ORIENTATION

JAW
RELATION
O Presented by : Dr Sonal Batra

Mds IInd year

Department of
and bridge

prosthodontics ,crown

Content :
INTRODUCTION
DEFINITION
TERMINOLOGIES
THEORIES OF HINGE AXIS
Importance Of Orientation Jaw Relation
FACE BOW
REVIEW OF FACE BOW
CLASSIFICATION OF FACE BOW

O ANTERIOR REFERENCE POINT

O POSTERIOR REFERENCE POINT
O FACE BOW TRANSFER
O CONCLUSION
O REFERENCES

Orientation jaw relation

O To orient

to locate
O It is the jaw relation when the mandible
is kept in its most posterior position , it
can rotate in the sagittal plane around
an imaginary transverse axis passing
through or near the condyles.(GPT 8)
O The position of the maxilla or mandible
in the skull is recorded using an
instrument called the face bow.

O The opening movement

to bring the jaw from

occlusal to rest position
is almost a pure hinge
movement.
O Here

the
mandible
moves on an arc of a
circle with a definite
radius from the TM J

O This path of the condyle

is determined by the
curvature
of
the
condylar head and the
curvature of glenoid

O Since the radius is not

constant for all the

patients it has to be
determined for every
individual patient.
O Relation of maxilla to the

opening and closing axis

has to be determined
O Opening and closing axis

can be located when the

mandible is in its most
posterior
position by
means of a FACE BOW

Terminologies
O Hinge axis : According to Boucher ;An

imaginary line through the two

mandibular condyles & around which the
mandible may rotate without translatory
movement.
O The opening axis :It is an imaginary line
around which the condyles may rotate
during opening & closing movements of
the mandible.
O Terminal hinge position :It is the most
retruded hinge position. In this condyles
are in definite position in fossae.

Hinge axis is a horizontal axis

around which the condyles rotate
during opening and closing movement
up to the range of 20-35 mm.

Hinge axis points

The left and right centers where
condyle exhibits pure rotation is
known as hinge axis points.

Hinge axis also called Horizontal axis ,Intercondylar

axis, Terminal hinge axis,Transverse horizontal axis .
Terminal hinge axis

Since rotation of condyles occur when mandible is

in its terminal retruded centric relation position, it was
known as terminal hinge axis.
Transverse horizontal axis

Today with the changing concept of CR, viz anterosuperior bracing, the term transverse horizontal axis is
preferred to terminal hinge axis.

How do we locate the hinge axis?

There are four theories explaining the location and
existence of the hinge axis:
1. Absolute location of the axis.

Arbitrary location of the axis.

3. Nonbelievers in the transverse axis
location.
4. Split axis rotation.
2.

Aull, Arthur E. A study of the transverse axis.

J Pros Dent 13:469-479, 1963.

GROUP I: - ABSOLUTE
LOCATION OF THE AXIS
O This group believes that there is a definite

transverse axis and it should be located as

accurately as possible.
O This relationship can be obtained :
1)With the aid of the face bow, to relate the
maxillary cast to the transverse axis of the
articulator in the same relationship as the
maxillae are related to the anatomic
mandibular axis through the condyles.

2)
The mandibular hinge axis is coincided with and
related to the maxillary hinge axis by means of a
centric relation record.
3)
The path of closure on the terminal hinge will,
therefore, be the same on the articulator as in the
mouth.
4)The cusps of the teeth can be placed so they will not
coincide during this border mandibular movement.
5)
The hinge axis is a component of every
masticatory
and cannot be disregarded.
The hinge axis relationships of the articulator must be a
duplicate of the hinge axis relationships of the jaw, or
mechanical reproduction of jaw motions on the
articulator are impossible.

GROUP II : ARBITRARY
LOCATION OF THE AXIS

O This group believes that an accurate

location of the terminal hinge axis position

would be of some value, but do not
believe that it has enough value over an
arbitrary location to be worth the added
effort necessary to locate it.
O This group fails to recognize that if the
hinge axis of the articulator does not
coincide with the hinge axis of the patient,
the path of closure will not be the same.

