SRM University Journal of Dental Sciences

Volume 2, Issue 1, January - March 2011

Review

Face bow a caliper - Review article

N Kalavathy1, A Ananthraj2, K Premanth1, C Santhosh Kumar1
1

Department of Prosthodontics, 2Department of Pedodontics, DAPMRV Dental College, Bangalore Abstract

To fabricate any restoration, on an articulator mandibular movements have to be simulated on it. To simulate the mandibular movements on an articulator various jaw relations have to be recorded and transferred to it. The face bow transfer forms an indispensable part of jaw relation recording procedures. Face bow transfer helps, transferring the spatial relationships of jaw relation to various reference points. The restoration fabricated with face bow transfer require less chair side correction and also patients are more comfortable as the occlusion relation of the restorations are in harmony with the stomatognathic system of the patient. Keywords: Face bow, orientation jaw relations, Hinge axis

Address for correspondence Dr. N. Kalavathy M.D.S., Professor and Head of the Department Department of Prosthodontics DAPMRV Dental College, Bangalore

Introduction
Recording of jaw relations is one of the most important steps in the complete denture treatment. The temporomandibular joint has a significant role in this procedure. Unlike the other joints of the body, the TMJ is peculiar in that it is lined by a fibro cartilage. The disc of the joint divides the TMJ into two synovial cavities. The relationship of maxilla to mandible is not the same in all the persons, the anatomy of maxilla and TMJ varies from person to person. The opening movement to bring the jaw from occlusal to rest position is purely a hinge movement. The mandible moves on an arc of the circle with a definite radius from the temporomandibular joint. This path of the condyle is determined by the curvature of the condylar head of the curvature of the mandibular fossa. Definitions: - It is a caliper like device that is used to record the relationship of the jaws to the opening axis of the jaws and to orient the casts in this same relationship to the opening axis of the articulator1. - It is a caliper like device used to record the spatial relationship of the maxillary arch to some anatomic reference point or points and then transfer this relationship

to an articulator. It orients the dental cast in the same relationship to the opening axis of the articulator. Customarily, the anatomic references are the mandibular transverse horizontal axis and another selected anterior point2. - Face bow is a caliper like device used to record the relationship of the maxilla to the TMJ3. Classification of face bows: 1) Arbitrary face bow a) Facia type ; Eg: Hanau 132-25m and Hanau 132-2c b) Earpiece type - Ex: Hanau 164-2 twirl bow and 153, Self centering or quick mount; Ex: Whipmix, Bergstorm,SAM 2) Kinematic facebow (Records true hinge axis) Anterior points of reference4: 1) Orbitale: In the skull, Orbitale is the lowest point of the infraorbital margin. On the patient it can be palpated through the overlying tissue and skin. One orbitale and two posterior points determine the horizontal axis of rotation will determine the axis-orbital plane. Orbital and the two posterior landmarks are transferred from the patient to the articulator with the facebow. The articulator must have the orbital indicator guide that is in the same plane as the hinge of the articulator.

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2) Orbitale minus 7 mm: The Frankfort horizontal plane passes through both the poria and one orbital point, because porion is a skull landmark. Sicher recommends using the midpoint of the upper border of the external acoustic meatus as the posterior cranial landmark on the patient. Gozalez pointed out that this posterior tissue landmark on the patient in average lies 7mm superior to the horizontal axis. The recommended compensation for this discrepancy is to work the anterior point of reference 7mm below Orbitale on the patient. 3) Nasion minus 7mm: According to Sicher, another skull landmark, the nasion can be approximately located in the head as the deepest part of the midline depression just below the level of the eyebrows. The Nasion guide or positioner of the quickmount facebow which is designed to be used with the Whipmix articulator fits into this depression. The cross bar (U shaped frame) is located 23mm below the midpoint of the Nasion pointer. When the facebow is positioned anteriorly to the Nasion guide the cross bar will be in the approximate region of Orbitale. The facebow cross bar and not the nasion guide is the actual anterior reference point locator. So this facebow employs an approximate Axis-orbital plane. 4) Alae of the nose: A line from the alae of the nose to the centre of the auditory meatus is called the CAMPER'S LINE. Augsberger concluded in a review of literature that the occlusal plane parallels this line with minor variations in different facial types. Knowing this, the dentist can transfer Campers line from the patient to the articulator by marking the right or the left alae on the patient, setting an anterior reference point to it and with the facebow transferring the ala anteriorly and the hinge axis posteriorly from the patient to the articulator. 5) Incisal edge plus anterior midpoint to articulators axis: Horizontal plane distance: Guichet emphasized that a logical position of casts in the articulator would be the one which would position the plane of occlusion near the mid horizontal plane of the articulator. The mid horizontal distance to the axis condylar plane is measured; this measured distance is measured onto the patients from the existing incisal edges of the planned occlusal plane and then the transfer is done. Posterior points of reference5, 6, 7: Prior to the aligning of the facebow on face, posterior reference points must be located and marked. They are located by A) Arbitrary method B) Kinematic method A) Arbitrary method: Most commonly used measurements and landmarks. (Various arbitrary hinge axis points)

