular movements.
- No one axis, but movement is a complex one.
 HISTORY
 Bennett (1908)
- No single fixed centre of rotation, constantly shifting in
sagittal plane.
- Mandible can rotate, translate.

 Needles (1923)
- Agrees with Bennett : Hinge Joint + Sliding Joint.
 HISTORY
 Wadsworth (1925) – Anatomist's view
1st movement around transverse axis passing through condyles
2nd movement on articular eminence

 The first actual kinematic location was evolved through the California
Gnathologic Society under the leadership of Dr. B. B. McCollum, and
credit for the idea of the mechanical location of an axis was given to
Dr. Robert Harlan.
 HISTORY
 McLean (1944)

- In construction of full dentures, with an incorrect hinge axis

location would result in unsatisfactory occlusion.

- Any alteration in the interocclusual distance must either be

made in the mouth or by the use of the hinge axis articulator.
 HISTORY
 Sloane (1951)
“The mandibular axis is not a theoretical assumption, but a
definitely demonstrable biomechanical fact. It is the axis
upon which the mandible rotates in an opening and
closing function when comfortably, not forcibly retruded.”
 History
 Granger (1952)
All rotations responsible for mandibular movement had axes, which met
at a common point within each condyle. If these points were joined it
would give the transverse hinge axis.

 Craddock & Symmons(1952)

Small opening - the axis passes through condyles
Wider opening - axis becomes displaced downward.
 THEORIES OF HINGE AXIS
(FOUR SCHOOLS OF THOUGHTS)

1. Absolute location theory of Transverse Axis

2. Arbitrary Theory of Transverse Axis Location

3. Non Believers Theory of Transverse Axis Location.

4. Split-axis rotation theory

Aull, Arthur E. A study of the transverse axis. J Pros Dent 13:469-479, 1963.
GROUP 1 : ABSOLUTE LOCATION OF HINGE AXIS
Mc collum, Lucia, Granger
 Definite transverse axis and should be located as accurately as
possible.

Mc Collum BB J Prost Dent 1960;10:428-435

GROUP 1 : ABSOLUTE LOCATION OF HINGE AXIS

 Using facebow, it is possible to relate the transverse axis of the articulator

in the same relation to the hinge axis of patient.

 The path of closure on the terminal hinge will be the same on the
articulator as in the mouth

 The hinge axis relationships of the articulators must be a duplicate of the

hinge axis relationships of the jaws or else mechanical reproduction of jaw
motions on the articulator are impossible.
GROUP 2 : ARBITRARY LOCATION OF HINGE AXIS.

Craddock & Symons and Weinberg

 An accurate location of terminal hinge position would be of some value, but
do not believe that it has an enough value over an arbitrary location to be
worth the added effort necessary to locate it.
 Craddock states that hinge axis will never be found to lie more than a few
mm distant from the assumed center of condyle itself.
 Group 3 : Nonbelievers
Beck (1959)

 Impossible to locate the terminal hinge position

with accuracy.

 If the terminal hinge position could be located

consistently within a radius of 1mm, this would be
more acceptable than a location with a variance of
a 2 mm radius.
 Beck proposed that there can be many compensating movements
of the condyle other than pure rotation and these cannot be
repeated by the opening and closing movement of the articulator
which is about one axis only.

 Various researchers like Kurth and Feinstein, Borgh and Posselt

could not record the axis without errors.
 Group 4 : Split axis rotation

• This group follows Transograph theory

• Harry Page believed in the “split- axis” in which each condyle rotates
independently of the other.

Dipankar Pal, Hinge Axis: concepts, theories and clinical significance - A review Asian Journal
of Science and Technology, Vol. 10, Issue, 04, pp.9639-9641, April, 2019
 Value of true hinge axis - Cohen 1960
1. The location of the transverse hinge axis serves only to orient the
maxilla and to record the static starting point for functional mandibular
movements.

2. Allows the transfer of opening axis of jaws to the articulator so that

occlusion would be on the same arc of closure as in the patients
mouth.
3. Study casts may be mounted to determine if the patients centric
occlusion is in harmony with centric relation.

