GENERAL DENTISTRY
Update on the parameters influencing the adjustment
of the sagittal and transversal condylar inclination of dental
articulators
Mathilde Bapelle, DDS/Julien Dubromez, DDS/Charles Savoldelli, DDS, PhD/Yannick Tillier, PhD/
Elodie Ehrmann, DDS, PhD
Objectives: The literature review aimed to compile and summa-
rize the results of research relating to the recordings of condylar
displacements obtained with extraoral devices, to guide clin-
icians to set dental (virtual) articulator parameters. The meta-
analysis was undertaken to assess the sagittal condylar inclina-
tion (SCI) and transversal condylar inclination (TCI, also known
as Bennett angle) values according to horizontal reference
planes, movement studied, and patient characteristics: dental
status, interocclusal relationship, skeletal pattern, and signs and
symptoms of temporomandibular disorders (TMD). Data
sources: A bibliographic search was conducted in the three fol-
lowing electronic databases: MEDLINE, EMBASE, and Cochrane
Library and Best Evidence. The review was restricted to trials
involving participants meeting the following criteria: (1) adult,
(2) no previous surgery in the temporomandibular region, and
Key words: Bennett angle, condylar inclination, condylar kinematic, dental articulator, literature review, temporomandibular joint
During extensive prosthodontic treatment, it is recommended
to use an individually adjusted articulator to simulate mandib-
ular movements.1 To adjust the articulator, two main param-
eters are commonly required for each temporomandibular
joint: the inclination of the sagittal and transverse condylar
paths. Sagittal condylar inclination (SCI; Fig 1) describes the an-
gle between the condylar path and the sagittal or other hori-
zontal reference plane.2 In contrast, transverse condylar inclina-
tion (TCI, also known as Bennett angle; Fig 2) represents the
78 QUINTESSENCE INTERNATIONAL | volume 53 • number 1 • January 2022
(3) no serious comorbidity conditions. Descriptive statistics
were calculated for all study groups and were compared by ap-
plying a one-way ANOVA. Conclusion: All 20 articles selected
corresponded to a total of 933 subjects evaluated. The recording
devices and horizontal reference planes had a significant impact
on the SCI values. Age, dental status, and the presence of symp-
toms and signs of TMD in subjects had no influence on SCI val-
ues, unlike Angle class II, division 2, the class II sagittal pattern,
or the increased vertical skeletal pattern SCI parameters (P < .05).
The mean TCI value was 8 degrees and was independent of in-
dividual patient characteristics and the extraoral recording de-
vice used. For accurate kinematic simulation, the patient’s per-
sonal plane of reference must be transferred to the system.
(Quintessence Int 2022;53:78–88; doi: 10.3290/j.qi.b1702361)
difference between the nonworking condyle in the horizontal
plane during medial joint movement, and the protrusive path.3
The displacement of the mandibular hinge axis must be re-
corded to ascertain its posterior determinants when seeking to
accurately simulate individual oral conditions in a (virtual) artic-
ulator.4-6 In clinical practice, due to the cumbersome use of the
devices, the lack of equipment, or the incompatibility of the
systems, arbitrary programming is often preferred to the steps
of recording condylar parameters, especially since certain stud-

