Eur J Dent Educ 2006; 10: 197–203
All rights reserved
The use of articulators in UK dental schools
J. R. Hindle and H. L. Craddock
Division of Restorative Dentistry, Leeds Dental Institute, Clarendon Way, Leeds, UK
Abstract The increasing complexity of many restorative proce-
dures often involves articulation of study and working casts to
ensure accurate fabrication of restorations. Correct selection and
use of articulators can be crucial to successful restoration. The
aim of this paper is to determine which articulators are recom-
mended for various restorative procedures in UK dental schools,
for use by undergraduate students. A questionnaire-based study
of all UK dental schools was carried out, with a 100% response
rate. Recommended articulator application for specified proce-
dures was established from the literature and questionnaire
Introduction
A rticulators are an extremely important tool in
many dental procedures. Since their invention
in the early 19th century (usually credited to Gariot in
1805) (1), the design of these instruments has
improved considerably. Developments in the reliabil-
ity and accuracy of these devices have revolutionised
many dental techniques. In modern day dentistry, a
wide range of different articulator designs and models
are available for the practitioner, although many of
these require some degree of skill and knowledge to
be used effectively. As general and specialist practi-
tioners become involved with a wider range of
techniques, their knowledge of appropriate articulator
choice and application must also develop accordingly.
An articulator should, ideally, provide sufficient
reproduction of a patient’s static and dynamic occlu-
sion to enable the laboratory to produce a restoration
that is in harmony with the patient’s masticatory
system. If restorations or prostheses are produced that
are not in harmony, this may lead to patient discom-
fort, fractured restorations or teeth, wear of restora-
tions or teeth and permanent changes in occlusal
relationships.
Little scientific evidence is available to support
articulator selection. A Medline search, using Dental
Articulators as key words, and limiting the subhead-
ings to classification, economics, history, instrumenta-
Copyright ª Blackwell Munksgaard 2006
european journal of
Dental Education
results were compared with this. The results indicated that dental
schools in the UK generally teach appropriate articulator use for
most procedures. However, there are some limited areas of what
may be argued to be inappropriate recommendation in some
establishments.
Key words: articulators; undergraduate teaching.
ª Blackwell Munksgaard, 2006
Accepted for publication, 7 April 2006
tion, methods, standards, statistics and data, training
and utilisation produced 101 titles from 1966 to the
present. Many papers were related to the history and
development of articulators, biographies of their early
advocates and recommendation, without the use of an
evidence base. The British Society for the Study of
Prosthetic Dentistry and the British Society for Restor-
ative Dentistry offer guidance in the selection of
articulators for various procedures.
The earliest articulators were developed for com-
plete denture construction. Today, commonly accep-
ted practice regarding articulator selection for
dentures (both partial and complete) is the use of
an average value articulator (2–4). A simple hinge
articulator allows the occlusion to be set up only in
intercuspal position and so lateral movements of the
prostheses against each other are likely to result in
instability (3, 4). The position of the condylar hinge
axis does not relate to the patient’s anatomical hinge
and therefore tooth contacts during the arc of
closure cannot represent those of the patient. The
use of a semi-adjustable or even fully adjustable
articulator could also be inappropriate in denture
construction. Even though a more accurate repre-
sentation of the patient’s condylar angle and the
relationship of their maxilla to the condylar hinge
axis can be obtained, these articulators assume a
high level of stability of the prostheses during
function (4). With tissue borne dentures this may
197
Hindle and Craddock
TABLE 1. Articulator recommendation for prosthesis construction
Textbook Complete dentures Partial dentures
Basker et al. (4) AV/SE – –
Grant and Johnson (9) AV/SE AV/SE
Davenport et al. (3) – AV/SE
McCord and Grant (5) AV/SE AV/SE
Smith (7) – –
Shillingburgh et al. (8) – –
Wassel et al. (10) – –
Ramfjord and Ash (11) – –
McCord et al. (12) AV/SE AV/SE
Roberts (13) – –
AV, average values; SE, semi-adjustable; SH, simple hinge; FA, fully adjustable.
not be the case, as some degree of movement during
function will always be present and so the extra
degree of accuracy obtained with a semi-adjustable/
fully adjustable articulator over an average value
articulator could be unnecessary.
An average value articulator assumes average
patient dimensions and measurements. These usually
relate to the intercondylar distance and the distance
between maxilla and condyles [defined by Bonwill (5)
as a 4 inch equilateral triangle for the average person].
Although 4 inches is a good estimate for the distance
between the condyles and maxilla in most individuals,
it is the distance between these points in both
horizontal and vertical planes that should be of
particular concern.
Accuracy can be improved by using a face bow
recording with an average value articulator. This
eliminates occlusal error due to an incorrect hinge
axis to maxilla dimension on the basic articulator,
yet retains the benefit of simplicity associated with
the set-up and use of an average value articulator.
Tooth borne partial dentures have many of the
occlusal requirements of fixed prostheses and more
accurate articulation is likely to be appropriate. It is
reasonable to state that an average value articulator,
either with or without a facebow, is adequate for all
routine partial and complete denture cases likely to be
undertaken by a general dental practitioner (Table 1).
Any articulator affording a greater degree of accuracy
than this would be unnecessary, but not incorrect to
use. However, hand-held models or simple hinge
articulators are inappropriate for these types of
prostheses.
The choice of articulator for ‘simple crowns’ will
depend on the number, site and function of the teeth
to be restored. Hand held models may be appropriate
in some instances when none of the units being
crowned is involved in either guidance of lateral
excursions or protrusive movements. In this study,
‘simple crowns’ were defined as one or two units to be
198
Simple crowns Complex crowns Bridgework
– –
– – –
– – –
SH SE/FA SE/FA
AV SE/FA SE/FA
SH/AV SE/FA SE/FA
SH/AV SE/FA SE/FA
– – SE/FA/AV
– – SE/FA
crowned at the same time. Unfortunately, this subdi-
vision is probably too vague, as situations where one
of the crowns is involved in guidance of lateral
excursions or protrusive movements (for example,
canines or upper central incisors) should strictly be
classified as ‘complex crowns’. In some situations,
given this definition of ‘simple crowns’, hand held
models are an adequate form of articulation (6),
providing that a stable occlusion is available with
the models obtained from the patient. Hand held
models replicate adequately the intercuspal position
of the patient, allowing crowns to be manufactured to
fit this occlusal position.
Initially, basic knowledge of articulator selection is
given during undergraduate dental education and the
aim of this paper is to determine whether this is in line
with current guidelines and practice.
Method
A questionnaire was sent to the Head of the Restor-
ative Department (who it is presumed would have an
overview of teaching in their respective establish-
ments) in the dental schools within the UK (see
questionnaire). Eight of the respondents replied after
the initial request. The remainder replied after follow
up.
The questionnaire enquired about the type of
articulator recommended for each procedure, and
not actual practice. It covered nine common dental
procedures appropriate to general dental practice and
provided a choice of seven different articulators for
each. Procedures investigated were:
• partial dentures with a stable occlusion;
• partial dentures without a stable occlusion;
• complete dentures;
• simple crowns (defined as one or two units);
• complex crowns (defined as three or more units);
• simple bridgework (defined as one or two units);
 Use of articulators in UK dental schools

