Journal of Oral Rehabilitation 2007 34; 136140

Three-dimensional analysis of the occlusal plane related to

the hamularincisivepapilla occlusal plane in young adults
P.-S. FU, C.-C. HUNG, J.-M. HONG & J.-C. WANG

Department of Prosthodontics, Graduate Institute of

Dental Science, Kaohsiung Medical University, Kaohsiung, Taiwan

SUMMARY The planes which serve as references for

cranium and face in dental clinical application
included the occlusal plane, Frankfort plane, Campers plane and hamularincisivepapilla (HIP)
plane. The HIP occlusal plane is a horizontal plane
passing through the bilateral hamular notches and
the incisive papilla (Dent Surv. 1975;51:60). The aim
of this study was to estimate the relationship
between the various occlusal planes and the HIP
plane in Taiwanese young adults with approximately optimal occlusion. Study casts of 100 young
adults (50 men and 50 women) were selected in this
study. All market points on the maxillary casts were
measured by a three-dimensional precise measuring
device. The angular relationship between the four
various occlusal planes and the HIP plane were
investigated. The vertical distances between the
cusp tips and incisal edges of maxillary teeth to
the HIP plane were measured. Data were performed

Introduction
When dentition is deficient or the occlusal plane is
disordered, the issue of how to make use of orofacial
marks to set up the ideal occlusal plane is quite
important in dental treatment. Functionally, the
dynamic relevance of the location of the occlusal plane
in relation to the hinge axis of the mandible is
important. Their positions and occlusal elements can
be changed to geometrically coincide with directional
madibular movements (1). 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
2007 Blackwell Publishing Ltd

by the Statistic analysis software programme (JMP

4.02). The Students t-test and Pearsons correlation
test were used to test the statistical significance
(P < 005).The results showed that the occlusal plane
defined as the incisal edge of maxillary central
incisor to mesiobuccal cusp tips of maxillary second
molars had the smallest included angle with the HIP
plane (261  081). The incisal edge of maxillary
right central incisal to mesiopalatal cusp tips of
maxillary first molars had the largest included angle
with the HIP plane (772  160). The curve is drawn
through the buccal cusp tips of maxillary teeth had
better parallelism with the HIP plane.
KEYWORDS: occlusal plane, hamularincisivepapilla
plane, three-dimensional analysis
Accepted for publication 23 May 2006

ensure normal function of the cheek, tongue and

masticatory muscles (25).
Anatomical landmarks that have been suggested to
clinically determine the position of the occlusal plane
are the upper lip (5), lateral margins of the tongue (3),
parallel to the Campers plane (5) and parallel to the
hamular notchincisive papilla plane (6). The Campers
plane or the ala-tragus line (ATL) remains the most
widely used guide and well-documented method for
occlusal plane orientation (7, 8). Results from a survey
among dental schools in USA and Canada (9) showed
that considerable differences existed between different
schools in the concepts concerning occlusal plane
orientation. However, the Campers plane was not
doi: 10.1111/j.1365-2842.2006.01682.x

ANALYSIS OF THE OCCLUSAL PLANE

precisely defined and much controversy exists concerning its reference value (10). Parallelism between the
natural occlusal plane and the examined Campers
plane has not been proved in his study (10).
Cooperman (6) indicated that one could locate the
anatomical landmarks of the hamular notches and
incisive papilla to orientate the hamularincisive
papilla (HIP) occlusal plane. Sugaya et al. (11) studied
the relationship between the HIP plane and the occlusal
plane in Japanese young adults as well. The results
suggest that by using the HIP plane one can quite
predictably reproduce occlusal plane. Kojima et al. (12)
used three-dimensional measuring system to analyse
the angle of the HIP plane and the occlusal plane. The
purpose of this research was to investigate the angular
and vertical relationship between the HIP occlusal
plane and the various occlusal planes in Taiwanese
young adults. The effect of gender on the various
occlusal planes was also investigated.

Materials and methods

Taiwanese subjects (50 men and 50 women) with: 28
teeth exclusive of third molars, with no history of
orthodontic treatment, angle class I canine and molar
relationships, crowding or spacing totally <2 mm, no
extensive restorations and no history of temporomandibular disorders were included in this study. The ages
of the subjects ranged from 19 to 28 years, with a mean
age of 224 years. Maxillary irreversible hydrocolloid
impressions* were made in our subjects. Stone casts
were then poured in them immediately. The manufacturers instructions were followed accurately.

