Presented byDr. Aatish Shah, P.

G Student

Introduction Definitions Facebow Reviews Anterior and Posterior Reference Points Conclusion References
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Orientation Relationship
Orientation relations are those that relate the mandible to the cranium in such a way that when the mandible is in its most retruded position, it can rotate around an axis which passes through or near the condyle.
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Face bow
A caliper like instrument used to record the spatial relationship of the maxillary arch to some anatomic reference point(s) and then transfer this relationship to an articulator; it orients the cast in the same relationship to the opening axis of the articulator.
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The Face bow 1. The face bow is an instrument used to record the spatial relationship of the maxillae to some anatomic reference and transfer this relationship to an articulator. Customarily this reference is a plane established by a transverse horizontal axis and a selected anterior point. - Glossary of prosthodontic terms, 1987

2. A caliper like instrument used to record the spatial relationship of the maxillary arch to some anatomic reference point or points and then transfer this relationship to an articulator; it orients the dental cast in the same relationship to the opening axis of the articulator. Customarily, the anatomic references are the mandibular condyles transverse horizontal axis and one other selected anterior point; called also as hingebow
- (Glossary of prosthodontic terms, January 1999 1)

The face bow is a caliper like device that is used to record the relationship of the jaws to the temporomandibular joints or the opening axis of the jaws and to orient the casts in this relationship to the opening axis of the articulator. (Boucher. 10th ed) A face bow is used to record the three dimensional relation of the maxillae to the cranium. The face bow record is used to orient the maxillary cast to the articulator this procedure is called the face bow transfer. Mandibular opening and closing movement are reproduced when the transverse horizontal axis is coincident with the articulator hinge axis. In order to create precise occlusion, the casts would be oriented correctly which depends on an accurate face bow transfer. (Lucia 1960)

Review

Review Literature:

The study of hinge axis opening of the mandible and the need to accurately locate it ,has occupied many distinguished workers over the years.

Locating the transverse hinge axis was first discussed by Campion (1902), who felt that the axis of the articulator should coincide with that of the patients. Gysi (1910), in his treatise stated the mandible in opening and closing rotates around another center, which, however has no influence in the setting up of teeth for articulators, and therefore need not be considered in construction of an articulation

Other important workers in this field were Bennet (1908, 1924), Needles (1923, 1927), and Wardsworth.

Stansberry (1928), was dubious about the value of face bows and adjustable articulators. He thought that since an opening movement about the hinge axis took the teeth out of contact, the use of these instruments was ineffective except for the arrangement of the teeth in centric occlusion. In his opinion, the plain line hinge type of articulator was just as effective. Mclean (1937) stated; the hinge functions of the lower portion of the temporomandibular joints are still disputed and little understood. The hinge portion of the jaw has two function of great importance to Prosthodontists

First, the hinge portion of the joint is the great equalizer for disharmonies between the gnathodynamic factors of occlusion when occlusions are synthesized on articulator without accurate hinge axis orientation, there may be minor cuspal conflicts, which must be removed by selective spot grinding.

The second function of the hinge portion of the joint is inherent in the fact that in it takes place all changes of the level of biting closure, commonly called opening or closing the bite.

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Regarding the satisfactory construction of full dentures, he said that opening or closing the bite on a articulator with an incorrect hinge axis location would result in unsatisfactory occlusion of a dentures when they were placed in the mouth.

When the hinge axis on the articulator was too far forward compared with its location on a patient, closing the interocclusal distance would result in the dentures meeting prematurely posteriorly.

If the axis was too far posteriorly, premature contact would occur anteriorly.

If the axis was too low, the lower denture would be forward of centric relation, If too high, the lower denture would be posterior to centric occlusion.

The conclusion was that any alteration in the interocclussal distance must be made in the mouth or by the use of a hinge articulator. If the latter were to be use, then the hinge axis must be determined as a stationary point (i.e. rotatory but not translatory) over the head of the condyle during hinge axis movements 11 and not by palpation or anatomical location.

McCollum (1939), was one of the leading advocated of the hinge axis theory and published a very important series of articles concerning restorative remedies. He stated: In 1921 I became convinced that the opening and closing center of the mandible was a most important factor in dental articulation and that its determination was preliminary to the transferring to an articulating instrument a record of jaw relations..

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In his articles he lauded Snow for his discovery of the face bow and its use and at the same time he criticized Gysi on his views of the hinge axis and for saying that changing vertical dimension is a chair side operation.

McCollum also described how to demonstrate conclusively the existence of the definite opening and closing axis by using a face-bow rigidly attached to the lower teeth with an orthodontic appliance. He found wide variation in anatomic location of the points and between sides of the same individual. He said that the hinge axis point remained constant throughout life.