• complex bridgework (defined as three or more Partial dentures (without a stable occlusion)
units); For this procedure, there was an almost even split of
• complex occlusal adjustment or equilibration; recommendation between the use of the average value
• implants. articulator and the semi-adjustable articulator. The
Articulators investigated were: most common choice still remained the average values
• hand held models; articulator, nine of the dental schools used this, closely
• simple hinge articulator; followed by six recommending the ‘arcon’ semi-
• average value articulator; adjustable articulator (Fig. 2).
• average value articulator with face bow;
• ‘arcon’ semi-adjustable articulator; Complete dentures
• ‘non-arcon’ semi-adjustable articulator; For complete denture construction the majority of
• fully adjustable articulator. dental schools used the average value articulator, as
These procedures, alongside the extensive range of for the other two prosthodontic techniques (Fig. 3).
articulators, were deemed adequate to provide a clear Ten schools recommended this, with only a few
picture of practices adopted for education in this recommending a semi-adjustable articulator. Only
regard throughout the UK’s dental schools. one dental school indicated that they advocated the
use of a simple hinge articulator for this situation.

Results Simple crowns (one or two units)

There appeared to be somewhat more variation in the
The questionnaires offered the option of ticking more teaching of articulator use for this clinical procedure.
than one type of articulator for any particular proce- The most popular recommendation (seven of the
dure and so the cumulative number of responses for schools) was for the ‘Arcon’ semi-adjustable articula-
each situation may exceed the number of dental tor, although six schools also recommended the use of
schools surveyed. However, it is the modal distribu- hand held models for simple crowns. There was also
tion of responses that was analysed. This indicated the
most commonly employed articulator by dental schools
10
around the country for each procedure. Outlying
9
results were also considered to identify any possible 8
discrepancies in practice. 7
6
5
Partial dentures (stable occlusion) 4
As can be seen from Fig. 1, the most common choice 3
for this procedure was an average value articulator. 2

Eight of the dental schools employed this, yet there 1

0
appeared to be a fairly even spread of recommenda- Hand held Simple Avg. value Avg. value Arcon semi Non-arcon Fully
hinge + bow semi adjustable
tion for most of the other articulators, but with a lower
frequency. Fig. 2. Articulator use for partial dentures (no stable occlusal
stop).