1 2
Fig 1 Sagittal condylar inclination (SCI) of the left condyle during protrusion
(measured at 3 mm).
ies have shown that complete mean value setting was associ-
ated with a relatively low risk of occlusal errors exceeding toler-
ance limits accepted in practice.7
As total digital flow is now possible, and with the emer-
gence of new integrated systems to record mandibular kine-
matics, it was necessary to take stock of the devices described
in the literature. The present work aimed to compile and sum-
marize the results from three decades of recordings of poster-
ior determinants.
The present original literature review and meta-analysis
were undertaken to assess the SCI and TCI values determined
based on data from jaw movement recording systems, as a func-
tion of horizontal reference planes, movement studied, and also
patient characteristics: dental status, interocclusal relationship,
skeletal pattern, and signs and symptoms of temporomandibu-
lar disorders (TMD).
Data sources
A bibliographic search was conducted in the three following
electronic databases: MEDLINE (15 January 2020), EMBASE
(15 January 2020), and Cochrane Library and Best Evidence (15
January 2020). The language of publications was restricted to
QUINTESSENCE INTERNATIONAL | volume 53 • number 1 • January 2022
Bapelle et al
Parasagittal plane
Fig 2 Transversal condylar inclination (TCI) of the right
condyle during left mediotrusion (measured at 4 mm).
English. Keywords and Boolean operators were used as follows:
(condylar kinematic AND hinge axis) OR (Bennett AND temporo-
mandibular) OR (condylar guidance AND temporomandibular)
OR (condylar inclination AND temporomandibular).
Resources selection
Two independent investigators screened the titles of publica-
tions found in the databases and, when available, the abstracts
of publications. Studies were analyzed based on the informa-
tion available in the publication. No authors were contacted.
The information relating to each study included in this
review was extracted and logged in Excel or Microsoft Word
(Microsoft). Extracted data related to the study characteristics,
recording device, horizontal reference plane, patient character-
istics, movement studied, TCI, and SCI. Any disagreements on
extracted data were resolved by consensus.
The review was restricted to trials involving participants
meeting the following criteria:
■ adult
■ no previous surgery in the temporomandibular region
■ no systemic arthritis or other serious comorbidity condi-
tions (eg, fracture in region, cancer, neurologic disease).
79
 GENERAL DENTISTRY
For the meta-analysis, the values of both condyles were com-
bined, because in the available sample size, no statistically sig-
nificant side-related differences are expected.8 Descriptive sta-
tistics were calculated for all study groups. Groups of patients
were compared by applying a one-way ANOVA (https://stat-
pages.info/anova1sm.html). The null hypotheses were:
■ The movement recorded has no influence on the SCI value
■ The patient’s personal characteristics have no influence on
the SCI and TCI values
■ The horizontal plane of reference has no influence on the
SCI values.
Review
Article selection
The initial searches of the electronic databases returned a total
of 164 references with abstracts. Based on title and abstract,
134 of these were eliminated. Upon full reading of the remain-
ing articles, 20 were retained, corresponding to a total of 933
patients. Among the 20 articles retained, 13 reported compara-
tive clinical trials and 7 reported a noncomparative clinical trial.
Several relevant parameters were extracted (Appendix 1,
available at http://qi.quintessenz.de) for the analysis: number
and median age of patients included, recording device, horizon-
tal reference plane, patient characteristics (symptoms and signs
of TMD, interocclusal relationship, or skeletal pattern), move-
ment studied, mean and standard deviation (SD) TCI and SCI.
80 QUINTESSENCE INTERNATIONAL | volume 53 • number 1 • January 2022
Fig 3 Representation of horizontal reference planes used in the studies.
Jaw movement recording systems and horizontal
reference planes
Several distinct recording systems were used in the different
studies: mechanical condylograph (five studies),9-13 electronic
axiograph (10 studies),1,8,10,14-20 pantograph (one study),21 ultra-
sonic system (three studies),2,22,23 optoelectronic system (two
studies),24,25 and intraoral recording with articulator (four stud-
ies).11,13,19,21 In addition to distinct recording systems, different
horizontal reference planes (Fig 3) were used when measuring
the condylar inclination: axis orbital plane (AOP; 10 stud-
ies),1,8,10-12,15-19 Camper plane (three studies),2,22,23 occlusal plane
(one study),25 Denar plane (terminal hinge axis and one anterior
reference point located 43 mm above the incisal edges of the
maxillary anterior teeth or the patient’s lower lip border; one
study),21 approximation of Camper plane (bilateral terminal
hinge-axis points taken as posterior reference points with anter-
ior reference point on left wing of nose; one study),24 or Frankfort
plane (four studies).9,13,14,20
Groups of subjects studied
Table 1 summarizes the characteristics of the subjects included
in the selected studies. In total, the 20 articles selected corre-
sponded to 933 subjects evaluated: 780 asymptomatic subjects
and 153 subjects presenting one or more signs of TMD. In the
asymptomatic group (780/933), 594 patients could be classed
in several subgroups: based on skeletal pattern (73 patients,
 Bapelle et al

Table 1

Patient characteristics No. of patients Studies

Symptomatic 153/933 Maglione et al,9 Theusner et al,14, Piehslinger et al15
Asymptomatic All subgroups 780/933 Canning et al,1 Cimić et al,2,22,23 Boulos et al,3 Caro et al,4 Ahlers et al,5 Mehl,6
Pröschel et al,7 Hernandez et al,8 Kucukkeles et al,10 Boulos et al,11 Konaté et
al,12 dos Santos et al,13 Theusner et al,14 Piehslinger et al,15 Stamm et al,16 Hüe,17
Schierz et al,18 Torabi et al,19 Han et al,20 Curtis,21 Matsumura et al,24
Zwijnenburg et al25
Dentition Fully dentate 19 Schierz et al18
Partially dentate 27 Schierz et al18
Edentulous 79 Hüe,17 Schierz et al18
Angle class Angle class I 333 Cimić et al,2,22,23 Boulos et al,11 Konaté et al,12 Stamm et al,16 Torabi et al,19
Zwijnenburg et al25
Angle class II 47 Stamm et al,16 Cimić et al23
Angle class III 16 Cimić et al23
Sagittal SP Sagittal SP I 16 Canning et al1
Sagittal SP II 42 Canning et al1
Sagittal SP III 15 Canning et al1
Vertical SP Vertical SP reduced 20 Canning et al1
Vertical SP average 42 Canning et al1
Vertical SP increased 11 Canning et al1
SP, skeletal pattern.

