Face-bow record without a third point of reference:

Theoretical considerations and an alternative technique

Carlo Ercoli, DDS,a Gerald N. Graser, DDS, MS,b Ross H. Tallents, DDS,c and Daniel Galindo, DDSd
Eastman Dental Center, University of Rochester, Rochester, N.Y.
Accurate mounting of dental casts is achieved by transferring the tridimensional spatial relationship
of the maxillary arch to an articulator. A face-bow is used to transfer this relationship to the articu-
lator, usually by relating the face-bow to a plane of reference. The most common reference plane is
the Frankfort plane, which has been assumed to be horizontal when the patient is in the natural
head position. The axis-orbitale plane has also been considered horizontal and used as reference.
However, it has been shown that both planes are not horizontal, and mounting a maxillary cast
according to these planes can result in an inaccurate mounting. This article describes an alternative
procedure for face-bow transfer without a plane of reference, and uses the angular relationship
between the occlusal plane and the condylar path to mount the maxillary cast on the articulator. The
elimination of a reference plane, to which relate the functional determinants of occlusion, avoids an
additional source of error during the mounting procedure. (J Prosthet Dent 1999;82:237-41.)

A ccurate mounting of dental casts is achieved by

transferring the tridimensional spatial relationship of
the maxillary arch to an articulator, often by using a
face-bow. This is traditionally done by using 3 reference
points. The criteria used in the selection of these refer-
ence points have been ease of location, convenience,
and reproducibility. Two points are located in the area
of the temporomandibular joints (TMJ).1 A third point
is selected, anterior to the TMJs, to define a plane of
reference, which is oriented in the articulator so that
the 3-dimensional position of the upper cast is repro-
duced as it is in the patient.
Ellis2 suggested that proper mounting of the maxil-
lary cast can be achieved when 2 relationships are estab-
lished: (1) The distance of the maxillary arch from the Fig. 1. A, Occlusal plane of maxillary cast. B, Trajectory of
intercondylar hinge axis. This relationship is recorded condylar inserts of articulator. C, Horizontal upper member
by locating the hinge axis.3-6 Once the axis of rotation of articulator when incisal pin is set at zero.
is located, the distance of the maxillary arch from
this axis is easily recorded with a face-bow. (2) The
3-dimensional relationship between the maxillary
occlusal plane and the skull. This function is inherent
with the use of a face-bow and is independent from the
first one.
Some investigators have suggested that the angular
relationship between the condylar path and the occlusal
plane also should be recorded.7-9 A plane of reference
has been used to record this relationship,10 and the
most common reference plane is the Frankfort plane
(FP).11 The FP is established, in profile, “by the lowest
point in the margin of the left and right bony orbit

aAssistantProfessor, Division of Prosthodontics.

bProfessor,Chief, and Program Director, Division of Prosthodontics.
cProfessor and Program Director, Temporomandibular Joint Disor-

ders Program. Fig. 2. A, Occlusal plane of maxillary arch. B, Condylar tra-

dResident, Division of Prosthodontics. jectory. C, Hypothetical horizontal plane.

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THE JOURNAL OF PROSTHETIC DENTISTRY ERCOLI ET AL

Fig. 3. Patient was instructed to protrude his mandible in an Fig. 6. Upper cast is mounted in articulator with split cast
edge-to-edge position. Right posterior teeth achieve greater technique. A, Cast. B, Compound. C, Mounting stone. D,
disclusion than left ones. Mounting ring.

Fig. 4. Silicone registration material is used to record protru- Fig. 7. Upper and lower casts secured together with com-
sive position. pound and nails; split cast mounting is open. A, Casts. B,
Green compound. C, Nails. D, Mounting stone. Arrow-
heads, silicone registration material.

Fig. 8. Condylar mechanisms of articulator are loosened and

Fig. 5. Face-bow record is taken without paying attention to split cast mounting is closed. A, Casts. B, Green compound.
third point of reference. No attention is paid to patient’s pos- C, Nails. D, Mounting stone. Arrowheads, silicone registra-
ture. tion material.

