142 The Jour nal of Indian Prosthodontic Society / July 2009 / Vol 9 / Issue 3

Relationship of anatomic landmarks
with occlusal plane
Rubina Gupta, Himanshu Aeran, S. P. Singh
ABSTRACT
Purpose: Evaluat ion of relat ionship bet ween various anat omical landmarks and t he occlusal plane in t he nat ural dent it ion
t hat could be used for est ablishing t he occlusal plane in complet e dent ures. Met hods: The st udy comprised of 1 0 0 dent ulous
subject s wit h all healt hy permanent t eet h in normal arch form and alignment . Three inst rument s were cust om-made for t he
purpose: t he occlusal plane analyzer t o check t he parallelism of t he ala-t ragus lines, and t he int erpupillary line, t he buccinat or
groove relat or and t he level analyzer for t he level of t he linea alba buccalis wit h t he occlusal plane. For t he ret romolar pad area
a met allic scale was used. Result s: Wit hin limit at ions of t his st udy, it was observed t hat , only 1 3 % subject s showed occlusal
plane parallel t o t he int erpupillary line. The post erior reference point of Camper’ s line was middle point for 7 2 % of males and
superior point for 8 0 % of females. Int raorally, 6 8 % of subject s have t he occlusal plane at t he same level as t hat of buccinat or
groove and 7 7 % of t he subject s had t he occlusal plane at t he middle one-t hird of ret romolar pad area. Int erpret at ion and
Conclusions: It was concluded t hat : t he occlusal plane is parallel t o Camper’ s plane post erior reference point as t he superior
point of t ragus in females and middle point in males. The occlusal plane is not generally parallel t o t he int erpupillary line.
Int ra-orally, t he level of buccinat or groove is reliable, while variat ions in ret romolar pad area make it an unreliable landmark
for orient ing t he occlusal plane.
KEY WORDS: Buccinat or groove, camper’ s line, occlusal plane, int erpupillary line, ret romolar pad area
DOI: 10.4103/0972-4052.57083
Ori gi nal Arti cl e
D epar t ment o f Pro st ho d o nt i cs, Subhar t i D ent al Co l l ege, M eer ut , I nd i a
A d d r ess fo r co r r espo nd ence: D r. Rubi na Gupt a, C/ O D r. S. K. Gupt a, A mbeka Eye & Laser H o spi t al , 2 0 3 / 4 8 , Sad ar Baz aar, M uz affar nagar - 2 5 1 0 0 1 ,
U . P, I nd i a. E- mai l : d r _ r ubi nagupt a@ yaho o . co m
INTRODUCTION
The desire t o look good and feel healt hy is not limit ed
by age. Since time immemorial, dentists have faced the
challenge of providing accord bet ween funct ion and
est het ics. The occlusal plane, lost in pat ient s rendered
edent ulous, should be relocat ed if complet e dent ures
are t o be est het ically and funct ionally sat isfact ory.
GPT (July 2005)
[1]
defines occlusal plane as “the average
plane est ablished by t he incisal and occlusal surfaces
of t he t eet h”. Generally it is not a plane but represent s
t he planar mean of t he curvat ure of t hese surfaces.
Funct ionally, t he inclinat ion of t he occlusal plane is
one of t he key fact ors governing occlusal balance and
phonat ion. Est het ically, t he ant erior occlusal plane
t akes on a fundament al role.
Con s i d e r i n g t h e i mp or t a n c e of t h e a c c u r a t e
establishment of the location and inclination of occlusal
plane on funct ion, est het ics and speech, a met hod t o
conform it t o t he occlusal plane t hat exist ed in t he
nat ural t eet h seems necessary. Various aut hors have
advocat ed different met hods for t he orient at ion of
t he occlusal plane. Most import ant and accurat e of
t hese is pre-ext ract ion record, eg: profile phot ographs,
lead wire, acrylic face mas k, dent ulous cas t s et c.
Unfortunately, these records are generally not available.
Numerous aut hors, since t he beginning of complet e
dent ure fabricat ion, have proposed several landmarks
to help define the level of occlusal plane. Various planes
like Frankfurt horizont al plane, Camper’s line, Palat al
line, Occlus al line, Mandibular line, Int erpupillary
line, Hamular not ch incisive papilla (H.I.P. plane) et c.
have been suggest ed. Many int raoral landmarks like
commissures of t he mout h by Gillis
[2]
in 1933, Incisive
papilla by Robert N. Harper
[3]
in 1948, parot id papilla
The Jour nal of Indian Prosthodontic Society / July 2009 / Vol 9 / Issue 3 143
Gupta, et al.: Anatomic landmarks with Occlusal Plane
by P. F. Foley and G. H. Lat t a
[4]
in 1985, upper lip line by
Rahn and Heart well
[5]
in 1986, height of t he ret romolar
pad, t he lat eral borders of t he t ongue et c. have also
been suggest ed
In 1979, H. Oka ne
[6]
found t ha t during clenching
maximum biting force was greatest and muscle activity
was least when t he occlusal plane was made parallel
t o t he ala-t ragus line. Landa
[2]
in 1947 said t hat t he
occlusal plane is parallel t o line drawn from t he alae
of nose t o t he middle point of t he t ragus while Art hur
O. Rahn and Charles M. Heart well (1986)
[7]
said t he
occlus al plane s hould coincide wit h Camper’s line
(superior border of t he t ragus). On t he ot her hand,
F. Rost amkhani, A. Sahafian and H. Kermani (2005)
[8]

conduct ed a cephalomet ric st udy and concluded t hat
t he inferior border of t he t ragus can be suggest ed
as t he post erior point for ala-t ragus line orient at ion.
