A comparative study of the occlusal plane in dentulous

and edentulous subjects

Peter R. L'EstrQnge, B.D.Sc., .",l.D.Sc., Ph.D.,* and Peter S. Vig, Ph.D., B.D.S.,
F.D.S., D.Orth.R.C.S. * *
Institute o/ Dental Surgery, Eastman Dental Hospital, and London Hospital
Medical College Dental School, Lon'don, England

The use of cephalometrics in pt~osthodontics has been advocated by orthodontists

for some time. ~ Recently, its introduction into prosthetic,treatment planning has be-
come evident, and'attempts have been made to establish cephalometric norms. 2 In
addition, cephalometric studies are extremely useful in the long.term evaluation of
prosthetic reconstructive procedures. "R.ecent research has helped clarify certain as-
pects of oral function and indicates the relation'sla)p which exists between the dimen-
sions of the maxillomandibular space and the movement patterns of various oral and
I~har3'ngeal structures during speech.":'
This article describes the preliminary part of an intensive study to determine the
location of artificial teeth based on ccphalometrie criteria. The primary hypothesis
in this study is that tl~e angulation and vertical height of the occlusal plane are pre-
dictable from an assessment of the maxillomandibular space as seen on a lateral skull
radiograph recorded with the opposing teeth in the intercuspal position.

LOCATING THE OCCLUSAL PLANE IN EDENTULOUS PATIENTS

The precise location of tile occlusal plane for edentulous patients is a controversial
matter. There appears to be a lack of agreement on how it should be orientated for
individual patients. Some of the current concepts include" (1) establishing the oc-
clusal plane 1 to 3 mm. below the resting lip anteriorly and parallel to the ala-tragus
line posteriorly)' '~' (2) positioning the occlusal plane parallel to and midway.between
the residual ridges, '~, ; (3) positioning the occusal plane on the same level as the
lateral border of the tongue, s' :' (4) terminating the occlusal plane posteriorly at the
middle or upper third of the retromolar pad, 7''' and (5) orienting the occlusal plane
with the buccinator grooves and the commissure of the lips. TM

Read before the Store Kro meeting in K6nigstein, West Germany.

*Senior I.eeturer, Prosthodonties, Institute of Dental Surgery, Eastman Dental Hospital.
**Reader, Orthodontics, London Hospital Medical College Dental School.
495
 496 L'Estrange and Vig j. I,,.ost~,~t.D~.,t.
May, 1975

" " 2 . , OF SP~g

LEt~G~r',

I
U

HEIGHT OF SPACE

Fig. 1. The length and height of the maxillomandibular space are outlined on a tracing of a
lateral cephalometric radiograph. T, the point where the occlusal plane meets the most lingually
placed incisor tooth; U, the point where the occlusal plane meets the shadow of the posterior
pharyngeal wall; 1, tongue base--taken as the deepest point in the concavity between the
posterior part of the base of the tongue and the anterloY-border o£ the epiglottis.

METHODS
Sample selection of subjects
Dentulous group. This group consisted of 26 men, ranging from 25 to 35 years
of age, with an average of 28.2 years. All subjects had complete or nearly complete
dentitions. While the dental occlusion in all subjects did not conform to the textbook
ideal, all were considered acceptable.
Edentulous group. This group consisted of 26 subjects, eight men and 18 women,
ranging from 3 6 t o 78 years of age, with an average of 60 years. All subjects possessed
complete dentures which h.ad been constructed according to a standard clinical
method and had replaced unsatisfactory dentures. The anterior teeth provided ac-
ceptable esthetics and phonetics, and the initial posterior reference point for the 0c-
clusal plane was the midpoint of the retromolar.pad. At the try-in, the angulation of
the oeelusal plane was examined to ensure that, at the postural position or in a
position slightly downward and forward of it, the posterior teeth were not above the
lateral convexity of the tongue.
The ability of patients to adapt to dentures varies. Individual differences in
maxillomandibular space dimensions 11 and pharyngeal structures ~ have an mItuence
on oral behavior. A system of morphologic typing, based on the dimensions of tile
maxillomandibular space and independent of incisor relationship, has been described
elsewhere. 13
Arbitrary mean values were taken for maxillomandibular space length and height.
Maxillomandibular heights of 70 ram. or more were taken as high, while those under
Volu,n,,3:~
Number 5 Occlusal plane in dentutous and edentulous subjects 497'

I'] ~- "W" t~ ''Lv "

Fig. 2. (A) The frontal view of radiopaque markers in position. (B) The radJopaque markers
in relation to the lower right first-molar and the retromolar pad.

