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.

Beyron’s 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 Begron’s 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. Saggital plane

2. Horizontal plane

3. 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).

Camper’s 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. Jaw relation stage

2. 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.

2. The Willis Gauge: - used for recording the vertical height before

extraction.

3. 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.

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 distance of the : photograph

Patients interpupillay = distance

Brow chin distance of : photograph

Patient’s brow –chin distance

4. 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 is measured using a measuring tape at the level of the

forehead.

o Width of the upper CI= Circumference of head 13

o Berry’s Biometric index :-

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 ½ 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 = Approximal3.3

Width of the 6 anterior teeth arranged on the curve of the properly

contoured occlusal rim .

4. H.Pound’s 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 caliper. This

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

the combined width of the anterior teeth.

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 patient’s 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.