FACEBOW

1. INTRODUCTION

2. DEFINITION

3. HISTORY OF FACEBOW

4. INDICATIONS

5. CONTRAINDICATIONS

6. ADVANTAGES

7. HINGE AXIS

- DEFINITION

- CONCEPTS REGARDING HINGE AXIS

- THEORIES OF HINGE AXIS

- NEED TO RECORD HINGE AXIS

8. CLASSIFICATION OF FACE BOWS

9. PARTS OF A FACE BOW

10. POSTERIOR REFERENCE POINTS

11. ANTERIOR REFERENCE POINTS

12. FACE BOW TRANSFER

INTRODUCTION

Mandible rotates around the imaginary “hinge axis” in the sagittal plane .The face bow helps in
locating this axis and used to record the anteroposterior and mediolateral spatial position of the
maxillary occlusal surfaces relative to this transverse opening and closing axis of the patient’s
mandible . This relation is transferred to the articulator with help of face bow , thus relating the
maxilla to the articulator in same way as it is in patient.

DEFINITIONS

According to GPT-8

 FACEBOW: 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. It is also called as hinge bow.

 EARBOW: an instrument similar to a facebow that indexes to the external auditory

meatus and registers the relation of the maxillary dental arch to the external auditory
meatus and a horizontal reference plane. This instrument is used to transfer the maxillary
cast to the articulator. The earbow provides an average anatomic dimension between the
external auditory meatus and the horizontal axis of the mandible.

 KINEMATIC FACEBOW: a facebow with adjustable caliper ends used to locate the
transverse horizontal axis of the mandible.

 TRANSVERSE HORIZONTAL AXIS: an imaginary line around which the mandible

may rotate within the sagittal plane. Also called as hinge axis/terminal hinge axis

HISTORY OF FACEBOW

The need to mount the mandibular casts in a int the articulator in a given positional relation to
the condylar mechanism was realized in the early 1860’s.

BONWILL(1860)

The distance from the center of each condyle to the median incisal point of the lower teeth is
10cm. The cast was mounted with occlusal plane in a horizontal position midway between the
upper and lower part of the articulator.
BALKWILL(1866)

He made a apparatus to measure the angle between the occlusal plane and the plane passing
through the lines extending from the condyles to the incisal line of the lower teeth.

Angle =220-300

HAYES (1880)

He made an apparatus to localize the plaster casts in the articulator , which was known as the
“caliper”

Its only purpose was to record the distance from the patient’s condyles to a point along the
midline of the maxillary occlusion rim.

WALKER (1890)
To measure the path of each condyle individually he devised an apparatus that he called the
“FACIAL CLINOMETER”. The facial clinometer, designed to measure the downward and
forward condylar paths, did not allow for active transfer of the casts to the articulator.

SNOW(1899)

Introduced the first instrument and technique for recording the anatomic relationship of the
maxillae to the condylar axis and transferring this relationship to the articulator.

WADSWORTH(1921)

He devised a face bow with the anterior reference point based on Wadsworth’s “naso-optic-
condylar” triangle
 GYSI(1928)

Constructed an instrument for registering the condylar path.

He employed this apparatus also as a face bow

INDICATIONS OF FACE BOW

• When cusp form teeth are used.

• Balanced occlusion in the eccentric position is desired.
• A definite cusp to fossa or cusp tip to marginal ridge is desired.
• Interocclusal check records are used for verification of the jaw positions.
• The occlusal vertical dimension is subjected to change, and the alterations of the tooth
occlusal surfaces are necessary to accommodate the change.

CONTRAINDICATION
 • When non-anatomic teeth are arranged on a plane in occlusal balance and the mandible is
in the most retruded relation to the maxilla at an acceptable vertical dimension.
• No change in vertical dimension is necessary.
• No interocclusal check records are made.
• When articulator that are not designed to accept an face bow transfer are used in the
denture procedure.

ADVANTAGES OF USING A FACEBOW

*Reduces occlusal errors in finished prosthesis.

*Permits programming of articulator.

*Permits diagnosis of existing occlusal condition of the individual.

*The arc of closure is registered.

*Kinematic facebow helps in recording centric relation position provided vertical dimension is
already established.

