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An Analysis of Maxillary Anterior Teeth Dimensions for the Existence of Golden Proportion: Clinical Study

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Background: Appearance of the face is a great concern to everyone, as it is a significant part of self-image. The study analyzed the clinical crown dimensions of the maxillary anterior teeth with respect to their apparent mesiodistal widths, width-to-height ratio to determine whether golden proportion existed among the South Indian population. Materials and methods: A total of 240 dentulous subjects were chosen for the study (120 males and 120 females) age ranging between 18 and 28 years. Full face and anterior teeth images of the subjects were made on specially designed device resembling a face-bow, mounted onto the wall under a standard light source. The width and height of the maxillary central incisors were measured on the stone casts using a digital caliper. Results: The mean perceived maxillary lateral incisor to central incisor width ratio was 0.67 in males and 0.703 in females. The mean perceived maxillary canine to lateral incisor width ratio was 0.744 in males and 0.714 in females. The mean width-to-height ratio of the maxillary central incisor was 79.49% in males and 79.197% in females. Conclusion: The golden proportion was not found between perceived mesiodistal widths of maxillary central and lateral incisors and nor between perceived mesiodistal widths of maxillary lateral incisors and canines. In the majority of subjects, the width-to-height ratio of maxillary central incisor was within 75-80%. There are no statistically significant differences in maxillary anterior teeth proportions between males and females. The results may serve as guidelines for treatment planning in restorative dentistry and periodontal surgery.
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Journal of International Oral Health 2015; 7(9):18-21
18
Maxillary anterior teeth dimensions and golden proportion … Sandeep N et al
Original Research
Received: 23
rd
April 2015 Accepted: 20
th
July2015 ConictsofInterest:None
SourceofSupport:Nil
An Analysis of Maxillary Anterior Teeth Dimensions for the Existence of Golden Proportion:
Clinical Study
NallaSandeep
1
,ParthSatwalekar
2
,SivaSrinivas
3
,ChandraSekharReddy
4
,GRamaswamyReddy
5
,BAnanthaReddy
2
Contributors:
1
Reader, Department of Prosthodontics, SVS Institute of
Dental Sciences, Mahabubnagar, Telangana, India;
2
Professor,
Department of Prosthodontics, SVS Institute of Dental Sciences,
Mahabubnagar, Telangana, India;
3
Professor, Department of
Conservative Dentistry, VYWS Dental College and Hospital,
Amaravathi, Maharashtra, India;
4
Professor, Department of
Prosthodontics, Career Postgraduate Institute of Dental Sciences
and Hospital, Lucknow, Uttar Pradesh, India;
5
Professor and Head,
Department of Prosthodontics, SVS Institute of Dental Sciences,
Mahabubnagar, Telangana, India.
Correspondence:
Dr. Sandeep N. Reader, SVS Institute of Dental
Sciences, Mahabubnagar - 509 001, Telangana, India.
Phone: +91-9908108568. Email: nallasandeep@gmail.com
Howtocitethearticle:
Sandeep N, Satwalekar P, Srinivas S, Reddy CS, Reddy GR,
Reddy BA. An analysis of maxillary anterior teeth dimensions for
the existence of golden proportion: Clinical study. J Int Oral Health
2015;7(9):18-21.
Abstract:
Background: Appearance of the face is a great concern to
everyone, as it is a signicant part of self-image. The study analyzed
the clinical crown dimensions of the maxillary anterior teeth with
respect to their apparent mesiodistal widths, width-to-height ratio
to determine whether golden proportion existed among the South
Indian population.
Materials and Methods: A total of 240 dentulous subjects were
chosen for the study (120 males and 120 females) age ranging
between 18 and 28 years. Full face and anterior teeth images of
the subjects were made on specially designed device resembling a
face-bow, mounted onto the wall under a standard light source. The
width and height of the maxillary central incisors were measured on
the stone casts using a digital caliper.
Results: The mean perceived maxillary lateral incisor to central
incisor width ratio was 0.67 in males and 0.703 in females. The mean
perceived maxillary canine to lateral incisor width ratio was 0.744 in
males and 0.714 in females. The mean width-to-height ratio of the
maxillary central incisor was 79.49% in males and 79.197% in females.
Conclusion: The golden proportion was not found between perceived
mesiodistal widths of maxillary central and lateral incisors and nor
between perceived mesiodistal widths of maxillary lateral incisors
and canines. In the majority of subjects, the width-to-height ratio of
maxillary central incisor was within 75-80%. There are no statistically
signicant dierences in maxillary anterior teeth proportions between
males and females. The results may serve as guidelines for treatment
planning in restorative dentistry and periodontal surgery.
Key Words: Clinical crown, dental esthetics, epidemiology,
esthetics, golden proportion, smile, tooth display
Introduction
Beauty is the pleasant experience seen with subjective senses,
interpreted by our associations, ltered by a philosophy of life,
and felt by intuition. The essence of beauty has been sought
since beginning of the time.
1
“The face excels in beauty when
compared with other anatomical divisions of the human
beings” - Leonardo da vinci.
2
For everyone, appearance of
face is of great concern, as it is signicant part of self-image.
3
Holmes has indicated the value of the facial beauty in general
and the important contribution of teeth to facial beauty by
this passage “A beautiful princess would not exchange one of
her upper central incisor tooth for the most precious jewels
for her crown.”
2
The maxillary anterior teeth size, shape, and
arrangement is the most inuential factor for harmonious
appearance, particularly when viewed from front.
4
This clinical
study determined existence of golden proportion among South
Indian population through analyzing the maxillary anterior
teeth clinical crown dimensions with respect to their apparent
mesiodistal width and width-to-height ratio.
Materials and Methods
A total of 240 dentulous subjects comprised 120 males and
120 females, with age ranging between 18 and 28 years
were chosen for the study. The subjects were the students
(postgraduates, undergraduates, internees, technicians),
patients, and their attendants who visited the hospital. All
subjects were from various places in the state of Andhra Pradesh,
South India. The sample was grouped according to gender to
determine the eect on the correlation of the measurements.
