J Bagh College Dentistry Vol. 28(4), December 2016 Time of Emergence Pedodontics, Orthodontics and Preventive Dentistry 153 Photographic Analysis of Macro- Aand Micro-Aesthetic Appearance in a Sample of Iraqi Adults With Class I Normal Occlusion Dana R. Mohammed, B.D.S.)a) Iman Al-Sheakli, B.D.S., M.Sc. (b) ABSTRACT Background: Generally, the facial esthetics depends on the esthetic appearance of the maxillary anterior teeth. The purposes of this study were to analyse the macro-aesthetic appearance of the face and the micro-aesthetic appearance of the maxillary anterior teeth to establish the normative values for class I normal occlusion and to detect possible gender differences. Materials and methods: The sample consisted of 120 Iraqi adults (60 males and 60 females) aged (18-23) years. Each individual was clinically examined, then with cephalostat based head position, extraoral and intraoral photographs were taken for each subject. The facial and dental measurements were measured using AutoCad program 2014. Descriptive statistics was obtained for the measured variables for both genders and independent samples t-test was performed to evaluate the genders difference. Results and conclusions: The results showed that there is a highly significant gender difference in most of the measured variables regarding the macro-aesthetic appearance, since the males have a larger facial dimensions than females, while for the micro-aesthetic appearance, there is a non-significant gender difference in most of the measured variables, that means the proportions of maxillary anterior teeth does not affected by gender difference. Key words: class I normal occlusion; macro-aesthetic appearance; micro-aesthetic appearance; photographic records.(J Bagh Coll Dentistry 2017; 29(1):153-159) INTRODUCTION Beauty can be defined as a combination of qualities that gives pleasure to the senses or to the mind. It is a philosophical concept and the aspects of which were studied under the term aesthetics obtained from the Greek word for perception (aisthesis) and was coined by the 18th century philosopher Alexander Baumgarten who established esthetics as a separate field of philosophy, therefore; esthetics is the study of beauty and to a lesser extent, it’s opposite to the term ugly. It involves both the understanding and the evaluation of beauty, proportions and the symmetry (1). Facial beauty is a mystery, a complex concept for which there is no equation, or numbers can successfully describe it (2, 3), whereas the dental esthetics is a complicated branch and may be regarded to be purely subjective; this ‘subjective’ branch of dentistry encompassed by rules and values that allow us to study it objectively (4). The Egyptians and the Greeks in the period 365 BC- 300 BC started to understand the Divine or Golden proportion that known as A Golden Ratio which is the ratio of 1:1.618 that considered to be the most esthetically pleasing to the human eye (5). Enhancement of esthetic appearance is one of the primary consideration for the patients that seeking orthodontic treatment. (1) MSc student, Department Of Orthodontics, College of Dentistry, University of Baghdad. (2) Assisstant Professor, Department of Orthodontics, College of Dentistry, University Of Baghdad. The term “appearance” is used in conjunction with the term “esthetics” because it involves a broader assessment of the patient’s face other than the teeth, so to achieve this goal, it is essential to make a comprehensive study of several facial and teeth factors to create a pleasing harmony of face and teeth (6, 7). Two-dimensional photogrametry has been used in orthodontics to evaluate the facial proportions and assess changes during orthodontic treatment, this method was shown to be sufficiently non-invasive, inexpensive and reproducible since it was simple to achieve in a conventional setting, without the need for a special equipment (8, 9). The macro-aesthetics and