Journal of Forensic Dental Sciences
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  Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 6  |  Issue : 2  |  Page : 92-96  

A comparative study to evaluate the vertical position of maxillary central incisor and canine in relation to incisive papilla line


1 Department of Prosthodontics, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
2 Career Postgraduate Institute of Dental Sciences, Lucknow, Uttar Pradesh, India

Date of Web Publication15-May-2014

Correspondence Address:
Mayank Shah
Institute of Dental Sciences, Room No. 3, Faculty Residence, Pilibhit Bypass Road, Bareilly 243 006, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-1475.132534

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   Abstract 

Objectives: The aim of the study was to determine the vertical distance of maxillary central incisor (CI) and maxillary canine (CA) from the incisive papilla (IP) line and their variation with age and sex. Materials and Methods: A total of 120 dentulous subjects following the inclusion and exclusion criteria were randomly selected from the local population. On the basis of gender and age, subjects were divided into four groups: M a , M b , F a and F b . Maxillary impressions of selected subjects were made and corresponding casts were retrieved. The cast was positioned on the surveyor and the center of IP was transferred to the labial side of maxillary right CI and CA regions with the help of analyzing rod of the surveyor and a line was drawn in this region which was referred to as "IP line." The measurements were made from the IP line to the mesio-incisal line angle of right maxillary CI-IP and cusp tip of right maxillary CA with the help of digital vernier caliper (CA to IP). Result: The mean vertical distance of maxillary CI-IP ranged from 6.31 ± 0.74 mm to 7.04 ± 0.87 mm and the mean vertical distance of maxillary CA-IP ranged from 5.83 ± 0.80 mm to 6.30 ± 0.82 mm. Conclusion: The CA position in relation to the IP line is more stable to its position than the CI position irrespective of age and sex.

Keywords: Analyzing rod, dental surveyor, digital vernier caliper, incisive papilla, occlusal plane


How to cite this article:
Shah M, Verma AK, Chaturvedi S. A comparative study to evaluate the vertical position of maxillary central incisor and canine in relation to incisive papilla line. J Forensic Dent Sci 2014;6:92-6

How to cite this URL:
Shah M, Verma AK, Chaturvedi S. A comparative study to evaluate the vertical position of maxillary central incisor and canine in relation to incisive papilla line. J Forensic Dent Sci [serial online] 2014 [cited 2019 Jul 18];6:92-6. Available from: http://www.jfds.org/text.asp?2014/6/2/92/132534


   Introduction Top


The selection and arrangement of maxillary anterior teeth for edentulous patients in a natural and esthetically pleasing form has remained an elusive and challenging endeavour. Dentist use various techniques, their clinical expertise and aesthetic sense to attain acceptable results.

The pre-extraction records can be preserved and utilized during the establishment of incisal plane and setting of the artificial teeth. [1] Non-availability of such pre-extraction records, necessitate the use of norms and guidelines, but the available ones have their own limitations. Also, there are no suitable guidelines for patients with maxillofacial defects especially cleft lip and cleft palate and patients suffering from facial palsy.

The most obvious landmark that appears to have survived intact from the dentate state is the incisive papilla (IP) and it has received a great deal of attention in relation to maxillary anterior teeth. Although, several studies [2],[3],[4],[5],[6],[7],[8],[9],[10] investigated the horizontal relationship between IP and the maxillary central incisors (CI), but there is no specific information in the literature relative to vertical distance between the IP and the maxillary anterior teeth in a single plane. So this study was performed to establish relationship between the vertical position of maxillary CI and maxillary canine (CA) in relation to IP line in one plane.

Various studies had been conducted in the past to relate the position of IP with maxillary CI and CA but only in horizontal plane, vertical plane had not been given much concern. This study was undertaken with the aim to "compare the relationship between the vertical position of maxillary CI and maxillary CA in relation to IP line." and objectives were: (1) To determine the vertical distance in one plane of maxillary CI and maxillary CA from the IP and more stable position. (2) Variation with age and sex in relative position of maxillary CI and maxillary CA from the IP line.


   Materials and Methods Top


The materials used for making impression and pouring cast were used, along with the dental surveyor and digital vernier caliper.

Data collection

A total of 120 dentulous subjects, with 70 males and 50 females were selected randomly with following inclusion criteria; Aligned full complement of natural permanent teeth up to II molar, no history of orthodontic treatment, angle Class I maxillomandibular relationship and a well traceable IP. Exclusion criteria were; any restoration and/or prosthetic treatment in maxillary anterior region, missing and/or supraerupted CIs, CAs and second molar in the maxillary arch, moderate to severe attrition or any pathologic wear of maxillary anterior teeth and maxillo-facial trauma.

On the basis of gender and age, subjects were divided into four groups as M a , M b , F a and F b [Table 1]. Maxillary impressions of selected subjects were made with irreversible hydrocolloid (Plastalgin, Septodont, India) and corresponding casts were retrieved [Figure 1] and [Figure 2]. The cast was secured on the cast holder of the surveyor and tripoding was done [Figure 3].

