CRANIO®

The Journal of Craniomandibular & Sleep Practice

ISSN: 0886-9634 (Print) 2151-0903 (Online) Journal homepage: http://www.tandfonline.com/loi/ycra20

Computerized Axiography: Principles and Methods

Eva Piehslinger M.D., D.D.S., Aleš G. Čelar M.D., Robert M. Čelar M.D. &
Rudolph Slavicek M.D., D.D.S.

To cite this article: Eva Piehslinger M.D., D.D.S., Aleš G. Čelar M.D., Robert M. Čelar M.D.
& Rudolph Slavicek M.D., D.D.S. (1991) Computerized Axiography: Principles and Methods,
CRANIO®, 9:4, 344-355, DOI: 10.1080/08869634.1991.11678382

To link to this article: http://dx.doi.org/10.1080/08869634.1991.11678382

Published online: 18 Feb 2016.

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Computerized Axiography:
Principles and Methods
Eva Piehslinger, M.D., D.D.S., Ales G. Celar, M.D.,
Robert M. Celar, M.D., Rudolph Slavicek, M.D., D.D.S.

Abstract This paper reviews earlier methods for the analysis of

mandibular movement and gives a detailed account of state-of-
the-art procedures. Special emphasis is given to computerized
axiography and the application of this method to the diagnostics
of the temporomandibular joint (TMJ). The article discusses the
advantages of computerized axiography over the mechanical
device and points out the limitations of the axiographic method.
One major advantage of the computerized system is having the
enlarged diagram of tracings on the computer screen. This
means that small changes such as initial disk displacements can
be diagnosed more readily than with the mechanical device.

Dr. Eva Piehslinger received her M.D. degree from the University of
Vienna in 1986. During her medical studies she worked for seven years
as an assistant at the Anatomical Institute of the University of Vienna.
After medical school she received her D.D.S. degree from the Dental
School, University of Vienna. Since 1989 she has been in practice at the
Dental Clinic in the Department of Removable and Fixed Prosthodontics
at the University of Vienna.

Dr. Ales G. Celar studied medicine at the University of Vienna from

1983 to 1989 and received his M.D. degree in 1989. He has been con-
ducting scientific studies at the Dental Clinic of the University of Vienna,
Department for Prosthodontics since October 1989. In October 1990 he
began in the postgraduate dental education program at the Dental Clinic
of the University of Vienna.

344 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE OCTOBER 1991, VOL. 9, NO. 4


