Twin-tables tecthnique for occlusal rehabilitation: Part

I-Mechanism of anterior guidance

Sumiya Hobo, DDS, MSD, PhD*
International Der;tal Academy, Tokyo, Japan, and University of California. School of Dentistrv.
Los Angeles, Cali:.

Anterior guidance and the condylar path have been considered independent factors.
In a recent study, it was revealed that the anterior guidance influenced the
working co:ndylar path and even changed when the lateral incisal path deviated
from the optimal orbit. This supports the hypothesis that anterior guidance and
condylar path are dependent factors. When setting anterior guidance, it is recom-
mended to set the working condyle so that it moves straight outward along the
transverse horizontal axis. The angle of hinge rotation created by the angular
difference between anterior guidance and condylar path assists the posterior
disclusion, but is not solely responsible. The anatomy of the cusps is created by
establishing the appropriate form of the posterior cusps aligned to the condylar
path so that it also contributes to posterior disclusion. Posterior disclusion is
crucial in controlling harmful lateral forces. The molars must disclude slightly
more than the deviation in the condylar path to avoid occlusal interferences. (J
PROSTHET DENT 1991;66:299-303.)

M .
artdlbular movement. has been studied kinemat-
ically through advanced research technology.1-3 Conse-
quently, anterior iguidance, which was previously a vague
occlusal concept, has heen ana.yzed and it is now possible
to compute anterior guidance from the condylar path.4 A
computer system developed for this purpose includes the
C,yberhoby computer pantograph with the capability to
measure the condylar path and produce digital and analog
data, the Cyberhoby fully adjustable articulator, and the
Anteroputer device, which computes three-dimensional
adjustments for the incisal table.5 However, this system is
expensive, complicated, and unsuitable for daily practice
despite its merit for research. A disparity then exists
between advances in research and daily clinical dental
practice.
Part I of this ar title reviews the mechanism of anterior
guidance to provide a foundation for understanding the
twin-tables technique. This technique is an uncomplicated
practical method to register anterior guidance from the
condylar path. Part II presents the procedures of this
technique for daily clinical practice.
IMPORTANCE OF ANTERIOR GUIDANCE
The orbit of the incisal point during protrusive move-
ment is guided by the lingual surfaces of the maxillary in-
cisors and is termed incisal guidance.j The lateral move-
ments are guided hy the lingual surfaces of the maxillary
--
Presented at .:he Amerir.an Acadc,my of Fixed Prosthodontics
meeting, Chicago, 111.
aDirector. International Dental Academy; Visiting Professor, Uni-
llersity of California, Sc.hool of Dentistry.
10/l/29420
canines, referred to as canine guidance. The term anterior
guidance has replaced the two terms. Although anterior
guidance only ranges from 2 to 6 mm, it greatly influences
occlusion, In healthy patients, anterior guidance is approx-
imately 5 degrees steeper than the cnndylar path in the
sagittal plane.8 Therefore, when a patient protrudes the
mandible, the anterior teeth guide it downward, creating
space between the posterior teeth referred to as posterior
disclusion. The same phenomenon occurs during lateral
movement because the lingual inclination of the maxillary
canine is steeper than the condylar path.
The mandible can be compared to a tripod configuration
for discussion purposes.g The posterior legs are represented
by right and left condyles whose shape helps to generate the
condylar path, and the anterior leg is represented by the
incisal point that influences anterior guidance. The three-
dimensional position of the mandible is determined by
these three elements so that if the condylar path alone is
measured without consideration of anterior guidance, man-
dibular movement is not accurately reproduced. Because
condylar path and anterior guidance are elements of one
anatomic unit, the mandible, they borh affect total man-
dibular movement.
ANTERIOR GUIDANCE AS AN
INDEPENDENT FACTOR
Early gnathologic concepts focused primarily on the
condylar path. The concepts were based on the theory that
the condylar path does not change during adulthood and
that the determination of anterior guidance is at the
discretion of the dentist. McCollum and StuartlO believed
that anterior guidance was independent ot the condylar
path. In clinical practice, the condylar path is measured

