Clinical, Cosmetic and Investigational Dentistry
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ORIGINAL RESEARCH
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Correlation Between Maxillary Anterior Teeth
and Common Facial Measurements
Hameed A Alshamri 1 , Mohammed M Al Moaleem 2 , Basem H Al-Huthaifi 3 , Mohammed A Al-labani 4 ,
Weaam RB Naseeb 5 , Shahad Mohammed Daghriri 5 , Ibtihaj Mohammed Suhail 5 , Wasan H Hamzi 5 ,
Mohammed J Abu Illah 5 , Abdulaziz Yahya Thubab 5 , Shuaib A Aljabali 3 , Mohammed M AlNehmi 1
1
Department of Restorative and Prosthodontics, College of Dentistry, University of Science and Technology, Sana’a City, Yemen; 2Department of
Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, Saudi Arabia; 3Department of Preventive and Biomedical Science, College of
Dentistry, University of Science and Technology, Sana’a City, Yemen; 4Department of Orthodontics, College of Dentistry, University of Sana’a, Sana’a
City, Yemen; 5College of Dentistry, Jazan University, Jazan, Saudi Arabia
Correspondence: Mohammed M Al Moaleem, Department of Prosthetic Dental Science, College of Dentistry, Jazan University, Jazan, 45142, Saudi
Arabia, Email malmoaleem@jazanu.edu.sa
Background: The symmetry between maxillary anterior teeth and the face holds significant importance. This study assessed and
analyzed the relationship between facial parameters and anterior teeth in the maxillary arch of male and female subjects. Specifically,
individual width and combined width (CW) measurements of the maxillary anterior teeth were investigated.
Methods: This study involved a total of 150 dentate Yemeni subjects (74 men and 76 women), whose ages ranged from 18 years old to 30
years old. A maxillary cast was created, and two digital photographs of the face of each subject were taken and analyzed. Digital calipers and
AutoCAD were used to gather measurement data of the dental parameters (intercanthal distance [ICD], interpupillary distance [IPD],
interalar width [IAW], intercommissural width [ICW], and bizygomatic width [BZW]) and facial parameters (profile distance).
Results: Significant correlations were found for the following: IPD and width of six maxillary anterior teeth of each of the study subjects;
ICD and their central incisors; and BZW and their canine width measurements. In contrast, IAW and ICW were not correlated with all tooth
measurements. Linear regression findings showed that the CW measurement of the four incisors was significantly correlated with all facial
parameter measurements, excluding the ICW and IAW in females and the IAW, ICW, and profile distance in males.
Conclusion: The IPD and ICD of males and females may be used to determine their CW measurements. The BZW and IPD of males
can be used to take precise anthropological measurements of the width of the central canines and incisors. Meanwhile, the IPD
distance of females can be used to assess the central and lateral incisor widths.
Keywords: dental measurement, facial measurement, anterior teeth, Yemen
Introduction
The symmetry between maxillary anterior teeth and face is intricately connected to notion of attractiveness and beauty, and
dental and facial measurements are strongly associated with aesthetic smiles. Clinicians may provide proper treatment plans
that take into account the various potential factors influencing the perception of an aesthetic smile by using self-satisfaction
measurements.1,2 Dental aesthetics is a main influence affecting people’s psychosocial wellbeing. Among the most critical
components of an aesthetic smile is proportion within the maxillary anterior dentition and the surrounding oral structures.3,4
A recent review supported that the existence of evidence of the golden proportion in natural smiles is lacking and the existence
of this proportion in dentistry is a myth and not a fact.5
Furthermore, the general appearance of the maxillary anterior teeth considerably influences dental and facial aesthetics.
