ORAL REHABILITATION

Clinical Determination of Occlusion

Sumiya Ho�o, DDS, MSD, PhD

Director
International Dental Acarlemy
Tokyo, Japan

r
Visiting P ofessor
Department of Fixed Prosthodontics
School of Dentistry
Vniversity of California. Los Angels
Los Angels, California

Hisao Takayama, BS, PhD

Senio r Researcher
International Dental Acarlemv
Tokyo.Japan

Kanagawa Institute of Technology

l.ecturer

Kanagawa, Japan

Quincessence Puhlishin� Co, Inc 1997

Tokyo, Herl in, Chicago, London, S<io Paulo, Mosrnw, Pra,i.:ue, Warsaw
 Editor: English version
M.S.
Lily T. Garcia, D. D. S.,
orative Dentistry,
Chair Department of Rest
�
Univ rsity of Colorado H
ealth Sciences Center,

Schoo l of Dentistry

© 1997 by Quintessence Publishing Co, Inc, Tokyo

All rights reserved.

This book or any part thereof may not be reproduced. stored in a retrieval
system. or transmitted, in any form or by any means. electronic, mechanical,
photocopying, recording. or otherwise. without prior written permission of
the publisher.

Printing and Binding: Sun Art Printing Co. Ltd, Osaka

ISBN 4-87417-532-5 C 3047

Printed in Japan
 Preface

The Twin-Stage Procedure proposed in this book may sound radical to some readers. Even
the authors would not have accepted this point of view if they had heard this concept ten
years ago. However, the Twin-Stage Procedure provides the means to control the amount of
disocclusion which has not been possible by avarage practitioners using previous procedures,
yet provide satisfactory clinical results.
Since dentistry is a practical science, the authors hope those who are skeptical will try the
procedures at least once. Observing the results, the authors believe the skeptics will
understand the authors' approach.
Gnathotogy has questioned and modified principles of. basic occlusal concepts from RUM
position to antero-superior position, from balanced articulation to mutually protected
articulation, and from sophisticated to more simplified procedures. Gnathology has been
flexible in the modification needed for the findings of new research. Thus Gnathology has
foundations to adapt innovation.
Dr. Charles E. Stuart, prior to his passing on January 10, 1982, expressed his hopes to Dr.
William H. McHorris (Tennessee, U.S.A.) and me to continue the study of mandibular
movement and focus on anterior guidance. The Twin-Stage Procedure was developed as a
result of Dr. Takayama and my efforts to fulfill his hopes. The authors' new procedures were
the results of intensive innovative studies which produce precise disocclusion without the
measurement of condylar path.
The Twin-Stage Procedure may be controversial in comparison with traditional procedures,
but the authors believe these new procedures have followed development of Gnathological
principles into scientifically-supported patient treatment.
Dr. Albert �olnit known as genuine Gnathologyst kindly read the manuscript of this book
several times and said that he was not certain if Dr.Stuart would like this idea if he were still
alive. However, he Indicated that the Twin Stage procedure would be an excellent method for
dentists who were not familiar with the pantograph and a fully adjustable articulator to obtain
gnathological occlusion.
Ors. Harry L. Gelfant and Dennis P. Nimchuk read and corrected the manuscript of this
book grammatically. They tried this method practically and confirmed that it worked well with
their occidental patients.
Special acknowledgement� to pr. Charles G. Eller, President, American Academy of
Gnathology, for his continuous encouragement throughout this endeavor and to Dr. Lily T.
Garcia, Chair, Department of Restorative Dentistry, University of Colorado Health Sciences
Center, School of Dentistry for her editorial efforts in the English version to complete this
book.

Sumiya Hobo
 Contents

Chapter 1 Theoretical Background 1

Disocclu sion •• •••·••• ··•• ••••• •··••••· ·· •··· · •·· · · · ····· •··· ····· ··•···· ·· ···· •••·· ·· ···· •····· ··· ·· ·····

Influences on the Amount of D isoccl usion

6
·· ··· · ··· ··· ····· ······ ·· ······· ······
•·· . . ·· ···· · ·· · ·

The Necessity for Disocclusion •· •·•·· ··· · · ··· ······ · ····· · ···· · · · ··· ···· ····· ·· ···· ······· ·· ··· · ·· · I6

Chapter 2 The Articulator 23

C ondylar Guidance Assembly •·· ··· · · ···· ·· ···· •·· ··· ···· ··· · ······ · ·· ···· •·· ···· ···· · ······· ···· ···· 23

Anterior Guidance A ssembly ••·•••••·••••••·••••·•••••·•·••···•···········•················ · · · · ····· 27

Crite rion for Select ion of an Articul ator ·· · ··· ·· ••· · ····· ·············· ····················· · ···· 29

Chapter 3 Twin-Stage Procedure 31

Standard. Value of the Cus p Angle ··· ••· •• •·•• ••• •·•••• •··•••····••·••••···•••···••· ···•·····••· · 31

Basi c Concept of Twin-Stage Procedure ·································· ······················ · 32

Adjusting Values of an Articul ato r ··•••· .............................·······••····•······ ···... ·• 33

C>utline of the Twin-Stage Procedure 00•••00••00•••••• • ............................................. 38

The Twin Ho by Articulator • •···•••· •·••· ••••• ····•· •·••••• •••• •·· ··· ···••· ••••• •·••••· · ·· •· ······· 38

Complete D enture Prosthesis ···· ..· .. ····· ..· ·.. ····· · ··· · ··· · •· ····· ···· ••· ··· ••··· · ·········· ····· 42

Systemat ic C onsideration ••••• ·•••••••••••••••••••••••••••••••···••··••••····•···••••··••••···•••··· ·•• 42

Contraindications ··•·••·· ··•· ···•··· ··•· ···••· · ······ ···•··••·····••·· ··•···············••·············· 42

 Chapter 4 A Clinical Evaluation Test 44

1l1C Articulator Test ··········· ············ · ··· ························ ··· ·· ················

· · · · ···· · ·•· 44

1l1C lntraoral Test······················································································· 49

Discussio n ··· ··
· ··· · ····· ··· ·
··· · · ·· ·········· · · · ··········· ·· ···· ····· · ·
·· ··· · · · · ··· ···· · ··
· ··· ·· ·· · ····· 50

Chapter 5 Occlusal Diagnosis on the Eccentric Position 54

C>cculusal Diagnosis ········· ··············· ······· ·····

· · · · ·········· ·· ·· ·············
··· · · · ·· · ··· ·· ·· 54
·

Fabrication of the Cast with Removable Anterior Segment · · · · ···· ······ ·····
·
·
· ·· · ·· ·· · ··· 61

Chapter 6 Full-Mouth Reconstruction 64

Chapter 7 Fabrication of a Single Crown 85

Chapter 8 Fixed Restorations and Occlusal Adjustment 91

Need for lntraoral Adjus tm en t · ······················· ··· · ·························· ·· ···· ··· ····· 91
· · · ·

G u ide for lntraor al Adjustment ········· ········· ······ ·· ··· · · ···· · · ····· ······ · ··· · · ···········•··· 105

Chapter 9 Group Function 111

Chapter 10 Occlusion for Osseointegrated Implants 119

Chapter 11 The Rationale for the Twin-Stage Procedure 135

· COllCept in Gnathology · ·· · ····· ···· · ···· · ·· ···· ··· ··· · · · ·· · ·· • ·· ··• • ·· · ·• • •· · • • •· · · ·• ···
· •· • ··• ·· · • • 135

1'he Prac tice of Gnathology ·· · ···· ···•············· ····· ··· · ·· ·

· ·•·•· ··••·· ······
.
.
....
... ····•· ··• 139

Appendix: Mathematical Formulae for Analyzing Mandibular Movement 143

Analytical Methcxls ···· · ···· · ····· ··· ···

· ·· · · ····· · ···· ·· ···· ··· ··· · · ·· ·· ······ · ·· · · · · ·•············ ··· 143

148
Kinematic Fonnulae for Mandibular Movement
···· ······ ··· ··· ···· ···· ·· · ··· ··· ·· ··· ··· · · ·· · · ·

Equations for Calculatin g th e Amount of D isoccl usion · · · • •· ·· · • •· ··• •

....
•• ·
..
• •·
..
•• · .. • 1S1

Index...................................................................................................... 165
 C hapter 1

Theoretical Backg rou n d

Dentists have tried for years to prevent harmful horizontal occlusal forces on teeth caused by
mandibular eccentric movements. The pantograph and fully adjustable articulator are
considered to be the results of their efforts. During development, the concept that focuses on
the condylar path as the reference of occlusion was utilized. This concept was derived from a
belief that the condylar path was unchangeable in a living body but the anterior guidance
could be changed freely by the dentist. The mandible can be analogous to an inverted tripod

point. As a result from the condylar path concept, one apex of this mandibular triangle has
(Guichet 1977). The posterior legs are right and left condyles and the anterior leg is the incisal

been neglected.
The concept of disocclusion (disclusion) is more commonly known in dentistry especially
when considering distribution of horizontal occlusal forces. Anterior guidance influences one
apex of the mandibular triangle and is very important because it helps produce disocclusion.
However, the mechanism for disocclusion has not been clarified to date and still remains an
interesting, yet vague, subject.
The "Twin-Stage Procedure," the new prosthetic procedures introduced in this book have
been redeveloped based on the Twin-tables technique initially described by Hobo (1991, 9 1).
This new procedure has been developed to reproduce disocclusion and anterior guidance
more precisely and s cientifically. It differs from the existing technique of occlusal
reconstruction and is based on scientific data and mathematical analyses of mandibular
movement. This chapter introduces the theoretical background for these new procedures to
the readers.

Dlsoccluslon

Definition of disocclusion

The occlusal scheme's eccentric movements are classified according to the contact condition
batween maxillary and mandibular posterior teeth, including balanced articulation, group
function and mutually protected articulation.
Balanced articulation is the "bilateral, simultaneous, anterior, and posterior occlusal contact
of teeth in centric and eccentric positions" (GPT-6, 1994). A balanced articulation can be
established when the sagittal incisal path of an articulator is parallel to the sagittal condylar
path and the cusp angle of a prosthesis is set parallel to both paths. It is easy to establish
balanced articulation during two-dimensional protrusive movement. However, during three­
dimensional lateral movement, balanced articulation is difficult to create.
The movement of the mandible is determined by the three points of the mandibular triangle,
right and left condyles and an incisal point. To form balanced articulation three-dimensionally,
four points instead of three points must exist, as well as right and left condylar points and right
and left sides of the dental arch.
If the mandible is compared to a table, a three-legged table stands easily on the floor but a
four-legged table is unstable unless all legs are cut evenly. In a balanced articulation, the two
front legs which represent the right and left sides of the dental arch would have 'multiple pegs'
compared to the teeth on each side. To form balanced articulation, each peg must be cut
evenly and precisely. Consequently, it is almost impossible to form a balanced articulation
three-dimensionally.
Grou function, as established by Schuyler (1959), was intended to distribute occlusal
forces uniformly to all teeth on the working s1 e, a so referred to as unilateral balanced
articulationJSchuyler recommended that all the upper and lower teeth on the working side
should contact evenl� It has been believed that this occlusal form exists extensively in the
natural dentition. However, according to Hobo and Takayama (1993), only 8% of natural
dentitions show even contact between maxillary and mandibular teeth on the working side
during lateral movement.
Again, if compared to a table, this is like a three-legged table. However, one front leg
which represents the working side of the dental arch would have 'pegs', analogous to the
number of teeth on the working side. In order to produce group function, all 'pegs' should
contact evenly during lateral movement. It is rare to find a natural dentition which exhibits
'pegs' with such precise length even if it is only unilateral. Consequently, group function is
difficult to generate prosthetically.
The definition of group function has changed recently. It was defined as umultiple contact
relations between the maxillary and mandibular teeth in lateral movements on the working
side, whereby simultaneous contact of several teeth acts as a group to distribute occlusal
forces" (GPT-5 1987). This definition indicates that if there are multiple contacts, the rest of
the teeth can disocclude. Conversely, Schuyler's criterion of avoiding cross-arch balance is
still applicable. The new definition of group function, where all teeth'disocclude except
multiple working side contacts in lateral movement, resembles the mutually protected
articulation description stated in the following.
D' Amico ( 1958) made an anthropological study on the skulls of primitive men and American
Indians in 1958. He found excessive abrasion in their dentitions. On the contrary, in the
dentition of anthropoids with large cuspids, no abrasion was observed since maxillary and
mandibular cusps disoccluded during eccentric movement. He stated cuspid-protected
articulation and disocclusion were natural adaptations for preventing a destructive occlusion.
In cuspid(canine)-protected articulation, the cuspid on the working side guides the mandible
and disoccludes the posterior teeth on both working and nonworking sides. Since the
mandible is guided by three components, right and left condyles and a cuspid on the working
side analogous to a three-legged table, the prosthetic procedures needed to reproduce such
an articul.ation are simplified. Thus, following D'Amico's observations, the significance of
cuspid guidance and disocclusion in the natural dentition was established, and the possibility
of preventing abrasion was noted. This occlusal scheme has been incorporated into the
concept of a "mutually protected articulation."
In GPT-5 (1987), disocclusion is defined as "separation of opposing teeth during eccentric
movements of the mandible." Mutually protected articulation was an occlusal scheme
proposed by Stuart and Stallard (1957) who considered that all anterior teeth not only cuspid
should work in concert to disocclude and has been defined as "an occlusal scheme in which
the posterior teeth prevent excessive contact of the anterior teeth in maximum intercuspation
and the anterior teeth disengage the posterior teeth in all mandibular excursive movements"
 Chapter 1 Theoretical Background 3

(GPT-5 1987). The cuspid-protected articulation is defined as "a.form of mutually protected

�
articulation in which the vertical and horizontal overlap of the c spid teeth disengage the
posterior teeth in the excursive movements of the mandible" (GPT-5 1987)) In function, the tip
of the lower cuspid and mesiobuccal slope on the buccal cusp of the first premolar slides in
contact along the lingual surface of the maxillary cuspid during lateral movement.
frhe influence of the contacting surfaces of anterior teeth on mandibular movements"
(GPT-5 1987) is called anterior guidance) The concept of disocclusion has evolved following
these concepts, although qualitative and quantitative analyses have not been done.

Amount of disocclusion

The concept of disocclusion is widely accepted today, most commonly described as the
separation of posterior teeth during eccentric movement. It is not clear yet how much the
cusps of the posterior teeth should disocclude.
When a cuspal interference is observed clinically, an interference is removed both
intraorally and on casts set in an articulator. This implies that the only rule is elimination of
interferences between maxillary and mandibular teeth during eccentric movements without
consideration for the amount of separation. Is this true? If maxillary and mandibular cusps
"nearly miss" during function, it can have negative consequences.
There is minimal literature available regarding the proper amount of disocclusion.
Shooshan (1960) and Scott (1964) stated that during lateral movement, the molars should
disocclude more than 0.5 mm between maxillary and mandibular posterior teeth on the
no�working side. Thomas (1967) stated when maxillary and mandibular cuspid have a tip-to­
tip relation during lateral movement, the molars should disocclude 1.0 mm. The exact amount
of dlsoocluslon has not yet been clarified.
Hobo and Takayama (1985, 93) experimentally measured the amount of disocclusion using
silicone impression material directly in the mouth of a subject. On an articulator, � silicone
index was made using the anterior teeth as a guide when the condyle mo�s 2 mm
eccentrically. Using this as a guide, the subjects were allowed to perform eccentric
movements. A silicone record obtained from the impression of right and left molars was cut
and the thickness was measured under magnification using a scale. The amount of
disocclusion during protrusive movement and- on -the IInonworking and working sides during
lateral movements averaged 1.06 mm, 1.00
'---- � ,, -=---

�
mm, 0.47 mm, respectively. The data by Nishio et
�
al (1986) were found to be similar to these data.
Hobo and Takayama (Haramoto et al 1993, Hoshino et al 1993, Hobo, Takayama 1993)
then measured the amount of disocclusion using a leaf gauge on stone casts mounted in an
articulator. By inserting strips of the leaf gauge between posterior teeth when the condyles
were moved 3 mm (average overbite of Orientals) eccentrically, the amount of disocclusion
was ·measured at 0.1 mm when a single strip (0.1 mm thick) could not be removed, and
measured at 0.2 mm when a single strip could be removed but two strips could not be
removed. The average amounts of disocclusion during protrusive movement was 1 .06 mm,
and 1.1 O m m on the nonworking and 0.41 mm on the working sides during lateral
movements.
The amount of disocclusion has never been defined but was observed subjectively using
the dentist's visual judgment. However, visual observation from a buccal approach tends to
miss the disocclusion occurring on the lingual side. Between the two different measurement
methods, the method using the silicone impression provides a precise measurement.
However, it is too complicated for a dentist to apply as a quantitative measure in daily
·I

practice. The method using a leaf gauge is much simpler and appropriate for clinical use.
The amount of disocclusion that occurs may be directly proportional to the extent of the
eccentric movement in most instances. However, in the two scenarios described above, even

if the amount of translation of the condyle was set at 2 mm when measured with the silicone
impression material and 3 mm when measured by the leaf-gauge method, the results
measured in both cases were almost identical. This is because, (1) silicone material deforms
easily but strips of a leaf gauge do not have the same material characteristics; (2) the closest
approximation between opposing occlusal surfaces is measured according to the specific
section of the silicone core observed, whereas the leaf-gauge method can provide a measure
of the minimum amount of disocclusion that occurs.
From the above data, Hobo and Takayama derived standard values for the amount of
disocclusion as 1.0 mm during protrusive movement, 1.0 mm on the nonworking side and 0.5
mm on the working side during lateral movements. The latter is one-half the amount that
exists in the former two (Table 1-1). Solnit has suggested more disocclusion if possible since
the bruxer will wear canines after 10 years and allow working side and nonworking side
contacts to recur (Solnit 1996).

Table 1-1 Measurement data and standard values of the amount of dis­
occluslon on molars (mm).

I
I
Length
of
I
1
Protrusion
Nonworking
side
Working side
� - �- --

I
Method ·-· - --� -

t
condylarl
SD SD Mean SD
L path Mean Mean

0.56 0.47 0.34

-

-_L_..�;,�.,=T
- -.,;,.;;.
; .- - T 2�00 ;:..-�o.ss 1.00

'·"' 1.06_ o . ., 1.10 0.36 0.41 0.27

Standard i 3.00 I 1.00 - -

1 . 00 -
0.50 " -

Mechanism of disocclusion

The mechanism of disocclusion during protrusive movement is illustrated in the following.

The mechanism of disocclusion I

This shows the case when the sagittal inclination of the condylar path Is 40 degrees, the
condylar and incisal paths are parallel, and the cusp angle of maxillary and mandibular molars
is also parallel to both the condylar and incisal paths. In this case, during the protrusive
movement the mandible does not rotate around the intercondylar axis but only translates.
Translation as defined means "parallel displacement of a body" (the mandible). Since
maxillary and mandibular molars slide in contact during eccentric movement, disocclusion
does not occur (Fig 1-1 ) .
 Chapter 1 Theoretical Background
.
.
5

----------

I a p T

L__
Fig 1·1 Mechanism of dlsocclusion I: When the condylar and lncisal paths are parallel, and
the cusp angle of maxillary and mandibular molars is also parallel to both the conctylar and incisal
paths, the mandible translates. Since the maxillary and mandibular molars slide in contact.
dlsoccluslon does not occur.
a: saglttal protrusive conctylar path Inclination (40 degrees),
{J: sagittal effective cusp angle (40 degrees),
r: sagittal protrusive inclsal path Inclination (40 degrees).

The mechanism of disocc lusion II

This shows the case when the sagittal condylar path inclination is 40 d&Qrees, the cusp angle
is parallel to the condylar path but the incisal path is steeper than the condylar path. In this
case, the mandible translates and rotates around the intercondylar axis; the maxillary and
mandibular molars dlsocclude. The component of disocclusion occurring when the incisal
path is steeper than the condylar path is referred to as the "anterior guide component'' of the
mechanism of disocclusion (Fig 1-2). McHorris (1979) recommended that the incisal path
lhould be 5 degrees steeper than the condytar path. However, when setting the sagittal
lncisal path inclination 5 degrees steeper than the condylar path, the author computed that
the amount of dlsocclusion during protrusive movement is only 0.2 mm, about one-fifth the
standard value (1.0 mm). If the incisal path is steeper than 5 degrees, the patient will
complain of discomfort.

The mechanism of dlsocclusion Ill

This shows the case when the sagittal inclination of the condylar path is 40 degrees, the
condylar and intlsal paths are parallel, however, the cusp angle is shallower than the
condylar path. In this case, the mandible does not rotate around the intercondylar axis, it only
translates. However, since the cusp angle is shallower than the condylar path, the maxillary
and mandibular molars di socclude. Thus, the component influencing the amount of
disocclusion when the cusp angle is shallower than the condylar path is referred to as the
·cusp shape componenr as a mechanism of disocclusion. In this way, the authors found that
the cusp angle was another important factor for disocc lusion (Fig 1 ·3).
 - ---· ---- --------·

'----- ------- --- · ·--

Fig 1·2 Mechanism of disocclusion II: When the cusp angle is parallel to the condylar path
but the incisal path is steeper than the condylar path, the mandible translates and rotates
around the intercondylar axis. In this case, the maxillary and mandibular molars disocclude.
The component of disocclusion occurring when the incisal path is steeper than the condylar
path is referred to as the •anterior guide componenr of the mechanism of disocc lusion.
a: sagittal protrusive condylar path inclination (40 degrees), ;1: sagittal effective cusp angle (40

degrees), r: sagittal protrusive incisal path inclination (60 degrees).

Note: The inclination of the incisal path is 60 degrees in the figure.

The mechanism of disocclusion IV

This shows the case when the sagittal inclination of the condylar path is 40 degrees, the
incisal path is steeper than the condylar path and the cusp angle is shallower than the
condylar path. In this case, the mandible translates and rotates simultaneously around the
intercondylar axis. By the additive effect of the anterior guide component caused by the
mandibular rotation and the cusp shape component occurring when the cusp slope is
shallower than the condylar path, the maxillary and mandibular molars disocclude widely . This
condition is seen often in healthy individuals (Fig 1·4).

Influences on the Amount of Disoccl usion

The three factors that determine disocclusion, condylar path, incisal path and cusp angle, and
their influences on the amount of disocclusion were investigated.

Condylar path

The condylar path is "the path traveled by the mandibular condyle in the temporo-mandibular
joint during various mandibular movements" (GPT-6 1994). It is an accepted belief that an
ideal occlusion can be created in a restoration when the condylar path is reproduced precisely
on an articulator. Is this true?
 Chapter 1 Theoretical Background 7

r--·-- --- ·--·- -------- -

-1

�----- ---- ------ ·- ··---- · -------�

Fig 1-3 Mechanism of disocclusion Ill: When the condylar and incisal paths are parallel and
the cusp angle is shallower than the condylar path, the mandible does not rotate around the
intercondylar axis; it only translates. However, since the cusp angle is shallower than the
condylar path, the maxillary and mandibular molars disocclude. Thus, the component influencing
the amount of disocclusion when the cusp angle is shallower than the condylar path is referred
to as the •cusp shape component." a: sagittal protrusive condylar path inclination (40 degrees)
p: sagittal effective cusp angle (25 degrees) y: sagittal protrusive incisal path inclination (40
degrees).

/J a

Fig 1-4 Mechanism of disocclusion IV: When the incisal path is steeper than the condylar path

around the intercondylar axis. By the additive effect of the anterior guide component and the
and the cusp angle is shallower than the condylar path, the mandible translates and rotates

cusp shape component, the maxillary and mandibular molars disocclude widely.

P: sagittal effective cusp angle (25 degrees),

a: sagittal protrusive condylar path inclination (40 degrees),

:r: sagittal protrusive inclsal path inclination (60 degrees).

Note: The inclination of the inclsal path Is 60 degrees in the figure.
Deviation of the condylar path
McCollum and Stuart (1955) stated the condylar path was a fixed factor for an individual
which defied the dentist's ability to change it. This has been a basic gnathological principle for
years. However, Beard and Clayton (1975) reported that when tracing the condylar path
repeatedly on a pantograph, the tracing deviated and the deviations among TMD patients
were larger than those in healthy individuals. Oliva, Hobo, Takayama ( 1986) repeatedly
measured the condylar path of individuals with normal occlusion using an electronic
measuring system and observed a deviation width of 0.4 mm average, and 0.8 mm maximum
on the nonworking side lateral condylar path. Since this maximum value was close to the
value 0.7mm, the vertical width of the kinematic axis loop measured by Kohno (1968, 72), the
authors assumed there were maximum deviations of 0. 7 to 0.8 mm on the protrusive condylar
path and the nonworking side condylar path.
In the study of Bennett movement by Hobo (1984), he found the vertical diameter of the
converging spot was 0.3 mm average; the converging spot represents the movement area of
the intercondylar axis in motion on the working side condyle. Dawson (1974) and Ramfjord
(1971) stated the value 0.2 mm as the length of "long" centric. Oishi (1967) examined the
mobility of the temporomandibular joint on a fresh cadaver and reported that when the
condyle was fixed with a metal jig in centric, he measured a "looseness" of the joint and
obtained the magnitude of 0.2 mm to 0.3 mm. These are values for centric, but the condylar
path on the working side exists very close to centric relation. The amount of the deviation in
centric may be similar to the deviation of the working side condylar path to a limited extent
From the above data, the following assumptions were made: the deviation was 0.8 mm
maximum on the protrusive condylar path and the nonworking side lateral condylar path, and
0.3 mm maximum on the working side condylar path .
Hobo thought the condylar path deviations were due to 'buffer spacing' which exists in the
glenoid fossa (Hobo, lchida, Garcia 1989). Since the temporomandibular' joint is subject to
strong mechanical stress, the 'buffer spacing' allows condylar mobility and helps prevent
transmission of direct stress to the articular eminentia across the articular disk. If 'buffer
spacing' does not exist and the condyle transmits strong stresses, the disk could not
withstand direct forces and would result in damage such as anterior disk displacement or a
disk perforation.
Hansson et al (1977) histologically examined the thickness of the soft-tissue layers and the
articular disk in the temporomandibular joint. They reported the soft-tissue layers were
thickest on the condyle superiorly about 0.4 mm to 0.5 mm, in the temporal component of the
postero-inferior slope of the articular tubercle about 0.5 mm, and in the articular disk, thickest
posteriorly, about 2.9 mm and thinnest in the middle part, about 1.1 mm. It seemed that their
data were consistent with the concept of "buffer spacing."
The "buffer spacing" differs from "free joint space." One analogy, for example, refers to
accurately machined gears, immobile when the gears are too close and tight. The gears
require accurate machining but at the same time, a spacing is needed to allow smooth
movement. This analogy can be applied to the temporomandibular joint; 'buffer spacing' is
necessary for the condyle and articular disk to function smoothly.

The difference between eccentric and returning condylar paths

When Hobo and Takayama (in press) measured mandibular movement using an electronic
computer measuring system with six degrees of freedom (Hobo, Mochizuki 1983), they
 Chapter 1 Thl'ore>ljcal Bal'kl(round 9

-- - -- - - -- ·- - -- - ---- - - -- - --

Posterior -
-Posterior

Right Condyle I .eft Condyfo

I. .. ..
0 0

] J;
..5 .5
Sagittal Plane Sagittal Plane>
l __ -- - - - ---- ----

Fig 1·58 Graphic results obtained when measuring the eccentric and returning condylar paths
using an electronic measuring system under tooth contact condition are shown.
Solid line: eccentric path, Dotted line: returning path, P: protrusive movement, R: right lateral
movement L: left lateral movement. This suggests that the returning condylar path (dotted line)
may be true border movement since its path is nearer than the eccentric condylar path to the
eminentia.

horizontal reference line C

Fig 1-Sb Graphic illustration of both condylar paths.

Solid line: eccentric path, Dotted line: returning
path , C: maximum intercuspation , T: direction changf
present at both ends.

allowed the condylar paths of the subjects to pertorm back-and-forth movements and found
differen.ces between the eccentric and returning condylar paths. Seventeen healthy subjects,
20 to 24 years of age, were examined further . As a result, it was found clearly that this
difference showed consistency within each subject and the returning condylar path always
passed above the eccentric condylar path. Rarely did both paths superimpose. No single
case was discovered where the eccentric condylar path existed above the returning condylar
path (Fig 1-5a).
The authors measured the graphic data output of both condylar paths. When linking the
eccentric and returning condylar paths, a loop-shaped path was formed (Fig 1-Sb). The width
between the eccentric and returning condylar paths measured at 2 mm from the condylar
position in maximum intercuspation, averaged 0.44 mm during protrusive movement and
0.79 mm during lateral movement, as shown in Table 1-2.
An arc, drawn with a radius of 2 mm with the center at the condylar position In maximum
lntercuspatlon, made two Intersection points on the paths. The angles formed by the two lines
drawn from the center of the arc to the two Intersection points were measured. They were
approximately 13 degrees average on the protrusive condyte path and 23 degrees average
on the nonworking side late ral condyle path as shown in Table 1-3 (Hob<l,Takayama in

press).
The eccentric condylar path can be measured by use of a pantograph and occlusal records.
Utilizing the above data, the returning condylar path of an individual patient can be
approximated by subtracting 13 degrees from the measured value of the eccentric condylar
path for protrusive movement and by subtracting 23 degrees for the lateral movement.
During opening and closing movements of the mandible, various muscles function. The
Ill

Table 1-2 The widths between the Table 1-3 Comparison betwe e n sagittal condylar

eccentric and returning condylar paths. path inclinations of eccentric and return ing paths

Diller­
Unit: mm Mean SD
------ . -- , Eccentric path Retu rni ng pat h
. ence

0.44
Unit : mm
Protrusive
0.26 SD Mea n
, Mean SD Mean
I
movement
-- -- - - --- - - - , ..

Lateral
0. 79 0.37
Protrusive
40.1 13.8 27.4 7.6 12. 7
'
movement movement

10.9 !
i

40.5 11.8 17.5

I

Lateral
23.0
movement :

muscles related to a closing movement are much stronger than the muscles related to an
opening movement. The muscles that influence eccentric movement may be the muscles
related to an opening movement. The muscles that influence the returning movement may be
related to the closing movement. The lateral pterygoid and digastric muscles, which function
during eccentric movement are weak; the masseter, temporal and medial pterygoid muscles,
which function during the returning movement that are relatively strong.
The soft tissues that connect the condyle and glenoid fossa may relax during an eccentric
movement. They may also contract unconsciously during the returning movement. Therefore,
one can imagine that the condyle positions in a relaxed manner in the glenoid fossa during
the eccentric movement and is held tightly during the returning movement. This may be the
reason for a difference as little as 1.0 mm superoinferiorly between the eccentric movement
and returning movement. The difference found between eccentric and returning condylar
paths supports the undeniable fact that "the condylar path is not fixed but is changeable."
As previously mentioned, the authors observed the deviation of eccentric condylar paths
when they were repeatedly measured. However, the eccentric and returning condylar paths
differ from the above deviation because these paths are created by the physiologic difference
in muscles (opening and closing) utilized.

