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 scientic data have been dened 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 between the anterior teeth and several facial measurements by gender were analyzed using the information obtained 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. Signicant differences 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 proportion nor any other recurrent proportion for all anterior teeth was determined. Bizygomatic width and interalar 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 distance, interalar width, and the maxillary anterior teeth, may help guide clinicians to impart a dental appearance that is harmonious with overall facial esthetics.

sthetics is a primary consideration for patients seeking prosthodontic treatment. 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
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 Professor. b Professor. c Research Assistant. d Research Assistant.

optimal dentolabial relations in harmony with the overall facial appearance. However, there is little scientic data in the dental literature to use as a guide for dening the proper size and shape of anterior teeth or determining normal relationships for them. Actual tooth size and morphology are addressed in dental literature, but inconsistent information is presented.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 specic isolated populations. In addition, some populations demonstrated no correlation between dental morphology and gender.2-4,6-10 These ndings indicate the need for evaluation of anterior dentition for comparisons among different populations or racial groups. Knowledge of racial norms may help specify certain esthetic and functional modications to treatment plans to
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A second purpose was to determine the presence of proportional relationships among the width of the maxillary central incisor, the interpupillary distance, and the bizygomatic 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 therapy that would undermine a healthy tissue-to-tooth relationship; (3) no interdental spacing or crowding; (4) no anterior restoration; and (5) no history of orthodontic treatment. Exclusion criteria eliminated subjects with (1) evidence of gingival alteration or dental irregularities; (2) apparent loss of tooth structure due to attrition, fracture, caries, or restorations; and (3) obvious problems that could disgure or otherwise affect the face and dentition. Using these criteria, 100 dental students (50 men and 50 women) were selected for evaluation. Their mean age was 22 years and their origins were from all around the country; in other words, they represented no specic 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 maximum smiling position. A specially designed device resembling 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, supported by the headrest, and with the occlusal plane of the maxillary teeth parallel to the oor. The stabilizer was adjusted to the subject by tting 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 oor, in the background and to the left of the subjects 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 ash (Minolta RD-175 and Macro Flash 1200 AF; Konica Minolta, Tokyo, Japan) was used. The images recorded
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Fig. 1. Specially designed stabilizer to standardize photographic conditions.

accommodate the multiple racial groups within modern societies. The most inuential factors contributing to a harmonious anterior dentition are the size, shape, and arrangement of the maxillary anterior teeth, particularly the maxillary central incisors as viewed from the front.11-14 Lombardi15 was the rst to emphasize the importance of order in dental composition, with a recurring ratio noted between all teeth from the central incisor to the rst premolar. Levin16 and, more recently, other authors12,13 indicated that the most harmonious recurrent tooth-to-tooth ratio was that of the golden proportion. Conicting 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 proportion 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 interpupillary distance.21,23 Similarly, a proportional relationship between the widest part of the nose and the anterior dental arch has been reported.22,25 These suggestions, however, should be substantiated by additional scientic 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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were acquired with the software driver for the digital camera of a personal computer (Macintosh Power PC 8600/200; Apple Computer, Cupertino, Calif), translated to Joint Photographic Experts Group (JPEG) format, 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 estimate 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 obtained 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 facial surface of the tooth and recorded in millimeters.4 The width-to-height ratios were computed for the central 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 software (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 perceived width of the central incisor, whereas that of the canine should be similarly related to the the lateral incisor. Thus, it follows logically that if the width of the lateral 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 anterior teeth when viewed frontally differ due to the curvature 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
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perceived widths, as measured on the anterior tooth images, were compared. In the current study, some of the suggestions concerning the relationships between the anterior teeth and several anatomic landmarks were evaluated. The following statements were tested: (1) the width of the central 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. Interpupillary distance was measured from midpupil to midpupil. 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 working independently. The 2 sets of measurements were compared. When they varied by 0.2 mm or less, the measurements 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 maxillary 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 intercanine distance, and the intercanine tip distance in both genders. The gender and the linear measurements of the related variables (interalar distance, intercanine distance, and intercanine tip distance) were the 2 factors. Duncan multiple-range tests were applied when appropriate. The level of signicance 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
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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).