Informed consent was obtained from all the subjects prior
to their participation. The study has been approved by
Institutional Ethical Committee.
The inclusion criteria were:
1. No missing maxillary and mandibular anterior teeth,
2. No gingival or periodontal conditions that alter healthy
tissue-to-tooth relationship,
3. No interdental spacing or crowding,
4. No anterior restorations,
5. No history of orthodontic treatment.
The exclusion criteria were:
1. Evidence of gingival alterations or dental irregularities,
2. Loss of tooth structure because of attrition, fracture, caries
or restorations,
3. Problems which aect the dentition and face.
19
Journal of International Oral Health 2015; 7(9):18-21
Maxillary anterior teeth dimensions and golden proportion … Sandeep N et al
Materials
Perforated metal stock trays, rubber bowls, curved metal
spatula, straight metal spatula, alginate impression material,
dental stone, dental plaster, base formers, sand paper (Figure 1)
were used for making the impressions and preparing the casts.
Tooth dimensions on the cast were measured using a digital
caliper, pointed ne tip pen (Figure 2). The photographs
were taken using head stabilizing device with nasion relator
(Figure 3). Tripod stand, digital camera (Cannon, Power Shot
A590 IS), a cheek retractor, stool, spirit level.
Methodology
Standardized photographs were acquired using a specially
designed wall-mounted device parallel to the oor resembling
a face-bow. Each subject was photographed with the head
upright, with maxillary occlusal plane parallel to the oor. The
ear pieces are xed into external auditory canals, and a nasion
relator attached to the nasion. Meter ruler was mounted on
the face-bow assembly perpendicular to the oor to aid in the
calculation of the conversion factor so that the size of the image
can be correlated to the actual size of the teeth (Figure 4). For
standardization of the photographs, the camera was set on to
the tripod with its lens parallel to the maxillary occlusal plane
and the mid-sagittal plane of the subjects. Head was aligned
with the center of camera lens. The focal distance was also
standardized which was xed at 5 feet. The cheek retractor was
used for better visibility of the maxillary anterior teeth. Full face
and anterior teeth images were made under a standard light
source in a frontal view.
Maxillarycastspreparation
Proper impression of the maxillary arch was obtained using
irreversible hydrocolloid and metal stock trays; then poured
immediately with dental stone. Care was taken to prevent
incorporation of air bubbles by using a mechanical vibrator
during preparation of the casts.
Digitalanalysisofmesiodistalwidthsofmaxillaryanterior
teeth
The images were acquired to computer and the perceived
mesiodistal width (the widest distance viewed from the
front) was measured for each tooth using the horizontal
measure tool of the imaging software (Adobe Photoshop CS,
version 8.0) (Figure 5). The clear outlines of the mesial and
distal contours of the teeth were obtained by enabling the
zoom function of the program so that precise measurements
were recorded. Three sets of readings were obtained, and
their mean was considered for tabulation. The perceived
mesiodistal widths of the maxillary lateral incisors were
divided by the perceived widths of the central incisors, and the
perceived mesiodistal widths of maxillary canines were divided
by the perceived widths of maxillary lateral incisors. As the
Figure 4: Subject in position for digital photograph.
Figure 1: Armamentarium for making alginate impressions
and preparing study models.
Figure 2: Digital caliper and marker used for obtaining
measurements from study model.
Figure 3: Head stabilizing device.
20
Journal of International Oral Health 2015; 7(9):18-21
Maxillary anterior teeth dimensions and golden proportion … Sandeep N et al
conversion factor appears in both numerator and denominator
of the fraction; while calculating the ratios of the teeth, it was
ignored. The calculated values were tabulated and compared
with the golden proportion (0.61-0.63 range was considered).
Furthermore, the dierence among males and females was
evaluated.
Measuringofmaxillarycentralincisorwidth-to-height
ratiofromthecasts
A sharp-tipped digital caliper was used to measure the width
and height of the maxillary central incisor. The maximum width
measured from mesial and distal contact points of the tooth
on a line perpendicular to the long axis. The longest distance
from the cervical margin to the incisal edge was recorded as
the height on a line parallel to the long axis. Dots were marked
each on the cervical region, incisal region and mesial and distal
borders, and the distance between them was measured using
a digital caliper. Three readings were taken, and the mean was
considered as the nal value. The central incisors width-to-
height ratios were calculated and compared to the 75-80% ratio
proposed as most esthetically pleasing. The data obtained were
tabulated and subjected to statistical analysis using unpaired
t-test and Chi-square tests.
Results
The study showed the mean perceived maxillary lateral incisor
to central incisor width ratio (Table 1) was 0.672 in males
and 0.702 in females. The perceived maxillary mean canine
to lateral incisor width ratio (Table 2) was 0.744 in males
and 0.714 in females. The mean width-to-height ratio of the
maxillary central incisor was 79.49% in males and 79.197% in
females (Table 3).
Discussion
Esthetics is the prime consideration for all the patients seeking
replacement of missing tooth. The width-to-height ratio of the
maxillary central incisors has been suggested to be signicant
in terms of overall dental appearance because these teeth
normally dominate in persons smile. The central incisor is said
to be in golden proportion when the coronal width-to-height
ratio should be equal to 62% or 0.62.
3
However, a width-
to-height ratio of 75-80% has been considered to be most
esthetically pleasing.
4,5
Lower values are said to create a long
narrow tooth while greater values result in a short wide tooth.
Hence, in the present study we evaluated the width-to-height
ratio of the maxillary central incisors and compared them with
the 75-80% ratio.
According to Preston
6
golden proportion is in the range of
0.61-0.63, the same range was considered in this study during
evaluation of the data. In the present study, golden proportion
between maxillary central and lateral incisor was found in
30 subjects (25%) in males and in 21 subjects (17.5%) in
females; the golden proportion between maxillary lateral
incisor and canine was found in 6 subjects (5%) in males and
in 12 subjects (10%) in females. Similar results were found
by Ali Fayyad et al.
