An analysis of maxillary anterior teeth: Facial and dental proportions

Ufuk Hasanreisoglu, DDS, PhD,a Semih Berksun, DDS, PhD,b Kerem Aras, DDS,c and
Ilker Arslan, DDSd
Faculty of Dentistry, Department of Prosthodontics, University of Ankara, Ankara, Turkey
Statement of problem. The size and form of the maxillary anterior teeth are important in achieving pleasing
dental and facial esthetics. However, little scientific data have been defined as criteria for evaluating these
morphological features.
Purpose. This study analyzed the clinical crown dimensions of maxillary anterior teeth to determine whether
consistent relationships exist between tooth width and several facial measurements in a subset of the Turkish
population.
Material and methods. Full-face and anterior tooth images of 100 Turkish dental students viewed from the
front and engaged in maximum smiling were recorded with digital photography under standardized conditions.
Gypsum casts of the maxillary arches of the subjects were also made. The dimensions of the anterior teeth, the
occurrence of the golden ratio, the difference between the actual and perceived sizes, and the relationship be-
tween the anterior teeth and several facial measurements by gender were analyzed using the information ob-
tained from both the computer images and the casts. One-sample, 2-sample, and paired t tests, and
repeated-measures analysis of variance and Duncan multiple-range tests were performed to analyze the data
(a=.05).
Results. The dimensions of the central incisors (P,.05) and canines (P,.01) varied by gender. The existence
of the so-called ‘‘golden proportion’’ for the maxillary anterior teeth as a whole was not found. Significant dif-
ferences emerged when the mean ratios between various perceived widths were compared with their ideal golden
ratios (P,.01). Proportional relationships between the bizygomatic width and the width of the central incisor,
and the intercanine distance and the interalar width in women were observed.
Conclusion. The maxillary central incisor and canine dimensions of men were greater than those of women in
the Turkish population studied, with the canines showing the greatest gender variation. Neither a golden pro-
portion nor any other recurrent proportion for all anterior teeth was determined. Bizygomatic width and inter-
alar width may serve as references for establishing the ideal width of the maxillary anterior teeth, particularly in
women. (J Prosthet Dent 2005;94:530-8.)

CLINICAL IMPLICATIONS
Information regarding average tooth dimensions, when considered with the bizygomatic dis-
tance, interalar width, and the maxillary anterior teeth, may help guide clinicians to impart
a dental appearance that is harmonious with overall facial esthetics.

E sthetics is a primary consideration for patients seek-

ing prosthodontic treatment. The development of new
dental materials and techniques has led to a greater num-
ber 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
This study received the Shield Award for Best Oral Presentation at the
28th Annual Congress of European Prosthodontic Association,
Izmir, Turkey, September, 2004.
This study was supported by the Republic of Turkey Prime Ministry
State Planning Organization; Project No. 97K120490.
a for evaluation of anterior dentition for comparisons
Professor.
b
Professor.
c
Research Assistant.
d
Research Assistant.
optimal dentolabial relations in harmony with the over-
all facial appearance. However, there is little scientific
data in the dental literature to use as a guide for defining
the proper size and shape of anterior teeth or determin-
ing normal relationships for them.
Actual tooth size and morphology are addressed in
dental literature, but inconsistent information is pre-
sented.1-5 Racial and gender differences in the average
dimensions of the maxillary anterior teeth have been
reported, but the results were valid only for specific iso-
lated populations. In addition, some populations dem-
onstrated no correlation between dental morphology
and gender.2-4,6-10 These findings indicate the need
among different populations or racial groups. Knowl-
edge of racial norms may help specify certain esthetic
and functional modifications to treatment plans to

