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CLINICAL IMPLICATIONS
Lower condylar angles were recorded from wax records when compared to the extraoral tracing
device. The wax method, although practical, may result in restorations with decreased cusp
height.
hen the subjects casts are mounted in a semiadjustable articulator by use of a facebow and intraoral or
extraoral records to adjust the condylar guidance, a close
approximation of the subjects mandibular movements
and occlusal relationships can be obtained.1,2 This can
facilitate the planning of occlusal adjustment and the
fabrication of restorations and prostheses that subsequently will require less adjustment intraorally.3-5 StudAn abstract of this project was presented in poster format (767)
during the 27th Annual Meeting of the AADR, Minneapolis, MN,
on March 5, 1998.
a
Professor, Division of Occlusion, Department of Restorative Dentistry.
b
Associate Professor, Division of Occlusion, Department of Restorative Dentistry.
c
Professor and Head, Division of Occlusion, Department of Restorative Dentistry.
54 THE JOURNAL OF PROSTHETIC DENTISTRY
ies that compared the pantographic method of measuring condylar inclination angles with the intraoral wax
protrusive method have consistently found higher angles with the pantograph and less variation than with
wax,6,7 with the exception of one study.8
One would assume that the pantographic method is
superior to the wax protrusive interocclusal registration;
however, the method requires skill and the equipment
expense cannot be discounted. In addition, it is difficult
to draw a consistent tangent to the tracings.9,10 This
results in greater angles than mathematical computation
or computer analysis of the tracings and is considered an
unsuitable way to measure the angles.9
It was found7 that protractors supplied by the manufacturers of 2 different pantographic systems were different and that different angles were obtained when one
manufacturers protractor was used to measure a recordVOLUME 89 NUMBER 1
trusion, which Craddock14 attributed to a lack of voluntary neuromuscular control. In addition, he was concerned that the wax record technique would have
minimum variation because it required the mandible to
be moved anterior to the functional range of movement
of the condyles (only 2 to 3 mm of protrusion) to give
angular readings. In discussing the practical consequences of variations in condylar guidance, he mentioned that the influence of the sagittal condylar guidance was greatest in the second and third molar areas.
He noted that a positive 10-degree change in the condylar guidance from the actual condylar guidance would
bring the molars 0.5 mm farther apart when the mandible was protruded in an end-to-end relationship, which
is approximately a 3-mm movement of the condyle. A
negative 10-degree change would bring the mandible
0.5 mm closer. He concluded that a 5-degree change
would cause a corresponding plus or minus 0.25-mm
change in the molar area. Craddock14 suggested avoiding precise measurements; he stated that the sagittal
condylar guidance should be considered as steep, moderate and somewhat flat rather than in terms of degrees
of angle. The wax protrusive record seems to fulfill
these generic requirements.
Lastly, wax is neither accurate nor reproducible.6
Other problems with the intraoral method, regardless of
the material used, are that the sagittal condylar angle
changes with the degree of protrusion11 and that the
intraoral record represents only one point along the condylar path.1 The purpose of this study was to compare
the sagittal condylar angles set in the Hanau articulator
by use of a method of obtaining an intraoral wax protrusive record to those angles found using the extraoral
method of tracing the condylar path with the Whip-Mix
quick-set recorder.
