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Journal of Oral Rehabilitation 2004 31; 546553

Influence of the inclination of the plate of an intra-oral


tracing device on the condylar position registered by tapping
movement
MD. M. RAHMAN, S. KOHNO, H. KOBAYASHI & K. SAWADA

Removable Prosthodontics,

Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan

The object of this study was to determine


the best inclination of the intra-oral tracing device
to get optimum condylar position with the registration of tapping movement. Three appliances with
different tracing plate inclinations were used in five
healthy subjects. The tracing plates were set at 0 to
occlusal plane (horizontal); at the angle formed by
drawing a line from condylar point to the stylus
position at occlusal plane (inclined); then at the
angle half to inclined (half-inclined). Subjects made
Gothic arch and tapping movements (n = 30) at a
30 mm interincisal distance with the head Camper
plane horizontal. The incisal and condylar points
were tracked with a 6-degree-of-freedom jaw movement tracking system. The location of gothic arch
apex, the distribution and mean position of
SUMMARY

Introduction
Occlusion includes the integrated relationships of the
teeth, jaw muscles and temporomandibular joints. To
produce good functional occlusion in prosthodontic
treatment, the correct registration of intermaxillary
relation is essential. When the intercuspal position (IP)
is lost, dentists must determine the proper IP for the
patient from the data of condylar position and masticatory muscle function. There are some different
methods for the registration of IP. Recording of tapping
movement remains popular because some studies
suggested that the convergent point of the tapping
movement seems to coincide the IP and is called
muscular position (15). However, the path of the
tapping movement is influenced by the head position
(6, 7), frequency of tapping movement (8, 9) and also
2004 Blackwell Publishing Ltd

30 tapping points from intercuspal position were


analyzed in incisal and condylar point between the
appliances. Data were analyzed with repeated measures one-way ANOVA. Results showed that mean
position of tapping points were significantly different among the appliances. Half-inclined appliance
recorded tapping points in a convergent area nearer
to intercuspal position (IP) than other appliances. In
all appliances, the contact points of the tapping
movement were anterior to Gothic arch apex.
KEYWORDS: condylar position, tapping point, tapping area, intra-oral tracing device, tracing plate
inclination, intecuspal position
Accepted for Publication 25 July 2002

the degree of the range of jaw motion (10). During bite


registration, it is essential for the clinician to record the
tapping points (the recorded contact points on the
tracing plate with tapping movement of the jaw) at a
convergent area and to determine the optimum intercuspal position. Then the convergent point of the
tapping point should be located near the intercuspal
position of the subject.
The authors in their previous study (7) recorded the
tapping points by intra-oral tracing device with central
bearing support in two head positions; Camper plane
horizontal and Frankfort plane horizontal. Based on the
results, it was concluded that in the head position with
Camper plane horizontal, it is possible to record the
tapping points in a convergent area. But to register the
tapping points near to the intercuspal position, the
researchers developed another new method by chan-

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INFLUENCE OF THE INCLINATION OF THE PLATE OF AN INTRA-ORAL TRACING


PLATE
ging the inclination of the tracing plate of the intra-oral
tracing device. There is one study (11) where an anterior
jig was used. Although the anterior jig had a slight
upward and backward slant but it was used only as a
technique for recording centric relation. To our knowledge there is no information in the literature about
tapping points, the inclination of the jig, especially nor
about its relation with the condylar position in the fossa.
In this study, the authors changed the inclination of
the tracing plate of the intra-oral tracing device.
Tapping points were recorded to find out the best
inclination of the plate to get an optimum intermaxillary relationship. In such a relation jaw will function in
harmony with the muscular position and optimum
condyle position within the fossa (1, 5). In searching for
the relationship we assumed that the intercuspal
position (IP) of the normal subject could be a reference
point of the relationship.

Materials and methods


Subjects
Five adult male fully dentate subjects, aged 2737 years,
volunteered for this study. They had normal occlusion
with good periodontal health and had no history of
craniomandibular dysfunction. The details of the experimental procedure were thoroughly explained to the
subjects but its objective was not disclosed to them.

Registration of tapping movements


A 6-degree-of-freedom measurement system (13)
(TRIMET)*, was used to measure the tapping movements in incisal and condylar point. The measuring
system consisted of six high-resolution linear CCD
(Charge Coupled Device) cameras, a control unit, a
personal computer for data analysis, a device for
digital allocation of reference points, and upper and
lower face bows (total weight: 40 g) that carried,
unilaterally, two small LEDs (Light Emission Diode)
each to make up a total of eight. The face bows were
attached onto the buccal surfaces of the dental arches,
and the motion of the LEDs was registered with the
six CCD cameras, which were set around the subjects
head (Fig. 1).
* Tokyo Shizaisha Co., Taito-ku, Tokyo, Japan.