Various aut hors like J . E. Scot t (1952)
[9]
described an
inst rument “t he bit e plane leveler, Nikzad S. J avid
(1974)
[10]
suggest ed t he use of “J -plane”, Kazanoglu
& J ohn W. Unger (1992)
[11]
described “Camper’s plane
indicat or”

and Urbano, Sant ana-Penin & Maria J . Mora
(1998)
[12]
described a U-shaped device for analyzing the
level of ala-t ragus line. In 1993, Vincent Kokich
[13]
said
for good esthetics the occlusal plane should be parallel
t o int erpupillary plane while J eff Morley and J immy
Eubank (2001)
[14]
said t he creat ion of an incisal plane
perpendicular t o t he facial midline produces a reliable
and repeat able posit ion t hat does not depend on t he
int erpupillary line.
J ack Piermat t i (2006)
[15]
said t he occlusal plane should
terminate at the upper level of the retromolar pad while
Art hur O. Rahn and Charles M. Heart well (1986)
[7]
said
post erior height should not exceed half t he height of
t he ret romolar pad. On t he ot her hand, K. Shigli, B.R.
Chetal and J. Jabade (2005)
[16]
found the lower one-third
of t he ret romolar pad consist ent wit h t he mandibular
occlusal plane while Robert L. Engelmeier (1996)
[17]
said
in the sagittal view the occlusal plane is determined by
t he incisal edges of maxillary cent ral incisors and t he
approximat e junct ure of t he upper and middle t hirds
of t he ret romolar pad.
K. Shigli, B.R. Chet al and J . J abade (2005)
[16]
found t hat
t he mean value of all readings of buccinat or groove
was 0.94 mm below t he mandibular occlusal plane
and is a reliable int raoral landmark for occlusal plane
det erminat ion.
It is evident t hat t he various concept s report ed in
lit erat ure allow variat ion in t he locat ion of occlusal
plane. Hence a need was felt to evaluate the relationship
bet ween t he occlusal plane, ext raoral and int raoral
landmarks.
Aims and Objectives
To assess relationships between intraoral and, extraoral
s oft t is s ue la ndma rks , Viz . Ret roret romola r pa d,
buccinat or groove, ala-t ragus line and int erpupillary
line, wit h occlusal plane
To determine consistency of soft tissue landmarks with
occlusal plane in both sexes and check for any variation
To evaluat e t he significance of soft t issue landmarks
in est ablishing lost occlusal plane
MATERIAL AND METHODS
Selection Criteria
The st udy was conduct ed on 100 dent ulous subject s
(50 males and 50 females)
• Age group = 17 – 21 yrs
• No hist ory of
• ort hodont ic t reat ment
• facial t rauma or surgery causing asymmet ry of t he
eyes
• no gingival or periodont al condit ions or t herapy
t hat would undermine a healt hy t oot h-t o-t is s ue
relat ionship.
• All healthy permanent teeth were present in normal
arch form and alignment wit h
• no int erdent al spacing or crowding present .
• t eet h were not grossly abraded or at t rit ed
• no gross dent al rest orat ions t hat might alt er t he
plane
• no e vid e nce of g ing iva l a lt e ra t ion or d e nt a l
irregularit ies
• Abs ence of a ny a ppa rent defect , deformit y or
asymmet ry of t he face
Instruments Used
1. Occlusal Plane Analyzer [Figure 1]
This ins t r ume nt wa s cus t om ma de t o che ck for
parallelism of ala-t ragus line t o t he occlusal plane and
occlusal plane t o int erpupillary line.
A FOX PLANE (Dr. Frank Fox (Dent sply / York division,
York, PA) was t aken. Four long screws were at t ached
at t he four ends of occlusal plane relat or arm, care was
t aken t o place t hese screws parallel t o each ot her.
Three met al plat es (t wo in oblique direct ion and one
in horizontal) were then attached to these screws. Two
plat es (oblique) were made parallel t o t he occlusal
plane relat or arm. It served t o analyze t he parallelism
of occlusal plane wit h ala-t ragus line. The t hird plat e
(horizont al) was parallel t o t he front al connect ing arm
which could relat e t he occlusal plane t o int erpupillary
line. A mark was made on bot h t he sides of all t he
plat es . The corres ponding mark, which was in a
straight line to the mark on the plate, was placed on the
144 The Jour nal of Indian Prosthodontic Society / July 2009 / Vol 9 / Issue 3
arms of t he fox plane. These marks helped det ermine
parallelism of t he plat es by measuring t he dist ance
bet ween t he plat es.
A met al key was also provided wit h t he inst rument
t o open t he met al collars and help move t he plat es up
and down.