Fig. 1. The three-dimensional precise measuring device used in

this study.

Surveying tools, positions and methods

This experiment utilized the accurate three-dimensional precise measuring device (Fig. 1). The tip of the
electron probe was 05 mm in diameter, with a liner
accuracy of 0005 lm. All the measured data were
recorded and analysed with the three-dimensional
surveying software.

Included angle measurement

Standardization of the models
Base former was used to establish the upper casts of all
subjects. Prior to each measurement, bases of the
gypsum models were corrected to parallel the granite
platform of the three-dimensional precise measuring
device.

*Cavex CA38, Cavex, Haarlem, the Netherlands.

GC New Plastone, Tokyo, Japan.

T.P. Orthodontics Inc., Houston, CA, USA.

The three-dimensional precise measuring device and

software were utilized to measure the included angles
among the HIP plane and occlusal planes I, II, III and IV.
The definitions of all the planes were described in
Table 1. As three points form a plane, the tip of the
electron probe lightly touched the centre of incisive
papilla and the lowest points of bilateral hamular
notches to determine the HIP plane. In a similar way,
the occlusal planes I, II, III and IV were determined
(Fig. 2).

CE-503V, Chien Wei Precise Technology Co., Ltd, Kaohsiung,

Taiwan.

KCMM version 1.60, Ishin Technology Co., Ltd, Kaohsiung, Taiwan.

2007 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 34; 136140

137

138

P . - S . F U et al.
Table 1. The definitions of the HIP occlusal plane and various occlusal planes used in this study
Plane
HIP plane
Occlusal plane
Occlusal plane
Occlusal plane
Occlusal plane

Anterior reference point

I
II
III
IV

The centre of incisive papilla

Mesio-labial incisal edge of upper
Mesio-labial incisal edge of upper
Mesio-labial incisal edge of upper
Mesio-labial incisal edge of upper

Posterior reference points

right
right
right
right

central
central
central
central

incisor
incisor
incisor
incisor

The lowest points of bilateral hamular notches

Mesio-buccal cusp tips of upper first molars
Mesio-buccal cusp tips of upper second molars
Mesio-palatal cusp tips of upper first molars
Mesio-palatal cusp tips of upper second molars

HIP, hamularincisivepapilla.

Results
The angular relationship among the HIP occlusal plane and
four various occlusal planes

IP

I
II
III
IV
HIP
H

Fig. 2. The angular relationship among the hamularincisive

papilla (HIP) plane and four various occlusal planes. H, the lowest
point of hamular notch; IP, the centre of incisive papilla.

The statistical analysis of the results was summarized in

Table 2. Occlusal planes I and II had the smaller
included angles with the HIP plane, and no significant
difference between genders (P > 005). Occlusal plane
III and IV had the larger included angles with the HIP
plane, and significant difference between genders (P <
005). Significant differences existed when comparing
included angles of the HIP to occlusal planes I and II
with the HIP to occlusal planes III and IV (P < 005).
The included angles of the HIP planeocclusal plane I
had a common positive correlation coefficient with the
HIP planeocclusal plane II (05 < r < 075). The
included angles of the HIP planeocclusal plane III
had a high-positive correlation coefficient with the HIP
planeocclusal plane IV (r > 075).

Vertical distance measurement

Once the orientation of the HIP plane was resolved, the
vertical distances from the mesiallabial incisal edges
and distallabial incisal edges of upper incisors, cusp tips
of upper canines, buccal and palatal cusp tips of upper
premolars and molars (exclusive of upper third molars
and Carabelli cusp) to the HIP plane were measured
(Fig. 3).

Statistical methods and analyses

In this study, all calculations were performed by the
statistical analysis software (SAS) programme JMP
version 4.02**. Data were compared by Students t-test
and Pearsons correlation coefficients, the significance
level was set at P < 005 for each analysis.

**SAS Institute Inc., Cary, NC, USA.

The vertical relationship between the HIP occlusal plane and

occlusal plane
The measurement of vertical distances between the
cusp tips and incisal edges of maxillary teeth to the HIP
plane were showed in Fig. 3. Comparing the curve
formed with buccal cusp tips and the curve formed with
palatal cusp tips, the former had better parallelism with
the HIP plane. Furthermore, the frontal occlusal plane
in men displayed better parallelism with the HIP plane
than the women (Fig. 4).

