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During the last century tremendous advances have been made in the diagnosis and treatment of complex developmental and acquired defects of the face and mouth. Advances in imaging, surgery, bone grafting, implant design and restorative techniques have created a unique and exciting opportunity to use digital imaging and computer aided design techniques to improve the quality of care and reduce costs. A historical review of diagnostic and treatment techniques will help illustrate the potential of the digital design process.
Jaw motion It wasn’t until the 1930’s that a scientific understanding of the actual motion of the jaw was understood. 1 This is one of the most complex joints in the body. The teeth and bone of the jaw are rigidly connected to two temporomandibular joints on each side of the skull. The jaw can make many different movements that include rotation as well as

translocation (gliding) as the articulating surface of the two jaw joints move. The shape of each tempromandibular joint is unique and each joint affects the form and position of teeth. Instruments were developed to locate a reproduceable axis of rotation from the patient and to mount dental models in a mechanical instrument called an articulator with the same axis of opening and closing as the patient. Other gliding border movements of

the jaw were recorded with an instrument called a recorder (Figure 1.). Generally, six reference plates are used to record the paths of movement of a stylus or pen against each plate. The recorder can then be removed from the patient and attached to the articulator and adjusted to follow the complex paths traced on the reference plates (Figure 2.). This system is still used today even though it was developed over 70 years ago.
Orthodontic analysis Orthodontic diagnosis evaluates the size and position of teeth in relation to the supporting jaws and soft tissues. Early work by Dr. Paul Simon 2 at the University of Berlin in the 1920’s used a complex system that allowed for the evaluation of teeth in relation to an anatomic reference plane called Frankfort Horizontal. Precise measurements of the position of specific teeth could be recorded using a device called a diameter (Figure 3.). In essence this was a Cartesian coordinate system that used Frankfort Horizontal and the anatomic midline of the palate for reference. Unfortunately, all the data points had to be recorded manually. A unique aspect of this system was that an undistorted full size

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