Correlation Between Maxillary Central Incisor Crown Morphology and Mandibular Dental Arch Form in Normal Occlusion Subjects
Correlation Between Maxillary Central Incisor Crown Morphology and Mandibular Dental Arch Form in Normal Occlusion Subjects
Correlation Between Maxillary Central Incisor Crown Morphology and Mandibular Dental Arch Form in Normal Occlusion Subjects
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1Department of Oral Biology, Dental School, USC - Sagrado Coração University, Bauru, SP, Brazil
2Department of Orthodontics, School of Health, UMESP - Methodist University of São Paulo,
São Bernardo do Campo, SP, Brazil
3Department of Forensic Dentistry, Ribeirão Preto Dental School,
The aim of this study was to evaluate the correlation between the morphology of the mandibular dental arch and the maxillary central
incisor crown. Cast models from 51 Caucasian individuals, older than 15 years, with optimal occlusion, no previous orthodontic
treatment, featuring 4 of the 6 keys to normal occlusion by Andrews (the first being mandatory) were observed. The models were
digitalized using a 3D scanner, and images of the maxillary central incisor and mandibular dental arch were obtained. These were
printed and placed in an album below pre-set models of arches and dental crowns, and distributed to 12 dental surgeons, who were
asked to choose which shape was most in accordance with the models and crown presented. The Kappa test was performed to evaluate
the concordance among evaluators while the chi-square test was used to verify the association between the dental arch and central
incisor morphology, at a 5% significance level. The Kappa test showed moderate agreement among evaluators for both variables of
this study, and the chi-square test showed no significant association between tooth shape and mandibular dental arch morphology. It
may be concluded that the use of arch morphology as a diagnostic method to determine the shape of the maxillary central incisor is
not appropriate. Further research is necessary to assess tooth shape using a stricter scientific basis.
Correspondence: Dr. Luiz Renato Paranhos, Rua Padre Roque, 958, Centro, 13800-033 Mogi Mirim, SP, Brasil. Tel.: +55-19-3804-4002. e-mail:
paranhos@ortodontista.com.br
form, among other traits, are genetically determined by maxillary incisor shape and mandibular arch form in
many genes from the parents (3,4). order to facilitate the production of complete dentures.
In the early 20th century, tooth shape was classified
according to facial shape, but inverted, and teeth were MATERIAL AND METHODS
grouped according to different geometric shapes: square,
triangular and oval (5). This classification contributed Fifty-one cast models from Caucasian individuals
somewhat to the creation of complete dentures. older than 15 years with healthy teeth and normal
The correct choice of artificial tooth size begins by occlusion were used. All patients had at least 4 of the 6
selecting the size and width of the six anterior maxillary keys to normal occlusion by Andrews, with the first key
teeth, although there is no consensus among authors (6) being regarded as essential for sample selection. Patients
regarding the existence of methods for such selection. In with craniofacial malformations, facial asymmetries and
clinical settings for all dental specialties, it is essential odontogenic anomalies were excluded from the sample
to use the correct proportion between teeth and face, in as well as models featuring lab errors and fractured teeth.
order to make forms more balanced and harmonious. The cast models were digitized using a 3D scanner
During oral rehabilitation, it is fundamentally important (dw5-140; Dental Wings, Montreal, Quebec, Canada).
to know the anatomical traits of the arches and dental The captured images were automatically processed
crowns, particularly while selecting artificial teeth for using Dental Wings software, generating a “.stl” file for
a total prosthesis. The dentist’s work is simple when each model. Then, the maxillary incisor and mandibular
the patient has photographic records previous to the dental arch images were captured using the Print Screen
extractions; the lack of a record prior to teeth extraction keyboard command and exported to CorelDRAW X3
hinders the reproduction of the size of the anterior (Corel Corporation, Ottawa, ON, Canada) vectoring
dental segment for a fully edentulous mouth. Thus, we software, in which they were cropped. Considering the
sought with this work to verify the correlation between morphology of the dental arch, the references were the
Figure 1. 3D scans of the mandibular arch. A= Arch exported; B= Marking of the incisal edge of the incisors and cusp tip of mandibular
canines, premolars and molars; C= Demarcation of Angle’s line of occlusion; D= Final morphology of the mandibular dental arch.
incisal edge of the incisors, cusp tip of the canines, buccal classification of the dental arch and the morphology of
cusp tip of the premolars and molars, thus establishing the central incisor, among examiners, the Kappa test was
Angle’s line of occlusion (Fig. 1). In order to improve used and interpreted according to Landis and Koch (7).
visualization, the image of the right maxillary central To verify the correlation between arch form and incisor
incisor was resized to 10 cm and set in negative, with morphology, chi-square was performed.
a dark background, in order to improve visualization A 5% significance level was adopted for all
(Fig. 2). tests and calculations were made using Statistics for
After that, the images were printed in the center WindowsTM version 5.1 (StatSoft Inc., Tulsa, OK, USA).
