Reproduction of excursive tooth contact in an articulator with computerized

axiography data
Katsushi Tamaki, DDS, PhD, a Ale~, G. C~lar, MD, DDS, b Stephan Beyrer,
MD, c and Hideo Aoki, DDS, PhD d
Kanagawa Dental College, Yokosuka, Japan

P u r p o s e . This study assessed the reproduction of excursive tooth contacts with a SAM2 "P" articulator
set up with the aid of computerized axiography.
M a t e r i a l a n d m e t h o d s . Articulator excursive tooth contacts were compared with intraoral excursive
contacts identified with occlusogram wax. The maxillary casts were mounted with a kinematic face-bow,
and the mandibular cast was oriented to the intercuspal position. The articulator was set using information
obtained from computerized axiography. Protrusion and laterotrusion to the left and right sides were
examined. The first 4 mm of excursive tooth contacts in the occlusogram were compared with the 4 mm of
excursive tooth contacts in the articulator.
Results. The articulator reproduced 82% of the teeth with protrusive tooth contacts and 90% of the teeth
with laterotrusive tooth contacts. The exact locations of excursive tooth contacts were reproduced in 66%
of protrusive contacts and 81% oflaterotrusive contacts. The articulator also created additional eccentric
dental contacts that were not originally present in the occlusogram. Twenty percent of the subjects showed
these additional contacts during protrusion; in lateral movement of the articulator these additional contacts
were present in 27% to the left side and 20% to the right. Clinically, these findings suggest that there are
limits to the ability of the articulator to reproduce excursive tooth contacts. These limitations should be
kept in mind when an articulator is used for diagnostic and restorative dental procedures. (J Prosthet Dent
1997;78:373-78.)

Diagnostic and restorative procedures often re-
quire articulators to simulate mandibular movements and
occlusal contacts. Since the i n t r o d u c t i o n o f articulators,
their ability to reproduce mandibular m o v e m e n t has been
investigated. 1-8 K n o w l e d g e o f the limits o f articulator
s i m u l a t i o n is i m p o r t a n t t o t h e clinician w h o uses
articulators.
T h e check-bite technique, 9 17 the p a n t o g r a p h , 7,8,18-22
and the axiograph 23 have all been used to set condylar
guidance o n articulators. Recently, c o m p u t e r technol-
o g y has been applied to axiography. 24,25
Study o f masticatory function has identified the ini-
tial 2 to 4 m m o f excursive mandibular m o v e m e n t s from
aAssistant Professor, Department of Crown and Bridge Prosthodon-
tics.
bAssistant Professor, Department of Fixed and Removable Prosthodon-
tics, University of Vienna, Vienna, Austria.
CDental Student, University of Vienna, Vienna, Austria.
~Professor, Department of Crown and Bridge Prosthodontics.
the intercuspal position as the m o s t significant in terms
o f t o o t h contact. 26-29 Within this range o f mandibular
m o v e m e n t , the purpose o f this study was to c o m p a r e
t o o t h contacts identified intraorally with t o o t h contacts
o n an articulator set with c o m p u t e r i z e d axiography.
Tooth contacts were identified intraorally with
o c c l u s o g r a m wax and o n an articulator with articulat-
ing paper.
MATERIAL AND METHODS
T h e 45 dentulous subjects o f this study were patients
o f the Vienna University Dental School, P r o s t h o d o n t i c
D e p a r t m e n t , and consisted o f 10 m e n and 35 w o m e n .
Their ages r a n g e d f r o m 13 to 62 years (average 36.1 _+
13.4 years). I n f o r m e d c o n s e n t was obtained before all
clinical procedures.
Intraoral guidance
Recordings o f the intraoral excursive t o o t h contacts
were p e r f o r m e d with o c c l u s o g r a m wax 3° (B6se Dentale