Gnathology
Historical Review
In 1744 Ferrain 1 first described the principles of
rotation and translation of the mandibular condyles.
His research established that the condyles rotated within
the glenoid fossae of the temporal bone with rotational
and translational capabilities. He described these
movements in all three degrees of freedom as protru-
sion-retrusion, mediotrusion-medioretrusion, and
opening -closing.
Langer2 applied moveable needles to the condyles
of corpses in 1860. He relocated these needles until
they exercised a purely rotational movement on open-
ing and closing. He found that the axis of rotation
passed bilaterally through the heads of both condyles.
Langer hypothesized that the lower jaw rotates around
a momentary axis traveling in space.
In 1889 Luce3 tracked mandibular movement pho-
tographically by taking still pictures of the travel of
extraoral reference points placed on a mandibular bow.
Condylar movement was first recorded in 1896 by
Ulrich and Walker, 4 who generated graphic curves
from a marking stylus fixed to a mandibular face-bow
onto plates attached to a cranial bow.
Campion5 ( 1902) determined the position of the
condyles by palpation and marked its path with dots
indicating various condylar positions on the patient's
skin. The tracing was transferred to paper and related
to an imaginary line from the external auditory meatus
to the lower end of the nose.
Bennett6 stated in 1908 that whenever the mandible
moves during opening, the hinge axis common to both
condyles moves as a collinear axis, establishing a true
hinge axis. Eitner, in 19097 , 1911, 8 and 1912, 9 dis-
cussed the notion of a "hinge axis" from which a pure
rotational movement occurred in the lower joint com-
partment. Eitner assumed that this movement can be
carried out by any individual, but that it was different
from a normal mouth opening movement. He con-
cluded that raising the bite was a matter of pure hinge
movement in the lower part of the joint with the axis
passing through both condyles.
From 1910 onward Gysi 10 elaborated on the rota-
tional and translatory capabilities of the condyles. He
defined the lower compartment of the temporoman-
dibular joint as being the rotational unit and the upper
compartment as the translatory component. Gysi used
the method employed by Ulrich and Walker4 to pro-
gram an articulator.
In 1912 Andresen 11 used the same method as Eitner
OCTOBER 1991, VOL. 9, NO. 4 THE JOURNAL OF CRANIOMANDIBULAR
0886-9634/91/0904-0344$03.00/0
THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
Copyright© 1991 by Williams & Wilkins
to locate the hinge axis. He employed an adjustable
facebow attached to the mandible with a writing stylus.
When the writing stylus did not move during small
opening and closing movements, he concluded that he
was on the axis. Lehne 12 (1920) followed up the work
of Andresen with a modified impression tray designed
not to interfere with occlusion while locating the hinge
axis. He determined that he was on the hinge axis
when no arc was observed during opening and all
tracings were on a dot. Andresen and Lehne are cred-
ited with the introduction of the kinematic technique
for locating the hinge axis.
In 1928 the anatomist Sicher 13 demonstrated that
pure-hinge movement was possible for the living sub-
ject by holding back the lower jaw. He further stated
that while a full pure-hinge opening of the mouth was
possible in postmortem subjects, living subjects could
only achieve two thirds as much opening.
In 1934 McCollum 14 introduced the gnathograph as
a means of using hinge axis tracings to program an
articulator. It is interesting that McCollum, apparently
unaware of the European literature, came to the same
conclusions as Eitner in his investigation of the ex-
istence of a hinge axis of the condyles.
From 1935 to 1939 Fischer 15 •16 studied the move-
ment of a point at the midincisal edge of the mandi-
bular centrals and determined that mandibular movement
occurred in three dimensions. He further stated that
this movement was restricted in space to particular
patterns.
McCollum 14 stated that the hinge axis of the con-
dyles was stable in space for at least six years in 1938.
He showed the influence of Bennett movement on the
cusps by mesiodistal movement of the rotating con-
dyle. McCollum used a reference plane (hinge axis to
orbital point) to record the sagittal hinge axis tracings
on wax-covered glass plates as angles from the ref-
erence plane.
Posselt 17 showed in 1957 that the mandible is ca-
pable of complex movements composed of translation
and rotation but that pure rotation around a transverse
axis is also possible. He referred to this rotation at the
posterior border position as ''terminal hinge move-
ment.'' Page contended that two independent axes oc-
curred in his transographics approach to functional
closure of the mandible. This hypothesis was dis-
missed by the Hinge Axis Committee of the Greater
New York Academy of Prosthodontists in 1959. They
showed that four hinge axis points, two next to each
