Arbitrary mandibular hinge axis locations

J. W. Simpson, D.D.S.,* R. A. Hesby, D.D.S., M.S.D.,+* D. L. Pfeifer, D.D.S., M.S.,***

and G. B. Pelleu, Jr., Ph.D.****
Naval Dental Clinic, Naval Medical Command, National Capital Region, Bethesda, Md.

lhe arbitrary method is an accepted technique for

locating the mandibular hinge axis. The ease and speed
of the technique compared with the lengthy and
complex method of locating the kinematic axis make it
the most commonly used method for transferring the
maxillary cast to an articulator.
Although many studies have compared various arbi-
trary hinge axis points with the kinematic location,
there is no consensus as to which arbitrary point most
closely and consistently lies on or near the kinematic
axis. When Lauritzen and Bodner’ located an arbitrary
axis point with a Richey condyle marker they found
that 40% of the points were within 6 mm of the
kinematic axis. Teteruck and Lundeen2 compared the
ear axis face-bow method and a selected arbitrary axis Fig. 1. Arbitrary and kinematic hinge axis locations
point. They found that 56% of the ear axis face-bow and reference lines are recorded on graph paper
point and 33% of the selected arbitrary axis points were affixed to a hinge axis flag.
within 6 mm of the kinematic axis. Schallhorn3 report-
ed that 97% to 98% of kinematic axes fell within 5 mm various arbitrary axis points and determine which
of Beyron’s point.4 Beck5 found that 58% of Beyron’s,4 arbitrary axis most closely approximates the kinematic
17% of Gysi’s,6 and 83% of Bergstrom’s’ points were axis. The purpose of this study was to compare the
within 5 mm of the kinematic axis. In an extensive location of selected arbitrary hinge axis points and an
study, Walker” found that there was no consistent experimental arbitrary axis point with the kinematic
relationship between any arbitrary axis location and axis.
the kinematic axis. He concluded that no single arbi-
trary point was suitable for the general population. MATERIAL AND METHODS
The discrepancies among studies reported in the Fifty subjects, 19 to 60 years of age (mean age 31.5
literature indicate a need to clarify descriptions of the years), with functionally acceptable occlusion, and no
clinical signs of temporomandibular joint dysfunction
participated in the study.
The opinions or assertions contained herein are the private ones of TMJ Instrument Hinge axis flags (TMJ Corp.,
the writers and are not to be construed as official or as reflecting Thousand Oaks, Calif.) were positioned on the face
the views of the Department of the Navy. slightly anterior to the tragus of the ear. Five arbitrary
Recipient of Honorable Mention, John J. Sharry Research Prostho-
dontist Competition, American College of Prosthodontists. axis points determined by anatomic landmarks were
This project was supported by Bureau of Medicine and Surgery recorded on graph paper attached to the flags (Fig. 1).
Clinical Investigation Program No. 83-06-1817 and conducted Beyron’s point4 was located 13 mm anterior to the
with the approval of the Committee for the Protection of Human posterior margin of the tragus of the ear on a line from
Subjects.
the center of the tragus to the outer canthus of the eye
*Commander (DC) USN; resident, Prosthodontics Department.
**Captain (DC) USN; Chairman, Prosthodontics Department. (Fig. 2, a). Gysi’s point6 was located 10 mm anterior to
***Captain (DC) USN; staff, Prosthodontics Department, the posterior margin of the tragus on a line from the
****Chairman, Research Department. center of the tragus to the outer canthus of the eye (Fig.