4. Helps in proper positioning of the casts in relation to intercondylar

shaft.
 Methods To Locate Hinge Axis
I. The Arbitrary method

II. The kinematic method

III. Modified methods :

1. Loma-Linda hinge axis method
2. Buhnergraph intraoral method
3. Technique using geometric principle to locate hinge axis
4. Abdal-Hadi’s method for locating arbitrary hinge axis
Dr. Deepika et.al., Hinge axis recording “the essential need in prosthodontics, International
Journal of Current Research, Vol. 10, Issue, 07, pp. 71178-71184, July, 2018
ARBITRARY METHOD OF LOCATING HINGE AXIS
 ANATOMIC METHOD

 MOST COMMONLY USED METHOD ESPECIALLY IN COMPLETE

DENTURES

 VARIOUS ANATOMIC LANDMARKS WERE USED TO LOCATE HINGE

AXIS ARBITRARILY.

 PROVIDES ENOUGH ACCURACY FOR RESTORATION OF MOUTH.

 ARBITRARY HINGE AXIS POINTS

a. Beyron point.
b. Gysi point
c. Bergstrom point.
d. Teteruck and Lundeen point.
e. Experimental arbitrary axis point.
 ARBITRARY HINGE AXIS POINTS
A. BEYRON’S POINT
13 mm anterior to the posterior margin of the tragus of the ear on a line
extending from the center of the tragus to the outer canthus of the eye.
B. GYSI’S POINT
11-13mm anterior to anterior margin of external acoustic meatus on line
from superior margin of external acoustic meatus to outer canthus of eye
C. BERGSTROM’S POINT
A POINT 10 MM ANTERIOR TO THE CENTER OF THE SPHERICAL INSERT FOR THE
EXTERNAL AUDITORY MEATUS AND 7 MM BELOW THE FH PLANE.
D. TETERUCK AND LUNDEEN'S POINT
About 13 mm anterior to tragus on line from the base of tragus to outer
canthus of eye.
E. EXPERIMENTAL ARBITRARY AXIS POINT
It is placed 10 mm anterior to the superior border of the tragus on
Camper’s line.
F. LAURITZEN AND BODNER’S POINT
12mm anterior to the centre of external acoustic meatus and 2mm inferior to the
porion - canthus line

G. SCHALLORN
13 mm anterior to the posterior margin of the tragus to the canthus
I. DENAR
12mm anterior to posterior border of the tragus and 5mm
inferior to the line extending from the superior border of the
tragus to the outer canthus of the eye.
 EXTERNAL AUDITORY MEATUS
On an average the external auditory meatus is 6 to
6.5mm posterior and 2.5mm superior to the actual

hinge axis point.

 DAWSON PALPATORY METHOD :

- From a position behind the patient, the index finger placed over the
joint area and the patient is asked to open widely

- By asking the patient to repeat an opening and closing arc, it is

possible to feel the condylar rotation and locate hinge axis
Beck (1954)
Compared the arbitrary points of Gysi, Beyron and Bergstrom in 12 subjects.

• Bergstom’s - 4.1mm from the kinematic axis,

• Beyron’s - 5.7mm from the kinematic axis
• Gysi’s - 10.7mm from the kinematic point.
 ADVANTAGES OF ARBITRARY METHOD

1. LESS TIME CONSUMING PROCEDURE.

2. UNCOMPLICATED PROCEDURE LEADS TO REDUCTION OF

ERRORS IN LOCATION.

3. RECORDS ALMOST 5MM AROUND THE ABSOLUTE LOCATION BY

KINEMATIC METHOD WHICH IS QUITE CONSIDERABLE.

4. TRANSFERRING THE FACEBOW RECORD TO ARTICULATOR

BECOMES SIMPLE.

5. CAN BE USED WITH A SEMI-ADJUSTABLE ARTICULATOR.

 Disadvantages of arbitrary method

• Because it is not an absolute location, even an error of 5mm

around true hinge axis might lead to occlusal discrepancies,
which increases the chair side time.
KINEMATIC METHOD OF LOCATING HINGE
AXIS
 Not commonly used because of the complexity in procedure.

 The kinematic axis was recorded for each patient using a

hanau kinematic transfer bow.