T a b l e !. Distribution of subjects in the four maxillomandibula~:space groups

Type o/ maxillomandibular space

i mmiii iiiiiiiiii
Sh°r'°"
llow
,,ll, II H I II I I I
high
I ll,, HI
Total jl

No, from dentulous

group 5 10 5 6 96
No. from edentulous
group 12 10 1 3 26

70 mm. were considered as low. Maxillomandibular space length of 80 ram. or less

was considered short, while those with lengths of 8l ram. or more were considered as
long (F.ig. 1). The combination of height and length of the maxillomandibular space
was a Significant morphologic feature, and the maxillomandibular spaces were further
subdivided into the categories of short and low, long and low, short and high, and
long and high (Table I).
Morphologic data
Morphologic data in this study were obtained from cephalometric lateral radio-
graphs of the skull made with the teeth in the intercuspal position. For the edentulous
group, the upper and lower right central incisors, the apex of the mesiobuccal cusp
of the lower right first molar, and the outline of the right retromolar pad were
clearly indicated in the radiographs by the application of radiopaque denture relief
metal (Fig. 2).

Cephalometric analysis
Tracings of the cephalometric radiographs of all subjects were made (Fig. 3).
The majority of points, planes, and angular measurements in the cephalometric
analysis were made in accord with certain definitions. 14 These are illustrated in Figs.
I and 3, left. Tile occlusal plane in this study was located (I) from the point midway
between the incisal tips of the maxillary and mandibular incisors to tile point midway
between the mesiobuccal cusps of the maxillary and mandibular first permanent
molars for the dentulous group and (2) at the apex of the mesiobuccal cusp of the
lower right first molar for the edentulous group.
 498 L'Estrange and Vig J. Prosthet. Dent.
May, 1975

Table II. Parametric measurements for thedentulous group

Coefficient
o/
p ii ill Hi
Parameter
ii milll liB i i ii w
Mean
Hi . II
Minimum Maximum S.D. variation
illll _ -

Maxiilomand~bular angle (degrees) 21.5 11 28 4.4 20.5

Angle Of occlusaI-maxillary planes
(degrees) 7.5 -"-1 18 4.0 52.9
Angle ofocclusal-rnandibular planes
(degrees) 13;9 9 20 2.8 19.9
Anterior M.S.H.* ---~ L.F.H.t
(ram.) 69.9 58 80 4.8 6.8
M.S.L.:I: (mm.) 80.5 71 97 5.7 6.9
Posterior M.S.H.* (ram.) 40.6 31 50 4.4 10.9
....... *l~axi]lornandibular" Space' height.
fLower facial height.
:i:Maxillomandibular: space length.

Table Iil. Parametric measurements for the edentulous group

Coefficient
ot
Parameter Mean J Minimum Maximum S.D. variation
Maxill0mandibular angle (degrees) 20.8 11 32 6.0 28.3
Angle of occlusal-rnaxillary~ planes 4.5 -1 12 3.4 68.5
(degrees)
Angle of occlusaI-rnandibular planes 16.3 8 30 5.6 34.7
(degrees)
Anterior M.S.H.* -- L.F.H.t 62.6 54 8I 6.7 10.6
(mm.)
M.S.L.:I: (mm.) 82.0 74 93 4.7 5.7
Posterior M.S.H.* (mm.) 34.2 24 44 5.6 I6.4
*'Maxillomandibular space height.
"['Lower facial height.
:l:Maxillomandibular space length.

