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Cover page of the Journal of Health Sciences


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 9  |  Issue : 2  |  Page : 165-169

Comparative evaluation of the most reliable posterior reference point of Camper's plane in relation with hamular notch-incisive papilla plane with change in gender of edentulous subjects: A cephalometric study


Department of Prosthodontics and Crown and Bridge, KLE V K Institute of Dental Sciences, KLE University, Belagavi, Karnataka, India

Date of Web Publication29-Sep-2016

Correspondence Address:
Kirandeep Kaur
Department of Prosthodontics and Crown and Bridge, KLE V K Institute of Dental Sciences, KLE University, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-5006.191259

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  Abstract 

Statement of the Problem: Camper's plane is widely used to orient occlusal plane in edentulous patients, but the most reliable posterior reference point of Camper's plane is controversial.
Purpose: The purpose of this study was to evaluate the most reliable posterior reference point of Camper's plane in relation with hamular notch-incisive papilla (HIP) plane with change in gender of edentulous subjects.
Materials and Methods: The study was performed on 20 males and 20 females in the age group of 50-65 years. The conventional method of primary and secondary impression making was followed. The deepest point of the right hamular notch and the center of the incisive papilla was marked with an indelible marker on the master casts. Two spherical metal ball bearings of 3.1 mm were attached to the cast at the marked points, using cyanoacrylate resin. Autopolymerizing acrylic resin was adapted over the cast to construct the temporary denture base. Three spherical metal ball bearings were attached to superior, middle, and inferior part of the tragus and one at the ala of nose. A lateral cephalogram was made placing the temporary denture base in position intraorally. Cephalometric image analysis was done using Adobe Photoshop CS5.
Results: Descriptive statistics of the data showed, in males, Camper's plane with superior point on tragus has a mean score of 8.71 ± 4.45, with middle point on tragus has 4.35 ± 3.17 and an inferior point on tragus has 4.01 ± 2.23. In females, Camper's plane with superior point on tragus has a mean score of 5.65 ± 2.64, with middle point on tragus has mean score of 2.71 ± 2.51, and inferior has 5.72 ± 3.09.
Conclusion: Within the limitations of the study, it was concluded that in males, Camper's plane with posterior reference point as inferior border of tragus was the most parallel to HIP plane and in females, middle border of tragus was most parallel as the posterior reference point of Camper's plane in relation to HIP plane.

Keywords: Camper′s plane, hamular notch-incisive papilla plane, posterior reference point


How to cite this article:
Kaur K, Nelogi SY, Patil R. Comparative evaluation of the most reliable posterior reference point of Camper's plane in relation with hamular notch-incisive papilla plane with change in gender of edentulous subjects: A cephalometric study. Indian J Health Sci Biomed Res 2016;9:165-9

How to cite this URL:
Kaur K, Nelogi SY, Patil R. Comparative evaluation of the most reliable posterior reference point of Camper's plane in relation with hamular notch-incisive papilla plane with change in gender of edentulous subjects: A cephalometric study. Indian J Health Sci Biomed Res [serial online] 2016 [cited 2022 May 17];9:165-9. Available from: https://www.ijournalhs.org/text.asp?2016/9/2/165/191259


  Introduction Top


Complete denture construction is a product of biological sciences as well as sound mechanical principles. Construction of a prosthesis that is in harmony with patient's stomatognathic system is the ultimate aim of prosthetic dentistry. Complete denture prosthesis places numerous factors which are associated with prosthesis and are in the control of operator. [1]

The occlusal plane, lost in patients rendered edentulous, should be relocated if complete dentures are to be esthetically and functionally satisfactory. Determination of optimum level and inclination of occlusal plane in an edentulous mouth is one of the key factors in governing occlusal balance and esthetics. [2]

The plane of occlusion is formed after joining the incisal edges of the mandibular central incisors to the distobuccal cusps of the mandibular first molars. As defined in the Glossary of Prosthodontic Terms, the occlusal plane is, "the common plane established by the incisal and occlusal surfaces of the teeth." Improper orientation of this plane jeopardizes the coordination between the components of oro-facial articulatory complex and also affects the esthetics. [3],[4]

