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FOR

SCIENTIFIC AND TECHNICAL INFORMATION

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UNCLASSIFIED

NOTICE: When government or other drawings, specifications or other data are used for any purpose other than in connection with a definitely related government procurement operation, the U. S. Government thereby incurs no responsibility, nor any obligation whatsoever; and the fact that the Government may have formulated, furnished, or in any way supplied the said drawings, specifications, or other data is not to be regarded by implication or otherwise as in any manner licensing the holder or any other person or corporation, or conveying any rights or permission to manufacture, use or sell any patented invention that my in amy way be related thereto.

A STUDY OF R SLA T110 N

TU S:TV:A SO(YENTRT2 PRO-

TllOJLTA

/b

1( 'A

STUDY OF INTEROCCLUSAL ECCENTRIC

PROTRUSIVE JAK~RELATION RECORDS

A Thesis

'I

Presented

in Partial Fulfillment of the Requirements d for the Degree Master of Sieece

~by~
4,-Frank Peter Rymarz D. D. S..

The Ohio State University

4~1963

Approved by:

Adviser Department of'Prosthetic Dentistry

',, -Dr

TISlA 11

Ii

ACKNOWLEDGENENTS

I would like to express my appreciation to my adviser, Dr. Carl 0. Boucher, for his advice during the research and in the I would also like to thank Professor

preparation of this thesis. George J.

Kienzle of the School of Journalism forhis assistance 0

in the preparation and editing of this thesis. I wish to extend special thanks to the graduate students in

prosthodontics who helped in this project. I also wish to extend my gratitude to the United States Air Force for making it possible for me to pursue this course of instruction.

ii

CONTENTS

Page

INTRODUCTION................................ METHODS AND MATERIALS RESULTS. .. DBISCUSSJION SUMMARY AND CONCLUSIONS REFERENCES .............................. .................... ............................ .3...................

1 3 14 32 41 43

cJ

S!~i

'

K:
-'---,-----

(9t

FIGURES

Figure 1. Pin-pointed incisal guide pin and incisal table graph ............. 2. 3. 4. 5. ....................... of protrusion
. .

Page

4 5 6

Condylar mechanism adjusted for 6 mm. Articulator set for making a 6 mm.

record ............

Plaster record trimmed to expose buccal cusps to facilitate accurate adjustment .......... Condyle track recorder ...... ................ ...

11 12

6. 7.

Condyle

track recorder

graphs

for Subject 5D

.....

...

13

The mean condylar inclinations of the clinical subjects--right side ........ ............... 30

8.

The mean condylar inclinations of the clinical subjects--left side ..... ...............

....

31

iv

(9i

TABLES Page Thirty degrees protrusive record adjustments ........... Five degrees protrusive record adjustments ......... Sixteen degrees protrusive record adjustments ....... Thirty-nine degrees right, forty-one degrees left protrusive record adjustments ... ............ Forty-six degrees right, forty-nine degrees left ......... protrusive record adjustments ......... Fourteen degrees right, twenty-one degrees left ........... protrusive record adjustments ....... Summary of protrusive record adjustments .......... Data for the clinical subjects .... .............. ... ... .. 15 16

Table I. II. III. IV.

... 17

...

18

V.

19 20 21 24

VI.

VII. k VIII. IX.

Maximum variations from the smallest setting of one record to the largest setting of another record ........................ for each subject ..... Comparison of the mean clinical resultsi . ........... ...

27 29

X.

V,!

V.i

tto 7 g++
INTRODUCTION Opinions vary about the value of recording the inclination of the condyle path with protrusive records.1-26,49 believe recording this relation is fore, Some dentists 1-4 merely a waste of time; Others, therewho

they use the plain-line articulator technique.

use an adjustable articulator technique, tion.

5

favor recording this rela-

-26,47-49 re-

Previous research has raised doubts about the accuracy, peatability and usefulness of protrusive jaw relation records.1,30-33,44

To help determine the value of such records

this study investigated the following questions: 1. Do different dentists adjust the horizontal condylar

guidances of the articulator to the same setting using the same record? 2. Can several interocclusal eccentric protrusive jaw rela-

tion records of the same patient be adjusted to accurately repeat the same setting of the horizontal condylar guidances of the articulator? 3'. How do protrusive records made with plaster compare to

those made with wax?

J1

2 4. What is the range of error if an average horizontal

condylar setting is used to determine the condyle path instead of a protrusive record?,

CI

II
C,

METHODS AND MATERIALS

This study was divided into two parts--one in the other in the clinic. In

the laboratory,

the laboratory a controlled study was using two sets of complete dentures Records for one set of for

made of protrusive records,

mounted on a Dentatus ARL articulator. dentures were made at 6 mm. and 3 mm. the other set were made at 4 mm.

of protrusion; records

and 2 mm.

Six records were made

for each protrusion with plaster* and six records were made for each protrusion with wax.** After the inclinations of the horisetting, one

zontal condylar tracks*** were adjusted to a specific

plaster and one wax record were made. at five additional settings,

This process was repeated

as shown in Tables I to VI.

The articulator was equipped with a pin-pointed incisal guide pin. A graph was placed on the incisal table (Fig. 1). The cali-

brated anterior stop screws of the articulator were turned in to

*Mirrotrue impression plaster, Whip-Mix Corp., Kentucky. **Extra-hard baseplate wax, Dentists'

Louisville,

Supply Co.,

New York.

