Anatomic comparison to arbitrary rebence ndch on
Hanau articulators
Frank R. Lauciello, D.D.S.,* and Marc Appelbawn, D.D.S.* *
Veterans Administration Hospital, Buffalo, N. Y.
T he face-bow registers the glenomaxillary rela-
tionship in three planes (anteroposteriorly, laterally,
and vertically). The anteroposterior and lateral posi-
tions are determined by the anatomic relationship
between the maxillae and the glenoid fossa. The
vertical position, i.e., the anterior reference point,
has been determined by various techniques.
One recommended method of locating the vertical
position when using Hanau articulatorsf is to elevate
the maxillary cast while the face-bow is still attached
to the articulator until the maxillary incisal edges (or
maxillary wax rim) are aligned to the level of a
groove on the incisal guide pin. This groove is 30 mm
below the horizontal condylar plane (a plane
described by the center of the condylar spheres and
the infraorbital indicator; see Fig. 5) and is called the
in&al reference notch. Unfortunately, the location of
this groove bears no relation to the anatomic anterior
reference point (orbitale). In other words, the 30 mm
measurement is not calibrated to approximate the
average distance between the orbitale and the maxil-
lary incisal edges.
The purpose of this investigation was to determine
the average orbitale-maxillary incisal edge distance
and to compare this measurement to the incisal
reference notch of the Hanau articulators.
LITERATURE REVIEW
Snow’ recommended that the occlusal plane be
made parallel to the Bromell or Camper plane
(ala-tragus line) and oriented to the articulator so
that it is parallel to the maxillary and mandibular
bows of the articulator. Gysi and Kohler’ used a
Supported by the medical research service of the Veterans
Administration.
*Chief of Prosthodontics.
**Senior Pmsthndnntic Resident.
tSeries 9682 (high post), 145 (low post), and 130 (University).
676
similar plane, which he referred to as “the prosthetic
plane.” More recent investigators have noted that
the Frankfort horizontal plane is usually parallel to
the floor when an individual is in an upright
position.“, ’ Cephalometrically, the Frankfort plane
is described as a horizontal plane that passes through
the right and left porion (the midpoint on the upper
margin of the external auditory meatus) and the
orbitale (the lowest point on the infraorbital rim). It
would seem logical to orient the maxillary cast to this
plane so that the articulator would more accurately
represent the patient.
Clinically, a maxillary cast is oriented to the
Frankfort horizontal plane by using an infraorbital
pointer that is attached to the face-bow. Theend of
the pointer is placed at the lowest margin of the
infraorbital rim. When transferred to the articulator,
the end of the pointer is placed level with the
condylar pIane by utilizing the infraorbita1 indica-
tor, thus orienting the maxillary cast to the (condy-
lar) axis-orbital plane, which closely parallels the
Frankfort horizontal plane. Thus the plane of occlu-
sion, when viewed on the articulator, will be similar
to that of the patient in an upright position. This
concept was somewhat disputed by Gonzalez and
Kingery.5 They determined cephalometrically that
the Frankfort horizontal plane was not parallel to
the axis-orbital plane. The condylar axis was found
to be an average of 7: 1 mm below the cephalometri-
tally determined porion. They suggested compensat-
ing for this error by adjusting the orbital pointer 7
mm above the orbital indicator or by placing the
orbital pointer 7 mm below the orbitale of the
patient during the transfer of the face-bow record.
This discrepancy has been clinically observed by
others* and has been compensated for in part by
*Persoltal communication: S. H. Payne and H. R. Q-tman,
1977.
DECEMBER 1976 VOLUME 40 NUMBER 6
ANATOMIC COMPARISON TO REFERENCE NOTCH