12

9 10
8
7 8
6
6
5
4
4
3
2 2
1
0 0
Hand held Simple Avg. value Avg. value Arcon semi Non-arcon Fully Hand held Simple Avg. value Avg. value Arcon semi Non-arcon Fully
hinge + bow semi adjustable hinge + bow semi adjustable

Fig. 1. Articulator use for partial dentures (stable occlusal stop). Fig. 3. Articulator use for complete dentures.

199
Hindle and Craddock

8 12

7
10
6
8
5

4 6

3
4
2
2
1

0 0
Hand held Simple Avg. value Avg. value Arcon semi Non-arcon Fully Hand held Simple Avg. value Avg. value Arcon semi Non-arcon Fully
hinge + bow semi adjustable hinge + bow semi adjustable

Fig. 4. Articulator use for simple crowns. Fig. 6. Articulator use for simple bridgework.

some recommendation for simple hinge and average 16

values (with and without a face bow) articulators to be 14

used in this situation (Fig. 4). 12

10
Complex crowns (three or more units) 8
All the UK dental schools advocated the use of an
6
‘arcon’ semi-adjustable articulator for the construction
4
of complex crowns. A small number of dental schools
2
indicated that they also used hand held models,
0
average value articulators (with and without a face Hand held Simple Avg. value Avg. value Arcon semi Non-arcon Fully
bow) and ‘non-arcon’ semi-adjustable articulators in hinge + bow semi adjustable

this situation (Fig. 5). Fig. 7. Articulator use for complex bridgework.

Simple bridgework (one or two units)

The most commonly recommended articulator for
One response each was also obtained for hand held
simple bridgework appeared to be the ‘arcon’ semi-
models and average value articulators (both with and
adjustable articulator, with 11 dental schools advo-
without a face bow) (Fig. 7).
cating this. However, other responses indicated a
fairly even recommendation of all the other articula-
Complex occlusal adjustment or equilibration
tors available, excluding the fully adjustable type
All UK dental schools recommended the ‘arcon’ semi-
(Fig. 6).
adjustable articulator for complex occlusal adjustment
and equilibration. One of these dental schools also
Complex bridgework (three or more units)
advocated the use of ‘non-arcon’ semi-adjustable
The articulator of choice for complex bridgework by
articulators for this procedure (Fig. 8).
all UK dental schools was the ‘arcon’ semi-adjustable.

16 16

14 14

12 12

10 10

8 8

6 6

4 4

2 2

0 0
Hand held Simple Avg. value Avg. value Arcon semi Non-arcon Fully Hand held Simple Avg. value Avg. value Arcon semi Non-arcon Fully
hinge + bow semi adjustable hinge + bow semi adjustable

Fig. 5. Articulator use for complex crowns. Fig. 8. Articulator use for occlusal adjustment.