***The condylar tracks on the Dentatus articulator are 36 synonymous with the condylar guidances on the Hanau articulator.

I.
I>)

Vc~

Fig.

1.

pin-pointed

incisal guide pin and incisal table graph.

Fig.

2.

Condylar mechanism adjusted for 6 mmn, of protrusion.

Fig.

3.

Articulator set for making a 6 mm. record.

C7
hold the condylar spheres in the desired number of millimeters of protrusion (Fig. 2 mm. 2). The modified incisal guide pin was opened
0

This allowed exact positional duplication for the plaster 3). adjusted

and wax records (Fig. Five dentists,

graduate students in prosthodontics,

each of these records once.

I adjusted each record three times--

first, after the second dentist, and lastly. I computed the mean for the three adjustments of each record that I made. I also computed the mean of the single adjustments I computed

that were made by the five dentists for each record.

the standard deviation for each series of record adjustments using the raw score formula (s.d.
w

,N(X

2
-(X

The resultsj Table VII

of this portion of the study are shown in Tables I to VI. summarizes these results.

Part Two was a clinical study of 15 subjects--10 dentulous and 5 edentulous. The dentulous subjects had at least 14 teeth in each

arch, with the exception of three who had one or more fixed bridges restoring their occlusion. The edentulous subjects had well fitting

complete dentures which had been constructed at The Ohio State University College of Dentistry by graduate students in prosthodontics. None of the subjects had symptoms of temporomandibular

joint disturbances.

C
The procedure used on each dentulous subject was as follows: Three plaster* and three wax** interocclusal protrusive jaw relation records were made with the anterior teeth in an edge-to-edge relationship but not quite touching. The wax records were made
47

using the technique advocated by Lauritzen.

Tin foil (0.003 inch) Extra hard'

was cut into strips 1/8 inch wide and 3 inches long.

baseplate wax was heated in a compound heater at 140OF until thoroughly softened. A strip of tin foil was laid on the edge of

a sheet of softened wax; the wax was folded around the tin foil to the desired thickness tor" each subject. two equal parts, as a handle. This wax strip was cut into

each with k inch of tin foil protruding to serve

These wax strips were then thoroughly softened in A plaster inter-

a compound heater at 140'F before they were used. occlusal centric jaw relation record was made. were made and dental stone casts poured.

Alginate impressions

The Almore hinge bow**** was used to locate the hinge axis on subjects 1, 2 and 3. The Dentatus face-bow with the orbital pointer

was used to locate the arbitrary hinge axis on all the other subjects. The upper casts were then mounted on the Dentatus articulator This placed the casts on the

with the hinge bow or face-bow.

****Almore Manufacturing Co.,

Portland 36, Oregon.

CI

C
articulator in relation to the Frankfort plane. so that the condylar inclinations of the different subjects could be compared.

9
This was necessary

The lower casts were mounted on the articulator with Each inter-

the plaster interocclusal centric jaw relation records.

occlusal record was carefully trimmed to expose the buccal cusps to insure accurate adjustment (Fig. 4). Each protrusive record was adjusted three times and the adjustments of the horizontal condylar tracks were recorded (Table VIII). The mean of the adjustments of the condylar tracks on each side for each subject were computed for the plaster records and for the wax records. (Fig. 5). The articulator was placed in the condyle track recorder Tracings were made for each subject with the condylar the mean of the plaster

tracks set according to the following: records,

the mean of the wax records and the average articulator The deviations of the tracings of the plaster and

setting of 40.

wax records from the 40' tracing were measured in millimeters at the point that the anterior teeth were in an edge-to-edge protrusive relationship (Fig. Tables VIII, 6). These data were recorded and compared in

IX and X and shown graphically in Figures 7 and 8.

The procedures for the edentulous subjects were the same as those used on the dentulous subjects with the following exceptions. The undercuts inside of their dentures were blocked out and dental

~(7.
stone casts were poured in them. These casts with the complete the same way the

10

dentures were mounted on the articulator in dentulous casts were. shown in Tables VIII,

The data for this part of the study is IX, X, and Figures 7 and 8.

also

2-4

IiI

Fig.

4.

Plaster record trimmed to expose buccal cusps to facilitate accurate adjustment.

Q 3,

12

Fig, 5i

Condyle track recorder.

:,

13

Fig. 6.

Condyle track recorder graphs for subject 5D.

C.

~7 ~

A S "

-&',-

~ ~

,,

C4

RESULTS

The data of part one, presented in Tables

the controlled laboratory study, are Table VII summarizes these results.

I to VII.

The five dentists did not adjust the horizontal condylar tracks of the articulator record. to the same setting using the same protrusive their adjustments increased as the amount

The variations in

of protrusion decreased. The over-all standard deviation of the wax records, and 6 mm. range, in the 4 This

was greater than that of the plaster records. Tables I to VII.

difference was not consistent as shown in fore,

There-

from the results of part one no significant difference can be

shown between the use of plaster and wax records. The data of part two, Tables VIII, the clinical study, are presented in

IX and X and in

the graphs in Figures 7 and 8. centric relation I felt

Since I mounted the dentulous casts in it

would be interesting to measure the number of millimeters this The ana-

position was posterior to the centric occlusal position. lyzing equipment used in ments are shown in this study made this easy.

