ORIGINAL ARTICLE

ANALYSIS OF MAXILLARYANTERIOR TEETH AND VARIOUS FACIAL

DIMENSIONS AMONG ADOLESCENTS IN RIYADH, SAUDI ARABIA
Fares Al-Sehaibany`, BDS, DMSc
INTRODUCTION
5
esthetics, but also to Iacial esthetics. Actual tooth size and
morphology are addressed in dental literature, but
6-8
inconsistent inIormation is presented. The width oI the ental and Iacial esthetics are considered as one oI
the primary goals Ior patients seeking dental anterior teeth is considered more crucial than their length,
1
D while the diIIerence in mesiodistal crown diameter has
treatment. Loss oI the anterior teeth due to
9-13
been reported to be larger Ior men than Ior women. The trauma or other Iactors is considered as a traumatic
most inIluential Iactors contributing to a harmonious
experience that prompts children and adults to seek dental
2
anterior dentition are the size, shape, and arrangement oI
care. The main goal oI dental clinicians is to have the
the maxillary anterior teeth, particularly the maxillary
maxillary anterior teeth restore optimal dentolabial
14-16
3,4
central incisors as viewed Irom the Iront.
relations in harmony with the overall Iacial appearance.
The development oI new techniques has led to a greater
17
The study oI Al Wazzan on Saudi adult subjects
number oI treatment options that maximize the likelihood
showed that intercanthal distance can be used as a
oI an attractive outcome. There is little scientiIic data in
preliminary method Ior determining the width oI the
the dental literature to use as a guide Ior deIining the
maxillary anterior teeth. Several anatomic
proper size and shape oI anterior teeth or determining
measurements have been proposed to aid in determining
normal relationships Ior them. The size and Iorm oI the
the correct size oI the anterior teeth, among them
maxillary anterior teeth are important not only to dental
bizygomatic, interalar widths, and interpupillary
18-22
distance. Arelationship between the widest part oI the
23
nose and the anterior dental arch has been reported. One
oI the available methods that can aid in the selection oI the
67 1PDAVol. 20 No. 2 Apr-1un 2011
OB1ECTIVE: The aims oI this study were to: 1). Analyze the clinical crown dimensions oI the maxillary anterior
teeth with respect to their width, height, and width to height ratio. 2). Compare the interpupillary distance and
bizygomatic Iacial width with the central incisors widths, and 3). Compare interalar width and intercanine width
between male and Iemale adolescents in Riyadh, Saudi Arabia.
METHODOLOGY: Two hundred sixty Iive subjects with age range Irom 16 to 18 years old were examined using
Iull Iace standardized digital photographs Ior Iacial dimensions, and sectional plaster dental casts Ior maxillary
anterior teeth measurements. The analysis oI anterior teeth measurements and several Iacial widths were analyzed
using the inIormation obtained Irom both the computer images and the dental casts. Descriptive statistics and
independent-sample -test were carried out to summarize the data.
RESULT: The results oI this study showed that no statistically signiIicant diIIerence was observed Ior width to
height ratios oI the central incisors and canines between male and Iemale subjects (P~0.05). However, a statistically
signiIicant diIIerence (P0.05) was observed between the male and Iemale in width to height ratios oI the lateral
incisors The ratios oI the interpupillary distance to the width oI the maxillary central incisors showed no
statistically signiIicant diIIerence between the two gender (P~0.05). The interalar width showed statistically
signiIicant diIIerences between male and Iemale subjects (P0.01).
CONCLUSION: The results oI the current study are considered to be oI importance to the clinician making
treatment decisions Ior adolescents.
Maxillary anterior teeth, Facial dimensions, Adolescents. KEYWORDS:
J Pak Dent Assoc.2011; 20 (2): 67-72
* Assistant ProIessor, Department oI Pediatric Dentistry and
Orthodontics, College oI Dentistry, King Saud University, Kingdom
oI Saudi Arabia.
Correspondance :~Dr. FaresAl Sehaibany <falsehaibanyksu.edu.sa~
width oI anterior teeth is the use oI the nasal width, the so- maxillaryanterior teeth.
24,25
called 'nasal index. Using an anthropoid model Ior No spacing or crowding in the maxillary anterior
sexual diIIerences in which a male is considerably larger
teeth.
than a Iemale has been observed that many human
No attrition or Iracture in the maxillary anterior
populations also show dimorphism in dental dimensions
teeth.
26,29
oI children and adults. Varying degree oI sexual
No historyoI Iacial and/or dental trauma.
dimorphism in human dentition may result Irom both Iood
No previous orthodontic treatment.
