The patient-specific

anatomical articulator

MAMATA DUGARAJU
2ND MDS

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TABLE OF CONTENTS

01 INTRODUCTION 02 TECHNIQUE

03 DISCUSSION 04 CONCLUSION

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 01
INTRODUCTION

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 Introduction
• For most oral rehabilitations, accurate mounting of patient casts onto a semi-adjustable articulator is considered a

standard practice that entails several procedures.

• This enables mounting of the maxillary cast onto the upper member of the articulator in the same spatial relationship

as the patient.

• The upper member of the articulator represents the FHP when set parallel to the floor/ bench.

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 Introduction

• A centric relation (CR) record is then required to mount the mandibular cast to the already mounted maxillary cast.

Furthermore, protrusive and lateral records are required to program the articulator to replicate function, expressed in

protrusive and lateral jaw movements.

• This entire mounting process is technique sensitive, must be accomplished as accurately as possible, and is still

challenging.

• The purpose of this article was to introduce to the profession a true patient-specific anatomical articulator for accurately

replicating in 3D with the patient anatomy in its correct relationship and orientation

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TECHNIQUE
1. Import the patient’s cone beam computed tomography (CBCT) data, including the temporomandibular joints, and
convert it into standard tessellation language (STL) file format.

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TECHNIQUE
2. Use a point cloud processing software program (3DReshaper; Hexagon Leica Geosystems) to clean the skull and
enamel meshes and then enhance and repair the anatomical features to be printed.

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TECHNIQUE
3. Import the digitized frame of the articulator (series 8500; Whip Mix Corp) into the software program.
4. Extract the plane of the articulator and align it to coincide with the patient’s FHP by using the porion and orbitale
bony reference points

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 TECHNIQUE
5. Explode the articulator parts from the compound mesh to remove unwanted segments before merging with the

patient’s anatomical landmarks.

6. Because of the current limitations of the CBCT data, it is advisable to import a surface scan of the patient’s

maxillary cast to provide clean features and more accurate surface representation by using dental scanner.

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TECHNIQUE
7. By using mesh registration algorithms, align the maxillary surface scan with the tooth data of the CBCT scan.

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 TECHNIQUE
8. Thereafter, the maxillary anatomical landmarks, specifically teeth and/or ridges, are anatomically related to the TMJs and
their respective housing fossae, which are now replacing the articulator frame parts.
This method of systematically merging and replacing the articulator frame segments with the patient anatomy ensures
accurate and faithful replication of the patient condyles and fossae and relates all parts anatomically to each other

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 TECHNIQUE
9. Print the patient’s anatomical parts with a 3D printer (M2; Carbon, Inc) in a rigid photopolymer resin (Rigid
Polyurethane, RPU 70; Carbon, Inc).
Mount the postprocessed parts onto a modified articulator frame to render it anatomical. The maxillary printed model
serves as a remount index

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13
 TECHNIQUE

Mount the patient mandibular cast to the supplied maxillary index by using a traditional CR record.

 The maxillary cast is then cross mounted by using the same CR record. This eliminates the use of or need for an earbow

transfer.

 Cross-mounting patient casts throughout the course of the prosthodontic therapy is now possible to facilitate prosthetic

laboratory procedures.

 The 3D-printed patient data, which replicate both the condylar fossae and the actual condyles at the correct

intercondylar distance, enable accurate generation of mandibular movements

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TECHNIQUE

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16
DISCUSSION

 The condylar elements and the patient maxilla

 Intercondylar distance

 Precise condylar pathways

 Act as remounting key

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The condylar elements and the patient maxilla

1. Relating these anatomical features has been the essence of traditional facebow and earbow devices.
2. The patient’s condyles and their respective fossae and the maxilla (whether dentulous or edentulous), which are all
anatomically related to each other, are printed in the exact same relationship.
3. Additionally, they are oriented to the FHP, eliminating potential mounting errors compared with conventional
methods. This valuable feature eliminates the need for earbow transfer

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 Intercondylar distance

1. Depending on the patient’s own anatomy, the intercondylar distance is precisely reproduced, eliminating
the need for relying on averages

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Precise condylar pathways

1. The shapes of the condyles and bony slopes are obtained directly and precisely from the

patient and not based on average values.

2. This practice is eliminated because the exact movement is reproduced and simulated based on

the printed fossa contours for each condyle and its respective fossa. In fact, determining or

specifying a certain degree for condylar inclination is not needed because there are no angles

to adjust

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 ACT AS REMOUNTING KEY

1. An important procedure throughout complex prosthodontic rehabilitation treatments is the need to

cross reference and remount patient casts for the purposes of diagnostic waxing and fabrication of

interim restorations.

2. The printed maxillary reference model (index) serves that purpose. This printed model serves as the

earbow record for cross-mounting when needed and is related accurately to the FHP and the condylar

hinge axis

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CONCLUSION

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 References

1. Azer SS, Kemper E. The patient-specific anatomical articulator. J Prosthet Dent.

2022;128(6):1158-64.

2. Bonwill WGA. The scientific articulation of the human teeth as founded on geometrical,

mathematical and mechanical laws. Dental Items of Interest 1899:617-43.

3. Weinberg LA. An evaluation of the face-bow mounting. J Prosthet Dent 1961;11:32-42.

4. Preston JD. A reassessment of the mandibular transverse horizontal axis theory. J Prosthet Dent

1979;41:605-13

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REFERENCES

5. Bailey JO, Nowlin TP. Evaluation of the third point of reference for mounting maxillary casts on

the Hanau articulator. J Prosthet Dent 1984;51:199-201.

6. The glossary of prosthodontic terms. ninth ed. J Prosthet Dent 2017;117:12.

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THANK YOU

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