530 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 94 NUMBER 6

HASANREISOGLU ET AL
Fig. 1. Specially designed stabilizer to standardize photo-
graphic conditions.
accommodate the multiple racial groups within modern
societies.
The most influential factors contributing to a harmo-
nious anterior dentition are the size, shape, and arrange-
ment of the maxillary anterior teeth, particularly the
maxillary central incisors as viewed from the front.11-14
Lombardi15 was the first to emphasize the importance
of order in dental composition, with a recurring ratio
noted between all teeth from the central incisor to the
first premolar. Levin16 and, more recently, other au-
thors12,13 indicated that the most harmonious recurrent
tooth-to-tooth ratio was that of the ‘‘golden propor-
tion.’’ Conflicting reports indicate that the majority of
beautiful smiles did not have proportions coinciding
with the golden proportion formula.14,17-19 Recently,
the ‘‘recurring esthetic dental proportion’’ concept
was introduced, stating that clinicians may use a propor-
tion of their own choice, as long as it remains consistent,
proceeding distally in the arch.14,18,19
To appear attractive, the maxillary anterior teeth
must be in proportion to facial morphology.12-14
Several anatomic measurements have been proposed to
aid in determining the correct size of the anterior teeth,
among them the intercomissural width, bizygomatic
width, interalar width, and interpupillary distance.20-24
Certain authors have proposed a relationship between
the width of the maxillary central incisor and the inter-
pupillary distance.21,23 Similarly, a proportional rela-
tionship between the widest part of the nose and the
anterior dental arch has been reported.22,25 These sug-
gestions, however, should be substantiated by addi-
tional scientific studies in similar populations.
The purpose of the present study was to analyze the
clinical crown dimensions of the maxillary anterior teeth
with respect to their width, height, and width-to-height
ratio and to determine whether a golden proportion
existed among these factors in a Turkish population.
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THE JOURNAL OF PROSTHETIC DENTISTRY
A second purpose was to determine the presence of pro-
portional relationships among the width of the maxillary
central incisor, the interpupillary distance, and the bizy-
gomatic width and also among the interalar width, the
intercanine distance, and the intercanine tip distance.
MATERIAL AND METHODS
Dental student volunteers from Ankara University
were solicited by a written announcement to participate
in the study and the students were examined by 1 of the
investigators of the present study. The inclusion criteria
were (1) no missing maxillary or mandibular anterior
teeth; (2) no gingival or periodontal conditions or ther-
apy that would undermine a healthy tissue-to-tooth re-
lationship; (3) no interdental spacing or crowding; (4)
no anterior restoration; and (5) no history of orthodon-
tic treatment. Exclusion criteria eliminated subjects
with (1) evidence of gingival alteration or dental irregu-
larities; (2) apparent loss of tooth structure due to attri-
tion, fracture, caries, or restorations; and (3) obvious
problems that could disfigure or otherwise affect the
face and dentition. Using these criteria, 100 dental stu-
dents (50 men and 50 women) were selected for evalu-
ation. Their mean age was 22 years and their origins
were from all around the country; in other words, they
represented no specific region. The subjects were not
preevaluated for the presence of an esthetic or unesthetic
smile. Informed consent was obtained from all subjects
prior to their participation. This study was performed
under the supervision of the research foundation of
the Ankara University and was supported and approved
by the Republic of Turkey Prime Ministry State
Planning Organization.
Full-face and anterior tooth images of the subjects
were made in a frontal view with all subjects in a maxi-
mum smiling position. A specially designed device re-
sembling a face-bow, mounted on a stand, was used to
standardize the photographic conditions. Each subject
was seated in a dental chair with the head upright, sup-
ported by the headrest, and with the occlusal plane of
the maxillary teeth parallel to the floor. The stabilizer
was adjusted to the subject by fitting the earpieces into
the external auditory canals (Fig. 1). In addition, a nasal
relater attached to the system was placed on the bridge
of the nose. The photographs were made with a constant
focal distance and under a standard light source. A meter
ruler (Prinex Enterprises Ltd, Rajagiriya, Sri Lanka) was
mounted perpendicular to the floor, in the background
and to the left of the subject’s head. The ruler aided in
the calculation of a conversion factor to correlate the
size of the image to the actual size of the teeth.26
Digital photographic equipment with a 100-mm
macro lens, 50-mm standard lens, and ring flash
(Minolta RD-175 and Macro Flash 1200 AF; Konica
Minolta, Tokyo, Japan) was used. The images recorded
531
THE JOURNAL OF PROSTHETIC DENTISTRY
were acquired with the software driver for the digital
camera of a personal computer (Macintosh Power PC
8600/200; Apple Computer, Cupertino, Calif), trans-
lated to Joint Photographic Experts Group (JPEG) for-
mat, and stored in database software (Filemaker Pro 4.0;
FileMaker Inc, Santa Clara, Calif). All photographs were
made by the same investigator to ensure standardization
of the procedure.
Irreversible hydrocolloid (Cavex CA37; Cavex