7
(in their study found 31.3% of males and
27.1% of females have golden proportion among width of
central incisor to the width of the lateral incisor and 13.1%
of males and 11.8% of females have the widths of their lateral
incisor in golden proportion to the width of their canine),
Preston
6
(17% between central and lateral incisor and 0%
between lateral incisor and canine), Mahshid et al.
8
(34.1%
between central and lateral incisor and <10% between lateral
incisor and canine).
The mean perceived lateral incisor to central incisor width
ratio was found to be 0.672 in males and 0.702 in females in the
present study. Similar results were observed by Preston
6
(0.66)
and Mahshid et al.
8
(0.67). The mean perceived canine to lateral
incisor width ratio was found to be 0.744 in males and 0.714
in females, this ratio was much lower than those identied by
Preston
6
(0.84), and Mahshid et al.
8
(0.87 in males and 0.85
in females). No statistical signicant dierence was observed
between perceived mesiodistal widths of maxillary anterior
teeth between males and females.
Figure 5: Perceived mesiodistal widths of the maxillary
anterior teeth.
Table 1: Mean perceived width of lateral incisor/central incisor in
males and females as analyzed by unpaired t‑test.
Sex N Mean±SD Comparison Signicance
Male 120 0.672±0.054 t=4.085; P=0.001 Signicant
Female 120 0.703±0.063
Table 2: Mean perceived width of canine/lateral incisor in males and
females as analyzed by unpaired t‑test.
Sex N Mean±SD Comparison Signicance
Male 120 0.744±0.084 t=2.644; P=0.009 Not signicant
Female 120 0.714±0.095
Table 3: Mean width to height ratio of maxillary central incisor in males
and females as analyzed by unpaired t‑test.
Sex N Mean±SD Comparison Signicance
Male 120 79.491±6.342 t=0.67; P=0.05 Not signicant
Female 120 79.197±4.834
21
Journal of International Oral Health 2015; 7(9):18-21
Maxillary anterior teeth dimensions and golden proportion … Sandeep N et al
Castro et al.
9
in their study evaluated the width-to-height
proportions of maxillary central incisor using a probe
(intra-orally) and a boley gauge (extra-orally on casts),
Sterrett et al.
10
used caliper to measure the dimensions on
the casts, Magne et al.
11
done the measurements on extracted
teeth using imaging software. However, in the present study,
the measurements were done on the stone casts using a digital
caliper (read up to 0.01 mm).
In the present study, 66 (55%) male subjects and 69 (57.5%)
female subjects were found to have their coronal width-to-
height ratio of the maxillary central incisors within the 75-80%.
Similar results were obtained by Castro et al.
9
(in their study
57.14% central incisors have their width-to-height ratio within
75-80% ratio). The mean width-to-height ratio of the maxillary
central incisors was found to be 79.5% in males and 79.2%
in female. Similar results were obtained by Magne et al.
11
(the mean width-to-height ratio of maxillary central incisor
was found to be 78%). The results did not coincide with
the studies by Sterrett et al.
10
(the mean width-to-height
ratio in their study was 85% in men and 86% in women),
and Hasanreisoglu et al.
12
(88% ratio in men, 91.2% ratio in
women). There is no statistical signicant dierence in the
ratio of width-to-height of maxillary central incisor between
males and females.
Geometrical or mathematical relationship between teeth is
an important determinant to achieve an esthetic restorative
result.
13,14
Statistically reliable relationship will be helpful
to support the existing relationship theories. Even though
literature suggests using golden proportions develops pleasing
proportions, the results of the present study show that golden
proportion did not exist between the perceived widths of the
maxillary anterior teeth. Larger sample size, with dierent
ethnic origin multicenter studies, is essential to prepare Indian
standards.
Conclusion
Esthetics in dentistry cannot be justified mathematically;
individuals should not be standardized in the same way.
Although we dentists should follow some fundamental
guidelines in esthetic treatment planning, it should be
acknowledged that esthetics varies greatly from person-to-
person. It is, therefore, important to consider the dento-facial
specicities of each individual and the various natural teeth
proportions during restoration or replacement of the maxillary
anterior teeth. In addition, individual cultural characteristics
and perceptions of beauty must be considered.
References
1. Young HA. Selecting the anterior tooth mold. J Prosth
Dent 1954;4:748-60.
2. Rabie AB, Wong RW, King NM. Aesthetic dentistry and
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3. Brisman AS. Esthetics: A comparison of dentists’
and patients’ concepts. J Am Dent Assoc
1980;100(3):345-52.
4. Ward DH. Proportional smile design using the recurring
esthetic dental (red) proportion. Dent Clin North Am
2001;45(1):143-54.
5. Davis NC. Smile design. Dent Clin North Am
2007;51(2):299-318, vii.
6. Preston JD. The golden proportion revisited. J Esthet Dent
1993;5(6):247-51.
7. Ali Fayyad M, Jamani KD, Aqrabawi J. Geometric and
mathematical proportions and their relations to maxillary
anterior teeth. J Contemp Dent Pract 2006;7(5):62-70.
8. Mahshid M, Khoshvaghti A, Varshosaz M, Vallaei N.
Evaluation of golden proportion in individuals with an
esthetic smile. J Esthet Restor Dent 2004;16(3):185-93.
9. Vinicus M, De Castro M, Santos NC, Ricardo LH.
Assessment of the “golden proportion” in agreeable smiles.
Quintessence Int 2006;37:597-604.
10. Sterrett JD, Oliver T, Robinson F, Fortson W, Kneak B,
Russel CM. Width/length ratios of normal clinical crowns
of maxillary anterior dentition in man. J Clin Periodontol
1999;26(3):153-7.
11. Magne P, Gallucci GO, Belser UC. Anatomic crown width/
length ratios of unworn and worn maxillary teeth in white
subjects. J Prosthet Dent 2003;89(5):453-61.
12. Hasanreisoglu U, Berksun S, Aras K, Arslan I. An analysis
of maxillary anterior teeth: Facial and dental proportions.
J Prosthet Dent 2005;94(6):530-8.
