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-I. (inathion
The norm as proposed by Simon is a straight or flat profile type with the
orbital plane passing through the cheilion and the gnathion, the subnasion iying
between the orbital plane and a line dropped from the nasion parallel to the orbital
plane. The face is composed of equal thirds, that is, the distance from the hair-
line to the nasion and the distance from the nasion to the subnasion and the distance
from the subnasion to the gonion are approximately equal in length. Also, the
distance from gnathion to gonion is approximately equal to the distance front
gonion to tragion (Fig. 2).
PROTRACTION
A maxillary protraction exists when the subnasion lies anterior to the nastitl~
line, all other landmarks being normal. A mandibular protraction exists where
the gnathion lies anterior to the orbial plane, all other landmarks being equal. :I
bimasillary protraction exists when the subnasion lies anterior to the nasion line
and the gnathion lies anterior to the orbital plane, other landmarks being normal.
Volume I FA(:IAI, TYI’t’S .
Sumhers 1 ant1 2
PROTRACTIONS
RETRACTIONS
ATTRACTION AiSTRACTlON
Fig. 1.
86
SIMON’S NORM
Fig. Y
ATTRACTION
An attraction may be considered to exist when the distance from the subnasion
to the gnathion is less than~other facial thirds. The shortening of the lower third
is primarily from the cheilion to the base of the mandible.
ABSTRACTION
An abstraction may be considerecl to exist when the distance from the SI&-
nasion to the gnathion is greater than other facial thirds. The excessive length- of
the low-er third being from eheilion to gnathion.
The following material is based upon photographic and~cephalometFic records of
10.5 students at the University of California. The individual cases were selected on
F.4CIAI. TYPES AN11 TOOTH ARRANGEMEKT 87
the basis of a harmonious relationship between tooth arrangement and facial type.
The facial landmarks used for measuring were marked in such a manner as to show
clearly on both the photographs and the cephalometric x-ray films. The facial photo-
graphs were taken one-quarter size with a National Gnathostatic Camera. The
mouth photographs were taken three-quarter size and the lateral views were ori-
ented to have the top of the negative parallel with the eye-ear plane. Thus, the relac
tionship of the labial surfaces of the teeth may be readily correlated with the facial
photographs. The cephalometric x-rays were taken with a Broadbent Bolton
Cephalometer. As the facial outline, the teeth, and the orienting landmarks may
be seen on the negative, tracings taken from these negatives are of great value in
checking the photographic data. The primary objective of the study was to de-
termine whether or not the arrangement of anterior teeth might follow definite
patterns peculiar to the various facial types, in those cases where a fine harmony
existed between the facial types and the tooth arrangement. The 105 selected
cases were segregated according to the Simon classification and the following dis-
tribution was noted as shown in Fig. 3.
Maxillary protractions 18
Maxillary protractions with mandibular retraction 69
Bimaxillary protractions 14
Bimaxillary retractions 1
Mandibular retractions 3
Mandibular protractions 0
Fig. 3.
Fig. 6
I’.\(‘I:\L TYPES AND TOOTH ARRXiYGE.\II-NT x4,
Himaxillary Protraction ( Fig. 6.1. -The facial protilc for this type, v:air>.
depending upon the zones of protraction. If the dental and alveolar zone’.i JiI-i'
not protractive, a comparativelv straight profile, slightly prominent iu the IWY~I-
two-thirds, will be commonly found. The occlusal plant is generally depres5rtl
posteriorly having less than 15 degrees between the eye-ear plane and the occi~i;ii
plane.
ln this type of case both the upper and lower anterior teeth will be in&&
lingually at the incisal, the angle between the labial stIrfaces of the central irr-
c$.ors and the occlusal plane being greater than 90 clegrccs. The lower anterior
teeth usualiy have their long axes at less than 90 degrees to the base of the mandible.
A protraction of the dental and alveolar zones will result in a convex profile of the
Negroid type whereas a retraction of the dental and alveolar zones will result iu
a concave profile. In those cases where the mandible is more protracted than
is the maxilla, an angular profrle will be found with its greatest prominence in the
mandibular third of the face. In these cases a dental protraction frequently is
noted resulting in an excessive prominence of the lower lip and the lower anterior
teeth may be Iabial to the upper anterior teeth (Fig. 7’1.
~ux~l~r~ Protracti0l-l is ~~~l,~~f~c~~~~nWith Mmdihlw lict vactim (Fig. H ,J_
The facial. profile of this type is convex with the greatest prominence in the upper
and middle thirds of the face. The subnasion is located anterior to the nasion
and the gnathion posterior to the orbita plane. The upper anterior teeth in tk
Volume 1 FACIAL TYPES AND TOOTH ARRANGEMENT
Numbers 1 and 2
type of patient are prominently curved incisal-gingivally and are so arranged that
all the anterior teeth incline Iingually at the incisal. In this respect the upper teeth
follow the satne arrangement as in the case of maxillary protraction. It should be
noted that there is frequently a tendency for the upper lateral incisors to lap the
upper central incisors, the centrals being more lingually inclined at the incisal than
the laterals. The lower anterior teeth in this type of face frequently incline labially,
thus reducing the overjet which might normally be expected due to the distal loca-
tion of the gnathion. The inclination of the lower central incisors with regard
to the base of the mandible is frequently greater than 90 degrees, the lower anteriors
leaning anteriorly.