Several anatomical facial measurements, including the bizygomatic width (BZW), interpupillary distance (IPD), interalar
width (IAW), intercanthal distance (ICD), and intercommissural width (ICW), can help in determining the individual and
combined dimensions of the maxillary incisor teeth.6–8
Clinical, Cosmetic and Investigational Dentistry 2023:15 289–300
Received: 26 September 2023
Accepted: 31 October 2023
Published: 7 November 2023
289
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Alshamri et al
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When pre-extraction records are unavailable, evaluation of the combined width (CW) measurements of the six
anterior maxillary teeth can be challenging. Meanwhile, the correlation between the width of the maxillary anterior teeth
and the width of the face can be used to generate samples of denture teeth and determine the proper size of teeth for fixed
restoration.9 The measurements of the individual width and CW of the six maxillary anterior teeth can be predicted on the
basis of the distance between the intercanthus, between the inter ala of the nose, or between corners of the mouth width
(ie, ICD, IAD, or ICW, respectively).8,10,11 Multiple facial measurements are crucial in making informed decision
regarding the width of maxillary anterior teeth.9,12
Facial and dental measurements exhibit variations across geographic locations, climate conditions, and the historical
backgrounds of different subjects; these measurements are closely associated with human DNA, such as facial shape and
features.13 When restoring teeth for facial aesthetics, dental professionals should take into account the patient’s heritage,
cultural background, and societal norms. However, pre-extraction records of the Yemeni population are typically unavailable.
The selection of the proper maxillary anterior tooth size can be complex and may result in unsatisfactory aesthetic outcomes.
On the other hand, even when dealing with individuals who have preextraction records, different measurement points on the
face still need to be assessed because older dental records of a patient might not be readily accessible.14 These gaps can
account for the numerous anatomical measurement methods that have been proposed by scholars.15
Hasanreisoglu et al examined the relationship between maxillary anterior tooth crown dimensions and facial
measurements and found that the dimensions of central incisors and canines vary between gender groups.16 Significant
differences were observed in the perceived widths in females, and proportional relationships were found between BZW
and central incisor width. The ICD to central incisor width and IAD to anterior tooth straight-line width were used as
dependent parameters for Kurdish male subjects. A L-Kaisy and Garib analyzed the frontal facial measurements and
found correlations between the mesiodistal width of the maxillary teeth and the ICD, IPD, and ICM.17 Gomes et al18
confirmed the strong correlation between the mesiodistal width of the maxillary teeth and other facial measurements.
However, no significant difference was established between the crown width and the face type of Bangladeshi subjects,
of whom approximately 55.7% had narrow faces, with mean crown width–length ratios of central and lateral incisors and
canines of 0.92±0.078, 0.88±0.172, and 0.89±0.097 mm.19 Parciak et al9 did not find correlations between the facial and
mesiodistal dimensions of the six maxillary anterior teeth of subjects from three ethnicities, except for the central incisor
width-to-BZW ratio; however, the ICWs of female subjects were higher than those of the general group across
ethnicities. Flavie et al used the width of the central incisor and the distance between the two maxillary canine pointers
to determine the bizygomatic distance.20
Regarding mesiodistal tooth width and tooth size discrepancies of Yemenis subjects, Al-Gunaid et al did not find any
significant differences in the tooth size and width between the right and left sides of the jaw.21 Men have larger teeth than
women, with clinically significant differences between their anterior and overall tooth size ratios. Alaghbari et al1 found
that men have larger mean dental arch dimensions and facial measurements than women, with the greatest difference
between their maxillary arch widths. Significant correlations were found between ICW and maxillary canine width.
Nevertheless, dental arch width was not significantly correlated with BZW, IAW, or MW.
Numerous studies1,21–23 have investigated the relation of teeth with certain anatomical features of the faces of Yemeni
subjects. However, none of these studies have evaluated the association between dental and facial aesthetic measurements
of Yemeni adults. This work is the first correlation study to evaluate and compare dental and facial measurements
between men and women using maxillary casts and digital images. In formulating the null hypothesis, a nonsignificant
relationship between gender and dental or facial aesthetic measurement was assumed.