13. Tarvade SM, Agrawal G. Smile analysis: A review Part I. Int
J Contemp Dent Med Rev 2015; 2015:Article ID: 200115.
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doi: 10.15713/ins.ijcdmr.68.
... Genetic factors can affect the calcification of teeth, the shape of a coronal structure, and the composition of minerals in the process of growth and development of teeth, whereas environmental factors such as diet, nutrition, radiation, and chemicals also affect the mesiodistal width of teeth [9,10,[17][18][19][20]. Nevertheless, ethnicity is suggested to have a greater influence on tooth proportions than gender [21][22][23][24]. However, it is recommended that the golden principle can be applied if the percentages are adjusted with variations in the ethnicity of the population [21,25]. ...
... The number of participants ranged from 14 to 903. Twenty-nine studies analyzed GP through 2D photographs [14,15,17,20,21,25,26,31-33, 37,40-42,45-51,56,58-60,63,64,68], 10 studies used dental casts [16,23,24,30,43,44,[53][54][55]61] while six studies used both methods of assessment [18,19,22,57,62,65]. Six studies performed direct clinical measurements of teeth on patients [35,36,38,39,66,67] and one study reported digital impressions, digital casts, and 2D photograph analysis in their research [52] ( Table 2). ...
... Six studies performed direct clinical measurements of teeth on patients [35,36,38,39,66,67] and one study reported digital impressions, digital casts, and 2D photograph analysis in their research [52] ( Table 2). All included studies [14][15][16][17][18][19][20][21][22][23][24][25][26] were categorized according to their geographical location. The majority (n = 27) of studies were carried out in the South Asian region, followed by West Asia (n = 13), Europe (n = 8), Africa (n = 3), North America (n = 3), East Asia (n = 2), Southeast Asia (n = 2), the Middle East (n = 2), and South America (n = 1) ( Table 3). ...
Article
Full-text available
The purpose of this systematic review was to analyze studies, identify the existence of golden proportion between the perceived widths of the maxillary anterior teeth among the different geographical populations, and evaluate the range of dental proportion that exists regionally. An electronic search was conducted using PubMed, Medline, EMBASE, Scopus, Science Direct, Web of Science, and the Cochrane Library. The focused question was, “Does golden proportion exist in natural, aesthetically pleasing smiles among different populations around the world?” The search conducted included studies from January 2000 to September 2020, identifying articles in English with the specific combination of MeSH and other related terms. The title search yielded eight hundred and ninety-eight articles, and seventy-five articles were selected for full-text analysis. However, only fifty-two full-text articles were included in the systematic review. The mean pre-dicted dental ratios were either larger or smaller than the successive widths of maxillary natural anterior teeth. Golden proportions were not found consistently among anterior teeth in different populations observed in the systematic review. The golden proportion is still a useful tool for the reconstruction of lost or damaged anterior tooth widths; however, it is not the only standard for restoring esthetic smiles worldwide, and anterior tooth proportions differ among populations based on their geographic, ethnic, and racial background. Moreover, consideration should also be given to an individual’s dentofacial variations in restoring anterior teeth.
... Tsukiyama et al. 16 and Olsson el al. 17 used standardized highresolution images of ex-vivo teeth from white and Asian subjects on which they registered the widest section of the mesiodistal plane of the anatomical crown (perpendicular to the longitudinal axis of the tooth) and the greatest cervico-incisal distance of the anatomical crown (parallel to the longitudinal axis of the tooth). In the same way, Sandeep et al. 18 used both resources (dental stone models and digital photographs) from a South Indian population, and using a digital caliper, defined crown width as the widest distance between the mesial and distal contact points (perpendicular to the axis longitudinal of the tooth), and crown length as the longest distance between the cervical margin and the incisal edge (parallel to the longitudinal axis of the tooth). The literature contains studies by different authors evaluating tooth shape, some of which have used the Kappa concordance test, which provided values that could be considered as moderate concordance according to the studies by Landis and Koch [19][20][21] . ...
... Regarding the width/height ratio of the clinical crown of the upper central incisor, our study found similar results to those reported for Asian (Japan, Taiwan), Caucasian (Switzerland, Sweden) and southern Indian populations, so it would seem that although the absolute dimensions vary among ethnic groups, the proportions appear to differ to a lesser extent [15][16][17][18] . ...
Article
Full-text available
The aim of this study was to analyze the dimensions of the clinical crown of upper central incisors and the prevalence of tooth shapes by two different protocols. Assessment was performed on each of the 111 dental stone type V maxillae models of students of dentistry from Buenos Aires University [93 females and 18 males, mean age 23.70 (± 2.26) years] The mesial and distal-vestibular angles were defined on each right upper incisor, and the following segments were defined: AB (zenith - incisal edge), CD, EF, GH (apical, middle, and incisal thirds - vestibule - mesial and vestibule-distal angles) and their lengths were determined with a precision caliper. Then, the CD/AB, EF/AB and mean CD-EF/AB ratios were calculated. Shapes were assessed by four independent observers, three of whom evaluated digital images of the models, while the fourth had no access to the images, and determined the shapes using an algorithm developed from the dimensions of the studied segments. Rates and confidence intervals were determined, and Fleiss' Kappa was calculated to assess the agreement among the evaluators who worked with the images and among all of them. Average incisor length was 10 mm, and widths at CD and EF were 7.35 mm (0.65) and 8.27 mm (0.58), respectively. Regarding shapes, 51.58% (47.90-55.20) of the incisors were identified as square, 18.02% (14.50-21.90) as ovoid and 30.41% (30.00-30.90) as triangular. Fleiss' Kappa agreement was 0.71 (0.62-0.80). The application of the proposed algorithm provided a considerable level of agreement among the observers. Regarding tooth size, both the average segment length and the proportions were similar to those reported by various authors.