Ohira Co., Niigata, Japan.

Fig. 1. The measurement of jaw movement by TRIMET. The face


bows set in place for recording in one of the subjects. The metallic
arms around the subject bear the CCDs that detect the motion of
the LEDs in the face bows.

From the data of movements of the LEDs, the


movements of the condyle were calculated by means
of analytic geometry (12). The reference point of the
condyle was defined as the point 20 mm medial to the
skin on the kinematic axis point (13, 14) in the right
side. Computing system at a rate of 100 points per
second with an overall accuracy of 015 mm processed
the data.

Intra-oral tracing devices


Three types of intra-oral tracing device with different
inclinations of tracing plate were constructed for this
experiment. They were named as horizontal; inclined;
and half-inclined (Fig. 2). The intra-oral tracing device

Fig. 2. The maxillary part of central bearing devices for one


subject. Horizontal appliance (lower-left), half-inclined appliance
(lower-right) and inclined appliance (upper-middle). The acrylic
resin base of each appliance showing palatal part (a), lingual part
(b), the tracing plate (c) and ball clasp for retention (d).

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Fig. 3. Schematic representation of the appliances showing the


inclinations of tracing plates set in the upper jaw. Central bearing
pin set in the lower jaw and is perpendicular to the tracing plate in
all the appliances.

consisted of a metal tracing plate and a central bearing


pin. The tracing plate was fixed on the upper dental
arch and the central bearing pin was located at the
midpoint of a line connecting the bilateral first molars
of the lower dental arch and was made perpendicular to
the tracing plate in all the appliances. In case of the
horizontal appliance, its tracing plate was set at 0 to
the occlusal plane. The inclination of the tracing plate
in the inclined appliance was set in relation to the
occlusal plane by drawing a line from condylar point to
the tip of the stylus. For subjects A, B, C, D and E, the
angle was 278  18 (mean  s.d.). The inclination of
the half-inclined appliance was half the angle of
inclined appliance (Fig. 3). The angle of the tracing
plate was determined by using the cephalometric
radiographs of the subjects. The base of the device
was fabricated with an auto polymerizing resin to create
an optimum fit and the tracing plate and the stylus
were set on it by the same material.
To avoid any occlusal interference during Gothic arch
tracing, the vertical dimension of the subjects were
increased with an average of 43  06 mm in the
incisal point.

contact but without any contact of the dentition. In this


study, the subjects were instructed to perform tapping
movements with an interincisal distance of 30 mm at a
frequency of 2 Hz for 15 s.
Tapping movements were preceded by two to three
practice attempts before the actual recording. The
subjects were asked to perform the tapping movements
for three consecutive trials. The jaw movements were
produced following the sound signals of a metronome.
The gothic arch tracing was performed by moving the
mandible forward and backward, then to the right,
forward and backward again and then to the left from
the posterior border point (15). In this way, the location
of the apex in the Gothic arch was recorded in the
incisal and the condylar point.

Analyzing method
The data were analyzed in the location of the incisal
point and the right condylar point of the subject in the
sagittal plane.
In this study, intra-oral tracing devices were used and
the vertical dimension was increased to record the
tapping movements without contact of dentition.
Therefore, the true IP of the dentition was lost on the
tracing plate. Then, the geometrically equivalent point
of the IP was obtained as follows. The position can be
calculated as an intersection of the Gothic arch plate
and the rotational trajectory of incisal point around the
kinematic axis (13, 14) in the condyle. This point was
denoted as calculated IP.
Ten tapping movements were selected from the
middle of each of the three tapping trials. The location
of the convergent points and the standard deviation
(s.d.) of 30 tapping movements were obtained to assess
the degree of the convergence of tapping points. The
reference position at the incisal point was the calculated
IP. At the condylar point the reference was the condyle
position in the IP without appliance.
Data were statistically analyzed using repeated measure one-way ANOVA, followed by the Scheffes F-test.

Experimental procedure
Each subject was comfortably seated upright with back
support on a dental chair. The head was free and
positioned with the Camper plane horizontal.
The intra-oral tracing devices were inserted in the
dental arches and the tapping movements terminated
with tracing pin and tracing plate of intra-oral device in

Results
Convergence of tapping points
Figs 4 and 5 demonstrate the influence of the inclination of tracing plate on the convergence of tapping points and the positions of the condyle on

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INFLUENCE OF THE INCLINATION OF THE PLATE OF AN INTRA-ORAL TRACING


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Fig. 4. Raw data showing the convergence of tapping movements


(n 30) of incisal point with horizontal appliance (left side),
inclined appliance (middle) and half-inclined appliance (right
side) in one subject (sagittal view).