2. Digital Vernier Callipers:
Digit al Vernier calipers, wit h an accuracy of .001mm,
were used t o check t he dist ance bet ween t he t wo
arrowheads on t wo parallel plat es.
3. Buccinator Groove Relator: [Figure 2]
It wa s cus t om ma de t o compa re t he level of t he
buccina t or groove (linea a lba bucca lis ) wit h t he
occlus a l pla ne. A ver t ica l impres s ion pla t e wit h
rounded ends was at t ached on eit her side of t he bit e
fork. The ends of t hese plat es were rounded t o avoid
any possible injury to the soft tissues. Small holes were
made on t he vert ical plat es t o help for t he ret ent ion of
t he impression mat erial.
4. Level Analyzer: [Figure 3]
An u–shaped plat e was made t o check t he level of
buccinat or groove wit h t he occlus al plane on t he
impression t aken. While fabricat ing, care was t aken t o
make sure bot h t he prongs of t he U were at t he same
level and parallel t o each ot her.
5. Metallic Scale:
A t hin 6” st ainless st eel scale was used t o relat e t he
occlusal plane t o t he ret romolar pad.
Procedure
STEP - 1: Parallelism of Occlusal Plane t o Campers Line:
Subject s are seat ed in an upright posit ion on a dent al
chair so t hat t hey looked forward at t he horizon. Using
a surgical marking pencil, t hree point s are marked
on t he t ragus of t he subject according t o it s locat ion
i.e. superior, middle and inferior. The occlusal plane
analyzer is placed in t he subject ’s mout h and held in
position by the subject biting over it. The plate is raised
unt il it coincided wit h ala of t he nose. [Figure 4]
The dis t ance bet ween t he arrowheads on t he t wo
plat es is t hen meas ured us ing t he digit al vernier
calipers. Same dist ance bet ween t he t wo plat es on
bot h sides indicat ed parallel opening. [Figure 5]
The post erior end is t hen checkedwhet her t o see if it
coincided wit h t he superior, middle or inferior point of
t he t ragus. The procedure was repeat ed for bot h t he
sides.
STEP – 2: Parallelism of Occlusal Plane to Interpupillary Line:
The parallelism of occlusal plane wit h int erpupillary
line is checked using t he same inst rument . Wit h t he
subject seat ed in t he upright posit ion, t he occlusal
plane analyzer is placed in t he subject ’s mout h and
held in position by the subject biting over it. The frontal
met al plat e is t hen made parallel t o t he int erpupillary
line. Finally, t he parallelism is checked wit h t he front al
connect ing arm of t he fox plane, by measuring t he
dist ance bet ween t he t wo plat es using digit al vernier
ca lipers . Sa me dis t a nce bet ween bot h t he ends
indicat ed parallelism. [Figure 5]
STEP – 3: Level of Occlusal Plane with Linea Alba Buccalis
For t he buccinat or groove, t he buccinat or groove
relat or and level analyzer are used. An irreversible
hydrocolloid impression mat erial (alginat e – Zelgan
2002.Dent s ply) is us ed t o make t he impres s ion of
t he buccinat or groove. An indelible pencil is used t o
mark t he groove in t he subject ’s mout h [Figure 6].
For t he impression, alginat e mat erial is placed on t he
vert ical impression plat es. It is made cert ain t hat t he
dist al aspect s of t he buccal vest ibules on bot h sides
are filled. The subject is t hen asked t o pucker his/ her
lips as in sucking wit h t he lips slight ly separat ed, but
wit hout t he loss of cont act of t eet h wit h t he bit e plat e.
This helps t ransfer t he mark t o t he impression. The
impression is t hen removed from t he mout h, washed
wit h wat er and excess t rimmed.
The level analyzer is t hen used t o check for t he level of
t he groove in relat ion t o t he occlusal plane. One of t he
prongs of t he plat e is kept on t he t op side of t he bit e
plate (depicting maxillary occlusal plane) such that the
second prong ext ends on t he ot her side of t he vert ical
plat e, carrying t he vest ibular impression [Figure 7].
The coincidence/ non-coincidence of t he groove t o
t he occlusal plane is t hen not ed. Similar procedure is
followed for t he ot her side also.
STEP – 4: Relationship of Occular Plane with Retromolar Pad
Using a surgical marking pencil, t he ret romolar pad
area of t he subject is divided int o t hree equal zones.
The st ainless st eel scale is t hen slided post eriorly over
t he cusps of t he mandibular post erior t eet h ensuring
it s cont act wit h t he t ip of t he cuspid on one side of t he
mandibular arch t o make cont act wit h t he ret romolar
pad. The zone of cont act i.e. t he superior one-t hird,
middle one-t hird or t he junct ion of superior or middle
one-third of the retromolar pad, is then recorded [Figure
8]. The process is repeated on the other side of the arch.
St at is t ical analys is was carried out us ing: CHI –
SQUARE TEST. The level of significance adopt ed was
5%.