micro-aesthetics are important divisions of esthetic appearance in orthodontics, this study aimed to analyse the macro-aesthetic appearance and micro-aesthetic appearance of maxillary anterior teeth to establish the normative values for class I normal occlusion in Iraqi adults with the aid of photographs and computer analysis and to detect the possible gender differences in macro and micro-aesthetic appearance. MATERIALS AND METHODS Sample The sample selected from undergraduate studentts at College of Dentistry-University of Baghdad. Out of 450 students examined, only 120 of them (60 females and 60 males) fitted the criteria of subject selection, which are: 1) All are J Bagh College Dentistry Vol. 28(4), December 2016 Time of Emergence Pedodontics, Orthodontics and Preventive Dentistry 154 Iraqies with age ranged 18-23 years, 2) having full permanent dentition regardless the third molars, 3) having normal overjet and overbite (2-4 mm), 4) bilateral class I buccal segments "molar and canine" (10), 5) skeletal class I relationship determined clinically (11) and 6) no spacing or crowding in anterior teeth. Whereas those with 1) history of facial trauma, 2) orthodontic/ orthognathic treatment, dento-facial deformities, surgeries, asymmetry or bad oral habits like thumb sucking and tongue thrust, 3) anterior or posterior crossbite, 4) active periodontal diseases and gingivitis, 5) extruded or rotated teeth in the anterior region, 6) signs of attrition and restoration of the maxillary anterior teeth, or proximal caries, 7) developmental anomalies such as supernumerary teeth, 8) prosthesis in the anterior teeth were excluded from the study. Methods History Each subject was seated on the dental chair and information about his/her name, age, medical and dental history was obtained. After that, a written consent form was obtained from the participants to assure their voluntary participation in the study. Then, each individual subjected to clinical examination which included examination of skeletal and dental relation. Standardization of the Photographs The camera (Canon D60, Japan) fixed in position and adjusted in height to be at the level of the individual’s eyes with a height adjustable tripod that controls the stability and the correct height of the camera according to the subject’s body height. The distance from the camera to the subject was fixed at a distance of about 101 cm measured from the camera lens to the ear rods, that were fit in the external auditory meatus in order to avoid the forward, backward, and tilting of the subject head (Cephalostat based head position) (12), and 56 cm from the camera lens to the ear rods for frontal intraoral photographs (13). The EF-S 18-200mm f/3.5-5.6 IS lens was used. Subjects were seated in front of a blue background, a ruler was placed on the plastic side of cephalostat near the subject head to correct the magnification. Photographic exposure The digital camera was set on the manual exposure shooting and from the wheel dial the camera was set on: ISO 2000, shutter speed of 80, aperture value set on f/5.6 and flash on. Two photographs were taken for each participant, for the facial photographs, each participant was positioned in the cephalostat with the interpupillary plane parallel to the floor (14), instructed to keep their teeth in maximum intercuspation and gently closed lips (15). The camera lens positioned parallel to the individual’s face and the subject was asked to look at the center of the camera’s lens during taking the photograph. The participant’s hair did not cover any part of the face (16). For the intraoral photograph, the cheek retractor was used to clearly display the maxillary anterior teeth, with the camera lens parallel to the labial surface of the teeth (17). Photographic analysis Each frontal facial and intra-oral photograph were analyzed by AutoCAD 2014 program. The analysis includes: 1-The Macro-aesthetic appearance that includes: a. Facial landmarks: according to Milutinovic et al. (18)  Glabella (Gl): It is the most prominent point on the midline of the face, between the eyebrows.  