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Articuladores

This article reviews studies on the capabilities of semi-adjustable articulators in developing occlusion. It focuses on three components: the condylar-fossa mechanism, intercondylar distance, and anterior incisal guidance. Positive and negative occlusal errors can occur with semi-adjustable articulators. The review aims to help clinicians choose the most suitable articulator to improve clinical outcomes.

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0% found this document useful (0 votes)
18 views8 pages

Articuladores

This article reviews studies on the capabilities of semi-adjustable articulators in developing occlusion. It focuses on three components: the condylar-fossa mechanism, intercondylar distance, and anterior incisal guidance. Positive and negative occlusal errors can occur with semi-adjustable articulators. The review aims to help clinicians choose the most suitable articulator to improve clinical outcomes.

Uploaded by

juliomoralesglz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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39

The relation of semi-adjustable articulators to clinical outcome - A review


!
Mohammed Aleem Abdullah*, MDS and Abdullah R. Al-Shammery , BDS, MS

Success or failure of prosthodontic clinical procedures often relies on the proper application of the principles of occlusion. This article
reviews in vitro and in vivo studies on strategies that attempt to explain the capabilities of semi-adjustable instruments in the
development of occlusion. This critical review enables the clinician to choose the most suitable instrument to improve clinical
outcomes. Scientific studies have been reviewed in relation to the following components of semi-adjustable instruments: (1)
condylar-fossa mechanism, (2) intercondylar distance, and (3) anterior incisal guidance and type of incisal guide pins. Positive and
negative restorative occlusal errors using semi-adjustable articulators are explained and documented. Recommendations are
provided for the selection of articulators that meet clinical requirements.

Introduction movements.1 Anatomical determinants, recorded


by interocclusal check records, are transferred to
semi-adjustable instruments to program the
Dental restorations should be fabricated on an mechanical components that control the
articulator that can accurately reproduce the movements and inf luence the occlusal
mandibular movements in order to minimize the morphology of restorations.3-7 The greater the
need for intraoral occlusal adjustments. Semi- accuracy in reproducing mandibular movements,
adjustable articulators are commonly used for the the less will be the occlusal correction required
fabrication of occlusal surfaces of crowns, fixed when the restorations are seated in the mouth.
partial dentures, implant prostheses and Recently, semi-adjustable articulators have been
conventional complete and removable partial introduced with new features such as a radial shift
dentures during diagnoses and treatment mechanism, condylar motion analogs, and rear
planning. wall adjustments to improve the articulator's ability
Numerous semi-adjustable instruments have to receive interocclusal static eccentric records and
been devised by prosthodontists since 1906.1 In simulate mandibular movements.8
1985, Martin and Gariot2 surveyed 53 North The purpose of this paper was to review the
American dental schools and reported that the functions and limitations of mechanical
articulators used for undergraduate instruction in c o m p o n e n t s th a t s i m u l a te m a n d i b u l a r
prosthodontics and occlusion were, in order of movements in order to enable the operator to
popularity: Whip-Mix**, Hanau Arcon H2 158, differentiate the weak and the strong attributes
nonarcon Hanau Model 96 H2, Hanau Radial Shift among various semi-adjustable instruments.
H-166+, and Denar Mark II++.
Ideally, a semi-adjustable articulator should Condylar fossa mechanism
simulate mandibular movements in three planes
in order to develop occlusal morphology of There are two types of condylar fossa
restorations that permit the passage of opposing mechanisms in semi-adjustable articulators. One
cusps without interfering with mandibular consists of condylar spheres set in straight tracks
Received 13 February 2001; Revised 12 June 2001; called, sagittal condylar guidances. The condylar
Accepted 20 August 2001 spheres are connected by a rigid condylar shaft
*Associate Professor, Department of Prosthetic Dental corresponding to the transverse hinge axis of the
Sciences, College of Dentistry, King Saud University, Riyadh,
Saudi Arabia mandible. The condylar shaft can move
!
Formerly Professor, Department of Restorative Dental mediolaterally within their respective condylar
Sciences, College of Dentistry, King Saud University and spheres. These instruments are called shaft
President, The Saudi Dental Society, Riyadh, Saudi Arabia articulators.9 Articulators of this type are Hanau 96
Address reprint requests to:
Dr. Mohammed Aleem Abdullah
H2 and Hanau H2 158 (Fig. 1). In the second type,
Department of Prosthetic Dental Sciences **Whip Mix Corp. Louisville California
P.O. Box 60169, Riyadh 11545 +Hanau Teledyne Buffalo NY
Saudi Arabia ++Denar Corp. Anaheim, California