These measureThe

Table VIII for each dentulous

subject.

average difference between these two positions was found to be 0.8 mm. with a range of 0 to 2.1 mm.

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21

AUTHOR.

FIVE DENTISTS

MEAN
R I. 30' 6 & 4 nen. P All 29.7 29.9 30.4 L 30.6 30.5 30.5 R 0.8 0.4 0,4

S.D
11 0.7 0.9 1.5 R 29.4 29 31.2

MEAN,
L 32.4 30.7 31.9 R 3.8 2.3 1.7

S.D.
L 3.0 2.5 2.2

W
II. 5 6 & 4 non. P W All

29.5
4.6 5.1 4.9 5.3

30.6
4.9 4.9 4.9 4.9

0.4
0.5 0.3 0.4 0.2

0.2
0.5 0.5 0.4 0.6

26.8
5.4 5.3 5.9 4.7

29.5
7 6.6 7.3 5.4

2.9
3.3 2.7 2.7 2.7

2.8
3.8 3,2 3.7 2.7

I11. 16'
6 & 4 nan.

All
P W

15.4
16 16 16 38.1 38.5 38.7 38.4 45.5 45.6 45.7 45.6 13.5 14.1 13.8 14.3

16
15.6, 15.6 15.5 41.2 41.4 41.4 41.4 50.3 49.5 49.9 49.1 21.6 21.5 22.1 20.9

0.6
0.5 0.4 0.6 0.9 0.6 0.7 0.3 0.7 0.6 0.4 0.8 0.8 0.5 0.2 0.8

0.8
0.6 0.7 0.4 0.7 0.4 0.1 0.7 1.0 0.4 0.5 0.2 0.8 0.5 0.3 0.7

16.8
15.7 17.7 13.6 40.5 39.1 41.2 37 47.1 47.6 47.9 47.214 15.2 15.8 14.7

18.2
16.3 18.3 14.3 43.2 42.8 44.3 41.3 51.2 50.9 52.8 49.1 21.4 22.1 24.2 20.1

3.6
2.7 2.7 2.7 4.0 3.3 3.1. 3.5 3.4 2.8 1.2 3.9 3.2 2.3 2.0 2.5

2.8
2.1 2.4 1.9 3.4 3.7 2.6 4.9 3.6 2.5 1.3 3.7 3.4 2.9 2.9 2.9

IV.

39'R,

41%L 6 & 4 nmn.

All P w

V.

46*R,

49%L 6 & 4 nan.

All P W

Vi.

14'R,

21%L 6 & 4 nan.

All P W

S.D.

Part I All 6 & 4 All " All " amn. P W

0.7 0.4 0.4 0.5

0.7 0.5 0.6 0.5

3.6 2.7 2.2 3.2

3.3 2.9 2.5 3.1

Table VII.

Suinaary of

Protrusive Record

Adjustments

22
The amount of protrusion to allow the anterior teeth to meet edge-to-edge is listed for each subject in Table VIII. The average

for the ten dentulous subjects was 5 mm. edentulous subjects was 5.4 mm. the subjects was 5.2 mm. The adjustment

The average for the five of

The average protrusion for all

of three interocclusal protrusive jaw relation

records of the same subject could not be adjusted to accurately repeat the exact same setting of the horizontal condylar guides of the articulator. The maximum variations from the smallest adjust-

ment of one record to the largest adjustment of another record in the three record series for each subject are listed in The variations between these records were greater than the dentulous subjects. Table IX.

for the edentulous

The plaster records for seven subjects

and the wax records for five subjects were within the error of the articulator adjustment. The error in the adjustment of the articu-

lator was not calculated in affecting it.

this study because of the many variables The error that Posselt
30

(See Discussion).

,31

re-

ported for the Dentatus articulator (4.60 used for this determination.

rounded off to 50) was

The condylar inclinations recorded with the plaster records differed significantly from most of those recorded with wax records. They differed on the right side from. -. side from 49 to a -14.16. It, 3 to -21.4o and on the left

was interesting to note that the

23 maximum variations on the right side both occurred in the dentulous subjects; while the maximum variations on the left side both occurred in the edentulous subjects. The average condylar inclinations for the subjects in this
study recorded with plaster records were 39.30 on the right side

and 38.20 on the left side. side and 40.4'

The average condylar inclinations with

i

plaster records for the dentulous subjects were 41.30 on the right

on the left side.

The average condylar inclinations

of the edentulous subjects with plaster records were 35.40 right side and 33.70 on the left

on the

side.

The average condylar incli-

nations recorded with wax records were 30.10 on the right side and 32.60 on the left side. The average condylar inclinations for the

dentulous subjects with wax records were 33.90 on the right side and 33.80 on the left side. The average condylar inclinations with wax

records for the edentulous subjects were 22.60 on the right side and.
30.10 on the left side.

The mean plaster and mean wax record for each subject varied from the average 400 articulator adjustment. shown in Table X and Figures 7 and 8. These differences are

The maximum variations reon the right

corded with the plaster records were 15.,80 to -12.80 side and 11.60 to -12.1' on the left side.

The maximum variations

recorded with the wax records were 11.40 to -35.10 on the right side
and 8.16 to -20.70 on. the left side.