Holland BV, Haarlem, Holland) impressions of the
maxillary arches were also made in stock trays (Asa
Dental, Bozzano, Italy) and poured with Type IV dental
stone (BegoStone; BEGO, Bremen, Germany). To esti-
mate the size of the anterior teeth, measurements were
made on the casts. A sharp-tipped digital caliper (Links
Brand; Harbin Measuring & Cutting Tool Group Co,
Ltd, Harbin, China), read to the nearest 0.01 mm, was
used to measure the teeth. The width dimension was ob-
tained by measuring the maximum distance between the
mesial and distal contact points of the tooth on a line
perpendicular to the long axis. Height was recorded as
the longest distance from the cervical gingival margin
to the incisal edge of the tooth on a line parallel to the
long axis. All of the measurements were made of the fa-
cial surface of the tooth and recorded in millimeters.4
The width-to-height ratios were computed for the cen-
tral incisors, lateral incisors, and canines, and the results
(expressed in percentages) were compared by gender. In
addition, width-to-height ratios of central incisors were
compared to the 80% ratio proposed as the most
esthetically pleasing by some authors.2,5
Evaluations regarding the occurence of the golden
proportion were conducted of the anterior tooth images
at maximum smiling. Perceived mesiodistal width (the
widest distance between the mesial and distal sides of
the tooth as viewed from the front) of each tooth was
measured using the measuring tool of the imaging soft-
ware (Adobe PhotoShop; Adobe Systems Inc, San Jose,
Calif) to the nearest 0.1 mm. According to the golden
proportion concept, the perceived width of the maxillary
lateral incisor should be approximately 62% of the per-
ceived width of the central incisor, whereas that of the
canine should be similarly related to the the lateral inci-
sor. Thus, it follows logically that if the width of the lat-
eral incisor is 1, the central incisor should be 1.618 times
wider and the canine, 0.618 times narrower.14,19 In the
present study, the perceived widths of the central incisor
and canine were divided by the perceived width of the
lateral incisor; the calculated values were then compared
with the expected golden ratio values of the related
teeth. However, the actual and perceived sizes of the an-
terior teeth when viewed frontally differ due to the cur-
vature of the arch and angulation of the teeth in relation
to the frontal plane.14,19 To determine the amount
of this discrepancy for each tooth group, the actual
tooth widths, as measured on the stone casts, and the
532
HASANREISOGLU ET AL
perceived widths, as measured on the anterior tooth
images, were compared.
In the current study, some of the suggestions con-
cerning the relationships between the anterior teeth
and several anatomic landmarks were evaluated. The fol-
lowing statements were tested: (1) the width of the cen-
tral incisor is 1:16 the bizygomatic width20; (2) the ratio
of the interpupillary distance to the width of the central
incisor is 6.618,20; and (3) the interalar width equals the
intercanine distance or intercanine tip distance.19,22
Bizygomatic width was determined by measuring the
distance between the 2 zygomatic prominences. Inter-
pupillary distance was measured from midpupil to mid-
pupil. The external width of the alae of the nose was
recorded at the widest point to establish the interalar
width. Intercanine distance at the widest point and
intercanine tip distance were also recorded. All linear
measurements were performed on the frontal full-face
images made while smiling, using the measuring tool
of the imaging software to the nearest 0.1 mm. The
data were analyzed by comparing the calculated value
for each proportional relationship with the related
constant proposed for both genders. All measurements
were performed by 2 noncalibrated investigators work-
ing independently. The 2 sets of measurements were
compared. When they varied by 0.2 mm or less, the mea-
surements were averaged; if they differed by more than
0.2 mm, the procedure was repeated.7
A 2-sample t test was performed to determine
whether there were gender differences in the width,
height, and width-to-height ratio of each tooth group.
In addition, a 1-sample t test was performed to compare
the width-to-height ratios of all tooth groups with the
proportion of 80%, to assess the incidence of the golden
proportion, and to analyze the relationships among the
width of the maxillary central incisor, the interpupillary
distance, and the bizygomatic width. The variations
between the actual and perceived widths of the maxil-
lary anterior tooth groups were evaluated using a
paired t test. A repeated-measures analysis of variance
(ANOVA) was used to analyze the data concerning the
relationship among the interalar distance, the interca-
nine distance, and the intercanine tip distance in both
genders. The gender and the linear measurements of
the related variables (interalar distance, intercanine dis-
tance, and intercanine tip distance) were the 2 factors.
Duncan multiple-range tests were applied when appro-
priate. The level of significance was established as
a=.05 for all statistical evaluations.
RESULTS
Figure 2 represents the means and SDs for the widths
and heights of the maxillary central incisors, the lateral
incisors, and the canines for both men and women.
When the mean width and height values of the 3 tooth
VOLUME 94 NUMBER 6
HASANREISOGLU ET AL THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 2. Mean width and height values (mm) of maxillary anterior teeth by gender. (*P,.05, **P,.01, n = 50).