The reference points used were; anterior reference point: Mesio-labial edge of the maxillary right CI and posterior reference points: Mesio-buccal cusp tips of maxillary right and left second molar [Figure 4]. The center of IP was marked [Figure 4] and transferred to the labial side of maxillary right CI and CA regions with help of analyzing rod of the surveyor [Figure 5] and a line was drawn in this region, which was referred to as "IP line" [Figure 6]. The measurements were made from the IP line to the mesio-incisal line angle of right maxillary CI-IP [Figure 7] and cusp tip of right maxillary CA with help of digital vernier caliper (CA-IP) [Figure 8].
Figure 1: Maxillary impression

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Figure 2: Maxillary cast

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Figure 3: Maxillary cast mounted on the surveyor

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Figure 4: Tripoding done and center of incisive papilla marked

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Figure 5: Centre of incisive papilla transferred on labial side with help of analyzing rod

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Figure 6: Incisive papilla line drawn on maxillary central incisor and canine

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Figure 7: Measurements of the distance from incisive papilla line to right maxillary central incisal edge

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Figure 8: Measurements of the distance from incisive papilla line to right maxillary canine cusp tip

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   Results Top


All the reading obtained were tabulated and statically analyzed. The analysis of the measurements showed that the mean vertical distance of maxillary CI-IP ranged from 6.31 ± 0.74 mm to 7.04 ± 0.87 mm [Table 2]. There was significant difference between two genders for younger age group (30-45 years) and no significant difference was observed between two genders for older age group (46-60 years) [Table 3] and Graph 1].

The mean vertical distance of maxillary CA to IP ranged from 5.83 ± 0.80 mm to 6.30 ± 0.82 mm [Table 4]. There was no significant difference among genders for both older and younger age groups [Table 5] and Graph 2].
Table 1: Group wise distribution of subjects


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Table 2: Mean right maxillary CI-IP distance in different groups


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Table 3: Intergroup differences for CI-IP distance


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Table 4: Mean right maxillary CA-IP distance in different groups


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Table 5: Intergroup differences for CA-IP distance


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   Discussion Top


In patients where all of the maxillary anterior dentition is missing, the Dentist should attempt to position the teeth in a fashion similar to the arrangement of ideal dentate patients of similar age, gender, race and facial structures. [11] To accomplish this several authors have used various guidelines such as phonetics, [11],[12],[13] upper lip, [14],[15],[16] lower lip [11],[17] and smile line [8],[18] to establish the maxillary incisal edge position. The most commonly used is phonetics, where "S," "Z," and "C", "F" and "V" sounds were proposed by Payne and Pound [12],[13] and Robinson [17] for position of incisal edges of upper teeth. While Sharry, Heartwell, Ellinger, et al. and Landa [14],[16],[19],[20] suggested that the occlusal aspect of maxillary occlusal rims should extend approximately 1-2 mm below the upper lip in repose and then speech should be used to modify this vertical position.

Although, above mentioned landmarks had been utilized for anterior teeth setting, but none of these guidelines are relatively stable and their anatomy varies greatly among individuals. [21]

In the present study, vertical position of maxillary central incisal edge and maxillary CA cusp tip was determined from IP because various studies [2],[3],[9],[11] concluded that there is no change in the position and dimension of IP in a mouth from dentate stage to the edentulous stage. Thus, describing IP as a relatively stable landmark which can be used as a guide for anterior teeth positioning.

In this study, for tripoding of the cast, the anterior reference point used was mesio-labial incisal edge of upper right CI and posterior reference points were mesio-buccal cusp tips of upper right and left second molar. This occlusal plane orientation was used as it is more comparable to the pterygomaxillary notch-IP occlusal plane which tends to be parallel to the natural occlusal plane as stated by Fu et al. [22]

The "IP line" would facilitate the implications of the study in edentulous subjects because the record base and occlusal rim covers the IP over the master cast. Thus by scribing the IP line on the occlusal rim with help of analyzing rod, the vertical position of IP on the occlusal rim could be identified for incisal plane determination and anterior teeth positioning in edentulous patients. [23]

The right maxillary CI-IP distance was observed to be consistent in different age groups in both males and females separately. Although no significant difference was observed between two genders of older age group (46-60 years), the difference between two genders was significant for younger age group (30-45 years), which may be attributed to the fact that females of younger age group have rounded and softer appearance of maxillary central incisal edge compared to that of males having sharper and vigorous maxillary central incisal edge. [24]

The right maxillary CA-IP distance was observed to be consistent in different age groups in both males and females. Gender wise too, there were no significant differences in either of the two age groups. This may be due to the reason that the maxillary CA morphology in this group of population was almost similar for both males and females.

Further, a long-term prospective study with larger sample size and their variation with age, race, dental and skeletal morphology is required to authenticate IP line as a landmark for arrangement of maxillary anterior teeth.


