DENTAL INSTRUMENTATION The History of Articulators: From Facebows to the Gnathograph, a Brief History of Early Devices Developed for

Recording Condylar Movement: Part II

Edgar N. Starcke, DDS

HIS ARTICLE continues an historical review, begun in the last issue, of landmark clinical investigations that advanced the professions understanding of the nature of condylar movement. The investigators unique recording devices, developed for registering and studying the movements of the condyles in human subjects, are described.

Contributions of George Campion and Norman Bennett

George G. Campion, of Manchester, England, generally supported the ndings of Charles E. Luce and William E. Walker on mandibular movement. When speaking of the S or ogee form of the condylar paths, however, Campion stated that the form and variations of the condyle paths show how futile the efforts must be to construct an anatomical articulator. He contended that no articulator could be truly anatomical unless it could imitate the exact condylar paths of each individual patient.1 He believed that J. B. Partt deserved the credit for being the rst to construct an articulator that embodied this essential principle. Campion designed an adjustable facebow xed to the mandibular teeth with modeling plastic to graphically record the various positions of the condyles on the face with a succession of dots (Fig 1). Using white blotting paper, the dots (made with a thick oil-based dye) were related to the ala-tragus line with one edge of the paper, lifted off, and transferred directly to either a paper record or a glass lantern slide.
Correspondence to: Edgar N. Starcke, DDS, Clinical Professor, Department of Prosthodontics, The University of Texas Health Science Center at Houston Dental Branch, 6516 M.D. Anderson Boulevard, P.O. Box 20068, Houston, TX 77225. E-mail: estarcke@mail.db.uth.tmc.edu Copyright 2002 by The American College of Prosthodontists 1059-941X/02/1101-0011$35.00/0 doi:10.1053/jpro.2002.31438

Although Campion did not produce an articulator of his own, he was concerned about misconceptions relating to the opening axis of the mandible and the design of that feature in articulators. He stated that although it had been suggested that during the opening movement, the mandible rotated about an axis located behind and below the condyles, he believed this description to be erroneous. His data showed that there could be no one axis about which the mandible travels in opening movement. He interpreted this movement to be complex, occurring about 2 axes: 1 approximately through the centers of the condyles (rotation) and the other through the centers of the curves of the 2 articulating eminences (translation). He concluded . . . the only part of the opening movement which an articulator is concerned to reproduce is the initial stage which is seen in the tracings to be a simple rotation about an axis passing through the condyles.1 On April 27, 1908, Norman G. Bennett of London, England presented a paper on mandibular movement to the Royal Society of Medicine Odontology Section. The article, originally published in the proceedings of the society that year, was reprinted in its entirety in the Journal of Prosthetic Dentistry in 1958.2 By 1908, Bennett had been studying mandibular movement for several years and on this occasion wanted to clarify one or two aspects of this thorny problem that he believed other investigators had not dealt with adequately. Specifically, he intended to show that no single xed rotation center of the condyles exists, but that the center is constantly moving. That is, for any normal opening movement of the mandible, a succession of instantaneous centers of rotation occurs in a curved path. The paths vary among individuals. Other observations relating to vertical movements of the mandible reported by Bennett in53

Journal of Prosthodontics, Vol 11, No 1 (March), 2002: pp 53-62

54 cluded the existence of a denite rest position of the mandible. . .as judged by subjective sensation and that the initial center of rotation of the mandible was located behind and below the condyle. He concluded, therefore, that altering the vertical dimension of occlusion on a hinge articulator would introduce errors.2 Bennetts description of the lateral paths of the condyles was actually of minor consideration. Essentially, the only data from this article that showed the condylar movements that now bear his name is illustrated in Fig 2 (movements of Bennetts right condyle). Line A is extreme vertical opening with no lateral movement. Line B is extreme opening with extreme lateral movement to the left. Line B is that of extreme opening combined with extreme movement to the right. Lines C, C represent extreme lateral movement to the left and right with the teeth in continuous contact. Bennetts comments were, [it] is interesting as showing that, in my case at least, in movement towards the side on which the condyle might be expected to remain stationary there is quite considerable movement of the condyle outwards away from its articular surface.2 Although Norman Bennett was a well-respected clinical investigator, it is remarkable nevertheless that this single case study received so much attention and has been seen as such an important mile-

