RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1.

NAME OF THE CANDIDATE

Dr. NAIR ROHIT UNNI

AND ADDRESS (in block letters)

POST - GRADUATE STUDENT,

DEPARTMENT OF PROSTHODONTICS,
BAPUJI DENTAL COLLEGE AND
HOSPITAL, DAVANGERE 577 004,
KARNATAKA.

2.

NAME OF THE INSTITUTION

BAPUJI DENTAL COLLEGE AND

HOSPITAL,
DAVANGERE.

3.

COURSE OF STUDY AND

MASTER OF DENTAL SURGERY

SUBJECT

IN PROSTHODONTICS INCLUDING
CROWN AND BRIDGE AND
IMPLANTOLOGY

4.

DATE OF ADMISSION TO
COURSE

5.

TITLE OF THE TOPIC

03-05-2010
EVALUATION OF THE INFLUENCE OF
THE NATURAL HEAD POSITION ON THE
INCLINATION OF VARIOUS
CRANIOFACIAL PLANES OF
PROSTHODONTIC IMPORTANCE TO
THE TRUE HORIZONTAL PLANE

6.

BRIEF RESUME OF THE INTENDED WORK:

6.1: Need for the study:
It is the goal of prosthodontic therapy to rehabilitate patients with lost or
compromised dentitions and restore them to a functionally and esthetically acceptable
level. Correct occlusal plane orientation is very important in prosthodontic reconstructive
treatment and it should closely resemble the occlusal plane of the lost natural teeth.1
The natural head position is the position of the head most comfortable for a patient
gazing at the horizon. The true horizontal plane is that plane which is perpendicular to the
force of gravity. 2 Historically, the Frankfort plane (porion - orbitale) has been assumed to
be parallel to the true horizontal plane when the subject is in the natural head position.
This concept has also found application in the design of dental articulators. In addition to
the use of the Frankfort horizontal plane, Campers plane has also been used as a reference
for maxillary cast mounting.3
So far, information used to define the spatial relationship of the Frankfort plane to the
true horizontal plane has largely been recounted from experience. 4 Knowledge about
orientation of other relevant planes such as Campers plane and the natural occlusal plane
to the true horizontal plane is limited. The natural head position has been shown to be
reproducible and its use with the true horizontal plane as the reference can avoid
individual and racial variations.5 Widespread research has been done for a craniofacial
reference plane, which in the natural head position would exhibit a constant relationship to
the true horizontal plane.6
The purpose of this study is to evaluate the relationship of the Frankfort plane,
Campers plane and the natural occlusal plane to the true horizontal plane when subjects
are in the natural head position.

6.2 : Review of Literature:

The author, in a study on the validity of the axis orbital plane and the use of orbitale
in a facebow transfer record, termed the Frankfort horizontal plane a misnomer and
stated that it would normally not be parallel to the true horizontal plane when the subject
is in the esthetic reference position.7
The authors evaluated frontal and lateral oriented profile photographs of 108 subjects
and quantitatively described the craniofacial soft tissue structure and head posture relative
to the ground. They found that the natural occlusal plane and Campers plane were
directed upward and backward in relation to the true horizontal plane in the natural head
position. The Frankfort plane was generally directed upward and forward but was closer to
the true horizontal plane in sitting photographs.8
The authors, in an integrated photographic radiographic analysis of craniofacial
reference planes, found that the hard tissue (porion-orbitale) and soft tissue (tragusorbitale) Frankfort planes were not coincident in all subjects and that the tragus was
usually lower and more anterior than the porion. Their results indicated a significant
deviation of the Frankfort plane from the true horizontal.9
The authors evaluated the 3-dimensional orientation of the occlusal plane and found
that Campers plane and the occlusal plane appeared nearly horizontal in the frontal
projection. Laterally, however, Campers plane deviated from the true horizontal plane by
about 18 and the occlusal plane deviated from the same by approximately 14. All
measurements were made with subjects in the natural head position.10
The authors assessed angles between craniofacial planes and the gravity horizontal
plane in 56 dentate subjects. They concluded that the occlusal plane was almost parallel to

the true horizontal plane in the natural head position and that Campers plane was not a
reliable landmark for occlusal plane reconstruction. They also stated that the Frankfort
horizontal plane did not represent the gravity horizontal plane (true horizontal plane).1
6.3 : Objectives of the study :
1. To evaluate the relationship between the Frankfort horizontal plane and the true
horizontal plane in the natural head position.
2. To evaluate the relationship between Campers plane and the true horizontal plane
in the natural head position.
3. To evaluate the relationship between the natural occlusal plane and the true
horizontal plane in the natural head position.

7.

MATERIALS AND METHODS:

7.1 Source of data :
Male and female healthy subjects with normal occlusion.
7.2 Method of collection of data (including sampling procedure, if any) :
80 healthy subjects will be selected from amongst dental students studying at Bapuji
Dental College & Hospital, Davangere aged 19 29 years after obtaining informed
consent for participation in this cross-sectional, descriptive type of study. A pre-defined
proforma will be used to record relevant information (Patient data, criteria for selection,
photographic measurements) from each subject.
Criteria for selecting subjects will be as follows :
A. Inclusion criteria
1. Full complement of permanent dentition including 2nd molar (at least 28 fully
erupted teeth in occlusion),
4

2. Angles class I molar relationship bilaterally.

B. Exclusion criteria
1.

Overjet more than 2 mm,

2.