Nasion (n): It is the point in the midline of both the nasal root and the nasofrontal suture.  Inner canthus of the eye (Ic): It is the medial angle of the palpebral fissure.  Pupil of the eye (p): It is the hole that located in the center of the iris of the eye.  Zygoin (zy): Most lateral point on zygomatic arch.  Alare of the nose (AL): Point located at each lateral rim of the ala of the nose at its widest width.  Subnasale (Sn): The point at which the nasal columella merges with upper mucocutaneous lip in the mid sagittal plane  Chilion (Ch): A point located at angle of the mouth.  Stomion (Sto): The midpoint of the intra- labial fissure.  The Labrale Superius (LS): The midline point at the border of the upper lip.  The Labrale Inferius (LI): The midline point at the border of the lower lip.  Menton (Me): A most inferior point located at the soft tissue chin. b. The Linear Facial Measurements: According to Proffit et al. (19):  Zygomatic width (zy-zy): The distance between the two zygion points.  Inter-canthal distance (ICD): The distance between the median angles of the palpebral fissure.  Interpupillary width (IPW): It is a horizontal line between the center of right and left pupils. J Bagh College Dentistry Vol. 28(4), December 2016 Time of Emergence Pedodontics, Orthodontics and Preventive Dentistry 155  Interalar width (IAW): The distance between the two alare points of the nose.  Mouth width (MW): The distance between the two angles of the mouth. c. Vertical Facial Measurements: According to Proffit et al. (19):  Facial height (N-Me): The distance between soft tissue nasion and menton.  Lower face height (Sn-Me): The distance between subnasale and menton.  Upper lip vermilion (ULV): The distance between labrale superius and stomion.  Lower lip vermilion (LLV): The distance between labrale inferius and stomion. 2-The Micro-aesthetic appearance includes: a. The Golden Proportion: It could be defined as the proportion of successive width of the maxillary anterior teeth. It should remain constant, when progressing distally from the midline (20). The mesiodistal width measured parallel to the incisal edge, and at the widest mesiodistal portion of the tooth of each lateral incisor and the canine, as shown in Figure 1. It was calculated as follow: -For lateral incisor=MDW of lateral incisor X 100 MDW of central incisor -For canine=MDW of canine X 100 MDW of lateral incisor b.The Golden Percentage: The proportional width of each maxillary anterior tooth (for the right and left side) should be: 10% for the canine, 15% for the lateral incisor, 25% for the central incisor of the total distance across the maxillary anterior segment (21), it was calculated as follow: -Golden Percentage= MDW central, lateral, canine X 100 CMDW of all maxillary anterior teeth *The mesiodistal dimension measured parallel to the incisal edge, and at the widest mesiodistal portion of the tooth of each central incisor, lateral incisor and the canine,as shown in Figure 1. Figure 1: Measurement of mesiodistal width of maxillary anterior teeth. b.Tooth Proportionality-Height and Width Ratio: The ideal maxillary central incisor width should be approximately 80% compared to it’s height (22). It was calculated as follow: -Width-height ratio= Width of the tooth X100 Height of the tooth * The incisogingival dimensions of the maxillary central incisor were measured at the longest apical-coronal portion of the tooth, as shown in Figure 2 c.Height of Contact Points: Contact between the anterior teeth is where the teeth actually touch (23). The golden ratio was applied to the height of the contact points of the anterior teeth. This ratio was calculated as follow: -For central incisor= Height of contact point between centrals X100 Height of central incisor -For lateral