condyle and two located 12 inches away from each
PRACTICE 345
 PIEHSLINGER ET AL.
condyle, were all aligned to the same axis, thus ruling
out the existence of two axes.
Hielscher imaged condylar movement using x-ray
kinematography in 1961. This technique provides in-
formation about dynamic aspects and their changing
positional relation.
Hickey (1963) 18 placed pins in the condyles of two
subjects and then photographed the movement exer-
cised by these pins in three dimensions.
Puff and Krause 19 ( 1965) quantified the spatial phe-
nomena of functional loading of the joints using se-
quentially related radiographs of the mandible.
Messerman ( 1967) developed the first electronic
measuring instrument consisting of six transducers
mounted between two external face-bows. It measured
six degrees of freedom of jaw motion. Their outputs
were fed into a multichannel tape recorder. The play-
back or duplicating device was named Case Gnathic
Replicator, a jaw motion reproducer mechanism.
Electrognathography was introduced in 1967 by
Bewersdorff2° as a method for recording jaw move-
ments in three dimensions by using three sensors for
magnetic induction, each attached to both mandibular
and cranial bows. This system offers the advantage of
being able to record intraoral functions.
Lee first published his studies in 1969. 21 •22 He used
dental air turbines located on the hinge axis to engrave
condylar movements in plastic blocks.
In 1970 Knap et al. created a measuring system
using six potentiometers as sensors providing electrical
signals from the mandibular incision for computer
analysis. This apparatus was located in front of the
face.
Korber (1971) recorded mandibular kinetics by ap-
plying a face-bow system with measuring plates and
sensors. Data were recorded by means of an oscillo-
scope and plotter. Gibbs and Messerman (1971) used
a double face-bow system and the Case Gnathic Rep-
licator. It recorded kinetic information of the mandible
for playback and computer analysis.
In 1975 Jankelson et al. described the mandibular
kinesiograph, a far-off joint technique. A permanent
magnet was mounted on the mandibular incisors, sens-
ing elements responded to the strength of the magnetic
field. Data were stored on tape for later replay or
computer analysis.
Guichet23 elaborated extensively on pantographing,
the programming of an articulator, and waxing tech-
niques in the 1971, Occlusion Manual of the Denar
Corporation.
Text In 1972 Preiskel, 24 doing hinge axis tracings, de-
scribed the "Fischer angle" as the angle between the
346 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
COMPUTERIZED AXIOGRAPHY
path traveled by the nonworking side condyle during
a lateral border movement and the path along which
it travels when a symmetrical protrusion is made.
Slavicek25 •26 attributes this angle to the fact that in
pantographing the recording flag is attached to the
mandible many millimeters from the condyle, thereby
introducing an uncontrollable artifact. Rosner27 de-
scribes this geometric problem as skew and tilt values
arising from not being at the proper intercondylar dis-
tance.
Lundeen and Wirth, 28 testing the reproducibility of
Lee's method in 1973, found that variations in un-
guided recordings occurred on the same patient with
different operators. When the operators guided the
patient through border movements, they were repro-
ducible.
Heners 29 used an amplifying oscilloscope in 1973
to view sagittal border movements, but not lateral mo-
tion, in real time.
Lauritzen30 illustrated and explained his extensive
usage of the hinge axis position in the mountings of
casts and fabrication of prostheses in his Atlas of Oc-
clusal Analysis (1974).
In 1976 McCoy et al. 31 used the plastic block en-
graving technique of Lee and their own research to
track mandibular movements and then photographed
these engravings for transferring these data to a com-
puter. They concluded that the collection and evalu-
ation of such data could clarify questions concerning
occlusion, tooth stability, effect on peridontal health
and permit correlations with the success of orthodontic
measures.
Lundeen et al. 32 evaluated mandibular border move-
ments in 1978, assessing the effect of border and Ben-
nett movements on tooth cusp form. They reasoned
that the determination of a patient's Bennett movement
and the inclination of the nonworking condylar path-
way would provide useful diagnostic and treatment
information.
In England, Winstanley (1977) 33 reported on the
use of pantographic hinge axis tracings to program an
articulator. He concluded that reasonable accuracy and
reproducibility were obtainable by experienced clini-
cians.
Shields et at.34 concluded in 1978 that hinge axis
tracings can be an aid in the detection of temporo-
mandibular dysfunction and muscular incoordination
as well as in the assessment of severity.
In 1979 Stuart35 obtained optimal occlusion with his
articulator frictionless condylar recording so that full
mandibular movements could be copied.
