part 2 of facebow record

1. DR PALAK MISHRA
MDS PROSTHODONTICS

2.  Acc to GPT-9:
 An instrument used to record the spatial
relationship of the maxillary arch to some
anatomic reference point or points and then
transfer this relationship to an articulator; it
orients the dental cast in the same relationship
to the opening axis of the articulator;
customarily the anatomic references are the
mandibular transverse horizontal axis and one
other selected anterior reference point.
2

3. FACEBOW
ARBITARY
EARPIECE
HANAU
DENAR
SLIDEMATIC
WHIPMIX QUICK
MOUNT
FASCIA
HANAU 132-
2SM MODEL
HANAU 132- 2C
MODEL
KINEMATIC
TMJ INSTRUMENT
PANTOGRAPH
AXIOGRAPH
3

4. KINEMATIC ARBITARY
MANDIBULAR MAXILLARY
•Locates hinge axis physiologically
•Require specific equipments
•Require skill and time consuming
•Determine orientation relation and
centric relation together
•Require stable record bases
•Use of arbitary points to locate hinge axis
•Doesn’t require elaborate equipments, easy
and quick
•Practically more acceptable
•Only determine orientation of maxilla
•No attachment to mandible so
exceptionally stable record base not required

5. BEYRON’S POINT 13 mm anterior to posterior margin of tragus of ear on a line from center
of tragus to the outer canthus of eye
WEINBERG POINT 11-13 mm anterior to the reference line drawn from middle and posterior
border of tragus of ear to the corner of eye
GYSI’S POINT 10 Mm anterior to posterior margin of ear on a line from center of tragus
to the outer canthus of eye
BERGSTROM POINT 10 mm anterior to the posterior margin of tragus on a line parallel to and 7
mm below the FH plane
TETRECK AND
LUNDEEN’S POINT
Located 13 mm anterior to the base of tragus on cathotragal line
EXTERNAL AUDITORY
MEATUS
On an average the external auditory meatus is 6 to 6.5 mm posterior and
2.5mm superior to the actual hinge axis point
PROTHERO’S POINT A line drawn from top of Richey condylar marker (placed in the external
auditory meatus) to the outer canthus of eye. A point 13mm anterior to
Richey condylar marker to this line is used as the arbitrary reference point

6. Orbitale The lowest point of the infra orbital rim.
Orbitale minus 7mm This plane represents Frankfort Horizontal plane
Nasion minus 23mm Lies on the deepest part of the midline depression just below the level
of the eyebrows.
Ala of the nose The right or left ala is marked on the patient and the anterior reference
pointer of the face-bow is set.
This method uses the Campers Plane as the Plane of orientation
43 mm superior from lower
border of upper lip
This plane represents Denar reference plane

7. 7

8.  U shaped frame
 Condylar rods
 Bite fork
 Locking device
 Third Reference
Point
8

9. 1. Represents the plane of the cranium
2. It forms the main frame of the face
bow.
3. All other components are attached to
this frame.
4. It extends from the region ofTMJ on
one side to the other side without
contacting the face.
9

10. 1. Represents the plane of the maxilla.
2. “U” shaped plate, which is attached to the
occlusal rims, while recording the orientation
relation.
3. It is attached to the frame with the help of a
rod called the stem.
4. The bite fork should be inserted 3mm below
occlusal surface within occlusal rim
10

11. 1. Two small metallic rods on either side of the
free end of the U shaped frame that Contact
the skin over theTMJ.
2. They are used to locate the hinge axis and
transfer it to the articulator.
3. Some face bows have ear piece that fit into
the external auditory meatus instead of
Condylar rods.
11

12. 12
1. Attaches the bite fork to the U-
shaped frame
2. Supports the facebow, occlusal rims
& the cast during articulation.
3. Consists of transfer rod and a
tranverse rod.
4. U shaped frame is attached to the
vertical transfer rod

13. 13
1. It is used to orient the face bow
assembly to a anatomical
reference point on the face along
with the two condylar reference
points.
2. It varies in the different face bows,
example orbital pointer-orbitale,
Nose piece –Nasion etc.

14.  Edentulous Bite Fork:
1. Allows patient to close against the opposing rim to stabilize the record bases
2. Heat bite fork and imbed it centered and parallel the occlusal plane
14

15.  For partially edentulous patient, cover bite fork with 2 layers of softened
baseplate wax.
 Face bow Landmarks:
1. External Auditory Meatus (Arbitrary hinge axis location)
2. Anterior reference point
3. Maxillary arch
15

16.  The condylar axis is located kinematically or arbitrarily.
 The bite-fork is attached to the upper occlusion rim
parallel to the occlusal plane.
 The stem of the bite fork is slipped in the universal
joint (or the transfer jig) and the clamp is left open, to
allow free movement of the assembly.
 Slide the face bow onto the bite fork.
 Extend Nasion support (anterior reference point)
& tighten.
16

17. The condylar rods are adjusted so that their ends
lie on the points representing the condylar axis.
Both rods should show equal calibrations.
The clamp at the bite fork is tightened.
The condylar rods are released and the entire
assembly is removed taking care that the fork is
firmly clamped to the face bow.
17

