UUnniivveerrssiittyy ooff TTeennnneesssseeee HHeeaalltthh SScciieennccee CCeenntteerr UUTTHHSSCC DDiiggiittaall CCoommmmoonnss Theses and Dissertations (ETD) College of Graduate Health Sciences 12-2012 VVeerriifificcaattiioonn ooff tthhee AAccccuurraaccyy ooff EElleeccttrroonniicc MMaannddiibbuullaarr MMoovveemmeenntt RReeccoorrddiinngg DDeevviicceess:: :: AAnn iinn vviittrroo iinnvveessttiiggaattiioonn Joshua Heath Balch University of Tennessee Health Science Center Follow this and additional works at: https://dc.uthsc.edu/dissertations Part of the Prosthodontics and Prosthodontology Commons RReeccoommmmeennddeedd CCiittaattiioonn Balch, Joshua Heath , "Verification of the Accuracy of Electronic Mandibular Movement Recording Devices: : An in vitro investigation" (2012). Theses and Dissertations (ETD). Paper 21. http://dx.doi.org/ 10.21007/etd.cghs.2012.0021. This Thesis is brought to you for free and open access by the College of Graduate Health Sciences at UTHSC Digital Commons. It has been accepted for inclusion in Theses and Dissertations (ETD) by an authorized administrator of UTHSC Digital Commons. For more information, please contact [email protected]. VVeerriifificcaattiioonn ooff tthhee AAccccuurraaccyy ooff EElleeccttrroonniicc MMaannddiibbuullaarr MMoovveemmeenntt RReeccoorrddiinngg DDeevviicceess:: :: AAnn iinn vviittrroo iinnvveessttiiggaattiioonn AAbbssttrraacctt One goal of restorative dentistry is to truly capture maxillomandibular relationships that accurately reproduce mandibular border movements and that would prescribe the best occlusal interface. Registration of horizontal and sagittal movements of the patient allows maximum cusp height and fossae depth with proper placement of occlusal ridges and grooves. The goal is to develop an occlusion that is interference free and entails the concepts of organic occlusion. Methods to transfer patient information to a highly adjustable articulator include mechanical recorders, mechano-electronic recorders and optoelectronic recorders. The purpose of this study is to verify the accuracy of electronic mandibular movement recording devices in vitro. For this investigation an articulator (Denar® D5A, Whip Mix Corp., Louisville, KY) with known condylar settings was employed as a mock patient. An experimental apparatus was fabricated to attach recording devices to the mock patient simulating clinical conditions. Mock patient movements were accomplished under clinically relevant conditions. The primary use of a pantograph is to record patient mandibular border movement and program an articulator so that the movements of the articulator simulate the border movements of the patient. The objectives of this four part investigation was to assess the accuracy of an optoelectronic pantograph (Freecorder® Bluefox, Dentron, Germany) in locating a known transverse horizontal axis (THA), assess the ability of an optoelectronic pantograph (Freecorder® Bluefox, Dentron) to accurately determine preset values of the mock patient, assess the ability of a mechano-electronic pantograph (Cadiax Compact 2®, GAMMA Dental, Austria) to accurately determine the preset values of the mock patient and compare the accuracy of the optoelectronic pantograph and mechano-electronic pantograph through statistical analysis mean values generated for each condylar setting were compared to known mock patient condylar settings. Settings were the same for the right and left condylar guide assemblies. Results of this investigation demonstrated that: 1) the optoelectronic pantograph did not locate a known transverse horizontal axis; 2) the optoelectronic pantograph did not record mandibular movement accurately; 3) the mechano-electronic pantograph did not record mandibular movement accurately; and 4) there were differences in accuracy between the optoelectronic pantograph and mechano-electronic pantograph. The majority of condylar guide assembly mean values predicted by the optoelectronic pantograph and mechano-electronic pantograph were statistically inaccurate and there were differences in accuracy between the optoelectronic and mechano-electronic pantographs. Clinically, the predicted mean values for the Lateral Condylar Inclination (LCI) and Progressive Mandibular Lateral Translation (PMLT) were within five degrees of the known mock patient settings. The values predicted by the optoelectronic pantograph over-compensated mandibular movement requiring shorter cusps for the restoration. The mechano-electronic pantograph prescribed longer cusps, for the restoration, that potentially induce interferences. Though statistically significant inaccuracies were identified, both mandibular recording devices may be considered clinically acceptable. However, the use of both mandibular recording devices investigated here will potentially result in occlusal restorations that require adjustment when placed in the oral cavity. DDooccuummeenntt TTyyppee Thesis DDeeggrreeee NNaammee Master of Dental Science (MDS) PPrrooggrraamm Prosthodontics RReesseeaarrcchh AAddvviissoorr David R. Cagna, DMD, MS KKeeyywwoorrddss mandibular recording devices, optoelectronic, mechano-electronic, electronic. SSuubbjjeecctt CCaatteeggoorriieess Dentistry | Medicine and Health Sciences | Prosthodontics and Prosthodontology This thesis is available at UTHSC Digital Commons: https://dc.uthsc.edu/dissertations/21 VERIFICATION OF THE ACCURACY OF ELECTRONIC MANDIBULAR MOVEMENT RECORDING DEVICES: AN IN VITRO INVESTIGATION A Thesis Presented for The Graduate Studies Council The University of Tennessee Health Science Center In Partial Fulfillment Of the Requirements for the Degree Masters of Dental Science From The University of Tennessee By Joshua Heath Balch December 2012 Copyright © 2012 by Joshua Heath Balch. All rights reserved. ii DEDICATION To “My Love” Dana who truly made this entire program possible. Without her total support, prayers, willingness to do whatever was needed and many hours of support this task would not have been accomplished. Her sacrifices were immeasurable. I am forever grateful and am blessed by having you in my life. iii ACKNOWLEDGEMENTS I would like to express my gratitude to everyone who has helped me in my endeavor of pursuing a Master of Dental Science in Prosthodontics. I am grateful to Dr. David Cagna, who has been a mentor and advisor in this project. I would also like to thank my committee members, Dr. Swati Ahuja, Dr. William McHorris, Dr. Gregory Paprocki, Dr. Mark Scarbecz and Dr. Russell Wicks for their advice and experience. I would also like to extend by special thanks to Whip Mix Corporation especially Jim Robinson for coordinationand Royce Thompson for his engineering and technical support in fabricating the maxillary face bow mounting apparatus. iv ABSTRACT One goal of restorative dentistry is to truly capture maxillomandibular relationships that accurately reproduce mandibular border movements and that would prescribe the best occlusal interface. Registration of horizontal and sagittal movements of the patient allows maximum cusp height and fossae depth with proper placement of occlusal ridges and grooves. The goal is to develop an occlusion that is interference free and entails the concepts of organic occlusion. Methods to transfer patient information to a highly adjustable articulator include mechanical recorders, mechano-electronic recorders and optoelectronic recorders. The purpose of this study is to verify the accuracy of