Simonet36 used the Pantographic Reproducibility In-
OCTOBER 1991, VOL. 9, NO. 4
PIEHSLINGER ET AL.
dex in 1981 to categorize a baseline of dysfunction
within subjects for studying Bennett movement.
In 1982 Klett37 used a light beam emitter with pho-
tosensor to measure and record three-dimensional
mandibular movements where artifacts could be elim-
inated.
Burckhardt described an optoelectronic infrared sys-
tem to determine hinge axis and centric relation in
1985 (C.R.J .M.-Stereognathograph). It included com-
puterized evaluation and permitted articulator pro-
gramming. Seebald used this system for simultaneous
and undistorted recordings of condylar movements in
space in 1986.
Recordings made by three simplified condylar
movement recorders were assessed by Mauderli and
Lundeen 38 to record internal derangements at the hinge
axis. Their 1986 report concludes by stating that this
diagnostic information could be preserved as a per-
manent record in the patient's chart.
Alsawaf and Missert39 •40 used the computerized ax-
iograph to study the three-dimensional real-time range
of motion of the geometrically calculated hinge axis
in condylar resected patients. In another study, using
healthy subjects with a located hinge axis, they re-
ported the effect of incisal guidance on hinge axis
movement. Missert41 .42 showed how computerized
axiographic data can be incorporated into the construc-
tion of phase one, two, and three treatment devices in
conjunction with computerized occlusal schemes, all
referenced to the same diagnostic and therapeutic plane.
He also reported on the verification of desired hinge
axis repositioning accomplished by these devices.
Curtise43 •44 in 1989 compared interocclusal records
to pantographic tracings.
The Vienna Research Group is reporting on using
both methods of axiography to standardize the clinical
methodology. Asymptomatic supernormals are stud-
ied to investigate the various methods used during the
instrumental phase of the dental physical and differ-
ential diagnosis.
Method
A conventional double face-bow system is attached
to the patient. The mandibular bow is used for trans-
mitting hinge axis movements of the mandible to the
upper face-bow. The mandibular bow can be adjusted
in two dimensions so as to localize the hinge axis in
the usual manner. The upper face-bow carries sagit-
tally mounted flags that are used in the electronic reg-
istration of hinge axis movement. This permits the
OCTOBER 1991, VOL. 9, NO. 4 THE JOURNAL
COMPUTERIZED AXIOGRAPHY
recording hinge axis translation within all mandibular
kinetics in two dimensions.
In the case of asymmetrical movement, there is tele-
scoping deviation of the recording styli. This corre-
sponds to a combination of the geometrical effect of
the sagittal flags and the individual lateral shift of the
mandible, the so-called Bennett movement. The use
of this axiographic method permits the correlation of
Bennett movement and translation.
Procedure
Instructing the Patient
The patient should be informed about the various
steps of the procedure and asked to relax. The patient
cannot do anything wrong, though individual steps
may have to be repeated. The commands have to be
practiced before mounting the face-bows.
Preparing the Instrument
The face-bows are prepared, and flags and styli must
be connected to the interface.
Making a Paraocclusal Clutch
The use of a paraocclusal clutch enlarges the di-
agnostic spectrum (Slavicek 1981). Temporomandib-
ular joint (TMJ) diagnostics is enhanced by the
functional and parafunctional dynamics of the masti-
catory organ.
The paraocclusal clutch permits the evaluation of
free or guided border movements without the influence
of occlusion and the observation hinge axis movement
during function (mastication) and parafunction (brux-
ism). Furthermore, MPI can be done on the patient,
avoiding all inaccuracies of making and mounting casts.
The yoke of a brass clutch is hand-bent to within 1 to
2 mm of the buccal and labial surfaces of the man-
dibular teeth in ICP, free from the maxillary antago-
nists. An autopolymerizing acrylic is placed on the
yoke, and an impression is made of these surfaces.
Since the material releases considerable heat, it should
be taken out of the mouth repeatedly until the initial
set is reached. A horizontal wax wafer can be placed
intraorally to keep the acrylic off the maxillary teeth.
The patient is instructed to bite to ICP with the wax
wafer in place. The clutch, loaded with acrylic, is then
inserted repeatedly (Figure 1).
OF CRANIOMANDIBULAR PRACTICE 347
PIEHSLINGER ET AL.
Figure I
The paraocclusal clutch fixed to the labial and buccal surfaces of
the mandibular teeth.
Mounting the Face-Bow
The operator stands behind the patient, holding the
face-bow with loose clamps in both hands. Silicone
putty is placed on the glabella adapter for patient com-
fort, conformed to this area while keeping the anterior
bow perpendicular to the sagittal plane, and set aside
awaiting final set (Figure 2).
