ESTETIC DENTAR

CLINICO-STATISTICAL STUDY OF YOUNG PEOPLES

AESTHETIC LANDMARKS VARIATIONS
Asist. Univ. Dr. Andrei Macris1, Dr. Gh. Meret2
1
Dental Faculty, Fixed Prosthetic and Dental Occlusion Department,
Carol Davila University of Medicine and Pharmacy, Bucharest
2
General dentist, Bucharest

ABSTRACT
Purpose. To establish the most important esthetic landmarks variation and its interrelation on young Romanian peoples.
Material and method. To achieve data it was used a photo camera with feature specifications: 7,2 Mpx sensor, 3x optical zoom, self lens and self flash. Also it was setup on Macro function and it was used a limited
1-2,4 optical magnification. From 109 only 106 subjects were used (64 females and 42 males) with ages
between 22 and 30 years. 3 cases were no passed because the photos were compromised. All photos are
the copies of original photos (no edit software was used). Every subject was taken 8 photos: 4 facial frontal
bite, frontal vertical inocclusion (relaxed), frontal smiling, lateral bite; 4 intraoral frontal bites, frontal relaxed,
canine bite right and left. The follow aesthetic landmarks were analyzed: Incisors middle line vs. median facial line; the central incisors visibility (relaxed position); vestibular incisor curve; the upper frontal teeth visibility (smiling); labial lateral space; cervical and occlusal embrasures visibility; gingival zenith. The data obtained was processed with Excels (MS Office 2003) functions.
Results and conclusions. Incisors middle line vs. median facial line revealed an asymmetry on right side
twice more on female cases rather males. The vestibular incisor curve analysis revealed an equal percents
of normal and reversed curve distribution on males rather females higher percent of normal curve. The upper frontal teeth visibility (smiling) in percents was normal, or higher than normal, on females group, rather
on males group with a lower visibility than normal.
Keywords: esthetic landmarks, incisors visibility, interincisiv line, median facial line

INTRODUCTION
The esthetic function of dento-maxillary system
always has been placed at the higher importance
level like masticatory and fonatory functions. The
Romanian literature reviews did not revealed significant information about young populations esthetic analysis.
The most important esthetic landmarks which
are often use by physicians to evaluate patients esthetic function are: median facial line a connection landmark between teeth and facial esthetic,
incisors middle line, central incisors visibility (relaxed position), vestibular incisor curve and the upper frontal teeth visibility (smiling position) a

mandatory evaluation landmark. For accuracy of

study results have been also chose other three no
less important landmarks: visibility of labial lateral
space, cervical and occlusal embrasure visibility
and gingival zenith.

PURPOSE
The aim of the study is to offer to physicians a
statistic based information about Romanian young
people esthetic landmarks variation.
It has been choose a descriptive statistical study.
All the dates can be use finally to guide the doctors
on esthetic treatment plans.

Adres de coresponden:
Dr. Andrei Macris, 168 tirbei Vod Str., Bl. 20B, sc. A, ap. 8, Sect. 1, Bucharest
E-mail: andrei.macris@gmail.com

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MATERIAL AND METHOD

RESULTS

The study has a descriptive design and includes

109 cases with ages between 22 and 30 years old,
64 females and 42 males, which are students in Bucharest. The main reasons to choose this subjects
are represented by having a good dental status and
also the knowledge about dental esthetic problems.
We used a digital photo camera with 7,2 Mpx,
3x optical zoom lenses, self flash and macro function (a 1 to 2,4 magnification factor). From 109
cases only 106 cases were valid, 3 cases cannot be
used because improper photo technique. All the
data have been collected using photo technique because all the landmarks analysis and also all the
comparisons we had made are greater than 3 mm
wide. For esthetic in office analysis, well-known
the doctors make eye-comparisons, we expected to
obtain accuracy data on these photo analysis.
For each case we obtained 8 photos: 4 intraoral
photos: frontal bite, frontal relaxed, lateral left and
right canine centered; 4 facial photos: anterior
frontal bite, anterior relaxed, frontal smiling and
lateral bite. The intraoral photos have been used for
statistical analysis and the facial photos for made
corrections on intraoral evaluation. No photo-edit
software have been needed and used. For statistical
analysis we used Microsoft Excel 2003 statistical
functions. All the photos received a counting number containing: current number, case number, photo
number in each case, and an index which represent
sex and age for each subject. For every particular
landmark and also for every correlation between
landmarks we established a short counting system
to convert observed photo data to prior statistical
values. For example: on incisors middle line vs.
median facial line analysis, the landmark was analyzed using frontal smiling position and received 3
possible values 1 for right deviation, 2 for coincidence and 3 for left deviation. Also, any further
correlation between landmarks received this model
of conversion data.
First step was to analyze every landmark and
obtain data for each sex distribution and for sex
comparisons. Second step consist in establish connections between landmarks and obtain also statistical data: incisors middle line vs. median facial
line, the incisors curve vs. the upper frontal teeth
visibility (smiling), the upper frontal teeth visibility
(smiling) vs. lateral labial space, the upper frontal
teeth visibility (smiling) vs. cervical embrasures
visibility and the upper frontal teeth visibility (smiling) vs. gingival zenith.