one study), interocclusal relationship (396 patients, seven stud-
ies), and edentulous state (125 patients, two studies).
Variation in SCI depending on the movement
studied and the horizontal reference plane
For the comparative analysis of the SCI, 15 studies were retained
(Table 2). The SCI was mainly studied based on protrusive move-
ments (13 studies), four studies analyzed the SCI in the context
of mouth opening, and two studies during mediotrusion.
ence plane reported the following results: 53.3 degrees (SD not
defined [ND]) and 51.4 ± 9.75 degrees (Table 2), respectively. The
difference between the two values was not significant (P = .454),
and the mean for these two studies was 52.36 ± 9.75 degrees
(assimilating the overall SD to that reported by Boulos et al11).
Comparison of these two pairs of studies reveals that the
horizontal reference plane has a significant impact on the SCI
values measured during mouth opening (P < .001). Thus, the
SCI value reported was around 15 degrees smaller when the
Frankfort plane was used rather than the AOP.

SCI during mouth opening SCI during protrusion

The studies by Theusner et al14 and Han et al20 assessing SCI
during mouth opening, taking the Frankfort plane as reference
horizontal plane, provided the following values: 35 ± 7.5 degrees
and 40.01 ± 8.12 degrees (Table 2), with no significant difference
between the two studies (P = .148). The average value over these
two studies was 37.28 ± 7.78 degrees.
The studies by Kucukkeles et al10 and Boulos et al11 assessing
the SCI during mouth opening with the AOP as horizontal refer-
Difference between values at 3 and 5 mm: The SCI values during
protrusion were determined at variable condylar displacement
amplitudes. While mandibular range of motion during angle
measurement was not specified in six studies,2,9,10,13,21,22 seven
studies measured the SCI value at 3 mm and/or 5 mm of dis-
placements (Table 2).8,12,17-20,24 The statistical analysis grouping
together and comparing the results from these seven studies
revealed no significant differences between the values mea-

QUINTESSENCE INTERNATIONAL | volume 53 • number 1 • January 2022 81

 GENERAL DENTISTRY

Table 2 SCI measured with different extraoral recording devices and horizontal reference planes

SCI (SD)

Opening Protrusion Mediotrusion

No. of HR
Study* Age (y) patients plane‡ NS 1 mm 3 mm NS 3 mm 5 mm 3mm 5 mm
Curtis21 31 20 Denar NA NA NA 29.5 (5.7) NA NA NA NA
9
Maglione et al 30.8 50 F NA NA NA 53.6 (11.0) NA NA NA NA
Theusner et al14 22–56 12 F 35 (7.5) NA NA NA NA NA NA NA
13
dos Santos et al ND 10 F NA NA NA 38.3 (7.0) NA NA NA NA
Han et al20 25.4 10 F NA NA 40 (8.1) NA 39.5 (7.2) 36.5 (6.5) 44.7 (6.2) 41.6 (6.4)
Matsumura et al24 24.2 10 ACP NA NA NA NA 34.6 (5.5) 32.6 (4.4) 35.6 (5.8) 31.3 (4.6)
22
Cimić et al 25.1 58 C NA NA NA 40.8 (10.1) NA NA NA NA
Cimić et al 2† 25.1 51 C NA NA NA 46.3 (10.1) NA NA NA NA
10
Kucukkeles et al ND 31 AOP NA 53.3 (ND) NA 52.5 (ND) NA NA NA NA
Boulos et al11 22.5 30 AOP NA NA 51.4 (9.7) NA NA NA NA NA
Konaté et al12 ND 63 AOP NA NA NA NA NA 45.7 (7.4) NA NA
Hernandez et al8 20–60 45 AOP NA NA NA NA 48.8 (8.1) 48.7 (7.1) NA NA
Hüe17 69 60 AOP NA NA NA NA 42.8 (11.0) 44.5 (9.0) NA NA
18
Schierz et al 64.2 65 AOP NA NA NA NA 35.7 (11.9) 33.3 (11.3) NA NA
Torabi et al19 25 22 AOP NA NA NA NA 41.6 (5.5) NA NA NA
ACP, approximation of Camper plane (bilateral terminal hinge-axis points as posterior reference points and anterior reference point positioned on left wing of nose); AOP, axis orbital plane;
C, Camper plane; Denar, terminal hinge axis and one anterior reference point located 43 mm above the incisal edges of the maxillary anterior teeth or the patient’s lower lip border;
F, Frankfort horizontal plane; HR plane, horizontal reference plane; NA, not applicable; ND, not defined; NS, mandibular displacement effected during angle measurement not specified;
SCI, sagittal condylar inclination; SD, standard deviation.
*Stamm et al16 was excluded from the summary table because the mean value and SD were omitted.
†
In the results presented by Cimić et al,2 only the first movement sequence was considered.

