Face bow/endodontic courses

FACE BOWFACE BOW
INDIAN DENTAL ACADEMY
Leader in continuing Dental Educationwww.indiandentalacademy.com

ContentsContents
 IntroductionIntroduction
 DefinitionDefinition
 HistoryHistory
 Indications and contraindicationsIndications and contraindications
 ClassificationClassification
 Hinge axisHinge axis
 Anterior and posterior reference pointsAnterior and posterior reference points
 Face bow transferFace bow transfer
 ConclusionConclusion
www.indiandentalacademy.com

IntroductionIntroduction

 Face bow essentially records the positional relation ofFace bow essentially records the positional relation of
the maxilla to the condyles in the centric relation andthe maxilla to the condyles in the centric relation and
later transfer this relation to the articulator so that thelater transfer this relation to the articulator so that the
maxillary cast is mounted in the same spatialmaxillary cast is mounted in the same spatial
relationship.relationship.

DefinitionDefinition
Boucher 11th edition:Boucher 11th edition:
 The face bow is a caliper like device that isThe face bow is a caliper like device that is
used to record the relationship of the jaws to theused to record the relationship of the jaws to the
temporo-mandibular joints or the opening axistemporo-mandibular joints or the opening axis
of the jaws and to orient the casts in the sameof the jaws and to orient the casts in the same
relationship to the opening axis of therelationship to the opening axis of the
articulator.articulator.

 Heartwell:Heartwell:
 Face bow is a caliper like device used toFace bow is a caliper like device used to
record the relationship of maxilla to therecord the relationship of maxilla to the
temperomandibular joint.temperomandibular joint.

 GPT-8:GPT-8:
 Caliper like instrument used to record theCaliper like instrument used to record the
spatial relationship of the maxillary arch to somespatial relationship of the maxillary arch to some
anatomic reference point or points and thenanatomic reference point or points and then
transfer this relationship to an articulator; ittransfer this relationship to an articulator; it
orients the dental cast in the same relationshiporients the dental cast in the same relationship
to the opening axis of the articulator”.to the opening axis of the articulator”.

HistoryHistory
 Bonwill,Bonwill, (1860) he determined(1860) he determined
the distance from the center ofthe distance from the center of
each condyle to the medianeach condyle to the median
incisal point and the lower teethincisal point and the lower teeth
as 10cm. He used this standardas 10cm. He used this standard
for mounting his casts in thefor mounting his casts in the
 Disadvantage:Disadvantage:
He did not mention at whatHe did not mention at what
level below the condylarlevel below the condylar
mechanism the occlusal planemechanism the occlusal plane
should be situated.should be situated.

 BalkwillBalkwill
(1866)(1866)demonstrated andemonstrated an
apparatus with which heapparatus with which he
could measure the anglecould measure the angle
formed by the occlusal planeformed by the occlusal plane
of the teeth and a planeof the teeth and a plane
passing through the linespassing through the lines
extending from the condylesextending from the condyles
to the incisal line of theto the incisal line of the
lower teeth. This angle variedlower teeth. This angle varied
from 22-30°.from 22-30°.

 Disadvantage:Disadvantage: The articulating caliper howeverThe articulating caliper however
did not enable a fixed transfer or 3-dimensionaldid not enable a fixed transfer or 3-dimensional
orientation of the cast to the articulator.orientation of the cast to the articulator.
 There was no control of the proper orientationThere was no control of the proper orientation
of occlusal planeof occlusal plane

 Richmond S.H.HayesRichmond S.H.Hayes
introduced first exampleintroduced first example
of functional face bowof functional face bow
like device intended forlike device intended for
locating the position oflocating the position of
the casts correctly in thethe casts correctly in the
articulator. He namedarticulator. He named
the device asthe device as
“articulating caliper”.“articulating caliper”.

 WalkerWalker invented theinvented the
“clinometer” a new type of“clinometer” a new type of
instrument with which itinstrument with which it
would have been possible towould have been possible to
obtain a relatively good valueobtain a relatively good value
for the position of the lowerfor the position of the lower
cast in relation to thecast in relation to the
condylar mechanism, bettercondylar mechanism, better
than with all the previousthan with all the previous
apparatus.apparatus.
 Disadvantage: BulkyDisadvantage: Bulky
exceedingly complicatedexceedingly complicated
apparatusapparatus

 GysiGysi constructed anconstructed an
instrument for registeringinstrument for registering
the condyle path.the condyle path.
However, he alsoHowever, he also
employed his apparatusemployed his apparatus
as a face-bow.as a face-bow.
 George B.Snow -1899
invented a device which
became prototype for
modern facebow

INDICATIONS OF FACE BOWINDICATIONS OF FACE BOW
 When disharmonies in occlusion resulting fromWhen disharmonies in occlusion resulting from
failure to use the face bow are analyzed, it can befailure to use the face bow are analyzed, it can be
concluded that the face bow should be usedconcluded that the face bow should be used
when:when:
 Cusp teeth are used.Cusp teeth are used.
 Balanced occlusion in the centric positions isBalanced occlusion in the centric positions is
desired.desired.

