An In Vivo Study to Compare and Evaluate the Correlation of the Facial Measurements with the Combined Mesiodistal Width of the Maxillary Anterior Teeth between Males and Females.

AIM: The aim of this study was to compare and evaluate the correlation of the facial measurements (interalar, intercommissural, intercanthal, and interpupillary distance) with the combined mesiodistal width of the maxillary anterior teeth between males and females.
OBJECTIVES: The objectives of this study were: (a) To evaluate the correlation of the facial measurements (interalar, intercommissural, intercanthal, and interpupillary distance) and combined mesiodistal width of maxillary anterior teeth. (b) To compare the correlation of the facial measurements (interalar, intercommissural, intercanthal, and interpupillary distance) with the combined mesiodistal width of maxillary anterior teeth between males and females.
MATERIALS AND METHODS: This study was carried out on 120 dentate Subjects selected from Yenepoya Dental College, Mangalore. The vernier caliper was used to measure the interalar, intercommissural, intercanthal, and interpupillary distance. The mesiodistal width of maxillary anterior teeth was measured on the cast. For accuracy, every distance was measured three times and the mean taken.
RESULTS: Comparison of parameters between males and females was calculated using independent sample t-test. The values obtained for each variables are interalar distance: for males 38.89 ± 2.19 and for females 35.58 ± 2.33. Intercommissural distance: for males 50.96 ± 2.99 and for females 47.15 ± 2.97. Intercanthal distance: for males 31.92 ± 1.46 and for females 30.46 ± 2.07. Interpupillary distance: for males 65.15 ± 2.82 and for females 61.78 ± 3.18. Mesiodistal width of maxillary anterior teeth: for males 52.55 ± 1.82 and for females 51.33 ± 2.50.
CONCLUSION: Within the limitations of this study, the study concluded there is a significant correlation between interalar, intercommissural, intercanthal, interpupillary distance, and mesiodistal width of maxillary anterior teeth in total subjects. In females, there is a significant correlation between interalar, intercanthal, interpupillary distance, and mesiodistal width of maxillary anterior teeth.

INTRODUCTION

Beauty is the pleasant experience seen with subjective senses, interpreted by our associations, filtered by a philosophy of life, and felt by intuition. The essence of beauty has been sought since the beginning of the time.[1]

“The face excels in beauty when compared with other anatomical divisions of the human beings” - Leonardo da vinci.[2] Face, the most expressive part of the human body is a significant part of self-image[3] as it determines an individual's social acceptance.[4] Poetry and literature for centuries have indicated that the facial beauty is contributed to a lot, by teeth[5] and it also gives one a unique beauty.[6]

Loss of teeth creates psychological trauma to the person as it affects the facial appearance and hence it is important that it is replaced in an esthetically pleasing and functionally comfortable manner.[4] One of the most influential factors for harmonious appearance and highly functional restoration for every denture wearer is a selection of an appropriate size, shape, and arrangement of maxillary anterior teeth. However, an elusive and challenging endeavor in achieving an esthetically pleasing form still remains, selection and arrangement of maxillary anterior teeth.[7]

It is with this view, this study was done to compare and evaluate the correlation of the facial measurements (interalar, intercommissural, intercanthal, and interpupillary distance) with mesiodistal width of maxillary anterior teeth between males and females.

MATERIALS AND METHODS

Subjects selected were dental students of Yenepoya Dental College, Mangalore including both males and females of age between 20 and 30 years with the regular alignment of maxillary anterior teeth.

Exclusion criteria included patients already undergone or undergoing prosthodontic or orthodontic treatment, proximal restorations on the distal surface of the canines, crowding of maxillary anterior teeth, spaced dentition, periodontal problems, neuromotor disorders like bell's palsy, trigeminal neuralgia, facial nerve paralysis, skeletal facial deformities like micrognathia, macrognathia, cleft palate, and subjects undergone maxillofacial surgery.

The measurements of interalar, intercommissural, intercanthal, interpupillary distance, maxillary anterior teeth width were made using vernier caliper. Each parameter was measured three times to ensure accuracy and mean was taken. The data were recorded on performa for statistical analysis.

The interalar distance was measured from the external width of the alae of the nose at the widest point [Figure 1], intercommissural distance from the widest outer surface of the corners of the mouth [Figure 2], intercanthal distance from the inner canthus of one eye to inner canthus of the other eye [Figure 3], and interpupillary distance from the mid pupil of one eye to mid pupil of the other eye [Figure 4]. The mesiodistal distal width of maxillary anterior teeth was measured on stone cast. The dental floss was placed between the distal surfaces of the maxillary canines from the region of the proximal contact points, and the mesiodistal width of the maxillary anterior teeth was marked with the marker on the dental floss and the mesiodistal width was measured using Vernier Caliper [Figure 5].

Figure 1

Recording of interalar distance

Figure 2

Recording of intercommissural distance

Figure 3

Recording of intercanthal distance

Figure 4

Recording of interpupillary distance

Figure 5

Measuring combined mesiodistal width of maxillary anterior teeth

RESULTS

Comparison of parameters between males and females was calculated using independent sample t-test [Graphs 1 and 2]. Statistical analysis showed a significant correlation between interalar, intercommissural, intercanthal and interpupillary distance and mesiodistal width of maxillary anterior teeth in all subjects of both males and females. The value of P < 0.05 considered to be statistically significant difference, and all the values obtained are <0.05.