THE JOURNAL OF PROSTHEI’IC DENTISTRY 819


Fig. 2. Arbitrary axis points: a, Beyron’s point; b,
Gysi’s point; c, Bergstrom’s point; d, Teteruck and
Lundeen’spoint; and e,experimental point. Brokenline
representsFrankfort horizontal plane.
Fig. 3. Camper’sline is located with flexible rule.
2, 6). Bergstrom’s point’ was marked 11 mm anterior
to the posterior margin of the tragus on a line parallel
to and 7 mm below the Frankfort horizontal plane
(Fig. 2, c). Teteruck and Lundeen’sz arbitrary axis
point was located 13 mm anterior to the tragus on a
line from the baseof the tragus to the outer canthus of
the eye (Fig. 2, d>. The experimental arbitrary axis
point selectedfor this study was placed 10 mm anterior
to the superior border of the tragus on Camper’s line
(Fig. 2, e). Camper’s line connectsthe superior border
of the tragus and the inferior border of the ala of the
nose (Fig. 3).9*‘o
The Almore mandibular hinge axis locator (Almore
International, Portland, Ore.) was used to locate the
kinematic axis as describedby Lauritzen and Bodner.’
820
SIMPSON ET AL
Fig. 4. Kinematic hinge axis is located by method of
Lauritzen and Bodner.’
Fig. 5. Facsimile of scattergraph used for compiling
data. Radius (n) represents 5 mm radius from kinematic
axis, and quadrant (b-c-d) represents tendency of arbi-
trary points to be located inferior to kinematic axis.
The true axis point was recorded on the samegraph
paper asthe a.rbitrary axis points (Fig. 4). The location
of the kinematic axis was verified by two additional
prosthodontists. To eliminate investigator bias, the
arbitrary axis points for half the subjectswere marked
before the kinematic axis was located. Arbitrary and
true axis points were also located on the contralateral
side thus giving 100 graphs for compilation and
analysis.
On completion of the graphs, all arbitrary axis
points were placedon individual scattergraphs(Fig. 5).
The percent Iof arbitrary axis points that fell within 5
mm of the kinematic axis was calculated for each point,
and the distancebetween each point and the kinematic
axis was measured.In addition, the directional tenden-
IUNE 1984 VOLUME 51 NUMEER 6
ARBITRARY MANDIBULAR HINGE AXIS LOCATION

Table I. Distribution and directional tendency of four arbitrary hinge axis points
No. of arbitrary points measured
Distance from Directional
Within 5 mm of kinematic axis tendency from
Arbitrarv points Total kinematic axis* (mm)t kinematic axis*
Experimental 100 78 3.6 ir 2.0 Evenly distributed
Gysi 100 49 5.2 + 2.8 Inferior
Bergstrom 100 36 6.3 + 3.0 Inferior
Beyron 100 34 6.2 + 2.3 Inferior & anterior

*Experimental arbitrary points differ significantly from other arbitrary points (p < .Ol, chi square analysis).
tMean and standard deviation for all points in each category. Experimental arbitrary points differ significantly from other arbitrary points
(p < .Ol, Student t test).
*Tendency shown by >80% of points in each category.

cy of the arbitrary points in relation to the kinematic
axis was noted. Statistical comparisonswere made by
meansof chi square analysis and the Student t test.
RESULTS
Because only 1 of 100 points of Teteruck and
Lundeen* was located within 5 mm of the kinematic
axis, thesepoints were excluded for statistical analysis.
The distribution and directional tendency of the four
remaining arbitrary axis points in relation to the
kinematic axis is summarized in Table I.
Of the experimental axis points, 78% were within 5
mm of the kinematic axis, and the mean distanceof the
points from the axis was 3.6 +- 2 mm. Forty-nine
percent of GysiV points were within 5 mm of the
kinematic axis, and the mean distance from the kine-
matic axis was 5.2 f 2.8 mm. Thirty-six percent of
Bergstrom’s’ points were within the 5 mm range and
the mean distance was 6.3 + 3 mm. Thirty-four per-
cent of Beyron’s4 points were within the 5 mm range
and the mean distance was 6.2 + 2.3 mm.
The number of experimental axis points within 5
mm of the kinematic axis differed significantly from
eachof the other arbitrary axis points within that range
(p < .Ol, chi square analysis). The mean distance of
the experimental axis points from the kinematic axis
also differed significantly from that of the other arbi-
trary points (p < .Ol, Student t test). In relation to the
kinematic axis, the experimental axis points were
evenly distributed, Gysi’# points and Bergstrom’s’
points were inferior, and Beyron’s4points were inferior
and anterior.
DISCUSSION
There is a marked difference betweenthe findings of
this study and results reported by other investiga-
tors.3s5s*
This study shows that 78% of experimental
arbitrary axis points were located within 5 mm of the
kinematic axis. Arstad” and Weinberg” reported that
a 5 mm error in locating the mandibular hinge axis
results in a negligible occlusal error of 0.2 mm at the
secondmolar.
In selectingthe experimental arbitrary axis point, it
was establishedthat the reference line must be recog-
nized in prosthodontics, and it must be easily located
anatomically. Walke? used a reference line drawn
from the superior border of the tragus to the outer
canthus of the eye. He reported that 80% of kinematic
axis points were located below this reference line and
posterior to a point 12 mm anterior to the superior
border of the tragus on the same reference line.
Therefore, we selectedan experimental arbitrary axis
point located below Walker’s reference line and closer
to the superior border of the tragus. The experimental
point was located on Camper’s line, 10 mm anterior to
the superior border of the tragus. Had the experimen-
tal arbitrary axis point been located precisely 9.5 mm
from the superior border of the tragus, 80% rather than
78% of the points would have beenwithin 5 mm of the
kinematic axis. Although 0.5 mm is readily measured
on graph paper, it is difficult to achieve such precision
clinically.
In a review of the hinge axis theory, Preston” stated
that a superior-inferior error in hinge axis location
results in a larger occlusaldiscrepancythan an error in
anterior-posterior location. The directional tendency of
the arbitrary axis points of Beyron, Gysi, and Berg-
strom was in an inferior or inferior-anterior direction
from the kinematic axis. The experimental arbitrary
axis points were evenly distributed around the kine-
matic axis.
SUMMARY AND CONCLUSIONS
This study compared selectedarbitrary hinge axis
locations with the kinematic axis location. Fifty sub-
jects were studied, and the data were statistically