HINGE AXIS

DEFINITION

Imaginary line between mandibular condyles around which the mandible can rotate within the
sagittal plane” GPT—8

Terminal hinge axis = Transverse axis = Transverse horizontal axis = Transverse hinge axis

CONCEPTS REGARDING HINGE AXIS

1. Sloane stated that the hinge axis is not a theoretical assumption, but definitely
demonstrable biomechanical factor.
2. Sicher stated that The terminal hinge position is the most retruded position of the
mandible, the centric position .
3. The proponents of Gnathology State that there is one transverse hinge axis & it can be
accurately located.
4. The proponents of transographics claim that Transograph is the only instrument that can
duplicate it.
5. Others claim that Better to use articulator like Hanau, that utilizes a Face-bow mounting
&an average of several readings for excursive movements.

THEORIES OF HINGE AXIS

 1. Absolute location of the axis

The hinge axis is a component of every masticatory movement and cannot be disregarded.

If the hinge axis of the articulator is not the same as the hinge axis of the patient then the
mechanical reproduction of jaw motions are impossible.Believe that there is a definitive
transvers axis and should be located

2. Arbitrary location of axis

The value of actually locating the exact hinge axis is not worth the effort. This group fails to
recognize that if the hinge axis of the articulator does not coincide with the hinge axis of the
patient, the paths of closure will not be the same.

3. Non-Believers in the transverse axis location

This group does not believe the hinge axis can be accurately located or believes other
movements are involved and can not be reproduced by an articulator simulating one axis

4. Split axis theory

This group believes there are two axis of rotation ( one in each condyle) and they parallel each
other.

1-The horizontal axis is a hypothetical line connecting the two horizontal rotation centers of the
two condyles of the mandible.

2- There is one hinge location

NEED TO RECORD AND TRANSFER HINGE AXIS

- Study casts can be mounted to determine if the patients centric occlusion is in

harmony with centric relation.

- Working casts can be mounted in the best relationship for the teeth or the denture
base.

- Since the hinge is a definite fixed component of every closing position of the
mandible, it is necessary to reproduce it on the appropriate instrument if the occlusion
is to be rehabilitated.

- It is possible to increase or decrease the vertical dimension on the instrument without

disturbing centric relation .
 - It is a starting point of lateral movements.

CLASSIFICATION
• KINEMATIC FACE BOW

• ARBITARY FACE BOW

- FACIA TYPE
- EARPIECE TYPE

ARBITRARY TYPE OF FACE BOW (Empirical or Anatomical face bow)

- In this type the axis is located by using anatomical land marks. Condyle rods of the
face bow are placed over the arbitrarily marked centers of hinge axis.

Facia type (eg-Hanau 132-2C and 132-2SM)

- The condlye rods located approximately over the condyles

- The positions on a line extending from the outer canthus of the eye to the to the top of
the tragus of the ear and approximately 13mm in front of the external auditory
meatus.

• The facia type of face bow utilizes approximate points on the skin over the
temporomandibular region as the posterior reference points.
• These points are located by measuring from certain anatomical landmarks on the face.

Ear piece type

-With orbitale indicator. eg-Denarslidematic ear bow

-With nasal indicator. eg-Whip mix Quick Mount bow, Novel nasion support (Artex )

- The ear pieces of the face bow are placed into external auditory meatus .

- An average distance from the external auditory meatus to an arbitrary hinge axis is
built into the face bow design. This distance is compensated for in the articulator by
offsetting the mounting point by an equivalent amount.

• This type of face-bow uses the external auditory meatus as the arbitrary posterior
reference point.
• For this a special ear piece is required instead of a condyle rod.

• Special condylar compensators on the face bow or the articulator then compensates for
this by positioning the condylar inserts at a prescribed distance behind the rotational axis of the
articulator.

• The ear –bow has gained in popularity because

• It is simple to use
• Does not require measurements or marks on the side of the face
• As accurate, if not more than arbitrary method.

The ear –bow has gained in popularity because

It is simple to use

Does not require measurements or marks on the side of the face

As accurate, if not more than arbitrary method.