Other important workers in this field were Higley (1940), Stuart (1947), Logan (1941), McLean (1944), and Branstad (1950).

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Robert. G. Schallhorn (1947), studying the arbitrary center and kinematic center of the mandibular condyle for face bow mountings concluded that using the arbitrary axis for face bow mountings on a semi adjustable articulator is justified. He says that since, in over 95% of there subjects, the kinematic center lies within a radius of 5 mm. from the arbitrary center.

Craddock and Symmons (1952), considered that the accurate determination of the hinge axis was only of academic interest since it would never be found to be move than a few millimeters distant from the assumed center in condyle itself.

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Posselt (1952), conducted extensive studies on the hinge axis. He found that the extent of hinge opening between the upper and lower incisor teeth was 19.2 mm. 1.9mm. Page (1952), described the hinge bow developed by Mc Collum in 1936 as one of the most important contributions made to dental science. Lucia (1953) stated the practical importance of the hinge axis and hinge axis transfer to an articulator is of tremendous importance. without a hinge axis transfer he thought it impossible to diagnose an occlusal problem.

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Bandrup Wognesen (1953), discussed the theory and history of face bows. He quoted the work of Beyron who had demonstrated that the axis of movement of the mandible did not always pass through the centers of the condyle. They concluded that complicated forms of registration were rarely necessary for practical work.

Other very important workers in this field were Laurizten (1951), Clapp (1952), Sloane (1951), Granger (1952), Lucia (1953), Sicher (1954), Thompson (1954), page (1955), Collet (1955), Kornfield, (1955), Trapozzano (1955), and Beck and Morrision (1956)

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Teteruck and Lundeen (1966), evaluated the accuracy of the ear face bow and concluded that only 33% of the conventional axis locations were within 6 mm of true hinge axis as compared to 56.4% located by ear face bow. They also recommended the use of ear bow for its accuracy, speed of handling, and simplicity of orienting the maxillary cast.

Thorp, Smith, & Nicholos ( 1978), evaluated the use of face bow in complete denture prosthesis occlusion. Their study revealed very small differences between a hinge axis face bow Hanau 132-SM face bow, and Whipmix ear-bow.

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Neol D. Wilkie 1979, analyzed and discussed five commonly used anterior points of reference for a facebow transfer.

He said that not utilizing a third point of reference may result in additional and unnecessary record making, an unnatural appearance in the final prosthesis and even damage to the supporting tissues. He suggest the use of the axis-orbital plane because of the ease of marking and locating orbital and therefore the concept is easy to teach and understand.

Bailey J.O.J.R.. and Nowlin T.P in 1981 in their study concluded that face-bow transfer utilization orbital as the third point of reference does not accurately establish the relationship of the Frankfurt horizontal to the occlusal plane on the articulator.

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Elwood. H. Staele et al 1982, evaluated esthetic considerations in the use of face-bow.

Goska and Christensen (1988), investigated cast positions using different face-bows. They concluded that it was not possible to establish clinical superiority between one type of face bow and another because the casts are mounted in relation to anatomic land marks that vary from subject to subject.

According to Sloanethe mandibular axis is not a theoritical assumption, but definitely demonstrable, and biomechanical fact. It is the axis upon which the mandible rotates in an opening and closing funcion when comfortably, not forcibly retruded.

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History of Facebow

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Bonwill.. Balkwill.. Hayes.. Walker.. Gysi.. Snow.. Wadsworth..

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Parts Of Facebow

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Parts of a Face Bow- Arbitary

It consists of a U shaped frame or assembly that is large enough to extend from the region of the temporomandibular joints to a position 2-3 inches in front of the face and wide enough to avoid contact with the sides of the face. The facia type of face bow has condyle rods that contact the skin over the temporomandibular joints. Whereas in the ear piece type it is known as a condylar compensator since their location on the articulator approximately compensates for the distances the external auditory meatuses are posterior to the transverse opening axis of the mandible. The part that attaches to the occlusion rims is the fork. The fork is attached to the face bow by means of a locking device, which also serves to support the face bow, the occlusion rims and the cast while they are being attached to the articulator.

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Kinematic Face bow The Kinematic face bow is initially used to accurately locate the hinge axis( within 1 mm). It is attached to a clutch, which in turn attaches to the mandibular teeth. As the mandible makes opening and closing movements the condylar styli move in an arc. Their position is adjusted until they exhibit pure rotation and not translation, when the mandible is opened and closed. The points of rotation are marked on the skin and this determines the true hinge axis. The mandibular clutch is removed and the face bow is attached to the maxillary arch. The true rotation points are again used to orient the tips of the condylar styli .

