ANTHROPOMETRIC MEASUREMENTS IN COMPLETE DENTURE CONSTRUCTION Introduction

Esthetics is a primary consideration for patients seeking prosthodontic treatment. For obtaining an optimal dentolabial relations in harmony with the overall facial appearance, the dentist should have a thorough knowledge about the various facial proportions in the population and use these proportions as guidelines during the construction of complete denture. Anthropometry is the branch of science that deals body both living and dead. Various anthropometric measurements are used in the jaw relation stage and selection and arrangement of teeth in the fabrication of complete Denture prosthesis. Facial landmarks and planes used in complete denture construction Rima oris: - The opening between the lips. Philtrum: - The vertical furrow in the midline of the upper lip bonded laterally by a slight ridge. Labial tubercle: - Is the slight midline protrusion in the red zone of upper lip. Mentolabial Sulcus: - The horizontal depression midway between the lower vermillion border and bottom of the chin. Nasolabial sulcus: - Is a depression in the skin on each side of the face, which runs angularly outward from the ala of the nose to approximately just outside the corners of the mouth. Tragus: - Of the ear is a useful guide to toxate the arbitrary hinge axis point for the placement of the condylar extension of fascia type of arbitrary face bow. Some believe the arbitrary centre of condylar rotation is situated 10-13 mm interior to

the posterior margin of tragus on a line joining the superior border (or the middle of ) the tragus to the outer canthus of eye. Ala of the nose :- A part of complete denture technique to make tentative on the actual occlusal plane parallel with the horizontal plane. Nasion :- It is a skull landmark It is the deepest part of the midline depression just below the level of eye brow. Orbitale :- Lowest point of the infra orbital rim. Beyrons point :- On a line extending from the tragus of the ear to the canthus of eye a point is marked 13 mm interior of posterior margin of the most prominent point of the tragus. The presumed transverse horizontal axis is assumed to pass through these point which was termed Begrons point. Incisive papilla :- Is a useful landmark for judging the likely site of upper anterior teeth. Facial planes used in complete denture construction Basically the skull is having 3 planes 1. 2. 3. Saggital plane Horizontal plane Frontal plane

THE HYPOTHETICAL AVERAGE POINT A hypothetical point of known measurements must be established to serve as a standard to evaluate one technique with other. The hypothetical point is derived by mathematics and permits evaluation of comparison.

The orientation of the mandible of an upright point in the above mentioned 3 planes of space . The protrusive condylar inclination is given as 40 degree to the horizontal plane. The second molar is located 50mm from the hinge axis as measured along the horizontal plane and 32 mm below it. The incisal edge of the mandibular central incisor is 100cm from the hinge axis measured along the horizontal plane and 32 mm below it. Frankfort Horizontal plane :- This plane connects the lowest point of the orbit (orbitale) and superior point of the external auditory meatus (porion). Campers line or Broom well plane A line from the superior border of the tragus of the ear to the inferior border of the ala of the nose. Axis orbital plane:One orbitale and the two posterior points that determine the horizontal axis of rotation will define the axis orbital plane. PROPORTIONS USED IN COMPLETE DENTURE CONSTRUCTION Facial proportion :- A well proportioned face can be divide into 3 equal vertical Thirds using 4 horizontal planes at the level of Hair line Supra orbital ridge Bone of the nose Inferior border of chin With in the lower face, the upper lip occupies a third of the distance while the chin occupies the rest of the space.

Golden proportion The ration between the width of the central incisor and lateral should be established and continue this ratio in the placement of the remaining teeth and spaces . The golden mean is 1.618. Lombardi Was the first to emphasize the importance of order in the distal composition, with a recurring ration noted between all teeth from central incisor to the first premolar. Recurring Esthetic dental proportion This recently introduced concept states that clinicians may use a proportion of their own choice as long as it remains consistent, proceeding distally in the arch. Uses of Anthropometric measurements in complete denture Mainly in the 1. 2. Jaw relation stage Selection and arrangement of teeth

Uses in jaw relation stage Vertical jaw relation Measurements are made as Pre extraction record & post extraction records. Pre extraction records Made using

1.

