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Orientation Jaw Realation
Orientation Jaw Realation
JAW
RELATION
PART -1
GUIDED BY – PRESENTED BY -
DR AJAYKUMAR NAYAK
DR SHILPA SOMAN
PROFESSOR
III MDS
2
Contents
• Introduction • Plane of orientation
• Jaw relation • Types of facebow
• Orientation jaw relation • Compatibility of specific
articulators with facebows
• Mandibular movements
• Facebow transfer
• Hinge Axis, terminal hinge
axis & centric relation • Recent advances
• True vs arbitrary hinge axis • Conclusion
• Opinion regarding location of • References
transverse hinge axis
• Facebow
4
Jaw relation
Boucher divided
DEFINITION jaw relation into:
GPT 9
5
movements
Terminal
hinge
axis
Centric
relation
9
Hinge axis
(transverse horizontal axis)
Hinge axis
(transverse horizontal axis)
Centric relation
(GPT 9)
A maxillomandibular relationship, independent of tooth contact, in which the
condyles articulate in the anterior-superior position against the posterior
slopes of the articular eminences;
in this position, the mandible is restricted to a purely rotary movement;
from this unstrained, physiologic, maxillomandibular relationship, the patient
can make vertical, lateral or protrusive movements;
it is a clinically useful, repeatable reference position
Learnable
Repeatable
Recordable
12
18- 25 cm
14
Therefore,
location of transverse
hinge axis :
Absolute
location
Arbitrary
Split axis
location
Non believers
16
3. Non believers
• Bohr, Posselt, Beck
• Believes that it is impossible to locate transverse axis with
accuracy (theoretical but not practical)
• Hinge movement of the mandible, together with its fragmentary
movements, cannot be repeated by the opening and closing
movements of an articulator which is about one axis only
19
Singh S, Rehan S, Palaskar J, Mittal S. Hinge axis-location, clinical use and controversies. Journal of
Research in Dentistry. 2017 Oct 3;4(6):158-61.
20
Facebow
21
Facebow
History of facebow
1866- Balkwill
1880- Hayes
1890- Walker
1905- Gysi
Wadsworth
23
1866- Balkwill
• Bite-frame
• Measured the angle formed by the occlusal plane & a plane passing
through the lines extending from the condyles to the incisal line of the
lower teeth.
22-30°
24
1880- Hayes
• Caliper- a tong like device
1890- Walker
• Clinometer
• Position of the lower cast in relation to the condylar
mechanism.
26
Wadsworth
• Employed a different plane,
which extends from the
condyle area and runs at right
angles to a line that connects
the most prominent points of
the chin and forehead
28
PARTS OF THE
FACEBOW
Constructed as 3 bars: 2 lateral & 1 anterior
29
U SHAPED
FRAME
Cast
support
BITE FORK
Mounting 3RD REFERENCE
platform POINT
Anterior
elevator
LOCKING
DEVICE
30
2. When cusp form teeth are used. 2. Monoplane teeth are used
ADVANTAGES
OF FACEBOW:
1. The arcs of movement in the articulator will differ from that of the
patient.
Denture Increased
instability RRR
Path of Pain,
TMJ
closure crepitus,
affected
altered subluxation
34
Errors of tooth movement associated with axis other
than actual terminal hinge axis
35
TYPES OF FACEBOW
Fascia
type
Arbitrary
Earpiece
Facebow
Kinemati type
c
36
PLANE OF
ORIENTATION
The maxillary cast is orientated in relation to a plane known
as the plane of orientation.
Formed by:
1. Anterior reference point
2. Posterior reference point
37
Orbitale
Anterior reference points
Beyron
Nasion Gysi
Teteruck and
Ala of nose
Lundeens point
Posterior Reference
Points
39
Gysi point
11-13 mm anterior to the upper third of the tragus of the ear on a
line extending from upper margin of the external auditory meatus
to the outer cantus of the eye
11-13mm
40
Beyron’s point
13mm anterior to the posterior margin of tragus on a line from centre of
tragus to outer canthus of eye
Closest to the true hinge axis
13mm
41
Bergstrom’s point:
About 10mm anterior to the centre of the spherical insert for the
external auditory meatus and 7mm below the FH plane.
Teteruck and 42
Lundeens point
13mm anterior of tragus on line joining base of tragus to outer
canthus of eye.
By palpation: 43
(Dawson’s method)
From behind the patient, place the index finger tip over the joint
area and ask the patient to open his mouth wide.