KINEMATIC TYPE OF THE FACE BOW (Physiological or Hinge face bow)
A face bow with adjustable caliper ends used to locate the transverse horizontal axis of the
mandible .(GPT 8)

The hinge axis of the mandible can be determined to within 1 mm by observing the movement of
kinematic face bow styli positioned immediately lateral to the TMJ close to the skin .

Because it is time consuming, they indicated when it is critical to precisely reproduce the exact
opening and closing movement of the patient on the articulator.

Alter the vertical dimension of the occlusion is to be made.

Locates the opening axis physiologically with exceptional accuracy.

- Eg: Hanau model D

PARTS OF THE FACE BOW

- -U shaped frame

- -Condylar rods

- -Ear pieces

- -Bite fork

- -Locking device

- -Orbital pointer

POSTERIOR REFERENCE POINTS

BEYRON POINT
 -

13mm anterior to posterior margin of tragus

on line from the centre of tragus to outer
canthus of the eye

BERGSTROM POINT

This plane runs from porion (superior border of the

external ecousticmeatus ) to the orbitale
( lowermost portion of orbit of eye )

FRANKFORT HORIZONTAL PLANE

FRANKFORT HORIZONTAL PLANE

10mm anterior to the center of

spherical insert of his facebow and
7mm below frankfort plane

BRANDNUP AND WOGNSEN

 12 mm anterior to most prominent
part of posterior border of tragus on
line from it to outer canthus of eye

GYSI’S POINT

13mm anterior to anterior margin

of external auditory meatus on line
from the superior margin EAM to
OCE

LAURITZEN AND BODNER

 12mm anterior to center of EAM
2mm
and 2mm inferior to porion-
12mm cathus line

DENAR

12mm anterior to posterior border of

tragus and 5mm inferior to line extending
5mm
from the superior border of tragus to
12mm OCE

ANTERIOR REFERENCE POINTS

 Orbitale
 Orbitale minus 7 mm
 Nasion minus 23 mm
 Alae of the nose
 Incisal edge plus articulator midpoint to articulator axis-horizontal plane distance

ORBITALE
 One orbitale and the two posterior points that determine the horizontal axis of rotation will
define the axis – orbital plane.

Orbitale and the two posterior landmarks defining the plane are transferred from the patient to
the articulator with the face-bow.

The articulator must have an orbital indicator guide.

Orbitale is transferred from the patient to this guide by means of the orbitale pointer on the
anterior cross arm of the face-bow.

ORBITALE MINUS 7 MM
 Sicher recommended using the midpoint of the upper border of the external auditory meatus as
the posterior cranial landmark on the patient.

Most articulators do not have a reference point for this landmark.

Gonzalez (JADA,1968,76:329) pointed out that this posterior tissue landmark on the average
lies 7 mm superior to the horizontal axis

7 mm
 Position the orbital pointer 7 mm above the orbital indicator of the articulator.

Bergstrom's arcon articulator automatically compensates for this error by placing the orbital
index 7 mm higher than the condylar horizontal axis

NASION MINUS 23 MM

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 Quick Mount face-bow which is designed to be used
with the Whip-Mix Articulator, fits into this depression

When the face-bow is positioned anteriorly by the nasion guide, the crossbar will be in the
approximate region of orbitale

The face - bow crossbar and not the naison guide is the actual anterior reference point locator.
 During the face-bow transfer, the crossbar of the face-bow supports the upper frame of the
Whip-Mix articulator. The inferior surface of the frame is in the same plane as the articulator's
hinge points.

From this it can be concluded that the Quick Mount face-bow used with the Whip – Mix
articulator employs used approximate axis-orbital plane.

ALAE OF THE NOSE

The dentist can transfer Camper's line from the patient to the articulator by marking the right or
left ala on the patient, setting the anterior reference pointer of the face-bow to it, and with the
face-bow, transferring the ala anteriorly, and the hinge points posteriorly, from the patient to the
articulator's hinge – orbital indicator plane

The desired location for the maxillary incisal edge should be marked on the wax occlusion rim
as an initial step in determination of the occlusal plane. This ensures that the tentative occlusal
plane will not be too high or low.
 The wax occlusion rim made parallel with Camper's line is transferred to the articulator with a
face-bow. Its occlusal plane is made parallel with the upper and lower articulator arms.