... Tsukiyama et al. 16 and Olsson el al. 17 used standardized highresolution images of ex-vivo teeth from white and Asian subjects on which they registered the widest section of the mesiodistal plane of the anatomical crown (perpendicular to the longitudinal axis of the tooth) and the greatest cervico-incisal distance of the anatomical crown (parallel to the longitudinal axis of the tooth). In the same way, Sandeep et al. 18 used both resources (dental stone models and digital photographs) from a South Indian population, and using a digital caliper, defined crown width as the widest distance between the mesial and distal contact points (perpendicular to the axis longitudinal of the tooth), and crown length as the longest distance between the cervical margin and the incisal edge (parallel to the longitudinal axis of the tooth). The literature contains studies by different authors evaluating tooth shape, some of which have used the Kappa concordance test, which provided values that could be considered as moderate concordance according to the studies by Landis and Koch [19][20][21] . ...
... Regarding the width/height ratio of the clinical crown of the upper central incisor, our study found similar results to those reported for Asian (Japan, Taiwan), Caucasian (Switzerland, Sweden) and southern Indian populations, so it would seem that although the absolute dimensions vary among ethnic groups, the proportions appear to differ to a lesser extent [15][16][17][18] . ...
Article
Full-text available
The aim of this study was to analyze the dimensions of the clinical crown of upper central incisors and the prevalence of tooth shapes by two different protocols. Assessment was performed on each of the 111 dental stone type V maxillae models of students of dentistry from Buenos Aires University [93 females and 18 males, mean age 23.70 (± 2.26) years] The mesial and distal-vestibular angles were defined on each right upper incisor, and the following segments were defined: AB (zenith - incisal edge), CD, EF, GH (apical, middle, and incisal thirds - vestibule - mesial and vestibule-distal angles) and their lengths were determined with a precision caliper. Then, the CD/AB, EF/AB and mean CD-EF/AB ratios were calculated. Shapes were assessed by four independent observers, three of whom evaluated digital images of the models, while the fourth had no access to the images, and determined the shapes using an algorithm developed from the dimensions of the studied segments. Rates and confidence intervals were determined, and Fleiss' Kappa was calculated to assess the agreement among the evaluators who worked with the images and among all of them. Average incisor length was 10 mm, and widths at CD and EF were 7.35 mm (0.65) and 8.27 mm (0.58), respectively. Regarding shapes, 51.58% (47.90-55.20) of the incisors were identified as square, 18.02% (14.50-21.90) as ovoid and 30.41% (30.00-30.90) as triangular. Fleiss' Kappa agreement was 0.71 (0.62-0.80). The application of the proposed algorithm provided a considerable level of agreement among the observers. Regarding tooth size, both the average segment length and the proportions were similar to those reported by various authors.
... The major concern for patients seeking esthetic dental treatment is the appearance of anterior teeth [2]. Among other parameters, the dimensions of maxillary anterior teeth are the most significant factors in achieving harmonious and esthetic outcomes [3]. However, defining ideal tooth dimensions is rather difficult owing to individual variations and proximal tooth wear [4]. ...
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Objective. To analyze the width and height ratios of maxillary anterior teeth at different crown levels through photographs, 3D, and plaster dental model techniques in a subset of the Pakistani population. Material and methods. This clinical study consisted of 230 participants. The maxillary impression, standardized photographs, and models were constructed for crown width and height analysis. The SPSS-version 25 was used for statistical analysis. Descriptive statistics were carried out for mean, standard deviation, and percentage calculation of teeth width and height, gender, and age of participants. Paired t-test analysis was carried out to compare the dependent variables ( teeth size, width, and height ratios) with independent variables ( techniques applied, side disparity). A p-value of ≤ 0.05 was considered statistically significant. Results. The mean width and height of maxillary anterior teeth obtained through photographs, 3D, and plater models were statistically different. The 3D dental model analysis showed reliable and accurate results. The mean width and height ratio of teeth were different on both sides of the arch. There was a significant difference (p=0.001) in crown width height ratios at different crown levels. Conclusion. The width and height ratios in the studied population were different at various crown levels. The dimensions of teeth varied from the incisal to the cervical part of the crown. Hence rather than relying on a single, fixed ratio of 78% to 80% suggested by researchers for anterior teeth. The clinician should adopt different crown width height ratios to restore teeth with the optimum esthetic outcome.
... Most of the studies found on the golden proportion involved an assessment of how it compared to tooth proportions in different populations and ethnic groups. Studies were found in Asia, 10,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Africa, 37 and Europe, [38][39][40] but no studies on the North or South American population were found. In reviewing these articles, 62% of them found that the golden proportion Table 1 Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies with percentages of "no," "unclear," and "n/a" combined for each of the eight categories Studies ...
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Purpose: The aim of this systematic review was to evaluate and compare three commonly used proportions that include the golden proportion, golden percentage, and Recurring Esthetic Dental (RED) proportion to identify which of the mathematical formulas, if any, can be used to provide predictable and repeatable esthetic clinical outcomes. Methods: A comprehensive search of electronic databases that included EBSCO, ProQuest, SCOPUS, Science Direct, Wiley, Google Scholar and PubMed was conducted using the terms: “golden proportion”, “golden percentage”, and “Recurring Esthetic Dental (RED) proportions” alone or in concurrence with one or both ensuing terms: “tooth proportions” and “esthetic tooth proportions”. In addition, the following journals were hand searched for relevant articles: Journal of Prosthodontics, Journal of Prosthetic Dentistry and Journal of Esthetic and Restorative Dentistry. Related citations were also considered. Results: Tooth proportions varied substantially in the natural dentition. No studies revealed findings that supported the use of one mathematical formula to predict esthetic success. The golden proportion is present between the central to lateral incisor in some cases, but rarely between the lateral incisor and the canine. When compared to the other proportions, the golden percentage provided better starting points for tooth shape and size, but only when values were adjusted to consider other factors such as ethnicity and/or facial proportions. Conclusion: Mathematical formulas did not provide consistent results that would allow for their use as a standardized guide for esthetically pleasing smiles. Although the golden percentage may be a good starting point if the percentages are adjusted on a case-to-case basis, generalized esthetic ideals cannot be determined by a mathematical formula and are open to interpretation by both the clinician and the patient. This article is protected by copyright. All rights reserved
... [4,5] Golden percentage even though widely used is inconsistent to judge the teeth width. [6][7][8][9][10] However, few studies also have emphasized the its utility in difficult clinical conditions. [11] Controversy still persists regarding the validity of golden proportion as a tool to evaluate the smile, thus the current study was undertaken with the aim to evaluate whether any other proportion is followed for tooth width in attractive smiles. ...
