Comparison of Maxillary Anterior Tooth Width and Facial Dimensions of 3 Ethnicities
Comparison of Maxillary Anterior Tooth Width and Facial Dimensions of 3 Ethnicities
Comparison of Maxillary Anterior Tooth Width and Facial Dimensions of 3 Ethnicities
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ABSTRACT
Statement of problem. As the cosmetic demands of patients increase, determining the appropriate dimensions of the maxillary anterior
teeth has become increasingly relevant. The relationship between facial measurements and tooth size provide guidance for maxillary anterior
tooth size selection. However, most publications on this topic have focused on the white population, and more data for tooth sizes and their
proportions in other ethnicities are needed.
Purpose. The purpose of this observational study was to investigate the relationship between the mesiodistal dimensions of the 6 maxillary
anterior teeth and the bizygomatic width, interpupillary distance, intercanthal distance, interalar width, and intercommissural width of
individuals of Asian, African-American, and white ethnicities.
Material and methods. Standardized digital images of 360 participants (120 Asian, 120 African-American, and 120 white) were used to measure
facial segments. Individual dimensions of the 6 maxillary anterior teeth were measured using stone casts with digital sliding caliper. The
combined width of the 6 maxillary anterior teeth on a straight line corresponded to the sum of the anterior tooth width. The means and
standard deviations from descriptive measurements were calculated and analyzed for face and maxillary anterior tooth ratios and
correlations. Statistical analysis was done using the Kruskal-Wallis procedure to compare facial and tooth parameters among the 3 ethnicities.
Appropriate post hoc comparisons that adjusted for multiple testing were conducted when warranted (a=.05). The Spearman rho correlation,
a nonparametric correlate of the Pearson correlation, was used to associate the facial and tooth parameters within the strata of sex and ethnicity.
Results. No consistent ratios were found among the examined facial dimensions and the mesiodistal dimensions of the 6 maxillary anterior
teeth among the 3 ethnicities, except for the central incisor width-to-bizygomatic width ratio. No correlations were found between the facial
dimensions and mesiodistal dimensions of the 6 maxillary anterior teeth among the 3 ethnicities except in Asian women. For Asian women,
the intercommissural width correlated with the width of the central incisor (P=.001), the width of 2 central incisors (P=.001), the width of 4
incisors (P=.003), and the width of 6 maxillary anterior teeth (P=.005).
Conclusions. No facial proportions by which the exact width of maxillary anterior teeth could be predicted were found in Asian, African-
American, or white populations. (J Prosthet Dent 2017;-:---)
Dental esthetics and facial appearance have become improves appearance and smile and serves as a visible
important to this current generation, resulting in an sign of successful aging.2
increased interest in achieving optimal treatment out- Lombardi3 stated that the proportion of selected tooth
comes.1 In addition, the generation approaching 70 years molds should be balanced with facial anatomy. Levin4
of age recognizes that maintaining their natural dentition indicated that the golden proportion gives the most
Supported by a research grant from Loma Linda University. This research was completed in partial fulfillment of the requirements for the degree of Master of
Science in Prosthodontics (E.C.P.). Presented at the Pacific Coast Society for Prosthodontics 80th Annual Scientific Meeting, June 2015 in Deer Valley, Utah.
a
Prosthodontist, Private practice, Loma Linda, Calif.
b
Prosthodontist, Private practice, Austin, Texas.
c
Resident, College of Dentistry, University of Dammam, Dammam, Saudi Arabia.
d
Professor and Director, Advanced Specialty Education Program in Prosthodontics, Loma Linda University School of Dentistry, Loma Linda, Calif.
e
Professor and Director, Hugh Love Center for Research and Education in Technology, Loma Linda University School of Dentistry, Loma Linda, Calif.
f
Distinguished Professor, Advanced Specialty Education Program in Prosthodontics, Loma Linda University School of Dentistry, Loma Linda, Calif.
Figure 1. Standardized photographs with ruler. A, Frontal view. B, Frontal view with facial measurements.
