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Importance of Hamular Distance Nikola Petričević1

Asja Čelebić1
Maja Baučić1
for Calculation of the Width of Robert Antonić2

Maxillary Anterior Teeth


1Department of Removable
Prosthodontics
School of Dental Medicine
University of Zagreb
2Department of Prosthodontics
School of Dental Medicine
University of Rijeka

Summary Acta Stomat Croat


2005; 291-294
Without pre-extraction photographs or casts it is not easy to select
suitable artificial teeth.
The aim of this study was to determine the relationship between the
width of frontal maxillary teeth and the width of the hard palate. The
aim was also to determine the possibility of reconstructing maxillary
frontal teeth dimensions, based on hard palate dimensions.
Teeth and hard palate dimensions were measured on maxillary casts
of 80 fully dentate individuals (26 men and 56 women) of Angle class
I occlusal relationship.
The maxillary central incisor is the widest among the frontal maxil-
lary teeth and canines are wider than second incisors. The width of the
maxillary frontal teeth arch, measured with a flexible ruler is 52.05 mm,
hamular distance 47.1 mm, distal maxillary width 46.1 mm, sum of the
widths of all maxillary frontal teeth 46.04 mm, frontal maxillary width
35.8 mm, and finally the width between canine cusp tips is 34.19 mm.
Based on the results of this study, the sum of all maxillary frontal ORIGINAL SCIENTIFIC
teeth widths is equivalent to hamular distance dimension, as well as PAPER
Received: April 7, 2005
distal maxillary width, as there were no statistically significant differ-
ences between them. After extraction of all teeth, distal maxillary width
is lost, which is not possible to reconstruct because of the individual Address for correspondence:
rate of alveolar bone resorption. On the other hand, hamular distance
remains the same dimension during the lifetime, because it is not de- Dr. Nikola Petričević
termined by teeth position but by anatomical structures. Therefore, the School of Dental Medicine
University of Zagreb
hamular distance dimension is a suitable reference for determination of Gundulićeva 5, 10000 Zagreb
the dimension of the sum of all maxillary frontal teeth widths. Croatia
e-mail:
Key words: hamular distance, maxillary frontal teeth width, distal nikolapetricevic@yahoo.com
maxillary width. phone: ++ 385 1 4802 165

Acta Stomatol Croat, Vol. 39, br. 3, 2005. ASC 291


N. Petričević et al. Importance of Hamular Distance

Introduction third molars), frontal teeth dental restorations, pros-


thetic appliance or attrition. Patients undergoing
Esthetically acceptable dentures do not differ orthodontic treatment or patients with asymmetries
from the natural teeth (1-4). Therefore the selection and abnormalities in tooth size or shape were also
of artificial teeth is an important phase in complete excluded from this study.
denture construction. Dimensions, shape and colour All patients were informed about the aim of the
are the most important factors in selection of artifi- study and the methods to be used and gave their
cial teeth (5-7). consent.
Attempts have been made to find a method for Alginate impressions of the maxillary jaw were
satisfactory selection of anterior teeth. The temper- made (Alginoplast fast set, Heraeus Kulzer, Hanau,
amental theory was the first one introduced (5), but Germany) and casts were poured in the hard stone
unfortunately completely unscientific. Almost 90 (Vel-Mix Stone, Kerr Italia S. p. A., Salerno, Italy).
years ago, Williams (9,10) suggested that a correla- Measurements were made on the casts using a pre-
tion existed between the upside-down facial shape cise caliper (TMA MEBA, Zagreb, Croatia). All the
and the shape of the upper central incisors. The den- measurements were made by one person.
tal outlines of the upper incisor were classified into The width of maxillary frontal teeth was mea-
three categories: tapered, ovoid and square-shaped. sured at their widest part. The sum of the widths of
Leon William’s theory was the most accepted one upper frontal teeth was computed by adding togeth-
although it did not suggest the size of the teeth. Frush er the widths of the left and right central incisor, the
and Fisher (11-13) introduced the dentogenic (SPA) left and the right second incisors and the left and the
theory. Selection of artificial teeth was determined right canines. A flexible millimeter ruler was also
on the basis of sex, personality, and age (SPA) of used to measure the curved distance between the
any individual. Lowery and Nelson (14, 15) pro- disto-aproximal contact points of the canines and
posed that a close relationship existed between face, the first premolars. The distance between the cusp
tooth and tooth arch form (palate form). tips of maxillary canines was also measured.
However, new studies were neither able to con- Hamular distance (distance between the left and
firm the relationship between face form and the the right hamular notch), frontal maxillary width
shape of upper central incisor (16-18), nor between (distance between central fissures of maxillary first
palatal shape and the form of the upper central inci- premolars) and distal maxillary width (distance
sor (19). between the apices of the mesial triangular fossae
The appearance of artificial teeth is usually not on the right and left maxillary first molars) were
as natural as it should be. It has been documented measured on the casts.
in the literature that artificial teeth are too narrow or Statistical analysis was made in SPSS 12 for
too long since the size of the prosthetic molds were Windows. Normality of the distribution was checked
too narrow in comparison with natural teeth (20). by Kolmogorov-Smirnov test. Means and standard
The aim of this study was to determine the pos- deviations were calculated and the significance
sibility of reconstruction of maxillary incisors and between means was tested using paired t test.
frontal teeth dimensions using some dimensions of
the hard palate.
Results