 A definite cusp fossa or cusp tip to tip incline relation isA definite cusp fossa or cusp tip to tip incline relation is
desired.desired.
 When interocclusal check records are used forWhen interocclusal check records are used for
verification of jaw positions.verification of jaw positions.
 When the occlusal vertical dimension is subjected toWhen the occlusal vertical dimension is subjected to
change, and alterations of tooth occlusal surfaces arechange, and alterations of tooth occlusal surfaces are
necessary to accommodate the change.necessary to accommodate the change.
 To diagnose existing occlusion in patients mouthTo diagnose existing occlusion in patients mouth

CONTRA INDICATIONSCONTRA INDICATIONS
 When monoplane teeth are arranged on a planeWhen monoplane teeth are arranged on a plane
in occlusal balance and the mandible is in mostin occlusal balance and the mandible is in most
retruded relation to the maxilla at an acceptableretruded relation to the maxilla at an acceptable
vertical dimension of jaw separation.vertical dimension of jaw separation.
 When no alterations of the occluding …When no alterations of the occluding …
necessitate change in the vertical dimension.necessitate change in the vertical dimension.
 No inter occlusal check recordsNo inter occlusal check records
 When articulators that are not designed to accept aWhen articulators that are not designed to accept a
facebow transferfacebow transfer

PARTSPARTS
 Basically it isBasically it is
constructed in 3 bars,constructed in 3 bars,
1 anterior, 2 lateral.1 anterior, 2 lateral.
 Face bow frame.Face bow frame.
 Ear rods.Ear rods.
 Orbital pointer.Orbital pointer.
 Caliper.Caliper.
 Bite fork.Bite fork.

ClassificationClassification
Face bow
Arbitrary Kinematic
Fascia type Ear piece type
With orbital indicator
With nasal relator

FACE BOWS ARE GROUPED ASFACE BOWS ARE GROUPED AS
FOLLOWSFOLLOWS
Arbitrary face bow :Arbitrary face bow :
 Uses arbitrary or approximate points on the face as theUses arbitrary or approximate points on the face as the
posterior points and condylar rods are positioned onposterior points and condylar rods are positioned on
these point.these point.
 They are widely used type of face bow and areThey are widely used type of face bow and are
sufficient for fabrication of most complete denture,sufficient for fabrication of most complete denture,
fixed partial and removable partial denture.fixed partial and removable partial denture.

Facial typeFacial type
 The facial type of faceThe facial type of face
bow utilizes approximatebow utilizes approximate
points on the skin over thepoints on the skin over the
temporomandibular region astemporomandibular region as
the posterior reference points.the posterior reference points.
These points are located byThese points are located by
measuring from certainmeasuring from certain
anatomical landmarks on theanatomical landmarks on the
face.face.

Ear piece typeEar piece type
 First described by Dabley in 1914. However it was onlyFirst described by Dabley in 1914. However it was only
during the early 1960: that it gained the popularity.during the early 1960: that it gained the popularity.
 It uses the external auditory meatus as an arbitraryIt uses the external auditory meatus as an arbitrary
reference point which is aligned with ear pieces similarreference point which is aligned with ear pieces similar
to those on a stethoscope.to those on a stethoscope.
 accurate relationship for most diagnostic andaccurate relationship for most diagnostic and
restorative procedures.restorative procedures.

AdvantagesAdvantages
 Simple to use.Simple to use.
 Do not require measurements or works on theDo not require measurements or works on the
face.face.
 As accurate as other face bows.As accurate as other face bows.
 It provides an average anatomic dimensionIt provides an average anatomic dimension
between the external auditory meatus andbetween the external auditory meatus and
horizontal axis of mandiblehorizontal axis of mandible

DisadvantagesDisadvantages
 Regardless of which arbitrary position isRegardless of which arbitrary position is
chosen a minimum error of 5mm from the axischosen a minimum error of 5mm from the axis
can be expected.can be expected.
 When coupled with the use of a thickWhen coupled with the use of a thick
interocclusal record made at an increased verticalinterocclusal record made at an increased vertical
dimension. This factor can lead to considerabledimension. This factor can lead to considerable
inaccuracyinaccuracy