Subjects and Methods
Study Design and Subject Size Calculation
This analytical cross-sectional study was approved by the Medical Ethics Committee of the Dental Faculty of the
University of Science and Technology (UST), Sana’a, Yemen (MECA No.: EAC/UST168). The research was conducted
between October 2022 and April 2023. The patients attended by the Prosthodontics Department of UST and Sana’a
University College of Dentistry in Sana’a City, Yemen, were selected as research subjects. All recruited subjects were
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informed about the research purpose, and those who agreed to participate signed consent forms. The subject size was
calculated using G*Power version 3.1.9.4 at an 85% confidence level and 0.05 precision, and the actual proportion was
71.4%. The selection of 150 subjects for the study was based on the number of clinically managed patients by the
departments 3 years prior to the study. A consent form signed by each participant was sought again before performing
impression and facial measurements.
Inclusion and Exclusion Criteria
One hundred and fifty male and female Yemeni participants were recruited. The age was between 18 and 30 years old
were enrolled in this cross-sectional study. The criteria included the following: the patient must have a symmetrical face,
complete permanent maxillary and mandibular dentition, class I molar and canine occlusion, normal hard and soft tissues
with no abnormalities, no crossbite, crowding of ≤2 mm, and spacing of ≤2 mm in either the maxillary or mandibular
arches, overjet of ≤3 mm, no attrition on teeth, no retained deciduous teeth, and no peg lateral incisors. Patients who were
using dental appliances, had undergone orthodontic treatment, had maxillofacial surgery, had dental implants, or had
periodontal surgery in the maxillary arch were excluded from the study.
Data Collection, Study Tools, and Study Cast Measurements
The data were produced using a study cast, and then the research subjects were photographed. The castes have
analyzed the dental arch dimensions on the dental stone casts (Dental Yellow Buff Stone, Type IV, USA) of a maxillary
impression constructed using a silicone putty-type impression material (Vinyl Polysiloxane, Hamburg, Germany).
Teeth were measured using a sliding caliper following the methods in the literature,1,9,20 and the width of each tooth in
the anterior of the arch was measured using a Digital Vernier Caliper (Mitutoyo, São Paulo, Brazil) with a sharp tip
and an accuracy of 0.01 mm. Dental parameters, such as individual mesiodistal width of maxillary central incisors,
lateral incisors, and canines, were measured on the dental cast (Figure 1A). The clinical crowns of the maxillary
anterior teeth were measured mesiodistally at the greatest dimension for each tooth width from the right to the left
canine. CW measurements of the six maxillary anterior teeth were measured in a straight line at the distal surface of
the canines as shown in Figure 1B.
Facial Measurements
Each research subject was instructed to sit upright and face forward while sitting on a dental chair, and then their facial features
were measured. Data on the frontal parameters (BZW, IPD, ICD, IAW, and ICW) were acquired using frontal view images
(Figure 2A), while data on the width of the profile distance were obtained using lateral view images (Figure 2B). Then, all
images were inputted into AutoCAD, and digital calipers were used to measure the facial features (in mm). The distance
between the medial canthi of the eyes represents the ICD. Participants in Figure 2 have provided a written informed consent for
the image to be published. Table 1 presents the measurements for all parameters related to the maxillary dental arch or facial
dimensions measurements. A single investigator (BM) performed all dental and facial measurements.
Data Analysis
The statistical analysis was performed in SPSS version 24.0 (SPSS Inc., Chicago, IL, USA). The p value was set to
a significant level of 0.05. The Shapiro‒Wilk test was used to verify a normal distribution. Descriptive statistics (mean
and standard deviation [SD]) and inferential statistics were used to compare the dental and facial measurements of the
male and female subjects. The mean differences in dental and facial measurements were assessed through a T-test. The
relationship between the face and maxillary anterior teeth was assessed by Pearson’s correlation coefficient test (r), with
values set between −1 and +1 (ie, −1 ≥ r ≥ 1, where r > 0 means a positive correlation, r < 0 denotes a negative
correlation, and r = 0 indicates the absence of correlation).