Many methods have been used to establish the lost occlusal plane in complete denture prosthodontics. However, no single method seems to be fully accepted. Contemporary concepts advocate establishing the plane of occlusion as close as possible to the position, which was previously occupied by the occlusal plane of the natural teeth to ensure normal function of the cheek, tongue, and masticatory muscles. [5],[6]

Various methods utilize intraoral and extraoral landmarks for orientation of the occlusal plane. Intraoral landmarks that have been suggested to clinically determine the position of the occlusal plane are the upper lip, lateral margins of the tongue, retromolar pad, parotid papilla, and buccinators groove. [7],[8]

The assessment of the patient's occlusal plane has been performed by comparing the inclination of an occlusal plane with selected craniofacial reference planes such as Frankfort horizontal plane and Camper's plane using lateral cephalograms and photographs. In dentate individuals, the inclination of occlusal plane is generally compared with Frankfort horizontal plane. [9] The Camper's plane or the ala-tragus line (ATL) is used for occlusal plane orientation in completely edentulous patients.

The hamular notch-incisive papilla (HIP) plane of occlusion was the result of studies begun in 1960 by Cooperman and Willard. HIP plane can quite predictably reproduce occlusal plane. This plane remains unaltered even with the loss of teeth, as incisive papilla remains in a constant position. These landmarks appeared to be least affected by residual ridge resorption and remained visible. This plane can be used in the determination of inclination of occlusal plane during complete denture construction. [10]

Extraorally, the technique of using the ATL to establish the lost occlusal plane is well documented. However, the definitions of ATL cause confusion, because of the exact points of reference do not agree. [9]

It is surprising how much vagueness exists as to exact nature of ATL. Hence, a study was taken up with the first objective as which is the most reliable posterior reference point of ala-tragus in relation to HIP plane and the second was to see any difference in posterior reference point of ala-tragus with change in gender.


  Materials and Methods Top


The study was conducted on patients reporting to the Department of Prosthodontics, KLE V.K Institute of Dental Sciences, Belagavi in the age group of 50-65 years. A written and informed consent was obtained for radiography and documenting purposes:

  • The study was conducted on edentulous subjects between two groups with change in gender
  • Group 1 included 20 male subjects between 50 and 65 years age group
  • Group 2 included 20 female subjects between 50 and 65 years of age group
  • The conventional method of primary and secondary impression making was followed
  • The deepest point of the right hamular notch and the center of the incisive papilla was marked with an indelible marker on the master casts.
  • Two spherical metal ball bearings of 3.1 mm were attached to the cast at the marked points, using cyanoacrylate resin
  • Autopolymerizing acrylic resin was adapted over the cast, using the sprinkle-on method, to construct the temporary denture base
  • Three spherical metal ball bearings were attached to superior, middle, and inferior part of the tragus and one at the ala of nose
  • A lateral cephalogram was made placing the temporary denture base in position intraorally [Figure 1]
  • Cephalometric image analysis was done using Adobe Photoshop CS5
  • The measurement scale was set individually for every patient [Figure 2]
  • The angle between the two lines that is between Camper's plane (superior, middle, inferior edge) and the HIP plane was measured and recorded individually [Figure 3]
  • The values were subjected to statistical analysis.
Figure 1: Lateral cephalogram showing radio-opaque metal ball bearings


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Figure 2: Measurement scale set in Adobe Photoshop CS5


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Figure 3: Angle recorded between campers plane hamular notch-incisive papilla plane


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  Results Top


Descriptive statistics of the data showed, in males, Camper's plane with superior point on tragus has a mean score of 8.71 ± 4.45, with middle point on tragus has 4.35 ± 3.17 and inferior point on tragus has 4.01 ± 2.23. In females Camper's plane with superior point on tragus has mean score of 5.65 ± 2.64, with middle point on tragus has a mean score of 2.71 ± 2.51 and inferior has 5.72 ± 3.09.


  Discussion Top


The Glossary of Prosthodontic Terms-8 defines an occlusal plane as "the average plane established by the incisal and occlusal surfaces of the teeth. In general, it is not a plane but represents the planar mean of the curvature of these surfaces." [10]

The occlusal plane is normally established anteriorly according to esthetics of patient and posteriorly parallel to Camper's plane. The use of ATL for determination of occlusal plane has been a topic of debate over past many years. This is because various researchers cannot come to a consensus as to which tragal reference should be used for formation of ALT. [1] Hence, a study was undertaken to comparatively evaluate the most reliable posterior reference point of Camper's plane in relation to HIP plane, with change in gender of edentulous patients.