RESULTS
Gupta, et al.: Anatomic landmarks with Occlusal Plane
The Jour nal of Indian Prosthodontic Society / July 2009 / Vol 9 / Issue 3 145
Figure 1: Occlusal plane analyzer Figure 2: Buccinator groove relator
Figure 3: Level Analyzer Figure 4: Parallelism of Occlusal Plane to Camper’s Line
Figure 5: Checking Difference with Digital Vernier Calipers Figure 6: Level of Occlusal Plane with Linea Alba Buccalis
Gupta, et al.: Anatomic landmarks with Occlusal Plane
Figure 7: Checking level of Linea Alba Buccalis using Level analyzer Figure 8: Relationship of occlusal plane with retromolar pad
146 The Jour nal of Indian Prosthodontic Society / July 2009 / Vol 9 / Issue 3
Occlusal Plane and Camper’s Line
The occlus al plane analyzer was us ed [Table 1]; a
variation of posterior reference point of Camper’s line in
males and females was also observed. It was seen that
72% of males had middle point as post erior reference
point while 80% of females had superior point as t he
post erior reference point showing parallelism t o t he
occlusal plane
Occlusal Plane and Interpupilalry Line
The same inst rument was used t o analyze parallelism
of t he occlus al plane wit h t he int erpupillary line.
Des pit e various claims only 13% s ubject s s howed
occlusal plane parallel t o t he int erpupillary line. Not
much difference was observed bet ween t he t wo sexes
[Table 2], 92% of males and 82% of females showed
cant ing
Occlusal Plane and Buccinator Groove
The buccinat or groove relat or was used t o relat e t he
occlusal plane wit h t he level of buccinat or groove. The
level analyzer was used to analyze the level; 70% males
and 66% females have t he groove at t he same level of
t he occlusal plane. So t he buccinat or groove can be
used as a reliable [Table 3] landmark for orient at ion of
occlusal plane.
Occlusal Plane and Retromolar Pad
A met allic scale was passed along t he cusp t ip from
cus pid t o mandibular II / III molar and ext ended
pos t eriorly t o check for t he relat ions hip bet ween
occlus a l pla ne a nd ret romola r pa d. Ins ignifica nt
diffe re nce be t we e n t he ma le s a nd fe ma le s wa s
observed as 76% of males and 78% of females wit h
occlusal plane at t he level of t he middle t hird of t he
ret romolar pad area [Table 4].
Comparing the right and lef side
Variat ion of occlusal plane relat ionship wit h t he ala-
t ragus plane, buccinat or groove and ret romolar pad
area was obs erved on t he right and left s ide. The
ret romolar pad area s howed maximum number of
variat ions followed by buccinat or groove; leas t in
relat ing t he ala-t ragus line t o occlus al plane. This
indicat es t hat ala-t ragus plane is a reliable [Table 5]
landmark for orient ing t he occlusal plane. Int raorally,
buccinat or groove is t he best available landmark.
DISCUSSION
The orient at ion of t he occlusal plane lost in pat ient s
rendered edent ulous should be relocat ed if complet e
dent ures are t o be est het ic and funct ion sat isfact orily.
The orientation of the occlusal plane forms the basis for
t eet h arrangement conducive t o sat isfact ory est het ics
and proper funct ion.
Table 1: Parallelism of occlusal plane with camper’s line
Camper’s Line Males Females Total
(Ala of T=the nose to) (%) (%) (%)
Superior point of tragus 24 80 52
Middle point of tragus 72 20 46
Inferior point of tragus 4 0 2
Table 2: Parallelism of occlusal plane with
Inter-pupillary line
Inter-Pupillary Line Males Females Total
(%) (%) (%)
Parallel to occlusal plane 8 18 13
Not parallel to occlusal plane 92 82 87
Table 3: Relationship between level of buccinator groove
and occlusal plane
Buccinator groove Males Females Total
(At the level) (%) (%) (%)
same as that of the occlusal plane 70 66 68
Superior to the occlusal plane 30 32 31
Inferior to the occlusal plane 0 2 1
Table 4: Relationship between occlusal plane and
retromolar pad area
Retro-molar pad Males Females Total
(Occlusal plane at the level of) (%) (%) (%)
Superior 1/3
rd
8 8 8
Middle 1/3
rd
76 78 77
Junction of superior and middle 1/3
rd
16 14 15
Table 5: Variation of occlusal plane relationship with
ala-tragus plane, buccinator groove and retromolar pad
area as observed on right and left side
Males Females Total
(%) (%) (%)
Camper’s line 20 28 24
Buccinator groove 32 26 29
Retromolar pad 30 38 34
Gupta, et al.: Anatomic landmarks with Occlusal Plane
Ant eriorly, occlusal plane mainly helps in achieving
es t het ics and phonet ics while pos t eriorly, it forms
a milling s ur fa ce . Thus , incor re ct re cord of t he
occlusal plane would hamper est het ics, phonet ics,
and mast icat ion. It may also affect t he st abilit y of a
complet e dent ure and ult imat ely res ult in alveolar
bone resorpt ion.
Funct ionally, inclinat ion of t he occlusal plane is one of
t he key fact ors governing occlusal balance. Movement
of t he mout h during chewing shows a harmonious
relat ions hip bet ween t he t ongue, t he mandibular
post erior t eet h, and t he buccinat or muscle; incorrect
locat ion of occlusal plane, result s in malfunct ions.