sured at 3 and 5 mm (41.22 ± 9.71 degrees and 41.89 ± 8.62 de-
grees, respectively; P = .451).
Difference depending on the horizontal reference plane
used: The study by Han et al20 assessing the SCI during protru-
sion at 3 and 5 mm with the Frankfort plane as horizontal ref- f
erence plane reports a mean SCI of 38.01 ± 6.85 degrees
(n = 20). In contrast, the study by Matsumura et al24 assessing
the SCI during protrusion at 3 and 5 mm, taking a line approx-
imating Camper plane as horizontal reference plane, reports a
mean of 33.58 ± 4.95 degrees (n = 20). Furthermore, the mean
measurement for the five other studies8,12,17-19 assessing the SCI
during protrusion at 3 and 5 mm, which all took the AOP as
horizontal reference plane, was 42.12 ± 9.38 degrees (n = 425)
(Table 2).
As above, statistical analysis revealed no significant differ-
ence between the SCI values during protrusion at 3 and 5 mm
when using the Frankfort reference plane or the approximation
of Camper plane (P = .276). However, a significant difference
was found between the results of studies using the Frankfort
plane or the approximation of Camper plane and results from
studies using the AOP (P = .053 and P < .001, respectively).
SCI during mediotrusion
Two studies assessed SCI during mediotrusion: Han et al20 and
Matsumura et al.24 These studies related to asymptomatic
patients in similar age-groups, between 20 and 30 years of age.
SCIs were measured at 3 and 5 mm, with no significant differ-
ence found between the values measured (P = .189). The mean
SCI according to Han et al20 (taking the Frankfort plane as refer-
ence horizontal plane) was 43.18 ± 6.34 degrees (n = 10),
whereas according to Matsumura et al24 (taking an approxima-
tion of Camper plane as reference) it was 33.45 ± 5.22 degrees
(n = 10).
SCI as a function of movement type
According to Table 2, the values obtained in mediotrusion and
in protrusion can be compared based on two studies. The first
is that by Matsumura et al,24 reporting data from 10 patients

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 Bapelle et al

Table 3 Transversal condylar inclination measured in the studies analyzed

No. of Patient Mediotrusive

Study Recording system Age (y) patients characteristics tracing TCI SD
14
Theusner et al Electronic (SAM) 22–56 12 Grp 1: asympt 10 mm 7.6 4.8

37 Grp 2: TMD 10 mm 6.2 4.2

Piehslinger et al15 Electronic (Cadiax) 13–65 48 Grp 1: asympt 3 mm free 7.6 10.8

66 Grp 2: TMD 3 mm free 7.7 12.7

48 Grp 1: asympt 3 mm guided 16.5 16.4

66 Grp 2: TMD 3 mm guided 14.5 18.9

Zwijnenburg et al25 Optoelectronic (OKAS-3D) 22 20 Asympt – Angle class I 10 mm 8.1 4.0

Han et al20 Electronic (Cadiax) 25.4 10 Asympt 3 mm 6.9 2.9

8
Hernandez et al Electronic (Cadiax) 20–60 45 Asympt 3 mm 7.9 3.5
1
Canning et al Electronic (Cadiax) 22.8 73 Asympt (several SP) 10 mm 8.7 3.7
18
Schierz et al Electronic (Cadiax) 64.2 65 Asympt (variable N of teeth) 3 mm 7.7 7.1