The distribution of the data was not different


Material and methods
from normal distribution, as revealed by Kolmogo-
rov-Smirnov (p>0.05).
A total of 80 individuals (26 men and 56 women,
aged 18-30 years) participated in the study. Individ- Means and standard deviations of maxillary fron-
uals were Angle class I occlusion (mimimal tooth tal teeth widths are shown in Figure 1.
rotations or compressions were allowed). Exclu- Significance of the differences between dimen-
sion criteria were: one or more teeth missing (except sions of the maxillary frontal teeth on the left and
292 A S C Acta Stomatol Croat, Vol. 39, br. 3, 2005.
N. Petričević et al. Importance of Hamular Distance

on the right side of the dental arch is shown in Table central incisor is 8.5 mm wide, maxillary second
1. No statistically significant differences were found incisor 6.5 mm, and maxillary canine 7.5 mm. These
between the widths of the teeth on the left and right results are in agreement with our results.
side of the dental arch (p>0.05). The sum of the width of all maxillary frontal
Means and standard deviations between canine teeth is important for esthetics of the frontal dental
cusp tips, sum of the width of all maxillary frontal arch. The aim of this study was to examine the rela-
teeth, width of maxillary frontal teeth arch (mea- tionship between the width of maxillary frontal teeth
sured with a flexible ruler), frontal maxillary width, (sum of widths of all maxillary frontal teeth, dimen-
distal maxillary width and hamular distance are sion of maxillary frontal teeth arch measured with a
shown in Figure 2. flexible ruler, width between canine cusp tips) and
Significance of the difference between palate the palate widths (frontal maxillary width, distal
width and the sum of the widths of all maxillary maxillary width and hamular distance). Results are
frontal teeth is shown in Table 2. No statistically shown in Figure 2.
significant difference was found between hamular The width of maxillary frontal teeth arch (mea-
distance and the sum of the widths of all maxillary sured with a flexible ruler) is 52.05 mm, the hamu-
frontal teeth. Also, no statistically significant differ- lar distance 47.1 mm, distal maxillary width 46.1
ence was found between distal maxillary width and mm, and the sum of widths of all maxillary frontal
the sum of the widths of all maxillary frontal teeth teeth 46.04 mm, frontal maxillary width 35.8 mm,
(p>0.05). Since the widths are not significantly dif- and finally the width between canine cusp tips 34.19
ferent hamular distance dimension, as well as dis- mm.
tal maxillary width could be used for selection of The width of maxillary frontal teeth is impor-
the sum of the widths of all maxillary frontal artifi- tant for selection of artificial teeth in removable
cial teeth. Statistically significant differences were prosthodontics. Width of the dental arch and width
found between other tested widths (p<0.05) and between the canine cusp tips are also important.
therefore are not suitable for selection of the width Significance of the differences was tested between
of all frontal artificial teeth. the sum of the widths of all maxillary frontal teeth
and other widths: the frontal maxillary width, distal
maxillary width and hamular distance. Significance
Discussion of the differences was also tested between hamular
distance and the width of the maxillary frontal teeth
Selection of artificial teeth is very important in arch measured with a flexible ruler, and between
removable prosthodontics because of its esthetic val- hamular distance and the width between the canine
ue. Decision on the selection of artificial teeth has cusp tips. No statistically significant difference was
to be based on the proper shape and exact dimen- found between the distal maxillary width and the
sions. Central position of the frontal teeth, especial- sum of the widths of all maxillary frontal teeth, or
ly maxillary frontal teeth, has the strongest influence between hamular distance and the sum of the widths
on esthetics (21). of all maxillary frontal teeth (p>0.05, Table 2).
Among maxillary frontal teeth, central incisors The sum of the widths of all maxillary frontal
are the widest and canines are wider than second teeth is not significantly different from distal max-
incisors (Figure 1). illary width or hamular distance. After extraction
In dental literature mean values are presented for of all the teeth, distal maxillary width is lost and it
the teeth, regardless of their position on the left or is not possible to reconstruct it because of the indi-
right side of the dental arch. Significance of the dif- vidual rate of alveolar bone resorption. On the oth-
ferences between dimensions of equivalent teeth on er hand, hamular distance does not change during
the left and right side of the dental arch was test- the lifetime (24), and it is not determined by teeth
ed (Table 1). No statistically significant differences position but by anatomical structures. Consequently,
were found (p>0.05). According to Brand and Issel- hamular distance is suitable reference for maxillary
hard (22) and Berkovitz et al. (23) the maxillary frontal teeth width selection.
Acta Stomatol Croat, Vol. 39, br. 3, 2005. A S C 293
N. Petričević et al. Importance of Hamular Distance

Frontal maxillary width is significantly smaller Conclusions


than the sum of the widths of all maxillary frontal
teeth (p<0.05, Table 2). Width between canine cusp 1. The values of the dimensions of frontal maxillary
tips was significantly smaller than the hamular dis- teeth may be helpful in the dental industry for
tance. Width between canine cusp tips measured in appropriate tooth molds.
this study did not differ from values reported by 2. Hamular distance dimension (distance between
other authors (25, 26). left and right hamular notch) is not statistically
The dimension of the maxillary frontal teeth arch, different from the sum of the widths of all max-
measured with a flexible ruler, is significantly larger illary frontal teeth (p>0.05), and therefore it is
than the hamular distance (p < 0.01, Table 2). It is suitable for the selection of the width of all max-
also larger than the sum of the widths of all maxil- illary frontal artificial teeth.
lary frontal teeth (p < 0.01, Table 2). This is due to
the position of the teeth in the dental arch.

294 A S C Acta Stomatol Croat, Vol. 39, br. 3, 2005.