QI
24 NM. DEVIATION OF INCISAL GUIDE PIN 0.5 R NM. DEVIATION OF INCISAL CUIDE PIN 0

HH. C. R. POSTERIOR TO C: CY ID 0'

PLASTER NM.' PROTRUSION 4 RECORD NUMBER I R 46 47.5 46 44 43 43 48 50 49 48 49 50 50 48 48.5 51 49 50 56.5 56.5 56 54.5 56 56 55 56 56 32 32.5 32 32 32 32.5 32 32 32 35 35 36 35 36 36.5
36.5 3i 32.5

WAX R 40 41 40 39 40.5 41 40 38.5 38.5 48 47 50 L 38.5 38 38 40.5 40 39.5 38 38.5 38 48 47 49 46.5 49 50 48 46 48 46.5 44 45 45.5 46 46 43 43.5 42..5 23 23 22 21.5 25 26 29 28 27.5 3036 30.5 28 32 30
36, 28 30.

L 47 47 48 48 48 47.5 60 59 60 52 52 52 53 52 52.5 49 50.5 49 49.5 50 49.5 46 46.5, 46.5 48 48 48 40.5 38.5 38.5 39 38.5 38 34 34 35.5 43 44 44 43 43.5 42.5
42 38 M8

11

1.75 R

0.5

I11

0,

2D

II

46.5 48.5 49.5 47.5 47 48 51.5 52 52 51.5 51 51 51.5 51.5 51 31 31 32

I1I

2.5

3D

2.1

0.5

2.75 L

II

2.5

III

0.25' L

4D

0.5

1I

0.5

28 29 28 30 30 30 28 32 29.5 24 27 27
28 i4 26

1-

,III

0.5 L

5D,

0.75

0.5 L

2.5

II

111

0.5 R

25
M. C. R. POSTERIOR TO C. 0.
6D 1

PLASTER MM. PROTRUSION

5.5

MM4. DEVIATION
OF INCISAL GUIDE PIN
1 R

WAX R
36 35 34 38 38 37.5 38 37.5

MM. DEVIATION
OP INCISAL GUIDE PIN2 L

RECORD

NMBER
1

R
34 33 33 40.5 41 40.5 41 41

L
36 35 35 34 35 35 35 34

L
31 32 30 30 31 30 31 31.5

II

0.75-R

II

0.25 R

40
7D 0.75 3.25 I 44 42.5 42.5 41 40 40

34
45 44 43.5 41.5 40 41.5 43 1 L

37
39 39.5 38 37.5 38 36 34

32
44 45 43 42.5 45 44 40 0.5 L

II

0.5

III

45 44
37 36.5 37

45

43 42.5
31.5 31.5 31 29 27.5

8D

15

35 36 18 i5
18 16.5 17"

39 41 19.5
20 19.5 28 28

II

S36
III 9D 0.5 6.5 I

35 35 37.5 38 37 38 38 38 43 42.5 43 40.5 38.5 40.5 39.5 38 38 38.5 38 38 34 34 33.5

28.5
21 27 30.5 26.5 27 26 29 28 29 29 28.5 28.5

2.25 L 1 L

18

28
21 22 22 16 16 15 20.5 19 21.5 23 21 21.5 39 38 37.5 33.5 32.5 32 32 32.5 33

2 0.5

L L

23 24 24.5 12.5 12 12.5 19 21 22.5 24 22.5 23 34 32 32.5 30 29 28 27.5 28.5 28

2.5

2.2

II

0.25 L

III

2.1

10D

0.15

9.2

38 38.5 38 40 40.5 39.5 36.5 37 37

II

1.5

III

26 MO. C. R. POSTERIOR TO'C. 0. IE PLASTER mm. PROTRUSION 5 RECORD NUMBER I R 22.5 21 20 30 31.5 32 29 29.5 29 22 22 22 20 20 20 2.5 3 3.5 39 39 39 37.5 37.5 37.5 39 38 38.5 46 46 46 36.5 37 36 29.5 30, 30 50 50.5 51 52.5 51 50 57.5 57 58 L 26 26 28 38 39 38.5 37.5 37 38 27 27 27 32 32 32 17 18 17.5 33.5 35 35 49 49.5 49.5 47.5 47.5 47.5 28 29 29 21 20.5 20.5 11. 12 12 37 37.5 37 37 42 42.5 44 44 44.5 DEVIATION OF INCISAL GUIDE PIN 1 L WAX R 2 5 0 25 21 24 15 15 16 5 5.5 5 4 4 3 6, 6 6 27 2.5 27.5 25 23 24 30.5 30 30 27.5 28 27 29 30 29 31 30.5 30.5 27.5 30. 27 4,1.5 42 41.5 27.5 27.5 28 L 31 32 31 38 36 38 35 36 36 29.5 30 30. 31 32 32 30 29 30 32.5 33 34 36 36 37 39.5 39 39 25. 24 24 27.5 28 27.5 21.5 21 21 24.5 25.5 24 30 30.5 30.5 23 23.5' 22,5' DEVIATION OF INCISAL GUIDE PIN 4.5 L

11

5.5 L

1.25 L

III

2E

'R

II

III

1.5 R

1.75 L

3E'

5.25

2.75R

1.5 R

II

2.5 R

2.5

I111

1.75R

0.5

4E

11

III

5E

3.75

'1

2.5

II

0.5 R

2.75 R

III

Table VIII.