OCTOBER 1997 THE JOURNAL OF PROSTHETIC DENTISTRY 373

THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 1. Axiograph assembled on patient.
i. . . . . R . . . . . . . . . . ~. .
,4 ' I '; ,1,0 ~ ~,1,0
i
. . . .
. . . .
Fig. 2. Axiographic recordings (example). Movement of left
and right hinge axis points in sagittal (x, z) and horizontal (x, y)
planes.
Spezialit~ten GmbH, Lfibeck Germany) while the pa-
tients were seated in an upright position. The wax, with
a thickness of 0.3 mm, was cut to the size of the maxil-
lary dental arch. The wax was warmed in the palms of
the examiner and put between the maxillary and man-
dibular dental arches. The patient was asked to close
into intercuspal position (ICP) and to keep the wax be-
tween the teeth for 10 seconds to soften the wax. Then,
the patient protruded the mandible while keeping con-
stant contact between maxillary and mandibular teeth.
During this movement, the examiner stood behind the
patient and supported the patient's mandible by push-
ing upward. The bimanual extraoral support provided
by the examiner at the left and fight gonial angle and
chin ensured maintenance of tooth contact during the
entire mandibular movement. Left and right lateral
movements were subsequently recorded with new
occlusogram wax sheets for each movement. Mandibu-
lar support was provided again by the examiner for each
movement. Each movement was made over a length of
4 ram, which resulted in wax perforations made at least
374
TAMAKI ET AL
4 mm in length, as observed by the examiner. One ex-
perienced examiner made all occlusogram recordings for
all subjects to avoid interexaminer variation. The
occlusograms were recorded twice. An estimation for
the reliability of the method through comparison of the
length of each tooth contact perforation on the two
occlusogram recordings was performed. The resultant
intraclass correlation coefficient for protrusive and lat-
eral movements was 0.99.
Recording mandibular movements
Mandibular movements were recorded with comput-
erized axiography (Cadiax, version 4.12, Gamma Co.,
Klosterneuburg, Austria). The patient was seated in an
upright position throughout the procedure. A mandibu-
lar brass clutch was customized with acrylic resin
(Protemp II, ESPE Co., Seefeld, Germany) was ce-
mented with cyanoacrylate to the facial surfaces of the
L_ ~.~-12
mandibular premolar and anterior teeth. This clutch did
not interfere with the occlusion. The clutch carried the
lower face-bow with two telescoping styli on each side
~ ,~ ": ~ := (Fig. 1). The same operator who made the occlusogram
recording used chin point guidance to identify the hinge
axis with computerized axiography.
The hinge axis movements were traced on vertical
plates mounted on the upper face-bow (Figs. 1 and 2).
Mandibular protrusion and laterotrusions to the left and
to the right were recorded with manual guidance in
. . . . . . . . IQ upward direction. The same examiner guided each sub-
. . . . . . . . '*Z
ject during axiography. After axiography, both hinge axis
points and the left orbital point were marked on the
patient's skin to establish the axis-orbital plane for the
face-bow transfer.
Fabrication of casts and m o u n t i n g
Alginate impressions (Ortho jel, Rocky Mountain,
Denver, Colo.) of the maxillary and mandibular jaws
were taken and poured with stone plaster (Die-keen,
Miles Inc., South Bend, Ind.). The kinematic face-bow
transfer was made with the marked orbital point and