Controlling the condylar path

Hobo (1982, 84) found the average working side condylar path moved straight outward on the
transverse horizontal axis and did not deviate within the sagittal plane. This suggested it was
a natural occurrence for the working side condyle to move in a similar direction as a healthy
temporomandibular joint.
Under the assumption that the working side condyle translates straight outward along the
transverse horizontal axis, Hobo and Takayama (1989) named the imaginary orbit of the
lateral incisal path the neutral line, computed mathematically for each subject based on the
mathematical model of mandibular movement. It was clearly observed that when a subject's
lateral incisal path deviated from the subject's neutral line, the working side condylar path
deviated sagittally. In other words, when the lateral incisal path is positioned above the
neutral line, the working side condylar path deviates superiorly. When the lateral incisal path
is positioned under the neutral line, the working side condylar path deviates inferiorly (Fig 1·
6). A similar tendency was observed in the anteroposterior direction.
In this way, the sagittal deviation of the working side condyle path showed a strong
correlation with the deviation from the neutral line of the lateral incisal path. The correlation
coefficient between the two deviations was 0.99 in the superoinferior direction, and 0.97 in an
anteroposterior direction, at p;;::0.001 level of significance (Hobo.Takayama 1989). The above
results suggested the possibility that the working side condyle path may deviate sagittally, as
 Chapter 1 Theoretical Background 11

--- - -----
- ----- -- - - ---- -- -

Fig 1 ·6 When the lateral incisal path is

positioned above the neutral line, the working
side condyle path deviates superiorly. When the
lateral incisal path is positioned under the
neutral line, the working side condyle path
deviates inferiorly. Solid line ( condylar path):
measured working side condyle path, Solid line
(incisal path): measured lateral incisal path,
Dotted line (condylar path): imaginary working
side condyle path which is supposed to deviate
straight outward along the transverse horizontal
axis. Dotted line(incisal path): imaginary lateral
incisal path = the neutral line computed for
each patient under the assumption the working
side condyle translates straight outward along
the transverse horizontal axis.

influenced by the anterior guidance because the condyle is supported by soft tissue.
To verify this clinically, it was necessary to confirm if the working side condyle path could
be controlled by changing the anterior guidance. Fifteen subjects were selected for this
experiment; the artificial control of the working side condyle path. The condylar paths of an
arcon-type semiadjustable articulator on which the working side condyle moves on the
transverse horizontal axis were adjusted using a subject's measured values. The neutral line
of the incisal path was converted mathematically to a computed value for the anterior guide
table.
Using the casts mounted on the articulator, a resin guide table and a pin which led the
subject's lateral incis�I path along the neutral line were fabricated (Figs 1-7 a through c).
When placing the guide table and pin in the subject's mouth, the authors observed that the
sagittal deviation of the working side condyle path within the sagittal plane decreased to one­
fourth the original amount (Hobo, Takayama in press). Moreover, it was discovered that in the
horizontal left lateral condvlar path of a subject, immediate mandibular translation (immediate
sideshift) disappearpd. As for the working side right condylar path of the same subject,
laterotrusion (Bennett movement) simultaneously disappeared (Fig 1-8).
In dentistry, the condylar path has been considered the standard reference for occlusion.
However, the above results showed the condylar path was not fixed but was changeable.
Furthermore, when changing the lateral incisal path, the immediate mandibular translation
disappeared instantaneously, and laterotrusion disappeared simultaneously. This proved the
condylar paths on both working and nonworking sides were influenced by the anterior
guidance.
The anterior guidance influences the condylar path, which infers the condylar path is
influenced by the patient's occlusion. Therefore, if the patient's occlusion is poor, his condylar
path is affected by malocclusion. If such a condylar path is measured precisely, reproduced
on an articulator, and used as a reference for the fabrication of a restoration, the occlusion of
the restoration can be affected adversely by the poor condylar path. Thus, the concept of
applying the measured value of a patient's condylar path as a reference for occlusion has
posed a crucial question.
To fabricate a restoration with good occlusion, an articulator is mandatory. However, the
condylar path on an articulator should not be a copy of the condylar path in the patient. To
avoid a vicious cycle, set the condylar paths on an articulator to produce a "good" occlusion.
12

------ -·-·---- __J

I - - ·- - - --- J

Fig 1 ·7• Maxillary resin guide table which led the Fig 1·7b Mandibul a r resin guide pin used for the
subject"s lateral incisal path along the neutral line. artificial control test of the working side condyle path.
Tip of the pin has a diameter of 2mm.

Fig 1·7c The guide table and the guide pin are placed
intraorally.

..----- --- -----·· --- ----··- ---- ··--.--

Right Condyle Left Condyle

Sagiual Horizontal Sagittal

INF- -Left Right - -INF

Right-

R?i}-
j

l
�\L
\
•
Scale: m

\
Frontal
-

�
Condylar Path

Fig 1-1 Results of the artificial control test of the working side condyle path obtained by measuring the lateral
movement of the subject using electronic measuring system. Dotted line: measured data obtained when the

table and guide pin In the subject's mouth, and allowing the guide table and tip of the guide pin to slide in
maxHlary and mandibular teeth slide In contact. Solid line : measured data obtained when placing resin guide

contact. R: Right lateral movement L: Left lateral movement.

 Chapter 1 Thcor�llcal Background 13

The influence of the condylar path on the amount of disocclusion

The effect of the condylar path on the amount of disocclusion at the second molars was
computed based on the authors' mathematical model of mandibular movement (Takayama
1 987, Takayama, Hobo 1 989), which is shown in the Appendi x. The method used for this
evaluation was as follows .
The standard amount of disocc l usion at the second molars was 1 .0 mm when the condyle
moved 3 mm from centric position during protrusive movement. When the sagittal condylar
path inclination decreased, it displaced the position of the cusp of the mandibular second
molar in a superior direction by 0.020 mm per degree. In this manner, the rate of influence of
the sagittal lateral condylar path inclination was also computed. They were 0.015 mm on the
nonworking side and -0.002 mm on the working side per degree.
As previously mentioned, there exists a deviation in the condylar path caused by the
difference between the eccentric and returning movements. The differences were 1 3 degrees
during protrusive movement and 23 degrees during lateral movement. The influence of a
deviation in the condylar path on the amount of disocclusion can be calculated by multiplying
the above rate of influence by the difference of the angles. As a result, they were 0.26 mm
during protrusive movement 0.35 mm on the nonworking side and 0.05 mm on the working
, -

side during lateral movement. Though the deviation of the condylar path was large, its rate of
influence on the amount of disocclusion was small.
Based on this analysis, the authors concluded it was impossible to fabricate a "good"
occlusion using the condylar path as the sole guiding factor. It is time to relinquish the
condylar path myth, which has ruled dentistry for many yea rs .

lncisal path

The incisal path is that traveled by the incisal point during eccentric · movement. It is the
ante rior determinant of mandibular movement. "The influence of the contacting surface of the
mandibular and maxillary anterior teeth on mandibular movements" is defined as incisal
guidance (GPT-6 1 994). As previously mentioned, the incisal path influenced the condylar
path. Since the condylar path is not valid as a reference, it is necessary to investigate if the
'
incisal path can be used as a new reference of occlusion instead of the condylar path.
The authors examined if deviations occurred in the incisal path comparable to those found
in the condylar path, and the influence of incisal path on the amount of disocclusion compared
to that found with the condylar path.

Variations in the incisal path and the occ urrence rate of malocclusion
Since the mobility of the anterior teeth ranges from 1 08 µm (central) to 64 µm (canine) (Rudd
et al, 1 964), there is little room for an unstable factor in the incisal path like the deviation of
the condylar path. In electronically measured graphic data for mandi bu la r movement, the
incisal path did not show a noticeable deviation.
Is the incisal path a reliable factor? To investigate this, the data for incisal path inclination in
normal individuals measured by different researchers were compared. The standard deviation
was 1 O degrees both in the protrusive and the lateral incisal path inclinations. It is known that
68% of the population statistically distributes within the range between the values of the
mean m inus standard deviation and the mean plus standard deviation, with normal
distribution. Accordingly, the above result indicates that 32 % of the sagittal protrusive incisal
path inclination is less than 35 degrees or more than 55 degrees against its mean value (45
degrees). Also. 32% of the frontal lateral incisal path inclination is less than 20 degrees. or
more than 40 degrees against its mean value ( 30 degrees) .
According to the report by Kelly et al ( 1 973), the occurrence rates of malocclusion included
vertical overlap 6.6%, open bite 2.5%, Angle's Class I I 9.4% and Class I l l 0.8%, totaling
1 9. 3%. These data showed one out of five patients would not have an incisal path as an
appropriate standard.
The above data indicated that among the patients with normal occlusion, there were large
variations i n the incisal path and the occurrence rate of malocclusion was high. It was
concluded that the incisal path as well as the condylar path would not be valid as references
for occlusion.

Influence of the incisal path on the amount of disocclusion

By using the above mentioned method, the rate of influence of incisal path on the amount of
disocclusion at the second molar when the condyle moved 3 mm from centric was computed.
When the sagittal inclination of the incisal path decreases by one degree, the amount of
disocclusion will decrease by 0.038 mm during protrusive movement. When the frontal
inclination of the i ncisal path decreases by one degree, the amount of disocclusion will
decrease by 0.042 mm on the nonworking side and 0.039 mm on the working side during
lateral movemen t .
There exists a variation in the incisal path by approximately 1 O degrees both on protrusive
and lateral movements from the mean value. The influence on the amount of disocclusion
was calculated by multiplying the above rate of influence by the amount of variation ( 1 0
d eg rees). As a result, they were 0.38 m m during protrusive movement, 0.42 mm o n the
nonworking side and 0.38 mm on the working side during lateral movement.
The above result was compared with that of the condylar path. The ratio bf the influences of
condylar and incisal paths was 1 :2 during protrusive movement; 1 :3 on the nonworking side
and 1 :4 on the working side during lateral movement. On the first molar, the ratio became 1 : 3
during protrusive movement and the other ratios were similar (Fig 1 - 9).
These results showed the influence of t he incisal path on disocclusion was much greater
than that of the condylar path . The concept that the incisal path is less important than the
cond y lar path must be reversed. The incisal path influences disocclusion more than the
condylar path. However, the incisal path cannot be used as the sole gu iding factor for
occlusion due to its unreliable character.

Cusp angle

Cusp angle is the inclination of the cusp slope from the cusp tip to the marginal ridge. It is
defined as "the angle made by the average slope of a cusp with the cusp plane measured
mesiodistally or buccolingually" (GPT 6 1 994). The cusp plane means the plane determined
-

by the two buccal cusp tips and the highest lingual cusp of a molar" (G PT-6 1 994) ,
anatomically means a plane comprised of three cusp tips. The angle formed by the average
cusp slope and the horizontal reference plane is called the effective cusp angle (Fig 1 -9).
The effective cusp angle during protrusive movement is referred to as the sagittal protrusive
effective cusp angle. The effective cusp angle during lateral movement on the working and
nonworking side are referred to as the frontal lateral effective cusp angle on the working and
nonworking side.
 Chapter 1 TheoretiC'al Background 15

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

tooth axi� tooth axis

cusp slol>f'

'/j
- -
r --
-

"
rusp plane cusp plane
horizontal reference plane
---- - ---· ·· · ----

Fig 1 -9 Cusp angle( a) is the inclination of the cusp slope from the cusp tip to the marginal ridge as compared
to the occlusal plane reference. The angle form ed by the average cusp slope and the horizontal reference
plane is called the effective cusp angle ( /l>.
-

Deviation of the cusp angle

Since horizontal tooth mobility of a molar is approximately 70 µm (Rudd et al, 1 964), the cusp
does not deviate by itself. However, variations may occur among individuals. To examine
this, the authors analyzed the data that measured occlusal morphology of study casts of
primary school pupils by using a contour line "moire method" (Sekikawa et al, 1 983;
Kanazawa et al, 1 984). As a result, each ratio of the standard deviation of distance and height
between cusp and fossa to the mean was 1 0.9% and 1 0.2%, respectively, and averaged
1 0.6%.
On the contrary, the ratio of variations of condylar and incisal path inclinations to the mean
was 43% and 32%, respectively. The data of cuspal morphology was, on average, four times
more reliable than that of the condylar path and incisal path. Accordingly, since the cusp
angle is one characteristic of cuspal morphology, it should have the same reliability.
The above data clarified that the cusp angle does not show the deviations that appeared in
the condylar path nor the variations that appeared in the incisal path among individuals, and
the cusp angle was three to four times more reliable than the other two factors.

The influence of the cusp angle on the amount of disocclusion

By using the above mentioned method, the influence of cusp angle on the amount of
disocclusion was computed. When the cusp angle increases one degree, the amount of
disocclusion will decrease 0.046 m m during p rotrusive movement, 0.046 mm on the
nonworking side and 0.041 mm on the working side during lateral movement
As a result, the influence ratio of the condylar path, incisal path and cusp angle to the
amount of disocc lusion on the second molar when the condyle moved 3.0 mm from centric
was approximately 1 :2:2 during protrusive movement; 1 :3:3 on the nonworking side; 1 :4:4 on
the working side during lateral movement (Figs 1 - 1 0a and b) .
The influence of the cusp angle is 40% to 44% of the total influence, which is comparable to
the incisal path but far larger than the condylar path. Since the cusp angle is more reliable
than other factors and its influence is large, the authors concluded that the new reference for
occlusion should be the cusp angle of newly erupted permanent teeth, not the condylar path
nor the incisal path.
16

/
/ 5

1-10a 1 -1 0b
l·-·----·

Fig Illustration of the influences ol protrusive Fi g The illu stration of the influences ol lateral
condylar path, i ncisal path and cusp angle on the condy l a r p a t h , i n c i s a l path a n d c u s p a n g l e on the
amount of disocclusion at the second molar. amount of disocclusion at the second molar.

The Necessity for Disocclusion

The concept of d isocclusion is widely acce pted . However, the explanation for why
disocclusion is necessary has not been clarified. If it is true that disocclusion provides "the
security in occlusion," there should be a reason why a specific amount of disocclusion is
necessary.

G raphic analysis

Using protrusive movement as an example, the reasons which necessitate disocclusion are
illustrated in the following. In this analysis, modified mean value will be used to simplify the
illustrations.

Scenario I
This shows the case when the sagittal condylar path inclination has a mean value for the
eccentric condylar path of 40 degrees and the incisal path has a mean value of 45 degrees.
The cusp angle also has a mean value of 25 degrees and is shallower than the condylar path.
I n this scenario, the mandible not only translates but rotates around the intercondylar axis
and maxillary and mandibular molars separate and produce 1 .0 mm disocclusion ( Fig 1 -1 1 ).

Scenario I I
This shows the case when the sagittal condylar path inclination has a mean value for the
returning condylar path of 25 degrees. The condylar path and the cusp angle are parallel.
The incisal path has a mean value of 45 degrees and is relatively steeper than the condylar
path (Fig 1 - 1 2).
 Chapter 1 Theoretical Background 17

.----- - - - - - - · ---- -- --- · -----

- ------ ---

Fig 1 -1 1 The necessity for disocclusion scenario I: When the incisal path is steeper and the
cusp angle is shallower than the condylar path, the mandible translates and rotates around

condylar path lncllnatlon (40 degrees), ;J: saglttal effective cusp angle (25 degrees) , r : sagittal
the lntercondylar axis and the maxillary and mandibular molars dlsocclude. a: sagittal protrusive

protrusive incisal path Inclination (45 degrees) , amount of dlsocclusion = 1 .0 mm.

In this condition, the mandible still translates and rotates around the intercondylar axis.
However, since the condylar path is shallow, the amount of disocclusion decreases. Tb.is
occu � because the condylar path changes from the eccentric condylar path to the r&turning
condylar path. This component, which decreases the amount of disocclusion, is called the
"condyl� effect."
If the' conaylarpath varies from the eccentric condylar path (40 degrees) to the returning
condylar [email protected] (25 degrees>. a cuspal Interference may occur To protect dentition from any
cuspal interference, a spj}Citic amou11l ofdisoc:efusion is necessary.

Scenario Ill
This shows the case when the sagittal condylar path inclination has a mean value for the
returning condylar path of 25 degrees. The cusp angle is parallel to the condylar path. The
incisal path has a lower value limit of variation (25 degrees) and is parallel to both the
condylar path and the cusp angle (Fig 1 -1 3). In this scenario, the mandible is limited to
translation only, and the maxillary and mandibular molars do not disocclude. The component
that decreases the amount of dlsocclusinn by shifting the iRcisal patl:I fi:om 45 �eg� to 25
degrees J!..called-"�mterior guide effect." If the incisal path varies from a mean value of 45
'
degrees to a lower value limit of variation (25 degrees), a cuspal Interference may occur. To
protect dentition from a potential cuspal interference, an additional amount of disocclusion is
necessary.
Figures 1 - 1 1 to 1 - 1 3 illustrate the necessity for disocclusion clearly. Moving from the step in
which both condylar and incisal paths have mean values and a standard amount of
disocclusion occurs (Fig 1 -1 1 ), the condylar path shifts to the returning condylar path (Flg.1 -
1 2). The incisal path reaches a lower limit value of variation and the amount of disocclusion
becomes zero (Fig 1 - 1 3). If both.. paths become shallower than the mean values, harmful
cuspal interferences could occur. Therefore, disocclusion is a "security mechanism" that
eliminates cuspal interferences. By the time the condylar path deviates from the eccentric
18

Fig 1·1 2 The necessity for disocclusion scenario I I : When the condylar path is parallel to the
'-- .

cusp a ngle , and the i ncisa l path is steeper than the condylar path, the mandible tra n sla tes an d
rota tes around the intercondy lar axis. The amount of disocclusion decreases. The component
that decreases the amount of disocclusion by shifting condylar path is called the ·condylar guide
effect."
a: sagittal protrusive condylar path inclination (25 degrees).

,1: sagittal effective cusp angle (25 degrees).

y: sagitta l protrusi ve incisal path inclination (45 degrees).

condylar path to approach the returning condylar path, the incisal path reaehes a lower limit
value of variation.

Mathematical analysis

To verify this theory, it was confirmed mathematically. First, the amount of disocclusion on the
second molar decreased by the "condylar guide effect" was estimated using the authors'
mathematical model of mandibular movement. In this analysis, actual mean value will be
used.
During protrusive movement, when the condylar path shifted from 40 degrees (eccentric
protrusive condylar path) to 27 degrees (returning protrusive condylar path), the amount of
disocclusion decreased 0.26 mm. During lateral movement, when the condylar path on the
nonworking side shifted from 40 degrees (eccentric lateral condylar path) to 1 7 degrees
(returning lateral condylar path), the amount of disocclusion decreased 0.35 mm.
If the amounts of disocclusion were not provided in a patient's restoration , a cuspal
interference may occur when the condylar path shifted from the eccentric condylar path to the
returning condylar path. The influence of the working side condylar path was not i ncluded in
this study as it is a negligible amount.
The measured value for the amount of disocclusion was 0.97 mm for protrusive movement
and 0. 78 mm for the nonworking side. The necessity for disocclusion was explained in
percentages with 1 00% equal to absolutely necessary; the necessity was 27% for protrusive
disoccl usion and 45% for the nonworking side disocclusion.
 Chapter 1 Theoretical Backgrou n d 19

- - · -- - --- - - - - - - - - ·

I p
I
I
I

L_ _ _________ ------ · -- -- -- - - ____ _ _J

Fig 1 -13 The necessity for disocclusion scenario Ill: When the condylar path is parallel to the
cusp angle and the lncisal path is almost parallel to them, the mandible translates. The
amount of disoccluslon becomes nearty zero. The component that decreases the amount of
disocclusion by shifting the incisal path is called •anterior guide component.• a: sagittal
protrusive condylar path inclination (25 degrees), 11: sagittal effective cusp angle (25 degrees), r :
sagittal protrusive lncisal path inclination (25 degrees).

The authors estimated the amount of disocclusion on the second molar decreased by the
"anterior guide effect". During protrusive movement, when the sagittal incisal path inclination
deviated from 45 degrees (the mean value) to 35 degrees (minimum value of the variation
obtained by subtracting the standard deviation from the mean value), the amount of
disocclusion decreased by 0.38 mm. During lateral movement, when the frontal incisal path
inclination deviated from 30 degrees (mean value) to 20 degrees (minimum value), the
amount of dlsocclusion decreased by 0.42 mm on the nonworking side and 0.38 mm on the
working side.
If these amounts of disocclusion were not inco rporated i n a restoration, a cuspa l
interference may occu r when the incisal path deviates from mean value to lower limit value of
variation. Thus another reason for the necessity for disocclusion was explained as 39% for
protrusive disocclusion, 54% for the nonworking side disocclusion and 88% for the working
side disocclusion.
The amounts of disocclusion caused by the condylar guide component and the anterior
guide component were totaled and compared with the measured amount of disocclusion (on
the second molar). The results are shown in Table 1 -4.
In Table 1-4, the amounts of disocclusion decreased due to the deviation of the condylar
path (C) and those due to the variation of the incisal path (A) were totaled (C + A). The
results were compared to the actual measured value (M) and found to be 66% in protrusive
movement, and 99% on the nonworking side, and 88% on the working side. Although the total
results do not equal 1 00%, the authors consider this sufficient to explain the necessity for
disoccluslon because the subjects are dynamic, living bodies. In conclusion, the necessity for
disoccluslon is explained as follows:
 Table 1-4 Quantitative estimate to explain the necessity for

disocclusion. (on the second molar)

I

' Lateral movement

· Protrusive · :

i Working
I
l
Nonwork-
movement .
_
_
_ _ _ j _ s i de I ing side
_ _
[
_
Condylar guide effect: C 0 . 26 mm 0. 35 mm

Anter��r �ui �e - effe:t� A I ? 3� mm j 0 � 38 m m ?·�2 m �-

- __ � : _ _ t
Amount of disocclusion I
I

I 0 . 38 m m l'
I
Estimate val ue: c + A = S 0 . 64 mm 0 . 77 mm

Measured value: M 0 . 97 m m l o . 43 m m ' 0. 78 mm

I
Estimate accuracy: S/M 66% 88% 99%

1) "Security insurance" to protect teeth from harmful effects due to a cuspal interference. An
interference can be caused by a difference between the eccentric and returning condylar
paths.
2) A redundant need to protect teeth from harmful effects due to any cuspal inte rference
since anterior guidance varies among individuals.
This investigation provides the reasons why it is necessa ry to create d isoccl usion.
However, in practice, the dentist cannot measure the returning condylar path of a patient nor
alter the i ncisal path of natural teeth logically. Therefore, it is impossible to rep roduce
disocclusion to fulfill the necessary reasons using prosthetic techniques available today. This
suggests the need for development of new procedures to support this concept.

References

Beard CC, Clayton JA : Electronic PAI consistency in diagnosing temporomandibular joint

dysfu �ction. J Prosthet Dent, 1 975;55:255 -259.

D'Amico A : The canine teeth-normal functional relation of the natural man. J South California
Dent Assoc, 1 958;26( 1 ) -26(7).

Dawson PE : Evaluation, diagnosis, and treatment of occlusal problems. St Louis: Mosby,

1 974;48- 79.

Glossary of Prosthodontic Terms. 5th ed. The Academy of Prosthodontics. J Prosthet Dent,
1 987;58:71 7-762.

Glossary of Prosthodontic Terms. 6th ed. The Academy of Prosthodontics. J Prosthet Dent,
1 994;71 :43- 1 1 2.

Guichet NF : Occlusion. Anaheim:Denar Corp, 1 977.

Hansson T, Oberg T, Carlsson GE, Kopps S : Thickness of the soft-tissue layers and the
articular disk in the temporomandibular joint. Acta Odonto Scand, 1 977;35:77 - 83.

Haramoto N, Takayama H, Hobo S : Measurement of the amount of disocclusion during

p rotrusive movement, P a rt I . Normal dentition with a nterior teeth . J J p n G n athol,
1 993; 1 4:4-6.
 Chapter 1 Th l'ordical lfacki:ro u n d :! I

on nonworking side during lateral movement, Part I . Under the condition with canine teeth. J
Hoshino G, Watanabe K, Takayama H, Hobo S : Measurement of the amount of disocclusion

Jpn Gnathol , 1 993; 1 4:4- 6.

Hobo S : Studies of a kinematic center of condyle during lateral movement of the mandible -
Existence of the spots of convergence in fields of motion of the intercondylar axis - . Shika
Gakuhou, 1982;82:1509-1545.

an electronic measuring system, Part I . Development of the measuring system. J Prosthet

Hobo S, Mochizuki S : A Kinematic investigation of mandibular border movement by means of

Dent, 1 983;50:368- 373.

measuring system, Part II. A study of the Bennett movement. J Prosthet Dent, 1984;51 :642-
Hobo S : A kinematic i nvestigation of mandibular border movement by an electronic

646.

electoronic measuring system, Part m. Rotational center of lateral movement. J P rosthet

Hobo S : A kinematic investigation of mandibular border movement by means of an

Dent,1984;52:66-72.

Hobo S : Twin-tables technique for occlusal rehabilitation, Part I . Mechanism of anterior

guidance. J Prosthet Dent, 1 991 ;66:299- 303.

Hobo S : Twin-tables technique for occlusal rehabilitation, Part II. Clinical procedures. J
Prosthet Dent, 1 991 ;66:471 -477.

Hobo S, Takayama H : Preliminary measurement and analysis of the amount of disocclusion.

J Jpn Prosthodontic Soc, 1985;29:472-473.

Hobo S, lchida E, Garcia LT : Osseointegration and oral rehabilitation. Quintessence:Tokyo,

•
1 990.

Hobo S, Takayama H : Effect of canine guidance on working condylar path. Int J Prosthodont,
1 989;2:73-79.

Hobo S, Takayama S : Prelimin ary measurement for d isoccl usion. J J pn G natho l ,

1993;14:1 -3.

Hobo S, Takayama H : Analysis on frequency of occurrence for canine guided occlusion and
group functioned occlusion. J Jpn Gnathol, 1 993;14:70-73.

Hobo S, Takayama H : Analysis of cuspid guidance effect on the working side condyle path
(in press).

Hobo S, Takayama H : Study of the eccentric and returning sagittal condylar paths (in press) .

Kanazawa E, Sekikawa M, Ozaki T : Three-dimensional measurements o f the occlusal

surface of upper first molars in a Japanese population. Acta Anat, 1 983; 116:90-96.

Kelly JE, Sanchez M, Van Kirk LE : An Assessment of the Occlusion of Teeth of Children.
National Center for Health Statistics, U S Public Health Service. 1 973;DHEW Publication
No. (HRA)74-1612.

sagittal plane, Part II. Analysis of sagittal axis with the multiple electronic flush apparatus. J
Kohno S : A study on condylar movements with reference to the mandibular movement in

Jpn Prosthodontic Soc, 1 968;12:350-380.

Kohno S : Analyse der Kondylen bewegung i n der Sag itta lebe n e . Dtsch Zahnarztl ,
1 972;27:739-743.

McCollum BB, Stuart CE : A Research Report. California; Scientific Press, 1 955.

McHorris WH : Occlusion with particular emphasis on the functional and parafunctional role of
anterior teeth, Part a . J Clin Orthod, 1 979; 1 3:684-701 .

Nishio K, Miyauchi S, Maruyama T : Clinical study on the analysis of chewing movements in

relation to occlusion. J Jpn Prosthodont Soc, 1 986;30:806-8 1 6.

Oishi T : A study on the anatomical structure of temporomandibular joint from the standpoint
of mandibular movement. J Jpn Prosthodont Soc, 1 967; 1 1 : 1 97-220.

Oliva RA, Takayama H, Hobo S : Three-dimensional study of mandibular movement using an

automatic electronic measuring system. J Gnathol, 1 986;5 : 1 1 5- 1 82.

Ramfjord SP, Ash MM : Occlusion. Philadelphia:Saunders, 1 971 ;95-96.

Rudd KD, O'Leary TJ, Stumpf AJ : Horizontal tooth mobility in carefully screened subjects.
Periodontics, 1 964;2:65-68.

Schuyler CH : Evaluation of incisal guidance and its influence in restorative dentistry. J

Prosthet Dent, 1 959;9:374.

Scott ME, Baum L : Procedure and techniques for restoring "canine function" for abraded
teeth. J South Calif Dent Assoc, 1 964;32:23-28.

Sekikawa M, Kanazawa E, Ozaki T, et al : Three-dimensional measurements of the occlusal

surface of lower first molars in a modern Japanese population. Jpn J Oral Biol, 1 983;25:737-
744.

Shooshan ED : A pin-ledge casting technique - its application in periodontal splinting. Dent

Clin North Am March, 1 960; 1 89-206.

Solnit A : Personal communication, 1 996.

Stuart CE, Stallard H : Diagnosis and treatment of occlusal relations of the teeth. paper
presented at the 77th Annual Session , Texas Dental Assoc . , San Francisco;University of
California Press, 1 957.

Thomas PK : Syllabus full-mouth waxing technique for rehabilitation, tooth to tooth cusp fossa
concept of organic occlusion . 2nd ed. San Francisco;University of California, School of
Dentistry, 1 967.

Takayama H : Kinematical and Experimental Analyses of the Mandibular Movement in Man

for Clinical Application. University of Tokyo; 1 987, Thesis.

Takayama H, Hobo S : The derivation of kinematic formulae for mandibular movement. Int J
Prosthodont, 1 989;2:285-295.
 Chapter 2

The Articu lator

The articulator is defined as "a mechanical instrument that represents the temporo­
mandibular joints and jaws, to which maxillary and mandibular casts may be attached to
simulate some or alt mandibular movements" (GPT-6, 1 994). To obtain good occlusion for
restorations, the use of an articulator is mandatory. There are various kinds of articulators.
When the condylar elements are similar to the human temporomandibular joint, this is called
an anatomical or arcon type articulator, commonly used today.
The movement of the anatomical articulator is controlled by the anterior and posterior
guiding mechanisms. The anterior guiding mechanism guides the anterior apex of the
mandibular triangle described in Chapter 1 . The posterior guiding mechanism guides the two
posterior apices of the mandibular triangle. The former is referred to as anterior guidance, the
latter, condylar guidance.
In any design of an anatomical articulator, condylar guidance has been regarded as the
important element while the anterior guidance mechanism has not received the same level
of engineering. In this Chapter, the authors discuss both condylar and anterior guiding
mechanisms to explore the necessary prerequisites of an articulator.

Condylar Guidance Assembly

The condylar guide assembly, located in the upper posterior region of an articulator, controls
movement of its mobile member (GPT-6) and consists of a condyle and housing (fossa). It is
set at the approximate location of a human TM joint. Accordingly, it functions similar to · the
relative movements of the condyle in the glenoid fossa. The condylar path produced by this
mechanism is discussed.

Sagittal condylar path

The sagittal condylar path as measured in a living body has a convex $-shaped curvature
Inferiorly. According to Aull (1 965), the sagittal condylar path that showed a straight line
occurred in only 8% of the population and the residual 92% showed a curved path. The arc
diameter with a minimum value of 1 0 mm was present in 34% of the population.
In the past, it was considered ideal treatment to use a fully adjustable articulator and
reproduce the curvature of the condylar path. For this purpose, several kinds of plastic
eminentia were selected and prepared or ground to match the specific pantograph tracing.
Measured results using recent electronic studies confirmed a sagittal eondylar path with a
convex S-shaped curvature inferiorly. However, such a curvature noticeably appeared when 5
to 1 O mm long tracings were drawn. Within 2 to 3 mm from centric . position where cusp tips
aligned in a tip-to-tip relation, the sagittal condytar path almost traced a straight line. This was
21

Table 2- 1 The sagittal incli nation of condylar path measured electronically

'
Nakano ( 1 975) Nishi ( 1 989) Hobo ( 1 992) , Arithmetical
1 I

�-
I
et al. mean
- -- - -
Protrusive
movement

Mean 41 . 8 40 . 8 39 . 1 40 . 6

_j_ - - -- i
SD value 7.8 9. 1 13.8 10.2
. _ _ - - -

Lateral
movement

M ean 40 . 3 40 . 7 40 . 5 40 . 5

+--
SD value 7. 6 9.8 1 1 .8 9.7
- -r -- - - 1
Fisher's angle
I - 1 .5 -0 . 1 1 .4 -0. 1

also confirmed based on the analyses when the diameter of an arc of curvature was 1 0 mm
(minimum) and the arc length was 3 mm: the difference between the curved tracing and an
approximate straight line was less than 5 degrees.
Accordingly, it was concluded that the sagittal condylar path on an articulator could be
straight and not necessarily a curve. Thus, it is not necessary to reproduce the cu rvature of
the condylar path using a fully adjustable articulator. It is sufficient to use a semiadjustable
articulator that has a straight condylar path.

Fisher's angle

The angle formed ·ntersection of the protrusive and nonworkin side co as

v 1n th sagitta p an PT-6) is referred to as "Fisher' angle." The mean va� is estimated
to be 5 degree . n a fully adjustable articulator, individual adjustment of both inclinations is
possible. However, a semiadjustable articulator only has one inclination adjustment.
Recent electronic studies i ndicate the sagittal inclination of the condylar path when
measured at the center of the condyle, showed 40 degrees to the "axis plane" during both
protrusive and nonworking lateral movements. Thus, the mean Fisher angle was nearly zero.
Table 2-1 shows measurement data of the sagittal inclination of the condylar path according
to recent electronic studies.
When Fisher's angle is measured individually, it often showed a positive or negative value.
However, it is not necessary to reproduce it due to the following reasons:
1) There are large deviations in the condylar path and Fisher's angle deviates less than the
deviation of the condylar paths.
2) The influence of condylar path on the amount of disocclusion is less than that of the incisal
path .
Since a mean Fisher anale is corrected to zero, the authors considered that it was not

Note: The difference between the various horizontal reference planes used among researchers was compensated;

'edge of maxillary right central incisor toward thejnfraort>ital margin.

the above data refer to the "axis plane: The "axis plane· is a horizontal reference plane including the transverse
horizontal axis and a point 43 mm above the incisal
 Chapter 2 The A rticul ator 2j

necessary to adjust the sagittal condylar path

--
inclination on an articulator between protrusive
and non working rat eral movements .

