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 Author's personal copy
J. Stomat. Occ. Med. (2012) 5:119–129
DOI 10.1007/s12548-012-0053-8
Three-dimensional analyses of the mandible
and the occlusal architecture of mandibular dentition
Hiroshi Fukoe, Cristian Basili, Rudolf Slavicek, Sadao Sato, Susumu Akimoto
Received: 5 April 2011 / Accepted: 11 June 2012 / Published online: 8 August 2012
© Springer-Verlag 2012
Abstract
Introduction The position and inclination of the long
axis of teeth in the human dentition can be described
by a set of rules. The purpose of this study was to analyze
the architecture of the mandibular dentition of adult
Caucasians using virtual three-dimensional (3D) recon-
struction of skulls and mandibles.
Method In this study 40 skulls from the Weissbach
collection at the Vienna Natural History Museum were
scanned using cone beam computed tomography. Sev-
eral angular and linear measurements obtained from
the reconstructed images were analyzed.
Results The inclination of second premolars and first
molars was nearest to vertical and mesial inclination
became progressively greater for molars. The angular
relationship between the tooth long axis and the closing
axis of lower incisors ranged from 95 to 98°, while the
tooth axis of buccal teeth with the contralateral condyle
sequentially increased from canines to third molars.
The architecture of occlusion showed that the Bonwill
triangle was equilateral with a length of approximately
100 mm (about 4 inches) on one side, the Balkwill angle
was approximately 25° and there was a distance of ap-
proximately 38 mm between the condyle and occlusal
plane (DPO). The angle of the condylar axis inclined to
correlate to the 3D structure of the mandible.
C. Basili ( ) · H. Fukoe · S. Sato, M.D. · S. Akimoto
Department of Craniofacial Growth and Development Dentistry,
Division of Orthodontics, Research Institute of Occlusion
Medicine, Research Center of Brain and Oral Science,
Kanagawa Dental College, 82 Inaoka-cho,
238-8580 Yokosuka, Kanagawa, Japan
e-mail: cristianbasili@gmail.com
S. Akimoto
e-mail: akimoto5895s@kdcnet.ac.jp
C. Basili
Department of Pediatric and Preventive Dentistry,
Universidad de Valparaiso, Valparaiso, Chile
R. Slavicek
Danube University, Krems, Austria
Three-dimensional analyses of the mandible and the occlusal architecture of mandibular dentition
original article
Conclusions This study defines the 3D architecture
of occlusion including tooth axis, condyle and shape of
the mandible. The results make it possible to consider
new aspects of the biomechanics of 3D reconstruction
of occlusion.
Keywords: Occlusion, Tooth axis, Sagittal inclination,
Vertical inclination, Sequential occlusion, Skull, 3D
computed tomography
Introduction
The occlusal architecture is closely related to mandibular
movements including chewing and grinding. The posi-
tion and inclination of the teeth in the three-dimensional
(3D) arrangement of the dentition is influenced by the
morphology, muscle activity or function and other fac-
tors. In addition, they are governed by some general rules
[9, 10, 12] which have been reported by many researchers.
Occlusal strength must be directed along the long axis of
the tooth and the direction of occlusal strength must be
geometrically related to the occlusal plane [13, 16]. These
rules apply especially to carnivorous animals; however,
as a result of chewing the morphology of the human mas-
ticatory organ has greatly changed phylogenetically.
From an ontogenetic point of view, during craniofacial
growth the vertical gap between the level of the condyle
and the occlusal plane gradually widens from the time
when the extension of the occlusal plane in early decidu-
ous dentition goes through the condyle to the time when
the greatest distance between the occlusal level and ver-
tical position of the condyle develops [6, 11, 12]. This type
of jaw growth creates functional problems. Mandibular
movement in any direction creates separation between
the upper and lower teeth and affects the efficiency of
chewing. The elements of occlusion including occlusal
plane, tooth axis, vertical dental height and height of the
mandibular ramus are altered during growth and each
of these changes influences the sophisticated system of
functional occlusion. Therefore, clinicians must under-
119
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original article
stand the rules that nature has established for occlu-
sion in order to successfully treat problems of human
occlusion.
Spee [20], who reported his research more than 100
years ago, connected the anterior surfaces of the man-
dibular condyles to the tips of the canines following the
buccal tips of premolar and molar teeth with an arc of a
circle tangential to the surface of a cylinder lying perpen-
dicular to the sagittal plane. He also reported that this
geometric arrangement is the most efficient pattern to
maintain maximum tooth contacts while chewing. This
theory became the basis of Monson’s spherical theory