Discussion
It is evident from the literature that there is controversy regarding the location of the occlusal plane. The
lack of highly reproducible reference structures hinders determining the orientation and position of the

2007 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 34; 136140

ANALYSIS OF THE OCCLUSAL PLANE

H

IP

Fig. 3. The vertical relationship

between the cusp tips and incisal
edges of maxillary teeth to the
hamularincisivepapilla plane.

Table 2. The included angles of

occlusal planes I, II, III and IV with
the HIP plane

17DB 17MB

16DB

17DP 17MP

plane
plane
plane
plane

16MP

14B

15B

14P

15P

12D

13

12M
11D

Total (n 100)

Men (n 50)

Women (n 50)

Mean  s.d.

Mean  s.d.

Mean  s.d.

Included angle
HIPocclusal
HIPocclusal
HIPocclusal
HIPocclusal

16DP

16MB

I
II
III
IV

353
261
772
654






080
081
160
108

346
276
679
580

HIP






068
070
164
098

360
245
865
727






091
089
085
053

11M

P-value
03724
00574
<00001*
<00001*

HIP, hamularincisivepapilla; s.d. standard deviation; *P < 005.

2
1
0
13 12D 12M 11D 11M
21M 21D 22M 22D 23
1
2
3
4
5
6
7
8
(mm)

R't
17D 17M 16D 16M 15

Fig. 4. The average vertical distances

between the cusp tips and incisal
edges of maxillary teeth to the
hamularincisivepapilla plane of
men and women in frontal view. BI,
buccal cusp tipsincisal edges; PI,
palatal cusp tipsincisal edges.

occlusal plane easily. One of the most common

methods for occlusal plane orientation is parallel to
the ATL (8, 13). Definitions of the ATL cause confusion,
however, because exact points of reference do not
coincide (14, 15).
The incisive papilla and hamular notches appeared to
be least affected by residual ridge resorption and
remained visible (1618). Our study confirms the
findings of many authors that parallelism between
the natural occlusal plane II and the HIP plane exists.
The results of this study showed that the occlusal plane
had the smallest included angle with the HIP plane
(261  081). This is in agreement with the results of
Sugaya et al. (11) in 100 Japanese young adults
(160  22). They studied the relationship of the HIP
plane and the occlusal plane of Japanese young adults.
They found that the HIP plane and the occlusal plane
(defined as the mesialincisal edge of upper right
central incisor and distalbuccal cusp tips of upper first
molars) had an included angle of 16. Karkazis and
Polyzois (19) applied cephalometry to investigate the

14

L't
24

25 26M 26D 27M 27D

HIP plane

Male-BI
Male-PI
Female-BI
Female-PI

relationship between the occlusal plane (defined as the

mesialincisal edge of upper central incisor and mesial
palatal cusp tips of upper first molars) and HIP plane.
The result was that the HIP plane had an included angle
of 457 with the occlusal plane. Kojima et al. (12)
found the angle of the HIP and the occlusal plane were
13  13. In summary, the small discrepancies of the
studies were probably because of the different methodologies, including molar landmarks selection and
various surveying instruments.
When the dentition is defective, there is a need to
establish the occlusal plane based on characteristic points
of certain intra-oral anatomic landmarks, regardless of
the dentition. The vertical distance measured from upper
cast tips to the HIP plane of this study can be a useful
guide for occlusal plane construction. An imaginary line
drawn through the buccal cusp tips of the upper cast has
better parallelism with the HIP plane. There are numerous techniques used for arbitrarily locating the hinge
axis to serve as the posterior reference points for a
facebow, it can be used to mount the maxillary cast on

2007 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 34; 136140

139

140

P . - S . F U et al.
the articulator. The mandibular cast is mounted on the
articulator using the centric relation record. The vertical
distance data may be utilized by using a new design of
the HIP plane locator in the near future.
Taking an accurate and clear impression of the
hamular notches is very important and thus the
accurate determination of HIP plane is achieved. In
order to correctly register the position of bilateral
hamular notches, our subjects were asked to open their
mouth slightly to reduce the tension of the pterygomandibular raphe. Furthermore, the impression was
made under minimal pressure to reduce soft tissue
distortion. The centre of the incisive papilla and the
lowest point of bilateral hamular notches were clearly
identified.
In this study, as with Sugaya et al. (11), a threedimensional precise measuring device was used to
measure maxillary casts, and the accuracy was higher
than with two-dimensional device. The tip of the
electron probe was used to lightly touch the check
points, then the included angles and vertical distances
data were easily calculated using a three-dimensional
surveying software. New technology may have since
become available, allowing for more precise measurement.
The three-dimensional movement of the mandible is
often complicated during the various movements. The
dynamic relevance of the location of occlusal plane and
directions of the cusp tips of teeth are important to the
movement of the condyles and can affect the delicate
movement of the mandible.