I mmediate mandibular translation

The angle formed between the sagittal plane and the average path of the advancing condyle,
as viewed · e horizontal lane ·ng lateral mandibular movements is called " the Bennett
angle" (G ion of the movement is immediate mandibular translation (or
immediate sideshift). The latter portion is called progressive mandibular translation (or
progressive sideshift)(Guichet 1 9821 To reproduce these movements , there a re fully
adJUstable articulators and semiadjustable articulators with elements available to adjust for
both movements.
Immediate mandibular translation occurs in the early stage of horizontal lateral movement.
When the mandible moves laterally, simultaneously the mandible translates first an average
of 0.4 m m toward the working side and then shifts to lateral rotational (or 'turning')
movement.The amount of immediate mandibular translation deviates 0 mm to 2.6 mm among
individuals (Hobo, Mochizuki 1 982). In studies at the University of Southern California during
1972-1980, over 1,200 pantographic recordings were made on students with a Oenar OSA
articulator. Eighty percent had sideshift of 0.2mm to 2.5mm ; some had more. Forty-three
percent produced more sideshift when induced than not induced(Solint 1 996).
If this translation is reflected on cuspal morphology, the operator must create a centri� _filide
by-grinding the slopes of opposing teeth so the cusp tips move t;>y _lh e_a_m_ount_Qf_ Lmm_�_d iate
mandibular translation toward the working side. In gnathology, this has b�n_a c!lt i��I
�rocedure. ttowever, this is difficult in practice__and can cause artificial horizon_taLdevlationJn
centric or result in grinding the most important centric stop.
When experimenting clinically using a resin guide table, Hobo and Takayama obtained a
result that suggested the possibility of eliminating immediate manfjibular translatio n .
Immediate mandibular translation is considered t o occur when the temporomandibular joint is
loose (lee 1 982) and a centric slide exists between the teeth. Therefore, if a centric slide
does not exist, immediate mandibular translation will not occur. In other words, without a slide
in a stable c entric position, the mandible must be guided to move without immediate
mandibular translation. This problem needs to be studied further, but at present the authors
su ggests that an articu lator may not need an adjustable mechanism for imm ediate­
mandibular translation.

Bennett angle
When the patient moves the mandible laterally, the working side condyle rotates and
translates laterally while the nonworking side condyle translates mesio-anteriorly. Thus, side
shift occurs. The lateral component of the side shift must be reproduced on an articulator.
However, the authors consider that an articulator may not need to reproduce the immediate
side shift. The horizontal lateral condylar path on the J1onworking side is composed of
immediate side shift and progress1Ve side sl1ift. If the torn1e1 is not reproduced, the horizontal
lateral condylar path becomes a line connecting centric and the position 3 m m from centric
where the cusp tips are aligned in a tip-to-tip relation. The angle formed by this line and
sagittal plane is called the "BenJl!ll angle." This suggests that the horizontal lateral condylar
path of an articulator must be reproduced by adjusting the Bennett angle (Hobo, Takayama
1993).This suggests the horizontal lateral condylar path of an articulator must be adjusted by
adjusting the Bennett angle (Hobo, Takayama 1 993).
 Fig 2·1 The measured Bennett angle data under a
tooth-contact condition is 1 0 . 7 � 6 . 4 degrees. The
value obtained by adding a standard deviation ( � ) to
the mean (m) is 1 7 degrees. Only 1 6% of the Bennen
angles are between 1 7 to 24 degrees during a tooth­
contact condition. Based on this finding . a value of 1 5

at
degrees i s a n appropriate adjustment for a n articulator
10 Ii

5 degree increment.
l l•·•
I since the angle scales on an articulator are marked
m . . ,,. • 2a
- ..J

How can the Bennett angle be adjusted? When measuring the Bennett angle with a
pantograph in a- mmttroth-=contact condition due to the clutch attachment. the_me..as.u.red value
of the Bennett angle reached a maximum of 50 de rees Hobo, 1 982). However, when it was
��������-:--��::--�::--��.><...� .. -;->--:---.:.--:--:-�::-���-- · �

measure m a tooth-contact condition, the measured value of the Bennett a n g l e was a

maximum of 24 degrees (Nakano, 1 975). Since the Bennett angle is subject to the measuring
condit1011s even if measured precisely, it changes easily when the occlusion is corrected. It is
difficult to obtain effective results from measurements on different individuals.
The value obtained by adding a standard deviation to a mean of the Bennett angle under a
05 are bet�een 1 7 to 24
-
i
toot�:.�C?n!�C! �o�d�tio�.!�_ 1 ?. �e_Qreei--bnfy 6°/0 of the Be��ett -;�91
degrees dtJr:ing tQQltl c:ontact condition (Fig 2-1 ). Based on this finding, the authors concluded
that 1 5 degrees was an appropriate adjustment value for the Ben nett angle in n at u ral
dentition. A value of 1 5 degrees instead of 1 7 degrees was selected since the calibrations on
. ..
an articulator are marked at 5 degree increments.

Laterotrusion

'"(be working side condylar movement was called Bennett's movement. This term is obsolete
and is referred to as laterotrusion (GPT-5, 1 987). Sideshift occurs on both working and
nonworking sides(Solnit 1 996). As previously mentioned, Hobo ( 1 982, 84) found the average
working side condylar path moved straight outward on the transverse horizontal axis and did
not deviate within the sagittal plane. Hobo and Takayama ( 1 989) computed an imaginary path
of the incisal point under the assumption that the working side condyle moves outward on the
transverse horizontal axis, and called it the neutral line.
They found that deviation within the sagittal plane occurred when the lateral incisal path
deviated from the neutral line. To prove this, a resin guide table was placed intraorally to
create movement along the neutral line. When the patient made a lateral movement, the
sagittal deviation of the working side condylar path decreased to one-fourth of the original
amount.
From the above results, it is evident that the deviation within the sagittal plane on the
working side condylar path is caused by poor anterior guidance. Thus, when the sagittal
deviation of the working side condylar path is reproduced precisely on an articulator and the
anterior restoration is fabricated, it may reproduce the sagittal deviation again . Therefore, it is
necessary to adjust an articulator to produce cuspid guidance so the working side condylar
path moves straight outward on the transverse horizontal axis, rather than to measure the
 Chapter 2 The :\ rt ic:u l ator 'l i

sagittal deviation and reproduce it. A functionally sound restoration with physiologic anterior
guidance can be obtained following this sequence.
If this view is correct, contrary to the present theory, it is not a fully adjustable but a
semiadjustable articulator that allows the working side condylar path to move straight outward
on the transverse horizontal axis. It is possible to obtain anterior restorations in harmony with
the working side condylar path when this concept is used "properly."
The authors recommend a semiadjustable articulator as the articulator of choice utilized for
clinical procedures. A nonadjustable articulator where laterotrusion along the transverse
horizontal axis is possible but condylar guidance and anterior guidance cannot be controlled,
is not clinically acceptable.

Anterior Guidance Assembly

This assembly is located in the anterior portion of the mandibular frame of an articulator and
consists of an incisal table and an incisal guide pin. These terms are referred to as anterior
guide table and anterior guide pin in GPT-5 (1 987).
Since the concept of anterior guidance including the mechanism and appl ication h as not
been clarified, the assembly component has been neglected relative to the importance placed
on the condylar guidance assembly.
After clarification through studies by Hobo and Takayama, the influence of a nt e ri o r
guidance was found to be two times greater on the second molars and three times greate r on
the first molars in comparison with that of condylar guidance. This follows the need to f u rther
clarify anterior guidance, its mechanism and application.
Past studies on mandibular movement concentrated mainly on the condylar path. The
condylar path can be measured easily using a pantograph and shows different values in
individuals. McCollum and Stuart studied the condylar path as the main•focus in the study of
mandibular movement. They seemed to disregard the incisal path. They might have hesitated
to admit it as a guiding factor of mandibular movement since the incisal path, guided by the
maxillary and mandibular teeth, could be altered by dental treatment. Thus, the study of the
"anterior guidance" has been overlooked.

I ncisal path
When mounting a study cast on an articulator and moulding the envelope of motion using the
tip of the anterior guide pin, a concave hollow shape is formed in softened resin placed on the
flat anterior guide table. It is understandable that the anterior guide table should not be flat but
maintain the vertical dimension. However, the shape of the curved hollow neither represents
the shape of the incisal path nor reflects the concave dome shape of palatal surfaces of
maxillary anterior teeth. This is only an envelope of motion formed by the hemispherical tip of
an anterior g u ide p i n.
When measuring anterior guidance at the incisal point using an electronic mandibular
movement measuring system , an arrow-shaped tracing is observed both sagittally and
frontally. Its line is almost straight within 2 to 3 mm from maxi mu m intercuspation where
maxillary and mandibular teeth contact during the eccentric movement in a normal subject.
This can be observed visually on a horizontal plane using a Gothic arch tracer.
Fig 2-2a The sagittal i n c l i nation of the adjustable Fig 2-2b The lateral wing angle of the ad1ustable
mechanical anterior g u ide table o n lhe Twin H o by mechanical a nterior g u i d e l a b l e o n the Twin H ob y
Articulator has a range of 0 70 degrees. Articulator has a range of O 45 degrees.

Accordingly, if the tip of an anterior guide pin is a pin point, the envelope of motion wil l form
an arrow shape, which includes a straight line. The shape of the anterior guide table should
be a straight line, not curved.

The anterior guide table

The anterior guide assembly of an articulator reproduces a convex pyramid-like cone at the
upper limit of the envelope of motion . This cone appears 2 to 3 mm anterior to maximum
intercuspation. The triangular-shaped gutter is formed by turning a triangular pyramid upside­
down to simulate the anterior guide table.
In Figures 2-2a and 2·2b, examples of adjustable mechanical anterior guide tables are
shown. The right and left lateral wings are attached to the center groove of the anterior guide
table. The i nclination angle of the center groove and the angle of the lateral wings are
adjustable. The former is called the sagittal inclination of the anterior guide table (Fig 2-2a),
the latter, the lateral wing angle (Fig 2-2b).
On this anterior guide table , the sagittal inclination is adjustable in the range of 0-70
degrees, while the lateral wing angle is adjustable in the range of 0 - 45 degrees. The anterior
guide table controls the path of the incisal point, one apex of the mandibular triangle , on an
articulator. The sagittal inclination of the anterior guide table corresponds to the sagittal
inclination of the protrusive incisal path. The lateral wing angle corresponds to the fronta!
inclination of the lateral incisal pat�. Also, the former corresponds to the sagittal slope of the
palatal surface of maxillary incisors and the latter corresponds to the frontal slope of the
palatal surface of the maxillary canine, Since the incisal point and tip of the anterior guide pin
are located apart, it is necessary to correct the differe nce between bOfb �then comparing their
paths (Takayama, Hobo 1 989· Takayama 1 993) .
A 1ously mentioned, the influence of the incisal path was /
found to be two to three
times greater than that of the nonworking condylar path; the anteriqr guidance assembly of an
articulator is also two to three times as important as that of the condylar guidance assembly .
 Chapter 2 Tht· \ rt1rnla1ur 2!1

Criterion for Selection of an Articulator

The purpose of an articulator is to establish centric relation and to reproduce mandibular

eccentric movements. To establish proper centric relation, an articulator must be equipped
with a reliable centric latch.
The factors that influence the reproduction of eccentric movement have been described in
this chapter. The following are the authors' new criteria for selection of an articulator:
1 ) An articulator must have a straight sagittal condylar path.
2) An articulator reproduces either one of the sagittal protrusive and nonworking side lateral
condylar path inclinations, but dose not necessarily reproduce Fisher's angle.
3) The immediate mandibular transl a1ion does not have to be reproaticed .
4) The Bennett angle 1s fixed at 15 degrees.
....

5) The working side condylar path must translate straight outward along the transverse
horizontal axis.
6) An ar:tic•dator does not need a curvedanterior guide table
7) The anterior guide table should be shaped like a triangular gutter and be adjustable for
both sagittal inclination and lateral wing angles.

References

Aull AE : Condylar determinants of occlusal patterns. Part I Statistical report on condylar path
variations. J Prosthet Dent, 1 965;25:826.
.

Glossary of Prosthodontic Terms. 4th ed. The Academy of Prosthodontics. J Prosthet Dent,
1 977;38:70 -107.

Glossary of Prosthodontic Terms. 5th ed. The Academy of Prosthodontics. J Prosthet Dent,
1 987;58:71 7 -762.

Glossary of Prosthodontic Terms. 6th ed. The Academy of Prosthodontics. J Prosthet Dent,
1 994;71 :43 - 1 1 2.

Guichet NF : Occlusion. Anaheim:Denar Corp, 1 9n;87 - 89.

Hobo S, Mochizuki S : A kinematic investigation of mandibular border movement by means of

an electronic measuring system . Part I . Development of the measuring system. J Jpn
Prosthodontic Soc, 1 982;26:61 9 -634.

Hobo S : Studies of a kinematic center of condyl e during lateral movement of the

mandible.Existence of the spots of convergence in fields of motion of the intercondylar axis.
Sika Gakuhou, 1 982;82:1 509 - 1 545.

Hobo S : A Kinematic investigation of mandibular border movement by means of an electronic

measuring system. Part II. A study of the Bennett movement. J Prosthet Dent, 1 984;51 :642 -
646.

Hobo s, Takayama H : Effect of canine guidance on working condylar path. Int J Prosthodont,
1 989;2:73 - 79.
JO

Hobo S. Takayama H : Reevaluation of the significance of the immediate side shift. J Jpn
Gnathol , 1 993; 1 4:36 -· 40.

Hobo S, Takayama H : Analysis of cuspid guidance effect on the working side condyle path
(in press).

Lee R L: Anterior guidance. I n: Lundeen HC, Gibbs CH Advances in Occlusion. Postgraduate

dental handbook series, Vol. 1 4, John Wright - Verlag. Boston-Bristol-London, 1 982;51 - 80.

Takayama H : Mathematical expressions for computing mandibular movement, Part I I .

Expression for computing cusp path inclination from condylar path and anterior guide. J Jpn
Gnathol , 1 993; 1 4: 1 26 - 1 29.

Takayama H, Hobo S : The derivation of kinematic formulae for mandibular movement. Int J
Prosthodont, 1 989;2:285 - 295.

Nakano M : A study on the relationship of anterior guidance to condylar path in lateral

excursions. J Jpn Prosthodont Soc 1 975; 1 9:647 - 665.

Nishi K : A study on changes of mandibular movement by aging, Part I . Analysis of sagittal

movements. 1 989;33:225 - 236.

Solnit A : Personal communication, 1 996.

Solnit A, Curnutte DC : Occlusal correction, principles and practice. Co, lnc,Chicago:Ouintessence,

1 988;71 , 1 30, 265.
 C hapter 3

Twi n-Stage Proced u re

Until today the condylar path has been regarded as the main determinant for occlusion in
prosthetic treatment. It is measured and used as a clinical reference. Since the condylar
path has been shown to have deviation and minimal influence on disocclusion, a question
arises. Is it proper to use the condylar path as the main determinant?
The deviation of the incisal path in each individual is less than that of the condylar path.
The incisal path influences disocclusion at the second molar twice as much as that of the
condylar path during protrusive movement, three times on the nonworkin side and four times
oCcurrence rate Of rnalocclus1on are incorporated, the inclination of the incisal path will be
on the working side during lateral movement. However, when individual variation an e

distributed broadly; the incisal path would not be a reliable reference for occlusion. This infers
that the cusp angle, which has not been studied previously, should be considered as a new
reference for occlusion.
Embryologically, the cusp angle is an independent factor from both condylar and incisal
paths. To obtain good occlusion in restorative treatment, the critical factor may require
reproducing a standard value for the cusp angle. The reproduction of condylar and incisal
paths on an articulator are to be regarded as subordinate factors. This last statement refutes
'
the long-established theory in the study of occlusion.

Standard Value of the Cusp Angle

The cusp angle was considered to be the most reliable reference for occlusion. However, it is
common knowledge that occlusal morphology in adulthood loses its original form due to
caries,• abrasion and restorative works. In particular, when the teeth are lost, no cusps exist
for a reference. Accordingly, the cuspal morphology of an average patRmt who visits the
dental office is not reliable and cannot be used as a reference for occlusion.
Since there are minimal variations in cusp morphology of permanent teeth immediately
after eruption, and if the value of the cusp angle at the time of eruption is used as a reference
for occl usion, making a restoration following this guide should be ideal for the patient.
The authors, however, found no available data on the cusp angle. To establish a new

obtain it, the measured amount of disocclusion was found as the only rehal:>le relevarrt data
reference for occlusion, it is necessary to define a standard value for the cusp angle. To

available. The amount of disocclusion is the supero-inferior distance between maxillary and
mandibular opposing cusps in the eccentric position, forming a geometrical triangle between
disocclusion, cusp path and cusp angle as shown in Fig 3-1 .
The cusp path can be determined from the measured values of the condylar path and
incisal path based on the mathematical model of mandibular movement. When the cusp path
is obtained in this manner, the value of the cusp angle is estimated using trigonometry.
 romponrnt
-J
horilnntal ·---
t..- ...
of r.usp Swtlh
I
humonlAI I cu.,p 1..ath 1nrlin1111on 1•H.vt1w• CU'P anMi.,
I
!
rc.of1·r<'ncf' planf'
maximum inh•rru,.,pa1ion

I
\"M"tiral rompontnt
1>f t·usp pelh
I

amount ol diMJ<"clu�1un

Fig 3-1 The principle for computing the amount of disocclusion.

Table 3-1 Standard values of effective cusp angle on molars.

Cusp angle '.Cusp angle on molars (deg)

1--
-

Sagittal protrusive �ffec ;�� cusp an� le - -- -;- - -- -

j
Frontal lateral effective cusp angle
15
(working side)

Frontal lateral effective cusp angle

I
I
20
(nonworking side)

Note: These values refer to the axis plane.

The cu� angles of the second molar were 27 degrees for the protrusive effective cusp
angle (sagittal plane along the cusp path to the axis plane), 1 4 de rees on lflewoTktng side
· ·

nd 21 de r t I t r ffe ive cus an le ron a E ane

along the cusp path to the axis___pla0e). Since the data used for this process were considered
to be mixed with some uncertain factors, when setting the standard values , one to two
degrees can be considered negligible. Consequently, the standard cusp angle values were
25 degrees during protrusive movement, 1 5 degrees on the working
si® and 20 degrees on it:ie nonwoi::king side d•1ring lateral movement (Table 3- 1 ) .
summarized as follows:

The above reference values were estimated originally for the second molar. For the ab_Qy_e
mentioned reason , these values should be applicable to all molars as _a norm.

Basic Concept of Twi n-Stage Proced u re

In order to provide disocclusion, the cusp angle should be shallower than the condylar path.
However, in reality, it is difficult to create this in a restoration. To make a shallower cusp angle
in a restoration, it is necessary to wax the occl usal morp hology to p roduce b a l anced
articulation so the cusp angle becomes parallel to the cusp path of opposing teeth during
eccentric movement. Since anterior teeth help produce disoccl usion , when a de ntal
technician waxes the occlusal morphology and tries to reproduce a shallower cusp angle, the
anterior portion of the working cast becomes an obstacle. On the other hand, when fabricating
 Chapter 3 T w i n Slagr Prorrd u rt 33

the anterior teeth to produce disocclusion, some guidance should be incorporated. The
methods necessary to achieve this have not been clarified.
The basic concept involved in the new procedure requires a methodical approach. The- cast
with a rem ovable anterior se ment is fabricated. First, reproduce the occlusal morphol ogVJ>f
posterior �h without the anterior segment and pr_oduce a cusp angle coincident with the
standard values of effective cusp anale.(J:eferred to as "Condition 1 ") .
secondly, reproduce anterior morphology with the anterior se_gment and pmvide.- anterior
guidance which produces a standard am (referred to as "Condition 2").
The app icat1on o t e two conditions describe� to fabricate the cusp angle a�g-�rne.nor
guidance are innovative clinical procedures. This is named the "twin-stage procedure."

Adjusting Values of an Articulator

Following the basic concepts of the twin-stage procedure necessitates the establishment of
adjustment values for an articulator to reproduce a standard cusp angle and standard amount
of disocclusion. An articulator is used for this purpose. However, in the twin-stage procedure,
an articulator is used as a tool for fabrication of restorations under the previously mentioned
conditions. What is important is not the reproduction but simulation of the mandibular
movement to produce certain conditions. To produce Conditions 1 and 2, the adjustment
values for the articulator are necessary and selected by specific calculations.

Articulator adjustment values for reproduction of the standard

cusp angle

The standard value of the sagittal protrusive effective cusp angle is 25 degrees. The
combination of sagittal inclinations of the condylar path and anterior guide table of an
articulator to obtain this cusp angle are limitless. However, the simplest combination is to
adjust each to 25 degrees and wax the occlusal morphology to produce balanced articulation.
A cusp angle of 25 degrees will be formed (Fig 3-2).
The 25 degrees is not the only adjustment value used to obtain a cusp angle of 25 degrees.
For example, when the condylar path is set as shallow as 10 degrees and the anterior guide
table is set as steep as 30 degrees, a 25-degree cusp angle can be created in the first molar.
If the condylar path is set as steep as 40 degrees and the anterior guide table is set as
shallow as 20 degrees, 'a 25-degree cusp angle also can be obtained at the first molar.
However, if adjustment values for the condylar path and anterior guide table are not set the
same, a 25-degree cusp angle will be obtained only on the first molar but a different cusp
angle value will be produced on the other molars. When both condylar path and anterior guide
table _ are adjusted to 25 degrees, a 25-degree cusp angle will be created on each cusp of the
posterior teeth.
T�erefore, it is recommended to ad'ust both the condylar path and e anterior guide table
to 25 degrees and fabricate cusps without anterior teeth to obtain a balanced a 1cu a ton. In
this manner, the 25-degree cusp angle can be made uniformly. This is the adjustment value
for the articulator to achieve Condition 1 .
:l l

f- ---- · -·-· -- · -

'
25

'
25

I
I
l
I Fig 3-2
__ _ _ _

Articulator adjustment values for forming the standard effective cusp angle. The standard value of the
sagittal protrusive effective cusp angle is 25 degrees. The combination of sagittal inclinatipns of the condylar
path and anterior guide table of an articulator to obtain this cusp angle are limitless. For example. the
combination of adjustment values of either 40 degrees tor the condylar path and 20 degrees for the guide table or
10 degrees for the condylar path and 30 degrees for the guide table will produce a 25-degree cusp angle at
least in the first molar. However, the simplest combination is to adjust each to 25 degrees and wax the occlusal
morphology to produce balanced articulation. A cusp angle of 25 degrees will be formed uniformly.

Adjustment values for generating disocclusion

(25 degrees), the anterior guidance should

After waxing the cusps to the standard angle value
1 .0 mm d uri ng
p rotrusive movement. There a re again an infinite n u mber of possible c o m b i n a t i on s of
be established to reproduce a standard amount of disocclusion, for example,

adjustment values for the condylar path and anterior guide table of an a rticulator. However,
the computed results showed a standard a m o u n t of d i soccl u s i o n was g e n e rat ecrDy
fabricating anterior guidance using a combination of 40 degrees for the condylar path and 45
degrees for the anterior guide table (Fi 3-3).
is combination of adjustment ..-lues is not the only one that generates the standard
amount of disocclusion. For example, when adjusting the condylar path to a sha llower value
(25 degrees) and the anterior guide table to a steeper value (50 degrees), 1 .0 m m amount of
 Chapter 3 Twin -Stage Procedure 35

,--· - - -

'
25

Fig 3-3 Adjustment values for generating disocclusion. After waxing the cusps to the standard value angle (25
----�

degrees), the anterior guidance should be established to generate the standard amount of disocclusion (D = 1 .0
mm for protrusive movement). The computed results showed the standard amount of disocclusion was
generated by fabricating anterior guidance using a combination of 40 degrees for the condylar path and 45
degrees for the anterior guide table of an articulator. There are an infinite number of possible combinations of
adjustment values for the condylar path and guide table. For example, the combination of adjustment values of
either 60 degrees for the condylar path and 38 degrees for the guide table or 25 degrees for the condylar
path and 50 degrees for the guide table wlU generate the standard amount of disocclusion. However, both
combinations create non-physiological movement. Therefore, the above combination is considered to be the
best.

disocclusion can be obtained. Also, when adjusting the condylar path to a steeper value (60
degrees) and the anterior guide table to a shallower value (38 degrees), 1 .0 mm disocclusion
can be obtained. H waver if the incisal path is more than 5 degrees steeper than the condylar *"t
path, patients complain of discomfort (McHorris
condylar path, the conayle rotates in a rev
. e 1nc1sa pa 1s shallower than the
�on - different from the ordinary direction - }rfa
A J
during pro rus1ve movemen at is not a physiological movement Kohno et al 1 975).
e condylar path to 40 degrees and the anterior guide table to 45 degrees when
::=;.
fabricating anterior guidance with the anterior segment attached to the cast. In this manner,
( 1 ) the standard amount of disocclusion will be obtained on molars, and (2) a physiological
anterior guidance will be fabricated . This is the adjustment value of an articulator for
Condition 2.
36

Articulator adjustment values for the twin-stage procedure (deg).

�- �
Table 3-2

C ndylar pat � L
�
A terlor guide table

I
·-
I I
I
Condition Lateral
I
I, l I1. I
Sagittal condylar Sagittal
Bennett angle I inclination
wing
path inclination

l angle

�- -r· ��-- 1-- t

--
��diti �� i --
� � 25 10

_
Condition 2 :
\ --
�ithou anterior teet

!I
__

40
·- -+. __ _

15
_

45
(
\I 20
with anterior teeth
. .

In the above example, the explanation was limited to a two-dimensional description using
protrusive movement as an example. Since lateral movement is a three-dimensional
phenomenon, the computation for determining articulator adjustment values for Conditions 1
· and 2 become more complicated. In Table 3-2, the results of computations are shown.
The adjustment values shown in Table 3-2 use the axis plane as the horizontal reference
plane. These adjustment values are effective only when the axis plane is used as reference
and requires a facebow transfer. When a different horizontal reference plane is used, a new
computation is necessary to obtain different adjustment values.

Physiological discrepancy
Since the articulator adjustment values shown in Table 3-2 are established to obtain a specific
cusp angle and anterior guidance on restorations, it is expected that some 'gap' may exist
between the condylar paths "on the articulator" and "a living body."
Suppose a restoration fabricated with a standard cusp angle and anterior guidance is
cemented in the patient's mouth. If the sagittal condylar path of the patient is steeper than
the articulator adjustment value (40 degrees), this difference is harmless becau�e the
amount of disocclusion increases. On the contrary, if the condylar path in the patient is

l
shallower than 40 degrees, the amount of disocclusion decreases to some extent. The

!
sagittal condyla r path distributes ± 1 4 degrees (SO) from the mean value (40 degrees).

to the mean of the returning condylar path (27 degrees) so the discrepancy must be
Within this limit, the lowest value of an eccentric condylar path (26 degrees) is almost equal

harmless. However, when the returning condylar path is much shallower than its mean,
cuspal interferences may occur (Fig 3-4).
When the condylar path of a patient is 1 6 degrees, there is no disocclusion, and maxillary
and mandibula r cusps s lide in contact evenly. Accordingly, when the condylar �ath
becomes shallower than 1 6 degrees, cuspal interferences will occur. However, since the�_ is
only an 8% occurrence rate of sagittal condylar paths less than 1 6 degrees, it is not
considered a serious problem clinically. Such cuspal interferences can be removed by
occlusal adjustments of the restoration in the patient's mouth (Fig 3-5) .
 Chapter 3 Twin -Stage Procedurr 37

25 '
�
�D
25' /"� I

• 45' I
I
i
_J
Fig M Suppose a restoration fabricated with a standard cusp angle and anterior guidance is cemented in the
patient's mouth. If the sagittal condylar path of the patient is steeper than the 40-degree articulator adjustment
value, this · difference Is harmle6s because the amount of dlsoccluslon increases. On the contrary. if the
condylar path In the patient is shallower than 40 degrees, the amount of disocclusion decreases to some extent.
However, as long as the deviation of the condylar path remains within the normal distribution, any discrepancy
must be harmless.

Fig of a patient is 1 8 degrees, there is no disocclusion. The maxillary and

evenly. Accordingly, when the condylar path becomes shallower than 16
3-5 When the condylar path
mandibular cusps slide In contact

sagittal condylar path lower than 1 8 degrees In only 8% of the population. Therefore, It would not be a serious
degrees, cuspal interferences will occur. However, statistical calculations show the rate of occurrence of a

problem Cllnlcally.
38

Outline of the Twin-Stage Procedure

Fabrication of the cusp angle
1) According to "Condition 1 ," adjust an articulator to the following values: sagittal condylar
path incli nation =25 degrees, Bennett a'lCJle=1 5 degrees, sagittal inclination of the
anterior guide table=25 degrees anQ lateral wing angle= 1 0 degrees.
2) Make the anterior se ment of tne maxillary or mandibular cast removable_ using �wel
f
pins. Remove the anterior segment. Make t e maxi ary anc mandibular casts on the
articul ato r SO that they do not disocclude during eccent ric ll!OVe ment
3 ) Wax the occlusal morphology at the posterio�teeth sg tt:1e ma)(illary anct mandibular
.

cusps cootaclduring eccentric movement. Thus, a balanced articulation is obtained and

every cusp will have a standard cusp angle.

Fabrication of anterior teeth

1 ) According to "Condition 2," adjust an articulator to the following values: sagittal condylar
path inclination=40 deg111es, Bennett angle=1 5 degrees, sagittal inclination of the anterior
guide table=45 degrees, and lateral wing"angle=20de es. gre
2) Reassemble the anterior segment of the cast. The maxillary and mandibular casts on the
articulator produce the standard amount of disocclusion.
3) Wax the palatal contours of the maxillary anterior teeth so the maxillary and mandibular
incisors contact during protrusive movement, and the maxillary and mandibular canines
on the working side contact during lateral movement. Thus, anterior guidance is
established and the standard amount of disocclusion will be produced,

The Twin Hoby Articulator

I n the twin-stage procedure, the authors have changed the concept that occlusion is
determined by the condylar path of the patient to one that refers to the standard value of the
cusp angle. Therefore, the objective for using an artjc11!ator shifted fi:om "repredblGtion" of
mandibular movement to "simulation" of mandibular movement and the design for an
articulator needs to be modified.
During the course of researching mandibular movement, the authors have tried to design
an articulator that meets the average dentist's needs. The Twin Hoby Articulator· has been
designed exclusively for the twin-stage procedure so the condylar guidance mechanism and
anterior guide table can be used as one unit (Fig 3-6).
l n.J]PT-6 (1 994), articulators are categorized from Class I to Class IV, The T�oby
Articulator is a Class Ill articula r, which is defined as "an instrument thatsimulates condylar

I nstrum ents allow for orientation of the cast relative to the joints and may be arcon or
pat ways by using averages or mechanical equivalents for all or part of the motion . _These

nonarcon instruments."

* Distributed by 3M Dental Products St. Paul, MN

 Chapter 3 Twin -Stage Procedure 39

The Twin Hoby Articulator is the articulator that systematically uses the condylar guidance
assembly and anterior guidance assembly as one unit. It is an arcon-type semiadjustable
articulator. The sagittal condylar path inclination is adjustable from -20 degrees to 70 degrees;
the scales a re ma rked by a red line at 25 degrees and a blue line at 40 deg rees
corresponding to Condition 1 and 2, respectively. The former scale is used to establish the
cusp angle and the latter is used to fabricate anterior guidance. Further, the Bennett angle is
fixed at 1 5 degrees and the amount of immediate mandibular t_ranslation is fixed at O mm for
both conditions.
The sagittal inclination and lateral wing angle of the anterior guide table are adjustable with
ranges between 0 to 70 degrees and 0 to 45 degrees, respectively. The scales are marked at
5-degree increments. The scales are marked at 25 degrees for the sagittal inclination and 1 0
degrees for the lateral wing angle in r#(t corresponding to Condition 1 . Scales are also
marked at 45 degrees for the sagittal inclination and 20 degrees for the lateral wing angle in
blue corresponding to Condition 2. The scales are marked in 5-degree increments on the
.
a"Oterior guide table in addition to the red and blue lines, to allow flexibility for adjustment
conditions in clinical cases such as group function (Table 3-3 ).