of the ideal arrangement of teeth for the dental arch in
which occlusal curvature is described in the sagittal and
frontal planes as the tangent of a sphere with a radius of
approximately 4 inches.
Page [16] introduced the “tangent law”, a geometric
principle of the mandibular dentition sagittal organiza-
tion in relation to the center of rotation in the condyle.
These studies were followed by subsequent researchers
[11, 13]. Understanding the rules to evaluate the natural
position and inclination of teeth is important for trea-
ting patients orthodontically, prosthodontically or with
implants, where the positions of the teeth differ from the
so-called normal position. Some researchers have repor-
ted various methods for measuring the dental inclina-
tion, generally bounded by the clinical crown inclination
[1, 9, 10], or limited by two-dimensional radiographs [13].
The revolutionary 3D computerized technology (CT)
allows this limitation to be overcome and dental incli-
nation can be calculated from the spatial coordinates,
where geometrical and mathematical models allow
angular or linear values to be evaluated according to a
reference system.
The purpose of this study was to analyze the archi-
tecture of the mandibular dentition on 3D computed
tomography (CT) of the reconstructed skulls of adult
Caucasians and to compare two methods of measure-
ment of the tooth axis.
Material and methods
Collection of skull samples
The sample comprised 40 Caucasian skulls randomly
selected from the Weissbach Collection at the Natural
History Museum of Vienna. This research protocol was
approved by the Donau University, the Kanagawa Den-
tal College Research Committee and the Natural History
Museum of Vienna. Augustin Weissbach (1837–1914), an
Austrian military physician/pathologist, collected these
skulls while employed at the military hospital in Cons-
tantinople, Turkey, in the second half of the nineteenth
century. Most of the skulls came from soldiers who ser-
ved in the Austro-Hungarian Imperial Army. Weissbach
donated his private collection to the Department of
Anthropology and Ethnography at the Natural History
Museum of Vienna in 1885. Archival records show that
120 Three-dimensional analyses of the mandible and the occlusal architecture of mandibular dentition
the skulls mainly belonged to adult male soldiers who
died at an age of 19–50 years [2–4].
The skulls were selected for examination on the basis
of the following criteria:
• no cranial deformities,
• complete skull bone structure and
• presence of a clinically acceptable occlusion with a
stable position of the mandible and a reproducible
occlusion.
A team of orthodontists checked the occlusion of each
specimen to confirm stability and reproducibility. Sili-
cone plaster was placed in the joint space to fill the area
between the mandibular fossa and the condylar head to
improve stability. Prior to taking skull images the denti-
tion of each specimen was rechecked and placed in sta-
ble maximum intercuspation. A custom-made plastic
head holder was constructed to support skulls during
CT scanning which were positioned with a laser marker,
according to the manufacturer’s instructions.
Cone beam computer tomography
Cone beam computer tomography (CBCT) scan images
were acquired with the Galileo Compact (Galileo, Sirona
Company System, Bensheim, Germany) at 220 V and
a frequency of 50/60 Hz with a total filtration of radio-
graph tube assembly > 2.5 Al. The cone-beam angle was
collimated to approximately 24° with an orbital angle of
204°. The scanning time was approximately 14 s and the
number of single exposures was 200 for each skull. The
field of view was 15 cm in diameter and 15 cm in height.
As the samples did not have a soft tissue component,
exposure parameters were controlled by automatic expo-
sure control. The CBCT data were exported from the Side-
xis XG (Sirona Dental System) software p-data base in a
4 Tb Lan disk HDL-GTR (I-O Data, Kanazawa, Japan) in
Dicom multifile format and imported into Maxilim soft-
ware version 1.0 (Medicim, Mechelen, Belgium) installed
in a Dell Precision T3400 computer (Dell, Texas, United
States). Maxilim models were obtained and re-evaluated
by a single calibrated operator. These 3D reconstructed
skull models were reanalyzed on the basis of the follow-
ing criteria:
• available nasion landmarks,
• available sella landmarks,
• skeletal basic structures and
• no healing in the antagonist alveolus in cases of
absence.
Three-dimensional cephalometric analyses
Computerized establishment of 3D reference planes
were defined (Fig. 1) and a 3D cephalometric analysis
was designed with 53 different landmarks (Figs. 2 and 3)
 Author's personal copy
Fig. 1 (Left): Lateral view of a three-dimensional computer to-
mography scan of a skull with the projection of the horizontal
plane and the vertical plane from a left view. Horizontal plane
(HP): automatically computed plane 6° below a line between
sella-nasion landmarks along the horizontal direction of the
