Bonakdarchian and Ghorbanipour 2010.3

One of the confusing and difficult aspects of complete
denture prosthodontics is the selection of appropriately
sized maxillary anterior denture teeth (Hoffman et al.,
1986). The anterior teeth are primarily selected to satisfy
esthetic concerns. The esthetic restoration of edentulous
patients has an important psychological effect (Sellen et al.,
1999; Al-Wazzan, 2001; Frush and Fisher, 1955). Patients
who receive their dentures expect them to appear similar
to their previous natural teeth (Gomes et al., 2009). The
mesiodistal width of teeth is a harder aspect to estimate
than the proper height of the anterior artificial teeth
(McArthur, 1985). Various guidelines have been suggested
for determining the maxillary anterior teeth when pre-
extraction records are not available, but different opinions
have been reported regarding their usefulness (Sellen et
al., 1999; Verjao and Nogueira, 2005). One of the methods
for selecting artificial anterior teeth is using certain guides
(Keng, 1960). Several anatomic measurements have
been suggested, including bizygomatic width (BZW),
interpupillary distance (IPD), interalar width (IAW),
and intercommisural width (ICW) (Zlatarić et al., 2007).
Different views have been reported on the significance
of the interalar width in selection of anterior tooth sizes.
Picard (1958) found that interalar width could be used
to estimate widths of the maxillary anterior teeth. This
was substantiated by Wehner et al. (1967) who suggested
extending parallel lines from the lateral margins of the alae
of the nose onto the labial surface of the maxillary occlusal
rim to estimate positions of the inter-canine cusp tips.

Hoffman et al. (1986) stated that there is a correlation
of 0.413 between IAW and intercanine tip distance (ICTD).
A weaker correlation coefficient of 0.217 was observed

between IAW and width of maxillary anterior teeth
(WMAT). ICTD was 3% greater than IAW and WMAT
was 31% greater than IAW. Aleem et al. (1997) reported
that WMAT is 26% greater than IAW. Al-El–Sheikh and
Al-Athel (1998) found significant associations between
IAW with (1) ICTD and (2) WMAT, and WMAT was 56%
greater than IAW. Mavroskoufis and Ritchie (1981) found a
positive association between nasal width and ICTD, which
promotes its use in establishing the width of the anterior
teeth. Latta et al. (1991) reported significant differences in
the IAW and IPD between races and sexes.

The aims of the present study were to compare IAW,
ICTD, and WMAT between males and females and to
derive predictive equations from a group of Iranian adults.

MATERIALS AND METHODS

This was a cross-sectional study of Iranian young adults.
The sample of convenience consists of dental students from
Isfahan University. A total of 120 cases were analyzed (60
males; 60 females). Inclusion criteria were: at least 18 years
old of Iranian descent; normal nose morphology without
a history of rhinoplasty; intact maxillary six anterior teeth
without history of orthodontic therapy; a Class I normal
occlusion without a diastema, spacing or crowding; and
well aligned teeth in the maxillary arch (Al-El–Sheikh and

Relationship Between Width of Maxillary Anterior Teeth
and Interalar Distance
Mortaza Bonakdarchian and Reza Ghorbanipour

Isfahan University of Medical Sciences Hezar Jerib Avenue, Isfahan, Iran

Correspondence to: Reza Ghorbanipour, Department of
Orthodontics, Faculty of Dentistry, Isfahan University of
Medical Sciences, Hezar Jerib Ave., Isfahan, Iran 81746-
73461
Email: dr_ghorbanipour@yahoo.com

ABSTRACT There are few guides to estimate the size
of denture teeth. The purpose of this observational
cross sectional study of Iranian adults was to evaluate
the relationship between interalar width compared to
intercanine tip distance and to the summed width of
the maxillary anterior teeth in adults. The samples were
selected from dental students in Isfahan University.
Interalar width was measured with calipers. Maxillary
inter-canine distance was measured between cusp tips
on dental casts. Mesiodistal widths of the six anterior
teeth also were measured. Independent t-tests, Pearson’s

correlation coefficients, and linear regression were used
for statistical analysis. Mean interalar width was 36.38
mm (sd = 3.81), intercanine tip distance was 34.15 mm (sd
= 2.05), and mean width of maxillary anterior teeth was
48.23 mm (sd = 2.07). There were significant associations
between interalar width and summed widths of the
maxillary anterior teeth and with intercanine distance. In
addition, predictive equations for estimation of tooth sizes
using interalar width were calculated by regression. These
statistical relationships may also be useful forensically.
Dental Anthropology 2010;23(2):53-56.

