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Table of Contents   
ORIGINAL RESEARCH  
Year : 2019  |  Volume : 30  |  Issue : 4  |  Page : 496-499
The incisive papilla as a guide to maxillary anterior teeth position for complete dentures


1 Department of Prosthetic Dentistry, SCB Dental College and Hospital, Cuttack, Odisha, India
2 Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India
3 Department of Oral and Maxillofacial Pathology, HiTech Dental College and Hospital, Bhubaneswar, Odisha, India
4 Department of Oral and Maxillofacial Surgery, HiTech Dental College and Hospital, Bhubaneswar, Odisha, India

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Date of Submission08-Aug-2018
Date of Decision28-Oct-2018
Date of Acceptance05-Nov-2018
Date of Web Publication18-Nov-2019
 

   Abstract 

Context: The incisive papilla as a guide for complete dentures. Aims: To evaluate incisive papilla as a guide to maxillary anterior teeth position for complete dentures. Settings and Design: To measure the linear distances from the incisive papilla to the maxillary central incisors in Odia population and compare it to other ethnic groups. Subjects and Methods: The subjects were selected following inclusion & exclusion criteria. The impressions of maxillary & mandibular arches were taken and poured with die stone to produce the cast. The incisive papilla & incisors were marked on casts with a pencil. The photographs of casts were traced on an acetate tracing paper. The anterior-most points of maxillary incisors, anterior, middle & posterior-most points of incisive papillae were marked on the tracing as A, I1,M, I2 respectively. The A to M and A to I2 distances were measured, analysed and compared with Caucasians, Southern Chinese, and Dravidians. Statistical Analysis: Independent sample “t” test and Analysis of Variance followed by the post-hoc Bonferroni test were used. Results: A sample of 100 subjects in the age group of 20 to 40 years with was selected. The A to M measurements of Odia population differed significantly from Caucasians but were similar to Southern Chinese population. The A to I2 measurements of Odia population differed significantly from Caucasians & Dravidians but were similar to Southern Chinese. Conclusion: The linear measurements from incisive papilla to maxillary incisors of the Odia population are similar to that of Southern Chinese but differ significantly from Caucasians and Dravidians.

Keywords: Complete dentures, incisive papilla, maxillary incisors, Odia population

How to cite this article:
Kar R, Mishra N, Pati D, Birmiwal KG, Gupta A, Raut S. The incisive papilla as a guide to maxillary anterior teeth position for complete dentures. Indian J Dent Res 2019;30:496-9

How to cite this URL:
Kar R, Mishra N, Pati D, Birmiwal KG, Gupta A, Raut S. The incisive papilla as a guide to maxillary anterior teeth position for complete dentures. Indian J Dent Res [serial online] 2019 [cited 2019 Dec 12];30:496-9. Available from: http://www.ijdr.in/text.asp?2019/30/4/496/271066

   Introduction Top


Complete dentures with properly positioned teeth are required to restore the contour of face in edentulous individuals. The maxillary anterior teeth should be positioned as close to positions occupied by natural teeth. The linear measurements from the incisive papilla to the maxillary central incisors have been used as a guide to position maxillary anterior teeth for complete dentures.

The studies on linear measurements from the incisive papilla to the maxillary central incisors has been carried out among the Caucasians,[1],[2],[3],[4],[5],[6] Chinese,[7] Jordanian,[8] Thai [9] and Dravidian [10] population. The Odia population of Eastern India which has a distinct linguistic and geographical identity, has no such recommended measurements of the incisive papilla to maxillary incisors. We hypothesized that the measurements from the incisive papilla to incisors in other ethnic groups will be applicable to Odia population of Eastern India.


   Subjects and Methods Top


Study design

This was an observational and analytical study carried out in the Department of Prosthetic Dentistry and Dental Materials. The institutional ethics committee (Regd no ECR/84/Inst/OR/2013) approval for this study was obtained vide IEC/IRB No: 648/04.05.2018. Informed consent of the subjects were obtained prior to enrolment for this study.

Study sample

The subjects were chosen from the population of patients, attendants of patients, student volunteers of the Hospital. The samples were selected on the criteria that all incisors, canines, premolars, and first molars were present in maxillary arches, and there was no gross misalignment, over- eruption and history of orthodontic treatment.

Production of cast and standardization of occlusal plane

The impressions of maxillary and mandibular arches were taken with irreversible hydro-colloid materials (Algitex, DIL, Batch no 776, Dental products of India), and poured with die stone type V (B.N. Chemicals, Kolkata, India) to produce casts. The casts thus produced were flattened at its base by a trimmer. These casts were standardized with its occlusal plane parallel to the horizontal plane.