Fig. 3. Mean values (%) of width-to-height ratios of each maxillary anterior tooth group by gender (*P,.05). Dotted line, 80%
width-to-height ratio for central incisors suggested by some authors2,5 as pleasing proportion.

Fig. 4. Comparison of calculated ratios (perceived width) of central incisors and canines to lateral incisors, with anticipated
golden ratio for central incisor (1.618) and canine (0.618) teeth by gender (*P,.01).

DECEMBER 2005 533

THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 5. Mean values of ratios of interpupillary distance and bizygomatic distance to width of central incisor by gender (asterisk,
P,.01).
Table I. Mean values (mm) and SDs of actual and perceived dimensions of anterior teeth
groups were compared for the differences between the
genders, the data revealed that the mean coronal width
and height measurements of male central incisors
(P,.05) and canines (P,.01) were significantly greater
than the corresponding dimensions for women, with the
central incisors being the widest teeth for both genders.
However, the lateral incisors did not exhibit significant
gender differences in width and height values.
A summary of the width-to-height ratios of tooth
groups, expressed in percentages, is shown in Figure 3.
The mean coronal tooth width-to-height ratios for
men versus women, respectively, were as follows: central
incisor, 88.7% versus 91.2%; lateral incisor, 82.1% versus
83.4%; and canine, 83.4% versus 87.3%. A comparison
between men and women of the ratios of the central in-
cisor and lateral incisor tooth groups showed no differ-
ences. However, a significant difference (P=.038) was
detected between the genders in the canine tooth group
ratios. Significant differences were also observed when
the mean values of the width-to-height ratios of central
incisors were compared with the proportion of 80% in
both genders (P =.001) (Fig. 3).
534
HASANREISOGLU ET AL
Ratios calculated for the maxillary central incisors and
the canines in reference to that of the lateral incisors
based on the golden proportion concept are shown in
Fig. 4. Significant differences (P,.01) emerged when
the mean ratios between various perceived widths (cen-
tral to lateral incisors and canines to lateral incisors) were
compared with their ideal golden ratios of 1.618 and
0.618, respectively, for both genders. For both men
and women, narrower central incisors and wider canines
compared to the lateral incisors were found rather than
golden ratio measurements (Fig. 4). Any other recurrent
proportion for all anterior teeth was not found.
Table I lists the data comparing the mean width
values of each tooth group as measured on casts and as
anterior tooth images. Initially, the differences between
the casts and anterior tooth images were compared with
respect to gender by means of a 2-sample t test. Since no
significant differences between men and women were
found, the values produced by measuring the casts ver-
sus those produced by the anterior tooth images were
again compared, this time using a paired t test and with-
out the gender variable. The results demonstrate that
VOLUME 94 NUMBER 6
HASANREISOGLU ET AL
Fig. 6. Duncan test results of interalar distance, intercanine distance, intercanine tip distance (mm) by gender. Identical capital
letters in same vertical row indicate that values are not statistically different at P,.05.
Table II. ANOVA results for interalar distance, intercanine
distance, intercanine tip distance (within-subjects effects)
Source Sum of squares df Mean square F Significance
Measurements 3481.726 2 1740.863 189.390 .000
Measurements 3 545.460 2 272.730 29.671 .000
Gender
Error (measurement) 1875.153 204 9.192
there were marked differences between the actual and
perceived dimensions of the maxillary anterior teeth
when progressing distally in the arch (P,.01).
When the authors investigated the hypothesis that a
ratio of 6.6 exists between the interpupillary distance
and the width of the maxillary central incisor,21 values
of 7.7 and 7.5 were found for men and women, respec-
tively. These values were significantly different (P,.01)
from the 6.6 ratio expected for both men and women.
Similarly, when the authors tested the statement that
the width of the central incisor should be 1:16 of the
bizygomatic width,21,23 no such relationship was dem-
onstrated in men. The mean ratio of the width of the
maxillary central incisors to bizygomatic width differed
significantly when compared with 1:16 ratio (P,.01).
However, the 1:16 ratio between the mean values of
the bizygomatic distance and the maxillary central inci-
sor width was found in women (Fig. 5).
When the relationships among the interalar width, in-
tercanine distance, and intercanine tip distance by gen-
der were examined, the repeated-measures ANOVA
indicated significant interactions between gender and
DECEMBER 2005
THE JOURNAL OF PROSTHETIC DENTISTRY
Table III. ANOVA results for interalar distance, intercanine
distance, intercanine tip distance (between-subjects effects)
Source Sum of squares df Mean square F Significance
Intercept 1158695.793 1 1158695.793 20522.587 .000
Gender 2.712 1 2.712 .048 .827
Error 5758.873 102 56.460
the related linear measurements (interalar width, inter-
canine distance, and intercanine tip distance) (Tables
II and III). Therefore, comparisons of these linear mea-
surements were performed independently for men and
women, with any significant interactions further re-
solved with Duncan multiple range tests. Consequently,