The cranial bow is attached to the patient by placing
the side branches tightly to the head in a parallel sagittal
position. The screws are fastened. The red ribbon is
placed over the parietal area, the branches of the face-
bow rest 2 em above the patient's ears. Then a rubber
band is attached to the face-bow and fixed to the occiput
with enough tension to tighten it.
Figure 2
The frontal aspect of the patient during computerized axiography.
The putty material is placed on the glabella and the paraocclusal
clutch is fixed buccally on the teeth of the lower jaw.
348 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE
COMPUTERIZED AXIOGRAPHY
Measuring Flag Distance
The distance between the lateral edges of the face-
bow branches is measured in millimeters.
Mounting the Flags
Flags are mounted and fixed with screws.
Mounting the Registering Face-Bow
On the lower bow the branches are loose. Zero is
established by approaching the zero marks on the face-
bow. Cyanoacrylate gel is used to glue the functional
occlusion clutch to the teeth, and the mandibular bow
is clamped to the rod of the clutch. The lateral bows are
aligned parallel to the cranial bow. The holes for the
styli are placed in a position approximate to each con-
dyle. The branches of the two face-bows have to be
parallelized. For this purpose, the branches of the lower
face-bow are held tightly against the branches of the
upper bow while rotating the bar of the lower bow. The
bolt for the clutch clamp is tightened, securing the an-
terior bar of the mandibular bow (Figure 3).
Introducing the Styli
The recording styli are placed in their respective
holes, and moved to an area on the recording plate
arbitrarily corresponding to the position of the con-
dyles. The clamping portions of the lateral bows are
secured (Figure 4).
Figure 3
Branches of the two bows are parallelized by holding the branches
of the lower bow against those of the upper one.
OCTOBER 1991. VOL. 9, NO. 4
PIEHSLINGER ET AL.
Figure 4
Flags and styli from lateral.
Real-Time Display
The real-time option from the main menu is used
to check the range of motion of the patient on the
recording area of the plates in X and Z directions. The
Y coordinate can be displayed linearly to check the
range of lateral movements.
Locating the Hinge Axis
A rotational opening movement of at least 10 mm
is necessary to locate the hinge axis. The stylus, when
not on the hinge axis position, makes an arc that the
computer uses to calculate the center of a circle. This
center is the hinge axis. When pathological conditions
(diskopathies, bony alterations) preclude such move-
ment, i.e., when only translational movement is pos-
sible, the computer calculates a geometric hinge axis
position. It also determines the direction and distance
to the calculated position. On the screen the hinge axis
appears as a circle, the stylus position as a cross. By
turning the screws of the lower face-bow, the cross
can be moved precisely to the hinge axis position. The
distance is indicated to an accuracy of one hundredth
of a millimeter. When both styli are close to the hinge
axis, the screen changes to a close-up view (zooming
option). In living systems it is not possible to set the
hinge axis to an accuracy of 0.01 mm; it should lie
within 0.2 mm.
Having found the hinge axis, one should perform
another check to ensure reproducibility. This may be
done by slight opening/closing in rotation and watch-
ing the axis point, which should not move during pure
hinging movement.
OCTOBER 1991, VOL. 9, NO. 4 THE JOURNAL
COMPUTERIZED AXIOGRAPHY
Adjusting the Orbital Marker
The orbital point is located by light fingertip pal-
pation of the area below the left eye. The rounded end
of the supplied ruler is placed at this site and kept
parallel to the cranial bow. The adjustable orbital
marking pin is lowered to the ruler, slid medially until
the tip touches the side of the nose, and secured. The
point on the skin directly under the marker is dotted
with a pen. A lead pellet will later be placed on the
dot to transfer the orbital point to the head film(s).
Fixing the Hinge Axis
Once located, the hinge axis has to be registered in
the recording system. The examinator takes the patient
to reference position using unforced chin point guid-
ance. The foot pedal for registration is pressed, and a
double beep indicates that the position has been stored.
Recording the Tracings
The classical movements for the orthopedic and
standard functional analyses are available from a menu
with numbered options. Entering the number auto-
matically transfers the corresponding text from the list
to the record of the next recording to be made.
1. Open/Close
2. Protrusion/Retrusion
3. Mediotrusion, Right-unguided
4. Mediotrusion, Left-unguided
5. Mediotrusion, Right-guided
6. Mediotrusion, Left-guided
7. Electronic mandibular position
indicator (EMPI)
The recordings listed above are standard options that
are always available. They can be augmented with
subsequent unlimited recordings typed into the record.