15
resources exploited and environment utilized. Latta
30
., reported a signiIicant diIIerence in the interalar width
The subjects were examined by one examiner in a
and the interpupillary distance between diIIerent races and
standing position. AIull Iace photographs in a Irontal view

gender. Racial and gender diIIerences in the average
in a rest position were taken using digital camera (Pentax
dimensions oI the maxillary anterior teeth have been
Optio S5, Golden, CO, USA). Acephalostat machine was
reported, but the results were valid only Ior speciIic
used to stabilize the head with FrankIort plane parallel to
isolated populations. In addition, some populations
the Iloor. The digital photographs were taken with a
demonstrated no correlation between dental morphology
standard distance Irom the subjects. Alginate impression
5,12-14
and gender.
(Dentsply, Dentsply Int. Inc.,York, PA, USA) was taken
using a disposable sectional tray as shown in Figure 1, and
These Iindings indicate the need Ior evaluation oI
poured immediately with orthodontic plaster ( Whip Mix ,
anterior dentition Ior comparisons among diIIerent
Exeter, KY, USA).
31
populations Ior both gender. Johnson pointed out that the
knowledge oI diIIerent dimensions oI Iacial appearance
might aid practitioners, since the treatment given would
then be in harmony with the Iacial appearance Ior patients
oI diIIerent races. ThereIore, knowledge oI racial norms
may help speciIy certain esthetic and Iunctional
modiIications Ior treatment plans to accommodate the
multiple racial groups within modern societies. The
literature showed no studies were done to compare
maxillary anterior teeth dimensions and Iacial widths
between male and Iemale adolescents in Riyadh. The aims
oI this study were to: 1). Analyze the clinical crown
dimensions oI the maxillary anterior teeth with respect to
their width, height, and width to height ratio. 2). Compare
the interpupillary distance and bizygomatic Iacial width
to the central incisors widths, and 3). Compare interalar
width and intercanine width between male and Iemale
adolescents in Riyadh, Saudi Arabia. .
The measurements oI the anterior teeth were made
directly on plaster dental casts. Width and height
measurements were made on the Iacial surIace oI the
This cross-sectional study was carried out on 265
maxillary anterior teeth and recorded in millimeters (mm)
subjects (146 male and 119 Iemale), with age range Irom16
using Digital caliper (Rocky Mountains Inc., Denver, CO,
to 18 years old. The subjects were randomly selected Irom
USA) with sharp tips. The width measurements were
dental clinics, College oI Dentistry at King Saud
obtained by measuring the maximum distance between
University and two private dental clinics in diIIerent areas
the mesial and distal contact points oI the tooth as
32
oI Riyadh, Saudi Arabia, according to the Iollowing
described by Hunter and Priest. The tips oI the digital
criteria:
caliper were inserted Irom the labial side oI each tooth and
No cranioIacial deIormity.
held incisally parallel to the long axis oI the tooth. Then
No missing maxillary anterior teeth.
the tips oI the gauge were closed until theycontact withthe
No caries or restoration in the maxillary anterior
contact points oI the tooth. The Length measurements
teeth.
were obtained by measuring the maximum distance
betweenthe incisal and gingival portionoI the tooth. No signs oI gingival inIlammation in the
METHODOLOGY
68
1PDAVol. 20 No. 2 Apr-1un 2011
Analysis of Maxillary Anterior Teeth and Various Facial Dimensions among
Adolescents in Riyadh, Saudi Arabia.
Al Sehaibany F
Fig 1: Aview oI the disposable sectional tray
The width and the height oI the counterpart oI each Interpupillary distance (IPD) was measured Iorm
tooth was measured, the sum oI the right and the leIt side midpupil to midpupil. The interalar width (IAW) was
measured as the width oI the alae oI the nose Irom the were calculated then the mean value were obtained Ior the
widest points in the external surIace as shown in Figure 3. width and the height oI each tooth. The dental casts and the
The data were entered into the computer using "Statistical Iacial photographs were numbered Ior the ease oI
Package Ior the Social Science" (SPSS Inc., Chicago, IL, identiIication. The measurements on the dental casts were
USA) version 16.0 Ior statistical analysis. Pearson
done as careIully as possible to avoid any damage on
Correlation CoeIIicient was used to determine the intra-
beaks contact.
examiner reliability. The measurements oI 35 randomly
selected subjects were redone two weeks later to
determine measurements error. Descriptive statistics
including the mean and standard deviation were
calculated Ior all measurements. Statistical comparison oI
the data oI this study was perIormed with independent
samples -test. The signiIicant level was set at 0.05..