interalar width, intercanine distance, and intercanine
tip distance demonstrated statistically significant dif-
ferences (P=.004) in men. Similarly, intercanine tip
distance differed from interalar width significantly
(P=.003) in women. However, the difference between
the intercanine distance and the interalar width in
women was not significant (Fig. 6).
DISCUSSION
In general, the Turkish population is genetically di-
verse due to its geographical location and historical
background,10 giving rise to many dental and facial
variations. Therefore, information regarding tooth
norms in this group may prove useful to clinicians
when restoring anterior teeth. The size and morphology
535
THE JOURNAL OF PROSTHETIC DENTISTRY
of the maxillary anterior teeth have been studied in
order to chart racial norms and gender characteris-
tics.1-4 In earlier studies, measurements were made us-
ing extracted teeth.1,3 However, recent investigations
attempted to measure the clinical tooth dimensions
either on casts or using computer-based images or intra-
oral evaluations.3-7,9,10 In most of these studies, the
width of the maxillary central incisor was used to assess
racial and gender differences. In the present study, the
recorded dimensions for this tooth, as well as for the
maxillary lateral incisors and canines, were comparable
to the mean values reported in similar studies of vari-
ous populations, including North American, Japanese,
and Chinese.4,6,7,9
Gender variations in the dimensions of the anterior
teeth have been noted for most racial groups, with men
exhibiting wider anterior teeth than women.3,4,6-9
Gillen et al3 reported that the maxillary anterior teeth
of men were wider and longer than those of women in
both white and black populations. Similarly, Sterrett
et al4 reported the mean width and length of the clinical
crowns of the maxillary anterior teeth of men to be
significantly greater than the corresponding dimensions
in women in a white population. Owens et al9 measured
the width of the maxillary central incisor in several racial
groups and noted variations in most of them, with men
again having wider central incisors than women. In the
present study, the mean coronal width and height values
for the central incisors (P,.05) and the canines (P,.01)
for men were significantly greater than the
corresponding dimensions for women, with the central
incisors being the widest teeth in both genders. These
findings are in agreement with the results of related
studies.4,6,7,9 However, the lateral incisors displayed
similar width and height averages for both genders,
which is in conflict with other reports.3,4,6,7,9 This
may be related to the heterogeneous nature of Turks,
who represent a gene pool composed of different
populations.10
The crown width-to-height ratio was accepted to be
the most stable reference, as it showed minimal varia-
tions between the genders or between teeth.2,5 In the
present study, ratios ranging from 72% to 124% were re-
corded, compared to ratios ranging from 76% to 86%
noted in the dental literature.3-5,17 That is, the width-
to-height ratios of the maxillary anterior teeth in both
genders were found to be greater than those suggested
in previous studies. It appears that the maxillary anterior
teeth of the Turkish population group studied display a
more square-like form due to the teeth having shorter
height and/or greater width than those of other popu-
lations. Gillen et al3 suggested that the height-to-width
ratios of the maxillary anterior teeth were not affected by
gender, either in white or black populations, although
the maximum width of the canines indicated important
gender and racial differences. Likewise, several recent
536
HASANREISOGLU ET AL
studies3,4,8,10 have reported that canines tend to exhibit
the greatest gender-based morphological difference
compared to other tooth groups. The results of the cur-
rent study revealed significant gender differences in the
width-to-height proportion of the canines, confirming
the findings of previous studies.3,4,8,10 Some shapes
and forms of teeth may appear to be more esthetically
appealing than others. In a study by Brisman,11 a
width-to-height ratio of 75% was preferred when a vari-
ety of tooth shapes were assessed by dental students and
patients. It has been stated that the maxillary anterior
teeth, especially the central incisors, should have a
width-to-height ratio of approximately 80% to achieve
the best appearance.2,5,17 In the current study, the
width-to-height ratios of the central incisors exceeded
the proportion of 80% suggested as ideal for an attractive
appearance in both men and women.
The golden proportion, when applied to the denti-
tion, indicates that if the perceived width of each ante-
rior tooth is approximately 62% the size of its adjacent
anterior tooth, then it is considered esthetically pleas-
ing.12-14 In the present investigation, a golden ratio or
other recurring proportion for all the anterior teeth in
the sample group evaluated was not detected. With re-
spect to the golden proportion concept, for both the
men and women, narrower central incisors and wider
canines as compared to the lateral incisors prevented
the golden ratio from being achieved (P,.01). Further-
more, some authors believe that the golden proportion
occurs more consistently in esthetically pleasing smiles
as opposed to randomly selected smiles.12,13,18,19 In
the current investigation, an esthetically pleasing smile
was not a criterion in selecting the subjects. Since the
