TJDSR Volume 30 (8) July 2012 IUDSR “Dr. Yogesh Rao, **Dr. Pankaj Yadav, ***Dr. Amit Kalara, ****Dr. Manjunath Badni, *****Dr. Sheetal Kumar Sagari ¢**Dr, Atual Bhandari ABSTRACT Selection of articulator has a direct bearing on the success of fixed or removable restorations, To avokd problem with fixed or removable restorations the use of fully adjustable articulators which duplicate the mandibular ‘movements with a high degree of precision is recommended. Articulator simulates equivalent movements of the TMJ but does not duplicate or produce identical movements as in the human mouth. It forms an important instrument to the dentist as it can be programmed with certain patients records allowing the operator and laboratory technician to fabricate a restoration that will be physiologically and psychologically acceptable. Properly mounted cast allow the operator to better visualize the patient occlusion from the lingual side. Chair side appointmentis reduced and more work can be designated tothe auxillary personnel. KEYWORLD Anticulators, Semi-adjustable, Fully adjustable, Facebow. INTRODUCTION In the fabrication of indirect dental prosthesis a ‘mechanical device is used to relate opposing casts called an articulator. An articulator is a mechanical instrument that represents the temporomandibular joints and jaws, to which maxillary and mandibular ‘casts may be attached to simulate some ot all mandibular movement (GPT 05). It is generally ‘known that the mechanical articulator originated as a simple hinge. The first improvements to the simple hinge came in the form of vertical and horizontal adjustment features, Hand held casts can provide information concerning alignment of the individual arches but do not permit analysis of functional relationships. For an analysis, the diagnostic casts need to be attached to an articulator. Articulators simulate the movement of the condyles in their corresponding fossac. REVIEW OF LITERATURE During the last two decades of 18° century, the profession was heavily influenced by the pervasiveness of Bonwill’s philosophies and his so-called “Anatomica articulator, As the new century approached, investigators began to have a much better understanding of the nature of mandibular movement. This was substantially due to breakthrough contributions like those of William E. Walker (the first adjustable condylar guide articulator, 1896), George Snow (the facebow, 1899), and Carl Christensen (the intraoral “check bite” technique, 1901). For the first time, a practical and accurate method for taking information from the patient and transferring it to an adjustable articulator ‘was possible.’ Some aspects of jaw physiology have been easy to duplicate mechanically on an articulator, such as the hinge movement, relation of easts to the hhinge, and inclination of the condylar path Consequently these features appeared first on the instruments. Other movements have been more difficult to reproduce mechanically. Among them are the Bennett movement in three dimensions, the timing of the Bennett movement, the exact curvature of the condylar path, and a determination of the intercondylar distance. The problems involved in duplicating these features have been solved by modern instrument design’. Articulators with improved functional features, such as those designed by Bonwill, Gysi (the “Simplex"), Snow, Gritman, and Kerr, were readily available but were regarded as too complicated. Even more troubling, the average practicing dentist was apathetic to the deplorable state of artificial teeth available, Realistically, most dentists did not have a clue as to why 90% of their removable prostheses were failures. Over the last 120, years, hundreds of different articulators have been, ‘constructed. Throughout these years there has been, no remarkable development on articulators. Today's articulators are handy, functional and more precise in both construction and operation, An articulator can simulate but they cannot duplicate all mandibular movement, They are classified according to how closely they can reproduce mandibular border movements, Dental restorations should be fabricated ‘on an articulator that can accurately reproduce the ‘mandibular movements in order to minimize the need for intraoral occlusal adjustments’. Most single crowns and simple fixed partial dentures are fabricated on small hinge articulators that have limited ability to duplicate mandibular movement or none at all. While many of the inaccuracies produced by this type of instrument may be corrected in the mouth using valuable chair time, the end result is an Mtn Pig Caes ot Dest and Rees Cate Grin Mega Pry ni 8088 Sear ene, Daun of Cosa Deny sn Endo, Mas aetna Secs New Dei 11002TJDSR Volume 30 (8) July 2012 ‘clusion that is less than optimal. Unfortunately, ‘many of these inaccuracies are not recognized and are allowed to remain in the mouth as occlusal interferences which frequently produce symptoms of ‘occlusal disease’, Semiadjustable articulators are commonly used for the fabrication of occlusal surfaces