DENTAL TECHNIQUE

Virtual facebow technique

Eneko Solaberrieta, PhD,a Asier Garmendia, PhD,b Rikardo Minguez, PhD,c Aritza Brizuela, PhD,d and
Guillermo Pradies, PhDe

In dentistry, digital workflows ABSTRACT

are becoming more popular
This article describes a virtual technique for transferring the location of a digitized cast from the
and more accurate. However, patient to a virtual articulator (virtual facebow transfer). Using a virtual procedure, the maxillary
some procedures are still being digital cast is transferred to a virtual articulator by means of reverse engineering devices. The
developed, and not all the following devices necessary to carry out this protocol are available in many contemporary practices:
steps have been digitalized. an intraoral scanner, a digital camera, and specific software. Results prove the viability of integrating
Nevertheless, virtual environ- different tools and software and of completely integrating this procedure into a dental digital
ments constitute the present workflow. (J Prosthet Dent 2015;114:751-755)
and future of the field.
Over the past few decades, the mechanical articula- using an electronic jaw movement registration system
tors used to simulate mandibular movements have been called Jaw Motion Analyser (Zebris) and then to move
replaced or supplemented with dental computer-aided digitized dental arches along those paths in the com-
design/computer-aided manufacturing (CAD/CAM) sys- puter. With these tools, static and kinematic occlusal
tems.1-4 These digital systems, consisting of 3-dimen- collisions could be calculated and visualized.
sional (3D) CAD of dental casts, have improved design However, the main problem with those virtual artic-
by introducing new materials, automating, or reducing ulators was transferring data from the patient to the
manual labor and providing higher profitability with simulation. The technique presented here overcomes this
better control of quality.5,6 Nonetheless, room for problem because it can align digital casts directly onto the
improvement remains in terms of CAD/CAM systems virtual articulator. This virtual facebow was developed to
and digital workflow. Progress in development and locate the maxillary digital cast of the patient in a cranial
improvement of these systems is bringing about better coordinate system. The protocol presented in this article
results at reduced costs. describes a method of virtually locating the digital casts
Currently, several CAD/CAM systems provide a vir- onto a virtual articulator by means of an intraoral scan-
tual articulator simulation. The first virtual articulator ner, a digital camera, and software (Agisoft and reverse
developed by Szentpetery at the Martin-Luther Univer- engineering software).
sity of Halle, Germany,7 was based on a mathematical The facebow10 and centric relation record have long
simulation of the mandibular movements that take place been used to orient dental casts on an articulator in the
in an articulator. The second version was developed by same relationship as that in the patient’s mouth.11-14
8 9
Kordass et al and Gaertner and Kordass at Greifswald However, the shift to the virtual environment has only
University in Germany. That articulator was designed to just begun in terms of the facebow, and standard
record the exact movement paths of the mandible by methodologies need to be developed and tested before

a
Assistant Professor, Department of Graphics Design and Engineering Projects, University of the Basque Country UPV/EHU, Bilbao, Spain.
b
Assistant Professor, Department of Mechanical Engineering, University of the Basque Country UPV/EHU, Bilbao, Spain.
c
Assistant Professor, Department of Graphics Design and Engineering Projects, University of the Basque Country UPV/EHU, Bilbao, Spain.
d
Associate Professor, Department of Prosthodontics and Occlusion, University of the Basque Country UPV/EHU, Bilbao, Spain.
e
Assistant Professor, Department of Buccofacial Prostheses Stomatology I, Complutense University of Madrid, Madrid, Spain.

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Figure 1. Patient data acquisition. A, Scanning with intraoral scanner. B, Placing infraorbital and temporomandibular target.

Figure 2. Three-dimensional (3D) geometry of patient’s face and facebow fork. A, Left lateral view. B, Frontal view. C, Right lateral view. D, 3D geometry
on Agisoft software.

the virtual facebow15 is part of routine practice. The
present protocol also allows the dentist to locate the
mandibular digital cast exactly on the maxillary digital
cast by using the virtual interocclusal record.16,17
TECHNIQUE
Phase 1: obtaining photographs and transferring data
1. Scan the maxillary and mandibular dental arches of
the patient with an intraoral dental scanner (3Shape
TRIOS; 3Shape A/S) to obtain digital casts (Fig. 1A).
2. Place 3 adhesive targets onto the patient’s
head. Locate the first 2 points next to the
temporomandibular joints and the third point onto the
infraorbital point (Fig. 1B).
3. Locate irreversible hydrocolloid (Pragl’x; Pierre
Roland) or scannable elastomeric impression ma-
terial on a plastic, colored facebow fork and intro-
duce the facebow fork into the patient’s mouth,
pushing it against the maxillary arch.
4. Make 8 to 10 photographs (Fig. 2A-C) by using a
digital camera (Nikon D3200; Nikon) and reverse
engineering software (Agisoft Photoscan; Agisoft
LLC) (minimum of 5 MB and constant values for
minimum ISO [exposure index] setting, lens F value,
and no flash) to obtain the 3D spatial relationship of
the shape of the head with target points related to