Torabi et al19 Electronic (Cadiax) 25 22 Asympt – Angle class I 3 mm 10.6 4.3

Polyvinyl siloxane / 25 22 Asympt – Angle class I 3 mm 15.8 2.6

SL Gamma Dental

Wax / SL Gamma Dental 25 22 Asympt – Angle class I 3 mm 16.0 3.3

23
Cimić et al Ultrasonic (Kavo) 26 98 Asympt (several Angle classes) NS 7.7 5.4
asympt, no signs or symptoms of TMD; NS, not specified; SD, standard deviation; SP, skeletal pattern; TCI, transversal condylar inclination; TMD, signs or symptoms of TMD.

aged 24.2 years old. The mean values for displacements at 3
and 5 mm were 33.45 ± 5.22 degrees in mediotrusion and
33.58 ± 4.95 degrees in protrusion; the difference was not sig-
nificant. The second study was that by Han et al,20 which com-
pared the values obtained in protrusion, mediotrusion, and
mouth opening for 10 patients aged 25.4 years old. The values
at 3 mm were, respectively, 39.46 ± 7.17 degrees, 44.73 ± 6.25
degrees, and 40.01 ± 8.12 degrees; once again the differences
were not statistically significant.
The SCI results from one study which recorded the values
measured during mouth opening (Boulos et al11) could be
compared to those from a group of four studies (Hernandez et
al,8 Hüe,17 Schierz et al,18 and Torabi et al19) for which the SCI
was recorded during a protrusion movement. At 3 mm of con-
dylar displacement, the values were 51.4 ± 9.75 degrees
(n = 30) and 41.66 ± 10.03 degrees (n = 192), respectively.
Thus, the SCI value determined during mouth opening was
significantly greater than that determined during protrusion
(P < .001).
TCI in mediotrusion
Among the 20 studies selected, nine reported data on the TCI
measured during mediotrusion (Table 3).1,8,14,15,18-20,23,25 There
was no significant difference between the TCI values measured
by axiography in the different studies retained (P = .798).
Influence of patient characteristics on SCI and TCI
Age
To determine whether age had an influence on the SCI value,
the authors only retained studies that:
■ indicated the age of patients with a mean age of less than
30 or over 60
■ used the same horizontal reference plane
■ presented data from asymptomatic subjects.
Five studies which used the AOP as reference horizontal plane
were retained for the analysis (Table 4). The SCI values were

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 GENERAL DENTISTRY

Table 4 Condylar inclination relative to the AOP as a function of age-group (less than 30 or greater than 60 years) for asymptomatic patients

Age range No. of Movement - range of

(y) Study Age (y) patients Condylograph motion SCI mean (SD)
11
< 30 Boulos et al 22.5 30 Mechanic (FAG) Opening - 3 mm 51.4 (9.7)
Canning et al1 22.8 16 Electronic (Cadiax) Combination - 10 mm 46.7 (7.2)
19
Tourabi et al 25.0 22 Electronic (Cadiax) Protrusion - 3 mm 41.6 (5.5)
> 60 Schierz et al18 64.2 65 Electronic (Cadiax) Protrusion - 3 mm 35.7 (11.9)
Hüe17 69.0 60 Electronic (SAM) Protrusion - 3 mm 42.8 (11.0)
SD, standard deviation.