Statistics
Values for the mean, standard deviation , range, and coefficient of variation Were
obtained. Selected features of the dentulous group were subjected to analysis of
variance using the F test 15 for inter- and intragroup variations in the four categories
of, maxillomandibular space.

RESULTS
Morphologic analysis
Morphologic analyses for both grbups are shown in Tables II and III.

Angulation of the occlusal plane to the maxillary plane

Dentulous group. Analysis of variance within and between the four groupings
of maxillomandibular sp~tce showed significant differences in the angles of t h e oc-
clusal-maxillary planes associated with the combined effects of the height and length
of the maxillomandibular space (Table I V ) .
Volume33
N u m b e r 5.
Occlusal plane in dentulous and edentulous subjects 499

a
Mx P

Oc P
/

Md P /
Fig. 3. (Le[t) A tracing from a cephalometric radiograph of a dentulous subject illustrates (a)
the anterior nasal spine, (p) the posterior nasal spine, (rn) menton, (MxP) the maxillary
plane, (MdP) .the mandibular plane, and (OcP) the occlusal plane. (Right) A tracing from
a Cephalometric radiograph taken from a subject in the edentulous group.

Table IV. Dentulous group. Comparison of angles of occlusal plane and maxillary
plane, in relation to height and length of maxillomandibular space
Angle (degrees)
w
Short and low
ii ill ii i j
j
I ,
Long and low ..........i .......................Short and high ..... I
.............
Long and high
9 8 18 3
8 -1 8 9
4 5 13 9
6 7 14 5
8 9 9 5
8 12
4
2
7
9
Mean 7.0 12.4 5.9 7.2
Analysis o[ variance: (1) significant difference a - t ' ~ x e ~ p e r cent level within and between
the four groups; (2) significant difference a t t h e 5 per cent le'e'e~elbetween high and low groups.
(3) significant difference at the 5 per cent between long and short groups.

The mean for the entire sample of dentulous subjects was 7.5 + 4.0 degrees (.see
Table I I ) . A comparison of the means'of the high and low types of maxillomandibu-
lar space indicated that long-and-lozo types tended to have the occlusal.plane more
parallel to the maxillary plane, while short-and-high types tended to have the oc-
clusal plane more steeply angulated to the maxillary plane. In other words, when the
height and length of the maxillomandibular space tended to be toward the opposite
extremes of the normal range, the occlusal plane deviated away from a mean angula-
tion to the maxillary plane.
Edentulous group. In all four types of maxillomandibular space, there was a
marked parallelism of the occlusal plane to the maxillary plane. The mean for the
entire_sample in this group was 4.5 + 3.4 degrees (see Table I I I ) .
 500 L;Estrange-and Vig j. Vrosthet. Dent.
May, 1975

Table V.-Dentulous group. Comparison of the angles of the occlusal-maxillary and

occlusai-mandibular plancs
I Angle (degrees)
. . . . S,.bJe t ...................... I . . . . . . . t 8.a,
1 18 9 -9
2 8 16 8
3 8 20 12
4 9 i6 7
5 3 14 11
6 -1 12 13
7 9 18 9
8 13 15 2
9 5 20 15
I0 8 10 2
11 9 16 7
12 7' 12 5
13 9 13 4
14 5 15 I0
15 4 12 8
16 5 15 10
17 8 12 4
18 6 12 6
19 4 13 9
20 2 15 13
21 7 13 6
22 9 13 4
23 14 13 -1
24 12 13 I
25 9 9 6
26 8 14 0
Mean 7.5 13.8 6.3
*A - - Occlusal-maxillary angle.
tB - - Occlusal-mandibular angle.
:l:Difference between these angles.
Angu|ation of the occlusal plane to the mandibular plane
T.he~e-a~rernents obraia~d from the dentulous group did not indicate a signifi-
cant relationship between the angulation of the occlusal plane to the mandibular
plane and the maxilIomandibular space characteristics. The mean for this group was
13.9 _+2.8 degrees (see Table I I ) .
The findings within the edentulous g r o u p were similar in that no associations
were found between the .angulation of the occlusal plane to the mandibular plane
and the maxillornandibular space characteristics. The mean for the entire sample in
this group was 16.3 + 5.6 degrees (see Table I I I ) .