Usually speech, mastication, swallowing, and bruxing
recordings are made with a duration of either four and
one-half or nine seconds. These recordings may dem-
onstrate functional patterns. The rotational or trans-
latory character of movement in speaking, as well as
asymmetries and avoidance patterns, can be observed.
The patient initiates the movement after the operator
presses the foot switch. The beginning of the recording
is signalled by a beep; the end is indicated by a second
beep. The recording is immediately displayed on the
screen for assessment and can be either saved or de-
leted. HCI from the protrusive-retrusive movement
OF CRANlOMANDIBULAR PRACTICE 349
PIEHSLINGER ET AL.
and the Bennett angle of mediotrusion can be used for
articulator programming.
The electronic device allows the superimposition of
several curves in different colors. This display is much
more detailed and accurate than in mechanical axiog-
raphy because the lines are much thinner and tracings
are magnified on the screen.
Superimposing different curves permits the exact
verification of the reproducibility of joint movements.
The superimposition of border movements and func-
tional movements like mastication or speech can be
of great value in the differential diagnosis of avoidance
mechanisms (Figure 5).
One major advantage of computerized axiography
is that it permits the plotting of Bennett movement.
The dial gauge of the mechanical device is not easy
to work with, especially when the TMJ is unstable
(Figure 6).
The graph of the axis movement consists of lines
recorded in 0.5-second steps during incursive and ex-
cursive movement. The tips of both styli are at the
end of these lines, and the distance between the lines
represents left to right movement coordination. The
curve at the top represents the view from above onto
the hinge axis in excursion; second curve from the top,
shows incursion. The two lower graphs represent the
anterior view of the excursive and incursive movement
(Figure 7).
Joints with early stages of discopathies usually move
more slowly than healthy joints or they may be stopped
by obstacles. Muscular imbalance can be detected when
there are no reproducible superimposed tracings and
when speed changes show an undulating pattern. The
protrusion/retrusion
~E
X I 1....-+--+1
;: : :
·~~
I I I I )o
Figure 5
The superimposition of two protrusive movements shows the good
reproducibility in this case.
350 THE JOURNAL OF CRANIOMANDIBULAR
COMPUTERIZED AXIOGRAPHY
computerized system can thus be used to document
the progress of physical therapy.
Color-coded time curves offer additional help. The
uppermost line indicates the distance in millimeters
covered by the X, Y, and Z coordinates during four
and one-half seconds. The distance "s," the linear
pathway from reference position, is also projected.
The middle diagram shows the Bennett angle and HCI
as functions of time. The lowest row represents the
velocities of the X, Y, and Z coordinates and the
distance "s" in millimeters per second. These curves
show the true distance traveled in space and the ac-
celerations in the X, Y, Z, and "s" directions. A
vertical line can be moved in intervals of one-tenth
seconds, and the coordinates of each point on the curve
can be determined. Bringing the curves in relation with
the fourth dimension, time, offers important diagnostic
information and is more in accordance with a living
system (Figure 8).
A cursor can be moved on the axiographic tracings
displayed on the screen. By using the arrow keys on
the keyboard, the cursor can be moved continuously
or in one-tenth to nine-tenths second intervals. Hinge
axis movement in time and in space can thus be ob-
served, which makes it possible to recognize asym-
metries and evaluate the continuity of movement. In
combination with the time curves, this provides valu-
able diagnostic clues.
The advantages of the computerized system will be
demonstrated on one special case. The analysis of the
axiographic tracings on the screen permitted the de-
tection of pathologies that had never been observed in
mechanical axiography.
Figure 9 shows an opening-closing movement of
average quantity and characteristics. There is a click-
+Y ing phenomenon that has never been observed using
t~
the mechanical device because of the thickness of the
: : :
lead of the recording pencil. The protrusive movement
does not reveal the clicking phenomenon, but it ap-
pears again in the chopping movement of mastication.
*** phenomenon that appears in the rotational, but not
A
in the translatory, movement (protrusion) indicates
changes in the lower joint space (in this case on the
head of the condyle). The magnetic resonance imaging
of the temporomandibular joints showed cystic changes
on the right condyle.
Electronic Mandibular Position Indicator (EMPI)
The EMPI offers the same data as the mechanical
position indicator. The EMPI mode contains a num-
bered listing of standard recordings.
PRACTICE OCTOBER 1991, VOL. 9, NO. 4
PIEHSLINGER ET AL. COMPUTERIZED AXIOGRAPHY