of crowns, fixed partial dentures, implant prostheses and conventional complete and removable partial dentures during diagnoses and treatment planning’ The success of fixed or removable restoration directly depends on the articulator selected as well as the skill and care with which it is used. An articulator classification was developed based on the instruments function, instrument capability, intent, registration procedure and registration acceptance were considered Classification of Artieulators: Anartculator classification was developed based on the instruments function, instrument capability, intent, registration procedure and_ registration acceptance were considered. Gillis’ divided artculators into two classes: (1) the adaptable or adjustable type and (2) the average or fixed type Boucher classified articulators as nonadjustable or adjustable. He also subdivided the adjustable type into two groups: (1) a two-dimensional instrument and 2) a three-dimensional instrument. Based on the design of articulators, another classification was devised by Beck. He divided articulators into three ‘eategoris: (1) the suspension instrument, (2) the axis instrument, (3) the tripod instrament. Posselt classified- articulators as plain tine, mean value, and adjustable. Sharry classiied-articulators as simple, hingetype, fixed-guides type, and adjustable Heartwell and Rahn: emphasizing the role of pantographs in record registration, divided antculators into two classes (1) instruments that will reeeive and reproduce pantographs and graphic tracings. (2) instruments that will not receive panto- graphs, Which are subdivided into four types: (a) hinge type, (b) arbitrary, (©) adjustable, and (@) instruments designed and used for complete denture construction, ‘Thomas, atempting to simplify the classification of auticulators, devised a new classification based on the type of records used. He divided ariculators into three types: (arbitrary (notadjustable), (2) positional (axis and nonaxis types, static records) (3) functional (axis and nonaxis types, functional records) Classification Of Articulators Using The New System: *A nonadjustable articulator can accept one or two of the following records: Fave bow, centric jaw relation ‘or protrusive record. Gariat, 1805; Evans, 1840; barn ‘door hinge, 1858; Bonwill, 1858; Walker, 1896 (hes adjustable condylar guidance, but does not accept the facebow record); Gritman, 1899; Snow, 1906; Gysi Simplex, 1912 Monson,” 1918; Stansbery, 1929 (based on the tripod theory, where there isno condylar ‘eontrol}; Philips Occlusoscope, 1931 (based on the tripod theory also, and does not accept the face-bow record); Kile Dentograph, 1945 (based on the principle of the tripod); Transograph, 1952 (contains two face-bows, upper and lower, connected to each ‘other; there is no condylar guidance); and Pankey- Mann, 1955 (based on the spherical theory using special face-bow to mount the mandibular cast) # A semi adjustable articulator can accept all three of those records. Snow Acme, 1910; Gysi Adaptable, 1910 (does not accept lateral records); Hanau H, 1922, Wadsworth, 1924; Gysi Trubyte, 1926 (does not accept the intereondylar distance record); House, 1927 (does not accept the intercondylar distance record, satisfies Bonwill principles); Dentatus, 1944; Berg strom Arcon, 1950; Hanau 130-28, 1963; and Whip- Mix, 1968. + 4 fully adjustable articulator can accept the following five records: Face bowcentric jaw relation, protrusive, lateral records, and intercondylar distance record Hanau Kinescope, 1923; McCollum Gnathoscope, 1935; Granger Gnatholator, 1950; Stuartaticulator, 1955; Ney-Depictro, 1962; Hanau 130-2 1, 1963 ! Simulator, 1968; and Denar D4- A,1968. ‘The non adjustable articulator incorporate average patient values to represent the inclination of the glenoid fossa and the eodyle fossa relationship and so cannot accurately reproduce an individual's ‘mandibular excursive movements’. Ideally, a semix adjustable articulator should simulate mandibular movements in three planes in order to develop ‘occlusal morphology of restorations that permit the passage of opposing cusps without interfering with ‘mandibular movements’. Anatomical determinants, recorded by interocclusal check records, are transferred to semi-adjustable instruments to program the mechanical components that control the ‘movernents and influence the occlusal morphology of restorations". The greater the accuracy in reproducing mandibular movements, the less will be the occlusal correction required when the restorations are seated in the mouth”, Semiadjustable articulators are commonly used for the fabrication of occlusal atTJDSR Volume 30 (8) July 2012 surfaces of crowns, fixed partial dentures, implant prostheses and conventional complete and removable partial dentures during diagnoses and treatment planning’. ‘A fully adjustable articulator has a wide range of positions and can be set to follow a patient's border movements. The final step in the progression of articulators is the fully adjustable