incisor= Height of contact point (central-lateral) X100 Height of central incisor -For canine= Height of contact point (lateral-canine) X100 Height of central incisor *The height of contact point was measured from the incisal convergence of the gingival embrasure to the gingival convergence of the incisal embrasure (24) as shown in Figure 2 d.Total Maxillary Anterior Teeth Width: The distance between the tips of the maxillary canines in a horizontal straight line was measured (25). (Figure 2) Figure 2: Measurement of height of maxillary central incisors,height of contact points and total anterior teeth width. RESULTS AND DISCUSSION The sample in this study was selected at age between (18-23) years because the individuals maintain the same facial pattern till 25 years (26), and to minimize the effect of any remaining skeletal growth since the majority of facial growth is usually completed by the age of 16-17 years (27), as well as the occlusion at this age has been established regardless of the third molars and the possibility of teeth being mutilated by caries or wasting diseases would be minimal (28). J Bagh College Dentistry Vol. 28(4), December 2016 Time of Emergence Pedodontics, Orthodontics and Preventive Dentistry 156 The results in table 1 showed that the mean values for facial parameters (macro-aesthetic appearance) were higher in males than females, this finding could be attributed to that the human being faces have dimorphic features between the sexes, especially after puberty (29), and because males have longer growth period than females, the males were having greater measurements than females (30), one exception is for the upper and lower lip vermillion, which were higher in females than males, this finding may be attributed to the suggestion that made by Peck and Peck (2) in that the esthetically attractive white female face demonstrated a larger lips, and found to be in agreement with Ahmed et al. (31) and disagree with Ellakwa et al. (32). Independent sample t-test indicated that there is a high significant difference regarding the measured facial variables except in the Inter-canthal distance (ICD), Zygomatic width (zy-zy), Upper lip vermilion (ULV), and Lower lip vermilion (LLV) where there is a non- significant gender difference, this comes in line with Asghari et al. (15) and disagree with Ellakwa et al. (32). Regarding the maxillary anterior teeth measurements, table 2 showed that the mean values of the measured variables were higher in males than in females except in the mesiodistal width of left (MDW L2) and right lateral incisor (MDW R2), height of the contact point between “central incisors (CI-CI), lateral incisor and canine (left and right LI-Ca)”, whereas the mean values of mesiodistal width of left canine (MDW 3L) were equal in both genders, this finding comes in line with Murthy and Ramani (33) and disagree with Gillen et al. (34) since the sexual dimorphism has been reported for the maxillary tooth dimension in most racial groups (21). Additionally, the independent sample t-test showed that there is a non-significant difference regarding the maxillary anterior teeth variables except in the inter-canine distance (ICaD), height of left central incisor and mesiodistal width of both central incisors where there is a high significant difference, this could be attributed to sex-linked inheritance, so that the sex-hormonal influences were suggested (35), since the sexual dimorphism has a genetic basis according to Garn et al. (36), but till now this hypothesis is not proved. Table 3 showed that there is a non-significant gender difference in micro-aesthetic appearance which is in agreement with Fayyad et al. (37) and Ahmed et al. (38) and in disagreement with Parnia et al. (39), beside that the mean values of the measured variables were higher in females than males, this may be due to that the gender is not considered a significant factor (37), since the proportions regarding the micro-aesthetic appearance were depending on the ethnic or racial characteristics rather than gender difference (39). In this study the sexual diamorphism was significant in macro-aesthetic appearance with males having larger facial measurements, on the other hand the gender had a non-significant effect on the maxillary anterior teeth proportions. Table 1: Descriptive statistics and gender differences in macro-aesthetic appearance in both genders Variables Descriptive statistics Gender difference (d.f.