   Conclusion Top


The results of the study showed that the CA position in relation to the IP is more stable to its position than the CI position irrespective of age and sex. Therefore, this study suggests that, for patients between the ages of 30 and 60 years, the CA tip has a more consistent position to the IP than the maxillary CI edge.

 
   References Top

1.Grave AM, Becker PJ. Evaluation of the incisive papilla as a guide to anterior tooth position. J Prosthet Dent 1987;57:712-4.  Back to cited text no. 1
[PUBMED]    
2.Harper RN. The incisive papilla: The basis of a technic to reproduce the key teeth in prosthodontia. J Dent Res 1948;27:661-8.  Back to cited text no. 2
    
3.McGee GF. Tooth placement and the base contour in denture construction. J Prosthet Dent 1960;10:651-7.  Back to cited text no. 3
    
4.Ortman HR, Tsao DH. Relationship of the incisive papilla to the maxillary central incisors. J Prosthet Dent 1979;42:492-6.  Back to cited text no. 4
[PUBMED]    
5.Boucher CO, Hickey JC, Woelfel JB. Responsibility of the dentist in complete dentures. J Prosthet Dent 1962;12:637-53.  Back to cited text no. 5
    
6.Martone AL. Clinical responsibility of concepts of functional anatomy and speech science to complete denture prosthodontics. J Prosthet Dent 1963;13:204-28.  Back to cited text no. 6
    
7.Ehrlich J, Gazit E. Relationship of the maxillary central incisors and canines to the incisive papilla. J Oral Rehabil 1975;2:309-12.  Back to cited text no. 7
[PUBMED]    
8.Watt DM. Tooth positions on complete dentures. J Dent 1978;6:147-60.  Back to cited text no. 8
[PUBMED]    
9.Mavroskoufis F, Ritchie GM. Nasal width and incisive papilla as guides for the selection and arrangement of maxillary anterior teeth. J Prosthet Dent 1981;45:592-7.  Back to cited text no. 9
[PUBMED]    
10.Grove HF, Christensen LV. Relationship of the maxillary canines to the incisive papilla. J Prosthet Dent 1989;61:51-3.  Back to cited text no. 10
    
11.Zarb G, Carisson G. Boucher's Prosthodontic Treatment for Edentulous Patients. 11 th ed. St. Louis: Mosby Co.; 2001. p. 270.  Back to cited text no. 11
    
12.Payne AG. Factors influencing the position of artificial upper anterior teeth. J Prosthet Dent 1971;26:26-32.  Back to cited text no. 12
[PUBMED]    
13.Pound E. Esthetic dentures and their phonetic values. J Prosthet Dent 1951;1:98-111.  Back to cited text no. 13
[PUBMED]    
14.Sharry JJ. Complete Denture Prosthodontics. 3 rd ed. New York: McGraw Hill Book Company; 1974. p. 168.  Back to cited text no. 14
    
15.Vig RG, Brundo GC. The kinetics of anterior tooth display. J Prosthet Dent 1978;39:502-4.  Back to cited text no. 15
[PUBMED]    
16.Heartwell CM, Arthur OR. Syllabus of Complete Dentures. 3 rd ed. Philadelphia: Lea and Febiger Publication; 1980. p. 126.  Back to cited text no. 16
    
17.Robinson SC. Physiological placement of artificial anterior teeth. J Can Dent Assoc (Tor) 1969;35:260-6.  Back to cited text no. 17
[PUBMED]    
18.Behrents RG. Growth in the Aging Craniofacial Skeleton. Craniofacial Growth Series. Monograph 17. Ann Arbor: University of Michigan; 1985. p. 112-5.  Back to cited text no. 18
    
19.Ellinger CW, Rayson JH, Terry JM, Rahn AO. Arrangement of anterior teeth. In: Ellinger CW, editor. Synopsis of Complete Dentures. Philadelphia, PA: Lea and Febiger; 1975. p. 163.  Back to cited text no. 19
    
20.Landa SL. Anterior tooth selection and guidelines for complete denture esthetics. In: Winkler S, editor. Essentials of Complete Denture Prosthodontics. Philadelphia, PA: Saunders; 1979. p. 282-300.  Back to cited text no. 20
    
21.Kharat DU, Madan RS. An investigation into the distance between incisive papilla and incisal edge of maxillary central incisor. J Indian Dent Assoc 1984;56:425-8.  Back to cited text no. 21
[PUBMED]    
22.Fu PS, Hung CC, Hong JM, Wang JC. Three-dimensional analysis of the occlusal plane related to the hamular-incisive-papilla occlusal plane in young adults. J Oral Rehabil 2007;34:136-40.  Back to cited text no. 22
    
23.Frush JP, Fisher R. How dentogenics interprets the personality factor. J Prosthet Dent 1956;6:441-9.  Back to cited text no. 23
    
24.Frush JP, Fisher R. How dentogenic restorations interpret the sex factor. J Prosthet Dent 1956;6:160-72.  Back to cited text no. 24
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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