200

12
10
8
6 guidance is to be copied, ideally incorporate the use of
4
2 establishments. For all other, ‘simple bridge’ situations
0
Hand held Simple Avg. value Avg. value Arcon semi Non-arcon
hinge + bow semi
Fig. 9. Articulator use for implants.
Implants
The final procedure considered in this investigation
was the provision of dental implants. As this is an area
of treatment not generally covered at an undergradu-
ate level, not all dental schools indicated a preference.
However, implants are becoming a more common
treatment option for general dental practitioners, and
so limited theoretical and clinical exposure to implant
retained restorations is being introduced into the
undergraduate curriculum of some dental schools in
the UK. Ten schools used arcon semi-adjustable
articulators for implant work, followed by three
responses for the ‘non-arcon’ semi-adjustable articu-
lator. Only one response each was obtained for the use
of hand held models and an average value articulator
(Fig. 9).
Discussion
Before any comparisons can be made between current
educational practices and recognised recommenda-
tions, the literature must be evaluated and current
guidelines established.
Although no evidence-based research exists to
assist in developing a ‘gold standard’ for articulator
use, the professional organisations and the current
texts used in undergraduate teaching provide a basis
from which to measure ‘ideal’ instrument choice.
The study shows that in the majority of cases,
articulator selection for the procedures listed in
this study follows current guidelines and good
practice.
It was worrying that one dental school indicated
that they taught the use of a simple hinge articulator
for complete denture construction as this allows no
reproduction of any sort of lateral excursion or
protrusion of the mandible and so is contraindicated
for complete denture cases, given their requirement
Use of articulators in UK dental schools
for an adequately balanced occlusion, both in centric
and lateral relationships of the teeth. ‘Complex
crowns’, simple bridges and complex bridges, where
three or more teeth are to be crowned or where
semi-adjustable articulators (4–6). All the UK dental
schools indicated that this was the practice in their
the use of hand held models was adequate and
Fully recommended practice (4, 7). This follows current
adjustable
guidelines.
Although complex occlusal adjustment or equili-
bration was unlikely to be a major feature in under-
graduate teaching, all schools felt that some form of
adjustable articulator was indicated.
Finally, the provision of implants is a technique
which only recently has started making its way into
the undergraduate curriculum in many UK schools.
Not all dental schools indicated a teaching preference
for this area, yet the majority of those that did chose
the semi-adjustable articulator.
The articulator predominantly recommended by the
UK’s dental schools for most procedures is the semi-
adjustable type. Its high degree of flexibility, com-
bined with its relative ease of use (when compared
with a fully adjustable type) makes this articulator the
most likely candidate to become the articulator of
tomorrow in this context. Despite this, the other
articulators discussed still have their place in various
dental procedures, as described earlier.
As with all questionnaires, the response rate from
the sample must always be considered in relation to
the results obtained. As the response rate for this
study was 100%, and the sample was of the entire
population of UK dental schools, the results should be
truly representative of teaching practices throughout
the UK. This assumes that the individual completing
the questionnaire for each dental school was fully
aware of teaching practices for each of the procedures
covered and also that they had interpreted the ques-
tions correctly. Even though the questionnaire was
checked for questioning bias by a statistician, these
factors must be taken into account when interpreting
the results.
Although this study gives the reader an appreci-
ation of what is being recommended regarding the
use of articulators in UK Dental Schools, it in no
way can be extrapolated to reflect what is used in
practice for each procedure. A further study is
underway to determine whether the procedures
advocated at Undergraduate level are incorporated
into every day practice by UK General Dental
Practitioners.
201
Hindle and Craddock
Conclusion
Undergraduate education in the use of articulators in
UK dental schools closely follows current guidelines
and recommendations in most cases.
References
1. Mohl ND, Zarb GA, Carlsson GE, Rugh JD. A Textbook
of Occlusion. Chicago, IL: Quintessence Publishing Co.,
1988.
2. Barsby MJ, Johnson A, Welfare RD, Winstanley RB.
Guides to standards in prosthetic dentistry – complete
and partial dentures. British Society for the Study of
Prosthetic Dentistry. Chicago, IL: Quintessence Publish-
ing Co., 2005.
3. Davenport JC, Basker RM, Heath JR, Ralph JP, Glantz PO.
A Clinical Guide to Removable Partial Dentures, 2nd
edn. London: British Dental Association, 2000.
4. Basker RM, Davenport JC, Tomlin HR. Prosthetic Treat-
ment of the Edentulous Patient, 3rd edn. London:
Macmillan Education Ltd, 1992.
5. McCord JF, Grant AA. A Clinical Guide to Complete
Denture Prosthetics. London: British Dental Association,
2000.
6. Bonwill WGA. The scientific articulationof the human
teeth as founded on geometrical mathematical and
202
mechanical laws. J Philadelphia Dent Assoc 1885: 873–
880.
7. Smith B. Planning and Making Crowns and Bridges, 3rd
edn. London: Martin Dunitz, 1998.
8. Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brackett
SE eds. Fundamentals of Fixed Prosthodontics, 3rd edn.
Chicago, IL: Quintessence Publishing Co., 1997.
9. Grant AA, Johnson W. Removable Partial Dentures, 2nd
edn. Edinburgh: Churchill Livingstone, 1992.
10. Wassell RW, Walls AWG, Steele JG, Nohl F. A Clinical
Guide to Other Crowns and Other Coronal Restorations.
London: British Dental Association, 2000.
11. Ramfjord S, Ash MM. Occlusion, 3rd edn. Toronto: W.B.
Saunders Co., 1983.
12. McCord JF, Grant AA, Youngson CC, Watson RM, Davis
DM. Missing Teeth – A Guide to Treatment Options.
Edinburgh: Churchill Livingston, 2003.
13. Roberts DH. Fixed Bridge Prostheses, 2nd edn. Bristol:
John Wright & Sons Ltd, 1980.
Address:
H.L. Craddock
Room 6129
Leeds Dental Institute
Clarendon Way
Leeds LS2 9LU, UK
e-mail: h.l.craddock@leeds.ac.uk
 Appendix
See attached a copy of the questionnaire and covering letter sent to the UK’s dental schools

Hand held Simple hinge Average value Average Arcon semi-adjustable Non-arcon Fully adjustable
models articulator articulator value articulator + articulator semi-adjustable articulator
(e.g. denar face bow (e.g. denar mark II) articulator (e.g. denar D5A)
automark) (e.g. dentatus)
Partial dentures (stable occlusion)
Partial dentures (without a stable occlusion)
Complete dentures
Simple Crowns (1 or 2 crowns)
Complex crowns (3+ crowns)
Simple bridgework (1 or 2 units)
Complex bridgework (3+ units)
Complex occlusal adjustment/repositioning
Implants

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Use of articulators in UK dental schools

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