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

Abstract

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.

Full text

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.

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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.
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