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Aim: The aim is to evaluate the maxillary anterior tooth proportion relationship using different calculations. Materials and Methods: Forty pleasing smile photographs were evaluated for the different calculations. Mesiodistal width of all the maxillary anterior teeth were measured and were subjected to different calculations like individual tooth width divided by the combined width of all the anterior teeth of one side and individual tooth width divided by the combined width of the remaining two teeth of one side. Calculated results were tabulated and were subjected to descriptive statistics. Results: Among the various formulas, the mesiodistal width of canine divided by the sum of mesiodistal width of central, lateral incisors, and canine showed the consistent quotient of 0.3 for all the subjects. Mesiodistal width individual teeth like central incisors when divided by the combined width of central incisor, lateral incisor and canine, also showed the constant quotient of 0.3 for all the patients. The sum of Mesiodistal width of central and lateral incisor when divided by combined width of central, lateral incisor and canine gave the constant value of 0.6. Conclusion: The consistent quotients obtained by the formulas like width of central incisors and the canine divided by the combined width of central-lateral incisors-canine and the other formulas can be used for building up of the missing teeth and the smile designing.
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Statement of problem. The recurring esthetic dental (RED) proportion has been a benchmark for the rehabilitation of the maxillary anterior teeth of North American patients. While it has been evaluated in other populations, the global application of RED proportions in the rehabilitation of maxillary anterior teeth is unclear. Purpose. The purpose of this systematic review was to examine the existing evidence on dental proportion to evaluate the existence of RED proportions in the esthetic smile in different geographic regions. Material and methods. A systematic search was conducted by reviewing different databases. The focused question was “Does recurrent esthetic dental (RED) proportion exist in esthetically pleasing smiles in different populations around the world?” The search included articles with a combination of MeSH keywords based on the dental proportion from Jan 2000 to July 2020. The titles and abstracts were identified by using a search protocol. The full texts of the articles were independently evaluated. The systematic review was modified to summarize the relevant data. The general characteristics, outcomes, and quality of studies were reviewed and analyzed systematically. Results. Seventeen studies were selected from the reviewed articles. Three studies were conducted in Europe, 10 in South Asia, and 4 in Western Asia. Eleven studies found that the mean perceived ratio of anterior teeth was not constant when progressing distally. Five studies reported that the ratio was constant in a small percentage of their populations, and 1 suggested that the ratio was constant if it remains between 60% and 80%. The central-to-LI and Ca-to-LI proportion values were not constant. Overall, the Ca-to-LI proportion values were higher than the central-to-LI proportions. Conclusions. RED proportions were not found in the successive widths of maxillary anterior teeth among the reviewed data from different geographic regions. RED proportions are not the only standard for restoring esthetic smiles worldwide, and anterior tooth proportions differ among populations based on their race and ethnicity.
Article
Objetivo: determinar la relación del cénit gingival y la morfología dentaria de las piezas dentales superiores del sector anterior en adolescentes peruanos. Material y Métodos: El estudio fue de tipo descriptivo, correlacional y transversal. La muestra fue de tipo probabilístico por conveniencia, y estuvo conformado por 92 adolescentes en la región Junín, Perú. Cada modelo fue analizado y se registró la morfología dental, la posición del cénit gingival y la distancia del cénit gingival al eje longitudinal de pieza dentaria. Resultados: Se obtuvo que la media de la ubicación del cénit gingival para el incisivo central superior era 72,8% hacia distal (0,54 mm), en cambio el incisivo lateral (59,2%) y canino (50,5%) estaban en la misma posición que el eje longitudinal del diente. Con respecto al tipo de forma dental, la forma oval se halló en el 71,2% de los incisivos centrales, en el 67,9% de los incisivos laterales y en el 73,9% de los caninos. Se concluyó que la ubicación del cénit gingival en los incisivos centrales superiores se hallaba hacia distal en relación al eje longitudinal, con una distancia promedio de 0,54 mm, en cambio en los incisivos laterales y caninos superiores su cénit gingival se hallaba en el eje longitudinal del diente. Con respecto a la morfología dentaria la forma oval fue la más predominante. Conclusiones: Existe una migración hacia distal de los cénits gingivales en los incisivos centrales, pero no en los incisivos laterales o caninos superiores.
Article
Statement of problem The color and form of teeth are 2 of the 3 main determinants of success in an esthetic restoration; the third is dental proportion. A recent systematic review of the literature devoted to the evaluation of dental proportion is lacking. Purpose The purpose of this systematic review was to investigate the quality and outcome of studies into maxillary anterior tooth proportion and to determine whether dental proportion ratios based on different geographic regions are appropriate. Material and methods An electronic search was conducted using PubMed, MEDLINE, Google Scholar, Embase, Scopus, Cochrane Library, Web of Science, and Science Direct databases. English-language articles reporting with the specific combination of medical subject heading (MeSH) key words were analyzed by 2 investigators. The titles, full text, and abstracts were scanned by investigators independently to identify articles that fulfilled the inclusion criteria. The general characteristics, outcomes, and quality of each study were reviewed and analyzed systematically. Results The search plan resulted in a total of 73 articles until September 2020; of which, 16 articles fulfilling the inclusion criteria were selected. The geographic distribution of the selected article revealed 12 articles from Asia, 2 from Continental Europe, and 2 from the United Kingdom. Golden percentage values of 25%, 15%, and 10% for central, lateral incisor, and canine teeth were not found. The mean predicted dental percentage was either larger or smaller than the successive widths of maxillary natural anterior teeth. Conclusions The golden percentage could not be used to formulate a smile design. Rather, the dental ratios should be set on a racial and ethnic basis for a population.