Results
Among the 150 participants, 74 (49.3%) were males and 76 (50.7%) were females, with a mean age and SD of the study
sample was 23.431±1.3. As shown in Table 2, the males and females differed significantly in terms of mesiodistal width
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Figure 1 Study cast of the participant during width measurements of central, lateral, canines (A) and both incisors, both laterals, and maxillary 6 anterior teeth width (B).
Figure 2 Parameters in facial measurements for frontal view (A) and lateral view (B).
of the left lateral incisor, right central and canine, and CW measurements. The maxillary anterior teeth of males have
a wider mesiodistal dimension, but they are not significantly different from those of females. The widest tooth width
(in mm) was the left central incisor (8.05 mm) in the male subjects, whereas the narrowest tooth width was for the lateral
incisors on the left and right sides (5.83 mm) among the female subjects. The facial measurements on both sides were
near to each other’s or similar for the male and female subjects, presenting only slight variations (ie, nonsignificant
difference; Table 3).
A weak correlation is established between the summation widths of the six maxillary anterior teeth measured in
a straight line (Table 4). By contrast, the IPD and CW measurements of the two central incisors, four incisors, and six
maxillary anterior teeth were strongly correlated. The CW measurements of the two central incisors and the summation
widths measured in a straight line were significantly correlated with ICD. In contrast to CW measurements of six
maxillary anterior teeth and four incisors, ICD presents a moderate correlation. These findings indicate that the ICD of
Yemeni adults can be estimated through CW measurements of the two central incisors and the summation width
measured in a straight line.
The summation width is strongly correlated with BZW but not with the six maxillary anterior teeth measured in
a straight line (Table 5). The IPD and CW measurements of the two central incisors, four incisors, and six maxillary
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Table 1 Parameters, Abbreviations and Their Definitions, Views of the Study Casts and Photographs
Source of Data
Parameters
and View
Abbreviations/
Definition
Area and Figure
Nos.
Study cast and
Central incisor
Area 1 of maxillary
frontal view
width
arch, Figure 1A
Lateral incisor
Area 2 of maxillary
width
arch, Figure 1A
Canine width
Area 3 of maxillary
arch, Figure 1A
Individual mesiodistal width of each maxillary canine from the facial side
Intercanine or
combined width
CW/Area 4 of
maxillary arch,
Horizontal distance between the right and left cusp tips of permanent canines;
otherwise, CW measurement of maxillary six anterior teeth
Mesiodistal width of each maxillary central incisor from facial sides
Mesiodistal width of each maxillary lateral incisor from the facial sides
Figure 1B
Intercanine
ITCD
Distance between distal surfaces of maxillary canines (in straight line)
CW measurement
CIW/Area 5 of
Horizontal distance of combined mesiodistal width of the two central incisors
of central incisors
maxillary arch,
from facial sides
distance
Figure 1B
Photograph and
frontal view
CW measurement
CW/Area 6 of
Horizontal distance of combined mesiodistal width of the four incisors from
of four incisors
maxillary arch,
Figure 1B
facial sides
Bizygomatic width
BZW/Area 1 of
frontal view in
Maximum horizontal distance between right and left zygion (most prominent
point of zygomatic arches).
Figure 2A
Interpupillary
IPD/Area 2 of
distance
frontal view in
Horizontal distance from mid-pupil of right eye to mid-pupil of left eye
Figure 2A
Intercanthal
ICD/Area 3 of
distance
frontal view in
Figure 2A
Interalar width
IAW/Area 4 of
frontal view in
Horizontal distance between inner corners of eyes
Horizontal distance between the right and left widest points of the outer
surfaces of ala of nose.
Figure 2A
Intercommissural
ICW/Area 5 of
Horizontal distance between mouth corners. By contrast, the horizontal
width
frontal view in
distance between the right and left corners of the mouth is taken when the
Figure 2A
mouth is closed or at rest.