Thus it can be said t hat for t he success of complet e
denture prosthesis, arranging the teeth in correct plane
The Jour nal of Indian Prosthodontic Society / July 2009 / Vol 9 / Issue 3 147
of occlusion is pivotal. Changes in the plane of occlusion
modify t he physical and funct ional relat ionship of t he
oral musculat ure leading t o an alt erat ion in funct ion,
comfor t and als o t he es t het ic value. Cons idering
t he impor t a nce of t he a ccura t e es t a blis hment of
t he locat ion and t he effect of t he inclinat ion of t he
est ablished occlusal plane on funct ion, est het ics and
speech, a met hod t o conform it t o t he occlusal plane
t hat exis t ed in t he nat ural t eet h s eems neces s ary.
Hence, t his s t udy was conduct ed t o examine t he
significance of various soft tissue landmarks as a guide
t o est ablish t he original occlusal plane as was present
in t he pat ient ’s nat ural dent it ion and det ermine t he
consist ency of soft t issue landmarks wit h t he occlusal
plane in bot h sexes and check for any variat ion.
SUMMARY AND CONCLUSIONS
On t he basis of t he result s obt ained, t he following
conclusions can be drawn:
In maximum number of subject s, t he occlusal plane
was found parallel t o Camper’s plane wit h t he ant erior
reference point as t he ala of t he nose and post erior
reference point as t he superior point of t ragus.
The pos t erior reference point of Ca mper’s pla ne
showing parallelism with occlusal plane varies in males
and females. In males, it is t he middle point of t ragus
and in females t he superior point of t ragus.
The occlus a l pla ne is not a lwa ys pa ra llel t o t he
int erpupillary line. Slight cant ing was observed.
The buccinat or groove is found t o be at t he level of t he
occlusal plane in most of t he subject s; independent of
sex of the subject. Hence, it can be considered the most
st able int ra-oral landmark for orient ing t he occlusal
plane.
Majorit y of t he subject s showed t he occlusal plane at
t he level of middle t hird of t he ret romolar pad area.
However, due t o high percent age of variat ion bet ween
the right and left side it cannot be considered a reliable
landmark for orient ing t he occlusal plane.
The results of this study indicate that no single method
wa s a ccura t e in det ermining t he occlus a l pla ne.
However, using more t han one of t hese paramet ers
along wit h a judicious clinical judgment , we can
be very close t o t he ideal occlusal plane level for an
edent ulous pat ient .
It must be const ant ly borne in mind t hat t he occlusal
plane is det ermined by t he dynamics of funct ion and
not by any part icular s t at ic relat ions hip. It is als o
advisable that occlusal plane should be selected on the
basis of anat omical landmarks, est het ics, phonat ion,
comfort and funct ion.
ACKNOWLEDGMENT
We place on record our grat it ude t o Dr. (Maj. Gen) V. K.
Sood and Dr. Sanjay Yadav.
Gupta, et al.: Anatomic landmarks with Occlusal Plane
Source of Support: Nil, Conflict of Interest: None declared.
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York. Scott (1952)[9] described an instrument “the bite plane leveler. K.: Anatomic landmarks with Occlusal Plane by P F. • All healthy permanent teeth were present in normal arch form and alignment with • no interdental spacing or crowding present. Jack Piermatti (2006)[15] said the occlusal plane should terminate at the upper level of the retromolar pad while Arthur O. have also been suggested In 1979. was placed on the 143 . Nikzad S. Two plates (oblique) were made parallel to the occlusal plane relator arm. E. upper lip line by . Kazanoglu & John W. deformity or asymmetry of the face Instruments Used 1.R. Okane [6] found that during clenching maximum biting force was greatest and muscle activity was least when the occlusal plane was made parallel to the ala-tragus line. A. Chetal and J. Retroretromolar pad. extraoral and intraoral landmarks. The Journal of Indian Prosthodontic Society / July 2009 / Vol 9 / Issue 3 Aims and Objectives To assess relationships between intraoral and. It is evident that the various concepts reported in literature allow variation in the location of occlusal plane. The third plate (horizontal) was parallel to the frontal connecting arm which could relate the occlusal plane to interpupillary line. Santana-Penin & Maria J. ala-tragus line and interpupillary line. Rostamkhani. Engelmeier (1996)[17] said in the sagittal view the occlusal plane is determined by the incisal edges of maxillary central incisors and the approximate juncture of the upper and middle thirds of the retromolar pad. Jabade (2005)[16] found that the mean value of all readings of buccinator groove was 0. which was in a straight line to the mark on the plate. Vincent Kokich[13] said for good esthetics the occlusal plane should be parallel to interpupillary plane while Jeff Morley and Jimmy Eubank (2001)[14] said the creation of an incisal plane perpendicular to the facial midline produces a reliable and repeatable position that does not depend on the interpupillary line. B. Frank Fox (Dentsply /York division. et al. Occlusal Plane Analyzer [Figure 1] This instrument was custom made to check for parallelism of ala-tragus line to the occlusal plane and occlusal plane to interpupillary line.Gupta. Chetal and J. On the other hand. Four long screws were attached at the four ends of occlusal plane relator arm. Landa[2] in 1947 said that the occlusal plane is parallel to line drawn from the alae of nose to the middle point of the tragus while Arthur O. Rahn and Charles M. PA) was taken. Mora (1998)[12] described a U-shaped device for analyzing the level of ala-tragus line.94 mm below the mandibular occlusal plane and is a reliable intraoral landmark for occlusal plane determination. F. A FOX PLANE (Dr.R. • teeth were not grossly abraded or attrited • no gross dental restorations that might alter the plane • no evidence of gingival alteration or dental irregularities • Absence of any apparent defect. The corresponding mark. with occlusal plane To determine consistency of soft tissue landmarks with occlusal plane in both sexes and check for any variation To evaluate the significance of soft tissue landmarks in establishing lost occlusal plane  Selection Criteria The study was conducted on 100 dentulous subjects (50 males and 50 females) • Age group = 17 – 21 