natural head position. Vertical plane (VP): Plane through Sella
landmark and perpendicular to the horizontal plane and sagit-
tal plane. Sagittal plane (SP): Plane through sella and nasion
landmarks perpendicular to the HP. (Right): Rotated image of
the three-dimensional skull showing the VP, HP, and the SP
which were located on the skulls using an optical mouse
on a 69 cm (27 inch) screen (Dell). A total of 64 angular
measurements was obtained with the Maxilim software.
All the angular and linear 3D cephalometric measure-
ment data were exported and recorded with the original
skull identification number. Excel files were exported to
SPSS software for statistical analysis to record the data.
Reference planes
The 3D inclination of each tooth was measured in rela-
tion to different reference planes (Fig. 1) which were
automatically computed by the Maxilim software after
the initial setting of the skull and the establishment of the
landmarks for sella-nasion (S-N). The settings of the skull
were consistent in the horizontal position with the virtual
grids and lines of the reference. The skull was vertically
positioned matching the virtual grid lines to the Frank-
furt plane. Sella-nasion landmarks are automatically
required initially by the software and the landmarks were
located in the computerized skull with anatomical views
and the use of frontal and lateral virtually created cepha-
lograms. With this information, the horizontal plane was
automatically established by the software definitions 6°
below the S-N line. At the same time, the sagittal and ver-
tical planes were set perpendicular to each other.
Landmarks for measurement of tooth axis
In a previous study two different methods of tooth axis
measurement were compared. The first method was defi-
ned as the axis line, which corresponds to the line esta-
blished from the occlusal landmark to the root landmark
in all teeth. Occlusal landmarks were defined as the mid-
Three-dimensional analyses of the mandible and the occlusal architecture of mandibular dentition
original article
point of the incisal edge of the lower incisors, the buccal
cusp tip of canines and premolars and the external sur-
face of the central fossa of the molars. Root landmarks
were defined as the mid-point of the anatomical root in
teeth with one root and the furcation of teeth with more
than one root. The second method was called the “root
line”, which corresponds to the line from the occlusal
landmark to the apex landmark defined as the apex of
teeth with one root or the mid-point between the apex
of the root in teeth with more than one root. The result
showed that the 3D measurement could be influenced by
these variations and that the use of the apex landmark
for measuring the tooth axis should be avoided which is
why the tooth axis of the axis line was chosen for measu-
rement in this study.
The occlusal plane was defined as the plane connec-
ting the lower central incisor point and the centro-buccal
cusps of right and left first molars. Condylar landmarks
were established as the 3D central point (center of con-
dyle), the most convex point of the lateral pole (late-
ral pole) and the most convex point of the medial pole
(medial pole; Fig. 3).
Linear and angular measurements
Inclination of tooth axis: For each quadrant, the tooth
inclination with respect to the sagittal plane, from a
frontal view, was considered to be positive if the root-
occlusal inclination was directed towards the same side
of the mouth (i.e., for the posterior teeth in the buccal-
vestibular direction; for the anterior teeth in a direction
diverging from the sagittal plane). In the measurement
of tooth axis with respect to the vertical plane, from a
lateral view, positive angles were those with the root-
occlusal inclination directed from posterior to anterior.
Angles consisted of the intersection of the lines between
condyle (ipsilateral or contra-lateral) and each occlusal
landmark. Tooth long axes were measured for all teeth.
Distance from occlusal landmark to second molar
occlusal plane OP7: For this measurement, the occlu-
sal plane which connected the line through lower incisor
and disto-buccal cusps of lower second molars was used
as a reference and the distance between the occlusal
plane and occlusal landmarks was measured. This mea-
surement characterizes the curve of Spee (Fig. 4).
Angle of closing axis and occlusal plane: The Balkwill
angle was measured. The Bonwill triangle consists of
both right and left condyle points and lower incisal point
and the lower occlusal plane (Fig. 5).
Measuring the mandibular condyle parameters: Con-
dylar landmarks were center point, lateral pole point and
medial pole point (Fig. 3). The measurements of inter-
condylar distance, interlateral pole distance and inter-
medial pole distance were established (Fig. 6a). The line
connecting the lateral pole and medial pole was defined
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original article

