Correlation Between Length of Digitus Minimus, Thumb, Length of Ear, Eye, and The Vertical Dimension of Occlusion
Deepthi Sogasu1, Dhanraj M Ganapathy2, Subhabrata Maiti3*
1 Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences Saveetha University,
Chennai-600077, Tamilnadu, India.
2 Professor and Head, Department of Prosthodontics, Saveetha Dental College And Hospitals, Saveetha Institute Of Medical And Technical Sciences,
Saveetha University, Chennai-600077, Tamilnadu, India.
3 Assistant Professor, Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences
Saveetha University, Chennai-600077, Tamilnadu, India.
*Corresponding Author
Subhabrata Maiti,
Assistant Professor, Department of Prosthodontics And Implantology, Saveetha Dental College And Hospitals, Saveetha Institute Of Medical And Technical Sciences, Saveetha
University, Chennai-600077, Tamilnadu, India.
Tel: 9007862704
E-mail: drsubhoprostho@gmail.com
Received: November 12, 2020; Accepted: November 27, 2020;Published: December 03, 2020
Citation: Deepthi Sogasu, Dhanraj M Ganapathy, Subhabrata Maiti. Correlation Between Length of Digitus Minimus, Thumb, Length of Ear, Eye, and The Vertical Dimension of Occlusion. Int J Dentistry Oral Sci. 2020;S5:02:007:32-38. doi: dx.doi.org/10.19070/2377-8075-SI02-05007
Copyright: Subhabrata Maiti© 2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Introduction: The vertical dimension of occlusion plays a very important role in the fabrication of complete dentures. Turrell has
suggested various methods of determining and measuring the vertical dimension of occlusion. It is suggested by many authors
that the determination of the vertical dimension of occlusion is unreliable, while others suggest that it must be determined with
the use if clinical judgment. Currently, there may be ways to determine the VDO using various radiographic methods like lateral
cephalograms or electromyographs. But it is not feasible for various dental facilities to be equipped with such machines. This study
aims to determine the vertical dimension of occlusion using non-invasive and anthropological methods.
Aim: To find the correlation between the length of the little finger, thumb, ear, and eye with the vertical dimension of occlusion.
Materials and Methods: 110 dental subjects were chosen from Saveetha Dental College. Inclusion criteria include subjects ranging
from 18 to 25 years. The exclusion criteria for the study was anyone with any pathology in their fingers and face. Digital Vernier
calipers were used to measure the length of the little finger, thumb, the length of the ear, the length of the eye from the inner to
the outer canthus. The results were tabulated and interpreted.
Results: The results suggest that there is a stronger correlation among the VDO with the ear, eye, thumb, and little finger for
females as compared to males. the results obtained in this study indicate that the most reliable measurement we can depend on for
the estimation of the vertical dimension of occlusion for both male and female subjects is the length of the ear.
Conclusion: This is a strong correlation with all the measurements to the vertical dimension of occlusion. This means that we
can predict the vertical dimension of occlusion of an edentulous patient using either of the above measurements. This can greatly
improve the success of complete denture prosthesis.
Clinical Significance: The use of anthropometric measurements such as the length of the ear, eye, thumb or little finger can be
used for determining the vertical dimension of occlusion in clinical settings.
2.Introduction
3.Materials and Methods
4.Results
5.Discussion
6.Conclusion
7.Acknowledgements
8.References
Keywords
Vertical Dimension of Occlusion; Digital Minimus; Anthropology.
Introduction
The vertical jaw relation plays the most important role in determining
the success of a complete denture prosthesis. It can be defined
as “The length of the face as determined by the amount of
separation of the jaws.”- GPT.The vertical jaw relation includes
the vertical dimension at rest and the vertical dimension at occlusion.
The vertical dimension at rest can be defined as “The length
of the face when the mandible is in the rest position.” The vertical
dimension at occlusion can be defined as “the distance between
two selected anatomic or marked points (usually one on the tip of
the nose and the other on the chin) when in the maximal intercuspal
position.”- GPT [1].