Table 3-3 Articulator adjustment values for Condition 2 in

group function (deg).

Condylar path
·-- --- ---
- - -
Anterior path

Saglttal condylar SagIttaI Lateral

Bennett angle
path Inclination lncllnatlon wing angle

40 15 45 0
i
Note: Articulator adjustment values for Condition 1 are the same as
Condhlon 1 In Table 3-2.

Fig H The Twin Hoby Articulator.

to

to a fully adjustable articulator. but the anterio r guidance assembly is well-made. The
The condylar guidance assembly of the Twin Hoby Articulator is quite simplified compared

traditional concept depends on the condylar paths, the two posterior apices of the mandibular

abandoning the traditional concept and emphasizing the anterior apex, the concept of the
triangle and has ignored the influence of anterior g u i d a n c e , the anterior apex . By

twin-stage procedure balances the three apices of the mandibular triangle.

By using the Twin Haby Articulator. the twin-stage procedure can be simplified as follows:
1) Adjust the condylar path and anterior guide table to the red marks to establish Condition
1 . Waxing the posterior occlusal morphology will create cusps with a standard value.
2) Adjust the condylar path and the anterior guide table to the blue marks to establish
Condition 2 and wax the anterior teeth. This helps create anterior guidance to coincide
with neutral line, which produces a standard amount of disocclusion.

Accessible mechanism

I n laboratory procedures, easy access is necessary so the articulator should have open
access for waxing, porcelain application and modification of the anterior teeth. The anterior
guide table and anterior guide pin of the Twin Hoby Articulator can be removed easily to
provide open access (Fig 3-7).
Each articulator is adjusted so the tip of the anterior guide pin and the center of the anterior
guide table coincide. The same identification number is marked on both the articulator and the
anterior guide table. The anterior guide pin has a lock mechanism to maintain the vertical
dimension (Fig 3-8). An index line is notched in the center of the anterior guide table to direct
the tip of the anterior guide pin perpendicular to the median plane (Fig 3-9).

Fig 3-7 The anterior guide table and anterior guide ptn
ol the Twin Hoby Articulator can be removed eastly to
provide open access in the front portion .
 Chapter 3 T 11· 1 n Stage Proced u re 41

Ag 3-8 Lock mechanism of the anterior guide pin. Fig 3-9 Index line on the anterior guide table.

Anterior guide table scales

The anterior guide table on the Twin Hoby Articulator has angle scales for sagittal inclination
and lateral wing angle marked on them.
1 ) Accuracy of the angle scales : In order to obtain successful results, adjustment of the
angle scales on the anterior guide table must be done with an accuracy of less than one
degree. Articulators that have an adjustable anterior guide table without angle scales
cannot be used for the twin-stage procedure.
2) Range of angle scales : There are articulators which have an ad·ustable anterior uide
table with a range of ang e sea es or the sagittal inclir:iation limited to 40 degrees.To
apply the twin-stage procedure, the angle scales for the sagittal inclination must reach at
least 45 degrees . ..
3) Horizontal reference plane : The horizontal reference planes differ between articulators
due to the difference in the anterior reference point specified by the manufacturer. Tu
adapt an articulator other than the Twin Haby Articulator to the twin-stage procedure
except Denar products, a computation to calibrate the standard values of the cusp angle
and the standard amount of disocclusion for each different horizontal reference plane to
the axis plane is necessary. _,
 Complete Denture Prosthesis

Since Gysi, it has been widely recognized that balanced a rticulation is most suitable for
complete denture prostheses. In order to make a balanced articulation , the occlusal surfaces
of denture teeth are adjusted to establish a standard cusp angle under "Condition 1 ."
Continue to use the same adjustment values as in "Condition 1 ." Set the anterior artificial
teeth to p roduce even c ontact d u r i n g eccentric move ment . I n t h i s m a n n e r , balanced
articulation suitable for complete denture prostheses will be produced.

Systematic Consideration

The experimental fact that the condylar path can be controlled by anterior guidance means
the condylar path can be changed by altering occlusion. The condylar path is not the cause

the effect. It means that if occlusion is improper, then the condylar path may adapt to it. As a
and the occlusion is not the effect; rather, the occlusion is the cause and the condylar path is

resu lt, an u ndesirable effect s uch as sagittal deviation of the working condylar path or
immediate mandibular translation may occur.
Accordingly, a patient's condylar path may be due to the present condition of the patient's
occlusion. If the patient's occlusion is improper, the occlusion of a restoration made on an

Suppose the condylar path and the anterior guide table of an articulator were adjusted to
articulator reproducing the patient's condylar path precisely must be improper.

p roduce occlusion the dentist wants to p rovide the patient by app lying the twin-stage
procedure. If the occlusion of a restoration is fabricated on this articulator, the restoration will
have ideal disocclusion. After cementing such a restoration i ntraorally, the condyle will move
as programmed. An articulator can be used as a simulator for performi ng the program. If it is
possible to obtain an occlusion that does not lead the te mporomandi bular joint, then TM
dysfunction attributed to malocclusion can be prevented, mai ntai ning the stomatognathic
system in good physiologic condition.

Contraindications

Presently, the twin-stage procedure is contraindicated i n the following cases

1 ),/"\bnormal curve of Spee
� Abnormal curve of Wilson
3}
�
Abnormally rotated tooth

may have
Abnormally inclined tooth
v I n the above contraindicated cases, the vertical axis of the poste rior
i nclined abnormally. As a result, the effective cusp angle may vary to some extent even
teeth

though the cusp angle of a n atural tooth varies minimally. In such conditi o n . the standard
effective cusp angle presented in the twin-stage procedure may not be applicable . As a result.
the occlusion of a restoration may be inaccurate.
 Chapter 3 T w m Sta1w Prr•ced u n· U

References

Glossary of Prosthodontic Terms.6th ed. The Academy of Prosthodontics. J Prosthet Dent,

1 994; 71:43 - 1 1 2.

McHorris WH : Occlusion with particular emphasis on the functional and parafunctional role of
anterior teeth. Part II. J Clin Orthod, 1979; 13:684 -701 .

Kohno S, Shiozawa I, Nakano M : The relationship of anterior guidance to condylar path in

protrusive movement. J Jpn Prosthodont Soc, 1 975;19:426 -433.
 Chapter 4

A C l i n ical Eval uation Test

To evaluate the twin-stage procedure, the following clinical tests were performed:
1) The articulator test
2) The intraoral test
I n the articulator test, after completion of the posterior occlusal wax-up on casts mounted
on an articulator (under Condition 1 ), and adjusting the articulator (under Condition 2), the
s pec i f ic a m o u n t of d i soccl u s i o n occ u r r i n g d u ri n g v a r i o u s ecce n t r i c m o v e m e nts was
determined. This is an in vitro test.
In the i ntraoral test, when the results of test 1 were completed and satisfactory, the
restoration made on the articulator was cemented i n the patient's mouth. Then it was tested to
determine if the amount of disocclusion was reproduced as occurred in test 1 . This is an in
vivo test.

The Articulator Test

After removing the anterior portion of the maxillary cast mounted on a Twin Haby Articulator,
the occlusal su rfaces of the maxillary and mandibular molar areas were scraped with a
scalpel. The articulator was adjusted (under Condition 1 ), and the ocd usal su rfaces of the
cast were waxed to a balanced articulation so the maxillary and mandibular teeth contacted
d u ring eccentric movements. In this way, the standard cusp angle would be reproduced . }i
1strict check must be done so a registration strip of 1 2.5 IJP1 thickness is held in position for
each molar at maxjm11m intercuspatien ana El�ringeach eccentric mOy�ment.
The articulator was readjusted under Condition 2. The condyles were moved 3 mm from
centric using a positioning index and protrusive and right and left lateral eccentric positions
were reproduced. Then, using a leaf-gauge consisting of 0 . 1 -mm-thick strips, the amount of
disocclusion was measured at each eccentric posit i o n . For each measu rement, the leaf·
gauge was inserted between the maxillary and mandibular molars.
While pushing the top of mounting screw on the upper frame of the articulator with one
hand, the leaf gauge was removed using the other hand with the "same degree of force' as
on the screw. If the force produced by pushing o n top of the screw with one hand is too
strong, the condyles may separate from the rear wall . Be cautious to avoid causing the upper
frame of the articulator to tilt when removing the leaf-gauge. Check if the tip of the anterior
guide pin that touches the surface of anterior guide table at maxi m u m intercuspation does not
separate from the surface of the anterior guide table at the eccentric position .
For example, a 1 .0 mm amount of disocclusion was created when nine strips of the leaf·
gauge could be removed, but when inserting ten strips of the leaf-gauge, the gauge could not
be removed. The amount of disocclusion was measured at each molar and t h e first and
second premolars at the same time. The data on each side during each ecce nt ric movement
were averaged.
 Chapter 4 ,\ C h n iral E\'al11a1ion Test -t5

The amount of disocclusion measured was 1 .01 ± 0.03 mm on both right and left sides
during protrusive movement, 0.92 ± 0.07 mm on the nonworking side and 0.50 ± 0.00 mm
on the working side during lateral movement. This indicates, by using this method, the
standard amount of disocclusion occurs within the amount of error less than 0 . 1 mm, which is
the thickness of a strip of a leaf-gauge. Thus, it has been verified that the standard amount of
disocclusion can be obtained on an articulator by applying Conditions 1 and 2.
As mentioned before in the twin-stage procedure, an articulator is used as a simulator of
mandibular movement and not as a precise reproducer. Since the adjustment values for the
articulator (Conditions 1 and 2) have been computer selected, if the adjustment value is
compared to the computer -aided design (CAD), the laboratory work performed on an
articulator adjusted by this value (Conditions 1 and 2) can be compared to computer-aided
manufacturing (CAM). The technology used for occlusal reconstruction in the twin-stage
procedure. is different from that commonly known as CAD/CAM to some extent.
The standard values of the cusp angle can be used to manufacture occlusal morphology in
CAD/CAM. Use of an universally accepted fixed value instead of direct measurement of the
condylar path is significant in further development of the CAD/CAM system. Thus, the twin­
stage procedure proposed in this book will provide a solution in production of a three­
dimensional occlusal dynamics by CAD/CAM.

Fig 4-A-1 Occlusal view of the maxillary cast Anterior Fig 4-A-2 Occlusal view of the mandibular cast.
tooth segment Is removable and the molar occlusal
surfaces are eHminated. A groove Is formed to provide
mechanical retention tor wax.

Fig 4-A-3 Adjust the sagittal condylar path to the red Fig 4-A-4 Adjust the anterior guide table to the red
line (25 degrees) also raferred to as "Concitlon 1 " . marks and fix the sagittal incisal path at 25 degrees and

is � Under Condition 1 .
the lateral wing angle at 1 0 degrees. Thus, the articulator
'"

Fig 4-A-5 T h e anterior tooth segment 1s removed Fig 4-A-6 By removing the anterior tooth segment.
from the maxillary cast. the influence of anterior guida nce can be elim1na1ed
Cusp-Iossa waxing technique is pe rformed u n der lh1s
condition.

Fig 4-A-7 Complete wax-up of the maxillary posterior Fig 4-A-8 Complete w a x - u p of t h e m a n d i b u l a r
teeth. posterior teeth.

Fig 4-A-9 When moving the articulator through Fig 4-A-1 0 A balanced occlusion is created and th�
eccentric movement, the maxillary and mandibular standard cusp angle is created on the ma xillary an
posterior teeth slide under a tooth-contact condition. mandibu lar teeth.
 Chapter 4 A C l inical E\'al uation Test .J 7

Fig 4-A-1 1 Alter the completion of the posterior wax· Fig 4-A-12 Adjust the anterior guide table to the blue
up, the sagittal condytar path of the articulator is marks and fix the sagittal incisal path at 45 degrees and
adjusted to the blue line (40 degrees) also referred to lateral wing angle at 20 degrees. Thus, the articulator is
as "ConditiOn 2 . • adjusted under Condition 2.

Fig 4-A- 1 3 Replace the maxlllary anterior teeth Fig 4-A-14 Right canine guidance does not exist
segment on the cast. during right lateral movement.

Fig 4-A-1 5 Add wax to establish anterior guidance Fig 4-A-16 The molars disocctude when eccentric

conclylar path and anterior guide table.

under Condition 2 within the articulator guided by the movements occur.
Fig 4-A·1 7 Right and left plastic indiees. When bol h Fig 4-A-1 8 When the index is fixed on the Iossa
are used on right and left sides, protrusive movement IS
_
portion of the articulator. the condyle is re positioned 3
reproduced; when used on one side. a lateral movement mm.
is reproduced -

Fig 4-A·1 9 Leaf-gauge for t h e verification of the

amount of disocclusion. A strip of leaf-gauge is o. 1 mm
thick ( 3M Health Care Ltd., Tokyo, •Japan ).

Fig 4·A·20 With t he articulator in the left lateral Fig 4·A·21 When inserting ten strips of leaf-gauge,
the
position, nine strips of leaf-gauge (0.9 mm) are inserted nt 01
gauge cannot be removed. Thus. the amou
with
between the maxillary and mandibular first molars on disoclc usion was confirmed as 1 .0 mm coincident
the nonworking side. The gauge is removed easily. the data for standard value.
 Chapter 4 A C l i n i c al Evalualic,n Test 19

Fig 4-A-22 With th e articulator in a right lateral Fig 4-A-23 Ten strips of the leaf-gauge could not be
movement, n i ne strips of leaf-gauge were inse rted removed . T h u s , the amount of d isocc lusion was
between the maxillary and mandibular first molars on the confirmed as 1 .0 mm.
nonworking side. The gauge can be removed with a
gentle pull.

Fig 4-A-24 With the articulator in a protrusive position, Fig 4-A-25 On the lefl side in protrusive position,
ten strips of leaf-gauge were Inserted but could not be ten strips of the leaf-gauge could not be removed.
removed-on the right side. The amount of disocclusion Thus, after waxing under Condition 1 and adjusting
is 1 .0 mm: under Condition 2, the standard amounts of disocclusion
were generated.

The lntraoral Test

Since a predictable standard amount of disocclusion on the articulator was verified, the
amount of disocclusion occurring intraorally was investigated to see if it was similar. Eight
occlusal reconstruction cases (total of right and left sides; N = 1 6) were selected. The
restorations were fabricated on an articulator using Conditions 1 and 2. The standard amount
of disocclusion was produced. The amount of disocclusion was checked d u ring each
eccentric movement using a leaf gauge in the same manner as in test 1 . The condyle of the
articulator was moved 3 mm using a positioning index to reproduce protrusive and right and
left lateral movements. Then, an anterior silicone core was fabricated using silicone
impression material for each eccentric position.
After the restorations were cemented in the patient's mouth , the patient was asked to
reproduce each eccentric position using the silicone core as a position guide. Then the
amount of disocclusion was measured using a leaf-gauge. Retractors were used and the leaf
gauge was inserted between the maxillary and mandibular molars, obliquely if necessary to
avoid the lips. For example, the 1 .0 mm amount of disocclusion corresponded to ten leaf -
.-. i t

gauge strips that could be removed under gentle biting conditions but not under heavy biting
cond itions . The amount of disocclusion was measured at the fi rst and second m o l a r s .

The results i ntraerally, in vivo, of the amount of d isocclusion are shown in Table 4 - 1
i ndividually. The data for each side during each eccentric movement were averaged .

compared with the data o n the articulator, in vitro. The measured data in vivo coincided with
the data in vitro with an error of less than 0. 1 mm.

Table 4 - 1 Comparison of the amounts of disocclusion. in vitro and i n vivo

(mm).

N-16 In vitro In vivo Difference

Protrusive 1 . 06 ± 0 . 1 3 1 . 01 ± 0 . 1 1 - 0 . 05 ± 0 . 06

Nonworking side 0 . 98 ± 0 . 05 0 . 94 ± 0 . 1 2 - 0 . 04 ± 0 . 1 0

Working side 0 . 52 ± 0 . 07 0 . 52 ± 0 . 07 0 . 00 ± 0 . 03

Discussion

To produce disocclusion in restorations, it has been necessary to use a pantograph. a fully­

adjustable articulator and make corrective occlusal adjustments using a remount technique by
the trial-and-error method. To verify it in the patient's mouth, an occlusal registration strip of
1 2 .5 µ m th ickness has been used. If the strip can be removed as soon as ecce ntric
movement starts when positioned between the maxillary and mandibular posterior teeth,
disocclusion is verified . However, use of this method does not allow control of the "amount" of
disocclusion.
If restorations were made using a pantograph and a fully adjustable articulator and placed
in the patient's mouth, the occlusion on the articulator d id not coincide exactly with that
present intraorally. However, when the twin-stage procedure was applied, the results showed

using an entirely different approach as previously mentioned, the quantitative co ntrol for the
that the amount of disocclusion on the articulator and in the mouth were almost the same. By

amount of disocclusion has become a reality in daily laboratory procedures. This method is
much easier than the method of using a pantograph and a fully adjustable articulator

Fig 4-B-1 O cc l us a l view of the maxillary occlusal Fig 4-8·2 Occlusal view of the mandibular restorations.
surfaces of the crown restorations.
 Chapter 4 .\ C l l n K;il Eval uation Tt·st :i i

Fig 4-8-3 Lateral view of the disocclusion created on Fig 4-8-4 The crown restorations fabricated using the
the right nonworking side. lwin-stage procedure follow lhe standard cusp angle and
anterior guidance. Lateral view of the disocclusion
created during left working movement.

Fig 4-8-5 The articulator condyle was moved 3 mm by Fig 4-8-6 A silicone index is made using silicone
using a positioning index to reproduce the eccentric impression material for each eccentric position.
position. Simultaneously, disocclusion can be confirmed using the
leaf-gauge.

Fig 4-8-7 Verify the amount of disocclusion on the Fig 4-8-8 Verify the amount of disocclusion on the
wortQng side during right lateral movement. nonworking side.
 Fig 4-8-9 Verify the amount of disocclusion on the
working side during left lateral movement.

Fig 4-B-10 Right lateral view of disocclusion created in Fig 4-8-1 1 Left lateral view of disocclusion created in
the mouth. the mouth.

Fig 4-8-12 Insert silicone Index for a 3 mm protrusive

position and measure the amounts of disocclusion.
 Chapter 4 .-\ C l i n il'al E raluat ion Tt·�I 'l:�

Fig 4-8-13 Insert the silicone index for a right lateral Fig 4·8·1 4 Measure the amounts of disocclusion
position and measure the amounts of disocclusion. during left lateral position.

Although the conc:fylar path is not measured using the twin-stage procedure. �lie amount of
dis0cclusion produced occurs within 0. 1 mm accuracy. This level of accuracy is attributed to a
shift from complete dependence on the condylar path to the concept that tocuses on three
factors: condylar pat� incisal path and cusp angle, all of which are treated as one unit
simultaneously. In the twin-stage procedure, the amount of disocclusion was programmed
and reproduced accurately. The influence of the condylar path on the amount of disocclusion
is less than what has been assumed.
Since the value of the condylar path of a patient differs from the value adjusted on an
articulator, the difference was supposed to appear clearly as different amounts of disocclusion
on the articulator and intraorally. In spite of possible conjecture, significant differences were
not found in the eight patients evaluated. This can be explained by the fact that the influence
of the condylar path on the amount of disocclusion is very small, almost negligible. The
reasons why the Influence of the condylar path is almost negligible are discussed.
There are noticeable deviations in the con lar ath re resented b the difference of .
eccentric an re urning con y ar paths. Further, the sagittal deviation of the working side
condylar path is guided by the lateral incisal path. Immediate mandibular translation. together
vfilh laterotrusjon can be controlled by anterior guidance.. These observations can be
attributed to the looseness of the temporomandibular joint structure in relation to the
surrounding soft tissues. This indicates that the posterior two apices of the mandibular
triangle are flexible.
What would happen if a small triangle existed at the anterior guidance area which guided
the mandible instead of the traditional mandibular triangle? If there are three contact points in
• the anterior portion and since the maxillary and mandibular posterior teeth disocclude during
eccentric movement, the mandible may be guided by this small triangle. As a result, the
condylar path may be influenced by anterior guidance.
If the above is true, the following is the most probable explanation. The anterior guidance of
restorations was made by adjusting the condylar path of the articulator to the normal value
(40 degrees) in the above tests. Accordingly, when the restorations were cemented in the
patient's mouth, the condyfar path of the patient might have been guided to the 40 degree
value. As a result, the standard amount of disocclusion occurred. The favorable coincidence
of the results in vivo and in vitro suggests the validity of the above-mentioned hypothesis. In
conclusion, the fact that the amount of disoccl usion intraorally coincided with the amount of
disocclusion occurring on an articulator, the twin-stage procedure is considered to be highly
reliable and useful for clinical dentistry.
 Chapter 5

Occl usa l Diagnosis

on the Eccentric Position

Occlusal Diagnosis

A typical method used to examine occlusal contacts utilizes an occlusal registration strip,
1 2.5 µm thick, inserted between the maxillary and mandibular molars. When held in centric
position, it can be removed easily as soon as an eccentric movement occurs. Tl;;li s onlx

cuspal interference in an eccentric position occurs with excessive amounts of tooll1 structure
x_e rifies if a cuspal contact exists or not; it does not quantify the amount of disocclusion . A

on interfering cusps or with insufficient palatal contours on the maxillary anterior teeth. The

twin-stage procedure clarifies and sets a standard of occlusion, making it possible to

actual cause for an interference cannot be distinguished by this type of examination. The

diagnose occlusion accurately. It is now possible to distinguish if a cuspal interference

occurs either by excess or insufficient tooth structure (Figs 5-A-1 through 5-A-42).

Fig S-A-1 Labial view of the maxillary and mandibular

teeth in maximum intercuspation.

Fig 5-A-2 Maximum intercuspalion. right side. Fig S·A-3 Maximum intercuspalion, left side.
 Chapter 5 Occlusal Diagnosis on tht· Errl'ntric Position .:>5

Fig S·A-4 Working side view during right lateral Fig 5-A-5 Maxillary and mandibular ��ontcrct Oil
movement. The molars do not disocclude. the working side during left latera!JP6�1,. ol
- -

Fig 1-A-I Diagnostic maxillary cast. The anterior Fig 5-A·7 Diagnostic mandibular cast.
segment Is removable.

Fig 5-A-8 Measurement of the ma>elllary triangle wllh Fig S-A-9 Fixation of the maxillary cast and facebow
facebow. record.
Fig 5-A- 1 0 Use the leaf gauge to deprogram the Fig S·A-1 1 Mount the m a n d i b u l a r cast using the
muscles. Then make the centric relation record with a centric relation record.
minimal amount of opening.

Fig 5-A- 1 2 Maxillary and ma ndibular casts are

mounted in centric relation pn the articulator. For
occlusal diagnosis. the centric relation position must be
reproduced.

Fig 5-A-1 3 Mark premature contacts at centric

Fig S-A-14 Eliminate premature contacts.
relation position.
 Chapter 5 (Jc:clusal Oiai:nosis on tht· Ecrl'ntrit- Posilion '17

Fig 5-A-15 After completion of occlusal adjustment Fig 5-A- 1 6 Remove premature contacts in centric
in centric relation position, mark the adjusted area. relation position to produce point centric.
-- ...

adjusted to the red marks of Condition 1 .

Fig S-A·1 7 To check Iha cusp angle of the posterior Fig S-A-1 8 The scales of the anterior guide table are

to the red line, Condition 1 .

teeth, adjust the sagittal condylar path of the articulator

Fig 5·A·1 9 Remove the anterior segment of the Fig S-A·20 Move the articulator into right lateral
maxillary cast. movement. The tip of the anterior guide pin must not lilt
off the anterior guide table.
Fig 5-A-21 Insert an occlusal registration strip (12.5 Fig 5-A 22 Mark the cuspal interference area with
-

11m thickness) between the maxillary and mandibular occlusal marking paper.
molars �heck ii a cuspal interference exists during
eccentric movement .
.-::::

Fig 5-A-23 Remove the cuspal interference. The Fig 5-A-24 Move the articulator through left lateral
interference occurred due to the excessive cusp angle movement.
present on the natural tooth.

Fig 5-A-25 Eliminate cuspal interferences. Fig s-A-26 Move the articulator through protrusive
movement.
 Chapter 5 Occl usal Diagnosis on the Ecctntrir Position 59

Fig S·A-27 Remove all cuspal interferences at Fig 5-A-28 E ven tooth contact i ndicates that a
eccentric position to allow the maxillary and the standard cusp angle is created.
mandibular molars even contact.

Fig 5-A-21 To check anterior guidance, the sagtttal Fig 5-A-30 The scales of the anterior guide table are

llne (Condition 2).

condylar path of the articulator ia adjusted to the blue adjusted to the blue marks for Condition 2 .

Fig 5-A-41 Place the anterior segment on the maxillary

CUL
hfl

Fig 5-A-32 Move the articulator through left lateral Fig 5-A-33 A standard amou nt of disocclus1on occurs
movement. in the poste rior region. The canines also disocclude.

Fig 5-A-34 Add wax where the amount of tooth Fig 5-A-35 Normal canine guidance is reproduced.
structure is insufficient. The addition of wax is needed to ob ta i n a standard
amount of disocclusion.

Fig 5-A-36 Move the articulator through right lateral Fig 5-A-37 During the right lateral movement. canine
movement. guidance does not exist.
 Chapter 5 Ocrlus;tl l >1ai.:11< >sis on tht· En"l'ntri.- Position f1 I

Fig S-A-38 Add wax to reproduce canine guidance. Fig 5-A-39 Canine guidance is produced.

Fig 5-A-40 Occlusal view of the adjusted diagnostic Fig 5-A-41 Occlusal view of the mandibular cast. By
maxlHary cast. using the adjustment values for Conditions 1 and 2,
diagnosing interferences and insufficient amount of
tooth structure can be clone accurately.

Fabrication of the Cast with Removable Anterior Segment

One of the significant advantages with the twin-stage procedure allows the operator to
perform occlusal correction on molars without anterior guidance. The fabrication of a cast with
a removable anterior segment is explained. The cast is normally made with a removable
maxillary anterior segment. If there is difficulty with removing the maxillary anterior segment,
then make the mandibular anterior segment removable instead (Figs 5-B -1 through 5-B-1 2).
Fig 5·8·1 A line is drawn parallel to the occlusal Fig 5-8·2 Tri m the base of the cast to the hne.
plane with a pencil along the mucobuccal lold ol the
maxillary cast.

Fig 5-B-3 Completion of trimming. The maxillary cast Fig S-8-4 Occl usal view of the maxillary cast.
has been trimmed with the base parallel to the
occlusal plane.

Fig 5·8·5 Drill six holes in the cast base with the Fig S-B-6 Distribution of the drilled holes on the casl
Pindex machine. base allows removal of three segments.
 Chapter 5 Ckdusal [)r ngn11s1s on th<· Ecc!'ntric Position li:i

Fig s-B-7 Glue dowel pins in the holes. then set the Fig 5-8-8 Apply a separating agent on the base.
plastic sleeves.

Fig 5-8-9 Fill the base former with labstone and set Fig 5-8-10 When the stone has set, remove the cast
the trimmed maxillary cast into the form. from the rubber frame.

Fig 5-8-11 Saw distal to the canines to create three Fig 5-8-12 The anterior segment is removable with
segments. dowel pins. In the twin-stage procedure, all casts must
be made with a removable anterior segment to eliminate
the influence ol anterior guidance.
 Chapter 6

F u l l-Mouth Reconstruction

reconstruction was a treatment alternative, according to traditional gnathological proced u res

T h e p a n tog ra p h and f u l l y-adjustable artic u l ator have been used w h e n a f u l l - m o u t h

Since this required an advanced skill level and long hours of work, it was not often utilized. To
obtain disocclusion to prevent occlusal interferences, no other methods were ava ilabl e.
I n the twin-stage procedure, disocclusion can be reproduced with accuracy and without
condylar path measurement. The procedure for full mouth-reconstruction is simpl ified and can

Since all the maxillary and mandibular anterior teeth and molars are restored in full mouth
be incorporated into everyday practice.

reconstruction, the cuspal angle and anterior guidance can be created precisely without
concerns about the remaining natural teeth. The amount of disocclusion can be reproduced
precisely as programmed. The effective cusp angle used for the new cli nical proce du re is
defined by the horizontal reference plane and influenced by the occlusal plane and Curve of
Spee. The following are important when establishing an occlusal plane.
1 ) Mount study casts on an articulator using the axis plane as the horizontal reference plane.
Position both the incisal edges of four mandibular incisors and the cusp tips of the mandibular
right and left first premolars on the same plane approximately parallel to the axis plane. The
tip of the mandibular canines can extend 0.4 mm above this plane.
2) The buccal cusp tips of the mandibular right and left second premolars and f i rs t and
second molars can be raised 1espectlvely, as shown m Table 6-1 , above the horizontal
plane. Consequently, a Cuive of Spee with a"tadius of approximately 1 80 mm is created
on the mandibular teeth.
These values are measured from the mounted study model on an articulator using1he axis
plane as the horizontal reference plane. The supero inferior distance of each cusp tip relative
to the plane is shown in Table 6-1 (Figs 6-1 through 6-1 03).

Table 6-1 Supero-inferior position of the mandibular cusp tips on a

curve of Spee (mm).

Mandibular I Mandibular second

L
Mandibular second first molar molar
premolar
Mesic- Disto- Mes lo- Dis to-
buccal I
; .
buccal buccal buccal

0.1 0.5
I 1 .5 3.0 4.0
 Chapter 6 Full �lou t h Rti:cmst ruction fl5

Fig 6-1 Labial view of maxillary and mandibular

anterior teeth, (pretreatment).

Fig 1-2 Occlusal view of maxillary teeth. Fig 8-3 Occlusal view of mandibular teeth.

Fig M Right lateral view. Fig 1-5 Left lateral view of maximum intercuspation.

do not ooclude position.

The molars are in reverse occlusion and the premolars
h(i

Fig 6-6 Locale the terminal hinge axis lo reproduce Fig 6-7 Mark the anterior reference. A point 43 mm
centric relation. above the incisal edge of maxillary right central incisor
toward the infraorbital margin and used lor the lacebow
transfer.

Fig 6-8 Transfer the terminal hi n ge axis to the axis

board and mount the maxillary cast.

Fig 6-9 Maxillary diagnostic cast mounted on axis jig. Fig 6-1 0 Remove the maxillary cast from the axis jig
and place it on the Twin Hoby a rticulator. Si nce the axis
jig and the articulator are fabricated using the same
standards, the relative position is t he same.
 Chapte r 8 Full -Mouth Reconst ruction 67

relation record.
Fig &-1 1 Mount the mandibular cast usi ng the centric Fig 8·12 The diagnostic casts mounted on the
articulator duplicate the patient's jaw relation.

Fig 6-13 Right lateral view of antenor teeth. Fig 8-14 Left lateral view of anterior teeth. Note the
open anterior tooth relation.

Fig e.15 The cusp morphology of the posterior teeth Fig 8-11 After the diagnostic wax-up, the poor occtusal
must be waxed to the proper occlusal relatlonshiP· The
CUip angle le made under Condition 1 . prosthellcally.
relation of the anterior teeth can be improved
I i :';

Fig 6-17 Anterior view of prepared abutmenl leelh.

Fig 6-1 8 Occlusal view of the maxillary prepared teeth. Fig 6-1 9 Occlusal view of the mandibu l a r prepared
teeth.

Fig 6-20 Whe n making the centric relation record, a Fig 6-21 Make the centric relation record.
Lucia jig is fixed on the maxillary anterior teeth lo
deprogram the muscles.
 Chapter 6 F u l l '.\loulh Rn:<>nslruction f)<J

Fig &-22 Make 3 records and store in a humidifier.

