THE FUTILITY OF THE FACE-BOW*

By C. J. STANSBERY, D.D.S., Seattle, Wash.

O N T R A R Y to correct practice, rabbit’s foot. T h e picture would be one

C the title of this paper was written

prior to the subject matter, and I
o f mental uncertainty if not of despair.
I certainly would not be so unkind as
am fearful that I overstepped myself in to try to convince him of the futility o f
the selection o f the word “ futility.” his rabbit’s foot. F or those who still
“ Futility,” meaning “ uselessness,” cov­ think that an articulator must imitate
ers a great deal of territory. Indeed, the maxillae and mandible, have con­
quite paradoxically to my title, I shall dyles, condyle paths and glenoid fossae,
begin by ascribing a use for the face-bow. have rotation points, centers and axes,
all mechanically incorporated within the
A s detailed in the Saturday Evening
instrument, I would not rob them of
Post, when our colored friend Florian
the peaceful assurance that they get from
Slappey, scion of Birmingham Dark
their “ rabbit’s foot,” the face-bow!
T o w n society, was confronted with the
A ll the research w ork that has been
necessity o f a railroad journey to a far
done during the past seventeen years,
city, he equipped himself with traveling
since D r. Gysi’s articles first appeared,
bag, railroad ticket and a rabbit’s foot.
and all the instruments that have been
T h e journey and mission safely and suc­
made to endeavor to put the results of
cessfully accomplished, we again find our
this research into practice have had but
colored gentleman back in Birmingham.
one goal : to so construct articulators that
I think we will all agree that the trav­
they imitate jaw movements and to make
eling bag and railroad ticket were neces­
dentures on them that w ill function in
sities befitting the gentleman’s style of
the patient’s mouth as they do on the
travel, but how about the rabbit’s foot?
instruments. These instruments, stripped
T o this gentleman, the talisman was per­
o f their geometric intricacies and ad­
haps of a value and usefulness equal to
justments, are but mechanisms designed
that of his ticket. It was an essential
to hold the casts of the patient’s jaws in
and necessary adjunct to his journey. It
the same relation as the jaws themselves
gave him confidence and assurance. F ur­
occupy in the different positions o f mas­
thermore, could he not point to his safe
tication. A t the present time, nearly all
return and to the successful accomplish­
adjustable instruments require the use
ment o f his mission as conclusive evi­
o f the face-bow with a technic that,
dence o f the efficacy o f his pocket-piece?
while not extremely exacting, is suffi­
Picture this gentleman deprived o f his
ciently so to be a large factor in deter­
ring all but a few from trying to keep
*R ea d b e fo re the Section on Full D enture
pace with modern denture construction.
P rosth esis at the Sixty-N in th A n n u a l Ses­
sion o f the A m e rica n D en tal A ssocia tion , T h e value attributed to the face-bow
D etroit, M ich ., Oct. 26, 1927. lies in placing the casts on the instru-
3 our. A. D. A., August, 1928 1467
 1468 T h e Journal o f the American D en tal Association
ment in the same relation to the open­
ing axis of the instrument as the jaws
bear to the opening axis of the patient.
It is necessary, in face-bow technic, to
locate the point o f emergence of this
axis on the face. T o do this, the opera­
tor feels for condylar movement, usually
at a point about one-half inch from the
tragus of the ear toward the outer can-
thus o f the eye. T h is is but an approxi­
mate position, and it has been proved
that this position varies greatly with
various degrees of opening. T h is proven
excursion of axial position must be en­
tirely ignored to give any weight to the
claim that, with the use o f the face-bow,
the articulator may be opened or closed
ad libitum during the procedure o f ar­
ranging the teeth fo r centric occlusion.
M oreover, the pure opening movement
about this axis immediately carries all
teeth out of contact; therefore, how can
it in any way effect their arrangement
for other than centric occlusion? T h e
old plain line hinge, with axis anywhere,
will do as well.
I believe that it is axiomatic and must
be accepted without argument or proof
that there is a correct vertical dimension
b e t w e e n maxillary and mandibular
ridges. A . K . Parks has explained this
correct opening very thoroughly.1 W ith
this premise, the opening or closing of
the articulator from the position regis­
tered with the bite-plates is an admis­
sion that the bite-plate positions were
w rong. Furthermore, any change is
simply a matter of guesswork, as the
operator has no registrations whatever
with which to establish the changed posi­
tion o f his instrument. Also, the regis­
trations for lateral and protrusive posi­
tions would not be true as related to
1. P arks, A . K . : T h e Lost V ertical D i ­ fixed relation to the upper and lower
m ension, D en t. D ig est, 33:451 (J u ly ) 1927.
this newly opened or closed position of
the instrument.