Table 1. Descriptive statistics for facial parameters (N=60) Table 2. Descriptive statistics for tooth parameters (N = 60)
Sex Measurement Ethnicity Mean (mm) ±SD 95% CI Width
Female BW Asian 168.7 10.43 166.04 171.44 Sex Measurement Ethnicity Mean (mm) ±SD 95% CI
African American 167.3 10.77 164.52 170.08 Female MRC Asian 7.8 0.46 7.72 7.96
White 166.4 10.63 163.65 169.14 African American 7.9 0.50 7.78 8.04
IPD Asian 74.0 5.27 72.61 75.33 White 7.7 0.44 7.61 7.84
African American 77.6 5.57 76.11 78.99 MRLI Asian 7.0 0.58 6.87 7.17
White 74.8 5.53 73.41 76.27 African American 7.2 0.63 7.08 7.41
ICD Asian 41.9 4.51 40.76 43.09 White 6.8 0.57 6.65 6.95
African American 40.7 4.11 39.65 41.77 MRCI Asian 8.5 0.57 8.37 8.67
White 39.3 3.98 38.26 40.31 African American 9.1 0.64 8.91 9.24
IAW Asian 45.6 3.97 44.58 46.63 White 8.6 0.50 8.42 8.68
African American 52.0 4.57 50.83 53.19 MLCI Asian 8.5 0.57 8.30 8.60
White 43.9 4.43 42.80 45.08 African American 9.1 0.70 8.89 9.25
ICW Asian 57.4 4.50 56.23 58.55 White 8.5 0.51 8.40 8.66
African American 64.7 4.98 63.41 65.99 MLLI Asian 7.0 0.58 6.82 7.12
White 60.5 4.97 59.19 61.76 African American 7.2 0.62 7.06 7.38
Male BW Asian 180.4 12.15 177.25 183.53 White 6.8 0.55 6.68 6.96
African American 178.9 14.52 175.16 182.66 MLC Asian 7.8 0.49 7.69 7.94
White 175.0 10.65 172.28 177.78 African American 7.9 0.47 7.75 7.99
IPD Asian 78.3 5.56 76.85 79.73 White 7.7 0.42 7.57 7.78
African American 82.7 6.59 81.03 84.43 Male MRC Asian 8.2 0.51 8.10 8.37
White 77.4 5.46 75.96 78.78 African American 8.5 0.57 8.35 8.64
ICD Asian 44.9 5.03 43.63 46.23 White 8.1 0.46 7.98 8.22
African American 44.4 4.57 43.20 45.56 MRLI Asian 7.3 0.50 7.19 7.45
White 40.3 3.96 39.32 41.36 African American 7.3 0.64 7.17 7.50
IAW Asian 50.1 3.83 49.08 51.06 White 7.0 0.53 6.84 7.11
African American 59.0 6.18 57.44 60.63 MRCI Asian 8.9 0.48 8.76 9.01
White 48.9 4.26 47.78 49.98 African American 9.4 0.57 9.22 9.52
ICW Asian 60.2 5.16 58.90 61.57 White 8.9 0.51 8.79 9.05
African American 69.4 6.48 67.74 71.08 MLCI Asian 8.9 0.51 8.75 9.01
White 64.7 5.30 63.30 66.03 African American 9.3 0.59 9.18 9.48
White 8.8 0.44 8.71 8.94
BW, bizygomatic width; IAW, interalar width; ICD, intercanthal distance; ICW,
intercommissural width; IPD, interpupillary distance. MLLI Asian 7.8 0.46 7.72 7.96
African American 7.9 0.50 7.78 8.04
White 7.7 0.44 7.61 7.84
RESULTS MLC Asian 7.0 0.58 6.87 7.17
African American 7.2 0.63 7.08 7.41
The descriptive statistics, including measurements of White 6.8 0.57 6.65 6.95
central tendency and dispersion, for facial and tooth
MLC, maxillary left canine; MLCI, maxillary left central incisor; MLLI, maxillary left lateral
measurements made among Asian women, Asian men, incisor; MRC, maxillary right canine; MRCI, maxillary right central incisor; MRLI, maxillary
African-American women, African-American women, right lateral incisor.
white women and white men are listed in Tables 1 and 2. Table 3. Descriptive statistics for 6 maxillary anterior teeth (N=60)
The most constant measurements for facial parameters Sex Measurement Ethnicity Mean (mm) ±SD 95% CI
were bizygomatic width and intercanthal distance among Female MRC-MLC Sum Asian 46.6 2.70 45.92 47.31
Asian, African-American, and white women. The differ- African American 48.4 2.78 47.67 49.11
ences for bizygomatic width were less than 2.4 mm and White 46.1 2.38 45.47 46.70
less than 2.7 mm for intercanthal distance. Male MRC-MLC Sum Asian 48.9 2.22 48.33 49.48
From the descriptive tooth measurements, the largest African American 50.4 2.71 49.74 51.14
teeth were maxillary central incisors in African-American White 47.8 2.27 47.18 48.35
men and women, and the smallest teeth were lateral MLC, maxillary left canine; MRC, maxillary right canine.
incisors in white men and women.
The mean distance between the distal surfaces of the than in the other ethnicities, which was primarily a result
maxillary canines, which is the most relevant distance for of the increased width of the central incisors. The same
anterior tooth selection in establishing the proper tooth results were seen for the men. In African-American men,
size for edentulous patients, for the groups is presented the measurements were also at least 2 mm wider than
in Tables 3 and 4. In African-American women, the the other ethnicities, again primarily because of the
combined width measurements were at least 2 mm wider increased width of the central incisors.
MLC, maxillary left canine; MRC, maxillary right canine. Mean significant difference (P<.05).
