Medical

Communication

Biosci. Biotech. Res. Comm. 10(2): 143-147 (2017)

Evaluation of the relationship between upper

intercanine and inner canthal distances in

selected patients

Hamid Neshandar Asli

* and Mastooreh Ganjeh Khosravi

Associate Professor

Dentist Dental Sciences Research Center, Department of Prosthodontics, Faculty of Dentistry, Guilan

University of Medical Sciences, Rasht, Iran

ABSTRACT

Esthetics is one of the important treatment goals in prosthetic dentistry. The correct choice of anterior teeth in terms

of size and appearance is very effective to the success of the prosthetic treatment. One of the ways to determine the

size of the anterior teeth is using facial indices. The aim of this study was to determine the relationship between

the upper intercanine width and the inner intercanthal distance. In this cross- sectional study, 114 patients admitted

to the Guilan Faculty of Dentistry (62 women and 52 men), over the age of 18 who were eligible, were randomly

selected. Inner intercanthal distance and the distance between the tips of the upper canines were measured with a

digital caliper. Data were analyzed using Pearson’s correlation coef cient analysis, independent and paired t-test. The

mean of intercanthal distance and intercanine width was 30.75 and 34.56mm, respectively. A signi cant relationship

existed between intercanthal distance and intercanine width. It was found the biometric ratio of 1 to 1.13 could be

used to estimate intercanine width. These results could be used as a helpful guide for selection of anterior teeth width

in the population of patients. This biometric ratio may not be reliable in women.

KEY WORDS: INTERCANTHAL DISTANCE, INTERCANINE WIDTH, ESTHETICS

143

ARTICLE INFORMATION:

*Corresponding Author: dr.neshandarasli@yahoo.com

Received 12

Feb, 2017

Accepted after revision 21

June, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

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144 EVALUATION OF THE RELATIONSHIP BETWEEN UPPER INTERCANINE AND INNER CANTHAL DISTANCES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Hamid and Mastooreh

INTRODUCTION

Esthetics is a primary consideration for patients seek-

ing prosthodontic treatment. The development of new

dental materials and techniques has led to a greater

number of treatment options that maximize the likeli-

hood of an attractive outcome (Owens et al. 2002). The

goal is to have the maxillary anterior teeth restore opti-

mal dentolabial relations in harmony with the overall

facial appearance. However, there is little scienti c data

in the dental literature to use as a guide for de ning

the proper size and shape of anterior teeth or determin-

ing normal relationships for them (Hasanreisoglu et al.

2005).

The eyes, the mouth and the interplay of the muscles

of facial expression around these organs telegraph the

personality and the moods of the individual. The ante-

rior teeth framed by the lips are the dominant features

of the mouth when the components of the oral region

of the face and the oral cavity are in harmony that

uniquely human gesture, the smile, can be a most pleas-

ing and attractive attribute for a person (Asal et al 2011).

An important element of prosthetic treatment of eden-

tulous patients is determination of size, shape and color

of arti cial anterior teeth that will restore the natural

dentolabial harmony, as well as the dentofacial structure

disturbed by teeth loss (Strajni et al. 2013).

It is a fact the various methods and indicators were

used to determine the size of arti cial anterior teeth

for edentulous patients but making the right choice is

extremely important for both functional and physiog-

nomic rehabilitation of these patients. It is therefore

necessary to establish parameters that are as objective

as possible in order to achieve optimal occlusion recon-

struction in prosthetic treatment of edentulous patients

(Baer and Reynolds, 1992).Physiognomic prostethics

develop one’s ability of observing space and one’s sense

of plastic restitution, which is necessary for all clini-

cal and technical works (Gonçalveset al. 2009). Accord-

ing to physiognomic standards, the visibility of anterior

teeth is determined by their correlation with the upper

and the lower lip (Gonçalveset al. 2009). Coincidence

between the canine distal aspects and commissures was

recorded only within 8% of both Egyptian and Saudi

populations. Additionally, within the Egyptian popu-

lation, coincidence was recorded only at Class-I ridge

relationship (Asal et al 2011). Studies on anthropometric

facial characteristics and the jaw complex, as well as

studies on their interrelations with natural teeth have

given us the knowledge of their mutual individual har-

mony. A great number of conducted studies on the

human face prove the existence of signi cant variations

in parameters among different races, nations and popu-

lations, as well as among individuals (Knezovic et al.

2007).