Figure 1. George C. Campions graphic facebow device. Campions method of recording the condylar paths involved placing a succession of dots on the face and transferring the dots with blotting paper to either paper or glass. (Reprinted from Campion, p 40.1)

Figure 2. An illustration of extreme opening and lateral movements of Norman Bennetts right condyle demonstrating the phenomenon now known as the Bennett movement. (Reprinted with permission.2)

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Figure 3. (A) Professor Alfred Gysi demonstrating mandibular movement. This is one of the earliest models of Gysis mandibular recorders. It was designed to record the movements of mandible at the condyles and chin in straight opening and closing. The pencils are pointed to record in the sagittal plane. The horizontal plates parallel the occlusal plane. (Reprinted from Clapp, p 143.9) (B) These recordings showed a downward and forward path of the condyle. (The arm and pencil have been removed to permit a better view of the condylar path.) Note that the chin path scribed a loop or teardrop effect. (Reprinted from Clapp, p 143.9) (C) Professor Gysi demonstrating the lateral movements of the condyles and chin. The pencils are turned to record on the horizontal plane. Gysi showed that the condyle on the working side moved out of the fossa away from the median line while the advancing condyle moved strongly inward (p 148).9 He also showed the components of the gothic arch or movements of the incisor point. (Reprinted from Clapp, p 149.9)

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Figure 4. (A) The Gysi Condyle Path Register and Accessories. This was Gysis rst commercially available model. It was adjustable and had 2 reversible styli ( J and K) for tracing the condylar paths in both the vertical and horizontal planes. Horseshoe plate A and incisor point marker E were attached to wax occlusion rims for making the tracings of the gothic arch. (Reprinted from Clapp et al, p 127.10) (B) The incisor point marker mounted on a wax occlusion rim and a mandibular horseshoe plate with a registered incisor path. (Reprinted from Hillyer, p 999.11)

stone in the quest for understanding mandibular movement. It is true that his conclusions have been found to be largely accurate; however, his methodology was hardly scientic. On the other hand, he did introduce basic new information and he probably never meant for his paper to be accepted for more than it was: a case study. As far as his research methodology was concerned, Bennett prefaced his article by reporting that the information he presented was fragmentary and it consists mainly of an account of some experiments that I undertook some time ago, but have not had the time to carry out to a full extent.2 There was only one test subject, Bennett himself, who was assisted in the experiment by his brother. Bennett described his apparatus as a facebow to which were attached 2 very small light bulbs, 1 opposite the center of the right condyle, and 1 opposite the center of the sulcus of the lower lip. With the facebow in place, his head was stabilized with the right side of his face parallel to a wall. A

biconvex lens was placed between the light bulbs and the wall to control the magnication and to focus the images. When the 2 light bulbs were turned on in a dark room, the images were projected on the wall. The paths of the mandibular movements (appearing as dots of light) were then traced by his assistant on a sheet of white paper placed on the wall. Bennett stated that when the lateral movements were made, he was facing the wall. This is interesting because the Bennett movement is described on the horizontal plane. However, to project the movement of the light bulbs during a lateral condylar movement on a wall toward which he was facing would have displayed the movement on the frontal (coronal) plane. For the image to be on the horizontal plane, it should have been projected on the ceiling with the head erect. Bennetts report did bring to the attention of the profession a concept that Balkwill had discovered but that had been buried for over 40 years. Norman

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Figure 5. (A) The Gysi Condyle Register, 1910. This view shows the technique for tracing the right vertical condylar path on a patient. Note that the horizontal point of the reversible stylus is used for tracing on a card held in position by an assistant. (Reprinted from Clapp et al, p 135.10) (B) The Gysi Condyle Register, 1910. This frontal view of the patient shows the technique for recording the lateral (Bennett) paths of the condyles. The vertical points of the reversible styli are used for tracing on the underside of the horizontal frosted glass plates that the assistant holds in position. (Reprinted from Clapp et al, p 146.10)

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Figure 6. (A) The Gysi Trubyte Facebow, 1928. This complete assembly consists of the Incisor Path Marker, attached to the maxillary occlusion rim; the gothic arch registering table, also attached to the mandibular occlusion rim; and the Sagittal Condyle Register, fastened to the gothic arch registering table by 2 anterior horizontal rods. The tracing ags are still held in position by an assistant. (Reprinted with permission.12) (B) The Gysi Trubyte Facebow and Articulator, 1928. This shows the Gysi Trubyte articulator with the facebow assembly in position with mounted casts. The right sagittal condyle path has been set and veried at 30 degrees. By this time, Gysi had abandoned the lateral condyle path registration for the controlling gothic arch feature of the incisal guide. (Reprinted with permission.12)

Bennett may not have explored mandibular movement thoroughly, but he certainly shed some light on the subject.

