Whaites E., Drage N, 6th edn. : Elsevier; 2020
Steele JG, Nohl FS, Wassell RW Crowns and other extra-coronal restorations: occlusal considerations and articulator selection. Br Dent J. 2002; 192:377-387

Use of a wax bite for accurate lateral skull radiographs

From Volume 17, Issue 2, April 2024 | Pages 77-79


Ian Murphy

BDS, MFDS (RCS Ed), MClinDent, MOrth (RCS Eng), FDS (Orth) RCS, PGCertClinEd, MFDS RCS Ed, MOrth RCS Eng

Post-CCST Orthodontics, Department of Orthodontics, Royal Surrey County Hospital, Guildford

Articles by Ian Murphy

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Nigel Taylor

MDSc, BDS, FDS RCS(Ed), MOrth RCs(Ed), MDSc, BDS, FDS RCS(Ed), FDS RCS(Eng), FDTFed RCS(Ed), M'Orth RCS(Ed), D'Orth RCS(Eng), Consultant Orthodontist

Consultant Orthodontist, Royal Surrey County Hospital, Guildford, UK

Articles by Nigel Taylor


CPD/Clinical Relevance: The reader will learn a method of simplifying the process of taking a lateral skull radiograph with the mandible in a reproducible position in patients who have a variable jaw closure position.


The technique of taking a lateral skull radiograph is standardized with the patient positioned in the cephalostat, the sagittal plane of the head parallel to the film, the X-ray source 1.5 m from the midsagittal plane of the patient and the film 30 cm behind the midsagittal plane, the Frankfort plane horizontal, ear rods in the external meatus, and teeth in maximum intercuspation.1 The final step of biting into maximum intercuspation can be problematic for some patients and lead to errors in jaw positioning recorded on the radiograph. Techniques to avoid repositioning errors reduce the need for imaging to be repeated and reduce X-ray exposure.

Most patients when asked to bite their teeth together, close into a comfortable, reproducible position where the maximum number of tooth contacts occur, the intercuspal position (ICP). Movement of the mandible into this position is guided by the tooth morphology, but may also be a learned habit as patients may posture their jaw to mask a malocclusion or avoid a displacement. A reproducible jaw position is important to plan treatment. To find the true occlusal discrepancy, the clinician must find the patient's centric relation, the occlusion when the teeth are in contact during closure on the hinge axis, with the condyles maximally seated in their fossae.2 It can be challenging to manipulate the patient into this position, and even harder again to then take a lateral skull radiograph in this position.

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