Orientation jaw relation

Maxillomandibular relations
Any spatial relationships of the maxillae to the mandible ; any one of the infinite relationships of the mandible to the maxillae GPT 8

Maxillomandibular relationship record

A registration of any positional relationship of the mandible relative to the maxillae GPT 8

Maxillomandibular relation are grouped into three (1) Orientation jaw relation (2) Vertical (3 ) Horizontal jaw relation

Vertical jaw relations establish the amount of jaw separation allowable for denture -VDR -VDO

Horizontal jaw relation establish the front to back and side to side relationships of one jaw to the other Centric Eccentric

ORIENTATION JAW RELATION

1st jaw relation It establish the relationship of the maxilla to the base of the skull or cranium It establishes angle or tilt of maxillae in three reference planes

 The mandible moves against a fixed maxilla and to accurately reproduce mandibular movements, tilt of maxilla is recorded 2 posterior and 1 anterior reference point

 When mouth opens and closes, in the 1st 12 mm and last 12mm shows rotational movement around an arc of a circle

 When the mandible is kept in its most posterior position, it can rotate in a saggital plane around an imaginary transverse axis passing through or near the condyles

 This is the terminal hinge axis which can be located accurately by using an instrument called as face-bow.

Hinge Axis

It is an imaginary line around which the mandible may rotate within the sagittal plane. It is also known as transverse horizontal axis.

Hinge axis
Snow recognized the importance of hinge axis in mandibular movements and developed a face-bow to be used to transfer the position of the axis to the articulator (1907).

 In 1921, McColum, Stuart and others reported the 1st positive method of locating the hinge axis. Sloane stated It is the axis upon which the mandible rotates in an opening and closing function comfortably, not forcibly retruded.

 Sicher said The hinge position or terminal hinge position is that position of the mandible from which or in which pure hinge movement of variably wide range is possible

 Lucia concluded The centers in the terminal hinge position provides a definite starting position relation of the mandible to the maxilla.

 Axis of rotation- centre of condyles If it is recorded, 2 posterior reference point is obtained 3rd reference point in maxilla- infraorbital notch or nasion

 These 3 reference points are recorded in facebow

FACE-BOW

 A caliper-like instrument 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 condyles transverse horizontal axis and one other selected anterior point- GPT-8

 Types : a] kinematic face-bow or hinge-face bow, b] arbitrary type of face bow

 c] it is also possible to simulate mandibular orientation by an arbitrary average technique without using a facebow.

 The face-bow is a caliper-like device that is used to record the relationship of the jaws to the TMJs or the opening axis of the jaws, and to orient the casts in this same relationship to the opening axis of the articulator.

 It is a caliper like device used to record the relationship of maxillae to the TMJ

Principle of Face Bow Use

The axis of opening of the articulator should be similar to the patient's mandibular arc of movement when the prosthesis is fabricated with the help of articulators.

 Since it is difficult to orient the mandible to the articulator, the maxillary cast is related to the articulator in the same relationship as that between the maxilla and condyles of the mandible, which is the center of mandibular movements.

 The mandibular cast is oriented to the maxillary cast, which in turn is oriented in the articulator. To accomplish this act of orientation, the face bow is used.

The purpose of this instrument is to orient the maxillary cast to the articulator in the same relationship to the opening and closing axis of the articulator as exists between the maxilla and the opening and closing axis in the temperomandibular joints

REVIEW OF FACE-BOWS

In 1880 Haves used a tongue like device which he called "Caliper." This instrument is not used, as the face-bow now , but it did relate the median incisal point to its distance from the condyles

 Gysi developed an instrument similar to a face-bow primarily to record the paths of the condyles.

However, it was also used to transfer the maxillary cast to the articulator.

 Snow introduced the Snow face-bow. The Snow type of bow utilizes estimated located marks on the skin at the condyle points as the hinge axis positions.

The condylar rods are adjusted to this point

 No adjustments compensate for asymmetric hinge points, either vertically or horizontally Therefore, if the terminal hinge rotational centers are to be located, a face-bow capable of being adjusted to any asymetric location must be used

 Another type of arbitrary face-bow is similar to the Hayes' Caliper.

The depressions anterior and medial to the tragus of the ears are used as the hinge axis points

 Whip-mix face-bow has another trend Specially contoured inserts on the condylar ends of the bow are placed in the external auditory meatus.

The bow arms are secured anteriorly

 The inserts are held in position until the bow is secured to the stem of the bite fork

Two types of face-bows

Kinematic/Hinge face bow- which locates the true hinge axis

Arbitrary face bow-which locates the arbitrary hinge axis.