18.  The Patient is seated in a comfortable
position with his head upright and supported
by a headrest.
 A point is marked 13 mm in front of the
auditory meatus on a line running from the
outer canthus to the superior border of
tragus.
18

19.  A notch index about 2mm deep is made in first molar
region.This helps to position of facebow.
 The maxillary and mandibular occlusal rims are
inserted in patient’s mouth.
 Aluwax is softened and shaped to the form of a
horseshoe.The bite fork is embedded into this soft
wax.The thickness of the bite fork and the wax
together should not be more than 6mm.
19

20.  The bite fork with wax is inserted into the
patient’s mouth.
 The midline of the bitefork should coincide
with the mid line of the maxillary occlusal
rims.
 The stem of the bite fork should be parallel
to the saggital plane.
 With bite fork in position face bow is guided
onto the stem of the bite fork .
20

21.  Thumbscrews tightened to maintain the
spatial relationships between face bow and
bite fork.
 Face bow assembly along with bite fork is
removed from the mouth and positioned in
the articulator
21

22. 1.The entire assembly is transferred to the articulator.
The articulator should be located in centric with the
incisal pin flush with the upper member.
2. Re-equalizing the calibrations to bilaterally equivalent
readings before tightening the condylar rods.
3. The facebow is adjusted by the elevating screw to align
the occlusal plane with the groove marked around the
halfway point of the incisal pin
22

23. 4. The third point of reference, on the articulator, if it is the infraorbital
indicator, which must be snug to the right so that it will be above the tip of the
infraorbital pointer, the entire face bow with maxillary cast in place must be
raised until the tip of the pointer contacts the infraorbital plane indicator
(infraorbital plate).
5. The cast is then supported in position (using Hanau mounting support or
prop) to support the weight of the maxillary cast and plaster during the
mounting process.
23

24. 6. Not all the semi adjustable articulators has orbital plane guides. which allows
the casts to be mounted in relation to the axis-orbital plane of the patient.
7. Some articulators and facebow doesn’t need whole the facebow assembly,
only the transfer assembly, so these articulators can accept both assemblies.
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25. 8. Before mounting the upper cast, the base
of the cast should be notched (scored) to ease
re- mounting procedure (cast indexing). And
painted with separating medium, then it
should be positioned in its place.
9. Stone should be place on the top of the
cast, the clearance between the cast and the
upper frame of the articulator should be filled
with the stone.
10. The articulator should be closed and
additional stone added to the sides of the
cast .
25

26.  Attach the maxillary stabilised
base to the bite fork
 Insert it in the mouth and have
the patient hold it in place with
both thumbs using light pressure
or place the lower base in the
mouth and close against the bite
fork
 The face bow is now carried to
the patient’s face and the
facebow fork toggle assembly is
slipped onto the stem of the bite
fork

27.  The plastic earpiece are inserted in the external auditory meatus and
brought slightly forward
 The nasion relator assembly is attached to the facebow
 The plastic nose piece should rest on the nasion and face bow is
tightened
 The facebow is locked to the bitefork
 The entire assembly is then carried to the articulator
 The upper cast is attached to the articulator .

28. 1. Handling and shipping the face-bow record to the laboratory is
simplified;
2. Relating the face-bow record to the articulator is easy;
3. Plastering is easier with the bow removed;
4. Only one face-bow is needed if additional biteforks and bitefork
clamping assemblies are obtained.
5. This method is recommended for busy practices that send casts to a
remote laboratory for mounting.
28

29.  The bite fork is heated and inserted into the maxillary occlusion rim
parallel to the occlusal plane with the patient’s midline aligned with the
index ring of the bite fork
 The face bow is assembled on the patient by inserting the stem of the
bite fork into the transfer jig as the earpieces are placed in the external
auditory meatus.
 The right and left arms of facebow are geared for equidistant movement
from the center
 The lockscrew on the face bow is tightened and the lockscrew on the
anterior reference point is loosened

30.  The facebow is raised or lowered until the pointer is aligned precisely
with the anterior reference point
 The clamps on transfer jig assembly are then tightened.
 The scale on facebow represents half the patient’s intercondylar distance
which is of value in setting articulator having an intercondylar adjustment

31.  The intercondylar distance is now measured
 The lock screw is loosened and the bow is opened and removed from the
patient
 The facebow is now detached from the bite fork assembly
 The incisal table is removed from articulator and the articulator index
insterted in its place
 The transfer jig with the bite fork and maxillary occlusal rim attached and
secured in the articulator inde prior to mounting the maxillary cast

32.  Items needed for mounting casts on the articulator.
32

33.  Set the centric latch in the
“open”position.
33

34.  Loosen the incisal guide pin
screw and remove the
incisal guide pin.
34

35.  Set each condylar guide to
the Face-Bow marking on
the condylar inclination
scale.
 Set the condylar
inclination to the 30°mark.
35

36.  Firmly tighten each clamp screw.
 This may be accomplished by
using the black thumb screws or
the hex drive.
36

37.  The immediate side shift setting
are irrelevant at this point.
However it is advisable to set
them to the “0”mark
37