 Spring bowSpring bow ::
 It is an earpiece faceIt is an earpiece face
bow made of spring steel andbow made of spring steel and
simply springs open andsimply springs open and
close to various head widths.close to various head widths.
 This instrument isThis instrument is
designed to orient thedesigned to orient the
occlusal plane to theocclusal plane to the
Frankfort horizontal plane byFrankfort horizontal plane by
means for a third point ofmeans for a third point of
referencereference

 Advantages :Advantages :
 The one piece design of bow eliminates the movingThe one piece design of bow eliminates the moving
parts and maintenance problems encountered withparts and maintenance problems encountered with
other models.other models.
 Easy and efficient to use.Easy and efficient to use.
 Sterilazable parts.Sterilazable parts.
 Adaptability to other articulation.Adaptability to other articulation.
 Direct/indirect mounting capability.Direct/indirect mounting capability.
 Disadvantage :Disadvantage :
 Inability to measure intercondylar distanceInability to measure intercondylar distance

KINEMATIC FACE BOW:KINEMATIC FACE BOW:
ACTUAL VALUE/ HINGE AXISACTUAL VALUE/ HINGE AXIS
 It is used to determine and locate the exact hinge axisIt is used to determine and locate the exact hinge axis
points. Though hinge axis of the mandible can bepoints. Though hinge axis of the mandible can be
determined by a clutch i.e., a segmented impression traydetermined by a clutch i.e., a segmented impression tray
like device attached onto the mandibular teeth with alike device attached onto the mandibular teeth with a
suitable rigid material such as impression plaster.suitable rigid material such as impression plaster.

 Indication :Indication :
 When it is critical to precisely reproduce the exactWhen it is critical to precisely reproduce the exact
opening and closing movement of the patient to theopening and closing movement of the patient to the
articulatorarticulator
 Draw backs :Draw backs :
 Extensive chairside.Extensive chairside.
 ExpensiveExpensive
 Rarely indicated for routine articulators withRarely indicated for routine articulators with
prosthodontic procedures.prosthodontic procedures.

Hinge AxisHinge Axis
 Definition: an imaginary line around which theDefinition: an imaginary line around which the
mandible may rotate within the saggital plane.mandible may rotate within the saggital plane.
 HistoryHistory
 Craddock & Symmons (1952)Craddock & Symmons (1952)
Method of palpation to locate hinge axis - SatisfactoryMethod of palpation to locate hinge axis - Satisfactory
 Trapozzano and LazzariTrapozzano and Lazzari
more than one condylar hinge-axis pointmore than one condylar hinge-axis point
questioned the accuracy and validity of hinge-axis locationquestioned the accuracy and validity of hinge-axis location
 Granger (1952)Granger (1952)
Only position where HA is common to both - CROnly position where HA is common to both - CR

Lucia (1953)Lucia (1953) -- Importance of the hinge-axisImportance of the hinge-axis
 To diagnose an occlusal problemTo diagnose an occlusal problem
 A centric relation record verificationA centric relation record verification
 To reproduce jaw movementsTo reproduce jaw movements
Schallohorn (1957)Schallohorn (1957)
 An arbitrary location 13 mm anterior to the tragusAn arbitrary location 13 mm anterior to the tragus
 95% of subjects within a radius of 5 mm from the arbitrary95% of subjects within a radius of 5 mm from the arbitrary
centrecentre

Trapozzano (1957)Trapozzano (1957) disagreed the split hinge axis theory.disagreed the split hinge axis theory.
The mandible would have to bend or the continuity ofThe mandible would have to bend or the continuity of
the mandible would have to be broken.the mandible would have to be broken.
 Joyce F. Palik, Donald R. Nelson, and James T.
White
 Accuracy of the ear bow
 Significant discrepancy in the antero posterior direction
but not in
 the superior-inferior direction
 Anterior to the terminal hinge axis 92% of the time
 It was not statistically repeatable

Thomas R Morneburg and Peter A. ProschelThomas R Morneburg and Peter A. Proschel
(2002)(2002)
• Estimated the frequency of occlusal error-Estimated the frequency of occlusal error-
arbitrary axesarbitrary axes
• 2 and 4 mm changes of vertical dimensions2 and 4 mm changes of vertical dimensions
• Found occlusal errors of less than 300Found occlusal errors of less than 300 µµm in them in the
second molar area in 87% of patients with a 2second molar area in 87% of patients with a 2
mm change of vertical dimensionmm change of vertical dimension

Value of true hinge axisValue of true hinge axis
 Allows the centric relation record in dentulousAllows the centric relation record in dentulous
situations to be accurately mounted on articulator withsituations to be accurately mounted on articulator with
the use of interocclusal centric record.the use of interocclusal centric record.
 Further it is impossible to check the accuracy of centricFurther it is impossible to check the accuracy of centric
interocclusal record without a hinge axis transfer. Hingeinterocclusal record without a hinge axis transfer. Hinge
axis recording is required to check the accuracy of twoaxis recording is required to check the accuracy of two
centric records.centric records.
 It is the starting point of lateral movements.It is the starting point of lateral movements.

