title: Quantifying the selection of maxillary anterior teeth using intraoral and extraoral anatomical landmarks.
abstract: BACKGROUND
  One of the major hurdles in clinical prosthodontics has been the selection and replacement of maxillary anterior teeth in the absence of pre-extraction records. The aim of this study was to determine if a relationship exists between intraoral and extraoral facial measurements that could assist dental practitioners in selecting esthetically appropriate maxillary anterior teeth in the absence of pre-extraction records.
  
  
  METHODS
  A cross-sectional study design was used with a sample size of one hundred and twenty participants. A questionnaire was used to identify the selection criteria and a photograph was taken for facial measurements using digitally calibrated software. Ninety-eight participants met the selection criteria and were included in the study. Measurements of intraoral landmarks were taken from stone casts of maxillary impressions using calibrated digital calipers. Each measurement was completed by two assessors to obtain mean values. Data were statistically analyzed using SPSS version 17 software. Data were assessed by one way analysis of variance (ANOVA) followed by post hoc (p < 0.05) to find any difference between tested groups. Pearson coefficients were used to determine whether correlation exists between measurements.
  
  
  RESULTS
  The mean values for intraoral maxillary landmarks were: Central incisor width = 8.39 mm, circumferential canine tip to canine tip distance = 34.89 mm, arch width = 48.24 mm, left arch length = 45.24 mm, right arch length = 45.56 mm. The mean values for extraoral landmarks were: Intercanthal distance = 33.24 mm, interpupillary distance = 60.68 mm, interalar distance = 38.27 mm, intercommissure distance = 50.61 mm. Differences existed within subgroups for all intraoral and extraoral measures. A weak positive correlation existed between intraoral (r < 0.4) and extraoral measurements (r < 0.38) that remained consistent when examined by gender.
  
  
  CONCLUSIONS
  This study showed that the average length and width of the maxillary arch and interalar width were the anatomical landmarks that provided the strongest predictive relationship with anterior maxillary teeth (r = 0.38 - 0.4). Using these dimensions an average multiplying factor can be used to calculate maxillary incisor width or canine tip to canine tip distance. As the predictive strength is not strong, the authors recommend its use as a preliminary guide for determining the width of the maxillary anterior teeth during the initial selection of artificial teeth in the absence of pre-extraction records.
  
  
  CONCLUSIONS
  The results of this study can be used to help dentists select the size of artificial maxillary anterior teeth in the absence of pre-extraction records.
authors.affiliation: Department of Biomaterials, Faculty of Dentistry, The University of Sydney, Westmead Oral Health Centre Level, Westmead Hospital, Australia. ayman.ellakwa@sydney.edu.au
authors.forename: Ayman
authors.initials: A
authors.lastname: Ellakwa
authors.forename: Kieran
authors.initials: K
authors.lastname: McNamara
authors.forename: Jasdeep
authors.initials: J
authors.lastname: Sandhu
authors.forename: Kedall
authors.initials: K
authors.lastname: James
authors.forename: Amit
authors.initials: A
authors.lastname: Arora
authors.forename: Iven
authors.initials: I
authors.lastname: Klineberg
authors.forename: Ali
authors.initials: A
authors.lastname: El-Sheikh
authors.forename: F Elizabeth
authors.initials: FE
authors.lastname: Martin
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks / Q000033:anatomy & histology*; D002508:Cephalometry / Q000379:methods*; D003430:Cross-Sectional Studies; D003481:Cuspid / Q000033:anatomy & histology*; D003724:Dental Arch / Q000033:anatomy & histology; D017267:Dental Prosthesis Design; D004955:Esthetics, Dental; D005145:Face / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D007180:Incisor / Q000033:anatomy & histology*; D008046:Lip / Q000033:anatomy & histology; D008297:Male; D008437:Maxilla / Q000033:anatomy & histology*; D009666:Nose / Q000033:anatomy & histology; D009811:Odontometry / Q000379:methods*; D009915:Orbit / Q000033:anatomy & histology; D010781:Photography; D011680:Pupil; D012984:Software; D014093:Tooth, Artificial