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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 11  |  Issue : 4  |  Page : 196-199

Evaluation of the incisive papilla as a guide to maxillary canine position in the moradabad population: An anthropometric analysis


Department of Prosthodontics and Crown and Bridge, Kothiwal Dental College and Research Centre, Moradabad, Uttar Pradesh, India

Date of Submission03-May-2019
Date of Decision24-Jun-2019
Date of Acceptance24-Jun-2019
Date of Web Publication1-Oct-2019

Correspondence Address:
Siddhi Tripathi
Department of Prosthodontics and Crown and Bridge, Kothiwal Dental College and Research Centre, Kanth Road, Moradabad - 244 001, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_46_19

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  Abstract 


Introduction: Incisive papilla has been used as a fixed anatomical landmark to guide teeth arrangement. However, controversy exists in literature whether to use anterior, middle, or posterior border of the incisive papilla for the determination of position of maxillary canines. Hence, a study was planned to ascertain the location of the incisive papilla to the intercanine line in a sample of population reporting to a teaching institute in Moradabad. Materials and Methods: A total of 200 participants aged 20–40 years were selected for the study. Impressions of the maxillary arches were made, and the casts were poured. The anterior point, midpoint, and posterior point of the incisive papilla and the tips of canines were marked on the cast. Photographs were taken and analyzed using Adobe Photoshop 7.0. The intercanine line was analyzed to assess whether it passed through the anterior, middle, or posterior border of the incisive papilla. Results: The Chi-square test revealed that there was a statistically significant difference (P < 0.05) of intercanine line in relation to different borders of the incisive papilla. The intercanine line passed through the anterior border of the incisive papilla in 8% of the participants, the middle border in 33.5% of the participants, between the middle and posterior border in 17.5% of the participants, and the posterior border in 41% of the participants. Conclusions: It was concluded that the intercanine line passed through the posterior border of the incisive papilla in maximum cases followed by the middle third, middle-posterior, and least through the anterior border of the incisive papilla. Hence, the posterior border of the incisive papilla is a reliable indicator for the placement of maxillary canines.

Keywords: Incisive papilla, intercanine line, maxillary canine


How to cite this article:
Tripathi S, Pandey S, Agarwal S, Hazarika P. Evaluation of the incisive papilla as a guide to maxillary canine position in the moradabad population: An anthropometric analysis. Indian J Dent Sci 2019;11:196-9

How to cite this URL:
Tripathi S, Pandey S, Agarwal S, Hazarika P. Evaluation of the incisive papilla as a guide to maxillary canine position in the moradabad population: An anthropometric analysis. Indian J Dent Sci [serial online] 2019 [cited 2019 Oct 17];11:196-9. Available from: http://www.ijds.in/text.asp?2019/11/4/196/268416




  Introduction Top


Restoration of the natural appearance of an edentulous patient is a vital part of prosthodontic treatment. In completely edentulous patients, it becomes important to place teeth in a position that will aid in establishing correct speech, esthetics, and harmonious incisal guidance.[1] However, in the absence of preextraction records, finding the most suitable position for artificial anterior teeth is challenging. In this regard, the incisive papilla is one of the most important biometric guides, as it is a stable landmark and remains unchanged after the anterior teeth extraction and subsequent resorption of the maxillary ridge.[2],[3]

The incisive papilla/palatine papilla is a small pear or oval-shaped mucosal prominence situated at the midline of the palate and posterior to the palatal surface of the central incisors.[4] Anterior border of the incisive papilla is not a reliable landmark, particularly when the papilla is continuous with the interdental papilla since postextraction changes occur at the anterior border. During edentulous transformation as the papilla changes to round form, its center also changes. Therefore, anterior border and center of the incisive papilla are likely to change after the extraction of incisor teeth, whereas the posterior border is relatively stable.[1],[5],[6]

Various authors are of different opinion regarding the part of the incisive papilla to be taken as reference for canine placement. Sapkota et al.[7] and Watt et al.[4] are of the view that C-P-C line passes through the posterior border of the incisive papilla. On the contrary, Lau and Clark,[5] Ehrlich and Gazit,[3] Solomon and Arunachalam,[6] Schiffman,[8] Huang et al.,[9] and Shrestha et al.[1] reported that the intercanine line passes through the middle border of the incisive papilla. Whereas Grove and Christensen[10] found that C-P-C line passes through the middle-posterior border of the incisive papilla. However, none of the studies were suggestive for the anterior border of the incisive papilla.