Photograph and
Lateral Profile
Area 6 of lateral
The vertical distance between the nasal tip and menton was used to gauge the
lateral view
Distance (width)
view in Figure 2B
profile width.
anterior teeth were strongly correlated. The CW data of two central incisors and the summation width measured in
a straight line were significantly correlated with ICD. ICD only had a moderate correlation compared with CW
measurement of maxillary six anterior teeth and four incisors. Our findings indicate that the ICD of Yemeni adults can
be estimated using CW measurement of the two central incisors and summation width measured in a straight line.
Meanwhile, the IPD is strongly correlated with the width of the right and left central incisors but only weakly correlated
with the left canine. The ICD was also poorly correlated with the widths of the left central incisor, left lateral incisor, and
right lateral incisor.
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Table 2 Comparison of Individual Tooth Measurements by Gender (n = 150)
Variables
Left Side
Central width
Lateral width
Canine width
Right Side
Central width
Lateral width
Canine-width
Sum of width in straight line
Gender
Mean and SD
t-test
p value
Male
8.05 (0.44)
1.82
070
Female
7.92 (0.42)
Male
6.04 (0.42)
2.89
0.004*
Female
5.83 (0.47)
Male
7.32 (0.52)
1.89
0.060
Female
7.17 (0.47)
Male
8.04 (0.42)
2.28
0.024*
Female
7.87 (0.44)
Male
6.06 (0.44)
2.79
0.006*
Female
5.85 (0.46)
Male
7.33 (0.50)
2.94
0.004*
Female
7.09 (0.49)
Male
36.38 (2.16)
1.68
0.096
Female
35.72 (1.80)
Note: *Significant.
Table 3 Comparison of the Mean Differences in Facial Measurements by Gender
Facial Measurements (mm)
Male (n = 74)
Female (n = 76)
p- value
Mean (SD)
Minimum
Maximum
Mean (SD)
Minimum
Maximum
BZW
111.0 (6.90)
98.00
128.0
109.1 (5.92)
95.00
122.00
0.092
IPD
60.8 (2.30)
56.00
65.00
59.9 (2.11)
56.00
65.00
0.091
ICD
30.0 (2.34)
26.00
34.00
30.1 (2.10)
26.00
38.00
0.717
IAW
34.1 (2.21)
30.00
38.00
34.0 (2.22)
29.00
39.00
0.792
ICW
46.8 (2.93)
39.00
52.00
45.6 (2.61)
40.00
52.00
0.011*
Facial Profile
77.1 (6.64)
64.00
87.00
76.2 (3.80)
61.00
84.00
0.608
Note: *Significant.
In the female subjects (Table 6), statistically significant correlations were found between BZW and the width of
canines on the left and right sides and the width of the right central incisor (p=0.001). However, no correlation was found
between the width of the profiles and the width of the six maxillary teeth. The IPD was also not correlated with the width
of the canines. Nonetheless, the IPD was significantly correlated with the central and lateral incisors on the left and right
sides.
Discussion
Given the importance of correlation in facial measurement studies, numerous scholars worldwide have used face
measurement parameters to determine tooth size for edentulous individuals or for fixed or removable prostheses.9–24
The main goal of this study was to establish accurate relationships between face measurements and maxillary anterior
tooth width. The mean widths of six maxillary anterior teeth are wider for men than women, as supported by previous
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Table 4 Correlation Between Gender and Facial and CW Dental Measurements (n = 150)
Men and Women
Sum Width of
Maxillary Six
Four
Two
the Six
Anterior
Incisors
Centrals
Anterior in
Straight Line
BZW (mm)
IPD (mm)
ICD (mm)
IAW (mm)
ICW (mm)
Facial Profile
(mm)
r
0.253
0.200
0.121
0.141
p
0.008*
0.014*
0.139
0.085
r
0.214
0.299
0.309
0.337
p
0.027*
0.000**
0.000**
0.000**
r
0.284
0.185
0.204
0.230
p
0.003*
0.023*
0.012*
0.005*
r
0.113
0.020*
0.014*
0.004
p
0.249
0.804
0.869
0.958
r
0.062
0.020*
0.064
0.078
p
0.527
0.811
0.434
0.345
r
0.103
0.087
0.080
0.087
p
0.289
0.289
0.331
0.291
Notes: Pearson’s correlation coefficient test (r); *Significant correlation at 0.05; **Highly significant correlation at 0.001.