Marking of landmarks on cast

The incisive papilla and the labial contour of the maxillary central incisors were marked on the cast. The incisive papilla was outlined with a sharp pencil (Natraj 621 HB pencil, India). The most labial contour of the central incisors was marked by means of a surveyor (Ney surveyor, Dentsply, Germany).

Photographic image

The casts were placed on the platform of photographic copying stand. A metal ruler (Camlin Pvt Ltd, India) was placed alongside the cast at the same level as that of the occlusal plane. A photograph was taken with a camera (Nikon FN3 with a 105 mm macro lens, Nikon Corporation Tokyo, Japan). The photograph with one to one ratio was produced from negative using the ruler as a guide.

Tracing and measurements

The photograph was traced on an acetate tracing paper (Gordon Harris 110 GSM matte 003”). A straight line was drawn just touching the anterior-most points on the labial contour of maxillary central incisors. The anterior-most & posterior-most points of incisive papilla were marked as I1& I2 respectively. A second straight line was drawn intercepting the first line and touching the anterior & posterior-most points of the incisive papilla. The mid-point of incisive papilla was determined by dividing the distance between the anterior and posterior-most points of the incisive papilla. The intersection of the first & second line was marked as point A. The middle, anterior & posterior-most points of incisive papilla were marked as M, I1, & I2 respectively as shown in [Figure 1].
Figure 1: Tracing of the middle, anterior & posterior-most points of incisive papilla on the acetate paper are marked as M, I1, & I2 respectively

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The following distances were measured in millimetres using a metal ruler (Camlin Pvt Ltd, India). The linear distances mentioned below were recorded five times and the mean of five measurements was analysed.

I) A to M: The anterior-most labial contour of central incisors to the midpoint of the incisive papilla.

II) A to I2: The anterior-most labial contour of central incisors to the posterior-most point of the incisive papilla.

Statistical analysis

The data collected were analysed using IBM SPSS 24.0 software (SPSS South Asia Pvt Ltd). The mean of A to M and A to I2 between two groups were compared by independent sample “t” test and among three groups by Analysis of Variance (ANOVA) followed by the post-hoc Bonferroni test.


   Results Top


Fifty males with mean age in years 29.16 ± 5.92 and fifty females with mean age in years 26.76 ± 5.17 were selected following the inclusion and exclusion criteria. Forty-six subjects had class I, thirty-nine subjects had class II and fifteen subjects had class III incisor relationships. The correlation of linear measurements A to M and A to I2 were analysed for sexes and classes of occlusion. Besides the mean A to M of the Bengali population was compared with that of the Caucasians [6] & Southern Chinese.[7] The mean A to I2 of the Odia population was compared with that of the Caucasian, Chinese, and Dravidian.[10]

Comparison by Gender in Odia population

The A to M (P = 0.895) & A to I2 (P = 0.372) measurements of Odia population had no statistically significant differences between males and females as shown in [Table 1] and [Graph 1], [Graph 2].
Table 1: Comparison of Anterior most labial contour of central incisors to the mid-point of the incisive papilla and anterior-most labial contour of central incisors to the posterior-most point of incisive papilla by gender in Odia population

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Comparison of Classes of Occlusion in Odia population

The A to M (P = 0.658) & A to I2 (P = 0.108) measurements of Odia population had no statistically significant differences among the classes of occlusion as shown in [Table 2] and [Graph 3], [Graph 4].
Table 2: Comparison of Anterior most labial contour of central incisors to the mid-point of the incisive papilla and anterior-most labial contour of central incisors to the posterior-most point of incisive papilla among classes of occlusion in Odia population

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Comparison with Caucasians, Southern Chinese, and Dravidian:

The A to M measurement of Odia population differs significantly from Caucasians [6] (P = 0.0019) but is similar to Southern Chinese population [7] (P = 0.2305). The A to M measurements of Odia population could not be compared with Dravidians [10] as the reported study on Dravidian population had no such measurements. The A to I2 measurements of Odia population differs significantly from Caucasian (P = 0.0001), & Dravidian population [10] (P = 0.001) but is similar to Southern Chinese population (P = 01381) as shown in [Table 3].
Table 3: Comparison of Anterior most labial contour of central incisors to the mid-point of the incisive papilla and anterior-most labial contour of central incisors to the posterior-most point of incisive papilla among Ethnic Groups

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Comparison of Odia population with Southern Chinese for gender & classes of occlusion.