The proper teeth arrangement and occlusal verti-

cal dimension are the key elements contributing to the

dento-facial beauty of edentulous patients. In the lit-

erature many anthropometric studies have been done to

standardize the tooth position in dental arch but most

of the studies were concerned for anterior teeth. Scarce

studies have examined the scienti c methods for deter-

mining the positioning of posterior teeth in complete

dentures (Debnath et al. 2014). Attempts were done to

determine accurate correlation between maxillary ante-

rior teeth, teeth size and face beauty, but scarce infor-

mation exist on the relationship between the upper

intercanine distance and the inner canthal distance and

face beauty. For instance, MavrosKouf and Richie (1981)

demonstrated some relationship between the nasal width

and the intercanine distance which suggested its use to

establish the width of the anterior teeth. So, the aim

of the current study was to estimate the relationship

between the upper intercanine distance and the inner

intecanthal distance in selected patients.

MATERIAL AND METHODS

In this cross- sectional study, 114 patients (62 women

and 52 men) admitted to the Guilan Faculty of Den-

tistry (Rasht, Iran) were selected. The inclusion criteria

were over the age of 18, had no asymmetry, disorder

or abnormality on eye and eye socket without previ-

ous surgery. The age of the patients was between 20-48

years old. Inner intercanthal distance and the distance

between the tips of the upper canines were measured

with a digital caliper.

STATISTICAL ANALYSIS

Results are expressed as means ± Sd. Differences between

groups were tested for statistical signi cance by paired

and independent t test, Pearson’s correlation coef cient

analysis using one-way variance analysis (ANOVA)

using SPSS statistical software. P<0.05 were considered

to denote signi cant differences between groups.

RESULTS

The results of the relationship between the upper interca-

nine distance and the inner canthal distance in patients

are presented in table 1-7. The mean intercanine to

intercanthal distance was 1.14 ± 0.063 and 1.12 ± 0.111

in men and women (table 1).

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS EVALUATION OF THE RELATIONSHIP BETWEEN UPPER INTERCANINE AND INNER CANTHAL DISTANCES 145

Hamid and Mastooreh

Table 1. The intercanine to intercanthal

distance (mm) ratio in patients

(Mean ± Sd) Min Max

Male 1.14 ± 0.063 1.0 1.31

Female 1.12 ± 0.111 0.9 1.47

Total 1.13 ± 0.093 0.9 1.47

Table 2. the intercanthal to intercanine

distance (mm) ratio in patients

(Mean ± Sd) Min Max

Male 0.88 ± 0.048 0.76 1

Female 0.91 ± 0.088 0.68 1.11

Total 0.89 ± 0.074 0.68 1.11

Table 3. The mean distance of the upper

canines tips (mm) in patients

(Mean ± Sd)

-test P value

Male 34.93 ± 1.87 1.926 0.053

Female 34.19 ± 2.16

Table 4. The mean of the intercanthal distance

(mm) in patients

(Mean ± Sd)

-test P value

Male 30.64 ± 1.73 -0.610 0.543

Female 30.86 ± 2.55

Table 5. The comparison of the distance of the upper

canines tips with intercanthal (mm) in male

(Mean ± Sd) Paired

test P value

Intercanthal 30.61 ± 1.731 -17.157 <0.0001

Canine 34.93 ± 1.823

Table 6. The comparison of the distance of the upper

canines tips with intercanthal (mm) in female

(Mean ± Sd) Paired

test P value

Intercanthal 30.86 ± 2.553 -8.363 <0.0001

Canine 34.19 ± 2.158

Table 7. Correlation between upper canines

tips with intercanthal (mm) in patients

Patients R square P-value

Male 0.495 0.000

Female 0.125 0.333

Total 0.231 0.014

Based on the table 2, the intercanine to intercanthal

distance (mm) ratio in patients was 0.89 ± 0.074 and

the intercanine to intercanthal distance was greater in

women (1.11 mm) compared to the men (1 mm).

As seen in table 6, signi cant difference detected

between the distance of the upper canines tips with

intercanthal distance which the canine distance was

3.33 mm greater than intercanthal distance (P=0.0001).

According to the table 3, there was no signi cant dif-

ference between the distance of the upper canines tips

between man and women (P=0.53).

Also, no signi cant difference was detected between

the intercanthal distance in patients (P=0.543) (table 4).

Signi cant difference was detected between the dis-

tance of the upper canine tips with intercanthal distance

in male which the canine distance was 4.23 mm higher

than intercanthal distance (P=0.0001) (table 5).

A signi cant correlation was detected between the

upper canines tips with the intercanthal distance (mm)

in patients (P=0.014) where by increasing in the inter-

canthal distance, the upper canines tips signi cantly

increased in men (P= 0.000) than women (P=0.333)

(table 7).