Data for the Clinical Subjects

.27

PLASTER R ID 2 3 4 5 6 7 8 9 7 3 2.5 0.5 1.5 8 5 3 5 6 L 13 4 4 6.5 2 2 5 4 3 4 R 2.5 3.5 1 4 5.5 4 5.5 8 12 5

WAX L 2.5 4 4 7.5 8 2 6 8.5 8 7

10
IE 2 3 4 5

11.5 2 1.5 16.5 8

12.5 5 16 18 7.5

25 3 7.5 4 14

7 3 7 7 8

Table IX.

Maximum Variations from the Smallest Setting of One Record to the Largest Setting of Another Record for Each Subject.

(~:iI

28 The condylar inclination on one side influenced the actual path of movement of the condylar track on the other side. When a

condylar inclination was steeper on one side than the other the effective path of protrusive movement was tipped. The graphs of

seven subjects illustrated this by tracing a path of a lower inclination higher than one of a steeper inclination. for subject 5D. (See Figure 6

The tipping of the effective protrusive path caused

an inclination of 38' to trace a steeper path than one of 400.) The variation of the protrusive records was measured in millimeters from the average 40' setting at the point that the anterior teeth were in an edge-to-edge protrusion. These measurements were

made on the graphs that had been traced for each subject on the condyle track recorder. These measurements, although very small

and subject to error, presented an approximation of the amount of error that could occur in the occlusion. Table X. They are listed in

I:

Ii

ii
211 .s-o.14'14010.0101'-440 .. 10.00.1.A.M0.14010 001.140100.1400101

01

-. r..j

01o.oC044fl

.9
0104

5d2dd
4 44

1o,oooo.oo
444 4114

04

1010-

404104 0-01'

0100-''01

jJ

01,

oOfl004001

044'..
4

441 0100.

ooo 0

oodllc

%S

oiooo

co.14000-'01 01.o. .11.-I 0440110401401404001 11 -101 o40101 ill 4444 0401010 04 1. 01-0 0401 04 04 0 01010 0010-004 01 44 ..oro 00400.3004104010-40 04010 0-10 4444444 4

01040101.01 40011410 44444 0-01040014 0400100010100 44414

01

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01

4W.

4>

01410.0404 014-.a,.-14. 11101 0 04 0140 0104040440 140101 p.1-.-1004010101014014 1 4.40 1004010 44444444 -s 0401 01404041 0141010-010101 404 01010 0400111 00 00,101010'I 0440404414 14444*0101,,-1014014

01 01 0 01

'1

10

101014 001401 0101410440 000-00 011110.3010101010104010-001 4444444444 01 0404 11110111 a04040101 0100111 01.4100000404011 0001 00401 040.40401.00 0l0-004404.10 .1401 04114 44 4 4 444114

104

0. 4

44 01 .04 40 0-4

014.01.0401404 01'00 0411 4444 01 4

0000 -01

40040014 04014401.3010 0010101.04040401001. ..4104fl01

4 0 -

401 101 . 0 01 01 01 01 04 0 0 01 01

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4

01404010104 0Y0140304'4 0400101401

Oo4OOlO

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01b00-4014010140-04010100401 * 04014 011 0 .34,140001001-001-0001401-01-s 0101001001401 01010010010010101 404010 .0010-010441

0

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04 0

01

01010-

01

.......................... -

4a04,0101010014010 4001010101001001

010040-01 0101010001

.40 -014 0 01

01 01

4. 4 0 010140100-0040 0101001

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____________

30

ITI

:800

40

IMR
'17Nit

Fig.7. ondyarhe ncliatins man o

th

cliica

sujcs-rgt

ie

I:two

31

Fig.

8.

The mean condylar inclinations of the clinical subjects--left side.

______

DISCUSSION

The variations

in

the condylar paths of different

subjects and

frequently on opposite sides of the same person point out a need for recording these relations. prosthodontic textbooks.
20

These facts are stressed in many Christensen 2 6 was the first to report

"2 5

a. lowering of the mandible in

the molar area during protrusion due (Christensen

to the inclinations of the paths of the condyles phenomenon). It is this change in

position that allows us to record

condylar inclinations with interocclusal protrusive jaw relation records. Whether the recording of the condyle path is worthwhile

or not due to the shortness of the path during function requires further investigation. CraddockI studied the use of protrusive interocclusal jaw relation records on three dentulous subjects. He used wax records,

made at various amounts of protrusion with and without biting pressure. He tried to correlate the positions of the condyles in He felt, as

the Glenoid Fossae with protrusive jaw relationships.

many other dentists,6,12,29 that the protrusive record should be made with the anterior teeth in an edge-to-edge relationship.

32

f !}

33 He concluded that this amount of protrusion was usually insufficient for accurate adjustment of the condylar guidances of the articulator. Therefore, he felt that the use of protrusive records were

merely a waste of time. Posselt and Franzen 30 reported on Nevakari's study of seven

subjects using protrusive interocclusal wax records to record condyle path inclinations. The registrations and the readings were Nevakari found the variation between

also done by a second dentist.

the results of the two dentists to be too large to be of any value. He therefore felt that wax records were unreliable for recording condylar inclinations. Posselt and.Franzen30 made a comparison study to Craddock's.I They obtained a smaller standard deviation than Craddock had. only difference between their two methods was that Craddock had mounted the casts for his study in centric occlusion on a Hanau H articulator. Posselt and Franzen mounted their casts in centric The

relation and oriented them to the Frankfort plane on a Dentatus ARL articulator. Posselt and Franzen felt that the differences in

their results were due to using the retruded position and possibly greater care in the handling of delicate wax records. I agree with Posselt and Franzen that the small difference in the mounting positions probably had little effect in the results, Studies have shown

but I agree.with them also that it might have.