= 118) Males (N=60) Females (N=60) Mean S.D. Mean S.D. Mean Difference t-test p-value ICD 31.62 3.17 30.89 3.37 0.73 1.230 0.221 (NS) IPW 63.41 4.69 60.96 4.59 2.45 2.888 0.005 (HS) zy-zy 127.77 7.68 125.73 9.05 2.04 1.334 0.185 (NS) IAW 39.68 3.07 35.51 3.26 4.18 7.225 0.000 (HS) MW 52.54 3.78 49.58 4.56 2.96 3.872 0.000 (HS) N-Me 125.60 9.02 115.47 7.95 10.13 6.524 0.000 (HS) Sn-Me 69.92 5.23 60.63 5.43 9.29 9.537 0.000 (HS) ULV 5.33 1.29 5.38 1.02 -0.05 -0.216 0.829 (NS) LLV 10.11 1.76 10.29 1.48 -0.18 -0.617 0.538 (NS) J Bagh College Dentistry Vol. 28(4), December 2016 Time of Emergence Pedodontics, Orthodontics and Preventive Dentistry 157 Table 2: Descriptive statistics and gender differences in Maxillary anterior teeth variables Variables Descriptive statistics Gender difference (d.f.=118) Males (N=60) Females (N=60) Mean S.D. Mean S.D. Mean difference t-test p-value MDW 1 L 8.80 0.60 8.63 0.49 0.17 1.703 0.091 (NS) MDW 1 R 10.37 0.96 10.26 1.06 0.11 0.596 0.552 (NS) H 1L 8.79 0.51 8.58 0.54 0.21 2.200 0.030 (S) H 1R 10.39 0.94 10.15 1.05 0.24 1.328 0.187 (NS) MDW 2L 5.84 0.53 5.90 0.64 -0.06 -0.554 0.581 (NS) MDW 2R 5.84 0.59 5.93 0.50 -0.09 -0.860 0.392 (NS) MDW 3L 4.79 0.61 4.79 0.57 0.00 -0.028 0.977 (NS) MDW 3R 4.70 0.61 4.59 0.54 0.11 1.032 0.304 (NS) MDW 1 17.59 1.08 17.21 1 0.38 2.009 0.047 (S) Height of the contact point CI-CI 3.97 0.83 3.98 0.83 -0.01 -0.060 0.952 (NS) Height of the contact point Left CI-LI 3.34 1.00 3.28 0.94 0.06 0.363 0.717 (NS) Height of the contact point Right CI-LI 3.54 0.94 3.48 0.84 0.06 0.391 0.697 (NS) Height of the contact point Left LI-Ca 2.92 0.86 3.00 0.88 -0.08 -0.529 0.598 (NS) Height of the contact point Right LI-Ca 3.15 0.89 3.17 0.84 -0.02 -0.141 0.888 (NS) IID 29.27 1.55 29.04 1.57 0.24 0.826 0.410 (NS) ICaD 34.51 1.88 33.60 1.84 0.90 2.660 0.009 (HS) Table 3: Descriptive statistics and gender differences in micro-aesthetic appearance Variables Descriptive statistics Gender difference (d.f.=118) Males (N=60) Females (N=60) Mean S.D. Mean S.D. Mean Difference t-test p-value Golden proportion: Left LI to CI 66.71 7.68 68.53 7.83 -1.82 -1.287 0.201(NS) Golden proportion: Right LI to CI 66.55 6.68 69.29 6.46 -2.74 -2.284 0.024 (S) Golden proportion: Left Ca to LI 82.55 12.25 81.91 11.42 0.64 0.297 0.767(NS) Golden proportion:Right Ca to LI 80.95 11.45 77.96 11.27 2.99 1.441 0.152(NS) Width-height ratio of left CI 85.41 7.72 84.91 8.90 0.50 0.328 0.743(NS) Width-height ratio of right CI 85.07 7.16 85.21 8.70 -0.14 -0.099 0.921(NS) CMDW 38.76 2.07 38.42 1.97 0.34 0.926 0.356(NS) Golden percentage: left CI to CMDW 22.72 1.23 22.48 1.02 0.24 1.150 0.252(NS) Golden percentage: right CI to CMDW 22.69 1.02 22.33 1.02 0.36 1.927 0.056(NS) Golden percentage: left LI to CMDW 15.09 1.23 15.35 1.30 -0.26 -1.141 0.256(NS) Golden percentage: right LI to CMDW 15.05 1.18 15.43 1.10 -0.37 -1.794 0.075(NS) Golden percentage: left Ca to CMDW 12.35 1.33 12.47 1.24 -0.12 -0.521 0.603(NS) Golden percentage: right Ca to CMDW 12.10 1.34 11.94 1.24 0.17 0.707 0.481(NS) Height of contact point %: CI-CI (left) 38.27 6.95 38.80 6.95 -0.52 -0.412 0.681(NS) Height of contact point %: CI-CI (right) 38.18 6.90 39.19 6.95 -1.01 -0.800 0.425(NS) Height of contact point % : CI-LI (left) 32.03 8.54 32.03 8.73 0 0 1 (NS) Height of contact point % : CI-LI (right) 33.93 7.80 34.38 7.85 -0.45 -0.315 0.754(NS) Height of contact point % : LI-Ca (left) 27.96 7.41 29.26 8.20 -1.30 -0.912 0.364(NS) Height of contact point % : LI-Ca (right) 30.13 7.49 31.19 7.19 -1.05 -0.785 0.434(NS) REFERENCES 1- Naini FB, Moss JP, Gill DS. The enigma of facial beauty: esthetics, proportions, deformity and controversy. Am J Orthod Dentofac Orthop 2006; 130(3): 277–82. 