In this study, digital lateral cephalogram was used to study the relationship between three Camper's planes with posterior reference points as superior, middle, inferior part of the tragus and HIP plane. Stainless steel spherical bearings were adhered to the superior, middle, and inferior points of the tragus of the right ear using adhesive tape. A stainless steel spherical bearing was also placed at the inferior border of the ala of the nose using surgical adhesive tape. Subjects with study templates were subjected to lateral cephalograms.

To reduce manual errors, cephalometric tracings were done using Adobe Photoshop CS5 software and the soft copy of the cephalogram. The measurement scale was set for each cephalogram. Lines were drawn connecting metal ball bearing at the incisive papilla and the right hamular notch. Three lines were drawn connecting the stainless steel spherical bearings placed on the superior, the middle, and the inferior points on the tragus and the ala of the nose. These lines were therefore marked as CPS, CPM, and CPI, respectively. The angles between CPS-HIP, CPM-HIP, and CPI-HIP, respectively were measured and recorded.

Descriptive statistics of the data show that Camper's plane superior was maximum and Camper's plane inferior was minimum in males. In females, mean values for Camper's plane inferior were maximum and Camper' plane middle were minimum.

This indicates that Camper' plane with an inferior point on tragus is the most parallel in males. A study carried out by Karkazis and Polyzois also advocates the use of the inferior border of tragus as a posterior landmark. [11] According to them, the inferior border of tragus is an excellent equivalent soft tissue landmark to the lower border of the external auditory meatus.

In females, Camper' plane with middle point on tragus is most parallel to HIP plane. Ismail and Bowman, Spratley are in favor of these results. [12]

It is an evident from the results that, the HIP plane is parallel to the Camper' plane. Hence, HIP plane can be considered as standard plane in complete denture fabrication. In support of these results Jayachandran et al. in their study conducted on dentulous and edentulous subjects concluded HIP plane parallel to occlusal plane. [2] Fu et al. in their study conducted on dentulous subjects stated that occlusal plane drawn through the buccal cusp tips of maxillary teeth had better parallelism with the HIP plane. [8]

The Camper's plane formed with the posterior reference point as an inferior point of the tragus is relatively parallel to the CPI-HIP plane in males. In females, the CPM, i.e., the ATL formed by joining the ala of the nose to the middle point on the tragus of the ear is relatively parallel to the HIP plane.

In support of results seen in males Simpson et al. state that Camper's plane is a line running from the ala of the nose to the inferior border of the tragus. [12]

Hindocha et al. conducted research to determine the relationship between the plane of occlusion and the Camper's line ATL using lateral cephalograms in dentulous subjects. According to them the tragal reference in this study population was more toward the inferior of the tragus. [13]

In support of results seen in females, Ismail and Bowman describe it as a line passing from the ala of the nose to the center of the tragus of external auditory meatus. Spratley also describes it as a line running from the center of the ala to the center of the tragus. [12]

The Glossary of Prosthodontic Terms defines it as a line running from the inferior border of the ala of the nose to some defined point on the tragus of the ear, usually considered to be the tip of the tragus. [10]

In contrast to the above results, Lloyd, Anthony, and Miller define it as a line running from the inferior border of the ala of the nose to the superior border of the tragus. [12]

Boucher defines it as the line running from the inferior border of the ala of nose to the superior border of the tragus of the ear. [12]

Gupta et al. fabricated an occlusal plane analyzer and concluded that the posterior reference point of Camper's line was middle point for 72% of the males and superior point for 80% of females. [14]

Trapozzano also used the upper border of the tragus as a reference point. [12] Sadr and Sadr in their photographic study on dentulous subjects concluded that the superior border of the tragus is suggested as the posterior reference for ATL. [15]

This study has also emphasized the use of middle border of tragus as the most reliable posterior reference point to mark Camper's plane for occlusal plane orientation in females which complies with Ismail and Bowman, Spratley and Glossary of Prosthodontic Terms. [10],[12]

On the other hand, this study does not agree with the findings of Boucher, Gupta, Tropozanno, and Sadr, who suggested the use of superior border of tragus as the most reliable posterior reference point of Camper' plane to orient occlusal plane. [12],[13],[14],[15]