 Permits vertical dimension to be changed in thePermits vertical dimension to be changed in the
 Allows the transfer of the opening axis to theAllows the transfer of the opening axis to the
articulator so that occlusion would be on thearticulator so that occlusion would be on the
same arc of closure as the lower jaw.same arc of closure as the lower jaw.
 Opening and closing movements of theOpening and closing movements of the
mandible are reproducedmandible are reproduced
 BenefitBenefit :: It helps in diagnosis / treatmentIt helps in diagnosis / treatment
planning of mounted study casts.planning of mounted study casts.

Facebow record is used….Facebow record is used….
 Balanced occlusion in CDBalanced occlusion in CD
 Class I & II casesClass I & II cases
 Open anterior bite or end to end relationshipOpen anterior bite or end to end relationship
 Single restoration on II molar not for premolar and I molarSingle restoration on II molar not for premolar and I molar
 Segmental restorationSegmental restoration
 Anterior restoration – primary guidance factor in excursive movementAnterior restoration – primary guidance factor in excursive movement
 Restoration of entire quadrantRestoration of entire quadrant
True hinge axis recordingTrue hinge axis recording
 Kinematic facebowKinematic facebow
 Trial & error method- McCollum(1921)Trial & error method- McCollum(1921)
 Indications - To precisely reproduce the exact opening & closingIndications - To precisely reproduce the exact opening & closing
 Drawback - Rarely indicatedDrawback - Rarely indicated
To sum upTo sum up

ProcedureProcedure
 Kinematic face bow styli positionedKinematic face bow styli positioned
 A clutch attached on to mand teethA clutch attached on to mand teeth
 Transverse component & adjustable side armTransverse component & adjustable side arm
 Mandible manipulated Terminal hingeMandible manipulated Terminal hinge
movementmovement
Movement of the styliMovement of the styli
Stationary One of the arcsStationary One of the arcs
Actual axis Adjusted withActual axis Adjusted with
of rotation thumb screwsof rotation thumb screws
 Hinge Axis markedHinge Axis marked www.indiandentalacademy.com

Kinematic face bow transferKinematic face bow transfer
 Impression on face bow forkImpression on face bow fork
 Face Bow attached to the forkFace Bow attached to the fork
 Styli aligned with Hinge AxisStyli aligned with Hinge Axis
markmark
 Pt in same positionPt in same position
 Pointer devicePointer device
 Face bow transfer to articulatorFace bow transfer to articulator

Plane of orientationPlane of orientation
The spatial plane formed by joiningThe spatial plane formed by joining
the anterior and posterior referencethe anterior and posterior reference
pointspoints
Posterior reference pointsPosterior reference points
Arbitrary hinge axis points Accuracy % Investigator
Beyron point 13 mm form posterior
margin of tragus to canthus
98.0 Schallhorn, beyron,
Beck
13 mm in front of anterior margin of
meatus
40.0 Beck, lauritzen and
bodner
13 mm from foot of tragus to
canthus
33.0 Teteruck and lundeen
Bergstrom point 10 mm anterior to
center of external auditory meatus
and 7 mm below Frankfurt plane
83.3 Beck
Ear axis 75.5 Teteruck and Lundeen

Anterior reference points :Anterior reference points :
1.1. Orbitale (B) Located byOrbitale (B) Located by
Hanau facebow with helpHanau facebow with help
of orbital pointer.of orbital pointer.
2.2. Orbitale minus 7 mm. (C)Orbitale minus 7 mm. (C)
This plane representsThis plane represents
Frankfort plane.Frankfort plane.
3.3. Nasion (A) Used with quickNasion (A) Used with quick
mount facebow (Whip mix)mount facebow (Whip mix)
4.4. Ala of nose (D) This planeAla of nose (D) This plane
represents campers planerepresents campers plane
5.5. 43 mm superior from lower43 mm superior from lower
border of upper lip (Denarborder of upper lip (Denar
reference plane locator –reference plane locator –
Denar facebow uses thisDenar facebow uses this
reference point)reference point)