38.  Insert the vertical rod of the
transfer assembly into the
transfer base and lower it until
the bottom of the vertical rod
contacts the transfer base.
 Secure it by tightening the
Clamp Screw
38

39.  Replace the upper frame onto
the lower frame so the front
of the upper frame now rests
on the Support Bar.
 Place a plastic mounting plate
on the upper frame.
39

40.  If using the face-bow fork
support, raise it until it touches
the undersurface of the face-
bow fork.
40

41.  Engage the centric latch on the
articulator to keep the
condyles in contact with the
posterior and superior walls of
the condylar guides.
41

42.  Position the upper cast into the bite registration. Ensure it is stable with
no rocking.
42

43.  Apply Mounting Stone to the base of the cast and to the mounting plate.
 Slowly close the upper frame until it contacts the support bar.
 Hold the frame in position until the mounting stone has set.
43

44.  Scan the edentulous jaws using an Intraoral
Scanner.
 For preliminary impression place a mark on
tip of the nose and mental regions, and
measure the distance between the marks
with a caliper as the occlusal vertical
dimension.
 Induce the patient’s mandible and close the
mouth to the distance.
 Polymerize the silicone putty as the
impression material between the maxillary
and mandibular jaws while maintaining the
distance of the vertical dimension.
44
Kanazawa M, Iwaki M, Arakida T, Minakuchi S. Digital impression and jaw relation record for
the fabrication of CAD/CAM custom tray. Journal of prosthodontic research. 2018;62(4):509-
13.

45.  Cut the polymerized silicone putty to a
thickness of about 15 mm for use as a jig to
make a preliminary jaw relation record.
 Scan the jig while keeping the jig between the
maxillary and mandibular jaws.
 Adjust the relationship of the data of the
maxillary and mandibular jaws with the CAD
software using the data of the jig.
 Create images of custom trays (CAD/CAM
trays) to make definitive impressions of the
jaw casts.
45

46.  Insert the stock Gothic arch tracing plate
into the slots on the lingual surface of the
maxilla tray and use the removable stylus
to copy the Gothic arch onto the
mandibular tray.
 The CR can be recorded using the Gothic
arch tracing plate and stylus after a
definitive impression is made.
 Use the three-dimensional (3D) images
of the custom trays to fabricate
CAD/CAM trays using a rapid prototyping
3D printer with UV-curable materials.
46

47. Images of custom trays (CAD/CAM trays) created with CAD software
47

48.  The preliminary jaw relation record can be simplified by simultaneous
scanning of the maxillary and mandibular jaws using a jig made of
silicone putty.
 Moreover, it is difficult to perform these steps efficiency, while melting
the wax rim with a hot spatula.
 With the proposed method, the time required for scanning can be
optimized by ensuring that the patient’s mouth remains closed by
placing a small amount of silicone putty between the maxillary and
mandibular jaws.
 Only the denture space can be simply replicated on a digital image
without an extra step or material.
 This method makes it possible to more accurately fabricate the tray
to limit the number of adjustments.
48

49.  CAD CAM trays (a) Maxillary mucosal surface,(b) The stock Gothic arch tracing plate can be inserted into the
maxillary, (c) Mandibular mucosal surface,(d) The removable stylus for writing the Gothic arch can be
inserted into the maxillary tray
49

50.  First, make a border mold using heavy-body silicone impression material, then make a
definitive impression with light-body silicone impression material, (a) Maxillary mucosal
surface, (b) Maxillary reverse surface, (c) Mandibular mucosal surface, (d) Mandibular reverse
surface.
50

51.  Custom trays have borders that can be
adjusted to control the movement of soft
tissues around the impression without
distortion. In addition, a uniform space can
be provided inside the tray to match the
shape of the tissues covering the denture-
bearing areas.
 These requirements are difficult to achieve
when making a definitive impression using
stock trays.
 Therefore, with the conventional methods,
a custom tray should be used to make the
definitive impression.
 The external shape of the CAD/CAM tray
must be similar to the external form of the
CD when making a definitive impression to
ensure the quality of the denture. 51
After making a definitive
impression, record the CR with
the Gothic arch in the
conventional manner.

52. According to the tooth mold
template that is positioned over
the midline, determine the midline
and smile line of the denture teeth
Jaw relation record
with CAD/CAM
trays and tooth
mold template
52

53. CONCLUSION-
 Failure to use the facebow leads to error in occlusion.
 Hinge axis is a component of every masticatory movement of the
mandible and therefore cannot be disregarded and this hinge axis
should be accurately captured and transferred to the articulat or.
So it becomes a fine representative of the patient and biologically
acceptable restoration is possible.
 Whatever may be controversy reasoned by in the use of facebow
but it should form a integral part of one prosthodontic treatment.

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•Kanazawa M, Iwaki M, ArakidaT, Minakuchi S. Digital impression and jaw relation record for the fabrication of
CAD/CAM custom tray. Journal of prosthodontic research. 2018;62(4):509-13.