Applicability of the Existence of Golden Standard and Golden Percentage in the Population of Jaipur, Rajasthan, India: A Comparative Study

INTRODUCTION

During the last few decades, it was noticed that both the patients and dentists show a rapid increase in interest for dental esthetics.¹ During a comprehensive treatment planning, dentists should have in-depth knowledge and understanding in esthetics, harmony, and proportion, as anticipated by people.²

At present, the concept of beauty or esthetics is highly determined by media. They influenced our life that brings facial “standards” that describe perceptions of esthetics, well-being, and fitness, mixed with feelings of social achievement, intelligence, prosperity, and happiness. Nowadays, an esthetic face considers the vital to success.^3–5 Hence, dental professionals should have a thorough knowledge of facial characteristics that considered “attractive” by the people.^6–9 The most important dental aspect within the esthetic factors which can be easily controlled is the relative dimension of teeth. Proximal/incisal tooth wear and the individual tooth size variations cause difficult to define ideal tooth dimensions. The “golden percentage” and “golden standard” were proposed to determine the apparent size of teeth as examined from the front.^10–14

The golden percentage and golden standard provide a guideline to achieve esthetic results after dental treatment. The ideal values for golden percentage and golden standard were given by study on a specific population. Snow¹⁰ proposed a bilateral analysis of perceived individual tooth width as a percentage of the total perceived width of the maxillary anterior teeth. He introduced the golden percentage to achieve an esthetically pleasing smile, in which the proportional width of right central incisor, lateral incisor, canine, left canine, lateral incisor, and central incisor is 25%, 15%, 10%, 10%, 15%, and 25%, respectively, of the total distance across the anterior segment. However, the results of previous studies showed that golden percentage and the golden standard are not applicable to different ethnic populations.^15–18

The aims of our study were to evaluate the existence and applicability of golden percentage and golden standard in Jaipur population and to compare the golden percentage and golden standard between male and female.

MATERIALS AND METHODS

The sample for this study comprised of study models of 300 subjects including 150 males and 150 females. The subjects were the students, patients, and their attendants who visited the Jaipur dental college and hospital. All subjects belonged to Jaipur by birth. The ancestor origin was established after enquiring with concerned subjects.

The inclusion criteria were the following:

• Jaipur individuals.
• Completely erupted upper anterior teeth.
• Absence of periodontal disease.
• No previous orthodontic treatment.
• Absence of prosthesis on upper anteriors.
• Absence of morphological variations.

Following are the exclusion criteria:

• Gross restoration.
• Any gingival alteration.
• Loss of tooth structure.

The instruments and dental materials used were the perforated metal stock trays, rubber bowls, curved metal spatula, straight metal spatula, alginate impression material, dental stone, dental plaster, base formers, and sandpaper.

A digital caliper (Fig. 1) with precision reading to the nearest 0.01 mm was used to measure the size of teeth. The mesiodistal (MD) width was measured between the contact points of the tooth. A single researcher measured tooth size twice, from right canine to left canine. If the difference between two measurements was more than 0.2 mm, then the tooth was measured again and only the new measure was registered.

RESULTS

DISCUSSION

The upper front teeth size, morphology, and arrangement are the most influential factor for harmonious appearance, especially when viewed from the front. In our study; with respect to the golden percentage, the mean and SD for the golden percentage of right central incisor and right canine is less than the standard golden percentage, but the width of the lateral incisor is slightly greater than the standard golden percentage. The difference in width of the right central incisor (24.931 μ 0.450), lateral incisor (15.465 μ 0.296), and canine (9.592 μ 0.275) to the standard golden percentage as suggested by Snow (25, 15, 10) is statistically significant (p %3C; 0.05) (Table 1 and Fig. 3).¹⁰

The mean and SD for the golden percentage of left central incisor and left canine is also less than the standard golden percentage, and the width of the lateral incisor is marginally greater than the standard golden percentage. The difference in width of left central incisor (24.931 μ 0.449), left lateral incisor (15.476 μ 0.350), and left canine (9.604 μ 0.268) to the standard golden percentage as recommended by Snow¹⁰ (25, 15, 10) is found to be statistically significant (p < 0.05) (Table 1 and Fig. 3).