In this study Pearson Correlation CoeIIicient showed
high reliability oI intra-examiner reliability oI repeated
measurements by the investigator (0.994 r 0.997).
\
The intercanine width was measured as a horizontal
distance between the cusp tips oI the upper canines as
shown in Figure 2. The Iacial dimensions were measured
using imaging soItware (Adobe PhotoShop CS, version
8.0, Adobe Systems Inc., San Jose, CA, USA).
Bizygomatic width (BFW) was determined by measuring
the distance between the two zygomatic prominences.
Table I, represents descriptive statistics oI the widths
and height oI the maxillary central, lateral incisors and
canines Ior both gender. When the mean widths and height
values oI the central, lateral incisors and canines were
compared, the results showed that the mean coronal
widths and height measurements oI central incisors and
canines were greater in male than the corresponding
dimensions Ior Iemale subjects. The diIIerence was
statistically signiIicant with the central incisors being the
widest teeth Ior both genders (p 0.05, P 0.02).
Moreover, the coronal width oI the lateral incisor was
observed to be greater in male than Iemale subjects, which
was statistically signiIicant (P 0.02). However, the
lateral incisors did not exhibit signiIicant diIIerence in
height between the two genders (P ~ 0.05) as shown in
RESULT
69 1PDAVol. 20 No. 2 Apr-1un 2011
Analysis of Maxillary Anterior Teeth and Various Facial Dimensions among
Adolescents in Riyadh, Saudi Arabia.
Al Sehaibany F
Fig 2: Occlusal view oI the plaster cast showing
the intercanine width (ICW).
Fig 3: Facial Irontal view showing Interpupillary Distance (IPD),
Bizygomatic Facial Width (BFW) and Interalar Width (IAW).
a
MeanSD Min Max MeanSD Min Max PValue
(mm) (mm) (mm) (mm) (mm) (mm)
Table I: Mean and standard deviation of the width and height of
the maxillary anterior teeth in millimeter for both gender
a
Independent Samples -test
S SigniIicant, *P 0.05, **P0.02, NSNon SigniIicant (P~0.05)
CIW mean width oI central incisor LIH mean height oI lateral incisor
CIH mean height oI central incisor CW mean width oI canine
LIW mean width oI lateral incisor CH mean height oI canine
Male Female
CIW 8.91+0.41 8.51 9.30 8.52+0.34 8.30 8.74 S**
CIH 10.23+0.38 9.95 10.51 9.82+0.36 9.64 10.00 S**
LIW 6.82+0.28 6.61 7.03 6.41+0.31 6.24 6.58 S**
LIH 8.65+0.39 8.47 8.83 8.53+0.40 8.31 8.75 NS
CW 8.16+0.33 8.11 8.21 7.64+0.32 7.42 7.86 S*
CH 10.21+0.42 10.12 10.30 9.51+0.38 9.30 9.72 S*
Table I. The mean width to height ratios oI the maxillary
anterior teeth Ior male versus Iemale subjects
respectively, were observed as Iollows: central incisors
(87) versus (86), lateral incisors (79) versus (75)
and canines showed equal ratio Ior the two genders( 80).
Acomparison between male and Iemale oI the ratios oI the
central incisors and canines showed no statistically
signiIicant diIIerences (P~ 0.05).
However, a signiIicant diIIerence (P 0.05) was
observed between the male and Iemale in width to height
ratios oI the lateral incisors as shown in Table II.
Direct measurements Irom dental casts provided
values that are not aIIected by the soIt tissue and adjacent
33
teeth. Lundstrom who recorded the dimensions oI six
anterior teeth intra-orally and on casts the diIIerences
between the two measurements were not signiIicant.
When restoring dentitions oI patients, diIIerent
dimensions oI maxillary anterior teeth must be taken into
consideration because esthetics deal with perception and
22
composition is not isolated or Iragmented inIormation.
The dimensions oI the maxillary anterior teeth have been
The ratio oI the interpupillary distance to the width
studied in term oI size and morphology in order to chart
oI the maxillary central incisors showed no statistically
11
gender characteristics. ScientiIic data regarding teeth
signiIicant diIIerence between the two gender (P ~ 0.05).
dimensions norms are useIul to dental practitioners when
values oI 7.6 and 7.4 were Iound Ior male and Iemale
restoring anterior teeth to optimize dental and Iacial
subjects respectively.
esthetics. Some authors measured the width oI the
maxillary central incisors in several racial groups and
On the other hand, the results oI this study showed no
noted variations in most oI them, with male subjects
statistically signiIicant diIIerence in the ratio oI
3,5
having wider central incisors thanIemale subjects.
bizygomatic Iacial width to central incisor width (P ~
0.05) between the two gender, the values Ior male and
In some studies, it has been reported that the maxillary
Iemale subjects were 16.5, 16.2 respectively as shown in
anterior teeth oI male were wider and longer than those
Table III.