Conclusion
This study found the HIP occlusal plane tends to be
more parallel to the occlusal plane II in angle class I
subjects, which may be used as a clinical practice
guideline. However, further study is needed to investigate the relationship between the occlusal plane and
the HIP plane in different skeletal and dental morphology groups.

Acknowledgments
The authors are grateful to Mr Eric Huang (BS
Biomedical Engineering, Johns Hopkins University)
for his help on checking and improving the English
for this article.

References
1. Solnit A, Curnutte DC. Occlusal Correction: Princicles and
Practice, 1st edn. Chicago: Quintessence; 1988:5457.
2. Landa JC. A scientific approach to the study of the temporomandibular joint and its relation to occlusal disharmonies.
J Prosthet Dent. 1957;7:170181.
3. Yasaki M. The height of the occlusal rim and the interocclusal
distance. J Prosthet Dent. 1961;11:2631.
4. Lundquist D, Luther W. Occlusal plane determination.
J Prosthet Dent. 1970;23:489498.
5. Hickey JC, Zarb GA, Bolender CL. Bouchers Prosthodontic
Treatment for Edentulous Patients, 9th edn. St Louis, MO: CV
Mosby; 1985:292.
6. Cooperman HN. HIP plane of occlusion in oral diagnosis. Dent
Surv. 1975;51:6062.
7. Sharry JJ. Complete Denture Prosthodontics, 3rd edn. Philadelphia, PA: Lea & Febiger; 1974:236.
8. Williams DR. Occlusal plane orientation in complete denture
construction. J Dent. 1982;10:311316.
9. Levin B, Saucer LJ. Results of a survey of complete denture
procedures taught in American and Canadian dental schools:
an update. J Prosthet Dent. 1985;54:302306.
10. Sinobad D, Postic SD. Roentgencraniometric indicators of the
position of the occlusal plane in natural and artificial dentition. Eur J Prosthodont Restor Dent. 1996;4:169174.
11. Sugaya K, Suminokura S, Ohira H, Masuda T, Shinya A,
Saitoh F, Tani S, Koshihara Y, Haga M. A study on correlationship among various planes in dental prosthetics. J Jpn
Prosthodont Soc. 1986;30:13471358.
12. Kojima T, Sohmura T, Takahashi J. A preliminary report on a
computer-assisted dental cast analysis system used for the
prosthodontic treatment. J Oral Rehabil. 2003;30:526531.
13. Javid NS. A technique for determination of the occlusal plane.
J Prosthet Dent. 1974;31:270272.
14. Ismail YH, Bowman JF. Position of the occlusal plane in
natural and artificial teeth. J Prosthet Dent. 1968;20:407411.
15. Karkazis HC, Polyzois GL. A study of the occlusal plane
orientation in complete denture construction. J Oral Rehabil.
1987;14:399404.
16. Watt DM, Likeman PR. Morphological changes in the denture
bearing area following the extraction of maxillary teeth.
Br Dent J. 1974;136:225235.
17. Ehrlich J, Gazit E. Relationship of the maxillary central
incisors and canines to the incisive papilla. J Oral Rehabil.
1975;2:309312.
18. GraveAMH,BeckerPJ.Evaluation of the incisive papilla as a guide
to anterior tooth position. J Prosthet Dent. 1987;57:712714.
19. Karkazis HC, Polyzois GL. Cephalometrically predicted occlusal plane: implications in removable prosthodontics. J Prosthet
Dent. 1991;65:258264.
Correspondence: Dr Chun-Cheng Hung, School of Dentistry,
Kaohsiung Medical University, 100 Tzyou 1st Road, Kaohsiung 807,
Kaohsiung, Taiwan.
E-mail: yuchali@ms21.hinet.net

2007 Blackwell Publishing Ltd, Journal of Oral Rehabilitation 34; 136140