Owing to the controversial findings in relation to the intercanine line and incisive papilla, a study was planned to ascertain the location of the incisive papilla to the intercanine line in a sample of population reporting to a teaching institute in Moradabad.


  Materials and Methods Top


Selection of subjects

A power analysis determined a minimum of 200 participants to ensure statistical robustness of the study. A total of 200 participants aged 20–40 years having a full complement of permanent teeth up to the second molar, Angle's Class I molar relationship and well traceable incisive papilla were included in the study. Participants with a history of orthodontic treatment, gross malalignment, supra-erupted teeth, diastema between the anterior teeth, restoration of the anterior teeth, and severe attrition of canines were excluded from the study. Random sampling was employed for inclusion of samples from the Outpatient Department of a teaching dental institute, Moradabad. Prior to the conduct of study, ethical clearance was obtained from the Institutional Ethical Review Board (KDCRC/IERB/04/2019/01).

Procedure

Impressions of the maxillary arches were made with irreversible hydrocolloid impression material (Algitex, DPI trading corporation Ltd) using metallic stock impression tray following the manufacturer's instructions. The casts were poured using Type III gypsum (Kaldent, Kalabhai, Dental Plaster Class II) using a dental vibrator and allowed to set. The anterior point, midpoint, and posterior point of the incisive papilla were marked on the cast by indelible marker. The points were joined to trace the boundary of the incisive papilla. Furthermore, the tip of canine on both sides was marked on the cast. Photograph of each cast was taken to mark the intercanine line and to find the relationship between the incisive papilla and the intercanine line. The cast was kept at a distance of 25 cm from the camera. Photographs were taken at a focal length of 13 mm, ISO speed of 160, maximum aperture of 4.34 and 1/60 s, and shutter speed of 2 s. Photographs obtained were transferred to the computer and analyzed using Adobe Photoshop 7.0. The line connecting tip of canines on the photograph was designated as the intercanine line. The intercanine line and center of the incisive papilla were remarked on the photograph and viewed to assess whether the intercanine line passed through the anterior, middle or posterior border of the incisive papilla [Figure 1], [Figure 2], [Figure 3].
Figure 1: Traced photograph showing intercanine line passing through the middle border of the incisive papilla

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Figure 2: Traced photograph showing intercanine line passing through the anterior border of the incisive papilla

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Figure 3: Traced photograph showing intercanine line passing through the posterior border of the incisive papilla

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The data obtained was analyzed using the Chi-square test. The level of significance was set at 0.05.


  Results Top


The Chi-square test revealed that there was a statistically significant difference (P < 0.05) of the intercanine line in relation to different borders of the incisive papilla [Table 1]. The intercanine line [Figure 4] passed through the posterior border of the incisive papilla (41%) in maximum samples, followed by the middle border (33.5%), between the middle and posterior border (17.5%), and least in the anterior border (8%) of the incisive papilla.
Table 1: Location of intercanine line on the incisive papilla in males and females

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Figure 4: Relationship between the intercanine line and incisive papilla

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Among males, the intercanine line [Figure 5] passed through the posterior border of the incisive papilla (57.5%) in maximum samples, followed by the middle border (24.7%), between the middle and posterior border (13.2%), and least in the anterior border (4.4%) of the incisive papilla.
Figure 5: Location of the intercanine line on the incisive papilla among males and females

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Whereas in females, intercanine line [Figure 5] passed through the middle border of the incisive papilla (44.8%) in maximum samples, followed by the middle-posterior border (22.9%), posterior border (19.5%), and least in the anterior border (12.6%) of the incisive papilla.


  Discussion Top


In this study, it has been revealed that the canine tip passes through the posterior border of the incisive papilla in majority of the participants, followed by middle, middle-posterior, and anterior border. Even though an objective measurement cannot be relied on all the time, it becomes important for determining correct location of maxillary canines and estimation of mesiodistal width of the six maxillary anterior teeth, thereby saving chairside time.