56
VOLUME 89 NUMBER 1
RESULTS
On the right side of the head, the pantographic
method gave statistically significant higher higher condyJANUARY 2003
Subject
Right side
Left side
Right side
Left side
1
2
3
4
5
6
7
8
9
10
Mean
SD
Mean
SD
46
40
45
30
50
40
40
45
45
30
41.10
7.53
45
35
35
35
45
35
40
30
30
25
35.50
6.43
30
20
25
30
50
22
34
25
25
20
28.10
8.94
25
35
30
35
55
25
25
30
20
35
31.50
9.73
38.30
6.98
29.80
9.25
DISCUSSION
Zamacona et al,18 fully aware of the problems found
by El-Gheriani and Winstanley,9 believed it was possible
to obtain accurate angles of the sagittal condylar path by
drawing a tangent to the tracing and measuring with a
57
quick set recorder and the Panadent quick analyzer recorder (Panadent Corp, Colton, Calif.). They combined
left and right sides and found that the wax method produced lower readings with a wider range of angles. The
Whip-Mix analyzer consistently produced higher readings than the Panadent recorder. The authors provided
an explanation for this. The 2 analyzers use slightly different anteroposterior planes. The Panadent uses the
transverse axis and a nosepiece, and the Whip-Mix uses
the average horizontal axis and a nosepiece. The horizontal axis is usually superior by a mean of 4 mm (range
2 to 9 mm) and posterior by an average of 3 mm from
the average horizontal axis. This difference could give a
smaller angle in the Panadent as compared with the
Whip-Mix. Another variable, as previously mentioned, is
the difference in the protractors supplied by each manufacturer. Ecker et al7 results were in degrees, and the
reference was nasion-porion.
Because the sagittal condylar guidance inclination is a
relative value related to a third point of reference, the
Frankfort plane was used as the reference for this study.
This plane was also used for the Whip-Mix quick-set
recorder.1,7,9
It became apparent that protrusive displacement of
the mandible for 6 mm or less may result in decreased
angulation of the condylar path. The readings suggest a
defined limitation of movement during procedures of
wax recording that is not manifested during pantographic movements.
Practical consequences of setting the articulators
condylar guidance higher than the subjects relative angle could possibly result in restorations with protrusive
and lateral interferences. It could also cause some interference to be missed when evaluating the movements
within the articulator. Setting the condylar guidance too
low could avoid development of interferences in restorations but could also indicate interferences in the articulator that are not present in the subject. A higher condylar guidance angle in a patient with dentures may be
better than a lower angle because the posterior teeth
may need adjustment with the higher angle, whereas the
anterior teeth may require adjustment with a lower angle.
Olsson and Posselt15 reviewed the literature, and the
studies they reviewed all agreed that the condylar path
inclination changes with the reference line. Nasion-sella
(porion, clinically) results in the highest angle, Frankfort
results in the next highest angle, and ala-tragus (Campers) results in the lowest angle. The selection of anterior
reference points (nasion or orbitalis, for example) is
more related to the use of a given model of articulator
(nasion for Whip-Mix and orbitalis for Hanau). These
variations do not seem to produce any influence in the
mounting results. Dos Santos et al16 found the same
relationship. The patients eminence angle was relatively
stable over time (changing rapidly only due to disease or
VOLUME 89 NUMBER 1
CONCLUSIONS
Within the limitations of this study, measurement of
the extraoral tracing of the sagittal protrusive condylar
path gave higher values with less variation than the intraoral wax protrusive method. Also, the extraoral recordings appeared to capture a sagittal representation of
the contour of the articular eminence from the most
retruded position forward in straight protrusion. The
first 2 mm of the eminence from the retruded position
(which the wax record did not capture) were the steepest
and appear to be the area from which the usual protractor measurements are made.
Thanks are due to Dr Gerald Re, Associate Professor, The University of Texas Health Science Center at San Antonio Dental School,
for his editing during the preparation of this manuscript.
REFERENCES
1. Donegan SJ, Christensen LV. Sagittal condylar guidance as determined by
protrusion records and wear facets of teeth. J Prosthet Dent 1991;45:46972.
2. Celenza FV. An analysis of articulators. Dent Clin North Am 1979;23:30526.
3. Payne JA. Condylar determinants in a patient: electronic pantographic
assessment. J Oral Rehabil 1997;24:157-63.
4. Bailey JO, Nowlin TP. Evaluation of the third point of reference for
mounting maxillary casts on the Hanau articulator. J Prosthet Dent 1984;
51:199-201.
JANUARY 2003
AT
SAN ANTONIO
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