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THE

WALTER HARRY

ACCURACY

OF AN EAR

FACE-BOW

R. TETERUCK,
C.
LUNDEEN, of

BSc., D.D.S.,M.S.D.,"AND B.A., B.S.,D.D.S""


College
of

University

Kentucky,

Dentistry,

Lexington,

Ky.

T face-bow
HE

USE of an anatomic articulator is dependent upon an accurate transfer.l The terminal hinge axis is generally accepted as the most stable reproducible point from which maxillary casts can be mounted. In 1961 Lauritzen described a relatively simple method of locating the true hinge axis. However, the arbitrary location is still the most common method of determining the axis. The most popular arbitrary method employs a point approximately 13 mm. anterior to the tragus of the ear on a line from the tragus to the outer canthus of the eye. The chief advantage of the arbitrary method is its ease of application to all situations requiring the mounting of casts. Results from several stud:es comparing both methods are conflicting.S-6 1t was the purpose of this study to compare the accuracy of a new arbitrary method of mounting maxillary casts to both a true hinge axis and the conventional 13 mm. arbitrary axis method. The new method (ear face-bow)+ employed the external auditory meatus and nasion as reference points. In addition to the primary objective of the investigation, measurements of the vertical position of the cast between the maxillary and mandibular members of the articulator as dictated by the nosepiece were recorded.

PROPER

ADJUSTING

THE

FACE-BOW

FORK

Accurately fabricated maxillary casts were obtained from 47 subjects with good complements of firm teeth. All three methods of locating the axis and transferring it to the articulator were employed on every subject. The same face-bow fork was used in all transfers to standardize the three methods of mounting. Black modeling compoundf was placed on the face-bow fork because of the dimensional stability and accuracy of the compound. The fork was centered on the upper teeth and the subjects were instructed to close gently into the softened modeling compound to register light imprints of the lower teeth. When the modeling compound had sufficiently hardened, the face-bow fork was
*Assistant Professor, Department **Associate Professor and Director tWhip-Mix Corp., Louisville, Ky. dKerr Mfg. Co., Detroit, Mich. of Restorative of Occlusion. Dentistry. Department of Restorative Dentistry.

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fs%

removed from the mouth and chilled under cold water. Then the compound was trimmed to a level so that only light imprints of the cusps remained. All compound in contact with soft tissue was removed. Only those records into which the casts would fit accurately were accepted.
THE EAR FACE-BOW TECHNIQUE

The face-bow fork was fitted onto the upper teeth, and the subject was asked to close the lower teeth into the imprints in the modeling compound to hold the fork rigidly. Then the patient was handed the caliper-like face-bow and instructed to place the plastic tips into his ears in a manner similar to using a stethoscope. At the same time, the universal toggle of the apparatus was attached to the face-bow fork stem. The patient held the plastic ear tips in the most stable bony part of the external auditory meatus by exerting an inward, forward, and upward pressure on the sidearms of the bow while the adjustment screws were tightened (Fig. 1). The ear face-bow is designed to indicate the intercondylar width of the patient as small, medium, or large. This width was recorded and used later to adjust the intercondylar width of the articulator. A third plane of reference which corresponds to the axis-orbital plane was established by means of a nosepiece spacer. The plastic tip of the nosepiece was raised to the level of the nasion and the toggle of the vertical support rod was tightened. The face-bow was removed by loosening the center screw and instructing the patient to remove the plastic ear tips while simultaneously opening the mouth to release the face-bow fork. The face-bow apparatus was secured to the articulator by fitting the small holes in the ear plugs over metal projections located on the sides of the condylar guidance housing. The center screw was tightened again, and the maxillary member of the articulator was placed on the cross member of the face-bow. The horizontal condylar guidance inclination was set at 35 degrees for all subjects. The maxillary cast was placed in the imprints in the modeling compound on the face-bow fork and attached to the mounting plate of the articulator with a minimum amount of fast-setting artificial stone (Fig. 1). A series of 10 successive ear face-bow mountings was performed on one subject to serve as a control. Differences in the ear mounting method on the same subject ranged between 0.25 and 2.75 mm. for an average of 1 mm. variation.
THE HINGE AXIS TECHNIQUE