Fig. 2 a Landmarks for

measuring tooth axes. The
measurement of the tooth
axis was developed as axis
line, which correspond to
the line connecting the
occlusall and mark to the
root landmark in every tooth.
Occlusall and mark was
defined as the mid-point of
the incisaledge in the lower
incisors, the bucal tips of
canines and premolars and
the external surface of the
central fossa in molars. b
Frontal X-ray view of the
difference between tooth
long axes (A) mid-point of
the anatomical root, (B) point
of root ápex. (A) was used
in this study. c Slice image
showing the difference that
exist in (B) when the root is
curved. d Frontal image of
the three-dimensional skull
representing the different
tooth long axes

Fig. 3 Landmarks for measuring three-dimensional struc- vex point (M). c Superior view of the mid-point between
ture of the condyle. a Most central point from a lateral distal and medial convex point. Landmark is indicated
view of the condyle. b Frontal view of the mid-point bet- by arrows
ween most lateral convex point (L) and most medial con-

as the condylar long axis. The intercondyle axis angle and
the angle formed by the condylar long axis and inter-
condyle connected line (condylar axis angle) were also
measured. In order to find the relationship between the
form of the mandible and the condylar axis angle, the
correlation between- the condylar long axis and relative
mandibular length, which is the anterioposterior length
of the mandible divided by the intercondylar length, was
calculated (Fig. 6b).
Statistical analysis
A standard statistical software package SPSS version 15
for Windows (SPSS, USA) was used for data analysis. Stan-
dard descriptive statistics (means and standard devia-
tions) were computed for each of the measurements.
Pearson’s r was calculated for the same measurements.
Results were deemed to be statistically significant if
p < 0.05. To determine intraobserver reliability and assess
the error of this cephalometric method, 3D tracings of
ten randomly selected skulls were measured again by
the same examiner 1 month later. Random and stan-
dard errors were calculated by correlation and showed
values between 0.79–0.98. A paired sample t-test was car-
ried out between the first and second angular and linear
measurements individually. The level of significance was
p < 0.05 and no systematic errors were detected.

122 Three-dimensional analyses of the mandible and the occlusal architecture of mandibular dentition
 Author's personal copy
Fig. 4 Measurement of the distance between the occlusal
plane and occlusal landmarks. In this particular measurement
the line connecting the lower incisor and disto-buccal cusp
of lower second molars was used as the occlusal reference
plane. The distance between the occlusal plane and occlusal
landmarks was measured
Fig. 5 (Left): Measurement angle consisted of closing axis
and occlusal plane (Balkwill angle). (Right): Angle formed by
the Bonwill triangle (green triangle), which consisted of both
right and left condyle points and lower incisal point (the clo-
sing axis) and the lower oclusal plane (grey triangle), which
was formed by connecting the lower interincisal point and oc-
clusal points of both right and left first molars
Results
Tooth axis to the sagittal reference plane
When the tooth axis was measured with respect to the
sagittal plane there were differences between the ante-
rior and posterior teeth. The anterior teeth showed posi-
tive angles, whereas canines, first premolar and central
incisors were oriented vertically. Posterior to the second
premolar the angles were negative and there was a pro-
gressive tendency for the inclination of posterior teeth to
increase (Fig. 7).
Three-dimensional analyses of the mandible and the occlusal architecture of mandibular dentition
original article
Fig. 6 Measurements related to mandibular architecture. a
Intercondylar distance, interlateral pole distance, and inter-
medial pole distance were measured. The line connecting the
lateral pole and the medial pole was created as the condylar
long axis. The inter-condyle axis angle and angle formed by
the condylar long axis and inter-condylar connected line (con-
dylar axis angle) were also measured. b Correlation between
the condylar long axis and relative mandibular length, for
which the antero-posterior length of the mandible was divided
by the inter-condylar length, was calculated
Tooth axis to the vertical reference plane
Tooth axis measurements to the vertical plane sho-
wed mesial inclinations. The inclination progressively
decreased from incisors to the posterior teeth and the
first molar, which showed the most upright orientation.
For the second and third molars, the inclination increa-
sed again with a strong mesial inclination (Fig. 8).
Three-dimensional distance between the occlusal
landmarks and the contralateral condyle
From central incisors to first premolars, distances bet-
ween the occlusal landmarks and the contralateral con-
dyle were almost equal, in the range of 100–105 mm,
indicating that the anterior teeth form a circular arch
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original article