INCISAL EDGE PLUS ARTICULATOR MIDPOINT TO ARTICULATOR AXIS-

HORIZONTAL PLANE DISTANCE

Measured from the midpoint of the articulator to the articulator axis - horizontal plane. Then
on the face from the incisal edge above a point is marked corresponding to the same distance.
That point is considered as the anterior reference point for face bow record.

FACEBOW TRANSFER

DEFINITION

The process of transferring the face-bow record of the spatial relationship of the maxillary arch
to same anatomic reference point or points and transferring this relationship to an articulator.
 GPT-8

THE PURPOSE OF FACEBOW TRANSFER

1. The reappearance of The Bonwill's triangle.

2. Reappearance on the Balkwill angle

3. The reappearance of the hinge opening and closing mouth movement axis

4. The reappearance of the opening and closing mouth way of the mandibular movement

5. The improvement of the reappearance of the mandibular movement

6. The prevention of the premature contact in the prosthesis

7.The establishment standard of the anterior guidance

8. The establishment standard of tooth shaft and overlap

PROCEDURE FOR HANAU FACE BOW:

Facebow, Facia with Bitefork

Facebow, Earpiece with Bitefork

HANAU™ Spring-Bows
  FACEBOW, FACIA WITH BITEFORK

Arbitrary axis for Hanau face bow:

*A condylar marker is used to scribe an arc about 13mm anterior to the external acoustic
meatus.

*Using a ruler held, so that it runs from corner of the eye (outer canthus) to the top of the tragus
of the ear

* Place a mark where this line intersects the arc made by the condyle marker. This locates the
arbitrary axis for the Hanau face bow condyle rods.

Mark the anterior point of reference

Orbitale is the third point of reference for Hanau face bows.

In the skull orbitale is the lowest point of the infraorbital rim. On a patient it can be palpated
through the overlying tissue and the skin.

One orbitale and two posterior points that determine the horizontal axis of rotation will define
the axis-orbital plane.

Contour the maxillary occlusal rim.

Reduce the mandibular occlusal rim to allow adequate interocclusal distance for the bite fork &
attached wax.

Softened wax is rolled into horse shoe shape & attached to the bite fork.

Attach the occlusion rim to the bite fork.

In dentulous patients the maxillary teeth indentations are recorded .

Place the bite fork along with the occlusion rim into the mouth & ask the patient to close which
will help to stabilize maxillary record base.

Secure the stem of the bite fork into the clamp of the face bow.

Adjust the condyle rods onto the arbitrary axis points.

Adjust the width of the condyle rods equidistant bilaterally.

Place the orbitale pointer over the mark.

  HANAU EAR BOW

Preparation of the bite fork .

The facial reference point is marked

The bite fork is inserted into the mouth.

The stem of the bite fork secured into the clamp of the face bow.

Ear pieces are inserted into external auditory meatus , tighten the screws

ADVANTAGES

The HANAU™ earpiece facebow is a simple method of securing a facebow record.

Nylon earpieces are parallel to the transverse hinge axis preventing uncomfortable penetration
into the auditory canal.

Earpieces are vented, minimizing distortion, it assures accurate and dependable function.

The Bitefork/Biteplane clamp has an overhead integral lock. No separate wrenches are required.
Finger pressure achieves locking without introducing torque into the bow.

 HANAU SPRING BOW

Ear piece type of facebow

Used with Hanau articulator

Reference points-

posterior-Porion, the superior border of external auditory meatus

anterior -Infra orbital notch

Plane of reference-Frankfort horizontal plane

Advantages:

- Auto-centering.
 - Sterilizable.

- Economical.

- Detachable transfer clamp assembly.

- Built-in reference pointer.

 WHIP MIX QUICK MOUNT FACE BOW

Arbitrary axis for Whip mix Facebow:

The insertion of plastic earpiece in the external auditory meatus automatically locates the
facebow in proper position

Attach the maxillary stabilized base to the bite fork.

Insert in the mouth and have the patient hold it in place with both thumbs using light pressure, or
place the lower base in the mouth and close against the bite fork.