GROUP III: NONBELIEVERS IN

THE TRANSVERSE AXIS
O This is a group LOCATION
who believe it is impossible to
locate the terminal hinge position with
accuracy.
O Beck has proposed a reason for doughting the
validity of the hinge axis location.
O He claims that there can be many
compensating movements of the condyle
other than pure rotation, and these
compensating movements are movements of
translation and side shift that are integrated
with the movement of rotation.

O He concludes that the opening and closing

hinge movement of the mandible together

with its fragmentary movements cannot be
repeated by the opening and closing
movements of the articulator which is
about one axis only.
O Therefore, an arbitrary terminal hinge
position would or could be just as accurate
as one located with a kinematic face bow.

GROUP IV: SPLIT AXIS

ROTATION:
O This group believe that each condyle

rotates independently of the other.

O In as much as the mandible is not
bilaterally symmetrical, and the
terminal hinge position mark on one
side of the face is usually higher than it
is on the other side of the face, it would
follow that there cannot be a common
axis.

O There must be two axes parallel to

each other with both axes at right

angles to the opening and closing
movements of the mandible.

REVIEW OF
LITERATURE

REVIEW OF LITERATURE.

REVIEW OF LITERATURE.

Importance of Hinge Axis

Registration:
Granger stated that purpose of recording

hinge axis is to provide a means of

transferring the patient to the laboratory
bench for construction of a restoration
which will be physiologically sound.
Study casts can be mounted to determine
if the patients centric occlusion is in
harmony with centric relation.

 Working casts can be mounted in the best

relationship for the teeth or the denture base.

Since the hinge is a definite fixed component
of every closing position of the mandible, it is
necessary to reproduce it on the appropriate
instrument if the occlusion is to be
rehabilitated.
It is possible to increase or decrease the
vertical dimension on the instrument without
disturbing centric relation.
It is a starting point of lateral movements.
Used to check the accuracy of two centric
relation records.

Hinge axis location

technique :

O Make an accurate impression of

an mandibular basal seat.

O Pour an accurate stone cast.
O Make an accurate record base of
self cure resin.
O Attach the occlusal rim to the
record base.
O A specially designed bite fork to
the rims with the stem parallel
to the sagittal plane

O Attach this assembly to

the mandible with chin

clamps or chin straps.
O Attach the hinge bow to
the stem & adjust the styli
to the location of the
condyles.
O Guide the patient in
making hinge openings &
closings.

Why it is necessary to
record orientation jaw
relation ??
O Angulation to maxilla in relation to

the base of the skull.

O Affects level of plane of occlusion of
the denture

Orientation of the plane of

the occlusal rim :
O The plane of the occlusal rim should

be parallel to the plane of the maxilla.

O The plane of the maxilla is determined

Anteriorly by inter pupillary

line

Posteriorly by ala tragus line

O The maxillary occlusal plane can be
verified by using a FOX PLANE.
O Anteriorly it should be parallel to the
interpupillary line & posteriorly to the
ala tragus line.

O The maxillary cast in the articulator is the

base line from which all occlusal relationships

start and it should be positioned in space by
identifying three points.
O The plane is formed by two points located
posterior to the maxillae and one point
located anterior to it.
O Posterior points are referred to as the

posterior points of reference and the anterior

one is known as the anterior point of
reference .

Posterior Points of
Reference

OThe position of the terminal hinge axis

on either side of the face is generally

taken as posterior reference points.
OPrior to aligning the face bow on the
face, the posterior reference pointsmust be located and marked. They are
located by
O
1)Arbitrary method
O
2)Kinematic method

a. Arbitrary method

The posterior points are located by

measuring prescribed distances from skin
surface landmarks.
Some of the commonly used posterior
points were shown by Beck to be near
the hinge axis clinically.
He concluded :Bergstrom point most
frequently is closest to the hinge axis.
Also, the Beyron point as the next most
accurate posterior point of reference

O Following are some of the most commonly

used measurements and landmarks:

1. Denar
O 12 mm anterior to posterior border of the
tragus and 5 mm inferior to the line extending
from the superior border of tragus to outer
cantus of the eye.
2.Lauritzen and Bodner
O 12mm anterior to center of external auditory
meatus and 2mm inferior to porion cantus line
3.Brandnup and wognsen
O 12mm anterior to most prominent point of
posterior border of tragus on line from it to
outer cantus of the eye.