Fig. 5. Illustration of condylar positions of tapping points


(n 30) with three appliances in one subject. They are superimposed in sagittal border movement. Black dots represent the
condylar positions with horizontal appliance (lower-left), halfinclined appliance (lower-right) and inclined appliance (lowermiddle).

corresponding tapping points in subject B. It clearly


shows that tapping points became convergent when it
was recorded on the inclined tracing plate (Fig. 4). The
condylar points corresponding to the tapping points
were scattered with the horizontal appliance. In cases of
inclined and half-inclined appliances, the distributions
of condylar points were small and posteriorly located in
comparison with the horizontal one. With the halfinclined appliance the distributions were smaller and
located more anteriorly than with the inclined appliance (Fig. 5).
In five subjects, with the horizontal appliance, the
s.d. of tapping points in the incisal point ranged from
017 to 049 mm with a mean of 03 mm. When the
appliance was changed to inclined, the s.d. of tapping
points became smaller and ranged from 005 to
024 mm with a mean of 012 mm. With the halfinclined appliance, the s.d. of tapping points ranged
from 007 to 023 mm with a mean of 016 mm (Fig. 6).

Fig. 6. The convergences of tapping points are described by


standard deviation (s.d.). The tapping points (n 30) of incisal
point (left side) and the corresponding condylar point (right side)
are shown. The upper, middle and lower part of the figure
represents the data with horizontal, inclined and half-inclined
appliances. When horizontal appliance was used, the standard
deviation of tapping points ranged from 017 to 049 mm in incisal
point and at the same time the deviation of condylar point ranged
from 011 to 029 mm. When the inclined appliance was used, the
s.d. in incisal point reduced by about 46, 64, 004, 86 and 71% in
subjects A, B, C, D and E, respectively. With half-inclined
appliance the s.d. reduced by about 37, 69, 008, 53 and 59%,
respectively. In case of condyle position, the deviation of condylar
point corresponding to the tapping points reduced by about 36,
44, 69 and 27% in subjects A, B, D and E, respectively. But in
subject C, the deviation increased by about 004% with inclined
appliance. With half-inclined appliance the deviation reduced by
about 29, 48, 009, 62 and 18% in subjects A, B, C, D and E,
respectively.

The s.d. of condylar points to the deviation of


corresponding tapping point of 30 tapping movements
with horizontal appliance ranged from 011 to 029 mm
with a mean of 021 mm. When the appliance was
changed to inclined one, it ranged from 008 to
024 mm with a mean of 013 mm. In case of halfinclined appliance, the s.d. ranged from 009 to 02 mm
with a mean of 013 mm (Fig. 6).
It indicates that with inclined and half-inclined
appliances, the tapping points can be recorded in a
more convergent area than the horizontal one.

Mean position of the tapping points


The position of the incisal point (Fig. 7) With the horizontal appliance, the mean position of 30 tapping points
was 055 mm anterior from the calculated IP with a
range of 023101 mm. When the horizontal appliance
was replaced by the inclined appliance, the mean
position of tapping points became nearer and was

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Fig. 7. Mean position and standard deviation (s.d.) of tapping


points (n 30) in five subjects. The mean position from the
calculated intercuspal position (IP) in incisal point (left side) and
the corresponding position of condylar point from the real IP
(right side). The upper, middle and lower part of the figure
represents the data with horizontal, inclined and half-inclined
appliances in sagittal view. When horizontal appliance was used,
the mean location of thirty tapping points from the IP ranged from
023 to 101 mm in incisal point for five subjects. At the same time
the corresponding condylar point deviation ranged from 012 to
056 mm. In case of inclined appliance, in incisal point the
distance between the mean location of tapping points to the IP
reduced by about 55, 89, 004, 87 and 77% in subjects A, B, C, D
and E, accordingly. With half-inclined appliance, the distance
reduced by about 93, 87, 96, 77 and 94%, respectively. In case of
condyle position, the corresponding condylar point deviation with
inclined appliance was reduced by about 75, 84, 59 and 87% in
subjects B, C, D and E, respectively. In subject A, it increased by
about 25%. However, this distance was less in comparison to
other four subjects. In case of half-inclined appliance the distance
was reduced by about 67, 84, 79, 100 and 77% in subjects A, B, C,
D and E, accordingly.