Article
Aim and objective: The present study was conducted to determine the golden proportion, golden mean, and the Preston proportion of the individuals between the widths of six maxillary anterior teeth and to determine which proportional formula exists in the population. Materials and methods: This study was conducted among 60 participants between 18 years and 30 years of age with an esthetic smile. They were grouped into 30 females and 30 males. Maxillary arch impressions were made using irreversible hydrocolloid material from each individual. The width of the anterior teeth on the graph paper was analyzed by using digital vernier caliper. The data were statistically analyzed by one way ANOVA test. Results: The study revealed that the formula of golden proportion and golden mean had no statistical differences between males and females but the Preston proportion has shown statistical differences in the total population. Conclusion: From the current study, it was concluded that the formulas of golden mean and golden proportion proposed by Ward can be used for smile designing and full mouth rehabilitations. Clinical significance: Demand for smiles has gained its importance with time. The golden proportion, golden mean, and the Preston proportion are the guidelines used by the professional for better esthetic proportion in the dentition.
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Smile design is the important aesthetic goal of every clinician. As in today's era smile is more important than ideal occlusion. But it's a multi-factorial process. There is no universal "ideal" smile. Smile analysis is fi rst based on soft tissue repose, how the lips animate on smile, gingival display, crown length, and other attributes of the smile. The second is the facial change throughout a patient's lifetime. Clinician should rank these smile attributes in order of their importance in creating a balanced smile. There are various methods of smile analysis. Developing a "standard of normalcy" for smiles is important as it would give guidelines for orthodontist and clinicians to have better treatment results. This article deals with all the diff erent process of smile designing and lays norms for a beautiful smile.
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Dentists have needed an objective way in which to evaluate a smile. A method for determining the ideal size and position of the anterior teeth has been presented here. Use of the FIVE to evaluate the RED proportion and the width-to-height ratio, tempered with sound clinical judgment, gives pleasing and consistent results. With the diversity that exists in nature, rarely does the final result follow all the mathematical rules of proportional smile design. This approach may serve as a foundation on which to base initial smile design, however. When one begins to understand the relationship between beauty, mathematics, and the surrounding world, one begins to appreciate their interdependence.
Article
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The size and form of the maxillary anterior teeth are important in achieving pleasing dental and facial esthetics. However, little scientific data have been defined as criteria for evaluating these morphological features. This study analyzed the clinical crown dimensions of maxillary anterior teeth to determine whether consistent relationships exist between tooth width and several facial measurements in a subset of the Turkish population. Full-face and anterior tooth images of 100 Turkish dental students viewed from the front and engaged in maximum smiling were recorded with digital photography under standardized conditions. Gypsum casts of the maxillary arches of the subjects were also made. The dimensions of the anterior teeth, the occurrence of the golden ratio, the difference between the actual and perceived sizes, and the relationship between the anterior teeth and several facial measurements by gender were analyzed using the information obtained from both the computer images and the casts. One-sample, 2-sample, and paired t tests, and repeated-measures analysis of variance and Duncan multiple-range tests were performed to analyze the data (alpha=.05). The dimensions of the central incisors (P<.05) and canines (P<.01) varied by gender. The existence of the so-called "golden proportion" for the maxillary anterior teeth as a whole was not found. Significant differences emerged when the mean ratios between various perceived widths were compared with their ideal golden ratios (P<.01). Proportional relationships between the bizygomatic width and the width of the central incisor, and the intercanine distance and the interalar width in women were observed. The maxillary central incisor and canine dimensions of men were greater than those of women in the Turkish population studied, with the canines showing the greatest gender variation. Neither a golden proportion nor any other recurrent proportion for all anterior teeth was determined. Bizygomatic width and interalar width may serve as references for establishing the ideal width of the maxillary anterior teeth, particularly in women.
Article
Statement of problem. Dimensions of teeth have been available for a century. Some significant and clinically relevant aspects of dental esthetics, however, such as the crown width/length ratios, have not been presented in tooth morphology sources until recently. Purpose. The purpose of this study was to analyze the anatomic crowns of 4 tooth groups (central incisors, lateral incisors, canines, and first premolars) of the maxillary dentition with respect to width, length and width/length ratios and determine how these parameters are influenced by the incisal edge wear. Material and methods. Standardized digital images of 146 extracted human maxillary anterior teeth from white subjects (44 central incisors, 41 lateral incisors, 38 canines, 23 first premolars) were used to measure the widest mesiodistal portion "W" (in millimeters) and the longest inciso-cervical/occluso-cervical distance "L" (in millimeters). The width/length ratio "R" (%) was calculated for each tooth. A 1-way analysis of variance was used to compare the mean values of W, L, and R for the different groups ("unworn" and "worn" subgroups, except for premolars). Multiple least significant difference range tests (confidence level 95%) were then applied to determine which means differed statistically from others. Results. There was no influence of the incisal wear on the average value of W (width) within the same tooth group. The widest crowns were those of central incisors (9.10 to 9.24 mm) > canines (7.90 to 8.06 mm) > lateral incisors (7.07 to 7.38 mm). Premolars (7.84 mm) had similar width as canines and worn lateral incisors. The L-value was logically influenced by incisal wear (worn teeth were shorter than unworn teeth) except for lateral incisors. The longest crowns were those of unworn central incisors (11.69 mm) > unworn canines (10.83 mm) and worn central incisors,(10.67 mm) > worn canines (9.90), worn and unworn lateral incisors (9.34 to 9.55 mm), and premolars (9.33 mm). Width/length ratios also showed significant differences. The highest values were found for worn central incisors (87%) and premolars (84%). The latter were also similar to worn canines (81%), which constituted a homogeneous group with worn lateral incisors (79%) and unworn central incisors (78%). The lowest ratios were found for unworn canines and unworn lateral incisors (both showing 73%). Conclusions. Along with other specific and objective parameters related to dental esthetics, average values for W (mesiodistal crown dimension), L (incisocervical crown dimension), and R (width/length ratio) given in this study for white subjects may serve as guidelines for treatment planning in restorative dentistry and periodontal surgery.