There are numerous - up to 29 such ways of obtaining the vertical dimension measurements as suggested by Turrell [2]. It has
been established that there is obvious and seizable importance of
vertical dimension of occlusion in the success of a complete denture
[3, 4]. Till the current day, there are no specific methods to
obtain the vertical dimension of occlusion and the methods vary
among different professionals, although some of the methods
are considered undependable by some investigators. The current
problem is the availability and employment of so many methods
to determine the vertical dimension of occlusion. It has been advocated
that the various factors are accountable for the vagueness
of these measurements and calculations; some of them being the
rage of differences observed in the physiologic and pathologic
conditions of the patient and estimating the distance based on
the thickness of skin present [5]. It has been established in the
book Grey’s Anatomy that the interlocking of the teeth during
occlusion determines the relationship between the maxilla and
mandible. It is also suggested that there is a reduction in the vertical
dimension of occlusion due to severe abrasion or loss of the
tooth or teeth [6, 7].
As established previously, one of the most important factors that
play a role in the success of a complete denture is measuring the
correct vertical dimension of occlusion. According to Naveen
Raj et al, the clinical judgment by the dentist will play a major
role in measuring the vertical dimension of occlusion. Based on
the separation between the maxilla and mandible under specific
conditions, the vertical dimension is classified into the vertical dimension
of rest and vertical dimension of occlusion. The vertical
dimension of occlusion will depend on the vertical height of the
pair of dentures when the teeth are contacting and at occlusion
[8]. Another study conducted by a group of prosthodontists from
India tried to find a relation of the vertical dimension of occlusion
with the cephalometric landmarks and its link with such traits
obtained through heredity. They found that there is a significant
trait of inheritance of traits from the father to the daughter and
from mother to daughter [9].
The main goal of providing a complete denture is to restore the
superlative and comfortable function and help in the habituation
of the dentures to the masticatory system. To satisfy the goal,
accurate vertical dimension measurements have to be made. The
final facial aesthetic and stomatognathic function of the complete dentures will depend on the evaluation of the vertical dimension
[10, 11].
The current literature available to us on the various methods to
determine the vertical dimension of occlusion is boundless. Despite
the lack of so many options available, the most commonly
used methods by the clinical practitioners are the physiologic
method, aesthetic method, and phonetics methods [12].
More than seven decades ago anthropometry was the only technique
available for quantifying body size and proportions as early
as 1921, equations for predicting body fat were developed from
measurements of body length, width, circumference, and skinfold
thickness. The distinct advantages of this technique are that it is
portable, non-invasive, inexpensive, and useful in field studies and
there is substantial literature available [13].
Materials and Methods
111 subjects from the OP department of Saveetha Dental College.
The subjects are of two groups- 55 females and 56 males.
The main inclusion criteria for this study are the subjects of the
age 18-25 years and without any skeletal or any facial pathology.
The exclusion criteria include anyone above 30 years and those
with some pathology in the head and neck region and in the fingers.
The digital Verniercaliper was used to measure the length of
the little finger, thumb, the length of the ear, the length of the eye
from the inner to the outer canthus. The results were tabulated
and interpreted. IBM SPSS Statistics 23 was used for the descriptive
statistics which includes the Pearson correlation coefficient, p
values, and the scatterplots.
Figure 1. Depicting the measurements made on the subject using Vernier calipers, a. measurement of Vertical Dimension of Occlusion, b. measurement of the length of the eye, c. measurement of length of the ear, d. measurement of the length of the thumb, e. measurement of the length of the little finger.
Results
The results in Table 1 show the mean and standard deviation of
the VDO, length of the thumb, ear, eye, and little finger of the
male and female subjects. the results suggest that the average values
of all 5 categories were higher among males relative to the female
subjects. Table 2 represents the Pearson’s correlation coefficients
and the p-value for the male and female subjects comparing
the VDO with the thumb, eye, ear, and little finger individually.
from the table, it is understood that the correlation coefficients obtained for the female subjects are all statistically significant. the
values of the correlation coefficient also signify a strong positive
correlation. whereas, for the male subjects, the correlation
between VDO and thumb; and VDO and little finger is not statistically
significant. the correlation between the VDO and eye
and VDO and ear is statistically significant. the Pearson correlation
coefficient for the results obtained for males is relatively
weak compared to that among female subjects. the correlation
for the VDO with the thumb is negative for males. The strongest
positive correlation among the male subjects is the VDO and the
length of the ear. Graph 1 represents the scatter plot showing
a strong positive, linear association between the VDO and the
length of the thumb among the female subjects. There doesn’t
seem to be any outliners in data. Graph 2 represents the scatter
plot showing a strong positive, linear association between the
VDO and the length of the eye among the female subjects. There
seem to be any outliners in data. Graph 3 represents the scatter
plot showing a moderate positive, linear association between
the VDO and the length of the ear among the female subjects.