THE JOURNAL OF PROSTHETIC DENTISTRY 821

 5IMl’SON ET AL

analyzed. Results showed significant differences 4. Beyron, H.: Orienterings problem vid protrwk wkonstruktion-
between the location of experimental arbitrary axis er ock bettstudier. Sven Tandlak Tidskr 351, 1942.
5. Beck, H. 0.: A clinical evaluation of the ~(on concept 01
point and those of Beyron, Gysi, and Bergstrom in articulation. J PROSTHET DENT 9:409, 19:~
relation to the kinematic axis. The arbitrary points of 6. Gysi, A.: T’le problem of articulation. I&w Cosmos 52:l.
Beyron, Gysi, and Bergstrom showed directional ten- 1910.
dencies, whereas the experimental arbitrary points 7. Bergstrom, G.: On the reproduction of denial articulation by
were evenly distributed around the kinematic axis. means of art culators: A kinematic invtstiqation. Acta Odontol
Sand 9:(Suppl 4), 1950.
This study indicates that the experimental arbitrary
8. Walker, P. hg.: Discrepancies between arbitrary and true hinge
axis point more closely and consistently approximated axis. J PROSTHET DENT 43:279, 1980.
the kinematic axis than the arbitrary points of Beyron, 9. BroomelI, I. N.: Value of temperamental indications in correct
Gysi, and Bergstrom. The finding suggests that the prosthesis of entire dentures. Dent Cosmos 39:1, 1897.
clinical use of a point on Camper’s line, 10 mm from 10. Augsburger, R. H.: Occlusal plane relation to facial type. J
PROSTHET DENT 3~755. 1953.
the superior border of the tragus, results in a more hrstad, T.: The Capsular Ligaments of ‘I’emporomandihular
11.
accurate transfer of the maxillary cast to the articula- Joint and Retrusion Facets of the Dentition m Relationship to
tor. Mandibular hIovements. Oslo, Norway, 1054, A. W. Brdggers
REFERENCES Boktykkeri A/S.
12. Weinberg, I,. A.: An evaluation of the face-bow mounting. J
I Lauritzen, A. G., and Bodner, G. H.: Variations in location of PROSTHET DENT 11:32, 1961.
arbitrary and true hinge axis points. J PRCXTHET DENT 11224,
13. Preston, J. D.: A reassessment of the mandibular transverse
1961. horizontal axis theory. .J PROSTHEI. DFNT 41:605. 1070
?. Teteruck, W. R., and Lundeen, PI. C.: The accuracy of an ear
face-bow. J PROSTHFX DENT 16~1039, 1966. Kf$rint rcyuel~ 110:
3. Schallhom, R. G.: A study of the arbitrary center and the DR. J. W. SIMYXXX
kinematic center of rotation for face-bow mountings. J PROS- NAVAL DENTAL CLINIC
WET DEKI. 7:162, 1957. NORFOLK, VA 23511

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