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Face-bow record without a third point of reference:

Theoretical considerations and an alternative technique


Carlo Ercoli, DDS,a Gerald N. Graser, DDS, MS,b Ross H. Tallents, DDS,c and Daniel Galindo, DDSd
Eastman Dental Center, University of Rochester, Rochester, N.Y.
Accurate mounting of dental casts is achieved by transferring the tridimensional spatial relationship
of the maxillary arch to an articulator. A face-bow is used to transfer this relationship to the articulator, usually by relating the face-bow to a plane of reference. The most common reference plane is
the Frankfort plane, which has been assumed to be horizontal when the patient is in the natural
head position. The axis-orbitale plane has also been considered horizontal and used as reference.
However, it has been shown that both planes are not horizontal, and mounting a maxillary cast
according to these planes can result in an inaccurate mounting. This article describes an alternative
procedure for face-bow transfer without a plane of reference, and uses the angular relationship
between the occlusal plane and the condylar path to mount the maxillary cast on the articulator. The
elimination of a reference plane, to which relate the functional determinants of occlusion, avoids an
additional source of error during the mounting procedure. (J Prosthet Dent 1999;82:237-41.)

ccurate mounting of dental casts is achieved by


transferring the tridimensional spatial relationship of
the maxillary arch to an articulator, often by using a
face-bow. This is traditionally done by using 3 reference
points. The criteria used in the selection of these reference points have been ease of location, convenience,
and reproducibility. Two points are located in the area
of the temporomandibular joints (TMJ).1 A third point
is selected, anterior to the TMJs, to define a plane of
reference, which is oriented in the articulator so that
the 3-dimensional position of the upper cast is reproduced as it is in the patient.
Ellis2 suggested that proper mounting of the maxillary cast can be achieved when 2 relationships are established: (1) The distance of the maxillary arch from the
intercondylar hinge axis. This relationship is recorded
by locating the hinge axis.3-6 Once the axis of rotation
is located, the distance of the maxillary arch from
this axis is easily recorded with a face-bow. (2) The
3-dimensional relationship between the maxillary
occlusal plane and the skull. This function is inherent
with the use of a face-bow and is independent from the
first one.
Some investigators have suggested that the angular
relationship between the condylar path and the occlusal
plane also should be recorded.7-9 A plane of reference
has been used to record this relationship,10 and the
most common reference plane is the Frankfort plane
(FP).11 The FP is established, in profile, by the lowest
point in the margin of the left and right bony orbit

Fig. 1. A, Occlusal plane of maxillary cast. B, Trajectory of


condylar inserts of articulator. C, Horizontal upper member
of articulator when incisal pin is set at zero.

aAssistant

Professor, Division of Prosthodontics.


Chief, and Program Director, Division of Prosthodontics.
cProfessor and Program Director, Temporomandibular Joint Disorders Program.
dResident, Division of Prosthodontics.
bProfessor,

AUGUST 1999

Fig. 2. A, Occlusal plane of maxillary arch. B, Condylar trajectory. C, Hypothetical horizontal plane.
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ERCOLI ET AL

Fig. 3. Patient was instructed to protrude his mandible in an


edge-to-edge position. Right posterior teeth achieve greater
disclusion than left ones.

Fig. 6. Upper cast is mounted in articulator with split cast


technique. A, Cast. B, Compound. C, Mounting stone. D,
Mounting ring.

Fig. 4. Silicone registration material is used to record protrusive position.

Fig. 7.
pound
Green
heads,

Fig. 5. Face-bow record is taken without paying attention to


third point of reference. No attention is paid to patients posture.
238

Upper and lower casts secured together with comand nails; split cast mounting is open. A, Casts. B,
compound. C, Nails. D, Mounting stone. Arrowsilicone registration material.