both hinge axis points. Polyvinyl siloxane (Stat BR, Kerr
Mfg. Co., Romulus, Mich.) was used to record the ICE
The maxillary cast was mounted in the articulator (SAM2
"P", SAM Pr~izisionstechnik, Munich, Germany; Snow
White Plaster No. 2, Kerr, Torino, Italy), using the ld-
nematic SAM face-bow. The lower cast was mounted
with the ICP bite.
Calculation o f the horizontal condylar inclination
and Bennett angle
C o m p u t e r software (Cadiwax, Gamma Co.,
Klosterneuburg, Austria) was used to record hinge axis
movements to calculate the horizontal condylar inclina-
tion (HCI) and the Bennett angle (BEN) at 1, 2, 3, and
4 mm of protrusive and lateral movements, respectively.
The values were recalculated for the 110 mm intercondy-
VOLUME 78 NUMBER 4
TAMAKI ET AL
Fig. 3. Occlusogram wax record transferred to cast.
Fig. 4. Markings of tooth guidance on cast.
lar distance of the articulator and used to set the condy-
lar adjustments of the articulator.
Marking occlusogram wax perforation and excur-
sive t o o t h contact in the articulator
The perforations of the occlusograms were transferred
to the maxillary cast by using an overlay (Fig. 3). The
perforated area was outlined with a pencil, and each
movement had separate marks (Fig. 4).
The excursive tooth contact of the articulator was
examined separately for each millimeter of movement.
Protrusion inserts (SAM Pr~izisionstechnik, Munich,
Germany) were used to aid in the marking of occlusal
contacts at 1, 2, 3, and 4 mm of each protrusive and
lateral movement. The calculated HCI and BEN angle
values were set for each millimeter. The presence or ab-
sence of contact on each tooth was confirmed with
shimstock foil (8 pm), then the contacting areas of each
millimeter were marked with articulating paper (22 pro,
Okklusions-Prfif-Folie, G H M Co., N~irtingen, Ger-
many). Connecting the markings at ICP for each milli-
OCTOBER 1997
THE JOURNAL OF PROSTHETIC DENTISTRY
0% 25 %
50 % 75 % 100 %
Area of ~ Area of
occlusogram ~---4 contact in
perforation ~ the articulator W
Fig. 5. Schematic illustration of judgment of coincidence be-
tween occlusogram perforation and corresponding area of
excursive tooth contact in articulator. Overlapping area ex-
pressed as percentage of occlusogram perforation.
meter of excursive movcment determined the extent of
tooth contact up to 4 mm cutoff of each excursive move-
ment.
Degree o f coincidence between occlusogram wax
perforation and articulator excursive t o o t h contact
The area of the transferred occlusogram perforation
(a) was measured in millimeters squared (mm2). The
extent (b) of overlap between transferred occlusogram
perforation and marked articulator tooth guidance up
to 4 mm was measured in millimeters squared (mm2).
The degree of overlap was calculated by the ratio (b/a)
and expressed as a percentage for each guiding tooth
(Fig. 5), and this percentage was determined for pro-
trusion and laterotrusions left and right. Furthermore,
a summation of all single tooth percentages divided by
the number of guiding teeth described the average co-
incidence of guidance on the maxillary cast for each
movement.
The perforations of the occlusogram and the marked
contacts on the cast were observed to determine the type
of articulation, such as canine guidance, group function,
balanced articulation, or others, during laterotrusion.
Teeth involved with eccentric occlusal tooth contact were
registered in all subjects.
375
THE JOURNAL OF PROSTHETIC DENTISTRY TAMAKI ET AL