yrs • No history of • orthodontic treatment • facial trauma or surgery causing asymmetry of the eyes • no gingival or periodontal conditions or therapy that would undermine a healthy tooth-to-tissue relationship. buccinator groove. Shigli. the lateral borders of the tongue etc. Various authors like J. On the other hand. In 1993. Jabade (2005)[16] found the lower one-third of the retromolar pad consistent with the mandibular occlusal plane while Robert L. Latta[4] in 1985. Viz. Heartwell (1986)[7] said posterior height should not exceed half the height of the retromolar pad. H. Kermani (2005)[8] conducted a cephalometric study and concluded that the inferior border of the tragus can be suggested as the posterior point for ala-tragus line orientation. Shigli. A mark was made on both the sides of all the plates. Sahafian and H. extraoral soft tissue landmarks. Foley and G. Rahn and Charles M. K. Rahn and Heartwell[5] in 1986. Unger (1992)[11] described “Camper’s plane indicator” and Urbano. Heartwell (1986)[7] said the occlusal plane should coincide with Camper’s line (superior border of the tragus). B. Hence a need was felt to evaluate the relationship between the occlusal plane. H. care was taken to place these screws parallel to each other. Javid (1974)[10] suggested the use of “J-plane”. height of the retromolar pad. Three metal plates (two in oblique direction and one in horizontal) were then attached to these screws. It served to analyze the parallelism of occlusal plane with ala-tragus line.

superior. An irreversible hydrocolloid impression material (alginate – Zelgan 2002. A metal key was also provided with the instrument to open the metal collars and help move the plates up and down. Metallic Scale: For the buccinator groove. For the impression. The occlusal plane analyzer is placed in the subject’s mouth and held in position by the subject biting over it. with an accuracy of . Statistical analysis was carried out using: CHI – SQUARE TEST. et al. alginate material is placed on the vertical impression plates. the parallelism is checked with the frontal connecting arm of the fox plane. middle or inferior point of the tragus. middle one-third or the junction of superior or middle one-third of the retromolar pad. Same distance between both the ends indicated parallelism. Procedure STEP .1: Parallelism of Occlusal Plane to Campers Line: Subjects are seated in an upright position on a dental chair so that they looked forward at the horizon. Similar procedure is followed for the other side also. The zone of contact i. Level Analyzer: [Figure 3] An u–shaped plate was made to check the level of buccinator groove with the occlusal plane on the impression taken. the buccinator groove relator and level analyzer are used. The process is repeated on the other side of the arch. middle and inferior. 5.Dentsply) is used to make the impression of the buccinator groove. 3. 4. the superior one-third. While fabricating. Same distance between the two plates on both sides indicated parallel opening. washed with water and excess trimmed.Gupta. [Figure 5] STEP – 3: Level of Occlusal Plane with Linea Alba Buccalis It was custom made to compare the level of the buccinator groove (linea alba buccalis) with the occlusal plane. the occlusal plane analyzer is placed in the subject’s mouth and held in position by the subject biting over it. The stainless steel scale is then slided posteriorly over the cusps of the mandibular posterior teeth ensuring its contact with the tip of the cuspid on one side of the mandibular arch to make contact with the retromolar pad. STEP – 2: Parallelism of Occlusal Plane to Interpupillary Line: Using a surgical marking pencil. but without the loss of contact of teeth with the bite plate. With the subject seated in the upright position. 2. This helps transfer the mark to the impression. One of the prongs of the plate is kept on the top side of the bite plate (depicting maxillary occlusal plane) such that the second prong extends on the other side of the vertical plate. The level analyzer is then used to check for the level of the groove in relation to the occlusal plane.e. The coincidence/non-coincidence of the groove to the occlusal plane is then noted. [Figure 5] The posterior end is then checkedwhether to see if it coincided with the superior. carrying the vestibular impression [Figure 7]. Buccinator Groove Relator: [Figure 2] The parallelism of occlusal plane with interpupillary line is checked using the same instrument. is then recorded [Figure 8]. Using a surgical marking pencil.001mm.: Anatomic landmarks with Occlusal Plane arms of the fox plane. Digital Vernier Callipers: Digital Vernier calipers. The impression is then removed from the mouth. A vertical impression plate with rounded ends was attached on either side of the bite fork. three points are marked on the tragus of the subject according to its location i. These marks helped determine parallelism of the plates by measuring the distance between the plates.e. the retromolar pad area of the subject is divided into three equal zones. It is made certain that the distal aspects of the buccal vestibules on both sides are filled. The frontal metal plate is then made parallel to the interpupillary line. [Figure 4] The distance between the arrowheads on the two plates is then measured using the digital vernier calipers. Finally.  The Journal of Indian Prosthodontic Society / July 2009 / Vol 9 / Issue 3 144 . Small holes were made on the vertical plates to help for the retention of the impression material. by measuring the distance between the two plates using digital vernier calipers. care was taken to make sure both the prongs of the U were at the same level and parallel to each other. were used to check the distance between the two arrowheads on two parallel plates. The subject is then asked to pucker his/her lips as in sucking with the lips slightly separated. The procedure was repeated for both the sides. STEP – 4: Relationship of Occular Plane with Retromolar Pad A thin 6” stainless steel scale was used to relate the occlusal plane to the retromolar pad. The level of significance adopted was 5%. The ends of these plates were rounded to avoid any possible injury to the soft tissues. The plate is raised until it coincided with ala of the nose. An indelible pencil is used to mark the groove in the subject’s mouth [Figure 6].