Fig. 8. Condylar mechanisms of articulator are loosened and


split cast mounting is closed. A, Casts. B, Green compound.
C, Nails. D, Mounting stone. Arrowheads, silicone registration material.
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ERCOLI ET AL

(orbitale) and the highest point in the margin of the


right or left bony auditory meatus (porion).11 Originally, this plane was defined parallel to the horizontal
plane of reference (HPR) (the Frankfort Agreement).11,12 The HPR can be defined as a horizontal
plane established on the face of the patient by 1 anterior reference point and 2 posterior reference points
from which measurements of the posterior anatomic
determinants of occlusion and mandibular motion are
made.11 Thus, it is a true horizontal plane.
The convention that the FP is parallel to a horizontal
plane implied, by definition, that the former is also horizontal. In 1906, the International Agreement for the
Unification of Craniometric and Cephalometric Measurement in Monaco further defined the FP as horizontal. This concept is so widely accepted that the Glossary
of Prosthodontic Terms (GPT-7)11 also defines the FP as
horizontal. Because the porion point is not reproducible
on the articulator, manufacturers of articulators substituted the axis for porion. In this way the axis-orbitale
plane (AOP) was assumed to coincide with the FP and by
definition11 with the HPR.13 In this way, the misconception was created that parallelism exists between the
FP, the AOP, the upper member of the articulator (when
the incisal pin is set at zero) and the HPR. However, it
has been demonstrated that (1) the FP is not parallel to
the AOP14 and (2) when a subject is standing in the natural head position (NHP, also called esthetic reference
position [ERP], defined as the position of the head
when an individual is sitting or standing erect with the
head level and eyes fixed on the horizon),13 the FP is
not parallel to the HRP.13,15,16
The upper and lower members of the articulator are,
in most articulators, parallel to each other, and to the
horizontal plane. Functional components of an articulator are the condylar inserts and the incisal guide table.
These elements are set at specific angular relationships
with the upper member of the articulator. That the
upper member of the articulator is horizontal (when
the incisal guide pin is zeroed), is likely the reason
why clinicians try to relate the spatial position of the
maxillary arch and the inclination of the condylar path
to an ideal horizontal plane in the patient.
Figures 1 and 2 illustrate this concept. Plane A corresponds to the occlusal plane of the maxillary cast in
the articulator and of the maxillary arch in the
patient.11 Plane B corresponds to the trajectory of the
condylar inserts in the articulator and of the condylar
path in the patient. Plane C is the horizontal upper
member of the articulator and the HPR when the subject is in the NHP.17 Clinicians have commonly
attempted to record the occlusal plane (plane A) and
condylar inclinations (plane B) relative to the HRP
(plane C), and transfer such relationships to the upper
member of the articulator. Planes A and B are easily
recorded from a patient and are readily transferred to
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THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 9. Right and left mean condylar inclination are recorded for future reference. Right condylar inclination (R) is
greater than left one (L) (black arrows). Compare this with
greater disclusion noted on patients right side in Figure. 1.
A, Upper member of articulator. B, Condylar inserts.

an articulator. Plane C is easy to locate on the articulator (it is represented by the upper member of the
instrument when the incisal guide pin is set at zero).
However, it is impossible to define it exactly in a patient
because of the individual variability of the NHP.17
This article describes an alternative procedure for
face-bow transfer that eliminates the need for a plane of
reference and uses the angular relationship between the
occlusal plane and the condylar path to mount the maxillary cast on the articulator.

PROCEDURE
1. Make impressions of the maxillary and mandibular
arches for diagnostic casts.
2. Rehearse with the patient to protrude his mandible
until the incisors are in an edge-to-edge position
(Fig. 3). (Patients with poor neuromuscular control and/or altered proprioception can be guided
in this position by the dentist. In partially or completely edentulous patients, wax rims are used to
simulate the dental arches.)
3. Instruct the patient to hold this position and
record it with the use of silicone registration material (Regisil PB, Dentsply Caulk, Milford, Del.)
(Fig. 4). Make 3 records.
4. After setting, trim the excess material so that only
the cusp tips are recorded.
5. Take a face-bow record without paying attention
to a third point of reference and/or the posture of
the patient (Fig. 5).
6. Mount the upper cast with a split cast technique3
(Fig. 6).
7. Mount the lower cast in maximal intercuspation and
separate the upper cast from the split mounting.
8. Relate the upper cast to the lower one by using 1
of the protrusive records. Secure the 2 casts
together with nails and compound material (Kerr
Co, Romulus, Mich.) (Fig. 7).
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THE JOURNAL OF PROSTHETIC DENTISTRY

9. Loosen the condylar mechanisms of the articulator


and adjust the right and left condylar inclinations
to allow the split cast to close (Fig. 8).
10. Repeat steps 8 and 9 with the other 2 protrusive
records.
11. Calculate the average values obtained with the 3
protrusive records and program the condylar settings of the articulator (Fig. 9).

