|Year : 2022 | Volume
| Issue : 4 | Page : 439-443
Analysis of the distance between lingual frenal attachment and mandibular incisal edge position in establishing occlusal plane in three different races
Jafar Abdulla Mohamed Usman, Arista Kesumo, Nor Shazana Shahirah Binti Mohd Shahari
Department of Prosthetic Dentistry, Faculty of Dentistry, Mahsa University, Jenjarom, Selangor, Malaysia
|Date of Submission||25-Aug-2021|
|Date of Decision||29-Oct-2021|
|Date of Acceptance||06-Dec-2021|
|Date of Web Publication||16-Nov-2022|
Jafar Abdulla Mohamed Usman
Associate professor, Department of Prosthetic Dentistry, Mahsa University, Selangor
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Introduction: The orientation of the occlusal plane forms the basis for the arrangement of teeth conducive to satisfactory esthetics and function, making it one of the most important clinical procedures in prosthodontic rehabilitation. This study aimed to analyze and compare the vertical distance between the anterior attachment of lingual frenum (AALF) and the incisal edge of mandibular central incisors among three races in Malaysia. Materials and Methods: The sample consisted of 63 dentate subjects (21 Malays, 21 Chinese, and 21 Indians) who were chosen based on the inclusion criteria. Two models were made using irreversible hydrocolloid impressions, and an average of the value was obtained. Lingual frenum was recorded in function. Casts were fabricated with dental stone. AALF was marked and the vertical distance was measured using a caliper. Results: In Malays, the mean and standard deviation of the vertical distance were 14.2 ± 0.9 mm, with a range of 12.3–16.0 mm; in Chinese were 14.4 ± 0.9 mm, with a range of 12.0–16.9 mm; and in Indians were 15.1 ± 1.0 mm, with a range of 13.0–17.2 mm. The difference among the three races regarding the distance between AALF and the incisal edge of mandibular central incisors was statistically significant (P < 0.05). Among the three races, Malays and Indians have the greatest mean difference. Conclusion: According to the results of the current study, the distance between AALF and the incisal edge of mandibular central incisors might be a proper criterion for the initial adjustment of occlusal rims. The values obtained from three different races were significantly different from one another, hence a different range of values was used to establish occlusal height for different races.
| Abstract in French|| |
Introduction: L'orientation du plan occlusal constitue la base de la disposition des dents propice à une esthétique et une fonction satisfaisantes, ce qui en fait l'une des procédures cliniques les plus importantes en réhabilitation prothétique. Cette étude visait à analyser et à comparer la distance verticale entre l'attache antérieure du frein lingual (AALF) et le bord incisif des incisives centrales mandibulaires entre trois races en Malaisie. Matériels et méthodes: l'échantillon était composé de 63 sujets dentés (21 Malais, 21 Chinois et 21 Indiens) qui ont été choisis en fonction des critères d'inclusion. Deux modèles ont été réalisés à partir d'empreintes hydrocolloïdes irréversibles, et une moyenne de la valeur a été obtenue. Le frein lingual a été enregistré en fonction. Les moulages ont été fabriqués avec de la pierre dentaire. AALF a été marqué et la distance verticale a été mesurée à l'aide d'un pied à coulisse. Résultats: en Malaisie, la moyenne et l'écart type de la distance verticale étaient de 14,2 ± 0,9 mm, avec une plage de 12,3 à 16,0 mm ; en chinois étaient de 14,4 ± 0,9 mm, avec une plage de 12,0 à 16,9 mm ; et chez les Indiens étaient de 15,1 ± 1,0 mm, avec une plage de 13,0 à 17,2 mm. La différence entre les trois races concernant la distance entre l'AALF et le bord incisif des incisives centrales mandibulaires était statistiquement significative (P < 0,05). Parmi les trois races, les Malais et les Indiens ont la plus grande différence moyenne. Conclusion: Selon les résultats de l'étude actuelle, la distance entre l'AALF et le bord incisif des incisives centrales mandibulaires pourrait être un critère approprié pour l'ajustement initial des rebords occlusaux. Les valeurs obtenues à partir de trois races différentes étaient significativement différentes les unes des autres, par conséquent, une plage de valeurs différente a été utilisée pour établir la hauteur occlusale pour différentes races.