Fig. 1. The right orbitale is located by palpating with a

small ball burnisher and marked on the skin with a
sharpened indelible pencil

selecting the infraorbital foramen instead of the

orbitale as the anterior reference point.
An alternative to the use of the infraorbital
pointer is the incisal reference notch on the Hanau
incisal guide pin.” The Hanau series 96H2 and 130 Fig. 2. The stainless steel bar is positioned intraorally to
may have a second incisal reference notch that record the incisal edges in compound.
measures 37 mm from the condylar plane. This
notch was introduced at the request of the University distance for all subjects. The patients were seated in
of Southern California Dental School. a contoured dental chair to lend proper support to
Other alternatives to the infraordital indicator the head and neck region. The orbitale was located
have been used with different face-bow techniques.’ utilizing Salzmann’s’O description, which states that
The Hanau XP-51 articulator has an incisal pin the orbital point is accepted as “the point on the
reference notch which measures 51 mm from the lower margin of the orbit which is directiv below the
condylar plane. It was thought that this arbitrary pupil when the eye is open and the patient looks
measurement might better approximate the average straight ahead.” The right orbitale was consistently
orbitale-maxillary incisal edge distance.* located by palpating with a small bat1 burnisher.
Once this point was located, a dot was made on the
METHOD skin with a sharpened indelible pencil (Fig. 1).
Sixty patients were selected according to sex and A stainless steel bar measuring 3.2 mm in thickness
race (Caucasian, Black, and Oriental) to give a was indexed to retain modeling compound. The
representative sample of the population. The third compound was heated, tempered, and placed
variable chosen was age; half of the individuals were around the bar. In many individuals the incisal
under 30 and half over 30 years of age. The catego- edges of the maxillary anterior teeth are at varying
rization by age was a further attempt to assure a lengths, and the compound was used to stabilize and
varied population, since Tallgren’s studies’ con- facilitate placement of the bar in the frontal plane,
cluded that the morphologic face height continues to parallel to the imaginary interpupillary line, while at
increase throughout adulthood. Subjects for this the same time approximating as closely as possible
study were excluded if they did not have a complete the incisal edges of the maxillary central incisors.
natural dentition. Patients with a history of cranio- The bar was positioned intraorally, recording the
mandibular surgery or severely abraded incisal edges incisal edges in the compound (Fig. 2). It was then
of their anterior teeth were also excluded. chilled and placed back into the mouth. The mov-
A specific technique was followed for locating and able arm of the Boley gauge was placed flush with
measuring the orbitale-maxillary incisal edge the inferior surface of the bar, while the other arm

THE JOURNAL OF PROSTHETIC DENTISTRY

 1AlJClELLOANDAPPELBAUM

Table I. Determination of measurement accuracy

Patient 1 Patient 2 Patient 3

46.6 50.6 55.9

2 47.2 50.2 56.5
46.5 50.6 56.2
4 46.6 50.7 56.1
5 47.3 50.4 55.4
6 47.1 49.7 55.7
7 46.6 50.5 55.5
8 47.1 51.2 55.7
9 47.3 50.4 55.5
10 47.5 50.5 55.4
11 46.9 50.7 55.4
12 47.1 49.9 55.4
13 47.2 50.5 55.2
14 47.5 50.5 55.2
15 47.2 50.4 55.5
Mean (E) 47.0466 50.4533 55.6400
Standard 0.3313 0.3461 0.3794
Fig. 3. The movable arm of the Boley gauge is placed deviation (s)
flush with the inferior surface of the bar to record the Variance (9) 0.0855 0.1198 0.1440
orbitale-incisal edge distance.