Saudi Dental Journal, Vol. 14, No. 1, January - April 2002


40 SEMI-ADJUSTABLE ARTICULATORS

the condylar fossa mechansisms of the upper articulator, a constant relationship always exists
member are seated on the condylar sphere between the maxillary occlusal plane and the
attached to the lower members on which they are condylar guides in any eccentric positions of the
free to move. Articulators of this type are Whip-Mix, upper member. Therefore the distance between
Denar Mark II, and Hanau Radial Shift (Figs. 2, 3). the hinge axis and mandibular teeth in the
articulator remains the same as found in the
patient's mouth. Also, the reproduction of
mandibular movements is more accurate than
with a non-arcon instrument and a harmonious
occlusion is more easily achieved. Contrarily,
Weinberg13 and Beck14 concluded that arcon and
non-arcon articulators produce the equivalent
movements, and they further stated that clinically
the arcon concept has no advantage.

Fig. 1. Hanau H2 158 articulator. The condylar spheres are


connected by a rigid condylar shaft which can move
mediolaterally within their respective condylar spheres.

Fig. 3. The Hanau modular system 194 articulator with fixed 11


cm intercondylar distance and adjustable radial shift guidance.

Intercondylar distance

The distance between the centers of the two


condyles is described as the intercondylar
distance. The more closely the articulator's
intercondylar distance replicates that of a patient
Fig. 2. The Denar Mark 11 articulator. The condylar fossa the more accurately the teeth are related to the
mechanism rests on fixed condylar spheres on which it is free to vertical axes of the condyles. The ability of these
move.
articulators to duplicate the path of lateral
Irrespective of the condylar fossa mechanism, movements is directly related to an accurate
the semi-adjustable articulators are classified as reproduction of the distance between each tooth
arcon and non-arcon instruments. The term arcon and the vertical axis of each condyle which
was coined by Bergstrom10 from the words corresponds to the radius of rotation15 (Fig. 4). If
articulator and condyle. The arcon articulators the exact length of the radius is not reproduced on
have their condylar guidance mechanisms the articulator the resulting path of movement of
attached to the upper member and the condylar the supporting cusps traversing the central fossae
spheres to the lower member which are analogous of the opposing teeth will cause an occlusal error
to the arrangement in the human skull (Figs. 1,2,3). (Fig. 5). Furthermore, several investigators have
Articulators of this type are Hanau H2 158-1 reported that an instrument with a fixed
through 158-6, Hanau Modular System 190 through intercondylar distance will not accept lateral check
195, Hanau Radial Shift 166-1, Denar Mark II, and records from most patients and therefore, cannot
Whip-Mix. The non-arcon articulators have their be programmed accurately.3-5, 10,15-16
condylar assembly attached to the lower member Articulators are built with either a fully
and condylar guidance mechanisms to the upper adjustable or semi-adjustable intercondylar
member, such as the Hanau 96 H2. distance mechanism. The Hanau 130 and Hanau
Studies have shown10,12 that with an arcon Modular System 195 series has a fully adjustable

Saudi Dental Journal, Vol. 14, No. 1, January - April 2002


ABDULLAH AND AL-SHAMMERY 41

intercondylar mechanism in which the condylar the superior wall of the protrusive condylar
posts can be moved mediolaterally to increase or guidance may be straight or curved with average
decrease the intercondylar distance in order to anatomical values. The average condylar path
reproduce the patient's intercondylar width. follows a curvature with a radius of approximately
Instruments with semi-adjustable intercondylar 0.75 inch (19 mm).13 The difference between a
mechanisms such as the Modulular Hanau 166-1 straight condylar path and the apogee of a curved
may be adjusted to four different positions; 100 condylar path is 0.4 mm, (Fig. 6). A difference of
mm, 110 mm, 125 mm and 140 mm. According to 0.4 mm in the protrusive condylar path will
Keshvad et al. 17 one additional use of produce 0.1 mm negative error in molar cusp
intercondylar distance measurement is that the height at the second molar.13 Hanau Modular
distance between right and left canines and first System articulators 190 through 195 are available
molars of both the arches can be determined and with a wide range of curve protrusive condylar
used in the arrangement of teeth in complete paths of 13 mm, 19 mm, and 25 mm radii, thus, the
operator can select a radius according to the