Mots-clés: Attachement lingual freinal, incisives mandibulaires, plan occlusal
Keywords: Lingual frenal attachment, mandibular incisors, occlusal plane
|How to cite this article:|
Usman JA, Kesumo A, Shahari NS. Analysis of the distance between lingual frenal attachment and mandibular incisal edge position in establishing occlusal plane in three different races. Ann Afr Med 2022;21:439-43
|How to cite this URL:|
Usman JA, Kesumo A, Shahari NS. Analysis of the distance between lingual frenal attachment and mandibular incisal edge position in establishing occlusal plane in three different races. Ann Afr Med [serial online] 2022 [cited 2022 Nov 29];21:439-43. Available from: https://www.annalsafrmed.org/text.asp?2022/21/4/439/361260
| Introduction|| |
Esthetic is very important and it is a primary concern for everyone regardless of their age. Edentulous states not only compromise esthetics but also compromise the integrity of the masticatory process.An edentulous state also causes loss of the occlusal plane. The occlusal plane helps in achieving esthetics for anterior teeth, thus incorrect record of the occlusal plane will compromise esthetics and also mastication. The GLOSSARY OF PROSTHODONTIC TERMS (May 2017) defines the occlusal plane as the average plane established by the incisal and occlusal surface of teeth. To reestablish esthetics and masticatory function, selection of anterior teeth with correct size, shape, and color is important to establish the correct occlusal plane, especially in a completely edentulous patient.
Orientation of the occlusal plane is the basics for the arrangement of teeth conducive to satisfactory esthetics and function. It is one of the most important clinical procedures in prosthodontic rehabilitation. Loss of teeth primarily affects the lower third of the face causing changes in facial appearance and expressions. A correct occlusal plane, correct tooth arrangement, is to imitate the preextraction condition of the edentulous patient, to enhance phonetics, denture stability, and physiologic support for lips, tongue, and cheeks.,
In the maxilla, the incisive papilla is used as a stable landmark for anteroposterior and vertical positioning of maxillary incisors. However, mandibular teeth are more displayed than maxillary teeth in various facial expressions. For example, during phonation, people usually display more of the mandibular anterior teeth than the maxillary anterior teeth. Most literature related to positioning artificial teeth emphasizes more on maxillary teeth instead of mandibular teeth, for example, maximum biting force, swallowing method, functional factor of phonetics with pronouncing f, v, and s, cephalometric radiograph, lip length, and amount of coverage of the maxillary central incisor.
The lingual frenum is a distinct fold of mucous membrane formed beneath the undersurface of the tongue. It is located lingual to mandibular incisors in the midline, which is quite prominent and can be accurately recorded during function. Hence, the preextraction measurement from the anterior attachment of lingual frenum (AALF) to incisor edge of lower incisor has been suggested as means of establishing occlusal plane for complete denture fabrication. This vertical distance is important for establishing the mandibular occlusal plane as well as for determining the vertical position of mandibular incisors in complete denture patients.
This study aims to analyze the distance between lingual frenum attachment and mandibular incisal edge position in establishing the occlusal plane and compare it to three different races.
There is no accurate method to determine the correct vertical dimension of occlusion for an edentulous patient. Even though many studies have been done earlier to determine the occlusal plane, they have been limited to a single race. The Malaysian population comprises multiracial people, hence it becomes necessary to find and establish an occlusal plane and compare it with three different races.
| Materials and Methods|| |
This study was approved by Research Management Centre in Mahsa University, Malaysia (ethical clearance number. RMC/EC20/2019), and performed in department clinics, prosthetic dentistry in 2019 with a study duration of 6 months. The study needed irreversible hydrocolloid (alginate) for making impressions, Type III gypsum product for pouring cast, and calipers. A total of 63 subjects, comprising 21 Malays, 21 Chinese, and 21 Indians, with ages between 20 and 30 years, were included in this study. The sample size was estimated based on one-way analysis of variance (ANOVA). Two impressions were taken with alginate using a stock tray to obtain the average and avoid an error. The examiner will hold the tray in place by placing two fingers in the first molar region and instruct the subject to elevate the tongue to wet the upper lip. After the impression was done, the cast was poured using a dental stone [Figure 1]. The examiner marked the anterior frenum attachment and the mesial incisal edge of the right mandibular central incisor using a pencil on the cast and measured the distance using a caliper [Figure 2]. Data obtained were analyzed based on three different races.
|Figure 2: Marking of anterior attachment of lingual frenum and mandibular incisor|
Click here to view
Subjects must be (1) dentulous with an aligned full complement of natural permanent teeth up to second molars and (2) the angle of Class I occlusion and well-developed lingual frenum.
Subjects having (1) Class II and III occlusion, (2) severe mandibular anterior teeth attrition, (3) bad periodontal conditions, (4) ankyloglossia, (5) supra-erupted and mobile teeth, (6) restored and grossly decayed teeth with altered incisor height, (7) parafunctional habits and persons who have undergone orthodontic treatment, and (8) lingual frenectomy should be excluded from the study.