2- Peck H, Peck S. A concept of facial esthetics. Angle Orthod 1970; 40(4): 284-319. 3- Adamson PA, Zavod MB. Changing perceptions of beauty: a surgeon's perspective. Facial Plast Surg 2006; 22(3): 188-93. 4- Rosenstiel SF. Dentists' preferences of anterior tooth proportion-a web-based study. J Prosthodont 2000; 9(3): 123-36. 5- Mahadevia S, Daruwala N, Desal S. Divine orthodontics. JADCH 2011; 1(2): 6-11. 6- Sarver DM. Enameloplasty and esthetic finishing in orthodontics: identification and treatment of microesthetic features in orthodontics. Part 1. J Esthet Restor Dent 2011; 23(5): 296-302. 7- Jamayet NB, Viwattanatipa N, Amornvit P, Pornprasertsuk S, Jira Chindasombatjaroen J, Alam J Bagh College Dentistry Vol. 28(4), December 2016 Time of Emergence Pedodontics, Orthodontics and Preventive Dentistry 158 MK. Comparison of crown width/length ratio of six maxillaryanterior teeth between different facial groups in bangladeshi population. International Medical J 2014; 21(1): 49-54. 8- Good S, Edler R, Wertheim D, Greenhill D. A computerized photographic assessment of the relationship between skeletal discrepancy and mandibular outline asymmetry. Eur J Orthod 2006; 28(2): 97-102. 9- Edler R, Wertheim D, Greenhill D. Comparison of radiographic and photographic measurement of mandibular asymmetry. Am J Orthod Dentofac Orthop 2003; 123(2): 167-74. 10- Angle EH. Classification of malocclusion. Dent Cosmos 1899; 41(3): 248-64. 11- Laura Mitchell. An Introduction to Orthodontics. 4th Ed. Oxford University Press. 2013. 12- Al-Ramahi SCA. Evaluation of buccal corridor in posed smile for Iraqi adults sample with class I normal occlusion. A master thesis, Department of Orthodontics, College of Dentistry, University of Baghdad. 2009. 13- Farias F, Ennes J, Zorzatto R. Aesthetic value of the relationship between the shapes of the face and permanent upper central incisor. Inter J Dent 2010; 2010: 6. 14- Aksakalli S, Demir A. The Comparison of facial estethics between orthodontically treated patients and their parents. Sci World J 2013: 903507. 15- Asghari A, Rajaeih S, Hassannia F, Tavakolifard N, Neisyani HF, Kamrava SK, Jalessi M, Omidian P. Photographic facial soft tissue analysis of healthy Iranian young adults: anthropometric and angular measurements. Med J Islam Repub Iran 2014; 29: 28- 49. 16- Varjão FM, Nogueira SS, Russi S, Arioli Filho JN. Correlation between maxillary central incisor form and face form in 4 racial groups. Quintessence Int 2006; 37(10): 767-71. 17- Koralakunte PR, Budihal DH. A clinical study to evaluate the correlation between maxillary central incisor tooth form and face form in an Indian population. J Oral Sci 2012; (3): 273-8. 18- Milutinovic J, Zelic K, Nedeljkovic N. Evaluation of Facial Beauty Using Anthropometric Proportions. Sci World J 2014: 1-8. 19- Ward DH. Proportional smile design using the recurring esthetic dental (RED) proportion. Dent Clin North Am 2001; 45(1):143-54. 20- Snow SR. Esthetic smile analysis of anterior tooth width: The golden percentage. J Esthet Dent 1999; 11(4): 177-84. 21- Sarver DM. Principles of cosmetic dentistry in orthodontics: Part 1. shape and proportionality of anterior teeth. Am J Orthod Dentofac Orthop 2004; 126(6): 749-53. 22- Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics. 5th Ed. St. Louis: Mosby Elsevier. 2013. 23- Morley J, Eubank J. Macroesthetic elements of smile design. J Am Dent Assoc 2001; 132(1): 39-45. 24- Gomes Vl, Gonçalves Lc, Costa Mm, lucas Bd. Interalar distance to estimate the combined width of the six maxillary anterior teeth in oral rehabilitation treatment. J Esthet Restor Dent 2009; 21(1): 26-36. 