9,

34 that in 90 per cent of adults centric relation is 27 28 to centric occlusion.2' 1 mm. posterior

Centric relation for the subjects in my

study averaged 0.8 mm. posterior to centric occlusion, with a rangei of 0-2.1 mm. Adding a millimeter or so to the protrusive relation

on the articulator will increase the ability and accuracy to adjust the condylar inclinations. The accuracy of the adjustment of pro-

trusive records to record condylar inclinations increases as the amount of protrusion increases. study and in many others. Posselt and Nevstedt31 studied the condyle path inclinations of 101 dentulous subjects. Dental students recorded these relaThey This has been demonstrated in this

tions with wax records under the supervision of instructors. observed a variation between 0 and 600.

The condylar inclinations

of most of their subjects were in the 40 to 50' range in relation to the Frankfort plane. The average inclination was 39.10 on the They felt that the condyle

right side and 40.4' on the left side.

path should be recorded when a patient has a condylar inclination over 49' or under 310. the subjects. They found this to occur in 50 per cent of

Since the condyle path would have to be recorded to

find out whether the patient was average or not, this indeed seems to indicate that the condylar inclination should be recorded.

)
30 Posselt and Franzen compared the condyle path inclination

35

obtained by five different dentists and found a difference of 50. They felt that this small difference was due to the considerable experience of these dentists with this technique. Each of these

dentists had adjusted the record three times and the mean and standard deviation was calculated for each. The average standard'

deviation for the five dentists was 3.6, with a range of 1.8 to 4.8. They did not mention the amount of protrusion at which this The average standard deviation for all the records

record was made.

in part one of my study adjusted by five dentists were 3.6 on the right side and 3.3 on the left. The difference in the record adjustments of the author and the five dentists in this study were mainly due to technique. Poor

adaptation of the record to the dentures by the adjusting dentist caused some of the large variations in the 6 and 4 mm. records. The varied hand position of the five dentists was another variable. None of the five used exactly the same hand position each time to hold the upper member of the articulator. I did, however, notice

that when the hand holding the upper member of the articulator into the record was placed anterior to the dentures the inclinations recorded were usually of a higher value. posterior to the mounted dentures, usually of a lower value., When the hand was placed

the adjustments recorded were.

Dentist III most often held the record

'36

in position on the dentures by holding the bottom tip of the slightly raised incisal guide pin in his fingers. could never be predicted. His results

Dentist V usually used the method of

adjustment recommended in the Dentatus Articulator Instruction Book.

37

None of the five dentists made effective use of their

tactile sense.
34

Posselt

recommends placing four fingers on the upper mount-

ing ring and exerting pressure over the middle of the casts to feel when the upper cast is resting evenly in the protrusive record. This is an excellent suggestion. It allows the use of tactile

sense to feel the correct adjustment in addition to just looking to see the accurate adaptation of the record to the casts or dentures or. the articulator. suggests that ....
36 The Hanau Articulator Instruction Book

"one hand might be placed on the upper member to Boucher 35

exert slight pressure to sense the satisfactory seating."

recommends placing the fingers of one hand on top of the articulator on the mounting screw to feel when the record is correctly adjusted. He 46 also recommends looking through a magnifying glass to observe the accurate adaptation of the protrusive record to the dentures or casts on an articulator. The Dentatus ARL articulator was selected for this study because of its similarity to the popular Hanau articulator and its previous use in similar research.

I..

37
Posselt 3 0 ' 3 1 reported an error of plus or minus 2.30 in the

adjustment of the horizontal condylar tracks of a Dentatus ARL articulator. I observed a similar error in the adjustment of the this study. I found that

Dentatus ARL articulator that was used in there were a couple of degrees of movement, amount of protrusion,

depending upon the the

during which I could observe no change in

accurate appearing adaptation of the record to the dentures.

This

movement was greater with small-amounts of protrusion and became smaller with increased amounts of protrusion. Because of this I felt that

variability I did not attempt to measure this error. it would differ in other articulators and even in

the same one that

I used due to friction, wear, handled.

tolerance and how the articulator was tracks of the articulator

I tried to adjust the condylar

to the center of this area of movement without looking at the condylar inclination markings. I adjusted each side separately, then

rechecked the adjustment of each side again to improve the accuracy of the adjustment. I attribute this technique to the production of

the small standard deviations of the records that I adjusted. Therefore, I believe a better understanding of the limitations could decrease the variation in adThe horizontal condylar guidances

and handling of the articulator justments by different dentists.

of a Hanau type articulator should be adjusted to the highest point of movement to keep the condylar spheres in direct contact with the

38 lower tracks. The horizontal condylar guidances of an arcon type

articulator should be adjusted to the lowest point of movement to keep the condylar spheres in direct contact with the upper tracks. The differences shown between the plaster and wax records in this study require further investigation. reasons for these differences. Swenson 22 stated some

"The registration will vary accord-

ing to the biting pressure exerted after the mandible has been protruded. path. If The greater the biting pressure, taken in wax (intraoral), the flatter will be the

it will depend on how soft the When it is registered with soft The fact that

wax is at the time of registration. plaster,

the inclination obtained is usually steeper."

biting pressure will flatten the inclination was demonstrated by record number III of subject 2E. One pin-point tooth contact on

the right side was believed to change the. path about 180 on that side and 13' on the other side. Possible factors accounting for the difference between the plaster and wax records in this study are resiliency of the wax,
48

uneven hardening of the wax, record sets.

and changes in muscle tension as the

I believe the difference was due mainly to a very I had asked

slightly more resistance of the wax than the plaster. the subjects about this.