Anterior reference
points
45
Significance
• Provides the anterior point for establishing
the AP tilt of the plane of orientation
• Determines the level at which the casts are
mounted
• To establish baseline for comparative studies
between patients
• Can visualize anterior teeth and occlusion in
the articulator in the same reference as the
face
46
Orbitale:
In the skull, orbitale is the lowest point of the infra orbital rim.
On a patient it can be palpated through the overlying tissue and the skin.
One orbitale and the two posterior points that determine the horizontal axis
of rotation will define the axis orbital plane.
Used in Hanau facebow
47
Ala of nose
The right or left ala is marked on the patient and the anterior
reference pointer of the face-bow is set.
This method uses the Campers Plane as the plane of orientation
50
Ala-tragus line
Line drawn from the upper part of the tragus to the lower edge of
the nostrils
53
Prosthetic plane
Is another oriention plane use by gysi
It is the line drawn from the lower part of the tragus to the lower
edge of nose.
54
Frankfort’s plane
Orbitale plane
Line drawn from the upper part of the tragus to the orbitale
Establishing Plane 55
Of Orientation
Maxillary occlusal rim is contoured to provide lip support
PART – 2
ORIENTATION JAW
RELATION
GUIDED BY –DR AJAYKUMAR NAYAK PRESENTED BY – DR SHILPA
PROFESSOR SOMAN
Methods of
57
Locating Hinge
Axis
ARBITRARY KINEMATIC
METHOD METHOD
58
Earpiece
type
Facia
type
60
Facia type
CONDYLAR RODS
Advantages:
• Simple
• Does not require measurements or
marks on the face.
• Accuracy is similar to facia type
method
63
5. Artex facebow
Hanau ear piece 64
Facebow transfer
67
FB should be pointed upwards during this action. Open the bow by pulling
outward and swing it down into position placing ear pieces gently into
71
1 2
3
74
Denar Slidematic 75
Face-bow:
Allows the maxillary arch to be
transferred to the articulator without
Reference plane
attaching the Face-bow to theindicator
articulator with the help of transfer
jig.
Bitearms
The Earpiece fork open and close
simultaneously and equidistantly by
a horizontal sliding gear
mechanism
Facebow with
Anterior point of reference- Marked
slidematic gear
using Denar Reference Plane
Locator
Whip-Mix quick
76
mount facebow
• Anterior reference point: nasion
Artex facebow
• The entire fork assembly
tightens with a single thumb
screw. This eliminates tilted
mountings.
• Very simple to use.
• There is a matching transfer
stand that eliminates sending
the facebow to the lab
• The maxillary model can also
be mounted by attaching the
facebow directly to the
instrument.
78
Kinematic facebow
• Hinge bow, adjustable axis facebow
• A facebow with adjustable caliper ends used to locate the
exact transverse axis of the mandible
• It is used with Fully adjustable articulator
• Used in full mouth rehabilitation
79
• Clutch is attached to
mandibular teeth with putty
.
82
Disadvantages of kinematic
facebow
PANTOGRAPH
2 face bows
6 records
3 tracings
Records centric
relation with terminal
hinge axis
Compatibility of specific 85
Armamentarium :
an intraoral scanner, a digital camera, and specific
software (Agisoft).
Solaberrieta E, Garmendia A, Minguez R, Brizuela A, Pradies G. Virtual facebow technique. The Journal
of prosthetic dentistry. 2015 Dec 1;114(6):751-5.
89
Solaberrieta E, Garmendia A, Minguez R, Brizuela A, Pradies G. Virtual facebow technique. The Journal
of prosthetic dentistry. 2015 Dec 1;114(6):751-5.
90
Solaberrieta E, Garmendia A, Minguez R, Brizuela A, Pradies G. Virtual facebow technique. The Journal
of prosthetic dentistry. 2015 Dec 1;114(6):751-5.
91
References
1. Contemporary fixed Prosthodontics, Stephen F. Rosenstiel, 3 rd edition.
2. Fundamentals of fixed Prosthodontics, Herbet Shillinburg, 3rd edition
3. Essentials of complete denture Prosthodontics, Sheldon Winkler, 2 nd edition
4. Hickey J, Zarb G, Bolender C. Boucher’s Prosthodontic Treatment for Edentulous
Patients : 9th ed.
5. Textbook of complete dentures, Rahn A, Heartwell C, 4 th edition
6. The concept of complete dentistry, Peter E Dawson
7. Jayachandran S, Ramachandran CR, Varghese R. Occlusal plane orientation: a
statistical and clinical analysis in different clinical situations. Journal of Prosthodontics:
Implant, Esthetic and Reconstructive Dentistry. 2008 Oct;17(7):572-5.
8. Solaberrieta E, Garmendia A, Minguez R, Brizuela A, Pradies G. Virtual facebow
technique. The Journal of prosthetic dentistry. 2015 Dec 1;114(6):751-5.