There doesn’t seem to be any outliners in data. Graph 4 represents the scatter plot showing a strong positive, linear association
between the VDO and the length of the little finger among the
female subjects. There doesn’t seem to be any outliners in data.
Graph 5 represents the scatter plot showing a weak negative association
between the VDO and the length of the thumb among
the male subjects. There seem to be a few outliners in data. Graph
6 represents the scatter plot showing a weak positive, linear association
between the VDO and the length of the eye among the
male subjects. There seem to be a few outliners in data. Graph
7 represents the scatter plot showing a strong positive, linear association
between the VDO and the length of the ear among the
male subjects. There seem to be a few outliners in data. Graph 8
represents the scatter plot showing a weak positive, linear association
between the VDO and the length of the little finger among
the male subjects. There seem to be few outliners in data.
Table 1. Table representing the Mean and Standard Deviation of the VDO, length of the little finger, thumb, ear, and eye (in mm) for male and female subjects.
Table 2. Table representing the Pearson correlation coefficient and p-values for the correlation between the VDO and thumb, VDO and Eye, VDO and Ear, VDO, and little finger for the male and female subjects. The data is found to be significant when the p-value is <0.05. The correlation is positive when the coefficient is greater than 0 and negative when the coefficient is lesser than 0. (*denotes significant results)
Graph 1. Scatter plot representing the correlation between VDO and thumb measurements for female subjects.
Graph 2. Scatter plot representing the correlation between VDO and eye measurements for female subjects.
Graph 3. Scatter plot representing the correlation between VDO and ear measurements for female subjects.
Graph 4. Scatter plot representing the correlation between VDO and little finger (digitusminimus) measurements for female subjects.
Graph 5. Scatter plot representing the correlation between VDO and thumb measurements for male subjects.
Graph 6. Scatter plot representing the correlation between VDO and eye measurements for male subjects.
Graph 7. Scatter plot representing the correlation between VDO and ear measurements for male subjects.
Graph 8. Scatter plot representing the correlation between VDO and little finger (digitusminimus) measurements for male subjects.
Discussion
For this study, a total of 54 female subjects and 56 male subjects
were measured for their VDO, length of the eye, ear, thumb, and
little finger using verniercalipers. It was identified that the mean or
average length of VDO among the female subjects is 59.49mm.
The average length of the little finger among the female subjects
is 56.60mm. The average length of the thumb among female subjects
is 58.52mm. The average length of the ear among female
subjects is 58.64mm. The average length of the eye among female
subjects is 41.23mm. The mean values of the VDO among the
male subjects is 67.63. The mean values of the little finger among
the male subjects is 64.54mm. The average length of the thumb
among male subjects is 77.93mm. The average length of the ear among male subjects is 62.37mm. The average length of the eye
among male subjects is 42.02mm [Table 1]. The results obtained
from the test were also subject to correlation tests. The results
collected from the female subjects were compared separately, independent
of the results collected from the male subjects. The
VDO measurements were compared with the measurements obtained
for the little finger (digitusminimus), thumb, ear, and eye.
The correlation of the four anthropometric parameters was
checked individually with the vertical dimension of occlusion for
both, the male and female subjects. The significance and correlation
of the values obtained from my study were calculated using
Pearson's correlation coefficient. The correlation between the
VDO and thumb is 0.991 [Graph 1]. The correlation between
the VDO and the eye is 0.6 which is a strong positive correlation
[Graph 2]. Similarly, the correlation between VDO and the ear is
0.991 which is also a very strong positive correlation [Graph 3].
The correlation between VDO and the little finger is 0.96 [Graph
4]. The p values for all the correlations are less than 0.05, thus the
results obtained are statistically significant. The correlation coefficients
suggest that there is a very strong correlation between the
VDO and the length of the thumb, ear, little finger, and the eye
in descending order of strengths of correlation among the female
subjects [Table 2].