compared only for the same movement and with the same
level of condylar displacement (125 patients17,18 versus 22 pa-
tients19). According to these results, age did not have a signifi-
cant influence on the SCI value (P = .348) or the TCI values.
Symptoms and signs of TMD
Three studies included patients presenting signs of TMD
(Table 1).9,14,15 A single study compared the SCI values for a
group of patients with signs of TMD (37 patients) to those for a
group of asymptomatic subjects (12 patients).14 The SCI values
determined for the two groups were not significantly different.
Two studies compared TCI values for a group of patients
with signs of TMD (103 patients) to those measured for a group
of asymptomatic subjects (60 patients).14,15 The mean TCI values
determined for the two groups was not statistically different
(Table 3).
Interocclusal relationship or skeletal pattern
Three clinical studies compared the posterior determinants of
jaw kinematics for groups of patients with different interocclu-
sal relationships or skeletal patterns.
In the study by Stamm et al,16 the SCI measured by electronic
axiography (Cadiax) in 23 asymptomatic adult volunteers with
class II, division 2 deep-bite relationships were compared to the
SCI measurements for 30 asymptomatic adult volunteers with
normal occlusion. In Class II/2 subjects, the SCI angle in protru-
sion and mediotrusion was approximately 7 degrees greater.
In 2011, the study by Canning et al1 grouped subjects (n = 73,
mean age 22.8 ± 6.8 years) based on their underlying sagittal (I,
II, or III) and vertical (reduced, average, or increased) skeletal
patterns. SCI recordings were made for each subject using the
Cadiax Compact system (Whip Mix). Significance testing was
undertaken to determine the effect of horizontal and vertical
skeletal pattern on the SCI values using the Student t test. SCI
values for sagittal II subjects were significantly higher than
those for sagittal I (P < .05; 4 degrees) and sagittal III (P < .001;
7 degrees) subjects. No statistical difference was found be-
tween SCI values in the sagittal I and III groups. Subjects with
an average vertical skeletal pattern had lower SCI values than
those with a reduced vertical skeletal pattern (P = .058) or an
increased vertical skeletal pattern (P < .01, statistically signifi-
cant). No patterns could be determined for TCI between the
study groups.
Cimić et al23 used an ultrasonic Arcus Digma II (Kavo) to re-
cord TCI for 98 participants (26.0 ± 5.2 years) divided between
four study groups: Angle class I; Angle class II, division 1; Angle
class II, division 2; Angle class III. For each participant, three pro-
trusive, three left laterotrusive, and three right laterotrusive
movements were recorded. No significant differences between
Bennett angle values were found for different Angle classes of
occlusion. The average Bennett angle value for all participants
was 7.7 degrees.
Dental status
In Schierz et al,18 SCI and TCI were measured using computer-
ized axiography (Cadiax Compact 2, Whip Mix) in prosthodon-
tic patients (mean age 64.3 ± 10.3 years; 45% female) who were
classed in three dentition categories (fully dentate, n =19; par-
tially dentate, n = 27; and edentulous, n = 19). Their results indi-
cate no statistically significant impact of dental status on the
values determined.
Similarly, no significant difference was found between the
results from the noncomparative study by Hüe,17 reporting the
SCI recordings for completely edentulous subjects and the

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 Bapelle et al

Table 5 Comparison of intra- and extraoral recordings to determine SCI and TCI

Condylograph and intraoral recording /

Study No. of patients articulator HR plane SCI mean (SD) TCI (SD)
21
Curtis 20 Pantograph (Denar) Denar 29.5 (5.7) NA
Polyvinyl siloxane / Denar 28.3 (4.8)
Wax / Denar 25 (4.6)
dos Santos et al13 10 Wax / Hannau F 29.8 (9.2) NA
Mechanic (Whip Mix) 38.3 (7.0)
Boulos et al11 30 Mechanic (FAG) AOP 51.4 (9.7) NA
Polyether / Whip Mix 8500 46.3 (9.1)
Wax / Whip Mix 8500 50.8 (7.9)
Polyether / Dentatus 45.2 (8.7)
Wax / Dentatus 48.4 (8.0)
19
Torabi et al 22 Electronic (Cadiax) AOP 41.6 (5.5) 10.6 (4.3)
Polyvinyl siloxane / SL Gamma Dental 40.3 (4.4) 15.8 (2.6)
Wax / SL Gamma Dental 39 (3.6) 16 (3.3)
AOP, axis orbital plane; Denar, terminal hinge axis and one anterior reference point located 43 mm above the incisal edges of the maxillary anterior teeth or the patient’s lower lip border; F, Frankfort
horizontal plane; HR plane, horizontal reference plane; NA, not applicable; SCI, sagittal condylar inclination; TCI, transversal condylar inclination; SD, standard deviation.

