A Comparative-Study on the Mesiodistal-Width of the Maxillary-Anterior-Teeth Using Several Extra Oral Factors in Different Arch-Form and Palatal-FormABSTRACT
Objective: To investigate the similarity between intercommissural width) ICW) to interalar width (IAW) and circumferential arc width (CAW) for different arch forms and palate forms in a section of the Iraqi population.
Material and Methods: A fine marker pen was used to measure the interalar width by putting two dots on the alae of the nose, and then the width was determined. Also, intercommissural distance was recorded on two dots marked in the lip corner. The circumferential arch width was measured by an arch form of stainless steel wire placed above the maxillary anterior teeth. A small point was denoted on the canines’ tips. After straightening the wire, the distance between the points was verified.
Results: There were significant differences between interalar width when compared with maxillary anterior teeth width in different arch forms and palate forms, except in the tapered arch form, there are no significant differences. Also, there were significant differences between intercommissural width when compared with maxillary anterior teeth width in different arch forms and palate forms, except in the tapered arch form, in which there are no significant differences.
Conclusion: The width of the nose is inconsistent with the six upper anterior teeth width chosen for edentulous patients. The study reveals that for both sexes, with tapered arch form, the distance between the interalar resembles the distance between canines’ tips.
Keywords:
Incisor; Dental Arch; Nasal Cavity; Mouth
Introduction
The face is the portion of an individual body that is most observable and from which social agreement can be known. So, the appearance of the face is an essential portion of the self-image and a chief concern for each subject, and teeth loss puts an individual in psychological distress and requires urgent replacement [1]. The prosthodontic is a part of dentistry that gives us artificial replacements for the lost parts of the oral cavity and face. The prosthodontic prosthesis is available in three forms: removable, fixed, and maxillofacial prosthesis. The complete denture is a removable prosthesis that restores the lost facial contours and vertical dimension [2].
The choice and restoration of upper anterior teeth with a lack of pre-extraction details is considered a great obstacle in clinical prosthodontics. So, agreeable esthetics are achieved for the prostheses by choosing maxillary teeth. However, individual dissimilarities affect the esthetics of anterior teeth. The acceptance of patients is obvious and great when the lost teeth are replaced with artificial teeth like natural ones, and an enhancing result is attained. The patient's aesthetic wishes were stated to be gratified by selecting anterior teeth because the esthetic of the anterior teeth is the main complaint of patients [3].
Nowadays, restoring the normal contour of teeth, the smile line, speech, and function are of great interest to the individual and the main aim of dentistry. The smile mainly includes the six maxillary anterior teeth, which are aesthetically essential for the appropriate form and size of anterior teeth. Sometimes, artifacts like pigments and crowding teeth are included to adjust the aesthetics and smile appearance to be looked at as natural supplements. So, the critical step in complete denture treatment is the selection of anterior teeth, which plays an essential role in esthetics, besides mastication and pronunciation [2]. So, appropriately selecting the artificial maxillary anterior teeth's size to obtain the correct width was considered a complicated and challenging part of a complete denture prosthesis. Width of teeth is more important in the choice of teeth than its length in a completely edentulous patient, while pre-extraction records are not presented. This is an obstacle when constructing new dentures or for poorly esthetics old dentures [4]. Nevertheless, traditional methods for selecting teeth are imperfectly established and depend on specific measurements and proportions of the face, which change according to different ethnicities [5].
Sometimes, the dental prosthesis either improves or reduces the patient’s personal appearance depending on the naturalness and attractiveness of the appearance of the patient, reflecting the artistic abilities of the dentist, which differ from one to the other [1]. Facial measurements such as the width of bizygomatic intercommissural, interalar, and distance of interpupillary had been used by several attempts as an anterior teeth selection guidance in complete denture fabrication to accurately quantify the anterior teeth selection [6,7]. The crucial factor is the canine setting in the arrangement of denture teeth in a manner that supports the tissue at the mouth corner besides its location in the dental arch turning [8]. The nasal index is a common guide in anterior teeth choice, which actually correlates the width of the interalar to the distance existing for upper anterior teeth settings by inclusion and width of the teeth during tooth mold selection [9].
The reference for anterior teeth width selection is the interalar distance, and it was stated that the width of the interalar is related to the width of anterior teeth [10]. The distance of the interalar probably denotes the space between the cuspid tips. The method of intercommissural is established on the hypothesis, which states positioning the maxillary canines’ distal surface approximately at the mouth commissures.