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December 2015 753

Figure 2. (continued). Three-dimensional (3D) geometry of patient’s face and facebow fork. A, Left lateral view. B, Frontal view. C, Right lateral view. D,
3D geometry on Agisoft software.

the facebow. Load the images into the software

(Agisoft Photoscan; Agisoft LLC) and build the 3D
geometry of the patient’s face with targets posi-
tioned on the facebow fork (Fig. 2D).
5. Scan the impression and the front side of the face-
bow fork with an intraoral dental scanner (3Shape
TRIOS; 3Shape A/S) (Fig. 3).
6. Using reverse engineering software (Rapidform
CADv2006; INUS Technology), load the facebow
fork 3D geometry and align it to the maxillary digital
cast by using the best-fit command (Fig. 4A).
7. Repeat step 6 of this protocol, aligning the 3D face-
facebow fork and impression-facebow fork (Fig. 4B).

Figure 3. Scanning facebow fork with impression.

Phase 2: alignment of 3D face-facebow fork and
impression-facebow fork
8. Blend the different surfaces of the scanned maxil-
lary digital cast into a single virtual cast, eliminate
surface abnormalities, remesh the organization of
the triangulated mesh of points, and fill in the
surface gaps that remain after data elaboration.
9. Create the cranial coordinate system by using the 2
temporomandibular points (Fig. 5A, B) and the
infraorbital point, locating the maxillary digital cast
on this reference system.
10. Transfer the maxillary digital cast to the virtual
articulator software, bringing the cranial coordinate
system to coincidence with the virtual articulator’s
coordinate system (Fig. 6A).
11. Locate the mandibular digital cast, scanning the
virtual interocclusal record with an intraoral scan-
ner in centric occlusion from 3 directions (left,
right, and front). Match these scans with the
maxillary and mandibular digital casts, positioning
the mandibular digital cast towards the maxillary
digital cast in the virtual articulator in maximum
intercuspation (Fig. 6B).
SUMMARY
The technique presented in this article describes the
virtual facebow. The first attempt at digitizing this pro-
cess was based in reverse engineering techniques using

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Figure 4. Alignments. A, Alignment of maxillary digital cast and impression-facebow fork. B, Alignment of 3-dimensional face-facebow fork and
impression-facebow fork.

Figure 5. Location of maxillary cast on patient’s face. A, Two temporomandibular points and infraorbital point on patient. B, Maxillary cast inside
patient’s virtual head.

an optical GOM industrial 3D scanner, and all the steps
were integrated into the digital workflow.7 Since its
development, this procedure has been improved to
minimize deviations.15
The technique presented here enables location of
the maxillary digital cast on a virtual articulator. Apart
from this, the digital location of the mandibular digital
cast on a virtual articulator can only be achieved by
using the virtual occlusal record procedure, that is, by
using an intraoral scanner that is available only in
leading dental clinics. The only specific equipment
needed is the software for the 3D reconstruction of the
patient’s face (Agisoft). The best-fit alignment can be
performed with reverse engineering software (Meshlab
or Rapidform).
The primary advantage of this technique is that it
works with any type of virtual articulator, thus generating
a universal virtual facebow. Because the procedure results
in a dental digital database, patient information can be
transferred to any machining or sintering center in the
world, resulting in greater flexibility and autonomy. In
addition, this technique provides a digital copy of the
patient’s face that is available throughout the diagnostic,
planning, and treatment phases.

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December 2015
Figure 6. Transfer to virtual articulator. A, Location of maxillary digital cast on virtual articulator. B, Maxillary and mandibular digital casts on virtual
articulator.
Overall, this technique constitutes a step forward
because once the patient has left the dental clinic, the
virtual patient remains in the computer. This virtual pa-
tient facilitates the work of the dentist and of the dental
technician. Additional studies need to be conducted to
validate the accuracy and the reproducibility of these
promising new digital systems.
The virtual patient technology currently available can
only make use of a limited amount of actual patient data.
In the future, a system, still to be fully developed, will
need to integrate data on movement registration, occlusal
records, digitalization, cast location, and 3D face geom-
etry into the 3D virtual patient application.
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Corresponding author:
Dr Eneko Solaberrieta
University of the Basque Country UPV/EHU
Department of Graphic Design and Engineering Projects
Alameda Urquijo s/n, Bilbao 48013
SPAIN
Email: eneko.solaberrieta@ehu.eus
Acknowledgments
The authors thank the Faculty of Engineering of Bilbao for locating the Product
Design Laboratory in their facilities and the University of the Basque Country
UPV/EHU and Andras Szentpetery for valuable guidance on this research.
Copyright © 2015 by the Editorial Council for The Journal of Prosthetic Dentistry.
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