Fig. 4. Distance between each tooth and vertical axis of the


condyle, R. It represents the radius of rotation of patient's
mandible (left) and articulator member (right). Fig. 6. Left top, average condylar path follows a curvature with
a radius of ¾ inch. Left bottom, the difference between
straight and curved condylar path is 0.4 mm. Right, occlusal
error at 2nd molar due to lack of provision for Fisher angle in the
articulator.

requirements of the patient.


Lateral condylar guidance

During lateral movements of the mandible, the


non-working condyle translates forward,
downward, and medially guided by the
neuromusculature and superior wall of the
glenoid fossae. Anatomically, the path of the non-
working condyle is steeper than the protrusive
condylar path inclination by approximately 50.13,18
Fig. 5. Top, the intercondylar distance of the patient is smaller The difference between the path of the non-
than that of the articulator. In the patient's mouth, the direction
of the ridge and groove is mesial, whereas in the articulator, it is
working condyle and protrusive condylar path
distal (bottom). inclination is called the Fischer Angle (Fig. 6).19 In
the semi-adjustable articulators, the two
dentures. inclinations are equal and there is no provision for
Protrusive condylar guidance a Fischer Angle. According to Weinberg,13 if lateral
check records have not been used, it is desirable to
As the mandible moves forward, both condyles increase the protrusive condylar guidance by 50.
move forward and downward. The inclination of Failing to accomplish this may cause a cusp incline
the superior wall of the condylar guide on the negative error of 2.5 degrees and a cusp height
articulator simulates the protrusive condylar path negative error of approximately 0.1 mm at the
and provides the protrusive condylar guidance. second molar (Fig. 6).
The influence of protrusive condylar guidance on During lateral movements of the mandible, the
occlusal morphology has been widel y condyle on the working side is called the rotating
reported.8,13,18 In semi-adjustable instruments, condyle and the non-working condyle is referred