MEOIDTRUSION RIGHT GUIDED

AXIS MOVH1ENT

-Y +Y

-1

10 ~ !I I 7 6 5 4 3 2 1
I > X

5
6
7
I
!I
R L
1.0

INKURSION +Z
recht• linka
& HOI BEN TiOi BEN
1 62.52 9.47 .86 19.94 53.30 -49.73
2 70.35 6.31 72.15 10.20 60.11 26.31
3 71.1!15.38 75.33 5.75
4 71.25 4.13 75.86 5.50
5 72.84 3.83 71.90 5.02
6 70~U 3.31 72.73 5.66
7 68.86 2.98 70.77 5.15
8 69.83 3.47 68.90 5.14
9 67.42 3.99 68.-49 4.87
10 66.30 4.09 67.14 4.82

Figure 6
Mediotrusion right of a healthy joint with a continuous increase of the Bennett-angle values.

I. RCP-ICP sition on the incisal table), delta L (anterior-posterior

2. Resilience distance of incisal pin position on the incisal table),
3. Estimated therapeutic position delta W (left-right distance of incisal pin position on
4. Power bite the incisal table), GAMMA (rotational angle of hinge
5. Ideal vertical position axis). The delta data are immediately displayed after
6. ICP-ICP after opening the EMPI record is made and can be saved or deleted
(Figure 10).
An unlimited number of additional recordings can RCP-ICP data can be transferred directly from CA-
be made. These recordings can also be done at four DIAX to CADIAS. HCI and Bennett movement are
and one-half or nine-second intervals. The EMPI mea- transferred. All tracings including EMPI evaluation
sures the difference between any two hinge axis co- can be seen on the screen or can be plotted. Further-
ordinate positions. Data are collected only at the initial more, data for articulator programming and the waxing
and final positions of the recording. technique may be printed on a laboratory sheet. The
The values are indicated as delta x (the deviation computer calculates HCI from protrusion-retrusion and
in the frontal plane), delta y (the deviation in the trans- the Bennett angle from mediotrusion. When the cusp
verse plane), and delta z (the deviation in the vertical coordinates are fed into the system, the inclination
plane). Each value is given for the right and left side: angles of the cusps can be printed on the laboratory
delta H (computer-calculated height of incisal pin po- sheet.

OCTOBER 1991, VOL. 9, NO. 4 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE 351

PIEHSLINGER ET AL. COMPUTERIZED AXIOGRAPHY

l-~F'EN/CLOSE AXIS MOVEMENT

+Y -.40 ~ 20 .co -Y
-Y +Y

J
_:f 4 I I> X El
f:. -Y
I 2 3 4 5 & 7 B 9 10 10 +Y -.40 -a
I I I > X <I

----- -·····.
4, 4

j
5
&
7 +Y -a .co -Y
---
-.40 20
....

~ L
8
9
10
--
+Z +Z

z It
tY ... -a 20 .co -Y

-----

z
Figure 7
Opening and closing movement of a healthy joint. The right graph represents the axis movement.

OPEN/CLOSE TIME CURVES

~ f\ ~1 fl
X
y
z
s
I I •••> time <sec> in t
I
2
I
J
I
4
•••> time <s
I 2 4

liO
BEH
HKN
IWICA

5I 5I
Sx
1!1 ~ 1!1
Is
time <sec) in mm/sec
I. I 4
-1!

...
=I
Figure 8
Time curves of healthy joints during opening and closing movement.

352 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE OCTOBER 1991, VOL. 9, NO. 4

PIEHSLINGER ET AL. COMPUTERIZED AXIOGRAPHY

AXIS MOVEMENT

+Y -41 -a liD 40 -Y

-Y OPEN/CLOSE +Y

~·if~ I I I I I I I > X .ZI I I I I I I I I I

t X
I 10 10 I I 7 I I l 40 -Y
1 I 3 4 5 I 7 I
-~ X c!l I I I I • I>
I
J
4
I
I
7 +Y .... -10 ~ ID 40 -Y
I
I
'" I k1i~~ I>
R L --·-·-----
- -·---::=·:.:.::-===:
10
- ·------
- - ·-- "*§d
+Z +Z

Figure 9
Clicking phenomenon during the opening and closing movement.

The computerized axiograph should be considered
an integral part of the differential diagnostic and treat-
ment system. The medical approach to computerized
axiography is that of an orthopedic examination of the
temporomandibular joints.
Conclusion
Computerized axiography permits the recording of
mandibular movement and offers analytical systems
for evaluation. Data of both temporomandibular joints
can be compared simultaneously in relation to changes
in space and time.
A major advantage of the computerized system lies
in the enlarged diagram of the tracings on the computer
screen. Small changes like initial disk displacements
cannot be diagnosed with the mechanical device be-
cause of the thickness of the recording pencil.
By means of different analytical options, various
parameters, such as axis movement in space, accel-
eration, deceleration, HCI, Bennett angle, and rotation
of the hinge axis, can be displayed for simultaneous
assessment. This can be instrumental in the differential
diagnosis of muscular or ligament problems. Repro-
ducibility can be checked by means of standardized
examination or superimposition options. This system
permits the measurement and qualification of tracings
of the hinge axis and helps determine the character-
istics of paths. The records can be used directly for
articulator programming. The system facilitates or-
thopedic quantifying diagnostics at a high level of

