ISPUB.
COM The Internet Journal of Dental Science
Volume 7 Number 2
The Facar Concept
N Gowri, N Gopichander, E Solomon
Citation
N Gowri, N Gopichander, E Solomon. The Facar Concept. The Internet Journal of Dental Science. 2008 Volume 7 Number
2.
Abstract
The restorative procedures have an effect on the shape of occlusal surface. The greatest care is ensured in restoring the
functional surfaces relative to the harmony of masticatory system. The use of different types of facebow, articulators in obtaining
the static, dynamic contacts and synchronization with TMJ apparatus are always debatable. This article, the Facar concept
evaluates and justifies the use of different types of facebow and articulators for the restorative procedures.
INTRODUCTION transferring the maxillomandibular relationships.
Restorative dentistry requires a series of appropriate clinical
DETERMINANTS AND KINETICS OF
laboratory procedures and a reliable armamentarium of MANDIBULAR MOVEMENTS
instruments. Each single phase of these should be executed
The four determinants of mandibular movements are viz: the
with accuracy, skill and speed to comply with the biological
two posterior determinants, one anterior determinant and a
conditions of the patient.
neuromuscular determinant.
A prosthesis which has the closest resemblance to the natural
Posterior determinant: (invisible component)
teeth should also harmonize with the various jaw movements
which are determined by the anatomical form of The TMJ and its suspensory ligaments, centres of rotation,
temporomandibular joint. Maxilla is stable in its relation to axes of rotation, translation of these centres.
the cranium while the mandible is dynamic in its motion to
maxilla since it is attached to the temporomandibular joint. Anterior determinant: (visible component)
The direction of mandibular movement is controlled by the
The contacting areas of upper and lower teeth, inclines of
neuromuscular system, the guiding influences of the
cusps and nature of occlusion in centric relation and
contacting teeth, inter condylar path width, their inclination
eccentric movements.
in relation to the masticatory surfaces and distance between
the individual tooth’s occlusal surfaces to the centers of Neuromuscular determinant:
movement. To be precise, the mandibular movements are
dictated by the TMJ, occlusion of teeth and the The role of muscle spindles, proprioceptive engram and
neuromuscular mechanism. The prosthodontist must relate neuromuscular response to prevailing occlusal condition.
these biologic mandibular movements to clinical application
The two posterior determinants are fixed. The third
during the treatment phase of patients
determinant namely occlusion can be modified by the dentist
These biological factors are of greater relevance in the to certain limit. The fourth neuromuscular determinant can
construction of fixed partial dentures as compared to be reflexly modified by the dentist indirectly as he alters the
complete dentures for the reason that the denture bearing third element viz. occlusion.
tissues are resilient which makes the complete denture to
Mandibular movements occur in three cranial planes viz.
move towards the alveolar ridge to nullify any minor
sagittal, horizontal and frontal, around three axes.
occlusal discrepancy. Whereas in fixed partial denture the
stresses from occlusal discrepancies are directed towards the Opening & closing movement – This takes place in the
periodontium, affecting its health. Therefore fixed partial sagittal plane around the horizontal axis between both the
restorations require greater precision in recording and condyles.
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The Facar Concept
Lateral movement – Left and right side movement in tragus and the outer canthus of eye. The condylar rods of the
horizontal plane takes place around the vertical axis facebow is centered on it during facebow transfer. In the
extending through the rotating condyle of the working case of ear piece facebow it has a ear plug which fits in to
side(ipsilateral side) 3 the external auditory meatus to orient the facebow as the
posterior reference. It has been found that on an average
The third movement is the combination of opening and external auditory meatus is 6-6.5 mm posterior and 2.5mm
lateral movement which takes place in the coronal plane superior to the actual hinge axis point 6 . Since the ear piece
around the sagittal axis of the working condyle depending on
facebow has not been oriented to the arbitary hinge axis
the side to which the mandible is moved.
points as in case of facia face bow, during the transfer of ear
These various mandibular movements are motions which piece facebow to the articulator, the ear plug is seated not on
occur concurrently around one or more of the axes. the condylar pins of the articulator but on the auditory pins
Masticatory function is therefore a combination of all these of the articulator which have the same dimensional relation
movements in three facial planes which occur in three axes 8 to the axis of the articulator as existing between the hinge
. Some of the armamentarium required to capture and axis and the external auditory meatus 12 .
simulate these jaw movements is discussed. Figure 1
FACAR is a term proposed to underscore the need for using Table 1
face bow and articulators collectively in prosthodontics. This
is an acronym for FAC (face bow) and AR (articulator).