238 VOLUME 82 NUMBER 2

ERCOLI ET AL THE JOURNAL OF PROSTHETIC DENTISTRY

(orbitale) and the highest point in the margin of the

right or left bony auditory meatus” (porion).11 Origi-
nally, this plane was defined parallel to the horizontal
plane of reference (HPR) (the Frankfort Agree-
ment).11,12 The HPR can be defined as a “horizontal
plane established on the face of the patient by 1 anteri-
or reference point and 2 posterior reference points
from which measurements of the posterior anatomic
determinants of occlusion and mandibular motion are
made.”11 Thus, it is a true horizontal plane.
The convention that the FP is parallel to a horizontal
plane implied, by definition, that the former is also hori- Fig. 9. Right and left mean condylar inclination are record-
ed for future reference. Right condylar inclination (R) is
zontal. In 1906, the International Agreement for the
greater than left one (L) (black arrows). Compare this with
Unification of Craniometric and Cephalometric Mea- greater disclusion noted on patient’s right side in Figure. 1.
surement in Monaco further defined the FP as horizon- A, Upper member of articulator. B, Condylar inserts.
tal. This concept is so widely accepted that the Glossary
of Prosthodontic Terms (GPT-7)11 also defines the FP as
horizontal. Because the porion point is not reproducible
on the articulator, manufacturers of articulators substi- an articulator. Plane C is easy to locate on the articula-
tuted the axis for porion. In this way “the axis-orbitale tor (it is represented by the upper member of the
plane (AOP) was assumed to coincide with the FP and by instrument when the incisal guide pin is set at zero).
definition11 with the HPR.”13 In this way, the miscon- However, it is impossible to define it exactly in a patient
ception was created that parallelism exists between the because of the individual variability of the NHP.17
FP, the AOP, the upper member of the articulator (when This article describes an alternative procedure for
the incisal pin is set at zero) and the HPR. However, it face-bow transfer that eliminates the need for a plane of
has been demonstrated that (1) the FP is not parallel to reference and uses the angular relationship between the
the AOP14 and (2) when a subject is standing in the nat- occlusal plane and the condylar path to mount the max-
ural head position (NHP, also called esthetic reference illary cast on the articulator.
position [ERP], defined as “the position of the head
PROCEDURE
when an individual is sitting or standing erect with the
head level and eyes fixed on the horizon”),13 the FP is 1. Make impressions of the maxillary and mandibular
not parallel to the HRP.13,15,16 arches for diagnostic casts.
The upper and lower members of the articulator are, 2. Rehearse with the patient to protrude his mandible
in most articulators, parallel to each other, and to the until the incisors are in an edge-to-edge position
horizontal plane. Functional components of an articu- (Fig. 3). (Patients with poor neuromuscular con-
lator are the condylar inserts and the incisal guide table. trol and/or altered proprioception can be guided
These elements are set at specific angular relationships in this position by the dentist. In partially or com-
with the upper member of the articulator. That the pletely edentulous patients, wax rims are used to
upper member of the articulator is horizontal (when simulate the dental arches.)
the incisal guide pin is “zeroed”), is likely the reason 3. Instruct the patient to hold this position and
why clinicians try to relate the spatial position of the record it with the use of silicone registration mate-
maxillary arch and the inclination of the condylar path rial (Regisil PB, Dentsply Caulk, Milford, Del.)
to an ideal horizontal plane in the patient. (Fig. 4). Make 3 records.
Figures 1 and 2 illustrate this concept. Plane A cor- 4. After setting, trim the excess material so that only
responds to the occlusal plane of the maxillary cast in the cusp tips are recorded.
the articulator and of the maxillary arch in the 5. Take a face-bow record without paying attention
patient.11 Plane B corresponds to the trajectory of the to a third point of reference and/or the posture of
condylar inserts in the articulator and of the condylar the patient (Fig. 5).
path in the patient. Plane C is the horizontal upper 6. Mount the upper cast with a split cast technique3
member of the articulator and the HPR when the sub- (Fig. 6).
ject is in the NHP.17 Clinicians have commonly 7. Mount the lower cast in maximal intercuspation and
attempted to record the occlusal plane (plane A) and separate the upper cast from the split mounting.
condylar inclinations (plane B) relative to the HRP 8. Relate the upper cast to the lower one by using 1
(plane C), and transfer such relationships to the upper of the protrusive records. Secure the 2 casts
member of the articulator. Planes A and B are easily together with nails and compound material (Kerr
recorded from a patient and are readily transferred to Co, Romulus, Mich.) (Fig. 7).

AUGUST 1999 239

THE JOURNAL OF PROSTHETIC DENTISTRY ERCOLI ET AL

9. Loosen the condylar mechanisms of the articulator relationship between the occlusal plane, and the condy-
and adjust the right and left condylar inclinations lar protrusive path regardless of the position of the
to allow the split cast to close (Fig. 8). upper member of the articulator. The incisal guide
10. Repeat steps 8 and 9 with the other 2 protrusive table can also be set with the same protrusive record.30
records. Any changes in the inclination of the maxillary cast
11. Calculate the average values obtained with the 3 (inclination of the occlusal plane) on the sagittal plane
protrusive records and program the condylar set- will not alter this ideal position, as far as the inclination
tings of the articulator (Fig. 9). of the condylar path is also modified for the same
angle.7,29
DISCUSSION
Protrusive records have been extensively used to
Anecdotal information has been used to define the record the inclination of the condylar path.1,30-32 Com-
spatial relationship of the FP to the HPR.11 The term parative studies have demonstrated that interocclusal
Frankfort horizontal plane is a misnomer and, as protrusive records do not differ from radiographic33
defined, the plane is not horizontal when a subject is in and pantographic34 records. However, some authors
the NHP.13,15,16 The AOP has also been misused as have criticized the use of interocclusal records to pro-
parallel to the HPR; according to Pitchford,13 these 2 gram the articulator.35,36 In particular, the repro-
planes would form an angle of 13 degrees. ducibility of protrusive records have been questioned.
The impossibility of locating a horizontal plane To minimize errors, the authors suggest to take 3
when the patient is in the NHP is inherent with the protrusive records and average them to program the
individual variability of this position.17 The concept of articulator.
NHP was first described by Broca,18 who defined it as It is our opinion that this technique simplifies the
“the position of a standing man when his visual axis is diagnostic procedures during patient evaluation by
horizontal.” Reproducibility of NHP has been the avoiding the location and transfer of planes of refer-
topic of research for decades with controversial ence. The protrusive record, which is used to mount
results.17,19-22 As stated by Solow and Tallgren,19 “the the cast, can also be used in the restorative phase, thus
natural head position has been the subject of consider- saving clinical time. Reference planes are not needed
able interest in the anthropological as well as in the for a correct mounting of stone casts. The elimination
orthodontic literature. Widespread research has been of a reference plane, to which the functional determi-
made for a craniofacial reference plane, which in the nants of occlusion are related, avoids an additional
natural head position, would exhibit a constant rela- source of error during the mounting procedure.
tionship to the true horizontal plane.” In the anthro-
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