CLINICAL RESEARCH

Comparison of Recordings Obtained With

Computerized Axiography and Mechanical
Pantography at 2 Time Intervals
Cynthia S. Petrie, DDS, MS,1 Gerald D. Woolsey, BS, DDS, MS,2
and Karen Williams, PhD3

Purpose: The purpose of this study was to compare recordings of mandibular movements obtained
with a Denar mechanical pantograph to those obtained with a Denar computerized axiograph (Cadiax
compact).
Materials and Methods: Pantographic recordings and computerized axiograms were collected on 10
subjects. All of the subjects had intact dentition and no clinical signs or symptoms of temporoman-
dibular dysfunction. Tracings produced with the 2 instruments were compared using pantographic
reproducibility indices (PRIs). Recordings with each instrument were repeated twice and assessed
for consistency. Pearson’s correlation coefficient was used to compare PRI scores obtained with the
pantograph and the axiograph. Recordings with both instruments were repeated 2 weeks to 1 month
later, and new PRI scores were calculated. Consistency between initial and second PRI scores for
each instrument was assessed using a coefficient of stability.
Results: The coefficients of stability between the initial and second recordings were r ⴝ 0.91 for
mechanical pantography and r ⴝ ⴚ0.06 for computerized axiography. Comparison of recordings
made by mechanical pantography and computerized axiography at the initial and second recordings
showed poor concordance, with coefficients of 0.23 and ⴚ0.11, respectively.
Conclusions: PRI scores recorded with the mechanical pantograph were consistent between the
initial and second recordings. In contrast, recordings with the computerized axiograph appeared
highly inconsistent across time. PRI scores calculated from the axiographs were significantly higher
than PRI scores calculated from pantographic tracings for the same subject.
J Prosthodont 2003;12:102-110. Copyright © 2003 by The American College of Prosthodontists.

INDEX WORDS: pantograph, computerized axiography, cadiax, pantographic reproducibility index,

dental occlusion, mandibular movement

P ANTOGRAPHY IS a well-established method

for recording mandibular movements.1-3 Infor-
mation derived from pantographic tracings is used
to program an articulator, so that the instrument is
able to reproduce as closely as possible the patient’s
mandibular movements.3 Temporomandibular ar-
ticulation is beneficial when analysis of the patient’s
occlusion is desired or when extensive restorations
are to be fabricated.3
From the University of Missouri-Kansas City, School of Dentistry,
Kansas City, MO
1
Assistant Professor, Department of Restorative Dentistry
2
Professor and Chair, Department of Restorative Dentistry
3
Professor and Director, Clinical Research Center
Accepted February 13, 2003.
Correspondence to: Dr. Cynthia S. Petrie, University of Missouri-
Kansas City, School of Dentistry, Department of Restorative Dentistry, 650
E. 25th Street, Kansas City, MO 64108 Email: petriec@umkc.edu
Copyright © 2003 by The American College of Prosthodontists
1059-941X/03/1202-0001$30.00/0
doi:10.1016/S1059-941X(03)00037-8
Besides programming a fully adjustable articu-
lator, pantographic recordings have also been used
to evaluate a patient’s ability to repeat mandibular
movements.4-8 The pantographic reproducibility in-
dex (PRI) has been established as a means of
evaluating the repeatability of mandibular move-
ments.4-6 The PRI can be calculated by quantita-
tively assessing the tracings on all 6 tables of the
pantograph.4-6 Several studies conducted by a single
research group have shown that individuals with no
signs or symptoms of temporomandibular disorder
(TMD) are able to reproduce mandibular excursive
movements in a very similar pattern each time4-6
and over a period of several months.7,8 The PRI
scores for these patients are relatively low, usually
between 0 and 15 on a scale of 0-144.5,6
A mechanical pantograph (Denar; Teledyne Wa-
terpik, Fort Collins, CO) was introduced in 19699
and has since been used to record 3-dimensional
mandibular movements in 2 planes, vertical and