Dakoneter: - records both the vertical dimension with the natural teeth in occlusion and position of the upper central incisors. The Willis Gauge: - used for recording the vertical height before extraction. Profile tracing :- A piece of soft lead wire is contoured to the face starting on the brow, following down the nose and lips and ending just below chin and a profile cut out is made. Two marks are made, one on incisive edge of centrals.

2.

3.

A line is drawn from this mark at right angles to the straight edge of the card and on this line 2nd mark is made. The distance from the 2nd mark to the labial surface of the central incisor is noted. Post extraction measurements 1. Niswonger (1930) suggested a technique used to measure free way space. Patient is seated with ala tragal line parallel with the floor. Two marks are made one on the upper lip and one on chin. Measurements are made in relaxed position and with the patient biting the occlusal rim. 2-4mm freeway space should be obtained. 2. Willis believed that the distance from the pupil of the eye to the rima oris should be equal to the distance from the base of the nose to the inferior border of chin, when the bite rims are in contact. 3. Wright (1939):- Suitable photographs of patient are made. He measured the distance between the pupils and distance from the eye brow to the lower border of the chin on the photograph. On the patient he measured the Interpupillary distance. Then he set up a proportional relation of photograph to patient using the interpupillary distance and applied this proportion to brow chin distance. Interpupillay Patients Brow chin Patients brow

distance of the photograph 4.

: interpupillay distance

= distance of photograph

: chin distance

Distance from the incisive papilla to mandibular incisors The distance of the papilla to the maxillary central Incisal edge is 6mm.

Usually the vertical (overbite) is 2mm. Hence the distance between the incisive papilla and lower incisors will be approximately 4 mm. Based on this value the vertical dimension at occlusion can be calculated. Measurements used to estimate the location of the terminal hinge axis Many techniques have been suggested

One popular method is that at a point 13 mm anteriorly from the posterior border of the tragus along a line connecting the most posterior border of the tongue to the outer canthus of eye. Another technique locates it 11mm anteriorly and 3 mm inferiorly to a line connecting the superior edge of the tragus to the outer canthus of eye. The Whipmix ear bow- estimates the terminal hinge axis to be 6 mm anteriorly and 2 mm inferiorly from the anterior border of the external auditory meatus. It is assumed that an estimated axis location using any of the accepted techniques will place the position within 6 mm of the true axis at 80% level.

Anthropometric measurements used in the selection of anterior teeth

o Anthropometric Cephalic index :- The transverse circumference of

the head forehead.

is measured using a measuring tape at the level of the

o Width of the upper CI= Circumference of head

o Berrys Biometric index :-

13

The width of the maxillary

Central incisor = Bizygomatic width

16 The width of the maxillary central Incisor = length of face 20 The bizygomatic width is the distance measured between the molar prominences on either side, 1-1 inches back of the lateral corner of the eye. Length is a measure of the distance from the hairline to the lower edge of the base of chin with the face at rest. 3. A face bow may be utilized to obtain this measurement Bizygomatic width = Approximal 3.3 Width of the 6 anterior teeth arranged on the curve of the properly contoured occlusal rim . 4. H.Pounds formula The width of the mazillary Central incisor = Bizygomatic width 16 The length of the mazillary Central incisor = Bizygomatic width 16 5. Based on the width of the nose :The width of the nose is measured by Vernier the combined width of the anterior teeth. caliper. This

measurement is transferred to the occlusal rim. The width of nose is equal to

6. Size of the maxillary arch The distance between the incisive papilla and hamular notch on one side is added with the distance between two hamular notches. This given the combined width of all anterior and posterior teeth of the maxillary arch. 7. Location of canine eminences : A canine eminence is formed in the region between the canine and the first premolar after extraction of teeth. The distance between the two canine eminences is measured the residual ridge . This measured value gives the combined width of the anterior teeth. 8. Location of the buccal frenal attachment: - The attachments of the buccal

