Journal of Dentistry, 7, No. 4, 1979, pp. 339-341.

Printed in Great Britain

The use of the ala-tragus line for occlusal

plane determination in complete dentures
R.Abrahams, BChD
P. D. Carey, BDS, HDD MDent
Department of Prosthetic Dentistry, University of Pretoria, South Africa

ABSTRACT
This investigation compares the location of the occlusal plane which exists in the natural dentition with
the prosthetic plane when orientated according to the ala-tragus line. The results show a variation be-
tween the orientation of the two planes, which supports the view that the prosthetic plane, determined
in this manner, is not a reliable indicator for the position of the occlusal surfaces of the artificial teeth.

INTRODUCTION
The alaatragus, or Camper’s line, extends from the lower border of the ala of the nose to the
superior border of the tragus of the ear (Heartwell, 1968) (Fig. 1). Although it is generally
accepted that, when fabricating full dentures, the artificial teeth should be set in the position
occupied by the natural teeth (Fish, 1948; Boucher, 1970; Payne, 1977) this line is widely
used and frequently taught (Levin and Sauer, 1969) as a method for determining the occlusal
plane.

METHOD
This investigation was carried out on 24 Caucasian subjects with 28-32 teeth present in an
acceptable arch form. Ah subjects possessed an Angle Class I jaw relationship and had not
undergone previous orthodontic treatment. Using standard radiological techniques, cephalo-
grams of each subject were taken. The ala-tragus line was reproduced on the radiograph by
attaching a length of orthodontic wire, which corresponded with the desired landmarks, to
the subject’s face. In order to identify the natural plane of occlusion which extends from the
mesioincisal angle of the upper central incisor to the mesiopalatal cusp of the first maxillary
molar (Fenn et al., 1970) a plastic block incorporating a radio-opaque marker was held in
position relative to the first maxillary molar by the subject, using gentle inter-occlusal
pressure. The natural occlusal plane was drawn in on the cephalograms and a line parallel
to this plane was drawn to intersect the ala-tragus line (Fig 2). The deviation between the
two planes was then measured and tabulated (Table I).

RESULTS
The results show that, with one exception, the natural occlusal plane is at a lower level in the
posterior region than the prosthetic plane when determined using the ala-tragus line. The
deviation between the two planes varied from 0 to 17’ with an average of 9.66” (9’40’) and
a standard deviation of 4.29’ (4” 17‘). This result is statistically significant (P<O.OOl), indi-
cating that there is an average postero-inferior deviation of 9”40’ of the natural plane from
the ala-tragus line.
340 Journal of Dentistry, Vol. ~/NO. 4

Fig. 1. Ala-tragus line extending from the lower

border of the ala of the nose to the upper border
of the tragus of the ear.

Fig. 2. Postero-inferior deviation of the natural

plane (PO) from the ala-tragus line (TA).

Table /. Measurement of the deviation between the natural occlusal plane and
the ala-tragus line

Angle* between Angle between

naruralplane natural plane
and ala-tragus and ala-tragus
Subject line Subject line

1 4 13 6.5
2 0 14 10.0
3 0.5 15 IO.0
4 13.0 16 15.5
5 5.0 17 16.5
6 10.0 18 14.0
7 10.5 19 9.5
8 11.0 20 6.0
9 14.0 21 14.5
IO 17.0 22 12.5
11 9.0 23 4.5
12 7.5 24 10.0

* All angles given in degrees.

DISCUSSION
This study has shown that the ala-tragus line is not a reliable guide for determining the pros-
thetic occlusal plane. According to Ismael and Bowman (1968) the location of this plane is
a controversialissue. Using the middle of the retromolar pad to orientate the prosthetic plane
they found that it was at a lower level in the posterior region than the plane which existed
before extraction of the teeth. Lindquist and Luther (1970) investigated the relationship
between the natural plane, the parotid papilla, retromolar pad, and the buccinator groove
and commissure of the lips. They established that a close correlation exists between the
natural occlusal plane and the buccinator groove and commissures of the lips, and suggest
Abrahams and Carey: Ala-tragus line 341

that a vestibular impression technique be used for determining the plane in completely
edentulous patients.
When constructing full dentures, the location of the occlusal plane allows for wide
variations, often depending on the judgement of the individual dentist. However, the muscles
of the tongue and cheeks were trained to function with the occlusal plane of the natural
teeth at a certain vertical height and this plane should be reproduced in the denture to
enable the tongue to place and stabilize the bolus between the teeth (Landa, 1957).
Although no scientific basis exists for assuming that the ala-tragus line parallels the
plane of occlusion, it has proved to be a useful reference line for the initial orientation of the
plane.

Acknowledgements
Our thanks to Professor H. S. Schoeman, Department of Statistics, University of Pretoria,
for statistical analysis of the results and to Miss E. Strydom who typed the manuscript.

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