Kinematic Method Of Locating Hinge Axis
The device consists of the following parts:
1. Clutch/ bite fork
2. Cross bar and stud
3. Axis indicator
4. Graph pad
5. Universal clamp/ screws
55
 Clutch/ bite fork

• Clutch is a mechanical device made to be

rigidly attached to mandibular teeth or the
mandibular residual ridge to which a hinge axis
bow is attached.
 Clutch fabrication

Dentulous patient
ACCURATE IMPRESSION OF MANDIBLE IS MADE

STONE CASTS ARE FABRICATED

CUSTOM- BUILT METAL CLUTCH/STOCK CLUTCH FITTED TO CAST

ATTACH STUD OR STEM TO CENTER OF LABIAL SURFACE OF CLUTCH

ATTACH CLUTCH TO TEETH WITH ZOE IMPRESSION PASTE

 Clutch fabrication

Edentulous patient
ACCURATE IMPRESSION OF MANDIBULAR BASAL SEAT

STONE CASTS ARE FABRICATED

MAKE AN ACCURATE RECORD BASE AND FABRICATE OCCLUSAL RI

SECURE SPECIALLY DESIGNED BITE FORK TO THE RIMS

ATTACH THIS ASSEMBLY TO MANDIBLE WITH CHIN CLAMPS OR CHIN

STRAPS
59
Hinge axis locator is positioned Rotate on a single point
 Advantages of kinematic method

1 . Hinge axis location is exact

2 . Decreased chair side time

3 . Occlusal discrepancies are well visualized, corrected and kept

to minimum.
 DISADVANTAGES OF KINEMATIC METHOD

 PATIENT COMFORT IS COMPROMISED

 THE INSERTION OF CLUTCHES MIGHT LEAD TO ALTERED POSITION OF CONDYLE

WHICH MIGHT INTERFERE WITH THE ABSOLUTE LOCATION

 IT IS TECHNIQUE SENSITIVE TRIAL AND ERROR METHOD THAT WARRANTS

REMAKING

 IT CAN BE USED ONLY WITH A FULLY ADJUSTABLE ARTICULATOR

 TIME CONSUMING.
 Modified methods

1. LOMA-LINDA HINGE AXIS METHOD

2. BUHNERGRAPH INTRAORAL METHOD

3. TECHNIQUE USING GEOMETRIC PRINCIPLE TO LOCATE HINGE AXIS.

4. ABDAL-HADI’S METHOD FOR LOCATING ARBITRARY HINGE AXIS

Dr.deepika et,al., Hinge axis recording “the essential need in prosthodontics” International
Journal of Current Research, Vol. 10, Issue, 07, pp. 71178-71184, July, 2018
 LOMA LINDA HINGE AXIS LOCATOR

• The opponents of use of a kinematic hinge-axis location for

edentulous patients point to its unreliability because of the resiliency
of the oral mucosa, the added weight of the recording clutch which
tends to shift the denture base, and the time-consuming nature of the
procedure. To eliminate some of these disadvantages, they have
developed a modification of the loma linda hinge-axis recording
device and face-bows for use on edentulous patients.
Fig. 1. The modified Lucite blank that accommodates the Loma
Linda hinge-axis recorde

Fig. 2. Modified Coe Bunce-Kanouse

aluminum tray containing a lower
modeling compound impression.
Fig. 3. The tissue surface of the modeling
compound impression and Lucite handle
made for a patient.
 Fig. 4. The Loma Linda recorder is
attached to the modeling compound
impression in a customized clutch.

Fig. 5. The hinge axis is located using the

Loma Linda recorder and customized
modeling compound clutch.

Fig. 6. The occlusion rim stabilized by cold-

curing acrylic resin is keyed into the Loma Linda
face-bow fork with modeling compound.