Beyorns point: A point 13mm anterior to the posterior margin of tragus of ear on a line drawn from the center of the tragus of tragus to the corner of the eye (Tragus canthus line ) Gysi's point: A point 10mm in front of the tragus on the tragus-canthus line. Bergstorm's point: A point 10mm anterior to the center of the spherical insert for the external acoustic meatus and 7mm below the Frankfort horizontal plane. Teteruck and Lundeen's point:13mm from the base of the tragus to the canthus. Beck's point: 10mm anterior to the center of the external auditory meatus and 7mm below the Frankfort plane. Brandrup Wognsen point: On line extending from the tragus to the lateral angle of eye, a point is marked at about 12mm in front of posterior margin of the most prominent tragus. Schlosser's point: A line drawn from the upper margin of the external auditory meatus to the outer canthus of eye. A point about 13mm in front of the tensed anterior margin of the meatus, on this line is used as the arbitrary hinge axis point. Prothero's point: A line drawn from top of Richey condylar marker (placed in the external auditory meatus) to the outer canthus of eye. A point 13mm anterior to Richey condylar marker to this line is used as the arbitrary reference point. Weinberg's point: This is a point 11-13mm anterior to the reference line drawn from the middle and the posterior border of the tragus of ear to the corner of eye. Lauritzen and Bodner's point: A point 13mm anterior to the tragus on the tragus-canthus line. Swenson: Described arbitrary location of the condyles as 11mm anterior to the meatus of ear on reference line from top of the meatus to the corner of eye. P.craddock and Symmon's point: A point 1cm anterior along a line drawn from the upper free margin of the tragus of ear to corner of eye. Description of Facebow: The facebow consist of 'U' shaped frame which is wide enough to avoid contact with sides of the face. In the condylar rods with graduation extending form main assembly which is

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placed over the posterior reference points. This helps to position the 'U' shaped frame at the center of the face. Once the facebow is adjusted, there are locknuts that are tightened. The part of the assembly that is attached to the wax rim is called bitefork. The fork is attached to the main frame of there is a pointer for the third point of reference like orbital pointer or nasion relator. In case of a Kinematic type of facebow, insteated of a fork attached to maxilla, it is attached to the mandible. There are attachments where the grids with graph paper are attached to frame which are either attached to maxilla, teeth of held by head straps or worn as spectacles. The cluth or the frok on the mandible in case of edentulous patient is stabilized using a chin clamp. Significance of a facebow usage7,8: 1) The theoretical advantage of using a facebow includes the anatomical similarity of the resulting relationship between the teeth and the Condyles. 2) The facebow transfer record is an integral part in analyzing and studying the occlusion of the natural teeth. 3) The better the cast on an articulator duplicate the distances to the condylar rotation centers, the less the potential for articulator produced errors of motion. A facebow record is used to transfer these relationships. 4) It records the intercondylar distance. 5) The true hinge axis is recorded when kinematic facebow is used. Kavo Arcus Facebow: A fully functional 3-dimensional computerized pantographic registration system to capture both, static and dynamic occlusal records for articulator programming and diagnostic set-ups. Accuracy and repeatability are unsurpassed, with all records permanently archived Clinical Advantages: Full mouth Reconstruction - Cosmetic and Implant Diagnostic Wax-ups that are gnathologically correct Articulator programming for TMJ derangements and functional disorders Splint therapy set-up Orthognathic surgical treatment planning

positioning of cast in relation to condyles. There are certain situations where in face bow transfer is not required, for example when monoplane teeth are being used, an articulator which can't receive face bow transfer. I would like to say that studies have proved that the masticatory performance was influenced by plane of orientation, and also hinge axis is an important component of mandibular movement which can't be disgraded. Hence and hinge axis should be accurately captured and transfered to the articulator whenever required. Thus we are able to get a fine representative of the patient and biological restoration is possible.

Figure 1: Facia type; Eg: Hanau 132-25m and Hanau 132-2c

Figure 2: Denar slidematic Earbow

Conclusion
The value of face bow has been a topic of considerable discussion and controversy in prosthetic dentistry for many years. However, face bow record helps in securing anteroposterior positioning of cast in relation to condyles. It also helps in achieving the exact anterioposterior or vertical

Figure 3: Hanau Face Bow

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Figure 10: Gysi's point Figure 4: Whipmix quick mount bow

Figure 11: Bergstorm's Point

12 12mm mm

2 m m m

Figure 12: Brandrup Wognsen point

Figure 13: Lauritzen and Bodner's point

Figure 5: Kinematic facebow (Records true hinge axis)

Figure 6: Orbitale

Figure 7: Nasion Figure 14: Recent advances in face bow

References
1. 2. Figure 8: Alae of the nose Figure 9: Beyorns point 3. Zard-Bolender. Complete dentures and implant supported prosthesis. 12th edition Mosby. Elsevier. Glossary of Prosthodontic terms no. 8, J Prosthet Dent 2005; 94: 10-92 Hartwell CM, Rahn AO. Syllabus of complete dentures. 4th edition Varshese publishing house.

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4. 5. 6.

7. 8.

Wilkie ND. The anterior point of reference. J Prosthet Dent 1979, 41; 488-95 Schillingburg 3rd edition fundamentals of fixed Prosthodontics. Lauritzen AG, Bonder GH. Variations in location of arbitrary and true hinge axis position. J Prosthet Dent; 1961, 11; 224-29. Walker PM. Discrepancies between arbitrary and true hinge axis. J Prosthet Dent. 1980, 43; 279-85. Wognsen TB. The facebow, its significance and application. J Prosthet Dent, 1953, 3; 618-28

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