Each of these complements one another to the accuracy of
restorative work. The use of articulators without face bow
record is not complete and therefore face bow should be
made mandatory.
FACE BOW
Centric relation is the starting position for all mandibular
movements. The position of condyle in centric relation to the
maxilla is required to orient the upper cast to the condylar
elements (i.e) the condylar axis of the articulator. Face bow
essentially records the positional relation of the maxilla to
the condyles in centric relation and later transfers this
relation to the articulator so that the maxillary cast is
mounted in the same spatial relationship as seen in the
mouth.
There are two types of face bows, the kinematic or the actual
axis face bow and arbitrary axis face bow 9 . The kinematic
face bow records the exact axis or centers of condylar
rotation which occur during the hinge movement of the
mandible 713 . Hinge axis transfer bow then relates the
position of condylar axis to the jaws in centric relation. This
face bow is also known as hinge axis face bow. The arbitrary
face bow relates the approximate condylar axis to the
maxilla 6 . The arbitrary face bow is available in two types,
the facia face bow and the earpiece face bow.(Table .1)
While using the facia facebow, the center of condyle is
arbitrarily marked on the side of the face 11-13 mm anterior
to the tragus on a line connecting the superior border of the
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The Facar Concept
Figure 2 ARTICULATORS
A brief review of articulator, its capability and its value in
the fabrication of various types of prosthesis is presented.
Articulators are instruments that attempt to reproduce the
range of jaw movements mentioned earlier. It is a
mechanical device designed to simulate the TMJ. Maxillary
and mandibular casts are attached to the articulator so that
the functional and parafunctional contact relations between
the teeth can be studied for diagnosis, occlusal rehabilitation
and equilibration. Besides this, it is also useful in the
fabrication of occlusal surfaces in fixed partial dentures and
arrangement of teeth in removable partial dentures.
Articulators are also required to establish occlusion in
maxillo facial prosthesis and for the fabrication of occlusal
splints. It should be mentioned that no articulator exactly
reproduces the full range of jaw movements nor is the
Some of the examples of face bows are given below
precise reproduction of jaw movement is required for every
Hanau face bows are of three basic types; the Hanau facia type of prosthesis. Therefore an understanding of capability
face bow, the ear face bow and the twirl face bow (spring of the instrument, as well as the various treatment objectives
face bow). of the patient is desirable.
The Whipmix quick mount bow was the first ear piece face Summary of the uses of articulator:
bow. A special nasion relator assembly or an infra orbital
Figure 3
pointer can also be added to the face bow.
Table 2: BASIS FOR CLASSIFICATION OF
The Denar face bow can be modified as an ear bow or a ARTICULATORS
facia bow. There is also a Denar kinematic face bow which
is used in conjunction with fully adjustable Denar D5A
articulator.
Panadent face bows are available in three different types.
The facia face bow, ear piece face bow and the Panadent
kinematic face bow.
There is also the TMJ face bow which is a kinematic type
and is probably one of the best kinematic type face bow
available. It is used with the TMJ articulator.
Hinge axis recording with kinematic face bow will give the
precise positional relation of the casts to each other in the
articulator 7 . This is because upon removal of check bites
after mounting of casts will give accurate closing of the casts
in centric relation, minimizing the occlusal errors commonly
seen when casts are mounted with the check bites using the CLASSIFICATION
arbitrary face bow.
Among the numerous articulators are available, the selection
To sum up the benefits, the use of face bow gives better of an articulator is based on the type of restoration to be
occlusion in centric relation and also reduces the occlusal fabricated, type of inter occlusal record used, its capability
interferences in lateral jaw movements. for condylar and incisal adjustments and the user’s skill.