DISCUSSION
Dentulous group. The differences (B-A, Table V) indicate the closer angular
relationship of the occlusal plane to the maxillary plane as compared with that of the
occlusal and mandibular planes. Significant correlations were found between the
angulation of the occlusal plane to the maxillary plane and the height and length of
 .Volume 33
Number 5
Occlusal plane in dentulous and edentulous subjects 501

Table VI. EdentuloUs group. Comparison of the angles of the occlusal-maxillary and
Occlusal.mandibular planes
Angle (degrees)
sub. i
1 10 20 10
2 8 21 13
3 ') 23 21
4 4 14 I0
5' 1 16 15
6 9 16 7
7 3 16 13
8- 3 26 ~ 23
9 2 30 28
10 5 13 8
II 5 15 10
12 3 12
I3 5 12 7
14 5 10 5
15 4 17 13
16 6 17 11
17 -1 13 I4
18 12 20 8
19 9 8 -1
20 5 10 5
21 7 12 5
22 2 22 2O
23 9 11 2
24 1 10 9
25 -1 24 25
26 0 16 16
Mean 4.5 16 11.5
*A - - Occlusal-maxillary angle.
~B -" Occlusal-mandibular angle.
:]:Difference between these angles.

the maxillomandibular space. Since the mean angulati0n of the occlusal plane to the
maxillary plane was 7.5 _+4.0 degrees and, in addition, the long.and.high and short-
and-low types of maxillomandibulm space had means t/h~--were less than 1 S.D.
(standard deviation) from the meaa...for the total sample, the mean value of 7.5
degrees is considered t o be an acceptable starting Point. However, when the dimen-
sions of the height and length of the maxillomandibular space diverge from each
other within the individual (i.e., long-and-low and short-and-high maxillomandibu-
far spaces), the divergence is seen to be approximately i S.D. less for the long-and-
low types (3.5 degrees) and 1 S.D. more for short-and-high maxillomandibular
spaces (11.5 degrees).
Edentulous group. The findings for this group were similar to those for the
dentulous group with respect to the angulation of the occlusal p!ane to the maxillary
and mandibular planes (Table VI). All subjects had a pronounced parallelism of the
occlusal plane to the maxillary plane, rather than to the-mandibular plane, with one
exception (subject 19, B-A = -1 degree). As with the dentulous group, the mean
 502 L'Estrange and Vig J. Prosthet. Dent.
May, I975

angulati0n of the occlusal plane to the maxillary plane for each of the four types of
maxillomandibular space was within 1 S.D. of the mean angulation for the entire
dentulous group.
It will be noted t h a t t h e mean value of the lower facial height (anterio r maxil-
lomandibular height) for the edentulous grou p was smaller than that for the dentu-
lous group (see Tables I and II). In addition, the mean value for the rnaxillomandib-
ular space ilength was greater in the edentulous group than in the dentuious group,
and only one subject was found to have the short-and-high type. These results may
be attributed to procedures in prosthetic treatment which generally t e n d t o produce
a smaller occlusal height than that assumed with the oi-iginal natural teeth, unless
an exact copy of that dentition has been provided by the dentist.
Twenty of the 26 subjects in the edentulous group had the incisor teeth ar-
ranged in an edge-to-edge occlusion or with a relatively small degree of vertical and
horizontal overlap. This approach to treatment w o u l d r a i s e the anterior reference
point of the-crcclusal plane and increase the likelihood of parallelism with the maxil-
lary plane.
Since tooth loss and subsequent prosthetic reconstruction in no way affect the
maxillary plane, it is considered preferable to relate the occlusal plane to the maxil-
lary rather than to the mandibular plane. Although the mandibular plane may also
be independent of the existence of the dentoalveolar structures, the mobile nature of
the mandible renders the orientation of the.mandibular plane infinitely variable in
relation to craniofacial skeletal landmarks.
When extensive oral rehabilitation is undertaken, the dimensions of theq-n-axillo-
mandibular space, recorded at the optimal occlusal vertical and anteroposterior jaw
relationship, are factors which can influence the angulation of the occlusal plane.
Recommendations have been given for tim angulation of this plane for each of the
four maxillomandibular space types.