Similar correlation tests were performed among the male subjects
where the correlation between the VDO and the thumb is -0.08
which is a mild negative correlation [Graph 5]. The correlation
between the VDO and the eye is 0.286 [Graph 6]. The correlation
of VDO and the ear is 0.704 which is a strong positive correlation [Graph 7]. The correlation of VDO and the little finger is 0.083,
representing a weak positive correlation [Graph 8]. The p values
for the correlation between VDO and the thumb; and VDO and
the little finger is greater than 0.05, thus the results are statically
insignificant. Whereas, the p values for the correlation of VDO
and eye; and VDO and ear is less than 0.05, thus the results obtained
are statistically significant [Table 2].
The results obtained in Table 1 suggest that the mean values of
all the 5 measurements were greater among males than compared
to the mean values of the same 5 measurements in females. The
results obtained from the correlation tests [Table 2 and Graphs
1-8] suggest that, among the males, there is a stronger correlation
of the VDO with the length of the ear and eye, with a stronger
correlation with the former. Among females, it is found that the
strongest positive correlation with the thumb and ear. The results
from my study prove that the most accurate measurements of the
VDO can be made and estimated with comparison to the length
of the ear, for both male and female subjects. Measurements can
be taken from the tip of the ear superiorly to the junction of
the ear inferiorly. This study can have a larger subject population,
further studies with increased subject size might help in the future
for increased accuracy.
The relation of the physiological rest position of the mandible,
during occlusion, and the interocclusal space between the teeth
helps in defining the vertical dimension of occlusion [14, 15].
Three different possible processes can explain the physiologic rest
of the mandible-myotatic reflexes, tone of the muscle depends
on its posture and gravity elasticity. They can individually influence
the vertical dimension or can work in unison [16]. The current
methods employed to determine the VDO include the use
of measuring devices in the mouth and head. Some other methods
include the swallowing method, bite force methods, the use
of telemetry, cephalometry, and other magnetic methods that are
used to determine the VDO of the patient. The problem faced
by all dentists is mainly the availability of so many methods to
determine VDO, but none of them allow for accurate measurements
and results among partially or fully edentulous patients [17,
18]. Many dentists while trying to achieve the correct and most
accurate VDO, try to alter the values. The factors they consider
while making these alterations include esthetics, restoration space
allowance, occlusal relationship corrections, prosthetic convenience.
The difficulty faced at this time is the likelihood of instability
of the prosthesis due to an increase or decrease of VDO [19,
20]. With such imbalance, there is a modified state of closure and
sufficiency. This can cause various changes and consequences including
angular cheilitis, altered phonetics, decreased masticatory
function, and pain in the edentulous ridges [21].
Anthropometry is a branch of science relating to the measurements
of the human body. It is used to study and understand
the nutritional status of children and adults. The anthropometric
measurements in children reflect their health status, growth
and development, and dietary adequacy over time. In adults, these
measurements can be used to analyze the health and the dietary
status, body composition, risk of disease.
The results obtained in our study regarding the mean values of
the 5 anthropometric measurements are justified by the results
obtained in other craniometric studies focussing on sexual dimorphism
among Indian populations. The study conducted by Raghavan et al suggests that the mean values of the measurements
obtained from males will be greater than the mean values of the
females in the Indian population [22].
A similar study conducted in Loni, India by Ladda et al., [23] suggested
similar results obtained in my study, supporting the fact
that the VDO is higher in males than in females. This suggests
that there is sexual dimorphism in the measurements of VDO.
But their study compared only the measurements of the fingers,
excluding the measurement of any facial features. Their results
will not be applicable for double-amputee patients. A study conducted
by Singh et al, [24] involved finding the correlation of the
VDO with facial features alone among the Indian population.The
results obtained in this study are justified by very similar studies
comparing the correlation of the VDO with another facial and
hand measurements done by Miran et al. [24]. their study was conducted
in Iraq.This study combines the correlation of the facial
and finger measurements with the VDO for Indian population.
Conclusion
The science of anthropometry is a very precise science of measurements
of the parts of the body. These measurements can be
used and compared with the VDO. Since there are various methods
of measuring the VDO with no specific and accurate method
for measurement, such correlations can be very useful. The VDO
that is measured can be correlated to any of the above anthropometric
measurements to arrive at a satisfactory result.
Acknowledgements
The authors are thankful to Saveetha Dental College for providing
a platform to express our knowledge.
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