Fig. 9 Box and whisker graph showing the mean values of the
distance between the occlusal landmark and the contralateral
condyle. The teeth are represented by numbers from 1 to 8.
The right-side teeth are represented in blue and the left-side
Fig. 7 (Left): Graphic representation of the tooth axis and the teeth in red
angular relationship to the vertical plane (VP) and the sagittal
plane (SP). (Right): Box and whisker graph showing the mean
values of the angles between each tooth axis related to the
sagittal plane (SP). The teeth are represented by numbers
from 1 to 8. The right-side teeth are represented in blue and
the left-side teeth in red

Fig. 10 Box and whisker graph showing the mean values of

the distance between the occlusal landmark and the ipsilateral
condyle. The teeth are represented by numbers from 1 to 8.
The right-side teeth are represented in blue and the left-side
teeth in red

Fig. 8 Box and whisker graph showing the mean values of the
angles between each tooth axis related to the vertical plane
(VP). The teeth are represented by numbers from 1 to 8. The
right-side teeth are represented in blue and the left-side teeth
in red

with respect to the condyle. Moving posteriorly from

the second premolar, the distances gradually decreased
(Fig. 9).

Fig. 11 Box and whisker graph showing the mean values of

Distance between the occlusal landmarks
and the ipsilateral condyle on 3D images
Distances between the occlusal landmarks and the ipsi-
lateral condyle decreased sequentially (Fig. 10).
Three-dimensional tooth axis
to the contralateral condyle
the angles between lines connecting the contralateral condyle
and each occlusal landmarks and tooth axes. The teeth are
represented by numbers from 1 to 8. The right-side teeth are
represented in blue and the left-side teeth in red
gradually increased from 103 to 120°, indicating a progres-
sive uprighting of the tooth axis with respect to a line tan-
gent to the mandibular functional closing axis (Fig. 11).

The angle between the tooth long axis and the closing axis
of the contralateral condyle, which is a line that connects
the contralateral condyle and the occlusal landmark,
was approximately 95° for incisors and close to 100° for
canines. Posteriorly from the first premolar, the angles
Three-dimensional tooth axis
to the ipsilateral condyle
The angle between tooth long axis and the closing axis
of ipsilateral condyle, which is a line that connects the

124 Three-dimensional analyses of the mandible and the occlusal architecture of mandibular dentition
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original article

Table 1 Linear measurements of structural parameter asso-

ciated with the mandibular structure
Measurements Mean SD
Intercondyle distance (mm) 98.8 ±5
Interlateral pole (mm) 117.5 ± 5.5
Intermedial pole (mm) 80.5 ± 4.5
Condyle-incisor distance (mm)
Right 101.6 ± 4.7
Left 100.9 ± 4.4
Condyle length (mm)
Fig. 12 Box and whisker graph showing the mean values of
Right 20.0 ± 1.9
the angles between lines connecting the ipsilateral condyle
and each occlusal landmarks and tooth axes. The teeth are Left 20.0 ± 2.0
represented by numbers from 1 to 8. The right-side teeth are DPO (mm) 38.1 ± 3.3
represented in blue and the left-side teeth in red DPO distance between the condyle and the cross point of the condyle
perpendicular to the occlusal plane