25- Bishara SE, Jakobsen JR. Longitudinal changes in three normal facial types. Am J Orthod 1985; 88(6): 466-502. 26- Jones, ML. Oliver RG. W&H Orthodontic Notes. 6th ed. Oxford: Wright 2000: 62. 27- Nithya CS, Ramachandra CS, Shetty PC. Correlation between the apparent widths of themaxillary anteriors and the golden proportion-A Survey. J Ind Orthod Soc 2008; 42(3): 9-12 28- Karaca Ö, Gülcen B, Kuş MA, Elmalı F, Kuş İ. Morphometric facial analysis of turkish adults. Balikesir Saglik Bil Derg 2012; 1(1): 7-11. 29- Kurkcuoglu A, Bahadıroglu S, Buyukberber Sg, Guclu S, Gurbuz S, Karslıoglu A, Yazıcı C, Pelin C. Evaluation of lower face heights and ratiosaccording to sex. Rev Arg De Anat Clin. 2013; 5(3): 213-21. 30- Genecov JS, Sinclair PM, Dechow PC. Development of the nose and soft tissue profile. Angle Orthod. 1990; 60(3): 191-98. 31- Ahmed HA, Al-labban Y, Nahidh M. Facial measurements and maxillary anterior teeth mesio- distal dimensions, is there a relationship? Iraqi Dent J 2013; 35(2): 39-43. 32- Ellakwa A, McNamara K, Sandhu J, James K, Arora A, Klineberg I, El-Sheikh A, Martin FE. Quantifying the selection of maxillary anterior teeth using intraoral and extraoral anatomical landmarks. J Contemp Dent Pract 2011; 12(6): 414-21. 33- Murthy B, Ramani N. Evaluation of natural smile: golden proportion, red or golden percentage. J Conserv Dent 2008; 11(1): 16-21. 34- Murthy B, Ramani RJ, Schwartz RS, Hilton TJ. An analysis of selected normative tooth proportion. Int J Prosthodont 1994; 7: 410-17. 35- Garn SM, Lewis AB, Kerewsky RS. X-Linked inheritance of tooth size. J Dent Res 1965; 44(2): 439-41. 36- Garn SM, Lewis AB, Swindler DR. KerewskyRS. Genetic control of sexual dimorphism in tooth size. J Dent Res 1967; 46(2): 963-72. 37- Fayyad MA, Jamani KD, Aqrabawi J. Geometric and mathematical proportions and their relations to maxillary anterior teeth. J Contemp Dent Pract 2006; (7)5: 62-70. 38- Ahmed N, Abbas M, Maqsood A. Evaluation of recurring esthetic dental proportion in natural smile of Pakistani sample. Pakistan Oral & Dental Journal 2014; 34(4): 739-42. 39- Parnia F, Hafezeqoran A, Mahboub F, Moslehifard E, Koodaryan R, Moteyagheni R, Saber F. Proportions of maxillary anterior teeth relative to each other and to golden standard in Tabriz dental faculty students. J Dent Clin Dent 2010; 4(3): 83-6. الخالصة مالي الجزئيوالمظهر الج للوجه الكلي الجمالي المظهر إلى تحليل الدراسة تهدف هذه هدفت. العلوية األمامية لألسنان الجمالي المظهر على يعتمد الوجه جمال بصورة عامة، الخلفية: .الجنسين بين عن االختالفات المحتملة للفئة األولى ذات االطباق الطبيعي والكشف المعيارية القيم لتأسيس العلوية األمامية لألسنان تثبيت ثم تمسريريا, فرد كل فحص سنة وأجري( 23-01) بين أعمارهم تتراوح الذين( إناث 01 و ذكور 01)العراقيين من البالغين 021من الدراسة عينة تكونت العينة والطرق: تم بمرجل ثالثي القوائم قابل للتعديل. هاعموق في المثبتة الرقمية الكاميرا الفم باستخدام ولداخل للوجه أمامية لكل فرد رقمية صورة و أخذت ، Cephalostatجهاز ال بأستخدام الرأس تم استخدام . (AutoCad 2102 برنامج) االلكتروني بالحاسب التصميم و الرسم نظام باستخدام األسنان قياسات الى أضافة جهللو عمودية وأربع مسافات خطية مسافات خمس قياس .بين الجنسين الفرق لتقييمt-test) ت المستقل ) اختبار و أجري الجنسين لكال المتغيرات لقياس الوصفي اإلحصاء J Bagh College Dentistry Vol. 28(4), December 2016 Time of Emergence Pedodontics, Orthodontics and Preventive Dentistry 159 أبعاد يتميزون بأن الذكور علما أن الكلي، الجمالي المظهر بشأن المقاسة المتغيرات معظم في الجنسين معنويا بين فرقا أن هناك صائيةالنتائج االح أظهرت النتائج و االستنتاجات: وهذا الجزئي، الجمالي للمظهر المقاسة بالنسبة المتغيرات معظم في الجنسين بين غير معنويا االحصائية أظهرت أن هناك فرقا أن النتائج حين في اإلناث، من والوجه أكبر الجمجمة الجنسين بين بالفرق تتأثر ال العلوية األمامية المتعلقة باألسنان النسب أن يعني J Bagh College Dentistry Vol. 28(4), December 2016 Time of Emergence Pedodontics, Orthodontics and Preventive Dentistry 160 J Bagh College Dentistry Vol. 28(4), December 2016 Time of Emergence Pedodontics, Orthodontics and Preventive Dentistry 161