Fig. 9.
Bivnuxillary Ii&action (Fig. 9).-The facial profile of this type varies from
concave to straight depending upon the zone and the amount of retraction. If an
alveolar retraction exists the profile will be found to be slightly concave. This
type is usually characterized by deep nasolabial sulci. The upper and lower central
incisors meet each other with an edge-to-edge relation. The upper anterior teeth
are inclined labially at the incisal as are the lower teeth. The long ‘axes of the
lo!ver teeth are nearly at right angles to the base of the mandible. When a straight,
profile is encountered, the upper and lower anterior teeth may be found to have
a perpendicular relationship to the occlusal plane and to have more overjet than
overbite. Insufficient cases of bimaxillary retractions have been studied, to d;tte,
to render reliable information.
Attnx-tim (Fig. 11) .--As this type is a vertical deviation from the norn1,
care must be taken to have the patient in centric occtr&an before classiiicatioll is
attempted. It is believed that an excessive free-way space is typical to this type.
The excessive free-way space in the rest position tends to obscure the condition.
When the teeth are in occlusion, the profile of this type of patient is rhxracirr-
ized by the deep mental sulct~s which is not nearly as prominent when uiewet’i’in
the rest position. The profile will vary in accordance with protractive or retrac-
tive tendencies of the individual case, as n-ill the tooth arrangement. The most
important factor peculiar to this type w-ill be the cIif5ctrltp in establishing con&
vertical dimension in edentulous cases due to the need for greater than aviriage
free-way space.
ATTRACTION
ABSTRACTION
L40straction (Fig. IL?).--This type is characterized by excessive length of tht*
mandibular third of the face. The facial profile is usually convex as this abstraction
generally is accompanied by mandibular retractive tendencies. The arrangement
of the teeth follows the usual inclinations found in mandibular retractions.
The above study of facial types from cephalometric radiographs also fur-
nished information with regard to the relationship between the lips and the an-
terior teeth in a rest position. The importance of the free-way space in an evalua-
tion of facial contour was also observed. It is common practice in the arrange-
ment of anterior teeth for prosthodontists to incline the upper anterior teeth in
order to give full support to the upper lip. ~1 study of cephalometric radio-
graphs will sho\v that frequently a space exists between the incisal half of the
anterior teeth and the upper lip. Support of the upper lip being supplied by con-
tact with the gingival half of the labial surface of the anterior teeth and the nl-
veolar process (Fig. 13), This is particularly true in cases of maxillary pro-
traction where the upper teeth are inclined lingually at the incisal, hut it is found
to exist to a lesser degree in almost all other types.
SUMMARY
To summarize the above data, it may be said that if protractive tendencies exist
in either the maxillary or mandibular areas, the gingival of the anterior teeth be-
come more prominent than the incisal. As retractive tendencies exist the incisal
of the anterior teeth become more prominent than the gingival. Lips are sup-
ported primarily by the gingival third or half of the centrals and laterals and not
by the incisal portion of the labial surface of the teeth. Facial contours should
be studied in the rest position and with the proper free-way space present if nat-
ural appearance is to be observed.
The information from this study is of primary value in those cases where
adequate pre-extraction records are not available ; however, the data presented may
also be found of value when modification of existing natural conditions is required
in order to improve esthetic values. If edentulous patients are studied and classi-
fied in accordance with the Simon classification, the above data may be applied in
the majority of cases. If this is done, the anterior teeth thus may be arranged in
harmony with individual facial types and the esthetic value of artificial dentures
will enhance rather than detract from the appearance of the patient wearing them.
The above data have been presented as a preliminary report as only 105 cases
were studied. It is hoped that the study will be continued until sufficient typical
cases are available to make a complete analysis of all possible combinations of facial
types. It is recognized that individual arrangement of human teeth is infinite in
number, but it was hoped that some semblance of uniformity might be ascertained
for the typical arrangement in accordance with facial types. It is felt that there
is sufficient evidence to indicate typical harmonious arrangement of teeth for the
major facial types as has been shown. Further investigation may call for a classi-
fication of faces more suitable than the Simon classification. However, until such
investigation is completed, it is believed that the material presented herewith shall
be of considerable value to students, teachers, and practitioners in the field of
denture prosthesis.
REFERENCES
1. Clapp, George W: The Life and Works of James Leon Williams, Part III, New York,
1925, The Dental Digest Publishing Co.
2. Williams, J. L.: New Classification of Natural and Artificial Teeth, New York City,
The Dentists’ Supply Co. of New York, 1914.
3. House, M. M., and Loop, J. L.: Form and Color Harmony in the Dental Art, copyright
by M. M. House, Whittier, Calif., 1939.
4. Swenson, Merrill: Complete Dentures, ed. 2, St. Louis, 1947, The C. lr. Mosby Company,
pp. 196-197.
5. Simon, Paul W. : Fundamental Principles of a Systematic Diagnosis of Dental Anomolies,
Boston, Mass., 1926, Stratford Company.
6. Price, Weston A.: Nutrition and Physical Degeneration, New York and London, 1942,
Paul B. Hoeber, Inc.
7. Coon,CarletonS.: The Races of Europe, New York, 1939, The Macmillan Company.
8. Margolis, Herbert : The Axial Inclination of the Mandibular Incisors, Am. J. Orthodontics
29: 571494, 1943.