The Lauritzen method3 was used to locate the true hinge axis. After the axis was located, the subject was placed in an upright position with the head out of the headrest. The axis points were marked on the skin while the mandible was held in the most retruded position. The hinge axis locating equipment was removed and the same face-bow fork was placed in the mouth. A hinge axis transfer bow was now securely attached to the face-bow fork stem and the condylar styli were adjusted to the true hinge axis markings with the patient again sitting erect (Fig. 2). The hinge-bow apparatus was removed from the patient and carefully repositioned onto the previously mounted maxillary cast on the articulator. The positions of the hinge axis styli

EAR

FACE-BOW

ACCURACY

Fig. oriented

l.-Above,

to the upper

The ear face-bow is in position on the subject. Below, The member of the articulator by means of the ear face-bow.

maxillary

cast

is

were then recorded on 1 mm. graph paper which was attached to a disc that accurately replaced the condylar housing mechanism of the articulator. The graph paper was positioned with the horizontal lines parallel to the upper member of the articulator. The discs were extended laterally to just meet the tips of the terminal hinge axis styli. At this time, the location of the styli was compared with the center axis of the instrument which was indicated by the intersection of the lines at the center of the disc (Fig. 2). By mentally dividing each millimeter square into four areas, it was possible to locate the position of the stylus to within 0.25 mm. This measurement was recorded on a master graph sheet.
THE CONVENTIONAL TRANSFER METHOD

The arbitrary location of the hinge axis was performed by aligning a flexible ruler between the foot of the tragus of the ear and the outer canthus of the eye and measuring anteriorly 13 mm. from the tragus (Fig. 3). This point was marked on the skin.

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3. Pros. Den. November-December. 1966

I pig .2 .-Above, POSliti .Oll of the true

The true hinge axis hmge axis is recorded

transfer bow is in position on the subject. in relation to the ear face-bow axis.

!Zo*, The

Fig.

3.-The

axis

is located

by measuring

13 mm.

anteriorly

on the

tragus-canthus

line.

v01u1nc 16 Number 6

EAR

FACE-BOW

ACCURACY

1043

The previously employed hinge axis transfer bow was reseated on the sub-, jects teeth and the condylar styli were adjusted to the arbitrary axis points. This measurement was recorded on the master graph sheet in a similar manner as described for the hinge axis location.
RESULTS

The results were transposed to show the variations of both arbitrary axis locations as they corresponded to the true hinge axis (Fig. 4 and Table I). This was necessary because the design of the ear face-bow made it impossible to record the data in the described manner. Measurements of the distance from the top of the upper mounting plate to the incisal edges of the maxillary central incisors were also recorded (Fig. 5). The distances as dictated by the nosepiece varied from 42.7 to 59.9 mm. for an average value of 51.3 mm. On this articulator, which measured 94 mm. between the upper and lower members on the average, the cast would be oriented slightly below the midpoint. For those dentists who desire to use a split cast technique, this location would seem to provide sufficient space for mounting the casts.

mm.

Fig. 4.-The axis points

records of the ear face-bow (dots) are plotted in relation

axis points to the true

(cross marks) and hinge axis (center).

the

conventional

13

TABLE I. THE RELATIVE LCCATION ens) AS COMPARED TO THE LOCATION -.~--__ I I

(PER CENT) OF 94 ARBITRARY OF THE TRUE HINX AXIS. DISTANCE

AXIS -

POINTS

(BOTHLMETH-

-.----___-. AXIS (MM.)