A n indictment which I wish to enter
against the face-bow is that it is a false
prophet: it assumes to locate an axis
when there is no axis, or at least only a
limiting position to a moving axis. This
in itself is not so serious but for the fact
that, with the detail involved in locating
the so-called axial position, it would be
assumed that it was a matter o f some
importance. O n the contrary, it has no
value in the functional arrangement of
the teeth but gives the beginner an en­
tirely erroneous idea o f ja w movement
which he afterwards finds impossible to
correlate with true ja w positions. T h e
false premise that the axial movement
is a fundamental one to functional artic­
ulation has been accepted without scru­
tinizing analysis and has divertingly
guided the endeavors of nearly all who
have given the movement o f the man­
dible thoughtful study. T his is fully
evidenced by the number of articulators
incorporating it that have appeared on
the market within the last few years.
T his erroneous guidance o f the research­
er’s thought is also directly chargeable
to face-bow technic.
T h e axis as established by the face-
bow does one thing and one thing only,
and this not an important one: it estab­
lishes a line common to both the maxil­
lae and mandible when they are in cen­
tric occlusion.
T his line, at its best, acts only in a
vertical opening, which is not a func­
tional movement. Suppose we have casts
mounted on an articulator and in the re­
lation o f centric occlusion. T h e position
of the axis is established: it occupies a
casts. L et us consider this axis from a
 Stansbery— T h e Futility of the Face-B ow
new point o f view. Consider the axis
to be not a single line but tw o axes, co­
incident one with the other, one the
axis o f the upper and one the axis of
the lower, but the two axes occupying
identically the same position. A very
common movement of the mandible, as
pointed out by D r. Gysi, is this: while
the condyle of the balancing side comes
downward and forward, the condyle of
the working side moves downward and
backward. T h e resulting condition on
which I wish you to concentrate your
attention is that both condyles moved
downward and with them carried the
axial line that w e have related to the
mandible, or the low er cast. Is it not
self-evident that, under these conditions,
there can be no intersection o f these
two lines, no point in common from the
very instant the movement began?
W e find no proponents o f axial in­
struments so rash as to make the claim
that if one condyle registers a given di­
rection downward and forward, the op­
posite condyle w ill register the opposite
direction upward and backward. T his
is the only condition in which it is pos­
sible to have the axis related to the man­
dible intersect the axis related to the
maxillae. T h e lateral movement o f the
mandible is necessarily modified by an
opening due to cusp height, but this
opening movement is not the same open­
ing movement that takes place around
the axis. T h e opening that accompanies
the lateral movement is determined by
conditions entirely different from axial
rotation and to restrict this movement
with any foreign condition, such as
maintaining a fixed point on the axis, is
to develop a movement which does not
exist in the patient. I am not antago­
nistic to axial instruments per s e ; but in
their present mechanical construction,
they obscurely force the pure or rotary
1469
opening into the lateral movement in­
stead of allowing the opening movement
which accompanies the lateral to de­
velop independently from its own causes.
These causes are the cusp and glenoid
fossa slopes. T h e axis as established by
the face-bow acts only in the pure open­
ing movement and is, unfortunately for
our purpose, nonfunctional. T h e error
o f mechanical construction referred to
is that part o f this axial position for a
nonfunctional movement is mechanically
retained in the lateral or functional
movements.
T his paper w ill be o f no value if de­
voted entirely to destructive criticism.
A constructive substitute for the face-
bow technic must be given. In this sub­
stitute, none o f the exactness nor pre­
cision toward which w e have been striv­
ing w ill be discarded, but a still higher
standard w ill be set and a more simple
technic provided for its accomplishment.
As previously mentioned, the aim o f all
adjustable instruments is t o 'h o ld the
casts in> the same relation one to the
other as are the edentulous ridges of the
patient and to move from one position
to another as do the ridges under the
control of the masticating muscles.
T here is no need to complicate our
problem with intangible and difficult-
to-obtain measurements, rotation points
and directrices when the simplest of the
fundamental conditions of position can
be so easily observed, recorded and
duplicated. W h en we examine our
edentulous patient, We cannot see the
condyles; we can but make an approxi­
mation of the form o f the glenoid
fossae; we can only hazard a guess,
within wide limits, o f the location of
the elusive w ill-o’-the-wisp rotation
centers. T h e most obvious thing that
we can see, presenting all the inform a­
tion which we require, is the changing
1470 T he Journal o f the American D ental Association
positional relation o f the ridges them­
selves. These relations we can accu­
rately record. W e have before us the
ridges of our edentulous patient, as our
tw o solids, and check-bites to establish
their relation in any position which we
may desire to take. These relations may
be duplicated by the casts on an instru­
ment if the instrument is free to assume
any position which the check-bites may
dictate.