Saudi Dental Journal, Vol. 14, No. 1, January - April 2002


42 SEMI-ADJUSTABLE ARTICULATORS

to as the orbiting condyle. As the orbiting condyle with a wide range of intercondylar width
moves downward, forward and medially, its path is adjustments and adjustable posterior, medial and
essentially divided into two components, superior fossa walls, have been introduced to
immediate side shift and progressive side shift. In simulate the immediate side shift with acceptable
the immediate mandibular side shift, the orbiting accuracy. The semi-adjustable instruments have
condyle moves essentially straight medially as it two main types of condylar guidance
leaves centric relation at the beginning of the
lateral jaw movement20 (Fig. 7). Since the teeth
are not separated or only slightly separated when
this movement occurs, the presence and degree
of immediate side shift influences the occlusal
morphology of natural teeth as well as artificial
teeth. Following the immediate side shift, the
orbiting condyle changes direction more or less
abruptly to follow a more anteriorly directed path. Fig. 8. A, if the rotating condylar path is outward and upward,
The rotating condyle moves laterally and is the height of the cusp incline on the working side will be flatter.
guided by the rear and superior fossa walls. The B, if the rotating condylar path is outward and downward, the
height of the cusp incline on the working side will be steeper.
rotating condyle path of movement has a principal
effect on the working inclines of the cusp on the mechanisms.23 One consists of moving condylar
working side15,18 (Fig. 8). The lateral rotating elements (two spheres set in an adjustable
condylar path may be inclined upward or straight condylar track as found in the Hanau H2
downward, backward or forward. The upward or series of articulators (Fig. 1). The other type has a
downward inclination of the rotating condylar path condylar fossa mechanism that seats on the fixed
in the coronal plane influences height of the condylar sphere on which it is free to move (Fig. 2).
The latter type of condylar fossa mechanism is
employed in Whip Mix, Denar Mark II and the
Hanau modular instruments (Figs. 2,3). The
capability to simulate the Bennett movement (side
shift) by these two different types of condylar
mechanisms is reported to vary.15,22,23 In the shaft
type instruments such as Hanau H2 models, the
upper member has a rigid condylar axis and its two
ends move medially and laterally within their
respective condylar spheres. On carrying out
lateral movements, the working condylar sphere
must be held against the centric stop while the
Fig. 7. During lateral movement of the mandible, the non-working side of the axis shoulder must
nonworking condyle (right side) moves downward, forward continuously maintain contact with the moving
and medially and its path is divided into immediate side shift non-working condylar sphere (Fig. 9).23 The
(ISS) and progressive side shift.
resulting gap between the working condylar axis
working cusp inclines.15,18 shoulder and the working condylar sphere
If the rotating condylar path is outward and represents the amount of bodily shifts of the upper
upward, the height of the cusp inclines on the member of the articulator which is an approximate
working side must be flatter. Whereas, when the simulation of the immediate and progressive
rotating condylar path is outward and downward, mandibular side shift.23 Since the working
the cusp height on the working side may be condylar element remains firmly in contact with
steeper (Fig. 8). The condylar mechanisms of the the centric stop acting as a fulcrum, the condylar
Hanau H2, Whip-Mix and Denar Mark II articulators axis moves backward and in a lateral
cannot be adjusted to upward and downward direction, 15,23-25 whereas, during Bennett
movements of the rotating condyle.15,18,21,22 movement, the working condyle moves in any one
Thus, it is reasonable to assume a negative or of the nine directions.15,22,31
positive occlusal error in the patient's mouth if In the non-shaft instruments such as Whip Mix
restorations are developed on semi-adjustable and Denar Mark II, the condylar fossa mechanisms
articulators. of the upper members are seated on the condylar
Several types of semi-adjustable articulators spheres which are attached to the lower member

Saudi Dental Journal, Vol. 14, No. 1, January - April 2002


ABDULLAH AND AL-SHAMMERY 43

on which they are free to move (Fig. 2). The records with accuracy. Aull18 explained that the
angulation of the medial fossa wall to the sagittal condylar element of the Whip Mix articulator is
plane is adjustable and is set for the progressive bounded posteriorly and superiorly by fossa walls
and only four directions of movement for the
working condyle are possible. These are straight
lateral, lateral and downward, lateral and forward
and lateral forward and downward Therefore, he
concluded that the simulation of the Bennett
movement by this instrument is limited. To
overcome this limitation, the Hanau Modular 194
and Denar Mark II instruments have an immediate
side shift path set to the average anatomical
inclination which is out and backward 25 degrees
in relation to the frontal plane (Figs. 11, 11A).
Fig. 9. Schematic representation of Bennett movement (SS) Abdullah3 reported 87% acceptability of lateral
recorded by Hanau H2 articulator. A.S.S. anterior screw stop interocclusal records for the Hanau Modular 194
(centric stop); C.A.S. condylar axis shoulder; S.S. side shift.

side shift (Bennett angle) by means of lateral


check records. In order for the non-working
condylar sphere to maintain contact with the
medial wall of non-working fossa, the upper
member must move bodily by a small amount
towards the non-working side. The bodily side
movement must occur with the superior and
posterior wall of the working fossa maintaining
contact with the working condylar sphere. The gap
between the working condyle sphere and the
medial wall of the working fossa indicates the Fig. 11. The Denar Mark II articulator showing condylar
amount of lateral shift of the upper member. This guidance mechanism with a side shift path preset to the
bodily shift of the upper member provides average anatomical inclination out and backward 25 degrees in
relation to the horizontal plane (arrows).
simulation of the immediate plus the progressive

Fig. 11A. Schematic representation of condylar guidance. A


Fig. 10. Diagrammatic representation of Whip-mix articulator and B, a 3 mm immediate side shift; C, curve path; D,
condylar guidance mechanism with a side shift. WC, working progressive Bennett angle, and E, curved posterior wall of
condyle; NWC, nonworking condyle. condylar guidance.