Overbite more than 4 mm,

3.

Previous orthodontic treatment ,

4.

Previous craniofacial surgery / trauma,

5.

TMJ disorders,

6.

Facial asymmetries,

7.

Occlusal or incisal wear, and

8.

Congenital facial defects.

Ink dots will be marked on the inferior-most point on the lateral border of ala of nose,
the inferior-most point of the tragus of the ear, supratragal notch of the ear and on the softtissue orbitale by the same operator. A Fox plane indicator will be clenched between the
teeth which will represent the extra-oral view of the natural occlusal plane. A plumb line
will be hung from the ceiling to establish a true vertical line of reference and will be
included in the ensuing image. The subject will be seated on a chair placed 150 cm from
the camera in a relaxed state in the natural head position such that the left lateral aspect of
the head faces the camera. To obtain the natural head position, the subject will be asked to
look at the reflection of his / her pupils in a mirror positioned 150 cm away at eye level.
A digital camera (7.2 mega pixel / 3x optical zoom) mounted on a tripod stand will be
adjusted to the level of the Fox plane indicator. One left side image will be taken for
each subject in this position. The image obtained will be transferred to a computer. On the
image, the true horizontal plane will be represented by a line drawn perpendicular to the

vertical plumb line. The Frankfort horizontal plane will be seen as a line joining the
supratragal notch with the soft tissue orbitale and Campers plane as a line joining the
inferior point on the tragus with the lower-most point on the lateral border of the ala of the
nose. Angular measurements (in degrees) between the true horizontal plane and the three
craniofacial reference planes will be made using the computer program, Screen
Protractor, version 4.0. Data collected from the subjects will be analyzed using
descriptive statistics, 1-sample Student t test, and independent t test.
7.3: Does the study require any investigations or interventions to be conducted on
patients or other humans or animals? If so, please describe briefly
Yes
Direct measurement of angle between Frankfort horizontal plane, Campers plane,
occlusal plane and the true horizontal plane is to be obtained from normal dentulous
subjects.
7.4: Has ethical clearance been obtained from your institution in case of 7.3?
Yes. Attached.

8.

LIST OF REFERENCES:
1. Petricevic N, Celebic A, Celic R, Baucic-Bozic M. Natural head position and
inclination of craniofacial planes. Int J Prosthodont 2006;19:279-80
2. Krueger GE, Schneider RL. A plane of orientation with an extracranial anterior point
of reference. J Prosthet Dent 1986;56:56-60
3. Wilkie ND. The anterior point of reference. J Prosthet Dent 1979;41:488-96
4. Ercoli C, Graser GN, Tallents RH, Galindo D. Face-bow record without a third
point of reference: Theoretical considerations and an alternative technique. J Prosthet
Dent 1999;82:231-41
5. Chiu CSW, Clark RKF. Reproducibility of natural head position. J. Dent.
1991;19:130-1
6. Solow B, Tallgren A. Natural head position in standing subjects. Acta Odont Scand
1971;29:591-607
7. Pitchford JH. A reevaluation of the axis-orbital plane and the use of orbitale in a
facebow transfer record. J Prosthet Dent 1991;66:349-55
8. Ferrario VF, Sforza C, Miani A, Tartaglia G. Craniofacial morphometry by
photographic evaluations. Am J Orthod Dentofac Orthop 1993;103:327-37
9. Ferrario VF, Sforza C, German D, Dalloca LL, Miani, Jr. A. Head posture and
cephalometric analyses: An integrated photographic / radiographic technique. Am J
Orthod Dentofac Orthop 1994;106:257-66
10. Ferrario VF, Sforza C, Serrao G, Ciusa V. A direct in vivo measurement of 3dimensional orientation of the occlusal plane and the sagittal discrepancy of the jaws.
Clin Orthod Res 2000;3:15-22

9.

SIGNATURE OF CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME & DESIGNATION OF

Dr. DHANYA KUMAR B.H., M.D.S.

PROFESSOR,
DEPARTMENT OF PROSTHODONTICS,
BAPUJI DENTAL COLLEGE AND
HOSPITAL,
DAVANGERE-577 004.

(in block letters)

11.1 GUIDE

11.2 SIGNATURE
11.3 CO-GUIDE (IF ANY)

11.4 SIGNATURE

11.5 HEAD OF DEPARTMENT

Dr. NANDEESHWAR D.B., M.D.S.

PROFESSOR AND HEAD,
DEPARTMENT OF PROSTHODONTICS,
BAPUJI DENTAL COLLEGE AND
HOSPITAL,
DAVANGERE-577 004.

11.6 SIGNATURE

12. 12.1 REMARKS OF THE

CHAIRMAN & PRINCIPAL

12. 2 SIGNATURE