First step landmarks statistic data:

1. Central incisors visibility (relaxed position):
sex distribution (all cases): not seen 52% females
and 38% males; 1/3 visibility 8% females and
only 2% males. These values was confirmed by sex
distribution (each sex): females 86% not seen and
14% 1/3 visibility; and males 95% not seen and
5% 1/3 visibility.
2. Incisors curve: sex distribution (all cases): reversed 19% females and 20% males; normal
42% females and only 20% males. These values
also was confirmed by sex distribution (each sex):
females 31% reversed and 69% normal; and males 50% reversed and 50% normal. We can remark a differnce of 19% between normal incisor
curve on females rather than males.
3. The upper frontal teeth visibility (smiling):
sex distribution (all cases): reduced 17% females
and 19% males; normal 40% females and only
20% males; increased 4% females and 1% males.
On sex distribution (each sex) we can see a slitghtly
diference curve distribution comparing with sex
distribution (all cases): females 28% reduced,
66% normal, 6% increased; and males 48% reduced, 50% normal and only 2% increased.
4. Labial lateral space: sex distribution (all cases): improper (malposition of teeth) 27% females and 20% males; ideal 31% females and 15%
males; improper (value discrepancy) only 2% females and 5% males. On sex distribution (each sex)
we can see a significant diference curve distribution comparing with sex distribution (all cases): females 45% improper (mallposition of teeth), 52%
ideal, 3% improper (value discrepancy); and males
50% improper (malposition of teeth), 38% ideal
and 12% improper (value discrepancy).
5. Cervical embrasures visibility: sex distribution (all cases): present 8% females and also 8%
males; absent 52% females and only 32% males.
These values was confirmed by sex distribution
(each sex): females 14% present and 86% absent;
and males 19% present and 81% absent. We can
observe a similar distribution on percentes to sex
distribution (each sex).
6. Gingival zenith: sex distribution (all cases):
acceptable (equal) gingival high 25% females
and 13% males; ideal 24% females and 18% males; least desirable high only 11% females and 8%
males. On sex distribution (each sex) we found: females 42% acceptable (equal) gingival high, 39%
ideal, 19% least desirable high; and males 33%
acceptable (equal) gingival high, 45% ideal and
21% least desirable high.

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Second step landmarks correlation:

1. Incisors middle line vs. median facial line
(Fig. 1).
The data revealed an asimmetry on right side
twice more on female cases rather males (Fig. 2).

FIGURE 3. The incisors curve (IC) vs. the upper frontal

teeth visibility (smiling) (VS)

FIGURE 1. Incisors middle line vs. median facial line sex

distribution (all cases)

FIGURE 4. The upper frontal teeth visibility (smiling) (VS)

vs. lateral labial space (LS)

(smiling) and absent cervical embrasures visibility.

The reason is also represented by small values obtained on visibility of upper teeth analysis.

FIGURE 2. Incisors middle line vs. median facial line sex

distribution (each sex)

2. The incisors curve vs. the upper frontal teeth

visibility smiling (Fig. 3).
On this landmark analysis we obtain a false value of 100% increased upper teeth visibility (smiling). The reason is represented by small values obtained on visibility of upper teeth analysis. Because
of a small percents of young people who had increased visibility, the data analysis was improper.
3. The upper frontal teeth visibility (smiling) vs.
lateral labial space (Fig. 4).
4. The upper frontal teeth visibility (smiling) vs.
cervical embrasures visibility (Fig. 5).
Also on this landmark analysis we obtain a false
value of 100% increased upper teeth visibility

FIGURE 5. The upper frontal teeth visibility (smiling) (VS)

vs. cervical embrasures visibility (CE)

5. The upper frontal teeth visibility (smiling) vs.

gingival zenith (Fig. 6).
On higher upper frontal teeth visibility we found
an acceptable presence of gingival zenith.

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46% to 53% on normal and reduced visibility of

upper frontal teeths landmark. From this point of
view this esthetic landmark comparison become
important because show us a balanced dental esthetic young peoples cases.

CONCLUSIONS

FIGURE 6. The upper frontal teeth visibility (smiling) (VS)

vs. gingival zenith (GZ)

DISCUSSIONS
There are differences between female group and
male group. Overall we have found both gropus
with a higher of 50% cases with normal, or close to
ideal, esthetic parametres. On female group there
are higher percents of cases with normal parametres rather male group.
For example on incisors middle line vs. median
facial line (sex distribution, for each sex), male
group present a slightly higher percent of overllaped situations than female group.
Also we found a convenient situation on the upper frontal teeth visibility (smiling) vs. lateral labial
space: ideal lateral space have an ideal situation in

1. Incisors middle line vs. median facial line

landmarks comparision: there is an asymetry on right side of young peoples, twice more on women
rather men. Finally, we recomand a higher attention
on clinical evaluation of midle lines landmarks
analysis on women cases.
2. Incisors curve landmark: on men cases there
are equal percents of normal and reversed situations and on women cases there is a higher percent of
normal situation. Concluding, we recomand a close
evaluation of smile on men cases.
3. The upper frontal teeth visibility (smiling)
landmark anlyse: the visibility is normal or higher
on female cases and reduced on males. The conclusion is also that in women cases the doctors must be
more sensitive on esthetic demands.
4. Labial lateral space: the data analysis show us
that is very important for doctor to evaluate lateral
teeths malpositions and implications on esthetic
young patients expectation.
5. On gingival zenith analysis: men cases presented an ideal situation rather than women cases,
for wich we can affirm they presented just an acceptable situation.

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