SUMMARY
A study was conducted in dentulous and edentulous subjects to determine the
location of occlusal plane as related to the maxillomandibular space. The results from
both the dentulous and edentulous groups indicate a close angular affinity between
the occlusal and maxillary planes.
In the dentulous group, significant associations were found between the angula-
tion of the occlusal plane to the maxillary plane and the height and length of the
maxillomandibular space. The occlusal plane in the long-and-low type of maxillo-
mandibular space tends to be more parallel to the maxill~'~plane, while the oc-
clusaI plane in the short-and-high types of maxillomandibular spa~h tends to be more
steeply angu|ated to the maxillary plane. The occlusal plane deviates away from a
mean angulation to the maxillary plane when the height and length of the maxillo-
mandibular space tend to be toward the opposite extremes of the normal range.
References
1. Ricketts, R. M. : Role of Cephalometrics in Prosthetic Diagnosis, J. PROSTHET.DENT. 6:
48B-503, 1956.
2. Nassif, N. J. : The Relationship Between the' Mandibular Incisor Teeth and the Lower Lip,
J. PaosraET. DENT. 24: 483-491, 1970.
Volume 33 Occlusal plane in dentulous and edentulous subjects 503
Number 5

3. Vig, P. S.: Variations in Orofacial Morphology and Function: With: Particular Reference
to Speechi Ph.D. Thesis, university Of London; 1968;
4. Craddoek , F.:W.: ~Prosthetic Dentistry, A Clinical Outline, ed. 2, St. Louis, 1951, The C.
V. Mosby Company, pp. 110-i12.
5. Schiosser, F. W., and Gehl, D. H . : Complete Denture Prosthesis, ed. 3, Philadelphia, 1953,
W. B. Saunders Company, p . 190.
6. Nagle, R. J., and Sears, V. H.i Denture Prosthetics, ed. 2, St. Louis, 1962, The C. V.
M0sby Company, p. 134.
7. Boucher, C; O.: Swenson's Complete Dentures, ed. 5,:St. Louis, 1964,The C.'=V. Moshy
Company, pp. 246:251.
8. Yasaki, M.: Height of the Occlusion Rim and the Interocclusal:Distance, J. PROSTHET.
DENT. I1: 26-31, 1961.
9. Ismail, Y. H., and Bowman, J. F.: Position of the Occlusa! Plane in Natural and ArtificiaI
Teeth, J. PROST~ET. DENT. 20: 407-41I, I968.
10. Lunquist, D. O., and Luther, W. W.: Occlusal PIane Determination, J. PROSTHET. DENT.
23: 489-498, ~I970.
11. Vig, P. S.: Adaptation to Altered Morphology, Dent. Pract; Dent.-Rec. 17: 225-234, 1967.
I2. Brodie, A. G.: Emerging Concepts of Facial Growthl Angle 0rthod. 41: 103-1!8, 1971.
13. Vig, P. S.: S0me Observations on the Production of Dental Fricatives and on theDevelop-
ment of Speech, J. Int. Assoc. Dent. Child. 4: 31-38, 1973.
14. Krogman, W. M., and Sassouni, V . : A Syllabus in Roentgenographic Cephalometry, Phil-
adelphia, i957, University of philadelphia.
15. Snedeeor, G. W.: Statistical Methods, ed. 3, Iowa, 1940, State College Press.

DR. L'ESTRANOE
INSTITUTE OF DENTAL" SURGERY
EASTMAN DENTAL HOSPITAL
GRAY'S INN RD.
LONDON, W C I X 8LD, ENGLAND

D~. Vio
LONDON HOSPITAL MEDICAL
COLLEGE DENTAL SCHOOL
LONDON, ENGLAND