Consequently, a suitable choice of upper anterior teeth size was the critical clinical phase in upper denture fabrication. Therefore, the selection, as well as the position of upper anterior teeth, were related to measurements of the face to attain a better esthetic. This paper aimed to examine the similarity of intercommissural width (ICW) to interalar width (IAW) and circumferential arc width (CAW) for different arch forms and palate forms in a section of the Iraqi population.
Material and Methods
Study Design and Ethical Clearance
This study was accomplished in the Department of Prosthodontics, Babylon University College of Dentistry and was approved by the ethical review committee (Opinion no. 4712). One hundred fifty subscribers who came for a common dental examination were chosen and were involved in the age range from 18-55 years and without any significant medical complications. A study description procedure criteria was given to subscribers, and if they accepted it, then they were requested to sign an informed consent.
The subscribers were separated into two groups depending on the shape of their hard palate, that is, U shapes and V shapes. The division into these groups was based on the following description:
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V-shaped, medium vaulted palate;
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U-shaped High vaulted palate.
The subscribers were separated into three groups depending on the shape of their arch: square, ovoid, and tapered arch. The division into these groups was based on the following description:
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The ovoid arch is broader between the canines and slightly inwards, the central incisor is inclined. The lateral incisors overlap the central, and the neck is depressed;
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In a square arch, the anterior teeth are straight up, the incisal edges are uniform, and the approximation is a straight line;
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For the tapering form, the arch is narrow from the left canine to the right canine, the teeth are slanted out from the cervical, and the incisal edges are forward.
Three parameters, interalar width, intercommissural distance, and circumferential arc width for each subscriber, were assessed by Vernier caliper. For more accuracy and precision, we repeat the measurements three times and then take the average.
Inclusion and Exclusion Criteria
The following inclusion criteria were established: 1) Natives of Iraq; 2) Subscribers without any fillings on the mesial and distal sides of six upper anterior teeth, which modifies its mesiodistal width; 3) Whole contact points of completely erupted six upper anterior teeth; 4) No maxillary anterior teeth crowding; 5) Subscribers without any congenital or acquired facial abnormality; 6) No orthodontic treatment history or extraction for permanent teeth; 7) No inflammation or hypertrophy for the gingiva; and 8) Subscribers were all at or over 18 years old.
Regarding the exclusion criteria, the following were adopted: 1) Subscribers who have experienced restorations or modifications in maxillary anterior teeth size; 2) Subscribers with maxillary anterior teeth spacing; 3) Subscribers with upper anterior teeth recession or hyperplasia of the gingiva; 4) Subscribers with previous orthodontic treatment; 5) Subscribers who have crowns or fixed prostheses; 6) Subscribers who experienced plastic facial surgery; 7) Under 18 years’ age old; 8) Asymmetrical face; and 9) Anterior tooth or teeth that are missing Congenitally.
The Interalar Width Recording Method
The subscriber was instructed to relax in an upright position on the dental chair. A fine marker pen was used to mark two points on the alae of the nose, and then, without any pressure, the width was determined by the Vernier caliper, as shown in Figure 1A.
(A) The interalar width recording. (B) The intercommissural distance recording. (C) The circumferential arc width recording.
The Intercommissural Distance Recording Method
Two dots were pointed in the lip corner passively using a Vernier caliper, as shown in Figure 1B.
The Circumferential Arc Width Recording Method
The circumferential arch width was measured using an arch form from stainless steel wire placed above the maxillary anterior teeth. A small mark was denoted on the canines’ tips. After straightening the wire, the area among two dots was evaluated (In subscribers with unnoticeable cusp tip as a result of attrition, the midpoint of the wear surface was engaged), as shown in Figure 1C. A new wire was used for each subscriber.
Data Analysis
The data were statistically analyzed using an Independent samples test with p-values>0.05.
Results
Table 1 illustrates the demographic data of the survey and the baseline characteristics for gender. The highest percentage of the total sample was male (57%). Also, the arch form distribution: the ovoid arch form was 52%, the squared was 26%, and the tapered arch form percentage was 22%. Regarding palate form, the highest percentage was for V-shaped (60%) of the total sample, followed by U-shaped (40%).
The IAW, ICW, and CAW Mean values and standard deviations are shown in Table 2. The IAW average of males (38.73 mm) was more than that located in females (35.02 mm). The ICW average of males (51.49 mm) was more than that of females (48.90 mm), while the CAW average for males (44.87 mm) was more than that located in females (43.19 mm), as shown in Table 3. The mean values of IAW, ICW, and CAW, according to arch form and palate form depending on gender, were shown in Tables 4 and 5 correspondingly.
The IAW, ICW, and CAW average values between different arch form, and palate forms according to gender by using student’s unpaired t-test (Independent samples test) with p-values >0.05 to reveal a significant difference between IAW, ICW, and CAW in all groups as presented in Table 6. The data analysis by independent samples test presented highly significant differences between IAW and CAW and between ICW and CAW in both dentulous genders.
