REGISTRATION OF THE CONDYLE PATH INCLINATION BY INTRAORAL WAX RECORDS-ITS PRACTICAL VALUE

ULF POSSELT, L.D.S., ODONT.DR., AND PER NEVSTEDT, L.D.S.

The Royal Dental School, Malmii, Sweden

as obtained from interocclusal wax records and the adj,ustment of the condyle path of the articulator depend on a number of factors during both the registration and the reading. The error of the single observation for the Dentatus articulator has been calculated to 2.3 degrees.l This value constitutes the average error of protrusions of 4 to 8 mm. in 10 persons with natural teeth (Table I). The figure is valid for a trained operator.t The variation between different operators was not examined in the previous investigati0n.l As mentioned previously, the articulator has an error of measurements of about 2.3 degrees1 This number (2.3) multiplied by the square root of 2 and multiplied by 2.5 results in an amount of 8.1 degrees. This number of degrees decides the difference between two single determinations of condyle path inclination which must be present for the two records to be differentiated. As the selectivity of the method is known, the next question is how often does the condyle path inclination deviate more than 8.1 degrees from a suitable mean value. This investigation was designed to determine the frequency of condyle path inclinations, with the error of measurement found with the Dentatus articulator as a background.
HE VALUE OF THE CONDYLE PATH INCLINATION MATERIALS

One hundred and one subjects (60 women, 41 men) were selected at random from the Department of Occlusal Analysis of the Royal Dental School, Malmo, Sweden. The average age was 35 years and the average number of teeth present was 26. The distribution of the frequency of the condyle path inclinations is seen in Fig. 1. The average shift of the condylar spheres for 30 subjects was 4.4 mm. (stand.ard deviation 1.7 mm.). The condyle path inclinations were measured in relation to the Frankfort plane. The average inclination was 39.1 degrees on the right side and 40.4 degrees on the left side, with a range of 60 degrees. The Dentatus articulator cannot be -*Head of the Department of Occlusal Analysis and Rehabilitation. tThe operator is the one who undertakes the intraoral registration of wax records. The reader examiner places the wax records on the casts, adjusts the condyle paths, and reads the condyle inclination.
43

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POSSELT AND

NEVSTEDT

adjusted to a condyle path inclination steeper than 60 degrees. The distribution oi frequency (Fig. 1) is asymmetric, which may be due to this upper limit in adjustment of the Dentatus articulator.
RESULTS

Results indicated that individual registrations of the condyle paths should be used, instead of the mean value adjustment of 40 degrees, when a patient had a condyle path inclination amounting to more than 49 degrees or not exceeding 31 degrees. This will be true in 50 per cent of the patients. If one is not satisfied with this selectivity, the reliability can be increased by repeating the determination of the condyle path inclination. Four independent repetitions cause the difference from the mean value adjustment, as demanded for a statistically established difference, to be diminished by one-half.
TABLE I. MEANSAND _ __._. ~.~~._~-~.~ .._.._ --.-~. ~-..I
i

STANDARD DEVIATIONOF CONDYLE PATH --.---.-. . ~-. .-_ __~_~.... _---_-~----_-__VENTATUSARTICULATOR .~ -... .-- --.-

INCLINATIONS ~----.

~- ~. -~.

__ SD*

~- ...~~ _-

VEGREE

OF PROTRUSION (MM.)

/ / M OS

I I

KS

1 f3 , I

30.1 30.0 30.9 30.3 ~

2.5 2.3 2.0 2.3 I ! ,

20.8 15.6 17.2 17.9

Average

The condyle path inclination was measured in relation to the occIusa1 plane. *The standard deviation was divided into the variance inside the classes and the variance between classes. This involved the error of the single observation (OS) and further the sensitivity partly for examiner (difftculty in reading the instrument) and partly for difierent condyle path inclinations (KS). DISCUSSION

A comparison between the graphic registration.according to the Gysi method and the interocclusal wax record registration seems to favor the latter.2 Provided a comparison between results from complete dentures and natural dentitions is allowed and provided also the results are caused by the record technique, the findings seem to coincide with those of Ekensten.3 The technique of the various operators seems to have great significance.4 The 202 condyle path inclinations were measured by students under the supervision of instructors. Therefore, it is conceivable that one or a few trained dentists would have obtained fewer deviations, For example, it is striking that 22 per cent of the values are below 30 degrees. On the other hand, one should consider that the 101 cases certainly included pathologic conditions of the temporomandibular joints, for instance, distal displacement of condyles.