Table 2 Angular measurements of structural parameters

Fig. 13 Graph showing the mean values of the distance bet-
ween the occlusal landmark and the second molar occlusal
plane OP7. The teeth are represented by numbers from 1 to 8.
The right-side teeth are represented in blue and the left-side
teeth in red
ipsilateral condyle and the occlusal landmarks, was
95–100° for incisors and close to 100° for canines. From
first premolar to first molar, the orientation of teeth was
closest to vertical, while the angles of second and third
molars were smaller (Fig. 12).
Distance from the occlusal landmark of each
tooth to the second molar occlusal plane OP7
(curve of Spee)
Measurements of the distance between the occlusal
landmark of each tooth and the occlusal plane showed
that values increased from canines to first molars, while
second molars showed a smaller value, indicating a slight
curvature of the buccal segment of the occlusal surface
(Fig. 13).
Three-dimensional architecture of the mandible
The distance between the lower incisor point to both
right and left condylar points was 101.6 mm and
100.9 mm on the right and left sides, respectively and the
intercondylar distance was 98.8 mm (Table 1). The trans-
versal length of the condyle was 20.0 mm on both sides.
The distance between the condyle and the cross point of
associated with the mandibular structure
Measurements Mean SD
Condylar axis angle (°)
Right 17.0 ± 6.6
Left 18.2 ± 5.3
Intercondylar axis angle (°) 144.8 ± 10.6
Balkwill angle (°) 25.4 ± 2.4
the condyle perpendicular to the occlusal plane (DPO)
was 38.1 mm.
The angle between the condyle axis and the line con-
necting right and left condyles was 17.0 and 18.2° on the
right and left sides, respectively, while the intercondyle
axis angle was 144.8° (Table 2) and the Balkwill angle was
25.4°.
In order to know the relationship between the ante-
roposterior dimension of the mandible and the condylar
axis, the correlation between the relative anteroposterior
length of the mandible and the condylar axis angle was
calculated. The correlation coefficient r was 0.261 and
the p-value was 0.064. Although the correlation was not
statistically significant, it was close to significance, indi-
cating that there was some relationship between these.
Discussion
In this study the architecture of occlusal relationships
of the human skull and mandible was analyzed using
3D-CBT. The inclination of the tooth axis was analyzed
in three dimensions with a group of skulls to describe its
relationship to the sagittal and vertical references planes.
The occlusion, including the tooth long axis and structure
of the mandible could be reconstructed, which would
have been hard to show with 2D cephalometric analyses.
In traditional 2D analyses the tooth axis is defined as the
line from the tip of the tooth or middle of the crown to
the apex of the tooth; however, these definitions change

Three-dimensional analyses of the mandible and the occlusal architecture of mandibular dentition 125
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original article