006 mm posterior from the calculated IP with a range


of 022 to -019 mm anterior. In the case of halfinclined appliance, the posterior to anterior position of
the tapping points ranged from )006 to 023 mm with
a mean position of 004 mm anterior from the calculated IP.
Using Scheffes test, the inclined and half-inclined
were both significantly different (P 00019 and
P 00066, respectively) compared with the horizontal
appliance.
The position of the condylar point (Fig. 7) With the
horizontal appliance, the mean position of the condyle
on 30 tapping points was 038 mm anterior from the
real IP with a range of 012056 mm. When
the inclined appliance was used, the mean position of
the condylar point became closes and was )009 mm

posterior from the real IP with a range of )021 mm


posterior to 007 mm anterior. However, with the halfinclined appliance, it became even more close and was
001 mm anterior from the real IP with a range of 008 mm posterior to 013 mm anterior.
Using Scheffes test, the inclined and half-inclined
were both significantly different, (P 00009 and
P 00055, respectively) compared with the horizontal
appliance.
The data revealed that in case of the half-inclined
appliance, the convergent points of the tapping movements were located nearer to the calculated IP and the
corresponding positions of the condyle were also nearer
to the real IP than other appliances.
In all subjects, the tapping points were anterior to
the apex of the Gothic arch. As regards to the incisal
point, with horizontal appliance, the distance from
Gothic arch apex to the tapping points mean position
ranged from 08414 mm with a mean of 103 mm in
five subjects. In case of inclined appliance it ranged
from 007 to 077 mm with a mean of 034 mm.
However, with the half-inclined appliance the distance
ranged from 018 to 068 mm with a mean of 048 mm
(Fig. 8).
With reference to the condylar point, with the
horizontal appliance, the distance from Gothic arch
apex to the corresponding mean position of tapping
points of condyle ranged from 052 to 106 mm with a
mean of 076 mm in five subjects. Where as with the
inclined appliance it ranged from 024 to 047 mm with
a mean of 037 mm. However, with the half-inclined
appliance the distance ranged from 025 to 064 mm
with a mean of 045 mm (Fig. 9).

Fig. 8. The distance between the Gothic arch apex and the mean
position of tapping points (n 30) with three appliances.

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Fig. 9. The distance between the Gothic arch apex and the
condylar position corresponding to the mean position of tapping
points (n 30) with three appliances.

Discussion
Design of the device and measuring method
The intra-oral tracing device that is widely used in
restasative clinics (Gothic arch tracing device) corresponds to the horizontal appliance in this experiment.
As the tracing plate is parallel to the occlusal plane, the
jaw-closing path is not perpendicular to the tracing
plate (16). This might produce unstable tapping movement points on tracing plate. There will be the anterior
component of the force when the stylus contacts on the
plate. To avoid this, the authors decided to modify the
appliance by changing the inclination of the tracing
plate so that the jaw-closing path would be perpendicular to the tracing plate. In this regard a new
appliance was fabricated. The authors considered the
hinge rotation of the condyle and determined the
inclination of tracing plate to set on a line drawn from
the condylar point to the tip of the stylus at occlusal
plane, which was named inclined appliance. For five
subjects the inclination of the tracing plates was
278  18 (mean  s.d.) to the occlusal plane.
In this experiment as the tapping movement was
performed at an interincisal distance of 30 mm, the
mandible translated and rotated simultaneously around
the condyle. Therefore, here the jaw-closing path was
more anteriorly located from the jaw-closing path
observed from a simple hinge rotation of the condyle.
With the inclined appliance there is possibility that the
jaw-closing path was not perpendicular rather steeper
to the tracing plate on tapping movement. When the
stylus contacts on the plate, the posterior component of
the force may be provoked. To compensate this problem

another appliance was fabricated, where the angle of


the tracing plate was half to the angle of inclined
appliance and named the appliance as half-inclined.
When clinicians use the intra-oral tracing device for
the registration of horizontal jaw relation, they consider
Gothic arch apex or the tapping movement point as a
reference position for occlusion. The Gothic arch apex
stands for the retruded contact position, which is a
static relative position of the jaw. Previously the Gothic
arch apex was considered as the centric relation
(1720) but now the definition of centric relation has
been changed (21). It has been suggested that the
centric relation of the condyle may correspond to the
intercuspal position of the teeth. On the other hand,
rhythmical tapping movements that are dynamic and
mimic the functional position are considered as in the
muscular position and also thought to coincide with the
intercuspal position of the dentition (15). Therefore, it
is possible to record the tapping movement with the
condyle in harmony with the musculoskeletally stable
position in the fossa rather than Gothic arch apex.
In order to achieve smooth tapping movements (9),
were recorded in the head position with Camper plane
horizontal at an interincisal distance of 30 mm with a
frequency of 2 Hz for 15 s. About the location of the
condyle as a measuring point, we chose the kinematic
axis (13, 14) that is a kinesiological reference point of
the condyle. Because the position of measuring point
has a great influence on the results, depending on the
ratio of mandible translational and rotational movement.

