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AUGUST 1999
Fig. 2. A, Occlusal plane of maxillary arch. B, Condylar trajectory. C, Hypothetical horizontal plane.
THE JOURNAL OF PROSTHETIC DENTISTRY 237
ERCOLI ET AL
Fig. 7.
pound
Green
heads,
Upper and lower casts secured together with comand nails; split cast mounting is open. A, Casts. B,
compound. C, Nails. D, Mounting stone. Arrowsilicone registration material.
ERCOLI ET AL
Fig. 9. Right and left mean condylar inclination are recorded for future reference. Right condylar inclination (R) is
greater than left one (L) (black arrows). Compare this with
greater disclusion noted on patients right side in Figure. 1.
A, Upper member of articulator. B, Condylar inserts.
an articulator. Plane C is easy to locate on the articulator (it is represented by the upper member of the
instrument when the incisal guide pin is set at zero).
However, it is impossible to define it exactly in a patient
because of the individual variability of the NHP.17
This article describes an alternative procedure for
face-bow transfer that eliminates the need for 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.
PROCEDURE
1. Make impressions of the maxillary and mandibular
arches for diagnostic casts.
2. Rehearse with the patient to protrude his mandible
until the incisors are in an edge-to-edge position
(Fig. 3). (Patients with poor neuromuscular control and/or altered proprioception can be guided
in this position by the dentist. In partially or completely edentulous patients, wax rims are used to
simulate the dental arches.)
3. Instruct the patient to hold this position and
record it with the use of silicone registration material (Regisil PB, Dentsply Caulk, Milford, Del.)
(Fig. 4). Make 3 records.
4. After setting, trim the excess material so that only
the cusp tips are recorded.
5. Take a face-bow record without paying attention
to a third point of reference and/or the posture of
the patient (Fig. 5).
6. Mount the upper cast with a split cast technique3
(Fig. 6).
7. Mount the lower cast in maximal intercuspation and
separate the upper cast from the split mounting.
8. Relate the upper cast to the lower one by using 1
of the protrusive records. Secure the 2 casts
together with nails and compound material (Kerr
Co, Romulus, Mich.) (Fig. 7).
239
DISCUSSION
Anecdotal information has been used to define the
spatial relationship of the FP to the HPR.11 The term
Frankfort horizontal plane is a misnomer and, as
defined, the plane is not horizontal when a subject is in
the NHP.13,15,16 The AOP has also been misused as
parallel to the HPR; according to Pitchford,13 these 2
planes would form an angle of 13 degrees.
The impossibility of locating a horizontal plane
when the patient is in the NHP is inherent with the
individual variability of this position.17 The concept of
NHP was first described by Broca,18 who defined it as
the position of a standing man when his visual axis is
horizontal. Reproducibility of NHP has been the
topic of research for decades with controversial
results.17,19-22 As stated by Solow and Tallgren,19 the
natural head position has been the subject of considerable interest in the anthropological as well as in the
orthodontic literature. Widespread research has been
made for a craniofacial reference plane, which in the
natural head position, would exhibit a constant relationship to the true horizontal plane. In the anthropologic field, the interest have been motivated by a
requirement for comparison of cranial structure in different populations.23-25 In the orthodontic literature,
the NHP has been used for assessment of facial esthetics in orthodontic analysis and treatment planning.26-28
Definitions of the NHP have varied among different
authors. Furthermore, methods used to help the
patient achieve this position (mirror, light sources, or
patient self-balance position) have also varied.19,20
In prosthodontics, the relationship of the occlusal
plane with the other determinants of occlusion have
been described by Hanau (Hanau Quint). 29 He
described how the inclination of the occlusal plane, the
condylar guidance, the incisal guidance, the cusp
height, and the compensating curve relate to each
other. Bergstrom1 further analyzed and discussed the
occlusal and articular variables and their reproduction
by articulators.
This article describes a procedure that uses a interocclusal record technique to record the angular relationship of the occlusal plane to the condylar path for
the purpose of accurately mounting the maxillary cast
on an articulator. With this technique, no attempt is
made to locate a plane of reference in the patient or in
the articulator; the clinician records and transfers the
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ERCOLI ET AL
relationship between the occlusal plane, and the condylar protrusive path regardless of the position of the
upper member of the articulator. The incisal guide
table can also be set with the same protrusive record.30
Any changes in the inclination of the maxillary cast
(inclination of the occlusal plane) on the sagittal plane
will not alter this ideal position, as far as the inclination
of the condylar path is also modified for the same
angle.7,29
Protrusive records have been extensively used to
record the inclination of the condylar path.1,30-32 Comparative studies have demonstrated that interocclusal
protrusive records do not differ from radiographic33
and pantographic34 records. However, some authors
have criticized the use of interocclusal records to program the articulator.35,36 In particular, the reproducibility of protrusive records have been questioned.
To minimize errors, the authors suggest to take 3
protrusive records and average them to program the
articulator.
It is our opinion that this technique simplifies the
diagnostic procedures during patient evaluation by
avoiding the location and transfer of planes of reference. The protrusive record, which is used to mount
the cast, can also be used in the restorative phase, thus
saving clinical time. Reference planes are not needed
for a correct mounting of stone casts. The elimination
of a reference plane, to which the functional determinants of occlusion are related, avoids an additional
source of error during the mounting procedure.
REFERENCES
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