electronic mandibular movement recording devices in vitro. For this investigation an articulator (Denar® D5A, Whip Mix Corp., Louisville, KY) with known condylar settings was employed as a mock patient. An experimental apparatus was fabricated to attach recording devices to the mock patient simulating clinical conditions. Mock patient movements were accomplished under clinically relevant conditions. The primary use of a pantograph is to record patient mandibular border movement and program an articulator so that the movements of the articulator simulate the border movements of the patient. The objectives of this four part investigation was to assess the accuracy of an optoelectronic pantograph (Freecorder® Bluefox, Dentron, Germany) in locating a known transverse horizontal axis (THA), assess the ability of an optoelectronic pantograph (Freecorder® Bluefox, Dentron) to accurately determine preset values of the mock patient, assess the ability of a mechano-electronic pantograph (Cadiax Compact 2®, GAMMA Dental, Austria) to accurately determine the preset values of the mock patient and compare the accuracy of the optoelectronic pantograph and mechano-electronic pantograph through statistical analysis mean values generated for each condylar setting were compared to known mock patient condylar settings. Settings were the same for the right and left condylar guide assemblies. Results of this investigation demonstrated that: 1) the optoelectronic pantograph did not locate a known transverse horizontal axis; 2) the optoelectronic pantograph did not record mandibular movement accurately; 3) the mechano-electronic pantograph did not record mandibular movement accurately; and 4) there were differences in accuracy between the optoelectronic pantograph and mechano-electronic pantograph. The majority of condylar guide assembly mean values predicted by the optoelectronic pantograph and mechano-electronic pantograph were statistically inaccurate and there were differences in accuracy between the optoelectronic and mechano-electronic pantographs. Clinically, the predicted mean values for the Lateral Condylar Inclination (LCI) and Progressive Mandibular Lateral Translation (PMLT) were within five degrees of the known mock patient settings. The values predicted by the optoelectronic pantograph over-compensated mandibular movement requiring shorter cusps for the restoration. The mechano-electronic pantograph prescribed longer cusps, for the restoration, that potentially induce interferences. Though statistically significant inaccuracies were identified, both mandibular recording devices may be considered v clinically acceptable. However, the use of both mandibular recording devices investigated here will potentially result in occlusal restorations that require adjustment when placed in the oral cavity. vi TABLE OF CONTENTS CHAPTER 1. INTRODUCTION .....................................................................................1  CHAPTER 2. LITERATURE REVIEW .........................................................................6  Articulation and Mandibular Movement: A Historical Perspective ................................6  Jaw Relators .................................................................................................................6  Anatomical Relationships ............................................................................................7  Methods and Devices to Record Mandibular Movement ................................................8  Photographic ................................................................................................................8  Stereographic ...............................................................................................................9  Static and Graphic ......................................................................................................10  Mechanical .................................................................................................................10  Optical ........................................................................................................................11  Radiographic ..............................................................................................................12  Motion Picture ...........................................................................................................12  Photoelectronic ..........................................................................................................13  Mechanical Pantograph ..............................................................................................13  Optoelectronic ............................................................................................................14  Mechano-electronic Pantograph ................................................................................15  Evaluation and Comparison of Mandibular Recording Devices ...................................15  CHAPTER 3. MATERIALS AND METHODS ............................................................18  Materials and Equipment ...............................................................................................18  Highly Adjustable Articulator ....................................................................................18  Reference Plate ..........................................................................................................18  Test Mandibular Recorders ........................................................................................25  Mounting Apparatuses ...............................................................................................27  Magnification .............................................................................................................27  Methods: General ...........................................................................................................31  Methods: Specific Aim 1 ...............................................................................................31  Methods: Specific Aim 2 ...............................................................................................32  Trial 1 .........................................................................................................................43  Trial 2 .........................................................................................................................43  Trial 3 .........................................................................................................................43  Methods: Specific Aim 3 ...............................................................................................43  Trial 1 .........................................................................................................................46  Trial 2 .........................................................................................................................46  Trial 3 .........................................................................................................................46  Methods: Specific Aim 4 ...............................................................................................46  CHAPTER 4. RESULTS .................................................................................................50  CHAPTER 5. DISCUSSION ..........................................................................................62  vii