Comparison of the measurements of the Odia Population with Southern Chinese population had no statistically significant differences for A to M and A to I2 as shown in [Table 4].
Table 4: Comparison of Odia population with Southern Chinese for classes of occlusion and gender

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   Discussion Top


The linear measurement of incisive papilla to the maxillary central incisors has been used as a guide in positioning of maxillary anterior teeth in complete dentures. A study in Odia population of eastern India was carried out to evaluate whether the distances from incisive papilla to maxillary central incisors may be used as a guide for positioning maxillary anterior teeth in complete dentures. The hypothesis was that the linear measurements from the incisive papilla to maxillary incisors of Caucasians,[6] Southern Chinese [7] and Dravidians [10] will be applicable to Odia population.

The study by Harper,[11] concluded that the distance from the centre of incisive papilla to incisal edges of maxillary central incisor was 5 to 8 mm. McGee,[1] Hicky,[2] Martone,[3] stated that labial surface of central incisors should be placed 8 to 10 mm anterior to the middle of the incisive papilla. Ortman et al.[4] and Solomon et al.,[10] observed that the average distance between the labial surface of central incisor and posterior point of incisive papilla is 12.454 ± 3.867 mm and 11.92 ± 2.1 mm respectively. Lau et al.[7] stated that the mean distance from the mid-point and posterior-most point of incisive papilla to incisors were 9.1 ± 1.11 mm, and 12.71 ± 1.49 mm respectively.

The Odia population had no statistically significant differences between males and females and among the classes of occlusion in A to M & A to I2 measurements. The linear measurements A to M of Odia population differed significantly from Caucasians (P = 0.0019) but were similar to Southern Chinese population (P = 0.2305). The linear measurement of A to I2 in Odia population differed significantly from Caucasian (P = 0.0001) and Dravidian population (P = 0.001) but was similar to Southern Chinese population (P = 0.1381). Odia population had no difference between males and females in A to M & A to I2 measurements which is similar to findings of Grave et al.,[12] Lau et al.,[7] Soloman et al.[10] The mean A to I2 measurements of Caucasians by Shin Soo-Yeon, Kim Tae Hyung [6] differed significantly (P < 0.05) between males & females which is in contrast to that of Odia population.

The linear measurements from incisive papilla to maxillary central incisors of the Odia population is similar to the Southern Chinese but differed significantly from Caucasians & Dravidians.


   Conclusion Top


The linear measurements from incisive papilla to maxillary incisors of the Odia population are similar to that of Southern Chinese but differ significantly from Caucasians and Dravidians.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
McGee GF. Tooth placement and base contour in denture construction. J Prosthet Dent 1960;10:651-7.  Back to cited text no. 1
    
2.
Hicky JC, Boucher CO, Woelfel JB. Responsibility of the dentist in complete denture construction. J Prosthet Dent 1962;12:637-53.  Back to cited text no. 2
    
3.
Martone AL. Clinical applications of concepts of functional anatomy and speech science to complete denture prosthodontics. J Prosthet Dent 1963;13:204-28.  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
    
5.
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. 5
    
6.
Shin SY, Kim TH. Correlation between the size of the incisive papilla and the distance from the incisive papilla to the maxillary anterior teeth. J Dent Sci 2016;11:141-5.  Back to cited text no. 6
    
7.
Lau GC, Clark RF. The relationship of the incisive papilla to the maxillary central incisors and canine teeth in Southern Chinese. J Prosthet Dent 1993;70:86-93.  Back to cited text no. 7
    
8.
Amin WM, Taha ST, Al-Tarawneh SK, Saleh MW, Ghzawi A. The relationships of the maxillary central incisors and canines to the incisive papilla in Jordanians. J Contemp Dent Pract 2008;9:42-51.  Back to cited text no. 8
    
9.
Bengakul C. Relation of the maxillary canines to the incisive papilla. J Dent Assoc Thai 1983;33:178-89.  Back to cited text no. 9
    
10.
Solomon EG, Arunachalam KS. The incisive papilla: A significant landmark in prosthodontics. J Indian Prosthodont Soc 2012;12:236-47.  Back to cited text no. 10
    
11.
Harper RN. The incisive papilla – Basis of technic to reproduce the positions of the key teeth in prosthodontia. J Dent Res 1948;27:661-8.  Back to cited text no. 11
    
12.
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. 12
    

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Correspondence Address:
Dr. Niranjan Mishra
Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack - 753 007, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_620_18

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