Al-Athel, 1998; Hasanreisoglu et al., 2005).
Sliding calipers were used with an accuracy of 0.1 mm.

Each distance was measured 3 times and the average was
recorded (Gomes et al., 2009). IAW (Fig. 1) was measured
from the widest point on either nostril (Zlatarić et al., 2007).

Irreversible hydrocolloid impressions (Cavex CA37,
Cavex Holland, BV, Haarlenm, Holland) of the maxillary
teeth were made and poured with hard dental stone
(Begostone, BEGO, Bremen, Germany). The straight-
line distance between canine tips (Fig. 2) was measured
(Hoffman et al., 1986). The maximum mesiodistal width
of each anterior tooth was measured, and these widths
were summed (coded as WMAT) (Gomes et al., 2009;
Hasanreisoglu et al., 2005).

Descriptive statistics, independent t-tests, Pearson’s
correlation coefficient, and linear regression analysis were
used for statistical analyses using the Statistical Package
for Social Sciences (SPSS Inc., Chicago, IL, USA).

RESULTS

Descriptive data are listed in Table 1. Results of
independent t-tests show that the values of IAW, ICTD and
WMAT were significantly greater in males than females.
Pearson’s r disclosed significant associations between IAW
and ICTD in females (r = 0.457; P < 0.05) and in males (r =
0.442; P< 0.05) and between IAW and WMAT in females
(r = 0.473; P < 0.05) and in males (r = 0.481; P < 0.05).
The predictive equations for estimating tooth sizes from
interalar width are summarized in Tables 2 and 3.

DISCUSSION

In earlier studies, measurements were made using
extracted teeth. Recent studies measured tooth dimensions
on casts or using computer-based images or intraoral
evaluations (Hasanreisoglu et al., 2005). It is generally
agreed that selection of the width of anterior teeth should
be based on facial measurements and proportions (Al-El–
Sheikh and Al-Athel, 1998). It has been reported that the
width of the nose may be used for selecting the size of the
anterior teeth, for positioning the maxillary canines and
for registering the curve of the anterior arch (Hoffman et
al., 1986).

Sex differences in the dimensions of the anterior
teeth have been noted for most racial groups, with men
exhibiting mesiodistally wider teeth than women (e.g.,
Hasanreisoglu et al., 2005; Strett et al., 1992; Lavelle, 1972;
Richardson and Malhotra, 1975).

The mean of IAW was 36.37 mm in the present study.
It was smaller than the means reported by Mosharraf et al.
36.6 mm (2006), Latta and Weaver 43.9 mm (1991), Dharap
and Tanuseputro (1997) 39.8 mm and was greater than the
mean reported by Hoffman et al. (1986) at 34.28 mm and
Al-El-Sheikh and Al-Athel (1998) at 33.27 mm.

In the present study the mean of ICTD was 34.15 mm,
which is smaller than means reported by Dharap and

Fig. 1. Measurement of interalar width.

Fig. 2. Measurement of straight-line distance between
the canine tips (intercanine tip distance)

Fig. 3. Measurement of maximum mesiodistal width of
maxillary incisor.

M. BONAKDARCHIAN AND R. GHORBANIPOUR

Tanuseputro (1997) 36.7 mm or Hoffman et al. (1986) 35.35
mm or Gomes et al. (2009) 37.44 mm.

The mean of WMAT in this study 48.23 mm was smaller
than the mean reported by Gomes et al. (2009) 53.67 and
Al-El-Sheikh (1998) 52.22 mm and was greater than means
reported by Hoffman et al. (1986) 44.85 mm, Al-Wazzan
(2001) 45.23 mm and Shillingburg et al. (1972) 45.80 mm.