102 Journal of Prosthodontics, Vol 12, No 2 ( June), 2003: pp 102-110

 June 2003, Volume 12, Number 2
horizontal.2,3 This pantograph has been used in
several studies and has proven accurate for record-
ing mandibular movements.4-8,10-14 In addition, pan-
tographic tracings provide more information about
a patient’s mandibular movements compared to
intraoral records of eccentric movements.11,12 Once
recordings have been obtained with a mechanical
pantograph, manual programming of a fully adjust-
able articulator is required. This manual program-
ming has the potential to introduce errors in artic-
ulator settings.13-15
Mandibular movements can also be recorded
using axiography.16-21 Investigators have linked con-
dylar pathway recordings to disc displacement,16
TMD,17,18 mandibular asymmetry,19 and tooth
wear.20 A computerized axiograph (Denar Cadiax
compact; Teledyne Waterpik) can produce axio-
grams of 3-dimensional mandibular movements.
Data can then be transferred to a software program
for computing articulator settings.22 According to
the manufacturer, this computerized axiograph can
record mandibular movements with an accuracy of
0.1 mm, within 10 minutes.22
Even though axiography has been used as a
diagnostic tool, the accuracy or reliability of the
recordings has not yet been investigated. In addi-
tion, data received from axiograms versus the tra-
ditional pantographic methods have not yet been
compared. The purpose of this in vivo investigation
was to compare PRI scores obtained with a mechan-
ical pantograph (Denar) and with a computerized
axiograph (Denar Cadiax compact). Consistency of
the recordings (coefficient of stability) obtained with
the 2 systems at 2 time intervals was also examined.
The following null hypotheses were examined in
this study:
1. There will be no consistency in PRI scores re-
corded for the mechanical pantograph across 2
time intervals.
2. There will be no consistency in PRI scores re-
corded for the computerized axiograph across 2
time intervals.
3. There will be no consistency between PRI scores
recorded with the mechanical pantograph and
with the computerized axiograph at each of the
2 time intervals.
Materials and Methods
Ten subjects (6 women and 4 men) with a mean age of
31.9 years (age range, 26 –50 years), were randomly
103
selected to participate in the study. The subjects were
either students or faculty from the University of
Missouri-Kansas City School of Dentistry. Subjects were
selected to participate in the study based on the following
inclusive criteria: presence of complete dentition (with
the exception of third molars), good general health,
absence of any signs/or symptoms of TMD and/or orofa-
cial pain, and no history of medications or treatments
that could affect mandibular movements. Patients’ in-
formed consent was obtained under a protocol approved
by the school’s Adult Health Sciences Institutional
Review Board.
Custom-made acrylic resin clutches were made for
each subject and were relined with polyvinyl siloxane
impression material (Blu-Mousse Super-Fast; Parkell,
Farmingdale, NY).23 Care was taken to ensure that only
minimal opening of the occlusal vertical dimension oc-
curred. Recordings were obtained with the Denar me-
chanical pantograph following the manufacturer’s rec-
ommendations, using arbitrary hinge axes as posterior
reference points.9 The subjects performed voluntary
mandibular movements under chin-point guidance.9,24
Tracings of 1 protrusive movement followed by 3 right
lateral movements and 3 left lateral movements were
recorded on recording blanks (Denar) placed on the 6
tables. Each movement began at the centric relation
position and ended either in maximum protrusion or in
maximum lateral excursion. Attention was taken to en-
sure that the subjects began each movement at the same
reference point. PRI scores were calculated following
previously published procedures.4-6 Based on these pro-
cedures, on each of the 6 recording tables, each move-
ment was divided into 2 halves. The following scores were
assigned: 0 for 1 single line; 1 for 1 double line; 2 for 2
single lines; 3 for 1 single line and 1 double line; and 6 for
3 lines. The PRI score was calculated as the sum of all the
foregoing scores from the 6 tables to yield a single score,
which could range from 0 to 144. The PRI scores were
reported as initial pantography PRI scores with the an-
terior tables. A second set of PRI scores was calculated
from the same recordings, following the same criteria as
for the initial set but omitting the scores of the anterior
tables. These scores were reported as initial pantography
PRI scores without the anterior tables (Table 1). The PRI
scores without the anterior tables were recorded to facil-
itate comparison of the recordings obtained with comput-
erized axiography. The Denar computerized axiograph
used in this study does not allow for recordings equivalent
to those of the anterior tables of the pantograph.
Recordings using computerized axiography were also
performed for each subject. The mandibular metal clutch
was customized by relining intraorally with polyvinyl si-
loxane impression material (Blu-Mousse Super-Fast),
and the computerized axiograph was assembled following
the manufacturer’s recommendations.22 The centric re-
lation reference position was recorded first, and the indi-
104 Computerized Axiography and Mechanical Pantography ● Petrie, Woolsey, and Williams