Convergence
Tapping points should be within a small convergent
area to record the jaw position during occlusal registration. Changing the inclination of the appliance, the
areas of the tapping points in sagittal view were 030,
016, and 012 mm in average of the s.d.; the steeper the
inclination the smaller the tapping area in incisal point.
(Fig. 6). In the case of the condyle position, the result
was same as incisal point, 021, 013 and 013 mm,
respectively (Fig. 6). It may be that the design of
horizontal appliance could not produce a convergent
tapping movement of the mandible; thereby the stylus
could not strike almost same point. While the mandible
has followed a muscular path, the point of its arrival is
imprecise and the recordings display scatter. On the
other hand, the inclined tracing plates of the inclined

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M D . M . R A H M A N et al.
appliances were able to enhance the convergent
tapping movements of the mandible and guided the
mandible to strike repeatedly in and around a point
precisely. As a result, the inclined appliances were able
to record the tapping points in a convergent area
compared with the horizontal appliance.

Position
To record the optimum intercuspal position the convergent tapping points should be located near the IP of the
subjects. In this study, as the inclination is increased, the
mean location of the incisal tapping points from the IP
moved posterior in mean values: 055, 004 and
)006 mm (anterior from IP) (Fig. 7). In the case of
condyle position, the change was also in the same
direction: 038, 001 and )009 mm anterior from the IP
corresponding condylar position in mean value (Fig. 7).
There are some studies that reported that the muscular reproducibility decreases when protrusive tooth
contacts are eliminated (22) and in this situation the
mandible is potentially elevated anteriorly when the
major jaw closing muscles become active (23). This
result may be applicable in case of the horizontal
appliance because the subjects produced tapping movements guided by condyle and the jaw closing muscles
only. The horizontal appliance could not provide
anterior guidance on tapping movements. Therefore,
it might record the tapping points anterior to the
calculated IP in scattered fashion. On the other hand,
the inclination of the tracing plate of inclined and halfinclined appliances, has the advantage of acting as an
anterior guidance and was able to inhibit the excessive
anterior movement of the jaw and allow the subject to
reproduce jaw tapping movements near the IP. This
might help overcome the limitations of horizontal
appliance during registration of tapping movements.
These results of the condylar position are coincident
with the concept of the stable position of the condyle
within the fossa (24). He described that the stable
position of the condyle has the width within 023 mm
by measuring human temporomandibular joint complexes separated from the body.

Inclination
From our result, we found that the inclination of the
plate makes the tapping area smaller and nearer to the
IP without devices. But, there was only little difference

between the inclined and the half-inclined one. With


the inclined one the position of the condyle will be a
little posterior to the IP position. The other hand, with
the half-inclined plate, the position will be a little
anterior to the IP. Boutault, Bodin and Fabie (25) found
that condyle at horizontal retrusion is connected with
pain. Desai et al. (26) reported that mandibular retrusion leads to alteration in disc morphology and induces
anterior positioning of the disc. From the viewpoint of
muscle activity, Sato et al. (27) found that in the
retruded mandibular position, the activity of the sternocleidomastoid muscle increases with a clenching
task. Because there are some possibility that with the
inclined plate one may register retruded mandibular
position. We concluded that the half-inclined plate is
better than the inclined one. It is suggested that the
registration of an exrended retruded mandibular position will cause some disharmony between condyle and
occlusal function.

Conclusions
From the distribution of the scattered tapping points,
the inclined appliances should be used to record the
convergent tapping area nearer to the intercuspal
position.
Half-inclined appliance (about 14 degrees to the
occlusal plane) is recommended and reliable as it allows
the recording of tapping points in a convergent area
with the condyle in optimum position in the fossa.

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Correspondence: Dr Shoji Kohno, Removable Prosthodontics, Graduate School of Medical and Dental Sciences, Niigata University, 5274,
Gakkocho-dori-2, Niigata City, Japan 951-8514.
E-mail: kohno@dent.niigata-u.ac.jp

2004 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 31; 546553

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