FROM THE HINGE

Ear axis (%) 13 mm. axis (%)

1.1 3.2

24.5 9.6

56.4 33.0

85.1 62.8

93.6 78.7

95.7 96.8

100 100

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J. Pros. Den. November-December, 1966

lary

Fig. K-The distance from central incisors is measured

the top Of the mounting by a vernier caliper.

plate

to the

incisal

edges

of the

maxll-

DISCUSSION

In similar studies3m6 comparing variations between the conventional arbitrary axis and the kinematic axis, results varied from 33 to 95 per cent of true hinge axis points falling within a 5 mm. radius of the arbitrary point. Our results differed markedly with those of Beyron4 and Shallhorn but were much closer to those of Lauritzen and Bodner3 and Becks.s Our tests indicate that 33 per cent of the arbitrary axis points located 13 mm. anterior to the tragus fell within a 6 mm. radius of the true hinge axis. Here again the location chosen for the 13 mm. arbitrary point could have been slightly different from the points selected by other investigators. On the other hand, 56.4 per cent of the arbitrary points achieved by the ear face-bow fell within a 6 mm. radius of the true hinge axis. By calculating the epicenter of the greatest concentration of hinge axis points from the original data and modifying the mounting holes in the ear plugs (Fig. 6) to this new center, it was estimated that the above figure could be increased to 75.5 per cent (Fig. 7). The concept of the ear face-bow is not new. 7-10 Although not the ultimate answer for condylar axis location, the ear face-bow technique has clear advantages over the most widely used method of arbitrary axis location. The accuracy, speed of handling, and simplicity of orienting maxillary casts with the ear face-bow are recommendations for its use in many routine restorative procedures.
SUMMARY

A study was conducted comparing the accuracy of a new arbitrary face-bow method and a conventional arbitrary method with a true hinge axis technique. A standardized method of recording the location of the various points was described. Of the 94 different axis locations registered, 33 per cent of the conventional axis locations were within 6 mm. of the true axis, as compared to 56.4 per cent located by the ear face-bow.

EAR

FACE-BOLT.

ACCI:RACY

1045

Fig. (arrow).

6.-A

modification

of the original

ear plug

shows

the

relocation

of the

mounting

holes

Fig. 7.-Deviations millimeters with the ear plugs included).

from amount

the true hinge of calculated

axis of both arbitrary face-bow deviation of the corrected ear

methods face-bow

(shown in with new

With a simple modification of the ear face-bow, it was calculated that the above figure could be increased to 75.5 per cent. Therefore, this method of arbitrarily mounting maxillary casts deserves consideration for many routine restorative procedures.
REFERENCES

1. Weinberg, 2.

L. A.: An Evaluation

of Basic Articulators
1963.

and

Their

Concepts.

Part

I. Basic

Rehabilitation, Oxford, 1964, Blackwell Scientific Publications. 3. Lauritzen, A. G., and Bodner, G. H.: Variations in Location of Arbitrary and True Hinge Axis Points, J. PROS. DENT. 11:224-229: 1961.
4. Beyron, H. : Orienterings Problem vid Protetisk Rekonstruktioner ock Bettstudier, Svensk.

Concepts, J. PROS. DENT. 13:622-644, Posselt, U. : Physiology of Occlusion and

tandl. taskr. 35:37, 53-54, 1942. 5. Schallhorn, R. G.: A Study of the Arbitrary Center and the Kinematic Center of Rotation for Face-Bow Mountings, J. PROS. DENT. 7:162, 1957. 6. Beck, H. 0.: A Clinical Evaluation of the Arcon Concept of Articulation, J. PROS. DENT. 9:409-421, 19.59.

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7. Dalbey, W. C.: How to Obtain Accurate Measurements in Artificial Denture Making. Locating the Fundamental Lines Used in Anatomical Articulation, D. Cosmos 56: 269-275, 1914. 8. Brandrup-Wognsen, T.: The Face-Bow, Its Significance and Application, J. PROS. DENT. 3:618-630, 1953. 9. GoodfrA&di$4 J. : New Face-Bow for Dentist-Laboratory Cooperation, J.A.D.A. 68 :86610. Bergstrom, G. . On the Reproduction of Dental Articulation by Means of Articulators, Kinematic Investigation, Acta odont. scandinav. 9:Supp. 4, 1950.
UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY LEXINGTON, KY. 40506