Teteruck and
Lundeens point:
located 13 mm anterior
to the tragus on a line from
the base of the tragus to
the outer canthus of the eye.
4.

5. Whip-Mix:
According to their design of their ear bow, in
antero posterior direction at anterior wall of
EAM & in superior-inferior direction
approximately at level of most prominent
point of posterior border of tragus.
6.Prothero:
On line from superior margin of EAM to OCE
intersecting with line 13mm anterior to
anterior edge of EAM.

7. Bergstrom point
10mm anterior to the center
of the spherical insert for
the external auditory
meatus and 7mm below the
Frankfort horizontal plane.
8. Beyrons point
13mm anterior to the
posterior margin of the
tragus of the ear on a line
from the center of tragus
extending to the corner of
the eye.

9. Gysi point
located 13mm in front of
the most upper part of the
external auditory meatus on
a line passing to the outer
canthus of the eye. This
method was proposed by
Gysi, Hanau, Snow and
Gilmer and is the most
common point used today
10.Weinbergs Point
A point 11-13mm anterior
on a reference line drawn
from the middle and
posterior border of tragus of
the ear to the corner of the

Anterior Point of
Reference
OThe 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.

Reasons for selecting an

Anterior point of reference
O 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.
O A planned choice of an anterior reference
point will allow the dentists and auxiliaries
to visualize the anterior teeth and the
occlusion in the articulator in the same
frame of reference that would be used
when looking at the patient.

Selection:
O Various Anterior Reference Points that

may be used are as follows:

1) Orbitale:
O In the skull, orbitale is the lowest point
of the infraorbital margin. On a patient it
can be palpated through the overlying
tissue and skin. One orbitale and two
posterior points that determine the
horizontal axis of rotation will define the
axis-orbital plane.

2) 7mm below Orbitale:

OThe Frankfort horizontal plane passes

through both porion and one orbital point.

Because porion is a skull land mark, Sicher
recommends using the midpoint of the upper
border of external acoustic meatus as the
posterior cranial landmark on the patient.
O Gozalez pointed out that this posterior
tissue landmark on the average lies 7mm
superior to horizontal axis.
The recommended compensation for this
discrepancy is to mark the anterior point of
reference 7 mm below orbitale on the patient.

3) 23mm below Nasion

O According to Sicher, another skull

landmark, the nasion can be

approximately located in the head as the
deepest part of the midline depression
just below the level of eye brows.
O The nasion guide, or positioner of Quick

Mount face bow which is designed to be

used with the whip mix articulator fits
into this depression

O 4) Alae of the nose: A part of many complete

denture techniques is to make tentative or the

actual occlusal plane parallel with the horizontal
plane.
O This can be achieved in two ways:
(1) A line from the ala of the nose to the center of
the auditory meatus describes Camper's line.
(2)A second method of establishing this
relationship is to make a wax occlusion rim
parallel to Camper's line on the face. The desired
location for the maxillary incisal edge should be
marked on the wax occlusion rim as an initial
step in determination of the occlusal plane.

5) 43 mm superior from lower border of upper lip

(Denar reference plane locator Denar facebow
uses this reference point

Kinematic method
O Most accurate method for

recording the correct

horizontal axis is by a
Trial and error method
developed by McCollum
in 1921 using a kind of
kinematic device.
O The technique of locating the terminal hinge
axis position is essentially the same for
dentulous and edentulous patients, but the
methods of attaching the clutch to the
mandible are quite different.

Face bow
O It is a caliper like device that is used to record

the relationship of the jaws to the opening axis

of the jaw & to orient the casts in this same
relationship to the opening axis of the articulator.
O PURPOSE:

Is to orient the maxillary cast to the articulator in

the same relationship to the opening & closing
axis of the articulator as exists between the
maxilla & the opening and closing axis in the
TMJ.