Table 1. PRI Scores for Mechanical Pantography without Anterior Tables and Computerized Axiography
Initial Pantography Initial Second Pantography
PRI without Axiography PRI without Second
Subjects Anterior Tables PRI Anterior Tables Axiography PRI
1 14 40 22 45
2 13 40 19 20
3 11 66 16 40
4 12 39 28 49
5 8 66 12 34
6 37 46 50 57
7 25 27 20 23
8 13 25 32 47
9 25 48 19 62
10 20 48 9 78

vidual was then guided with light chin pressure to per- stability. A similar strategy was used to compare the
form a protrusive movement, a mediotrusion right initial and second PRI scores recorded with the comput-
movement, a mediotrusion left movement, and opening erized axiography. In addition, the concordance between
and closing of the mandible.22 The recording of the PRI scores obtained with mechanical pantography and
mandible opening and closing was not used in our eval- computerized axiography was assessed for both time
uation, but this movement was necessary to complete the intervals using Pearson’s correlation coefficient.
procedure with the specific computerized axiograph. Ex-
cursive movements were performed up to the border
movements. After the aforementioned data were trans-
ferred to a software program, the same procedure was
repeated 2 more times. To calculate PRI scores, the
tracings for each lateral excursion were printed from the
software program in the following manner. The initial
recording of each excursion was printed on standard
printing paper (Great White; International Paper, Mem-
phis, TN), and subsequent tracings were printed on clear
transparency film (HP Premium Inkjet Transparency
Film; Hewlett Packard, Brea, CA). The transparencies
were then superimposed over the paper copy on a flat,
hard surface, and PRI scores were calculated using the
method reported by Clayton et al.4-6 These scores could
range between 0 and 96.25 The scores obtained with this
technique were reported as initial axiography PRI scores
(Table 1).
All recordings and ratings were performed by a single
investigator to eliminate problems with interrater reli-
ability. A lengthy training period was provided to famil-
iarize the investigator with the instruments. In addition,
a pilot study was conducted to ensure the reproducibility
of methods with both instruments. The mechanical pan-
tograph and computerized axiograph recordings on each
individual were performed on the same day, 1 immedi-
ately after the other but in a random sequence.
Subjects were seen 2 weeks to 1 month after the initial
recordings for retesting. The same procedures as earlier
were followed with both instruments, and second pantog-
raphy PRI without anterior tables and second axiography
PRI scores were recorded (Table 1). Figure 1. Representative pantographic tracings of 1 sub-
Consistency between the initial and second PRI scores ject, recording 3 right lateral movements, 3 left lateral
recorded with the mechanical pantograph, with and with- movements, and 1 protrusive movement. The “PRI score
out anterior tables, was assessed using a coefficient of with the anterior tables” for this subject was 9.
 June 2003, Volume 12, Number 2 105

Figure 2. Computerized axiograms, for the same subject as in Figure 1 after superimposing 3 recordings of right
lateral mandibular movement. “Right” and “left” refer to the subject’s right side and left side, respectively. The 2 upper
graphs show recordings on the horizontal posterior plane, whereas the 2 lower graphs show recordings on the sagittal
posterior plane. It can be seen that the centric relation reference position (beginning of each curve) was not coincident
for all recordings.