THE JOURNAL OF PROSTHETIC DENTISTRY 299


Fig. 1. Effect of anterior guidance on working condylar
path. Neutral line represents imaginary incisal path (dot-
ted line) when working condyle moves along transverse
horizontal axis. Actual incisal path is steeper than neutral
line. Working condyle then moves below transverse hori-
zontal axis or detrusion (A). If actual incisal path is flatter
than neutral line, working condyle moves above axis or
surtrusion (B) .
with a mechanical pantograph using clutches without the
influence of anterior guidance. When the condylar path is
adjusted on the articulator and the diagnostic casts are
mounted, both condylar path and anterior guidance are
combined to simulate total mandibular movement. Cur-
rent prosthodontic procedures follow this premise.
There are sparse studies that support this concept, and
Dawsons statementl is particularly well-known. He stated
that the condylar path was not a determination of anterior
guidance, and that it does not matter whether the ante-
rior path is flat or curved, concave or convex or parabolic,
the rotating condylar sliding down the unchanged condy-
lar path permits the lower anterior teeth to follow any
number of path variations without interference. He
concluded that anterior guidance could be freely changed
by the dentist.
To verify whether condylar guidance and anterior guid-
ance were independent factors, the lateral condylar paths
in 10 patients were measured with an electronic mandibu-
lar recording device.12 The measurements were recorded
under two test conditions: tooth-contact, or without clutch
condition, and nontooth contact, or with clutch condition.
The results demonstrated that the working-side condylar
path changed remarkably while the nonworking-side
condylar path did not reveal noticeable changes. The
working condyle, under the nontooth-contact condition or
with a clutch, exhibited small sagittal displacements and
showed a tendency to move straight laterally along the
transverse horizontal axis. Conversely, under the tooth-
contact condition, the working condyle moved laterally and
deviated sagittally in various directions. From this move-
ment, it was observed that the condylar path was affected
by anterior guidance and condylar guidance and anterior
guidance were dependent, not independent, factors.
300
HOBO
Fig. 2. During protrusive movements, condyle rotates
along horizontal axis if anterior guidance (/?)is steeper than
condylar path ((Y).Angle of hinge rotation compensates for
this angular difference.
Takayama and Hobo 13-15derived kinematic formulae to
calculate anterior guidance from the condylar path. Ante-
rior guidance computed from these formulae confirmed a
statistical correlation to the data of anterior guidance on
the same patients at p < 0.01 level of significance. With the
identical formulae, an imaginary incisal orbit was com-
puted for each patient under the assumption that the
working condyle translates straight laterally along the
transverse horizontal axis. Then this orbit, or the neutral
line, and the actual lateral incisal paths under tooth-con-
tact conditions were compared. The results demonstrated
that the working condylar path deviated superiorly when
the actual lateral incisal path was above the neutral line,
and the working condylar path deviated inferiorly when the
actual lateral incisal path was below the neutral line (Fig.
1). A similar tendency was noted in the anteroposterior di-
rections. Therefore there was a correlation between devia-
tion of the lateral incisal path from the neutral line and
sagittal deviation of the working condylar path at p < 0.01
level of significance.12
Sagittal deviation of the working condylar path-either
surtrusion, detrusion, retrusion, or protrusion-is evident
when anterior guidance and the condylar path are in dis-
cord. This correlation also indicated that anterior guidance
and condylar guidance were dependent factors.
According to the study of 50 test patients, the mean
working condylar path is a straight lateral movement along
the transverse horizontal axis.2*3 If this movement is phys-
iologic, then the incisal path deviation from the neutral line
may imply that the working condyle compensates for dis-
crepancies by deviating within the sagittal plane. It is then
recommended to adjust the anterior guidance so that the
working condyle moves straight outward along the trans-
verse horizontal axis during lateral movement.
ANGLE OF HINGE ROTATION
Posterior disclusion occurs when anterior guidance is
steeper than the condylar path. Early gnathologic concepts
SEPTEMBER 1991 VOLUME 66 NUMBER 3
TWIN-TABLES TECHKIQI E: PAHT I

Table I. Degree of disclusion

Angle cusp
Me;lSUrlXl of hinge shape
\ .due rotation factor (mm)
---
Protrusiw .l 0.2 0.9
Korking J.5 0.5 0
Nonworkir~p I.0 0.5 0.5
- -__-. ___

suggested a fully balanced occlusion as the ideal occlusion

with anterior guidance paralle. to the condylar path. Ante-
rior guidance was considered an extension of the condy-
lar path. Setting anterior guidance for balanced occlusion Fig. 3. During protrusive movement, condyle translates
was simple because it was parallel to the condylar path. without rotation when anterior guidance (~3)and condylar
However, when the concept of edisclusion was introduced by path (fi) are parallel.
I)Amico,7 the relationship between anterior guidance and
condylar path was questioned because the degree to which
anterior guidance was set, to the condylar path was un-
known.
The mandible rotates around the intercondylar axis
during eccentric movements when anterior guidance is
steeper than the condylar path (Fig. 2). The factor that
compensates for the difference in steepness is the angle of
hinge rotatron. The dentist should determine the influence
that the angle of hinge rotation contributes to disclusion to
establish an ideal anterior guidance.
Takayama and Hobo15 analyzed disclusion relative to
the angle cd hinge rotation by using kinematic formulae.
The results indicated that the angle of hinge rotation con-
-tributed to posterior disclusion by approximately 0.2 mm
-for protrusive movement and 0.5 mm on average for lateral Fig. 4. When cusp inclination of molars is parallel to an-
movement on both working and nonworking sides. Accord- terior guidance, there is no posterior disclusion despite
ing to an investigation of molar disclusion during eccentric steeper anterior guidance (fi) than condylar path ((Y).
movements when the right and left condyle moves 3 mm in
protrusive movement and the nonworking condyle moves
3 mm in lateral movement, the amounts of disclusion were
1.1 t 0.6 mm during protrusive movement, and 0.5 i O.:i
mm on the working side and 1.0 + 0.6 mm on the non-
working side during lateral movement measured at the
mesiobuccal cusp tip of the mandibular first molar.16 The
actual disclusion on the working side (0.5 mm) was equal
to the amount created by the angle of hinge rotation (0.5
mm). Howlever, t.he actual disclusion during protrusive and
lateral movements on the nonworking side differ from the
angle of hinge rotation. This leaves residual amounts of
disclusion unaccounted for, namely, 0.9 mm in protrusive I ,/