was positioned level to, and in some instances in N

contact with, the orbitale marking (Fig. 3). The
%U,di
= 0.0855 + 0.1198 + 0.1440
measurement
millimeter.
was read to the nearest tenth of a
The Boley gauge was then removed and
J 3
= 0.3412 = Average standard deviation
closed. The same procedure for placement of the
Boley gauge was repeated to yield a total of three
measurements for each subject. The average the smallest measurement found in a previous pilot
measurement was derived, and 3.2 mm was study of 20 subjects. However, the 45 mm base
deducted (to account for the thickness of the stainless measurement exceeds the present incisal reference
steel bar) to arrive at the final determination. Where notch measurement by 15 mm. Therefore, if our
the incisal edge of the central incisors did not contact subjects’ base measurements were significantly
the bar, usually due to extruded canines, the distance greater than 45 mm, they certainly would be,signif-
of the incisors from the bar was calibrated and icantly greater than the 30 mm incisal reference
subtracted from the final measurement. notch. Utilizing the 95% level of confidence and the
In an effort to standardize the technique and previously determined standard deviation for our
statistically determine the accuracy of locating the measuring technique, a two-tailed z-test indicated
orbitale and reading from the Boley gauge, 15 that five subjects were more than sufficient in each of
measurements were made on each of three subjects the categories of age, sex, and race (Fig. 4).
by the procedure previously described. After each
determination, however, the orbitale marking was RESULTS
remqved and the patient was asked to leave the The five measurements in each of the subject
operatory and then return. The data were tabulated, categories were tabuIated according to sex, race, and
and the mean, standard deviation, and variance age (Table II). The means, standard deviations, and
were determined (Table I). From this information t values were determined for each subject category
the average standard deviation was derived using the (Table III). With a one-sided t-test, each of the I2
formula listed in Table I. groupings was compared to the base anatomic
Next it was necessary to ,determine whether 60 measurement of 45 mm. Each proved to be statisti-
patients constituted a sufficient statistical sample. cally significant at the 97.5% confidence level.
To determine this, it was necessary to compare our Based upon this information, our results indicated
measurements to some base measurement. The bas,e that the average orbitale-maxillary incisal edge
measurement of 45 mm was selected, since this was distance determined from the representative popula-

678 DECEMBER1978 VOLUME40 NUMBER6

ANATOMIC COMPARISON TO REFERENCE NOTCH

Table II. Raw data DETERMINATION OF SAMPLE SIZE

Race 2 test (two tailed at 95% level of confidence)

PI-po1
Sex and age Black White Oriental + z6) st
!J = (Za
62.4 53.2 59.9
[
Male, 59.2 57.5 50.7
(30 62.9 57.8 51.0 zci= 1.96

52.1 54.8 56.7

li=o
61.6 55.3 57.2
True difference = 15mm
62.2 48.0 54.3
= 1.65
Male, 51.9 55.1 57.8 z6
>30 58.2 54.1 54.9
= 0.34
61.3 53.4 57.2 st
58.2 58.1 58.7 (I.96 +
v = 1.6s1 0.q * = [o.os2] 2 = (1
15.0
51.2 47.2 51.3
Female, 48.2 49.8 52.7 Fig. 4. Determination of the adequacy of the sample size
<30 47.5 52.9 51.0 using a two-tailed z-test.
50.8 47.8 53.2
51.1 53.0 53.2
Table III. Analysis of raw data
50.2 46.9 50.3
Female, 54.6 49.8 54.1 Race
>30 51.2 52.9 58.5
57.6 47.8 54.7 Sex and age Black White Qriental
48.1 53.0 51.5
Male, F = 59.64 2 = 55.76 K = 55.10
(30 5 = 4.45 s = 1.94 s = 4.07
tion used in this study was 53.99 + 4.17 mm (Table t = 7.36 t = 12.38 t = 5.55
III). As previously mentioned, this measurement was
Male, Z = 58.36 R = 53.74 X = 56.98
significantly greater than the base measurement of >30 5 = 4.04 s = 3.68 5 = 1.45
45 mm, which was used for statistical comparison. t = 7.40 t = 5.32 t = 18.41

DISCUSSION Female, Z = 49.76 P = 50.04 j? = 52.28

(30 s = 1.77 s = 3.41 s = 1.06
It has been reported that improper orientation of
t = 6.02 t = 3.30 i = 15.40
the maxillary cast does indeed affect the balancing
cusp angle.“. I1 However, raising or lowering the Female, $2 = 52.34 j? = 50.08 z = 53.82
face-bow orientation has no appreciable effect on the >30 s = 3.76 s = 2.82 s = 3.18
protrusive (mesiodistal) cusp inclines, since ihe t= 4.36 t = 4.02 t = 6.19

change of the condylar inclination recording is One-sided t-test: t,.,,,,,,, = 2.78, df = 4.