Table 5 Correlation Between Facial Measurements and Individual Width of Six Maxillary Anterior Teeth Measurements for Males (n = 74)
Teeth Measurements
Left Side
Facial Measurements (mm)
Central Incisor
Lateral Incisor
Canine
Central Incisor
Lateral Incisor
Canine
BZW
r
0.137
0.066
0.466
0.151
0.098
0.286
p
0.245
0.574
0.000**
0.200
0.404
0.013*
r
0.305
0.139
0.261
0.308
0.204
0.214
p
0.008*
0.239
0.025*
0.008*
0.081
0.067
r
0.173
0.028*
0.222
0.193
0.119
0.125
p
0.139
0.811
0.058
0.100
0.314
0.289
r
0.077
0.104
0.169
0.048
0.049
0.020*
p
0.515
0.378
0.150
0.684
0.680
0.864
r
0.197
0.108
0.104
0.207
0.089
0.203
p
0.093
0.362
0.380
0.077
0.451
0.083
r
0.179
0.090
0.274
0.244
0.081
0.136
p
0.127
0.446
0.018*
0.036
0.492
0.248
IPD
ICD
IAW
ICW
Facial profile
Right Side
Notes: Pearson’s correlation coefficient test (r); *Significant correlation at 0.05; **Highly significant correlation at 0.001.
studies.21,24,25 However, few studies on the African population have shown contrasting results.20,26 The average distance
between the distal surfaces of maxillary canines is 36.013 mm, which is similar to the values reported for Croatian and
Kashmiri populations.27,28 The minor variations may be attributed to differences in measurement methods.
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Table 6 Correlation Between Facial Measurements and Individual Width of Six Maxillary Anterior Teeth Measurements for Females (n = 76)
Teeth Measurements
Left Side
Facial Measurements (mm)
BZW
IPD
ICD
IAW
ICW
Facial profile
Right Side
Central Incisor
Lateral Incisor
Canine
Central Incisor
Lateral Incisor
Canine
r
0.029*
0.071
0.136
0.024*
0.076
0.218
p
0.802
0.544
0.240
0.840
0.514
0.059
r
0.226
0.368
0.126
0.333
0.338
0.204
p
0.050*
0.001**
0.277
0.003*
0.003*
0.076
r
0.286
0.286
0.125
0.295
0.269
0.126
p
0.012*
0.012*
0.283
0.010*
0.019*
0.277
r
0.022*
0.108
0.018*
0.061
0.073
0.090
p
0.849
0.351
0.879
0.601
0.528
0.438
r
0.146
0.009*
0.047*
0.127
0.004*
0.084
p
0.207
0.939
0.685
0.275
0.973
0.471
r
0.113
0.024*
0.001**
0.131
0.003*
0.006*
p
0.329
0.838
0.996
0.259
0.976
0.960
Notes: Pearson’s correlation coefficient test (r); *Significant correlation at 0.05; **Highly significant correlation at 0.001.