Results obtained with the mechanical pantograph (without

Figure 1 shows representative tracings recorded
with the mechanical pantograph on all 6 tables for
1 subject. Figure 2 shows 3 superimposed tracings
of the mediotrusion left movement recorded with
the computerized axiograph for 1 subject for the
same time interval. The recordings on this subject
were representative of the population tested in this
study and show the differences in the repeatability
of the recordings with the 2 instruments.
PRI scores were recorded with the mechanical
pantograph including the anterior tables. These
PRI scores could potentially range from 0 to 144.
Additionally, PRI scores were recorded using trac-
ings from computerized axiography and from me-
chanical pantography without including the ante-
rior tables. These PRI scores have a possible range
of 0 to 96. Table 1 shows the distribution of data
anterior tables) and computerized axiograph for
initial and second recordings for each of the 10
subjects. Correlation coefficients were computer-
ized to examine consistency of recordings for each
instrument over time and between instruments at
each time interval (Table 2). These results suggest
that only the mechanical pantograph PRI scores
calculated with anterior tables have acceptable con-
sistency across 2 measurement intervals (r ⫽ 0.91).
Assessing the consistency of the initial and second
PRI recordings for the mechanical pantograph
without the anterior tables revealed a considerable
decrease in the coefficient of stability (r ⫽ 0.56), as
shown in Figure 3. The PRI scores for computerized
axiography for the initial and second tracings
showed inconsistency, as evidenced by a coefficient
of r ⫽ ⫺0.06 (Fig 4).

Table 2. Correlation Coefficients for PRI Scores

Bivariate Correlates for PRI Scores Coefficient
Initial Pantography PRI: Second Pantography PRI (With Anterior Tables) 0.91
Initial Pantography PRI: Second Pantography PRI (Without Anterior Tables) 0.56
Initial Axiography PRI: Second Axiography PRI ⫺0.06
Initial Pantography PRI (Without Anterior Tables): Initial Axiography PRI ⫺0.23
Second Pantography PRI (Without Anterior Tables): Second Axiography PRI 0.11
106 Computerized Axiography and Mechanical Pantography ● Petrie, Woolsey, and Williams

Figure 3. Consistency of initial and second PRI scores calculated from tracings recorded with the mechanical
pantograph without including the anterior tables in the calculation.