compensated by the simultaneous change in angula- ji = Mean, s = Standard deviation.
tion of the occlusal plane. According to Weinberg,” Sum of E
Average x -N(12)= 53.99.
if the face-bow mounting is oriented 16 mm too high
Sum of s’
on the articulator, a disclusion of 0.2 mm will be Average s = -k N 4.17.
noted on the balancing occlusal side. Manly and
associates” described a perception experiment and
reported that patients with complete maxillary and step in the construction of complete dentures with a
mandibular dentures were able to distinguish thick- well-balanced occlusion.
nesses down to a 0.18 mm threshold. Similarly, Brill The results of this study showed a significant
and associates’” reported that patients with complete difference between the average orbit&-maxillary
dentures can perceive objects 0.6 mm thick. incisal edge distance and the 30 mm incisal reference
It has been suggested that balanced occlusion is notch measurement on the Hanau incisal guide pin.
necessary for the stability of complete dentures and The average difference was approximately 24 mm
for the health of the oral tissues.“-‘” An accurate for the representative population selected.
plane of orientation does appear to be an essential As mentioned previously, Gonzalez and Ringery”

THE JOURNAL OF PROSTHETIC DENTISTRY 679

 LAUCIELLO AND APPELBAUM

Fig. 6. The face-bow transfer utilizing an adjusted orbital

indicator is the most accurate method of anatomically
orienting the maxillary cast to the articulator.

Fig. 5. Comparison of anterior reference planes to Frank-

fort horizontal. A, Axis orbital plane approximately 54
mm from the maxillary incisal edges. 8, Frankfort hori-
zontal plane. C, Modified axis orbital plane approximately
47 mm from maxillary incisal edges. D, Hanau incisal
reference notch 30 mm from maxillary in&%1 edges. sz,
Transverse hinge axis. p, Porion. o, Orbitale.

noted that the porion was an average of 7.1 mm

above the condylar axis point, which is used as the Fig. 7. Modified orbital indicator shows addition of 7,1
mm of plexiglass.
posterior reference point relating the face-bow to the
articulator. Taking this information into considera-
tion, the average determination of 54 mm was condylar plane of the articulator is the most accurate
adjusted to 47 mm, thus more accurately paralleling method of anatomically orienting the maxillary cast
the axis-orbital and Frankfort horizontal planes (Fig. to the articulator (Fig. 6). A modified orbital indica-
5). Therefore, if an incisal reference notch is to be tor, showing the addition of 7 mm of plexiglass, is
used as a third point of orientation for the face-bow, illustrated in Fig. 7.
it should be calibrated 47 mm from the condylar It should also be mentioned that when using the
plane. In contrast to accepting the completely arbi- adjusted infraorbital pointer or the 47 mm reference
trary 30 mm incisal reference notch, this will lend notch, interference may be noted with the lower bow
some empirical credence to the calibration. of the articulator when mounting the mandibular
However, a wide range of measurements for the cast. Therefore the selection of the high-post Hanau
distance between the maxillary incisal edges and (series 9682 and 130) articulator is recommended.
orbitale were recorded (Table 11). The greater the
orbitale-incisal edge distance varies from the 47 mm CONCLUSION
measurement, the correspondingly greater will be The average orbitale-maxillary incisal e.dge
the occlusal error. Therefore, it is suggested that distance for the representative .population used in
using the orbital pointer when making the face-bow this study was found to be significantly greater than
transfer and adjusting the pointer 7 mm above the the 30 mm incisal reference notch on the incisal