In the current study, the results of facial parametric analyses for BZW, IPD, IAW, and ICW revealed greater mean
values in the Yemeni male than female subjects, which is consistent with earlier research.1 In relation to the mean facial
measurement distance, the mean value of BZW was higher in the Yemeni male than female subjects, which aligns with
the findings about the Kashmiri population28 but not with the Iraqi population29 or among other races.9 The mean IPD
obtained in this study was 60.4 mm, which is consistent and within the range of values in earlier studies conducted in
Turkey, the United States, and Malaysia;14,30,31 however, the values were less than those in prior studies that reported
larger means of 73 and 69 mm.9,18
Meanwhile, no differences in the mean ICD were found between the Yemeni male and female subjects, which is
comparable to the 28–35 mm range reported in the literature.32,33 In contrast with the research of other scholars,
Abdullah et al,34 Al Wazzan et al35 and Dwivedi et al36 documented wider mean values of 28 and 34–36 mm, which
can be explained by their research subjects having much wider eyes, and their ethnicity varied. Additionally, the IAW in
this work showed a mean of 34 mm, with statistically nonsignificant differences between males and females, which is
similar to the findings about Iraqi subjects29 but contrasts with some published investigations.18,36 In terms of the ICW,
the mean of males was 46.87 mm higher than that of females (45.69 mm), with a statistically significant difference. This
finding is consistent with the research results for Pakistan (45.24 mm)37 and Yemen by Alaghbari et al1 who reported
males with a larger ICW mean than females (30.94 and 27.69 mm, respectively). However, the ICW mean obtained in
this work contrasts with those of other studies.9,38 Overall, the male subjects had a greater mean for facial characteristics
compared with female subjects. The human faces of males and females vary, especially during puberty, which may
explain the derived results.39 Females recorded a higher psychological impact than males in relation to maxillary anterior
teeth symmetry and this reflected on their quality of life in Polish subpopulation.40
BZW was significantly correlated with summation width. This finding aligns with a previous finding12 that showed
BZ distance and age acting as predictors of central incisor and maxillary anterior teeth widths. Mishra et al24 and Ellakwa
et al41 found weak correlations between IAW and the six maxillary anterior teeth. Ariani et al42 who studied the
Indonesian population did not find any correlation between IAW and ICW and canine distance. Hunter and Priest43
used soft tissue measurements to demonstrate correlations between IAW and the width of six maxillary anterior teeth;
nonetheless, this finding contrasts with the findings on subjects from Mongolia.44 Meanwhile, despite the method of
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recruiting live participants, this study could not confirm the conclusions provided by Hunter and Priest,43 which found
that IAW is not equal to the CW measurement of six maxillary anterior teeth when multiplied by a factor of 1.31. The
finding of this study also differs from that documented by Hoffman et al45 but it aligns with Parciak et al.9
A strong correlation was found between the BZW and the width of the left and right canines of males and the general
population. This scenario differed for females. Meanwhile, the finding regarding the 1:14 ratio for the BZW to central
incisor width was similar to the range of 1:13–1:19 reported by Flavie et al20 but it differed from the 1:16 ratio reported
by Ellakwa et al41 and Bozkir et al.46 To the best of our knowledge, no research has been conducted on the use of BZW
to measure anterior teeth as suggested earlier.47 Among Chinese population, wider maxillary incisors and canines were
recorded, which is not in parallel with this study findings.48
The width of the left canine and the right and left central incisors of the male subjects recruited in this study were
significantly correlated with the IPD. Meanwhile, the IPD of the female subjects was significantly correlated with the
width of the right central incisor, the right and left lateral incisors, and the left central incisor but poorly correlated with
the central incisor. This finding implies that the width of six maxillary anterior teeth and IPD have a strong statistical
correlation across the population. The aforementioned finding is consistent with that found by Al-Kaisy and Garib17 but
contradicts the results obtained by Parciak et al,9 which did not find a correlation between IPD and the width of six
maxillary teeth. The ratio of IPD to the width of the maxillary central incisor, which was equal to 6.6,30 was not found in
this study; rather, the ratios of 7.55 mm for males and 7.56 mm for females were established, which accords with the
ratios of 7.7 and 7.5 mm for males and females, respectively.16
Furthermore, this study did not find significant differences in ICD with respect to sex orientation, which is consistent
with the findings reported in the literature.1,20,38 The width of six maxillary anterior teeth and ICD were not significantly
correlated among the male subjects, which is similar to that for the Iraqi population.29 The ICD was significantly
correlated with the right and left central incisors of the female subjects, which is consistent with the findings with
Köseoğlu et al.14 In terms of the total population, the ICD was correlated with the left and right central incisors but
weakly correlated with the right lateral incisors and left canine width. The minor variations across the different scholarly
findings may be related to genetic variability attributable to geographical origins and historical backgrounds.