instrument. Fully adjustable articulators have a large range of adjustability in three dimensions and are accordingly the most complex and expensive. The accuracy of reproduction of movement depends on the care and skill of the operator. They can be very useful as ‘weatment complexity increases. When itis necessary to restore entire dentition, especially in the presence ofatypical mandibular movement, A fully adjustable articulator can accept the following five records: Face bow, centric jaw relation, protrusive, lateral records and intercondylar distance record, Bonwill theory articulators/theory of equilateral triangle: During the 1864 meeting of the American Dental Association, Bonwill demonstrated his “anatomical articulator," His design varied from ‘others in that he recognized that the "condyles often, move away from the position they occupy during hinge closure." Its simplicity and practicality led to quick acceptance and usage by the profession, His, theories and fundamentals would become the basis, for articulation of teeth and for subsequent articulator design. In Bonwills own words: "There can be no excuse for failure or unartistic work when this instrument is once understood, and the law controlling the human javs + According to this theory the teeth move in relation to each other as guided by the condylar and incisal ‘guidance’s * Distance between the condyles and distance between condyles and midpoint of central incisors is equal”. Function of articulators + The primary function of the articulator is to act as a representative in patients +Itis used to simulate the patients temporomandibular joint, muscles of mastication, mandibular ligaments, maxilla and mandible and the complex neuromuscular mechanism that programmes the ‘mandibularmovements. +The articulator is made to simulate the equivalent movements of the TMJ but does not duplicate or produce identical movements asin the human mouth sIt forms an important instrument to the dentist as it ‘can be programmed with certain patients records allowing the operator and laboratory technician 19 fabricate a restoration that will bephysiologcelly and psychologically acceptable. Requirements of articulators: (1) face-bow record (2) centric jaw relation record (3)protrusive record lateral records (S)intercondylar distance record Other requirements *Itshould hold eassin comecthorizontal and vertical reltionshpsi.e,centricrelations +shoul providea positive anterior vertical stop. “itshould accept face bow transfer record, should ‘openand close ina hinge movement “Ttshouldallow protusive and lateral jaw motions Moving parts shouldmove freely and accurately ‘Moving pres shouldbe often rigid construction “Should be easy to fix and attach the maxillary and mandibular east tothe articulator and also to attach fiom theartculators Four features are required of an articulator: 1-centricrelation ofthe mandible 2 contr of lateral incisor point movements 3 sagital inclinations ofthe condylar path 4 inisorpath Four methods of adapting the articulator The" intra-oral cheekbite method with plastic material 2Theintra-oral checkbite method withplaster 3 Theextra-oal graphic method withthe face-bow 4. Theintra oral dentographie method Usesin Prosthodontics 1. Semingjustable artculators are essential in planning fixed prosthodontic treatment 5.To diagnose the state of occlusion in both the natural and artifical dentition, 3. To plan dental procedures based on relationship iberween opposing naturel and artificial teeth eg evaluation ofthe possibility of balanced occlusion, 4."To aid in the fabrication of restoration and prosthodontic replacements 5.Tocorrectand modify completed restorations 6. Toarrange artificial teeth, Usesin Restorative Dentistry 1. For most single restorations, s nonadjustable atiulator with fixed condylar path will produce aa scceptablereslt 2. When. multiple restorations or fixed patal dentures are being fabricated, greater segments ofthe beclusion are being replaced, and there isa need for accuracy. Ifthereasbeen nc loss ofthe verticalTJDSR Volume 30 (8) July 2012 Table 1, Matching treatment with articulators dimension of occlusion and no evidence of occlusal disease or an immediate side-shifl, the usc of a semiadjustable articulator is warranted. Use of a face-bow transfer further minimizes tooth-hinge axis errors, although some still exist if an arbitrary hinge axis us used as the point of reference. Lateral ‘checkbites (interocclusal records) are used to set the condylar inclination, and adjustment for the Bennett, angle is possible. This type of instrument will also provide incisal guidance. While errors still exist in the semiadjustable articulator, it isa definite step upward from thenonadjustable articulator, 3. The fully adjustable instrument is indicated for extensive treatment in which opposing quadrants are restored, for reconstruction of the entire occlusion, ‘and for patients with a significant side-shift during lateral mandibular movements, Its use is particularly desirable when there is a need to restore lost