The differences among studies would seem to be due
to ethnic differences or, possibly, different measurement
techniques. Some studies used digital photography and
obtained facial measurement from them, so they may have
some errors because of the effect of the third dimension of
anteroposterior length (Gomes et al., 2009; Hasanreisoglu
et al., 2005), while others took measurements on the face
(Hoffman et al., 1986; Al-El–Sheikh and Al-Athel, 1998;
Mosharraf et al., 2006). Al-El-Sheikh and Al-Athel (1998)
and Mosharraf et al. (2006) measured dental dimensions
intraorally and Hoffman et al. (1986) used wax rim indices.
Hasanreisoglu et al. (2005) and Gomes et al. (2009) measured
dimensions from dental casts.

Genetic heritage would seem to be the main cause
of variation between different groups (McArthur, 1985;
Mavroskoufis and Ritchie, 1981). Participants in the current
study were Iranian, and this is one source of the observed
differences among groups.

There was a significant association between IAW and
ICTD in females (r = 0.457; P < 0.05) and in males (r = 0.442,
P < 0.05), which agrees with the studies of Hoffman et al.
(1986) (r = 0.49, P < 0.05), Mavroskoufis and Ritchie (1981),
and Dharap and Tanuseputro (1997) (r = 0.31, P < 0.05).

In the current study there was a significant relation
between IAW and WMAT in females (r = 0.473; P < 0.05)
and in males (r = 0.481; P < 0.05). Hoffman et al. (1986),
Mosharraf et al. (2006), and Al-El-Sheikh and Al-Athel
(1998) reported similar associations in their studies (P <
0.05).

Concerning the estimation of ICTD from IAW, Hoffman
et al. (1986) found the ratio of 1.31 between IAW and
WMAT, this ratio was 1.30 in Gomes et al.’s study (2009)
and 1.26 in a study conducted by Aleem et al. (1997) and
1.56 in Al-El-Sheikh and Al-Athel’s study (1998). Other
studies calculated the ratio of means, whereas we provide
regression equations for estimating WMAT from IAW,
which is more useful. Different results in this study are
assumed to be due to different measurement methods, to
ethnic differences, and to different methods of analyzing
the data statistically.

From a clinical perspective, we promote the predictive
equations in Tables 2 and 3 for estimating tooth sizes in
Iranians. These equations will help dentists provide
Iranian patients the best esthetics relative to their previous
natural teeth and in harmony with their facial dimensions.

CONCLUSIONS

Within the limitations of the present study, the following
conclusions were drawn:
1. The dimensions of IAW, ICTD and WMAT were larger

in males.
2. There were significant relationships between IAW and

ICTD and WMAT in each sex.

ACKNOWLEDGEMENTS

This study (No. 385074) was supported financially by
Research Center of Isfahan University of Medical Sciences
and Health Services), Isfahan, Iran. We are grateful to
the department of prosthodontics in Isfahan faculty of
dentistry and all the students who participated in this
study.

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21:7-10.

TABLE 1. Descriptive statistics

Sex n Mean Max Min sd

IAW†
Female 60 34.32 40.4 27.6 2.863
Male 60 38.43 47.5 30.8 3.549
Total 120 36.38 47.5 27.6 3.816

ICTD
Female 60 33.25 36.3 29.1 1.735
Male 60 35.05 40.2 31.2 1.962
Total 120 34.15 40.2 29.1 2.052

WMAT
Female 60 47.67 52.7 41 2.367
Male 60 48.78 54.6 40 2.873
Total 120 48.23 54.6 40 2.679

†IAW, interalar width; ICTD, intercanine tip distance;
WMAT, width of maxillary anterior teeth.

TOOTH SIZE AND INTERALAR WIDTH

TABLE 2. Predictive equation for estimation of ICTD and WMAT from IAW in males (Y = a + bX)

Y X r P value Predictive equation

ICTD IAW 0.442 <0.0001 ICTD = 26.143 + 0.216 × IAW

WMAT IAW 0.481 0.0080 WMAT = 43.807 + 0.129 × IAW

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M. BONAKDARCHIAN AND R. GHORBANIPOUR

TABLE 3. Predictive equation for estimation of ICTD and WMAT from IAW in females (Y = a + bX)

Y X r P value Predictive equation

ICTD IAW 0.457 0.016 ICTD = 28.187 + 0.145 × IAW

WMAT IAW 0.473 0.000 WMAT = 42.194 + 0.159 × IAW