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Kinematic location of the hinge axis works well when natural mandibular teeth remain to stabilize the clutch mechanism. However, they are generally not used for complete denture prosthesis prosthesis fabrication because the resiliency of the soft tissues and the resultant instability of the mandibular record base make precision location of the rotational centers almost impossible.

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Arbitrary face bow:

The arbitrary type of face bow is so called because it uses arbitrarily located marks on the skin at the condyle points as the hinge axis position.

1. Facia type: In the facia type the condyle rods are positioned on a line
extending from the outer canthus of the eye to the supero- inferior center of the tragus and approximately 13mm anterior to the distal edge of the tragus of the ear. This locates the condyle rods within 5mm. of the true center of the opening axis of the jaws. The presence of an assistant is required to hold the bow while the prosthodontist without clamping the condyle rods centers the device so that equal readings are obtained on both sides. The wing nut of the clamp is tightened to hold the face bow in place on the occlusal fork attached to the maxillary occlusion rim.

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2. Ear piece type:

The earpiece face bow is designed to fit into the external auditory meatus. Here also the fork is attached to the maxillary occlusion rim. The whip mix, Hanau earpiece , Denar, slidematic face bow are equipped with plastic earpieces at the condylar ends of the bow. When an earpiece face bow is removed, it is attached to the articulator by orienting centering holes in the earpieces on the side of the condylar housings of the articulator. With the denar slidematic face bow, the anterior portion of the apparatus is removed from the bow proper and supported in the articulator by a special jig, which replaces the incisal guide table.

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All articulators require either an arbitrary or specific third point of reference for articulating the maxillary cast. This is done with an orbitale pointer or a nasion relator .(Neol D Wilkie)

It is important to remember that the critical relationship being transferred is between the maxillae and the hinge axis, to raising or lowering the anterior part of the face bow does not alter this relationship. Varying the position of the anterior part of the face bow will create a change in the absolute values for the condylar guidance settings. However, as long as eccentric records are used to determine condylar guidances after the casts are mounted the values for condylar guidance will be equivalent relative to the mounting of the casts.

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# 1 2

Description Screw T- Screw

3
4 5 6 7 8 9 11

T- Screw
Horizontal clamp Toggle clamp Lock washer Toggle clamp Retaining ring Bite fork HEX nut

10 Cross bar assembly

12 Face bow (Right)

13 Center locking nob 14 Face bow (Left) 15 Upright post 16 Nose piece shaft 17 Face bow nob 18 Nose piece 19 Washer
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Whip Mix Model 9600 Face bow

The Plane of orientation

The maxillary cast in the articulator is the baseline from which all occlusal relationships start and it should be positioned in space by identifying three points, which cannot be on the same line. The plane is formed by two points located posterior to the maxillae and one point located anterior to it. The posterior points are referred to as the posterior points of reference and the anterior one is known as the anterior point of reference.

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Why should articulator accept face bow????

Relate the lower cast to the upper cast in centric relation position. Hinge axis is the starting point of lateral movements. Changing the vertical dimension
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Types of Face bow

1. Arbitrary uses the average

determinants for the position of the hinge axis

A) Ear piece typeHanau-164-2 Twirl bow,and 153, quickmount, slidematic B) Fascia typehanau132-25m and hanau 132-2c

2. Kinematic Demands precise

determination of the actual hinge axis
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Parts of Face bow

U shaped Frame
Ear rods/styli Fork Pointers
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c a

b Hanau Spring Bow

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Posterior points of reference:

The position of the terminal hinge axis on either side of the face is generally taken as the posterior reference points.

Location of the Posterior References Points:

Prior to aligning the face bow on the face, the posterior reference points must be located and marked. The posterior points are located by Arbitrary method Kinematic method.

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Denar

12mm anterior to posterior border of the tragus & 5mm inferior to a line extending from the superior border of tragus to outer canthus of eye
12mm anterior to the center of external auditory meatus on Frankfort plane

TSN

Lauritzen & Bodner

12mm anterior to the center of external auditory meatus and 2mm inferior to porion canthus line.

Whip mix

Antero-posterior direction at the of external auditory meatus & in supero-inferior direction approximately a level of most prominent point of posterior border of tragus
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BrandrupWongsen

12mm anterior to most prominent point of posterior border of tragus on a line from outer canthus of the eye.