3,4
oI Iemale. It was reported that the mean width and
height oI the clinical crowns oI the maxillary anterior teeth
oI Iemale in black population subjects are greater than the
corresponding dimensions in Iemale subjects in a white
12,16
population. In the present study, the mean width and
height values Ior the central incisors and the canines Ior
male subjects were signiIicantly greater than the
corresponding dimensions Ior Iemale subjects, with the
central incisors being the widest teeth in both genders.
3,4
These Iindings coincide with the results oI other studies.
The lateral incisors displayed similar height averages Ior
both genders, which does not coincide with other
13,27
reports. In as study oI 443 Saudi adults subjects oI The interalar width showed statistically signiIicant
17
diIIerences between male and Iemale subjects (P0.01). Arab extraction, Al Wazzn reported that the mean
Furthermore, when the two genders were compared a mesiodistal width oI the central incisors oI male subjects
statistically signiIicant diIIerence was observed in the is signiIicantly greater than that oI Iemales, which is in
intercanine width (P 0.05) as shown in Table IV. agreement with the Iindings oI the present study. Variation
34
based on gender has also been reported by Abdullah,
DISCUSSION
70 1PDAVol. 20 No. 2 Apr-1un 2011
Analysis of Maxillary Anterior Teeth and Various Facial Dimensions among
Adolescents in Riyadh, Saudi Arabia.
Al Sehaibany F
a
Male Female PValue
W/H W/H
Table II: Width (W) to height (H) ratios of the maxillary anterior
teeth by gender
a
Independent Samples -test
S SigniIicant, *P 0.05, NSNon SigniIicant (P~0.05)
CICentral Incisor, LI Lateral Incisor, CCanine
CI 0.87 0.86 NS
LI 0.79 0.75 S*
C 0.80 0.80 NS
a
Male Female PValue
Mean SD Mean SD
(mm) (mm)
Table III: Mean and standard deviation (SD) of the ratios of the
Interpupillary distance and bizygomatic facial width to
the width of central incisor by gender
a
Independent Samples -test
NSNon SigniIicant (P~0.05)
IPD/WCI interpupillary distance to central incisor width
BFW/WCI Bizygomatic Iacial width to central incisors width.
IPD/WCI 7.6+0.31 7.4+0.28 NS
BFW/WCI 16.5+0.80 16.2+0.76 NS
Table IV: Mean and standard deviation (SD) of the interalar
width and intercanine width by gender
a
Independent Samples -test
SSigniIicant, *P 0.05, **P0.01
IAWInteralar width
ICWIntercanine width
IAW 34. + .8 32. 3 .8 31. + .6 29 15 32.86 S** 7 1 5 6 0 1 .
ICW 2.1+1.5 9.7 34.5 0.8+1.2 28.71 3 .9 S 3 2 3 2 0 *
Male Female
a
Mean SD Min Max Mean SD Min Max P-value
(mm) (mm) (mm) (mm) (mm) (mm)
which revealed that male subjects had greater coronal central incisors exhibitingthe greatest width.
widthoI the central incisors than Iemales.
3. Width to height ratios oI the canines were equal
Previous studies suggested that width to height ratios Ior the twogenders.
oI the maxillary anterior teeth were not aIIected by gender
4. Interalar and intercanine widths were and the width oI the canines indicated important gender
4,13
signiIicantlydiIIerent betweenthe two genders. .
and racial diIIerences. The results oI the current study
revealed signiIicant gender diIIerences in the width to
height proportion oI the lateral incisors which coincide
12
with the Iindings oI previous studies. The width to
height ratios oI the central incisors and canines did not
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8,11
45:143-154. whichare inaccordance with other studies.
2. Boucher CO, Hickey JC, Zarb GA. Prosthetic Treatment Ior
th
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is a Iacial segment that does not modiIy aIter achieving the
C. Width/length ratios oI normal clinical crowns oI the
35
adults measures at about 14 years oI age. The current
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24
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th
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36 37 24
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38
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Analysis of Maxillary Anterior Teeth and Various Facial Dimensions among
Adolescents in Riyadh, Saudi Arabia.
Al Sehaibany F