Most of them noticed no difference between A few thought there might

the plaster and wax closing resistance. have been. a slight difference.

Further research is recommended to

learn the answer to these problems.

c-'

Posselt and Nevstedt

31

reported that they are not completely

convinced about the amount of difference in the condyle path which other authors report as being insignificant. Craddock, 1 feels thait

a change of 100 changes the posterior occlusion only 0.5 mm. in the second molar area. make this change. Marolt 3.1 pointed out that it
31

requires 150 to

Nevakari

reports a change of 0.5 mm. or less Hanau 4 9 felt that the maxi,

for 96 per cent from an average of 450.

mum tolerance was 0.1 mm. but does not tell how he came to this conclusion. According to CraddockI the error in the occlusion at the second molar would be one-half of the values listed in Table X. He made

this statement because he felt that the second molar is located half way between the condylar and incisal guidances. Of course this

will vary with the position in the articulator that the casts or dentures are mounted. My results in Table X differed from The tipping of the effective protru-

Craddock's in most instances.

sive path, as explained before, may be the reason for this difference. Studies have also been made on the type of articulator design and how it effects protrusive movements.
30 38 4 5

'

The results of

some of these studies have been somewhat conflicting. It certainly appears that this and mos.t previous studies favor Of course this could be',e

the recording of the condylar inclinations.

40

because most of those who do not record it do not bother to mention it. The big unanswered question appears to be whether the condyle

path is long enough during function to record it accurately or not.

Ii

SUMMARY AND CONCLUSIONS

-Th-i-a-s.tudy-in~ves-t-i.gated-several aspects of interocclusal

eccentric protrusive jaw relation recordsAto help clarify the value of their use. .9-l-The findings of this study were: ive dentists did not adjust the horizontal condylar

tracks of the articulator to the same setting using the same protrusive record. of these records, Awlehoughthwewre differences in the adjustments

the variations were not great enough to be able The variations tended A better under-

to say that protrusive records are worthless.

to increase as the amount of protrusion decreased.

standing of the limitations and hand-ingrof the articulator could d'ecrease/h *__2 tric variation in adjustments by difference dentists.

The adjustment of several protrusive interocclusal eccenjaw relation records of the same subject did not accurately

repeat the same setting of the horizontal condylar tracks of the articulator. to error in The variations that did occur were believed to be due the adjustment of the articulator, differences in posi-

tion and possibly to muscle tensions while the records were being made.

4i

'IL

42

3.

In part one no significant difference could be shown In part two

between the adjustment of plaster and wax records.

almost all of the plaster records produced a steeper inclination than the wax records. Further research is suggested to clarify

the reasons for this difference. 4. Although the findings presented here are not conclusive

they indicate some reasons for recording condylar inclinations with protrusive records. Further research is necessary.

J!

____ ___ ___ ____ ___

__

,---

-.-

REFERENCES

l.-

The Accuracy and Practical Value of Records Craddock, F. W.: 697-710, 1949. of Condyle Path Inclination, J.A.D.A. 38: Occlusion of Cuspless Teeth for Balance and Pleasure, M. A.: 305-312, 1955. Comfort, J. Pros. Den. 5: From Mouth to Articulator: Kurth, L. E.: 517-520, 1962. J.A.D.A. 64: Porter, C. Pros. G.: Den. Static Jaw Relations,

2.

3.

4.

The Cuspless Centralized Occlusal Pattern, 5: 313-318, 1955. J. Pros.

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5.

Current Status of Prosthodontics, Boucher, C. 0.: Den. 10: 417-422, 1960.

6.

)
7.

Hickey, J. C., Boucher, C. 0. and Woelfel, J. B.: Responsibility of the Dentist in Complete Dentures, J. Pros. Den. 12: 646, 1962. Sears, V. H.: Comprehensive Denture Service, 531-551, 1962. J.A.D.A. 64:

8.

Discussion of Interocclusal Records, Dresen, 0. M.: 236-241, 1958. 57:

J.A.D.A.

9.

Registration of Centric and Protrusive Smith, E. H. Jr.: Records for Construction of Complete Dentures, J.A.D.A. 53: 403-410, 1956. Trapozzano, V. R.: 332, 1955. Occlusal Records, J. Pros. Den. 5: 325-

10.

11.

Condylar Adjustments, A Simplified Equipment Wright, W. H.: and Accurate Method for its Use in the Practice and Teaching of Full Denture Construction, J.A.D.A. 14: 661-662, 1927.

43

44
12. Owen, E. B.: J.A.D.A.

The Condyle Path: Its Limited Value in Occlusion, 36: 284-290, 1948.

13.

Hanau,

R. L.: Full Denture Prosthesis - Intraoral Technique for Hanau Articulator Model H. ed. 4, Buffalo, N. Y. 1930, Hanau Engineering Co.