It also revealed highly significant differences between IAW and CAW in different arch forms and palate forms except in tapered arch form there is no significant differences, as well as a highly significant difference between ICW and CAW in different arch forms and palate forms except in tapered arch form there are no significant differences.
Discussion
In different races and ethnic groups, it was proved that between the various facial parameters, there is a significant difference, so the features of any population could not be used for another [8]. In the concept of complete denture construction, choosing artificial upper anterior teeth with proper size was a challenging and confusing part.
The same position of the natural predecessor should be occupied by artificial anterior teeth. This research aimed to establish the validity of IAW as a guide to getting mesiodistal-width of upper anterior teeth. For the edentulous situation, any significant relationship would be useful. Furthermore, the method that uses nasal width for choosing the maxillary anterior teeth in prosthodontics expects the location of the upper canine.
In this research, IAW and ICW were measured using the caliper instruments. For more accuracy and precision, we repeated the measurements three times and then took the average [9,11]. The width of the nose and distance between the tips of the natural upper canine were measured and compared in all types of ridges: square, ovoid, tapering arch forms, and V-shaped and U-shaped palate forms.
The average IAW of females was smaller than males, and this is due to the effect of gender; this result agrees with the study of Keng [12], Ahn et al. [13], Frush and Fisher [14], Smith [15], Dharap and Tanuseputro [16], and Miranda and D’Souza [17] who establish in their research that the nose of males was wider than the females nose due to the effect of the gender factor. The average ICW of males was greater than that of females, and this is in line with previous research, which found that the ICW in men was significantly broader than in women [18,19]; besides that, the average circumferential arc width of males was greater than females and independent samples test revealed that this was statistically significant. This is because the size of the arch and teeth were different between males and females. Other studies [6,20,21] have found the same results, revealing an effect of gender on these measurements. Our study found a great significant difference among all measurements in both genders; this is supported by Srimaneekarn et al. [5], Zlatarić et al. [21], Al-el-Sheikh and Al-Athel [22] and Deogade et al. [23].
In the choice of maxillary six anterior teeth, we can use the observation that says the IAW is more or less similar to ICD in the general opinion, but this concept was followed as shown by our research as a general rule. Our research exposes that the IAD corresponds to the distance between the canine's tip in both genders with tapered arch form, but this is not so in square and ovoid arches, in which ICD was greater than the IAD and the canines were placed more distal, and this result can be used in the choice and teeth arrangement in the clinical application. In the edentulous arch, the IAD in tapering arch form is used to place the tip of canine teeth and its dependable references, as well as in artificial anterior teeth, its effect on gaining the suitable ICD. Our result is consistent with Smith [15] and Deogade et al. [23], who establish that there is no significant relationship between ICD and IAW of the nose. Also, these results agree with Dr. Alwazzan, who establishes that nasal width may not be confident to be used for choosing artificial maxillary anterior teeth [24]. However, our result disagrees with the result obtained by Lee [25]. Also, there is a significant difference between intercommissural width and circumferential arch width between males and females and between different arch forms and palate forms except with tapered arch form, with no significant differences.
The study conforms to Keng’s [12] study, which finds that men have larger intercanine distances and a wider nose. This study highlights that the IAW and the ICW are not always related. Also, if the ‘arch form’ was considered as another variable, there is enough association to use the IAW to obtain the estimated intercanine. The IAD can be used to give us a sense of estimate ICD through the arrangement of upper anterior teeth in complete dentures in patients with tapered arch form. In this context, the guidance of IAD is certainly useful. Related to the dentulous arch forms, the form of the arch in a completely edentulous patient could not permanently correspond to the arch form in a normal dentulous individual. Also, there is a chance of transforming the ovoid and square arch to tapering, or the opposite is true. The arch form of an edentulous patient is constant if there is no surgical intercession. As stated by Boucher et al. [26], there is no change in the arch form after natural teeth missing. The results of our research justify the recommendations highlighted in the study, with a rare exception.
Conclusion
A significant difference between IAW and the ICW was found; therefore, the width of the nose is inconsistent for six maxillary anterior teeth width choices. The study exposes that in both genders, with tapered arch form, the distance of the interalar resembles the distance between the canines’ tips. In a population of males, the measurements were higher, and this should be respected when choosing teeth for various sexes. There is a highly significant difference among all measurements in both genders.
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Financial Support
None.
Data Availability
The data used to support the findings of this study can be made available upon request to the corresponding author.
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Academic Editor:
Alessandro Leite Cavalcanti