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An attempt toward individual condyle path registration naturally implies that the imitation of relatively large gliding movements on the articulator is considered of value. ?Jot all articulation theories have this as a goal. Whether or not an adjustment of the condyle path inclination is meaningless because of the shortness of the path during functional contact movements is another question. The opinion depends on a number of factors, especially which movement one wishes to imitate on the articulator. Therefore, the question can hardly be answered in general.
NUMBER
32 30 28 26 24 22 20 18 16 14 12 10 8 6 4' 2'

OF JOINTS

I.
2 7 12 17 22 27 32 37 42 47 52 57

.
62

-------------Fig. I.-The

RIGHT SIDE LEFT SIDE RI.+LE. SIDE

CONDYLE PATH INCLINATIONS

distribution

of the frequency

of the condyle path inclinations.

The first and foremost advantage of the articulator is its capability to secure definite relations between the mandible and the maxillae. The instrument is further able to imitate paths of movements between these positions approximately correctly. The use of the movement path after adjustment of the individually adjustable articulator depends to a large degree on clinical training and common sense. The positional registration is the primary thing. The starting position, centric relation, again is the most important of all. Several authorP deal with the question of how much a change in the condyle path inclination changes tooth to tooth relations during movements on the articu-

lator. Craddock states that a change of the condyle path inclination of 10 degree:, results in a vertical change at the molars of 0.5 mm, Marolt points out that with a change of 15 degrees of the condyle path inclination, the vertical relation r~f tllc second molar changes only 0.5 mm. during protrusion. He evidently places t!~t: limit of tolerance here, Nevakar? states that in 96 per cent the vertical VKI~T !n the molar region on protrusion, after the adjustment of an average condyle path inclination of 45 degrees, will be 0.5 mm. or less. Hanau puts a much more narr{jn. margin (0.1 mm.) for what is tolerable in the vertical direction. lJnfortunatr~l?-. Hanau does not show how he has arrived at this limit of tolerance, neither do other authors explain why they consider values in the vicinity of or immediatei\ below 0.5 mm. to be without significance. Therefore, the values, which have been stated as insigniiicant do not appear completely convincing. It is likely that such vertical differences play a lesser r(J( in complete dentures than in natural dentitions. Clinical experience indicates that even minimum occlusal disturbances in natural dentitions can be of significance.
C:ONCLUSION

This investigation indicates that the condyle path registration, as determined with interocclusal wax records, can have some value. However, the present stud! only gives some aspects on the problem. The variation between different reader examiners should be further investigated, and the limit of tolerance for changes in the occlusal relationship of the teeth should also be examined.
SVMMARY

The frequency of condyle path inclinations with the error of measurement for the Dentatus articulator as a background was investigated. The error of measurement for one operator has previously been reported. The condyle path inclinations in 101 subjects, as determined by interocclusaI wax records, varies between 0 and 60 degrees. The greatest frequency is around 40 to 50 degrees as related to the Frankfort plane. The minimum established difference between two single condyle path inclinations was calculated to be between 8 and 9 degrees. Disregarding the variation between different operators (which should be further investigated), the condyle path registration by means of interocclusal was records possesses some value.
REFERENCES

I. Posselt, U., and Franz&, G. : Registration of the Condyle Path Inclination by Intraoral Wax Records: Variations in Three Instruments, J. PROS. DEN. I&441-45$ 1960, 2. Posselt, U., and Skytting, B. : Registration of the Condyle Path Inclinatron: Variations Usmg the Gysi Technique, J. PROS. DEN. it%?43-247, 1960. 3. Ekensten, B.: Jamforande undersijkningar over graden av artikulationsj%mvikt vid proteser utforda i medelvirdeszoch individuella artikulatorer, Odont. tskr. S5:1-48, 1947. 4. Nevakari, K. : Sagittaalisen leukanivelradan yksiliilfisen kaltevuuden mHiiri2~mistarkkaudesta intraoraalista vahaindeksitekniikkaa kiyttiien (Observations Concerning the Accuracy in Registering the Sag&al Condylar Guid&ce with the Intraoral Check-bite Method), Fin& tand%k. sillsk fiirhandl. S3:2%-212, 1957.

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5. Craddock, F. W.: The Accuracy and Practical Value of Records of Condyle Path Inclination, J.A.D.A. 38:697-710,.1949. 6. Hanau, R. L.: Dental Engineering. Shall We Adjust an Articulator to Anatomical and Technical Requirements or May We Expect Our Patients to Fit an Average Articulator? J.N.D.A. 9:595-609, 1922. 7. Marolt, A. : Der praktische Wert der Messung der sagittalen Kondylenbahn fur die Prothetik, Schweiz. Monaschr. Zahnhk. 64:948-959, 19.54. 8. Nevakari, K. : Alaleuan toiminnallinen protruusioliike (The Functional Protruding Movement of the Mandible), Finska tandlik. sillsk. fiirhandl. 54:94-120, 1958.
THE ROYAL DENTAL SCHOOL MALM~. SWEDEN