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The anterior point of reference /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit ,or call

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  • 1. Good morning
  • 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  • 3.  Two major objectives 1.restoration of the occlusion. 2.control of the form and position of the teeth. Neglect in positioning the maxillary cast can result in: 1. additional and unnecessary record making. 2. un natural appearance in the final prosthesis. 3. damage to the supporting tissues.
  • 4.
  • 5. Posterior points of reference 1) Bergstrom point—A point 10 mm anterior to the center of the spherical insert for the external auditory meatus & 7 mm below the FH plane.Beck stated that it lies close to hinge axis. 2)Beyron –A point 13 mm anterior to the posterior margin of the tragus of ear on a line from the center of the tragus to the outer canthus of the eye
  • 6.  If the maxillary cast is positioned without the correct maxillae-hinge axis relationship, deflective tooth contacts occur.  Deflective contacts contribute to 1. periodontal trauma. 2. muscle spasm. 3.TMJ pain 4. loss of supporting edentulous tissues.
  • 7.  THE ANTERIOR POINT OF REFERENCE Selection of the anterior point of reference determines which plane in the head will become the plane of reference when the prosthesis is being fabricated. The act of affixing a maxillary cast to an articulator relates the cast to the articulator’s hinge axis, to the vertical axes, to the condylar determinants, to the anterior guidance, and to the mean plane of articulator.
  • 8.  The selection of the (anterior) points of reference is useful so that different maxillary casts of the same patient can be positioned in the articulator in the same relative position.  When three points are used the position can be repeated, and also reduce time with complicated time consuming recording techniques such as pantographic tracings to repeat the records each time the technique calls for a new casts. For this reason it is important to identify the mark permanently or be able to repetitively measure a anterior reference, point as well as the posterior points of reference.
  • 9. SELECTION OF ANTERIOR POINT OF REFERENCE  Orbitale : In the skull orbitale is the lowest point on the infraorbital rim. On a patient it can be palpated through overlying skin. One orbitale and the two posterior points that determine the horizontal axis is defined as the axis - orbital plane.  This plane can be transferred to articulator with the help of an orbital pointer on the face bow or by raising the facebow itself to the level of the orbitale.
  • 10.  Advantage: 1. it is easy to locate and mark the orbitale. 2. the concept is easy to teach and understand.  Disadvantage: Relating the maxilla to the axis-orbitale plane will slightly lower the maxillary cast anteriorly from the position that would be established if the Frankfort horizontal plane were used.
  • 11.  Orbitale minus 7mm : The Frankfort ' s horizontal plane passes through the poria and one orbitale because these points are (skull) bony landmarks. Sicher recommends using the mid point of the external auditory meatus as the posterior cranial landmark. This land mark lies 7mm superior to the axis and recommends compensation by making anterior point of reference 7mm below the orbitale or positioning the orbitale pointer 7mm above in the articulator to the orbitale indicator.
  • 12.  Nasion minus 23mm : According to Sicher another skull landmark the Nasion can be used as the anterior reference point. The nasion guide or positioner which relates to the deepest part of the midline depression just below the level of eyebrows, as used in whipmix articulator the quick mount face bow is designed so that it moves in and out but not up and down from its attachments to the cross bar.
  • 13.  . The cross bar is located approximately 23mm below the nasion. When the face bow is positioned the cross bar will at the level of the orbitale. The disadvantages of using this kind of face bow is that this technique depends upon the large nasion guide, the morphologic characteristics of the nasion notch and the variance of the nasionorbitale measurements from 23mm in the patient.
  • 14.  Incisal edge plus articulator midpoint to articulator axis- horizontal plane distance. Guichet - Emphasized that a logical position for the casts in the articulator would be one which would position the plane of occlusion near the mid horizontal plane of the articulator. In accordance with this concept, the distance from the mid horizontal plane to the articulator’s axishorizontal plane is measured. The same distance is measured onto the patients from the existing incisal edges or planned occlusal plane and then transfer is done.
  • 15.  Alae of the Nose : The occlusal plane actually parallels the horizontal plane which was concluded by Augsburger in review of literature that the occlusal plane parallels the camper's line with minor variations. Knowing this we can transfer camper’s plane from the patient to the articulator by using either right or left ala as the anterior reference point.
  • 16.  Importance of selection of anterior reference point:  A planned choice of anterior reference point will allow the dentist and auxiliaries to visualize the anterior teeth and occlusion in the articulator in the same frame of reference that would in patient i.e. as if patient standing in normal postural position with eyes looking straight ahead.  Mounting the maxillary cast relative to the FHP will accomplish this objective.
  • 17.  The dentist may wish to initially establish the restored occlusal plane parallel to the horizontal in order to better control the occlusal plane in its final position.  The objective is to achieve a natural appearance in the occlusal plane. Mounting the cast relative to camper’s line best meet this objective.
  • 18.  The dentist may wish to establish a baseline for comparison between patients, or for the same patient at different periods of time. This is possible only through the use of a three-point mounting that is constant from one patient to another or for the same patient.
  • 19.  If the camper’s line- horizontal reference plane is used, raise the back of the articulator to achieve the effect of the Frankfort horizontal plane mounting.
  • 20.  If the Frankfort horizontal plane reference is used, raise the anterior of the articulator to achieve the effect of paralleling the occlusal plane and Camper’s line with the horizontal.
  • 21.  The hinge line, the interpupillary line, and a transverse line across the occlusal surfaces are three common frontal view reference lines.  Hinge line being better seen in the articulator. The latter two are observed in the patient.
  • 22. SUMMARY: Three points in space determine the position of the maxillary cast in an articulator. The dentist most frequently concerned with selecting the two posterior reference points. Improper selection of anterior reference point affect the development of occlusion and esthetics. Five commonly used anterior points of reference and the reasons for the use of each have been discussed.
  • 23.