DENTAL TECHNOLOGY

DANIEL H. GEHL, Section editor

Hinge-axis location and face-bow transfer for

edentulous patients

Robert P. Renner, D.D.S.,* and Virgil M. S. Lau, D.D.S.**

SUNYStony Brook, School of Dental Medicine, Stony Brook, N. Y.

N umerous articles describe methods of obtaining centric relation at a proper

vertical dimension for edentulous patients. However, there has only been a passing
interest in transferring these vital jaw relation records to an articulator by means of
actual hinge-axis location and a face-bow transfer.lm5 Chair-side and laboratory
procedures could be considerably shortened if an accurate hinge axis could be
located and transferred to an adjustable articulator for edentulous patients. Once
this objective is achieved, dentists can (1) alter the vertical dimension of occlusion
on the articulator6 ; (2) obtain the centric relation records and verify them at the
try-in at an altered vertical dimension of occlusion; (3) minimize the remounting
procedures to perfect the occlusal scheme; (4) safely use a cusp-form (anatomic)
posterior tooth where indicated with minimal occlusal adjustments’; and (5)
develop an occlusion which would preserve and restore oral function.
The opponents of use of a kinematic hinge-axis location for edentulous patients
point to its unreliability because of the resiliency of the oral mucosa, the added
weight of the recording clutch which tends to shift the denture base, and the
time-consuming nature of the procedure. To eliminate some of these disadvantages,
we have developed a modification of the Loma Linda hinge-axis recording device
and face-bows for use on edentulous patients.

PROCEDURES
Modification of the hinge-ajcis locator.t ( 1) Cut two parallel channels down
the length of a clear Lucite plastic blank to accommodate the hinge-axis recorder
and flags (Fig. 1).

*Assistant Professor, Department of Restorative Dentistry.

“*Associate Professor, Department of Restorative Dentistry.
tLoma Linda alloy, Loma Linda, Calif.
352
 Transfer of hinge-axis location for the edentulous 353

Fig. 1. The modified Lucite blank that accommodates the Loma Linda hinge-axis recorder.

Fig. 2. Modified Coe Bunce-Kanouse aluminum tray containing a lower modeling compound
impression.
Fig. 3. The tissue surface of the modeling compound impression and Lucite handle made for
a patient.

(2) Modify a set of lower edentulous impression trays* with cold-curing acrylic
resin to accommodate the modified Lucite blank.
(3) Cut a pair of hollow tubes, four in all, */a inch in length.
(4) Perforate each of the aluminum trays, and shorten the handle.
(5) Fix the Lucite blank and hollow tubes to the trays with a mix of cold-
curing acrylic resin. The resin is allowed to harden, chemically locking the Lucite
to the tray as a new handle and mechanically locking the tubes as stabilizers for a
circummandibular elastic effect (Fig. 2). The acrylic resin covers all external
portions of the edentulous trays and is smoothed and contoured to eliminate all
sharp and rough edges. A series of lower impression trays can thus be modified to
make clutches for use with the Loma Linda hinge-axis locator.
Technique of a simplified hinge-axis location. (1) Select a modified tray of the
proper size for the patient.
(2) With modeling compound, make a lower, functional, border-molded impres-
sion to serve as a stable, customized clutch for the hinge-axis locator (Fig. 3). If
the clutch is not stable, elastics, added around the hollow tubes and under the
chin to the opposite side and cushioned with gauze, will most often completely
stabilize the clutch.

Woe Bunce-Kanouse style impression trays, Coe Laboratories, Chicago, Ill.

 J. Prosthet. Dent.
354 Renner and Lau March, 1976

Fig. 4. The Loma Linda recorder is attached to the modeling compound impression in a cus-
tomized clutch.
Fig. 5. The hinge axis is located using the Loma Linda recorder and customized modeling com-
pound clutch.

Fig. 6. The occlusion rim stabilized by cold-curing acrylic resin is keyed into the Loma Linda
face-bow fork with modeling compound.
Fig. 7. The modeling compound occlusal keys orient the maxillary occlusion rim in the Loma
Linda face-bow fork.

(3) Place the hinge-axis locator and flags on the Lucite blank of the clutch,
and lock them into place (Fig. 4).
(4) Place squares of graph paper bilaterally over the approximate location of
the patient’s condyles.
(5) Position the flags on the recorder over the graph paper, and locate a
kinematic hinge axis on the patient.
(6) Record the hinge axis with a pencil dot at the appropriate location on the
graph paper with the patient’s mandible protruded. This is done one side at a time.
The hinge-axis location is verified with the pencil dots on the graph paper (Fig. 5).
The hinge-axis is thus located.
(7) Remove the clutch and hinge-axis recording from the patient. Do not disturb
the graph paper with the hinge-axis location marked on it. A face-bow transfer to
an articulator* is made by use of the hinge axis.
*Whip-Mix articulator, The Whip-Mix Corporation, Louisville, Ky.
Volume 35 Transfer of hinge-axis location for the edentulous 355
Number3

Fig. 8. Face-bow transfer record.