Gysi: The Gothic Arch and Bennett Movement

Alfred Gysis contributions to the understanding of mandibular movement are considerable. However, this article will focus on only the early and more notable recording instruments that he de-

veloped during the course of his investigations. Gysi was inventive, clever, and tenacious and, through his painstaking analysis of the work of his predecessors, was able to develop new instruments and establish concepts of mandibular movements. Although his instruments have since been superceded, many of his concepts remain valid today. In 1910, Gysi reported on his research of the previous 20 years in a series of articles for the Dental Cosmos.3-6 He stated that, in 1901, he had con-

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Figure 7. The Snow facebow, 1924, the rst instrument used by B. B. McCollum to locate the hinge axis. (Reprinted from McCollum, p 529.13)

Figure 9. (A and B) Two views of the rst instrument to record the paths of motion of the mandible in all three dimensions at one and the same time (1934).13 The instrument had styli to record both the vertical and lateral condylar paths. It also featured 2 anterior styli located in the midline: 1 vertical to record the incisor point and 1 horizontal to record the opening and closing motion. (Reprinted with permission.14)

4 Figure 8. (A) Early in 1927, a 3-piece adjustable facebow had been developed. Cast metal clutches had replaced the unreliable modeling plastic devices. A maxillary facebow was added to cover up the movable skin to make the determination of the hinge axis more precise. (B) This double exposure photography shows the mouth dropped open technique with only rotation of the caliper pin. (Reprinted from McCollum, p 534.13)

60 structed a simple apparatus for measuring the slant of the condyle paths to the occlusal plane [condylar inclination]. In the 3 photographs shown in Fig 3, Professor Gysi demonstrates mandibular movement with an early experimental tracing device. Figure 3A and B shows tracings of the condylar path on the sagittal plane and those at the symphysis that occur with a straight opening and closing movement. Gysi was not the rst to determine the individual condylar paths for articulator use, but he began to improve and rene the process for clinical purposes. He was the rst, however, to register the paths of the incisor point in the horizontal plane. He referred to the combined anterior lateral tracings as the Gothic Arch. He was also the rst to measure the lateral condylar paths (Balkwill-Bennett movements) and to incorporate this feature into an articulator (Fig 3C). Gysi remarked that recording the movement of these points on the mandible was the easiest part of the whole problem, but it took seven years to make an articulator with which to imitate these movements.3 Gysi, of course, was referring to the 2 adjustable articulators that preceded his Adaptable, introduced to US dentists in 1910 and patented in 1912. The Adaptable was the rst articulator to include the Balkwill-Bennett movement feature.7 These 3 Gysi articulators appeared in the Journal of Prosthodontics March 2001 article in this series.8 Figure 4A shows the various components of Gysis rst practical clinical version of his condylar graphic-tracing device (Gysi called it the condyle register). In combination with his incisor point marker (Fig 4B), these instruments were capable of tracing the gothic arch as well as the condyle paths on both the vertical and horizontal planes. The major drawbacks in the design of the condyle register were that it was necessary for an assistant to hold the tracing surfaces (cardboard or glass) in position and, that the vertical and horizontal condylar tracings could not be accomplished at the same time (Fig 5A and B). When Gysi introduced the Trubyte articulator in about 1928, the notable change in the accompanying condyle register was that the lateral condylar path feature was no longer included (Fig 6A and B). By this time, Gysi had developed the concept of setting the controls of the articulator by following the guiding edges of the gothic arch incisal table.