80 Table I. Types of laterotrusive articulation as seen in

70 occlusogram and articulator (frequency and percentage: n =
90, i.e., 45 left + 45 right)
60

5O
Occlusogram Articulation Occlusogram Articulator
e-

40 Articulator Group function 52 (58%) 52 (58%)

Canine guidance 16 (18%) 16 (18%)
~ 30 ACT Balanced 19 (21%) 21 (23%)
20 Premolar guidance 1 (1%) 0 (0%)
10 Molar guidance 1 (1%) 0 (0%)
Hyperbalance 1 (1%) 1 (1%)
1 2 3 4 5 6 7 8
Total 90 (100%) 90 (100%)

Teeth
Fig. 6. Frequencies of teeth involved with protrusive tooth
contact in occlusogram and articulator. ACT, Additional con-
tacting tooth, namely, tooth with cuspal guidance in articula-
tor but without perforation in occlusogram.
8O
70
6O
3O
ZO
10
0 --
8 r 6 s 4 a 2 1 1 z
Working side
Fig. 7. Frequencies of teeth involved with laterotrusive tooth
contact in occlusogram and articulator. Additional contact-
ing tooth (ACT), namely, tooth with cuspal guidance in articu-
lator but without perforation in occlusogram.
RESULTS
Teeth involved with eccentric occlusal tooth
contact
Figures 6 and 7 show the frequency of the teeth in-
volved with protrusive and lateral movement. The max-
illary first incisor exhibited the highest frequency of pro-
trusive guidance (58% in the occlusogram, 69% in the
articulator) (Fig. 6). The canines showed the highest
frequency in laterotrusion (working side: occlusogram
36%, articulator 39%) (Fig. 7). The distribution of guid-
ance on single teeth showed no significant differences
between occlusogram and articulator contacts (Fisher's
exact probability test).
However, the articulator identified additional contact-
ing teeth (ACT) not identified with the occlusogram
wax. Twenty percent of the subjects exhibited ACT dur-
ing protrusive and lateral movement on the right side,
and 27% during lateral movement on the left.
The distribution of protrusive ACT clustered exclu-
sively at the lateral incisor, canine, and first premolar
(81% of lateral movement) (Fig. 6). Additional contact-
ing teeth were located on the laterotrusive side and
ranged from the central incisor to the sccond prcmolar.
Oflaterotrusive ACT, 19% were found in the nonwork-
ing side (Fig. 7). The articulator reproduced 82% of the
teeth involved with protrusive guidance and 90% of the
teeth involved with laterotrusive guidance.
I k~ Oc¢lusogram
L o c a t i o n o f duplicated eccentric occlusal contacts
[ ] Articulator
UACT Comparison of the location of occlusogram perfo-
ration and excursive tooth contact on the mounted
cast revealed that the exact location of the intraoral
contact area was correctly reproduced at an average
frequency for protrusive (66%) and lateral movements
a 4 s 6 r a (81%). The remaining percentage of excursive con-
N o n w o r k i n g side tacts up to 4 mm did not coincide with the recorded
intraoral guidance and was found on different tooth
structures on the casts.
Articulation
Six types of lateral articulation were seen in the
occlusogram and articulator. In the occlusograms, group
function was present in 58% of the laterotrusions, fol-
lowed by canine guidance (18 %), and balanced articula-
tion with mediotrusive contacts of premolars a n d / o r
molars (21%, no fully balanced articulation). The remain-
ing 3% included articulation that was premolar only or
molar only guidance (2%) and immediate disclusion of
the working side by a nonworking side interference
(hyperbalance) (1%) (Table I).
In the articulator, group function was observed 58%,
canine guidance 18%, and balanced articulation 23%. For
the other types of articulation, hyperbalance was found
(1%) but premolar only or molar only guidance was not
found (0%) (Table I).
Of the different groups of accepted articulations,
namely, group function or canine guidance, it was not
possible to reproduce 10% of them in the articulator:
Among four lateral excursions of intraoral group func-
tion, three became intraoral canine guidance in the ar-
ticulator and one became balanced articulation. Intraoral
canine guidance changed to group function in three in-
stances; one balanced articulation turned into group