Multiple comparisons (Bonferroni test) for the 6 Ethnicity Asian African American White
.030
maxillary anterior teeth showed that the sum of the width
of the 6 maxillary anterior teeth was statistically different F M
among the ethnicities for both women and men (Kruskal- Sex
Wallis procedure, P<.001). Specifically, the sum was
Figure 3. Central incisor width-to-bizygomatic width ratio. BZW,
statistically larger among women for African-Americans
bizygomatic width; MRCI, maxillary right central incisor.
than Asians (P=.001) and for African-Americans than
whites (P<.001). The sum was also statistically larger
DISCUSSION
among men for African-Americans than Asians (P=.002)
or whites (P<.001). The null hypotheses were accepted. No consistent ratio
The central incisor width-to-bizygomatic width and correlation between facial dimensions and mesio-
(CI/BZ) ratio was variable among African-Americans, distal dimensions of the 6 maxillary anterior teeth was
Asians, and whites for both men and women. Howev- found among the 3 ethnicities.
er, similarity in the CI/BZ ratio was observed between The maxillary central incisor width-to-bizygomatic
the sexes for Asians and whites only. Based on the width ratio of 1:16 as reported by Berry7 was not found
results, the CI/BZ ratio was 1:18 for African-American in this study, which was closer to the findings of House
women, 1:19 for African-American men, and 1:20 for and Loop8 (1:13 to 1:19). In this study, the widest
Asian men and women. For whites, the CI/BZ ratio was dimension of the face was used as the bizygomatic
closer to 1:19 for women and 1:20 for men (Table 5, measurement. Asian individuals usually have smaller
Fig. 3). teeth and wider faces, which might also indicate why the
The Spearman rank correlation coefficient or Spe- ratio was higher for this population. The factor of 6.6
arman rho was used for a nonparametric measure of between the interpupillary distance and the width of the
statistical dependence between 2 variables.34 Correlation maxillary central incisor, as determined by Cesario and
analysis using Spearman rho showed a strong and Latta,10 was not correlated in this study.
positive correlations between the width of the central No stable ratio and correlation were found between
incisor, width of the 2 central incisors, width of the 4 the width of central incisor, 2 central incisors, and 4
incisors, and width of the 6 maxillary anterior teeth maxillary incisors to the intercanthal distance. This is not
to the intercommissural width among Asian women in agreement with the findings of Al Wazzan.11 In that
(Fig. 4). study, intercanthal distance was measured using a Boley
70.00 70.00
65.00 65.00
ICW (mm)
ICW (mm)
60.00 60.00
55.00 55.00
50.00 50.00
45.00 45.00
7.00 7.50 8.00 8.50 9.00 9.50 10.00 14.00 16.00 18.00 20.00
MRCI Width A MRCI and MLCI Width B
70.00 70.00
65.00 65.00
ICW (mm)
ICW (mm)
60.00 60.00
55.00 55.00
50.00 50.00
45.00 45.00
27.50 30.00 32.50 35.00 37.50 40.00 45.00 50.00 55.00 60.00
MRLI - MLLI Width C MRC - MLC Width D
Figure 4. A, Correlation of width of right maxillary central incisor to intercommissural width in Asian women (Spearman rho=.422 [P=.001]).
B, Correlation of width of maxillary central incisors to intercommissural width in Asian women (Spearman rho=.440 [P=.001]). C, Correlation of width of
maxillary central and lateral incisors to intercommissural width in Asian women (Spearman rho=.379 [P=.003]). D, Correlation of width of maxillary
incisors to intercommissural width in Asian women (Spearman rho=.357 [P=.005]). ICW, intercommissural width; MLCI, maxillary left central incisor;
MRCI, maxillary right central incisor.
gauge to the nearest tenth of a millimeter, and mea- anterior segment of the maxilla and did not agree with the
surements of the maxillary anterior teeth were also findings of Hoffman et al.15 However, the findings of this
completed intraorally using a Boley gauge. The mea- study were in agreement with those of Smith,16 who stated
surement methodology was different in the present that neither the nasal nor the interalar width correlated
study, where photographic images with image processing with the width of the distance from canine to canine. The
software and actual casts for measurements were used. distal surfaces of the canines in this study were not located
This change in methodology could have resulted in the at the commissures as shown by Clapp and Tench.17
discrepancy in findings between the 2 studies. No stable ratio was found between the combined
The combined width of the maxillary central incisors width of the 6 maxillary anterior teeth and inter-
was not found to be in the golden proportion to the commissural width in white men and women in the
intercanthal distance, which is not in agreement with the study by Al Wazzan.19 Our study is in agreement with
findings reported by Abdullah.12 these findings with the exception of the Asian female
Krajicek13 reported a stable ratio between the width of population. In Asian women, our study found a corre-
the 6 maxillary anterior teeth and interalar width as lation between the width of a central incisor, the com-
measured on the soft tissue of cadavers. Our study, bined width of central incisors, the combined width of all
performed on live participants, did not agree with those incisors, and the combined width of the 6 maxillary
results. anterior teeth to the intercommissural width.
In our study, the interalar width, when multiplied by The findings from the present study were not in
factor of 1.31 did not equal the combined width of the agreement with any particular study but did have some
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