: Anatomic landmarks with Occlusal Plane Figure 1: Occlusal plane analyzer Figure 2: Buccinator groove relator Figure 3: Level Analyzer Figure 4: Parallelism of Occlusal Plane to Camper’s Line Figure 5: Checking Difference with Digital Vernier Calipers Figure 6: Level of Occlusal Plane with Linea Alba Buccalis Figure 7: Checking level of Linea Alba Buccalis using Level analyzer Figure 8: Relationship of occlusal plane with retromolar pad The Journal of Indian Prosthodontic Society / July 2009 / Vol 9 / Issue 3 145 .Gupta. et al.

buccinator groove is the best available landmark. Movement of the mouth during chewing shows a harmonious relationship between the tongue. Occlusal Plane and Retromolar Pad Table 4: Relationship between occlusal plane and retromolar pad area Retro-molar pad (Occlusal plane at the level of) Superior 1/3rd Middle 1/3rd Junction of superior and middle 1/3rd Males (%) 8 76 16 Females (%) 8 78 14 Total (%) 8 77 15 A metallic scale was passed along the cusp tip from cuspid to mandibular II / III molar and extended posteriorly to check for the relationship between occlusal plane and retromolar pad. The level analyzer was used to analyze the level. It was seen that 72% of males had middle point as posterior reference point while 80% of females had superior point as the posterior reference point showing parallelism to the occlusal plane Occlusal Plane and Interpupilalry Line Table 2: Parallelism of occlusal plane with Inter-pupillary line Inter-Pupillary Line Parallel to occlusal plane Not parallel to occlusal plane Males (%) 8 92 Females (%) 18 82 Total (%) 13 87 The same instrument was used to analyze parallelism of the occlusal plane with the interpupillary line. 92% of males and 82% of females showed canting Occlusal Plane and Buccinator Groove Table 3: Relationship between level of buccinator groove and occlusal plane Buccinator groove (At the level) same as that of the occlusal plane Superior to the occlusal plane Inferior to the occlusal plane Males (%) 70 30 0 Females (%) 66 32 2 Total (%) 68 31 1 The buccinator groove relator was used to relate the occlusal plane with the level of buccinator groove. It may also affect the stability of a complete denture and ultimately result in alveolar bone resorption. 70% males and 66% females have the groove at the same level of the occlusal plane. least in relating the ala-tragus line to occlusal plane.Gupta. a variation of posterior reference point of Camper’s line in males and females was also observed. and the buccinator muscle. and mastication. et al. Intraorally. results in malfunctions. arranging the teeth in correct plane The Journal of Indian Prosthodontic Society / July 2009 / Vol 9 / Issue 3  The orientation of the occlusal plane lost in patients rendered edentulous should be relocated if complete dentures are to be esthetic and function satisfactorily. inclination of the occlusal plane is one of the key factors governing occlusal balance. occlusal plane mainly helps in achieving esthetics and phonetics while posteriorly. incorrect location of occlusal plane. it forms a milling surface. buccinator groove and retromolar pad area as observed on right and left side Males (%) Camper’s line Buccinator groove Retromolar pad 20 32 30 Females (%) 28 26 38 Total (%) 24 29 34 Variation of occlusal plane relationship with the alatragus plane. Comparing the right and left side Table 5: Variation of occlusal plane relationship with ala-tragus plane. Thus it can be said that for the success of complete denture prosthesis. The orientation of the occlusal plane forms the basis for teeth arrangement conducive to satisfactory esthetics and proper function. So the buccinator groove can be used as a reliable [Table 3] landmark for orientation of occlusal plane.: Anatomic landmarks with Occlusal Plane Occlusal Plane and Camper’s Line Table 1: Parallelism of occlusal plane with camper’s line Camper’s Line (Ala of T=the nose to) Superior point of tragus Middle point of tragus Inferior point of tragus Males (%) 24 72 4 Females (%) 80 20 0 Total (%) 52 46 2 The occlusal plane analyzer was used [Table 1]. This indicates that ala-tragus plane is a reliable [Table 5] landmark for orienting the occlusal plane. Not much difference was observed between the two sexes [Table 2]. Despite various claims only 13% subjects showed occlusal plane parallel to the interpupillary line. Thus. The retromolar pad area showed maximum number of variations followed by buccinator groove. Insignificant difference between the males and females was observed as 76% of males and 78% of females with occlusal plane at the level of the middle third of the retromolar pad area [Table 4]. incorrect record of the occlusal plane would hamper esthetics. Anteriorly. buccinator groove and retromolar pad area was observed on the right and left side. Functionally. 146 . phonetics. the mandibular posterior teeth.