number of individuals within this population of dental
students having an attractive smile is unknown, it is dif-
ficult to interpret the lack of golden proportion in this
group.
Rather than being focused on the 62% proportion,
Ward19 recommended using other ratios, such as 70%,
to provide a more pleasing appearance. In an Internet-
based study by Rosenstiel et al,18 it was reported that
rather than concentrating on a single ratio such as the
golden proportion, other ratios reflecting harmony
among the tooth lengths should be considered when
striving to produce a satisfactory appearance. However,
in the present investigation, the occurrence of any other
continuous proportion was not detected.
When the values of the tooth widths as measured on
the casts and as anterior tooth images were compared,
marked differences were found between the actual and
perceived dimensions of the anterior teeth while moving
distally in the arch (P,.01). This discrepancy was cre-
ated by the curvature of the arch and angulation of the
maxillary anterior teeth in relation to the frontal plane
of the photograph. The perceived dimensions of the
maxillary anterior teeth are more important than the
VOLUME 94 NUMBER 6
HASANREISOGLU ET AL
actual dimensions because most of the proportional re-
lationships are based on perceived sizes rather than the
actual dimensions.14,19 In this respect, the central inci-
sors are the most dominant anterior teeth in the dental
arch because they can be seen in their full size, as has
been determined in the present study. Thus, the neces-
sity of performing proportional smile evaluations from
the frontal view (as others see the patient) and not
from the casts has been emphasized once more by the
current study.14,19
The relationship between the width of a central inci-
sor and the bizygomatic width (1:16) is commonly
used to determine the size of the maxillary anterior
teeth.2,3,19 Cesario and Latta21 found that a ratio of
6.6, which had previously been proposed, existed be-
tween the interpupillary distance and the central incisor
width in white men and women, and also in black
women. Recently, in a study by Latta et al,23 the rela-
tionships among the width of the mouth, the interalar
width, the bizygomatic width, and the interpupillary
distance were evaluated. It was concluded that these re-
lationships might be used as references if applied in com-
bination, although racial and gender differences were
detected when anatomic measurements were evaluated
individually. In the present study, values of 7.7 and
7.5 were found for men and women, respectively.
These values were significantly different (P,.01) from
the 6.6 ratio expected to occur in both genders. In addi-
tion, the 1:16 ratio of the bizygomatic distance to the
central incisor width was found only in women. The in-
teralar width has been commonly used to estimate the
position of the maxillary canines.12,20,25 In the current
investigation, when the relationships among the intera-
lar width, the intercanine distance, and the intercanine
tip distance were analyzed, the measurements obtained
for intercanine distance and the interalar width were
identical in women, but not in men. One possible expla-
nation of this finding was that in the current study pop-
ulation, the base of the nose was larger in men than in
women (mean interalar widths of 66.5 mm and 62.9
mm, respectively), whereas the mean intercanine dis-
tances were 60.6 mm in men and 62.8 in women.
Therefore, the suggested hypothesis regarding the coin-
cidence of intercanine distance to interalar width was
valid only for women, according to the findings of the
present study.
These findings, together with the results of earlier
published reports,3,21-25 suggest that methods based
on the relationship between the anterior teeth and cer-
tain facial measurements should be used as preliminary
guides in estimating the width of the maxillary central
incisors or the localization of the canines.
In the present study, limitations such as inaccuracies
common to the making of dental casts or minor posi-
tional differences that can occur during photography
might have affected the measurements. Additional
DECEMBER 2005
THE JOURNAL OF PROSTHETIC DENTISTRY
research on a greater sample size selected more system-
atically is needed before extrapolating the results to the
general population.
CONCLUSION
Within the limitations of the present study, the fol-
lowing conclusions were drawn:
1. The dimensions of the maxillary central incisors
(P,.05) and canines (P,.01) varied in men and
women, with the canines exhibiting the greatest gen-
der-based differences.
2. No statistically significant golden ratio or any other
continuous proportion for the anterior teeth as a whole
was found in the population studied.
3. Proportional smile evaluations are generally based on
the perceived size of the anterior teeth from the frontal
view. In this respect, the central incisors are the most
dominant anterior teeth in the dental arch because
they can be seen in their full size.
4. There were no statistically significant differences be-
tween the 1:16 ratio of bizygomatic distance to width
of central incisor, and the interalar distance to interca-
nine distance in women. These linear measurements
might be used as initial references in establishing the
width of the central incisors or the localization of the
canines, particularly for women.
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Evaluation of 24-hour shear bond strength of resin composite to