14.

Pearson, W. D.: Reducing Frictional Resistance in the Occlusion of Dentures, J. Pros. Den. 5: 338-341, 1955. Lindblom, G.: 657-664, The Value of Bite Analysis, 1954. J.A.D.A. 48:

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16.

Lucia, V. 0.: Modern Gnathological Concepts, 1961, The C. V. Mosby Company.

St.

Louis,

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Stuart, %. E.: A-curacy in Measuring Functional Dimensions and Relations in Oral Prosthesis, J. Pros. Den. 9: 220-236, 1959. Francis, E. E. Jr.: tion, J. Pros. Relations in Complete Denture ConstrucDen. 9: 367-373, 1959.

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19.

Christensen, P. B.: Accurate Casts and Positional Relation Records, J. Pros. Den. 8: 475-482, 1958. Prothero, J. H.: Prosthetic Dentistry, Chicago, Dental Publishing Company, pp. 21-24. 1928, Medico-

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Anthony, L. P.: The American Textbook of Prosthetic Dentistry,, Philadelphia, 1942, Lea and Febiger Co., pp. 17-18. Swenson, M. G.: Complete Dentures, ed. The C. V. Mosby Company, pp. 166. 4, St. Louis, 1959,

22.

23.

Nagle, R. J. and Sears, V. H.: Denture Prosthetics Complete Dentures, ed. 2, St. Louis, 1962, The C. V. Mosby Company, pp. 297-300. Sharry, J. J.: Complete Denture Prosthodontics, New York,

24.

1962,
192,

McGraw-Hill Book Company,

and 215.

pp. 116-118,

122-123,

_______________________

45

25.

Schlosser, R. 0. and Gehl, D. H.: Complete Denture Prostheses, ed. 3, Philadelphia, 1953, W, B. Saunders Company, pp. 20-23, 211-217. Christensen, C.: The Problem of the Bite, Dent. 1184-1195, 1905. Cosmos., 47:

26. 27.

Osborne, J. and Lammie, G. A.: Partial Dentures, Oxford, England, 1959, Blackwell Scientific Publications, p. Sicher, H.: Oral Anatomy, ed. Mosby Company, p. 176. 3, St. Louis, 1960,

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The C. V.

29.

Clinical Guide for Removable Partial Dentures, University of Kentucky, College of Dentistry, Department of Prosthodontics, pp. 47-48. Posselt U. and Franzen, G.: Registration of the Condyle Path Inclination by Intraoral Wax Records: Variations in Three Instruments, J. Pros. Den. 10: 441-454, 1960. Posselt, U. and Nevstedt, P.: Registration of the Condyle Path Inclination by Intraoral Wax Records--Its Practical Value, J. Pros. Den. 11: 43-47, 1961. Isaacson, D.: A Clinical Study of the Condyl, Den. 9: 927-935, 1959. Path, J. Pros.

30.

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Gysi, A.: Practical Application of Research Results in Denture 199-223, 1929. Construction, J.A.D.A. 16: Posselt, U.: Physiology of Occlusion and Rehabilitation, Philadelphia, 1962, F. A. Davis Company, pp. 131-133. Boucher, C. 0.: Dental Prosthetic Laboratory Manual, Columbus, Ohio, 1959, The Ohio State University Book Store, pp. 39, 40, 143, 149. Hanua Articulator Technique, Buffalo, New York, Hanau Engineering Company, Inc., pp. 9-11. Instructions for Use of the Dentatus Articulators, Stockholm, Sweden, 1960, AB Dentatus Co.,, pp. 12, l3-14.

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46

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Villa, H. A.: Requirements of Articulators for Protrusive Movements, J. Pros. Den. 9: 215-219, 1959. Villa, H. A.: Features, Beck, Requirements in Articulators: Contraindicated J. Pros. qen. 9: 619-623, 1959.

39.

40. 41.

H. 0.: Selection of an Articulator and Jaw Registrations, J. Pros. Den. 10: 878-886, 1960. Choosing the Articulator, J.A.D.A. 64: 468-475,

Beck, H. 0.: 1962.

42.

Marolt, Alfred: Selection of /Articulators Suitable for Registration of all Mandibular Movements, Den. Abs. 7: 294-295, 1962. Derksen, A. A. D. and Van Haeringen, W.: Protrusive Movement in Articulators, J. D. Res. 37: 127-135, 1958. Palmqvist, 0.: Registration of the Condyle Path Inclination by Means of Protrusive Relation Records--An Articulator Investigation, Svensk. tandlak. - tskr. 43: 217-230, 1950. Bergstrom, G.: On the Reproduction of Dental Articulation by Means of Articulators, Acta odont. scandinav. 9: suppl. 4, 72-103, 1950. Boucher, C. 0.: Lecture, of Dentistry. The Ohio State University, College

43.

44.

45.

46.

47. 48.

Lauritzen, A. G.: Mounting of Casts for Functional Analysis of Occlusion. 1314 Lakeside Ave., S., Seattle 44, Washington. Sears, V. H.: Unstrained Jaw Relation Records, 722-724, 1960. Hanau, J.A.D.A. 61:

49.

R. L.: Dental Engineering. Shall we Adjust an Articulator to Anatomical and Technical Requirements or May we Expect Our Patients to Fit an Average Articulator? J.N.D.A. 9: 595-609, 1922.

Tol?