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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 signicantly 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 signicant 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 incisor and lateral incisor tooth groups showed no differences. However, a signicant difference (P=.038) was detected between the genders in the canine tooth group ratios. Signicant 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).
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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. Signicant differences (P,.01) emerged when the mean ratios between various perceived widths (central 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 signicant differences between men and women were found, the values produced by measuring the casts versus those produced by the anterior tooth images were again compared, this time using a paired t test and without the gender variable. The results demonstrate that
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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 Signicance

Table III. ANOVA results for interalar distance, intercanine distance, intercanine tip distance (between-subjects effects)
Source Sum of squares df Mean square F Signicance

Measurements 3481.726 2 1740.863 189.390 Measurements 3 545.460 2 272.730 29.671 Gender Error (measurement) 1875.153 204 9.192

.000 .000

Intercept 1158695.793 1 1158695.793 20522.587 Gender 2.712 1 2.712 .048 Error 5758.873 102 56.460

.000 .827

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, respectively. These values were signicantly 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 demonstrated in men. The mean ratio of the width of the maxillary central incisors to bizygomatic width differed signicantly 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 incisor width was found in women (Fig. 5). When the relationships among the interalar width, intercanine distance, and intercanine tip distance by gender were examined, the repeated-measures ANOVA indicated signicant interactions between gender and
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the related linear measurements (interalar width, intercanine distance, and intercanine tip distance) (Tables II and III). Therefore, comparisons of these linear measurements were performed independently for men and women, with any signicant interactions further resolved with Duncan multiple range tests. Consequently, interalar width, intercanine distance, and intercanine tip distance demonstrated statistically signicant differences (P=.004) in men. Similarly, intercanine tip distance differed from interalar width signicantly (P=.003) in women. However, the difference between the intercanine distance and the interalar width in women was not signicant (Fig. 6).

DISCUSSION
In general, the Turkish population is genetically diverse 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
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of the maxillary anterior teeth have been studied in order to chart racial norms and gender characteristics.1-4 In earlier studies, measurements were made using extracted teeth.1,3 However, recent investigations attempted to measure the clinical tooth dimensions either on casts or using computer-based images or intraoral 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 various 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 signicantly 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 signicantly greater than the corresponding dimensions for women, with the central incisors being the widest teeth in both genders. These ndings 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 conict 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 variations between the genders or between teeth.2,5 In the present study, ratios ranging from 72% to 124% were recorded, compared to ratios ranging from 76% to 86% noted in the dental literature.3-5,17 That is, the widthto-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 populations. 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
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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 current study revealed signicant gender differences in the width-to-height proportion of the canines, conrming the ndings 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 variety 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 dentition, indicates that if the perceived width of each anterior tooth is approximately 62% the size of its adjacent anterior tooth, then it is considered esthetically pleasing.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 respect 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). Furthermore, 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 difcult 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 Internetbased study by Rosenstiel et al,18 it was reported that rather than concentrating on a single ratio such as the golden proportion, other ratios reecting 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 created 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
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actual dimensions because most of the proportional relationships are based on perceived sizes rather than the actual dimensions.14,19 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, as has been determined in the present study. Thus, the necessity 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 incisor 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 between 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 relationships among the width of the mouth, the interalar width, the bizygomatic width, and the interpupillary distance were evaluated. It was concluded that these relationships might be used as references if applied in combination, 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 signicantly different (P,.01) from the 6.6 ratio expected to occur in both genders. In addition, the 1:16 ratio of the bizygomatic distance to the central incisor width was found only in women. The interalar 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 interalar 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 explanation of this nding was that in the current study population, 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 distances were 60.6 mm in men and 62.8 in women. Therefore, the suggested hypothesis regarding the coincidence of intercanine distance to interalar width was valid only for women, according to the ndings of the present study. These ndings, together with the results of earlier published reports,3,21-25 suggest that methods based on the relationship between the anterior teeth and certain 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 positional differences that can occur during photography might have affected the measurements. Additional
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research on a greater sample size selected more systematically is needed before extrapolating the results to the general population.

CONCLUSION
Within the limitations of the present study, the following 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 gender-based differences. 2. No statistically signicant 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 signicant differences between the 1:16 ratio of bizygomatic distance to width of central incisor, and the interalar distance to intercanine 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.