OCTOBER 1991, VOL. 9, NO. 4 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE 353

PIEHSLINGER ET AL. COMPUTERIZED AXIOGRAPHY

hU· lU' ni.::SIUENCE

+X+
dXR-= 0.26
dXR• o.o8 dZR-= o. i2
dZR- o. i6
dXL• o. i6
dZL• 0.22
dY• 0.03
dH- -LA7
dlf• -o. i&
dL• i.i9
.,z +w+z tt•ill1m
it•2mm
dXLa
dY..
O.i3
dZL-= o.5A
-0.06
dH= -i.67
dW.. -o. i6
dla i.Ai
Ga11ma-= -o •73
+·+
I +z
---1--- If
+z tt-tln:tl

tt•2m~,

1+
SaMa• -o.65
RCP - ICP RESILIENCE
dXR.. -o. i2

+~+ I
dXR- 0.00 dZR• o. i3
dZA- dXLa o.i6

+z + +z
O.i9
dXLa O.OA ~---X X
dZLc 0.22
dZL• O.iB dY• -o.o5
dY• -O.Oi dH• LOO +z x 1 +z

-r-·
dH- 2.82 dWa -O.Ai tt•tmm
dlfa -0.02 tt-t 111m dl• -0.7i it•tmm

sa•·
dl• -2.06
t.2A
RCP - ICP
If tt•3mm Ga11111a• o•.w

+~+
dXR- 0.20 ICP -> pcwerbite

+·+
dZR- 0.32 dXR= o.os
dXL• o.!A dZRa o.o8
dZL• o.26 dXL= -o. i7
dY= o.oo dZL• -0.06
dH= -3.27
dill• -0.07
dl•2.62
sa•· -i.AA
+z ++•z tt•tmm
tt•3mm
dY• o.oo
dH= -3.25
dlf• 0.47
dL• 2.29
J +z
- - If
+z tt-1111111
tt-3111111

l
Gaua• -L A3

t
E M P I

ICP - ICP aTter- opening

+·+
dXRa -o.Ao
dZR• -o. i3
dXL• o.o6
dZL• o.oo
dY• -0.06
dH-= 0.83
dlf• -0.62 +z x I +z tt·••

)"
dL• -o.7a
Gallmaa o. 36

Figure 10
Plotting of the electronic mandibular position indicator (EMPI).

accuracy and is helpful in treatment planning and in and speech, for instance, can reveal avoidance mech-
the evaluation of therapy. anisms and functional asymmetries.
The double stylus system ensures the accurate de-
Reprint requests to:
termination of the hinge axis position and also allows Eva Piehslinger, M.D., D.D.S.
an exact evaluation of rotational capacities. Not only University of Vienna-School of Medicine
Universitiitsldinikfor Zahn-Mund und Kieferheilkunde Wien
border movements but also functional movements can I 090 Wien, Wlihringerstrasse 25a
be of diagnostic value. The recordings of mastication Vienna, Austria

354 THE JOURNAL OF CRANIOMANDIBULAR PRACTICE OCTOBER 1991, VOL. 9, NO. 4

PIEHSLINGER ET AL.
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Robert M. Celar, M.D.
Dr. Celar received his M.D. degree from the University of Vi-
enna in 1989. In the fall of the same year he started working as a
scientific collaborator at the Dental Clinic of the University of
Vienna. In October 1990 he started the postgraduate dental edu-
cation program at the Dental Clinic of the University of Vienna.
Rudolph Slavicek, M.D., D.D.S.
Dr. Slavicek received special training in cardiology and pa-
thology at the University of Vienna, Austria, and received his M.D.
degree in 1954. He received his D.D.S. degree in 1957 with special
studies in restoration and prosthetics. He is currently in private
practice in Vienna and is head of the Dental Clinic Department of
Removable and Fixed Prosthodontics at the University of Vienna.
He is founding president of the European Academy of Cranio-
mandibular Disorders.
PRACTICE 355