Figure 4. Consistency of PRI scores calculated from tracings recorded by computerized axiography for the 2 time
intervals.
 June 2003, Volume 12, Number 2
The consistency of the initial PRI scores between
pantography and axiography was very poor (r ⫽
⫺0.23). Similarly, the consistency of the second PRI
scores between pantography and axiography was
low (r ⫽ 0.11).
For the computerized axiography recordings, the
posterior reference point (centric relation) was not
consistently reproduced in 30% of the cases. The
recordings illustrated in the representative photo-
graph in Figure 2 show that the posterior reference
point was different in each of the 3 recordings. The
centric relation position was reproduced for all re-
cordings obtained with the mechanical pantograph.
Discussion
In this investigation, mandibular tracings were col-
lected on 10 subjects with intact dentition and no
signs or symptoms of TMD. This population was
selected to ensure that useful comparisons of the
consistency and accuracy of mandibular tracings
recorded with the Denar computerized axiograph
and the Denar mechanical pantograph could be
made. In addition, a close protocol was followed to
ensure that all recordings were performed in a
similar manner. According to previously reported
studies, individuals with complete dentition and the
absence of any temporomandibular pathosis are
capable of reproducing mandibular movements
over time with a high degree of accuracy.4,5,7,8 The
aforementioned studies, performed with the same
mechanical pantograph used in the present inves-
tigation, found that this population had low PRI
scores.4-6 Our findings are in agreement with pre-
vious investigations,7,8 which have found that man-
dibular movements recorded with the Denar me-
chanical pantograph were consistent between 2
time intervals. A high level of consistency (r ⫽ 0.91)
was found between the initial PRI scores with the
anterior tables recorded with the mechanical pan-
tograph and second PRI scores with the anterior
tables recorded with the mechanical pantograph. In
contrast, the close agreement of the mandibular
movements recorded at different times was not
reproduced with computerized axiography. There
was poor concordance between the initial record-
ings with the computerized axiograph and the sec-
ond recordings with the same instrument (Tables 1
and 2). Because the same population was used for
the recordings with the mechanical pantograph and
strict protocol was followed when the recordings
were made and evaluated, the inconsistency found
107
in the recordings obtained with the computerized
axiograph is most likely attributed to the instru-
ment.
Several studies performed by a single group of
researchers have used PRI indexes to detect and
diagnose TMD.4-8,10,25 The findings suggest that
individuals with complete dentition and absence of
any temporomandibular pathosis have low PRI
scores. It has been hypothesized that the absence of
TMD renders these individuals capable of repro-
ducing mandibular movements consistently over
time.7,8 In the same vein, patients who recorded
higher and more variable PRI scores were catego-
rized as unable to reproduce mandibular move-
ments over time and were definitively diagnosed
with TMD.5,6 The diagnoses on these patients were
done before accepted TMD criteria were estab-
lished.29 In addition, other researchers have ques-
tioned the validity of diagnosing TMD exclusively
on the basis of PRI scores.30 These researchers
believe that until long-term studies are instituted
and their results evaluated and considered in addi-
tion to clinical signs and symptoms of TMD, the
PRI index by itself cannot be used to diagnose
TMD.30
In this investigation, PRI scores were used to
compare the consistency of recordings of mandibu-
lar movements between 2 time intervals and the
consistency of mandibular recordings between 2
different instruments. PRI scores are the sums of
individual scores recorded in each of the 6 tables of
the mechanical pantograph to create a composite
score that represents 3-dimensional mandibular
movements in the horizontal and vertical planes.
Other investigators have used devices other than
the mechanical pantograph and methods other
than the PRI score to record mandibular move-
ments on individuals with no TMD.31,32 In these
studies, the presentation of the results is more
complicated than the comparison of PRI scores.
The different scores in the different planes and in
the different tables make evaluation of the results
rather confusing.
PRI scores for the mechanical pantograph were
also calculated excluding the scores on the anterior
tables (Table 1). Statistical analysis (Table 2)
showed that these results had a considerably lower
level of consistency over time (r ⫽ 0.56). Excluding
the anterior tables from the mechanical panto-
graph recordings was done to allow comparison of
these recordings with the axiograph recordings,
because the axiograph does not provide anterior
108 Computerized Axiography and Mechanical Pantography ●
tables. In a previous study,25 this exclusion was also
imposed, because the tested device being compared
to the mechanical pantograph did not provide an-
terior tables. Our findings indicate that the ante-
rior tables of the mechanical pantograph need to be
included in the calculation of the PRI scores. The
initial PRI scores with the anterior tables compared
to the second PRI scores with the anterior tables
were found to be highly reliable (r ⫽ 0.91), as
shown in Table 2.
The mechanical pantograph used in this study
allows the use of 2 different posterior reference
points: a kinematic hinge point and an arbitrary
hinge axis (as described in the manufacturer’s