when 3D is introduced. In this study a new definition of

3D tooth axis was created in order to show the variability
of tooth anatomy, which is especially observed in the api-
cal third of the root, where due to different influencing
factors, such as eruption, tooth development and func-
tion, a displacement of the apex is frequently identified.
For these reasons axis line was used in this study, corre-
sponding to the line connecting the occlusal landmarks
to the root landmarks, which is defined for single-rooted
teeth as the mid-point of the anatomical root and for
multi-rooted teeth as the furcation of the tooth.
The present study provides an insight into the arran-
gement of teeth that differs from previous observati-
ons [13]. Lower anterior teeth from the central incisors
through first premolars had a negative inclination to the
sagittal reference plane, while second premolars through
third molars showed progressively increased positive
values, which indicated a lingual inclination (Fig. 7).
Anteroposterior inclination of the tooth long axis showed
that lower anterior and posterior teeth, including inci-
sors, canine and second and third molars, were mostly
mesially inclined against the vertical reference plane,
while the first premolars through first molars were mostly
upright (Fig. 8). When the relation of the tooth long axis
to the closing axis (a line between the occlusal landmarks
and contralateral or ipsilateral condyle) was observed,
the angle of the long axis of lower incisors ranged from
95 to 98°, while that of the tooth axis of buccal teeth with
the contra-lateral condyle showed a sequential increase
from canine to third molar (Fig. 14). The tooth axis with
the ipsilateral condyle showed increasing values from
central incisors to first molars but decreased in second
and third molars. Previous reports of tooth long axis
against closing axis with 2D measurements indicated
that the lower incisor axis was about 90° and posterior
segments were progressively smaller [13]. The present
results differ from previous studies due to different mea-
surement methods in 2D and 3D. These results provide
new ways to consider the biomechanics of 3D represen-
tation of occlusion.
Understanding the rules that govern occlusal relati-
onships, including evaluation of the natural position and
inclination of the dentition, is important for rehabilita-
ting patients in all disciplines, including orthodontics,
implantology and prosthodontics, in which positional
relationships of the dentition that are not normal are
concerned. Some researchers have proposed different
methods for measuring the inclination of teeth, which
were generally limited to the clinical crown inclination
[1, 9, 10] or were subject to the known limitations of 2D
radiographic methods of visualization [13]. The revolu-
tionary 3D computerized technology has overcome these
limitations. Dental inclination can now be calculated
with geometrical and mathematical models to evaluate
angular or linear values based on a reference system.
The second premolars and first molars showed the
most upright position. The tooth inclination increased
progressively to the last molars. This finding could be
related to functional influences as this area receives the
Fig. 14 Three-dimensional relationship of the tooth long axes
and the closing axis on a selected three-dimensional skull.
Mean values of the sample for each teeth are represented by
mean angle value and the number of each teeth (angle/num-
ber of the teeth). Lower incisors were from 95 to 98°. Buccal
teeth with contralateral condyle showed a sequential increase
from canine to third molar, which formed a functional unit as a
chewing organ. From the biomechanical point of view, these
arrangements of tooth long axis provide enhancement of the
crush/shear ratio power stroke of mastication
most intense force as a result of mastication, which indi-
cates that this spatial position could help in force dis-
tribution through the mandible or some influence from
muscle activity. The inclination of the other teeth could
be functionally influenced by other biomechanical fac-
tors, such as size or morphological shape of the mandi-
ble that affect the relative inclination with respect to the
mandibular condyle.
Many researchers have emphasized the critical law
of occlusal physiology: occlusal strength must be direc-
ted along the long axis of each tooth [5, 7, 17–19, 21].
The direction of occlusal strength is geometrically rela-
ted to the occlusal plane [8, 22]. In extensive restorative
treatment it is necessary to consider this biomechanical
factor.
From the biomechanical point of view, it is important
to understand these arrangements of the tooth long axis.
Osborn [14] sub-divided the principle of crushing food
into two components, crush and shear, where the direc-
tion of biting force is not perpendicular to the functio-
ning tooth on the occlusal surface. When the tooth long
axis is in an upright position, the vector of biting force
provides more shear force than that of an inclined tooth
axis (Fig. 15). The research results presented show that
the second premolars and first molars were the most
upright, while the second and third molars were the most
mesially inclined, indicating that the premolars and first

126 Three-dimensional analyses of the mandible and the occlusal architecture of mandibular dentition
 Author's personal copy

original article

Fig. 16 a The figure represent the functional unit of chewing

organ together with occlusal surfaces and the mandibular
condyles. b The orientation of the tooth long axis is perpendi-
cular to the curved transversal occlusal plane (Wilson curve)
and enhances the resistance to the torque developed during
the powerful function of chewing. c The orientation of the
tooth axis in relation to the condyles influence the compo-
nents of crush and shear during biting forces