680 DECEMBER 15’78 VOLUME 40 NUMBER6

ANATOMIC COMPARISON TO REFERENCE NOTCH

guide pins of Hanau articulators. Using the data
gathered from this study, the following suggestions
are recommended:
1. According to the present anatomic data, the
incisal reference notch on Hanau articulators should
be calibrated 47 mm below the condylar plane.
2. However, due to the wide range of measure-
ments recorded for the orbitale-maxillary incisal
edge distance, it is suggested that the use of the
orbital pointer when making the face-bow transfer
and adjusting the pointer 7 mm above the condylar
plane of the articulator is the most accurate method
of anatomically orienting the maxillary cast to the
articulator.
3. The short-mount Hanau articulator (series 145)
has an interbow distance insufficient to accommo-
date the positioning of the mandibular cast when
utilizing the adjusted orbital indicator or the recali-
brated incisal reference notch, and it is therefore
unsuitable for accurate face-bow transfer records.
We wish to express our appreciation to Dr. J. David Eick,
Associate Professor of Biomaterial Sciences, State University of
New York at Buffalo, for his valuable assistance in compiling and
analyzing the statistical data. We also wish to thank the Medical
Illustration Department at the Buffalo Veterans Administration
Hospital.
REFERENCES
1. Brandrup-Wognsen, T.: The face bow, its significance and
application. J PROSTHET DENT 3:618, 1953.
2. Gysi, A., and KGhler, L.: Handbuch der Zahnheilkunde (von
Scheffl. t. Vienna, 1929, Urban and Schwarzenberg.
3. Granger, E. R.: Practical Procedures in Oral Rehabilitation.
Philadelphia, 1962, J. B. Lippincott Co., p 63.
4. McCollum, B. B., and Stuart, C. E.: A Research Report.
South Pasadena, Calif., 1955, Scientific Press, pp 54-58.
5. Gonzalez, J. B., and Kingery, R. H.: Evaluation of planes of
reference for orienting maxillarv casts on articrrlators. ,J Am
Dent Assoc 76:329, 1968.
6. Boucher, C. O., Hickey, J. C., and Zarb, G. A.. Prosthodon-
tic Treatment for Edentulous Patients, rd 7 Saint Louis,
1975, The C. V. Mosby Co., p 301.
7. Hickey, J. C., Lundeen, H. C., and Bohannan, H. M.: A new
articulator for use in teaching and general dentistry.
J PRO~THET DENT 18:425, 1967.
8. Tanaka, H., Finger, I., and Porter, M. R.: A new semi
adjustable articulator. Part II. Adjustment of a new-concept
articulator. J PROSTHET DENT 33:158; 1975.
9. Tallgren, A.: Changes in adult face height due to aging, wear
and loss of teeth and prosthetic treatment. a roetgen cepha-
lometric study mainly on Finnish women. Acta Odontol
Stand 15:1, 1957. (Suppl 24)
10. Salzmann, J. A.: Orthodontic Practice and Tcschnics. Phil-
adelphia, 1957, J. B. Lippincott Co., p 139.
1I. Weinberg, L. A.: An evaluation of the face-bow mounting.
J PROSTHET DENT 11:32, 1961.
12. Manly, R. S., Pfaffman, C., Lathrop, D. D., and Kayser, J.:
Oral sensory thresholds of persons with natural and artificial
dentitions. J Dent Res 31:305, 1952.
13. Brill, N., Schubeler, S., and Tryde, G.: Aspects of occlusal
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12:123, 1962.
14. Schuyler, C. H.: Full denture service as influenced by tooth
forms and materials. J PROSTHET DENT 1:33. 1951.
15. Payne, S. H.: Study of posterior occlusion in duplicate
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16. Ortman, H. R.: Role of occlusion in complete denture
prosthodontics. J PROSTHET DENT 25:121. 1971.
Reprint requeststo:
DR. FRANK R. LAUCIELLO
CHIEF OF PROSTHODONTICS
VETERANS ADMINISTRATION HOSPITAL
BUFFALO, N. Y. 14215

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