In general, the value for central incisor and canine is slightly lesser and the value of lateral incisor is marginally greater than those recommended by the standard golden percentage (Table 1 and Fig. 3). This shows that the standard golden percentage (25, 15, and 10) is not applicable to Jaipur population. Similar results were found by Snow who proposed that golden percentage theory is applicable if percentages are adjusted according to the ethnicity of the population.¹⁰

Our results are in agreement with Fayyad et al.¹⁵ who also suggested that the golden percentage was not applicable on the subjects of their study. However, a slight modification of these percentages can be adopted taking into consideration the ethnicity differences of the subjects. In their study, the values obtained were 12%, 15%, 23%, 23%, 15%, and 12%. Similarly in Jaipur population also golden percentage can be adjusted to 9%, 15%, 24%, 24%, 15%, and 9%.

The upper anterior teeth are closely related to the jaw and facial appearance, which are important for esthetics and physical anthropology. The maxillary anterior teeth should be put in optimal dentolabial relations, in harmony with the overall facial appearance. The size and form of the maxillary anterior teeth are important for both dental and facial esthetics. The harmonious anterior dentition is influenced by many factors like morphology and arrangement of the maxillary anterior teeth, specifically the upper central incisors in anterior view.^13,22–24

Data related to the natural tooth dimensions are available through various tooth morphology sources.^23–25 The mesiocervical and incisocervical dimensions of teeth were available since 1902 and it is only recently that the crown width/length ratios have been considered.¹¹

Sterrett et al. used the caliper to measure the dimensions on the casts and he found a homogenous ratio (81%) for the three anterior maxillary tooth groups.¹¹ Magne et al. did the measurements on extracted teeth using imaging software. He measured the width/length ratios and provides data for worn and unworn teeth. The ranking for width/length ratio for the specimens studied emphasizes the difference between unworn teeth, with average ratios between 73% and 78%, and worn teeth, with average ratios between 79% and 87% teeth.²⁶ However, in the present study, the measurements were done on the stone casts using a digital caliper (read up to 0.01 mm) (Fig. 1).

Peixoto et al. concluded that the ideal width-to-height ratio for the central incisor should lie between 75% and 80%. However, an esthetically acceptable ratio appearance is in the 65–85% range.²¹ The results of our study showed width-to-height ratio greater than previous studies conducted by Hasanresioglu et al.,¹⁸ and Parnia et al.,¹⁹ Wolfart et al.,20 and these studies concluded that there is no golden standard in the nature. Another study conducted in Korea showed similar results for the noncelebrities group.²³ The difference between ideal width-to-height ratio (80%) and our result (right central incisor 80.309% and left central incisor 80.283%) was found to be statistically significant (p < 0.05). These results are because of differences in racial characteristics (Table 2 and Fig. 4). Our results are in disagreement with Ku et al. who concluded that after analyzing maxillary anterior teeth of Korean adults, their results were in accordance with the general Western standards of esthetics.²⁷

The golden percentage was compared for the male and female groups, and the difference between right and left central incisors, right and left lateral incisors is statistically nonsignificant (p %3E; 0.05), whereas the difference between right and left male and female canine widths is statistically significant (p < 0.05). Our results are in agreement with previous studies which concluded that gender has no statistically significant effect when the golden percentage was compared between male and female groups (Table 3 and Fig. 5).^15,28

There was no statistically significant (p > 0.05) difference in the width/height ratio of maxillary central incisors between the male and female groups. Our results are in agreement with Nalla et al. (Table 4 and Fig. 6).²⁹

CONCLUSION

• The golden percentage and golden standard show ethnic variation as it does not exist in the Jaipur population as described by Snow. Hence, the population-specific golden standard and golden proportion should be used for proper diagnosis and treatment planning.
• The difference between male and female for the golden percentage and golden standard is statistically nonsignificant except the golden percentage for right and left canines.

CLINICAL SIGNIFICANCE

The result of this study shows deviation from ideal golden percentage and golden standard for Jaipur population which can be used clinically as a guideline for esthetic results.

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