Fig. 9. The indexed master cast is ready for mounting to the upper member of the Whip-Mix
articulator.
Fig. 10. The maxillary cast is mounted on the upper member of the Whip-Mix articulator.

Face-bow transfer technique. (1) Make a well-fitted, stabilized, maxillary oc-

clusion rim of cold-curing acrylic resin to aid in the face-bow transfer.
(2) Adjust the maxillary occlusion rim for proper length, lip support, and the
approximate occlusal plane.
(3) Make anterior and posterior keys in the occlusion rim to relate the rim to
the face-bow fork (Fig. 6). Check the maxillary occlusion rim intraorally for
stability in the index on the fork before the transfer is made (Fig. 7) .
(4) Stabilize the face-bow fork in the modeling compound index to the maxillary
occlusal rim by having the patient close against the fork with gauze placed between
the mandibular residual ridge and the face-bow fork (Fig. 8) .
(5) Heat the hinge-axis locator rods, and place them in the compound cups
at the hinge-axis location. This is done one side at a time.
(6) Locate the third point of reference.
(7) Position the axis orbital pointer to the third point of reference, and secure
it to the face-bow (Fig. 8).
(8) Remove the face-bow record from the mouth, and place it on the mounting
stand.
356 Rennet- and Lau J. Prosthet. Dent.
March. 1976

Mounting the cast to the articulator. (1) Place the indexed master maxillary
cast in the maxillary occlusal rim.
(2) Insert the upper member of the articulator with its mounting rod into the
face-bow record on the mounting stand (Fig. 9).
(3) Apply a suitable separating medium to the cast.
(4) Attach the cast to the mounting plate of the articulator (Fig. 10).
This completes the mounting of the maxillary cast from the face-bow transfer.

SUMMARY AND CONCLUSIONS

There are distinct advantages to locating the hinge axis for the edentulous pa-
tient by use of the modified Loma Linda hinge-axis locator. These include : ( 1)
alteration of the vertical dimension of occlusion on the articulator may be accom-
plished since the opening or closing takes place around the patient’s terminal hinge
axis; (2) valid and verified centric and eccentric relation records may be obtained
at an increased vertical dimension of occlusion that is in harmony with the patient’s
terminal hinge axis; (3) cusp-form posterior teeth can be articulated and verified
in the mouth with minimal occlusal correction by use of a terminal hinge axis.
Some disadvantages to the procedure may include : ( 1) the additional procedure
of making a modeling compound clutch for hinge-axis location; (2) the initial
modification of the edentulous trays to accommodate the recording device; and
(3) the technique is used with the Whip-Mix articulator; however, it can be
modified for use with other articulators.

References
1. Stuart, C. E., and Stallard, H.: Why an Axis? J. South. Calif. State Dent. Assoc. 32: 204-
205, 1964.
2. McCollum, B. B.: Mandibular Hinge Axis and a Method of Locating It, J. PROSTHET.
DENT. 10: 428-435, 1960.
3. Anderson, J. N., and Storer, R.: Immediate and Replacement Dentures, ed. 2, Oxford, 1973,
Blackwell Scientific Publications, pp. 315, 318.
4. Levao, R.: Value of the Hinge Axis Record, J. PROSTHET. DENT. 5: 623-625, 1955.
5. Trappozano, V. R., and Lazzari, J. B.: A Study of Hinge Axis Determination, J. PROSTHET.
DENT. 11: 858-863, 1961.
6. Beresin, V. E., and Schiesser, F. J.: The Neutral Zone in Complete Dentures, St. Louis,
1973, The C. V. Mosby Company, p. 89.
7. Stuart, C. E.: Why Dental Restorations Should Have Cusps, J. South. Calif. Dent. ASSOC.
27: 198-200, 1959.
8. Lau, V. M. S., Aufdemberg, T. W., and Baum, L.: Simplified Technique for Hinge Axis
Location and Face Bow Transfer, in Kilpatrick, H. C.: Work Simplification in Dental Prac-
tice, ed. 3, Philadelphia, 1974, W. B. Saunders Company, pp. 566-575.

SUNY-STONY BROOK
SCHOOL OF DENTAL MEDICINE
STONY BROOK, N. Y. 11790