The Face-bow is carried to the patient's face, and the face-bow fork assembly is slipped onto the
stem of the bow fork (bite fork)

The plastic earpieces are inserted into the external auditory meatus and brought slightly forward.

The nasion relator assembly is attached to the face-bow; the plastic nose piece should rest on the
nasion and the face-bow is tightened.

The face-bow is locked to the bite fork. The positioning of the face¬bow and locking of the bite
fork to the face-bow must be done carefully or the purpose of the face-bow transfer is defeated.

The entire assembly is then carried to the articulator. The upper cast is attached to the articulator.

 DENAR SLIDEMATIC FACE-BOW

Arbitrary axis for Denarslidematicfacebow:

-The Denarslidematicfacebow uses the external auditory meatus for arbitrary hinge axis location.

-A built in reference pointer aligns the face bow with the horizontal reference plane.

-The anterior reference point is marked on the patient’s right using Denar reference plane locator
Anterior reference point for Denarslidematicfacebow:

The point is 43mm above the incisal edges of right central incisor or left incisor for dentulous
patient.

For edentulous patient this distance is measured up from the lower border of the upper lip when
the lips are relaxed.

The bite fork is heated and inserted into the maxillary occlusion rim parallel to the occlusal plane
with the patient's midline aligned with the index ring of the bite fork.

The face-bow is assembled on the patient by inserting the stem of the bite fork into the transfer
jig as the earpieces are placed in the patient's external auditory meatus.

The right and left arms of the face-bow are geared for equidistant movement from its center

The lock screw on the face¬bow is tightened and the lock screw on the anterior reference pointer
is loosened.

The face¬bow is raised or lowered until the pointer is aligned precisely with the anterior
reference point. The clamps in the transfer jig assembly are then tightened.

The scale on the face-bow represents half the patient's intercondylar distance, which is of value,
is setting articulators having an intercondylar distance adjustment.

The intercondylar distance is recorded at this time.

The lock screw on the face bow is loosened, and the bow is opened and removed from the
patient.

The face-bow is detached from the bite fork assembly.

KINEMATIC FACEBOW:

•Facebow is attached to the lower jaw by means of clutch. This extends to the region of the ears
and is fixed to the mandibular teeth.

•Graph of Grid paper is placed near temporomandibular joint region, at the end of the arm just
anterior to the tragus region. This detects the stylus movement.

•The mandible is manipulated to a retruded position from which it is guided to open and close 10
mm.
• Initial movement of the stylus may be arc shaped.

•The stylus is adjusted in small increments to move it up, down, forward or back, until the pin
simply rotates without tracing an arc.

•This point identified as the hinge axis is tattooed on the skin and preserved for future reference.

•A third reference point is selected and marked on the face and recorded by adjusting the pointer
on the facebow.

•The facebow is removed from the patient and transferred to the articulator

 PANTOGRAPHIC RECORDING

To faithfully simulate all the mandibular movements on an articulator, it is necessary to obtain a

precise tracing of the paths followed by the condyle.

This can be achieved more accurately by means of a pantographic recording

Which will capture all the characteristics of the mandibular border movements from its retruded
position to the most forward and most lateral position

A pantograph is made up of two components

Two face bows

Mandibular component, which is affixed to the mandibular teeth and supports six recording
tables, and

Maxillary component, which is attached to the maxillary teeth and supports six styluses.

When the maxillary and mandibular components are in place, the styli are situated directly on the
recording tables.

The components are attached temporarily to the teeth.

Two recording tables are located near each condyle.

One records the movement of condyle in the horizontal pane, while at the same time the other
records the movements in the vertical plane.

In addition two anterior tables record the lateral movements of the mandible in horizontal plane.
When the pantographic tracing is made three border movements are recorded:

(1) protrusive

(2) rightlaterotrusive and left laterotrusive.

As the mandible precisely executes these movements, the recording tables also move, causing
the styli (which are stationary) to scribe a line across the table.

After the tracing is completed, the pantograph is stabilized and then removed from the patient.

It serves two important functions:

acts as a facebow to transfer the maxillary cast to the articulator in exact relationship to the
condyles,

It stores all the needed information for adjusting the articulator to the precise condylar
movements of the patient.