Article
One of the most important tasks in esthetic dentistry is creating harmonious proportions between the widths of maxillary anterior teeth when restoring or replacing these teeth. The “golden proportion” is a main guideline introduced in this field. This study aimed to investigate the existence of the golden proportion between the widths of the maxillary anterior teeth in individuals with an esthetic smile. This study was conducted with 157 dental students (75 women and 82 men), with ages ranging from 18 to 30 years. Students whose natural smile did not develop any visual tension (see below) with regard to the study's and their own criteria were selected as having esthetic smile. An image measurement program was used to measure the apparent mesiodistal widths of six maxillary anterior teeth on the scanned photographs of these subjects. The existence of the golden proportion was investigated in the width ratios of maxillary anterior teeth. The golden proportion was not found to exist between perceived maxillary anterior teeth widths of individuals with an esthetic smile. The golden proportion is not a common factor in esthetic smiles.
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Drawings and photographs of shape, symmetry, and proportion of maxillary central incisors were evaluated by 112 dentists, 215 dental sutdents, 399 male patients, and 695 female patients. A significant difference was found between the evaluations of patients and dentists; the preferences of dental student; were between those of patients and dentists. Male and female patients had similar opinions.
Article
The purpose of this investigation was to analyze the clinical crown of the 3 tooth groups of the maxillary anterior sextant of the permanent dentition of normal subjects with respect to (i) width, length and the width/length ratios and (ii) determine if there is a correlation between tooth dimensions or tooth group ratios and subject height. Subjects (> or = 20 y.o.) were recruited for this study if (i) the free gingival margin on the facial surface of teeth in the maxillary sextant was positioned apical to the cervical bulge, (ii) there was no evidence of attachment loss; as determined by lack of a detectable CEJ and (iii) the marginal tissue was knife edged in form, firm in consistency and coral pink in color. Teeth were excluded if (i) there was evidence of gingival alteration, i.e., gingival overgrowth/hyperplasia, inflammation, altered passive eruption, attachment loss, gingival recession or history of periodontal surgery, or (ii) there was evidence or history of incisal edge/proximal tooth alteration as in, i.e., restorative intervention, traumatic injury or occlusal wear into dentin. At least 1 suitable tooth from each tooth group of the maxillary anterior dentition had to be present. A maxillary impression was taken and poured in yellow die stone. The widest mesial-distal portion and the longest apical-coronal portion of the test teeth were measured. Gender, ethnicity and subject height (SH) were recorded for each participant. Due to a limited ethnic diversity only data from the Caucasian group were analyzed. The mean coronal tooth width (mm) of males versus females was CI: 8.59 versus 8.06, LI: 6.59 versus 6.13 and CA: 7.64 versus 07.15. The mean coronal tooth length (mm) of males versus females was CI: 10.19 versus 9.39, LI: 8.70 versus 7.79 and CA: 10.06 versus 8.89. All width and length measures were significantly greater for males than for females. The mean coronal tooth width/length ratios for males versus females was CI: 0.85 versus 0.86, LI: 0.76 versus 0.79 and CA: 0.77 versus 0.81. A comparison between genders of the width/length ratios of the CI and LI were found not to differ, however the CA ratio for females was significantly greater than for males. A statistically significant difference was found to exist between the mean (cm) SH for males versus females: 181.2 versus 164.0. A positive correlation (p < or = 0.0001 to 0.0691) was found to exist between tooth group width/height ratios within genders. No significant correlation was found between any of the tooth dimensions or tooth group ratios and SH. The results of this study indicate that within male and female Caucasians, the mean width/length ratio of the maxillary 3 anterior tooth groups is 0.81. As well, within both genders there is a positive correlation between tooth group width/length ratios. The significance of these findings with respect to periodontal mucogingival plastic surgical procedures is discussed.
Article
Dimensions of teeth have been available for a century. Some significant and clinically relevant aspects of dental esthetics, however, such as the crown width/length ratios, have not been presented in tooth morphology sources until recently. The purpose of this study was to analyze the anatomic crowns of 4 tooth groups (central incisors, lateral incisors, canines, and first premolars) of the maxillary dentition with respect to width, length and width/length ratios and determine how these parameters are influenced by the incisal edge wear. Standardized digital images of 146 extracted human maxillary anterior teeth from white subjects (44 central incisors, 41 lateral incisors, 38 canines, 23 first premolars) were used to measure the widest mesiodistal portion "W" (in millimeters) and the longest inciso-cervical/occluso-cervical distance "L" (in millimeters). The width/length ratio "R" (%) was calculated for each tooth. A 1-way analysis of variance was used to compare the mean values of W, L, and R for the different groups ("unworn" and "worn" subgroups, except for premolars). Multiple least significant difference range tests (confidence level 95%) were then applied to determine which means differed statistically from others. There was no influence of the incisal wear on the average value of W (width) within the same tooth group. The widest crowns were those of central incisors (9.10 to 9.24 mm) > canines (7.90 to 8.06 mm) > lateral incisors (7.07 to 7.38 mm). Premolars (7.84 mm) had similar width as canines and worn lateral incisors. The L-value was logically influenced by incisal wear (worn teeth were shorter than unworn teeth) except for lateral incisors. The longest crowns were those of unworn central incisors (11.69 mm) > unworn canines (10.83 mm) and worn central incisors (10.67 mm) > worn canines (9.90), worn and unworn lateral incisors (9.34 to 9.55 mm), and premolars (9.33 mm). Width/length ratios also showed significant differences. The highest values were found for worn central incisors (87%) and premolars (84%). The latter were also similar to worn canines (81%), which constituted a homogeneous group with worn lateral incisors (79%) and unworn central incisors (78%). The lowest ratios were found for unworn canines and unworn lateral incisors (both showing 73%). Along with other specific and objective parameters related to dental esthetics, average values for W (mesiodistal crown dimension), L (inciso-cervical crown dimension), and R (width/length ratio) given in this study for white subjects may serve as guidelines for treatment planning in restorative dentistry and periodontal surgery.