Following this, before performing a clinical examination, appropriate and well-documented consent for participation in this study was obtained from the individuals.
| Results|| |
The measurements of all the subject's models are tabulated in [Table 1]. The mean distance among the races was 14.5 ± 1.0 mm, as shown in [Table 2]. The result showed that the mean value for Malays was 14.2 mm with a range between 12.3 and 16.0 mm. The mean value for the Chinese was 14.4 mm with a range of 12.9–16.9 mm whereas, for Indians, the mean value was 15.1 mm with a range value of 13.0–17.2 mm.
|Table 2: Mean and standard deviation of distance from the anterior attachment of lingual frenum to the mandibular incisor in three different races|
Click here to view
ANOVA test was done to compare the distance of AALF with mandibular central incisor between the races and P = 0.008 (P < 0.05) was obtained, as shown in [Table 3]. Post hoc test (Sidak) was done, with Malays and Indians having the greatest mean difference [Table 4].
| Discussion|| |
Correct registration of occlusal vertical dimension is important in the fabrication of a complete denture. Alteration in the vertical dimension will lead to the impairment of esthetic, speech functions and even cause muscle discomfort. To establish an ideal occlusion, the orientation of the occlusal plane plays an important role. Correct orientation of the occlusal plane has a role in the achievement of esthetic., When the occlusal plane is placed too high, this will prevent the tongue from resting on lingual cusps of the mandibular denture leading to its displacement. This leads to the displacement of the tongue into its new position that is higher than the normal position; when the occlusal plane is placed too low, it will cause the tongue and cheek biting.,,
Maximum attention is given to maxillary anterior teeth to establish esthetic, but less attention is given to mandibular anterior teeth. Research done by Cade showed that mandibular anterior teeth do play a role in appearance as mandibular anterior teeth were displayed to a greater extent than maxillary anterior teeth during various facial expressions. Research done by Payne and Silverman showed that mandibular anterior teeth are displayed more compared to maxillary anterior teeth during phonation.,
Many previous studies were done that cleared that the positioning of maxillary anterior teeth being emphasized compared to the positioning of mandibular anterior teeth. In the maxilla, the incisive papilla is considered a stable landmark when positioning the maxillary anterior teeth, but little information regarding the positioning of mandibular anterior teeth is present. Research done by Aeran H et al. compared the relationship of labial and lingual frenum to the height of mandibular central incisors. From the result, they found that the lingual frenum is more stable when recorded during function as the standard deviation (SD) of the distance between mandibular incisors and lingual frenum obtained is clinically low when compared to the SD obtained from the distance of mandibular incisors and labial frenum. A study done by Kaushik et al. indicated that the distance between lingual frenum and incisal edges of mandibular incisors can be used as a reliable landmark when lingual frenum is recorded during function.
Few previous studies had been conducted in three different ethnic groups. The first study was done by Bissau in which the mean value of the distance of lingual frenum and mandibular incisor teeth obtained for the Syrian population was 10.26 mm, and it was also noted that the measurements could be used for positioning the mandibular incisor and to establish the occlusion vertical dimension. The next study was done by Rahman et al. where they conducted the study in the Iraqi population to determine the distance between the attachment of lingual frenum and mandibular central incisors. The mean value obtained was 10.7 mm for males and 10.9 mm for females and concluded that the lingual frenum was considered a stable landmark when recorded in function. Finally, according to the research done by Parimala and Prithviraj in Bangalore city, India, in which the calculated mean distance of lingual frenum and mandibular central incisor was 12.3 mm and this measurement, could be used to establish the occlusal plane for mandibular teeth and also help in the positioning of mandibular anterior teeth.
In the present study the mean value of the distance between the AALF and incisal edges of mandibular incisors was 14.2 mm for Malay, 14.4 mm for Chinese, and 15.1 mm for the Indian population. These measurements can be implied while constructing the occlusal rim and can be used as a guide in anteroposterior positioning of anterior mandibular teeth that will help in reducing the chairside time.
The variations in the value obtained when compared to the previous studies can be explained by the differences in measurement techniques and anatomical variation between each individual. For future research, different races such as Iban and Kadazandusun can be included as these are the largest ethnics in Sarawak and Sabah, respectively, comparison between gender among the races, increase in the sample size can also increase the accuracy of the study, and finally, further studies can include individuals with Class II and III relations.
| Conclusion|| |
The distance of AALF and incisor edge of mandibular central incisor can be used for adjustment of the occlusal rim in which the value is 14.2 ± 0.9 mm for Malays, 14.4 ± 0.9 mm for Chinese, and 15.1 ± 1.0 mm for Indians.
Therefore, the distance between AALF and the incisal edge of mandibular central incisors might be a proper criterion for the initial adjustment of occlusal rims. The values obtained from three different races were different from one another, hence a different range of values was used to establish occlusal height for different races, to reduce chairside adjustment of occlusal rims.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]