Arbitrary face bow

Fascia type Earpiece type Hanau face bow Slidematic(denar) Twirl bow Whipmix

PARTS OF A FACE BOW

1. 2. 3. 4. 5. U-shaped frame Condylar rods Bite fork Locking device Orbital pointer with clamp

U shaped frame
Main frame of the face-bow All other parts attached to this with clamps

 This assembly is large enough to extend from the region of the TMJ to atleast 57.5cm [2-3 inches] in front of the face and wide enough to avoid contact with the sides of the face This records the plane of cranium

Condylar rods
Two small metallic rods on either side of ushaped frame that contacts the skin over the TMJ
It is placed on the face with the condylar rods and located approximately over the condyles

 Helps to locate the hinge / opening axis of the TMJ

 Position the condylar rods on a line extending from the outer canthus of the top of the tragus & approximately 13 mm in front of the EAM .

 This generally locates the rods within the 5mm of the true centre of opening of the jaws (eg:kinematic ), some rods fit into the EAM (arbitrary face bow-EARPIECE)

Bite fork U shaped plate attached to the occlusal rim for recording orientation jaw relation
Attached to the frame by a rod called stem

Locking device Bite fork attached to the face bow by means of locking device ,which also serve to support the face bow ,occlusion rims &casts ,while the casts are being attached to the articulator

U-shaped frame

Stem of bite fork Transfer rod Transverse rod

Orbital pointer Designed to mark the anterior reference point [infra-orbital notch]

Functions of Face Bow

1. To record the relationship of maxilla to temperomandibular joints. 2. Transfer the above relation from the patient to the articulator by using posterior and anterior reference points.

 3. Simulation of mandibular movements of the patient on the articulator by accurate transfer of the cast to the articulator

USES OF FACE BOW

When cusp form teeth are used When balanced occlusion in the eccentric position is desired When a definite cusp fossa or cusp tip to cusp incline relation is needed

 Interocclusal check record after face bow transfer aid in verifying jaw position

If the occlusal vertical dimension is changed & the alteration of the tooth occlusal surfaces are necessary to accommodate the change

Face Bow Record

Arbitrary record: Most commonly used face-bow in complete dentures

 Axis of rotation is roughly fixed at 13mm anterior to external auditory meatus on a line from the top of the tragus of the ear to the outer canthus of the eye in the fascia type face bow.

 With the earpiece face bow, external auditary meatus is used as a reference for the arbitrary position of axis of rotation.

 This actual position used is posterior to the condyles and attaching the face bow 6 mm anterior to the condyles on the articulator compensates it.

 Temporomandibular joint position thus becomes posterior area of reference for location of axis of rotation of condyles.

 Slidematic these are electronic devices that gives reading corresponding to one half of the patients intercondylar distance and require specific articulator

 Anterior reference point is 43mm superior to the incisal edge of the upper central incisors for dentate / to the lower border of upper lip in a relaxed state in the edentulous Posterior reference point is EAM

 Kinematic face bow record: The true hinge axis is determined by a series of opening and closing movements when the mandible is in the terminal hinge position.

 12-15 degree pure rotational movement is possible in this position and maximal incisal opening of 20-25mm is obtained

 After this determination, hinge axis position is marked on the skin on the face. Another anatomic point of reference also used is infraorbital notch through orbital indicator on the face bow.

 Used in fabrication of FPD and full mouth rehabilitation. Requires a fully adjustable articulator to accept the true hinge axis

FACE BOW TRANSFER PROCEDURE

PRELIMINARY STEPS

1. Seat the patient in a comfortable position in the dental chair with the backrest extending to slightly below the scapula. The patient's head should be in an upright position with the headrest supporting the occiput

2. Locate the axis points by measuring 13 millimeter anterior to the middle of the tragus of the ear . Record points on the skin or on adhesive tape placed in the area

 3. Contour the maxillary occlusion rim; establish the occlusal plane; place the guide lines for the arranging of teeth on the labial section and a mounting index on the occlusal surface in the regions of the first molars that is approximately 2 millimeters deep

4. Apply a thin layer of petrolatum to the occlusion rims to facilitate separating from the wax on the bite fork.

5. Reduce the mandibular occlusion rim to allow adequate interocclusal distance for the fork and attached wax.

 6. Adjust the condyle rods to the face for centering the bow by placing the ends over the condyle points so that the ends lightly touch the skin or tape. Secure either the right or left condyle rod; lock and remove the bow from the face.