Nonetheless, ICD may be regarded as a reliable measurement of facial features for determining the width of maxillary
anterior teeth among Yemeni adults.
This study did not find any correlation between IAW, ICW, and six maxillary anterior teeth, which is consistent with
previous results.20,38 The central incisor width was statistically greater among the female subjects and lower than the
IAW/4 ratio, confirming the Turkish and Saudi population studies.14,49 Furthermore, ICW was not significantly correlated
with all intraoral measurements, confirming the findings of Hoffman et al and QAMAR et al.45,50 No correlations were
established between profile measurements and the six maxillary anterior teeth among males, females, and the general
population; this finding differs from those of other races/ethnicities, as reported in the literature.9,14,15,20,34
A commonly accepted view is that genetic causes and environmental adaptation both affect craniofacial features.51
Another explanation is that people of the same ethnicity, even those from the same villages, may have different facial
physical characteristics, as illustrated in the literature.42,52,53 In this study, the male subjects presented longer facial
measurements and lower face heights than the female subjects. This finding is supported by similar studies conducted in
other countries or regions, such as Turkey, Cameroon, Iraq, and the central part of India.14,20,54–56 Furthermore, this study
found significantly positive aesthetic correlations in the facial dimensions and dental characteristics of the Yemeni
population. The aesthetic measurements of Yemenis people frequently match the acknowledged aesthetic norms
established by dentists. Alone orthodontic treatment in participants with teeth and face asymmetry appears to significantly impact a range of psychological and aesthetic measurements.57 Orthodontics and prosthodontics have a moderate
quality of evidence on influence on the self-esteem of both genders.58,59
One of the limitations of this study is that the research subjects were recruited from only one city and did not include
different cities in the south, east, and west. Second, it does not include some other facial parameters, and categorizes the
participants into different age groups. For research recommendation, future research may use digital calipers to evaluate
the left and sides of the teeth. Also, to use some digital x-rays measurements or check the possibility of included artificial
inelegancy in such topic.
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Conclusions
IPD and ICD can be used to determine CW measurement of four incisors of male and female research subjects. Furthermore,
BZW and IPD can be used to gather specific anthropological measurements for the width of central incisors and canines in
males. Meanwhile, IPD can be used to measure the width of central and lateral incisors in females.
Ethical Approval
The procedures were conducted according to the principles outlined in the Declaration of Helsinki and Ethical Conduct
for Research with Human Beings and the Good Clinical Practice Guidelines. Ethical approval was granted by the Ethics
Board of the Medical Ethics Committee of the Dental Faculty of the University of Science and Technology (UST),
Sana’a, Yemen in January/5/2018, No.: EAC/UST168.
Consent to Participate
Informed consent was taken from all participants included in the study.
Acknowledgment
We wish to express our gratitude to our colleagues at UST Yemen for their assistance in gathering and processing the
data. We would like to extend our special thanks to our supervisor, Prof. Mohsen Alhamzi, for his support and for all of
the opportunities we were given to advance this research.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design,
execution, acquisition of data, analysis and interpretation, funding or in all these areas; took part in drafting, revising,
or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which
the article has been submitted; and agree to be accountable for all aspects of the work.
Funding
This study received no fund from any institution or company.
Disclosure
The authors declare that they have no conflicts of interest in this work.
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