  Conclusion Top


Within the limitations of the present cephalometric study to determine the most reliable posterior reference point of Camper's plane with change in gender of edentulous patients has shown that. The HIP plane is parallel to the Camper's plane. There is the difference in the most reliable posterior reference point of Camper's plane with change in gender of edentulous subjects. In males, the Camper's plane formed with the posterior reference point as inferior border of the tragus is most parallel to CPI-HIP plane. Hence, it can be taken as the acceptable reference point to mark Camper's plane for orientation of occlusal plane in males in the age group of 50-65 years whereas.

In females, the Camper's plane formed with the posterior reference point as middle border of the tragus is most parallel to CPM-HIP plane. Hence, it can be taken as the acceptable reference point to mark Camper's plane for orientation of the occlusal plane in females in the group of 50-65.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shaikh SA, Lekha K, Mathur G. Relationship between occlusal plane and three levels of ala tragus line in dentulous and partially dentulous patients in different age groups: A pilot study. J Clin Diagn Res 2015;9:ZC39-42.  Back to cited text no. 1
    
2.
Jayachandran S, Ramachandran CR Varghese R. Occlusal plane orientation: A statistical and clinical analysis in different clinical situations. J Prosthodont 2008;17:572-5.  Back to cited text no. 2
    
3.
Van Niekerk FW, Miller VJ, Bibby RE. The ala-tragus line in complete denture prosthodontics. J Prosthet Dent 1985;53:67-9.  Back to cited text no. 3
    
4.
Gupta R Aeran H, Singh SP. Relationship of anatomic landmarks with occlusal plane. J Indian Prosthodont Soc 2009;9:142-7.  Back to cited text no. 4
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5.
Sinobad D. The position of the occlusal plane in dentulous subjects with various skeletal jaw-relationships. J Oral Rehabil 1988;15:489-98.  Back to cited text no. 5
    
6.
A1 Quran FA, Hazza'a A, AI Nahass N. The position of the occlusal plane in natural and artificial dentitions as related to other craniofacial planes. J Prosthodont 2010;19:601-5.  Back to cited text no. 6
    
7.
Williams DR. Occlusal plane orientation in complete denture construction. J Dent 1982;10:311-6.  Back to cited text no. 7
    
8.
Fu PS, Hung CC, Hong JM, Wang JC. Three-dimensional analysis of the occlusal plane related to the hamular-incisive-papilla occlusal plane in young adults. J Oral Rehabil 2007;34:136-40.  Back to cited text no. 8
    
9.
Rich H. Evaluation and registration of the H.I.P. plane of occlusion. Aust Dent J 1982;27:162-8.  Back to cited text no. 9
    
10.
The glossary of Prosthodontic terms. J Prosthet Dent 2005; 94:10-92  Back to cited text no. 10
    
11.
Hercules C. Karkiazis., Gregory L. Polyzois, Akibiades J. Zissis. Relationship between ala-tragus line and natural occlusal plane. Implications in denture prosthodontics. Quint Int 1986;17(4): 253-55.  Back to cited text no. 11
    
12.
Shetty S, Zargar NM, Shenoy K, Rekha V. Occlusal plane location in edentulous patients: A review. J Indian Prosthodont Soc 2013;13:142-8.  Back to cited text no. 12
    
13.
Hindocha, A. DĄ Vartak, V. NĄ Bhandari, A. J., & Dudani, M. (2010). A cephalometric study to determine the plane of occlusion in completely edentulous patients: part I. The Journal of Indian Prosthodontic Society2010; 10(4): 203-207.  Back to cited text no. 13
    
14.
Deogade SC, Gupta PL, Shankaran GN, Sharma S, Mishra A Lateral cephalometric radiographs: An adjunct in positioning the occlusal plane in natural and artificial dentitions as related to other craniofacial planes. J Indian Acad Oral Med Radiol 2011;23:620-3.  Back to cited text no. 14
    
15.
Sadr K, Sadr M. A study of parallelism of the occlusal plane and ala-tragus line. J Dent Res Dent Clin Dent Prospects 2009;3:107-9.  Back to cited text no. 15
    


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  [Figure 1], [Figure 2], [Figure 3]



 

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