side shift (Fig. 10). articulator and 80% for whip Mix articulator.
Hickey et al.26 stated that the design of the Anterior or incisal guidance
condylar housing in the Whip Mix allows the
working condyle to move in a lateral direction only Several designs of anterior guidance tables are
during Bennett movement. Heartwell,12 Knap and available. The anterior guidance consists of two
Zeibert,16 Belle et al.5 concluded that the Whip components, the incisal pin and the table. The
Mix articulator will not accept all lateral check table may be classified as a mechanical or a

Saudi Dental Journal, Vol. 14, No. 1, January - April 2002


44 SEMI-ADJUSTABLE ARTICULATORS

evidence that anterior guidance influences the


working condylar path and supports the
hypothesis that anterior guidance and condylar
path are dependent factors.28

Discussion

When an articulator is used in the analysis of


occlusion and development of occlusal
morphology of restorations, it is desirable to
understand its design, capabilities and limitations.
Certain semi-adjustable instruments are
capable of approximating the patient's
Fig. 12. The offset incisal pin on Hanau articulator. intercondylar distance with small, medium and
large settings, thus allowing the vertical axes of
customized anterior guidance system. mandibular rotation on the articulator to
Incisal pin correspond more closely to those of the patient.
According to Aull18 the small and medium settings
The types of incisal pins are (1) straight (2) appear to reproduce the patient's intercondylar
curved and (3) off set pins.9 Articulators with distance more accurately than the larger
straight pins are incapable of accepting alterations intercondylar distance range.
in vertical dimensions because by raising or Investigators have reported that the working
lowering the incisal pin, the contact at the center condyle has a tendency to move more backward,
of the incisal table will be lost (Fig. 1). The curved upward and laterally as the intercondylar distance
pin holder on the Denar Mark II (Fig. 2) and the off increases.24,25 Thus, large intercondylar distance
set pin on Hanau 2 (Fig. 12) permit change in duplication may be even more critical in the
vertical dimension without altering the central development of occlusal morphology.31 Some of
position of the incisal pin on the table.2,19,27-30 the latest semi-adjustable articulators such as
Hanau Modular Series have a fixed intercondylar
Incisal guide table distance of 90 mm and the manufacturers claim
that the adjustable posterior wall of the condylar
The mechanical incisal guide table consists of housing compensates for the lack of intercondylar
protrusive and lateral components (Fig. 1). The adjustments. This theory has been mathematically
working tooth guidance, whether it is canine tested but not clinically proven.21,22
guidance or group function, govern the lateral The working condylar movements should be
protrusive component of working movement and considered when restoring occlusal morphology
is simulated by raising the lateral wings of the of posterior teeth with group function. Many
mechanical incisal guidance table.19,20,23,26 The investigators have reported that the posterior wall
mechanical Schulyer incisal guidance has a special of the condylar housing controls the direction of
device that may be used to develop freedom in the working condyle during lateral excur-
centric occlusion (long centric)27 as shown in Fig. sions.3,21,22 However, Schulte et al. and Proschel
12. et al.31 stated that superior wall inclination signi-
When natural anterior teeth are present, a ficantly influences the working condylar
custom anterior guidance can be provided by movement and that the rear wall inclination has
fabricating an anterior guidance jig of acrylic on less influence. They further stated that
the anterior guidance table. The customized harmonious occlusion may be developed without
anterior guidance table provides curved surfaces reproducing the exact rear wall angulation of the
rather than flat planes. The flat planes of the working condylar fossa.31
mechanical incisal guide table allows only limited The working condyle in the patient includes
contact between the anterior teeth whereas, both anteroposterior, and superoinferior
curved planes that are develop in acrylic resin components of movement in addition to the direct
follow the guiding surfaces of teeth and provide lateral side shift during lateral mandibular
more accurate contacts and freedom in centric excursion.16,18 Semi-adjustable articulators cannot
occlusion if it is present in the natural dentition.27 be adjusted to upward and downward movement
The recent mandibular movement studies provide of the rotating condyle.15,18,21-22 It is therefore,

Saudi Dental Journal, Vol. 14, No. 1, January - April 2002


ABDULLAH AND AL-SHAMMERY 45

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Saudi Dental Journal, Vol. 14, No. 1, January - April 2002

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