Advantages for using a

face bow:
1Permits more accurate use of lateral rotation points
for the arrangement of teeth.
2)Its aid in securing an anteroposterior cast position
with relation to the condyles of the mandible.
3)It registers the horizontal relationship of the casts
quite accurately, and this assists in correctly
locating the incisal plane.

4)It is an aid in the vertical position of the cast

on the articulator.
5)The face bow transfer will be exact in the
positional relation of the casts.
6)The face bow transfer allows a more
accurate arc of closure on the articulator when
the interocclusal records are removed and the
articulator is closed.

Review of the face bow

BONWILL(1860)
O The distance from the

center of each condyle

to the median incisal
point of the lower teeth
is 10 cm .
O The cast was mounted
with occlusal plane in a
horizontal position
midway between the
upper and lower part of
the articulator .

BALKWILL(1866)
O He made a apparatus to

measure the angle

between the occlusal
plane and the plane
passing through the lines
extending from the
condyles to the incisal line
of the lower teeth .
O Angle =220-300

O In 1880 HAYES used a tong like device

which he called caliper.

O GYSI developed an instrument similar to a

face bow primarily to record the paths of

the condyles.
O At the same time in 1899 SNOW

introduced the snow face bow

O In 1905, CAMPION made graphic records of

movements of the mandible of a living subject.

He expressed the importance of locating the
hinge axis. He emphasized that maxillary cast
should be at the same orientation on the
articulator as the patients maxillae is to the
TMJ.
O In 1921, McCOLLUM, STUART and others
reported the discovery of the first positive
method of locating the axis.
O In 1927, McCOLLUM WITH ROBERT HARLAN
introduced a method of recording the hinge axis
and developed the first hinge axis face bow.

O In 1938 THIELEMAN introduced anterior

reference point orbitale.

O In 1952 SLOANE stated that the mandibular
axis is not a theoretical assumption, but a
definately demonstrable biomechanical fact.
It is the axis upon which the mandible rotates
in an opening and closing function when
comfortably, not forcibly retruded.
O 1955 MCCOLLUM AND STUART developed
pantograph.
O In 1956 SICHER said that the hinge position
or the terminal hinge position is that position
of the mandible from which or in which pure
hinge movement of a wide range is possible.

O In 1956, LUCIA concluded that the centers in

the terminal hinge position provide a definite

starting position relation of the mandible to the
maxillae or their duplicates on an articulator.
O The anterioposterior relation of mandible to
the maxillae at the terminal hinge position is
the same as CR. It is a repeatable border
position. Therefore, it is a point of return.
O Like CR, hinge axis is stable, reproducible and
repeatable. Therefore, it is used as an
important reference in mounting casts in
articulator, so that the opening axis of the
articulator coincides with the terminal hinge
axis.

O In 1961 LAURITZEN AND WOLFORD

demonstrated the varying degrees of accuracy

in locating the transverse hinge axis among
skilled operators in the range of 0.5 to 2mm.
O In 1972 KOHNO termed the horizontal axis
connecting the left and right rotational centers
as Kinematic axis.
O In 1957 & 1984 SCHALLHORN AND COHEN G
reported that an arbitary axis recording
technique will lie within 5mm of the kinematic
axis in 88.98% of a patient population.
O In 1960 BROTMAN Geometric significance of
transverse axis.
O In 1961 WEINBERG An evaluation of face bow
mounting.

O In 1982 ZUCKERMAN Geometry of arbitary

hinge axis as it is related to the occlusion.

Demonstrated the importance of the axis
through mathematical models of occlusal
errors that would result with deviations from
the transverse hinge axis of the patient.
O In 1979 WILKIE The ant-point of reference
and described the importance of the anterior
reference point.
O In 1979 PRESTON presented various
limitations and errors of the face bow
transfer technique due to both equipment
and anatomic asymmetry.