(Table 2)
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The Facar Concept
Articulators can be basically classified as non arcon and relining and rebasing complete denture which does not
arcon type 125 . In non arcon articulators the condylar slot is require protrusive and excursive movements.
located in the lower member of the articulator and the
NON ADJUSTABLE ARTICULATOR
condylar sphere in the upper member, whereas in the arcon
type the condylar fossa is situated in the upper member and Construction of this type of articulator is based on average
the condylar sphere is in the lower member. Early measurements of lateral movement and they move in a fixed
articulators irrespective of their type were of non arcon type. pattern, since the inclination mechanism of condylar path in
Non arcon articulators do not truly represent the articular the articulator is fixed. Most of the complete denture and
fossa – condyle mechanism in the TMJ, while in arcon partial denture work especially preclinical denture
articulators the condyle fossa mechanism is reversed and is construction is done with this type of articulator. Since the
similar to what is seen in TMJ. The arcon principle AR human condylar path movements are variable, it is not
(articulator) CON (condyle) was first introduced by justifiable that the lateral movement in an articulator is
Bergstorm 4 when he first designed the Bergstorm articulator limited to a mean value. Further the distance between the
in 1950. Present day articulators are mostly of arcon type. hinges and the tooth to be restored is also significantly less
in a non adjustable articulator. Therefore it has a smaller
The critical component in an articulator is the analogue or radius closure path, resulting in a steeper arc than seen
the mechanical equivalent of the articular fossa and condyle clinically thereby forming premature contacts on the
of the TMJ which is generally referred as condyle fossa restoration requiring time consuming intra oral corrections.
assembly. The condyle fossa assembly is either in the form Further this articulator cannot accept face bow record. For
of an adjustable condylar track or a slot, fossa box or these reasons its use is limited only to procedures described
condylar housing. In more advanced articulator system it can above. This has resulted in the necessity to develop
also be in the form of a preformed or customized fossa articulators which have condylar inclination that can be
moulding, fossa insert or fossa analogue against which the adjusted and led to the development of semiadjustable
condylar spheres articulate articulators.
One of the most comprehensive methods of classifying SEMI ADJUSTABLE ARTICULATOR
articulators is follows
This instrument attempts to simulate patient’s condylar path
Simple articulator or cast relator. They are of hinge by using mechanical equivalents which are capable of
articulator, fork articulator and plain line articulator types. imitating all or part of its motion. This articulator is
(ex) Gariot articulator, Evans articulator commonly used where some degree of precision work is
required. While using this articulator the occlusal
Non adjustable articulator or mean value articulator – adjustments during insertion phase is diminished. This does
(condylar path not adjustable) (ex) Gysi simplex articulator, not require an inordinate amount of time or expertise as
Ash three point articulator when using fully adjustable articulator. Casts mounted in
this articulator have about the same spatial dimension as the
Adjustable articulator (condylar path adjustable)
condyle to the teeth, thus discrepancies in the difference in
(a) Semi adjustable articulator (ex) Hanau Model H the radius of arc of closure is minimized 14 . This has a
articulator, Dentatus ARL articulator, Whipmix articulator, considerable clinical significance as occlusal corrections in
Bergstorm Arcon articulator, SAM articulator, Denar Mark the finished restoration are minimal.
II type, Artex- Girbach, Gerber’s condylator, Kavo protar
When a face bow record is made, semi adjustable articulator
(b) Fully adjustable articulator (ex) TMJ articulator, is mandatory. A semi adjustable articulator does not fully
DenarD5A articulator, Stuart gnathoscope. serve its function in the absence of a face bow record. In
conjunction with face bow this articulator is indicated for
SIMPLE ARTICULATOR diagnostic evaluation of study casts, occlusal analysis,
These are initial group of articulators which are simple occlusal correction & rehabilitation. It is ideal to use a semi
holding instrument capable of accepting single static adjustable articulator with face bow for complete denture
registration. Only vertical motion is acceptable. These construction to minimize occlusal errors. Further it is the
articulators are used for single crowns and simple bridges, articulator of choice for denture remount procedures.
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The Facar Concept
FULLY ADJUSTABLE ARTICULATOR We acknowledge the Dr.M.Vasantakumar M.D.S., Principal
This articulator accepts three dimensional dynamic and Head of Prosthodontics Department, SRM Dental
registrations, as compared to semi adjustable articulator College, Ramapuram, Chennai- 89 for his suggestion and
which can accept only in two dimensions. It allows input in the manuscript.
orientation of the casts to the TMJ and reproduction of all
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ACKNOWLEDGEMENT
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The Facar Concept
Author Information
N. Gowri, B.D.S.
Private practice
N. Gopichander, MDS
Reader, Dept of Prosthodontics, SRM Dental College
E.G.R. Solomon, MDS
Professor Emeritus, SRM Dental College
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