Fig. 15 Mesial inclination of tooth and crush/shear ratio du-

ring chewing function. Principle of crushing food which con-
sisted of two components crush and shear because the direc-
tion of biting force is not perpendicular to the occlusal surface
of functioning teeth. a Upper and lower figures represent dif-
ferent relations between upright and inclined tooth in relation
to the biting force. b When the tooth long axis is in the upright
position, the vector of biting force provides more shear force
than that of an inclined tooth axis. Left figure represent an
Fig. 17 Three-dimensional architecture of the mandible. The
upright molar with a higher shear force vector. Right figure
present results show that there are close relationships among
represent an inclined molar and the small shear force vector
the lower tooth long axis, the distance between the occlusal
plane and the condyle. a Representation of a primate mandi-
ble with shorter distance between condyles. b Human man-
dible figure representing the equilateral triangle with equiva-
molars provid more shearing force than other teeth in the
lent distances between condyles and interincis or landmark.
dentition. These biomechanical arrangements are neces-
c Three-dimensional image of the mandible showing the in-
sary for chewing food effectively. This also applies to the tercondyle inclination angle (red triangle) and Bonwill triangle
transversal direction of biomechanics (Fig. 16), in which (green triangle)
the tooth axis of the lower buccal segment progressively
inclines medially (Fig. 7) and acts as a functional unit
during chewing. The orientation of long axes of the pre- vides a force perpendicular to tooth contact (crush) and
molar-molar teeth, perpendicular to the mediolateral a force parallel to the occlusal surface (shear) (Fig. 16c).
tilt of the occlusal surface, enhances resistance to the The increasing forward and mediolateral tilt of posterior
torque developed in the frontal plane during the power most molar teeth could influence increasing the crush/
stroke of mastication [14, 15]. The direction of force pro- shear ratio.

Three-dimensional analyses of the mandible and the occlusal architecture of mandibular dentition 127
 Author's personal copy
original article
This implies that there is a relationship between the
shape of the condyle and the dynamic function of the
mandible. The relative condylar position against the
lower occlusal surface (occlusal plane) continuously
changes during growth and development, indicating
increasing DPO and Balkwill angles. The architecture of
the occlusion, including the mandibular structure, sho-
wed that the Bonwill triangle was an equilateral triangle
measuring 100 mm (4 inches) on each side, that the Balk-
will angle was about 25° and that DPO was about 38 mm.
The inclination of the condylar axis angle is very close to
statistical correlation with the 3D structure of the man-
dible, which suggests that a larger sample might find
this possible relationship (Fig. 17). All these variables of
the occlusal architecture are related to the biomechani-
cal function of chewing and must be matched to ensure
balanced function.
Conclusions
This study shows the 3D architecture of occlusions inclu-
ding tooth axis and structure of the mandible. In this
sample the second premolars and the first molars showed
the most upright position with progressively increasing
mesial inclination toward the last molars. The relation-
ship between the tooth long axis and closing axis showed
that the long axis angle of the lower incisors was between
95 and 98; however, the tooth axis of buccal teeth with
the contralateral condyle sequentially increased from the
canines to third molars. The condylar axis angle tended
to correlate with the 3D structure of the mandible, which
could indicate that there is a possible relationship bet-
ween the evolutionary change of the mandible and the
functional inclination of the condylar axis. These results
shed new light on the biomechanics of 3D representation
of occlusion.
Take home message
The inclination of teeth in the three-dimensional arran-
gement of the dentition appears to follow some rules. All
teeth showed mesial inclination, whereas first and se-
cond premolars were in a comparatively upright positi-
on. They are possibly related to biomechanical functions
of the masticatory organ.
Acknowledgements
This work was performed at the Research Institute of Oc-
clusion Medicine and Research Center of Brain and Oral
Science, Kanagawa Dental College and supported by a
grant-in-aid for open research from the Ministry of Edu-
cation, Culture, Sports, Science and Technology, Japan.
The authors would like to express their gratitude to the
research project postgraduate students, especially Drs.
EM Tanaka, M Fujii, C Taguchi, S Koizumi, K Sugimoto,
C Sato, T Kodama, M Shinomiya, S Okada, A Horisawa,
R Yamashita, T Takahashi, Y Kim, M Shirazu, H Park, Y
Kawai, K Onodera, K Tajima, Y Onodera and K Tajima for
128 Three-dimensional analyses of the mandible and the occlusal architecture of mandibular dentition
helping with data collection. The research findings of this
project were presented at the IAAID Summer School 2009
in Tokyo, Japan.
Conflict of interest
The authors declare that there is no actual or potential
conflict of interest in relation to this article.
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