PLANE OF ORIENTATIONPLANE OF ORIENTATION
The spatial plane formed by joiningThe spatial plane formed by joining
anterior and posterior reference points isanterior and posterior reference points is
called plane of orientationcalled plane of orientation
Posterior reference pointsPosterior reference points
It is located by arbitrary method/It is located by arbitrary method/
kinematic methodkinematic method
Arbitrary method :Arbitrary method :
By measurement:BERGSROM POINTBy measurement:BERGSROM POINT
BEYRON POINTBEYRON POINT
““Beck’’-Bergstrom point closest to hingeBeck’’-Bergstrom point closest to hinge
axisaxis
Beyron point next most accurate pointBeyron point next most accurate pointwww.indiandentalacademy.com

The following steps apply for all facebow procedures :
• Preparation of bite fork
• Orientation of face bow to bite fork and reference
points
• Orientation of face bow to articulator.
• Attachment of maxillary cast to articulator.
When using a Hanau Face Bow
• Infraorbital notch serves as a anterior point of
reference.
• Plane established by the external auditory opening &
infraorbital notch
• Face bow is used to record the position of the
maxillary arch.
• The spatial information is transferred to the
articulator.

PROCEDURE
Modeling plastic is
heated – 600
Adapted to the
bite fork
Position over the
maxillary teeth
It is removed
when cooled
Chilled in water
and trimmed
Well adapted
record base

To verify accurate fit
and stability
Bite fork position face
bow is guided onto the
stem of the bite fork
Earpiece into the
external auditory
openings
Orbital pointer
positioned
Thumbscrews tightened to maintain the spatial
relationships between face bow and bite fork

• Maxillary rim attached
to the bite fork.
• Bite fork position
• Ear-piece inserted
• Clamp holding the bite
fork locked
• Fully assembled face
bow and ear-piece
clamps are loosened
• Bow is centered in the
articulator

WHIP MIX QUICK MOUNT FACEBOW TECHNIQUE
Armamentarium Wax added to
mandibular incisor
portion
Bite fork to maxillary
teeth
Thinning the posterior
wax
Nasion relator
positioned
Knobs tightened

DENAR EAR & MEASUREMENT TYPE FACE BOW
Denar ear face-bow
transfer
Spatial adapting on the
incisal table
Denar measurement type
assembled face-bow
Oriented to the
articulator
Maxillary cast oriented in all spacial
relationship as present in patientwww.indiandentalacademy.com

ConclusionConclusion

List of referencesList of references
 Contemporary fixed prosthodontics, Stephen F. Rosenstiel, 3rdContemporary fixed prosthodontics, Stephen F. Rosenstiel, 3rd
edition.edition.
 Fundamentals of fixed prosthodontics, Herbet t. Shilling burg thirdFundamentals of fixed prosthodontics, Herbet t. Shilling burg third
edition.edition.
 Complete denture prosthodontics – Dr. John Joy Manapalli.Complete denture prosthodontics – Dr. John Joy Manapalli.
 Stewart’z clinical removal partial prosthodontics, third editionStewart’z clinical removal partial prosthodontics, third edition
 Essentials of complete denture prosthodontics, Sheldon Winkler,Essentials of complete denture prosthodontics, Sheldon Winkler,
second edition.second edition.
 McCracken’s removable partial prosthodontics, eleventh editionMcCracken’s removable partial prosthodontics, eleventh edition
 Prosthodontic treatment for edentulous patients, George A ZarbProsthodontic treatment for edentulous patients, George A Zarb
twelfth edition.twelfth edition. www.indiandentalacademy.com

 J Of Oral Rehabilitation 1985; 12: 135-159.J Of Oral Rehabilitation 1985; 12: 135-159.
 Int J Prosthodont 2002; 15:358-364.Int J Prosthodont 2002; 15:358-364.
 J Prosthet Dent 2001;85:236-45.J Prosthet Dent 2001;85:236-45.
 J Prosthet Dent 1985;53(6):800-804.J Prosthet Dent 1985;53(6):800-804.
 J of oral rehabilitation 1999;26:661-665.J of oral rehabilitation 1999;26:661-665.
 J of Prosthet Dent 1986;56(5):606-616.J of Prosthet Dent 1986;56(5):606-616.
 J of Prosthet Dent 1979;41(6):605-613.J of Prosthet Dent 1979;41(6):605-613.

Thank UThank U

Next journal club byNext journal club by
Dr. Kesava ReddyDr. Kesava Reddy
on Saturday, 15/07/06on Saturday, 15/07/06

Face bow/endodontic courses

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