Noteworthy Abstracts porcelain according to surface treatment
of the Guler AU, Yilmaz F, Ural C, Guler E. Int J Prosthodont 2005;
Current Literature 18:156-60.

Purpose: The purpose of the present in vitro study was to examine shear bond strengths of resin composite to
porcelain according to surface treatment.
Materials and Methods: One hundred eight feldspathic porcelain blocks were prepared. Specimens were
divided into nine surface treatment groups: sandblasting with 50- or 110-mm Al2O3, acid etching with
hydrofluoric acid, applying silane agent, and combinations of these treatments. Microhybrid resin composite
was condensed and light cured for 40 seconds on the porcelain specimens, which were then stored in distilled
water at 37°C for 24 hours before mechanical testing.
Results: The bond strengths were significantly different according to one-way ANOVA. The lowest bond
strength was observed in the silane group (4.09 MPa); the highest bond strengths were observed with
acid etching + silane (11.97 MPa) and sandblasting with 50-mm Al2O3 + acid etching + silane (12.34 MPa)
(no significant difference between groups).
Conclusion: Acid etching with 9.6% hydrofluoric acid gel or sandblasting with 50- or 110-mm Al2O3 particles
alone did not provide adequate bond strength. Silane agent was effective in increasing the shear bond strength
of resin composite to porcelain after sandblasting or acid etching. Porcelain treatment with a combination of
50-mm Al2O3 air abrasion, 9.6% hydrofluoric acid, and silane agent provided higher bond strengths than
treatment with any of these procedures alone.—Reprinted with permission of Quintessence Publishing.

538 VOLUME 94 NUMBER 6