Types of face bow :

Arbitrary face bow
Kinematic face bow
OFacia type
OEar piece type
OHanau face bow ( spring bow )
OSlidematic ( denar )
OWhipmix
OTwirl bow

KINEMAT
IC
Opening axis is located
physiologically

Rotational points located by

attaching to mandible as
patient opens & closes his
mouth . A pointer is adjusted
until axis of rotation is located

Used in F.P.D & full mouth

rehabilitation

Requires elaborate equipment

& is time consuming

Locates the true hinge axis with

exceptional accuracy

ARBITRARY
Axis is located using anatomic
landmarks

Centers of rotation are

located 13mm anterior to
EAM on lines towards outer
canthus of eye

Used in fabrication of complete

dentures

Not as complicated as kinematic

Locates the rods within 5mm of

true hinge axis

Various commercially available face bows and

their applications
WHIP MIX

DENAR
SLIDEMA
TIC

HANAU
SPRING BOW

WHIPMIX FACEBOW
O It is a earpiece type of facebow.
O It has a Nasion Relator which is positioned

against the bridge of nose.

O It has intercondylar scale in front of
facebow.
O The facebow is connected to pins on the
condylar housing of articulator.
O These pins are located behind the hinge
axis &therefore automatically compensate
for posterior location of the external ear.

DENAR SLIDEMATIC
FACEBOW
O It is a earpiece type facebow.
O A Denar reference plane locator is used to

locate the anterior reference plane .

O It also has Transfer Jig which allows the
mounting of maxillary cast to the articulator
without attaching the facebow .

Hanau face bow

Ear piece type

Hanau 153 series

Fascia type
Hanau
model C

Hanau spring bow

Hanau twirl bow /
164-2
Hanau 159-2 type

Hanau 13225
13226
1592

Kinematic type
Hanau model
D

Face bow consists of :

O U shaped frame
O Bite fork
O Condylar rods
O Orbital pointer
O Locking device

U shaped frame :
O It forms the main frame of the face bow.
O All the other components are attached

to the frame with the help of the clamps.

O Extend from TMJ to at least 2- 3 inches
anterior to the face.
Condylar rods :
O Two small metallic rods which are
present on the either side of the frame.
O Help in locating the hinge axis or
opening axis of the TMJ.
O Some have ear piece which fits into the
external auditory meatus.

Bite fork :
OIt is a u shaped plate , which is attached to
the occlusal rims.
OIt is attached to the frame with the help of a
rod called the stem.
Locking device :
OIt supports face bow , occlusal rim and cast
during articulation.
OIt consists of transfer rod and transverse rod.
Orbital pointer:
OUsed to mark the anterior reference point
( infraorbital notch ).
OIt is present only in arbitrary face bow.

Arbitrary Face bow:

O They use arbitrary or approximate points

on the face as posterior reference points.

O The condylar rods are positioned on
these predetermined points during the
face bow transfer procedure.
O Arbitrary face bows are most commonly
used for complete denture patients.
O This placement of condylar rods will
generally locate the opening axis within
5mm of the true center of the opening
axis of the jaws

O Facia type: Utilizes approximate points on

the skin over the temperomandibular joint

region as posterior reference points. These
points are located by measuring from
certain anatomical land marks on the face.
O Ear piece type: It was first described by

Dalbey in 1914. This type of face bow uses

the external auditory meatus as the
arbitrary posterior reference point. For this
a special ear piece is required instead of a
condylar rod.

Kinematic Face bow

O It is used to determine and locate the

exact hinge-axis points.

O The fork of the kinematic face bow is
attached to the mandibular occlusal rim.
O Then as the patient retrudes the
mandible and opens and closes the jaws
the dentist observes the movement of
the points of the condylar rods.

O Kinematic face bow is a more complex

instrument requiring the fabrication of clutches

which have to be attached to the lower jaws.
O Since the face bow is used to orient the casts
on the articulator in the same relation to the
opening axis of the jaws, the face-bow record
is not a maxillomandibular record.
O It is a record made for the orientation of the
casts to the instrument. However, the use of a
kinematic face bow can aid in recording of
centric relation .

Face bow transfer

procedure
1) Seat the patient
in the
comfortable position ;
patients head should be
in the upright position
with the head rest
supporting the occiput .

2) Locate the axis point by

measuring 13 millimeters
anteriors to the middle of
the tragus of the ear on a
line drawn from the outer
canthus of the eye to the
middle of the tragus of the
ear.