frenum are marked on the residual ridge . The distance between the two markings recorded along the residual ridge gives the combined width of the maxillary anteriors . 9. Location of the corners of the mouth :- The corner of the mouth are recorded on the occlusal rim and the distance is measured between these markings. The anterior teeth are set with these markings . 10. Location of the ala of the nose :- The patients is asked to sit upright and look straight if line passing through the midpoint between the eyebrows and the lateral end of the ala of the nose extruded on to the occlusal rim gives the combined width of the anterior teeth . Arrangement of anterior teeth Schiffman has shown that the maxillary incisors. Fall approximately 8-10 mm anterior to the point of intersection of a line that bisects the midline of the

palate perpendicularly through the incisive papilla. This perpendicular bisecting line also extends outward approximately through the midline of the maxillary canines. STUDIES REGARDING THE ANTHROPOMETRIC MEASUREMENTS Byron.E.Kern (1967):- Examined 509 skulls and concluded that 1. There was no high percentage consistency ratio between bizyagomatic

width of skull and width of crown of the maxillary central incisor . 2. Nasio-menton measurements of the skull was related to the length of the maxillary central incisor. 3. Measurement of cranial circumference of skulls was related to the width of maxillary anterior teeth. 4. Extremely high percentage of skulls showed equal measurements between the nasal width of the four maxillary incisors . Brain Smith (1975):- Concluded a study on 80 subjects with radiographs correlating interalar and interalarfold widths of the nose width that of the intercanine distance and showed that no significant correlation existed between the inetrcanine distance and the width of the nose would not be a reliable guide for selecting or arranging anterior tooth . Harold.R.Ortman(1979):- Studied the relationship between incisive papilla and maxillary central incisor . He found out that the mean distance between the most anterior point on the maxillary central incisor and

posterior

border of incisive papilla was 12.454mm

with a standard

deviation 3.867mm.
Mauroskoufis (1981):- On investigation of 64 dental students showed that

the interalar nasal width could be used as a reliable guide for selecting the width of anterior teeth and that incisive papilla provides a stable anatomic land mark for arranging the labial surface of central incisor at 10mm anterior to the posterior border of papilla. The mesiodistal width of the set of anterior teeth (4 incisors and mesial halves of the canine) should be determined by adding 7 mm to the patients nasal width. Ray me Arthur (1985):- conducted a study to determine the relationship of the maxillary central incisors width when mandibular teeth were

present . He concluded that a factor of 1.62 could be used to select the appropriate width for missing maxillary central incisor. G.H. Latta et al (1991) conducted a study measuring the width of the outh, interalar width, Bizyqomatic width and interpapillary distance in edentulous patients. No correlation was found between widths for the population as a whole nor when the population was further divided by races, sex or groups. Daniel .H.Ward (2001):- He stated that when golden proportion is used, lateral incisor seems to be too narrow and canine is not predominant enough. This author has proposed a RED proportion ie recurring Esthetic Dental proportion . According to this the dentist can establish his own proportion and remain consistent while moving distally .

In Endomorph use higher proportion Ectomorph use lower proportion

REFERENCE:

Zarb G A, Bolender C L, Carlsson G E : Bouchers Prosthodontic treatment for edentulous patients 11th Ed, Mosby Inc 1997.

Rahn A O, Heartwell C M: Textbook of complete dentures 5th Ed Sheldon Winkler: Essentials of complete denture prosthodontics 2nd Ed, Ishiyaku Euro America Inc 1996.

Bernard Levin: Impressions for complete dentures Quintessence publishing Co 1984.

Neill D J, Nairn R I: Complete denture prosthetics 3rd Ed, Wright publishing Co 1990.

David Lamb: Problems and solutions in complete denture prosthodontics, Quintessence publishing Co 1993.

Halperin A R, Graser G N, Rogoff G S: Mastering the art of complete dentures, Quintessence publishing Co 1988.