REFERENCES
1. Ash MM. Wheelers atlas of tooth form. 5th ed. Philadelphia: Saunders; 1984. p. 24-5. 2. Chiche GJ, Pinault A. Esthetics of anterior xed prosthodontics. Chicago: Quintessence; 1994. p. 61-5. 3. Gillen RJ, Schwartz RS, Hilton TJ, Evans DB. An analysis of selected normative tooth proportions. Int J Prosthodont 1994;7:410-7. 4. Sterret JD, Oliver T, Robinson F, Fortson W, Knaak B, Russel CM. Width/ length ratios of normal clinical crowns of the maxillary anterior dentition in man. J Clin Periodontol 1999;26:153-7. 5. Magne P, Belser U. Bonded porcelain restorations in the anterior dentition: a biomimetic approach. Chicago: Quintessence; 2002. p. 64-70. 6. Lavelle CLB. Maxillary and mandibular tooth size in different racial groups and in different occlusal categories. Am J Orthod 1972;61:29-37. 7. Richardson ER, Malhotra SK. Mesiodistal crown dimension of the permanent dentition of American Negroes. Am J Orthod 1975;68:157-64. 8. Sherfudhin H, Abdullah MA, Khan N. A cross-sectional study of canine dimorphism in establishing sex identity: comparison of two statistical methods. J Oral Rehabil 1996;23:627-31. 9. Owens EG, Goodacre JC, Loh PL, Hanke G, Okamura M, Jo K, et al. A multicenter interracial study of facial appearance. Part 2: a comparison of intraoral parameters. Int J Prosthodont 2002;15:283-8. _x 10. Iscan MY, Kedici PS. Sexual variation in bucco-lingual dimensions in Turkish dentition. Forensic Sci Int 2003;137:160-4. 11. Brisman AS. Esthetics: a comparison of dentists and patients concepts. J Am Dent Assoc 1980;100:349-52. 12. Ricketts RM. The biologic signicance of the divine proportion and Fibonacci series. Am J Orthod 1982;81:351-70. 13. Marquardt SR. Dr. Stephen R. Marquardt on the Golden Decagon and human facial beauty. Interview by Dr. Gottlieb. J Clin Orthod 2002;36: 339-47. 14. Gurel G, editor. The science and art of porcelain laminate veneers. London: Quintessence; 2003. p. 83-6. 15. Lombardi RE. The principles of visual perception and their clinical application to denture esthetics. J Prosthet Dent 1973;23:358-82.

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16. Levin EI. Dental esthetics and golden proportion. J Prosthet Dent 1978;40: 244-52. 17. Qualtrough AJ, Burke FJ. A look at dental esthetics. Quintessence Int 1994;25:7-14. 18. Rosenstiel SF, Ward DH, Rashid RG. Dentists preferences of anterior tooth proportiona web-based study. J Prosthodont 2000;9:123-36. 19. Ward DH. Proportional smile design using the recurring esthetic dental (red) proportion. Dent Clin North Am 2001;45:143-54. 20. Scandrett FR, Kerber PE, Umrigar ZR. A clinical evaluation of techniques to determine the combined width of the maxillary anterior teeth and the maxillary central incisor. J Prosthet Dent 1982;48:15-22. 21. Cesario VA Jr, Latta GH Jr. Relationship between the mesiodistal width of the maxillary central incisor and interpupillary distance. J Prosthet Dent 1984;52:641-3. 22. Hoffman W Jr, Bomberg TJ, Hatch RA. Interalar width as a guide in denture tooth selection. J Prosthet Dent 1986;55:219-21. 23. Latta GH Jr, Weaver JR, Conkin JE. The relationship between the width of the mouth, interalar width, bizygomatic width, and interpupillary distance in edentulous patients. J Prosthet Dent 1991;65:250-4. 24. Abdullah MA. Inner canthal distance and geometric progression as a predictor of maxillary central incisor width. J Prosthet Dent 2002;88:16-20.

25. McCord JF, Grant AA. Registration: stage IIIselection of teeth. Br Dent J 2000;188:660-6. 26. Berksun S, Hasanreisoglu U, Gokdeniz B. Computer-based evaluation of gender identication and morphologic classication of tooth face and arch forms. J Prosthet Dent 2002;88:578-84. Reprint requests to: DR SEMIH BERKSUN ANKARA UNIVERSITY DIS HEKIMLIGI FAKULTESI PROTEZ BOLUMU BESEVLER, 06500, ANKARA TURKEY FAX: 190 (312) 2123954 E-MAIL: berksun@dentistry.ankara.edu.tr 0022-3913/$30.00 Copyright 2005 by The Editorial Council of The Journal of Prosthetic Dentistry.

doi:10.1016/j.prosdent.2005.10.007

Noteworthy Abstracts of the Current Literature

Evaluation of 24-hour shear bond strength of resin composite to porcelain according to surface treatment Guler AU, Yilmaz F, Ural C, Guler E. Int J Prosthodont 2005; 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 hydrouoric 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 37C for 24 hours before mechanical testing. Results: The bond strengths were signicantly 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 signicant difference between groups). Conclusion: Acid etching with 9.6% hydrouoric 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% hydrouoric acid, and silane agent provided higher bond strengths than treatment with any of these procedures alone.Reprinted with permission of Quintessence Publishing.

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