Fig 1-23 Occlusal view of the maxillary master cast. Fig 1-24 Occlusal view of the mandibular master cast.

Fig 1-25 Mount the maxillary master cast using the Fig 6-26 The maxillary cast mounted on the axis jig is
hinge bow. ready for transfer.
Fig 6-27 Transfer the maxillary cast to the Twin Fig 6-28 Mount the mandibular cast using the centric
Hoby Articulator. The articulator is set under Condition 1 . relation record.

Fig 1·29 Maxill ary and mandibular master casts

mounted In centric relation position.

record by using the split-cast method. The other records

Fig 6-30 Check the precision of the centric relallon Fig 6-31 Since the spli1-cast su rfaces coin cide
precisely, the maxillary and mandibular casts have
are used to verily the mounting. been mounted at centric relation.
 Chapter 6 Full �louth R�const ruction 71

Fig 6-32 Remove the anterior segment of the maxi llary Fig 6-33 The posterior teeth can be waxed to meet
cast. Condition 1 .

Rg 1-34 Maxillary cusp cones identify cusp positions. Fig 8-35 Mandibular cusp cones identify cusp
positions for the cusp-Iossa waxing technique.

Fig &-38 Wax the maxillary marginal and cuspal ridges. Fig 8-37 Wax the mandibular marginal and cuspal
ridges.
Fig 6-38 Occlusal view of the completed maxillary Fig 6-39 Occlusal view of the mandibular posterior
posterior tooth wax-up. tooth wax-up.

Fig 6-40 The maxillary and,mandibular molars slide

in contact evenly. This indicates a standard cusp angle
has been created for Condition 1 .

Fig 6-41 Maxillary and mandibular molars under Fig 8-42 Maxillary and mandibular molars und er
even tooth contact, (left side). even tooth contact, (right side).
 Chapter 6 F u ll '.\louth Ri·rnn•a ruet ion i3

blue marks of Condition 2.

fig 6-43 The sagittal condylar path of the articulator is Fig 8-44 The anterior guide table is adjusted to the
set at Condition 2 (blue line) to create anterior guidance.

Fig 8-45 Replace the anterior segment on the Fig 8-48 The tip of anterior guide pin must not lift off
maxillary working cast. the incisal table. Wax the anterior teeth.

Fig 6-47 The wax-up shOuld create anterior guidance.

71

F i g 6-48 Disocc l u s ion visi ble d uring protrus ive Fig 6-49 The molars produce the standard amount ol
movement. diSocclusion during eccentric movement.

Fig 8-50 Ceramometal copings filled on the working

cast.

fig 6·51 Coping try-in on the maxillary teeth. Fig 6-52 Coping try-in on the mandibular teeth.
 Chapter 8 Full �louth Reconstruction 75

Fig 1-53 Wdh the articulator adjusted to Condition 1 , Fig 6-54 Bisque-bake ceramometal crowns are seated
complete posterior restoration porcelain application. on the mandibular cast.
Bisque-bake ceramometal crowns are seated.

artlculetor In eccentriC posltionS.

Fig l•H Verify posterior tooth contact with the

Flt Ml � posterior teeth contact evenly. Fig 1-57 Left posterior teeth contact evenly.
 the bluemarks of Condition 2.
Fig 6·58 Adjust the sagittal condylar path to the blue Fig 6-59 Adjust the scales of the anterior guide table to
line of Condition 2.

Fig 6-60 Move the articulator through lateral movement

and check disocclusion.

Fig 6-61 View of the disocclusion ol right posterior Fig 6-62 View of the disocclusion of the left poste rior
teeth at a position 3 mm along the condylar path length teeth at a position 3 mm along the condylar path
during protrusive movement. length during left lateral movement.
 Chapter 6 FulJ. \louth Rl-con!ilruction ;7

Fig 6-63 Maxillary and mandibular molars at the Fig 6-64 After the crowns have been tried in, make a
maximum intercuspation (centric relation position). facebow transfer for the remount procedure .

record.
Fig M5 Use a Lucia jig to make the centric relation Fig 6-66 M ix impression material and place in a
remount tray. The remount i m pression registers the
occlusal indices of maxillary teeth.

Fig 6-67 Maxillary indices. The mandibular occlusal Fig 1-68 Position the crowns Into the indices.
indices and remount impression are made during the
same procedure.
78

Fig 6-69 Make resin dies for each crown; the screws Fig 6-70 Seat the resin dies into each crown and add
provide mechanical retention in the remount cast. sticky wax to stabilize the crowns.

Fig 6-71 Fiii the base former with stone and set the
index into it to make the remount cast.

fig 6-72 Completed maxillary remount cast. Fig 8-73 Completed mandibular remount cast.
 Chapter 8 Ful Dlouth Reconstruction 79

Fig 6-74 Mount the maxillary remount cast using the Fig 6-75 The maxillary and mandibular remount casts
hinge bow record. mounted on the articulator in centric relation position.
The articulator is adjusted to Condition 1 .

Fig 8-78 Remove the anterior restorations since the Fig 6-77 Close the articulator in centric relation to
anterior segment Is not removable. check for premature contacts.

movements. Check if all posterior teeth contact evenly.

Fig 6-78 The articulator Is moved through eccentric Fig 6-79 When a cuspal interference exists, mark it
with ooclusal marking ribbon.
XI)

Fig 6-80 Remove the interference.

Fig 8-81 Verify i i maxillary and mandibular molars Fig 6-82 Posterior teeth slide in even contact, (left
slide In contact evenly during eccentric movements. working posilion).

Fig 6-83 The sagittal condylar path of the articulator is Fig 6-84 Adjusl the anterior guide !able to the blue
adjusted lo lhe blue line of Condilion 2 to check anterior marks of Condition 2.
guidance.
 Chapter 6 F u II :\lout h Rc:rnnst ruc11011 81

Fig 6-85 The articulator is moved through eccentric

movements to check disocclusion.

Fig 1-88 Disocc:lusion of right posterior teeth. Fig 8-87 Disoccluslon of left posterior teeth.

Fig Mii Seat the crowns lntraorally. Check the centric

relation position. The anterior open relation has been
i mproved.
Fig 6-89 Occlusal marks in centric relation position Fig 6-90 Occlusal marks in centric relalion pos111on
of the maxillary teeth. The anterior teeth must not of the m a nd i b u l a r teeth . The centric contacts are
contact the opposing teeth in maximum intercuspation. distributed well throughout the posterior teeth.

Fig 6-91 Mix the cement tor insertion. Fig 6-92 Cement the crowns.

Fi g 6-93 Initially cement only the maxillary and Fig 6-94 II only one tooth contacts. let the patient
ma nd ibular anterior teeth. Alter cementing. check ii the mark the occlusat marking ri bbon lo ident i fy the area
mandibu l a r a nterior teeth slide in contact during
eccentric movement.
 Chapter 6 F u ll '.\loulh Nl'constructinn 113

Fig 8-15 Interfering area is removed.

Fig 1-18 After adjusting Interferences prepare to

cement the posterior crowns.
Fig 1-17 In this case, the mandibular molars are
cemented temporarily and after a specific period for
postoperative observation, tt:iey are cemented
pennanently.

Fig 1-91 OcduSal YleW of maxillary restorationS. Fig 1-91 Occlusal view of mandibular restorations.
Ii i

Fig 6-1 00 Lett view of maximum i ntercuspation Fig 6-101 Disocclusion of the posterior tee th (left
position (centric relation). Reverse occlusion has been view).
corrected completely.

position (centric relation).

Fig 6-102 Right view of maximum intercuspation Fig 6-103 Disocclusion of posterior teeth (right view).
 Chapter 7

Fabrication of a Single Crown

In daily practice, it is a rare procedure to measure the condylar path and use an adjustable
articulator when producing a single crown. However, if a cuspal interference occurs due to the
abnormal occlusion of a single crown, it can affect the stomatognathic mechanism in a
number of ways.
By using the twin-stage procedure, it is possible to produce a single crown with precise
occlusion. In this chapter, the posterior teeth were selected as examples but when fabricating
the anterior teeth, adjust the articulator under Coadition 2 and proceed with laboratory
procedures. The procedure results in creating a standard anterior guidance for a crown.
In single crown fabrication, the occurrence of disocclusion depends on the occlusal
condition of the remaining teeth. If there is abnormal occlusion of the remaining teeth, the
amount of disoccfusion as programmed may not be created. In this instance, single-crown
restoration and an occlusal adjustment must be combined (Figs 7-1 through 7- 28).

Fig 7-1 Ooclusal view of maxillary teeth. Fig 7-2 Occlusal view of mandibular teeth.
 Fig 7-3 Close-up view of the tooth prepared for an
onlay.

Fig 7-4 Make a facebow record; this uses an arbitrary Fig 7·5 The maxillary cast is mounted using l t"i r:
axis locator. In the twin-stage procedure, the effective facebow record and the mandibular cast is mounted or
cusp angle refers to the horizontal reference plane so a the articulator at maximum intercuspation.
facebow record is essential even for a single-unit
restoration.

Fig 7-6 In this case. the front segment of the maxillary Fig 7·7 The mandibular cast must be made removable
cast does not have to be made removable. using dowel pins. For a single-crown restoration. the die
needs to be made removable and isolated.
 Chapter 7 Fabrn:auon of a Sinl{ll· Crown Hi

Fig NI The sagittal condylar path of articulator is Fig 7·9 The anterior guide table is adjusted to the red
adjusted to the red line for Condition 1 . marks for Condition 1 .

Fig 7·1 0 The mandibular teeth are removed from the Fig 7-1 1 The die is left on the mandibular cast.
working cast, leaving the cle.

Fig 7·1 2 Make the initial wax ooping.

88

Fig 7-13 Make cusp cones to position the cusps for a Fig 7-1 4 Wax a physiological morphology on the
cusp-Iossa waxing. occlusal surface.

Fig 7·1 5 Close the articulator and confirm centric Fig 7·11 The oontac::t8 marked on the occlusal surface
conlaCtB. show Ideal points.

Fig 7-1 7 Move the articulator through eccentric Fig 7·1 8 For a single-crown restoration. a standard
movement to make the wax pattern slide in contact with cusp angle is created under Condition 1 . As tor the
articulating teeth evenly. anterior teeth, anterior guidance under Condition 2 is
created.
Fig 7-1 9 The wax pattern slides in contact with the Fig 7-20 Replace the remaining segments on the cast.
articulating teeth evenly. Thus. the standard cusp
angle can be created.

At 7-21 Correct the contact points and contours of the

proximal surfaces.

�
Fig 7-22 To confirm disOCclusion. a just the sa�i tal ! Fig 7-23 Adjust the anterior guide table to the blue
Condition
condylar path of articulator to the blue line tor marks for Condition 2.
2.
'Il l

Fig 7·24 Move the articulator t h rough eccentric Fig 7·25 This shows disocclusion du ring protrusive
movements. move m e n t . II the occlusion of r e m a i n i n g teeth 1 s
abnormal, the standard amount of disocclusion may
not be created throughout posterior teeth. This may be
an indication for an occlusal adjustment.

Fig 7-26 Completed MOD onlay.

Fig 7-27 MOD onlay is cemented intraorally. Fig 7-28 Occurrence of disocclusion during protrusive
movement. lntraorally, there is a predictable amount ol
disocclusion created in the final restoration using the
twin-stage procedure.
 Chapter 8

Fixed Restorations and

Occlusal Adj ustment

Need for lntraoral Adjustment

If the occlusion of the remaining teeth is abnormal, the maxillary and mandibular molars do
not contact evenly, even though the articulator is adjusted under Condition 1 and an eccentric
movement occurs. In this instance, the working cast must be corrected before waxing the
restorations to create a balanced articulation.
The ground portion of the working cast implies the same adjustments must be done
intraorally, also. If this is not done accurately, disocclusion cannot be reproduced as
programmed. The following figures show an example in which precise disocclusion was
created by occlusal adjustment of the natural teeth and by re-creating anterior guidance (Figs
8-A-1 through 8-A- 80).

Fig 8-A-1 Occlusal view of the maxillary teeth shows Fig 8-A-2 Occlusal view of the mandibular teeth
several prepared teeth. shows one prepared tooth.

Fig 8-A-3 Maxillary wortdng master cast. The anterior Fig 8-A-4 Mandibular working master cast.
segment is removable.
 Fig 8-A-5 Make a lacebow record; m this case. using
an arbitrary hinge axis. Mark the anterior refe rence point
43 mm above the incisal edge of maxillary nght central
incisor toward t he infraorbital margin.

Fig 8-A-6 Mount the maxillary working cast using the Fig 8-A-7 The mandibular working cast is mounted
facebow record. on the articulator in maximum intercuspation.

fig 8-A-8 To create the standard cusp angle for Fig 8-A-9 The anterior guide table is adjusted to the
.
posterior teeth. the sag1na1 condylar path of articulator red marks for Condition 1 .
is adjusted to the red line for Cond1t1on 1 .
 Chapter 8 F i xed Restorations and Ocdusal .-\dj u!;lment 93

Fig 8-A-1 0 Position articulating paper between the Fig 8-A-1 1 Follow the same procedure on the opposite
maxillary and mandibular posterior teeth . Open and side.
close the articulator to mark contacts.

Fig 8-A·1 2 Remove the maxillary anterior segment to

remove the anterior guidance influence.

Fig 8-A-1 3 Cuspal interferences were marked on the Fig 8-A-14 Left molars cannot contact due to the right
right second molar during left lateral movement. cuspal interference. It is impossible to create the
balanced occlusion on a restoration with this inter­
ference.
'l l

Fig 8-A-1 5 Position the articulating ribbon between the Fig 8-A-16 The mark indicates the cuspal interference
right second molars and identify the cuspal 1nter1erence,

Fig 8-A-17 Remove the interterence. Fig 8-A- 1 8 The cuspal interference on lhe right sec o1 'ri
molars is removed on the stone cast.

Fig 8-A-1 9 The left molars contact during the left Fig 8-A-20 Remove the interference.
lateral movement but a cuspal inter1erence occurs in
this area.
 Chapter 8 F1 xtd Rest or:a11ons :and Occlus:al .'\djustm<'nt 9j

Fig 8-A-21 Maxillary working cast with completed Fig 8-A-22 Mandibular cast with completed occlusal
occlusal adjustment of molars. adjustment.

Fig 8-A-23 Move the articulator through left lateral Fig 8-A·24 Left posteriOr teeth slide in contact evenly.
movement.

lateral Fig 8-A-26 Right molars slide in close contact.

Fig l-A-25 Move the artic:ulator through right
movement
'l h

Fig 8-A-27 Move the articulator through protrusive Fig 8-A-28 Maxillary and mandibular teeth slide in
movement. close contact.

Fig 8-A-29 Add wax on the die to make the wax Fig 8-A-30 Make the wax coping.
coping.

Fig 8-A-31 Completed wax coping on the master die.

Fig 8-A-32 Transfer the wax coping to the working cast Fig 8-A-33 Occlusal surfaces of l h e wax crowns are
::ind complete waxing the occlusal morphology. completed.

Fig 8·A·34 The wax crowns contact evenly with Fig 8-A-35 Move the articulator through rig h t lateral
articulating teeth and a balanced occlusion is created. movement.

Fig 8-A-36 Move the articulator through left lateral Fig 8-A-37 On the left side. the wax crowns contact
movement. evenly.
Fig 8-A-38 Move the articulator through protrusive Fig 8-A-39 Wax pattern slides in close contact.
movement.

•
Fig 8-A-40 Occlusal view of maxillary waxed crowns. Fig 8-A-41 Occlusal view of mandibular wax pattern.
By combining treatment with an occlusal adjustment, a
standard cusp angle is created.

Fig 8-A-42 Occlusal view of completed ma xillary Fig 8-A-43 Occlusal view ol cornpieluJ mandibular
crowns. restoration and crowns.
 Chapter 8 F netl Re�torations and fkc l u sal \cl1ustmt•11l 99

Fig 8-A-44 Reattach the maxillary anterior segment to

cheek the amount of disocclusion.

Fig 8-A-45 Adjust the saglttal condylar path to the blue Fig 8-A-46 Anterior guide table is adjusted to the blue
line for Condition 2. marks for Condition 2 .

Fig 8-A-47 Move the articulator through left lateral Fig 8-A-48 Disocclusion has been produced on the
movement. posterior teeth. The left canine contacts correctly and
guides the mandible. This indicates lateral incisal
path guided by this canine guidance is coincident with
a standard lateral incisal path (neutral line) established
using anterior guidance adjusted to the blue marks of
Condition 2.
I 110

Fig 8-A-49 Note the posterior teeth disocclude and the Fig 8-A-50 Move the articulator through right lateral
canine does not contact. This indicates a lack of canine movement.
guidance on the right side.

Fig 8-A-51 Move the articulator through protrusive Fig 8-A-52 Disocclusion occurs du ring protrusive
movement. movement.

Fig 8-A-53 Right and leh position indices. Fig 8-A-54 Place an index on the poste11or wall of the
Iossa box. The condylar element is positioned 3.0 mm
anteriorly. When using an index on one side, a lateral
movement position occurs and when using 60th on right
and left sides. protrusive movement position occurs.
 Chapter 8 F1 :u·d R1:s111ra1ion� and Ckd usal _\diu slml•n! IOI

Fig 8-A-55 The amount of disocclusion on the working Fig 8-A-56 The standard a mount of disocclusion
side during lateral movement was verified as the during protrusive movement was 1 .0 mm_
standard amount. 0.5 mm.

Fig 8-A-57 Occlusal adjustment reduction guide made Fig 8-A-58 The a rea where the tooth structure
on the wortting cast indicates the areas where cuspal protrudes through the surface of the occlusal reduction
interferences occur. guide Is the cuspal interference portion.

Fig 8-A-59 Remove cuspal interference.

1 ll�

Fig 8-A-60 Gold crowns cemented in the maxillary Fig 8-A-61 Gold crown and inlay cemented in the
arch. mandibular arch.

Fig 8-A-62 Maximum intercuspation. Fig 8-A-63 Maximum intercuspation.

Fig 8-A-64 Disocclusion during right lateral movement. Fig 8-A-65 Disocclusion during left lateral movement.
Due to the lack of canine guidance. the second molar
still contacts. Proper disocclusion can be created by
restoring canine g uidance. The adjusted surface s
s h o u l d be made c o i n c i d e n t w i t h t h e b l ue ma rks
(Condition 1) on the articulator.
 Chapter 8 F i :v·d lf r �turall•m� and (kdu�al ,\ dju�tnn·nt J O:i

Fig 8-A-66 To create proper canine guidance, the

maxillary ri ght lateral i ncisor and canine were
prepared for ceramometal crowns.

Fig 8-A� Mount the working casts on the articulator Fig 8-A-68 Labial view of the working cast.
at maximum intercuspation.

(Condition 2) to obtain the standard anterior guidance.

Fig 8-A-69 Adjust the articulator to the red marks Fig 8-A-70 Completed wax copings.
I'• I

Fig 8-A-71 W a x a n d c heck t h e w a x - u p w i t h t h e Fig 8-A-72 Completed wax-up o f t h e a n t e r ior

restorations.
articulator through eccentric movements.

F.lg 8-A- 73 Molars show t h e sta ndard a mo u n t of Fig 8-A-74 Completed copings.
disocclusion by canine guidance.

Fig 8-A-75 Bisque-bake porcelain for lry-in. Fig 8-A-76 While moving the articulator through right
lateral movement, canine guidance is checked.
 Chapter 8 F i x l·d lfrst<irat1on-; a n d Ocdusal .\d111slml· n t 1 05

Fig 8-A-77
surface.
Canine guidance marked on the palatal
Fig 8-A-78
]
Glazed ceramometal crowns.

Fig 8-A-79 Crowns cemented in the mouth. Fig 8-A-80 Since ceramometal crowns create normal
canine guidance, molars show the standard amount
of disocclusion.

Guide for lntraoral Adj ustment

It is very difficult to reproduce intraoral adjustments accurately from the ground portions on a
working cast. The following introduce a method for fabrication of the occlusal reduction guide
for equilibrating natural teeth intraorally (Figs 8-B-1 through 8-B- 29).
The steps to fabricate occlusal reduction guide are as follows:
1 ) An impression of the occlusal surfaces of study cast.
2) Complete the working cast.
3) Block out the cast except occlusal surfaces.
4) Box the cast and pour mixed clear resin.
5) Trim and smooth the occlusal reduction guide.
6) Mark the adjusted areas of the study cast in black.
7) Reduce the surface of the guide with a bur to expose the portion in black.
 /
Fig 8-8-1 Make a mold of the occlusal plane of the Fig 8-8-2 Use light-body impression material to make
stone model using silicone putty material. a detailed impression of the occlusal anatomy.

Fig 8-B-3 Impressions made of occlusal surfaces. Fig 8-8-4 Completed duplicate cast.
Pour the impressions using labstone.

Fig 8-B-5 Blockout areas except the occlusal surfaces Fig 8-8-6 Add wax between the utility wax and cast to
with utility wax. seal around the teeth.
 Chapter 8 F i Hd lkst11ra 11on-; and Ocrl usal Adjustm ent I Oi

Fig B-B-7 Build walls around the duplicate cast Fig 8-8-8 Apply separating medium to exposed stone
with boxing wax. surfaces.

Fig 8-8-9 Pour mixed autopolymerizing transparent Fig 8-B-1 0 Alter curing the resin in a pressure pot,
(clear) resin carefully to avoid creating bubbles. remove it from the duplicate cast. An occlusal
adjustment reduction guide should fit the duplicate cast.

Fig 8-B-1 1 Finishing the occlusal reduction guide, Fig 8-B-12 Trim and smooth the occlusal reduction
trimming evenly to 5 mm thickness. guide.
1 1 1 .-,

Fig 8-8-13 Completed occlusal reduction guide. Fig 8-8-14 While fabricating the occlusal reduction
guide. occlusal adjustments made on the working cast
are made under Condition 1 . The occlusal surfaces of
the wor k i n g cast have h a d c u s p a l i n t e r f e re nces
removed.

Fig 8-8-15 Use a black marker to color all adjusted Fig 8-8-16 The adjusted areas are marked in black.
areas.

Fig 8-8- 1 7 The black marks can be confi rmed Fig 8-8-18 Reduce the occlusal adjustment reduction
through the clear occlusal reduction guide. guide surface with a bur to expose the portion in black.
The bur must be positioned similar to use intraorally so
the occlusal reduction guide can be placed and followed
easily in the mouth.
 Chapter 8 F 1 �,-d l<t·'<t<o1 a t 1 1 •1i-. a n d Ocdusal .\diu�1n11·nt l f l' l

f"ig 8-8-1 9 Trimmed portions o f the occlusal reduction

guide are parallel to the adjusted surfaces on the cast.
The slope of the guide directs the bur so the amount
of tooth structure can be removed intraoralty as on the
cast.

Fig 8-8-20 Maxillary cast and the occtusal adjustment Fig 8-8·21 Mandibular cast and occlusal adjustment
reduction guide. reduction guide.

Fig 8-8-22 Occlusal adjustment reduction guides Fig 8-8-23 Each occlusal guide is seated intraorally.
deltvered from the laboratory.
 1 111

Fig 8-8-24 Excess amount of tooth structure can Fig 8-8-25 Mandibular teeth after occlusal adjustment.
be identified easily since it protrudes through the
occlusal adjustment reduction guide. Move the bur
along the guide and remove the amount of tooth
structure level with the trimmed surface of the guide.

Fig 8-8-26 Occlusal reduction guide fitted to the Fig 8-8-27 Maxillary teeth alter occlusal adjustment.
maxillary teeth. Excess amounts of tooth structure are
seen protruding through the guide.

Fig 8-8-28 Fit the occlusal guide intraorally. Fig 8-B-29 View of tooth surfaces alter occlusa l
adjustment completed.
 Chapter 9

G roup Function

Group function i s indicated when cuspid guidance is absent due to the loss ·ne. J n
group function, t e amount of disocclus1on o n the working side during lateral movement must
be zero. The articulator adjustment values for "Condition 2," were values for a m utually
proteeted articulatjoo that produced the standard amount of djsocclus ion. The articulator
adjustment values for "Condition 2" must be modified . This can be done by changing the
lateratwmg angle of the anteriorg•1ide table tram 20 degrees to O degrees.
The modified adjustment values for "Condition 2" in group function are shown in Table 9- 1 .
Under the above conditions, the amount of d isocclusion on the nonworking side become 0.5
mm. When group function is employed, it is not necessary to change values for "Condition 1 "
(Figs 9-1 through 9- 36).

Table 9-1 Articulator adjustment values for Condition 2 in

group function (mm).
Condylar path i
Anterior guide table
-5;-
� ;
path mchnat1on l
t�����-dylar eenn��-�:��el - � Sa_g i�-1-l_ �L;��;
mchnat1on : wing angle al
-.

i
--·--- ------------·
40 · 15 45 ----· -· 0-- · ·- ---- -
for Condition
in Table 3-2.
Note: Articulator adjustment values 1 are the same as
Condition I
1 1 :!

Fig 9-1 The treatment plan tor this patient included Fig 9-2 Occlusal view ol the maxillary working cast.
restoration using osseointegrated implants. Since
immediate surgery was contraindicated due to the
patient's health condition, a fixed partial denture was
fabricated as an interim prosthesis. A mutually protected
occlusion is contraindicated due to the missing canine.
To distribute lateral forces on the remaining teeth, group
function must be created.

Fig 9-3 Measurement for the facebow record. Mark Fig M Mount the maxillary cast.
the anterior reference point 43 mm above the incisal
edge of maxillary right central incisor toward the
infraotbital margin.

Fig 9-5 Mount the mandibular cast with the teeth in Fig 9-6 Maxillary and mandibular casts mounted
maximum intercuspation. on the articulator.
 Chapter 9 G roup Fu nction 1 1 :s

Fig t-7 Since the maxillary anterior segment includes Fig M Remove the mandibular anterior segment. The
prepared teeth planned with some posterior abutments, articulator is adjusted to the red lines lor Condition 1 .
the mandibular anterior segment is made removable.

Fig M Occlusal view of completed wax-up.

Fig 9-11 The standard cusp angle la created in the

Fig t-10 Ooclusal surfaces of posterior teeth are made
to slide in contact with opposing teeth during eccentric posterior wax-up.
movement
1 1 1

Fig 9-1 2 Adjust the sagittal condylar path to Condition sti

Fig 9-1 3 To create group function during n t lateral
2 ; the scale is adjusted to the blue line. movement. the left lateral wing angle of the anterior
guid_!table is adjusted to 0 d�es. Since disocclusion
occurs dunng lateral movement, the right lateral wing
angle is adjusted to the blue mark (20 degrees). For
each case. sagittal inclination of anterior guide table is
adjusted 10 the blue mark (45 degrees).

Fig 9-1 4 Replace the anterior segment of the

mandibular cast.

Fig 9·1 5 Move the articulator through right la te ral Fig 9-16 Move the articulator through latera l movement
and make sure the anterior guide pin slides on n-,e
movement and use occlusal marking ribb<>t to mark
surface of the anterior guide table.
contacts.
 C hapter 9 (; ruup Functmn 1 1 �>

Fig •17 Adjust the carbOn-marked areas to create the Fig •1 1 During right lateral movement. all working side
appropriate occlusal scheme. teeth contact in group function.

Fig •19 Right working side showS group function. Fig •20 The canine guides while the posterior teeth
dtsoccl ude during left lateral movement.

are cast
Fig •21 After making cut-backs. wax patterns
finished and porcelain iS applied and ba
ked.
1 l fi

Fig 9-22 Check occlusion in the bisque-bake stage. Fig 9-23 Move the articulator with the guide pin llong
the anterior guide table to obtain a correct guiding
surface.

Fig 9-24 When the guide surface is incorrect, marks Fig 9-25 Adjust the marks to remove the interferences.
demonstrate interferences.

Fig 9-26 Group function is created after adjustment. Fig 9-27 Disocclusion is created during left lateral
The anterior guide pin contacts the antenor guide table movement.
during the movement.
 Chapter 9 c ; roup F u nction 11i

fig 9-28 Fix the 3 mm position index on the condylar Fig 9-29 Move the articulator through protrusive and
wall. right and left lateral movements and make a silicone
record for each movement position.

Fig 9-30 Occlusal view of the completed fixed partial

denture.

Fig 9-32 Measure the amount of disocclusion at each

Fig 9-31 Fit the prosthesis intraorally.
eccentric position using a leaf gauge.
1 18

Fig 9-33 The group function created on the articulator Fig 9-34 The amount of disocclusion on the non­

function is 0.5 mm, one-haff the amount produced In a

is created in the mouth. The amount of disocclusion on working side during right lateral movement in group
the working side during right lateral movement is 0 mm.
standard case.

Fig 9-35 Since mutually protected occlusion is created Fig 9-31 The amount ol disocclusion on the wortclng
during left lateral movement. the amount of dlsoccluslon side during left lateral movement is 0.5 mm.
on the nonworking side is 1 .0 mm.
 Chapter 1 0

Occ l usion for

Osseoi nteg rated I m plants

The ideal occlusion on an osseointegrated implant has not been investigated with six degrees
of freedom biomechanically. The current accepted tenet is to avoid horizontal forces on
fixtures. The authors propose the following guidelines based on their clinical results:
1 ) With natural anterior teeth p re se nt and fixtures i m p l a nted i n the m o l a r r e g i o n ,
disocclusion must b e created.
2) When the fixtures are implanted in the anterior region and natural molars are present,
group function must be created.
3) For edentulous cases, a balanced articulation must be created.
The various occlusal schemes prescribed in the fabrication of an implant suprastructure ca n
be created easily using combinations of articulator adjustment values. The t w i n - stage
procedure is very effective in laboratory protocol for this type of dental treatment. Articulator
adjustment values necessary to obtain each occlusal scheme are shown in Table 1 0- 1 .

Articulator adjustment values for osseointegrated Implants cases (deg).

:
Table 1 0-1

'f
i
(1 l Condition 1

( 2 1 : Condition 2
- - -- - -
-·- · - - --· - - - - - ---·· --

I
Type of Implanted Occlusal Condylar path
lncisal guide table
adjustment
portion of fixture scheme adjustment values
Suprastruc- values

tu re
Sagittal
+ ·· ·--- - -

Sagittal
-·----

Lateral wing

,_
inclination
--.---
incl ination angle

-- -
-·-·

(1) (2) (l l (2) {1 ) (2)

- - - ----· ,______ ... --

------ --
- ·- - -· ·-- - ·· - - -- - ·
----·-·-· ·--· - --

Posterior area MPA 25 40 25 45 10 20

Edentulous ·-· - - - -

Anterior area GF 25 40 25 45 10 0

Anterior/

I I
Complete BA 25 25 25 25 10 10
fixed Imp lant Posterior area
prosthesis

Bennett ment value Is flxed a s 1 5 degrees.

angle of the condylar path adjust
1 :! 1 1

Case 1

Fig 10-A·1 Occlusal view of the maxillary teeth shows Fig 10-A·2 View of mandibular teeth show i mplants In
an implant in tooth no. 1 4 position. Since healthy anterior tooth nos. 1 9 and 20 positions.
teeth e x i s t , a mutually protected occlusion is the
appropriate occlusion.

Fig 1 0·A·3 Maxillary working cast . Anterior tooth Fig 10-A-4 Mandibular working cast.
segment is made removable. The implant site is made
with a soft-tissue model.

Fig 1o-A-5 Make the lacebow record. Fig 1 0-A-6 Mount the maxillary working cast.
 Chapter 10 OtTlu,ion l1 1 r Osw11111tt·i:r<ikd I m plants 121

Fig 1 0-A-7 Maxillary and mandibular working casts are

mounted on the articulator in maximum inter-cuspation.

Fig 1 0-A-8 To create a standard cusp angle on the Fig 1 0-A-9 The scales of Iha anterior guide table are

Condition 1 (red line).

superstructure, the sagittal condylar path is adjusted to adjusted to Iha red marks for Condition 1 .

Fig 1 0-A-10 Remove the ma� illary anterior segment

.
to remove the influence of antenor guidanCe.
Fig 1 0-A·1 1 Move the articulator through eccentric Fig 1 0-A- 1 2 Locale interferences using occlusal
movements and check if the maxillary and mandibular registration strips of 1 2.5 µm in thickness.
teeth slide in oontact evenly.

Fig 10-A-13 Adjust the interfering areas. Fig 10-A-14 Maxillary and mandibular molars slide in
contact evenly.