Graph 1

Comparison of facial parameters in males and females

Graph 2

Comparison of mesiodistal width of maxillary anterior teeth in males and females

Pearson correlation test was used to find the correlation between interalar, intercommissural, intercanthal and interpupillary distance and mesiodistal width of maxillary anterior teeth in males and females [Graphs 3-6]. It showed a moderate correlation between intercanthal and interpupillary distance in males. In females, there was a significant correlation between interalar, intercanthal, interpupillary distance, and mesiodistal width of maxillary anterior teeth, but there was a moderate correlation between intercommissural and interalar distance.

Graph 3

Comparison of interalar distance and mesiodistal width in males and females

Graph 6

Comparison of interpupillary distance and mesiodistal width in males and females

Comparison of intercommissural distance and mesiodistal width in males and females

Comparison of intercanthal distance and mesiodistal width in males and females

Multiple linear regression between facial parameters and mesiodistal width of maxillary anterior teeth was calculated using ANOVA, and a regression equation for calculating the mesiodistal width of maxillary anterior teeth was observed.

Overall mesiodistal width = 62.91 + Interalar* (−0.20) + Intercommissural* (0.15) +

Intercanthal* (−0.31) + Interpupillary* (−0.04) + Gender* (1.86)

(Note: For gender: Male is 1 and female is 0)

Male mesiodistal width = 53.51 + Interalar* (−0.15) + Intercommissural* (0.13) +

Intercanthal* (−0.26) + Interpupillary* (0.10)

Female mesiodistal width = 70.14 + Interalar* (−0.21) + Intercommissural* (0.18) +

Intercanthal* (−0.33) + Interpupillary* (−0.16)

DISCUSSION

Selection of the maxillary anterior teeth plays a very significant role for achieving esthetics in complete denture. A major hurdle in clinical prosthodontics is selection and replacement of maxillary anterior teeth in the absence of pre-extraction records.[89]

Many attempts have been made to quantify the selection of the maxillary anterior teeth for the complete denture using facial measurements as guides.

The present study was an attempt to investigate the potential relationship between the interalar distance, intercommissural distance, intercanthal distance, interpupillary distance, and the combined mesiodistal width of maxillary anterior teeth.

Interalar distance and mesiodistal width of maxillary anterior teeth

The result of the present study showed that in 120 patients (60 males and 60 females) studied there is a significant correlation between interalar distance and the mesiodistal width of maxillary anterior teeth. In 60 males studied, there is no significant correlation between interalar distance and the mesiodistal width of maxillary anterior teeth. In 60 females studied, there is a significant correlation between the interalar distance and the mesiodistal width of maxillary anterior teeth.

This result can be substantiated with the results of the study conducted by Gomes et al. which states that there is a significant correlation between interalar and the combined mesiodistal width of the six anterior teeth, when observed from the frontal aspect[7] and also by Tripathi et al. which also implies a significant correlation between interalar width and intercanine distance.[10]

Intercommissural distance and mesiodistal width of maxillary anterior teeth

The result of the present study showed that there is a significant correlation between intercommissural distance and the mesiodistal width of maxillary anterior teeth in 120 subjects (60 males and 60 females) studied. In 60 males studied, there is no significant correlation between interalar distance and the mesiodistal width of maxillary anterior teeth. In 60 females studied, there is no significant correlation between intercommissural distance and the mesiodistal width of maxillary anterior teeth.

This result can be validated with the results of the study conducted by Al Wazzan et al. which showed no correlation between the width of the mouth and the mesiodistal width of the upper anterior teeth[11] and also by Fabiana Mansur Varjao and Sergio Sualdini Nogueria which showed a weak correlation between the distal of the canines and the distance between the corners of the mouth in the 4 racial groups.[12]

Intercanthal distance and mesiodistal width of maxillary anterior teeth

The result of the present study showed that in 120 patients studied (60 males and 60 females) there is a significant correlation between intercanthal distance and the mesiodistal width of maxillary anterior teeth. In 60 males studied, there is no significant correlation between intercanthal distance and the mesiodistal width of maxillary anterior teeth. In 60 females studied, there is a significant correlation between the intercanthal distance and the mesiodistal width of maxillary anterior teeth.

This result can be substantiated with the result of the study conducted by Gomes et al. which showed a significant correlation between inner canthal distance and the combined mesiodistal width of the six anterior teeth when observed from the frontal aspect.[7]

Interpupillary distance and mesiodistal width of maxillary anterior teeth

The result of the present study showed that in 120 subjects (60 males and 60 females) studied there is a significant correlation between interpupillary distance and the mesiodistal width of maxillary anterior teeth. In 60 males studied, there is no significant correlation between interpupillary distance and the mesiodistal width of maxillary anterior teeth. In 60 females studied, there is a significant correlation between the interpupillary distance and the mesiodistal width of maxillary anterior teeth.

This result can be corroborated with the result of the study conducted by Gomes et al. which showed a significant correlation between interpupillary distance and the combined mesiodistal width of the six anterior teeth when observed from the frontal aspect.[7]

CONCLUSION

The results of this study concluded there is a significant correlation between interalar, intercommissural, intercanthal, interpupillary distance, and mesiodistal width of maxillary anterior teeth in total subjects. In males, there is no significant correlation between interalar, intercommissural, intercanthal, interpupillary distance, and mesiodistal width of maxillary anterior teeth. In females, there is a significant correlation between interalar, intercanthal, interpupillary distance, and mesiodistal width of maxillary anterior teeth.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.