manual).9 The computerized axiograph used in this
study allows the use only of an arbitrary hinge axis
located at the external auditory meatus.22 In the
present study, an arbitrary hinge axis was used for
both the pantograph and the computerized axio-
graph for simplicity and ease of comparison of
results obtained by the 2 different instruments. The
arbitrary hinge axis for each instrument was estab-
lished according to the manufacturer’s recommen-
dations for that instrument.9,22 It has been shown
that using an arbitrary hinge axis instead of a
kinematic hinge axis has minimal influence on the
accuracy of recordings of mandibular move-
ments.33,34
If inaccurate recordings were used to program
an articulator, then the restorations fabricated on
this instrument would not be precise. Inaccuracies
in the recordings can be introduced by inexperi-
enced operators, the equipment itself, and/or the
patients/subjects of the studies.26 It has been found
that the accuracy with which an articulator is pro-
grammed based on pantographic recordings can
vary significantly.13,14 Therefore, further investiga-
tion is needed to evaluate whether the differences
in the recordings found with the 2 instruments used
in this study would have an effect on articulator
settings. Several investigators have stated that use
of a mechanical pantograph entails uncertainty,
mainly in programming the rear and top wall of the
fossa, because the working pathways on the poste-
rior table are usually short (Fig 1).13-15 In the
present study, the most inconsistent recordings for
the computerized axiograph were the working
pathways on the posterior tables. These appeared
irregular and short; Figure 2 shows an example of
this.
An explanation for the inconsistency among re-
cordings obtained with the computerized axiograph
Petrie, Woolsey, and Williams
may be the lack of a central bearing point on the
clutches. The axiograph used in the present study
uses a single mandibular clutch, and the patient/
subject performs mandibular eccentric movements
keeping the maxillary teeth in contact with the
mandibular clutch. Several subjects complained
about the surface finish on the metal clutch; it felt
“rough and abrasive” on their maxillary teeth. Ex-
amination of the multiple recordings obtained with
the computerized axiograph revealed that in 30% of
the cases investigated, the posterior reference point
(centric relation) was not reproduced consistently
(Fig 2). Lack of a central bearing point made depro-
gramming difficult, and the centric relation posi-
tion could not be repeated. In all subjects, the
centric relation position was repeated when record-
ings with the pantograph were performed. The poor
reproducibility of the centric relation position, as
well as the presence of interferences occurring with
the mandibular clutch, may account for some of the
differences found in the recordings between the 2
instruments and for the inconsistency of the record-
ings with the axiograph between the 2 time inter-
vals.27,31 Further investigation of the axiograph
used in this study modified to include 2 clutches and
a central bearing point could be advantageous. A
recent in vitro investigation on the same comput-
erized axiograph used in the present study, at-
tached on an articulator that simulated the man-
dibular movements, reports that this axiograph is
accurate in recording condylar inclination and Ben-
nett angle.35 The results of this in vitro study should
be viewed with caution; because no human subjects,
only articulators, were used to produce the mandib-
ular movements, no inaccuracies were introduced
from the inability to repeat the centric relation
position.
Another possible explanation for the inconsis-
tent results obtained with computerized axiography
may be the relatively thick layer of polyvinyl silox-
ane material used to attach the mandibular clutch
to the teeth. This elastomeric material can exhibit
significant resiliency. Therefore, the clutch is not
firmly attached to the teeth, and movement be-
tween the teeth and the clutch can occur during
mandibular recordings. This movement may ac-
count for some of the variability found in the results
obtained with computerized axiography.
Although computerized axiography did not pro-
duce consistent results in the present study, obtain-
ing these recordings was less time-consuming and
simpler than obtaining mechanical pantograph re-
 June 2003, Volume 12, Number 2
cordings. Manual manipulation of the articulator is
not necessary, because the computer software pro-
vides the articulator settings.
Conclusions
Within the limitations of this in vivo investigation,
the following conclusions can be drawn:
1. PRI scores recorded from pantographic tracings
were consistent for the 2 time intervals in sub-
jects with no signs or symptoms of TMD (r ⫽
0.91), when the anterior tables of the panto-
graph were included in the calculation of the
scores.
2. PRI scores recorded using mechanical panto-
graphic tracings without the anterior tables were
less consistent than PRI scores recorded using
pantographic tracings with anterior tables.
3. Computerized axiography showed a lack of con-
sistency across time, and these recordings varied
tremendously in comparison with those obtained
from mechanical pantography.
4. The centric relation position could not be repro-
duced and/or recorded consistently with comput-
erized axiography. However, it was reproduced
consistently with mechanical pantography.
Acknowledgment
The authors wish to express their sincere appreciation to
Ms. Pat Gray, Product Manager and Ms. Deborah Kelly,
Occlusal Sales Representative, Waterpik Technologies,
for their instrumental support.
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