Fig 1 0-A-1 5 Lateral view of the working casts. The Fig 10-A-1 6 Estheticone (Branemark) abutn1ents are
occlusion on the implants can be controlled precisely. used for esthetic purpose.
 Chapter 10 Ot:rlu"'"" lor Ossl'nintt·i.:ratrd Impl a n ts I :n

Fig 1 0-A·17 Fix the gold cylinders on the abutments Fig 1 0-A- 1 8 Fit the plastic sleeve and cut to the
using guide pins. appropriate length. Make a framework by connecting
the sleeves with a pattern resin.

Fig 1 0·A·11 Crown wax-up fulfills esthetlcs and

oc:clu&al morphology conditions.

Fig
used to Fig 10-A-21 Fix the gold cylinder over the abutment.
10-A-20Estheticone abutment will be
maximize esthetic results.
l�I

-up f u lfills esth etic s a n d

Fig 1 0-A-22 F11 the plastic sleeve and build pattern Fig 1 0-A -23 C rown wax
ns.
resin over the cylinder. occlusat morphology conditio

Move the articulator through eccent ric Fig 1 0-A-25 Confirm wax pa1lerns slide in contact
movements . with articulating teeth evenly.

Fig 1 0-A-26 Occlu:;;il view ot niax1llary wax pattern. Fig 1 0-A-27 Occlusal view of mandibular wax patterns.
 Chapter 1 0 <kdu�1on l<•r (h�co111tq:ratt·d Implants 1 25

Fig 1 0-A-28 Replace the maxillary anterior segment

to cheek the amount of disocclusion.

Fig 1 0-A-21 Adjust the sagittal condylar path to the Fig 10-A-30 The scales of anterior guide table are
blue line for condition 2. adjusted to the blue marks for Condition 2.

disoccluslon Fig 10-A-32 The standard amount of dlsocclusion

Fig 1 0-A-31 The sta ndard amo unt of
ement. ocx:urs during right lateral movement.
occurs during left lateral mov
Fig 10-A-33 Completed superstructure for the implant· Fig 1 o-A-34 Completed supe rstructure for the
supported unit. mandibular implants.

Fig 1 0-A-35 Move the articulator through eccentric Fig 10-A-38 A predictable amount of disocclusio n
movement. occurs between posterior teeth.

Fig 10-A-37 Occlusal view of superstructure placed F i g 1 o-A-38 Occlusal view of sup e rstructure .
inlraorally. mandibular implants.
 Chapter 10 Occlus1on for Osseomtegr�tl•d Implants 127

Fig 1 0-A-39 Cuspal interference as shown in Flg.10- Fig 1 0-A-40 Fit t h e occlusal adjustment reduction
A-13 on t h e opposing molars i s identified. g u ide . The area protruding through the occlusal guide
is adjusted.

Fig 10-A-41 Following the positioning slopes created

in the occlusal reduction guide.

Fig and mandibular Fig 1 0-A-43 Left lateral movement creates a

1 0-A-42 Left view of � maxillary
predictable amount of dlsocduaion.
teeth in maximum intercuspatiOn.
Fig 1 0-A-44 Right view of the maxillary and Fig 1 0-A-45 Right lateral view creates a predlctable
mandibular teeth in maximum intercuspalion. amount of disocclusion (right lateral view).

Case 2

Fig 1 0-B-1 Occlusal view of maxillary teeth with Fig 1 CMl-2 Six nxtures are .visible in the mandibular
multiple preparations. posterior areas.

Fig 1 0-8-3 Maxillary working cast. Anterior tooth Fig 1 0-8-4 Mandibular working cast. The Implant
segment is removable. areas have soil-tissue models incorporated Into the
working cast.
 Chapter 10 On:lu s1rin lor Oss1:ointl·i;:ratC'd Implants I :!9

Fig 1 0·8·5 Occlusal record frames are fabricated Fig 10-8-6 Use gold screws to fix the record frame
combining impression copings with pattern resin. Note on the abutment.
the indices shaped in the resin.

Fig 10-8-7 View of the occlusal records fixed on the Fig 1 0-S-8 Make the centric relation record using
mandibular Implants. the occlusal record frame.

Fig 10-8-9 Make a facebow record. Fig 1o-B-10 Mount the maxillary working cast.
1 30

Fig 1 0-B- 1 1 F i x the occlusal record frames o n the Fig 10-S-12 Place the record material over the frame
working cast. on the working cast.

Fig 10-S-13 Mount the mandibular cast. Fig 10-8-14 Maxillary and mandibular working casts
are mounted on the articulator in centric relation position.

Fig 1 0-8-15 To create a standard cusp angle on the Fig 10-8-16 The scales of the anterior guide table are
superstructure, the sagittal condylar path of the articulator adjusted to the red marks for Condition 1 .
is adjusted to the red line for Condition 1 .
 Chapter 10 Ordusllln fu r Ossl'ointei:ratl'd I m plants nI

Fig 1 0�8-1 7 Remove the maxillary an terior tooth Fig 1 O-B - 1 8 The influence of anterior guidance is
segment. removed for the posterior wax-up.

Fig 1 0·8·1 9 Place the plastic sleeves on each

abutment and make a frame with pattern resin.

Fig 1 0-B-20 Right lateral view of wax patterns. The Fig 10-8·21 Left lateral view. The molars slide in
molars slide in contact evenly with the opposing wax­ contact evenly with articulating teeth during eccentric
up during eccentric movement. movement.
1 3�

Fig 1 0·8·22 To check disocclusion. the maxillary

anterior tooth segment iS repositioned.

Fig 1 0-S-23 Occlusal view of completed maxillary wax Fig 10-S-24 Occlusal view of mandibular wax patterns.
patterns.

Fig 1 0-B-25 Sagittal condylar path is adjusted to the Fig 1 0-B-26 The scales of anterior guide table are
blue line for Condition 2. adjusted to the blue marks for Condition 2.
 Chapter 10 Ckduo;ion for o�sl'oi n tl'i?ratl·d I m p l a n ts I :n

Fig 1 O-B-27 A predictable a mount of disocclusion Fig 1 0-8-28 A predictable amount of disocclusion
occurs during right lateral movement. occ urs during left lateral movement.

Fig 1 0-8-29 Right lateral view of disocc l usion Fig 1 H-30 Left lateral view of disocclusion between
between completed restorations. completed restorations.

Fig 1 0-B-31 Occlusal view of maxillary restorations Fig 1 0-B-3 2 Occlusal view of t h e mandibular
seated intraorally. restorations.
J J.1

Fig 1 0- B -33 R ight lateral worki ng movement Fig 1 O-B-34 Left late ral working movement
demonstrates a predictable amount of disocclusion. demonstrates a predictable amount of disocclusion.
 Chapter 1 1

The Rationale for

the Twi n-Stage Proced u re

Concept in G nathology

The twin-stage procedure based on the theory of occlusion by Hobo and Takayama is
introduced in this book. The authors categorized it as improving concepts in gnathology.
Gnathology was established by Beverly B. McCollum in 192 1 . Gnathology contrib11ted-to the
science of dentistry by helping establish the concept of centric relation and develop a method..
for itsclinical use. It also inventing the pantograph as a measuring device for the condylar path.
The Tully adjustable articulator was then developed to reproduce mandibular moveme n t .

These instruments were utilized in formulating concepts of physiological distribution of the

horizontal forces produced during eccentric movement (Stuart, Golden 1984) .

Reproduction of centric relation

In 1924, Robert Harlan and Beverly B. McCollum developed the first consistent method for
locating the terminal hinge axis and established the concept of centric reiation (McCollum,
Stuart 1955). With the help of Charles E. Stuart, centric relation was defined as the RUM
(rearmost.upper most and midmost)position. It was used as one of the principles of gnathology
for more than half a century.
Frank V .Celenza treated 32 full-mouth reconstruction cases using the R U M position
coincident wi th maximum intercuspation and followed the results for 2 to 12 years. In 1973,
he reported that only two still showed maximum intercuspation coincident with the RUM
position. From this finding, he doubted if the RUM position was really useful as a standard
of occ l usion (Celenza 1973) .
I n 1984, he stated: "the glenoid fossa is not line� with articular cartilage which begins
at the anterior border and continues anteriorly down to the articular eminence. The condyle
has articular cartilage on its anterior and superior surface. In order to articulate these
surfaces, the condyle must be placed anteriorly. Besides, the posterior band of the articular
disk is an unfavorable area for art iculation since nerve and vascular impingement most likely
occurs" (Celenza 1984) . Based on this observation, Celenza recommended the antero­
superior position for centric relation. In GPT-5 ( 1987) , the definition of centric relation was
revised from "most retruded" to an "antero-superior position.n

The terminal hin e axis is the rotational axis of the mandible when the condyle is at RUM
position and-@ransverse horizontal axis is the one when e co e 1s at the antero-
"
superic); '2Q§iljon. Both axes exist about 0.2 mm apart (Hobo, l�ata 1985).
When a facebow transfer is made, the horizontal axis is used as a posterior reference.
Clinically, it is almost impossible to measure the axis when the condyle is positioned antero-
 Table 1 1 - 1 The effect ol the difference between terminal
hinge axis and transverse horizontal axis. measured at the
second molar position.

Amount of Anterior!
Discrepancy: 0. 2mm

Opening I , Centric Eccentric

:

Lucia jig 3 mm 8 11 m 2 11m

. -- __ j_ -
Leaf gauge I mm 3 11 m , 0. 711m

superiorly. Therefore, when measuring the horizontal axis, the dentist is compelled to push
the conclyle forcibly to the most retruded position or RUM position. The axis obtained in
such a way is the terminal hinge axis and not a transverse horizontal axis.
It is now common practice to deprogram the neuromuscular mechanism when recording
centric relation . Lucia's anterior jig was designed to g uide the condyle into the most
physiological position in the glenoid fossa during recording of centric relation (Lucia 1 964).
The leaf-gauge has been used for recording antero-superior position while blocking the
neuromuscular mechanism (Long 1 973, Williamson et al 1 980, Woelfel 1 986). Centric relation
is usually recorded at the antero-superior position, which is the transverse horizon'talaxis,
whereas the terminal hinge axis is used when mounting the maxillary cast on an articulator.
hen mounting the mandibular cast on the articulator, antero-supe rior position (the

Using the authors' analysis, 1t was found that the effect of the difference between the two
transverse orizontal axis) is used. This c_?_nfuses most deotists.

O. 7 to 2 µm on the cusp path during eccentric movement. Since the results show that the
rotational axes was less than 3 to 8 µm at the second molar position in centric and less than

influence between the axes are small, it is possible to utilize either rotational axis clinically.
I n daily clinical practice, the arbitrary axis obtained by an earbow-type facebow is
commonly used. However, estimates of a maximum error of + 5 mm between the arbitrary
axis and the measured terminal hinge axis can be found in the literature (Gordon, Stoffer

relation record is 3 mm thick and a n error of + fi mm exists, the occlusal position can deviate
1 984, Schulte et a l 1 984, Palik et al 1 985, Bowley, Bowman 1 992). Assuming the centric

a maximum of + 400 µm mesiodistally. This error is too large.

When reproducing centric relation in cases with excessive occlusal damage, it is better to
use the measured terminal hinge axis, not an arbitrary axis. The concept of centric relation,
one of the original subj ects gnathology emphasized, was p a rtl y revised but remains valuable
and useful.

Reproduction of the eccentric relation

Initially in gnathology. a balanced articulation was used as the ideal occlusion for eccentric
relations. In order to apply this occlusal scheme to restorations, an articulator becomes very
important espe c i a l l y to accomodate the side shift. A rticul ator adjustment and precise
reproduction of eccentric movements are two questions that need clarification.
 C hapter 1 1 Tht· R a t w n a h: for tht· T w i n StaJ.il' Prol'eclun· U7

Fig 1 1 -1 Recording a pantograph tracing. Fig 1 1 -2 Transfer of the tracing t o the fully-adjustable
articulator.

McCollum recorded the condylar path of the patient using a pantograph and found it did not
change either when the mandible was guided by cusps of the natural teeth or using clutches
with various bearing pins (McCollum, Stuart 1 955). From these findings, he concluded that
the condylar path was a fixed factor in individuals and anterior guidance could be altered .
This became an accepted concept i n dentistry. Thus, the posterior two apices of the
mandibular triangle were further emphasized. The condylar path became the most important
determinant within the fundamentals of occlusion. The fully adjustable articulator was
developed for precise reproduction of the condylar path.
When D'Amico (1 958) introduced cuspid orotected �iculation, then Stallard and Stuart
modified it toanterior guided articulation ( 1957,63)the concept of an ideal occlusion shifted from a
balanced articulation to a mutually protected articulation. The reproduction of disocclusion drew
attention and anterior guidance, closely related to disocclusion, became the focus.
A subject that requires investigation within gnathology concerns how to control anterior
guidance and provide proper disocclusion. However, previous research methods used in
Gnathology have not addressed these problems because the methodology was too primitive
to compare with the electronic systems used today'.
The authors used an electronic measuring system with six tiegrees of freedom, which had a
superior measuring capability surpassing the mechanical pantograph. In addition, research
between Hobo, a dentist, and Takayama, a physicist has been well documented. They used
the mathematical model for mandibular movement as an analytical tool and proceeded with
the computed analyses.
The research results in the field of dentistry must be applicable and effective for clinical
use. The authors focused on a detailed study of the condylar path leading to development of
a computerized pantograph and fully adjustable articulator as clinical tools (Hobo 1 983) .
H owever, t h e authors found that clinical results i n reproducing d isocclusion were
unsatisfactory.
During the course of fundamental research using the electronic measurin g system , the
results,
authors found large deviations in the condylar path. Through these experimental
which has been regarde d as an
questions arose about the concept of the condylar path,
important reference in occlusion for years.
I :l8

Using mathematical analyses, the influence of the condylar path on disocclusion was found
to be less than was previously thought. It was one-half to one-fourth the influence compared
to the incisal path effect on disocclusion. From these results, use of the condylar path as the
major reference for occlusion became questionable.
Since the influence of the incisal path on disocclusion is important, the authors tried to
determine if the incisal path would become a new reference for occlusion instead of the
condylar path. William H . McHorris determined the appropriate amount of anterior guidance
and introduced many new findings. He reported the sagittal inclination of the incisal path
should be no more than 5 degrees steeper than the sagittal inclination condylar path; if
greater than 5 degrees, the patient complained of discomfort (McHorris 1 979).
This suggestion was tested in the twin-stage procedure. However, the 5 degree difference
of the incisal path produced only 0.2 mm disocclusion, 20% of the standard amount. Besides,
anterior guidance showed large variations among individuals. The authors concluded the
incisal path also was not acceptable as reference for occlusion.
The last element to be considered was the cusp angle. As previously mentioned, there was
minimal variation in cusp angles of molars among individuals. The authors concluded the
cusp angle was the most suitable reference for occlusion and new prosthetic procedures were
established based on this concept. This is a departure from the theory of the condylar path

The authors studied the effects of the twin-stage procedure in vitro and in vivo. It was
that has been regarded as the most important reference in occlusion for years.

found that disocclusion occurred evenly within 0.1 mm in accuracy in both tests. The value of
any clinical procedure should be partially based on efficiency, and from this perspective, this
has been demonstrated to be efficient and predictable.

Future pantograph development

Now it is not necessary to measure the condylar path with development•of the twin-stage
procedure. This does not mean the measurement of mandibular movement is obsolete. The
pantograph is an effective tool in the diagnosis and assessment of temporomandibular joint
disease and considered to be essential for educational purposes.

triangle has two degrees of freedom for movement (a total of six degreesoT freedom). The
During the movement of the mandible in three-dimensions, each apex of the mandibular

mandibular movement measurement system must be capable of measuring to six degrees of

process the 011tput data and analyze the res.ults, a computer-assisted pantog raph is
freedom to perform a complete measurement. In order to rn�asf:.!re the movement accurately,
__

indis� . Since the mechanical pantograph 1s norcorrfmteriZed-andTaa<s -onea ex,

Therefore, the mechanic.al pantograph does notfulfill the purpos�

(the anterior position), it is capable o measurement in only fou r degrees of freedom. ·

Development of a computerized measuring system for mandibular movement with six

degrees of freedom continues to be important. The database for mandibular movement with
six degrees of freedom is still insufficient, and accumulation of additional measurement data
is necessary.
The next generation pantograph system must be a total system capable of measuring
eccentric and masticatory movements with six degrees of freedom under tooth-contact
condition.It must be capable of measuring opening and closing movements in reference to a
horizontal plane, centric relation position, vertical dimension, and measuring muscle activity.
The addition of computer graphics would be helpful for patient education.
 Chapter 1 1 The R a tion a le for the Twin -Sta�r Procedure I '.-19

A dilemma i n Gnathology

Peter K. Thomas treated more than 1 ,000 patients requiring full-mouth reconstructions and
was judged by his high success rate. The cusp-fossa waxing technique developed by
Thomas is used widely in the practice of gnathology (Thomas 1 967, Thomas, Tateno 1 976).
On occasion as a guest lecturer at the I nternational Dental Academy (Tokyo, Japan), he
frequented the laboratory and repeatedly taught " don't make the cusps too steep." He felt if
the cusp was made too steep, the teeth would be loaded heavily by horizontal occlusal forces
and could result in clinical failure. Based on this concept, Thomas taught waxing shallow cusp
angles.
Experienced clinicians and technicians often find the movement of the articulator is not
coincident with the facets on the cast when an articulator is adjusted using condylar path
measurements. Donegan et al (1 99 1 ) reported there were differences between the measured
valu� of the condylar path obtained by the "check bite" mefh6cf(31" degrees) ana l>Y-adjusting
the articulator to match occlusal facets on the cast (24 degrees):- - - ·- ·
The existence of a facet indicates the maxillary andmandibular teeth slide along an
- - - ·- -
· · · · -

abraded surfac.e. This phenomenon cannot be explained unless the exTste.nce of another
condylar path is introduced; the existence of both eccentric and reh.ffmng condylar paths is
suggested.
-
Assuming the measured value of the sagittal condylar path is 40 degrees and the wax-up is
done on an articulator with this condylar path setting, the cusp angle becomes 40 degrees
which is steeper than the average cusp angle (24 degrees) of natural teeth. This will result in
a cuspal interference on the returning mandibular movement. The validity of reproducing the
condylar path to produce good occlusion was a dilemma in gnathology. In the twin-stage
procedure, the cusp angle was set shallow (25 degrees). The authors believe that this may be
what Peter K. Thomas intended.

The Practice of Gnathology

There has been criticism that gnathologic concepts are too soph isticated, a barrier for
applying concepts to everyda� ractice. In an attempt to solve this problem, Guichet ( !�69)
refined it by developing..-{1}ra fully adjustable articulator with a si ngle-axis mechanism
equipped with a compact condylar guidance mechanism, (�umatic, small-sized, light­
weight pantogra J?!l . �eory fn which maxillary and mandibular restoratioJW easily
disocclude by adjusting the condylar path traci ount of motion on the articulator is
slightly larger than e motion of a living body.
In the twin-stage procedure, it is possible to provide a predictable amount of disocclusion
for a restoration scientifically without measuring the condylar path. This should contribute to
an easier understanding of gnathological concepts.
I n standard gnathological procedures, it is necessary to remount the case to correct occlusal
discrepancies by trial-and-error to obtain point-centric contacts and insure disocclusion. Such a
method was introduced in detail by Lucia ( 1 983) and has been regarded as an essential
p rocedure. Howeve r, since m utually protected articulation with a specific amount of
disocclusion can be produced easily by applying the twin-stage procedure, adjustments during
remount procedures become easier. This new procedure will enhance a dentist's ability to
provide excellent restorations and improve overall patient care in clinical practice.
CAD/CAM i n dentistry

The search for making restorations using computer-assisted devices is occurring in the field
of dentistry, stimulated by the progress in CAD/CAM technology within the industrial field.
This is based on the concept of making restorations uti l izing a computer-aided milling
machine. Developing a computer-assisted milling machine with a sophisticated measuring
system is needed to correspond to individual tooth alignment, esthetics, morphology and
occlu sion. Comp letion of the next level of care would be unreal istic under the present
technology.
Dentistry is customized treatment. Accordingly, the custom nature of dental treatment must
be incorporated into CAD/CAM for dentistry. The authors' research has been performed
based on computer-aided designs. Therefore, the norms for cusp angle (design data) on
which the new procedures based were established with the aid of computers. In order to
actualize these norms for cusps on restorations, the adjustment values for an articulator were
also computed with the aid of a computer. The twin-stage p rocedu re is analogous to
CAP/CAM, but addresses many needs in dentistry.

Current trends

Today the procedure for establishing centric relation position is used in its original form, but
use of a pantograph and a fully-adjustable articulator are rare except by some specialists. As
a result of not u si ng a complicated articulator, many dentists use whatever is available
including a simple hinge-type articulator. Consequently, occlusion has become a minor
concern in daily clinical practice.
The occlusion of restorations is considered to be of concern primarily for laboratory
technicians, not for dentists. A dentist commonly delegates the work to a laboratory technician
after he makes an impression. When a restoration is finished in the laboratory, the dentist
simply places it in the patient's mouth. If it does not occlude well, he places the responsibility
on the laboratory technician. A dentist seems to ignore occlusion and focuses his interests on
other subjects like esthetic dentistry or osseointegrated implants.
In academic presentations, most speakers just show slides of "before" and "after" treatment
and omit the intermediate procedures. When the speaker is asked how the laboratory work
was done, he replies it was a matter for the laboratory technician. In the past, it was very
important for a speaker to show intermediate laboratory procedures in detail.
McCollum emphasized through gnathology that dentistry should address the problems of
occlusion, scientifically. Dentists should treat patients ethically, based on scientific support. In
order to maintain and enhance success in gnathology, it is necessary to re-focus clinical
treatment.
 Chapter 1 1 Thi· l fa t 1 < 1 n a l t· f, , r t ill' T w 1 11 StaJ.:l· l' ron:d u rt 1 ·1 1

References

Bowley JF, Bowman HC : Evaluation of variables associated with the transverse horizontal
axis. J Prosthet Dent, 1 992;68:537 - 541 .

Celenza FV : The centric positin - replacement and character. J Prosthet Dent, 1 973;30:
591 - 598.

Celenza FV : The theory and clinical management of centric positions: centric relation and
centric relation occlusion. I nt J Periodont Rest Dent, 1 984;6:63 86. --

D'Amico A : The canine teeth, Normal functional relation of the natural teeth of man . J
South Califortia Dent Assoc, 1 958;26( 1 ) - 26(7).

Donegan SJ , Christensen LV : Sagittal condylar guidance as determined by protrusion

records and wear facets of teeth. I nt J Prosthodont, 1 99 1 ;4:469 -- 472.

Gordon SR, Stoffer WM, Conner SA : Location of the terminal hinge axis and its effect on the
second molar cusp position. J Prosthet Dent, 1 984;52:99 - 1 0 5 .

Glossary of Prosthodontic Terms. 5th ed. The Academy of Prosthodontics. J Prosthet Dent,
1 987;58:7 1 7 - 762.

Guichet NF : Procedures for Occlusal Treatment. Anaheim:Denar, 1 969;71 · - 77.

Hobo S : A kinematic theory of the measurement of the mandibular movement and a computerized
pantograph. J Gnathol, 1 983;2:9 - 26 .

Hobo S, Iwata T : Reproducibility of mandibular centricity in three dimensions. J Prosthet Dent,

1 985;53:649 - 654.

Long JH : Locating centric relation with a leaf gauge. J Prosthet Dent, 1 973;29:608.

Lucia VO : A technique for recording centric relation. J Prosthet Dent, 1 964; 1 4:492 - 505.

Lucia VO : Modern gnatholological concepts updated Chicago;Quintessence, 1 983;305 - 328.

McCollum BB, Stuart CE : A Research Report. CA;Scientific Press, 1 955;6.

McHorris WH : Occlusion with particular emphasis on the functional and parafunctional role of
anterior teeth, Part II. J Clin Orthod, 1 979; 1 3:684 - 701 .

Palik J F , Nelson OR, White JT : Accuracy of an earpiece facebow. J P rosthet Dent,

1 985;53:800 - 804.

Schulte JK, Rooney DJ , E rdman AG : The hinge axis transfer p rocedure: A three­
dimensional error analysis. J Prosthet Dent, 1 984;51 :247 - 25 1 .

Stuart CE. Stallard H : Diagnosis and treatment of occlusal relations of the teeth . Paper
presented at the 77th Annual Session, Texas Dental Assoc., San Fransisco : U niversity of
Carifomia P ress, 1 957.

Stallard H, Stuart CE : Concepts of occlusion - what kind of occlusion should recusped tooth
be given. Dent Clin North Am, 1 963;7:59 1 - 606,655 - 660.
142

Stuart CE, Gordon IB : The History of Gnathology, Ventura, Calif;CE Stuart, 1 981 ;64.

Thomas PK : Syllabus full-mouth waxing technique for rehabilitation. Tooth to tooth

cusp -fossa concept of organic occlusion, 2nd ed. San Francisco:Univ of California, 1 967.

Thomas PK, Tateno G : Gnathological Occlusion. Tokyo:Shorin, 1 976.

Williamson EH, Morse PK, Swift TR : Centric relation. A comparison of muscle determined
position and operator guidance. A J Ohio, 1 980;77: 1 33 - 1 45.

Woelfel JB : New device for accurately recording centric relation. J Prosthet Dent, 1 986;56:7 1 6 -
727.
 A p p e n d ix

M athematica l Formu lae for

Ana lyzing Mandibular Movement

Takay�nd Hobo rep art�n �e �����

o rmula�_for -�and ij;>JJlar movement that were
derived from a kinematic theorem, as thematical Model of Mandih11!ar Moveme nt"
(Takayama 198 7 , Takayama, Hobo 1 989, 89 ). Then, they developed a math ematical
•

formulae for computing the amount of d isoccl usion based on the k i nematic formulae for
man d i bular �ent (Takaya� 994, �-
I n this book, computed results we re used for analyzing the mechanism of d isoccl usion
and com puting the norm val ues for adjusting an articul ator. They were computed by
means of the mathematical form ulae for com puting the amount of disocclusion . I n the
Appendix, the k i nematic formulae for mand ibular move ment and the math ematical
formu lae for computing the amount of disocclusion will be descri bed, with the outl i n e of
the procedures for d eriving them.

Analytical Methods

M andi bular movement is controlled by the neuromusc ular system and its bord er
movement is restricted by the right and left condylar paths as well as the i nc isal path. I n
dentistry, the mandible is regarded a s a ri gid body and movements are measured
assuming that the mandible does not undergo any deformation d u ring movement.
Provided that the h uman mandible does not undergo any d eformation , its move ment i n
th ree-dimensional space can be analyzed b y m e ans o f t h e rigid body k i n ematics
established in classical mechanics (Goldstei n 1 950). Accord i n g to E u l er's theorem,
movement of a rigid body in three-di mensional space can be d escribed analyti cally by
th e th ree-dimensional displacement of a reference point defined on the rigid body,
together with the three-d imensional rotation of the rig id body around the referen c e point.

Kinemati c theorem

Let the reference coordi nate system in three-dimensional space be de noted by 00-X-Y­
Z, and the motion coordinate system fixed to the rig id body be denoted by 0-x-y-z. The
three-dimens ional displacement of the origin of the motion coord inate system, O, against
the reference coordinate system is denoted by ( A Ox, A Ov. A Oz ), the three-dimensional
rotation matrix of the rigid body around the origin by R, the u n it matrix by E, the three­
dlmensional coord inates of an arbitrarily selected target point on the rigid body in the
motion coordinate system by (A,B,C), and the three-d imensional displacement of the
target reference point in the reference coord inate system by ( A X, A Y, A Z). Then Euler' s
- ----- -·-- --· - -·----
·---

* G ranted for partial r�productio n by Gordon and Brearh "' 'l'nce Pu blishers.
Lau sanne·. Swiss
1 44

theorem in kinematics i s expressed b y the following matrix equatlon7.

(!;)= - G) + (!�J
(R E) x

The physical significance of the above equation is that three-dimensional movement of

z of the motion coordinate system with each axis X, Y, Z of the

a rigid body consists of one rotation and one translation. If the direction co�ines of pairs
of each axis x, y,

the general expression of the rotation matrix A is given by the following formula:
reference coordinate system are denoted by 1 1 ,12,13; m 1 ,m2,m3; n 1 ,n2,n3; respectively, then

A = ( �1
n,
;2
n2
;3
n3
) .

6 , Y , e, the rotation matrix A can be simplified

If the amount of three-dimensional rotation can be assumed to be min imal, then by
Introducing three components of rotation

)
to the following first-order approximation:

-6 -e
A =

(! -Y
1

Therefore, three-dimensional movement of a rigid body, as a first approxi mation, can

y

1
.

be expressed by the fol lowing formula:

Table 1
(!;) (! �; :) G) (!�J
= x

was obtained by expanding the above matrix expression, and Is used as the
+

basis of the following k i nematical analysis of mandibular movement.

Table 1
---- as a first-order approximation.

+
Kinematic formulae tor the three-dimensional movement of a rigid body
· · ·--· ---

AV=
A X = - BX & - c x e A OX
C X Y + A X S + 11 0Y

body
A Z = A X 9 - B X Y + A. OZ
(A. B. C.): Three-dimensional coordinates of an arbitrarily selected target point on the rigid In

reference
the motion coordinate system
( 11 X, /1 V, A Z): Three-dimensional displacement of the target reference point (A,B,C) In the
coordinate system
( A Ox, A Ov. ll. Oz): Three-dimensional displacement ol the origin ol the motion coordinate system, 0, In the
r eferenc e coord inate system
( 6 , Y . e ): Three components ol rotation of the rigid body around the origin of the motion coordinate
system against the reference coordinate system
 Appendix '.\lalhematical For m u l ae for :\ na l y z i n ii Mandibular '.\tovement HS

C'

The reference coordinate system and

the mandible. X: Anteroposterior axis -- ---c
Fig 1

(anterior is positive); Y: Right and left axis � -

(right is positive ); Z: Sup�oinferior axis
\' ---- ·-
. "

(in�rior is pos�e); C': Right condyle; c1:

Le condyle; I: lncisal point; M: Center of
the intercondylar axis; 6 : Angle formed by
the y-axis with the Y-axis in the plane X-Y;
Y : Angle formed by the y-axis with the I.
plane Y-Z; 9 : Angle by which the pl ane z-x
rotates around the y-axis.

Coord inate syste m s

The reference coordinate system 00-X-Y-Z can be fitted to the maxil lae. As shown i n Fig
1 , the X-axis is formed by the straight line running from anterior to posterior (with ante rior
positive); the Y-axis is the straight line running from right to left (with right positive): and
the Z-axis is the line running from superior to inferior (with inferior positive). The motion
coordinate system 0-x-y-z can be fitted to the mandible, with the system positioned so
that the axes are parallel in direction to the correspond ing axes in the reference
coordinate system 00-X-Y-Z at the initial point of movement, centric relation.
The y-axis corresponds to the axis connecting the centers of the right and left
condyles C ',C ' (intercondylar axis), and at the initial point, (centric relation), the axis is
arranged to coincide with the transverse horizontal axis when both condyles are located
in stable positions within the temporomandibular joint fossae and pressed slightly

The three components 6 , Y , 9 shown in Fig 1 indicate three-dimensional rotation of

superoanteriorly against an articulator d isk located anterosuperiorly within the fossae.

the motion coordinate system relative to the reference coordinate system: S is the angle
formed by the y-axis with the Y-axis in the plane X-Y; Y is the angle formed by the y­
axis with the Y-axis in the plane Y-Z; e is the angle by which the plane z-x rotates
around the y-axis. All angles are expressed in radians.

Notation and def i n itions

Table 2 shows each component of three-dimensio nal displacement for the centers of the
right and left condyles and the incisal point, and each component of the three­
d imensional rotation of the mandible, with nomenclature and notation for facial
dimension s. Table 3 gives nomenclat ure, notation and definitions for directiona l angles in
the condylar path and incisal path. Fig 2 is a schematic diagram illustrating these
notations and definitions for the condylar paths (upper figure) and the incisal path (lower
figure).
1 46

Table 2 Each component of three-dimensional displacement lor the centers of the right and left condyles and
the incisal point. and each component of three-dimensional rotation of the mandible. with nomenclature and
notation for facial dimensions.