Beyron

13mm anterior to posterior margin of tragus on line from the center of tragus to outer canthus of eye

Gysi

10mm anterior to posterior margin of tragus on line from superior margin of outer canthus of the eye On line from superior margin of EAM to outer canthus of eye intersecting the line 13mm anterior to EAM
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Prothero

Lundeen

13 mm anterior to the tragus on a line from the base of the tragus to the outer canthus of the eye.

Simpson

11 mm anterior to the tragus on the campers line.

Wienberg

11-13 mm anterior to the reference line drawn from the middle and posterior border of the tragus.

Bergstrom

10mm anterior to center of spherical insert of this face bow & 7mm below Frankfort plane
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Beyrons Point

Bergstroms Point

Brandrup Wongsens Point

Gysis Point
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Lauritzen & Bodner Point

Denar Point

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a. Beyron point.
b. Gysi point c. Bergstrom point. d. Experimental arbitrary axis point. e. Teteruck and Lundeen point.
All these points locate hinge axis within the proximity of 5mm of 45 the true hinge axis

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The Anterior points of referenceIt was important to ascertain at what level in the articulator the occlusal plane should be placed. The selection of the anterior point of the triangular spatial plane determines which plane in the head will become the plane of reference when the prosthesis is being fabricated. The prosthodontist can ignore but cannot avoid the selection of the anterior point. The act of affixing a maxillary cast to an articulator relates the cast to the articulators hinge axis, to the vertical axes, to the condylar determinants to the anterior guidance, and to the mean plane of the articulator.

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Reasons for selecting an anterior point of reference1. When three points are used the position can be repeated, so that different maxillary casts of the same patient can be positioned in the articulator in the same relative position to the end controlling guidances. For this reason it is important to identify the mark permanently or be able to repetitively measure an anterior point of reference as well as the posterior points of reference.

2. A planned choice of an anterior reference point will allow the prosthodontist and the auxiliaries to visualize the anterior teeth and the occlusion in the articulator in same frame of reference that would be used when looking at the patient. For example, when using the Frankfort horizontal plane as the plane of reference, the teeth will be viewed as though the patient were standing in a normal postural position with the eyes looking straight ahead.
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3.

An occlusal plane not parallel to the horizontal in the beginning steps of denture fabrication may be unknowingly located incorrectly because of a tendency for the eye to subconsciously make planes and line parallel. Therefore the prosthodontist may wish to initially establish the restored occlusal plane parallel to the horizontal in order to better control the occlusal plane in its final position.

4.

The prosthodontist may wish to establish a baseline for comparison between patients, or for the same patient at different periods of time.

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ORBITALE

Lowest point of the infra orbital rim and on a patient it can be palpated through the overlying tissue and the skin. When the porion is used as the posterior landmark it lies 7mm superior to the horizontal axis and this discrepancy can be compensated by marking the anterior point of reference 7mm below the orbitale on the patient while using a fascia facebow.
The nasion guide or positioner fits into the depression of the nasion and cross bar attachment of the face bow is attached 23mm below the midpoint of the nasion positioner.
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ORBITALE -7

NASION - 23

INCISAL EDGE AND ARTICULATOR MIDPOINT TO ARTICULATOR AXISHORIZONTAL PLANE STADEs E.R.P. correction

The occlusal plane is placed at the mid horizontal plane of the articulator

16.5 mm correction of the obitale pointer

PITCHFORDs E.R.P. correction

11.5 mm correction from the porion and 18 mm correction from the axis.

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Significance of Facebow

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Conclusion

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References
Bouchers . Prosthodontic treatment of edentulous patients, 8th edition. Winkler. Essentials of complete denture prosthodontcs, 2nd edition. Swenson. Complete denture, 4th edition Arthur Aull. A study of the transverse hinge axis. J Prosthetic dentistry 2003;13(3);469-480 Neol D. Wilkie. The anterior point of reference. JPD, 41(5); 488-496,May 1979. B.B.Mccollum. Mandibular hinge axis and method of locating it . JPD 1960;10(3),428-434.
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 Bandrup and wongsen. Significance and application of facebow, J Prosthetic dentistry 1953;3(5);618631. D.Seifert et al. Relation of reference planes; Acta stomatol croat, 2000; 4; 416-418. N. Kalavaty et al . A face bow- a caliper devicereview.SRM university journal of dental science, march 2011;2(1);37-42. Lauritzen et al. variation in location of arbitary and true hinge axis point. J Prosthetic Dentistry 1961;11(2);224-229. Google
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Carl O Boucher, It must be recognized that the person operating the instrument is more important than the instrument. If dentists understand articulators and their deficiencies, they can compensate for their inherent inadequacies.
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