and 0.5 mm on the nonworking side (Table I), thus

suggesting that the angle of hinge rotation was not solely Fig. 5. Posterior disclusion is evident when cusp inclina-
responsible for disclusion. The residual amounts can also tion of molars is parallel to condylar path and anterior
be attributed to another determinant of disclusion, the guidance (8) is steeper than condylar path ((Y).
cusp shape factor.

CUSP SHAFE FACTOR trusive movement without discluding, despite the degree of
When the slopes of posterior cusps are parallel to the steepness (Fig. 3). If anterior guidance is steeper than the
condylar path inclination and anterior guidance is parallel condylar path, the posterior teeth disclude. However, if the
to the condylar path, the opposing cusps slide during pro- cusp inclination of the molars is parallel to anterior guid-

THE JOURPIAL OF PROSTHETIC DENTISTRY 301


Fig. 6. Cusp inclination (A) decreases (is more shallow) if
it is semicircular (B). Producing a convex cusp diminishes
cusp inclination.
ante, there is no posterior disclusion even though anterior
guidance is steeper than the condylar path (Fig. 4). The
posterior teeth disclude only when the cusp inclination of
the molar is parallel to the condylar path and anterior
guidance is steeper than the condylar path (Fig. 5). The
cusp inclination (A) also becomes more shallow with a
semicircular shape (B) as illustrated in Fig. 6. The shape of
the cusp has great influence on the disclusion of posterior
teeth. To produce fully balanced occlusion, it is then nec-
essary to make the cusp with a straight edge, whereas for
disclusion the cusp requires a convex semicircular shape.
If the shapes of the posterior cusps are less steep than the
condylar path, the posterior teeth disclude even if anterior
guidance is parallel to the condylar path. The residual
amounts of disclusion that were not accounted for by the
angle of hinge rotation can be attributed to this mecha-
nism, regulated by the cusp shape factor. The semicircular
shape of the cusps affects posterior disclusion and is the
factor contributing to the residual disclusion. This is called
the cusp shape face. In practice it is critical that cusp in-
clination, including the semicircular shape of the cusp,
combined with the angle of hinge rotation contributes to
posterior disclusion. The molar cusp inclination should be
parallel to the condylar path, not parallel to anterior guid-
ance, in establishing posterior disclusion.
FACTORS THAT DETERMINE
DISCLUSION
Molar disclusion during eccentric movements is effective
in eliminating harmful lateral occlusal forces. However, a
comprehensive theory identifying factors that determine a
specific amount of disclusion is unavailable in the litera-
ture. Mechanically, the maxillary and mandibular teeth
should be in contact during eccentric movements for opti-
mal chewing efficiency. Maximal shear force is observed
with a fully balanced occlusion. However, the condyle must
follow one orbit precisely during eccentric movements for
HOBO
Table II. Comparison of buffer space with disclusion
Buffer space Disclusion
(mm) (mm)
Protrusive 0.8 1.1
Working 0.3 0.5
Nonworking 0.8 1.0
optimal function in a fully balanced occlusion. If the
condyle deviates slightly, it directly influences the relation
between the teeth, resulting in occlusal prematurities and
deflective occlusal contacts.
McCollum and StuartlO described the condylar path as
a fixed entity in an adult. In a recent study, when repeti-
tive lateral movements were compared with the respective
condylar paths, no movement traced the same line.17 The
deviation in the condylar path during eccentric movements
was attributed to the shock-absorbing nature of the artic-
ular disk. This study refers to this deviation in condylar
path as a buffer space. The average buffer spaces are 0.2
mm in centric relation, 0.3 mm in laterotrusion, and 0.8 mm
along the protrusive and nonworking sagittal condylar
path. Molar disclusion should be greater than the buffer
space to avoid occlusal interferences during eccentric
movements.
When the average amount of disclusion is compared with
buffer space, the amounts closely match (Table II). In pro-
trusive movement, the amount of buffer space is 0.8 mm
and disclusion on the nonworking side is 1 mm. The
amount of disclusion should be slightly more than the
buffer space to prevent deflective occlusal contacts provid-
ing separation between the opposing posterior dentition, so
that when the condyle is displaced during articular disk
compression, harmful occlusal forces can be controlled.
SUMMARY
The mechanism of anterior guidance was reviewed from
recent mandibular movement studies to provide a basis for
understanding the twin-tables technique, which is a prac-
tical method for establishing anterior guidance from the
condylar path. Anterior guidance and the condylar path
previously were considered independent factors. In a
recent study, it was revealed that anterior guidance influ-
ences the working condylar path and even changes when
the lateral incisal path deviates from the optimal orbit.
This supports the hypothesis that anterior guidance and
the condylar path are dependent factors. In setting anterior
guidance, it is recommended to set the working condyle so
that it moves straight outward along the transverse hori-
zontal axis.
The angle of hinge rotation produced by the angular dif-
ference between anterior guidance and the condylar path
assists posterior disclusion but is not solely responsible.
The anatomy of the cusps is created by establishing the
appropriate form of the posterior cusps aligned to the
SEPTEMBER 1991 VOLUME 66 NUMBER 3
TWIN-TABLES TECHNIQV'? PART I