DISCUSSION
Anecdotal information has been used to define the
spatial relationship of the FP to the HPR.11 The term
Frankfort horizontal plane is a misnomer and, as
defined, the plane is not horizontal when a subject is in
the NHP.13,15,16 The AOP has also been misused as
parallel to the HPR; according to Pitchford,13 these 2
planes would form an angle of 13 degrees.
The impossibility of locating a horizontal plane
when the patient is in the NHP is inherent with the
individual variability of this position.17 The concept of
NHP was first described by Broca,18 who defined it as
the position of a standing man when his visual axis is
horizontal. Reproducibility of NHP has been the
topic of research for decades with controversial
results.17,19-22 As stated by Solow and Tallgren,19 the
natural head position has been the subject of considerable interest in the anthropological as well as in the
orthodontic literature. Widespread research has been
made for a craniofacial reference plane, which in the
natural head position, would exhibit a constant relationship to the true horizontal plane. In the anthropologic field, the interest have been motivated by a
requirement for comparison of cranial structure in different populations.23-25 In the orthodontic literature,
the NHP has been used for assessment of facial esthetics in orthodontic analysis and treatment planning.26-28
Definitions of the NHP have varied among different
authors. Furthermore, methods used to help the
patient achieve this position (mirror, light sources, or
patient self-balance position) have also varied.19,20
In prosthodontics, the relationship of the occlusal
plane with the other determinants of occlusion have
been described by Hanau (Hanau Quint). 29 He
described how the inclination of the occlusal plane, the
condylar guidance, the incisal guidance, the cusp
height, and the compensating curve relate to each
other. Bergstrom1 further analyzed and discussed the
occlusal and articular variables and their reproduction
by articulators.
This article describes a procedure that uses a interocclusal record technique to record the angular relationship of the occlusal plane to the condylar path for
the purpose of accurately mounting the maxillary cast
on an articulator. With this technique, no attempt is
made to locate a plane of reference in the patient or in
the articulator; the clinician records and transfers the
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ERCOLI ET AL

relationship between the occlusal plane, and the condylar protrusive path regardless of the position of the
upper member of the articulator. The incisal guide
table can also be set with the same protrusive record.30
Any changes in the inclination of the maxillary cast
(inclination of the occlusal plane) on the sagittal plane
will not alter this ideal position, as far as the inclination
of the condylar path is also modified for the same
angle.7,29
Protrusive records have been extensively used to
record the inclination of the condylar path.1,30-32 Comparative studies have demonstrated that interocclusal
protrusive records do not differ from radiographic33
and pantographic34 records. However, some authors
have criticized the use of interocclusal records to program the articulator.35,36 In particular, the reproducibility of protrusive records have been questioned.
To minimize errors, the authors suggest to take 3
protrusive records and average them to program the
articulator.
It is our opinion that this technique simplifies the
diagnostic procedures during patient evaluation by
avoiding the location and transfer of planes of reference. The protrusive record, which is used to mount
the cast, can also be used in the restorative phase, thus
saving clinical time. Reference planes are not needed
for a correct mounting of stone casts. The elimination
of a reference plane, to which the functional determinants of occlusion are related, avoids an additional
source of error during the mounting procedure.
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Reprint requests to:


DR CARLO ERCOLI
UNIVERSITY OF ROCHESTER
EASTMAN DENTAL CENTER
DIVISION OF PROSTHODONTICS
625 ELMWOOD AVE
ROCHESTER, NY 14620
FAX (716) 244-8772
E-MAIL: Carlo_ercoli@urmc.rochester.edu
Copyright 1999 by The Editorial Council of The Journal of Prosthetic
Dentistry.
0022-3913/99/$8.00 + 0. 10/1/99196

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