T h e most important relational posi­
tion with which we have to deal is the
position of centric occlusion. T h e posi­
tion o f centric occlusion is the destina­
tion o f all masticating movements, and
to get there, and exactly there, is a
matter of extreme import.
W e know that in order to locate and
fix any given point, its position must be
referred to by three measurements in
different directions, usually at right
angles to one another, or, which amounts
to the same thing, by a given direction
and distance from a point previously
located. Here, the direction and dis­
tance take the place of the three meas­
urements. T o fix the position of a given
solid, three points must be selected either
in the solid or its projections, and each
of these three points fixed in relation to
previously located points. W ith this
extremely simple geometric basis, known
by every one, applied to our cast posi­
tions, the problems o f articulation will
be greatly simplified. It is nothing new
and requires no change in one’s line of
thought to consider the parts o f an
articulator as projections of the attached
casts. T o locate the cast, we have but
to locate the position of any three points
of projection. As all positions are rela­
tional, our problem is to establish the
relations of the lower to the upper cast.
T h e simplest relational position possible
of one point to another results when they
are in contact. I f three fixed points of
projection of the upper are in contact
with three corresponding points o f pro­
jection of the lower, in this relation we
have no measurements nor directions to
record. T his simple contact relationship
of projected points o f the articulator is
selected as the relation to hold the casts
in centric occlusion.
In a lateral excursion o f the mandible,
the mandible takes an entirely new
relational position to the maxillae. This
new relation is determined by three fac­
tors ; namely, the cusp slopes, the slope
of the right condyle path and the slope
of the left condyle path. Each one of
these factors is variable and independent
of the other two. In the opposite lateral
excursion, a new set of three factors
holds forth, these, in turn, variable and
independent o f the first set of factors.
As stated, our problem is to establish
the various relations o f the casts by
recording and duplicating the relations
of the natural ridges. T h e check-bites
taken at the time the ridges occupy their
various functional positions give us our
records. These various functional posi­
tions are ascertained by observing an
easily visible Gysi tracing.
Next comes the duplicating o f these
recorded relations and the supplying of
a means o f movement from one rela­
tion to another. W h en the check-bite
o f any certain relation is interposed
between the casts, the three coinci­
dent projection points in the relation
of centric occlusion are all moved
away from the points with which they
were in contact. As the factors which
controlled the recorded relation were
variable in direction, just so the direc­
tions in which these points move away
from one another w ill be variable. This
condition demands a mechanism that will
register the positions of these three
 Stansbery— T h e Futility o f the Face-Bow
points in any direction in which they
may move and allow a return to their
starting point, or centric occlusion.
T h e universal adaptability o f the de­
vices on the three-dimensional articulator
to register the positions o f these projec­
tion points furnishes us with all that is
necessary to record any relation o f man­
dible to maxillae, be its relation average
or erratic, A three-legged milking stool
has the deservedly earned reputation of
being able to stand steadily on its legs
on the roughest grou n d ; a fourth leg
w ould add nothing. A relation is re­
corded by three dimensions; why en­
deavor to add a fourth by using the
f ace-bow ?
DISCUSSION
C h a rles A . M a th ia s, L ou isv ille, K y . : T h e
an atom ic o r ad ju stable a rticu lator w h ich
D r. S tansbery puts in the sam e class w ith
the ra b b it’ s fo o t is one o f the outstand ing
fa cto rs in d e v e lo p in g denture w o rk . U p to
the tim e o f B o n w e ll, y ou w ill all a g ree that
ou r denture serv ice w a s v e r y p o o r. M en
h a v e been striv in g fo r som eth ing better.