vertical dimension or when there is evidence of occlusal disease and breakdown’ Uses in Surgery 1. Articulation of study models is an essential part of the presurgical preparation in patients undergoing orthognathic surgery. The articulator is used to support the study models on which the surgical moves ‘are performed prior to the construction of inter- ‘occlusal wafers. The crucial question for model surgery is whether it is necessary to use a facebow record to transfer the condyle tooth relationship to the articulator’ Usesin Orthodontics 1. Where a significant discrepancy (>2mm) exists between the retruded contact position and the intercuspal position. Diagnosis will be assisted by knowledge of the magnitude of the discrepancy which can be measured on the articulator 2. Orthodontic cases with multiple missing teeth, in which @ stable inter-cuspal relationship cannot be recorded 3. Cases undergoing maxillary and bimaxillary ‘orthognathie procedures. 4. Articulator mounting of study models pre- orthodontic and pre debond in individuals with temporomandibular disorders Virtual Articulators- Dental Virtual Articulator simulates and analyzes ‘mandibular movements of the human jaw. This is achieved by means of CAD systems and Reverse Engineering tools. Different articulators have been selected to be modelled through different CAD systems (SolidEdge and CATIA). The design process has been carried out using measuring tools and Reverse Engineering tools available at the PDL ‘These tools are: Handyscan\REVsean 3D scanner and its software (VXscan), Reverse Engineering and ‘Computer-Aided Inspection Software (Geomagic Studio and Qualify), Rapidform XOR, as well as ‘ATOS Irev.2GOM 3D scanner. Once the articulator is digitized, the next stage is to obtain the upper and lower dentures digitally. Apart from this, it is necessary to register the relative location of the ‘occlusal surface referred to the intercondylar axis. This is achieved by means of the face bow. ‘Afterwards, the design of the dental prosthesis is developed ‘using the CAD system and finally, ‘mandibular movements are simulated. Once the articulators are selected their structures and shapes are analyzed in order to clarify how to use the Reverse ingincering and measuring tools. The gencral structure, this is, upper and lower bodies, is similar in both articulators, but the TML-s, which are the most important part of the articulators, present a great variety of configurations. The technician can choose the type and adjustment of the articulator. There are several advantages in producing computer-aided prostheses such as time, data rogistration, material resistance, control of several. parameters, etc. Therefore, nowadays there is no doubt as to the vast potential offered by CADICAMSsysiems, Throughout the last years, thanks to 3D scanning and computing developments, some very relevant improvements, hhavebeenmade indigital dentistry Virtual Articulator Design Process The selected articulator and even more importantly the skill and care, with which itis used, have a direct ceffecvimpact on the success of fixed or removable restorations. If the dentist's only concem is. the relationship of the antagonist teeth at the point of ‘maximum intercuspation, the design and the use of an articulator will be greatly simplified. Since the 93 —TJDSR Volume 30 (8) July 2012 intercuspation postion is static, the articulator will need to act only as a rigid hinge, which is litle more than a handle forthe model, The mandible, however, doesnot act a a simple hinge. Rather than this, itis ‘capable of rotating around axes in thee planes Once the articulators are selected, their structures and shapes are analyzed in order to clarify how to use the Reverse Engineering and measuring tools. The general structure, this i, upper and lower bodies, is similar in both aiculators, but the TMI-s, which are the most important part ofthe articulator, present @ great variety of configurations “The. Virtual Articulators are able to design prostheses kinematically. They re capable 1. Simulating human mandibular movements, 2. Moving digitalized occlusal surfaces against cach other accordingto these movements, and 5. Correcting digitalized occlusal surfaces to enable smooth and colision-free movements An educational module is constructed for didactic objectives inorderto cmonstrate and illustrate the functions of dental aticulators andthe human masticatory system “simulate different ypes of excursive movements and itsinfluence onthe occlusal surface. canalyze te role and influence of different parameter settings on articulator movements sanalyze of the occlusion of digitized occlusal surfaces of natural dental arches". The two main practical implications ofthis research project are the improvement of existing dental CAD- CAM systems by adding the kinematics and the analysis of the simulations of different artculators, Since each articulator has an individual pattem of movement. Current popular aticutaors” 1. Mean Value Articulator Also called as “Three Point Articulator