9. Shetty S, Shenoy KK, Sabu A. Evaluation of accuracy of transfer of the maxillary
occlusal cant of two articulators using two facebow/semi-adjustable articulator systems:
An in vivo study. The Journal of the Indian Prosthodontic Society. 2016 Jul;16(3):248.
10. Singh S, Rehan S, Palaskar J, Mittal S. Hinge axis-location, clinical use and
controversies. Journal of Research in Dentistry. 2017 Oct 3;4(6):158-61.
92
THANK YOU !
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Review of
literature
Evaluation of accuracy of transfer of the maxillary occlusal cant100
of
two articulators using two facebow/semi-adjustable articulator
systems
AIM
To compare the accuracy of the angle made by Frankfort horizontal plane-occlusal
plane on maxillary casts, mounted using the respective facebows on Artex Amann
Girrbach and Hanau Wide-vue semi-adjustable articulators with cephalometrically
derived Frankfort horizontal plane-occlusal plane angle as a control.
METHODOLOGY
Shetty S, Shenoy KK, Sabu A. Evaluation of accuracy of transfer of the maxillary occlusal cant of two
articulators using two facebow/semi-adjustable articulator systems: An in vivo study. The Journal of the Indian
Prosthodontic Society. 2016 Jul;16(3):248.
101
Pictorial representation of the angle formed between Frankfort horizontal Plane (a) Occlusal, Plane (b)
measured using RadiAnt DICOM software on a cephalogram. Insert (c) represents a parallel line to insert (b)
Shetty S, Shenoy KK, Sabu A. Evaluation of accuracy of transfer of the maxillary occlusal cant of two
articulators using two facebow/semi-adjustable articulator systems: An in vivo study. The Journal of the Indian
Prosthodontic Society. 2016 Jul;16(3):248.
102
RESULT
CONCLUSION
Shetty S, Shenoy KK, Sabu A. Evaluation of accuracy of transfer of the maxillary occlusal cant of two
articulators using two facebow/semi-adjustable articulator systems: An in vivo study. The Journal of the Indian
Prosthodontic Society. 2016 Jul;16(3):248.
103
AIM
Jayachandran S, Ramachandran CR, Varghese R. Occlusal plane orientation: a statistical and clinical
analysis in different clinical situations. Journal of Prosthodontics: Implant, Esthetic and Reconstructive
Dentistry. 2008 Oct;17(7):572-5.
104
METHODOLOGY
• The occlusal plane of ninety adults were compared with their HIPs.
• In dentulous subjects, the maxillary stone cast was mounted on the Wills
surveyor with HIP, which was made parallel to the horizontal plane using
the tripoding method.
• The vertical distance between the occlusal plane and floor of the surveyor
was measured at four points. When the measured values were equal, the
two planes were confirmed to be parallel for that situation. In turn, this
relation confirmed the parallelism between the occlusal plane and HIP.
• In the edentulous subjects, the occlusal plane, established clinically using
the ala tragal line, was compared with the HIP radiographically using lateral
cephalograms.
• Paired t-test was used to test the equality of the mean differences at a 0.05
significance level.
Jayachandran S, Ramachandran CR, Varghese R. Occlusal plane orientation: a statistical and clinical
analysis in different clinical situations. Journal of Prosthodontics: Implant, Esthetic and Reconstructive
Dentistry. 2008 Oct;17(7):572-5.
105
The cast fixed on the surveyor using the Lateral cephalograph of the edentulous patient
tripoding method with occlusion rims (metal balls and the central
bearing plate attached to the maxillary record
base and occlusion rim, respectively) in place.
106
RESULTS
• The mean differences from the right canine were: 0.055 cm at the left
canine, 0.05 cm at the right molar, and 0.065 cm at the left molar in
dentate subjects and 0.001 cm between the incisive papilla and hamular
notch in edentulous subjects.
• The HIP appeared parallel to the occlusal plane as the paired t-test
showed no statistically
• significant difference (p > 0.05).
CONCLUSION
In the population tested, the HIP was parallel to the occlusal plane.
Therefore, this may be a viable reference in complete denture
prosthodontics.
Jayachandran S, Ramachandran CR, Varghese R. Occlusal plane orientation: a statistical and clinical
analysis in different clinical situations. Journal of Prosthodontics: Implant, Esthetic and Reconstructive
Dentistry. 2008 Oct;17(7):572-5.
107
Conclusion
The use of face bow is indispensable for diagnosis, treatment planning &
treatment procedures.
By using face bow the risk of occlusal errors are minimized thereby