The results of the present study are in accordance with the study conducted by Watt et al.[8] who stated that canines should be located in a coronal plane passing through the posterior border of the papilla. Similarly, Sapkota et al.[7] found that intercanine line passed through the posterior border of the incisive papilla.

However, the results are in contradiction with the studies conducted by Lau and Clark,[5] Solomon and Arunachalam,[6] Huang et al.,[9] and Shrestha et al.[1] who found that Canine-Papilla-Canine (CPC) line passes through the middle border of the incisive papilla. Whereas Schiffman [8] documented that in 92% of cases, “the line connecting the tips of the canines was within an area of 1-mm anterior and posterior to the center of the incisive papilla.“ On the contrary, Grove and Christensen[10] stated that C-P-C line passes through the middle-posterior border of the incisive papilla in about 90% of the cases. The inconsistency of the results with the previous studies can be attributed to variability in geographic location and ethnicity of the sample population studied.

The clinical significance of this study lies in its application to complete denture prosthodontics. The incisive papilla is a useful anatomical landmark to locate the position of canine in maxillary complete dentures. As record base and occlusal rim cover the C-P-C line over the master cast, it is better to scribe the intercanine line passing through the posterior border of the incisive papilla continuing till the land area of the cast. In the laboratory, it is a distinct advantage for both the students and the technicians as a guide for correct placement of maxillary canine. Furthermore, correct mesiodistal width of the six maxillary anterior teeth from midcanine to midcanine can be determined.

The present study challenges the conventional school of thought that intercanine line passes through the middle border of the incisive papilla. As the posterior border is a more stable landmark in comparison to the middle border, it should be used as a reliable indicator for the placement of maxillary canines.

Further studies with larger sample size, different geographical locations, various arch forms, and different shapes of the incisive papilla should be conducted for the evaluation of the incisive papilla as a guide for maxillary canine placement.


  Conclusions Top


Within the limitations of the study, it was concluded that the relationship of intercanine line was such that it lay within the boundary of the incisive papilla. In most of the cases, it passed through the posterior border followed by the middle border, between the middle and posterior border, and least through the anterior border of the incisive papilla. Hence, the posterior border of the incisive papilla can be regarded as a reliable indicator for the placement of maxillary canines.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shrestha S, Joshi SP, Yadav SK. Relationship of incisive papilla to maxillary incisors and canines. J Contemp Dent Pract 2016;17:306-12.  Back to cited text no. 1
    
2.
Zarb GA. Bolender CL. Prosthodontic Treatment for Edentulous Patients. 12th ed. India: Mosby Publishers; 2005.  Back to cited text no. 2
    
3.
Ehrlich J, Gazit E. Relationship of the maxillary central incisors and canines to the incisive papilla. J Oral Rehabil 1975;2:309-12.  Back to cited text no. 3
    
4.
Watt DM, Likeman PR, Grave AM. Evaluation of the incisive papilla as a guide to anterior tooth position. J Prosthet Dent. 1987;57:712-4.  Back to cited text no. 4
    
5.
Lau GC, Clark RF. The relationship of the incisive papilla to the maxillary central incisors and canine teeth in Southern Chinese. J Prosthet Dent 1993;70:86-93.  Back to cited text no. 5
    
6.
Solomon EG, Arunachalam KS. The incisive papilla: A significant landmark in prosthodontics. J Indian Prosthodont Soc 2012;12:236-47.  Back to cited text no. 6
    
7.
Sapkota B, Chettiar RS, Srivastava S, Marla V, Koju S. Assessment of the relationship of incisive papilla to maxillary central incisor and canine-papilla-canine line among the dentate population of central Nepal. Kathmandu Univ Med J 2017;58:150-4.  Back to cited text no. 7
    
8.
Schiffman P. Relation of the maxillary canines to the incisive papilla. J Prosthet Dent 1964;14:469-72.  Back to cited text no. 8
    
9.
Huang SJ, Chou TM, Lee HE, Wu YC, Yang YH, Ho CD, et al. Exploring the distance between upper central incisor edge and incisive papilla in Taiwanese population. Taiwan J Oral Med Health Sci 2004;20:4-10.  Back to cited text no. 9
    
10.
Grove HR, Christensen LV. Relationship of maxillary canines to the incisive papilla. J Prosthet Dent 1989;42:492-96.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1]



 

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