T h e an a tom ic a rticu lator is a m aterial e x ­
p ression o f m uch thought an d stu d y ; co n ­
sequently, m en h ave le a rn e d m ore o f real
denture construction. E v e ry m an w h o c o n ­
tributed to the w o rk d id it sin cerely, and at
a loss o f tim e and m oney, fo r the g o o d it
m igh t be to the dental p ro fe ssio n . I d o not
k n ow D r . Stansbery’s tech nic o r w h at kind
o f an instrum ent he uses w h en a rra n g in g
the teeth, i f an y at a l l ; fo r he so com p letely
condem n s p ra ctica lly all o f them , w h en he
says, “ F or those w h o still think that an
articu la tor m ust im itate the m ovem ents o f
the m an d ible, h a v e condyles, con d y le paths,
and g le n o id fossae, h a v e rotation points,
centers and axes, all m ech a n ica lly in co r­
p ora te d w ithin the instrum ent . . . ” I know
o f no an atom ic articulator that does not
h a v e represen tatives o f con d yle and con d yle
paths. Q u o tin g fr o m M r. H a n au , “ T h e
m ovem ents o f the a rticu lator do not neces-
sa rily rep rod u ce o r im itate ja w m ovem ents
but the m ovem ents are e qu iva len t.” A s fo r
the rotation points, centers and a x e s: they
are not n ecessa rily in the instrum ent, m ore
ra re ly e v e r in it, but at som e points outside.
1471
T h e g oal that D r. Stansbery speaks o f, c o n ­
stru ctin g articu lators to m ake dentures fu n c ­
tion in the m outh as they d o on the m achine,
if p ossible, w o u ld be id eal. A ll o f the
ad ju stable m etal articu lators that I h a v e
used require the use o f the fa ce -b o w . T h e
use o f the fa c e -b o w m a y not h a v e the p re ­
cision o f p la cin g a w ell fitting in la y or
p orcela in ja ck et crow n , still w h en it is used
p rop erly, the con d yle heads m ay be located
w ith in a m illim eter o r s o ; an d this is v e r y
accurate w h en w e con sid er a rad iu s o f about
V/z inches. I ca n ’t see h ow this can deter
any m an fr o m keep ing p ace w ith m odern
o r scientific denture construction . I d on ’t
see h o w w e can get alon g w ith ou t its use in
such instrum ents as the H a n au , G y si or
W a d s w o rth . On the other hand, if w e are
not satisfied w ith one technic, w e ca n ex­
perim ent or d o such research w o rk as w e
m ay desire, to find som eth ing better than
w h at w e h ave been using, so lo n g as w e are
able to p ro v e to ou rselves that the n ew
tech nic is better than the one d isca rd ed .
T h e v a lu e attributed to the use o f the fa c e -
b o w is that o f p la cin g the casts on the in­
strum ent in the sam e relation that they
occu p y in the m outh an terop osteriorly , w h en
the bite rim s are trim m ed to correct v ertica l
heigh t and the ja w s are at rest in cen tric
occlu sion. W e can do this w ith the fa c e -
b ow , fo r this is all that it is intend ed to do.
T h e so -ca lle d fe e lin g fo r the con d y le head
is not fo r the head but the p osterior p ortion o f
the ram us, as the head o f the con d y le is
com p letely hidden fr o m touch and is a lw a ys
fo u n d ju st b e lo w the lo w e r b o rd e r o f the
p osterior root o f the zyg om a tic arch. The
fa c e -b o w w a s not intended to be used ex­
cept in p la c in g the casts correctly in the
articu lator in centric occlu sion, but the p osi­
tion o f the casts g r ea tly affect the line o f
occlu sion o r prosth etic cu rv e. W e assume
w e h a v e ra d ii run ning fr o m the cusps o f
the lo w e r teeth to the con d yles, each tooth
d e scrib in g the a rc o f a circle in la b ia l m o ­
tion ; then, if these ra d ii are too lo n g o r too
short, w e w ill experien ce cusp in terferen ce
and h a v e d islod g em en t o f dentures. I am
gla d that D r. Stansbery brin g s out the
p oint o f lost v ertica l dim ension, as this c e r ­
tainly is a g rea t fa cto r in correct denture
construction , and w henever established
should n ev er be ch an ged. T h is g iv e s us
the nu llified an terior com p onen t w h ic h D r.
W a d s w o r th stressed so m uch, this b e in g one
 T h e Journal of the American t)ental Association
o f the c h ie f fa ctors in sta b iliz in g the d en ­
tures. T h e con d y le heads, b e in g a p art o f
the m an d ible, and the fa c e -b o w used to
m easure the distance fr o m the con d y le to the
m edian line, o f the lo w e r denture w h en bite
blocks a re in cen tric occlu sion , reg ard less o f
w h eth e r the ja w s are op en ed o r closed,
these relations n e v e r ch an ge. T h e fa c e -b o w
is a m e a su rin g instrum ent d esign ed fo r
reg iste rin g the an terop osterior relation ship
o f the a lv e o la r rid g es to the con d y les w h en
the latter are at rest in the g le n o id fossa,
as in n orm al closu re. T h is a p p lia n ce is
ind isp ensable in m ounting the casts in true
relation to the rotation centers. A ft e r se v ­
eral rea d in g s o f D r. Stansbery’ s p ap er I
c a n ’t see that the tech nic he g iv e s is any m ore
exact o r sim pler and easier than the fa c e -
b o w tech nic g iv e n by H anau , W a d s w o r th
and others. T h e r e is no doubt in m y m ind
that it has a great d eal o f m erit, D r. Stans-
b e ry b e in g a m an o f lo n g experien ce. H is
p ap er m akes us stop to think. T h e r e is no
royal ro a d to scientific denture construction,
and w e all h a v e to w o rk fo r it ourselves.