7. Soften a sheet of low fusing baseplate wax and roll together in the shape of a horseshoe.

8. While the wax is soft, imbed the prongs of the bite fork in it. Fold the wax over at the margins to secure it to the fork.

The thickness of the wax should be approximately 6 mm

9. Place the prongs of the bite fork with the attached soft wax between the occluding surfaces of the occlusion rims. Adjust the midline of the fork to coincide with the midline on the occlusion rim. Extend the stem of the fork forward and parallel to the sagittal plane.

10. Instruct the patient to close the jaws until both occlusion rims are imbedded in the soft wax to a depth that insures a stable seat. The relation of the mandible to the maxillae is of no importance except to place favorable pressure to stabilize the maxillary record base.

 11. Slide the stem of the fork through the opening in the clamp of the bow and adjust the condyle rods to the arbitrary axis points

12. Adjust the width of the condyle rods equidistant bilaterally and secure the clamp of the bow to the stem of the bite fork.

Asymmetrical setting of the condyle rods within the accommodating range of the articulator width will not result in error if the bow is arranged symmetrically on the articulator.

13. Slide the condyle rods from the skin. Extend the condyle rods back to the axis points to check against displacement that may have occurred when the clamp was secured.

 14. When the infraorbital notch is used as the anterior point of reference, the pointer should be placed in the clamp provided for it on the bow.

 Palpate the infraorbital notch and mark it with a skin marker. Place the point of the pointer over the mark and secure the clamp to the pointer

 Remove the assembly from the face and allow the wax to set hard before removing the bite fork and face-bow record from the occlusion rims.

Recording orientation jaw relation using a kinematic face bow

it is attached to the mandibular occlusion rim &hinge axis is located based upon the opening movements of the mandible Fabrication of clutch-which relates face bow to the mandibular residual alveolar ridge

 A record base is fabricated over the mandibular cast An occlusion rim made of impression compound is built on record base

 Bite fork is attached to this occlusal rim Extending outside this bite fork is the horizontal stem, which lies parallel to the sagittal plane

Procedure
Clutch along with the stems is placed in patients mouth .
Hinge bow is attached to the stem of bitefork & condylar rods are located at a point 13mm in front of EAM on the canthotragus line

 Patient is in semisupine mandible guided to produce opening and closing movements which are purely rotational. Patient asked to make eccentric movements

 Condylar rods will move during mandibular movements The point at which condylar rods shows pure rotation indicates terminal hinge axis .

 If patient opens widely then condylar rods move anteriorly . Condylar rods are locked and face bow is removed

FACE-BOW MOUNTING 1. Set the sliding condylar rods symmetrically on both sides until the bow gently springs over the articulator condyle shaft, provided the rods are adjusted symmetrically on the face.

2. If the rods were not symmetrically adjusted on the face, shift the rods equidistantly in opposite directions until the bow gently springs over the ends of the articulator shaft.

2. Raise or lower the face-bow to adjust for the vertical position until the low lip line, which was recorded on the labial surface of the occlusion rim, is on a level with the groove marked around the incisal pin .

 If an infra-orbital pointer is used, adjust the pointer to touch the pointer plate attached to the maxillary bow of the articulator. 3. Support the face-bow securely in position with the face-bow support

4. Soak the maxillary cast in water for at least five minutes to insure adhesion of the plaster to the stone.

 6. Carefully remove the excess plaster. Allow the plaster to harden before removing the face-bow assembly. The maxillary cast is related to the opening axis in the articulator in the same anteroposterior and horizontal position as the maxillae in the skull are related to the arbitrarily located opening axis in the temporomandibular joints

5. Secure the incisal guide pin with its top flush with the top of the maxillary bow of the articulator.

 Open the maxillary bow of the articulator and apply a creamy mix of dental plaster to the top of the articulator until the incisal guide pin is stopped on the guide table and the mounting plate on the maxillary bow is imbedded in the plaster.

 Carefully remove the excess plaster. Allow the plaster to harden before removing the face-bow assembly.

 The maxillary cast is related to the opening axis in the articulator in the same anteroposterior and horizontal position as the maxillae in the skull are related to the arbitrarily located opening axis in the temporomandibular joints

conclusion
There are theoretical advantageous of using facebow however these might not necessarily produce a better clinical end result.

Any type of facebow and all articulators suffer from errors and can only approximate conditions in the patients masticatory system.

Also facebow is helpful in supporting the maxillary cast while it is being mounted on articulator.