Nomenclature Notation

(Protrusive movement)
Average anteroposterior displacement ol the centers ol the right and l eft condyles
b.Xcp
Average superoinferior displacement of the centers of the right and left condyles
b. Zcp
Anteroposterior displacement of the incisai point b. X1p
Superoinferlor displacement of the incisal point b. Z 1p

(Lateral movement)
Anteroposterlor displacement of the center of the nonworking side condyle b. Xc1
Lateral displacement of the center of the nonworking side condyle b. Yc1
Superolnferlor displacement of the center of the nonworking side condyle b. Zc1
Anteroposterior displacement of the center of the working side condyle b. Xw1
Lateral displacement of the center of the working side condyle b.Yw1

A Xu
Superolnferior displacement of the center of the working side condyle b. Zw1
Anteroposterlor displacement of the incisal point
Lateral displacement of the incisal point b. Y11
Superolnferlor displacement of the lnclsal point b. Zu

(Rotation of the mandible)

Horizontal component of lateral rotation around the center of the working side condyle
Frontal component of lateral rotation around the center of the work ing side condyle
Angle of hinge rotation around the lntercondylar axis during protrusive movement
Angle of hinge rotation around the lntercondylar axis during lateral movement

(Facial dimension)
Anteroposterlor distance from the intercondylar axis to the lnclsal point
Lateral distance from the origin of the motion coordinate system to the lnclsal point
Superolnferlor distance from lntercondylar allis to the l ncisal point
lntercondylar distance
,,
--- -- ________ _ ____ -- --·----- - _ _____,,_,

Note: 81 = 0 during protrusive movement, and B1 = Lc/2 during lateral movement.

Table 3 Directional angles and lengths In the condylar path and the inclsal path.

Nomenclature Notation Definition

. - --- ------

(Protrusive movement)

tan· 1( b. Zip/ b. X1p)

Sagittal Inclination of the protrusive condylar path O cp = tan·1( A Zc,,I A Xcp)

(( A Xcp)2 + ( A Zcp)2)
Sagittal Inclination of the protrusive incisal path O ,P =
Length of the condylar path during protrusive movement l'l cp =

tan. 1( A Zr,/ A Xc1l

(Lateral movement)
Sagittal inclination of the lateral condylar path O c1 =

ta n - 1 ( b. Zu/ A X11)
Bennett angle ol the lateral condylar path Be = tan ' 1 ( b. Yeti b. Xc1)

tan"1(AZ11/ AY11)
Sagittal Inclination of the lateral incisal path Ou =

tan-1( AY1i/ A X11)

Frontal inclination of the lateral incisal path � II =

( b. Yc1)2 + ( A Z.:.)2]
Horizontal inclination of the lateral incisal path 'l' u =
Length of the nonworking side condylar path l'l c1 = .; (( b. Xc1)2 +
------- ·----- --
---- --- ---- - ----- - -- --- . ---- - ----
 Appendix Mathematical For-mulae for Analyz ing Mandibular Movement 147

·
,---, ------· - -- ·--·--
c

/
Non- W orkina

I
x Conclylar Pa1h

Workin1 Condylar Path

Protru!!li\·c.­
Condylar Pa1h

�--

Fig 2 A schematic diagram Illustrating each

component of three-dimensional displace­
' .. • J . . .
ment for the centers of the right and left
condytes and the lnclaal point, and
'--'l'• , U.fl l.atPr•I
directional angles In the condylar paths and I nc1sal Palh
the lnctsal path. a: Condylar path (upper
Q .,
figure); C: Working condyle, c·: Nonworking
condyte; b: lnclsal path (lower figure). The

b
nomenclature of the other notations in the
flguree are shown In Tables 2 and 3.

Analytical procedures

The analytical procedures applied In this Appendix for deriving mathematical formulae
for computing mandibular movement have the fol lowing special features.
1 ) In kinematics, Euler's theorem confers the advantage of allowing the origin of a
motion coord inate system to be defined at an optional point on a rigid body. This
advantage has been used In this analysts. For each mode of mandibu lar movement,
the origin of the motion coordinate system fitted to the mandible was set at (1 ) the
(2)
center of the working side condyle (point C' or C ' in Fig 1 ) for lateral movement.
center of the lntercondylar axis (point M In Fig 1 ) for protrusive movement, and the

2) Each component of three-dimensional mandibular rotation during protrusive and

lateral movements Is approximately 1 • (ca.1 /60 radians) or less when the maxillary and
mandibular molar teeth oppose each other. Therefore, the first-order approximations
shown in Table 1 of the kinematic theorem, representing the three-d imensional
movement of a rigid body, were applied to the analyses provided that three­
dlmenslonal rotations were very small.

1 to calculate the three- dimensional displacement of a target point on the mandible

3) The first step was to derive kinematic formulae for mandibular movement from Table

during pr0truslve and lateral movements. The second step was to develop
mathematical formulae for computing the amount of dlsocctuslon first on a llvlng body
and next on an articulator during protrusive and lateral movement utl llz l ng the
kinematic formulae of mandibular movement obtained by the first step .
1 411

Kinematic Formulae for Mandibular Movement

Protrusive move m e nt

A Y are om itted from Table 1 . and the following

Since lateral d i splacement d uring protrus ive movement is unsta ble and is not based on

A Ov 0, 6 = O. Y 0. The formulae of Table 1

border movement, the form u lae for three
parameters are given with values: = = were

M in Fig 1 ), resultin g in the following

then applied to the origin of the motion coordi nate system d u ri n g protrusive movement,
ie to the center of the intercondylar axis (point
relationships:

F u rthermore, from the defi nitions of /\ cp and 0 cp g iven i n Tab l e 3, the following
express ions were obtained:

A d d itionally, i n Ta ble 1 e was rewritten as e hp · The form u l ae i n Table 1 were

partic u larized by these procedures to g ive k i n ematic form u lae for protrusive movement.
The results are shown i n Table 4. The three-di mens ional d i s placement d u ring protrusive
movement of an arbitrar ily sel ected target on the mandible can be cal c u l ated with these

0
formulae . I n this analysis, protrusive movement i s treated as two-dimen s ional movement

cp. 9 hp. /\ cp.

confined to the sagittal p l ane, so there are three degrees of freedom. The parameters
on th e r i ght-hand s i d es of the analytical formulae in Ta b l e 4 correspond to
the three degrees of freedom. e hp is the angle of h i nge rotation . d uring protrusive
movement; it represents the ang l e of rotation of the man d ib l e around the intercondylar

1 to the incisal point, and using the relationsh i p !::i. O z

axis and a p p l i e s with i n th e condylar path and the i n c i sal path. Applying the formulae i n
Table = A Zcp. the following
relation s h i p is obtained:

e h p - � Z ,0 - Zc0)
_
A
A 1
The above equation i n d icates that the angle of h i n g e rotation of the man d i b l e d uring
protrusive movement is related only to the d i fference between the s u p e roinferior
d i s p l acement of the i nc i sal point and the average sup eroinferior d i sp lacement of the
c e nters of the right and left condyles.

Table 4 Kinematic formulae for protrusive movement.

6 X = cos O cp X /\ c p c x e "P
6Z = s in O c p X !1 0., + A X 9 tip

Note: Notations are defined in Tables 2 and 3.

 Appendix Mathematical Formulat> for Analyz ing Mandibular �fovcment 1 49

Late ral movement

In the case of lateral movement to the right, the formulae in Table 1 were first applied to
the center of the working side condyle (right condyle) (point C' in Fig 1 ) , and the
following relationships were obtained: A O x = A Xw1: A Ov = A Yw1: A O Z = A Zwl.

(left condyle) (point c ' in Fig 1 ), and by substituting 6 1 for 6 , and Y 1 for Y , the following
Then the formulae in Table 1 were applied to the center of the nonworking side condyle

relationships were obtained, using the definition tan 0 c1 = ( A Zc1/ A Xc 1):

iA Xc1- �
Le
61 =

y 1 = tan O ci X 6 1 + ( A Xw1 X ta. �� c_L- A Z�}

__

The Bennett angle Be, frequently used in dentistry, can be su bstituted for A Yw1 using
the following relationship:
A Yw1 = (Lc X 6 1 + A Xw1)X tanB9.
Utilizing these procedures, the formulae in Table 1 were particularized to give
kinematic formulae for the right lateral movement. In the process, S 1 was su bstituted for
6 . y I for y . and e hl for e . Then A Ox . A Ov. A O z , y I and A Yw1 were eliminatited ,
using the above equations. Sign inversion was appl ied to the formulae to obtain a
positive value for B. Table 5 shows the results obtained .

T•ble 5 Kinematic formulae for lateral movement

--- --- - ---- ------- - --- - - - ·· - -- -
-----

(C Xtan O c1 + A + LcX tanBe)X 8 1 + C X (tan O c1 X ll Xw1 - A Z,.1)/Lc + tanB.X A"l<,.,

AX = B X 6 1 - C X 0 h1 + A Xw1

B Xtan O c1 X 8 1 + A X 0 111 + B X (tan C c1X A Xw1 - A Zw1)/Lc + A Zw1

AY =

ll Z =

- - - -· -- - -------- ----- - ·
-- - - -

Note: Notations are defined In Tables 2 and 3.

For left lateral movement, the formulae of Table 1 were first applied to the center of
the left condyle, c, (working side), and then to the center of the right condyle, C,
(nonworking side), to obtain formulae by the same procedures as for right lateral
movem ent. In this case, sign inversion was applied to 6 1, Y 1. A Y, and A Yw1 to g ive them
positive values, but not to 8. The formulae obtained were the same as for right lateral
movement. The formulae of Table 5, therefore, are valid as kinematic formulae for
calculating the three-dimensional displacement of an arbitrarily chosen reference point
on the mandible during both left lateral and right lateral movements.
Six degrees of freedom are allowed in lateral movement, with the six corresponding
parameters being 0 Cit Be. e hi· 5 I• A Xw11 and A Zw1. e hi is the angle of hinge rotation
during lateral movement; it represents the angle of rotation of the mandible around the
lntercondylar axis; and applies within the condylar and lnclsal paths. The value e hi
remains the same provided that the origin of the motion coordinate system Is located at
any point on the intercondylar axis. Therefore, if the origin of the motion coordinate
system is moved to the center of the intercondylar axis (point M In Fig 1 ), and the
formulae in Table 1 are applied to the lncisal point, substitution of ( A Zc1 + A Zw1)/2 for A
Oz gives the following relationship:
) '>(J

The above e quation ind icates that the angle of hinge rotation of the mandible d uring
lateral movement is related only to the d ifference between superoinferior d isplacement
of the incisal point and the average superoinferior d isplacement of the c enters of the
nonworking and work ing condyles.

T h e amount of d i s h armony in t h e l ateral i nc i s a l path

It is known that the amounts of sagittal displacement in the center of the work ing condyle
are relatively small, taking values of almost zero in the mean trajectory of 50 subjects
accord ing to a report by Hobo (Hobo 1 984). During life, the condyles are located in the
temporomandibu lar joint fossae, surrounded by soft tissue, and their paths are not
mechan ical ly d etermined like those of articulators. Therefore, it may be possible for the
paths to und ergo sl ight d eviations d u e to the i nfluence of muscu lar forces or to
i nterference between the max i l lary and mandi bular teeth. Since the forces of muscle
contraction influence the working side during lateral movement, it would be natural that if
the center of the working condyle, which is the center of lateral rotational movement,
were to move, it would move l aterally toward the exterior of the working side. However,
in every i ndividual, the center of the working condyle undergoes sagittal d is placements
which, although they are small, can not be neglected because they mean that the moving
ce nter of rotation deviates sag ittally. Relationship between the sag ittai d isplacements of
the work ing condyl e, 6. Xw1. 6. Zw1. and the X- and Z- components of the lateral incisal
path , have been analyzed. If the X- and Z- components of displacement of the incisal
point are d enoted by 6. X0;1 and 6. z0 11 when both 6. Xw1 and 6. Zw1 are equal to zero, and
by 6. Xau and 6. zau when 6. Xw1 and 6. Zw1 take some nonzero values, then from Table 5:
•

A Xa;1 - A X0;1
= 6. Xw1
0 0
6. Z u - 6. Z ;1 (1 /2)tan 0 c1 X 6. Xw1 + (1 /2) 6. Zwi
=

or conversely

6. Xw1 = ( 6. X0il - A X0il )

A Zw1 =
8 0
2( 6. Z ; 1 - 6. Z u) - tan O c1 X ( 6. X 011 - 6. X0;1).

The above equations show that the relationship betwe en the pair of val ues, 6. Xwi . 6.
Zw1 and the pair of values ( 6. X0 ,1 - 6. X 0;1). ( 6. Z 0 ,1 - 6. Z 0;1) is such that if both members of
one pair, whichever pair it may be, take a common value of zero, then both members of
the other pair also take the common value of zero; the pairs are mathematically in a
mutual cause-effect relationship.
The result of an experim ental analysis for the relationship was reported by Hobo and
Takayama ( 1 989)8 . It ap pears that there is strong correlation between the pair of values,
( A X 0 il
- 6. X0;1). ( A Z11;1 - ti Z0 ; 1) a n d the pair o f val ues ( 6. Xw1), ( 6. Zw1). As mentioned in

val u es ( 6. X8;1 - ti x0il). ( 6. Z 811 - 6. z0.1) take a common val ue of zero the neutral line.
this book , th ey named the lateral incisal path for which both members of the pair of
 Appendix Mat h«mat u:al For m u l al' for :\naly zing �lan d i b u l a r '.\1ovc m c n t I 31

( /1 X8 i1 - /1 X01 1) and ( /1 Z 8 i 1 - /1 z 0i1) are tentatively d efined as the anteroposterior and

superoinferior components of d isharmony i n the lateral incisal path. The sagittal
displacement of the working condyle and the amount of disharmony in the lateral incisal
path are mathematically and experimentally found to be in a mutual cause-effect
equivalent relationship {Hobo, Takayama 1 989). When in addition the flexi ble movement
of actual condyles in surrounding soft tissue is considered, as well as the constraints on
the movement of the incisal point due to the restriction of hard teeth , the amount of
disharmony m ay be assumed to be dominant, with the sagittal d isplacement of the center
of the working condyle being under its influence.

Normal ized k i n ematic form u l ae for l ateral move ment

An experime ntal proof for the assumption that the amount of disharmony in the lateral
lncisal path is dominant over the sagittal displacement of the center of the working
condyle is given in this book. This means that the amount of d isharmony of the lateral
i ncisal path is the cause and the sagittal displacement of the center of the working
condyle the effect. Therefore, if the amount of disharmony of the lateral incisal path is

working condyle, { /1 Xw1• /1 Zw1) is zero. This assumption is more accurate for prostheses
negligible, then it may be assumed that the sagittal d isplacement of the center of the

than for natural teeth because, as described in this book, the lateral incisal path of a
prosthesis can be made to coincide with the neutral line so that the amount of
d isharmony becomes negligible, by using a semiadjustable articulator on which the
center of the working condyle moves straight outward along the transverse horizontal
axis.
Table 6 shows the formu lae simplified by putting the sag ittal d isplacement of the
center of the working condyle { 11 Xw1. 11 Zw1) equal to zero in Table 5. In Table 6, S 1 was
eliminated by substituting A c1 using the relationships /1 Xc1 = A cl X cos 0 cl and Ii Xc1 = Le
X 6 1 + A Xwi. putting A Xw1 equal to zero. and obtaining the relation S 1 A ci X cos 0 =

c 1 /Lc.
H ereafter Table 6 will be referred to as giving normalized kinematic formu l ae for
lateral movement and utilized for analyzing mandibular movement.

Table 6 Normalized kinematic formulae for lateral movement

----- -- -·-·--- - · --- -

AX = BX Ac1Xcos Oc1/Lc-CX e,,1

AY = (CXtan 0c1 + A + Lc X tanBa)X A c1 X cos O cillc
AZ = BXsin Oc1X /\ c1llc + A X 9 ,,,
--- · ------ -------

Note: Notations are defined in Tables 2 and 3.

Equations for Calculating the Amou nt of Disocclusion

Notation and defin itions

Notation and definitions necessary for calculating the amount of d isocclusion are
I S2

T8ble 7 Each component of three-dimensional displacement for an arbitrarily selected cuap tip on a living body
and an articulator together with each component of three-dimensional displacement for the point of anterior guide
pin of an articulator, and angles of hinge rotation of the mandible on a llvlng body and an articulator. with each
component of three-dimensional coordinates for the cuap tip and the point of anterior guide pin.

Nomenclature Notation

(Protrusive movement)
Anteroposterior displacement of the cusp tip on a living body A X1mp
Superolnferior displacement of the cusp tip on a living body A Z',,.,,
Anteroposterlor displacement of the cusp tip on an articulator ti. x11_
Superolnferlor dllplacement of the cu1p tip on an articulator f:. Zllmp

(Lateral movement)
Anteropo1terlor displacement of the cusp tip on nonworking side on a living body A X'.,,"
Lateral displacement of the cusp tip on nonworking tide on a living body A V',,,,.
Superopo1terlor dl1placement of the cu1p tip on nonworking aide on a living body A Z',,.,.
Anteropo1terlor displacement of the cusp tip on working side on a living body A X',..,.
Lateral displacement of the cusp tip on working side on a llvlng body A V',,.,.
Superopo1terlor displacement of the cuap tip on working tide on a living body t:. Z',,.,.
Anteropo1terlor dl1placement of the cusp tip on nonworking side on an artlculator A X11mn
Lateral displacement of the cu1p tip on nonworking side on an articulator A Y9,,, n
Superopo1terlor displacement of the cusp tip on nonworking side on an articulator A Z11mn
Anteropoeterlor displacement of the cusp tip on working side on an articulator A X11,_
Lateral displacement of the cusp tip on working side on an articulator ti. V II,,,.,
Superoposterior dl1placament of the cusp tip on working side on an articulator A Z11mw

(Point of the anterior guide pin )

Anteroposterlor displacement during protrusive movement AX p
11
Superopo1terlor displacement during protrusive movement ti. Z 11p
Anteropo1terlor dl1placement during lateral movement ti. X 111
Lateral dl1placement during lateral movement ti. yg1
Superolnferlor displacement during lateral movement A Zg1

(Hinge rotation of the mandible)

Angle of hinge rotation around the lntercondylar axis during protru1lve movement on a living body 0 '""
Angle of hinge rotation around the lntercondylar axis during lateral movement on a llvlng body e 'h•
Angle of hinge rotation around the lntercondylar axis during protrusive movement on an articulator 9 11,,,.
Angle of hinge rotation around the lntercondylar axla during lateral movement on an articulator e 11h1

(Three-dlmen1lonal position)
Anteroposterlor distance from the lnclaal point to an arbltrarily selected cusp tip a.,,
Lateral distance lrom the lnclsal point to an arbitrarily selected cusp tip b.,,
Superolnferlor distance from the lncisal point to an arbitrarily selected cusp lip c,,,

+
Anteropoaterlor distance from the lntercondylar axis to an arbitrarily selected cusp tip A, - a,,,
Lateral distance from the origin of the motion coordinate system to an arbitrarily selected cusp tip on 81 b,,,
nonworking aide
Lateral distance from the origin of the motion coordinate system to an arbitrarily selected cusp tip on 81 - b.,,
working side
Superolnferlor distance from the lntercondylar axla to an arbitrarily selected cuap tip C1 - c..,
Anteroposterlor distance from the lntercondylar axis to the point of the anterior guide pin of an A11
articulator
Lateral distance from the origin of the motion coordinate system to the point of the anterior guide pin 8
11
of an articulator
Superolnferlor distance from the lntercondylar axis to the point of the anterior guide pin of an C11
articulator

-Note: 811.;0 d;ln g-protr.;sive movement. and 80 = Lc/2 during lateral movement
 Appendix �l athcmatical Form u l ac for A n a l y z i n g M a n d i b u lar �lo\"cment l .'i3

shown In Tables 7, 8 and 9. Table 7 shows each component of three-dimensional

displacement for the cusp tips of the right and left molars on a living body and on an
articulator, and angles of hinge rotation of the mandible on a living body and on an
articulator, with each component of three-dimensional coord inates for the cusp tips and
the leading edge of the anterior guide pin. Table 8 gives nomenclature , notation and
definitions for directional angles in the cusp path on a living body and on an articulator,
and d i rectional angles in the trajectory of the lead i ng edge of the anterior guide pin on
an articulator. Table 9 shows each component of cusp angle and amount of d isoccl usion
on a living body and on an articu lator, and notations for sagittal inclination and flap angles
of the lateral wings of the anterior guide table.
Fig 3 is a schematic diagram ill ustrating notations and defin itions in relation to the
amount of d isocclusion during p rotrusive movement. Fig 4 is a sche matic d iagram
illustrating notations and definitions in relation to the amount of d isocclusion d u ring lateral
movement.

T8ble 8 Directional angles in the cusp path on a living body and an articulator. and d irectional a n g l e s in the

-- -
trajectory of the point of an terior guide pin on an arti c u lator .
-- -------

N om en c l atur e N otat ion Defi n ition

(Protrusive movement)
-

tan 1 ( 6 Z0mp1 6 X11mp)

Saglttal Inclination of the protrus ive cusp path on a l i vin g body 0 1mp - tan 1( 6 Z1mr/ 6 X1mn)
=
Saglttal Inclination of the protrusive cusp path on an articulator O gmp

(Lateral movement)
Frontal Inc l ination of the nonworking side lateral cusp path on a �'mn = tan· ' ( 6 Z'mn/,·" -[( 6 X1mn)2+( 6 Y1mn)2])

Horizontal Incl inat ion of the nonworki ng side lateral cusp path on
living body
't' 'mn = tan· 1 ( A Y'mn/ A X'mnl
a llvlng body
Frontal ln c ll natlon of the working side lateral cusp path on a �' ....., = tan " 1 ( A Z 1mw/j [( A X1mw)2+( A Y1mw)2D
living body
Horizontal I nc linat ion of the working side lateral cusp path on a 't' 'mw = tan · 1 ( A Y1,_/ A X1mw)
living body
Frontal I ncl ination of the nonworking side lateral cusp path on an � 0mn = tan"1 ( A Z0mn1./ (( 6 X0mn)2 + ( A Y0mnl2D
articulator
Horizontal lncllnatlon of the nonworking side lateral cusp path on 't' 11mn =

an articulator

v0rnw)2))
Frontal inclination of the working side lateral cusp path on an � 11mw = tan·1( A Z11mw/ ;-- [( A X11mw)2 + ( A
articulator
Horizontal lncllnatlon of the working side lateral cusp path on an 't' 11mw = tan· 1 ( A Y0mwl A X11mw)

articulator

(Trajectory of the leading edge of the anterior guide pin)

Saglttal lncllnatlon of the trajectory of the leading edge of the 0 OP =

anterior guide pin during protrusive movement

Frontal Inclination of the trajectory of the leading edge of the � 111 '"'

anterior guide pin during lateral movement

Horizontal lncllnatlon of the trajectory of the leading edge of the 't' 111 =

anterior guide pin during lateral movement

------ ----- - . -- - ·- ------
1 54

Table 9 Each component of cusp angle and amount of disocclusion on a living body and on an articulator, and
notations for sagittal Incl ination and flap angles ol the lateral wings ol the anterior guide table.

Nomenclature Notation

(Cusp angle)
Sagittal cusp angle of the opposing cusp
Nonworking side cusp angle of the opposing cusp
Working side cusp angle of the opposing cusp
(Amount of d isocclusion)
Amount ol disocclusion during protrusive movement on a living body D'mp
Amount of disocclusion on nonworking side during lateral movement on a living body D'mn
Amount ol disocclusion on working side during lateral movement on a living body D'mw
Amount of disocclusion during protrusive movement on an articulator Dgmp
Amount of disocclusion on nonworking side during lateral movement on an articu lator Dgmn
Amount of dlsocclusion on working side during lateral movement on an articulator Dgmw
(Anterior guide table)
Sagittal inclination of the center line between the right and left lateral wings of the anterior guide table
Flap angle of the right and lateral wing of the anterior guide table

---- -------- ·---- ---- -

Note 1 : Cusp angle is defined as the angle made by the average slope of a cusp with the cusp plane measured
meslodistally or buccollngually (GPT-6). However. in this book, cusp angle is defined as the angle made by the
average slope of a cusp with the horizontal reference plane. Therefore. the latter should be called "effective
cusp angle" in a strict sense. Furthermore, In this book, cusp angle Is measured in the vertical plane Including
the cuspal path of the opposing cusp. This d eflects the direction of the vertical section of the cusp slope on
nonworking side from meslodistal to buccolingual. changing the value of the cusp angle to some extent from the
value based on the above definition.
Note 2: Sagittal inclination of the center line between the right and left lateral wings of the anterior guide table
( O gp) is equal to saglttal Inclination of protrusive path of the leading edge of the anterior guide pin, providing that
the leading edge of the anterior guide pin slides in contact along the anterior guide table
4

---1
�---'-....,...�,.----:� c
---- A X Mr--

I'
Fig 3 Schematic diagram illustrating notations and Fig 4 S c h e m at ic diagram illustrating notations and
definitions in relation to the amount ol disocclusion definitions in relation to the amount of dlsoccluslon
during protrusive movement. The nomenclature of during lateral movement. The nomenclature of
notations in the figure are shown in Table 9. notations in the figure are shown in Table 9.
 Appendix �lalht·mau.:al h•r m u l ;i,· (. ,r \ n al y 1 i ni.: \ l a n d 1 h11 l a r \fri,·1·mn11 I ) ',

R e lati n g the con dylar and i n c isal paths

Protrus ive movement

When the incisal point is selected as the target point in the kinematic formulae for
protrusive movement (Table 4), the left-hand sides of the formulae represent the sag ittal

calculated theoretica lly in this way, using measured data on the condylar path ( Q cp . /\
displacement of the incisal point during protrusive movement. The incisal path can be

cp) and the angle of hinge rotation ( e hp ) during protrusive movement. Table 1 0 shows
the formulae used for calcu lating the sagittal incl ination of the incisal path , Q i p . against
the horizontal p lane during protrusive movement, to be given as directional angles.
Hereafter Table 10 is referred to as giving kinematic formulae relating th e protrusive
condylar path and the protrusive incisal path.

Table 10 K inematic formula relating the protrusive condylar path and the protrusive incisal path.

Note: Notations are defined In Tables 2 and 3

Lateral movement
When the incisal point is selected as the target point in normalized kinematic formulae
for lateral movement (Table 6), the left-hand sides of the formulae represent the three­

can be calculated theoretically in this way using measured data on the condylar path ( Q
dimensional d isplacement of the incisal point during lateral movement. The incisal path

ct.Be. /\. c1) and the angle of hinge rotation ( 0 hi) d uring lateral moverT)ent. Since Table 6
was used instead of Table 5, it was assumed that sagittal displacement of the center of
the working condyle, ( A Xwi. A Zw1) was zero. The genera l case, in which the workin g
condyle is allowed to undergo a sagittal displacement, a n d A Xw1 and !::. Zw1 are not equal
to zero, was omitted for the reason that such detailed analysis is not necessary i n regard
to the previous analysis on the amount of d isharmony in the lateral incisal path . Table 1 1
shows formulae used in calculating the following directional angles for the incisal path
during lateral movement.

T1ble 11 Kinematic formulae relating lateral condylar path and lateral incisal path.

0 11 = -1 l.!! 2}!-.LX s ln () � A��L+ -�t'.><_9 h,

tan
(1 /2) A c1Xcos O c1 - C,X 9h1

Cll u = -1 __ (1 /2)L,X_�in 0 ,1X A,1/L, + A,x e !IL_ __

(C1 X tan 0 ,1 + A . + Lc X tanB.) X A c1 X cos O c1llc

tan

'f' ,, :::: tan · 1 {�t��±_ A1 + _ L��-�X A � X c()�9 c1 /�

(1 /2) A c1 X cos O c1 - C,X 9 h1
-· -·

Note 1 : Notations are defined in Tables 2 and 3.

Note 2: 81 in the formulae in Table 8 was put equal to Lc/2 .
1 ) Sag ittal incli nation Q ii with respect to the horizontal plane;
2) Frontal inclination <I> ;1 with respect to the horizontal plane;
3) Horizontal incli nation 't' ii with respect to the frontal plane. H ereafter Tab le 1 1 will be
referred to as giving ki nematic formulae relating th e lateral condylar path and the lateral
incisal path (the term " normalized " is omitted). Since the fol lowing re lations hip connects
0 ,1 . <I> ;1 . 't' ;1:

tan O u = tan <I> 11 X tan 't' i1

these three parameters are not completely independent, and if values are given
independently for any two param eters the third can be d eterm ined.

Ca l c u l ations on l iv i ng body

Angles of hinge rotation on living body

and 1 1 , the directional angles and lengths i n th e condylar path, 0 cp. f\ cp. 0 ci. B e. /\ ci. are
Among the parameters on the right-hand sides of the analytical form ulae in Tables 1 0

the analytical formulae in Tables 1 0 and 1 1 , the angles of hinge rotation, 0 hp. e hi· are
measurable on a l iving body. However, the other parameters on the rig ht-hand sides of

0 ;p. 0 ;1 . <I> i i. 'f ii . on the l eft-hand sides of the analytical formulae in Tabl es 1 0 and 1 1 are
difficult to measure directly. On the other hand, the d irectional angles in the incisal path,

measurab le.

the angles of h i nge rotation , e hp. 0 h1. in terms of measurable parameters including
Therefore. in view of analyzing mandibular movement, it is advantageous to express

0 1p regarding the 0 hp in Table 1 0 to g ive an expression for the ang le of hinge rotation
directional angles i n the condylar and i ncisal paths, by solving the analytical formula for

during protrusive move ment e h p and either one of the analytical formu lae for 0 11, <I> 11, 't' ii

mathematically any formula can be used among the three for Q 11, <I> 11, 'f 1 1 in Table 1 1 .
regard i ng the E> h1 in Table 1 1 to give e h1 during lateral movement. Fo r lateral movement,

However, the analytical formula for <I> i i i n Table 1 1 was selected, for the reason that

lateral move ment. Additionally, E> hp was rewritten as E> 1hp i n Table 1 0 and E> hi as 0 1h1 in
frontal incli nation of the lateral incisal path is dominant over anterior gu idance during

Ta ble 1 1 .
The results are s hown in Table 1 2. The angles of hinge rotation d uring protrusive and
l ateral move ment can be calculated with these eq uations. The upper su bindex "t" of e 'hp

Table 1 2 Equations for calcu lating angles of hinge rotation during protru s ive and lateral movements on a living
body.

Protrusive movement:

8 'hp

Lateral movement

0 ',., ; , / [(C, X tan O , , + A , . ;. . l. X ta n B , . ) '- lan <D ,, lc >< tan 0 01J X A cL X cos 0 0,llc

Note: Notations arc rJ r,fined 1n Tables 2 . 3 and 7

 Appendix Mathematical For m u l a� for :\ nalyzinit Mandibular :'ofon: ment 1. 17

and 9 1h1 in the equations indicates that the right-hand sides of the equations represent
the angles of hinge rotation where the angle of hinge rotation is created by the maxillary
" "
and mand ibul ar anterior teeth on a l iving body. Then Table 1 2, based on Tables 1 0 and
1 1 , shows equations for calculating angles of hinge rotation d uring protrusive and lateral
movements on a l iving body.
Thre e-dimens ional displacements of the c usp ti p a n d d i rectional a n g l es of the
cusp path

The three-dimensional coordinates of an arbitrarily selected cusp tip in the motion

coordinate system are represented as ((Ai-am). (Bi-bm). (Ci-cm)) where (am. bm.Cm) is the
three-dimensional distance from the incisal point to the cusp tip.
When the cusp tip is arbitrarily selected as the target po i n t in the kinematic formulae
for protrusive moment (Table 4) and the normalized kine matic formulae for lateral
movement (Table 6), the left-hand sides of the formu lae in Tables 4 and 6 represent the

e hp and 9 hi on the right-hand sides of the formulae in Tables 4 a n d 6 were s u bstituted

three-dimensional d isplacement of the cusp tip during p rotrusive and l ateral movements.

by 9 1hp and 9 'hi. respectively. The equations for calculating 0 1 h p and 0 1 h1 are given in

theoretically in this way, using measured data on the condylar path ( 0 c p . /\ c p . 0 c 1 . Be. /\ c1 )
Table 1 2 . The three-dimensional d isplacement of the cusp tip can be calc u l ated

and on the incisal path ( 0 1p. <1> 11) during protrusive and lateral movem ents .

of the right and left molars of the mandible. The equations for calculating e hp a n d e 1h1
Table 1 3 shows each component of three-dimensional d i splacement for the c usp tips
1

In Table 1 3 are given in Table 1 2 where the angle of hinge rotation is create d by the
maxillary and mandibu lar "anterior teeth " on a l iving body. Then Table 1 3, based on
Tables 4 and 6, gives equations for calculating three-dimensional displacements of the
cusp tip during protrusive and lateral movements "on a l iving body. "

Table 1 3 Equations for calculating three-dimensional displacements of an arbitrarily selected cusp tip of the
mandible during protrusive and lateral movements on a living body.