3) Mark the points on the skin.

4) Contour the maxillary occlusion rim ;
establish the occlusal plane ; Place the
guide lines for the arranging of teeth on the
labial section.
5) Mount index on the occlusal surface in the
regions of the first molars.
6) Apply a thin layer of the petroleum to the
occlusal rims
7) Reduce the mandibular occlusal rim to
allow adequate interocclusal distance for
the fork & attached wax.
8) Adjust the condyle rods to the face for
centering the bow.

Facebow record
O Soften a sheet of low fusing

base plate wax and roll together

in the shape of a horseshoe.
O While the wax is soft , bite fork
is embedded in it.
O Place the prongs of the bite fork
with the attached soft wax
between the occluding surfaces
of the occlusal rim.
O Instruct the patient to close the
jaws until both occlusal rims are
embedded in the soft wax.

O Slide the stem of the

fork through the

opening in the clamp
of the bow.

O Adjust the condylar

rods to the arbitrary

axis points.

 Adjust the width of the

condyle rods equidistant
bilaterally & secure the
clamp of the bow to the
stem of the bite fork.
Slide the condyle rods
from the skin.
Extend the condyle rods
back to the axis points to
check any displacement.
When the infra orbital
notch is used as the
anterior point of
reference the pointer
should be placed in the
clamp provided for it on

Face Bow Mounting

O Set the sliding condylar rods symmetrically

on both the sides until the bow gently

springs over the articulator condylar shaft.

Raise or lower the face bow to adjust for

the vertical position until the occlusal
plane anteriorly is on a level with the
groove marked around the incisal pin. If
an orbital pointer is used, adjust the
pointer to touch the pointer plate
attached to the maxillary member of the
articulator.

O Soak the maxillary cast in water for

atleast 5 minutes to insure adhesion of

plaster to stone.
O Secure the incisal guide pin with its top
flush with the top of maxillary member of
the articulator. Open the maxillary
member of the articulator and apply a
creamy mix of dental plaster to the top
of the articulator until the incisal guide
pin is stopped on the guide table and the
mounting plate is embedded in the
plaster.

O Carefully remove the excess plaster. Allow

the plaster to harden before removing the

face bow assembly. The maxillary cast is
related to the opening axis in the
articulator in the same anteroposterior
and horizontal position as the maxilla in
the skull are related to the opening axis in
the TMJ
O From here further records can be made
starting with a tentative center relation
record.

CONCLUSION
O Failure to use the facebow leads to error

in occlusion.
O 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

References
O Charles m. heartwell , arthur o. rahn ;

syllabus of complete denture ; 4th

edition.
O George a. zarb , charles l. bolender ;
boucher s prosthodontic treatment for
edentulous patients ; 10th & 12th
edition.
O Sheldon winkler ; essentials of complete
denture prosthodontics ; 2nd edition.

O Syllabus of complete dentures Charles M

Heartwell, 4th Edition

O Schalhorn, R. G. A study of the arbitrary center
and kinematic center of rotation for facebow
mounting. J Prosthet Dent 7: 162-169, 1957.
O Granger, E. R. Clinical Significance of the Hinge
Axis Mounting. DCNA, Mar 1959:205-213.
O Lauritzen, A. G., and Bodner, G. H. Variations
in location of arbitrary and true hinge axis
points. J Prosthet Dent 11: 224-229, 1961.
O Aull, Arthur E. A study of the transverse axis. J
Pros Dent 13:469-479, 1963.

O Preston, J. D. A reassessment of the

mandibular transverse horizontal axis theory. J

Prosthet Dent 41: 605-613, 1979.
O Simpson, J.W. , Hesby, R.A. , Pfeifer, D.L. and
Pelleu, G.B. Arbitrary mandibular hinge axis
locations. J Prosthet Dent 51: 819-822, 1984.
O Gordon, S.R., Stoffer, W.M. and Connor, S.A.
Location of the terminal hinge axis the second
molar cusp position. J Prosthet Dent 60:553559, 1988

THANK YOU