results of three comparable studies using the same recording
system and the equivalent horizontal reference plane.8,18,19
Variation depending on the recording technique used:
intraoral records
Among the articles selected, four11,13,19,21 compared SCI values
recorded intraorally with those obtained using an extraoral
recording device, one19 also compared the TCI values obtained
with these systems (Table 5).
Discussion
Twenty articles were retained, corresponding to a total of 933
patients. Different groups were compared: 780 asymptomatic
subjects and 153 subjects presenting one or more signs of
TMD. In the asymptomatic group (780/933), 574 patients could
be classed in several subgroups based on skeletal pattern (73
patients), interocclusal relationship (396 patients), and edentu-
lous state (125 patients). Moreover, in addition to six distinct
recording systems, six different horizontal reference planes
were used when measuring the condylar inclination. This com-
plicated the compilation and interpretation of the results.
As would be expected, and contrary to the initial null hy-
pothesis, the horizontal reference plane has a significant impact
on the SCI values in protrusion. The SCI value measured when
taking the AOP (42.13 ± 9.38 degrees) as horizontal reference
plane was greater by around 8.55 degrees relative to when an
approximation of Camper plane (33.58 ± 4.95 degrees) was
used, and 4.12 degrees relative to the Frankfort plane
(38.01 ± 6.85 degrees). In addition, when comparing the means
from studies using the AOP as horizontal reference plane (based
on indications from the material and methods sections for mea-
surement of the SCI at 3 and/or 5 mm) one study18 (n = 130,
34.48 ± 11.65 degrees) gave a significantly different result
(P < .001) compared to the other four8,12,17,19 (respectively: n = 63,
45.7 ± 7.42 degrees; n = 90, 48.77 ± 7.6 degrees; n = 120, 43.65
± 10 degrees; n = 22, 41.65 ± 5.55 degrees). Thus, the other four
studies reported substantially higher values than those reported
by Schierz et al,18 where the SCI angles were between 30 and 37
degrees. The reason for this difference might be a different defi-
nition of the reference plane of the patient’s cranium. The mean
age of participants was not significantly higher, and thus could
not explain the difference. Excluding data from Schierz et al18
from the comparison, the SCI value measured when taking the
AOP (42.13 ± 9.38 degrees) as horizontal reference plane was
greater by around 10.14 degrees relative to when an approxima-
tion of Camper plane (33.58 ± 4.95 degrees) was used, and 5.71
degrees relative to the Frankfort plane (38.01 ± 6.85 degrees).
The null hypothesis that the type of movement has no influ-
ence on the value of SCI has not been confirmed. The SCI for

QUINTESSENCE INTERNATIONAL | volume 53 • number 1 • January 2022 85

 GENERAL DENTISTRY
different type of movements could be compared if the same
horizontal reference plane was applied, and if the angle was
measured at the same amount of mandibular displacement.
The values obtained in mediotrusion and in protrusion can be
compared based on two studies20,24 and the differences were
not statistically significant. Otherwise, the compilation of five
studies (using AOP), showed that the SCI value determined
during mouth opening (51.4 ± 9.75 degrees, n = 30)11 was sig-
nificantly greater than that determined during protrusion
(41.66 ± 10.03 degrees, n = 192)8,17-19 (P < .001). However, para-
doxically, Han et al,20 which was the only study to compare the
values obtained in protrusion, mediotrusion, and mouth open-
ing (10 patients), showed that the differences were not statisti-
cally significant.
The null hypothesis that the patient’s personal characteris-
tics would not influence the SCI value has been partially con-
firmed. According to the present literature analysis, the
patient’s age1,11,17-19 and dental status8,17-19 did not have a signif-
f diax measurements correlated better with silicone records, but
icant influence on the SCI value.
Only one study14 compared the SCI values for a group of
patients with signs of TMD (37 patients) to those for a group of
asymptomatic subjects (12 patients). The SCI values deter-
mined for the two groups were not significantly different. How-
ever, the difference calculated between the traces for maximal
opening and closing compared to traces for protrusive and
retrusive movements was significantly greater in the symptom-
atic group.14
Two clinical studies compared the SCI for groups of patients
with different interocclusal relationships or skeletal patterns. In
the study by Stamm et al,16 in a group of Angle class II/2 sub-
jects, the SCI angle was approximately 7 degrees greater than
in the control group. The open-close movement proceeded
uncharacteristically, significant differences were observed only
in protrusion, or mediotrusion, and their combined rotation
component. This group rotated their jaws to a significantly
higher angle in protrusive and mediotrusive movements and
had longer condylar path lengths than the control group.
Canning et al1 grouped subjects based on their underlying
sagittal (I, II, or III) and vertical (reduced, average, or increased)
skeletal patterns. SCI values for sagittal II subjects were signifi-
cantly higher than those for sagittal I (P < .05; 4 degrees) and
sagittal III (P < .001; 7 degrees) subjects. No statistical difference
was found between SCI values in the sagittal I and III groups.
Subjects with an average vertical skeletal pattern had lower SCI
values than those with a reduced vertical skeletal pattern
(P = .058) or an increased vertical skeletal pattern (P < .01, sta-
tistically significant).
86 QUINTESSENCE INTERNATIONAL | volume 53 • number 1 • January 2022
Based on the present literature analysis, the average Ben-
nett angle value obtained with extraoral recording device
appears to be approximately 8 degrees. This information should
be considered when programming average values into an artic-
ulator. The null hypothesis that the patient’s personal charac-
teristics would not influence the TCI value has been confirmed.
The TCI value was unaffected by the patient’s age, skeletal pat-
tern, Angle class, number of residual teeth, and the presence of
signs and symptoms of TMD. However, interestingly, one
study15 reported a highly significant difference between Ben-
nett angles for free and guided movements (P < .001) in the
direction of an increase by around 7 to 9 degrees.
Concerning the comparison of intra- and extraoral record-
ings, Curtis21 reported better agreement between axiography
(Pantograph, Denar) and intraoral recording with silicone
rather than wax (P < .05) associated with the Denar articulator.
The results presented by Torabi et al19 also indicated that Ca-
the differences between Cadiax and intraoral records were sta-
tistically significant for all measurements. Similarly, dos Santos
et al13 revealed a significant difference between the results ob-
tained by extraoral tracing and wax protrusive records. In con-
trast, according to Boulos et al,11 most combinations of eccen-
tric interocclusal recording techniques were statistically similar
to the axiographic technique. This result appears to contradict
other studies, which reported unreliable results with eccentric
interocclusal recording techniques. The findings reported indi-
cated that, as an interocclusal recording material, wax was as
reliable and valid as elastomeric materials. Whatever the study,
the Bennett angles recorded were lower,19 and the sagittal con-
dylar inclination values were higher11,13,19,21 when using elec-
tronic or mechanical axiography rather than routine intraoral
recording methods.
Conclusion
The age, dental status, and presence of symptoms and signs
of TMD in subjects had no influence on SCI values, whereas
the Angle class II/2, class II sagittal pattern, or increased verti-
cal skeletal pattern parameters did significantly increase SCI
values.
By combining the data from all studies selected, the litera-
ture review and meta-analysis revealed that the jaw movement
engaged has an impact on the SCI value. Indeed, during mouth
opening, the SCI was significantly greater than during protru-
sion, by around 10 degrees. However, the SCI values were
equivalent in protrusion and mediotrusion.
 Bapelle et al