5:139-45.54:209–13. Harper RN. Scott JE. Morley J.31:270-2. Engelmeier RL. Mora MJ. Rahn and CM. 9.3:755-69.42:497-501. Shigli K. it is the middle point of tragus and in females the superior point of tragus. A study of the position of the parotid papilla relative to the occlusal plane.2:46–9. Dent Clin North Am 1996. The Scott system of precision articulation in threedimensional occlusion. The occlusal plane indicator: A new device for determining the inclination of the occlusal plane. Source of Support: Nil. it can be considered the most stable intra-oral landmark for orienting the occlusal plane. J Prosthet Dent 1952. The results of this study indicate that no single method was accurate in determining the occlusal plane. Okane H.94:10-92. Rahn AO. et al. esthetics. Hence.  1. the following conclusions can be drawn: In maximum number of subjects. J D Res 1948. Macroesthetic elements of smile design. Changes in the plane of occlusion modify the physical and functional relationship of the oral musculature leading to an alteration in function. J Am Dent Assoc 2001. esthetics and speech. Heartwell: Textbook of complete dentures.80:374-5. The Journal of Indian Prosthodontic Society / July 2009 / Vol 9 / Issue 3 147 . Unger JW. 1986. 16. Complete denture esthetics. The occlusal plane is not always parallel to the  We place on record our gratitude to Dr. Ala-Tragus and Camper’s Lines.53:124-6. comfort and also the esthetic value. Validity of soft tissue landmarks in determining the occlusal plane.5:174–8.2:362-79. J Dent 2005. J Prosthet Dent 1953.the basis of a technic to reproduce the positions of key teeth in prosthodontia. It is also advisable that occlusal plane should be selected on the basis of anatomical landmarks. A Cephalometric Study on the Relationship between the Occlusal Plane.132:39–45. Sanjay Yadav. 3. J Prosthet Dent 1998. 15.Gupta. Latta GH. Wolters Kluwer Co. a method to conform it to the occlusal plane that existed in the natural teeth seems necessary. J Prosthet Dent 1992. due to high percentage of variation between the right and left side it cannot be considered a reliable landmark for orienting the occlusal plane. Sahafian A. Determining the occlusal plane with the Camper’s plane indicator. 5. 4. 14. However.40:71–84. phonation. the occlusal plane was found parallel to Camper’s plane with the anterior reference point as the ala of the nose and posterior reference point as the superior point of tragus. J Prosthet Dent 1985. Conflict of Interest: None declared. Hence. K. Gen Dent 2006.67:400–501. interpupillary line. Tsuru H. Piermatti J. Occlusal plane relation to facial type. A technique for determination of the occlusal plane. Javid NS. Jabade J. 8. Tooth position in full-mouth implant restorations — a case report. Heartwell: Textbook of complete dentures. 2.27:661–8. Considering the importance of the accurate establishment of the location and the effect of the inclination of the established occlusal plane on function. this study was conducted to examine the significance of various soft tissue landmarks as a guide to establish the original occlusal plane as was present in the patient’s natural dentition and determine the consistency of soft tissue landmarks with the occlusal plane in both sexes and check for any variation. The incisive papilla . J Prosthet Dent 1974. AO. It must be constantly borne in mind that the occlusal plane is determined by the dynamics of function and not by any particular static relationship. In males. 13. 1986. Chetal BR. Charles M. The posterior reference point of Camper’s plane showing parallelism with occlusal plane varies in males and females. Nagasawa T. 7. However. using more than one of these parameters along with a judicious clinical judgment.  On the basis of the results obtained. Augsburger RH.: Anatomic landmarks with Occlusal Plane of occlusion is pivotal. Majority of the subjects showed the occlusal plane at the level of middle third of the retromolar pad area. Slight canting was observed. 12. Santana-Penin UA. J Esthet Dent 1993. J Prosthet Dent 1979. we can be very close to the ideal occlusal plane level for an edentulous patient. 5th ed. Wolters Kluwer Co. Kazanoglu A. The buccinator groove is found to be at the level of the occlusal plane in most of the subjects. comfort and function. J Prosthet Dent 2005. The effect of anteroposterior inclination of the occlusal plane on biting force. The glossary of prosthodontic terms. Esthetics and Anterior Tooth Position: An Orthodontic Perspective Part II: Vertical Position. Sood and Dr. Foley PF. Kokich V. 17. J Indian Prosthodont Soc 2005. 5th ed. Kermani H. Rostamkhani F. independent of sex of the subject. 6. Yamashina T. (Maj. in Patients with Angle’s Class III Malocclusion. Eubank J. 11. Gen) V. 10.

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