A Brief Look at the Origins of Gnathology

Meanwhile, in Los Angeles, CA, Beverly B. McCollum, Charles E. Stuart, and Harvey Stallard were making history in a newly developing eld of dentistry. In 1924, the eld was given a name: gnathology. Harvey Stallard, who coined the term, is generally regarded as the author of the language of gnathology. That same year, McCollum developed the rst method to locate the mandibular hinge axis. His rst attempt was with the use of an ordinary Snow facebow. The facebow fork was modied and fastened to the mandibular teeth with modeling plastic (Fig 7). He subsequently developed a practical adjustable mandibular hinge axis facebow with a companion facebow-like device that was attached to the maxillary teeth for securing the recording ags in position under the styli (Fig 8A and B). The devices used for fastening the components of the hinge axis facebow to the maxillary and mandibular teeth evolved from facebow forks to cast aluminum custom clutches. Also in 1924, Charles E. Stuart, a young graduate of the University of Southern California School of Dentistry, joined McCollums research efforts. And with Harvey Stallard, Stuart was the guiding force who brought to a successful completion the work that McCollum had begun but was unable to complete because of a lengthy illness resulting from a stroke he had suffered in 1949.14 He died in 1968. In 1926, McCollum organized the Gnathological Society of Southern California. The members and associates were dedicated to McCollums quest to accurately record and replicate mandibular movement, and most of these men became passionately involved in this new concept of gnathology. Without the generous contributions of their time, personal efforts and, of course, nancial support, this ambitious project would probably not have been feasible. From 1924 to 1928, 9 different models of experimental articulators were made before McCollum placed into production an articulator that met his standards, the Gnathoscope.14 It would take another 5 years, largely because of the efforts of Stuart, to produce an instrument capable of measuring mandibular movement in 3 planes. In 1934, the prototype of the Gnathograph was demonstrated at the annual meeting of the University of

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Figure 10. The second device to record the movements of the mandible in all 3 dimensions, 1935. It was described as a simpler and more universal apparatus. Note that 2 anterior horizontal tables have been added and the vertical table has been eliminated. (Reprinted with permission.14)

Southern California Alumni Association (Fig 9A and B). In 1935, the second instrument to record movements in 3 planes was developed (Fig 10). Besides styli to trace both the horizontal and vertical condylar paths, it featured 1 anterior vertical stylus for the gothic arch and 1 horizontal stylus for tracing the opening and closing movements on the

sagittal plane. In 1937, the rst satisfactory recording device, the Gnathograph, was introduced (Fig 11). From the Gnathoscope and Gnathograph, Charles Stuart would eventually develop his own gnathological system, including an articulator and pantograph for which he received a patent in 1955.

Figure 11. The Gnathograph, a satisfactory recording device, with the axis orbital plane indicator in position, c.1937. It featured horizontal and vertical styli for tracing the condylar inclination and Bennett paths, as well as 2 anterior vertical styli for tracing the gothic arch lateral movements. The custom-made metal clutches had metal plates attached, the lower with a central-bearing screw, the round end of which rested on the upper plate during all mandibular movements. (Reprinted with permission.14)

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References
1. Campion GG: Some graphic records of movements of the mandible in the living subject and their bearing on the mechanism of the joint and the construction of articulators. Dent Cosmos 1905;47:39-42 2. Bennett NG: A contribution to the study of movements of the mandible. J Prosthet Dent 1958;8:41-54 3. Gysi A: The problem of articulation (Part I). Dent Cosmos 1910;3:1-19 4. Gysi A: The problem of articulation (Part II). Dent Cosmos 1910;3:148-169 5. Gysi A: The problem of articulation (Part III). Dent Cosmos 1910;3:268-283 6. Gysi A: The problem of articulation (Part IV). Dent Cosmos 1910;3:403-418

7. Gysi A: Dental Articulator. US Patent No. 1,041,270. October 15, 1912 8. Starcke EN: The history of articulators: The appearance and early use of the incisal pin and guide. J Prosthodont 2001; 10:52-60 9. Clapp GW (ed): Prosthetic Articulation. New York, NY, The Dentists Supply Company, 1914 10. Clapp GW, Tench RW (eds): Professional Denture Service. New York, NY, The Dentists Supply Company, 1918 11. Hillyer E: Development of the anatomical articulator. Dent Cosmos 1913;55:989-1005 12. Swenson MG (ed): Complete Dentures (ed 1). St. Louis, MO, Mosby, 1940 13. McCollum BB: Fundamentals involved in prescribing restorative dental remedies. Dent Items Interest 1939;61:522-535 14. McCollum BB, Stuart CE (eds): A Research Report (ed 1). South Pasadena, CA, Scientic Press, 1955