The patient characteristics, like the extraoral recording
device, did not significantly influence the TCI values measured
in the various studies retained. The current combined analysis
suggested that the average Bennett angle value was approxi-
mately 8 degrees.
The reliability of intraoral recordings could be questioned.
Indeed, the data showed a trend for lower TCI, and higher SCI
values obtained using electronic or mechanical axiographs
compared to values determined from intraoral recordings.
The literature review presented here highlights the wide
variety of studies undertaken to record mandibular kinematics.
The recording systems used to measure condylar inclination
were very varied and used six distinct horizontal reference
planes. The latter, as expected, had a significant impact on the
SCI values determined. This result confirms the need to transfer
the patient’s personal plane of reference to the system if accu-
rate kinematic simulations are to be performed. These data
must therefore be integrated into the digital flux in a rehabili-
tation setting.
Disclosure
The authors have no conflict of interest to declare. There are no
funding sources to declare.

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QUINTESSENCE INTERNATIONAL | volume 53 • number 1 • January 2022 87

 GENERAL DENTISTRY

Mathilde Bapelle Dr,r Oral Rehabilitation Department, Faculty of
Dentistry, Université Côte d’Azur, University Hospital Center of
Nice, Nice, France
Julien Dubromez Dr,r Oral Rehabilitation Department, Faculty of
Dentistry, Université Côte d’Azur, University Hospital Center of
Nice, Nice, France
Charles Savoldelli University Lecturer, Hospital Practitioner,r
Oral and Maxillofacial Surgery, Faculty of Medicine, Institut Univer-
sitaire de la Face et du Cou, Université Côte d’Azur, University Hos-
pital Center of Nice, Nice, France; and Biomechanics / Department
of Computational Mechanics & Physics CEMEF - MINES ParisTech,
PSL Research University, CNRS UMR 7635 CS10 207, Sophia Anti-
polis, France
Yannick Tillier Professor,r Biomechanics / Department of Compu-
tational Mechanics & Physics CEMEF - MINES ParisTech, PSL Re-
search University, CNRS UMR 7635 CS10 207, Sophia Antipolis,
France
Elodie Ehrmann University Lecturer, Hospital Practitioner, Oral
Rehabilitation Department, Faculty of Dentistry, Université Côte
d’Azur, University Hospital Center of Nice, Nice, France; and Bio-
mechanics / Department of Computational Mechanics & Physics
CEMEF - MINES ParisTech, PSL Research University, CNRS UMR 7635
CS10 207, Sophia Antipolis, France

Correspondence: Dr Elodie Ehrmann, Faculté de Chirurgie-Dentaire, Université Côte d’Azur, 24 Avenue des Diables Bleus, 06357 Nice
Cedex 04, France. Email: elodie.ehrmann@univ-cotedazur.fr

88 QUINTESSENCE INTERNATIONAL | volume 53 • number 1 • January 2022