Protrusive movement:
t. X1mp = cos O cp X A cp - (Ci - cm) X 01mp
t:. Z'mp = sin O cp X A cp + (A, - a,.. ) X 91mp

+
Lateral movement on nonworking side:
t:. X'mn = (Lc/2 bm)X A c1 X cos O c1/Lc - (C1 - Cm)X 9 1111

(Lc/2 + bm)X sin 0 c1 X I\ cillc + (A1 - &m) X 9 \.,,

fl Y'mn = ((C1 - c,.. ) X tan 0 c1 + (A,-am) + LcX tanB.JX A cL X cos O c1ILc
t. Z'mn =

ll X'mw
Lateral movement on working side:

0 c1 + (A1-am) +
- c.,,) X 6 1 111
(Lc/2 - bm)X /\ c1 X cos O c1/Lc - (C,
IJ. 'tmw
=

- bm)X sin O c1 X A c1llc +

Lc X tanB. J X A c1 X cos O c1I Lc

A Z'mw
= ((C 1 - cm) X tan

(A, - a,.. ) X 0 1111

= (Lc/2

-
-- ----
-
-·
Note: Notations are defined In T able �2. 3 and 7 ·
 The e quations for calculating three-dimensional d isplacements of the cusp tip in Table
1 3 g ive the trajectory of the cusp tip, or the cusp path on a living body. Therefore, each
directional angle in the cusp path on a l iving body can be calculated by first substituting
e 1hp and e 1h1 g iven in Table 1 2 for each corresponding angle of hinge rotation in the
rig ht-hand sides of the formulae in Table 1 3, and then su bstituting each component of
three-dimens ional displacements of the cusp tip given in Table 1 3 for the corresponding
compon ent i n the defin ition for each d irectional angle i n the cusp path on a l iving body
shown in Table 7 .

Amounts of d isocclusion
The amount of disocclusion during protrusive movement can be computed in the sag ittal
plane. Fi gure 3 is a schematic diagram ill ustrating notations and defin itions in relation to
the amount of disocclusion during protrusive movement.
In F i g . 3, the contact point of the cusp tip against the occlusal surface of the opposing
cusp at maximum intercuspation is denoted by C . When the cusp tip is displaced by A
Xmp. A Zmp from C during protrusive movement and its pos ition is de noted by Pp, the

protrusive c usp path ( 0 mp) is L PpCHp. where C-Hp is th e sagittal section of the
protrusive cusp path is represented by C - P p . Then the sagittal incli nation of the

horizontal reference plane . When the sag ittal section of the cusp slope is denoted by C­
Sp. L SpCHp is the sagittal cusp angle ( W mp) of th e opposing cusp. The amount of
d i soc clusion during protrusive movement (Dmp) is d efined by PS . Then an eq uation for
calculating the amount of disocc lusion during protrusive movement ( Dmp) can be derived

The equation for protrusive movement in Table 1 4, based on the result of appl ying
by applying tri gonometry to Fig 3.

trigonometry to Fig 3, enables calcu lation of the amount of disocclusion during protrusive
move ment on a living body. The amount of d isocclusion on a l iving body d uring
protrusive movement ( D1mp) can be calculated by substituting each corresponding right­
hand side of the equation for two-d imensional displacements of an arp itrarily selected
cusp tip on a l iving body during protrusive movement in Table 1 3 for A X1mp and A Z1mp in
Table 1 4, and the right-hand side of the equation for angle of hinge rotation on a living
body during protrusive movement in Table 1 2 for 9 1hp in Table 1 3.

Table 14 Equations for calculating amounts of disocclusion during protrusive and lateral movements on a living

body.

Protrusive movement·
D1mp = l1 Z1mp - l1 X1mp X tan w mp
Lateral movement on nonworking side:

D1mn = f!. Z'mn "· tan W mn X , [( 6. X 1m n)2 + ( l!. Y'mn)?)

Lateral movement on working side:

01mw = f1 Z1mw - ta n W mw X , 1 7
· -[( f1 X mw) - ( 6. Y'now)2]

Note: Notations are defined in Tables 7 and 9

 Appendix Mathl"mat1cal Formul a(· fur . \ nalyl1n _i: \ l a n d i h 1 1 l a r �lo\' l' mcnt 1 54

dimensionally. Figure 4 is a schematic d i a g ra m illustrating notations and definitions in

The amount of d isocclusion during l ateral move m e nt must b e analyzed three­

movement. In F i g 4, each notation for the working side is shown in parentheses adjacent
relation to the amounts of disocclusion on nonworking and working sides during lateral

to or below the notation for the nonworking side. The method used to obtain equations
for calculating the amount of disocclusion on the nonwork i ng side w i l l be described first,
followed by that for the working side.
In Fi g 4, t h e contact point of the cusp tip again st the o c c l usal surface of the o ppos i n g
cusp at maximum intercuspation is denoted by C. When th e cusp tip is d is p l a c e d by ll
Xmn. A Y mn• A Zmn on th e nonworking side during l ateral move ment and t h e pos ition is
denoted by Pn. the lateral cusp path on the nonwork i n g side i s represented b y C- P n.
Then the frontal inclination of the nonworking s i d e c usp path (<I> mn) is L PnC Hn. where C­
H n is the vertical section of the horizontal referen c e p l a n e a long th e nonwork i n g s i d e
cusp path. When t h e vertical section of the c usp s l o p e o f t h e o p p o s i ng c u s p i s d enoted
by C-80, L S0CH0 is the nonworking side cusp a n g l e ( w mn) of the op po si n g cusp. The
amount of disocclusion on the nonworking s i d e d ur i n g late ral move ment (D mn) i s defined
by PnSn. Then an equation for calculating the amount of d i socclusion on t h e nonworking
side d uring lateral movem ent (Dmn) can be obta i n e d by a p p l y i n g tri gonometry to Fig 4 .

movement (Dmw) can be obtained in the same way as that for the no n worki n g side ( D m11) .
An equation for calculating the amount of disocclusion on th e work i n g s i d e d u r i n g l ate ral

by replacing lower subindex " n " by " w " , " mn " by " mw" , and the term " nonwor k i n g" by
"working " in the above d escriptions.

trigonometry to Fig 4 , g ive equations that enable c a l c u l ation of amou nts of d i socclus ion
The equations for lateral movement in Table 1 4, based on the resu lts of applying

during lateral movement on a living body. The amounts of d i socc l usion on nonwork i ng
and working sides during lateral movement (D1mn a n d D 1mw) c a n b e c a l c ulated by
substituting the right-hand sides of the corresponding e q uatio ns for thre e -d i m e nsional
d i sp l a ce m ents of an arbitrarily selected cusp tip on a li v i n g � ody d u r i n g lat e ra l
movement in Table 1 3 for A X1 mn. A Y1mn. A Z1mn o n the nonwork i n g side and A X 1mw. ll
Y1mw . A Z1mw o n the working side in Table 1 4 , and by substituting t h e r i g h t- h and side of
the equation for the angle of hinge rotation on a living body during lateral movement in
Table 1 2 for 0 1 h1 in Table 1 3.

Cal c u l ations on an Arti c u l ator

R e l ation of the condylar p ath a nd the trajectory of the anterior g u i d e pin

In clinical practice, when constructing dentures on articulators, it is impossible to adjust

the articulators directly using values for the i ncisal path. The articulators generally used
in dental practice enable the condylar path to be adjusted directly, but the i ncisal path is
guided by sliding the leading edge of an anterior guide pin fixed to the maxilla in contact
along an anterior guide table fixed to the mandible anteroinferior to the incisal point. The
anterior g uide table is d ivided into right and left lateral wings bordered by a center l i ne,
and can be used to adjust the i ncisal path by means of adjustin g its sagittal inclination
and flap angles of each of the lateral wings.
Kinem atic formulae relatin g the condylar path and the trajectory of the leading edge of
the anterior g uide pin can be derived by substituting the distances from the l ntercondylar
axis to the leading edge of the anterior guide pin (Ag. Bg. Cg) for the d istances from the
lntercondylar axis to the incisal point (A1.B1,C1) In the formulae In Tables 1 0 and 1 1 .
Results are shown in Table 1 5, g iving the directional ang les _m the trajectory of the
_
lead i n g edge of the anterior g uide pin ( 0 gp. 0 gi. <!> g1. 't' g1).
lliO

Table 15 Kinematic formulae relating the condylar path and the trajectory of the leading edge of the anterior
guide pin during protrusive and lateral movements.

Protrusive movement:

= . _
Lateral movement:

0 04 tan ·
1 (1 /2)L,X sin .Qk! X.flct!!,.c .+ A�6°b1
( 1 /2) /\ ,1 X cos 0 ,1 - c 0 x e h1
CJ> 91 _ tan 1 (1/2)L, >.< s_in Q,LX (\_.,_t11-< + A-11 X e ollL_
-
(C9 X tan 0 c1 + A9 + L 0 X tanB.)X /\ c1 Xcos 0 cillc
1 (C11Xtan 9..a..±.&.f .. _hXtanB.)X /\,1X c<>.S O ,1tL,
'+' 01 = tan
(1 /2) /\ ,1 X cos 0 ,, - c 0 x e 0"1

Note: Notations are defined in Tables 2, 3, and 8.

Sagittal inclination of (the center l i ne) the anterior guide table is equal to the sagittal
inclination of the trajectory of the leading edge of the anterior guide pin ( 0 gp ). provid ing
that the l eading edge of the anterior guide pin slides in contact along the anterior guid e
table. However, the flap angles of the lateral wings o f the anterior guide table (Wg1) must
be calculated using three -dimensional analytical geometry as i n the fol lowing.
Lateral wing angle of the anterior guide table
The surface of the lateral wing of the anterior guide table along which the l eading edge
of the anterior g uide pin slides in contact is expressed by the following matrix equation,
providing that the surface of the lateral wing of the anterior table i ncludes the trajectories
of the leading e dge of the anterior guide pin during protrusive movement and lateral

( )
movement:

� � � tan gp = 0
cot 't' g1 1 tan <l> g1
where 0 QP• <l> 9i. 't' 9, are the di rectional angles in the trajectory of the leading edge of an
anterior guide pin during protrusive and lateral movements, given in Table 1 5.
The mathematical formula expressing the surface of the lateral wing of the anterior
guide table was obtained by expanding the above matrix equation, giving the following
result:
tan 0 9p X x + (tan <l> 9, - tan 0 9p X cot 't' 91) X y - z = 0.

The flap angle of the lateral wing of the anterior guide tabl e is defined as the angle
formed by the s urface of the lateral wing of the anterior guide table, which is expressed

0) by the sagittal inclination of the center line of the anterior guide table ( Q gp). The
by the above equation and the plane that i nclines against the horizontal refe rence plane
(z =

latter plane is expressed by tan 0 9p X x - z 0, and a mathematical formula relating the

=

flap angle of the lateral wing (W91) and the di rectional angles in the trajectory of the

geometry. The result is shown in Tab le 1 6.

leading edge of the anterior guide pin were derived using three-dimensional analytical

Table 1 6 Mathematical formula relating the flap angle ol the lateral wing angle and the directional angles In the

----- - .-
trajectory of the leading edge ol the anterior guide pin.

cos 0 0p X (tan CJ> 0, - tan 0 0p/tan '+' 01)2 + 1 I

1 1
Wg1 = cos (· -�-- 2
,

Note: Notations are defined in Tables 8 and 9.

 Appendix �lat hl·mat 1cal Form u l al· for :\nal y z in� �la11dihul;tr �lo n m r n t lbl

Angles of h i n g e rotation o f t h e m a n d i b l e d u ri n g protrus ive a n d l atera l movem e n t

A n equation for calculating t h e ang l e of h i n g e rotation o n a n articulator during protrusive
movem e nt ( e 9 hp) can be d erived by s ubstituting the distances from the intercondylar
axis to the l eading edge of the anterior guide pin A9,C9 for the distances from the
lntercondylar axis to the i ncisal point Ai.Ci in the formulae i n Table 1 2. T he result is
shown as the first equation i n Table 1 7.
An equation for calculating the angle of h inge motion during lateral movement on an
articulator ( e 9 hr) was derived analytically using the equation for calculating flap angle of
the anterior guide tabl e (Wg1) show n in T able 1 6 by the fol lowing proc e dures .
First, the mathematical formula relating the flap angle of the lat e ra l w i n g of the anterior
guide table and the d i rectional angles in the traj ectory of t he lead i n g edge of the
anterior guide pin (Table 1 6) was simplified, resulting in the fol low i n g equation :
tanW gr/ cos 0 gp = tan <l> gt - tan 0 g p / ta n '+' g 1
N ext, the right-hand sides of the formulae for <1> 9 1 and '+' 9 1 i n Table 1 5 were su bstituted
for <l> gr and 't' gr, rspectively, In the a bov e e q uat i on, re sult i n g in the fol l owi n g e q uation:

tanW9 tl cos 0 9 p = [(Lc/2)X (tan 0 c1 - tan 0 9 p)

+ (Ag + C 9 X tan 0 9p)X 9 9 h1/( A c1 X cos O c1/ L c ))
+ [C9 X tan 0 ct + A9 + L c X tan B e ] .

T•ble 17 Equations for calculating angles of hinge rotation during protrusive and lateral move m e nts on an
articulator.
---- · --- ----- ....

Protrusive movement:

Lateral movement:
9 11h 1 = [(Lc/ 2)X (tan 0 11p - tan 0 cp) + (C11 X tan 0 c1 + A11 + Lc X tanB.) X tanW111/cos 0 11p)
X A cL X cos O c1/(Lc X (C0 X ta n 0 11p + A11))

Note: Notations are defined in Tables 2. 3. and 9.

an articulator ( 9 9 h1) was obtained. The result is shown as the second equation in Table
Third, the equation for calculating angle of hinge rotation during lateral movement on

17.
Thus, Table 1 7 gives equations for calculating angles of hinge rotation during
protrusive and lateral movements on an articulator.

Three-d imensional displaceme nts of t h e cu sp ti p

Equations for calculating three-dimensional displacements of an arbitrarily selected cusp

tip during protrusive and lateral movements on an articulator can be obtained by
replaci ng upper subindex t in T ab l e 1 3 by upper subindex g. The result is shown in
"" " "

Table 1 8. The equations for calculating 9 hp and 9 h1. which appear in Table 1 8, are
9 9

given in Table 1 7. The three-dim ensional d isplaceme nt of the cusp tip on an articulator
can be calculate d theoretic ally in this way, using adjusted values on the condylar path
1 B /\ c1) and on the anterior guide table ( 0 OP• W01) during protrusiv
( 0 cp. /\ cp1 O c ,
e and
e.

lateral movements on an articulator.

 Table 1 8 shows each component of three-dimensional d isplacement for arbitrarily

angles of hinge rotation ( e 9hp and e 9h,) are created by the leading edge of the anterior
se lected cusp tips of the right and left molars of th e mandible on an articu lator. Since the

g u ide pin and the anterior guide table on an articulator, Table 1 8 gives equations for
calculating three-dimensional d isplacements of the cusp tip "on an articulator.
"

Table 18 Equations 1or calculating three-dimensional displacements of an arbitrarily se lected cusp tip of the
mandible during protrusive and lateral movements on an articulator.

Protrusive movement:
t. Xgmp = cos 0 cp X fl ep - (C, - Cm)X 9 °..,P
t. Zgmp = sin O ep X fl ep + (A, - am)X 9 9mp
Lateral movement on nonworking side:
t. X9mn = (Lc/2 + bm)X fl e1X cos 0 eillc - (C, - cm)X 0 °h,

(Lc/2 + bm)X sin O c1 X fl c11Lc

C. Yg mn = [(C. - Cm) X tan 0 ct + (A, - 8m) + Le X tanB.JX fl CL X COS 0 c,fL,
.6. Z0mn = + (A, - am) X 9 9h1

- b..,)X fl c1 X cos O c11Lc - (C, - c..,) X 6 °h1

Lateral movement on working side:
.6. X9mw = (Lc/2

(Lc/2 - b..,) X sin O c1 X /\ c1/Lc

t. Y0mw = l(C, - cm)Xtan 0 0, + (A; - a..,) + L0 X tanB.JX /\ 01 X cos 0 c11Lc
.6. Z0mw = + (A, - am)X 9 °h,

Note: Notations are defined in Tables 2. 3, and 8.

Equ ations for c a l c u l at i n g amounts of d isoc c l us i on on an

a rt i c u l ator

nonworking and work ing sides during lateral movement on an artictJlator ( Og p. D gmn.
Equations for calculating amounts of disocclusion during protrusive movement and on

D gmw) can be obtained in the same way as those for a l iving body: by applying
" "
trigonometry to Fig's 3 and 4 and by replac ing upper subindex "t" in Table 14 by g .
The resu lts are shown in Table 1 9.
Table 1 9, based on the resu lts of applying trigonometry to Figs 3 and 4, g ives
e quations for calcu lating amounts of disocclus ion on an articulator. The amounts of
disocclusion d uring protrus ive movement and on nonworking and work ing sides d uring
lateral movement on an articulator (D9mp. D9mn. D9mw) can be calculated by substituting
the right-hand sides of the correspond ing equations for three -dimensional displacements
of an arbitrari ly selecte d cusp tip on an arti culator in Table 1 8 for A X9m p . A Z0mp. ti. X0mn.
A Y9mn. A Z9mn. A X9mw. A Y9mw. A Z9mw in Table 1 9, by su bstituting the right-hand sides of
the corresponding equations for the angles of hinge rotation on an articulator in Table 1 7
for e 0hp and 9 9h1 i n Tabl e 1 8, and by su bstituting the right-hand side of the equation for
the flap angle of the lateral wing of the anterior guide table in Table 1 6 for Wgl In Table
1 6.
 Appendix \lathrn1 � t i r a l Formu la" for . \ n al y z i ni.: \lanu1 h u l a r \lon:mt-nt l f.3

Table 1 9 Equations fOf calculating amounts of d i socclusion during protrusive and lateral movements on an

articulator.

Protrusive movement:
. D0mp = t::. Z0mp - t::. X0mp X tan w mp
Lateral movement on nonwork ing side:

0°mn = t::. Z9mn - tan w m n X , (( t::. X0mn)2 + ( t::. Y9mn)2)

Lateral movement on working side:
0°mw = t::. Z 11mw - tan wmw X . " (( t::. X0mw)2 + ( t::. Y0mw)2]

Note: Notations are d efined in Tables 6 an d 9.

References

Goldstein H: Classical M echanics. Addison-Wesley Publ.Co. , 1 950: p p 1 1 8- 1 26.

electronic measuring system. Part II A study of the Benn ett movement. J Prosthetic
Hobo S: A kinematic investigation of mandibular border movement by means of an

Dent, 5 1 :642-646,1 984.

Hobo S, Takayama H: Effect of canine guidance on the work ing condylar path. I nt J
Prosthodont, 2:73-79, 1 989.

Takayama H: Kinematical and Experimental Analyses of the Mandi bular M ovement in

Man for Clinical Application. PhD thesis, No.8203, U n iversity of Tokyo, 1 987 .

Takayama H , Hobo S: The d erivation of kinematic formulae for mandibular movement. I nt

J Prosthodont, 2:285-295, 1 989.

Takayama H, Hobo S: Kinematical and experimental analyses of the mandibular

movement in man for clinical appl ication. Precision Machinery, 2: 229-304, 1 989.
Takayama H: Mathematical expressions for computing mandibular movement, Part III
Expressions for computing the amount of d isocclusion from condylar path, incisal path
and cuspal incl ination. J Jpn Gnathol, 1 4:20-23, 1 994.

Takayama H : M athematical expressions for computing mandibular movement, Part N

Expressions for computing the amount of d isocclusion from condylar path, anterior guide
and cuspal inclination. J Jpn G nathol, 1 6:82-88, 1 995.
1 64

Twin Hoby Articulator

6 1----� �--- @
<DMaxillary frame ®Centric latch lock lever
<ZlAnterior guide pin stopper ®Scale for sagittal condylar path inclination
(3)Anterior guide pin @Fossa box
©Anterior guide table ®Condyle
®Adjusting screw of sagittal inclination @Centric latch lever
$Adjusting screw of lateral wing angle @Mandibular frame
<7)Adjusting screw of sagittal condylar path inclination

Hoby Face bow

,-------< 3

---- 1©

CDReference pointer l'Hit«i> fork

(ZJTransfer pin ClFact>bow side arm

Distributed by
3M DENTAL PRODUCTS
3M Center, Building 225-45- 1 1
SL Paul, MN 55144- 1000 U.SA
 Index 1 65

Index

A Bowman 1 36

adjustable mechanical anterior guide table 28 c

adjustment values for generating disocclusion 34

amount of disocclusion 3. 1 3, 16. 1 9.35.38,45.49,53,64 CAD/CAM 45, 1 40

anatomical articulator 23 -- for dentistry 1 40
Angle's Class II 14 cast with removahle anterior segment 61
Angle's Class Ill 14 Celenza 1 35
anterior guidance 3,20,23.38.53. 1 37 centric relation 1 35
---assembly 27 centric stop 25
anterior guide component 5 Clayton 6
anterior guide effect 19 clinical evaluation test 44
anterior guide pin 27,40,44 comparison of the amounls of lli�occlusion. in vitro and
anterior guide table 27 ,28,40,4 1 ,44 in vivo 50
anterior guiding mechanism 23 complete denture prosthesis 42
anterosupcrior position 1 35 computer-aided manufacturing(CA M ) 45
arbitrary axis 1 36 computer-assisted pantograph 1 38
arcon-typc articulator 23 computerized pantograph 1 37
arcon type semiadjustable articulator 39 concept of centric relation 1 35
articulator 23.49,64 Condition I
--adjustment values for reproduction of standard cusp 33,36,44 .45,57,67,70,79,87,9 1 . 1 02 , 1 1 3. 1 2 1 . 1 30
angle 33 Condition 2

--adjustment values for the twin-st.age procedure 36 33,36,44,47,59,73,76,80,89,99, 1 03 , l I l , 1 1 4. 1 25 , 1 32

---adjustment values for Condition 2in group function condylar guidance 23
111 -- assembly 23
---adjstment values for osseointegratcd i mplant cases condylar guide effect 1 8,20

1 19 condylar path 5,6, 1 3, 1 7.5 3. 1 37, 1 39

----1est 44 -- inclination 5 . 1 0.24

Aull 23 contraindicated cases 42

axis plane 24.32,36,4 1 ,64 controlling the condylar path 10

coordinate systems 1 45

B correct ive occlusal adjustments 50

42,64
criterion for selection of an articulator 29

balanced articulation l ,38,44.1 1 9. 1 37 Curve of Spec

5, 15, 1 7,3 1 ,32,33.38.42.44,53.63.64, 1 38

basic concept of twin-stage procedure 32 Curve of Wilson 42

6 cusp angle
Beard
25.26,36.39, l I l , 1 1 9 cusp path 31
Bennett angle

3,19,20.36,54
1 1 ,26 cusp shape component 6
Bennett movement
1 36 cuspal interference
Bowley
1 66

cuspid pro1ec1ed anicu lalion 2.1 37 Fisher's angle 24

fixed restorations 91

D full-mouth reconsrruction 64

fully adjustable articulator 23,50, 1 37 , 1 39 , 1 40

D'Amico 2. 1 37

Dawson 8 G
dcviarion of the condylar palh 8

deviation of the cusp angle 16 Garcia 8

difference be1ween eccenrric and returning condylar gnathology 25. 1 35. 1 37. 1 39. 1 40

palhs 8,20,53 Golden 1 35

disclusion I Goldstein 1 43

disocclusion 1 . 1 3. 1 7.3 1 .49.64. 1 37, 1 38 Gordon 1 36

Donegan 1 39 Gothic arch tracer 28

group function 2,39.1 1 1 . 1 1 9

E Guichet 1 ,25 . 1 39

earbow-type facebow 1 36 H
eccentric and returning condylar paths 8,20,53

eccentric condylar path 8, 1 7 , 1 9.53 Hansson 8

eccentric movement 1 . 10.44,49, 1 36 Hobo 1 .2.3.8.9, 1 0. 1 1 , 1 3.25,26,28, 1 35 , 1 37, 1 43. 1 5 1

eccentric position 44.49 horizontal axis 1 35

eccentric relation 1 36 horizontal lateral condylar path 26

effect of the difference between terminal hinge axis and horizontal reference plane 41

transverse horizontal axis 1 36

effective cusp angle 1 4 ,32,42,64

electronic measuring system with six degrees of

freedom 9, 1 37 immediate mandibular translation 1 1 ,25.53

equations for calculating amounts of disocclusion on immediate sideshift 1 1 .25

articulator 1 62 incisal guide pin 27

equations for calculating amounts of disocclusion on incisal table 27

living body 1 58 incisal path 5. 1 3. 1 7,53, 1 38

equations for calculating angles of hinge rotation on -- inclination 5, 1 38

living body 1 56 inclined tooth 42

equations for calculating angles of hinge rOlalion on index line on the anterior guide table 41

articulator 161 influence of the condylar path 53

equations for calculating three-dimensional ---- on the amount of disocclusion 13

displacements of the cusp tip on living body 1 57 influence of the cusp angle on the amount of

equations for calculating three-dimensional disocdusion 16

displacements of lhe cusp tip on articulator 1 62 infl uence of 1he incisal pa1h on the amount of

establishment of group function I l l disocdusion 14

influence ratio of the condylar path, incisal path and

F cusp angle 10 the amoum of disocclusion 16

intraoral test 49

fabrication of anterior teeth 38 in vitro rcsr 44

facebow record 55.86.92. 1 1 2. 1 29 in vivo resr 44

66,1 35 Iwata 1 35
facebow transfer
 Index 1 67

K N

Kelly

necessi ty for disocclusion

14 Nakano 24
kinematic fonnulae for mandibular moveme nt 1 49

neutral line
1 7.20
kinematic fonnulae for lateral movement 149 1 1 ,26
kinematic fonnulae for protrusive movement 1 48 Nishi 24
kinematic fonnulae relating the condylar and the incisal

nonadjus table articulator

Nishio 3
paths 1 55 27

of the anterior guide pin

kinematic fonnulae relating the condylar path and the

formulae
nonworking side 2.4. 1 3 . 1 6,20

on articu lator
trajectory of the leading edge normalized kinematic for latl'ral movement
1 59

notation and definitions

151
kinematic theorem 143 1 45 . 1 5 1
Koh no 8,35

0
L
occlusal adjustment 91

di agnosis on the eccentric

lateral incisal path 1 1 ,26.53 occlusal contact 54

lateral movement 4 , 1 0. 1 3. 1 4. 1 5, 1 9.20, 1 49 occlusal posit ion 54

lateral wing 28 occlusal i nterfe rence s M

-- angle 28.36.39. 1 1 1 occlusal registration strip 54

le af-gauge
laterotrusion 1 1 ,26�'1 3 occurrence rate of malocclusion 14

4.44.48. 1 36 Oish i 8

Lee 25 open bite 14

lock mechanism of the anterior guide pin 41 opening and muscles 10

Long 1 36 osscointegrated implant 1 19

Lucia 1 36 , 1 40 outline of theTwin-Stage Procedure 38

Lucia's anterior jig 1 36

p
M
Palik 1 36

14 pantograph 26, 1 37 , 1 40
malocclusion
2,23,53 physiological anterior guidance 35
mandibular triangle
physiological discrepancy 36
mathematical fonnulae for the lateral wing angle of the
1 60 posterior guiding mechanism 23
anterior guide table on aniculator
posterior reference 1 35
mathematical model of mandibular movement

1 3, 1 8,32. 1 43 progressive mandibular translation 25

25, 1 35 progressive sideshift 25

maximum intercu spati on
8, 1 35 . 1 37 protrusive movement 4, 10, 1 3, 14, 1 6; 1 9.20, 1 48
McCollum
35, 1 38
McHorris
1 38 A
mechanical pantograph
5
mechanism of disocdusion
13 Ramfjord 8
mobility of the anterior teeth
reference for occ lusion 3 1 . 1 38
2 , 1 37
mutually protected articulation
removable anterior segment 61

returning condylar path 9, 1 7, 1 9.53

 1 68

returning movement 10 T
rotated looth 42

rotation 6 Takayama 2,3,8, I 0. 1 1 . U.26.28. 1 37. 143, 1 5 1

Rudd 15 Takeno 1 39
RUM position 1 35 tcmporomandibular joint 8,25,53

terminal hinge axis 1 35

s the amount of dishannony in the lateral incisal path 1 50
Thoma� 3, 1 39
sagittal condylar path 23 translation 5,25
--inclination 24,36,39. 1 1 1 transverse horizontal axis I 0, 1 1 . 1 36
-- inclinations of eccentric and returning paths 10 Twin Hoby Anicu lator 38,40,44
sagittal deviation of the working side condyle path twin-stage procedure 1 ,33,38,44,50,53,6 1 , 1 39, 1 40
1 1 .27,53 twin-tables technique I
sagittal inclination of the anterior guide table

28,36,39, 1 1 1 v
sagittal inclination of the incisal path 1 38

Schulte 1 36 variations in the incisal path 14

Schuyler 2 vcnical overlap 14
Scott 3

�miadjustable articulator 24,27 w

Shooshan 3

single crown fabrication 85 widths between the eccentric and returning condylar
Sol nit 25 paths IO
Stallard 2 Williamson 1 36
standard amount of disocclusion 4, 1 3, 1 8,35 .38,45.49 1 36
Woelfel
standard cusp angle 3 1 ,38,44 working side 2,3. 1 3, 1 6,20,25
Stoffer 1 36 -- condyle 8
Stuan 2,8, 1 35. 1 37 -- condylc path 1 0, I 1 ,27,53
About the authors

Sumiya Hobo. D.D.S.,M.S.D.,Ph.D., received his graduate training in

Fixed Prosthodontics at Indiana University. He was appointed Assistant
Professor at Indiana and later Assistant Professor at U .C.L.A. He was
P rofessor and Chairman of Occlusion at Ohu University School of
Dentistry, Japan. Received Ph. D. degree from Tokyo Dental College.
He received the B. B. McCollum Award from the American Academy of
Gnathology and was awarded the high honor, the Japan Invention Prize
for h i s work i n developi ng art i c u l a tor syste m s . He has authored
nu merous textbooks including Fundamentals of Fixed Prosthodontics
which has been translated i nto 1 0 languages and used in dental schools

D entistry, Crown & Bridge P rosthodontics and Fel low in both the
worldwide. He is a member of the American Academy of Restorative

American and International College of Dentists.

Hisao Takayama, B.S .. Ph. D .. received h is graduate training in Physics

from 1 951 to 1 956 at Tokyo University. He was chief engineer at Nippon
Avionics Co., Ltd . , which was a subsidiary of NEC Corp. and Hughes
Aircraft Co .. During his service with the conpany. he engaged in licensed
production of military computer systems and devices for Japan Air Self
Defence Force and developments of computer systems for medical use.
He developed an computer pantograph , named Cyberhoby 1n 1 980. In
1 987 , he received h i s P h . D . degree in e n g i n e e r i n g f r o m T okyo
U ni ve rsity by P h D thesis entitled "Ki nematical and e x p e r i m e n t a l
analyses of the mandibular movement in Man for clinical application." He
has been lecturer of Kanagawa I nstitute of Technology since 1 988. He
joined International Dental Academy, Tokyo, Japan in 1 991 as senior
researcher in the field of science of occlusion. With Dr. Hobo. he is a
coauthor of 1 0 English papers and 24 Japanese papers in dentistry and
two books in Japanese, "Occlusion" and "Clinical atlas in occlusion".