of a 90 g/m2 white paper, below pre-set models of
arches and dental crowns, as previously reported (2). RESULTS
Each sheet showed the tooth models classified as
square, oval and triangular, as well as the arches with System and casual errors tests showed no
the same denominations. All images of the arches and statistically significant results, demonstrating a good
crowns were then distributed separately to 12 dentists, reliability of the method (p<0.05). The result of the
who were requested to indicate the most closely form Kappa test showed significant concordance for both arch
that resembled the models of arches and crowns. After form and tooth shape, being greater for the arch (k=0.55)
1 week, the answers were collected. than for teeth (k=0.52) (p<0.05). According to Landis
To evaluate method error, a second analysis and Koch (7), the concordance value was “moderate”
was carried out by 3 dentists chosen at random. The for both arch and teeth.
approximated interval between the first and second Arch forms and tooth shapes were chosen
analysis was 2 weeks. To verify system and casual according with the most part of the evaluators opinions,
errors, the paired t-test and Dahlberg’s error formula once the objective was not to calculate an average, but
were used, respectively. To verify the concordance of the to relate one kind of arch with one kind of tooth shape.
Figure 2. 3D scans of the maxillary right incisor. A= Tooth exported; B= Delimitation of tooth morphology; C= Isolated image of the
incisor crown; D= Negative image of the crown.
The chi-square test showed no statistically significant research group (2). This is likely due to characteristics
correlation between arch form and tooth shape, as shown of the sample, such as gender, and the evaluation
in Table 1 (p=0.480). The prevalent form for both teeth methodology. For women, the oval (round) or square
and arch morphology was the oval. shapes should be preferentially chosen and, for men,
rectangular with rounded edges (square-round) is the
DISCUSSION most common (14). Moreover, women have teeth with
different size than men (15). The aesthetic perception of
Several methods have been applied to choose lay people and dentists using photographs to associate
the ideal tooth shape, particularly maxillary incisors the smile with maxillary central incisor shape was
in totally edentulous patients (5,8,9). The relationship also evaluated (16). The photos were altered to show
between teeth and other facial structures has already 3 different tooth shapes (square, conic and oval),
been studied, but the only significant finding was that associating them with each facial contour, totaling 18
there are an appropriate ratio between the dimensions images. The oval-shaped tooth was the most popular
of a patient’s hard palate with the sum of six maxillary among dentists, but there was no concordance between
frontal teeth (10). In addition, some authors (11,12) the shapes of the face and the maxillary central incisor.
have found a possible association between tooth shape Izard (17) has stated that dental arch width has
and dental arch form, and are constantly seeking for a a positive correlation with facial width and that the
more efficient and reliable method to choose the shape of dimensions of the dental arches are compatible with
artificial teeth during the construction of total prostheses. the different facial types. Individuals with a shorter face
Patient oral rehabilitation must take into (brachyfacial) tend to have excessively broad arches,
consideration factors such as shape, placement and while the opposite occurs with dolichofacial individuals
color of the maxillary central incisors; these are key (18,19). Regardless of morphologic variety, there seems
characteristics to obtain an aesthetically harmonious to be a direct relationship between tooth size and arch size
smile (13), contributing to improve the facial balance. (15,20), considering that broad maxillary and mandibular
Nevertheless, sex, age, ethnicity and even the personality dental arches usually have larger teeth (11,12) and that
and aesthetic wishes of each patient must be considered. ethnic differences influence the size and shape of teeth
In the present study, the morphology of the and arches (21,22).
maxillary central incisor was mostly oval (47.06%), The present study did not find an association
followed by square (31.37%) and triangular (21.57%) between arch morphology and tooth shape. Nevertheless,
(Table 1). This prevalence of maxillary central incisor it is interesting to notice that the oval tooth shape was
morphology was evaluated in a recent study of our the most prevalent in oval-arch individuals. These
results is in agreement with those of other authors
(13,23) and diverge from the study of Al-Khatib et al.
Table 1. Correlation between mandibular dental arch form and (15). This difference may be due to ethnical differences
maxillary central incisor shape. of the samples, as well as the characteristic of the
Tooth shape occlusion. Other studies that found correlation used
Arch form Total the measurements of other anatomical landmarks, such
Oval Square Triangular
as face length (24), inverted facial shape, bizygomatic
n 11 8 2 21 distance (25), pterygomaxillary notches (8), as well as
Oval
(%) (52.4) (38.1) (9.5) (100.0) different methods of image classification and analysis.
Sellen et al. (13), using a sophisticated method of
n 8 6 6 20
Square image superimposition, analyzed the correspondence of
(%) (40.0) (30.0) (30.0) (100.0) 4 aesthetic values: face shape, tooth shape, dental arch
n 5 2 3 10 form and palatal contour form. The most significant
Triangular correspondence was between arch form and facial
(%) (50.0) (20.0) (30.0) (100.0)
shape (28%), followed by a low correspondence (24%)
n 24 16 11 51
Total between dental arch form and tooth shape. Some years
(%) (47.1) (31.4) (21.6) (100.0) later, Berksun et al. (23), using standardized digital
photographs, attempted to verify a subjective correlation
χ2=3.48; p=0.480.
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