R eg a rd le ss o f our instrum ent, w h eth er plain
line o r anatom ic, w ith o r w ith ou t fa c e -b o w
technic, w e must h a v e a th orou gh k n ow ledg e
o f the u n d erly in g fa ctors in denture co n ­
struction. O u r instrum ent w ill g iv e us effi­
cien cy on ly in p rop ortion to our k n ow led g e
and skill.
C. J. S tan sbery (c lo s in g ): U n fortu n ately
D r. M a th ia s does not seem to h a v e grasp ed
the im p ort o f m y paper. T o m ake cle a re r the
points w h ich I intend to b r in g out, I shall
r e v ie w the discussion. I do not put an atom ic
n or a d ju sta b le articu lators in the sam e class
w ith the “ rabb it’s fo o t ,” but w ish to make
articu lators m ore ad ju sta b le and m ore a n ­
atom ic by elim in atin g the use o f the fa c e -
b o w , w h ich stands in the w a y o f this de­
sired result. T h e articu lators and fa c e -b o w
h a v e been stepping-stones to a m ore p e rfe ct
denture construction. I am m isquoted in the
sentence b eg in n in g “ T hose who still think
that an a rticu lator m ust im itate the m o v e ­
ments o f the m an d ible, h a v e con d yles, etc.”
R efere n ce to m y p ap er w ill sh ow that sen­
tence to be, “ F or those w h o still think that
an articu lator must im itate the m a x illa e and
m an d ible, h a v e condyles, con d y le paths and
g le n o id fossae, h a v e rotation points, centers
and axes, all m ech an ically in corp ora ted
w ithin the instrum ent . . . ” It is this m e­
ch an ica l in corp ora tion and im itation o f the
physical m an d ible and m ax illae to w h ich
this sentence refers. D r. M a th ia s kn ow s “ o f
no an atom ic articu la tor that does n ot h ave
represen tatives o f con d y le, con d y le paths,”
but he does k n ow that “ the rotation points,
centers and axes . . . are . . . at som e points
outside.” T h e th ree-d im en sion al instrum ent
places the cond yles and con d y le paths alon g
w ith the rotation points and axes, all out­
side. T h e instrum ent’ s im itation o f fu n c ­
tional m ovem ents o f the p atien t is c o n trolled
and g u id ed by three u n iv ersa l d irection d e ­
v ices w h ich h ave no an atom ic cou n terpa rt.
I jo in w ith D r. M ath ias in not seein g h ow
such a sim ple tech nic can deter an yone from
keep ing pace w ith m odern denture con stru c­
tion ; but u n fortu n a tely the fa ct rem ains that
it does. It is also true that w ith the instru­
ments he m entions, H a n a u , G y si o r W a d s ­
w orth , the use o f the fa c e -b o w is essential
because these instrum ents are not u n iv ersa lly
ad ap table, the restriction existin g in the
m ovem ent o f the w o rk in g con d yle. A ll the
points that D r. M a th ia s m entions in defense
o f the fa c e -b o w I w ill adm it are true, except
the in feren ce as to its b ein g an essential to
p ra ctical w ork . T h e th ree-d im en sion al in ­
strument w ith its sim plicity o f tech n ic w ill
open the w a y to a g rea t m an y w h o are not
inclined to research. L et me d ra w an
a n alogy. T h e electrical en gin eer in d e scrib ­
in g a spark p lu g cou ld fill p ages w ith d e­
scriptions o f and research on induction coils,
high potential v olta g es, spark gaps, etc., but
you can teach a 1 0 -y ea r-old to take a d v a n ­
tage o f all these w ith a p a ir o f p liers and
a thin dim e. So it is w ith prosthetics. T h e
research men must d o a g rea t d eal o f w ork
w h ose on ly p ra ctical v a lu e is to la y the
fou n d a tion o f a sim plified technic that the
rank and file m ay use. T h is the th ree-d im en ­
sional instrum ent does, and at no loss, but a
g ain in precision ov e r past m ethods.