Fig. 7. The modeling compound occlusal keys

orient the maxillary occlusion rim in the Loma
Linda face-bow fork.
 Instruments used to determine true hinge axis
 BUHNERGRAPH INSTRUMENT
 PANTOGRAPH: KINEMATIC
FACEBOWS THAT INCLUDE A
RECORDING DEVICE SO THAT THE
EXACT CONDYLAR MOVEMENTS CAN
BE PROGRAMMED INTO A FULLY
ADJUSTABLE ARTICULATOR.
 TRANSOGRAPH
 ELECTRONIC MATHEMATICAL
METHOD
Stereognathography

Axitron-computerised axiograph

Digital recording system

Importance of Hinge Axis
1. Determines terminal hinge positon – The posterior most position that
the mandile can reach is the hinge position and is achieved by training
the patients musculature. The proprioceptive neural patterns in normal
automatic and in learned hinge movements are different. In the learned
movements, the proprioceptive sensations in the capsule are
consciously felt while they exert their loading influence under the
closing movement.
2. Locate centric relation: Location of hinge axis during face bow transfer
helps in the anteroposterior relation of the mandible to the maxilla at
the terminal hinge position which is the same as centric relation.
In numerous patients investigated, the reference point representing
the hinge axis appeared mostly in the neck of the condyle at the
posterior border in a region corresponding to the center of the
mandibular articulation. In some patients it was slightly forward at
the center of the neck of the condyle.
Thus the location of transverse hinge axis serves only to orient
the maxilla and to record the static starting point for functional
mandibular movements.
1. Cohen in 1960 stated that by determining hinge axis,
- Study cast can be mounted to see if the patients centric occlusion is in
harmony with centric relation.
- Casts can be mounted in best relationship for teeth on denture bases.
- Possible to increase/decrease the vertical dimension on the instrument,
without disturbing the centric relation.
2. Hinge axis expresses relation of border movements – It expresses a relation
of border movements which involve or include the limits of all physiologic
movements. Therefore with the artificial teeth arranged, the patient has the
possibility of carrying out all the jaw movements in the same field of action
as he could have with his own teeth.
 VIRTUAL FACEBOW TECHNIQUE USING STANDARDIZED BACKGROUND
IMAGES
ALEXANDRU PETRE, DMD, PHD, SERGIU DRAFTA, DMD, PHD, COSMIN STEFANESCU, DMD,CAND
LUMINITA OANCEA, DMD, PHD

Standardized conditions for

Cropping and resizing. Frontal face photograph with teeth
making photographs
separated slightly
Determine and mark the hinge axis on the skin.
Using one of the standard methods mark the
points corresponding to the terminal hinge axis
with an appropriate pencil
A, B, Facebow plastic fork aligned with cast. C, D, Profile photograph aligned.
Different methods of transferring digitized casts onto the virtual
articulator have been proposed, including a
• 3-dimensional (3D) optical scanner,
• Digital axiography,
• A series of photographs converted into a 3D face scan,
• Stereophotogrammetry,
• Cone beam computed tomography (CBCT),
• Cephalometric images, and scanning the position of a pointer
in 6 positions with reference to the head.
However, none of these have been widely adopted
 CONCLUSION
 Hinge axis is a component of every masticatory movement of the
mandible and therefore cannot be disregarded and this hinge axis
should be accurately captured and transferred to the articulator.
So it becomes a fine representative of the patient and biologically
acceptable restoration is possible.
 An occlusion that is restored to an incorrect arc of closure may
have interceptive and deflective tooth contacts in the hinge closing
movement. Such contacts are undesirable in either natural or
artificial occlusions and may contribute to periodontal trauma,
muscle spasm, TMJ pain, loss of supporting edentulous tissues.
 REFERENCES
 ESSENTIALS OF COMPLETE DENTURE-WINKLER 2 ND EDITION
 SYLLABUS OF COMPLETE DENTURE-HEARTWELL 4 TH EDITION
 PROSTHODONTIC TREATMENT FOR EDENTULOUS PATIENTS BY ZARB BOLENDER 12TH
EDITION.
 PROSTHODONTIC RX FOR EDENTULOUS PATIENT – BOUCHERS 10 TH EDITION
 POSSELT: TERMINAL HINGE MOVEMENT OF MANDIBLE. J PROSTHET DENT 1957; 7: 787-797.
• SICHER, H 1956, ‘THE BIOLOGICAL SIGNIFANCE OF HINGE AXIS DETERMINATION’. J
PROSTHET DENT, VOL 6, NO 5, PP. 616-620.
• SUNINT SINGH1,ET,AL.,HINGE AXIS - LOCATION, CLINICAL USE AND CONTROVERSIES, • JOURNAL OF
RESEARCH IN DENTISTRY 2017, 4(6):158-161