376 VOLUME 78 NUMBER4

TAMAKI ET AL
function, and one premolar only and one molar only
guidance became balanced articulation.
DISCUSSION
The distribution of protrusive additional contacts of
teeth (ACTs) was concentrated around the canine. This
indicates the steep structures of the canine, which qualify
for additional protrusive guidance in a slightly changed
system, namely, the articulator. Also, the lateral incisor
and the first prcmolar show cusp inclinations steep
enough for protrusive guidance that occurred as ACT.
The ACTs in lateral movements emphasize the same
potential of incisors, canines, and premolars on the work-
ing side, whereas the nonworking side showed few ACT
only.
In the imitation of the concepts of articulation, it was
noteworthy that 10% of lateral movements were not re-
produced in original form. Differences of the type of
articulation between occlusogram and articulator were
due to ACT in the casts, which were not present in the
occlusogram, as well as contacts not reproduced by the
articulator.
The percentage for the correctly reproduced area of
guidance illustrated that details of intraoral cuspal ar-
ticulation were not absolutely reproducible in the ar-
ticulator. A similar study ofHara 3~showed a coincidence
o f 65% between intraoral and articulator contacts in
intercuspal position and laterotrusive positions at 1, 3,
and 5 mm in the Hanau H2 articulator. Hara adjusted
the articulator according to check-bite technique and
Hanau formula.
The higher incidence oflaterotrusion contacts in this
study can be explained by the instrumentation of, for
example, kinematic face-bow transfer instead of an arbi-
trary face-bow, recorded hinge axis movements from
computerized axiography, along with curved articula-
tor structures versus check-bite and linear simulation of
the condylar path by the Hanau H 2 articulator. To im-
prove articulator setting, this study incorporated values
from hinge axis movements calculated for each millime-
ter. The accuracy o f computerized axiography has been
evaluated from a mechanical viewpoint, but even so, it
showed sufficient analytical capability. 32
The observed limitations of articulator duplication of
excursive tooth contacts has received insufficient atten-
tion. Several researchers have analyzed occlusal and ar-
ticular parameters on mounted casts seeking correlation
of these parameters, e.g., with signs and symptoms oftem-
poromandibular joint (TMJ) dysfunction.33,34Whenever
conclusions were drawn from analyses of casts, the repro-
duction of occlusion and articulation was taken for granted
despite limitations indicated by other authors? s 370cclusal
errors, which refer to such limitations, were not quanti-
fied at the level of teeth in an articulator, but were as-
sessed by mathematical approaches or geometrical meth-
ods that tested the reproduction of mandibular move-
OCTOBER 1997
THE JOURNAL OF PROSTHETIC DENTISTRY
ments. 38-4°"Adequate reproduction of jaw movements ''41
was stated that is not in agreement with the results of this
study.
The excursive guidance scheme, namely, canine guid-
ance or group function, of 10% of the subjects was in-
correctly reproduced on the articulator. Several factors
may contribute to the difference between occlusogram
and articulator findings, despite considering the even-
tual limitations of materials,42-4~for example, in bite reg-
istration and mounting procedures. First, tooth mobil-
ity that is caused by the periodontal membrane 46-5°can-
not be duplicated by the articulator. Although the
condylar position is stable in the joint, the condyle may
exhibit lateral, upward-posterior and upward physiologic
displacement in the TMJ. sl Laxity of the TMJ capsule
allows variable condylar paths, whereas the articulator
offers one type of movement. In laterotrusion, the work-
ing side condyle may move in the lateral and upward or
backward and downward direction. Such movements
cannot be carried out in the condylar housing of the
articulator, which restricts the condylar sphere in mov-
ing upward and backward. Tracings of the working
condyle during Bennett movement emphasize the im-
portance of having an adjustable posterior wall on the
articulator. 5~Whenever a subject does not perform a cor-
rect lateral border movement of the mandible, a protru-
sive component will cause occlusogram perforations that
differ from pure laterotrusion contacts. Such movements
in between laterotrusion and protrusion result in dis-
crepancies between occhisogram and articulator occlusal
contacts.
The complexity of these factors illustrates the limits
of duplicating excursive occlusal contacts on the articu-
lator. Considering the exact location of guidance, cvcn
the use of kinematic face-bow and hinge axis tracings
did not exceed an average reproduction of approximately
80% on the articulator. Accurate assessment of excursive
occlusal contacts requires careful intraoral examination
with methods such as the use of occlusogram wax.
SUMMARY
During protrusion and laterotrusion the intraoral ex-
cursive tooth contact was recorded by occlusogram wax
in 45 persons and compared with the excursive tooth
contact found in mounted casts of the same subjects.
The articulator was adjusted based on values of com-
puterized axiography recordings. The area of excursive
tooth contact was reproduced to the extent of average
66% in protrusion and 81% in latcrotrusion by the ar-
ticulator. Differences between stomatognathic system
and articulator reveal the limits of diagnostic and re-
constructive procedures carried out in articulators dur-
ing oral rehabilitation. Diagnosis of functional occlusal
interferences cannot be accomplished by visual inspec-
tion and articulator simulation alone, but must also be
based on intraoral examination procedures such as
377
THE JOURNAL OF PROSTHETIC DENTISTRY TAMAKI ET AL

occlusogram wax application. The results of this study traoral wax records: variations in three instruments. J Prosthet Dent
1960;10:441-54.
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an articulator is only an approximation of dynamic oc- intercuspal position during chewing movements. An evaluation from move-
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We express our thanks to Dr. Barbara Schneider, Institute for 30. Slavicek R. Clinical and instrumental functional analysis for diagnosis and
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32. Ino S, Tamaki K, Aoki H, Endo Y, Ohba H, Kimura T, et al. An experimental
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