DISCUSSION

Facial attractiveness is a factor in many important social

interactions. A number of studies have found that facial

attractiveness is related to how humans perceive oth-

ers (Ahila et al. 2014). The development of new dental

materials and techniques has led to a greater number

of treatment options that maximize the likelihood of an

attractive outcome. Toward this end, the size and form

of the maxillary anterior teeth are important not only

to dental esthetics, but also to facial esthetics. The goal

is to have the maxillary anterior teeth restore optimal

dento-labial relations in harmony with the overall facial

appearance (Ahila et al. 2014). As observed in this study,

the mean of intercanthal distance and intercanine width

was 30.75 and 34.56mm, respectively.

A signi cant relationship was detected between inter-

canthal distance and intercanine width. It was found that

the biometric ratio of 1 to 1.13 could be used to esti-

mate intercanine width. Ideal arrangement of teeth for

an edentulous patient becomes dif cult in the absence

of pre-extraction records. Various methods have been

adopted for the ideal arrangement of teeth most of them

reveals a dependence on the physical characteristics of

the dento-facial landmarks such as Inter-alar width,

Bi-zygomatic width and Facial heights. Beside these,

146 EVALUATION OF THE RELATIONSHIP BETWEEN UPPER INTERCANINE AND INNER CANTHAL DISTANCES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Hamid and Mastooreh

various intra oral landmarks like Incisive papilla and

Inter-canine distance have also been taken into consid-

eration for selection and arrangement of teeth (Debnath

et al. 2014). Also, Wehner et al (1967) who suggested

extending parallel lines from the lateral surfaces of the

ala of the nose onto the labial surface of the maxil-

lary occlusion rim to estimate the inter-canine cusp tip.

Scandrett (1982) also reported a signi cant correlation

between the interalar width and the width of maxillary

anterior teeth.

The sex related correlation reported for gender and

reliability of the face biometric index, however, contro-

versial reports exist. For instance there was no correla-

tion between facial measurement for neither the popula-

tion as a whole nor when the population was divided

into sex and race. There was a correlation between facial

and teeth measurements in women while no correlation

was found in men (Al-el-Sheikh and Al-Athel, 1998). In

our study, we found this biometric ratio may not be reli-

able in women. We think that further research is needed

to determine accuracy of the observed results.

In a study by Bonakdarchian and Ghorbanipour

(2010) about the relationship between interalar width,

intercanine tip distance, and denture teeth size reported,

mean and standard deviation values for interalar width,

intercanine tip distance and the width of anterior maxil-

lary teeth were 36.38 ± 3.81, 34.15 ± 2.05, and 48.23 ±

2.068 mm, respectively. There were signi cant relations

between interalar width, intercanine tip distance and

widths of the six anterior teeth. Dimensions seem to be

greater in men. It seems the use of interalar width can

provide a more reliable predictive equation for tooth size

(Bonakdarchian and Ghorbanipour, 2010). It is reported

the innercanthal distance and interalar width cannot be

used as a preliminary method for determining the width

of the maxillary anterior teeth for edentulous patients

(Deogade et al. 2015).

Various modalities have been suggested for select-

ing the size of the anterior teeth like inter-alar distance,

inter-canthal distance, bi-zygomatic width, intercanine

width. However there is no reliable method for selec-

tion of anterior teeth and etc (Ahila et al. 2014). Patients

receiving their  rst dentures often expect to appear

similar to when they had their natural teeth. Therefore,

the correct selection of the arti cial teeth is essential to

achieve a pleasant esthetic outcome. If some natural teeth

are remained, it is easier to choose arti cial teeth that

blend with the natural dentition than to choose teeth for

the edentulous patient with no pre-extraction records

available (Ahila et al. 2014). It is reported, canines tend

to exhibit the greatest gender-based morphological dif-

ference compared to other tooth groups (Berksun et al.

2002). Inter-canine width method is based on the hypoth-

esis that the maxillary canines’ distal aspects should be

located approximately at the commissures of the month

(Asal et al 2011). Gender variations in the dimension of

anterior teeth for most racial with men exhibiting wider

anterior teeth than women with the canines showing the

greatest gender variation (Hasanreisoglu et al., 2005) i.e.

for men, the canines distal aspects are distal to com-

missures. Moreover, Arja et al. (1974) reported some

gender differences; meanwhile the signi cant difference

was recorded between all males at ridge relationships.

It is suggested the innercanthal distance may be a reli-

able predictor of the width of the maxillary central inci-

sors. Interpretation and extrapolation of the results must

be tempered, however, by an acknowledgement of the

study’s limitations. The innercanthal distance should be

used only as a reference value in estimations of central

incisor width (Reddy et al. 2014). In conclusion, these

results could be used as a helpful guide for selection of

the anterior teeth width in the population of patients.

This biometric ratio may not be reliable in women.

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