or Free Plane “Articulator”, these instruments are routinely wsed in dental colleges to teach undergraduate students ‘These instruments are nonadjustable, non arcon type, designed using fied dimensions. Aspringis mounted within the condylar track to stabilize the condylar elements and hold them in their posterior most position Hanau F12 Articulator ‘These instruments are condyla or non arcon type. ts prototype, the model H, designed by Rudolph Hanau, twas originally designed for complete denture ‘onstruction, both models have received widespread acceptance throughout dental profession, The Hana. HD articulator hes a fixed Intereondylar distance of 110 mm and does accept a face-bow transfer. The lateral horizontal condylar inclinations are simulated by means ofa protrusive interocclusal record. Hana suggested the formula L = (H/8) + 12 (L = Lateral condylar angle in degrees and H = horizontal ‘condylar inclination in degrees) to arrive at an acceptable side shift angle, The lateral adjustment for side shift range from 0-30 degrees, The mechanical incisal guide table is adjustable both in sagittal and frontal planes. The face-bows that can be utilized with the Hanau H2 articulator are the facia face-bow, the ‘earpiece face-bow, the Twirl-bow and the adjustable axis or kinematic face bow Whip Mix Articulator The basic Whip-Mix is an arcon articulator. It was, ‘designed by Charles Stuart in 1955 so that restorative dentistry could be accomplished with greater precision without the use of very expensive ‘equipment or more time consuming techniques. The intercondylar distance isadjustable to three positions: small (S), 96mm; medium (M), 110 mm; and large (L), 124’ mm; by means of removable condylar ‘guidance spacers along the instrument's horizontal axis. The horizontal condylar inclinations are set by means of a lateral or protrusive interocclusal record, ‘The amount of Bennett movement is set by means of a lateral interocclusal record, The articulator is available either with a mechanical incisal guide table, adjustable in both sagittal and frontal planes, or witha plastic incisal guide table that can be individually ‘customized. ‘The face bows that can be utilized with the Whip-Mix articulator are Quick Mount or earpiece face-bow and the adjustable axis or kinematic face-bow. The bridge of the nose is utilized as the anterior reference point with the earpiece face- bow. The incisal guide ins straight and onc endis flat, ‘and the other end rounded. REFERENCE 1. Rosenstiel S, Land MF, Fujimoto J: Contemporary Fixed Prosthodontics, 3" ed. St, Louis, Missouri Mosby Ine. 2001 2. The History of Articulators: The “Articulator Wars” Phenomenon with Some Circumstances Leading up to It Joumal of Prosthodontics 2010;19:321333. 3. Donald L. Mitchell, Noel D. Wilkie, Articulators through the years. Part II, From 1940, J Prosthet Dent 1978;39:4:451-58 4, Abdullah MA and Al-Shammery AR. The relation of semi-adjustable articulators to clinical outcome - A review, Saudi Dental JoumalTJDSR Volume 30 (8) July 2012 2002514:39-46, 5. Hobo §, Shillingburg HT, Whittset LD. Articulator selection for restorative dentistry. J Prosthet Dent 1976;36:35-43. 6, Rittani, A, Classification of articulators. J Prosthet Dent 1980;43:344-347, 7. LR Clark, i Hutchinson and J.R Sandy. Functional ‘occlusion:II The role of articulators in functional orthodontics J of Orthodontics.2001;28:numlber2:173-177. 8. Starcke EN. The history of articulators: Early attempts to reduce mandibular movements, J Prosthodont 2000;9:51-56 9. Abdullah MA. A study of acceptability of lateral interocclusal records by a mandibular articulator ‘Prosthet Dent 1995;74:408-411. 10. Gatson ML, Bardy RD, Varmilyea SG. A study of | acceptability of lateral interocclusal record by Hanau H2 articulator. J Prosthet Dent 1985;53:252-256. 11, Bell LM, Matich JA. A study of the acceptability of lateral records by the Whip-Mix articulator, J Prosthet Dent 1977; 38:22-25, 12, Cobot LB. Using articulators to enhance clinical practice Br, Dent 1998;184:272-27. 13, Dixon DL. Overview of articulation materials and methods for the prosthodontic patient, J Prosthet Dent 2000;83:235-247, 14, Hobo S, Shillingburg HT, Whittset LD. Articulator selection for restorative dentistry. J Prosthet Dent 1976;36:35-43, 15. Jemry J, Herschfeld. The Anatomical Articulator Quintessence Intemational "Classics in Dental History," in Bulletin of the History of Dentistry. 1984 vol 11:1178 16. B. Solaberrieta, O, Etxaniz, R. Minguez, J Muniozguren, A. Arias, Design of a Virtual Articulator for the Simulation and Analysis of Mandibular Movements in Dental CAD/CAM. CIRP Design Conference 30-31, March 2009, (pp323-330, 17. Joshi PR, Bhat GS, Dixit Selection of articulator for general dental practice. Kathmandu University Medical Journal 2008; 6: 112-116, Request for updating Contact Details. All the Local branch office bearers are requested to send updated member's list and their contact details to ensure correct & timely delivery of the journal Please mail at [email protected] 95}-