condylar path; thus it also con1 ributes to posterior disclu-

sion.
Posterior disclusion is crucial in controlling harmful lat-
eral forces but the factors that determine the precise
amount of disclusion nave not been established. The dis-
elusions recorded in healthy adults were 1.1 k 0.6 mm in
protrusive movement and 0.5 t 0.3 mm on the working
side and 1.0 z 0.6 mm on the nonworking side during lat.-
era1 movement. T hesr number; correlated with the devia-
tion in the condylar path. The molars must disclude
slightly more than the deviation in the condylar path to
avoid occlusal interferences.

REFERENCES
I. Hobo S. M<lchlzukh S. A kinematic mvestigation of mandibular border
mwement by means of an electronw measuring system. Part I. Devel-
opment of 1he measuring system. . PROWHET DENT 1983:50::368-73.
:!. Hobo S. .4 Linemat ic investigation (of mandibular border movemem b)
means of an electronic measuring system. Part II. A study of the Eien-
nett mctvernent. J PHOSTHET DENT 1984;51:642-6.
3. Hobo S. A kinematic investigation e)f mandibular border movement b>
means of ar electronic measurmg s!~stem. Part III. Rotational center ot
lateral movement. J PHOSTHET DEUT 1984;52:66-72.
4. Hobo S. Taknyamrt H. Kinematic iwestigation of anterior guidance as
a basis for ww gnathol,)gical conwpts. J Gnathology 1989;8:14-48.
5. Hobo S, Takayama H. \ new system for measuring condylar path and
computing anterior gllidance. Part I. Measuring principles. Int .I
Prosthodon t 1988;1:99 06.

A compa:rison of the abrasiveness of six ceramic surfaces and

gold
Richard Jacobi, DDS,a Herbert T. Shillingburg, Jr., DDS,b and
Manville (G. Duncamon, Jr., DDS, PhDC
University of Oklahoma, College of Dentistry, Oklahoma City, Okla.

A type III gold alloy and six different ceramic surfaces were secured in an abrasion
machine opposing extracted teeth to determine their relative abrasiveness and
resist,ance to wear. The rankings of restorative materials from least abrasive to
most abrasive were: gold alloy, polished; cast ceramic, polished; porcelain, polished;
cast ceramic, polished and shaded; porcelain, polished and glazed; cast ceramic,
cerammed skin shaded; and cast ceramic, cerammed skin unshaded. The ranking of
materials from most wear-resistant to least wear-resistant was: gold alloy, cast
ceramic cerammed, cast ceramic cerammed and shaded, porcelain polished,
porcelain glazed, cast ceramic polished and shaded, and cast ceramic polished. (J
PROSTHET DENT 1991;66:303-9.)

Gold has long been a preferred dental restorative
rnaterial because of biocompstibility, durability, and low
Supported b:f Presbyterian Healt 2 Foundation grant PHF No. 45
BAssociate Professor, Departmen-; of Fixed Prosthodontics.
tProfessor and Chairman, Depar ;ment of Fixed Prosthodontics.
CProfessor and Chsirman, Department of Dental Materials.
10/l/24177
abrasiveness against natural teeth; however, the primary
disadvantage is an unnatural metallic appearance. Porce-
lain crowns, inlays, and veneers were introduced more than
100 years ago to serve as more natural-appearing restora-
tions. Ceramic materials have become increasingly popu-
lar because of improvements in materials and techniques.
The excessive wear of natural teeth opposing porcelain
has stimulated authors to discourage the use of porcelain

THE JOURNPhL OF PROSTHETIC LIENTISTRY 303